Effectiveness of embedding a specialist preventive care clinician in a community mental health service in increasing preventive care provision: A randomised controlled trial.

OBJECTIVE: Clinical practice guidelines recommend that community mental health services provide preventive care for clients' chronic disease risk behaviours; however, such care is often not routinely provided. This study aimed to assess the effectiveness of offering clients an additional consultation with a specialist clinician embedded within a community mental health service, in increasing client-reported receipt of, and satisfaction with, preventive care. METHOD: A randomised controlled trial was undertaken in one Australian community mental health service. Participants (N = 811) were randomised to receive usual care (preventive care in routine consultations; n = 405) or usual care plus the offer of an additional consultation with a specialist preventive care clinician (n = 406). Blinded interviewers assessed at baseline and 1-month follow-up the client-reported receipt of preventive care (assessment, advice and referral) for four key risk behaviours individually (smoking, poor nutrition, alcohol overconsumption and physical inactivity) and all applicable risks combined, acceptance of referrals and satisfaction with preventive care received. RESULTS: Analyses indicated significantly greater increases in 12 of the 18 preventive care delivery outcomes in the intervention compared to the usual care condition from baseline to follow-up, including assessment for all risks combined (risk ratio = 4.00; 95% confidence interval = [1.57, 10.22]), advice for all applicable risks combined (risk ratio = 2.40; 95% confidence interval = [1.89, 6.47]) and offer of referral to applicable telephone services combined (risk ratio = 20.13; 95% confidence interval = [2.56, 158.04]). For each component of care, there was a significant intervention effect for at least one of the individual risk behaviours. Participants reported high levels of satisfaction with preventive care received, ranging from 77% (assessment) to 87% (referral), with no significant differences between conditions. CONCLUSION: The intervention had a significant effect on the provision of the majority of recommended elements of preventive care. Further research is needed to maximise its impact, including identifying strategies to increase client uptake.

Differences Between Landline and Mobile Phone Users in Sexual Behavior Research.

This study investigated differences between the demographic characteristics, participation rates (i.e., agreeing to respond to questions about sexual behavior), and sexual behaviors of landline and mobile phone samples in Australia. A nationally representative sample of Australians aged 18 years and over was recruited via random digit dialing in December 2011 to collect data via computer-assisted telephone interviews. A total of 1012 people (370 men, 642 women) completed a landline interview and 1002 (524 men, 478 women) completed a mobile phone interview. Results revealed that telephone user status was significantly related to all demographic variables: gender, age, educational attainment, area of residence, country of birth, household composition, and current ongoing relationship status. In unadjusted analyses, telephone status was also associated with women's participation rates, participants' number of other-sex sexual partners in the previous year, and women's lifetime sexual experience. However, after controlling for significant demographic factors, telephone status was only independently related to women's participation rates. Post hoc analyses showed that significant, between-group differences for all other sexual behavior outcomes could be explained by demographic covariates. Results also suggested that telephone status may be associated with participation bias in research on sexual behavior. Taken together, these findings highlight the importance of sampling both landline and mobile phone users to improve the representativeness of sexual behavior data collected via telephone interviews.

Perceptions of air quality and concern for health in relation to long-term air pollution exposure, bushfires, and COVID-19 lockdown: A before-and-after study.

Background: Air pollution is a major health burden and the leading environmental risk factor for non-communicable diseases worldwide. People's perceptions and concerns about air pollution are important as they may predict protective behaviour or support for climate change mitigation policies. Methods: This repeat cross-sectional study uses survey data collected from participants in Sydney, Australia in September-November 2019 (n = 1,647) and October-December 2020 (n = 1,458), before and after the devastating 2019/2020 bushfires and first COVID-19 lockdown restrictions in Sydney in 2020. Participants' perceptions of air quality and concerns for health in relation to air quality were modeled against estimates of annual average NO2 and PM2.5 concentrations in their neighbourhood. Results: Participants in suburbs with higher estimated air pollution concentrations generally perceived poorer air quality and were more concerned for health in relation to air quality. A 5 µg/m3 increase in NO2 was associated with perceived poorer air quality (OR 1.32, 95%CI 1.18-1.47). A 1 µg/m3 increase in estimated PM2.5 was associated with perceived poorer air quality (OR 1.37, 95%CI 1.24-1.52) and greater concern for health (OR 1.18, 95%CI 1.05-1.32). Air quality was perceived as better in 2020 than in 2019 in both NO2 and PM2.5 models (p<0.001). Air quality concern increased in 2020 in both models. Discussion: This study provides the first Australian data on the association between estimated air quality exposure and air quality perceptions and concerns, contributing new evidence to inform public health approaches that increase awareness for air pollution and reduce the health burden.

The effectiveness of community-based cycling promotion: findings from the Cycling Connecting Communities project in Sydney, Australia.

BACKGROUND: Encouraging cycling is an important way to increase physical activity in the community. The Cycling Connecting Communities (CCC) Project is a community-based cycling promotion program that included a range of community engagement and social marketing activities, such as organised bike rides and events, cycling skills courses, the distribution of cycling maps of the area and coverage in the local press. The aim of the study was to assess the effectiveness of this program designed to encourage the use of newly completed off-road cycle paths through south west Sydney, Australia. METHODS: The evaluation used a quasi-experimental design that consisted of a pre- and post-intervention telephone survey (24 months apart) of a cohort of residents (n = 909) in the intervention area (n = 520) (Fairfield and Liverpool) and a socio-demographically similar comparison area (n = 389) (Bankstown). Both areas had similar bicycle infrastructure. Four bicycle counters were placed on the main bicycle paths in the intervention and comparison areas to monitor daily bicycle use before and after the intervention. RESULTS: The telephone survey results showed significantly greater awareness of the Cycling Connecting Communities project (13.5% vs 8.0%, p < 0.05) in the intervention area, with significantly higher rates of cycling in the intervention area (32.9%) compared with the comparison area (9.7%) amongst those aware of the project. There was a significant increase in use of bicycle paths in the intervention area (28.3% versus 16.2%, p < 0.05). These findings were confirmed by the bike count data. CONCLUSION: Despite relatively modest resources, the Cycling Connecting Communities project achieved significant increases in bicycle path use, and increased cycling in some sub-groups. However, this community based intervention with limited funding had very limited reach into the community and did not increase population cycling levels.

Active travel: a climate change mitigation strategy with co-benefits for health.

Reducing the burning of fossil fuels for transport will help reduce the rate of climate change and the severity of the impact of climate change. The alternatives to private motor vehicles include active travel modes such as walking, cycling and use of public transport. While simultaneously reducing carbon dioxide emissions and traffic congestion, active transport leads to increased levels of physical activity and social interaction. This article summarises a number of NSW active travel initiatives. Despite some positive steps in NSW, other Australian states have invested far more and can demonstrate greater changes in travel behaviour.

Health sector leadership in mitigating climate change: experience from the UK and NSW.

The threat to human health from climate change means that all levels of government and private and public agencies will need to change their current practices to reduce carbon emissions. The health sector will also need to respond and change practice. The National Health Service in the United Kingdom is developing a systematic and strategic approach to reduce its carbon footprint, as described in the recently released NHS Carbon Reduction Strategy for England. The work is being led by the Service's new Sustainable Development Unit. While the Australian health care system has not yet embraced a shared vision for carbon reduction, there are examples emerging of how the sector is contributing to reduce greenhouse gas production. Examples from two NSW area health services to reduce energy use and promote active transport are presented. In both countries, these changes are supported by new legislation and policy.

Demographic and psychosocial features of participants in bondage and discipline, "sadomasochism" or dominance and submission (BDSM): data from a national survey.

INTRODUCTION: People with sexual interests in bondage and discipline, "sadomasochism" or dominance and submission (BDSM) have been seen by many professionals as damaged or dangerous. AIM: To examine sexual behavior correlates of involvement in BDSM and test the hypothesis that BDSM is practiced by people with a history of sexual coercion, sexual difficulties, and/or psychological problems. METHODS: In Australia in 2001-2002, a representative sample of 19,307 respondents aged 16-59 years was interviewed by telephone. Weighted data analysis used univariate logistic regression. MAIN OUTCOME MEASURES: Self-reported demographic and psychosocial factors; sexual behavior and identity; sexual difficulties. RESULTS: In total, 1.8% of sexually active people (2.2% of men, 1.3% of women) said they had been involved in BDSM in the previous year. This was more common among gay/lesbian and bisexual people. People who had engaged in BDSM were more likely to have experienced oral sex and/or anal sex, to have had more than one partner in the past year, to have had sex with someone other than their regular partner, and to have: taken part in phone sex, visited an Internet sex site, viewed an X-rated (pornographic) film or video, used a sex toy, had group sex, or taken part in manual stimulation of the anus, fisting or rimming. However, they were no more likely to have been coerced into sexual activity, and were not significantly more likely to be unhappy or anxious-indeed, men who had engaged in BDSM scored significantly lower on a scale of psychological distress than other men. Engagement in BDSM was not significantly related to any sexual difficulties. CONCLUSION: Our findings support the idea that BDSM is simply a sexual interest or subculture attractive to a minority, and for most participants not a pathological symptom of past abuse or difficulty with "normal" sex.

A description of health care system factors in the implementation of universal weight management services for children with overweight or obesity: case studies from Queensland and New South Wales, Australia.

BACKGROUND: The prevalence of childhood obesity poses an urgent global challenge. The World Health Organization (WHO) Commission on Ending Childhood Obesity recommends the provision of appropriate family-based, lifestyle weight management services through universal health care to support families of children with overweight or obesity; however, there are few examples of their implementation 'at scale'. The purpose of this research was to compare and contrast the impact of system and organisational factors on the implementation of childhood obesity management services within two Australian States (New South Wales and Queensland) to comprehensively describe their influence on the achievement of the WHO recommendation. METHODS: Purposeful stratified sampling was used to select health service study sites (n = 16) representative of program implementation (none, discontinued, repeated) and geographic location within each State. Within each health service site, staff involved in program delivery, co-ordination and management roles participated (n = 39). An additional 11 staff involved in implementation at State level also participated. The Consolidated Framework for Implementation Research (CFIR) was used to develop interview scripts. Telephone interviews were recorded and transcribed. Transcripts were thematically coded and scored according to CFIR constructs and rating rules to identify enablers and barriers to implementation according to sample characteristics. RESULTS: New South Wales achieved ongoing implementation; Queensland did not. Enablers included a quality evidence-based program, State government recognition of the urgency of the health issue and a commitment to address it, formally appointed and funded internal implementation leaders, strong communication and reporting at all levels. Barriers included the complexity of the health issue, in particular a lack of clear roles and responsibilities for local health service delivery, inadequate ongoing funding and challenges in meeting the diverse needs of families. CONCLUSIONS: This research is an important progression of the evidence base in relation to the translation of childhood obesity management trials into routine health service delivery. Understanding enablers and barriers to program implementation 'at scale' is imperative to inform future planning and investment by Australia and WHO member states to meet their commitment to deliver childhood weight management services as part of universal health coverage.

Random digit dialing and directory-based samples in telephone surveys of HIV risk: a comparison from the Australian Study of Health and Relationships.

PURPOSE: To compare the estimates of HIV-related risk derived from a sample drawn through random digit dialing and that component of the sample drawn from households listed in a telephone directory. METHODS: The prevalence of key outcomes, and their 95% confidence intervals, was estimated for the total sample and for that component of the sample drawn from households listed in a telephone directory. RESULTS: On all outcome measures the sample derived from listed households was more conservative. With few exceptions, the estimates derived from the overall sample and from listed households were not significantly different. CONCLUSION: A continued reliance on random digit dialing seems unwarranted.

Sex in Australia: the rationale and methods of the Australian Study of Health and Relationships.

OBJECTIVE: To describe the methods and process of the Australian Study of Health and Relationships. METHODS: A computer-assisted telephone interview was developed and applied to a stratified sample of the Australian population. After initially weighting to reflect the study design, the sample was further weighted to reflect the location, age and sex distribution of the 2001 Census. RESULTS: Interviews were completed with 10,173 men and 9,134 women aged 16-59 years from all states and Territories. The overall response rate was 73.1% (69.4% among men and 77.6% among women). After accounting for the survey design and weighting to the 2001 Census, the sample appears broadly representative of the Australian population. CONCLUSION: The combination of methods and design in the Australian Study of Health and Relationships, coupled with the high response rate, strongly suggests that the results of the study are robust and broadly representative of the Australian population.

Sex in Australia: a guide for readers.

The Australian Study of Health and Relationships (ASHR), a survey of 19,307 people aged 16-59 years which had a broad focus across many aspects of sexual and reproductive health. Our primary goal in presenting these data is to describe the overall prevalence of key outcomes and the ways in which they are patterned with respect to a range of sociodemographic factors. The socio-demographic factors used include age, gender, language spoken at home, highest level of education completed, region of residence, household income and occupational category. Where appropriate we also include stated sexual identity. Our choice of these factors reflects the fact that they are major elements in the structure of the Australian population and Australian society. For the purpose of reporting the initial results, we have grouped these outcomes into 18 papers. They are bracketed by an introductory methods paper which provides a detailed account of the design and execution of the study, and a concluding paper reflecting on the key themes emerging from the findings, the strengths and limitations of our approach and recommendations for future research.

Sex in Australia: attitudes towards sex in a representative sample of adults.

OBJECTIVE: To describe social attitudes towards sex of Australian adults and correlates of a scale of sexual liberalism. METHODS: Computer-assisted telephone interviews were completed by a representative sample of 10,173 men and 9,134 women aged 16-59 years. The overall response rate was 73.1% (69.4% men, 77.6% women). Respondents were asked about their agreement with nine attitude statements. Factor analysis and examination of internal consistency resulted in a six-item scale of liberalism. Correlates of attitude statements and the liberalism scale were examined. RESULTS: Most people agreed that premarital sex was acceptable, that oral sex was considered 'sex', that sex was important for a sense of well-being and that extramarital sex was unacceptable. Men were more likely (36.9%) to disapprove of sex between two men than women were to disapprove of sex between two women (25.1%). Higher levels of education were associated with increased liberalism for men and women, as was speaking English at home, identifying as homosexual or bisexual, vaginal intercourse before age 16, having had more than one sexual partner in the year before interview, having had heterosexual anal intercourse, having no religion or faith, smoking tobacco, and drinking more alcohol. CONCLUSION: Sexual attitudes of Australians largely support a heterosexual paradigm with no sex outside the relationship. High levels of approval of premarital sex are consistent with decreasing age of first intercourse in Australia. Higher levels of liberalism were associated with greater sexual adventurism and health risk taking.

Sex in Australia: selected characteristics of regular sexual relationships.

OBJECTIVE: To describe selected characteristics of Australian adults' regular or ongoing sexual relationships. METHOD: Computer-assisted telephone interviews were completed by a representative sample of 10,173 men and 9,134 women aged 16-59 years. The overall response rate was 73.1% (69.4% men, 77.6% women). Respondents indicated how often they had sex in the past four weeks, contraceptive use, their own and their partners' expectations about having sex with other people during their relationship, whether they had discussed these expectations with their partners and whether they had an explicit agreement about sex with other people. RESULTS: 85.3% of men and 89.5% of women were in a regular heterosexual relationship, among whom 81.4% of men and 89.3% of women reported contraceptive use. Men and women who had a regular partner for the past 12 months had had sex with their partners an average of 1.84 times per week in the four weeks before interview; younger people had sex more often. Most respondents expected themselves and their partners to not have sex with other people, although men were less likely than women to have discussed these expectations with their partner. Bisexually identified men and women were significantly less likely than heterosexually identified men and women to support having sex only with their regular partner. Only 4.9% of men and 2.9% of women in regular heterosexual relationships had concurrent sexual partners in the past 12 months. CONCLUSION: Australians' attitudes to not having sex with people while in a regular relationship are highly consistent with their behaviour.

Sex in Australia: first experiences of vaginal intercourse and oral sex among a representative sample of adults.

OBJECTIVE: To describe the characteristics of Australian adults' first vaginal intercourse and contraceptive use on that occasion, as well as first oral sex. METHOD: Computer-assisted telephone interviews were completed by a representative sample of 10,173 men and 9,134 women aged 16-59 years. The overall response rate was 73.1% (69.4% men, 77.6% women). Respondents indicated their age at first vaginal intercourse (if ever), the partner's age, their relationship to their partner, the duration of the relationship before first intercourse, and what contraception (if any) was used. Respondents also indicated their age when they first had oral sex. RESULTS: For men, the median age at first intercourse declined from 18 among men aged 50-59 to 16 for men aged 16-19. For women the decline in median age was from 19 to 16. For women born between 1941 and 1950 the difference in median age at first vaginal intercourse and subsequent first oral sex was six years but for women born between 1981 and 1986 the difference in medians was one year. For men, a similar convergence was observed. Contraceptive use at first intercourse has increased significantly, from less than 30% of men and women in the 1950s to over 90% in the 2000s. For men, first intercourse before age 16 was significantly associated with greater numbers of lifetime and recent sexual partners, ever having paid for sex and having had a sexually transmitted infection (STI), and for women, with greater numbers of lifetime and recent sexual partners, ever having been paid for sex and ever having had an STI. CONCLUSION: Sex education should be given so that all young people have information about contraception and disease prevention before they begin their sexual careers.

Sex in Australia: sexual identity, sexual attraction and sexual experience among a representative sample of adults.

OBJECTIVE: To describe the prevalence of same-sex and opposite-sex attraction and experience in Australia and the prevalence of different sexual identities. METHOD: Computer-assisted telephone interviews were completed by a representative sample of 10,173 men and 9,134 women aged 16-59 years from all States and Territories of Australia. The overall response rate was 73.1% (men, 69.4%; women, 77.6%). Men and women were asked about their experience of same-sex and opposite-sex attraction and experience along with their sexual identity. The agreement and disagreement between sexual attraction and sexual experience were explored. RESULTS: Among men, 97.4% identified as heterosexual, 1.6% as gay or homosexual and 0.9% as bisexual. Among women, 97.7% identified as heterosexual, 0.8% as lesbian or homosexual and 1.4% as bisexual. Among men, 91.4% reported only opposite-sex attraction and experience, as did 84.9% of women. Thus, some same-sex attraction or experience was reported by 8.60% of men and 15.1% of women. Of men, 4.2% reported sexual attraction and sexual experience that was inconsistent, as did 8.2% of women. Factors associated with this agreement or disagreement included age group, non-English-speaking background, education and socio-economic status. CONCLUSION: Relatively few Australians reported a sexual identity other than heterosexual. However, both same-sex attraction and homosexual experience are more common than homosexual or bisexual identity would suggest. Reporting same-sex attraction or experience was associated with poorer mental health and is likely to reflect responses to homophobia in Australian society.

Sex in Australia: heterosexual experience and recent heterosexual encounters among a representative sample of adults.

OBJECTIVE: To describe numbers of opposite-sex partners, experiences of different heterosexual behaviours, and recent heterosexual experiences among a representative sample of Australian adults. METHODS: Computer-assisted telephone interviews were completed by a representative sample of 10,173 men and 9,134 women aged 16-59 years from all States and Territories. The response rate was 73.1% (69.4% among men and 77.6% among women). RESULTS: Men reported more sexual partners than women over their lifetime, in the past five years and in the past year. 15.1% of men and 8.5% of women reported multiple sexual partners in the past year. Reporting multiple opposite-sex partners was significantly associated with being younger, identifying as bisexual, living in major cities, having a lower income, having a blue-collar occupation, and not being married. All but a handful of respondents' most recent heterosexual encounters involved vaginal intercourse and condoms were used in one-fifth of these sexual encounters. Anal intercourse was very uncommon during respondents' most recent heterosexual encounters. CONCLUSION: Patterns of heterosexual experience in Australia are similar to those found in studies of representative samples in other countries. IMPLICATIONS: There may be a need for interventions targeted at people with multiple sexual partners to promote safer sexual behaviour and to reduce the likelihood of transmission of HIV and other sexually transmitted infections.

Sex in Australia: homosexual experience and recent homosexual encounters.

OBJECTIVE: To describe the prevalence and features of homosexual experience and recent homosexual encounters among a representative sample of Australian adults. METHODS: Computer-assisted telephone interviews were completed by a representative sample of 10,173 men and 9,134 women aged 16-59 years from all States and Territories. The overall response rate was 73.1% (69.4% among men and 77.6% among women). RESULTS: Overall, 8.6% of women and 5.9% of men reported some homosexual sexual experience in their lives (p<0.001); these figures fell to 5.7% and 5.0% respectively (p=0.106) when non-genital sexual experience was excluded. 1.9% of men and 1.5% of women reported homosexual experience in the past year. Men who reported homosexual experience reported more same-sex partners than did women (means 31.6 and 3.2, p<0.001), and men and women who identified as homosexual or bisexual reported more sexual partners in total than those who identified as heterosexual. Respondents reporting homosexual experience were significantly more likely to be from an English-speaking background, have higher levels of education, live in a major city, and report a white-collar or managerial/professional occupation. Women who reported homosexual experience were less likely to have a middle or high income. In the most recent homosexual encounter, genital touching was the most commonly reported practice, and oral sex was reported much more frequently than in heterosexual encounters. CONCLUSION: Homosexually and bisexually identified men and women had higher total numbers of partners than heterosexuals. Improved societal attitudes towards homosexuality are likely to lead to further increases in estimates of the prevalence of homosexual experience in the community.

Sex in Australia: sexual difficulties in a representative sample of adults.

OBJECTIVES: The Australian Study of Health and Relationships reports on sexual behaviours in a representative sample of Australian adults. METHOD: Between May 2000 and June 2001, computer-assisted telephone interviews were completed by a representative sample of 10,173 men and 9,134 women aged 16 to 59 years (response rate 73.1%). Respondents were asked whether in the past year they had for a period of at least one month experienced a range of sexual difficulties. RESULTS: The most common sexual difficulty was lack of interest in having sex (24.9% men, 54.8% women). Women were more likely than men to report being unable to come to orgasm (28.6% vs. 6.3%), not finding sex pleasurable (27.3% vs. 5.6%), physical pain during intercourse (20.3% vs. 2.4%) or worrying during sex about their body looking unattractive (35.9% vs. 14.2%). Men were more likely to report coming to orgasm too quickly (23.8% vs. 11.7%). Men (16.0%) and women (17.0%) were equally likely to have felt anxious about their ability to perform sexually. Erectile difficulties and lack of interest in sex were higher among the over-40s. Anxiety about performance was highest among men under 20. Experience of sexual difficulties correlated with self-reported ill health. CONCLUSION: The assumption that everyone should be interested in sex, should want to have it and should enjoy having it is a socially normative prescription and not a description of the actual state of affairs. Women reported less interest in sex, less pleasure and more pain than men.