Pre-diabetes in adults 45 years and over in Ireland: the Survey of Lifestyle, Attitudes and Nutrition in Ireland 2007.

OBJECTIVES: Pre-diabetes is an important indicator of future diabetes burden and many countries are reporting prevalence estimates of pre-diabetes. To date in Ireland, estimates of the prevalence of pre-diabetes were unavailable. Our objectives were to estimate the prevalence of pre-diabetes in a nationally representative sample of Irish adults and to explore determinants of pre-diabetes. METHODS: The Survey of Lifestyle Attitudes and Nutrition 2007 was a cross-sectional survey on health and lifestyle in a nationally representative sample of Irish adults. Analysis was performed on a subsample of 1132 participants ≥ 45 years who provided blood samples. Determination of pre-diabetes was based on American Diabetes Association HbA1c cut points of 39-46 mmol/mol (5.7-6.4%). To explore determinants, we modelled pre-diabetes prevalence as a function of a set of health system and socio-demographic variables using logistic regression. RESULTS: The overall weighted prevalence estimate of pre-diabetes in participants ≥ 45 years was 19.8% (95% CI 16.4-23.9). There was no significant difference between age or gender-specific prevalence rates. Obesity was significantly associated with pre-diabetes on univariate and multivariate analysis. Population attributable fraction estimates for excess BMI, physical inactivity and poor diet as causes of pre-diabetes were 31.3% (95% CI -3.9 to 54.5), 10.0% (95% CI -2.7 to 21.3) and 6.1% (95% CI -4.9 to 15.9), respectively. CONCLUSIONS: The high levels of pre-diabetes detected in this study are worrying. Population level interventions to address diet and lifestyle factors are needed urgently to prevent progression to diabetes in high-risk individuals.

Profiling health in the UK and Ireland.

The technique of describing health using a range of measures has been termed 'health profiling'. This article discusses the emergence of health profiling in the UK and Ireland over recent years, led by the public health observatories (PHOs). The steps in developing health profiles are described, including defining the purpose, consulting users, choosing indicators, establishing the methods of presentation, disseminating and evaluating. Health profiles have developed and improved through collaboration between the PHOs in the UK and Ireland. Looking to the future, the PHOs are developing inter-related health profiles ranging from small area to European regions, enhanced and informed by the addition of themed profiles for different population groups, lifestyles and diseases.

Identifying trajectories of adolescent smoking: an application of latent growth mixture modeling.

The goal of the current study was to identify discrete longitudinal patterns of change in adolescent smoking using latent growth mixture modeling. Five distinct longitudinal patterns were identified. A group of early rapid escalators was characterized by early escalation (at age 13) that rapidly increased to heavy smoking. A pattern characterized by occasional puffing up until age 15, at which time smoking escalated to moderate levels was also identified (late moderate escalators). Another group included adolescents who, after age 15, began to escalate slowly in their smoking to light (0.5 cigarettes per month) levels (late slow escalators). Finally, a group of stable light smokers (those who smoked 1-2 cigarettes per month) and a group of stable puffers (those who smoked only a few puffs per month) were also identified. The stable puffer group was the largest group and represented 25% of smokers.

Measurement of community beliefs about colorectal cancer.

Few educational campaigns have focused on bowel cancer, though studies have indicated that members of the community need and want current information about relevant issues. In order to facilitate research in this area, reliable and valid measures of community attitudes are needed. Content validity of a survey instrument was obtained through use of a Delphi process with Directors of Education from the Australia Cancer Council and focus group discussions with informed members of the public. The subsequent survey of community perceptions about colorectal cancer included a broad range of content areas related to the risk of bowel cancer, preventing and coping with bowel cancer and beliefs about susceptibility and severity. The construct validity of these content areas was investigated by use of a factor analysis and confirmation of an association with related predictor variables. Two measures related to personal influence and anticipated coping responses showed favourable psychometric properties, including moderate to high levels of internal consistency and test-retest reliability. A test of the concurrent validity of these measures requires further development of instruments related to colorectal cancer or adaptation of measures from other areas of health research.

A randomised trial of population screening for melanoma.

OBJECTIVES: Melanoma is a significant cause of morbidity and mortality worldwide and incidence is increasing. Survival after treatment is inversely related to the thickness of the tumour at diagnosis. Population screening has the potential to reduce mortality but there is no conclusive evidence of benefit. Such evidence can come best from a randomised trial. Here we describe the design of a community based randomised trial of a population screening programme for melanoma in Queensland, Australia and early results of the first phase of the trial. METHODS: A total of 44 communities (aggregate population 560 000 adults aged 30 years or more) will be randomised to receive either a community based screening programme for 3 years or normal practice. The screening programme promotes thorough skin self examination and whole body skin examination by a doctor and provides open access skin cancer screening clinics. In its first phase, the trial is underway in nine intervention and nine control communities. The primary outcome measure is mortality from melanoma during 15 years of follow up. RESULTS: The first phase of the trial has shown the feasibility of implementing a population skin screening programme including regular skin cancer screening clinics, and has shown the strong support of communities and doctors for the programme. There has been a significant 2.5-fold increase in participation in screening in the intervention communities in this first phase after the first 12 months of the trial and no significant increase in participation in screening in control communities during this period. CONCLUSIONS: The design of a community based randomised trial of screening for melanoma has been successfully peer reviewed and the intervention has been shown to be feasible in practice. This randomised trial may be one of the last opportunities to develop the evidence required for public health recommendations for population screening for melanoma.

Evaluation of a three-year school-based intervention to increase adolescent sun protection.

The efficacy of a school-based intervention was evaluated using a randomized controlled trial in Australia. In consecutive grades (8, 9, and 10), students in the intervention group received components of a program that addressed issues related to the need to protect yourself from the sun, behavioral strategies related to using sun-protective measures, personal and social images of having a tan, the use of sun-safe clothing, and how to change their schools through forms of structural change. Pre- and postintervention measures among junior high school students showed greatest improvement in the intervention group's knowledge scores and minimal changes in sun protection behavior from Grade 8 to Grade 9, which were not maintained through Grade 10. Results of the study highlight some limitations of school-based interventions for changing sun protection behaviors.

Evaluation of antenatal smoking cessation programs for pregnant women.

Smoking during pregnancy has been linked to health problems, including the risk of low birthweight, preterm labour, spontaneous abortion and perinatal death. Two trials to investigate the efficacy of self-help materials were undertaken. During the first trial, a self-help booklet developed overseas was evaluated through a randomised controlled design to determine the effects of the booklet alone, compared with the booklet with midwife counselling for the women. We recruited 217 women into the study and followed them up at 20 weeks' gestation to ascertain smoking cessation and to measure process variables. Smoking cessation rates were lower than expected, and process measures indicated that materials were not being used. A second trial was commenced after a comprehensive review of the materials with focus groups of pregnant women and one-to-one interviews of nurses and doctors. Trial 2 was based new materials, and used a magazine-style (smoking cessation) booklet designed by the focus groups. A total of 119 women were randomly allocated into the new-materials group or a usual-care group. The materials were well received, relevant and pertinent, and were used by the women. Smoking cessation rates at 20 weeks' gestation were biochemically validated and indicated that 9 per cent in the intervention group and none in the usual-care group had stopped smoking. The use of overseas programs needs to be approached with caution.

Examination of skin naevi in Australian general practice: dissonance between care and need?

Over 26 months, 223 general practitioners recorded consultations involving the management of skin naevi and some demographic details of the patients. We used data from the Health Insurance Commission and the Australian Bureau of Statistics to estimate population consultation rates. Of 749,171 consultations, 9,729 involved management of naevi. The annual rate per 1,000 of these consultation was 11.3 (95% CI 11.0-11.6) for males and 17.0 (95% CI 16.6-17.5) for females. The rate was significantly higher in the 15-44 year age group, at 21.8 consultations per 1000 individuals annually, compared to 6.3 for younger ages and 16.0, 16.1 and 8.6 for the 45-64, 65-74 and 75+ age groups respectively. There was a seasonal variation, with rates highest in the hot months (of about 16 annual consultations per 1,000 individuals) and lowest in the cooler months (14 for the two years' cooler seasons sampled). There was a significant variation between the rates of different states and territories, but this did not follow a latitude difference. There is a dissonance between the distribution of melanomas (relatively concentrated among older patients and males) and the general practice management of skin naevi (relatively concentrated among younger patients and females). Although melanomas (particularly those with the poorest prognosis) are relatively concentrated in older men, paradoxically, more skin naevi are managed in general practice among younger and female patients.

Barriers to health promotion activities in public hospitals.

Despite the central role hospitals have in the health care system, relatively few health promotion activities are conducted in Australian public hospitals. This study investigated the types of obstacles that were perceived to inhibit health promotion activities in hospitals. A questionnaire for self-completion was sent to medical superintendents in all public hospitals in Queensland and 112 questionnaires were returned (92.6 per cent response rate). The results indicated that lack of finance, lack of interest by relevant others, and needs (for appropriate programs, training and patient receptivity) were the barriers reported by superintendents. The barriers of 'interest' and 'needs' were related to a lack of written policies in some areas, but not directly to levels of other health promotion activities being conducted in the hospitals. Success in facilitating health promotion programs in hospitals will need to include a change in the environment, in particular the views of medical superintendents. The combination of attitude change and the availability of a motivated person (such as a health promotion officer) to lead the activities may be needed in order to produce an increase in the level of health promotion in public hospitals.

Effect of a public awareness campaign on the appropriateness of patient-initiated skin examination in general practice.

The aim of the study was to describe the appropriateness of patient-initiated skin examinations, and assess whether an awareness program leads to a greater proportion of inappropriate patient-initiated skin examinations. General practitioners (n = 27, response rate 71 per cent) from a regional town in Queensland recorded details of consultations involving a skin examination over a five-week period straddling the 1991 National Skin Cancer Awareness Week. The outcome measure was the clinical impression (benign, suspicious or malignant) of the most serious skin lesion presented by each general practice patient (n = 1183). Thirty-six per cent of patient-presented lesions were clinically suspicious or malignant. Lesions were more likely to be clinically suspicious or malignant if they were presented as the primary reason for the consultation (odds ratio OR = 1,219.95 per cent confidence interval (CI) 1.01 to 1.48); if the patient was aged over 35 years (OR = 5.594, CI 1.08 to 7.66); or male (OR = 1.634, CI 1.35 to 2.00). Following a public skin cancer awareness campaign, there was a slight nonsignificant decrease (OR 0.938, CI 0.91 or 1.25) in the proportion of clinically suspicious and malignant lesions detected. An increase in the number of skin examinations following an awareness campaign did not result in an increase in the proportion of inappropriate skin examinations. Patient-initiated skin examinations have an important role to play in the early detection of skin cancer.

Predictors of sun protective behaviors among school students.

A random sample of students (N = 3,655) in Grades 7, 9, and 11 from 55 schools in Queensland (Australia) were surveyed about their sun protection knowledge, attitudes, and behaviors. An aggregate sun protection behavior index (SPBI) was developed from self-reported behaviors on a school day and a weekend day. Repeated measures regression analyses revealed that negative views of sun protection measures were associated with low scores on the SPBI, an association that was strongest among older students and in larger schools. Low perceived parental sun protective behaviors were associated with low SPBI ratings, and this association was greatest in small schools and on Saturdays. Older students had lower SPBI ratings, but their scores increased on Saturdays. Gender did not appear to be independently related to the SPBI after adjustment for the other variables. These findings reinforce the need for adolescent sun protection programs to address the complex interactions among psychological, social, and environmental factors that influence different subgroups of the student population.

Patient reports of health education activities in a public hospital.

Hospitals have been greatly underutilised as settings for health promotion activities in Australia. Most research on this subject has been derived from hospital administrators or clinicians. An exit survey of inpatients (n = 460) of a large regional public hospital in Queensland was conducted to examine reported levels of health education in relation to cancer prevention and control. Patients indicated considerable receptivity to a range of secondary prevention activities in the hospital setting, indicating the potential for an increased contribution to the national health agenda by many hospitals.

Childhood drowning and near-drowning in Brisbane: the contribution of domestic pools.

OBJECTIVE: To describe the epidemiology of domestic swimming pool drowning and near-drowning in Brisbane and to examine the efficacy of a broad range of preventive options, including pool fences. DESIGN: A prospective, hospital-based, injury surveillance system to describe the epidemiology of drowning and near-drowning and a community survey to describe pool fencing. SETTING: The surveillance questionnaire was completed at presentation in the Emergency Department by the parent, nurse and doctor. Personal interviews in households that were randomly selected by means of a stratified sampling scheme provided the pool fencing description. PARTICIPANTS: All 139 children suffering from an immersion injury resulting in presentation at a hospital in the catchment area of The Mater Children's Hospital were included. There were 204 households with a swimming pool in the 1024 households interviewed in the community survey. RESULTS: The 100 domestic pool drownings and near-drownings were equivalent to 15.5 incidents per year per 100,000 children aged 0-13 years and 64.9 per year per 100,000 for the critical 1-3 years age group. Of 72 children who gained unintended access to a domestic pool, 88.9% were less than 3 years of age and 52.8% were less than 2 years. All 10 of the children who drowned and five who were severely brain damaged (age range, 12-32 months) were in this group. The risk of a drowning or near-drowning involving unintended access to an unfenced pool is 3.76 times higher than the risk associated with a fenced pool (95% confidence limits for relative risk: 2.14, 6.62). CONCLUSIONS: Pool fences are an effective method of preventing child drownings and near-drownings. This effectiveness can be further improved if compliance with gate closure can be enhanced. This should be emphasised in health promotion accompanying the introduction of universal pool fencing.

Caregiver factors and pool fencing: an exploratory analysis.

OBJECTIVES: To explore the relationship between caregiver characteristics and the adequacy of domestic swimming pool fencing. SETTING: A typical metropolitan area of a large Australian capital city, Brisbane. METHODS: From a reanalysis of the dataset of the 1989 Brisbane Home Safety Survey of 1050 householders, associations between 10 caregiver factors, pool ownership, and quality of pool fencing, were analysed. Household characteristics relating to toddlers (children < or = 4 years), and socioeconomic measures were also included in the analyses. Pool fencing quality was measured on an ordinal scale derived from Australian Standards Association guidelines, confirmed through home visits by trained inspectors. RESULTS: Caregiver factors did not distinguish households with a swimming pool from those without, nor were they associated with adequacy of pool fencing among pool owners. Pool owners, with or without children, were less likely to perceive having a childproof fence as being important. Strongest correlates of adequacy of pool fencing were socioeconomic indicators of surrounding districts. CONCLUSIONS: These results do not support the arguments of opponents of compulsory pool fencing that caregiver factors are adequate to prevent toddler drownings and obviate the need for a pool fence. Pool owners do not appear to perceive their pool as a hazard for young children, and complacency about the adequacy of pool fencing needs to be replaced by increased caregiver health beliefs, skills, and perceptions.

Changes in skin protection behaviors, attitudes, and sunburn: in a population with the highest incidence of skin cancer in the world.

This study describes changes in skin protection attitudes and outdoor behaviors of adults in Queensland, Australia, using two cross-sectional telephone surveys conducted in 1988/89 (N = 1699) and 1991/92 (N = 2317). After adjustment for potential confounders, there were significant improvements in some skin protection attitudes, time spent outside, hat wearing, sunscreen use, overall skin protection (p < 0.01) and shade use (p < 0.05) between 11:00 AM and 3:00 PM on the previous Sunday. The degree of attitudinal and behavioral change varied with age, gender, region, and reported skin type. However, recent sunburn experience remained unchanged. A similar study in Victoria, Australia, observed changes in skin protection attitudes, behaviors, and recent sunburn. We speculate on possible explanations for the lack of improvement in recent sunburn experience despite the improvement in skin protection attitudes, and behaviors, and suggest that part of the explanation may be environmental differences. This has implications for generalizability of such studies outside the geographical region in which they were conducted.

Development of an instrument for monitoring adolescent health issues.

The aim of the project was to develop a survey instrument to monitor relevant health status and health-related behaviors among secondary school students. The development of the instrument occurred in three main phases: collection of existing surveys, workshops with relevant health professionals and focus groups with adolescents. The topics for inclusion were refined using Health Goals and Targets for Australian Children and Youth and consultations with health professionals, and included alcohol/illicit drug use, smoking, nutrition, exercise, injury, mental health, violence and sexual health. Content validity was demonstrated through a comprehensive literature review, review and application of existing instrumentation, dialog and exchange with health professionals, and focus groups with adolescents. The process of peer review through correspondence with health professionals, and the coordination of workshops and focus groups established face validity. Responses from students also indicated that they interpreted the questions as intended. The instrument was piloted in five secondary schools during class periods. Process evaluation was also conducted to determine the appropriateness of the survey and the procedures used in administering the survey. Feedback from school staff was supportive and favorable with respect to the choice of issues. Reliability was assessed by a test-re-test procedure 2 weeks apart. In general, most of the questions showed moderate to high reliability (kappa > 0.5) indicating agreement of 50% or greater. This instrument was developed as a monitoring instrument and places emphasis on determining prevalence levels of a range of health issues and health behaviors to assist with identifying clustering patterns of negative health outcomes. Although the instrument is primarily for use with students in school hours, the nature of the instrument allows modification for use in older groups of adolescents and out-of-school youth. The final version of the questionnaires for senior and junior students can be accessed via the Internet (http://;+www.spmed.uq.edu.au/CHPCPR /qu estionnaire).

Child injury in Brisbane South 1985-91: implications for future injury surveillance.

Specific childhood injury types are ranked by occurrence rate for mortality, hospital admission and emergency department attendance. Cases are drawn from the resident population of Brisbane South, 0-13 years of age, for the period 1 July 1985 to 30 June 1991. A total of 47,244 injuries, 7056 admissions and 99 deaths were analysed. The overall mortality rate was 12.6/100,000 per year (95% confidence interval (CI), 10.2-15.3), the overall admission rate was 911/100,000 per year (95% CI, 890-932) and the overall hospital attendance rate was 6013/100,000 per year (95% CI, 5958-6067). A fall was the most frequent injury mechanism for admissions and 65% of attendances involved injury in the child's own home. The surveillance data establish regional variation for childhood injury risk within Australia and identify an unexplained downward trend in head injury that requires further investigation. The future development of injury surveillance in Australia requires simplified coding which can be integrated into new computerized patient management information systems.

A measure of skin familiarity and its role in the early detection of skin cancer.

Skin self-examination (SSE) is promoted widely so that individuals will become familiar with their skin and be better able to identify suspicious changes earlier. However, individuals can also become familiar with their skin other than through purposeful SSE. In this article, we develop a measure of skin familiarity based on the density of spots on 14 different areas of the body. A factor analysis of the 14 body-area scores revealed that they could be grouped into four broad body regions (shoulders and back, front of legs, back of legs, and feet). Each total body score and body-region score has high internal consistency (Cronbach's alpha coefficients ranging from 0.79 to 0.93). Moreover, the scores correlate as expected with skin self-examination behaviors and other personal characteristics, indicating high construct validity. We consider the advantages that skin familiarity measures offer over the exclusive use of SSE measures in the assessment of early detection activities and discuss the direction of future research in this area.

Skin cancer prevention: a link between primary prevention and early detection?

The aim of this paper was to determine if there is any link between primary prevention and early detection for skin cancer. Results from a study of a large random sample of Gold Coast residents (N = 995) identified an association (P < 0.01) between individual primary prevention and early detection activities. People were also more likely to use both prevention methods if they had personal experience with skin cancer (P = 0.01) or if they were male (P = 0.05). Future primary prevention and early detection skin cancer programs might be most effective if they are combined.