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The ethical effect of aesthetics is underexplored in literatures on healthcare, especially reproductive services. Healthcare aesthetics play a particular role in influencing patient choice, and in so doing, mediates who is – and is not – welcomed into certain medical spaces. This is particularly pertinent in the context of assisted reproductive clinics, which are often seeking competitive advantage in a market where patients purportedly have a choice amongst providers, and where providers have the capital to invest in clinic design and social media presence to attract patients. Interrogating aesthetic and spatial dimensions of reproductive clinics is especially critical in uncovering gendered, class, and racial assumptions of reproductive futures. As such, ethical inquiry would benefit from examining the aesthetic qualities of ART and its implications on the reproduction of commercialized, gendered, and racialized health settings. In this paper, we draw on reflections made by participants about aesthetics during qualitative interviews on commercial influences on ART services. We expand on these initial reflections by engaging with feminist literature on the image in reproductive ethics and broader scholarship regarding health environments. In doing so, we examine the normative assumptions and effects held within clinic aesthetics to discuss the construction and influence of 'pink' reproductive spaces. • Commercial ART clinics adopt 'pink aesthetics' of female empowerment and choice. • Aesthetics can trouble patriarchal medicine but commodify feminist justice. • Social media and advertising are critical to cultivating gendered aesthetics. • Pink aesthetics reinforces personal responsibility over reproductive futures. • The pink aesthetic constitutes reproductive imaginaries and subjectivities. [ABSTRACT FROM AUTHOR]

This article draws on arts-based psycho-social research to explore embodied and visceral knowing and feeling in the context of people living with a diagnosis of borderline personality disorder (BPD). It presents a discussion of creative artworks solicited through a nation-wide online survey conducted in Australia in 2021 that generated intimate and affective understanding about living with a diagnosis of BPD. To investigate what lived experiences of distress associated with a BPD diagnosis communicate through sensation, emotion, image and affective capacity, the authors put to work Blackman's (2015) concept of "productive possibilities of negative states of being" and the broader theoretical framework of new materialism. This approach allows a more transformative feeling-with that exceeds the normative affective repertoires and scripts associated with a diagnosis of BPD. The authors recognise the often unspoken and invisible affects of complex mental distress and trauma, and purposefully open the space for affective and symbolic aspects of creative artworks to communicate what is less known or has less presence in dominant biomedical frameworks about living with a BPD diagnosis. The article foregrounds the lived and living experience of participants to generate experiential rather than clinical understandings of the diagnosis. • Lived experience of borderline personality disorder (BPD) is under researched. • Arts-based research enables understanding the emotional toil of mental illness. • Our data highlight the lived experience of distress associated with BPD diagnosis. • This research calls for countering stigma and creating empathy. • Understanding the complex terrain of mental distress leads to better treatment. [ABSTRACT FROM AUTHOR]

The demanding nature of caregiving and limited social support can lead to informal carers experiencing loneliness, which can impact their well-being and overall health service use (HSU). The study aims to examine the association between loneliness with HSU and Health state utility values among informal carers in Australia. Data were derived from three waves (2009, 2013, and 2017) of the nationally representative longitudinal Household Income and Labour Dynamics of Australia (HILDA) survey, focusing on adult informal carers. Outcome measures included visits to the General Practitioner, the number of hospital admissions, and the SF-6D score. Generalized Estimating Equations (GEE) analysis was conducted to explore the associations between loneliness and HSU, as well as loneliness and utility values (based on SF-6D) while adjusting for age, sex, education, marital status, income, and physical/mental health conditions. After controlling for covariates, lonely carers reported lower utility values (IRR = 0.91, 95%CI [0.89, 0.93], p < 0.001) compared to non-lonely carers. Lonely carers reported a higher number of GP visits (IRR = 1.18, 95% CI [1.04, 1.36], p < 0.05) as well as a higher likelihood of visiting specialists (AOR = 1.31, p = 0.046) and hospital doctors (AOR = 1.42, p = 0.013) compared to the non-lonely carers. The findings of this study highlight the relationship between loneliness on both healthcare utilization and carers' overall well-being. Addressing loneliness through targeted interventions and social support systems can help improve health outcomes and potentially reduce the overall healthcare costs among informal carers in Australia. • Loneliness is linked to lower health state utility values among informal carers. • Lonely informal carers tend to meet GPs and specialist more frequently. • Interventions targeting to reduce loneliness can reduce cost and improve wellbeing. [ABSTRACT FROM AUTHOR]

Early childhood interventions have the potential to reduce children's developmental inequities. We aimed to estimate the extent to which household income supplements for lower-income families in early childhood could close the gap in children's developmental outcomes and parental mental health. Data were drawn from a nationally representative birth cohort, the Longitudinal Study of Australian Children (N = 5107), which commenced in 2004 and conducted follow-ups every two years. Exposure was annual household income (0–1 year). Outcomes were children's developmental outcomes, specifically social-emotional, physical functioning, and learning (bottom 15% versus top 85%) at 4–5 years, and an intermediate outcome, parental mental health (poor versus good) at 2–3 years. We modelled hypothetical interventions that provided a fixed-income supplement to lower-income families with a child aged 0–1 year. Considering varying eligibility scenarios and amounts motivated by actual policies in the Australian context, we estimated the risk of poor outcomes for eligible families under no intervention and the hypothetical intervention using marginal structural models. The reduction in risk under intervention relative to no intervention was estimated. A single hypothetical supplement of AU$26,000 (equivalent to ∼USD$17,350) provided to lower-income families (below AU$56,137 (∼USD$37,915) per annum) in a child's first year of life demonstrated an absolute reduction of 2.7%, 1.9% and 2.6% in the risk of poor social-emotional, physical functioning and learning outcomes in children, respectively (equivalent to relative reductions of 12%, 10% and 11%, respectively). The absolute reduction in risk of poor mental health in eligible parents was 1.0%, equivalent to a relative reduction of 7%. Benefits were similar across other income thresholds used to assess eligibility (range, AU$73,329-$99,864). Household income supplements provided to lower-income families may benefit children's development and parental mental health. This intervention should be considered within a social-ecological approach by stacking complementary interventions to eliminate developmental inequities. • Income supplements provided to lower-income households may improve children's development. • Household income supplements may also be beneficial to parental mental health. • The absolute reduction in risk of poor outcomes ranged between 0.8% and 2.8%. • Household income supplements alone are insufficient to eliminate child inequities. • Stacking multiple complementary interventions over the life course is needed. [ABSTRACT FROM AUTHOR]

Obesity remains a significant public health concern globally with over one billion adults projected to be obese by 2025. To better understand the drivers of obesity and to inform policy, it is important to explore the factors that influence obesity. The objective of this paper to examine if the crime rates in the neighbourhood or local area in which a person lives influences their likelihood of being obese. Thus, we seek to contribute to the literature on the determinants of obesity by asking the question: what is the effect of neighbourhood (i.e., postcode) crime on obesity? We also examine the pathways through which neighbourhood crime influences obesity with a focus on the role of social capital, physical activity and sleep quality. Using 14 waves of longitudinal data from the Household, Income and Labour Dynamics in Australia (HILDA) survey merged with official police statistics on crime rates at the postcode level, we apply identification strategies that address endogeneity arising from endogenous sorting and omitted variable bias. We find that an increase in neighbourhood crime rates is associated with an increase in body mass index (BMI) and the likelihood of being obese. Exploring the pathways through which neighbourhood crime influences obesity, we find that social capital and physical activity are important channels, while sleep quality is not. The evidence also suggests that the effects of violent crime are more pronounced compared to property crime. Our findings suggest that targeting crime, and in particular violent crime, which seems to be driving the findings, is a core mechanism for reducing BMI and maintaining healthy body weight. The mediating role of physical activity and social capital also suggest that public policy can specifically target these areas by providing interventions that promote social capital and physical activity even amidst high crime rates. • We examine the impact of neighbourhood crime on obesity. • We use 14 waves of longitudinal data from Australia. • Neighbourhood crime increases obesity. • Social capital and physical activity are important channels. • Effects are stronger for females than males. [ABSTRACT FROM AUTHOR]

Cold indoor temperature (<18 °C) is associated with hypertension-related and respiratory disease, depression, and anxiety. We estimate total health, health expenditure and income impacts of permanently lifting the temperature in living areas of the home to 18 °C in cold homes in South-eastern Australia (N = 17 million). A proportional multistate lifetable model was used to estimate health adjusted life years (HALYs), health expenditure and income earnings, over the remainder of the lifespan of the population alive in 2021 (3% discount rate). Multiple data were integrated including the prevalence of cold housing (5.87%; mean temperature 15 °C), the effect of temperature to hypertension-related, respiratory disease, depression and anxiety. Eradicating cold housing was predicted to lead to 89,600 (95% UI 47,700 to 177,000) lifetime HALYs gained over the population's remaining lifespan, nearly half of which occurred from 2021 to 2040. Respiratory disease (32.4%) and mental illness (60.6%) made large contributions to HALYs gained, but also had large uncertainty (95% UI 30.0%–42.9% and 45.1%–64.6%, respectively) due to uncertain estimates of their magnitude of causal association with cold housing. Health gains per capita were 6.1 times greater (95% UI 4.7 to 8.1) among the most compared to least deprived quintile. From 2021 to 2040, health expenditure decreased by AUD$0.87 billion (0.35–1.98) and income earnings increased by AUD$4.35 billion (1.89–9.81). Eliminating cold housing would lead to substantial health gains, reductions in health inequalities, savings in health expenditure, and productivity gains. Next steps require research to reduce uncertainty about the magnitude of causal associations of cold with mental and respiratory health. • Cold housing significantly impacts cardiovascular, respiratory, and mental health. • Eradicating cold housing leads to health gains across population's lifespan. • Eradicating cold housing leads to health expenditure savings and income gains. • Health gains are higher among the most compared to least deprived quintile. • Further research needed to reduce uncertainty on the magnitude of health impacts. [ABSTRACT FROM AUTHOR]

Abstract This paper describes who is most likely to experience household employment insecurity and housing affordability stress – double precarity – and estimates the degree to which housing affordability mediates the effect of employment insecurity on mental health. We use a cohort of 24,201 participants in 2016 Household, Income and Labour Dynamics in Australia survey (6.2 repeated measures on average). We estimate the likelihood of onset of household employment insecurity, housing affordability stress and change in housing costs using longitudinal regression analyses for socio-demographic groups. We assess mediation by estimating how much exposure variable coefficients attenuate with inclusion of a mediator in fixed effects regression models. We also apply causal mediation methods to fixed-effects regression models to better account for exposure-mediator interaction and meet strict model assumptions. If people's households become insecurely employed, there are five times greater odds of them also experiencing housing affordability stress (OR 4.99 95%CI 4.21–5.90). Key cohorts within the population are shown to be especially vulnerable to double precarity – notably single parents (OR 2.91, 95%CI 1.94–4.35) and people who live alone (OR 4.42, 95% CI 3.03–6.45) (compared to couples), and people who are recently separated or divorced (OR 2.59, 95%CI 1.81–3.70). Mediation analysis confirms that household employment insecurity has a small, negative effect on mental health (Beta −0.24, 95%CI -0.38-0.11 on a 1 to 100-point scale with 10-point standard deviation). Estimates from casual mediation analyses suggest housing affordability accounts for 20% of the total effect; likely concentrated in the lowest and highest strata of income. Employment and housing insecurity represent a form of double precarity for people in households with a single income. When we consider the impact on mental health, we find evidence of a causal relationship between insecure employment onset and mental health, around one fifth of which is mediated by changing housing cost and onset of affordability stress. Highlights • Insecurely employed households are five times as likely to have unaffordable housing. • Lone person and lone parent households are more susceptible to double precarity. • Housing costs mediate the impact of insecure employment on mental health. [ABSTRACT FROM AUTHOR]

Extreme weather and climate-related disaster events are associated with a range of adverse health outcomes. People are not equally vulnerable to the adversity, experiencing varied patterns of long-term health trajectories in recovery depending on their vulnerabilities, capacities, and resiliencies. This study aims to identify latent mental and physical health trajectories and their associations with person- and place-based pre-disaster predictors. Using an Australian, population-based, longitudinal dataset spanning 2009–19, group-based multi-trajectory modelling was applied to identify the distinct mental, social, emotional, and physical health trajectories of people who had experienced damage to their home following a climate-related disaster event. Multinomial logistic regression was used to assess a series of social vulnerability predictors (demographic, socioeconomic, housing, health, neighbourhood, and geographical) of health patterns. We identified three distinct health trajectories. Most individuals experienced small or minimal health impacts at the time of the disaster year followed by a fast recovery. However, one-fifth of the exposed population were severely affected during and post disaster. This cohort had the worst mental and physical health prior to the disaster and experienced the largest decreases in mental and physical health and the lowest recoveries. Pre-existing mental and physical conditions were the most substantial risk factors, increasing the probability of experiencing high impact and slow recovery by 61% for mental health and 51% for physical health. In addition, vulnerability in the form of housing affordability stress, lower household income, and lack of community attachment, participation and safety were also significant independent risk factors for ongoing post-disaster health problems. Critically, people's mental and physical health recovery is dependent on pre-disaster vulnerabilities in health, resource access, and capacities. These findings could assist policymakers and health practitioners to more effectively target people most at risk and design prevention and response strategies to prevent the exacerbation of poor health and wellbeing. • Most people exposed to disaster experienced low health impacts. • One fifth experienced large health decreases and slow recovery post-disaster. • Pre-disaster poor health increased risk for severe physical impacts by 51%. • Pre-disaster poor health increased risk for severe mental impacts by 61%. • Adaptation to climate-related disasters requires understanding prior vulnerability. [ABSTRACT FROM AUTHOR]

Rationale Interventions asking patients to commit to speaking with their doctor about a health-related issue could be used to improve quality of care. Objective To evaluate the impact of commitment questions targeting patients on the uptake of recommended health services within a national quality improvement program (Veterans' MATES). Methods Patients targeted in the home medicines reviews (HMRs), dose administration aids (DAAs), renal function testing and diabetes interventions were posted educational information and response forms which asked whether they intended to talk to their general practitioner (GP) about the targeted service. Uptake of the service after each intervention was determined using health claims data. Log binomial regression models compared the monthly rate of service use in the nine months post-intervention among patients answering ‘yes’ to a commitment question with non-responders and patients answering ‘no’ or ‘unsure’. Results Each intervention targeted up to 58,000 patients. The average response rate was 28%. Positive responses were associated with increased uptake of HMRs (rate ratio ( RR ) 2.64, 95% CI 2.39–2.92; p < 0.0001), dose administration aids ( RR 2.53, 95% CI 2.29–2.79; p < 0.0001), renal function tests ( RR 1.18, 95% CI 1.13–1.24; p < 0.0001), GP management plans ( RR 1.30, 95% CI 1.14–1.48; p < 0.0001) and diabetes care plans ( RR 1.47, 95% CI 1.24–1.75; p < 0.0001) compared to non-responders. Similar increases in uptake were also observed among positive responders when compared to patients responding ‘no’ or ‘unsure’ to the commitment question. Conclusion Positive responses to commitment questions distributed as part of national, multifaceted interventions were consistently associated with increased uptake of targeted services. [ABSTRACT FROM AUTHOR]

Background People with disabilities have difficulties in obtaining work. However, evidence suggests that those with disabilities derive substantial mental health benefits from employment. This paper assesses how the relationship between work and mental health is influenced by psychosocial job quality for people working with a disability. Methods The study design was a longitudinal cohort with 13 annual waves of data collection, yielding a sample of 122,883 observations from 21,848 people. Fixed-effects within-person regression was used to control for time invariant confounding. The Mental Component Summary (MCS) of the Short Form 36 (SF-36) measure was used as the primary outcome measure. The main exposure was a six-category measure of psychosocial job quality and employment status (including ‘not in the labour force’ [NILF] and unemployment). Disability status (‘no waves of disability reported’ and ‘all contributed waves with reported disability’) was assessed as an effect modifier. We also conducted a secondary analysis on respondents contributing both disability and non-disability waves. Results For those with no disability, the greatest difference in mental health (compared to optimal employment) occurs when people have the poorest quality jobs (−2.12, 95% CI −2.48, −1.75, p < 0.001). The relative difference in mental health was less in relation to NILF and unemployment (−0.39 and −0.66 respectively). For those with consistent disability, the difference in mental health when employed in an optimal job was similar between the poorest quality jobs (−2.25, 95% CI −3.84, −0.65, p = 0.006), NILF (−2.84, 95% CI −4.49, −1.20, p = 0.001) or unemployment (−2.56, 95% CI −4.32, −0.80, p = 0.004). These results were confirmed by the secondary analysis. Conclusions Efforts to improve psychosocial job quality may have significant mental health benefits for people with disabilities. This will contribute to the economic viability of disability employment insurance schemes in Australia and other high-income countries. [ABSTRACT FROM AUTHOR]

The unbalanced distribution of general practitioners (GPs) across geographic areas has been acknowledged as a problem in many countries around the world. Quantitative information regarding GPs' location decision over their lifecycle is essential in developing effective initiatives to address the unbalanced distribution and retention of GPs. This paper describes the age profile of GPs' location decision and relates it to individual characteristics. I use the Medicine in Australia: Balancing Employment and Life (MABEL) survey of doctors (2008–2012) with a sample size of 5810 male and 5797 female GPs. I employ a mixed logit model to estimate GPs' location decision. The results suggest that younger GPs are more prepared to go to rural and remote areas but they tend to migrate back to urban areas as they age. Coming from a rural background increases the likelihood of choosing rural areas, but with heterogeneity: While male GPs from a rural background tend to stay in rural and remote areas regardless of age, female GPs from a rural background are willing to migrate to urban areas as they age. GPs who obtain basic medical degrees overseas are likely to move back to urban areas in the later stage of their careers. Completing a basic medical degree at an older age increases the likelihood of working outside major cities. I also examine factors influencing GPs' location transition patterns and the results further confirm the association of individual characteristics and GPs' location–age profile. The findings can help target GPs who are most likely to practise and remain in rural and remote areas, and tailor policy initiatives to address the undesirable distribution and movement of GPs according to the identified heterogeneous age profile of their location decisions. [ABSTRACT FROM AUTHOR]

This short report assesses the predictors of subjective health and happiness among a cohort of refugee youth over their first eight years in Australia. Five waves of data collection were conducted between 2004 (n = 120) and 2012–13 (n = 51) using mixed methods. Previous schooling, self-esteem, moving house in the previous year, a supportive social environment, stronger ethnic identity and perceived discrimination were significant predictors of wellbeing after adjusting for demographic and pre-migration factors. When compared with a previous analysis of this cohort over their first three years of settlement, experiences of social exclusion still have a significant impact on wellbeing eight years after arriving in Australia. This study contributes to mounting evidence in support of policies that discourage discrimination and promote social inclusion and cultural diversity and which underpin the wellbeing of resettled refugee youth. [ABSTRACT FROM AUTHOR]

The poor mental and physical health of people with disabilities has been well documented and there is evidence to suggest that inequalities in health between people with and without disabilities may be at least partly explained by the socioeconomic disadvantage (e.g. low education, unemployment) experienced by people with disabilities. Although there are fewer studies documenting inequalities in social capital, the evidence suggests that people with disabilities are also disadvantaged in this regard. We drew on Bourdieu's conceptualisation of social capital as the resources that flow to individuals from their membership of social networks. Using data from the General Social Survey 2010 of 15,028 adults living in private dwellings across non-remote areas of Australia, we measured social capital across three domains: informal networks (contact with family and friends); formal networks (group membership and contacts in influential organisations) and social support (financial, practical and emotional). We compared levels of social capital and self-rated health for people with and without disabilities and for people with different types of impairments (sensory and speech, physical, psychological and intellectual). Further, we assessed whether differences in levels of social capital contributed to inequalities in health between people with and without disabilities. We found that people with disabilities were worse off than people without disabilities in regard to informal and formal networks, social support and self-rated health status, and that inequalities were greatest for people with intellectual and psychological impairments. Differences in social capital did not explain the association between disability and health. These findings underscore the importance of developing social policies which promote the inclusion of people with disabilities, according to the varying needs of people with different impairments types. Given the changing policy environment, ongoing monitoring of the living circumstances of people with disabilities, including disaggregation of data by impairment type, is critical. [ABSTRACT FROM AUTHOR]

It has been suggested that complementary medicines are currently ‘under-regulated’ in some countries due to their potential for harm as a direct result from side-effects or interactions; from delaying more effective care; or from the economic cost of purchasing an ineffective or inappropriate treatment. The requirement of additional labelling on complementary medicine products has been suggested in Australia and may provide additional information to consumers at the point of purchase. This paper details a unique way of testing the potential effects on consumer behaviour of including either a traffic light logo or regulatory statement on labels. Using a discrete choice experiment, data were collected in 2012 in a sample of 521 Australians with either type 2 diabetes or cardiovascular disease. We find that additional labelling can affect consumer behaviour, but in unpredictable ways. The results of this experiment are informative to further the dialogue concerning possible regulatory mechanisms. [ABSTRACT FROM AUTHOR]

Many governments have implemented incentive programs to improve the retention of doctors in rural areas despite a lack of evidence of their effectiveness. This study examines rural general practitioners' (GPs') preferences for different types of retention incentive policies using a discrete choice experiment (DCE). In 2009, the DCE was administered to a group of 1720 rural GPs as part of the “Medicine in Australia: Balancing Employment and Life (MABEL)” study. We estimate both a mixed logit model and a generalized multinomial logit model to account for different types of unobserved differences in GPs' preferences. Our results indicate that increased level of locum relief incentive, retention payments and rural skills loading leads to an increase in the probability of attracting GPs to stay in rural practice. The locum relief incentive is ranked as the most effective, followed by the retention payments and rural skills loading payments. These findings are important in helping to tailor retention policies to those that are most effective. [ABSTRACT FROM AUTHOR]

Chronic pain is associated with significant costs to individuals directly affected by this condition, their families, the healthcare system, and the society as a whole. This paper investigates the relationship between chronic pain and life satisfaction using a sample of around 90,000 observations from the first ten waves of the Household, Income and Labour Dynamics of Australia Survey (HILDA), which is a representative survey of the Australian population that started in 2000. We estimate the negative impact on life satisfaction and examine the persistence of the effect over multiple years. Chronic pain is associated with poor health conditions, disability, decreased participation in the labour market and lower quality of life. We calculate the compensating income variation of chronic pain, based on the measurement of chronic pain, the life satisfaction of individuals and the income of households. Panel data models with random and fixed effects are used to control for characteristics of individuals that do not vary over time. Further, we investigate whether individuals who experience chronic pain exhibit adaptation and recovery in life satisfaction after 3 years. Overall, we find that chronic pain has a large negative association with life satisfaction, and that the compensating income variation is substantial (around 640 US$ per day). [ABSTRACT FROM AUTHOR]

This study aimed to test whether counter-advertisements (i.e. messages contesting industry marketing) make pre-adolescent children less susceptible to the influence of food promotions. Since children have lower media literacy levels due to their immature cognitive abilities, specific research questions explored were: (1) whether the effectiveness of counter-ads is contingent on children having understood them; and (2) whether counter-ads may be detrimental when they are misinterpreted. A between-subjects experimental design using a web-based methodology was employed. 1351 grade 5-6 students (mean age 11 years) from schools located in metropolitan Melbourne, Australia participated. Participants were randomly shown an animated web banner advertisement (counter-ad challenging front-of-package promotion or control ad) and a pair of food packages from the same product category comprising an unhealthy product featuring a front-of-package promotion (nutrient content claim or sports celebrity endorsement) and a healthier control pack without a front-of-package promotion. Responses to the assigned advertisement, choice of product (healthy versus unhealthy) and ratings of the unhealthy product and front-of-package promotion on various nutritional and image-related attributes were recorded for each child. Sixty-six percent of children who viewed a counter-ad understood its main message. These children rated the front-of-package promotion as less believable and rated the unhealthy product bearing the front-of-package promotion as less healthy compared to the control group. However, children who misunderstood the counter-ad rated the unhealthy product bearing a front-of-package promotion as more healthy and rated the front-of-package promotion more favourably than those who correctly understood the counter-ad. Counter-advertising may have unintended consequences when misunderstood. If public health organizations or government pursue counter-advertising as a strategy to reduce the negative influence of unhealthy food marketing among children, caution is needed in designing counter-ads to guard against possible contradictory effects. [ABSTRACT FROM AUTHOR]

Abstract: Successful health promotion and disease prevention strategies in complex community settings such as primary schools rely on acceptance and ownership across community networks. Assessing multiplier impacts from investment on related community activity over time are suggested as key alongside evidence of program health effects on targeted groups of individuals in gauging community network engagement and ownership, dynamic impacts, and program long term success and return on investment. An Australian primary school based health promotion and prevention strategy, the Stephanie Alexander Kitchen Garden National Program (SAKGNP), which has been providing garden and kitchen classes for year 3–6 students since 2008, was evaluated between 2011 and 2012. Returns on Australian Federal Government investment for school infrastructure grants up to $60,000 are assessed up to and beyond a two year mutual obligation period with: (i) Impacts on student lifestyle behaviours, food choices and eating habits surveyed across students (n = 491 versus 260) and parents (n = 300 versus 234) in 28 SAKGNP and 14 matched schools, controlling for school and parent level confounders and triangulated with SAKGNP pre-post analysis; (ii) Multiplier impacts of investment on related school and wider community activity up to two years; and (iii) Evidence of continuation and program evolution in schools observed beyond two years. SAKGNP schools showed improved student food choices (p = 0.024) and kitchen lifestyle behaviour (p = 0.019) domains compared to controls and in pre-post analysis where 20.0% (58/290) reported eating fruit and vegetables more often and 18.6% (54/290) preparing food at home more often. No significant differences were found in case control analysis for eating habits or garden lifestyle behaviour domains, although 32.3% of children helped more in the garden (91/278) and 15.6% (45/289) ate meals together more often in pre-post analysis. The multiplier impact on total community activity up to two years was 5.07 ($226,737/$44,758); 1.60 attributable to school, and 2.47 to wider community, activity. All 8 schools observed beyond two years continued garden and kitchen classes, with an average 17% scaling up and one school fully integrating staff into the curriculum. In conclusion evidence supports the SAKGNP to be a successful health promotion program with high community network impacts and return on investment in practice. [Copyright &y& Elsevier]

Abstract: Divorce has been identified as a risk factor for suicide. However, little research has been conducted on the time trajectory of the influence of relationship separation on suicidal outcomes. This study aimed to assess the effects over time of relationship breakdown and separation on suicidality. Data were drawn from 6616 Australian adults participating in the PATH through Life Project, a population-based longitudinal study. Suicidal ideation was reported by 406 participants (6.1%), and 99 (1.5%) reported a suicide plan or attempt in the past year. The effects of separation on suicidality were strongest soon after separation, with a nearly three-fold increase in ideation (adjusted OR = 2.73, p < 0.001) and an eight-fold increase in plans/attempts (adjusted OR = 7.75, p < 0.001) in the two years following separation, gradually diminishing subsequently. The period up to four years before a separation was also found to be a time of increased risk for suicidal thoughts and behaviours, while marriage was protective. Separation is a strong risk factor for suicidality and mental health services should target recently separated individuals. [Copyright &y& Elsevier]

Abstract: The literature has shown strong associations between health, financial and social life events and mental health. However, no studies as yet have looked at the temporal nature of the effects of life events on stated mental health nor have they included the effects of the events befalling partners within a household. This paper looks at the spillover in mental health, measured with the SF-36 scale, from one partner to the other, using life events to identify this relationship. We propose a new model that allows for both a temporal spacing of effects (anticipation and adaptation) as well as a spillover factor, which we define as the degree to which the events that are experienced by the partner affect us in the same way as if these events were to happen to us. We use data from 51,380 person-year observations of the Household, Income and Labour Dynamics in Australia survey (2002–10) which consistently measures nine distinct events, including illnesses, social shocks and financial shocks. We find that the events befalling a partner on average have an effect about 15% as large as the effect of own events. We use the estimates to compute the compensation required to offset own and partner's life events. The methodology in this paper is potentially useful for estimating other spillover parameters such as the effects of others in the family or in the neighbourhood. [Copyright &y& Elsevier]

Abstract: Western cultural practices and values have largely shaped advance care planning (ACP) policies across the world. Low uptake of ACP among ethnic minority groups in Western countries has been interpreted with reference to cultural differences. This paper adopts a life-history approach to explore attitudes towards ACP among older, first-generation Dutch-Australian and Italian-Australian migrants. Thirty people participated in extended ethnographic interviews (N = 17) and group discussions (N = 13) during 2012. Transcripts were thematically analyzed and interpreted using a Foucauldian perspective on knowledge and power. Migration experiences, ongoing contact with the native country and participation in migrant community support networks influenced attitudes towards ACP. Dutch participants framed ACP discussions with reference to euthanasia, and adopted a more individualist approach to medical decision-making. Italian participants often spoke of familial roles and emphasized a family-based decision making style. The importance of migrant identity has been neglected in previous discussions of cultural factors influencing ACP uptake among ethnic minority groups. The unique migration experience should be considered alongside culturally appropriate approaches to decision-making, in order to ensure equitable access to ACP among migrant groups. [Copyright &y& Elsevier]

Abstract: A key policy issue in many countries is the maldistribution of doctors across geographic areas, which has important effects on equity of access and health care costs. Many government programs and incentive schemes have been established to encourage doctors to practise in rural areas. However, there is little robust evidence of the effectiveness of such incentive schemes. The aim of this study is to examine the preferences of general practitioners (GPs) for rural location using a discrete choice experiment. This is used to estimate the probabilities of moving to a rural area, and the size of financial incentives GPs would require to move there. GPs were asked to choose between two job options or to stay at their current job as part of the Medicine in Australia: Balancing Employment and Life (MABEL) longitudinal survey of doctors. 3727 GPs completed the experiment. Sixty five per cent of GPs chose to stay where they were in all choices presented to them. Moving to an inland town with less than 5000 population and reasonable levels of other job characteristics would require incentives equivalent to 64% of current average annual personal earnings ($116,000). Moving to a town with a population between 5000 and 20,000 people would require incentives of at least 37% of current annual earnings, around $68,000. The size of incentives depends not only on the area but also on the characteristics of the job. The least attractive rural job package would require incentives of at least 130% of annual earnings, around $237,000. It is important to begin to tailor incentive packages to the characteristics of jobs and of rural areas. [Copyright &y& Elsevier]

Abstract: There is increasing evidence of a direct association between unaffordable housing and poor mental health, over and above the effects of general financial hardship. Type of housing tenure may be an important factor in determining how individuals experience and respond to housing affordability problems. This study investigated whether a relationship exists between unaffordable housing and mental health that differs for home purchasers and private renters among low-income households. Data from 2001 to 2010 of the longitudinal Household, Income and Labour Dynamics in Australia (HILDA) survey were analysed using fixed-effects linear regression to examine change in the SF-36 Mental Component Summary (MCS) score of individuals aged 25–64 years, associated with changes in housing affordability, testing for an interaction with housing tenure type. After adjusting for age, survey year and household income, among individuals living in households in the lower 40% of the national income distribution, private renters in unaffordable housing experienced somewhat poorer in mental health than when their housing was affordable (difference in MCS = −1.18 or about 20% of one S.D. of the MCS score; 95% CI: -1.95,-0.41; p = 0.003) while home purchasers experienced no difference on average. The statistical evidence for housing tenure modifying the association between unaffordable housing and mental health was moderate (p = 0.058). When alternatives to 40% were considered as income cut-offs for inclusion in the sample, evidence of a difference between renters and home purchasers was stronger amongst households in the lowest 50% of the income distribution (p = 0.020), and between the 30th and 50th percentile (p = 0.045), with renters consistently experiencing a decline in mental health while mean MCS scores of home purchasers did not change. In this study, private renters appeared to be more vulnerable than home purchasers to mental health effects of unaffordable housing. Such a modified effect suggests that tenure-differentiated policy responses to poor housing affordability may be appropriate. [Copyright &y& Elsevier]

The effect of COVID-19 lockdowns on mental health is a major concern worldwide. Measuring the impacts, however, is difficult because of a lack of data that tracks and compares outcomes and potential protective social factors before and during lockdowns. We aim to quantify the impact of a second lockdown in 2020 in the Australian city of Melbourne on levels of depression, anxiety, and loneliness, and analyse whether social relations in the neighbourhood may buffer against the worst effects of lockdown. We draw on quasi-experimental data from a nationally-representative longitudinal survey conducted in Australia. We use a difference-in-difference approach with a number of control variables to estimate changes in mental health among respondents in Melbourne following the imposition of the lockdown. A measure of perceived neighbourhood social relations is included as an explanatory variable to analyse potential protective effects. Lockdown is estimated to have increased depressive symptoms by approximately 23% and feelings of loneliness by 4%. No effect on anxiety was detected. Levels of neighbourhood social relations were strongly negatively associated with mental health symptoms. A significant interaction between lockdown and neighbourhood social relations suggests that lockdown increased depressive symptoms by 21% for people with average perceived neighbourhood relations, compared with a 9.7% increase for people whose perceived relations is one standard deviation greater than average. The results add to evidence of the harsh impacts of the COVID-19 pandemic and associated lockdowns on mental health. Importantly, neighbourhood social relations and social cohesion more broadly may be an important source of social support in response to lockdowns. These findings provide important insights for researchers and policy-makers in how to understand and respond to the mental health impacts of COVID-19. • A lockdown in Melbourne, Australia in 2020 increased depressive symptoms. • Neighbourhood social relations are negatively associated with mental health. • Neighbourhoods may have had a protective effect on depression during lockdown. • The findings highlight the potential benefit of social and community investment. [ABSTRACT FROM AUTHOR]

Using a population-based longitudinal dataset in Australia over nearly 20 years, this study examines the impact of tenure instability on mental health and psychological distress among a low-income working-age population. The analysis compares private renters (who are notable for their relative tenure insecurity in the Australian context) and homeowners with similar sociodemographic characteristics. To enhance group comparability and address the presence of time-varying covariates that confound and mediate the relationship between tenure exposure and mental health, marginal structural models were used applying weights estimated cumulatively over time. The results show that while private rental tenants report worse mental health than homeowners initially (mental health difference: Beta = −5.29, 95%CI −7.61 to −2.97; psychological distress difference: Beta = 1.77, 95%CI 0.55 to 2.99), this difference diminishes to become statistically indistinguishable by 5–6 years of occupancy (mental health difference at year 6: Beta = −2.09, 95%CI −4.31 to 0.13, predicted mental health increases: from 65.06 to 69.83 for private renters and from 70.46 to 72.02 for homeowners; psychological distress difference at year 5: Beta = 0.81, 95%CI −0.09 to 1.71, predicted psychological distress decreases: from 19.85 to 18.04 for private renters and from 17.95 to 17.10 for homeowners). Residential stability is particularly beneficial for private renters in early middle adulthood (35–44 years), with each additional year of stable occupancy for private renters correlated with a 0.99 (95%CI 0.46 to 1.53) increase in mental health and a −0.47 (95%CI −0.69 to −0.24) decrease in psychological distress. The findings provide evidence that stable and secure rental tenure is protective of mental health, and the mental health of stable renters becomes comparable to that of homeowners over time. This adds support for housing policies that promote and improve the stability and security of rental tenure. • A causal examination of mental health differences across tenure types. • Private rental tenants report worse mental health than homeowners initially. • After 6 years of occupancy, mental health of private renters and owners is similar. • Stable rental tenure is comparable to homeownership in supporting mental health. • Stability is particularly beneficial for private renters between 35 and 44 years. [ABSTRACT FROM AUTHOR]

Some evidence indicates under-perception of overweight is associated with lower levels of weight loss. This might be due to 'visual normalisation' of overweight through comparisons made in communities where average body mass index (BMI) is high, resulting in under-perception of overweight, which in turn, may protect against negative weight-related self-perceptions and/or reduce motivation to lose weight. Evidence in support of this hypothesis was found initially in a precision-weighted multilevel logistic regression analysis of 3729 overweight Australians aged >18 y, after adjusting for age, sex and area-level disadvantage. Participants whose BMI was -1 kg/m2 or less than the community mean BMI had lower odds of weight-related dissatisfaction (OR = 0.64, 95%CI = 0.51–0.80) and perceived overweight (OR = 0.56, 95%CI = 0.45–0.70), compared with peers whose BMI was within ± 1 kg/m2 of the community mean. Moreover, participants whose BMI was 1 kg/m2 or greater than the community mean BMI had higher odds of weight-related dissatisfaction (OR = 1.97, 95%CI = 1.69–2.30) and perceived overweight (OR = 2.81, 95%CI = 2.41–3.28) when compared to the same reference group. These findings were consistent for men and women; however, they were attenuated towards the null and rendered statistically insignificant after adjustment for personal BMI. Overall, these results indicate that among adults who are overweight, personal BMI, rather than the relative difference between personal and community BMI, is the stronger determinant of weight-related perception and satisfaction. • Application of multilevel models to precision-weight area-level body mass index means. • Associations for relative BMI indicated initial support for 'visual normalisation'. • Adjustment for personal BMI explained associations with relative BMI. [ABSTRACT FROM AUTHOR]

While the evidence of mental health benefits from investing in green space accumulates, claims of reduced healthcare expenditure are rarely supported by evidence from analyses of actual healthcare data. Additionally, the question of 'who pays?' has been ignored. We addressed these gaps using person-level data in three Australian cities. 55,339 participants with a mean follow-up time of 4.97 years in the Sax Institute's 45 and Up Study (wave 2, collected 2012–2015) were linked to fee-for-service records of antidepressant prescriptions and talking therapy subsidised by the Australian Government (including data on per unit fee, state subsidy, and individual co-payment). Total green space, tree canopy and open grass within 1.6 km road network distances were linked to each participant. Multilevel logistic, negative binomial, and generalised linear models with gamma distribution adjusted for demographic and socioeconomic confounders were used to assess association between each green space variable and prescribing/referral and costs of antidepressants and talking therapy. Prescription of at least one course of antidepressants occurred for 20.01% (n = 11,071). Referral for at least one session of talking therapy occurred in 8.95% (n = 4954). 13,482 participants (24.4%) had either a prescription or a referral. A 10% increase in green space was associated with higher levels of antidepressant prescribing (e.g. incident rate ratio (IRR) = 1.06, 95%CI = 1.04–1.08). Tree canopy was not associated with antidepressant prescribing or referrals for talking therapy. Open grass was associated with higher odds (OR = 1.17, 95%CI = 1.13–1.20) and counts (IRR = 1.05, 95%CI = 1.02–1.08) of antidepressant prescriptions. Open grass was also associated with lower odds (OR = 0.87, 95%CI = 0.82–0.92) and counts (IRR = 0.93, 95%CI = 0.90–0.96) of talking therapy referrals. Open grass was associated with higher total and mean per-person levels of expenditure on antidepressant prescriptions. Although green space supports mental health, these unexpected results provide pause for reflection on whether greening strategies will always result in purported reductions in mental healthcare expenditure. • Open grass was associated with antidepressants prescribing. • Open grass was associated with higher mental healthcare costs. • Tree canopy was not associated with mental healthcare expenditure. [ABSTRACT FROM AUTHOR]

We investigated whether ethnic and country of birth differences in adult Body Mass Index (BMI) were associated with differences in diet, physical activity and ethnic density (the percentage of an ethnic group within the neighbourhood environment). A sample of 214,807 adults living in Australia was extracted from the 45 and Up Study. Analyses comprised multilevel modelling of BMI for 38 ethnic and country of birth groups. Physical activity was ascertained using the Active Australia Survey. Dietary measures included self-reported consumption of fruit, vegetables, meat and cheese. Ethnic density was objectively measured using 2006 Australian Census data. Possible confounders included age, gender, household income, educational qualifications, economic status, couple status, language, duration of residence, neighbourhood affluence and remoteness. Compared to Australian-born Australians (age-gender adjusted mean BMI = 27.1, 95%CI 27.1, 27.2), overseas-born groups often had lower mean BMI, especially the Chinese born in China (23.2, 23.0, 23.4). Exceptions included the Italians (BMI = 28.1), Greeks (28.5), Maltese (27.6), Lebanese (28.4) and Croatians (27.8) born in their ethnic-country of origin. Regardless of birthplace, BMI was lower for the English, Scottish, and Chinese, but higher for Italians and Greeks. Some ethnic differences reflected the ‘healthy migrant’ hypothesis, whereas others did not. These differences were only partially attenuated by controls for portions of fruit and vegetables, meat and cheese, frequency of participation in physical activity, and other explanatory variables. Ethnic density was associated with lower BMI for the English and Irish ( p < 0.05), regardless of whether they were born in the UK, Ireland, or Australia. Ethnic differences in adult weight status in Australia do not appear to be fully explained by conventional risk factors. For some groups, but not all, living among others of the same ethnic group may proxy unmeasured health-promoting factors and these contexts, along with other factors that harm health (e.g. racial discrimination) warrant further investigation. [ABSTRACT FROM AUTHOR]

High suicide rates evident in Australian young adults during an epidemic period in the 1990s appear to have been sustained in older age-groups in the subsequent decade. This period also coincides with changes in employment patterns in Australia. This study investigates age, period, and birth cohort effects in Australian suicide over the 20th century, with particular reference to the period subsequent to the 1990s youth suicide epidemic in young males. Period- and cohort-specific trends in suicide were examined for 1907–2010 based on descriptive analysis of age-specific suicide rates and a series of age–period–cohort (APC) models using Poisson regression. Under-employment rates (those employed part-time seeking additional hours of work) and unemployment rates (those currently seeking employment) for the latter part of this time series (1978–2010) were also examined and compared with period- and cohort-specific trends in suicide. A significant increasing birth cohort effect in male suicide rates was evident in birth cohorts born after 1970–74, after adjusting for the effects age and period. An increasing birth cohort effect was also evident in female suicide rates, but was of a lesser magnitude. Increases in male cohort-specific suicide rates were significantly correlated with increases in cohort-specific under-employment and unemployment rates. Birth cohorts that experienced the peak of the suicide epidemic during the 1990s have continued to have higher suicide rates than cohorts born in earlier epochs. This increase coincides with changes to a labour force characterised by greater ‘flexibility’ and ‘casualised’ employment, especially in younger aged cohorts. [ABSTRACT FROM AUTHOR]

Abstract: In many countries, the health outcomes of Indigenous populations are far worse than those of non-Indigenous populations. Two possible reasons for these differences are poor lifestyle choices and a lack of access to health services when ill. This paper uses Australian data on 17,449 adults, which was collected in the National Health Survey 2004–05 and the National Aboriginal and Torres Strait Islander Health Survey 2004–05, to examine whether Indigenous Australians make different lifestyle choices and health services use than non-Indigenous Australians. After controlling for a range of observable characteristics, it is found that Indigenous Australian are more likely to make poorer lifestyle choices, but are more likely to use health services than non-Indigenous Australians. There is evidence that these results are magnified for Indigenous Australians who live in remote areas. As the lifestyle choices of Indigenous Australians are so different from those of non-Indigenous Australians, the payoff from policies aimed at changing these choices is likely to be large both in terms of the efficient use of the health budget and more importantly in terms of health outcomes for Indigenous Australians. [Copyright &y& Elsevier]

Abstract: Recent rapid growth in the range of contraceptive products has given women more choice, but also adds complexity to the resultant decision of which product to choose. This paper uses a discrete choice experiment (DCE) to investigate the effect of adverse information and positive promotion on women''s stated preferences for prescribed contraceptive products. In November 2007, 527 Australian women aged 18–49 years were recruited from an online panel. Each was randomly allocated to one of three information conditions. The control group only received basic information on contraceptive products. One treatment group also received adverse information on the risks of the combined oral pill. The other group received basic information and promotional material on the vaginal ring, newly introduced into Australia and on the transdermal patch, which is unavailable in Australia. Respondents completed 32 choice sets with 3 product options where each option was described by a product label: either combined pill, minipill, injection, implant, hormonal IUD, hormonal vaginal ring, hormonal transdermal patch or copper IUD; and by the attributes: effect on acne, effect on weight, frequency of administration, contraceptive effectiveness, doctor''s recommendation, effect on periods and cost. Women''s choices were analysed using a generalized multinomial logit model (G-MNL) and model estimates were used to predict product shares for each information condition. The predictions indicated that adverse information did not affect women''s preferences for products relative to only receiving basic information. The promotional material increased women''s preferences for the transdermal patch. Women in all groups had a low preference for the vaginal ring which was not improved by promotion. The findings highlight the need for researchers to pay attention to setting the context when conducting DCEs as this can significantly affect results. [Copyright &y& Elsevier]

Abstract: Accompanying patients from active treatment towards specialist palliative care is a complex sphere of clinical practice that can be fraught with interpersonal and emotional challenges. While medical specialists are expected to break ‘bad news’ to their patients and ease their transitions to specialist palliative care if required, few have received formal training in such interpersonal complexities. Furthermore, there also often exists clinical ambiguity around whether to continue active treatment vis-à-vis refocusing on quality of life and palliation. In this paper we explore the experiences of twenty Australian medical specialists, focussing on issues such as: dilemmas around when and how to talk about dying and palliation; the art of referral and practices of representation; and, accounts of emotion and subjective influences on referral. The results illustrate how this transitional realm can be embedded in emotions, relationships and the allure of potentially life-prolonging intervention. We argue that the practice of referral should be understood as a relational and contextually-bound process. [Copyright &y& Elsevier]

Abstract: We used cross-sectional data to investigate whether current, past and never smokers report different levels of social interaction and whether the level of social interaction varied according to the type of interaction being measured. Self-reported questionnaire data were obtained from 239,043 men and women aged 45 years or older living in Australia between February 2006 and February 2010. The study participation rate was 18%. Poisson regression models were used to estimate the percentage differences in the mean values of four social interaction outcomes according to smoking status after adjusting for age, place of residence, income, education, health insurance status, physical limitation, psychological distress and exposure to passive smoke: number of times 1) spent with friends/family, 2) spoken on the telephone, 3) attended social meetings in the past week, and 4) number of people outside of home that can be depended upon. 7.6% of males and 6.9% of females were current smokers, 43.6% of males and 28.6% of females were ex-smokers and 48.8% of males and 64.5% of females had never smoked. Compared to never smokers, current smokers reported significantly fewer social interactions in the past week and had fewer people outside the home that they could depend on. Men and women current smokers attended 24.0% (95% CI, 20.3, 27.5) and 31.1% (95% CI, 28.1, 34.1) fewer social group meetings on average than never smokers. Smokers exposed to passive smoke reported higher levels of social interaction than those not exposed. Past smokers reported levels of social interaction that were intermediate to those of current and never smokers and the more years they had abstained from smoking, the more social interaction they reported on average. Our data are in line with previous research showing that smokers are not only worse off economically, physically and mentally, but are also less likely to be socially connected. [Copyright &y& Elsevier]

Abstract: Sedentary behaviors are associated with multiple health problems, independently of physical activity. Neighborhood environment attributes might influence sedentary behaviors, but few studies have investigated these relationships. Moreover, all previous studies have been conducted within single countries, limiting environmental variability. We investigated the shape of associations between perceived neighborhood environment attributes and sedentary behavior in three countries; and whether these associations differed by country and gender. Data from USA (Seattle and Baltimore regions), Australia (Adelaide) and Belgium (Ghent) were pooled. Data collection took place between 2002 and 2008. In total, 6014 adults (20–65 years, 55.7% women) were recruited in high-/low-walkability and high-/low-income neighborhoods. All participants completed the International Physical Activity Questionnaire (domain-specific physical activity, transport-related sitting and overall time spent sitting) and the Neighborhood Environmental Walkability Scale (environmental perceptions). The number of destinations within a 20 min walk from home, perceiving few cul-de-sacs, good walking and cycling facilities, and traffic safety were included in an index of motorized transport correlates. This index was linearly negatively associated with motorized transport time, so the higher the scores on the index (more activity-friendliness), the lower the amount of motorized transport. No gender- or country-differences were identified. Perceived aesthetics and proximity of destinations were included in an index of overall sitting time correlates. A linear negative relationship with overall sitting time was found, but associations were stronger for men and not significant in Belgian adults. In conclusion, consistent and expected correlates were found for motorized transport in the three countries, but results were less clear for overall sitting time. Future studies should include even more countries to maximize environmental variability, but present findings suggest that neighborhoods may be designed to improve health through supporting more active and less sedentary transportation, which can be expected to have health benefits. [Copyright &y& Elsevier]

Financial incentives are often used to improve recruitment and retention of physicians in rural and remote areas. In 2010, the General Practice Rural Incentive Program (GPRIP) was introduced in Australia, causing an exogenous change in the eligibility for rural incentives for some geographical areas. This study investigates the effect of this policy reform on waiting times for a non-urgent GP appointment using panel data (2008–2014) on 2058 GPs. Using difference-in-difference methodology, results show that the number of GPs in practices in newly eligible areas increased. However, no evidence is found that this reduces waiting times for existing patients, and only weak evidence is found that waiting times for new patients fell, by around 16%. Our results suggest that financial incentives may only play a limited role in improving access to primary care and should not be the only solution to address medical workforce shortages in underserved areas. • Using financial incentives to improve recruitment and retention of GPs to rural areas are common. • We provide new evidence on the effect of these policies on waiting times for GPs. • We exploit changes in the eligibility of geographic areas for these incentives. • There is evidence of more GPs in practices, but effects on waiting times are mixed and sensitive to model specification. • Other policies should be used to improve access to rural primary care. [ABSTRACT FROM AUTHOR]

Caregiver mental health is crucial to the wellbeing of children. This is most apparent when caregivers face high levels of stress or life adversity. To study this phenomenon in the current global context, this study examined the relation between stress/disruption from the COVID-19 pandemic and the mental health of female and male caregivers. Pre-pandemic childhood adversity was considered as a moderator of this association. A multi-national sample (United Kingdom, 76%; United States, 19%; Canada, 4%, and Australia, 1%) was recruited in May 2020, of whom 348 female and 143 male caregivers of 5–18 year-old children provided data on the constructs of interest. At this time, caregivers reported on their history of adverse childhood experiences (ACEs) and COVID stress/disruption. About two months later (July 2020) caregiver mental health was evaluated. We examined differences between female and male caregivers on ACEs, COVID stress/disruption, and mental health (distress, anxiety, substance use, and posttraumatic stress). Main and interactive effects of ACEs and COVID stress/disruption on each mental health outcome were examined. Female caregivers reported higher COVID stress/disruption, more ACEs, and greater distress, anxiety, and posttraumatic stress symptoms compared to male caregivers. Among female caregivers, higher COVID stress/disruption and more adverse childhood experiences (ACEs) independently predicted all mental health outcomes, consistent with a stress accumulation model. Among male caregivers, a pattern of interactions between COVID stress/disruption and ACEs suggested that the effects of COVID stress/disruption on mental health was stronger for those with higher ACEs, especially for substance use, consistent with a stress sensitization model. Higher levels of stress and mental health difficulties among female caregivers suggests a disproportionate burden due to pandemic-related disruption compared to male caregivers. Findings speak to the disparate effects of COVID-19 on the mental health of female compared to male caregivers, and the role of pre-existing vulnerabilities in shaping current adaptation. • Cross-national sample of caregiver mental health and COVID-19 stress/disruption. • Compared to male caregivers, female caregivers report more COVID stress/disruption. • Female caregivers report higher distress, anxiety, and posttraumatic stress. • For female caregivers, COVID stress and ACEs independently predict mental health. • For male caregivers, COVID stress and ACEs interact to predict mental health. [ABSTRACT FROM AUTHOR]

The effects of poor-quality work (high job demands, low job control, job insecurity, and effort-reward imbalance) are harmful to health but it isn't clear whether exposure to these psychosocial work stressors over time translates into increased risk of mortality. We investigated the effect of time-varying psychosocial work stressors on mortality using data from a longitudinal cohort of working Australians by examining association between job control, job demands, job insecurity, unfair pay overtime and all-cause mortality. We examined whether gender modified these relationships. Over 20,000 participants from the Household Income and Labour Dynamics in Australia survey with self-reported repeated exposure measures were followed for 15 years. Survival analysis models with baseline hazard specified by the Weibull distribution were used to examine the association between psychosocial work stressors over time and mortality. Low job control (HR=1.39; 95% CI: 1.06-1.83) and job insecurity (1.36; 1.06-1.74) were associated with increased risk of mortality. High job demands (1.01; 0.75-1.34) and effort-reward unfairness (1.20; 0.90-1.59) were not associated with mortality. The effect of job insecurity was attenuated (1.20; 0.93-1.54) after controlling for sociodemographic and health risk factors. Male participants exposed to low job control and job insecurity had an 81% and 39% increase risk of mortality, respectively. Long-term exposure to low job control and low job security is associated with increased risk of all-cause mortality. Effects were largely restricted to males and persisted after adjustments for sociodemographic and health characteristics. The lack of effects observed for females may have been due to the small number of deaths in females. Awareness of implications of the adverse effects of psychosocial work stressors on health and mortality in workplaces, and interventions to improve job control and job security could contribute to better health and wellbeing, reducing the effect of psychosocial work stressors on mortality. • Repeated exposure to poor-quality work may result in work-related stress. • Exposure to psychosocial work stressors may impact on health. • Not clear whether exposure over time translates into an increased risk of mortality. • Low job control and job insecurity were associated with increased risk of mortality. • Associations were stronger for men than women. [ABSTRACT FROM AUTHOR]

Compulsory co-payments limit access and may compromise quality in primary care. Patient Chosen Gap Payments (PCGPs) allow patients to specify a (voluntary) out-of-pocket contribution, creating an incentive for patient-centred care without the need for complex outcomes-based funding formulae. It is not yet known if widespread use of PCGP services is consistent with consumer preferences. We conducted a discrete choice experiment (DCE) in a sample of the adult Australian general population (n = 1457) during April 2019 to simulate patient choice between alternative primary care services and describe preferences for PCGP services. Participants also completed a supplementary valuation task in which participants reported their intended PCGP contribution for PCGP services. Finally, we conducted policy-simulations to predict market shares when PCGP clinics operate alongside the two existing models of primary care funding in Australia. Results suggest that patients prefer shorter wait time, longer consults, lower compulsory copayments, services with higher patient satisfaction ratings, choice of doctor and $0 suggested voluntary contribution for PCGP services. Policy-simulations suggest that high-quality PCGP services could obtain market share of up to 39% and voluntary contributions of up to $25.36 per service (95%CI: $10.24, $40.47), potentially adding $1.48 billion AUD in revenues and funding for primary care at no cost to government. Low-quality PCGP services are unlikely to capture significant market share and PCGP contributions were lowest for low-quality PCGP services ($12.12, 95%CI: $2.09, $26.34). Further field testing is recommended where (i) patients make consequential choices (e.g. real payments for simulated services), and (ii) dynamic effects on quality of care and utilisation can be observed; particularly in vulnerable populations. We conclude that PCGP services aligned with patient preferences could capture significant market share and substantially increase revenue to general practice. • Patient chosen gap payments are chosen by the patient, not fixed by the provider. • Quality and service design are important to patients when choosing healthcare. • PCGPs appear a viable alternative pricing model in the market for primary care. • PCGP clinics could capture 39% market share and add $1.48 billion AUD in revenue. [ABSTRACT FROM AUTHOR]