Prevalence and correlates of advance care planning among Australian hospital inpatients.

The prevalence and factors associated with advance care planning (ACP) documents for Australian public hospital inpatients were determined through cross-sectional study of 123 Victorian hospitals between July 2016 and December 2018. Of the 611 786 included patients, 2.9% had an ACP document. Odds increased significantly in those comorbid, unpartnered, regional and >5 admissions, which supports future ACP conversations and document creation.

Correlates of poor oral health related quality of life in a cohort of people who use methamphetamine in Australia.

OBJECTIVES: Methamphetamine use impacts oral health, but little is known about its impacts on oral health related quality of life (OHRQoL). In this study we examined OHRQoL in a cohort of people who use methamphetamine and assessed associations with sociodemographic, behavioural, psychosocial and dental service utilisation correlates. A secondary aim was to examine the relationship between methamphetamine route of administration and OHRQoL, to test whether smoking the drug is associated with reduced OHRQoL. METHODS: Cross-sectional analysis was performed, using data from VMAX, a cohort of people who use methamphetamine at least monthly in Victoria, Australia (n = 194). Utilising the oral health impact profile (OHIP-14), we assessed three OHRQoL outcomes: OHIP-14 prevalence, OHIP-14 extent and OHIP-14 severity. Regression analyses examined associations between independent variables and the three OHIP-14 outcome measures. RESULTS: A significant segment of the cohort (35%) reported poor OHRQoL. Overall, no statistically significant association was detected between methamphetamine route of administration and the three OHIP-14 outcomes. Participants living in rural areas, with moderate-to-severe self-reported depression and with methamphetamine dependence had significantly worse OHRQoL levels, which persisted after adjusting for other covariates. CONCLUSION: Overall, VMAX cohort participants reported reduced OHRQoL levels. Our findings highlight the need for upstream interventions to improve the OHRQoL of people who use methamphetamine, with specific focus on those living in rural locations. Further research on the links between OHRQoL and mental health among people who use methamphetamine is required.

Correlates of anxiety and depression in a community cohort of people who smoke methamphetamine.

OBJECTIVE: Anxiety and depression are the most common mental health disorders experienced by Australians. These disorders are commonly found in people who use methamphetamine; however, much of this research has involved participants recruited from treatment settings who inject methamphetamine. We therefore explored (1) the prevalence of moderate to severe anxiety and depression in a community-recruited cohort who smoked methamphetamine and (2) examined potential factors associated with moderate to severe anxiety or depression in this cohort. METHOD: Data were derived from baseline surveys of 725 participants of the prospective 'VMAX' study, recruited from metropolitan and non-metropolitan areas of Victoria, Australia, via snowball and respondent-driven sampling. Anxiety and depression were measured using the Generalized Anxiety Disorder-7 and the Patient Health Questionnaire-9 instruments. Independent associations between moderate to severe scores on these measures and demographic, socio-economic, substance use and other health and social characteristics were examined using multivariable logistic regression. RESULTS: More than half (60%) of the participants were classified as experiencing moderate to severe anxiety and/or depression. In the multivariable models, having poor/very poor self-rated health, methamphetamine dependence and being unemployed were associated with higher odds of experiencing both moderate to severe depression and moderate to severe anxiety. Living in a large rural town, identifying as Aboriginal and Torres Strait Islander and smoking methamphetamine were associated with lower odds of experiencing moderate to severe depression. Being female was associated with higher odds of experiencing moderate to severe anxiety. CONCLUSION: The high rates of anxiety and/or depression found in the VMAX cohort were associated with demographic, socio-economic, substance use and other health and social factors. The prevalence of moderate to severe anxiety is a novel finding that warrants further study. Further work is needed to determine how anxiety and depression change over time among people who smoke methamphetamine, to help identify key intervention points.

Interventions for improving medical students' interpersonal communication in medical consultations.

BACKGROUND: Communication is a common element in all medical consultations, affecting a range of outcomes for doctors and patients. The increasing demand for medical students to be trained to communicate effectively has seen the emergence of interpersonal communication skills as core graduate competencies in medical training around the world. Medical schools have adopted a range of approaches to develop and evaluate these competencies. OBJECTIVES: To assess the effects of interventions for medical students that aim to improve interpersonal communication in medical consultations. SEARCH METHODS: We searched five electronic databases: Cochrane Central Register of Controlled Trials, MEDLINE, Embase, PsycINFO, and ERIC (Educational Resource Information Centre) in September 2020, with no language, date, or publication status restrictions. We also screened reference lists of relevant articles and contacted authors of included studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs), cluster-RCTs (C-RCTs), and non-randomised controlled trials (quasi-RCTs) evaluating the effectiveness of interventions delivered to students in undergraduate or graduate-entry medical programmes. We included studies of interventions aiming to improve medical students' interpersonal communication during medical consultations. Included interventions targeted communication skills associated with empathy, relationship building, gathering information, and explanation and planning, as well as specific communication tasks such as listening, appropriate structure, and question style. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. Two review authors independently reviewed all search results, extracted data, assessed the risk of bias of included studies, and rated the quality of evidence using GRADE. MAIN RESULTS: We found 91 publications relating to 76 separate studies (involving 10,124 students): 55 RCTs, 9 quasi-RCTs, 7 C-RCTs, and 5 quasi-C-RCTs. We performed meta-analysis according to comparison and outcome. Among both effectiveness and comparative effectiveness analyses, we separated outcomes reporting on overall communication skills, empathy, rapport or relationship building, patient perceptions/satisfaction, information gathering, and explanation and planning. Overall communication skills and empathy were further divided as examiner- or simulated patient-assessed. The overall quality of evidence ranged from moderate to very low, and there was high, unexplained heterogeneity. Overall, interventions had positive effects on most outcomes, but generally small effect sizes and evidence quality limit the conclusions that can be drawn. Communication skills interventions in comparison to usual curricula or control may improve both overall communication skills (standardised mean difference (SMD) 0.92, 95% confidence interval (CI) 0.53 to 1.31; 18 studies, 1356 participants; I² = 90%; low-quality evidence) and empathy (SMD 0.64, 95% CI 0.23 to 1.05; 6 studies, 831 participants; I² = 86%; low-quality evidence) when assessed by experts, but not by simulated patients. Students' skills in information gathering probably also improve with educational intervention (SMD 1.07, 95% CI 0.61 to 1.54; 5 studies, 405 participants; I² = 78%; moderate-quality evidence), but there may be little to no effect on students' rapport (SMD 0.18, 95% CI -0.15 to 0.51; 9 studies, 834 participants; I² = 81%; low-quality evidence), and effects on information giving skills are uncertain (very low-quality evidence). We are uncertain whether experiential interventions improve overall communication skills in comparison to didactic approaches (SMD 0.08, 95% CI -0.02 to 0.19; 4 studies, 1578 participants; I² = 4%; very low-quality evidence). Electronic learning approaches may have little to no effect on students' empathy scores (SMD -0.13, 95% CI -0.68 to 0.43; 3 studies, 421 participants; I² = 82%; low-quality evidence) or on rapport (SMD 0.02, 95% CI -0.33 to 0.38; 3 studies, 176 participants; I² = 19%; moderate-quality evidence) compared to face-to-face approaches. There may be small negative effects of electronic interventions on information giving skills (low-quality evidence), and effects on information gathering skills are uncertain (very low-quality evidence).  Personalised/specific feedback probably improves overall communication skills to a small degree in comparison to generic or no feedback (SMD 0.58, 95% CI 0.29 to 0.87; 6 studies, 502 participants; I² = 56%; moderate-quality evidence). There may be small positive effects of personalised feedback on empathy and information gathering skills (low quality), but effects on rapport are uncertain (very low quality), and we found no evidence on information giving skills. We are uncertain whether role-play with simulated patients outperforms peer role-play in improving students' overall communication skills (SMD 0.17, 95% CI -0.33 to 0.67; 4 studies, 637 participants; I² = 87%; very low-quality evidence). There may be little to no difference between effects of simulated patient and peer role-play on students' empathy (low-quality evidence) with no evidence on other outcomes for this comparison. Descriptive syntheses of results that could not be included in meta-analyses across outcomes and comparisons were mixed, as were effects of different interventions and comparisons on specific communication skills assessed by the included trials. Quality of evidence was downgraded due to methodological limitations across several risk of bias domains, high unexplained heterogeneity, and imprecision of results. In general, results remain consistent in sensitivity analysis based on risk of bias and adjustment for clustering. No adverse effects were reported.  AUTHORS' CONCLUSIONS: This review represents a substantial body of evidence from which to draw, but further research is needed to strengthen the quality of the evidence base, to consider the long-term effects of interventions on students' behaviour as they progress through training and into practice, and to assess effects of interventions on patient outcomes. Efforts to standardise assessment and evaluation of interpersonal skills will strengthen future research efforts.

A realist review of scholarly experiences in medical education.

CONTEXT: Scholarly experiences have been increasingly employed to support the development of scholarly skills for medical students. How the characteristics of the various scholarly experiences contributes to scholarly outcomes or the complexities of how the experiences build skills warrants further exploration. OBJECTIVES: To identify how medical students' scholarly experiences lead to scholarly outcomes under what circumstances. METHODS: A realist review was conducted with a search of Ovid MEDLINE, CINAHL, Scopus and ERIC databases using the terms "medical student" and "scholarly experience" and related synonyms. Studies involving the engagement of medical students in a range of compulsory scholarly experiences including quality improvement projects, literature reviews and research projects were included. Key data were extracted from studies, and realist analysis was used to identify how contexts and mechanisms led to different outcomes. RESULTS: From an initial 4590 titles, 28 studies of 22 scholarly experiences were identified. All were primarily focused on research-related scholarly experiences. Organisational research culture that valued research, dedicated time, autonomy and choice of experience were found to be key contexts. Adequately supported and structured experiences where students can see the value of research and quality supervision that builds student's self-efficacy were identified as mechanisms leading to outcomes. Outcomes included increased research skills and attitudes, scholarly outputs (eg publications) and future interest in research or other scholarly endeavours. CONCLUSIONS: The design of scholarly experiences for medical students needs to ensure protected time, adequate supervision and autonomy, to achieve scholarly outcomes. Much of the focus is on research and traditional outcomes with little known about the role or outcomes associated with other scholarly work.

Supervision training in healthcare: a realist synthesis.

Supervision matters: it serves educational, supportive and management functions. Despite a plethora of evidence on the effectiveness of supervision, scant evidence for the impact of supervision training exists. While three previous literature reviews have begun to examine the effectiveness of supervision training, they fail to explore the extent to which supervision training works, for whom, and why. We adopted a realist approach to answer the question: to what extent do supervision training interventions work (or not), for whom and in what circumstances, and why? We conducted a team-based realist synthesis of the supervision training literature focusing on Pawson's five stages: (1) clarifying the scope; (2) determining the search strategy; (3) study selection; (4) data extraction; and (5) data synthesis. We extracted contexts (C), mechanisms (M) and outcomes (O) and CMO configurations from 29 outputs including short (n = 19) and extended-duration (n = 10) supervision training interventions. Irrespective of duration, interventions including mixed pedagogies involving active and/or experiential learning, social learning and protected time served as mechanisms triggering multiple positive supervisor outcomes. Short-duration interventions also led to positive outcomes through mechanisms such as supervisor characteristics, whereas facilitator characteristics was a key mechanism triggering positive and negative outcomes for extended-duration interventions. Disciplinary and organisational contexts were not especially influential. While our realist synthesis builds on previous non-realist literature reviews, our findings extend previous work considerably. Our realist synthesis presents a broader array of outcomes and mechanisms than have been previously identified, and provides novel insights into the causal pathways in which short and extended-duration supervision training interventions produce their effects. Future realist evaluation should explore further any differences between short and extended-duration interventions. Educators are encouraged to prioritize mixed pedagogies, social learning and protected time to maximize the positive supervisor outcomes from training.

Communication of advance care planning decisions: a retrospective cohort study of documents in general practice.

BACKGROUND: Doctors, particularly general practitioners, play a significant role in assisting patients to create advance care plans. When medically indicated, these documents are important tools to promote congruence between end-of-life care and patient's personal preferences. Despite this, little is known regarding the availability of these documents in hospitals. The aim of this study was to identify the proportion of people who died in hospital without an advance care plan and how many of these had advance care planning (ACP) documents in their general practice records. METHODS: A retrospective cohort study was conducted of patient hospital records with manual linkage to general practice records. The large regional hospital in Victoria, Australia has a catchment population in excess of 300,000 people. The study sample was patients aged 75 years and over who died in the hospital between 1 January 2016 and 31 December 2017. The hospital records of these patients were examined to identify those which did not have a system alert for ACP documents on the file. Alerted ACP documents were limited to those legislated in the state of Victoria: advance care plan, Enduring Power of Attorney (Medical Treatment) or Enduring Power of Guardianship. Where no ACP document system alert was found in the hospital record, the patient's nominated general practice was consented to participate and the corresponding general practice record was examined. Data were analysed using descriptive statistics. RESULTS: Of the 406 patients who died in hospital, 76.1% (309) did not have a system alert for any ACP document. Of the 309 hospital records without a system alert, 144 (46.7%) corresponding general practice records were examined. Of these, 14.6% included at least one ACP document, including four advance care plans, that were not available in hospital. CONCLUSIONS: Unless ACP documents are consistently communicated from general practice, patient's preferences may be unknown during end-of-life care. It is important that both doctors and patients are supported to use connected electronic health records to ensure that documents are readily available to healthcare staff when they are required.

Rural health services' relationships with patients: An enabler and a barrier to advance care planning.

OBJECTIVE: The barriers and enablers to the uptake of advance care plans has been well documented but more so in metropolitan health services. Rural and regional areas have their own challenges of higher rates of chronic illness and an aging population when considering end of life care. This study aimed to explore the creation of advance care plans in a regional location that has service links to smaller health services. DESIGN: A qualitative study involving thematic analysis of interview data. SETTING: A regional local government area in Victoria, Australia. PARTICIPANTS: Twelve representatives from rural and regional health services, including hospital, private practice and community organisation staff. MAIN OUTCOME MEASURES: Barriers and enablers to the creation of advance care planning documents. RESULTS: The data analysis yielded two main identified themes around Plan creation and communication of patient wishes: system and societal challenges to the creation and communication in advance care planning; and rural communities' expectation of the health service-patient relationship and advance care planning. CONCLUSION: Although barriers to advance care planning are well known, rural and regional practitioners need to be aware of the effect long-term continuity of care from health practitioners and connections with health services has on advance care plan creation, and whether the paucity of written Plans effects end-of-life care. A potential solution was seen in the pending linkages to the national electronic patient record.

Context matters for primary health care access: a multi-method comparative study of contextual influences on health service access arrangements across models of primary health care.

BACKGROUND: Equitable access to primary health care (PHC) is an important component of integrated chronic disease management. Whilst context is known to influence access to PHC, it is poorly researched. The aim of this study was to determine the contextual influences associated with access arrangements in four Australian models of integrated PHC. METHODS: A multi-method comparative case study design. Purposive sampling identified four models of PHC across six sites in two Australian states. Complexity theory informed the choice of contextual factors that influenced access arrangements, which were analysed across five dimensions: availability and accommodation, affordability, acceptability, appropriateness and approachability. Semi-structured interviews, document/website analysis and non-participant observation were used to collect data from clinicians, administrative staff and other key stakeholders. Within and cross-case thematic analysis identified interactions between context and access across sites. RESULTS: Overall, financial viability, objectives of the PHC model and relationships with the local hospital network (LHN) underpinned access arrangements. Local supply of general practitioners and financial viability were strong influences on availability of after-hours services. Influences on affordability were difficult to determine because all models had nil/low out-of-pocket costs for general practitioner services. The biggest influence on acceptability was the goal/objectives of the PHC model. Appropriateness and to a lesser degree affordability arrangements were influenced by the relationship with the LHN. The provision of regular outreach services was strongly influenced by perceived population need, referral networks and model objectives. CONCLUSIONS: These findings provide valuable insights for policy makers charged with improving access arrangements in PHC services. A financially sustainable service underpins attempts to improve access that meets the needs of the service population. Smaller services may lack infrastructure and capacity, suggesting there may be a minimum size for enhancing access. Access arrangements may be facilitated by aligning the objectives between PHC, LHN and other stakeholder models. While some access arrangements are relatively easy to modify, improving resource intensive (e.g. acceptability) access arrangements for vulnerable and/or chronic disease populations will require federal and state policy levers with input from primary health networks and LHNs.

Evaluation of a local government "shelter and van" intervention to improve safety and reduce alcohol-related harm.

BACKGROUND: The entertainment precincts of cities, while contributing to local economies, need to be carefully managed to mitigate harms. Individual behaviours and government regulation have typically been the foci of interventions aimed at reducing alcohol-related harm. Little is known about how changes to the built environment might influence alcohol-related harms in these settings. The aim of this study was to explore how a public shelter and a volunteer-funded and staffed mobile van in a regional city influenced perceptions of safety and reduction in alcohol-related harm. METHODS: An intrinsic case-study approach was used. Document reviews, qualitative interviews with 16 key informants (volunteers, licensees, police, local business owners, patrons, community members and security guards), observation, and secondary data analysis were conducted in 2016. A conceptual framework of the causative pathways linking the drivers of alcohol consumption with social and health outcomes was used to inform the analysis. RESULTS: The shelter and van were frequently utilised but there was no significant association with a reduction in the proportion of alcohol-related hospital emergency department presentations or police incident reports. Occupational health and safety risks were identified for the volunteers which had no management plan. CONCLUSIONS: The findings highlight the challenge faced by local governments/authorities wanting to provide community-based interventions to complement other evidence-based approaches to reduce alcohol-related harm. Local governments/authorities with restricted regulatory oversight need to collaborate with key agencies for targeted upstream and evidence-based alcohol prevention and management interventions before investing resources. Such approaches are critical for improving community safety as well as health and social outcomes in communities at greatest risk of alcohol-related harm.

Awareness of alcohol as a risk factor for cancer is associated with public support for alcohol policies.

BACKGROUND: Globally, alcohol is causally related to 2.5 million deaths per year and 12.5% of these are due to cancer. Previous research has indicated that public awareness of alcohol as a risk factor for cancer is low and this may contribute to a lack of public support for alcohol policies. The aim of this study was to investigate the relationship between awareness of the alcohol-cancer link and support for a range of alcohol policies in an English sample and policy context. METHODS: A cross-sectional survey of 2100 adult residents in England was conducted in which respondents answered questions regarding awareness of the link between alcohol and cancer and support for 21 policy proposals. Principal component analysis (PCA) was used to reduce the 21 policy proposals down to a set of underlying factors. Multiple regression analyses were conducted to estimate the relationship between awareness of the alcohol-cancer link and each of these policy factors. RESULTS: Thirteen per cent of the sample were aware of the alcohol-cancer link unprompted, a further 34% were aware when prompted and 53% were not aware of the link. PCA reduced the policy items to four policy factors, which were named price and availability, marketing and information, harm reduction and drink driving. Awareness of the alcohol-cancer link unprompted was associated with increased support for each of four underlying policy factors: price and availability (Beta: 0.06, 95% CI: 0.01, 0.10), marketing and information (Beta: 0.05, 95% CI: 0.00, 0.09), harm reduction (Beta: 0.09, 95% CI: 0.05, 0.14), and drink driving (Beta: 0.16, 95% CI: 0.11, 0.20). CONCLUSIONS: Support for alcohol policies is greater among individuals who are aware of the link between alcohol and cancer. At the same time, a large proportion of people are unaware of the alcohol-cancer link and so increasing awareness may be an effective approach to increasing support for alcohol policies.

Developing a model of family focused practice with consumers, families, practitioners and managers: a community based participatory research approach.

BACKGROUND: While governments are urging adult mental health services to support consumers in the context of their family, there is little information about what family focused practice is, nor how it might be enacted. METHODS: Informed by the principles of Community Based Participatory Research, workshops were held in three rural Australian communities in 2015 to discuss the meaning of family focused practice and how such practices might be promoted. RESULTS: Participants described the need to raise community awareness about mental illness and provide practical support to the family. Participants emphasized the importance of practitioners genuinely communicating with consumers and their families about mental illness and the need for collaborative care and treatment planning. They also highlighted the challenges of living in rural places and posed some solutions. CONCLUSION: On the basis of the results and previous literature, we developed a model of family focused practice that outlined various stakeholders and their enactments. The model has the potential to inform policy, professional development and practice guidelines.

Comparing visual acuity, range of vision and spectacle independence in the extended range of vision and monofocal intraocular lens.

IMPORTANCE: This study is the first to compare the extended range of vision (ERV) intraocular lens (IOL) targeted at micro-monovision to a monofocal targeted at binocular emmetropia. BACKGROUND: Compares visual acuity, range of vision and spectacle independence in monofocal and ERV IOLs. DESIGN: Assessor-blinded retrospective cohort study. PARTICIPANTS: Eighty-eight participants (176 eyes) with bilateral IOL implants at 5+ month postoperative review. METHODS: Regression analyses (general estimating equations and multiple linear regression) tested associations between IOL type (ZA9002 Tecnis 3-piece or Tecnis ZCT monofocal; and Tecnis Symfony ERV IOL) and visual acuity, adjusting for key confounders including residual astigmatism. MAIN OUTCOME MEASURES: Monocular and binocular visual acuity measured with and without distance refractive correction at distance (3.00 m), intermediate (1.00 and 0.63 m) and near (0.40 m) (logMAR units); near vision reading test used British 'N' notation; self-reported spectacle independence. RESULTS: There was no significant difference between ERV and monofocal groups in uncorrected binocular visual acuity at distance (P = 0.595). Binocular uncorrected visual acuity at intermediate (0.63 m: monofocal 0.24, ERV 0.09, P < 0.001) and near (0.40 m: monofocal 0.42, ERV 0.18, P < 0.001) were significantly better in the ERV group. Binocular uncorrected near vision: all the ERV group read N8 or better, compared to 36% in the monofocal group (P < 0.001); 93% of the ERV group reported spectacle independence at near compared to 33% in the monofocal group (P < 0.001). CONCLUSIONS AND RELEVANCE: The ERV IOL, targeted to achieve micro-monovision, demonstrated superior range of visual acuity and spectacle independence compared to the monofocal targeted to achieve emmetropia.

What's in a name? An overview of organisational health literacy terminology.

Organisational health literacy (OHL) is a relatively new concept and its role in improving population health outcomes is gaining recognition. There are several terms being used in relation to OHL but there is no consensus about the definition of OHL nor agreement on a single approach to its application within health services. This contested space continues to create discussion and debate between health literacy researchers worldwide. Increasingly, health service accreditation standards are moving towards including OHL and so services need to clearly define their roles and responsibilities in this area. Inherent in this is the need to develop and validate quantifiable measures of OHL change. This is not to say it needs a 'one-size-fits-all' approach but rather that terminology needs to be fit for purpose. This paper reviews the literature on OHL, describing and contrasting OHL terminology to assist practitioners seeking OHL information and health services clarifying their roles and responsibilities in this area.

Identification of cancer risk and associated behaviour: implications for social marketing campaigns for cancer prevention.

BACKGROUND: Community misconception of what causes cancer is an important consideration when devising communication strategies around cancer prevention, while those initiating social marketing campaigns must decide whether to target the general population or to tailor messages for different audiences. This paper investigates the relationships between demographic characteristics, identification of selected cancer risk factors, and associated protective behaviours, to inform audience segmentation for cancer prevention social marketing. METHODS: Data for this cross-sectional study (n = 3301) are derived from Cancer Council New South Wales' 2013 Cancer Prevention Survey. Descriptive statistics and logistic regression models were used to investigate the relationship between respondent demographic characteristics and identification of each of seven cancer risk factors; demographic characteristics and practice of the seven 'protective' behaviours associated with the seven cancer risk factors; and identification of cancer risk factors and practising the associated protective behaviours, controlling for demographic characteristics. RESULTS: More than 90% of respondents across demographic groups identified sun exposure and smoking cigarettes as moderate or large cancer risk factors. Around 80% identified passive smoking as a moderate/large risk factor, and 40-60% identified being overweight or obese, drinking alcohol, not eating enough vegetables and not eating enough fruit. Women and older respondents were more likely to identify most cancer risk factors as moderate/large, and to practise associated protective behaviours. Education was correlated with identification of smoking as a moderate/large cancer risk factor, and with four of the seven protective behaviours. Location (metropolitan/regional) and country of birth (Australia/other) were weak predictors of identification and of protective behaviours. Identification of a cancer risk factor as moderate/large was a significant predictor for five out of seven associated cancer-protective behaviours, controlling for demographic characteristics. CONCLUSIONS: These findings suggest a role for both audience segmentation and whole-of-population approaches in cancer-prevention social marketing campaigns. Targeted campaigns can address beliefs of younger people and men about cancer risk factors. Traditional population campaigns can enhance awareness of being overweight, alcohol consumption, and poor vegetable and fruit intake as cancer risk factors.

Liquor licences issued to Australian schools.

BACKGROUND: Children's positive socialisation to alcohol is associated with early initiation of drinking and alcohol-related harm in adult life. Internationally, there have been reports of adults' alcohol consumption at school events in the presence of children. The aim of this research was to identify the conditions under which Australian schools are required to apply for a liquor licence and the associated prevalence of liquor licences for these events where children were likely to be present. METHODS: A document review was conducted to examine temporary liquor licensing legislation. Quantitative analysis was used to examine relevant licensing data. Coding criteria was developed to determine school type, student year levels and the likely presence of children. RESULTS: Four jurisdictions provided data on 1817 relevant licences. The average annual licences/100 schools was highest amongst Independent schools followed by Catholic and public (government) schools. The rates were highest in Queensland and Victoria where children were present at 61% and 32% of events respectively. CONCLUSIONS: While there are legislative differences across jurisdictions, the prevalence of adults' alcohol use at school events in the presence of children may reflect the various education department policies and principals' and school communities' beliefs and attitudes. Licences are not required for all events where liquor is consumed so the prevalence of adults' use of alcohol at school events is likely to be higher than our analyses imply. Such practices may undermine teaching about alcohol use in the school curriculum and health promotion efforts to develop alcohol-free events when children are present.

Compositional, Contextual, and Collective Community Factors in Mental Health and Well-Being in Australian Rural Communities.

There are disproportionately higher and inconsistently distributed rates of recorded suicides in rural areas. Patterns of rural suicide are well documented, but they remain poorly understood. Geographic variations in physical and mental health can be understood through the combination of compositional, contextual, and collective factors pertaining to particular places. The aim of this study was to explore the role of "place" contributing to suicide rates in rural communities. Seventeen mental health professionals participated in semi-structured in-depth interviews. Principles of grounded theory were used to guide the analysis. Compositional themes were demographics and perceived mental health issues; contextual themes were physical environment, employment, housing, and mental health services; and collective themes were town identity, community values, social cohesion, perceptions of safety, and attitudes to mental illness. It is proposed that connectedness may be the underlying mechanism by which compositional, contextual, and collective factors influence mental health and well-being in rural communities.