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Relationships and sexuality education for young people in Australia and elsewhere is a controversial topic. Numerous studies in Australia have focused on curriculum, policy, teachers, schools, sexting and other behaviours, and knowledge regarding sexually transmitted infection (STI)/human immunodeficiency virus (HIV) and pregnancy prevention. Few large-scale national studies have engaged with young people about what they want out of their sex education, and what they suggest would be most valuable for future programs in Australia. Data for the study included qualitative comments about experiences of sex education (n = 2316) provided in a national survey of adolescent sexual health. An initial thematic inductive analysis identified comments falling into two dominant themes: positive and negative experiences of their sex education. Results indicate that young people in Australia are articulate and understanding of the gaps in their sex education. A majority of comments highlighted negative experiences. These comments primarily discussed issues of delivery (timing, environment, person) and content quality (comprehensiveness). A minority highlighted positive commentary also around delivery (environment, person) and content quality (comprehensiveness). The findings of this study illuminate contemporary adolescent concerns regarding their experiences of education. Understanding these experiences can inform future curriculum development, teacher training and the design and implementation of policy.

Effective school-based relationship and sexuality education (RSE) can improve youth sexual outcomes, including knowledge and behaviour. National pedagogical guidance in the form of the Australian Curriculum: Health and Physical Education (AC: HPE), which includes RSE, was released in 2015. This study sought to determine the sexual health knowledge and school-based RSE experiences of Australian students since the release of the AC: HPE. It presents findings from the Sixth National Survey of Secondary Students and Adolescent Sexual Health, which surveyed 6,180 Australian Year 10, 11 and 12 students. Findings are compared to those from the same survey conducted in 2013 -- prior to the release of the AC: HPE. Analyses examined the associations between perceived relevance of RSE and demographic characteristics/context of RSE; and between sexual health knowledge, demographic characteristics and receipt of RSE. A thematic analysis of responses to an open-ended question provides additional context. Findings indicate that the AC: HPE has had little impact on RSE experiences and sexual health knowledge as findings remain mostly unchanged from 2013: overall knowledge scores have remained moderate to low and peak among young people aged 16-18 in year 12 at school even though most receive RSE in earlier years. Students value their RSE, but their comments reflect inconsistent teaching.

Sexuality education is a trusted source of information and guidance for adolescents and young people on sexual health, sexuality and relationships, and it can improve the sexual health of this population. Such education is most effective when informed by the views of young people themselves; however, there is limited research that investigates young people's experiences of school-based sexuality education. This paper presents findings related to sexuality education from the Fifth National Survey of Secondary Students and Sexual Health, which surveyed 2,193 Australian Year 10, 11 and 12 students from diverse school systems. Descriptive analyses were used to describe the nature of sexuality education the students report having received. Chi-square and T-test analysis were used to determine associations between the relevance of sexuality education, the nature of sexuality education and demographic characteristics, as well as associations between students' knowledge of HIV, STIs and HPV and their receipt of sexuality education. Additionally, a thematic analysis of the open-ended qualitative responses was performed to provide additional context to the quantitative results. Findings from the study elucidate students' own perceptions of their school-based sexuality education and provide valuable insight for designing and implementing school-based sexuality education based on students' opinions and needs.

This case study trialled the introduction of a student-response system (Top Hat) in a third-year engineering Fluid Mechanics course (n = 44) to improve student engagement, motivation and cognition. It was recognised that for the potential benefits of student-response systems (SRSs) to be fully realised, more time must be allocated for student engagement and the active learning components of the course. In order to allow sufficient time to fully engage with the SRSs and other classroom activities, traditional lectures were revised and the classroom format was flipped. This paper presents the initial case study results focusing on the use of SRSs. Overall, the new flipped lecture and SRS teaching format demonstrated a substantial increase in the level of student engagement, motivation, active learning and attendance compared to previous cohorts. However, the increased levels of engagement did not appear to reflect on any large increase in students' individual grades.

The study contributes to the understandings of how women negotiate work and family over the life course by investigating what factors impact young women's aspirations for full time, part-time, and other forms of work. Using data from the Australian Longitudinal Study on Women's Health (ALSWH) with its nationally representative sample of Australian women, the authors examine how women moving from their 20s to early 30s change their aspirations for employment (at the age of 35) after significant life events and changes, including the birth of a child. Multinomial logistic regression analyses across two transition periods (N = 7,505 and N = 7,584) showed that changes in employment aspirations co-occurred with movement into marriage or stable relationships and with changes in aspirations for family size. As young women become mothers, or move into situations in which motherhood is likely, many adjusted their employment aspirations away from full-time employment and toward part-time work. The findings suggest a growing awareness of the practical difficulties of balancing paid work and family roles within the current context of work and family policy and practice in Australia. Women's choices are not free of constraints; rather, younger generations of women negotiate work and family life by adjusting and changing their own aspirations within the context and circumstances of their lives. (Contains 3 tables.)

Rates of oral contraceptive pill use have declined over the past decade in Australia. While some women use highly effective methods, others rely on less effective methods such as condoms, withdrawal and fertility awareness. We aimed to understand motivations for relying on these methods among young women in Australia. Women aged 18–23 years who reported using less effective methods and participated in the Contraceptive Use, Pregnancy Intention and Decisions (CUPID) study formed the sample for this analysis. Using thematic analysis, we analysed 140 free-text comments. Findings suggest that less effective methods were used when they were assessed as being best suited to current reproductive needs. These methods were perceived as offering benefits that hormonal and more invasive methods did not, and participants were largely satisfied with them. By contrast, some less effective method use was driven by a lack of choice or alternative options, previous bad experiences with hormonal methods, a lack of appropriate information about alternatives and difficulty accessing other methods. It is therefore essential to move beyond 'LARC-first' contraceptive counselling approaches to ensure young women are provided with accurate information regarding all contraceptive options available (including how to negotiate their use) and how to use them to their greatest efficacy. [ABSTRACT FROM AUTHOR]

Australia has a relatively high proportion of stay-at-home mothers, despite most young women aspiring to combine motherhood with paid work. Using two waves of quantitative data from the 1973–1978 cohort of the Australian Longitudinal Study on Women's Health, and interviews with a subsample of stay-at-home mothers, we aimed to understand the role of agency in women's work–family outcomes and the impact upon their well-being. More than four out of five stay-at-home mothers (83%) had previously aspired to combine motherhood with paid work. There were no differences in mental health scores of stay-at-home mothers according to prior work aspirations. However, stay-at-home mothers had marginally lower life satisfaction, and were more dissatisfied with the progress of their career when they had previously aspired to paid work, compared with unpaid work. Although women described their current situation as a 'choice', their choices were deeply embedded within gendered, social and economic contexts. [ABSTRACT FROM AUTHOR]

Divorce is a life-changing event with financial implications for women. Although large-scale studies have examined the factors associated with financial coping after divorce, little attention has been paid to the lived experience of women over time. In this study, we used mixed methods to examine the financial well-being of divorced women over 20 years from 1996 to 2016. Using data from the Australian Longitudinal Study on Women's Health [ALSWH], we analyzed women's ratings of their ability to manage on available income, and their narrative comments about financial coping over eight waves, beginning in midlife (ages 46–51). The ratings improved over time, particularly as women reached peak career in their 50s or 60s or entered retirement. Despite this upward trajectory, financial strain persisted for ~40% of the cohort who faced poor health or diminishing job prospects. We conclude that, although financial hardship often eases over time, women's early ratings of financial coping predict levels of income security in older age. [ABSTRACT FROM AUTHOR]

Public health responses to the vaccine‐refusal (VR) movement are hindered by inadequate research about the movement's aims, identity and perceived value for its members. This study examined how members of the VR movement in Australia described the movement and what being part of it meant to them. Descriptions of the VR movement by 696 members from across Australia were collected between January and May in 2017 via an online survey. The data were analysed using thematic discourse analysis. Members' understandings of the movement and the beliefs underpinning these understandings were examined. Vaccine refusal was underpinned by distinct epistemic beliefs. Participants believed that mainstream vaccine promotion relies on dishonest communication of compromised research. They saw the VR movement as a science‐based movement, researching both 'mainstream' and 'hidden' knowledge, promoting scientific values and advocating for better vaccine studies. Participants believed responsible parenting requires personally researching healthcare choices. Participants constructed the movement's identity in relation to common criticisms of vaccine refusal. These were discredited and repurposed to portray the movement as being brave and righteous. Participants believed people in the movement are astute, informed, responsible and courageous. They believed many members were impacted by vaccine‐related harms, from which the movement now saves others. They saw themselves as fighting for an inconvenient truth that the mainstream ignores. Vaccine promotion needs to address the epistemic beliefs associated with vaccine refusal, yet these have been inadequately understood. Our findings contribute to understanding these beliefs. Furthermore, our findings suggest what messages targeting vaccine‐refusing people should focus on. This may include acknowledging the significant effort that vaccine‐refusing people invest in trying to protect their children, catering to vaccine‐refusing people's high engagement and desire for detailed information, and avoiding stigmatising or confrontational vaccine‐promotion strategies. [ABSTRACT FROM AUTHOR]

Introduction: Relationships and sexuality education (RSE) for young people in Australia and elsewhere is a contentious topic. While focus has been on sexting practices, curriculum and policy and teachers and schools, few studies have examined how discourses of silencing are reflected in what young people want from their RSE. Methods: Using thematic analysis on 1258 open-ended comments from a 2018 survey of young people and sexual health and a theoretical framework of 'Thick Desire,' this paper explores what students in Australia desire from a RSE program and how they have come to understand those desires. Results: This analysis reveals that young people in Australia understand and are articulate about the gaps in their RSE. Young people are negotiating a 'silencing' of knowledge and education around several important factors and are drawing from broader social, cultural and political influences that shape their experiences. Specifically, young people actively desire a RSE that includes more in-depth information about sexually transmissible infections (STIs) and sexual health issues, programs that are inclusive of diverse genders and sexualities, RSE that is delivered by qualified providers and programs that include discussions concerning relationships, consent and pleasure. Social and Policy Implications: The findings of this study suggest several important policy recommendations to improve RSE education, particularly focusing on the sexual rights of young people, the lack of consistency and clarity in existing RSE national policy and the impact that silencing can have on young people's knowledge and safety in engaging in sexual activity. [ABSTRACT FROM AUTHOR]

Objective. The aim of this study was to evaluate the cost-effectiveness of the Australian Contraceptive ChOice pRoject (ACCORd) intervention. Methods. An economic evaluation compared the costs and outcomes of the ACCORd intervention with usual care (UC). Data from the ACCORd trial were used to estimate costs and efficacy in terms of contraceptive uptake and quality of life. Rates of contraceptive failure and pregnancy were sourced from the literature. Using a Markov model, within-trial resultswere extrapolated over 10 years and subjected to univariate sensitivity analyses. Model outputs were expressed as the cost per quality-adjusted life years (QALY) gained and cost per unintended pregnancy resulting in birth (UPB) avoided. Results. Over 10 years, compared with UC, initiating contraception through the ACCORd intervention resulted in 0.02 fewer UPB and higher total costs (A$2505 vs A$1179) per woman. The incremental cost-effectiveness of the ACCORd intervention versus UC was A$1172 per QALY gained and A$7385 per UPB averted. If the start-up cost of the ACCORd intervention was removed, the incremental cost-effectiveness ratio was A$81 per QALY gained and A$511 per UPB averted. The results were most sensitive to the probability of contraceptive failure, the probability of pregnancyrelated healthcare service utilisation or the inclusion of the costs of implementing the ACCORd intervention. Conclusions. From a health system perspective, if implemented appropriately in terms of uptake and reach, and assuming an implicit willingness to pay threshold of A$50 000 the ACCORd intervention is cost-effective. [ABSTRACT FROM AUTHOR]

Background: The Australian Contraceptive ChOice pRoject (ACCORd) aimed to assess the impact of a complex general practice intervention on the uptake of long‐acting reversible contraceptives (LARC). Aims: Using survey data from enrolled women, we aimed to compare the ongoing use and satisfaction of women who chose one of the hormonal LARC methods including the levonorgestrel intrauterine system (LNG‐IUS) or levonorgestrel implant compared to the oral contraceptive pill (OCP). Materials and Methods: We used the data from participants' baseline, six and 12‐month surveys to identify new users of implants, LNG‐IUS or OCP. We included demographic information, ongoing use of the contraceptive method, reasons for dissatisfaction and discontinuation and experience of side‐effects. Proportions were compared using χ2 tests. Results: Of the 740 women enrolled in ACCORd, 176 started using a hormonal LARC or OCP in the study's first six months with 76 using the IUS (43%), 60 the implant (34%) and 40 (23%) the OCP. Twelve‐month continuation rates for the LNG‐IUS, implant and OCP were 93, 83 and 65% respectively (P < 0.001). Satisfaction was highest among the LNG‐IUS users; 86% were very/somewhat satisfied compared to 75% of implant users and 61% of OCP users (P < 0.001). Main reasons for method dissatisfaction were irregular bleeding and mood changes which were similar for all methods. Conclusions: This study provides further evidence that hormonal LARC methods have higher continuation and satisfaction rates compared to the OCP with similar side‐effects. Since hormonal LARC methods have the highest contraceptive efficacy, these should be offered first‐line to women. [ABSTRACT FROM AUTHOR]

Women's coping strategies may be affected by many factors, including their health and wellbeing, their social roles, and the broader environment. While the coping strategies of vulnerable women have been studied, little qualitative research has focussed on how women from the general population cope with their difficulties. The aim of this paper is to explore difficulties and coping strategies among Australian women. Women's perspectives on their ways of coping with the difficulties they had faced in their lives were thematically analysed from semi-structured telephone interviews with 36 women purposively sampled from over 7,000 women from the 1973-78 cohort of the Australian Longitudinal Study on Women's Health. Difficulties were identified with health, relationships, finances, and work/study. Coping strategies included using resources, support from others, lifestyle strategies, and cognitive strategies. It is helpful for psychiatric mental health nurses and other health professionals to understand women's coping strategies in order to better support women experiencing difficulties. [ABSTRACT FROM AUTHOR]

CONTEXT: Unintended pregnancy is common among young women. Understanding how such women use contraceptives— including method combinations—is essential to providing high‐quality contraceptive care. METHODS: Data were from a representative cohort of 2,965 Australian women aged 18–23 who participated in the 2012–2013 Contraceptive Use, Pregnancy Intention and Decisions baseline survey, had been heterosexually active in the previous six months, and were not pregnant or trying to conceive. Latent class analysis was employed to characterize women's contraceptive choices; multinomial logistic regression was used to evaluate correlates of membership in the identified classes. RESULTS: The vast majority of women (96%) reported using one or more contraceptives, most commonly short‐acting hormonal methods (60%), barrier methods (38%), long‐acting contraceptives (16%) and withdrawal (15%). In total, 32 combinations were reported. Four latent classes of method use were identified: no contraception (4% of women); short‐acting hormonal methods with supplementation (59%, mostly the pill); high‐efficacy contraceptives with supplementation (15%, all long‐acting reversible contraceptive users); and low‐efficacy contraceptive combinations (21%); supplementation usually involved barrier methods or withdrawal. Class membership differed according to women's characteristics; for example, women who had ever been pregnant were more likely than other women to be in the no‐contraception, high‐efficacy contraceptive or low‐efficacy contraceptive combination classes than in the short‐acting hormonal contraceptive class (odds ratios, 2.0‐3.0). CONCLUSIONS: The complexity of women's contraceptive choices and the associations between latent classes and such characteristics as pregnancy history highlight the need for individualized approaches to pregnancy prevention and contraceptive care. [ABSTRACT FROM AUTHOR]

Most people living with HIV (PLHIV) with reliable access to antiretroviral treatment (ART) have a life expectancy similar to uninfected populations. Despite this, HIV can negatively affect their social and psychological wellbeing. This study aimed to enhance understanding of the expectations PLHIV hold for HIV cure research and the implications this has for HIV cure research trials. We interviewed 20 Australian PLHIV about their expectations for HIV cure research outcomes and the impact a potential cure for HIV may have on their everyday lives. Data were analysed thematically, using both inductive and deductive approaches. The significance of a cure for HIV was expressed by participants as something that would offer relief from their sense of vigilance or uncertainty about their health into the future. A cure was also defined in social terms, as alleviation from worry about potential for onward HIV transmission, concerns for friends and family, and the negative impact of HIV-related stigma. Participants did not consider sustained medication-free viral suppression (or remission) as a cure for HIV because this did not offer certainty in remaining virus free in a way that would alleviate these fears and concerns. A cure was seen as complete elimination of HIV from the body. There is an ethical need to consider the expectations of PLHIV in design of, and recruitment for, HIV cure-related research. The language used to describe HIV cure research should differentiate the long-term aspiration of achieving complete elimination of HIV from the body and possible shorter-term therapeutic advances, such as achieving medication free viral suppression. [ABSTRACT FROM AUTHOR]

Having children compels parents to examine their vaccine beliefs, particularly if they are vaccine-hesitant or refuse all vaccines. Presently, little is known about the specific ways in which having children influences the vaccine beliefs of parents. This research examined how having children changed the attitudes of Australian vaccine-hesitant and vaccine-refusing parents towards childhood vaccination. We asked 904 Australian parents who believed that having children changed their attitudes to vaccination to describe these changes. Parents' responses were inductively, iteratively coded and thematically analysed. Themes were compared between parents who believed all vaccines should be refused, parents with varying degrees of vaccine hesitancy, and parents who were fully vaccine-accepting. Low numbers of responses from fully vaccine-accepting parents meant that this paper focused on mostly vaccine-hesitant and vaccine-refusing vaccine parents. Five themes were identified. Having children prompted all parents to learn about vaccine choices. Hesitant and refusing parents' interpreted vaccine choices through a lens of distrust of pharmaceutical companies and regulatory bodies overseeing vaccine safety. The distrust fuelled parents' fears about vaccination risks, such as side effects. Parents became concerned about the scheduled timing of vaccinations, particularly of the Hepatitis B vaccine. Parents among the three groups that believed some or all vaccines should be refused reported that a vaccine permanently injured their child. This research contributes to understanding how having children affects the vaccine attitudes among vaccine-hesitant and vaccine-refusing parents. Greater support for parents with negative vaccination experiences may prevent hesitant attitudes. The vaccination schedule needs to be communicated to parents better. [ABSTRACT FROM AUTHOR]

Objectives: Hepatitis B is a viral infection primarily affecting people from culturally diverse communities in Australia. While vaccination prevents infection, there is increasing mortality resulting from liver damage associated with chronic infection. Deficits in the national policy and clinical response to hepatitis B result in a low diagnosis rate, inadequate testing and diagnosis processes, and poor access to hepatitis B treatment services. While research identifies inadequate hepatitis B knowledge among people with the virus and primary health care workers, this project sought to identify how specialist clinicians in Australia negotiate cultural diversity, and provide often complex clinical information to people with hepatitis B. Design: A vignette was developed and presented to thirteen viral hepatitis specialist clinicians prior to an electronically recorded interview. Recruitment continued until saturation of themes was reached. Data were thematically coded into themes outlined in the interview schedule. Ethical approval for the research was provided by the La Trobe University Human Research Ethics Committee. Results: Key messages provided to patients with hepatitis B by clinical specialists were identified. These messages were not consistently provided to all patients with hepatitis B, but were determined on perceptions of patient knowledge, age and highest educational level. While the vignette stated that English was not an issue for the patient, most specialists identified the need for an interpreter. Combating stigma related to hepatitis B was seen as important by the specialists and this was done through normalising the virus. Having an awareness of different cultural understandings about hepatitis B specifically, and health and well-being generally, was noted as a communication strategy. Conclusion: Key core competencies need to be developed to deliver educational messages to people with hepatitis B within clinical encounters. The provision of adequate resources to specialist clinics will assist in addressing gaps in the clinical response to hepatitis B. [ABSTRACT FROM AUTHOR]

Aboriginal and Torres Strait Islander peoples are disproportionately affected by hepatitis C, an infection that is curable with direct acting antivirals (DAAs). The Australian Government funded access to DAAs from March 2016 for all people with hepatitis C, with primary care physicians, along with clinical specialists, permitted to prescribe these treatments. The Victorian Aboriginal Health Service, in recognising the effect of liver disease from viral hepatitis within their community, and of the increased availability to DAAs, established a Liver Clinic to facilitate access to treatment for people attending the service. This study conducted semi-structured interviews to document the health service provider perspectives on the barriers and enablers to treatment; explored patients' experiences of hepatitis C treatment and cure; and sought to identify possible health system-level changes to facilitate increased access and uptake of treatment by Aboriginal people. The study found the success of the clinic was supported by the multidisciplinary and accessible nature of the health service, and the relationships built over time between clinic staff and people with, or at risk of, hepatitis C. For those treated, the individual effect of the cure not only eliminated the hepatitis C virus, but reduced shame and increased broader social participation. [ABSTRACT FROM AUTHOR]

Hepatitis C is a global public health issue affecting 150-170 million people worldwide, and over 227,000 Australians with an increasing morbidity resulting from the infection. The Australian Government funded access through the national health scheme to Direct Acting Antiviral (DAA) medication for all people with hepatitis C, regardless of disease staging or mode of transmission to eradicate hepatitis C in Australia. The availability of these drugs not only alters the end result of hepatitis C treatment from that of sustained viral response to cure, but necessitates a refocusing of the public health response to hepatitis C. This project, conducted prior to this funding announcement, interviewed key stakeholders in Australia to investigate the potential impact of DAAs on individuals with hepatitis C and their public health implications. The findings include that while DAAs are revolutionary, there remains essential barriers to their uptake including stigma and discrimination, and a lack of attention to the systematic implementation of the cure. [ABSTRACT FROM AUTHOR]

Participation in HIV cure-related clinical trials that involve antiretroviral treatment (ART) interruption may pose substantial individual risks for people living with HIV (PLHIV) without any therapeutic benefit. As such, it is important that the views of PLHIV are considered in the design of HIV cure research trials. Examining the lived experience of PLHIV provides unique and valuable perspectives on the risks and benefits of HIV cure research. In this study, we interviewed 20 PLHIV in Australia about their knowledge and attitudes toward clinical HIV cure research and explored their views regarding participation in HIV cure clinical trials, including those that involve ART interruption. Data were analysed thematically, using both inductive and deductive coding techniques, to identity themes related to perceptions of HIV cure research and PLHIV’s assessment of the possible risks and benefits of trial participation. Study findings revealed interviewees were willing to consider participation in HIV cure research for social reasons, most notably the opportunity to help others. Concerns raised about ART interruption related to the social and emotional impact of viral rebound, including fear of onward HIV transmission and anxiety about losing control. These findings reveal the ways in which PLHIV perspectives deepen our understanding of HIV cure research, moving beyond a purely clinical assessment of risks and benefits in order to consider the social context. [ABSTRACT FROM AUTHOR]

Introduction: Addiction is increasingly defined as a "brain disease" caused by changes to neurochemistry. While nicotine addiction has historically been excluded in the brain disease model of addiction (BDMA), it is beginning to be labeled a chronic brain disease. We investigated whether Australian smokers endorse brain-based explanations of smoking, and whether these beliefs are associated with quitting self-efficacy or treatment intentions.Method: Cross-sectional study of Australian smokers (N = 1538) who completed a survey measuring their agreement with statements on the brain's role in smoking. Logistic regressions tested associations between these items and socio-demographic variables, quitting self-efficacy and intention to use cessation medications.Results: The majority (57.9%) agreed that smoking changed brain chemistry and 34.4% agreed that smoking was a brain disease. Younger participants and those with more education were more likely to endorse brain-based understandings of smoking. Participants who agreed smoking changed brain chemistry were more likely to report an intention to use cessation medicines (OR 1.5, 95% CI = 1.0-2.2) as were those who agreed that smoking was a brain disease (OR 1.5, 95% CI = 1.1-2.1). Self-efficacy did not differ between those who agreed and disagreed that smoking changed brain chemistry. However, those who agreed that smoking was a brain disease had higher self-efficacy than those who disagreed (OR 1.7, 95% CI = 1.3-2.3).Conclusion: A neurobiological view of smoking does not dominate public understandings of smoking in Australia. Endorsement of neurobiological explanations of smoking were associated with increased intention to use cessation aids, but were not associated with reduced self-efficacy.Implications: Explaining tobacco dependence in neurobiological terms is unlikely to induce feelings of fatalism in relation to smoking cessation. Those who endorse biomedical explanations of smoking may be more open to using cessation pharmacotherapies. Describing smoking in terms of alterations in brain chemistry may be more acceptable to smokers than labeling smoking a "brain disease" or "brain disorder." [ABSTRACT FROM AUTHOR]

The benefits of nationally coordinated schemes to manage the introduction of new (SQIDs) have been acknowledged in various countries. This review compares the existing frameworks used in Australia, Austria, Germany, New Zealand, Switzerland, and the United States. The review describes the framework and structure of each system, and their individual components are presented. The Australian and New Zealand protocols have yet to be formally adopted and remain largely untested. The Australian and New Zealand protocols are compared with successfully established processes operating in Austria, Germany, Switzerland, and the United States. Adequate resourcing of administrative processes and having the technical capability to review test results were found to be a critical component of the successfully adopted certification schemes. Based on the level of success of the introduction of alternative certification systems, the most successful have been integrated into the formal legislative frameworks found in each country. The creation of a successful SQID certification pathway in Germany has been driven by the implementation of new fees on the release of stormwater from private property, with exemptions where stormwater is actively managed at source. The review presented in this paper may be of benefit to countries considering the development of their own SQID evaluation and verification protocols. [ABSTRACT FROM AUTHOR]

Background: Access to most contraceptives in Australia requires a prescription from a doctor, and it has been shown that doctors can influence women's decision-making with respect to contraception. However, little research has documented how women experience their interactions with doctors within the context of a contraceptive consultation. Understanding such experiences may contribute to our knowledge of factors that may influence women's contraceptive decisions more broadly. Methods: We report on findings from the Contraceptive Use, Pregnancy Intentions and Decisions (CUPID) survey of young Australian women, a large-scale longitudinal study of 3,795 women aged 18-23 years. We performed a computer-assisted search for occurrences of words that indicated an interaction within the 1,038 responses to an open-ended question about contraception and pregnancy. We then applied a combination of conventional and summative content analysis techniques to the 158 comments where women mentioned an interaction about contraception with a doctor. Results: Our analysis showed that women desire consistent and accurate contraception information from doctors, in addition to information about options other than the oral contraceptive pill. Some young women reported frustrations about the choice limitations imposed by doctors, perceived by these women to be due to their young age. Several women expressed disappointment that their doctor did not fully discuss the potential side-effects of contraceptives with them, and that doctors made assumptions about the woman's reasons for seeking contraception. Some women described discomfort in having contraception-related discussions, and some perceived their doctor to be unsupportive or judgmental. Conclusions: Both the content and the process of a contraceptive consultation are important to young Australian women, and may be relevant contributors to their choice and ongoing use of a contraceptive method. These findings provide useful insights into aspects of the patient-provider interaction that will enhance the efficacy of the contraceptive consultation. It is recommended that doctors adopt patient-centred, shared decision-making strategies to support women in making choices about contraception that suit their individual circumstances. We also acknowledge the need to involve other health care providers, other than doctors, in educating, informing, and assisting women to make the best contraceptive choice for themselves. [ABSTRACT FROM AUTHOR]

Floating treatment wetland (FTW) systems are an innovative stormwater treatment technology currently being trialled in Australia. FTWs provide support for selected plant species to remove pollutants from stormwater discharged into a storage basin. The plant roots provide large surface areas for biofilm growth, which serves to trap suspended particles and enable the biological uptake of nutrients. FTWs can be installed at the start of the construction phase and can therefore start treating construction runoff almost immediately. FTWs have the potential to provide a full range of stormwater runoff treatment (e.g. sediment and nutrient removal) from the construction phase onwards. A 101 m2 FTWs has been installed within a greenfield development site on the Sunshine Coast, in Australia. The two-year research study investigated the pollution removal performance of the FTW for two different locations, one with low and one with moderate influent pollutant concentrations. This paper presents the research methodology used, and the initial study results of the treatment efficiency of FTWs. [ABSTRACT FROM AUTHOR]

Current international targets aim for 90% of people diagnosed with HIV to be on antiretroviral treatment (ART). This paper aims to identify sociodemographic and attitudinal factors associated with ART non-use over time in three samples of Australian people living with HIV (PLHIV). Data for this paper were derived from an Australian cross-sectional survey of PLHIV that was repeated at three different time points: 1997, 2003, and 2012. There were approximately 1000 respondents to each survey (n = 3042 in total). The survey included approximately 250 items related broadly to health and well-being, ART use, and attitudes towards ART use. Univariate and multivariate logistic regression analyses were used. While the proportion of participants using ART increased between 1997 and 2012 (78.8–87.6%,p < .001), there was a decrease between 1997 and 2003 to 70.6% (p < .001). Factors linked to ART non-use remained steady over those 15 years. In all cohorts, people less likely to be using ART were younger and had a more recent diagnosis of HIV. In 2003 and 2012, people in full-time employment were less likely to be using ART, while those whose main source of income was a pension or social security were more likely to be using ART. Multivariate models showed that, at each time point, a belief in the health benefits of delayed ART uptake was associated with non-use. These findings suggest that there may be barriers to ART uptake that have persisted over time despite changes to clinical guidelines that now encourage early uptake. [ABSTRACT FROM PUBLISHER]

Study Question: Do young women with polycystic ovary syndrome (PCOS) or endometriosis report more psychological distress than their peers without a history of these conditions?Summary Answer: Young women (aged 18-23 years) with PCOS or endometriosis had a greater risk of moderate to severe psychological distress than women without a history of these conditions.What Is Known Already: Psychological distress appears common among women with PCOS and endometriosis. However, population-based studies that examine the psychological outcomes for adolescents and young women are generally absent from the literature.Study Design, Size, Duration: This is a secondary analysis of data collected from 17 015 young, Australian women participating in a national, longitudinal cohort study. Women were first surveyed in 2012-2013 when they were aged 18-23 years. In 2014, women completed the second survey when they were aged 19-24 years and 11324 (67%) women responded.Participants/materials, Setting, Methods: We analysed data from 11 238 women who participated in both Surveys 1 and 2 and who responded to questions about PCOS and endometriosis. Using logistic regression, we compared the odds of moderate to severe psychological distress at Surveys 1 and 2 for women reporting a recent diagnosis (within the last 12 months) of PCOS or endometriosis and women with a pre-existing diagnosis, with that for women without a history of these conditions.Main Results and the Role Of Chance: At Survey 2, around 60% of women reporting a diagnosis of PCOS or endometriosis had moderate to severe levels of psychological distress. Compared to women without a history of these conditions, the odds of moderate to severe psychological distress at Survey 2 were significantly higher for women recently diagnosed with PCOS [Adjusted Odds Ratio (AOR) = 1.62, 95% CI = 1.21-2.18] or endometriosis (AOR= 1.77; 95% CI = 1.20-2.63) and for women with a pre-existing diagnosis of PCOS (AOR = 1.57, 95% CI = 1.30-1.89) or endometriosis (AOR = 1.61; 95% CI = 1.26-2.06). Women recently diagnosed with PCOS or endometriosis also had a greater likelihood of moderate to severe distress in the year prior to their diagnosis. The association between PCOS and psychological distress was attenuated when adjusting for BMI, but hormonal contraceptive use did not attenuate the risk of distress among the women with PCOS or endometriosis.Limitations, Reasons For Caution: All data were self-reported and, therefore, the diagnoses of PCOS or endometriosis were not confirmed by a medical practitioner.Wider Implications Of the Findings: Health professionals should be aware of the potential psychosocial and healthcare needs among young women with these conditions, particularly women with PCOS who are obese. While hormonal contraceptives may help to regulate the hormonal aspects of these conditions, they do not appear to reduce women's psychological distress. Because psychological distress among the young women in this study remained elevated even after diagnosis, this supports the need for multidisciplinary health care to help women adjust to their diagnosis and treatment regimens and facilitate positive, long-term mental health outcomes. Future research that examines medical and psychosocial sources of distress for young women with PCOS and endometriosis is needed.Study Funding/competing Interests: I.J.R. was supported by an Australian National Health and Medical Research Council Centre for Research Excellence (grant number: APP1000986). G.D.M. is funded by the Australian Research Council Future Fellowship (FT120100812). The Australian Longitudinal Study on Women's Health is funded by the Australian Government Department of Health. H.T. is supported by an Australian National Health and Medical Research Council Practitioner Fellowship. The authors declare that no competing interests exist.Trial Registration Number: N/A. [ABSTRACT FROM AUTHOR]

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Recruitment of young people for epidemiologic research remains challenging, with marked decreases in the effectiveness of face-to-face, mail, and telephone recruitment methods. We report on the implementation and feasibility of an innovative and flexible approach used to recruit participants for a longitudinal cohort study about contraceptive use and pregnancy (the Contraceptive Use, Pregnancy Intention, and Decisions (CUPID) Study). Australian women aged 18-23 years were recruited using a range of online, networking, and offline methods, including social media (primarily Facebook (Facebook Inc., Menlo Park, California; http://www.facebook.com)), faceto- face events, distribution of promotional material, and media releases. Over the course of the 1-year recruitment period (beginning in September 2012), a total of 3,795 eligible women were recruited to complete the online survey, at a cost of approximately A$11 per participant. This sample was found to be broadly representative of the Australian population of women aged 18-23 years in terms of demographic characteristics, with the exception of an over representation of tertiary-educated women (88.7% compared with 72.6%). This study demonstrated that although current recruitment strategies are required to be innovative and flexible in order to engage young people in epidemiologic research, representative samples can be achieved online at reasonable cost. [ABSTRACT FROM AUTHOR]

The oral contraceptive pill remains the most widely used contraceptive method. We consider The Pill’s depiction as variously revolutionary and liberating, oppressive for women, and more recently, a ‘lifestyle drug’. Drawing on discourses of (hetero)sex, heterosexuality and gender performance, we discuss how contraceptive use has been feminised and consider the current gap in understanding how women negotiate their positioning as responsible for contraception. To begin to fill this gap, we conducted a thematic discourse analysis using 75 free-text responses (to a general question in a wider contraceptive survey) to explore how women account for their agency and responsibility in discussions of accessing contraception. We identified two themes: responsibility for education and information and ‘finding contraceptive fit’. Women’s discussions of responsibility for education and information highlight the need for transparency from educational bodies, which are positioned as lacking in their delivery of contraceptive information. Women describe “finding contraceptive fit” as an embodied process of experimentation with contraception to ultimately find one with minimal negative side effects. We situate our findings within critiques of the gendered nature and production of health, conceptualising contraceptive use as a distinctly feminine practice, which promotes self-surveillance and embodied awareness. [ABSTRACT FROM PUBLISHER]

Objective A comprehensive life course perspective of women's experiences in obtaining and using contraception in Australia is lacking. This paper explores free-text comments about contraception provided by women born between 1973 and 1978 who participated in the Australian Longitudinal Study on Women's Health (ALSWH). Methods The ALSWH is a national population-based cohort study involving over 40,000 women from three age groups, who are surveyed every three years. An initial search identified 1600 comments from 690 women across five surveys from 1996 (when they were aged 18-23 years) to 2009 (31-36 years). The analysis included 305 comments from 289 participants. Factors relating to experiences of barriers to access and optimal contraceptive use were identified and explored using thematic analysis. Results Five themes recurred across the five surveys as women aged: (i) side effects affecting physical and mental health; (ii) lack of information about contraception; (iii) negative experiences with health services; (iv) contraceptive failure; and (v) difficulty with accessing contraception. Conclusion Side effects of hormonal contraception and concerns about contraceptive failure influence women's mental and physical health. Many barriers to effective contraception persist throughout women's reproductive lives. Further research is needed into reducing barriers and minimising negative experiences, to ensure optimal contraceptive access for Australian women. [ABSTRACT FROM AUTHOR]

This paper examines how the relationships between the factors (predisposing, enabling and illness) of the 1973 Andersen framework and service use are influenced by changes in the caring role in older women of the 1921–26 cohort of the Australian Longitudinal Study on Women's Health. Outcome variables were the use of three formal community support services: (a) nursing or community health services, (b) home-making services and (c) home maintenance services. Predictor variables were survey wave and the following carer characteristics: level of education, country of birth, age, area of residence, ability to manage on income, need for care, sleep difficulty and changes in caring role. Carer changes were a significant predictor of formal service use. Their inclusion did not attenuate the relationship between the Andersen framework factors and service use, but instead provided a more complete representation of carers' situations. Women were more likely to have used support services if they had changed into or out of co-resident caring or continued to provide co-resident care for a frail, ill or disabled person, needed care themselves, and reported sleep difficulties compared with women who did not provide care. These findings are important because they indicate that support services are particularly relevant to women who are changing their caring role and who are themselves in need of care. [ABSTRACT FROM PUBLISHER]

This study describes field investigations designed to compare the infiltration capacities of 55 permeable pavement systems installed in the Netherlands and in Australia. The ages of the pavements varied from 1 to 12 years. Using infiltrometer testing, the performance of the pavements has been compared in terms of their ability to infiltrate a three month average recurrence interval storm event in the case of the Australian pavements or the minimum specification for European infiltration capacities of 97.2 mm/h for the Dutch pavements. Many of the tested pavements broadly follow a hypothetical decay curve of infiltration rate with age of pavement. However, these are clustered into two distinct groups (Dutch and Australian) with the older Australian pavements appearing to maintain higher infiltration rates relative to their age. The study has shown that the performance of the clogged permeable pavement systems was still generally acceptable, even after many years in service. [ABSTRACT FROM AUTHOR]

Introduction and Aims Recent, high profile articles in leading science journals have claimed that the enhancement use of prescription stimulants is a common practice among students worldwide. This study provides empirical data on Australian university students' perceptions of: (i) the prevalence of prescription stimulant use by their peers for cognitive enhancement; (ii) motivations for such use; (iii) efficacy; and (iv) its safety. Design and Methods Participants were 19 Australian university students with an average age of 24 who were recruited through emails lists, notice board posters and snowball sampling. Semi-structured interviews were conducted during 2010 and 2011, recordings transcribed and responses coded using thematic analysis. Results Participants typically did not believe the use of stimulants for cognitive enhancement was common in Australia. Perceived motivations for use included: (i) 'getting ahead' to perform at high levels; (ii) 'keeping up' as a method of coping; and (iii) 'going out' so that an active social life could be maintained in the face of study demands. Australian students were generally sceptical about the potential benefits of stimulants for cognitive enhancement and they identified psychological dependence as a potential negative consequence. Discussion and Conclusions This study is an important first step in understanding the use of stimulants for cognitive enhancement in Australia, amid calls for more widespread use of cognitive enhancing drugs. It is important to conduct further studies of the extent of cognitive enhancement in Australia if we are to develop appropriate policy responses. [ABSTRACT FROM AUTHOR]

This longitudinal study examined characteristics of women diagnosed with sexually transmitted infections (STI) for the first time in their later 20s and early 30s. Participants were 6,840 women (born 1973-1978) from the Australian Longitudinal Study on Women's Health. Women aged 18-23 years were surveyed in 1996 (S1), 2000 (S2), 2003 (S3), and 2006 (S4). There were 269 women reporting an STI for the first time at S3 or S4. Using two multivariable logistic regression analyses (examining 18 predictor variables), these 269 women were compared (1) with 306 women who reported an STI at S2 and (2) with 5,214 women who never reported an STI across the four surveys. Women who reported an STI for the first time at S3 or S4 were less likely to have been pregnant or had a recent Pap smear compared to women reporting an STI at S2. Women reporting a first STI at S3 or S4 were less likely to have been pregnant or had a recent Pap smear compared to women reporting an STI at S2. Women were more likely to report an STI for the first time at S3 or S4 compared to women not reporting an STI at any survey if they were younger, unpartnered, had a higher number of sexual partners, had never been pregnant, were recently divorced or separated, and reported poorer access to Women's Health or Family Planning Centres at S2. These findings demonstrate the value of longitudinal studies of sexual health over the life course beyond adolescence. [ABSTRACT FROM AUTHOR]

Background: This article compares public attitudes toward the use of prescription drugs for cognitive enhancement with the use of performance enhancing drugs in sport. We explore attitudes toward the acceptability of both practices; the extent to which familiarity with cognitive enhancement is related to its perceived acceptability; and relationships between the acceptability of cognitive enhancement and legalized doping in sport. Methods: A survey was administered through a computer-assisted telephone interviewing system to members of the Australian general public aged 18–101 years in the state of Queensland. Results: Of 1,265 participants, 7% agreed that cognitive enhancement is acceptable; 2.4% of the total sample said they had taken prescription drugs to enhance their concentration or alertness in the absence of a diagnosed disorder, and a further 8% said they knew someone who had done so. These participants were twice as likely to think cognitive enhancement was acceptable. Only 3.6% of participants agreed that people who play professional sport should be allowed to use performance-enhancing drugs if they wanted to. Participants who found cognitive enhancement acceptable were 9.5 times more likely to agree with legalized doping. Conclusions: Policies that facilitated the use of prescription drugs by healthy people for cognitive enhancement or permitted performance-enhancing drugs in sport would be at odds with the attitudes of the vast majority of our participants. Furthermore, our findings do not support media claims that the use of prescription drugs for cognitive enhancement is widespread in all sectors of society. [ABSTRACT FROM PUBLISHER]

STUDY QUESTION What is the self-reported use of in vitro fertilization (IVF) and ovulation induction (OI) in comparison with insurance claims by Australian women aged 28–36 years? SUMMARY ANSWER The self-reported use of IVF is quite likely to be valid; however, the use of OI is less well reported. WHAT IS KNOWN AND WHAT THIS PAPER ADDS Population-based research often relies on the self-reported use of IVF and OI because access to medical records can be difficult and the data need to include sufficient personal identifying information for linkage to other data sources. There have been few attempts to explore the reliability of the self-reported use of IVF and OI using the linkage to medical insurance claims for either treatment. STUDY DESIGN This prospective, population-based, longitudinal study included the cohort of women born during 1973–1978 and participating in the Australian Longitudinal Study on Women's Health (ALSWH) (n = 14247). From 1996 to 2009, participants were surveyed up to five times. PARTICIPANTS AND SETTING Participants self-reported their use of IVF or OI in two mailed surveys when aged 28–33 and 31–36 years (n = 7280), respectively. This study links self-report survey responses and claims for treatment or medication from the universal national health insurance scheme (i.e. Medicare Australia). MAIN RESULTS AND THE ROLE OF CHANCE Comparisons between self-reports and claims data were undertaken for all women consenting to the linkage (n = 3375). The self-reported use of IVF was compared with claims for OI for IVF (Kappa, K = 0.83), oocyte collection (K = 0.82), sperm preparation (K = 0.83), intracytoplasmic sperm injection (K = 0.40), fresh embryo transfers (K = 0.82), frozen embryo transfers (K = 0.64) and OI for IVF medication (K = 0.17). The self-reported use of OI was compared with ovulation monitoring (K = 0.52) and OI medication (K = 0.71). BIAS, CONFOUNDING AND OTHER REASONS FOR CAUTION There is a possibility of selection bias due to the inclusion criteria for participants in this study: (1) completion of the last two surveys in a series of five and (2) consent to the linkage of their responses with Medicare data. GENERALIZABILITY TO OTHER POPULATIONS The results are relevant to questionnaire-based research studies with infertile women in developed countries. STUDY FUNDING/COMPETING INTEREST(S) ALSWH is funded by the Australian Government Department of Health and Ageing. This research is funded by a National Health and Medical Research Council Centre of Research Excellence grant. TRIAL REGISTRATION NUMBER None. [ABSTRACT FROM AUTHOR]

BackgroundTobacco smoking and poor mental health are both prevalent and detrimental health problems in young women. The temporal relationship between the two variables is unclear. We investigated the prospective bi-directional relationship between smoking and mental health over 13 years.MethodParticipants were a randomly selected community sample of 10 012 young women with no experience of pregnancy, aged 18–23 years at baseline (1996) from the Australian Longitudinal Study on Women's Health. Follow-up surveys over 13 years were completed in 2000, 2003, 2006 and 2009, allowing for five waves of data. Measures included self-reported smoking and mental health measured by the Mental Health Index from the 36-item short-form health questionnaire and the 10-item Center for Epidemiologic Studies Depression Scale. Sociodemographic control variables included marital status, education level and employment status.ResultsA strong cross-sectional dose–response relationship between smoking and poor mental health was found at each wave [odds ratio (OR) 1.41, 95% confidence intervals (CI) 1.17–1.70 to OR 2.27, 95% CI 1.82–2.81]. Longitudinal results showed that women who smoked had 1.21 (95% CI 1.06–1.39) to 1.62 (95% CI 1.24–2.11) times higher odds of having poor mental health at subsequent waves. Women with poor mental health had 1.12 (95% CI 1.17–1.20) to 2.11 (95% CI 1.68–2.65) times higher odds of smoking at subsequent waves. These results held after adjusting for mental health history and smoking history and sociodemographic factors. Correlation analysis and structural equation modelling results were consistent in showing that both directions of the relationship were statistically significant.ConclusionsThe association between poor mental health and smoking in young women appeared to be bi-directional. [ABSTRACT FROM PUBLISHER]

Abstract: Background: Women change contraception as they try to conceive, space births, and limit family size. This longitudinal analysis examines contraception changes after reproductive events such as birth, miscarriage or termination among Australian women born from 1973 to 1978 to identify potential opportunities to increase the effectiveness of contraceptive information and service provision. Methods: Between 1996 and 2009, 5,631 Australian women randomly sampled from the Australian universal health insurance (Medicare) database completed five self-report postal surveys. Three longitudinal logistic regression models were used to assess the associations between reproductive events (birth only, birth and miscarriage, miscarriage only, termination only, other multiple events, and no new event) and subsequent changes in contraceptive use (start using, stop using, switch method) compared with women who continued to use the same method. Results: After women experienced only a birth, or a birth and a miscarriage, they were more likely to start using contraception. Women who experienced miscarriages were more likely to stop using contraception. Women who experienced terminations were more likely to switch methods. There was a significant interaction between reproductive events and time indicating more changes in contraceptive use as women reach their mid-30s. Conclusion: Contraceptive use increases after the birth of a child, but decreases after miscarriage indicating the intention for family formation and spacing between children. Switching contraceptive methods after termination suggests these pregnancies were unintended and possibly due to contraceptive failure. Women’s contact with health professionals around the time of reproductive events provides an opportunity to provide contraceptive services. [Copyright &y& Elsevier]

Abstract: A number of biogerontologists have expressed an interest in intervening in the ageing process in order to extend the human life span. This study explored the attitudes of members of the Australian public towards the potential development and use of life-extension technologies and their attitudes towards the ethical, social and personal implications of life extension. Participants were presented with a vignette outlining the prospect of a “life-extension pharmaceutical” that could increase maximum life span by slowing the ageing process. While 65% supported such research, only 35% said that they would use a life-extension technology if one became available. Men were more supportive of research and more disposed to use life-extension technologies than women. Concerns about the potential ethical, social and personal implications predicted levels of overall support for, and intention to use, life-extension technologies. Our survey suggests that public attitudes towards life extension are neither overwhelmingly “pro” or “con” and in fact more nuanced than either proponents or opponents of life extension have often assumed. [Copyright &y& Elsevier]

Interpretation of changes in health and health care utilization patterns across the life span depends on an understanding of the effects of age, period, and cohort. The purpose of this article is to illustrate differences among three generations of women in demographic factors, health risk factors, and health status indicators from 1996 to 2008. The article examines data from the Australian Longitudinal Study on Women’s Health, a broad-ranging project funded by the Australian Government Department of Health and Ageing (DoHA) and involving three age groups of women (born in the periods 1973—1978, 1946—1951, and 1921—1926) who were first surveyed in 1996 and will be surveyed every 3 years until at least 2015. Patterns in selected demographic factors (marital status and level of educational qualification), health risk factors (smoking, alcohol consumption, physical activity, and body mass index [BMI]), and health status indicators (asthma, hypertension, diabetes and depression; physical functioning and mental health scores from the SF-36) were examined to illustrate examples of biological age, generational differences, or period effects that affect all age groups and generations simultaneously. The results can be used to inform the development of responsive and effective models for both prevention and management of chronic disease, including health and aged-care systems that will meet the needs of different generations of women across their life span. [ABSTRACT FROM PUBLISHER]