Search

Author(s): Anita Lal, Ana Maria Mantilla-Herrera, Lennert Veerman, Kathryn Backholer, Gary Sacks, Marjory Moodie, Mohammad Siahpush, Rob Carter, Anna Peeters In supporting information file S4 Table, some table row headers [...]

Low socio-economic status (SES) has been associated with lower cervical screening rates. Mass media is one known strategy that can increase cervical screening participation. This study sought to determine whether a mass media campaign conducted in Victoria, Australia, in 2005 was effective in encouraging women across all SES groups to screen. Data were obtained from the Victorian Cervical Cytology Registry for each Pap test registered during 2005 and categorized into SES quintiles using the Index of Socio-Economic Advantage/Disadvantage. Negative binomial regression was used to determine the impact of the campaign on the weekly number of Pap tests and whether the media campaign had a differential effect by SES, after adjusting for the number of workdays per week, age group and time since previous test. Cervical screening increased 27% during the campaign period and was equally effective in encouraging screening across all SES groups, including low-SES women. Mass media campaigns can prompt increased rates of cervical screening among all women, not just those from more advantaged areas. Combining media with additional strategies targeted at low-SES women may help lessen the underlying differences in screening rates across SES.

Objectives. We sought to assess the impact of several tobacco control policies and televised antismoking advertising on adult smoking prevalence. Methods. We used a population survey in which smoking prevalence was measured each month from 1995 through 2006. Time-series analysis assessed the effect on smoking prevalence of televised antismoking advertising (with gross audience rating points [GRPs] per month), cigarette costliness, monthly sales of nicotine replacement therapy (NRT) and bupropion, and smoke-free restaurant laws. Results. Increases in cigarette costliness and exposure to tobacco control media campaigns significantly reduced smoking prevalence. We found a 0.3-percentage-point reduction in smoking prevalence by either exposing the population to televised antismoking ads an average of almost 4 times per month (390 GRPs) or by increasing the costliness of a pack of cigarettes by 0.03% of gross average weekly earnings. Monthly sales of NRT and bupropion, exposure to NRT advertising, and smoke-free restaurant laws had no detectable impact on smoking prevalence. Conclusions. Increases in the real price of cigarettes and tobacco control mass media campaigns broadcast at sufficient exposure levels and at regular intervals are critical for reducing population smoking prevalence.

Background A sugar-sweetened beverage (SSB) tax in Mexico has been effective in reducing consumption of SSBs, with larger decreases for low-income households. The health and financial effects across socioeconomic groups are important considerations for policy-makers. From a societal perspective, we assessed the potential cost-effectiveness, health gains, and financial impacts by socioeconomic position (SEP) of a 20% SSB tax for Australia. Methods and findings Australia-specific price elasticities were used to predict decreases in SSB consumption for each Socio-Economic Indexes for Areas (SEIFA) quintile. Changes in body mass index (BMI) were based on SSB consumption, BMI from the Australian Health Survey 2011-12, and energy balance equations. Markov cohort models were used to estimate the health impact for the Australian population, taking into account obesity-related diseases. Health-adjusted life years (HALYs) gained, healthcare costs saved, and out-of-pocket costs were estimated for each SEIFA quintile. Loss of economic welfare was calculated as the amount of deadweight loss in excess of taxation revenue. A 20% SSB tax would lead to HALY gains of 175,300 (95% CI: 68,700; 277,800) and healthcare cost savings of AU$1,733 million (m) (95% CI: $650m; $2,744m) over the lifetime of the population, with 49.5% of the total health gains accruing to the 2 lowest quintiles. We estimated the increase in annual expenditure on SSBs to be AU$35.40/capita (0.54% of expenditure on food and non-alcoholic drinks) in the lowest SEIFA quintile, a difference of AU$3.80/capita (0.32%) compared to the highest quintile. Annual tax revenue was estimated at AU$642.9m (95% CI: $348.2m; $1,117.2m). The main limitations of this study, as with all simulation models, is that the results represent only the best estimate of a potential effect in the absence of stronger direct evidence. Conclusions This study demonstrates that from a 20% tax on SSBs, the most HALYs gained and healthcare costs saved would accrue to the most disadvantaged quintiles in Australia. Whilst those in more disadvantaged areas would pay more SSB tax, the difference between areas is small. The equity of the tax could be further improved if the tax revenue were used to fund initiatives benefiting those with greater disadvantage., Author(s): Anita Lal 1,*, Ana Maria Mantilla-Herrera 2, Lennert Veerman 3, Kathryn Backholer 1, Gary Sacks 1, Marjory Moodie 1, Mohammad Siahpush 4, Rob Carter 1, Anna Peeters 1 Introduction [...]

Objectives. We used 4 waves of prospective data to examine the association of smoking cessation with financial stress and material well-being. Methods. Data (n = 5699 at baseline) came from 4 consecutive waves (2001-2005) of the Household Income and Labour Dynamics in Australia survey. We used mixed models to examine the participant-specific association of smoking cessation with financial stress and material well-being. Results. On average, a smoker who quits is expected to have a 25% reduction (P Conclusions. Our findings indicate that interventions to encourage smoking cessation are likely to improve standards of living and reduce deprivation. The findings provide grounds for encouraging the social services sector to incorporate smoking cessation efforts into their programs to enhance the material or financial conditions of disadvantaged groups. The findings also provide additional incentives for smokers to stop smoking and as such can be used in antismoking campaigns and by smoking cessation services.

Objective: To examine Australian smokers' attitudes towards regulation of the tobacco industry and to compare their attitudes with those of three similar countries--the United Kingdom (UK), the United States (US), and Canada Method: A telephone survey of 2,056 adult Australian smokers and 6,166 Canadian, US, and UK smokers was conducted in 2004 as the third wave of the International Tobacco Control Policy Evaluation Four-Country Survey. Results: Australian smokers display the strongest support for regulation. Only 16% believe that tobacco companies should be allowed to advertise/promote cigarettes as they please, 70% agree that tobacco products should be more tightly regulated, and 64% agree that governments should do more to tackle the harms of smoking. Smokers see government failure to do so in cynical terms--77% agree that governments do not really care about smoking because of money from tobacco taxes. Opposition comes largely from smokers who hold self-exempting beliefs about smoking's risks, have a positive attitude to smoking, do not accept that smoking is socially denormalised, and do not hold tobacco companies responsible for harms caused by smoking. Conclusions and Implications: The majority of Australian smokers believe that the tobacco industry is partly responsible for the predicament they find themselves in and want governments to act more strongly in their real interests. The strong relationship between support for regulation and cynicism about government inaction should stimulate governments into action. Key words: Tobacco, government regulation, smokers' attitudes.

Objective: Lone mothers are among the most disadvantaged groups in many countries. Smoking prevalence among this demographic group is considerably higher than the general population. Previous work has shown that only part of this difference can be explained by age, not having a partner, living alone, and socio-economic factors. This study examined the contribution of mental health, the social environment, and the lifecourse in explaining the effect of lone motherhood on smoking status. Methods: Cross-sectional data from the 1995 National Health Survey and 2001 National Drug Strategy Survey were used. Smoking was defined as daily smoking. Mental health was assessed using a 14-item scale from the SF-36. Proportion of friends who smoke was used as an indicator of the social environment. Age started smoking daily ([less than or equal to] 18 and >18) was used as a lifecourse factor. Results: Mental health, proportion of friends who smoke and age of smoking initiation had strong associations with smoking status. However, they accounted for a small part of the association of being a lone mother and a smoker. After controlling for these factors, the odds of being a smoker among lone mothers were still twice those of mothers with partners (OR 2.1, 95% CI 1.7-2.7). Conclusions and Implications: Improving the socio-economic status (SES), mental health and the social environment of lone mothers could help reduce their high smoking prevalence. However, much of the effect of being a lone mother remains even after controlling for these factors. More research is needed to discover why prevalence is so high among this demographic group.

Background: Despite evidence to the contrary from overseas research, the introduction of smoke-free legislation in South Australia (SA), which required all restaurants to go smoke-free in January 1999, sparked concerns among the hospitality industry about loss of restaurant business. This study aimed to determine whether the law had a detrimental impact on restaurant business in SA. Methods: Using time series analysis, we compared the ratio of monthly restaurant turnover from restaurants and cafes in SA to (a) total retail turnover in SA (minus restaurants) for the years 1991 to 2001 and (b) Australian restaurant turnover (minus SA, Western Australia and the Australian Capital Territory) for the years 1991-2000. Results: There was no decline in the ratio of (a) SA restaurant turnover to SA retail turnover or (b) SA restaurant turnover to Australian restaurant turnover. Conclusion: The introduction of a smoke-free law applying to restaurants in SA did not adversely affect restaurant business in SA.

Objectives. This study examined rural-urban gradients in US suicide mortality and the extent to which such gradients varied across time, sex, and age. Methods. Using a 10-category rural-urban continuum measure and 1970-1997 county mortality data, we estimated rural-urban differentials in suicide mortality over time by multiple regression and Poisson regression models. Results. Significant rural-urban gradients in age-adjusted male suicide mortality were found in each time period, indicating rising suicide rates with increasing levels of rurality. The gradient increased consistently, suggesting widening rural-urban differentials in male suicides over time. When controlled for geographic variation in divorce rate and ethnic composition, rural men, in each age cohort, had about twice the suicide rate of their most urban counterparts. Observed rural-urban differentials for women diminished over time. In 1995 to 1997, the adjusted suicide rates for young and working-age women were 85% and 22% higher, respectively, in rural than in the most urban areas. Conclusions. The slope of the relationship between rural-urban continuum and suicide mortality varied substantially by time, sex, and age. Widening rural-urban disparities in suicide may reflect differential changes over time in key social integration indicators.

Objective: To report smoking prevalence among Australian lone mothers by age and socio-economic group and to examine the extent to which the difference in smoking prevalence between lone mothers and other women is due to socio-economic factors. Methods: This was a secondary analysis of data from the 1995 National Health Survey (NHS), which was conducted by the Australian Bureau of Statistics (ABS). Information was collected from 53,800 respondents using face-to-face interviews. This analysis was limited to single mothers (n=1,184) who had at least one dependent child aged under 15. The outcome measure was smoking status, distinguishing regular smokers from occasional smokers, ex-smokers and never-smokers. Results: The overall smoking prevalence among lone mothers was 46.3% (Cl 43.5%-49.1%). Lone mothers who were younger, less educated, received government pension/benefits, occupied rental housing or who lived in more disadvantaged areas were more likely to smoke than others. A strong `lone mother effect' remained after controlling for socio-economic variables. The odds of smoking for lone mothers were 2.4 times greater than for married mothers (95% Cl 2.0-2.9) and twice as large as those for women living alone (95% Cl 1.6-2.4). Conclusion: As the prevalence for this population group is considerably higher than the prevalence for other women within each age category, programs to assist lone mothers to quit smoking are a priority for the long-term health of these women and their children. Furthermore, we discuss how policies and interventions that enhance the material conditions and social circumstances of lone mothers can bring about a decline in their smoking prevalence.

Objective: To investigate the relationship between social integration and mortality at the aggregate level of analysis. Method: The data were compiled from several Australian Bureau of Statistics documents. The unit of analysis was State (Territory)-year. The multivariate regression analysis included data from all States and the Australian Capital Territory for 1990-96. Five indicators of social integration percentage of people living alone; divorce rate; unemployment rate; proportion of people who are discouraged job seekers; and unionisation rate - were used as predictors of nine measures of mortality. Results: Higher levels of social integration, as measured by all indicators except unionisation, were associated with lower mortality rates. In the case of unionisation, higher levels were associated with increased mortality rates. Conclusion: Studies concerning the relationship between social integration and health should investigate the 'type' and 'level' of social integration that is conducive to better health. Implications: To help reduce disparities in health and mortality across communities, public health researchers and policy makers need to closely monitor geographic and temporal trends in social integration measures. Social policies that emphasise investment in social integration or social capital through job creation and training, provision of gainful employment and social services for discouraged and marginalised workers, improved work conditions and social support may lower mortality directly or through their beneficial effects on health-promoting behaviours such as reduced levels of smoking, drinking and physical inactivity.

Reasons for preferring alternative medicine in Australia are explored. Personal health attitudes and beliefs seem to be the reason for selecting alternative medicine rather than dissatisfaction with traditional medicine.

Abstract Background Disadvantaged groups are an important target for smoking cessation intervention. Smoking rates are markedly higher among severely socially disadvantaged groups such as indigenous people, the homeless, people with a mental illness or drug and alcohol addiction, and the unemployed than in the general population. This proposal aims to evaluate the efficacy of a client-centred, caseworker delivered cessation support intervention at increasing validated self reported smoking cessation rates in a socially disadvantaged population. Methods/Design A block randomised controlled trial will be conducted. The setting will be a non-government organisation, Community Care Centre located in New South Wales, Australia which provides emergency relief and counselling services to predominantly government income assistance recipients. Eligible clients identified as smokers during a baseline touch screen computer survey will be recruited and randomised by a trained research assistant located in the waiting area. Allocation to intervention or control groups will be determined by time periods with clients randomised in one-week blocks. Intervention group clients will receive an intensive client-centred smoking cessation intervention offered by the caseworker over two face-to-face and two telephone contacts. There will be two primary outcome measures obtained at one, six, and 12 month follow-up: 1) 24-hour expired air CO validated self-reported smoking cessation and 2) 7-day self-reported smoking cessation. Continuous abstinence will also be measured at six and 12 months follow up. Discussion This study will generate new knowledge in an area where the current information regarding the most effective smoking cessation approaches with disadvantaged groups is limited. Trial registration number ISRCTN: ISRCTN85202510