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These two videos were developed to support participant understanding and engagement in our national online community attitudes survey. Video one presents: information on the types of information captured in a general practice record, introduces privacy laws and explains identifiability. Video two presents: using general practice data for research purposes, the roles of Human Research Ethics Committees, and details several safeguards used in research projects. This project was supported by Digital Health CRC Limited (DHCRC). The Digital Health CRC Limited is funded under the Commonwealth's Cooperative Research Centres (CRC) Program.

These two videos were developed to support participant understanding and engagement in our national online community attitudes survey. Video one presents: information on the types of information captured in a general practice record, introduces privacy laws and explains identifiability. Video two presents: using general practice data for research purposes, the roles of Human Research Ethics Committees, and details several safeguards used in research projects. This project was supported by Digital Health CRC Limited (DHCRC). The Digital Health CRC Limited is funded under the Commonwealth's Cooperative Research Centres (CRC) Program.

Background Outbreaks of infectious disease cause serious and costly health and social problems. Two new technologies – pathogen whole genome sequencing (WGS) and Big Data analytics – promise to improve our capacity to detect and control outbreaks earlier, saving lives and resources. However, routinely using these technologies to capture more detailed and specific personal information could be perceived as intrusive and a threat to privacy. Method Four community juries were convened in two demographically different Sydney municipalities and two regional cities in New South Wales, Australia (western Sydney, Wollongong, Tamworth, eastern Sydney) to elicit the views of well-informed community members on the acceptability and legitimacy of: making pathogen WGS and linked administrative data available for public health research using this information in concert with data linkage and machine learning to enhance communicable disease surveillance systems Fifty participants of diverse backgrounds, mixed genders and ages were recruited by random-digit-dialling and topic-blinded social-media advertising. Each jury was presented with balanced factual evidence supporting different expert perspectives on the potential benefits and costs of technologically enhanced public health research and communicable disease surveillance and given the opportunity to question experts. Results Almost all jurors supported data linkage and WGS on routinely collected patient isolates for the purposes of public health research, provided standard de-identification practices were applied. However, allowing this information to be operationalised as a syndromic surveillance system was highly contentious with three juries voting in favour, and one against by narrow margins. For those in favour, support depended on several conditions related to system oversight and security being met. Those against were concerned about loss of privacy and did not trust Australian governments to run secure and effective sys

Background Outbreaks of infectious disease cause serious and costly health and social problems. Two new technologies – pathogen whole genome sequencing (WGS) and Big Data analytics – promise to improve our capacity to detect and control outbreaks earlier, saving lives and resources. However, routinely using these technologies to capture more detailed and specific personal information could be perceived as intrusive and a threat to privacy. Method Four community juries were convened in two demographically different Sydney municipalities and two regional cities in New South Wales, Australia (western Sydney, Wollongong, Tamworth, eastern Sydney) to elicit the views of well-informed community members on the acceptability and legitimacy of: making pathogen WGS and linked administrative data available for public health research using this information in concert with data linkage and machine learning to enhance communicable disease surveillance systems Fifty participants of diverse backgrounds, mixed genders and ages were recruited by random-digit-dialling and topic-blinded social-media advertising. Each jury was presented with balanced factual evidence supporting different expert perspectives on the potential benefits and costs of technologically enhanced public health research and communicable disease surveillance and given the opportunity to question experts. Results Almost all jurors supported data linkage and WGS on routinely collected patient isolates for the purposes of public health research, provided standard de-identification practices were applied. However, allowing this information to be operationalised as a syndromic surveillance system was highly contentious with three juries voting in favour, and one against by narrow margins. For those in favour, support depended on several conditions related to system oversight and security being met. Those against were concerned about loss of privacy and did not trust Australian governments to run secure and effective sys

2019 Australian Health Promotion Association Issue addressed: Sugar-sweetened beverages (SSB) are the leading source of free sugars in Australian children's and adults' diets. This study explores drivers of consumption among parents and young adults to inform interventions. Methods: Eight focus groups (n = 59) stratified by gender, age/life stage and SES were analysed thematically. Results: Daily SSB consumption was normalised. Participants drank SSBs to avoid perceived energy/sugar deficits, to treat themselves and as a function of familial influence. Frequent consumption was considered acceptable if "in moderation" and/or "balanced" with exercise/diet; however, there was a large disconnect between this language of moderation and actual consumption practices. Participants acknowledged that social norms had changed over time. There was little evidence of accurate knowledge of sugar content for any beverage type. Participants relied heavily on packaging and labelling, much of which conveyed a health halo effect. While participants could list health effects of excess consumption, they were considered long-term or of low personal relevance. Awareness of health recommendations was low. Conclusions: Consumers' adoption and use of concepts such as "treat," "moderation" and "balance" reflect both food and beverage industry marketing and public health messaging. However, the disconnect between this language and knowledge and consumption practices is problematic. So what?: SSB consumption is very high with serious implications for health. Curbing consumption among young adults and parents has potential to change the health trajectories for current and future generations. There is a clear need to increase health literacy around SSB consumption. Simple consumption guidelines, clearer sugar content labelling and health warnings offer potential.

2020, 2020 Informa UK Limited, trading as Taylor & Francis Group. This study analyses the relationship between food choices and morality by exploring how Australian adults conceptualise and negotiate their sugar intake. Fifteen in-depth, semi-structured interviews were conducted with English speaking adults residing in South Australia. Participants were purposively sampled from a national survey based on their sugar consumption levels, age and gender. The data were analysed using thematic analysis. Participants initially defined sugars as good or bad based on source, colour, texture, taste and impact of sugar on health. On being provided with evidence on amounts of sugar present in commonly consumed foods and drinks, participants redefined their perceptions to consider all sugars as bad sugars. This created moral challenges for the participants leading to two types of justifications for their own sugar consumption. One group of justifications drew on socially evaluative statements that participants used to present themselves as morally virtuous. Here sugar was considered as an essential source of energy and part of a balanced diet; limited to infrequent occasions such as celebrations, social gatherings and cultural practices; and as a cultural obligation. The second group of justifications located the source of morality within the individual and presented sugar intake as important for emotional and psychological wellbeing, and also as something that could be controlled by taking responsibility. There were no differences in discourses between low and high sugar consumers. This study provides new insights on how Australians conceptualise sugar in diet and make consumption decisions, which are important for influencing sugar consumption at a societal level.

2020 Elsevier Ltd Sugar-containing beverages are the leading source of added sugar consumption among young adults. The aim of this study was to explore how young adults conceptualise what influences the healthfulness of sugar-containing beverages. Seven focus groups stratified by gender and educational institute were conducted with South Australians aged 18-25 years (n = 32). Focus groups were semi-structured and included a ranking activity where participants individually ranked eight beverages from least to most healthy. Focus groups were recorded, transcribed verbatim and thematically analysed. Participants commonly selected soda (soft drink) and energy drink as the least healthy beverage and water as the healthiest, but those between varied in rankings. Four themes were identified relating to how participants conceptualise beverage healthfulness in the thematic analysis: ingredients harmful to health, properties beneficial to health, functionality, and packaging. While participants were aware that beverages can contain high amounts of sugar, and that this can be harmful to health, many other factors influence the perceptions of beverage healthfulness and these can outweigh the perceived harms of consumption. Public health interventions and policies are needed to address misperceptions about the healthfulness of sugar-containing beverages to better put the harms of high sugar consumption in perspective for consumers.

2020 The Author(s). Background: The lack of attention to Indigenous epistemologies and, more broadly, Indigenous values in primary research, is mirrored in the standardised critical appraisal tools used to guide evidence-based practice and systematic reviews and meta-syntheses. These critical appraisal tools offer no guidance on how validity or contextual relevance should be assessed for Indigenous populations and cultural contexts. Failure to tailor the research questions, design, analysis, dissemination and knowledge translation to capture understandings that are specific to Indigenous peoples results in research of limited acceptability and benefit and potentially harms Indigenous peoples. A specific Aboriginal and Torres Strait Islander Quality Appraisal Tool is needed to address this gap. Method: The Aboriginal and Torres Strait Islander Quality Appraisal Tool (QAT) was developed using a modified Nominal Group and Delphi Techniques and the tool's validity, reliability, and feasibility were assessed over three stages of independent piloting. National and international research guidelines were used as points of reference. Piloting of the Aboriginal and Torres Strait Islander QAT with Aboriginal and Torres Strait Islander and non-Indigenous experts led to refinement of the tool. Results: The Aboriginal and Torres Strait Islander QAT consists of 14 questions that assess the quality of health research from an Aboriginal and Torres Strait Islander perspective. The questions encompass setting appropriate research questions; community engagement and consultation; research leadership and governance; community protocols; intellectual and cultural property rights; the collection and management of research material; Indigenous research paradigms; a strength-based approach to research; the translation of findings into policy and practice; benefits to participants and communities involved; and capacity strengthening and two-way learning. Outcomes from the assessment of the t

Objective: To provide insights into complexities of seeking access to state and federal cross‐jurisdictional data for linkage with the Australian Childhood Immunisation Register (ACIR). We provide recommendations for improving access and receipt of linked datasets involving Australian Government‐administered data. Methods: We describe requirements for linking eleven federal and state data sources to establish a national linked dataset for safety evaluation of vaccines. The required data linkage methodology for integrating cross‐jurisdictional data sources is also described. Results: Extensive negotiation was required with 18 different agencies for 21 separate authorisations and 12 ethics approvals. Three variations of the 'best practice' linkage model were implemented. Australian Government approval requests spanned nearly four years from initial request for data, with a further year before ACIR data transfer to the linkage agency. Conclusions: Integration of immunisation registers with other data collections is achievable in Australia but infeasible for routine and rapid identification of vaccine safety concerns. Lengthy authorisation requirements, convoluted disparate application processes and inconsistencies in data supplied all contribute to delayed data availability. Implications for public health: Delayed data access for safety surveillance prevents timely epidemiological reviews. Poor responsiveness to safety concerns may erode public confidence, compromising effectiveness of vaccination programs through reduced participation.

2019 Wolters Kluwer Health, Inc. All rights reserved. Objective: This scoping review aims to explore international literature relating to alcohol warning labels as a public health approach for reducing alcohol-related harm. Introduction: Alcohol-related harm is a global public health issue. More than 200 injuries, diseases and conditions are attributable to alcohol, and almost 6% of all global deaths are related to alcohol consumption.A common approach to raising public awareness of health hazards is product warning labels. Currently, 31 countries or territories have mandated the inclusion of alcohol warning labels on alcoholic beverages. However, research findings on the effectiveness of alcohol warning labelling to reduce alcohol-related harm are mixed and debatable. Inclusion criteria: This review will consider studies that focus on alcohol warning labelling (in the form of alcoholic beverage containers, simulated messages displayed on a computer screen or cards shown to participants that depict alcohol warning labels on beverage containers) as a strategy to reduce alcohol related harm (e.g. drunk driving, violence and drinking while pregnant, etc.). Methods: PubMed, Embase, Scopus, Cochrane Library, PsycINFO, Web of Science, CINAHL and JSTOR will be searched for relevant articles. The search for unpublished studies will utilise Trove and Google Scholar. Studies published in English from 1989 to the present will be considered. Retrieved papers will be screened for inclusion by at least two reviewers. Data will be extracted and presented in tabular form and a narrative summary that align with the review's objective.

Objective: To establish high intake of free sugars and its related disease burden as a significant public health challenge in Australia. Design: We discuss five key actions to reduce intake of free sugars tailored to the Australian context. These strategies are informed by reviewing the global scientific evidence on the effectiveness of a range of policy responses to reduce intake of free sugars at the population level. Setting: Australia. Participants: Australian population. Results: The five key actions to reduce population levels for intake of free sugars tailored to the Australian context include prioritising health in trade agreements and policy; introducing a fiscal policy supporting health and promoting food reformulation; regulating advertising and improving labelling; strengthening the current dietary guidelines; and encouraging healthy choices Conclusions: The adoption and implementation of the strategies discussed in the current commentary would aid in tackling the rising health burden from the intake of free sugars in Australia.

Issue addressed: The Health Star Rating (HSR) System provides a useful tool to communicate health and nutrition messages to consumers. Given the large contribution from sugar-containing beverages to sugar intake in the Australian diet and the adverse health outcomes associated with frequent consumption, it is important to investigate how the HSR System is displayed on beverages. Our research measured and compared the presence of the HSR System on the labels of sugar-containing and sugar-free beverages in Australia. Methods: We conducted a survey of the labels on 762 ready-to-drink (≤600 mL) nondairy/nonalcoholic beverages, sampled from 17 South Australian supermarkets in late 2016. We measured the presence of a star rating icon or an energy-only icon (which is an option of the HSR System for beverages). Results: The HSR System was observed on 35.3% of beverages, with only 6.8% displaying a star rating icon and 28.5% displaying an energy-only icon. When present (n = 52), star rating icons were almost universally 5 stars (94.2%), and of these, they were predominantly displayed on 100% juices (85.7%). Almost all beverages with a star rating contained high amounts of sugar; only three sugar-free beverages displayed a star rating. Conclusions: We found that there are low uptake and limited use of the HSR System on beverages. So what?: The HSR System on beverages could better achieve its objectives if the energy-only icon were removed from the graphic options, the algorithm were adjusted so that 100% juices cannot display a 5-star rating, and the System were made mandatory.

A Masterclass Program was developed to strengthen the research capacity of staff within Aboriginal Community-Controlled Health Organisations (ACCHOs) and featured three Masterclasses delivered across Australia, including Understanding Research, Undertaking Research and Research Evaluation. A mixed-method process and impact evaluation of the Masterclass Program was undertaken. The process evaluation examined the reach of the Program and the impact evaluation comprised an online survey (n = 45) and semi-structured interviews (n = 21) with Masterclass participants. During 2014-17, 27 Masterclasses were delivered to 260 people, including predominantly ACCHO personnel but also Indigenous doctors and research institute staff who work closely with the ACCHO sector. Most survey respondents felt the Masterclasses improved their understanding of research and their willingness to participate in and undertake research. The qualitative analysis confirmed this and suggested that Masterclasses were implemented in a supportive learning environment which led to increased research capacity (increased research awareness, changed perceptions, increased understanding, critical thinking and new confidence) and ultimately enhanced research engagement (willingness to participate, motivating others, empowered critique of research partners and proposals, interest in further research training). Barriers to research engagement and areas for improvement of the Masterclass Program before, during and after Masterclasses were also identified.

With older adults living longer, health service providers have increasingly turned their attention towards frailty and its significant consequences for health and well-being. Consequently, frailty screening has gained momentum as a possible health policy answer to the question of what can be done to prevent frailty's onset and progression. However, who should be screened for frailty, where and when remains a subject of extensive debate. The purpose of this narrative review is to explore the dimensions of this question with reference to Wilson and Jungner's time-tested and widely accepted principles for acceptable screening within community settings. Although the balance of the emerging evidence to support frailty screening is promising, significant gaps in the evidence base remain. Consequently, when assessed against Wilson and Jungner's principles, extensive population screening does not appear to be supported by the evidence. However, screening for the purpose of case-finding may prove useful among older adults.

Background: The rate of overweight and obesity in Australia is among the highest in the world. Yet Australia lags other countries in developing comprehensive educative or regulatory responses to address sugary drink consumption, a key modifiable risk factor that contributes substantial excess sugar to the diet. Measurement of sugary drink consumption is typically sporadic and nutrition focussed and there is limited knowledge of community perceptions and awareness of the health risks associated with excess sugary drink consumption. The aim of this study was to assess the demographic characteristics, behavioural risk factors and attitudes and knowledge associated with sugar-sweetened beverage (SSB) and 100% fruit juice consumption. Methods: A face-to-face household survey was conducted in 2014 using a stratified random sampling strategy to represent the South Australian population aged 15 years and over. The survey contained questions on sugary drinks, with past week SSB consumption and 100% fruit juice consumption used as outcome variables. Associations were examined with demographic characteristics, behavioural risk factors, and sugary drink attitudes and knowledge. Results: Of the 2732 respondents, 35% had consumed SSBs 1-6 times (moderate consumers) and 16% had consumed SSBs 7 or more times (frequent consumers) in the past week. Furthermore, 35% had consumed 100% fruit juice in the past week, with 10% consuming every day. Rates of SSB consumption were consistently higher among males, younger age groups, and groups with lower education attainment, as well as smokers and frequent consumers of fast food. Awareness of health risks and sugar content of SSBs was low, especially among frequent SSB consumers. Fruit juice consumption was higher among males, younger age groups, the physically active and among those believing that 100% fruit juice did not contain more sugar than SSBs. Conclusions: Consumption of SSBs and 100% fruit juice is common but awareness of health ris

ObjectiveTo examine the ways in which sugar-containing beverages are being portrayed as 'better-for-you' (BFY) via features on product labels.DesignCross-sectional audit of beverage labels.SettingAdelaide, Australia. Data on beverage labels were collected from seventeen grocery stores during September to November 2016.SubjectsThe content of 945 sugar-containing beverages labels were analysed for explicit and implicit features positioning them as healthy or BFY.ResultsThe mean sugar content of beverages was high at 8·3 g/100 ml and most sugar-containing beverages (87·7 %) displayed features that position them as BFY. This was most commonly achieved by indicating the beverages are natural (76·8 %), or contain reduced or natural energy/sugar content (48·4 %), or through suggesting that they contribute to meeting bodily needs for nutrition (28·9 %) or health (15·1 %). Features positioning beverages as BFY were more common among certain categories of beverages, namely coconut waters, iced teas, sports drinks and juices.ConclusionsA large proportion of sugar-containing beverages use features on labels that position them as healthy or BFY despite containing high amounts of sugar.

Background Current research into alcohol consumption focuses predominantly on problematic drinkers and populations considered likely to engage in risky behaviours. Middle-aged drinkers are an under-researched group, despite emerging evidence that their regular drinking patterns may carry some risk. Methods We searched Scopus, Ovid Medline, and Ovid PsycInfo for peer-reviewed, English-language publications appearing prior to 31 December 2015 and relating to the construction of alcohol consumption by middle-aged non-problematised drinkers. Thirteen papers were included in our thematic analysis. Results Middle-aged non-problematised drinkers constructed their drinking practices by creating a narrative of normative drinking via discourses of gender, identity, play, and learning to drink. They also used drinking norms to construct their gender and identity. Health was not identified as a significant consideration for the population of interest when constructing alcohol consumption, except where drinking behaviours were likely to harm another. Conclusions These results suggest that public health campaigns aimed at reducing alcohol consumption may be more effective if they focus on unacceptable drinking behaviours instead of personal health outcomes.

Efforts to reduce sugar intake levels have been primarily limited to increasing knowledge and changing attitudes. We conducted a systematic review to (1) identify factors influencing adults' knowledge and attitudes about sugar, and (2) determine if there is an association between knowledge and attitudes about sugar and sugar intake. We searched 15 electronic databases from inception to December 2016 for English language publications including adults with relevant exposure and outcome measures. Findings were summarised meta-narratively. Of 3287 studies, 22 studies (14 for objective one and 8 for objective two) were included. Individual (liking of sugary food), interpersonal (attitudes of peers) and environmental factors (media, health professionals and food labelling) influenced adults' knowledge and attitudes about sugar, at least to some extent. Overall, quality of the studies included in our review was weak, and evidence for the application of the Knowledge-Attitude-Behavior model for understanding sugar intake is limited. Protocol registered in the PROSPERO International prospective register of systematic reviews (registration number CRD42015027540).

There is a shortage of medical practitioners able and/or willing to prescribe OST. This qualitative study investigated an alternative model of care where by pharmacists co-prescribed with an accredited doctor for OST patients. Semi-structured face-to-face interviews with 14 OST patients were conducted at a state government drug and alcohol clinic about their views on pharmacist prescribing OST for them. In the second phase of the study, three focus group interviews with 18 pharmacists were conducted to explore their views on a policy proposal which would allow them to co-prescribe for OST patients. Transcripts were analysed using the five-step framework approach with the support of the software package NVivo. In general, both patients and pharmacists supported co-prescribing. Improved patient continuity of care and convenience were regarded as the main benefits of having a pharmacist co-prescriber. Continued doctor involvement with patient was supported under a co-prescribing model, but not all pharmacists may desire or be suitable to fulfil the role of a co-prescriber. Changes to health care relationships and provisions to ensure adequate support of pharmacist co-prescribers were important consideration factors in moving forward with this proposed new model of care.

presented at the Global Evidence Summit: Using evidence. Improving lives, 13-16 September 2017, Cape Town, South Africa

Understanding the processes and the factors influencing intersectoral collaboration is vital for the ongoing success of programmes that rely on effective partnerships between sectors, such as the school-based immunization programme, the school dental health programme and health promotion interventions delivered in school settings. We studied school-based health programmes delivered by partnerships between health, education and the local government sectors. We used purposive sampling to identify 19 people working in school-based health programmes and interviewed them about the barriers and enablers of successful collaboration. Data were analysed thematically. We found that collaboration between complex systems was a skilled endeavour which relied on a strong foundation of communication and interpersonal professional relationships. Understanding the core business, operational context and intersectoral point-of-view of collaborative partners was important both for establishing good intersectoral programmes and sustaining them as contexts and personnel changed. Aligning divergent sectoral agendas early in the collaborative process was essential for ensuring that all partners could meet their core business needs while also delivering the programme outcomes.

Background: This study aimed to investigate the relationship between road users' attitudes and their travel behaviors, to explore the acceptability of traffic measures for sustainable transport promotion, and to investigate predictors of intention to reduce car use. Method: Using a cross-sectional survey, 381 residents in Adelaide were interviewed via a computer-assisted telephone interviewing system. Descriptive analysis was used to describe demographic, travel behavior, and effectiveness of potential traffic measures. Attitude statements relating to transport use were factor-analyzed into four factors: “sustainable transport benefits awareness,” “traffic problems awareness,” “cycling safety concerns and car use comfort” and “public transport negative emotion.” Scores on these factors were analyzed with Spearman's correlation and logistic regression. Results: In general, “push” measures (e.g. more expensive petrol) were considered less effective than “pull” measures (e.g. cheaper public transport). “Cycling safety concerns and car use comfort” and “public transport negative emotion” factors were positively related to the annual driving distance of the participants. Both “sustainable transport benefits awareness” and “traffic problems awareness factors” were positively associated with the acceptance of measures for sustainable transport promotion. Furthermore, participants who used cars more frequently, had high sores on “cycling safety concerns and car use comfort,” and had a bachelor degree or higher would be less likely to reduce car use. Conclusion: These findings indicate the importance of increasing public awareness of traffic problems and perceived benefits of sustainable transport as a potential strategy to reduce car use.

Time, money and commitment are needed to increase the value of medical research — and to respect participants.

Introduction Childhood obesity is a significant challenge for public health internationally. Regulatory and fiscal measures propagated by governments offer a potentially effective response to this issue. Fearing public criticism, governments are often reluctant to use such measures. In this study we asked a descriptively representative and informed group of Australians their views on the use of legislation and fiscal measures by governments to address childhood obesity. Methods A citizens’ jury, held in South Australia in April 2015, was asked to consider the question: What laws, if any, should we have in Australia to address childhood obesity? Results The jury agreed that prevention of obesity was complex requiring multifaceted government intervention. Recommendations fell into the areas of health promotion and education (n = 4), regulation of food marketing (n = 3), taxation/subsidies (n = 2) and a parliamentary enquiry. School-based nutrition education and health promotion and mandatory front-of-pack interpretive labelling of food and drink were ranked 1 and 2 with taxation of high fat, high sugar food and drink third. Conclusion The recommendations were similar to findings from other citizens’ juries held in Australia suggesting that the reticence of decision makers in Australia, and potentially elsewhere, to use legislative and fiscal measures to address childhood obesity is misguided. Supporting relevant informed public discussion could facilitate a politically acceptable legislative approach.

Across the world, pain is under‐treated in emergency departments (EDs). We canvass the literature testifying to this problem, the reasons why this problem is so important, and then some of the main hypotheses that have been advanced in explanation of the problem. We then argue for the plausibility of two new hypotheses: pain's under‐treatment in the ED is due partly to (1) an epistemic preference for signs over symptoms on the part of some practitioners, and (2) some ED practices that themselves worsen pain by increasing patients' anxiety and fear. Our argument includes the following logic. Some ED practitioners depart from formal guidance in basing their acute pain assessments on observable features rather than on patient reports of pain. This is potentially due to an epistemic preference for signs over symptoms which aims to circumvent intentional and/or unintentional misrepresentation on the part of patients. However, conducting pain assessments in line with this epistemic preference contributes to the under‐treatment of pain in at least three respects, which we detail. Moreover, it may do little to help the practitioner circumvent any intentional misrepresentation on the part of the patient, as we explain. Second, we examine at least four ED practices that may be contributing to the under‐treatment of pain by increasing patient anxiety and fear, which can worsen pain. These practices include failing to provide orienting information and partially objectifying patients so as to problem‐solve along lines pre‐established by modern medical science. We conclude by touching on some potential solutions for ED practice.

Obesity remains a major public health challenge across OECD countries and policy-makers globally require successful policy precedents. This paper analyzes New York City’s innovative experiences in regulatory approaches to nutrition. We combined a systematic documentary review and key informant interviews (n = 9) with individuals directly involved in nutrition policy development and decision-making. Thematic analysis was guided by Kingdon’s three-streams-model and the International Obesity Task Force’s evidence-based decision-making framework. Our findings indicate that decisive mayoral leadership spearheaded initial agenda-change and built executive capacity to support evidence-driven policy. Policy-makers in the executive branch recognized the dearth of evidence for concrete policy interventions, and made contributing to the evidence base an explicit goal. Their approach preferred decision-making through executive action and rules passed by the Board of Health that successfully banned trans-fats from food outlets, set institutional food standards, introduced menu labeling requirements for chain restaurants, and improved access to healthy foods for disadvantaged populations. Although the Health Department collaborated with the legislature on legal and programmatic food access measures, there was limited engagement with elected representatives and the community on regulatory obesity prevention. Our analysis suggests that this hurt the administration’s ability to successfully communicate the public health messages motivating these contentious proposals; contributing to unexpected opposition from food access and minority advocates, and fueling charges of executive overreach. Overall, NYC presents a case of expert-driven policy change, underpinned by evidence-based environmental approaches. The city’s experience demonstrates that there is scope to redefine municipal responsibilities for public health and that incremental change and contentious public discussion can impa

Objective: To describe the main characteristics of systematic reviews addressing questions of chronic disease and related risk factors for Indigenous Australians. Methods: We searched databases for systematic reviews meeting inclusion criteria. Two reviewers assessed quality and extracted characteristics using pre‐defined tools. Results: We identified 14 systematic reviews. Seven synthesised evidence about health intervention effectiveness; four addressed chronic disease or risk factor prevalence; and six conducted critical appraisal as per current best practice. Only three reported steps to align the review with standards for ethical research with Indigenous Australians and/or capture Indigenous‐specific knowledge. Most called for more high‐quality research. Conclusion: Systematic review is an under‐utilised method for gathering evidence to inform chronic disease prevention and management for Indigenous Australians. Relevance of future systematic reviews could be improved by: 1) aligning questions with community priorities as well as decision maker needs; 2) involvement of, and leadership by, Indigenous researchers with relevant cultural and contextual knowledge; iii) use of critical appraisal tools that include traditional risk of bias assessment criteria and criteria that reflect Indigenous standards of appropriate research. Implications: Systematic review method guidance, tools and reporting standards are required to ensure alignment with ethical obligations and promote rigor and relevance.

Cancer is the second most common cause of alcohol-related death in both men and women in Australia. In view of this and other health risks, mandatory health warnings on alcoholic beverages have been proposed in Australia and introduced elsewhere. This paper reviews academic literature and statements from selected advocacy groups to identify the ethical justifications that are used in relation to mandatory health warnings on alcoholic beverages. The paper then analyses how these justifications relate to the ethics of public health interventions in the context of cancer prevention. This involves examining the potential tension between the utilitarian nature of public health interventions and the liberalism characteristic of many of the societies in which those interventions occur.

A problem-based learning (PBL) assumption is that silence is incompatible with collaborative learning. Although sociocultural studies have reinterpreted silence as collaborative, we must understand how silence occurs in PBL groups. This essay presents students’ explanations of dominance, leadership, and silence as PBL group roles. An ethnographic investigation of PBL groups, informed by social constructionism, was conducted at two dental schools (in Australia and Ireland). The methods used were observation, interviews, and focus groups. The participants were volunteer first-year undergraduates. Students attributed dominance, silence, and members’ group roles to personal attributes. Consequently, they assumed that groups divided naturally into dominant leaders and silent followers. Sometimes silence had a collaborative learning function, but it was also due to social exclusion. This assumption enabled social practices that privileged some group members and marginalized others. Power and participation in decision making in PBL groups was restricted to dominant group members.

This chapter concerns public perceptions about who should have access to scarce antiviral drugs and vaccines in a flu pandemic. Two methods of public engagement are compared and evaluated; namely a survey, and a deliberative forum. In undertaking public engagement, researchers and policy makers may be motivated by the desire to build policy which is acceptable and workable in the community, that is instrumental goals are foremost. With instrumental goals in mind, there are a number of ways to collect community views but they may provide quite different answers as shown in the two examples described here. In the chapter we explore, the relationship between choice of method of engagement and (i) the findings of the engagement exercise, and (ii) the acceptability and applicability of these findings in a policy context.

Background Schools are increasingly asked to participate in a range of public health programs, but there has been little consideration of the impact of these programs on policy and/or implementation. We investigated intersectoral collaboration between the health and education sectors using a case study of a school-based immunization program (SBIP). Methods The study was undertaken in South Australia. We undertook an ethnographic review examining health and education system functioning at a variety of levels using a mixed methods approach, informed by an interactive and multidirectional knowledge transfer framework. Results Facilitators for intersectoral collaboration included: explicit responsibilities for specific activities; clear communication channels; including the core values of each sector in planning and implementation; and collaborative development of health educational programs. Including consumers as key stakeholders in planning and implementing intersectoral programs is important. While the SBIP itself is currently successful, threats to its sustainability were identified. Conclusions Outcomes included: (i) a clearer understanding of the functioning of the SBIP in SA including wide-ranging and practical recommendations to facilitate the implementation of the program in both sectors, including revisions to enhance the experience for students; (ii) a broader outcome focusing on identification of barriers and facilitators for intersectoral collaboration and suggestions for enhancing such collaborations.

In health care and medicine, the focus on humans and their bodies and the complex and potentially conflicting web of personal, professional, and financial relationships between researchers, students, government, and industry create a quite distinctive environment for academic integrity and misconduct. Although the history of medical research and practice is obviously lengthy, descriptions of scientific misconduct and of attempts to control and regulate it are a very short and recent chapter. The backdrop to contemporary efforts to address medical misconduct is the Nuremberg Code, developed in the light of the Nazi medical atrocities during World War II. Despite the wide adoption of the Nuremberg Code and related declarations, research that contravened the code and declarations has continued to occur. Noteworthy examples include the Tuskegee Syphilis Study in the United States and Cervical Cancer Study in New Zealand. Misconduct in the generation, analysis, and dissemination of medical research findings and cases of fabrication and falsification of laboratory-based data have provided some of most egregious examples of contemporary research misconduct. Efforts to manage misconduct have focused on the development of human research ethics guidelines and committees, codes of conduct, and guidelines for publication of scholarly work in medical journals.

Adolescents' views, and preferences are often over-looked when public health policies that affect them are designed and implemented. The purpose of this study was to describe young people's views and preferences for determining government funding priorities for adolescent immunization programs.

In health care and medicine, the focus on humans and their bodies and the complex and potentially conflicting web of personal, professional, and financial relationships between researchers, students, government, and industry create a quite distinctive environment for academic integrity and misconduct. Although the history of medical research and practice is obviously lengthy, descriptions of scientific misconduct and of attempts to control and regulate it are a very short and recent chapter. The backdrop to contemporary efforts to address medical misconduct is the Nuremberg Code, developed in the light of the Nazi medical atrocities during World War II. Despite the wide adoption of the Nuremberg Code and related declarations, research that contravened the code and declarations has continued to occur. Noteworthy examples include the Tuskegee Syphilis Study in the United States and Cervical Cancer Study in New Zealand. Misconduct in the generation, analysis, and dissemination of medical research findings and cases of fabrication and falsification of laboratory-based data have provided some of most egregious examples of contemporary research misconduct. Efforts to manage misconduct have focused on the development of human research ethics guidelines and committees, codes of conduct, and guidelines for publication of scholarly work in medical journals.

This chapter concerns public perceptions about who should have access to scarce antiviral drugs and vaccines in a flu pandemic. Two methods of public engagement are compared and evaluated; namely a survey, and a deliberative forum. In undertaking public engagement, researchers and policy makers may be motivated by the desire to build policy which is acceptable and workable in the community, that is instrumental goals are foremost. With instrumental goals in mind, there are a number of ways to collect community views but they may provide quite different answers as shown in the two examples described here. In the chapter we explore, the relationship between choice of method of engagement and (i) the findings of the engagement exercise, and (ii) the acceptability and applicability of these findings in a policy context.

Background Deliberative forums can be useful tools in policy decision making for balancing citizen voice and community values against dominant interests. Objective To describe the use of a deliberative forum to explore community perspectives on a complex health problem—disinvestment. Methods A deliberative forum of citizens was convened in Adelaide, South Australia, to develop criteria to support disinvestment from public funding of ineffective pathology tests. The case study of potential disinvestment from vitamin B12/folate pathology testing was used to shape the debate. The forum was informed by a systematic review of B12/folate pathology test effectiveness and expert testimony. Results The citizens identified seven criteria: cost of the test, potential impact on individual health/capacity to benefit, potential cost to society, public good, alternatives to testing, severity of the condition, and accuracy of the test. The participants not only saw these criteria as an interdependent network but also questioned “the authority” of policymakers to make these decisions. Conclusions Coherence between the criteria devised by the forum and those described by an expert group was considerable, the major differences being that the citizens did not consider equity issues and the experts neglected the “cost” of social and emotional impact of disinvestment on users and the society.

Background The National Human Papillomavirus (HPV) Vaccination Program in Australia commenced in 2007 for females and in 2013 for males, using the quadrivalent HPV vaccine (HPV 6,11,16,18). Thus far, we have demonstrated very substantial reductions in genital warts and in the prevalence of HPV among young Australian women, providing early evidence for the success of this public health initiative. Australia has a long history of school-based vaccination programs for adolescents, with comparatively high coverage. However, it is not clear what factors promote success in a school vaccination program. The HPV.edu study aims to examine: 1) student knowledge about HPV vaccination; 2) psycho-social outcomes and 3) vaccination uptake. Methods/Design HPV.edu is a cluster randomised trial of a complex intervention in schools aiming to recruit 40 schools with year-8 enrolments above 100 students (approximately 4400 students). The schools will be stratified by Government, Catholic, and Independent sectors and geographical location, with up to 20 schools recruited in each of two states, Western Australia (WA) and South Australia (SA), and randomly allocated to intervention or control (usual practice). Intervention schools will receive the complex intervention which includes an adolescent intervention (education and distraction); a decisional support tool for parents and adolescents and logistical strategies (consent form returns strategies, in-school mop-up vaccination and vaccination-day guidelines). Careful process evaluation including an embedded qualitative evaluation will be undertaken to explore in depth possible mechanisms for any observed effect of the intervention on primary and secondary outcomes. Discussion This study is the first to evaluate the relative effectiveness of various strategies to promote best practice in school-based vaccination against HPV. The study aims to improve vaccination-related psychosocial outcomes, including adolescent knowledge and attitudes

Groups are central to problem-based learning (PBL) and educational and professional outcomes relevant to clinical education. However, PBL groups in practice may differ from theoretical conceptions of groups. Therefore, this study explored students’ understandings of the purpose and value of PBL groups for their learning. We conducted a naturalistic study with novice (first-year) students at two dental schools (Australia, Ireland), using observation and interviews analyzed thematically. Students constructed PBL learning as individual knowledge gain, and group purpose as information gathering and exchange; few students acknowledged the learning potential of group processes. Group value depended on assessment and curriculum context. Findings are explained in relation to how students’ epistemologies and perceptions of their learning contexts shaped group behaviour. Implications for health professional education practice are considered.

The link between alcohol consumption and cancer is well established, but public awareness of the risk remains low. Mandated warning labels have been suggested as a way of ensuring “informed choice” about alcohol consumption. In this article we explore various ethical issues that may arise in connection with cancer warning labels on alcoholic beverages; in particular we highlight the potentially questionable autonomy of alcohol consumption decisions (either with or without labels) and consider the implications if the autonomy of drinking behavior is substantially compromised. Our discussion demonstrates the need for the various ethical issues to be considered and addressed in any decision to mandate cancer warning labels.

This special issue of the HPJA deals with ethics and health promotion. The accompanying editorial focuses particularly on Human Research Ethics Committee (HREC) approval for health promotion research, evaluation and quality assurance (QA), based on the first three papers in this issue. In this brief editorial, we introduce the remaining papers, noting some common threads that are woven through the papers.

This is the last in a six-part series on general practice ethics. Cases from practice are used to trigger reflection on common ethical issues where the best course of action may not be immediately apparent. The case presented in the article is an illustrative compilation and not based on spe-cific individuals.

This is the third in a six-part series on general practice ethics. Cases from practice are used to trigger reflection on common ethical issues where the best course of action may not immediately be apparent. The case presented in this article is an illustrative compilation and is not based on specific individuals. In the first article, the authors provided a suggested framework for considering the ethical issues to assist practi-tioners in reaching an ethically justifiable decision.

Objectives. We investigated ethical issues in school-based immunization programs for adolescents and how they are addressed. Methods. We used qualitative methods and an ethnographic approach to observe 9 secondary schools on immunization days in South Australia in 2011; concurrently, we conducted 9 focus groups with female secondary school students, 6 semistructured interviews with parents, and 10 interviews with nurses and teachers. We explored ethical challenges from the perspective of these groups. Results. We identified ethical challenges for the delivery of adolescent immunization in a school-based setting in 3 main areas: informed consent, restrictions on privacy, and harm to students in the form of fear and anxiety. Conclusions. We found areas in which the design and delivery of school-based immunization programs can be improved. Information about immunization should be provided in ways that are appropriate to young people and their parents, and privacy protections should be enhanced when possible. Involving young people in the design and delivery of programs would assist with making these improvements.

Urinary Incontinence has been associated with psychological effects such as depression. We aimed in this study to explore the subjective experience of the burden of urinary incontinence, in relation to mental health, in order to explain how these conditions interact. A qualitative study was undertaken using the Framework Approach to analyse in-depth interviews with nineteen women regarding their experiences with psychosocial outcomes for those with urinary incontinence with and without comorbid depression. Older women across all severities of incontinence and categories of depression tended to cope better than younger women. Within our resilience framework, two patterns of resilience - relational and situational – appear to contribute most to the experiences of women with incontinence and the particular way they respond to depression. Resilience-focused interventions in women newly diagnosed with incontinence may lessen the impact of depression on these women.

This is the fifth in a six-part series on general practice ethics. Cases from practice are used to trigger reflection on common ethical issues where the best course of action may not be immediately apparent. The case presented in the article is an illustrative compilation and not based on specific individuals.

This is the first in a six-part series on general practice ethics. Cases from practice are used to trigger reflection on common ethical issues where the best course of action may not immediately be apparent. The case presented in this article is an illustrative compilation and is not based on specific individuals. The authors have provided a suggested framework for considering the ethical issues to allow practitioners to come to an ethically based conclusion.

This special issue of the HPJA focuses on ethics in the context of health promotion practice. This editorial takes a narrower focus: the issue of Human Research Ethics Committee (HREC) approval for health promotion research, evaluation and quality assurance (QA). We will focus on three papers in the special issue: each argue that those working in health promotion should consider ethics from the very beginning of their research, evaluation and/or QA activities. The first paper, by Ainsley Newson and Wendy Lipworth, is entitled ‘Why should ethics approval be required before publication of health promotion research?’ In it they argue that ‘journals should not, in general, publish articles with no ethics approval’, even if the findings are interesting or apparently important. The second paper, by Peter Sainsbury, is entitled ‘Development and oversight of ethical health promotion quality assurance and evaluation activities involving human participants’. In it he argues that the boundaries between research, evaluation and QA are not clear, and that all of these activities should be underpinned by research ethics principles and focus on the central issue of potential risk to participants. The final paper, a commentary by Judy Allen, reflects on the ethical dimensions of health promotion research and evaluation from the inside of an HREC.

Surveillance of adverse events following immunisation (AEFI) is an essential component of vaccine safety monitoring. The most commonly utilized passive surveillance systems rely predominantly on reporting by health care providers (HCP). We reviewed adverse event reports received in Victoria, Australia since surveillance commencement in July 2007, to June 2013 (6 years) to ascertain the contribution of consumer (vaccinee or their parent/guardian) reporting to vaccine safety monitoring and to inform future surveillance system development directions. Categorical data included were: reporter type; serious and non-serious AEFI category; and, vaccinee age group. Chi-square test and 2-sample test of proportions were used to compare categories; trend changes were assessed using linear regression. Consumer reporting increased over the 6 years, reaching 21% of reports received in 2013 (P <0.001), most commonly for children aged less than 7 years. Consumer reports were 5% more likely to describe serious AEFI than HCP (P = 0.018) and 10% more likely to result in specialist clinic attendance (P <0.001). Although online reporting increased to 32% of all report since its introduction in 2010, 85% of consumers continued to report by phone. Consumer reporting of AEFI is a valuable component of vaccine safety surveillance in addition to HCP reporting. Changes are required to AEFI reporting systems to implement efficient consumer AEFI reporting, but may be justified for their potential impact on signal detection sensitivity.

Background Measures to improve the quality and sustainability of healthcare practice and provision have become a policy concern. In addition, the involvement of stakeholders in health policy decision-making has been advocated, as complex questions arise around the structure of funding arrangements in a context of limited resources. Using a case study of assisted reproductive technologies (ART), deliberative engagements with a range of stakeholder groups were held on the topic of how best to structure the distribution of Australian public funding in this domain. Methods Deliberative engagements were carried out with groups of ART consumers, clinicians and community members. The forums were informed by a systematic review of ART treatment safety and effectiveness (focusing, in particular, on maternal age and number of treatment cycles), as well as by international policy comparisons, and ethical and cost analyses. Forum discussions were transcribed and subject to thematic analysis. Results Each forum demonstrated stakeholders’ capacity to understand concepts of choice under resource scarcity and disinvestment, and to countenance options for ART funding not always aligned with their interests. Deliberations in each engagement identified concerns around ‘equity’ and ‘patient responsibility’, culminating in a broad preference for (potential) ART subsidy restrictions to be based upon individual factors rather than maternal age or number of treatment cycles. Community participants were open to restrictions based upon measures of body mass index (BMI) and smoking status, while consumers and clinicians saw support to improve these factors as part of an ART treatment program, as distinct from a funding criterion. All groups advocated continued patient co-payments, with measures in place to provide treatment access to those unable to pay (namely, equity of access). Conclusions Deliberations yielded qualitative, socially-negotiated evidence required to inform ethical, accountab

Deliberative inclusive approaches, such as citizen juries, have been used to engage citizens on a range of issues in health care and public health. Researchers engaging with the public to inform policy and practice have adapted the citizen jury method in a variety of ways. The nature and impact of these adaptations has not been evaluated. We systematically searched Medline (PubMED), CINAHL and Scopus databases to identify deliberative inclusive methods, particularly citizens' juries and their adaptations, deployed in health research. Identified studies were evaluated focussing on principles associated with deliberative democracy: inclusivity, deliberation and active citizenship. We examined overall process, recruitment, evidence presentation, documentation and outputs in empirical studies, and the relationship of these elements to theoretical explications of deliberative inclusive methods. The search yielded 37 papers describing 66 citizens' juries. The review demonstrated that the citizens' jury model has been extensively adapted. Inclusivity has been operationalised with sampling strategies that aim to recruit representative juries, although these efforts have produced mixed results. Deliberation has been supported through use of steering committees and facilitators to promote fair interaction between jurors. Many juries were shorter duration than originally recommended, limiting opportunity for constructive dialogue. With respect to citizenship, few juries' rulings were considered by decision-making bodies thereby limiting transfer into policy and practice. Constraints in public policy process may preclude use of the ‘ideal’ citizens' jury with potential loss of an effective method for informed community engagement. Adapted citizens' jury models provide an alternative: however, this review demonstrates that special attention should be paid to recruitment, independent oversight, jury duration and moderation.