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The National Bowel Cancer Screening Program (NBCSP) was introduced in Australia in 2006, offering free immunochemical Faecal Occult Blood Test (FOBT) to persons aged 50, 55 or 65. The study aimed to examine the prevalence of selfreported screening for colorectal cancer (CRC) using the FOBT and factors associated with not having an FOBT. A cross-sectional study of Australian general practice patients aged 50 and over with no personal history of CRC completed a health risk survey while waiting for scheduled appointments between November 2010 and November 2011. A total of 5671 patients from 12 practices were approached to participate. Of the 4707 eligible patients (adults attending for care who understood English and were capable of providing informed consent), 4062 (86%) consented to participate, with 2269 eligible to complete the FOBT items. Approximately half (52%) of participants reported ever having an FOBT. More than one-third (39.7%) of the sample reported having an FOBT in the prior three years. Those who recalled receiving a mailed kit as part of the NBCSP were five times more likely to report being screened. Those less likely to report screening were aged 50–59 years, were female and had been diagnosed with a form of cancer other than CRC. There is justification for the extension of the NBCSP to ensure a majority of the age-appropriate population is screened for CRC. Further work is needed to identify whether high rates of screening are achievable using the mailed-kit approach, and how to increase participation by females, those aged 50–69 years and those diagnosed with other cancers.

Objective:This study examines the effectiveness and costs of follow‐up phone calls in improving response rates to a community survey.

This study examines the effectiveness and costs of follow‐up phone calls in improving response rates to a community survey.

Background.Perceived competencies and support for formal postgraduate training across a range of preventive and other interactional skills were examined in three medical groups.

To assess the prevalence, type, location of and injuries from home accidents, including falls and other accidents, and to explore whether variables including socio‐demographic characteristics, medication use and home hazards were associated with all home accidents and falls.

Objectives:To assess the prevalence, type, location of and injuries from home accidents, including falls and other accidents, and to explore whether variables including socio‐demographic characteristics, medication use and home hazards were associated with all home accidents and falls. Method:657 older people were interviewed about accidents in the previous four weeks. For a subsample (n=425), a home hazard check was completed. Results:Of the 101 accidents reported, 51% (n=51) were falls and 50% (n=50) were other accidents. The most common location for all accidents was outside (30%). Most resulted in minor injury to the legs (43%) or arms (39%). Medical treatment was sought for 14% of accidents. Having more than five hazards and infrequent home visits by healthcare providers were associated with having at least one accident and at least one fall. Use of a walking aid was also associated with falling. Conclusion:Rates of falls and other accidents are considerable. Implications:Work is required to confirm the importance of the relationships suggested and to provide data on the burden of injury associated with non‐fall accidents.

Objective: To assess the prevalence and predictors of perceived unmet needs among women diagnosed with breast cancer, with a particular focus on the impact of location (rural/urban). Method: A random sample of women in NSW diagnosed with breast cancer was surveyed during 1995–96. The Breast Cancer Patients' Needs Questionnaire (BR‐CPNQ) explores patients' perceived needs across five domains: psychological, health information, physical/daily living, patient care/support and interpersonal communication. Items assessing breast cancer specific needs and access to services and resources were included. Of 235 eligible rural women, 134 (57%) consented to participate and 129 (55%) returned completed surveys. Of 196 eligible urban women, 102 (52%) consented to participate and 100 (51%) returned completed surveys. Results: For 12 of the 52 items, at least one‐third of the sample reported ever having a moderate/high need for help. Of the 15 highest moderate or high unmet needs, 10 related to health information and three to psychological needs. There were few differences in the prevalence of needs reported by rural and urban women. Only in the physical/daily living domain were rural women more likely than urban women to report some need for help (OR=2.59, 95% Cl 1.21–5.52). Conclusions: Unmet needs, particularly in the information and psycho‐social domains, are reported by both rural and urban women with breast cancer, with sub‐groups experiencing different types of needs. Implications: There is a need to develop and trial targeted and innovative strategies to meet the health information and psychological needs of women with breast cancer, and the physical/daily living needs of rural women diagnosed with breast cancer.

To assess the prevalence and predictors of perceived unmet needs among women diagnosed with breast cancer, with a particular focus on the impact of location (rural/urban).

Objective:To assess Australian radiation and medical oncologists'self‐reported knowledge about and attitudes towards a range of non‐traditional therapies used by people with cancer. Design:Postal survey during May and June 1997 of all 265 radiation and medical oncologists practising in Australia. Participants:161 oncologists returned surveys (61% response rate). Main outcome measures:Oncologists'own level of knowledge, and, for each known therapy, their perceptions of its likely harm or benefit in patients being treated curatively and palliatively, and of the prevalence of use among their patients. Results:Oncologists reported knowing most about acupuncture, antioxidant therapy and meditation and least about cellular therapy, magnetotherapy and psychic surgery. The therapies most likely to be considered helpful were meditation, acupuncture and hypnotherapy. Those most likely to be considered harmful were coffee enemas, psychic surgery, Iscador therapy and diet therapies. Perceptions of patients'use of most therapies varied widely, with herbal therapies, antioxidant therapy and meditation considered the most commonly used. Conclusions:These results indicate self‐identified gaps in oncologists'knowledge about non‐traditional therapies their patients may use; they suggest a need to consider including education about these therapies in oncologists'training.

Objective:To explore the factors associated with waiting times for surgery in public hospitals. Setting:Three major acute care public hospitals in one Area Health Service. Participants:691 adult patients entered onto the computerised booking list between 16 and 22 November 1994, and then between 16 January and 12 February 1995, were interviewed prospectively and followed up over a minimum of 18 months. Data were obtained from the Area Health Service's computerised booking system and patient self‐report. Results:Relevant surgical specialty, urgency rating, employment status and health insurance status were significantly associated with waiting time. Age, hospital, sex, country of birth, education, marital status and holding a Health Care Card were not significantly associated with waiting time. Self‐reported health status (as measured by the SF‐36) was not associated with waiting time for surgery. Conclusions:Waiting time for surgery was not simply determined by how urgently patients need surgery, but also by the type of surgery needed and patient's employment and health insurance status. The extent of disability experienced by patients, as measured by the SF‐36, was not reflected in waiting times for surgery.

Binge consumption contributes substantially to the occurrence of alcohol-related harm. Despite its importance, binge drinking is not well defined in the literature. The present study examines the proportions of respondents identified as binge drinkers by three separate measures: a 1-week retrospective drinking diary (RD), the Alcohol Use Disorders Identification Test (AUDIT), and a quantity/frequency (QF) question. Overall, AUDIT detected the highest proportion of binge drinkers, followed by QF and RD. There was also good agreement between QF and RD, as well as QF and AUDIT. Ultimately, the measure of choice should be that which provides information most appropriate to the purposes of each study.

Abstract: Campaigns involving sending personally addressed letters to encourage women to have Pap smears increase Pap smear rates. The aim of this study was to assess whether this effect is maintained when campaigns are repeated regularly. In October 1992, a letter reminding women of the importance of screening was mailed to all women in three New South Wales postcode regions where a similar letter had been sent three years previously. The response was compared to the response in three regions receiving no earlier letter. The number of women attending for cervical screening during the three months after distribution of the letters was assessed from Health Insurance Commission claims for cervical cytology. These attendances were compared with expected attendances based on the attendance patterns over 28 pre‐intervention quarters. Significant postintervention increases in attendance were observed in all three regions receiving an initial letter. However, in one region, the increase in attendances, around 1 per cent of eligible women, was not significandy greater than the increase in the control region (z= 0.15, P= 0.88). The second letter campaign had no measurable effect on attendances. No significant increase in screenings was observed in two of the towns. A significant increase was observed in one region, but this was not significandy greater than the increase in the control region (z= ‐0.05, P= 0.96). These results suggest that repeated direct‐mail campaigns to promote screening for cervical cancer may be of no benefit. A one‐off campaign may result in an increase in screenings in the short term.

General practitioners are the main providers of Papanicolaou smear‐tests yet, given the current suboptimal rates of cervical screening, it is clear that their full potential as screening providers is not being realized. To date, no information has been available concerning the possible barriers to the provision of Papanicolaou smear‐tests by general practitioners. The present study assessed the views of a random sample of NSW general practitioners regarding the value of smear‐tests, the most appropriate providers, the recommended screening protocol, and factors that were thought to influence both practitioners' provision and women's utilization of screening. The results indicate a number of changes to the current system which could

Background.Smoking is associated with a large burden of illness in both developed and developing countries. Effective prevention of the uptake of smoking and achieving high rates of smoking cessation are essential to significantly reducing this problem. Therefore, researchers have sought to identify effective smoking reduction strategies which might be implemented in the community. Despite this wealth of research, making choices from among the available strategies with demonstrated effectiveness remains a difficult task.Methods.The study aimed to explore the level of agreement among experts on the perceived relative effectiveness and cost effectiveness of 29 smoking reduction strategies in a given environment. Experts were selected at random from tobacco control organizations in Australia. Fifty experts completed a mailed questionnaire.Results.It was found that there was little agreement among the experts regarding the perceived relative effectiveness and cost effectiveness of 29 smoking reduction strategies.Conclusions.It was concluded that the results suggest that experts may not be able to provide clear and consistent direction to health organizations on how best to reduce smoking rates. This is a concern given the current need for an effective, well-targeted worldwide attack on tobacco-related mortality and morbidity.

Objective– Evaluation of three potential methods for increasing Pap smear use: television media, television media combined with letter based recruitment, and television media combined with general practitioner based (GP based) recruitment.Setting - A trial of each intervention was carried out in three postal regions in New South Wales, Australia — a rural locality (containing about 1000 women), a country town (about 3000 women), and a major rural centre (about 10000 women). Three control regions were selected to be demographically similar to the corresponding intervention regions.Methods– Outcome data on regional Pap smear rates were obtained from government health insurance claims for cervical screening, and from pathology service records. Expected Pap smear rates for the three months after the intervention were predicted from 45 pre-intervention months and were compared with observed rates for this period.Results– Television media alone was associated with a significant increase in attendances for screening in one of the three regions where a trial was carried out: 13.3% in the rural centre. The media/ letter based campaign was associated with a significant increase in attendances in two out of three regions: 52.7% in the rural locality, 43.2% in the rural centre. The media/GP based campaign was associated with significant increases in attendances in all three regions: 50.2% in the rural locality, 80.8% in the country town, 15.7% in the rural centre. All three interventions were associated with significant increases in the number of women attending for cervical screening above those observed in the control regions. Furthermore, these increases were not restricted to women at low risk. They were also found for older women (aged 50–69 years) and women who had not had a Pap smear within the past three years.

Background: This study assessed surgeons' current perceived level of competence in a number of interactional skills, their perceptions of the need for training and assessment in interactional skills, and their perceptions of the appropriateness of the format and content of two existing communication skills training packages.

Objective: To explore the opinions of surgeons about the NHMRC clinical practice guidelines for the management of early breast cancer(the Guidelines)and their views about and use of the accompanying Consumer's guide. Design: Cross‐sectional telephone survey. Participants and setting: Surgeons throughout Australia who manage breast cancer, designated as “breast” or “general” (members or non‐members of the Royal Australasian College of Surgeons' Section of Breast Surgery) and “urban” or “rural”. Results: Among 150 respondents (64% response rate) more than 80% of surgeons reported having read all or most of the Guidelinesand believed they were useful in improving women's management and wellbeing, easy to understand, evidence­ based, a good summary of recent evidence, and that they would assist agreement between women and healthcare providers. Surgeons agreed with most of the recommendations in the Guidelines,but 26% disagreed that “women should ideally be treated by a specialist who treats a large number of similar patients and who has access to the full range of treatment options in a multidisciplinary setting”. In terms of medicolegal implications, 41% believed that the Guidelineswould protect clinicians, while, of the 37% of surgeons who believed that they would expose doctors to increased problems, significantly more breast than general surgeons believed this (50% v. 19%; P<0.001). Only 37% of surgeons routinely gave the Consumer's guideto all or more than half their patients. Conclusions: Surgeons are generally positive about the Guidelines,but certain issues should be addressed if they are to be optimally implemented, including confusion about the medicolegal implications, perceived difficulties with providing multidisciplinary care and poor use of the Consumer's guide.

Childhood and adolescence are critical periods in the etiology of subsequent melanoma and nonmelanocytic skin cancers. The aims of the study were (a) to develop a valid measure of solar protection in 9 to 11-year-old school students, (b) to evaluate the differential effectiveness of two interventions aimed at changing solar protection in this age group, and (c) to identify the predictors of use of a high level of solar protection. A Solar Protection Behavior Diary was developed and validated during a pilot, after which 11 schools were randomly allocated to one of three groups: intensive intervention (247 students), standard intervention (180 students), or control (185 students), with students in years 5 and 6 participating in the study. Students completed the validated diary (for 5 days) and a knowledge and attitudes questionnaire at pretest and at two posttest periods (4 weeks and 8 months after pretest). Results indicated that students in the intensive intervention group were significantly more likely to have used a high level of protection at both posttest periods compared to the control and standard intervention groups. There was no difference in the protection level of the control and standard intervention groups at either posttest, indicating that this minimal intervention was not effective in changing the solar protection behavior of the students. Students with a high level of solar protection at pretest were also significantly more likely to have a high level of protection at both posttest periods, and those with a greater number of opportunities to protect were less likely to protect at the second posttest.

Background and design— Australia has the highest rates of skin cancer in the world, and the incidence is estimated to be doubling every 10 years. Despite advances in the early detection and treatment of melanoma about 800 people still die nationally of the disease each year. A possible strategy for further reducing the mortality from melanoma is an organised programme of population screening for unsuspected lesions in asymptomatic people. Arguments against introducing melanoma screening have been based on cost and the lack of reliable data on the efficacy of any screening tests. To date, however, there has been no systematic economic assessment of the cost effectiveness of melanoma screening. The purpose of this research was to determine whether screening may be potentially cost effective and, therefore, warrants further investigation. A computer was used to simulate the effects of a hypothetical melanoma screening programme that was in operation for 20 years, using cohorts of Australians aged 50 at the start of the programme. Based on this simulation, cost—effectiveness estimates of melanoma screening were calculated.Results— Under the standard assumptions used in the model, and setting the sensitivity of the screening test (visual inspection of the skin) at 60%, cost effectiveness ranged from Aust$6853 per life year saved for men if screening was undertaken five yearly to $12137 if screening was two yearly. For women, it ranged from $11 102 for five yearly screening to $20 877 for two yearly screening.Conclusion— The analysis suggests that a melanoma screening programme could be cost effective, particularly if five yearly screening is implemented by family practitioners for men over the age of 50.

This study explored the prevalence and predictors of solar protection behaviour in a community sample of beachgoers. A total of 670 participants was randomly selected from six beaches in the Newcastle district. The solar protection behaviour of each participant was assessed by direct observation and interview. A subsample was also asked to complete a written questionnaire to assess attitudes to solar protection use, knowledge of skin cancer and awareness of recommended solar protection behaviours. Forty‐five per cent of the beachgoers in this sample were using a high level of solar protection, and a substantial proportion (16 per cent) of the sample was not using any kind of solar protection. Sunscreen with SPF 15+ was applied to at least one body region by 69 per cent of the sample, 17 per cent of the sample were wearing a recommended hat, 15.1 per cent were using shade, and 3.4 per cent were wearing a recommended style of shirt at the time of observation. Chi‐square analyses of the data for under‐15‐year‐olds indicated that a significantly greater proportion of 0‐ to 9‐year‐olds were well protected compared to 11‐ to 14‐year‐olds, but there was no difference in use of protection by boys and girls under 15 years of age. Stepwise regression analysis of the adult sample (15 years and over) showed that the predictors of overall level of solar protection were marital status and frequency of skin self‐examination in the past 12 months. The practical implications of these findings for future community‐based skin cancer prevention programs are discussed.

The purpose of this paper is to report on the government revenue gained from the sale of cigarettes to minors and the proportion of this revenue that is spent on attempting to prevent adolescents from taking up this habit Prevalence of smoking by minors was extrapolated for the individual states using Australian prevalence data; estimates of annual cigarette consumption were coupled with the respective cost of cigarettes in each state to derive an estimate of the total revenue accumulating from cigarette consumption by minors. From our analysis, approximately 211 000 Australian children under the legal age to purchase cigarettes consumed approximately 11.5 million packets of cigarettes in 1990. The estimated tax revenues to the federal and state governments from these sales were $8.42 million and $12.78 million respectively. While the average state revenue from cigarette consumption by minors during 1990 was just over $60 per under‐age smoker, only $0.11 per under‐age smoker was spent on anti‐smoking campaigns in 1990. This is equivalent to approximately 0.002 per cent of state revenue from cigarette smoking by those under the legal purchase age being spent on discouraging adolescents from taking up this habit Clearly, there is an inequitable expenditure on antismoking activities, given the enormous resources obtained from sales to minors.

The effects of two distribution strategies on the recall of receipt, retention, utilisation and perceived acceptability of written health education materials were investigated in two semirural communities. We randomly selected 512 people, 212 from general practitioners' surgeries, who received the materials from their general practitioners at the end of a routine consultation, and 300 from the electoral register, who received it through the mail in a personally addressed envelope. Of all those who received the materials, 55 (10.7 per cent) were not contactable and 386 (84.5 per cent) of those contacted consented to the survey. Structured interviews were conducted with consenting individuals two weeks after distribution to assess recall of receipt, retention, utilisation and perceived acceptability. Of those receiving the material by mail, 77.4 per cent recalled receiving it, 75.4 per cent reported keeping the booklet and 66.7 per cent reported reading it Of those receiving it from a general practitioner, 90.9 per cent recalled receiving it, 93.3 per cent reported keeping the booklet and 56 per cent reported reading it Perceived acceptability of the material was high, with over 80 per cent of respondents finding it very or fairly eye‐catching, believable, interesting and easy to read. Although general practitioner distribution led to higher rates of receipt and retention, mail‐out distribution led to higher utilisation rates and allowed access to a larger proportion of the population, resulting in more people being exposed to the education message.

The accessibility of health care services has been suggested to be one factor with the potential to ameliorate the health effects of socioeconomic disadvantage. From a randomly selected sample of households in the Lower Hunter Valley region, 2623 adults were surveyed in 1987–88 to identify their reported use of medical, allied and alternative health services during the previous four weeks. There was a higher prevalence of use of the 'usual’ general practitioner and medical services among educationally disadvantaged respondents only. No significant differences were evident between educational or between occupational groups in the prevalence of use of either alternative services or health services generally. Fewer occupationally disadvantaged respondents reported using allied health services. There was no difference in the number of health services used. Disadvantaged respondents were more likely to use medical services exclusively. Only educationally disadvantaged service users reported using any health, medical or general practitioner services more frequently than expected. In contrast, only occupationally disadvantaged service users reported using allied health services (and allied health services other than dentists) more frequently. The lack of consistent differentials in use across health services in favour of disadvantaged respondents suggests that a number of health care services may not be responding to the greater need for health care among disadvantaged members of the community.

Campaigns involving sending personally addressed letters to encourage women to have Pap smears increase Pap smear rates. The aim of this study was to assess whether this effect is maintained when campaigns are repeated regularly. In October 1992, a letter reminding women of the importance of screening was mailed to all women in three New South Wales postcode regions where a similar letter had been sent three years previously. The response was compared to the response in three regions receiving no earlier letter. The number of women attending for cervical screening during the three months after distribution of the letters was assessed from Health Insurance Commission claims for cervical cytology. These attendances were compared with expected attendances based on the attendance patterns over 28 pre‐intervention quarters. Significant postintervention increases in attendance were observed in all three regions receiving an initial letter. However, in one region, the increase in attendances, around 1 per cent of eligible women, was not significandy greater than the increase in the control region (z= 0.15, P= 0.88). The second letter campaign had no measurable effect on attendances. No significant increase in screenings was observed in two of the towns. A significant increase was observed in one region, but this was not significandy greater than the increase in the control region (z= ‐0.05, P= 0.96). These results suggest that repeated direct‐mail campaigns to promote screening for cervical cancer may be of no benefit. A one‐off campaign may result in an increase in screenings in the short term.

Objective: To develop strategies to overcome barriers to preventive care in general practice. Method: Participants invited to attend a one‐day works hop ranked barriers to preventive care in a pre‐workshop survey. During the workshop , small groups generated strategies to overcome the most influential barriers . After the workshop, participants nominated strategies for implementation in the ideal world and in the realities of resource constraints. Participants: Twenty‐six participants representing general practice, medical academe, funding authorities,health pol icy planners, researchers ,medico political organisations and consumers.Results: The surveys yielded preferred strategies for implementation in the ideal world and 10 preferred strategies for implementation given likely resource constraints. Conclusions: Authoritative guidelines are needed to guide clinical practice and to evaluate research. Other comprehensive strategies to overcome barriers to preventive care must be implemented and evaluated for effectiveness and acceptability in field experiments before wider implementation. The con trolled implementation and evaluation of these strategies requires genuine collaboration amongst clinicians. health policy planners, researchers,fun ding authorities and general practice academe.(Med J Aust 1991; 154: 523‐531)

Abstract: The aim of this paper was to compare the benefit and costs of cigarette smoking from the government's perspective during a one‐year period. This was undertaken by estimating, among other things, the publicly financed health care expenditure attributable to smoking and comparing it with tobacco taxes paid by smokers. This comparison of benefits and costs may provide a yardstick from which to measure the relative worth (in financial terms) an average smoker is to the government, an assessment that may be important when assessing health priorities and any level of commitment to reducing smoking rates. It is estimated that in 1989–90 an average smoker cost the government $203.57, while benefits received totalled an average of $620.56 in the same year. If the government were serious about addressing cigarette smoking as a primary health objective its efforts would portray this. The results of this analysis suggest that the objective of raising revenue from smoking is more of a priority than reducing smoking rates.

Abstract: We aimed to determine the relative effectiveness of an education intervention and a threat–of–enforcement intervention in reducing sales of cigarettes to under–age youth by randomly allocating 300 retailers in a nonmetropolitan region of New South Wales to: a control group with no intervention; a minimal–intervention group, which received an educational letter; and a maximal–intervention group, which received a threat of enforcement followed by a visit from a public health officer. Retailers were checked for compliance at pretest and post–test, six months apart, by twelve 18–yearolds who were judged by independent raters to look younger. The retailers were surveyed by telephone at both times for knowledge, attitudes and self–reported sales practices. Neither intervention achieved significant improvements for the two key behavioural outcomes: requiring proof of age and display of a warning sign. Neither was there an intervention effect on knowledge about the law. The greatest improvement in the proportion of retailers who believed that the legal age should be 18 or over was in the minimal–intervention group, and both intervention groups were less likely than the control group at post–test to think that it was acceptable to sell to a person who was nearly 18. There was poor overall compliance with the revised legislation at pre–test. The finding of a pretest–to–post–test improvement but no differential intervention effect highlights the methodological difficulties of such research. The interventions may, however, have been pardy successful in modifying the attitudes of retailers. (Aust N Z J Public Health 1997; 21: 590–6)

There have been few attempts to study systematically researchers' views about priorities for addiction research. This mail/telephone survey of 101 Australian researchers achieved a 90% response rate. Respondents believed there should be a 50/50 split between the agency‐directed and researcher‐initiated methods of funding allocation. The top four drugs in terms of desired proportions of research spending were alcohol 32%, tobacco 18%, opiates 9% and prescribed drugs 9%. Researchers' preferences for high funding allocations on prevention research were at odds with the low level of Australian studies in this area. Complexities of design and methodology were nominated as the most important barriers to prevention research. The divide between qualitative and quantitative approaches was not identified as a major barrier to personal or prevention research. In addition to increases in both overall and specific funding, greater collaboration and political support were viewed as important facilitating factors for research efforts. Improved researcher training and the need to integrate research into quality assurance programmes were also nominated as useful means of encouraging prevention studies.

In this randomized trial patients with non-insulin-dependent diabetes were allocated to one of four programs: a minimal instruction program (n=59). an education program of individual visits (n=57), an education program incorporating a group education course (n=66), and a behavioral program (n=59). Individual and group education programs had higher attrition rates than the behavioral and minimal programs. The four programs, which involved different amounts of patient contact time, delivery format, and instructional strategies. all produced reductions in HbA atid BMI, with no significant differences between the programs. There were no differences between groups over three time periods in total cholesterol, HDL cholesterol, systolic blood pressure, or proportion of patients consulting an ophthalmologist. The behavioral program ploduced a greater reduction in diastolic blood pressure over 12 months that the education programs and a greater reduction in the cholesterol risk ratio over 3 months than the other programs. The behavioral program patients were more likely to have visited a podiatrist after 6 months and reported higher satisfaction.

This study presents findings on solar protection policies and practices in primary and secondary schools in New South Wales, Australia. The findings suggest that policies have been more fully articulated in primary schools than in secondary schools and that there is wide scope for further public health initiatives to protect children from the risk of skin cancer. Little attention has been given to the potential benefits of timetable changes and provision of shade in school environments, although school principals considered the latter would be a successful means of increasing protection. The level of solar education provided in the schools surveyed in our study was minimal, suggesting that urgent attention should be given to incorporating these issues in the school curriculum. Observations of school children's solar protection behaviours suggest that the majority of children used some form of protection in the middle of the day, but the form of protection changed with age. Consideration of more structural and environmental changes is needed to maximise the opportunities for solar protection in schools.

The aim of this paper was to compare the benefit and costs of cigarette smoking from the government's perspective during a one-year period. This was undertaken by estimating, among other things, the publicly financed health care expenditure attributable to smoking and comparing it with tobacco taxes paid by smokers. This comparison of benefits and costs may provide a yardstick from which to measure the relative worth (in financial terms) an average smoker is to the government, an assessment that may be important when assessing health priorities and any level of commitment to reducing smoking rates. It is estimated that in 1989-90 an average smoker cost the government $203.57, while benefits received totalled an average of $620.56 in the same year. If the government were serious about addressing cigarette smoking as a primary health objective its efforts would portray this. The results of this analysis suggest that the objective of raising revenue from smoking is more of a priority than reducing smoking rates.

Abstract: We aimed to determine the relative effectiveness of an education intervention and a threat-of-enforcement intervention in reducing sales of cigarettes to under-age youth by randomly allocating 300 retailers in a nonmetropolitan region of New South Wales to: a control group with no intervention; a minimal-intervention group, which received an educational letter; and a maximal-intervention group, which received a threat of enforcement followed by a visit from a public health officer. Retailers were checked for compliance at pretest and post-test, six months apart, by twelve 18-yearolds who were judged by independent raters to look younger. The retailers were surveyed by telephone at both times for knowledge, attitudes and self-reported sales practices. Neither intervention achieved significant improvements for the two key behavioural outcomes: requiring proof of age and display of a warning sign. Neither was there an intervention effect on knowledge about the law. The greatest improvement in the proportion of retailers who believed that the legal age should be 18 or over was in the minimal-intervention group, and both intervention groups were less likely than the control group at post-test to think that it was acceptable to sell to a person who was nearly 18. There was poor overall compliance with the revised legislation at pre-test. The finding of a pretest-to-post-test improvement but no differential intervention effect highlights the methodological difficulties of such research. The interventions may, however, have been pardy successful in modifying the attitudes of retailers. (Aust N Z J Public Health 1997; 21: 590-6)

There have been few international comparisons of patient-centered cancer care delivery. This study aimed to compare the experiences of patient-centered care (PCC) of Japanese and Australian radiation oncology patients. Participants were adults with cancer attending a radiotherapy appointment at a Japanese or Australian clinic. Participants completed a survey asking about 10 indicators of PCC. Overall, 259 Japanese and 285 Australian patients participated. Compared with Japanese participants, Australian participants were significantly more likely to report receiving information about: what the treatment is, and the short-term and long-term side effects of treatment. A higher proportion of Australian participants reported being asked whether they wanted a friend or family member present at the consultation. There were no differences in the frequency with which Japanese and Australian participants were asked by their clinicians about whether they were experiencing physical side effects or emotional distress. International differences highlight the (1) need to exercise caution when generalizing from one country to another; and (2) the importance of context in understanding PCC delivery and the subsequent design of quality improvement interventions.

Despite the widespread use of print materials in public health education, little is known about the costs and processes involved in developing these materials and their effectiveness in practice. We examined a sample of printed health education materials, using interviews and checklists. The most cost-effective processes for developing materials were not being used and the effectiveness of materials was rarely evaluated.

This research aimed to determine whether, between 1990 and 1993, there were any changes in the government revenue gained from sale of cigarettes to minors and the proportion of this revenue spent on attempting to prevent the uptake of this habit by adolescents. The methodology is consistent with the 1990 study, although some revisions have been necessary. From our analysis, it is estimated that state revenue from under-age smoking increased 97% from $9.37 million in 1990 to $18.45 million in 1993. State expenditure on anti-smoking campaigns (for the entire population) increased 24% from $9.47 million in 1990 to an estimated $11.75 million in 1993. When this expenditure is converted to a relative amount, relative state expenditure per under-age smoker fell an estimated 10%, from $4.40 in 1990 to $3.98 in 1993. This is equivalent to approximately 7.7% and 5.1%, in 1990 and 1993 respectively, of state revenue from cigarette smoking by those under the legal purchase age being spent on discouraging adolescents from taking up this habit. These results suggest a growing inequity in the expenditure on anti-smoking activities compared to revenues received from sales to minors.

Abstract: Despite the widespread use of print materials in public health education, little is known about the costs and processes involved in developing these materials and their effectiveness in practice. We examined a sample of printed health education materials, using interviews and checklists. The most cost‐effective processes for developing materials were not being used and the effectiveness of materials was rarely evaluated.

This research aimed to determine whether, between 1990 and 1993, there were any changes in the government revenue gained from sale of cigarettes to minors and the proportion of this revenue spent on attempting to prevent the uptake of this habit by adolescents. The methodology is consistent with the 1990 study, although some revisions have been necessary. From our analysis, it is estimated that state revenue from under‐age smoking increased 97% from $9.37 million in 1990 to $18.45 million in 1993. State expenditure on anti‐smoking campaigns (for the entire population) increased 24% from $9.47 million in 1990 to an estimated $11.75 million in 1993. When this expenditure is converted to a relative amount, relative state expenditure per under‐age smoker fell an estimated 10%, from $4.40 in 1990 to $3.98 in 1993. This is equivalent to approximately 7.7% and 5.1%, in 1990 and 1993 respectively, of state revenue from cigarette smoking by those under the legal purchase age being spent on discouraging adolescents from taking up this habit. These results suggest a growing inequity in the expenditure on anti‐smoking activities compared to revenues received from sales to minors.