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Understanding the school nurse's experience in human papillomavirus (HPV) vaccine promotion can reduce vaccine disparities. HPV vaccination is critical to cancer prevention. Despite the importance of the school nurse in vaccine promotion, there is a lack of understanding. This article aims to examine the knowledge, attitude, experience, and role of school nurses related to HPV vaccination and promotion in school settings. A systematic search for school nurses and their experiences related to HPV vaccination was conducted. A thematic synthesis was undertaken using the socioecological model. This review highlights the complexity of HPV vaccine promotion in schools over time. Multilevel factors impact nursing practice. Nurses have good vaccine knowledge and positive attitudes. Poor workflow processes, competing demands, and vaccine communication challenge school nurses. The themes that were synthesized informed the LEADS model. With the support of school nurses, reaching the goal of eliminating cervical cancer as a public health problem is possible.

Teachers are responsible for children at school during peak ultraviolet (UV) times of the day. It is paramount that teachers have knowledge and understanding of UV to effectively protect themselves and their students. The aim of this pilot study was to investigate the effect of a short intervention on preservice teachers' sun protective behaviours, knowledge and perceived skill to teach sun safety. Participants (n =161; median age=20 years) attended a 45-minute preservice teacher sun safety intervention and completed pre- and post-test surveys. Post-intervention, most participants indicated they felt: (1) more informed about the dangers of UV and risks of developing skin cancer (93.3%); (2) more knowledgeable about the importance of sun protection (92%); and (3) more skilled to teach sun safety (87.4%). Our findings indicate that the targeted preservice teacher sun safety education intervention improved understandings of UV, effective sun-protective practices, and their perceived skills to teach sun safety.

School-based educational programs are identified as an effective means to increase awareness and promote sun protective behaviours in young people. Regardless, the adolescent age group are difficult to influence, somewhat resistant to sun protection and esteem tanned skin. The ability of Pre-Service Teachers (PSTs) to develop sun safety education for adolescents was tested at a teacher education institution in Western Australia. More particularly, to create understandings of their ability to mobilise health literacy in sun safety education. Thirty PSTs studying secondary education developed three consecutive lesson plans for use with adolescent students of Year 7. The three lesson plans comprised learning activities (n=444), which were categorised as teaching either functional, interactive or critical health literacy. Results indicate a significantly greater than expected frequency of functional activities, suggesting that PSTs need specific training to support the planning and development of teaching and learning that promotes critical health literacy skills.

Skin cancers are the most common malignancy in Australia. Regular sunscreen use can reduce the incidence of cutaneous squamous cell carcinomas and actinic keratoses and has been associated with reducing the incidence of basal cell carcinomas and melanomas. However, sunscreen effectiveness is limited by the failure of the population to use it routinely. Interventions that promote the daily application of sunscreen may reduce the morbidity, mortality, and economic burden associated with skin malignancies. We reviewed the literature that examines the effectiveness of interventions to increase routine sunscreen use and found that no one strategy has been shown to be clearly effective in adults and that relatively few studies have aimed to increase routine use in groups at extreme skin cancer risk. Future research should consider how interventions can be best designed and how sunscreen use is measured so that cost-effective, feasible strategies that result in improved sunscreen use in adults can be established.

Skin cancer prevention efforts in Australia have increasingly incorporated a focus on protection during incidental sun exposure. This complements the long-present messages promoting protection in high-risk settings and avoidance of acute intense bouts of sun exposure. Data from two waves of a cross-sectional direct observational survey was used to assess the prevalence and correlates of N = 12,083 adolescents' and adults' sun protection behavior (arm and leg cover, hat, sunglasses, and shade cover). Individuals were observed in public outdoor settings in Melbourne, Australia during peak ultraviolet (UV) times (11 a.m.-3 p.m.) on summer weekends. Settings included pools and beaches, parks and gardens, and for the first time in 2018, outdoor streets and cafés which may capture more incidental forms of sun exposure and represent another public setting where Australians commonly spend time outdoors. Females and older adults were consistently better protected than males and adolescents. Physical activity was strongly associated with low shade cover across settings. Weather was more strongly associated with sun protection at outdoor streets/cafes and parks/gardens than at pools/beaches but use of observed sun protection (particularly arm cover and covering hat) was low across settings. Continued public education about UV risk and its relation to weather and the seasons is needed to promote the routine use of multiple forms of sun protection during outdoor activities in peak UV times, especially among males and adolescents. Findings also highlight the importance of considering activity demands of public spaces in shade planning to optimize sun protection during outdoor activities in public spaces.

Autistic individuals may be at risk of premature mortality, and physical health comorbidity increases this risk; however, most studies fail to include older autistic adults or consider lifestyle-related factors that affect health. We developed an anonymous, online physical health survey. The final sample included n = 2368 individuals (mean age = 41.42), and of these, n = 1156 were autistic individuals (mean age = 40.98). We utilized three sex-stratified statistical models to determine the prevalence of cancer, cardiovascular conditions, respiratory conditions, and diabetes. All three models indicate that autistic females are more likely to have cardiovascular conditions, respiratory conditions, asthma, low blood pressure, arrhythmias, and prediabetes than non-autistic females, and autistic males are more likely to have arrhythmias than non-autistic males; these results suggest that autistic individuals carry increased risks for these conditions when compared to the general population, even after controlling for age, ethnicity, education level, body mass index, smoking, and alcohol use. Further, these risks may differ depending on biological sex for autistic individuals. Autistic adults, and particularly autistic females, have greater and wider-ranging risks than previously thought, even after controlling for demographic and lifestyle-related factors. Although this is a large sample of autistic adults across the lifespan, future research should employ larger, population-based samples to confirm these findings.

Purpose: The aim of this paper is to distinguish pedagogies supporting critical health literacy development in adolescent populations. Specifically, for sun safety education in schools. Design/methodology/approach: The paper draws on an exploratory intrinsic case study design to qualitatively examine the learning conditions that Pre-Service Teachers' (PsTs) mobilise to advance Health Literary (HL) in learning activities. Findings: This paper presents data that shows the different ways thirty Pre-Service Teachers (PsTs) in Western Australia conceptualise HL in sun safety education for Year 7 students (12-13 years old). Examination of three consecutive lesson plans categorised learning activities (n = 444) according to HL competencies. Data shows that the PsTs pedagogically advance HL but are constrained when conceptualising learning to support critical HL. Further examination of the lesson plans of the 11 PsTs who pedagogically advanced learning to support a critical level of health literacy, distinguished the learning conditions and pedagogies supporting critically health literate adolescents. Originality/value: By distinguishing pedagogies to situate individual and social health within broader societal goals, the paper identifies teacher education institutions as key players enabling young people to socially advocate healthier living, particularly, regarding melanoma and non-melanoma incidence.

Background: There is paucity of research from Australia about comorbidity in older people with intellectual disability (PwID). This paper examines the burden of chronic diseases and associated sociodemographic correlates in a cohort of PwID aged 60+. Methods: A cross-sectional survey was used with community-dwelling older PwID in urban/rural regions of two Australian states. Recruitment was undertaken via a multi-prong approach and each subject (N = 391; 236 urban/155 rural) personally interviewed. Results: Findings show older PwID experience considerable multimorbidity (X = 3.8; 53.5% had 2-6 conditions). Conditions included arthritis (40%), diabetes (26%), cardiovascular diseases (23.6%), asthma (16.1%), carcinomas (10.0%) and mental health disorders (34.5%). Conclusions: There was significant multimorbidity in older PwID, with evolution of life trajectories of select conditions associated with socioeconomic disadvantage and heath facility access barriers. Greater scrutiny of progressive health debilitation leading into older age and increased engagement by healthcare systems is required earlier in the lives of PwID.

This study describes the quantitative aspects of metaphor in academic publications. In particular, we analyze the frequency of metaphor types and source domains in medical papers written by native and non-native speakers of English. The data have been collected from selected published articles on cancer and tissue engineering. The method combines a manual procedure with a semantic tagger and keyness statistics in Wmatrix software for metaphor identification. The results show that while the distribution of metaphor is relatively stable across tissue engineering and cancer articles written by native and non-native speakers, indirect metaphor is more often used than other types of metaphor. Moreover, the findings indicate that some metaphorical source domains are specifically used for a particular topic and that some are more frequently exploited by native speakers of English than by non-native speakers. This study has implications for English for Academic Purposes (EAP) pedagogy and the development of metaphorical awareness activities as it may set the ground for future corpus studies that analyze metaphor properties in academic registers.

Background: Economic evaluations are less commonly applied to implementation interventions compared to clinical interventions. The efficacy of an implementation strategy to improve adherence to screening guidelines among first-degree relatives of people with colorectal cancer was recently evaluated in a randomized-controlled trial. Using these trial data, we examined the costs and cost-effectiveness of the intervention from societal and health care funder perspectives. Method: In this prospective, trial-based evaluation, mean costs, and outcomes were calculated. The primary outcome of the trial was the proportion of participants who had screening tests in the year following the intervention commensurate with their risk category. Quality-adjusted life years were included as secondary outcomes. Intervention costs were determined from trial records. Standard Australian unit costs for 2016/2017 were applied. Cost-effectiveness was assessed using the net benefit framework. Nonparametric bootstrapping was used to calculate uncertainty intervals (UIs) around the costs and the incremental net monetary benefit statistic. Results: Compared with usual care, mean health sector costs were $17 (95% UI [$14, $24]) higher for those receiving the intervention. The incremental cost-effectiveness ratio for the primary trial outcome was calculated to be $258 (95% UI [$184, $441]) per additional person appropriately screened. The significant difference in adherence to screening guidelines between the usual care and intervention groups did not translate into a mean quality-adjusted life year difference. Discussion: Providing information on both the costs and outcomes of implementation interventions is important to inform public health care investment decisions. Challenges in the application of cost-utility analysis hampered the interpretation of results and potentially underestimated the value of the intervention. Further research in the form of a modeled extrapolation of the intermediate increased adherence effect and distributional cost-effectiveness to include equity requirements is warranted.

Background: The success of public health campaigns to engender healthy behavior depends on effective communication of desired messages that inspire action utilizing health information that must be successfully understood. Research, however, illustrates that health guidelines are differentially interpreted, with health literacy and proclivities varying. Purpose: This article presents findings from a study examining major Australian health guidelines and behaviors regarding sun exposure, alcohol consumption, physical activity, and smoking. Methods: An online survey of rural and regional Australian university employees was designed and utilized to gather data about respondent health literacy relative to national guidelines. Results: Findings reveal disparate health literacy and behaviors among the 60 university employees surveyed, with antismoking being the most effectively communicated health message known and adopted. Discussion: Given that "Dr. Google" was respondents' preferred source for health and health risk information, surpassing medical professionals, friends/family, and other media sources, the study raises concerns about the quality, availability, and suitability of Internet-based health information. Translation to Health Education Practice: Reconceptualizing health messages beyond "lose/gain" frameworks is suggested as a way to improve health knowledge to better assist individuals with negotiating conflicting content/quality of information available, differing health literacy, and differing sociocultural environments. A AJHE Self-Study quiz is online for this article via the SHAPE America Online Institute (SAOI) http://portal.shapeamerica.org/trn-Webinars

In Australia, where high temperatures, excessive ultraviolet (UV) radiation and an outdoors lifestyle is commonplace, adherence to sun protection by adolescents is poor. As a group of sun-seekers, adolescents have the highest incidences of sunburns and repeat sunburns. This health-compromising behaviour occurs despite the knowledge that simple preventive actions reduce harm. It occurs irrespective of school-based programmes like SunSmart, the availability of public health interventions that target youths and the advertising of the UV Index across the media. This paper reports on a study that investigated the ability of pre-service teachers (PsTs) of health education to translate sun safe knowledge gathered from freely available sources into lesson planning. The research sample for the study comprised 48 PsTs of secondary schooling. Discussion of the data reflects on the professional standards for teachers to provide insight for content inclusions in curriculum planning aimed to increase adolescent awareness about sun protection.

There are increasing concerns that research regulatory requirements exceed those required to manage risks, particularly for low- and negligible-risk research projects. In particular, inconsistent documentation requirements across research sites can delay the conduct of multi-site projects. For a one-year, negligible-risk project examining biobank operations conducted at three separate Australian institutions, we found that the researcher time required to meet regulatory requirements was eight times greater than that required for the approved research activity (60 hours versus 7.5 hours respectively). In total, 76 business days (almost four months) were required to obtain the necessary approvals, and site-specific processes required twice as long (52 business days/approximately 10 weeks) as primary Human Research Ethics Committee and Research Governance Office processes (24 business days/approximately five weeks). We describe the impact of this administrative load on the conduct of a one-year, externally-funded research project, and identify a shared set of application requirements that could be used to streamline and harmonise research governance review of low- and negligible-risk research projects.

A video game called "Re-Mission" has recently been investigated with adolescent and young adult cancer patients enrolled in a multi-site randomized controlled evaluation of the game as a psycho-educational intervention. The main focus of the trial was to determine effects of the game on self-care and other health-related outcomes. It was also considered valuable to evaluate participants' perceptions of the game as (1) acceptable as a treatment-related activity for young cancer patients, and (2) credible as an intervention designed to change patients' knowledge, attitudes and self-care behaviors relating to treatment. Although the cancer-related content of the game is informed by surveys of cancer professionals and patients themselves, acceptability and credibility with end-users have been important factors influencing the usability and efficacy of a range of psychological interventions. As part of the multi-site trial, 197 patients with cancer, between the ages of 13 and 29, were assigned to the treatment group. Most patients (148) completed a 9-item acceptability/credibility rating scale following 3-months' access to Re-Mission. These "completers" played Re-Mission more than the other patients, but did not differ from them on gender, age, or prior game experience. Responses to the questionnaire were analyzed as two factors representing acceptability and credibility. A mean rating for acceptability (4.1 on scale of 5) indicated a good level of acceptability, and mean rating for credibility (3.7 on scale of 5) indicated a moderate level of belief in the game as an effective intervention. Correlation analyses showed that whereas acceptability and credibility ratings were not significantly associated with educational level, both were significantly (p less than 0.01) and positively correlated with amount of time spent playing the video game during treatment (acceptability: r=0.26, credibility: r=0.25 ). The findings indicate that the self-care intervention video game would be a useful addition to the psycho-educational resources available to treatment teams. (Contains 1 table and 3 figures.)

Autism spectrum disorder (ASD) and intellectual disability (ID) are neurodevelopmental disorders with strong genetic components. Increasingly, research attention has focused on whether genetic factors conveying susceptibility for these conditions, also influence the risk of other health conditions, such as cancer. We examined the occurrence of hospital admissions and treatment/services for cancer in mothers of children with ASD with or without ID compared with other mothers. After linking Western Australian administrative health databases, we used Cox regression to estimate the hazard ratios (HRs) of any hospitalisations and treatment/services for cancer in these groups of mothers. Mothers of children with ASD without ID had greater risk of admissions for cancer (HR 1.29 [95% CI 1.1, 1.7]), and for treatment/services in particular (HR 1.41 [95% CI 1.0, 2.0]), than mothers of children with no ASD/ID, while mothers of children with ASD with ID were no more likely to have a cancer-related hospital admission than other mothers. Mothers of children with autism without ID had increased risk of cancer, which may relate to common genetic pathways.

Queensland, Australia has the highest rates of skin cancer globally. Predetermined criteria were used to score the comprehensiveness of sun protection policies (SPP) of primary schools across Queensland. SPP were sought for schools in 10 regions (latitude range 16.3°S-28.1°S) from 2011 to 2014. Of the 723 schools sampled, 90.9% had a written SPP available publicly. Total SPP scores were low {mean 3.6 [95% CI: 3.4-3.9]; median 2 [interquartile range (IQR) 2, 4]}, with only 3.2% of schools achieving the maximum score of 12. Median SPP scores were higher in Northern and Central Queensland [both 2 (IQR 2, 6) and (IQR 2, 5), respectively] than in Southern Queensland [2 (IQR 2, 3); P = 0.004]. Clothing and hat-wearing were addressed in most policies (96% and 89%) while few schools used their SPP to plan outdoor events (5.2%) or reschedule activities to minimize sun exposure (11.7%). The SunSmart Schools program has been operating in Queensland for 17 years, and while most primary schools now have a written SPP, most are not comprehensive. Incentive-based approaches (5-star-rating award scheme and grants) may assist in addressing this issue, to reduce sun exposure of students and teachers. These data provide a baseline from which improvements in the comprehensiveness of school SPPs can be evaluated.

In response to increasing calls to introduce warning labels on alcoholic beverages, this study investigated the potential effectiveness of alcohol warning statements designed to increase awareness of the alcohol-cancer link. A national online survey was administered to a diverse sample of Australian adult drinkers (n = 1,680). Along with attitudinal, intentions and demographic items, the survey included an online simulation that exposed respondents to one of six cancer warning statements delivered across a range of situational contexts. Half of the statements made general reference to cancer and half mentioned specific forms of cancer. Respondents reported on the believability, convincingness and personal relevance of the warning statements. Pre- and post-exposure data were captured relating to respondents' alcohol consumption intentions. Of the six statements tested, "Alcohol increases your risk of bowel cancer" produced the highest scores across all outcome measures. All statements produced favorable changes in alcohol consumption intentions, including among high-risk drinkers. There is thus the potential for these and similar statements to be used as a suite of rotating warning messages located on alcoholic beverage labels and applied in various public education contexts.

Background: Quality of life (QoL) is an important construct when assessing treatment outcomes. Aims: To examine the relative contributions of functioning, psychological well-being and self-efficacy on self-perceived QoL with a sample of total laryngectomy patients in Australia who had surgery for advanced laryngeal cancer. Methods & Procedures: In a cross-sectional study, 113 members of the Laryngectomy Associations of New South Wales and of Victoria, Australia, were recruited, and each was sent a series of questionnaires for postal return. Four psychometrically validated measures were used for participants to document their QoL, functioning (speech, swallowing), psychological well-being and general self-efficacy. Outcomes & Results: Eighty-six (77%) questionnaires were returned and 83 were analysed. The cohort consists of 70 men and 13 women aged between 46 and 88 years. Overall, this sample of total laryngectomy survivors demonstrated significantly reduced physical health QoL (p < 0.001) and social relationship QoL (p = 0.011) and higher levels of depression (p = 0.008) and anxiety (p = 0.001) when compared with normative samples. This was in the context of them having higher than normal self-efficacy scores and, at worst, mild (self-rated) impairment of speech and of swallowing. Psychological well-being (sr[superscript 2] = 0.43, p < 0.001) had a stronger association than functioning (speech, swallowing, sr[superscript 2] = 0.08, p < 0.05) for their psychological QoL. Psychological well-being (sr[superscript 2] = 0.17, p < 0.001) and not functioning (sr[superscript 2] = 0.05, p > 0.05) were significantly associated with social relationship QoL. Self-efficacy scores were significantly higher than norms in this cohort, but were not associated with either their psychological QoL or social relationship QoL, after controlling for psychological well-being and functioning. Conclusions & Implications: For survivors of laryngeal cancer treated by total laryngectomy, it is important to be aware of the impact of psychological well-being (depression, anxiety, stress) on self-perceived QoL. In addition to rehabilitating function (speech, swallowing), specific interventions to assist these individuals better manage their psychological well-being will likely improve their perceived life satisfaction/QoL.

Many students treated for cancer experience significant challenges in maintaining their education during and beyond cancer treatment. Late effects of cancer treatment combined with prolonged periods of missed schooling can dramatically impact upon a student's physical, cognitive and social development. This study examined the relationship between cancer type, cancer treatment, time absent from school, school services and academic areas affected by the cancer diagnosis. An online survey was completed by 80 parents, representing 80 children with cancer, and 136 siblings. Twenty-four parents/carers participated in five focus groups held across rural and regional New South Wales (NSW). Additional difficulties for children and adolescents post cancer treatment were reported by 62.3% of parents and included difficulties with attention, mobility, hearing and fine motor skills. Further areas of specific academic need were identified in mathematics, memory, concentration and confidence. Despite the high level of additional need, only 9.3% of students were reported as receiving additional funding support upon their return to school. Emotional descriptions referring to turmoil, lack of understanding and lack of support were contained within the focus group transcriptions. Results indicated a high level of specific educational and psychosocial needs for this group of students who, having overcome a potentially fatal illness, must continue to fight to learn.

Melanoma is the most common cancer among 15- to 29-year-olds in Australia, with rates increasing with age. The "Dark Side of Tanning" (DSOT) mass media campaign was developed in 2007 to influence attitudes related to tanning. This study aimed to assess recall and impact of the DSOT campaign. Data were collected using online surveys of 13- to 44-year-olds living in New South Wales in the summer months of 2007-2010 (n = 7490). Regression models were used to determine predictors of recall of DSOT and to investigate associations between exposure to the campaign and tanning attitudes. The campaign achieved consistently high recall (unprompted recall 42-53% during campaign periods; prompted recall 76-84%). Those who recalled DSOT advertisements had a higher likelihood of reporting negative tanning attitudes compared with those who reported no recall, after adjusting for other factors (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.01-1.27 for unprompted recall; OR 1.19, 95% CI 1.03-1.36 for prompted recall). Being interviewed in later campaign years was also a significant predictor of negative tanning attitudes (e.g. fourth year of campaign versus first year: OR 1.24, 95% CI 1.01-1.53). These results suggest that mass media campaigns have potential to influence tanning-related attitudes and could play an important role in skin cancer prevention.

Objectives: This study examined the knowledge, attitudes and practices of clinicians in promoting physical activity to prostate cancer survivors. Design: A purposeful sample was used and cross-sectional data were collected using an anonymous, self-reported online questionnaire or an identical paper-based questionnaire. Settings: Health services and online questionnaire. Methods: Clinicians were invited to complete the questionnaire which measured their knowledge, attitudes and practices relating to physical activity for their patients. Results: Thirty-one clinicians completed a questionnaire. Most participants were men (71%), aged 30-40 years (45.2%), and radiation oncologists (35.5%). Although clinicians recognized the benefits of physical activity for their patients, few always gave advice about physical activity. Advice was verbal in nature, very few provided written material and none referred patients to an exercise specialist. Older age, a belief that physical activity reduces side effects of treatment, higher confidence and disagreement that physical activity has risks were associated with higher frequency of providing physical activity advice. Over half of the clinicians (55%) reported that advising patients on physical activity was not part of their role. Conclusions: This study provides preliminary evidence that physical activity advice may not be provided routinely to prostate cancer survivors. It is important for future research to address the involvement of clinicians in physical activity promotion so that holistic care is provided.

Increasing public knowledge remains one of the key aims of skin cancer awareness campaigns, yet diagnosis rates continue to rise. It is essential we measure skin cancer knowledge adequately so as to determine the nature of its relationship to sun-related behaviors. This study investigated the psychometric properties of a new measure of skin cancer knowledge, the Skin Cancer and Sun Knowledge (SCSK) scale. A total of 514 Western young adults (females n = 320, males n = 194) aged 18 to 26 years completed measures of skin type, skin cancer knowledge, tanning behavior, sun exposure, and sun protection. Two-week test-retest of the SCSK was conducted with 52 participants. Internal reliability of the SCSK scale was acceptable (KR-20 = 0.69), test--retest reliability was high (r = 0.83, n = 52), and acceptable levels of face, content, and incremental validity were demonstrated. Skin cancer knowledge (as measured by SCSK) correlated with sun protection, sun exposure, and tanning behaviors in the female sample, but not in the males. Skin cancer knowledge appears to be more relevant to the behavior of young women than that of young males. We recommend that future research establish the validity of the SCSK across a range of participant groups.

Much of the evidence translation literature focuses narrowly on the use of evidence in the initial policy formulation stages, and downplays the crucial role of institutions and the inherently political nature of policy making. More recent approaches acknowledge the importance of institutional and political factors, but make no attempt to incorporate their influence into new models of evidence translation. To address this issue, this article uses data from a comparative case study of bowel cancer screening policy in Australia, the United Kingdom and New Zealand, to propose alternative models of evidence incorporation which apply to all stages of the policy process.

This study aimed to determine whether there have been shifts in news coverage of sun protection issues over a 12-year period in the context of an evolving skin cancer prevention agenda. A content analysis was performed on all relevant articles (N = 552) published in the two metropolitan daily newspapers in Melbourne, Australia, from 2001 to 2012. Coding variables included theme, article type, prominence, spokesperson and topic slant. Articles were collapsed into three 4-year blocks and a series of chi-square analyses conducted to examine changes over time in coverage of topical issues (i.e. vitamin D and sunbeds) and established sun protection themes [i.e. health effects of ultraviolet (UV) exposure, education/prevention, attitudes/behaviour]. Coverage of vitamin D and sunbed issues increased over time and became more positive for sun protection objectives. The proportion of articles reporting on established sun protection themes remained steady over time (range: 36-38%) and there were no changes observed in the way these topics were presented in the news media. These results highlight that potentially competing sun protection issues that emerge over time need not pose a threat to existing skin cancer prevention programmes but instead can provide opportunities to further spread programme messages while increasing credibility.

Evaluate the comprehensiveness of primary school sun-protection policies in tropical North Queensland, Australia. Pre-determined criteria were used to assess publicly available sun-protection policies from primary schools in Townsville (latitude 19.3°S; n = 43), Cairns (16.9°S; n = 46) and the Atherton Tablelands (17.3°S; n = 23) during 2009-2012. Total scores determined policy comprehensiveness. The relationship between policy score, SunSmart status and demographic characteristics was explored. At least 96.6% of primary schools sampled had a sun-protection policy. Although policies of Cancer Council accredited "SunSmart" schools addressed more environmental, curriculum and review-related criteria than those of "non-SunSmart" schools, the overall median score for both groups was low at 2 from a possible 12 (48.5% of SunSmart schools [SSSs]: inter-quartile range [IQR = 2.0-9.0] versus 65.9% of non-SSSs: [IQR = 2.0-3.0], P = 0.008). Most policies addressed hat wearing, while criteria related to shade provision at outdoor events, regular policy review and using the policy to plan outdoor events were poorly addressed. Although most primary schools in skin cancer-prone North Queensland have written sun-protection policies, the comprehensiveness of these policies could be vastly improved. These schools may require further support and advice to improve the comprehensive of their policies and incentives to continually implement them to achieve and maintain exemplary sun-protection compliance.

Objective: Skin cancer incidence continues to rise as a tanned appearance remains desirable, particularly among young women. Fake tanning provides a tanned appearance without exposure to ultraviolet radiation. In order to advance our understanding of the factors that contribute to long-term behavior change, this study explores determinants associated with different types of tanning. Participants: The sample included 162 female students from the University of Adelaide, Australia, aged 18-26 years. Data were collected in July 2010. Methods: The current study measured differences in skin type, skin cancer knowledge, unrealistic optimism, appearance motivation, and sun-protective and sun exposure behaviors amongst outdoor tanners, fake tanners, and tan avoiders through an online survey. Results: Differences were observed for skin type, skin cancer knowledge, unrealistic optimism, sun protection, and sun exposure. Conclusions: A "one-size-fits-all" approach to skin cancer prevention may not be appropriate; type of tanning behavior may need to be considered in health promotion work.

Objective: To determine differences in sun-protection behaviours, and incidence of sunburn, between Australian adolescent female fake tan users and non-users. Design: Cross sectional survey. Method: 398 adolescent females aged 12 to 18 years participated in a survey at public venues, schools, and online. The main outcome measures were self-reported fake tan usage in the past 12 months, frequency of sunburns and habitual sun-protection behaviours. Setting: Surveys were completed in New South Wales, Australia. Results: The prevalence of self-reported use of fake tanning products in the past 12 months among Australian adolescent females was 34.5%. Female fake tan users were significantly less likely to report wearing a hat, wearing a shirt with sleeves or wearing pants covering to the knees. There was no difference between fake tan users and non-users in use of sunscreen, seeking shade, wearing sunglasses or avoidance of peak ultraviolet (UV) hours. Logistic regression modelling, when accounting for age, desire for a tan and skin type, revealed fake tan users were more likely to experience frequent sunburns and less likely to wear protective clothing. Conclusions: Our findings show that fake tan use among Australian female adolescents is associated with decreased sun protection, specifically reduced use of both upper and lower body protective clothing. Fake tan users were significantly more likely to experience repeated sunburns, after controlling for skin type. These findings provide impetus for the development of health education programmes targeting a new sub-group of adolescents with distinct tanning behaviours. (Contains 4 tables.)

Exposure to ultraviolet radiation is an important risk factor for skin cancer. The Global Solar Ultraviolet Index (UVI) was developed as a tool to visualize the amount of harmful radiation and to encourage people to use sun protection. We conducted a systematic review of the effectiveness of the UVI. We employed a comprehensive search strategy to explore the impact of the UVI on five outcome categories. Twenty-seven of a total of 260 studies met our inclusion criteria; data extraction and quality appraisal were undertaken for 25 studies, comprising 3 randomized controlled trials, 2 non-randomized intervention studies and 20 cross-sectional studies. Nearly half of these studies were from Australia and New Zealand. We found low to intermediate levels of UVI awareness and low levels of UVI understanding. Studies rated moderate or strong suggest that the UVI does not influence knowledge, attitudes, sun protection behavior or sun exposure. Overall, the findings imply that the UVI, as currently implemented, has not been successful at improving sun protection practices and reducing sun exposure among the population at large. Drawing on experience with theory-based sun protection programs, we advocate for more realistic expectations of what the UVI can and cannot achieve.

Mobile phone text messages (SMS) are a promising method of health promotion, but a simple and low cost way to obtain phone numbers is required to reach a wide population. We conducted a randomised controlled trial with simultaneous brief interventions to (i) evaluate effectiveness of messages related to safer sex and sun safety and (ii) pilot the use of mobile advertising for health promotion. Mobile advertising subscribers aged 16-29 years residing in Victoria, Australia (n = 7606) were randomised to the "sex" or "sun" group and received eight messages during the 2008-2009 summer period. Changes in sex- and sun-related knowledge and behaviour were measured by questionnaires completed on mobile phones. At follow-up, the sex group had significantly higher sexual health knowledge and fewer sexual partners than the sun group. The sun group had no change in hat-wearing frequency compared with a significant decline in hat-wearing frequency in the sex group. This is the first study of mobile advertising for health promotion, which can successfully reach most young people. Challenges experienced with project implementation and evaluation should be considered as new technological approaches to health promotion continue to be expanded.

Bowel cancer is a serious health problem in developed countries. Australia, the United Kingdom (UK) and New Zealand (NZ) reviewed the same randomised controlled trial evidence on the benefits and harms of population-based bowel cancer screening. Yet only NZ, with the highest age standardised rate of bowel cancer mortality, decided against introducing a bowel cancer screening programme. This case study of policy making explores the unique resource, ethical, institutional and political environments in which the evidence was considered. It highlights the centrality of context in assessing the relative worth of evidence in policy making and raises questions about the suitability of knowledge utilisation strategies.

Content analysis data on the tans of 4,422 female Caucasian models sampled from spring and summer magazine issues were combined with readership data to generate indices of potential exposure to social modeling of tanning via popular women's magazines over a 15-year period (1987 to 2002). Associations between these indices and cross-sectional telephone survey data from the same period on 5,675 female teenagers' and adults' tanning attitudes, beliefs, and behavior were examined using logistic regression models. Among young women, greater exposure to tanning in young women's magazines was associated with increased likelihood of endorsing pro-tan attitudes and beliefs. Among women of all ages, greater exposure to tanned models via the most popular women's magazines was associated with increased likelihood of attempting to get a tan but lower likelihood of endorsing pro-tan attitudes. Popular women's magazines may promote and reflect real women's tanning beliefs and behavior. (Contains 3 tables and 1 figure.)

Limiting exposure to sunlight during childhood can significantly reduce the risk of skin cancer. This was the first national study to assess the sun protection policies and practices of early childhood services across Australia. It also examined the key predictors of services' sun protection practices. In 2007, 1017 respondents completed a self-administered survey about the sun protection policies and practices in their early childhood service (response rate of 59%). Most (95%) had a written sun protection policy. The most common policy inclusions were hat wearing (91%), sunscreen use (87%) and enforcement of policy (97%). Less frequently reported inclusions were protective clothing (69%), information for parents/caregivers (58%) and regular reviews/updates of policies (65%). Basic sun protection practices (e.g. required any type of hat and sunscreen use) were more commonly reported than extensive practices (required protective clothing or regularly applied sunscreen). Higher sun protection policy scores, being a formal childcare service as opposed to a kindergarten/pre-school and having SunSmart status as opposed to not, were associated with higher sun protection practice scores (P less than 0.001). Sun protection policies may be improved through encouraging services to have more specific policy inclusions and to model their policies on the SunSmart Early Childhood Program. (Contains 5 tables.)

Sun protection is not commonly perceived as an important issue by adolescents yet this behaviour would, if adopted, confer significant lifelong protection against skin cancer. Despite the world's highest skin cancer rates, Australia remains a culture which values sun seeking, tanning and outdoor activities. This qualitative study used ethnographic methods to produce insights into sun protection behaviours and attitudes of Australian adolescents aged 15 and 16 years. Applying the Theory of Planned Behaviour to the analysis, the study involving 51 adolescents revealed the complexity of the factors that influence sun protection behaviours, such as peers, lifestyle, environments, social norms and fashion. Sun protection was imbued with associations of negativity, dullness and irritation which was dissonant with adolescents' buoyant, dynamic and "fun filled" experience of the sun. Key barriers to sun protection were found to stem from the perceived impact of sun protection behaviour on the peer dynamic, negative perceptions around what sun protection communicates about the user, the tone of existing sun protection communications and the spontaneous unplanned nature of the adolescent lifestyle. The paper concludes by discussing the implications for health promotion with this hard to reach group. (Contains 3 tables and 4 figures.)

Young adults participating in outdoor sports represent a high-risk group for excessive sun exposure. The purpose of this study was to identify modifiable social cognitive correlates of sunscreen use among young adult competitors. Participants aged 18 to 30 years who competed in soccer (n = 65), surf-lifesaving (n = 63), hockey (n = 61), and tennis (n = 48) completed a sun habits survey. Almost half (n = 113) of the participants used sunscreen inadequately and 30% (n = 70) reported not using sunscreen. In fully adjusted models, social cognitive attributes significantly (p less than 0.05) associated with inadequate sunscreen use (vs. nonuse) included skin cancer risk perceptions (OR = 0.6, 95% CI = 0.3, 1.0), perceived barriers to sunscreen use (OR = 0.5, 95% CI = 0.3, 0.9), and stronger personal norms for applying sunscreen (OR = 1.8, 95% CI = 1.0, 3.2). These findings provide insight into the attributes that enable or inhibit the use of sunscreen among young competitors and as a result may be useful in informing behavior change interventions within the sporting context. (Contains 3 tables.)

We investigated whether the five-factor structure of the Preventive Health Model for colorectal cancer screening, developed in the United States, has validity in Australia. We also tested extending the model with the addition of the factor Self-Efficacy to Screen using Fecal Occult Blood Test (SESFOBT). Randomly selected men and women aged between 50 and 76 years (n = 414) responded to a survey. Confirmatory factor analyses indicated that the U.S. model provided adequate fit for the group as a whole and for men and women separately, thereby demonstrating cross-cultural validity for measuring factors influencing the decision to screen. The inclusion of SESFOBT in the model resulted in a comparable, but less parsimonious, fit. However, self-efficacy is a demonstrated mediator of intention and action, and it is argued that the addition of SESFOBT as a sixth factor may have utility for the design of strategies to increase actual uptake of FOBT. (Contains 3 tables and 1 figure.)

Cognitive Behaviour Stress Management for women with breast cancer has demonstrable empirical efficacy, however its effectiveness in the applied clinical setting has not been examined to date in an Australian setting. A 10-week group program was offered to five women with early stage breast cancer. Clinical changes in distress, coping, and social support from pre-test, to post-test and 1-month follow-up are reported. Overall, the group yielded strong favourable effect sizes indicating clinical improvement over time in PTSD symptoms and social support, but strong unfavourable effect sizes in cognitive avoidance. In terms of clinical cut-offs, all women met criteria for PTSD at baseline, with two women recovering at follow-up. The two participants with highest baseline distress experienced large improvements in depression, anxiety and PTSD at post-treatment, but rebounded to baseline at follow-up. Women qualitatively reported the major benefits of the program to be acquiring skills in relaxation and cognitive restructuring, and obtaining social support. This case study provides preliminary support that a CBSM program can improve PTSD and social support, however it raises concerns regarding the deteriorations observed in cognitive avoidance. Ways of addressing cognitive avoidance and the maintenance of gains warrants further investigation. (Contains 2 tables and 3 figures.)

Skin cancer is an increasing problem in Europe, America and Australasia, although largely preventable by avoiding excessive ultraviolet (UV) exposure. This paper presents the findings of a systematic review of qualitative research about the prevention of skin cancer attributable to UV exposure. The aim is to understand elements that may contribute to the successful or unsuccessful conveyance of skin cancer prevention messages and their uptake by the public. A systematic review was undertaken using evidence identified through searching electronic bibliographic databases and Web sites and reference list checks. Predefined inclusion and exclusion criteria were used. Sixteen study reports (relating to 15 separate studies) were included from the United Kingdom, United States, Australia, Canada and New Zealand. Each included study was quality appraised, and the findings were extracted into an evidence table. A coding scheme, framed by the Health Belief Model, was developed by the reviewers and informed analysis and synthesis. This showed that most people perceived their susceptibility to skin cancer, and its severity, as low. While benefits of adopting changed behaviour were acknowledged, there were substantial barriers to this, including positive perceptions of a tan as healthy and attractive and the hassle of covering up or using sunscreen. Peers, parents and media may offer "cues to action" that encourage adoption of preventative behaviour and finally self-efficacy or the perceived ability to make such changes. Effective health education messages will need to address the barriers to adopting protective behaviours identified through this review.

Recently there have been several news items about possible cancer clusters in the Australian media. The term "cancer cluster" is used when an unusually large number of people in one geographic area, often a workplace, are diagnosed with cancer in a short space of time. In this paper the authors explore this important health issue using probability theory and in particular the binomial distribution. This paper also illustrates how students can use the binomial distribution to gain a more thoughtful approach to cancer clusters and demonstrates how mathematics should be applied in practice.

To understand young people's low levels of sun protection behaviour, 145 young people (aged 12 to 20 years) were recruited from Queensland, to participate in a one-hour focus group where they discussed issues related to sun protection and images of tanned and non-tanned people. Responses were content analysed to identify common sun protection beliefs and perceptions. Key barriers and motivators for sun protection were identified. Despite young people's awareness of the advantages of sun protection, health promotion efforts still need to focus on not only reducing beliefs about the costs of performing sun protection but also decreasing the positive view of tanned images among youth.

A technique for using highlighter ink as an ultraviolet dosimeter has been developed for use by secondary school students. The technique requires the students to measure the percentage of colour fading in ink drawn onto strips of paper that have been exposed to sunlight, which can be calibrated to measurements of the ultraviolet irradiance using an inexpensive and readily available pocket-sized meter. The concepts introduced in the article provide students with simple computer image processing and scientific measurement skills that enhance understanding of the ultraviolet environment. The methods presented in this article allow school students to make accurate measurements of personal ultraviolet exposure using self made and calibrated ultraviolet dosimeters which until now have not been readily available to schools. (Contains 2 tables and 3 figures.)

To examine modelling of outcomes relevant to sun protection in Australian women's magazines, content analysis was performed on 538 spring and summer issues of popular women's magazines from 1987 to 2005. A total of 4949 full-colour images of Caucasian females were coded for depth of tan, extent of clothing cover, use of shade and setting. Logistic regression using robust standard errors to adjust for clustering on magazine was used to assess the relationship between these outcomes and year, setting and model's physical characteristics. Most models portrayed outdoors did not wear hats (89%) and were not in shade (87%). Between 1987 and 2005, the proportion of models depicted wearing hats decreased and the proportion of models portrayed with moderate to dark tans declined and then later increased. Younger women were more likely to be portrayed with a darker tan and more of their body exposed. Models with more susceptible phenotypes (paler hair and eye colour) were less likely to be depicted with a darker tan. Darker tans and poor sun-protective behaviour were most common among models depicted at beaches/pools. Implicit messages about sun protection in popular Australian women's magazines contradict public health messages concerning skin cancer prevention. (Contains 4 tables and 1 figure.)

In Australia, general health and medical services are subsidised by the government. This includes care for people with disabilities, screening and diagnostic services for common diseases, including cancer, and care and treatment for various medical conditions. In Western Australia, the majority of state-provided health services are well documented in linkable databases. We have examined data from a large cohort of people receiving services for learning disability from the state and linked this with the state cancer registry and hospital records. While people with learning disability appear to be at similar risk for cancer, they may have poorer treatment outcomes as they already experience a range of health conditions which can exacerbate medical complications associated with treatment and/or other primary or secondary co-morbid conditions. Our results show that the mean number of hospital admissions were higher for the cancer group, even when adjustments were made for conditions such as childhood leukaemia and renal dialysis both of which often require frequent hospitalisations. Multivariate regression analyses showed that younger age, female sex and severe or unspecified level of disability were significant contributors to the frequency of hospital admissions. Qualitative information gleaned from detailed chart reviews showed that in addition to considerable morbidity, some patients were admitted repeatedly either because of lack of supportive environments and/or lack of compliance with treatment. Issues in providing appropriate support services for individuals and their carers are discussed.

The article presents a technique to measure the ultraviolet index using a personal hand-held ultraviolet meter to illustrate concepts of physics. Measurements of the erythemally effective (sun-burning) direct solar beam, diffuse skylight, and total global ultraviolet irradiance are converted to daily ultraviolet index measurements. Daily ultraviolet index measurements are then compared to the daily forecast ultraviolet index. The influence of the local environment on the measured and forecast ultraviolet index is further examined with respect to surface reflection, shade structures, trees and buildings placed within the local environment, which each play a significant role in influencing the ultraviolet index at any one location. The measurement techniques presented in the article are provided to suit primary and secondary school-aged children. (Contains 7 figures and 3 tables.)

Objective: To explore adolescents' self-reported reasons for sun protection, as adolescents as a group continue to have poor sun protection practices. Methods: Seventeen age- and gender-segregated focus groups were conducted in Australian high schools. Results: Reasons for using sun protection included personal comfort, appearance, policies, fear of skin cancer, expectations of authority figures, peer actions, and habit. Reasons for not using sun protection included desire for a tan, inconvenience, low perceived risk, and fashion. Age and gender effects were found. Conclusions: Avenues for intervention with adolescents include authority figures, peer advocacy, the fashion industry, and improved sun protection products.

Purpose: The purpose of this paper is to show that the "Back on Track" program is designed to support students with a chronic illness (usually cancer) to maintain contact with their school and peers whilst undergoing treatment, to promote socio-emotional wellbeing and to facilitate the ease of return to school when they are well. An evaluation of the program occurred in its first year. Design/methodology/approach: A clarificative evaluation approach was used. This involved collecting data about the elements of the program design and implementation to understand and make explicit the logic of the program. It comprised three stages: documenting the program design; gathering stakeholder feedback about the experiences in the program; and reviewing the program logic of the design and implementation approaches. Findings: The program ("Back on Track") actively engaged teachers, parents, students and Program staff in negotiating strategies to keep the students (patients) connected with their school and peers whilst undergoing hospital-based treatment for their chronic condition, in this case cancer, and when recovering at home before a full return to school. Difficulties emerged with the use of Information Communication Technologies (ICTs) as one of the key program components in keeping the students connected. There were also differences in views between the Program staff, schoolteachers and some of the students and their parents about the ongoing role of the Program once students had returned to school. Originality/value: The paper indicates what is needed to enhance the implementation and success of programs such as "Back on Track" for this group of young people who have significant chronic illnesses, which necessitate prolonged absences from school and separation from peers. (Contains 2 notes.)

Excessive exposure to sunlight during early childhood increases the risk of developing skin cancer. Self-administered questionnaires exploring sun-protection knowledge, practices and policy were mailed to the directors/co-ordinators/senior teachers of all known early childhood services in Queensland, Australia, in 2002 (n = 1383; 56.5% response). Most (73.7%) services had a written sun-protection policy (SPP). However, 40.6% of pre-schools and kindergartens had not developed a written SPP. Most directors had moderate knowledge about sun-protection (median score: 7/12 [IQR 6, 8]), but few understood the UV index, the sun-protection factor rating for sunscreens or the association between childhood sun-exposure, mole development and melanoma. Pre-school teachers had lower knowledge scores than directors of long day care centers and other services (P = 0.0005). Staff members reportedly wore sun-protective hats, clothing and sunglasses more often than children. However, sunscreen use was higher among children than staff. Directors' knowledge scores predicted reported hat, clothing, sunscreen and shade utilization among children. Remoteness impacted negatively on director's knowledge (P = 0.043) and written SPP development (P = 0.0005). Higher composite sun-protection scores were reported for children and staff from services with written sun-protection policies. SPP development and increased sun-protection knowledge of directors may improve reported sun-protective behaviors of children and staff of early childhood services. (Contains 4 tables.)

Background: Down syndrome is one of the commonest causes of intellectual disability. As life expectancy improves with early and more intensive surgical and medical treatments, people with the disorder are more likely to exhibit classic morbidity and mortality patterns and be diagnosed with diseases such as cancer. Methods: A profile of cancer cases among people with Down syndrome has been compiled, based on the analysis of a linked data set that included information from the Disability Services Commission of Western Australian and the State Cancer Registry. Results and conclusions: Although the total age- and sex-standardized incidence ratios (SIRs) for people with Down syndrome were similar to that for the general population, SIRs for leukaemia were significantly higher while the incidence of certain other types of cancers was reduced. Overall, there was a lower incidence of solid tumours in Down syndrome, possibly reflecting the age profile of the study cohort.

BreastScreen (a free breast cancer screening service) has been implemented in Australia since 1991. Surveys conducted overseas consistently report that women of Chinese ancestry have low participation rates in breast cancer screening. Although Chinese women's use of breast cancer screening services has been investigated abroad, to date there are few studies of mammographic screening behavior among Chinese-Australian women. The purpose of this study is to explore and investigate the factors associated with mammographic decisions of Chinese-Australian women. Using a qualitative approach, in-depth interviews were conducted with 20 Chinese-Australian women. These were augmented by additional data from ethnographic observations. The findings show two facilitators: organizational factors (an invitation letter from BreastScreen and seniors' clubs arrangements) and the influence of "significant others". Barriers identified were fear perceptions of mammography, modesty and fear of stigmatization. This study provides a useful framework for designing and implementing mammographic screening services for Chinese-Australian women that may improve their participation rates.