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Objectives The Child Dental Benefits Schedule (CDBS) is an Australian Government initiative providing basic dental care to children from low-income households. We sought to investigate levels of utilisation of the CDBS among Aboriginal and non-Aboriginal children to determine whether there is equal access to dental services provided through the schedule. Methods CDBS data were obtained for four financial (July–June) years (from 2013–14 to 2016–17). The data captured all claims made during this period. The data included estimates of usage by Aboriginal status, age group and Dental Benefits groups (administrative categories of related dental procedures). Results The utilisation of CDBS services was lower for Aboriginal children. However, in 2013–14, although the odds of using the schedule were higher for non-Aboriginal children (odds ratio (OR) 0.89; P

Expanded carrier screening (ECS) for recessive monogenic diseases requires prior knowledge of genomic variation, including DNA variants that cause disease. The composition of pathogenic variants differs greatly among human populations, but historically, research about monogenic diseases has focused mainly on people with European ancestry. By comparison, less is known about pathogenic DNA variants in people from other parts of the world. Consequently, inclusion of currently underrepresented Indigenous and other minority population groups in genomic research is essential to enable equitable outcomes in ECS and other areas of genomic medicine. Here, we discuss this issue in relation to the implementation of ECS in Australia, which is currently being evaluated as part of the national Government’s Genomics Health Futures Mission. We argue that significant effort is required to build an evidence base and genomic reference data so that ECS can bring significant clinical benefit for many Aboriginal and/or Torres Strait Islander Australians. These efforts are essential steps to achieving the Australian Government’s objectives and its commitment “to leveraging the benefits of genomics in the health system for all Australians.” They require culturally safe, community-led research and community involvement embedded within national health and medical genomics programs to ensure that new knowledge is integrated into medicine and health services in ways that address the specific and articulated cultural and health needs of Indigenous people. Until this occurs, people who do not have European ancestry are at risk of being, in relative terms, further disadvantaged.

Objectives and importance of study: The consequences of sensorineural hearing loss in young children include poor speech and language development, poor educational outcomes,and delayed socio-emotional development. For children who face socio-economic disadvantage, middle ear disease is more prevalent, access to primary health care is more difficult, and psychosocial and education supports are limited. Because of this, the consequences may be amplified. Understanding the risks associated with hearing loss and middle ear dysfunction in underserved populations can enable an earlier, more targeted and cost-effective approach to identifying those with hearing loss and effectively connecting them to systems of care. Study type: Retrospective study. Method: This study describes the outcomes of an ear and hearing screening program for children from lower socio-economic backgrounds (n = 2489; mean age 11.0 years, standard deviation 1.74 years) in New South Wales (NSW), Australia, between 2013 and 2016. Screening was conducted in a quiet room, and the test protocol included otoscopy, 226 Hertz (Hz) tympanometry, and pure tone screening at octave frequencies from 500 Hz to 4000 Hz with a referral criterion of 20 decibels hearing level (dB HL) at any one frequency. Outcomes were categorised into 1) pass; 2) middle ear dysfunction only; and 3) did not pass hearing screen (with or without middle ear dysfunction). Multinomial logistic regression was used to investigate risk factors for hearing loss and middle ear dysfunction. The factors examined were age, gender, socio-educational advantage, quarter of year assessed, non-English speaking background (NESB), Aboriginal status and region. Results: Higher risks of middle ear dysfunction were associated with younger age and seasonal variation, with higher risk in winter and spring months (July–September and October–December, compared with January–March). There were no differences between those from NESB and those with English as a first language, between the Aboriginal population and non-Aboriginal population, or between those who resided within or outside a major city. Conclusion: More than one in 10 school-age children from lower socio-economic backgrounds experience hearing loss (11.5%). Targeted ear and hearing screening programs offer an opportunity to identify hearing loss during critical learning years and seasons, mitigating longer-term effects on education, and social and mental health.

Background There is currently no standardised way to share information about initiatives across disciplines such as health, environment, basic science, manufacturing and international development. As we face increasingly complex problems, such as global air and water pollution, the distinctions between disciplines can limit our ability to respond effectively. When data about initiatives are not reported in a standardised way, essential information is lost, along with opportunities for collaboration and comparison. ‘Citizen science’ and participatory action research are increasingly recognised as crucial methods to use to solve problems, as these methods can help ensure that initiatives are aligned with the priorities of those affected, thus redefining what it means to be a ‘researcher’. However, current reporting methods lack data about the ways in which different people are involved in initiatives, making it difficult to collate and appraise data about the most effective ways to involve different people. The Standardised Data on Initiatives (STARDIT) reporting system provides a way to share this data. Standardised data can inform effective ways to share power during the design, implementation and evaluation stage of initiatives. For example, when designing a response to an epidemic, standardised data can inform which affected individuals or organisations could be involved in the design of the response and which outcomes are most important. Objective STARDIT will enable many kinds of data to be reported in a standardised way across disciplines, helping people appraise initiatives and synthesise evidence for the most effective ways to involve people. Method STARDIT has been co-created in a collaborative way, informed by a number of reviews and guidelines. STARDIT development is informed by the participatory action research paradigm, and is being co-designed by people from multiple disciplines and organisations around the world, using a combination of face to face events, online events and online discussion and decision tools. STARDIT data is hosted using Wikidata which works across multiple languages and is both human and machine readable. Results Since its inception in July 2019, over 100 people from multiple disciplines have been involved in the STARDIT co-design process, including through participation in multiple online discussions and three face-to-face events. People from across the world accepted the public invitation to be a part of shaping development of the system by giving feedback on multiple versions, including people from Cochrane, John Hopkins University and the Health Research Authority UK. Four Alpha Version STARDIT reports have been published for a number of research projects. A working demonstration of the Beta Version was publicly released in February 2021 (ScienceforAll.World/STARDIT). It is hosted by Wikimedia Foundation servers under a Creative Commons licence.

There is good evidence that fluoride varnish programs are effective in preventing dental caries in children. This study aims to provide a costing for the scale-up of a child fluoride varnish program in New South Wales (NSW), Australia. Most child fluoride varnish programs are school-based, and a number of studies have examined the acceptability and cost effectiveness of using non-dental providers to apply the fluoride varnish. This paper describes the number of primary schools in Australia that could be targeted using a standard population-based risk criteria based on published data. A costing method was developed for various scenarios of school enrolment and provider types, along with potential revenue from the Child Dental Benefits Schedule (CDBS). Most of the costs of a school-based fluoride varnish program can be covered by the CDBS with assumptions of 80% child consent and 75% CDBS eligibility. While the scale-up of child fluoride varnish programs to prevent dental caries has been recommended by numerous strategic plans and reports, particularly for Aboriginal and Torres Strait Islander children, limited progress has been made. This paper concludes that using a standardized criteria for targeting schools using a combination of ICSEA and Aboriginal enrolments, and aiming at four applications a year, is feasible, and that the main costs of the program could be covered by using the CDBS.

Issue addressed: The consumption of soft and other sweetened drinks is an emerging nutrition issue in Australia. In 2005-6, 63% of NSW children aged between 2 and 15 years consumed sweetened drinks (soft drinks, cordials or sports drinks) weekly, 33% of which consumed at least 6 cups per week. In 2008 NSW Health implemented the ?Water Campaign? to increase the proportion of NSW children up to 15 years of age who consume water in place of sweetened drinks. Methods: A pre-post survey study design was used to evaluate the Campaign. Two telephone surveys of stratified random samples of 500 respondents each from the primary target audience (parents and carers of children up to 15 years of age) were conducted across NSW. Results: Fifty-three per cent of respondents in the post-survey said that they recalled the mass media Campaign when it was described to them compared to 19% in the pre-survey. There was an increase in parents? knowledge of the high sugar content of sweetened drinks and a decline in the reported consumption of sweetened drinks by boys. Conclusions: Though modest in size and duration, the campaign was successful in achieving a number of campaign objectives, particularly changes in parent?s and carer?s knowledge and awareness of water related nutrition and reduced reported consumption of sweetened drinks among boys. Key words: sweetened drink, water, social marketing, mass media campaign, overweight, obesity

Background Lifestyle risk factors like smoking, nutrition, alcohol consumption, and physical inactivity (SNAP) are the main behavioural risk factors for chronic disease. Primary health care is an appropriate setting to address these risk factors in individuals. Generalist community health nurses (GCHNs) are uniquely placed to provide lifestyle interventions as they see clients in their homes over a period of time. The aim of the paper is to examine the impact of a service-level intervention on the risk factor management practices of GCHNs. Methods The trial used a quasi-experimental design involving four generalist community nursing services in NSW, Australia. The services were randomly allocated to either an intervention group or control group. Nurses in the intervention group were provided with training and support in the provision of brief lifestyle assessments and interventions. The control group provided usual care. A sample of 129 GCHNs completed surveys at baseline, 6 and 12 months to examine changes in their practices and levels of confidence related to the management of SNAP risk factors. Six semi-structured interviews and four focus groups were conducted among the intervention group to explore the feasibility of incorporating the intervention into everyday practice. Results Nurses in the intervention group became more confident in assessment and intervention over the three time points compared to their control group peers. Nurses in the intervention group reported assessing physical activity, weight and nutrition more frequently, as well as providing more brief interventions for physical activity, weight management and smoking cessation. There was little change in referral rates except for an improvement in weight management related referrals. Nurses’ perception of the importance of ‘client and system-related’ barriers to risk factor management diminished over time. Conclusions This study shows that the intervention was associated with positive changes in self-reported lifestyle risk factor management practices of GCHNs. Barriers to referral remained. The service model needs to be adapted to sustain these changes and enhance referral. Trial registration ACTRN12609001081202

To examine possible associations between driving to work, physical activity and overweight and obesity.Secondary analysis of cross-sectional data from a representative sample of the 2003 New South Wales Adult Health Survey, Australia.A total of 6810 respondents aged 16 years or over.Self-reported height and weight, modes of transport to work, level of physical activity, fruit and vegetable intake and social-economic status.Almost half of the respondents (49%) were overweight. The main mode of transport to work was driving a car (69%), 15% used public transport, 7% walked, 2% cycled and 6% worked at home. People who drove to work were less likely to achieve recommended levels of physical activity compared to non-car users (56.3 vs 44.3%, chi2 = 82.5, P0.0001). Driving to work was associated with being overweight or obese (adjusted odds ratio = 1.13 (95% CI 1.01-1.27), P = 0.047). Inadequate level of physical activity was independently associated with overweight or obesity. Socially and economically disadvantaged people were also more likely to be overweight and obese. In addition, being female or never married or having higher level of education was associated with a significantly reduced odds ratio of being overweight or obese, as was speaking a language other than English at home. No association was found between weight status and recommended vegetable or fruit intake.Driving to work is the dominant mode of commuting in a modern society and its impact on health requires scrutiny. The association found in this study between driving to work and overweight and obesity warrants further investigation to establish whether this relationship is causal. If proved as such, then promoting active transport modes such as walking, cycling and public transport should form a key component of global obesity prevention efforts.

Promoting active transport is an increasingly important focus of recent health promotion initiatives addressing the major public health concerns of car dependence, decreased levels of physical activity and environmental health. Using active transport that relies less on the use of private cars and more on alternatives such as walking, cycling and public transport has the potential to increase population levels of physical activity and to improve the environment. Over 12 months, a combined social and individualized marketing campaign was delivered to a cohort of randomly selected health service employees (n = 68) working at a health care facility in inner-city Sydney, Australia. Pre- and post-intervention surveys measured changes in mode of transport, awareness of active transport and attitudes towards mode of transport. Following the intervention, we found there was a reduction in the proportion of participants who drove to work 5 days per week and a decrease in trips travelled by car on weekends. In addition, there was high awareness of the intervention amongst participants and their understanding of the concept of active transport improved from 17.6% at baseline to 94.1% at the follow-up survey (p < 0.01). There was also a significant shift in attitudes, which suggested increased positive regard for active transport. Our findings suggest that a combined social and individualized marketing campaign in the workplace setting can increase the use of active transport for the journey to work and trips on weekends. However, before these findings are widely applied, the intervention needs to be tested in a controlled study with a larger sample size.

Background Social marketing integrates communication campaigns with behavioural and environmental change strategies. Childhood obesity programs could benefit significantly from social marketing but communication campaigns on this issue tend to be stand-alone. Methods A large-scale multi-setting child obesity prevention program was implemented in the Hunter New England (HNE) region of New South Wales (NSW), Australia from 2005–2010. The program included a series of communication campaigns promoting the program and its key messages: drinking water; getting physically active and; eating more vegetables and fruit. Pre-post telephone surveys (n = 9) were undertaken to evaluate awareness of the campaigns among parents of children aged 2–15 years using repeat cross-sections of randomly selected cohorts. A total of 1,367 parents (HNE = 748, NSW = 619) participated. Results At each survey post baseline, HNE parents were significantly more likely to have seen, read or heard about the program and its messages in the media than parents in the remainder of the state (p

Closed-circuit television has the potential to promote health in hospitals, as a significant number of patients watch large amounts of television (TV) during their stays. This project sought to investigate the potential of a dedicated hospital TV channel to communicate health messages in an entertaining way by assessing the reach and appeal of a closed-circuit hospital TV channel ? RPAtv. A cross-sectional survey of 162 inpatients and visitors at the Royal Prince Alfred Hospital was conducted. Sixty-four percent of participants were aware of RPAtv, with patients (72%) significantly more likely (P < 0.001) to be aware of RPAtv than visitors (41%). Almost 60% of those who were aware of the channel had viewed it. Of those who had viewed RPAtv, 73.3% rated the programming as 'good' or 'very good'. When asked about programming preferences, 34% suggested that the channel should include health and hospital information. However, 66% said that they would rather watch programming that was entertaining, light-hearted and escapist. The high approval rating of programming by viewers suggests that the channel is improving the experience of patients and visitors during their time in hospital. However, its effectiveness as a vehicle for health promotion could be somewhat limited. Any health education-focused objectives of similar channels need to be realistic about the extent of likely increases in health knowledge.

Background The risk factors for chronic disease, smoking, poor nutrition, hazardous alcohol consumption, physical inactivity and weight (SNAPW) are common in primary health care (PHC) affording opportunity for preventive interventions. Community nurses are an important component of PHC in Australia. However there has been little research evaluating the effectiveness of lifestyle interventions in routine community nursing practice. This study aimed to address this gap in our knowledge. Methods The study was a quasi-experimental trial involving four generalist community nursing (CN) services in New South Wales, Australia. Two services were randomly allocated to an ‘early intervention’ and two to a ‘late intervention’ group. Nurses in the early intervention group received training and support in identifying risk factors and offering brief lifestyle intervention for clients. Those in the late intervention group provided usual care for the first 6 months and then received training. Clients aged 30–80 years who were referred to the services between September 2009 and September 2010 were recruited prior to being seen by the nurse and baseline self-reported data collected. Data on their SNAPW risk factors, readiness to change these behaviours and advice and referral received about their risk factors in the previous 3 months were collected at baseline, 3 and 6 months. Analysis compared changes using univariate and multilevel regression techniques. Results 804 participants were recruited from 2361 (34.1%) eligible clients. The proportion of clients who recalled receiving dietary or physical activity advice increased between baseline and 3 months in the early intervention group (from 12.9 to 23.3% and 12.3 to 19.1% respectively) as did the proportion who recalled being referred for dietary or physical activity interventions (from 9.5 to 15.6% and 5.8 to 21.0% respectively). There was no change in the late intervention group. There a shift towards greater readiness to change in those who were physically inactive in the early but not the comparison group. Clients in both groups reported being more physically active and eating more fruit and vegetables but there were no significant differences between groups at 6 months. Conclusion The study demonstrated that although the intervention was associated with increases in advice and referral for diet or physical activity and readiness for change in physical activity, this did not translate into significant changes in lifestyle behaviours or weight. This suggests a need to facilitate referral to more intensive long-term interventions for clients with risk factors identified by primary health care nurses. Trial registration ACTRN12609001081202

This paper explores access to and acceptability of home visiting for early childhood health and wellbeing among the New South Wales population. The study examined demographic and social characteristics of children and their families to identify the factors that predicted home visiting by a community health nurse or volunteer, as well as the level of acceptability of home visiting as a strategy for improving child health. The data were extracted from the 2001 NSW Child Health Survey and a total of 3570 respondents who reported having a child aged 4 years or under were included in the study. The results show that culturally and linguistically diverse populations were less likely to be visited by a nurse or volunteer (adjusted odds ratio (OR), 0.78; 95% CI, 0.64?0.97), and when they were visited were more likely to find the visit ?uncomfortable? or ?very uncomfortable? (adjusted OR, 1.54; 95% CI, 1.19?1.99). Other factors associated with acceptability included the age of both children and mothers, education levels of parents and home smoking status. For home visiting to be effective in promoting child health, these factors must be considered.