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Objective: To estimate the burden of pancreatic cancer in Australia attributable to modifiable exposures, particularly smoking., Design: Prospective pooled cohort study., Setting, Participants: Seven prospective Australian study cohorts (total sample size, 365 084 adults); participant data linked to national registries to identify cases of pancreatic cancer and deaths., Main Outcome Measures: Associations between exposures and incidence of pancreatic cancer, estimated in a proportional hazards model, adjusted for age, sex, study, and other exposures; future burden of pancreatic cancer avoidable by changes in exposure estimated as population attributable fractions (PAFs) for whole population and for specific population subgroups with a method accounting for competing risk of death., Results: There were 604 incident cases of pancreatic cancer during the first 10 years of follow-up. Current and recent smoking explained 21.7% (95% CI, 13.8-28.9%) and current smoking alone explained 15.3% (95% CI, 8.6-22.6%) of future pancreatic cancer burden. This proportion of the burden would be avoidable over 25 years were current smokers to quit and there were no new smokers. The burden attributable to current smoking is greater for men (23.9%; 95% CI, 13.3-33.3%) than for women (7.2%; 95% CI, -0.4% to 14.2%; P = 0.007) and for those under 65 (19.0%; 95% CI, 8.1-28.6%) than for older people (6.6%; 95% CI, 1.9-11.1%; P = 0.030). There were no independent relationships between body mass index or alcohol consumption and pancreatic cancer., Conclusions: Strategies that reduce the uptake of smoking and encourage current smokers to quit could substantially reduce the future incidence of pancreatic cancer in Australia, particularly among men., (© 2019 AMPCo Pty Ltd.)

Objective: To understand self-injury and its correlates in the Australian population., Design, Participants and Setting: Cross-sectional survey, using computer-assisted telephone interview, of a representative sample of 12,006 Australians from randomly selected households., Main Outcome Measures: Data on demographics, self-injury, psychiatric morbidity, substance use, suicidality, disclosure and help-seeking., Results: In the 4 weeks before the survey, 1.1% of the sample self-injured. For females, self-injury peaked in 15-24-year-olds; for males, it peaked in 10-19-year-olds. The youngest self-injurers were nine boys and three girls in the 10-14-year age group, and the oldest were one female and one male in the 75-84-year age group. Mean age of onset was 17 years, but the oldest age of onset was 44 years for males and 60 years for females. No statistically significant differences existed between those who did and did not self-injure on sex, socioeconomic status or Indigenous status. Most common self-injury method was cutting; most common motivation was to manage emotions. Frequency of self-injury during the 4-week period ranged from 1 to 50 instances (mean, 7). Self-injurers were significantly more psychologically distressed, and also more likely to use substances. Adults who self-injured were more likely to have received a psychiatric diagnosis. Self-injurers were more likely to have experienced recent suicidal ideation (OR, 11.56; 95% CI, 8.14-16.41), and have ever attempted suicide (OR, 8.51; 95% CI, 5.70-12.69). Most respondents told someone about their self-injury but fewer than half sought help., Conclusion: The prevalence of self-injury in Australia in the 4 weeks before the survey was substantial and self-injury may begin at older ages than previously reported. Self-injurers are more likely to have mental health problems and are at higher risk of suicidal thoughts and behaviour than non-self-injurers, and many self-injurers do not seek help.

Objective: To examine the comparative prevalence and distribution of obesity and psychological disturbance in the asthma and non-asthma populations, and to determine how these comorbidities are associated with physical functioning., Design, Setting and Participants: A South Australian population-representative study of 3175 adults who provided data on asthma, psychological morbidity, physical functioning, and body mass index. Bivariate and multivariate analyses identified how these comorbidities were distributed in asthma and non-asthma subpopulations, and the variance in physical functioning that they explained., Main Outcome Measures: Rates of obesity and psychological morbidity, and physical functioning scores in asthma and non-asthma populations., Results: Men and women in the asthma population had similar prevalences of obesity (35.3% v 33.6%) and psychological morbidity (29.5% v 29.4%). When compared with non-asthma controls, both comorbidities were significantly higher only in men with asthma. The prevalence of psychological morbidity within different weight categories in the asthma population compared with non-asthma weight-category controls varied by sex. Physical functioning was lower in the asthma population than the non-asthma population (46.6 [95% CI, 45.9-47.3] v 48.8 [95% CI, 47.8-50.0]; P < 0.001), and psychological morbidity explained 22% of this variance., Conclusions: Psychological morbidity and obesity are common in people with asthma. The sex-specific variation in psychological morbidity across weight categories suggests that future studies of psychological morbidity in groups with asthma should adopt designs that consider sex-specific controls rather than comparisons between the sexes.

Objectives: To identify the incidence of self-reported harmful adverse events in the health care of community-dwelling adults, and to examine attitudes about safety in the health system., Design: Cross-sectional, population-based survey., Participants and Setting: Analysis of data from 3522 adults participating in Stage 2 of the North West Adelaide Health Study, who were surveyed in 2004 and 2005., Main Outcome Measures: Self-reported adverse events causing harm in the past year; attitudes to safety in health care, including adequacy of current measures for preventing adverse events, and the effect of groups like patients themselves, doctors and governments on patient safety., Results: The annual incidence of self-reported harmful adverse events was 4.2%. The main types were medication error (45.5%) and misdiagnosis or wrong treatment (25.6%). Multiple logistic regression showed that self-reported harmful adverse events were more likely in people who had been hospitalised in the past 12 months (odds ratio [OR], 2.5; 95% CI, 1.9-3.4), those who had low annual income (< $12 000), those who completed higher education to the level of Bachelor degree or higher (OR, 3.0; 95% CI, 1.0-9.4), and those who had some level of dissatisfaction with their recent health care; and less likely in those more risk-averse rather than those with a tendency to risk-taking behaviour (OR, 0.6; 95% CI, 0.4-0.9). People were more likely to believe that individual health care professionals had a positive effect on safety than professional groups or government, and that more resources were the key to improving the safety of health care., Conclusion: We found an incidence of self-reported harmful adverse events that was significantly lower than that found by a 2002 Australian survey (4.2% v 6.5%; P = 0.009). Better communication to help patients acquire more realistic risk perception may help reduce harm. Better communication could also increase public advocacy for systems improvement in safety to counter persisting community beliefs that individual action alone can redress the situation.

Objectives: To examine changes in asthma prevalence in the context of other population changes between 1990 and 2003, for specific age and sex groups., Design: Cross-sectional survey based on household interviews, repeated annually., Setting and Participants: Representative samples of the South Australian population between 1990 and 2003 (around 3000 people per year)., Main Outcome Measures: Current prevalence of doctor-diagnosed asthma and other health and demographic variables potentially associated with asthma, and asthma management., Results: Response rate was over 71%. Between 1990 and 2003, asthma prevalence increased significantly, doubling in females (from 7.3% in 1990 to 14.6% in 2003), with a smaller increase in males (from 7.8% to 9.4%). Asthma also increased in all age groups, but the largest relative increases occurred in people aged 55 years and older. Logistic regression analyses showed that obesity was a major predictive variable for every age group studied. The prevalence of asthma morbidity (waking at night and days lost from usual activities because of asthma) among those with asthma showed no significant changes between 1990 and 2003. Asthma action plans (introduced on a population basis in 1992) peaked in their distribution at 42% in 1994, and then declined to half that percentage in 2003. The increase in asthma prevalence occurred at the same time as increases in population prevalence of obesity (10.3% to 18.7%) and diabetes (3.1% to 6.9%), and decline in recent vigorous exercise (42.4% to 32.7%)., Conclusions: The increase in asthma prevalence over a decade was large, but concentrated among specific sex and age groups. The increase accompanied population increases in obesity and diabetes and a decline in vigorous exercise.

Objective: To survey the use, cost, beliefs and quality of life of users of complementary and alternative medicine (CAM)., Design: A representative population survey conducted in 2004 with longitudinal comparison to similar 1993 and 2000 surveys., Participants: 3015 South Australian respondents over the age of 15 years (71.7% participation)., Results: In 2004, CAMs were used by 52.2% of the population. Greatest use was in women aged 25-34 years, with higher income and education levels. CAM therapists had been visited by 26.5% of the population. In those with children, 29.9% administered CAMs to them and 17.5% of the children had visited CAM therapists. The total extrapolated cost in Australia of CAMs and CAM therapists in 2004 was AUD$1.8 billion, which was a decrease from AUD$2.3 billion in 2000. CAMs were used mostly to maintain general health. The users of CAM had lower quality-of-life scores than non-users. Among CAM users, 49.7% used conventional medicines on the same day and 57.2% did not report the use of CAMs to their doctor. About half of the respondents assumed that CAMs were independently tested by a government agency; of these, 74.8% believed they were tested for quality and safety, 21.8% for what they claimed, and 17.9% for efficacy., Conclusions: Australians continue to use high levels of CAMs and CAM therapists. The public is often unaware that CAMs are not tested by the Therapeutic Goods Administration for efficacy or safety.

Objective: To identify changes in mental health literacy in regard to depression between 1998 and 2004., Design and Setting: Face-to-face interviews with a random and representative sample of the South Australian population in 2004, compared with a similarly conducted survey in 1998 that used the same vignette, questions and methodology., Participants: 3015 randomly selected participants, aged 15 years and over., Main Outcome Measures: Responses to both open-ended and direct questions about symptoms and treatment options for depression., Results: The 3015 interviews conducted represented a response rate of 65.9%. Compared with 1998, in 2004 there was a significant increase in the proportion of people recognising depression in the vignette, acknowledging personal experience of depression, and perceiving professional assistance to be more helpful and less harmful. However, although more people nominated psychiatrists or psychologists as therapists of choice, the difference between 1998 and 2004 was not significant., Conclusions: There has been a significant increase in mental health literacy, at least as regards depression, in the South Australian community between 1998 and 2004. The lack of significant change in psychiatrists and/or psychologists being perceived as therapists of choice is of concern and suggests that community education about their expertise may be appropriate.

Objective: To determine whether mental illness is associated with accessibility and remoteness., Design: A cross-sectional, population-based, computer-assisted telephone interview survey, stratified by Accessibility and Remoteness Index of Australia (ARIA) categories., Setting: Secondary analysis of data collected from 2545 South Australian adults in October and November 2000., Outcome Measures: Psychological distress and depression as determined by the Kessler 10 Psychological Distress Scale, the SF-12 measure of health status, and self-reported mental illness diagnosed by a doctor in the previous 12 months., Results: Overall, mental illness prevalence estimates were similar using the three measures of psychological distress (10.5%), clinical depression (12.9%) and self-reported mental health problem (12.7%). For each measure, there was no statistically significant variation in prevalence across ARIA categories, except for a lower than expected prevalence of depression (7.7%) in the "accessible" category. There was no trend suggesting higher levels of mental illness among residents of rural and remote regions., Conclusions: The prevalence rates of psychological distress, depression and self-reported mental illness are high. However, we found no evidence that the prevalence of these conditions varies substantially across ARIA categories in South Australia. This finding may challenge existing stereotypes about higher levels of mental illness outside metropolitan Australia.

Objective: To describe changes in use of hormone replacement therapy (HRT) in an Australian population and to determine HRT use in women at risk of cardiovascular disease and osteoporotic fracture., Design: Data were derived from the 1997 South Australian Health Omnibus Survey (a representative population survey) and compared with data from 1991, 1993 and 1995 Omnibus Surveys., Setting: South Australia, 1997., Participants: 1049 women aged 40 years and over from a random selection of 4400 households., Results: Among women aged 55-64 years (and thus likely to be postmenopausal), 60% had used HRT (ever use). Nearly two-thirds of these women used it currently. In this age group, mean length of HRT use had increased to 70 months (median, 60 months). Rates of HRT use had not changed significantly between 1991 and 1997 in women under 55 years, but had increased significantly in women aged 55 years or over (P < or = 0.01). Among women currently using HRT, 5.4% had used testosterone therapy, while 4% used unregistered products purported to contain hormones. Rates of ever use of HRT in women with zero, one, two, or three or more cardiovascular risk factors were 33%, 37%, and 45%, respectively. Among women with a diagnosis of osteoporosis, 52% had used HRT, with a mean length of use of 86 months (median, 60 months)., Conclusion: HRT use is increasing in older-age groups. Longer-term therapy with potential for primary prevention is now occurring, but half of those with osteoporosis and more than half of those with risk factors for cardiovascular disease have not used HRT.

Objective: To determine changes in the use of hormone replacement therapy (HRT) in South Australia between 1991 and 1993., Design and Setting: Survey of women aged 40 years and over, as part of the 1991 and 1993 South Australian Health Omnibus Surveys (household interviews); 868 were interviewed in 1991 and 790 in 1993., Outcome Measures: Rates of HRT use., Results: In 1993, 19.0% of women aged 40 years and over were taking HRT and 28.5% had ever taken it (currently or in the past). The highest rates were in the 50-54 years age group (46.2% current use and 57.8% ever use). Between 1991 and 1993 there was a 40% increase in the number of women taking HRT and a significant increase (P < 0.01) in the median duration of therapy, from 38 to 54 months. There were also significant increases in rates of use by country women and Australian-born women (P < 0.01). Premarin and Provera remained the most commonly used products in 1993., Conclusion: Australian perimenopausal women are increasingly using HRT. This may reflect recent educational programs on the menopause for both health professionals and the public, and also an increasing number of choices of therapy.