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Objective: Does the provision of a nurse-based intervention lead to smoking cessation in hospital patients? Methods: At tertiary teaching hospital in Newcastle, Australia, 4,779 eligible (aged 18-80, admitted for at least 24 hours, and able to provide informed consent) and consenting (73.4%) in-patients were recruited into a larger cross-sectional survey. 1,422 (29.7%) smokers (in the last 12 months) were randomly assigned to control (n=711) or intervention group (n=711). The brief nurse-delivered intervention incorporated: tailored information, assessment of withdrawal, offer of nicotine replacement therapy, booklets, and a discharge letter. Self-reported cessation at 12 months was validated with CO and salivary cotinine. Results: There were no significant differences between groups in self-reported abstinence at three or 12 months post intervention, based on an intention to treat analysis. At three months, self-reported abstinence was 27.3% (I) and 27.5% (C); at 12 months was 18.5% (I) and 20.6% (C). There were no differences in validation of self-report between intervention and control groups at 12 months. Conclusion: This brief nurse-provided in-patient intervention did not significantly increase the smoking cessation rates compared with the control group at either three or 12-month follow-up. Implications: A systematic total quality improvement model of accountable outcome-focused treatment, incorporating assertive physician-led pharmacotherapy, routine assessment and recording of nicotine dependence (ICD 10 coding), in-and outpatient services and engagement from multidisciplinary teams of health professionals may be required to improve treatment modalities for this chronic addictive disorder.

Objective: To examine associations between poor mental health and sociodemographic, psychosocial and health related variables in midlife Australian women. Method: The random population-based sample comprised 13,961 Australian women aged 45-50 years who participated in the baseline postal survey for the Australian Longitudinal Study on Women's Health, conducted in 1996. The outcome measure, poor mental health status, was measured by the Mental Health Index (MH) of the SF-36. Results: Sociodemographic factors associated with poor mental health were low educational levels, being unemployed or engaged solely in home duties, and non-English speaking background (European). Health related factors independently associated with poor mental health were having five or more visits to the doctor in the past year, menopausal status (surgical and peri-menopausal), less exercise, and smoking 20 or more cigarettes per day. Among psychosocial variables, low satisfaction with partner or close relationships, low perceived social support outside family, and more life-events over the past 12 months were independently associated. Conclusion: The findings suggest a number of areas in which preventive interventions could be strengthened to improve quality of life among mid-aged women. These include policy changes to promote and support more education and employment opportunities for women before they reach midlife, increase understanding of the link between health risk behaviours and psychological well-being, and provide counselling services to improve women's relational and psychosocial circumstances. KEYWORDS. Psychological distress, women, midlife, sociodemographic factors

Purpose: Early identification of elder abuse requires a valid, easily administered screening instrument. This study examined the reliability and validity of the Vulnerability to Abuse Screening Scale (VASS), a 12-item self-report measure with four factors (Vulnerability, Dependence, Dejection, and Coercion). Design and Methods: The sample consisted of 10,421 nationally representative Women's Health Australia study participants, aged 73-78, who completed the Time 2 postal survey in 1999. We tested validity of the VASS factor structure and whether baseline risk status independently predicted Time 2 attrition. Results: Findings confirmed the VASS factor structure and construct validity. Four factors explained 51% of variance, and these factors were internally consistent. The Vulnerability and Coercion factors held the strongest face and construct validity for physical and psychological abuse. The Dependence and Dejection factors were valid and reliable and significantly predicted 3-year attrition after controlling for confounders. Implications: Further work is needed to determine sensitivity and specificity of VASS as a screening instrument for elder abuse. Qualitative research could examine specific experiences and contexts of vulnerable women. Key Words: Elder abuse, Dependence, Dejection, Psychosocial, Cohort.

Objective: To examine associations between cigarette smoking and menstrual symptoms and miscarriage among young women. Method: The study sample consists of 14,779 women aged 18-23 years who participated in the mailed baseline survey for the Australian Longitudinal Study on Women's Health, conducted in 1996. The main outcome measures are self reported menstrual symptoms and miscarriages. Results: Current smokers and ex-smokers had an increased risk of menstrual symptoms and miscarriages compared with women who had never smoked, with the highest risk occurring in heavy smokers (adjusted odds ratios for those smoking >20 cigarettes per day: premenstrual tension 1.5 (95% confidence interval 1.3 to 1.7), irregular periods 1.5 (1.3 to 1.8), heavy periods 1.6 (1.4 to 1.9), severe period pain 1.5 (1.4 to 1.7), one or more miscarriages 2.0 (1.5 to 2.8). The odds ratios generally increased with numbers of cigarettes smoked and a younger age of starting to smoke. Conclusion: This study suggests that young women who smoke are at higher risk of a range of menstrual problems and miscarriage than those who have never smoked. The immediacy of this risk (in contrast to the longer term risks of chronic disease) can be used to improve the relevance of anti-smoking campaigns targeted to young women.

The author assesses the effectiveness of a multifaceted dissemination strategy compared with a simple mail-out startegy in promoting the adoption of SunSmart skin protection policies and practices in elementary and secondary schools in New South Wales. The author gives various statistics and finds that further research is needed to determine the most effective ways of ensuring that adoption of a comprehensive sun-protection policy leads to effective implementation of sun-protection practices in schools.

Interventions with retailers to cut down on cigarette sales to minors in Australia have been studied in a randomized controlled trial. Neither intervention achieved significant improvements for the two key behavioral outcomes, which were requiring proof of age and displaying a warning sign. Knowing about the law was not shown to have an intervention effect. Interventions may have been partly successful in modifying attitudes of retailers. One group received an educational letter and the other received a threat of enforcement of laws followed by a visit from a public health officer.

Guidelines for breast cancer treatment were evaluated by groups of cancer patients, doctors, and nurses. Results of this study showed different groups had different priorities. Doctors gave some aspects of preparation lower priorities, while patients and nurses emphasized consistent information, patient assistance, and a medical team that prepares patients., Guidelines for preparing cancer patients for threatening medical procedures were developed and refined and their perceived relevance and importance rated by three concerned groups--84 breast cancer patients, 64 doctors, and [...]

This paper describes development, over a five-year period, of the Hunter Region Health Promoting Schools Project in New South Wales (NSW), Australia. The project implemented the principles and philosophy of the Health Promoting Schools concept and evaluated its effectiveness using a randomized controlled trial involving 22 public secondary schools. An overview of the preliminary intervention model based on the health promoting schools philosophy and trialed in a pilot study is provided. The authors also outline barriers to, and difficulties in, implementing the philosophically based intervention model in the secondary school setting. The current intervention approach, which evolved over five years, is described in relation to the roles played by project team members and school communities. In addition, the authors outline guiding principles arising from the new approach which facilitated adoption of health promotion strategies in secondary school settings. (J Sch Health. 1999;69(6):227-232), Much has been written about the health of young people and the potential role schools play in enhancing and maintaining health. A number of models for comprehensive school health[1-4] have [...]

Eighty-four breast cancer patients, 64 oncologists, and 140 oncology nurses rated the importance of 15 general principles and 12 recommended steps to guide clinicians in breaking bad news to patients. [...]

Background: Older women are at increasing risk of various forms of familial violence, yet detection is poor and very little is known of the long-term health effects of this psychosocial problem. The effectiveness of the 'Vulnerability to Abuse' Screening Scale (VASS) in predicting three year health outcomes was investigated among women enrolled in the Australian Longitudinal Study on Women's Health, now known as Women's Health Australia.Methods: The sample comprised a cohort of 10,421 women aged 73-78 who completed the 1996 and 1999 postal surveys (attrition rate 19.5%). The Time 2 sample had a small bias towards lower risk for elder abuse at Time 1 and better health on SF-36 and self-rated health. The VASS is a 12-item self-report measure with 4 factors: vulnerability, coercion, dependence and dejection.Results: Overall, physical health (PCS) declined while mental health (MCS) increased over the three year period. Decline in physical health was predicted by only the dejection factor, but not by factors which seem to more directly measure abuse. The predictive validity of the VASS for three year mental health outcomes was given partial support. Three of the four VASS factors (dejection, vulnerability, and coercion) predicted decline in mental health at the univariate level, however, after adjusting for confounders, only one VASS factor (dejection) independently predicted decline in mental health.Conclusions: While the VASS shows some promise as a marker of health risk in older women, only the dejection factor proved consistently predictive of declining health status. Further research is needed to determine longer term predictive validity of the scale and to gain a clearer picture of how abusive experiences impact on older women's health. [ABSTRACT FROM AUTHOR]

Our objective was to examine associations between self-reported sexually transmitted infections (STIs) and sociodemographic, lifestyle, health status, health service use and quality of life factors among young Australian women; and their use of family planning and sexual health clinics and associations with health, demographic and psychosocial factors. The study sample comprised 14,762 women aged 18-23 years who participated in the mailed baseline survey for the Australian Longitudinal Study on Women's Health, conducted in 1996. The main outcome measures are self report of ever being diagnosed by a doctor with an STI, including chlamydia, genital herpes, genital warts or other STIs, and use of family planning and sexual health clinics. The self-reported incidence of STI was 1.7% for chlamydia, 1.1% genital herpes, 3.1% genital warts, and 2.1% other STIs. There was a large number of demographic, health behaviour, psychosocial and health service use factors significantly and independently associated with reports of having had each STI. Factors independently associated with use of family planning clinic included unemployment, current smoking, having had a Pap smear less than 2 years ago, not having ancillary health insurance, having consulted a hospital doctor and having higher stress and life events score. Factors independently associated with use of a sexual health clinic included younger age, lower occupation status, being a current or ex-smoker, being a binge drinker, having had a Pap smear, having consulted a hospital doctor, having poorer mental health and having higher life events score. This study reports interesting correlates of having an STI among young Australian women aged 18-23. The longitudinal nature of this study provides the opportunity to explore the long-term health and gynaecological outcomes of having STIs during young adulthood. [ABSTRACT FROM AUTHOR]