A randomised experimental study comparing perceptions of two energy drink health warning labels.

ISSUE ADDRESSED: Consumption of energy drinks is a public health concern, particularly in adolescents and young adults. This study explored energy drink consumers' reactions to an energy drink-specific warning label (risk of cardiac effects) and a more general sugary drink warning label (risk of obesity). METHODS: An online experimental study randomly allocated Australian energy drink consumers aged 18-39 years (N = 435) to view one of two label conditions (cardiac effects or obesity). Participants were assessed on: intention to reduce energy drink consumption, perceived health threat, perceived label effectiveness and policy support for energy drink warning labels. RESULTS: Mean intentions to reduce consumption scores were similar across the two label conditions (Mobesity  = 2.5, Mcardiac  = 2.6) overall; and were higher for the cardiac label (compared to obesity label) for some subgroups: females (Mobesity  = 2.3, Mcardiac  = 2.8; p = .037), older (25-39 years; Mobesity  = 2.4, Mcardiac  = 2.8; p = .016); and higher education level (Mobesity  = 1.9, Mcardiac  = 2.7; p = .004). While perceived health threat measures were higher for obesity than cardiac effects, perceived label effectiveness measures of 'believable' and 'relevant to me' were higher for the cardiac label than the obesity label (believable: 71.0% vs 56.1%; relevant: 42.5% vs 29.4%). Participants who viewed the cardiac label were more likely to support policy than those shown the obesity label (OR = 1.6, 95%CI [1.1, 2.3], p = .02). CONCLUSIONS: Health effect warnings labels were perceived by energy drink consumers to be impactful and are supported. Labels with energy drink-specific health effects may offer additional benefit. SO WHAT?: Policy makers can feel confident that warning labels on energy drinks will confer public health benefit.

Which drinkers have changed their alcohol consumption due to energy content concerns? An Australian survey.

BACKGROUND: Alcohol is a discretionary, energy dense, dietary component. Compared to non-drinkers, people who consume alcohol report higher total energy intake and may be at increased risk of weight gain, overweight, and obesity, which are key preventable risk factors for illness. However, accurate consumer knowledge of the energy content in alcohol is low. To inform future behaviour change interventions among drinkers, this study investigated individual characteristics associated with changing alcohol consumption due to energy-related concerns. METHODS: An online survey was undertaken with 801 Australian adult drinkers (18-59 years, 50.2% female), i.e. who consumed alcohol at least monthly. In addition to demographic and health-related characteristics, participants reported past-year alcohol consumption, past-year reductions in alcohol consumption, frequency of harm minimisation strategy use (when consuming alcohol), and frequency of changing alcohol consumption behaviours because of energy-related concerns. RESULTS: When prompted, 62.5% of participants reported changing alcohol consumption for energy-related reasons at least 'sometimes'. Women, those aged 30-44 years, metropolitan residents, those with household income $80,001-120,000, and risky/more frequent drinkers had increased odds of changing consumption because of energy-related concerns, and unemployed respondents had reduced odds. CONCLUSIONS: Results indicate that some sociodemographic groups are changing alcohol consumption for energy-related reasons, but others are not, representing an underutilised opportunity for health promotion communication. Further research should investigate whether messaging to increase awareness of alcohol energy content, including through systems-based policy actions such as nutritional/energy product labelling, would motivate reduced consumption across a broader range of drinkers.

Further evidence from the LiveLighter® campaign: A controlled cohort study in Victoria and South Australia.

ISSUE ADDRESSED: The LiveLighter® healthy weight and lifestyle social marketing campaign, developed in Western Australia, employs graphic advertising to communicate negative health effects of overweight and motivate behaviour change. This study extends prior evidence of the effectiveness of the LiveLighter® campaign by evaluating its implementation in a new jurisdiction. METHODS: A controlled cohort design was employed in intervention (Vic) and comparison states (SA), with and without campaign exposure. Population surveys conducted at baseline (BL) (n = 1000 each state), had 75% retention at follow-up (FU) (Vic: n = 715; SA: n = 787). RESULTS: Total campaign awareness was moderate (61.5%). Exposed respondents indicated the campaign was "believable" (91.0%), made a strong argument for reducing weight (87.3%), made them "stop and think" (70.1%), motivated action to reach/stay a healthy weight (59.1%) and was "relevant" (55.6%). The proportion of respondents indicating "toxic fat build up" was a health consequence of overweight increased significantly from BL to FU in Vic and to a lesser extent in SA (Vic:55.7% vs 75.9%; SA:58.1% vs 62.6%, interaction P < .001). The proportion indicating cancer is a health consequence of overweight increased significantly from BL to FU in Vic, but not in SA (Vic:77.1% vs 83.4%; SA:77.8% vs 78.1%, interaction P < .05). CONCLUSIONS: This study extends the evidence base for the LiveLighter® campaign. Sustained campaign activity with clear behavioural recommendations is required to translate improved knowledge into behaviour change. SO WHAT: Evidence-based mass media campaigns can positively impact health behaviours to address the unsustainable increasing burdens of unhealthy weight, dietary risk and inadequate physical activity. A National Obesity Campaign is needed and LiveLighter® is a ready-made, relevant Australian resource.

A randomised online experimental study to compare responses to brief and extended surveys of health-related quality of life and psychosocial outcomes among women with breast cancer.

PURPOSE: Collecting patient-reported outcomes is important in informing the well-being of women with breast cancer. Consumer perceptions are important for successful implementation of monitoring systems, but are rarely formally assessed. We compared reactions to two different surveys (assessing psychosocial outcomes and/or Health-related Quality of Life (HrQoL) outcomes) among Australian women with breast cancer. METHODS: Women (18 + years) within 5 years diagnosis of breast cancer were randomly allocated to complete one of two online surveys: (i) minimum HrQoL measures or (ii) minimum HrQoL measures plus psychosocial outcomes (body image, depression, anxiety stress, fear of cancer recurrence, decisional difficulties and unmet need). Participants completed questions regarding their perceptions of the survey, including qualitative feedback. RESULTS: Data were available for 171 participants (n(i) = 89; n(ii) = 82), with 92% (n = 158) providing 95-100% complete data. Perceptions were comparable between survey groups, and high (80-100%) regarding time burden, ease of completion, comprehensible, appropriateness and willingness to participate again and moderately high (67-74%) regarding willingness to answer more questions and relevance. Qualitative feedback indicated gaps across both surveys, including financial/work-related issues, satisfaction with information and care, need for nuanced questions, and impact of side effects/treatment, and from the minimum set only, emotional well-being and support. Impairment in some HrQoL and psychosocial outcomes were observed among participants. CONCLUSIONS: Assessment of HrQoL and psychosocial outcomes was well received by consumers. Results alleviate concern regarding possible patient burden imposed by longer more in-depth surveys. The importance placed on assessment brevity should not outweigh the need to assess outcomes that consumers consider important.

From participation to diagnostic assessment: a systematic scoping review of the role of the primary healthcare sector in the National Bowel Cancer Screening Program.

Primary health care (PHC) plays a vital support role in organised colorectal cancer (CRC) screening programs by encouraging patient participation and ensuring timely referral for diagnostic assessment follow up. A systematic scoping review of the current evidence was conducted to inform strategies that better engage the PHC sector in organised CRC screening programs. Articles published from 2005 to November 2019 were searched across five databases. Evidence was synthesised and interventions that specifically require PHC involvement were mapped to stages of the CRC screening pathway. Fifty-seven unique studies were identified in which patient, provider and system-level interventions align with defined stages of the CRC screening pathway: namely, identifying/reminding patients who have not responded to CRC screening (non-adherence) (n=46) and follow up of a positive screen referral (n=11). Self-management support initiatives (patient level) and improvement initiatives (system level) demonstrate consistent benefits along the CRC screening pathway. Interventions evaluated as part of a quality-improvement process tended to report effectiveness; however, the variation in reporting makes it difficult to determine which elements contributed to the overall study outcomes. To maximise the benefits of population-based screening programs, better integration into existing primary care services can be achieved through targeting preventive and quality care interventions along the entire screening pathway.

A systematic scoping review of determinants of multidisciplinary cancer team access and decision-making in the management of older patients diagnosed with colorectal cancer.

Early diagnosis of colorectal cancer (CRC) and access to optimal treatment achieves optimal cancer outcomes. However, CRC survival inequalities persist with a lower survival rate for older patients (≥65 years). Although the reasons for poorer cancer survival in older people are complex, evidence suggests that these patients are less likely to receive best practice care as indicated by access to multidisciplinary team (MDT) care. Three electronic databases were systematically searched to examine factors that affect access to, and clinical decision-making, in the context of MDT care of older people with CRC. We included studies reporting empirical data relating to predictors for a patient's case being discussed at a MDT meeting and/or factors that impact treatment decision-making during the meeting. From 303 returned titles and abstracts, eighteen articles were reviewed. Eight studies specifically selected older patients, with eligibility criteria varying from ≥65 to ≥80 years. Five articles explored predictors of MDT access, with all articles identifying age as a negative, and advanced stage as a positive predictor of MDT discussion. Fourteen studies explored factors that influenced the MDT decision-making process, with older age and presence of comorbid disease negatively influencing treatment decisions (cases less often discussed and/or treatment not recommended). A few studies identified access to a MDT discussion as an independent predictor for CRC treatment. Access to the MDT process for older patients with a CRC diagnosis should be based on relevant geriatric domains rather than on chronological age alone, which is expected to allow more appropriate clinical decision-making and reduce treatment inequities for older patients with cancer.

Engagement of General Practice in an Australian Organised Bowel Cancer Screening Program: A Cross-Sectional Survey of Knowledge and Practice.

BACKGROUND: Understanding factors causing variation in family physicians/general practitioners (GPs) screening knowledge, understanding and support of organised population-based colorectal cancer (CRC) programs can direct interventions that maximise the influence of a CRC screening recommendation from a GP. This study aims to assess contextual factors that influence knowledge and quality improvement (QI) practice directed to CRC screening in Australian general practice. METHODS: A convenience sample of anonymous general practice staff from all Australian states and territories completed a web-based survey. Multivariate analyses assessed the association between CRC screening knowledge and QI-CRC practice scores and patient, organisational and environmental-level contextual factors.  Results: Of 1,013 survey starts, 918 respondents (90.6%) completed the survey. Respondents less likely to recommend FOBT screening had lower knowledge and QI practice scores directed to CRC screening. Controlling for individual and practice characteristics, respondents' rating of the Australian National Bowel Cancer Screening Program (NBCSP) support for preventive care, attending external education, and sufficient practice resources to implement QI practice (generally) were the strongest factors associated with QI practice directed towards CRC screening. Knowledge scores were less amenable to the influence of contextual factors explored. CONCLUSION: More active engagement of family medicine/general practice to improve screening promotion could be achieved through better QI resourcing without changing the fundamental design of population-based CRC screening programs.