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In this study, Bayesian estimation is performed for a class of random coefficient self-exciting integer-valued threshold autoregressive processes with explanatory variables. A new model with a linear structure is obtained through model reconstruction, which makes Markov Chain Monte Carlo method easy to perform. By introducing the latent variables series, a complete data likelihood is obtained. Based on this likelihood, the full conditional distributions are easily obtained for all the parameters and latent variables. By maximizing the posterior probability function, the threshold parameter is accurately estimated. Finally, some numerical results of the estimates and a real data example of crime counts in Ballina, New South Wales, Australia are presented. [ABSTRACT FROM AUTHOR]

The growing trend towards young adults staying in the parental home has garnered much recent scholarly interest. However, less is known about which young adults are living at home, and the impacts this has over young adults' lives. Using The Household, Income and Labour Dynamics in Australia (HILDA) dataset, this study examines the profiles of co-residing young adults and how these have changed over the first two decades of the 21st century. It then analyses the associations between co-residence and young adults' mental health, applying a propensity score modelling approach to determine differences in mental health between young adults living at home and their counterparts living independently. Results indicate that rates of co-residence have increased over the 2000s, most steeply amongst those residing outside of major cities (by 46%), older adults (by 36%), females (by 28%), and low-income groups (by 10%). Findings show a significant negative association between co-residence and mental health (a 4-point difference on the 100-point scale, 95% CI -5.93, -2.14). However, the greatest differential in mental health between co-resident and independent young adults is observed amongst those for whom rates of co-residence have increased most dramatically, i.e., females and older adults (a 6-point difference in mental health) and residents of regional and rural areas (a 5-point difference in mental health). We situate this discussion in the context of intensifying housing market constraints, considering how the transformation of the Australian housing system into a vehicle for wealth accumulation has generated barriers to residential independence. [ABSTRACT FROM AUTHOR]

Background: Early childhood caries (ECC) remains one of the most prevalent childhood diseases in Australia, disproportionately affecting disadvantaged populations. Aim: To investigate the ECC experience including risk factors, incidence of caries, pain and infection as well as relapse rates of caries and secondary dental general anaesthesia (GA). Design: A retrospective cohort study included dental records of children with ECC, aged <72 months at an Australian public dental hospital paediatric dentistry department from 2013 to 2015 (n = 102). Dental caries, pain, infection, referral patterns, demographic and caries risk factor data were recorded for 24 months. Descriptive statistics were used for patient characteristics and clinical data, and Kaplan–Meier curves and parametric exponential survival models for time‐to‐event series. Results: The study population demonstrated higher‐than‐national average dmft and disease progression at baseline. Major risk factors for the development of caries, pain and infection were daily consumption of sweetened beverages, poor oral hygiene, residing in lower socio‐economic areas, older age and being male. Rates of caries relapse and new referral for secondary treatment under general anaesthesia were relatively high. Conclusion: A high degree of ECC progression and recurrence in this population indicates a need for a more comprehensive approach to ECC addressing multilevel root causes and systemic risk factors. [ABSTRACT FROM AUTHOR]

Background People with chronic conditions experience high psychological distress. Methods Using the National Health Survey in Australia during 2017–18, the study assessed whether and which health literacies moderated the relationship between chronic conditions and psychological distress for diabetes, chronic kidney disease (CKD), cardiovascular disease (CVD), arthritis, other musculoskeletal conditions, asthma, other chronic lower respiratory diseases and cancer. Psychological distress was regressed on chronic diseases, health literacy domains and their interactions, controlling for demographic, socioeconomic and health factors. Results Of 5790 adults, 4212 (72.75%) aged 18–64; 846 (14.6%) had high or very high psychological distress, 1819 (31.4%) had diabetes, CKD or CVD, 2645 (45.7%) musculoskeletal conditions, and 910 (15.7%) lower respiratory conditions. Having sufficient information from healthcare providers was associated with the lowest level of psychological distress for CKD and cancer. Social support was associated with significantly lower levels of psychological distress for cardiovascular, musculoskeletal and lower respiratory conditions. Understanding health information was associated with the largest improvement in psychological distress for diabetes. Conclusions Higher health literacies were associated with reduced risks of psychological distress among individuals managing chronic conditions. Interventions for improving self-management and health inequalities should incorporate disease-specific health literacy enhancement strategies at individual and organizational levels. [ABSTRACT FROM AUTHOR]

Introduction: Exposure to environmental noise from within homes has been associated with poor mental health. Existing evidence rests on cross-sectional studies prone to residual confounding, reverse causation, and small sample sizes, failing to adequately consider the causal nature of this relationship. Furthermore, few studies have examined the sociodemographic distribution of noise exposure at a country level.Methods: The study, conducted in 2021, examined the impact of environmental noise from road traffic, airplanes, trains, and industry on mental health and psychological distress as reported by 31,387 respondents using a 19-year longitudinal data set in Australia (2001‒2019). To improve the capacity to make causal inference and reduce bias from measurement error, reverse causation, and unobserved confounders, analyses used instrumental variables, fixed-effects models, and an aggregated area-level measure of noise exposure. Utilizing the large-scale national data set, sociospatial distributions of noise exposure were described.Results: Private and public rental tenants, lone parents, residents of socioeconomically disadvantaged areas, and those with long-term health conditions were more likely to report residential noise exposure. This exposure to noise was consistently associated with poorer mental health (self-reported noise: β= -0.58; 95% CI= -0.76, -0.39; area-level noise: β= -0.43; 95% CI= -0.61, -0.26), with the relationship strongest for traffic noise (β= -0.79; 95% CI= -1.07, -0.51). Notably, when noise exposure decreased over time, there was an increase in mental health (β= 0.43; 95% CI= 0.14, 0.72).Conclusions: The study provides strong evidence of a negative mental health effect of perceived residential noise, and the results have implications for healthy home design and urban planning. These findings should be validated with further studies that measure noise intensity and housing quality. [ABSTRACT FROM AUTHOR]

Background: Real-world data on long-term (> 5 years) weight loss and obesity-related complications after newer bariatric surgical procedures are currently limited. The aim of this longitudinal study was to examine the effectiveness and sustainability of bariatric surgery in a cohort with clinically severe obesity in a multidisciplinary publicly funded service in two teaching hospitals in New South Wales, Australia. Methods: Patients were adults with complex clinically severe obesity with a BMI ≥ 35 kg/m2 and at least three significant obesity-related comorbidities, who underwent bariatric surgeries between 2009 and 2017. Detailed obesity-related health outcomes were reported from annual clinical data and assessments for up to 9 years of follow-up. Data were also linked with the national joint replacement registry. Results: A total of 65 eligible patients were included (mean, 7; range, 3–12 significant obesity-related comorbidities); 53.8% female; age 54.2 ± 11.2 years, with baseline BMI 52.2 ± 12.5 kg/m2 and weight 149.2 ± 45.5 kg. Most underwent laparoscopic sleeve gastrectomy (80.0%), followed by laparoscopic adjustable gastric banding (10.8%) and one anastomosis gastric bypass (9.2%). Substantial weight loss was maintained over 9 years of follow-up (p < 0.001 versus baseline). Significant total weight loss (%TWL ± SE) was observed (13.2 ± 2.3%) following an initial 1-year preoperative intensive lifestyle intervention, and ranged from 26.5 ± 2.3% to 33.0 ± 2.0% between 1 and 8 years following surgery. Type 2 diabetes mellitus (T2DM), osteoarthritis-related joint pain and depression/severe anxiety were the most common metabolic, mechanical and mental health comorbidities, with a baseline prevalence of 81.5%, 75.4% and 55.4%, respectively. Clinically significant composite cumulative rates of remission and improvement occurred in T2DM (50.0–82.0%) and hypertension (73.7–82.9%) across 6 years. Dependence on continuous positive airway pressure treatment in patients with sleep-disordered breathing fell significantly from 63.1% to 41.2% in 6 years. Conclusion: Bariatric surgery using an intensive multidisciplinary approach led to significant long-term weight loss and improvement in obesity-related comorbidities among the population with clinically complex obesity. These findings have important implications in clinical care for the management of the highest severity of obesity and its medical consequences. Major challenges associated with successful outcomes of bariatric surgery in highly complex patients include improving mental health in the long run and reducing postoperative opioid use. Long-term follow-up with a higher volume of patients is needed in publicly funded bariatric surgery services to better monitor patient outcomes, enhance clinical data comparison between services, and improve multidisciplinary care delivery. [ABSTRACT FROM AUTHOR]

Objective: This study examined factors related to hospital length of stay (LOS), reported referral on discharge, and hospital readmission, for children and adolescents (C&A) admitted to public hospitals for anorexia nervosa (AN), in a large health jurisdiction in Australia. Method: Sociodemographic, illness, treatment, and hospital factors associated with LOS, reported referral to post‐hospital treatment, and readmission within 28 days were analyzed for C&A with AN admitted to all New South Wales public hospitals in 2017, using median, multinomial logit and logit models. The sample comprised 289 admissions by 200 C&A aged 9–18 years with a primary or secondary diagnosis of AN. Results: AN as a primary diagnosis and the presence of some physical and mental co‐occurring conditions (e.g., malnutrition and obsessive–compulsive disorders) conferred a longer LOS. The majority of admissions were recorded being referred to primary care physicians (59.86%) and relatively small numbers to outpatient mental health services (5.54%) or outpatient eating disorder services (8.30%), with age, area socioeconomic status, and illness factors related to referral type. Male, low socioeconomic status, the presence of some co‐occurring illnesses (e.g., adjustment disorder and viral infection), and rural or remote locations increased the likelihood of readmission. Discussion: The findings have implications for service design, in particular the pathway to care from hospital into community for AN. Targeted interventions should consider recognizing and treating physical co‐occurring illnesses at presentation to the health system, ensuring appropriate referral to community services, and providing services in socioeconomically disadvantaged and rural or remote areas. [ABSTRACT FROM AUTHOR]

Background: Adherence to weight‐loss medication is suboptimal, leading to poor health outcomes. Short message service (SMS) can potentially improve adherence. Methods: A total of 3,994 participants with overweight or obesity in Australia receiving Saxenda® (liraglutide 3.0 mg) were enrolled from September 1, 2017, to February 28, 2018, through doctors, pharmacists, or websites and were randomly assigned to receive none, three, or five SMS per week. Participants were additionally offered a face‐to‐face consultation with a diabetes educator or a call from a dietitian. Medication adherence was measured as whether the total scripts claimed were at least as many as the total claims expected by March 31, 2018, and was modeled adjusting for age, sex, baseline BMI, residential region, enrolment channel, the total number of SMS, and additional patient support. Results: Participants receiving five SMS (OR, 6.25; 95% CI: 4.28‐9.12) had greater adherence than those receiving three SMS (OR, 3.67; 95% CI: 2.67‐5.03) or zero SMS per week. The effectiveness of SMS on adherence decreased as participants received more SMS over time. Moreover, the odds of adhering to liraglutide were higher for participants enrolled with pharmacists compared with those enrolled with doctors (OR, 2.28; 95% CI: 1.82‐2.86) and for participants who received a face‐to‐face consultation (OR, 3.10; 95% CI: 1.82‐5.29) or a call (OR, 1.31; 95% CI: 1.02‐1.68) compared with those who received no extra support. Conclusions: Integration of SMS into routine clinical practice should consider not only the frequency and content of reminders but also additional patient support to achieve higher and more sustained adherence to medication and health behavior changes. [ABSTRACT FROM AUTHOR]

Australia experienced some of the world's longest and most stringent lockdowns during the COVID-19 pandemic. While lockdown measures had consequences for mental health, investigation is lacking on the potential for green and blue space coverage within people's local environments to ameliorate the impact of lockdowns with varied lengths using longitudinal cohorts. This study examined the impact of lockdown durations on population mental health and tests the effect modification of neighbourhood green and inland and coastal blue space coverage in metropolitan areas. We merged population-based longitudinal data on more than 11,000 individuals collected over a ten-year period from 2012 to 2021 with national land use data describing green and blue space coverage. We used fixed effect models to estimate the relationship between lockdowns (with different durations and staggered introduction) and mental health, controlling for sociodemographic, health, and geographical confounders, and tested the significance of effect modification of green and blue space. Results show that extended lockdowns led to considerably larger decreases in mental health (COVID-y1: −2.66, 95%CI: −3.43, −1.89; COVID-y2: −2.65, 95%CI: −3.33, −1.97) relative to short lockdowns. The mental health effect of lockdowns was smaller where green spaces and inland and coastal blue spaces were available. Effect modification was statistically significant for green space, with smaller negative mental health effects observed where there was sizeable green space coverage, particularly during long lockdowns (COVID-y1: −2.69, 95%CI: −3.63, −1.76 for coverage <5%; −3.27, 95%CI: −4.70, −1.84 for coverage 5%–10%; −0.60, 95%CI: −2.03, 0.83 for coverage ≥30%; COVID-y2: −2.74, 95%CI: −3.62, −1.87 for coverage <5%, −2.95, 95%CI: −3.98, −1.92 for coverage 5%–10%; −2.08, 95%CI: −3.28, −0.88 for coverage ≥30%). Findings support the consideration of nature exposure to improve people's mental wellbeing and resilience when designing lockdown measures in response to future public health emergencies. • Extended lockdowns led to considerably larger decreases in mental health. • More green and blue spaces were associated with better mental health resilience. • Differential mental health impacts of lockdown durations reduced with more greenspace. • Protective effects of greenspace coverage were more salient for extended lockdowns. [ABSTRACT FROM AUTHOR]

Extreme weather and climate-related disaster events are associated with a range of adverse health outcomes. People are not equally vulnerable to the adversity, experiencing varied patterns of long-term health trajectories in recovery depending on their vulnerabilities, capacities, and resiliencies. This study aims to identify latent mental and physical health trajectories and their associations with person- and place-based pre-disaster predictors. Using an Australian, population-based, longitudinal dataset spanning 2009–19, group-based multi-trajectory modelling was applied to identify the distinct mental, social, emotional, and physical health trajectories of people who had experienced damage to their home following a climate-related disaster event. Multinomial logistic regression was used to assess a series of social vulnerability predictors (demographic, socioeconomic, housing, health, neighbourhood, and geographical) of health patterns. We identified three distinct health trajectories. Most individuals experienced small or minimal health impacts at the time of the disaster year followed by a fast recovery. However, one-fifth of the exposed population were severely affected during and post disaster. This cohort had the worst mental and physical health prior to the disaster and experienced the largest decreases in mental and physical health and the lowest recoveries. Pre-existing mental and physical conditions were the most substantial risk factors, increasing the probability of experiencing high impact and slow recovery by 61% for mental health and 51% for physical health. In addition, vulnerability in the form of housing affordability stress, lower household income, and lack of community attachment, participation and safety were also significant independent risk factors for ongoing post-disaster health problems. Critically, people's mental and physical health recovery is dependent on pre-disaster vulnerabilities in health, resource access, and capacities. These findings could assist policymakers and health practitioners to more effectively target people most at risk and design prevention and response strategies to prevent the exacerbation of poor health and wellbeing. • Most people exposed to disaster experienced low health impacts. • One fifth experienced large health decreases and slow recovery post-disaster. • Pre-disaster poor health increased risk for severe physical impacts by 51%. • Pre-disaster poor health increased risk for severe mental impacts by 61%. • Adaptation to climate-related disasters requires understanding prior vulnerability. [ABSTRACT FROM AUTHOR]

Using a population-based longitudinal dataset in Australia over nearly 20 years, this study examines the impact of tenure instability on mental health and psychological distress among a low-income working-age population. The analysis compares private renters (who are notable for their relative tenure insecurity in the Australian context) and homeowners with similar sociodemographic characteristics. To enhance group comparability and address the presence of time-varying covariates that confound and mediate the relationship between tenure exposure and mental health, marginal structural models were used applying weights estimated cumulatively over time. The results show that while private rental tenants report worse mental health than homeowners initially (mental health difference: Beta = −5.29, 95%CI −7.61 to −2.97; psychological distress difference: Beta = 1.77, 95%CI 0.55 to 2.99), this difference diminishes to become statistically indistinguishable by 5–6 years of occupancy (mental health difference at year 6: Beta = −2.09, 95%CI −4.31 to 0.13, predicted mental health increases: from 65.06 to 69.83 for private renters and from 70.46 to 72.02 for homeowners; psychological distress difference at year 5: Beta = 0.81, 95%CI −0.09 to 1.71, predicted psychological distress decreases: from 19.85 to 18.04 for private renters and from 17.95 to 17.10 for homeowners). Residential stability is particularly beneficial for private renters in early middle adulthood (35–44 years), with each additional year of stable occupancy for private renters correlated with a 0.99 (95%CI 0.46 to 1.53) increase in mental health and a −0.47 (95%CI −0.69 to −0.24) decrease in psychological distress. The findings provide evidence that stable and secure rental tenure is protective of mental health, and the mental health of stable renters becomes comparable to that of homeowners over time. This adds support for housing policies that promote and improve the stability and security of rental tenure. • A causal examination of mental health differences across tenure types. • Private rental tenants report worse mental health than homeowners initially. • After 6 years of occupancy, mental health of private renters and owners is similar. • Stable rental tenure is comparable to homeownership in supporting mental health. • Stability is particularly beneficial for private renters between 35 and 44 years. [ABSTRACT FROM AUTHOR]

Background Persistent exposure to environmental noise in people's homes has been associated with cardiovascular disease and poor mental health. Many studies conducted on noise and health are based on observational studies and the extent to which findings reflect residual confounding are not known. Methods Using the Household, Income and Labour Dynamics survey in Australia, we examine the impact of environmental noise (traffic, airplanes, train, industry) on self-reported mental health measured by the Short Form 36 Health Survey. Fixed-effects longitudinal regression analyses are used to account for differences between people over time, reducing confounding from time-invariant factors and reporting bias. Time-varying factors were adjusted including age, education, equivalised income, employment, household structure, chronic condition, government payment status and tenure type. Results Results show a significant decrease in average mental health as the level of noise increased. Exposure to loud traffic noise 'fairly commonly' or 'very commonly' negatively impacted mental health (-1.18; 95%CI -1.56, -0.81 and -1.33; 95%CI -1.77, -0.89) and exposure to noise from airplanes, trains or industry 'fairly commonly' or 'very commonly' negatively impacted mental health (-1.57; 95%CI -1.88, -1.27 and -1.48; 95%CI -1.89, -1.08). Conclusions This provides robust evidence of short-run mental health effects of noise exposure within people's homes. More research could be done to explore this over a longer-time frame. Key messages With increasing numbers of people living in urban areas, reducing environmental noise near people's homes or improving the capacity of homes to reduce external sources of noise (e.g. double glazing) may have public health benefit. [ABSTRACT FROM AUTHOR]

Vaccine refusal and hesitancy pose a significant public health threat to communities. Public health authorities have been developing a range of strategies to improve childhood vaccination coverage. This study examines the effect of removing conscientious objection on immunisation coverage for one, two and five year olds in Australia. Conscientious objection was removed from immunisation requirement exemptions for receipt of family assistance payments (national No Jab No Pay) and enrolment in childcare (state No Jab No Play). The impact of these national and state-level policies is evaluated using quarterly coverage data from the Australian Immunisation Register linked with regional data from the Australian Bureau of Statistics at the statistical area level between 2014 and 2018. Results suggest that there have been overall improvements in coverage associated with No Jab No Pay , and states that implemented additional No Jab No Play and tightened documentation requirement policies tended to show more significant increases. However, policy responses were heterogeneous. The improvement in coverage was largest in areas with greater socioeconomic disadvantage, lower median income, more benefit dependency, and higher pre-policy baseline coverage. Overall, while immunisation coverage has increased post removal of conscientious objection, the policies have disproportionally affected lower income families whereas socioeconomically advantaged areas with lower baseline coverage were less responsive. More effective strategies require investigation of differential policy effects on vaccine hesitancy, refusal and access barriers, and diagnosis of causes for unresponsiveness and under-vaccination in areas with persistently low coverage, to better address areas with persistent non-compliance with accordant interventions. • Removing conscientious objection increased overall childhood vaccination coverage. • The policy responses were heterogeneous. • Socioeconomically advantaged areas were less responsive to policy changes. • Benefit-dependent and lower-income areas were more responsive to policy changes. • Areas with pre-existing low coverage were more persistent and less responsive. [ABSTRACT FROM AUTHOR]

This study provides an empirical investigation on the impact of fertility intentions on residential relocation behaviours of partnered women during periods of housing price inflation in Australia. The finding suggests that there is a significant impact of fertility intentions on residential mobility. Couples with strong fertility intentions tend to move from one owner‐occupied dwelling to another with more capacity in more affordable local government areas. However, there is substantial heterogeneity around housing market conditions. The translation of fertility intention into relocation was not observed in housing markets with high affordability pressures. This study extends previous research on fertility intention and relocation behaviour by considering how housing market conditions can interfere the translation of fertility intentions into residential moves and the realisation of fertility intentions in births. [ABSTRACT FROM AUTHOR]

Background: Early detection and treatment are essential to ensuring the best possible health outcomes for people with eating disorders (EDs). However, low diagnostic accuracy and a lack of specific ED training are common workforce challenges in Australia and internationally. Online learning provides a potential solution in facilitating the access to evidence-based training programs. The InsideOut Institute has developed the first online clinical training program in EDs to assist with educating health professionals in the identification, assessment, and management of EDs. The aim of the study is to evaluate the effectiveness of the online training program, The Essentials, in mitigating barriers to health professionals treating patients with EDs. Methods: Pre and post training questionnaires assessed participants' attitudes, knowledge, and skills in relation to treating people with EDs. Demographic and work-related information (gender, discipline, work setting, practice length and remoteness) and participants' ratings of the online learning experience and satisfaction on completion were collected. The Wilcoxon signed rank test was applied to test for changes in learning outcomes before and after completion of the program. A multivariate linear regression model was estimated for each of the learning outcomes with personal and work-related characteristics as covariates. Results: Among 1813 health professionals who registered for The Essentials program between 1 October 2013 and 31 July 2018, 1160 completed at least 80% of the five learning modules. There were significant improvements in confidence, knowledge, skills to treat EDs and a reduction in stigmatised beliefs among the 480 participants who completed both pre and post assessments. Results from the regression models suggest that psychologists, dieticians, and those working in rural areas were more willing to treat EDs after completing the program. Additionally, those working in hospitals and regional or rural areas experienced the largest improvement in confidence for treating patients with EDs. Conclusions: The Essentials program represents a new and effective way of meeting the educational needs of partaking health professionals working with ED patients. Greater investment in the development and testing of evidence-based online training programs for EDs may help to address some of the considerable workforce development challenges in EDs. [ABSTRACT FROM AUTHOR]

Cold indoor temperature (<18 °C) is associated with hypertension-related and respiratory disease, depression, and anxiety. We estimate total health, health expenditure and income impacts of permanently lifting the temperature in living areas of the home to 18 °C in cold homes in South-eastern Australia (N = 17 million). A proportional multistate lifetable model was used to estimate health adjusted life years (HALYs), health expenditure and income earnings, over the remainder of the lifespan of the population alive in 2021 (3% discount rate). Multiple data were integrated including the prevalence of cold housing (5.87%; mean temperature 15 °C), the effect of temperature to hypertension-related, respiratory disease, depression and anxiety. Eradicating cold housing was predicted to lead to 89,600 (95% UI 47,700 to 177,000) lifetime HALYs gained over the population's remaining lifespan, nearly half of which occurred from 2021 to 2040. Respiratory disease (32.4%) and mental illness (60.6%) made large contributions to HALYs gained, but also had large uncertainty (95% UI 30.0%–42.9% and 45.1%–64.6%, respectively) due to uncertain estimates of their magnitude of causal association with cold housing. Health gains per capita were 6.1 times greater (95% UI 4.7 to 8.1) among the most compared to least deprived quintile. From 2021 to 2040, health expenditure decreased by AUD$0.87 billion (0.35–1.98) and income earnings increased by AUD$4.35 billion (1.89–9.81). Eliminating cold housing would lead to substantial health gains, reductions in health inequalities, savings in health expenditure, and productivity gains. Next steps require research to reduce uncertainty about the magnitude of causal associations of cold with mental and respiratory health. • Cold housing significantly impacts cardiovascular, respiratory, and mental health. • Eradicating cold housing leads to health gains across population's lifespan. • Eradicating cold housing leads to health expenditure savings and income gains. • Health gains are higher among the most compared to least deprived quintile. • Further research needed to reduce uncertainty on the magnitude of health impacts. [ABSTRACT FROM AUTHOR]

Objectives: While systems thinking has gained recognition as an important approach in health policy and prevention research, its application in the context of fall prevention among community-dwelling older adults has been underutilised. Here, we build on the guiding principles of the systemic lens component of the Prevention System Change Framework to assess and identify potential changes that are required to facilitate policy action in the field of falls prevention., Methods: We conducted a desktop search to identify policy documents encompassing falls prevention among community-dwelling older adults in Australia. Documents were considered eligible if they were published in the last 10 years and were authored or endorsed by federal or state government bodies. We collaboratively examined eligible documents to gain insights into the current policy landscape in falls prevention and to illustrate opportunities for action and the potential for strengthening partnerships., Results: There is no current national policy on preventing falls in older adults in Australia. While we identified eight policy documents, none focused exclusively on falls prevention, indicating that falls are currently not perceived as a public health issue that warrants a dedicated policy framework. We identified a need for a comprehensive national policy that draws upon insights from various disciplines, suggests intersectoral collaboration, addresses health inequities and involves meaningful engagement with key stakeholders. Future falls prevention policies may benefit from clear governance structures and specific targets, along with mechanisms for monitoring and evaluating outcomes., Conclusion: Falls prevention is a pressing public health concern that requires dedicated policy resources. Adopting a systems-oriented approach can help reduce falls and their associated burdens on individuals and the healthcare system. Acknowledging the urgency and complexity of this challenge is a first, essential step toward crafting a comprehensive national falls prevention policy., Competing Interests: None declared.

Background: Understanding the role of how people are housed in reducing the long-term health and housing effects of climate-related disasters is crucial given our changing climate. We examine long-term health and housing trajectories and health effects of climate-related disasters in relation to housing vulnerabilities over a decade., Methods: We conducted a matched case-control study using longitudinal population-based data from the Household, Income and Labour Dynamics in Australia survey. We included data from people whose homes had been damaged by climate-related disasters (eg, flood, bushfire, or cyclone) between 2009 and 2019 and matched control cohorts with similar sociodemographic profiles who had not been exposed to disaster-related home damage during this period. We included data from de-identified individuals with at least 1 year of data before disaster and 3 years after disaster. One-to-one nearest neighbour matching was performed on the basis of demographic, socioeconomic, housing, health, neighbourhood, location, and climate characteristics 1 year before disaster. Conditional fixed-effects models for matched case-control groups were used to assess health trajectories, using eight quality-of-life domains on mental, emotional, social, and physical wellbeing, and housing trajectories, using three housing aspects of cost (ie, housing affordability and fuel poverty), security (ie, residential stability and tenure security), and condition (ie, housing quality and suitability)., Findings: Exposure to home damage from climate-related disasters had significant negative effects on people's health and wellbeing at disaster year (difference between exposure and control groups in mental health score was -2·03, 95% CI -3·28 to -0·78; in social functioning score was -3·95, -5·57 to -2·33; and in emotional wellbeing score was -4·62, -7·06 to -2·18), with some effects lasting for 1-2 years after disaster. These effects were more severe for people who had housing affordability stress or were living in poor quality housing before the disaster. People in the exposure group had a slight increase in housing and fuel payment arrears following disasters. Homeowners had increased housing affordability stress (1 year after disaster: 0·29, 95% CI 0·02 to 0·57; 2 years after disaster: 0·25, 0·01 to 0·50), renters had a higher prevalence of acute residential instability (disaster year: 0·27, 0·08 to 0·47), and people who were exposed to disaster-related home damage had a higher prevalence of forced moves than did the control group (disaster year: 0·29, 0·14 to 0·45)., Interpretation: Findings support the need for recovery planning and resilience building to consider housing affordability, tenure security, and housing condition. Interventions might require divergent strategies for populations in different precarious housing circumstances, and policies should target long-term housing support services for highly vulnerable groups., Funding: The National Health and Medical Research Council Centre of Research Excellence in Healthy Housing, University of Melbourne Affordable Housing Hallmark Research Initiative Seed Funding, Australian Research Council's Centre of Excellence for Children and Families over the Life Course, and Lord Mayor's Charitable Foundation., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Objectives: Examine the effect of No Jab No Play policies, which linked vaccine status to childcare service entry without allowing for personal belief exemptions, on immunisation coverage., Study Design: Immunisation coverage rates from the Australian Immunisation Register were linked to regional level covariates from the Australian Bureau of Statistics between January 2016 and December 2019. Differential timings of policy rollouts across states were used to assess changes in coverage with the implementation of policies with generalised linear models. Quantile regression and subgroup analysis were also conducted to explore the variation in policy responses., Results: Baseline mean vaccination rates in 2016 were 93.4% for one-year-olds, 91.2% for two-year-olds and 93.2% for five-year-olds. Increases in coverage post-policy were significant but small, at around 1% across age groups, with larger increases in two and five-year-olds. Accounting for aggregate time trends and regional characteristics, implementation of the policies was associated with improved full immunisation coverage rates for age one (post-year 1: 0.15% [95 %CI-0.23; 0.52]; post-year 2: 0.56% [95 %CI 0.05; 1.07]), age two (post-year 1: 0.49 [95 %CI: 0.00; 0.97]; post-year 2: 1.15% [95 %CI: 0.53; 1.77], and age five (post-year 1: 0.38% [95 %CI 0.08; 0.67]; post-year 2: 0.71% [95 %CI 0.25; 1.16]. The policy effect was dispersed and insignificant at the lowest quantiles of the distribution of immunisation coverage, and smaller and insignificant in the highest socioeconomic areas., Conclusion: Findings suggest that No Jab No Play policies had a small positive impact on immunisation coverage. This policy effect varied according to prior distribution of coverage and socio-economic status. Childcare access equity and unresponsiveness in high socioeconomic areas remain concerns., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Purpose: This study examined the effects of economic downturns at the time of graduation on short-term and long-term mental health of graduates., Methods: Using a large longitudinal dataset whose respondents graduated from their highest level of education between 2001 and 2018 in Australia, the study investigated the effects of initial labor market conditions on psychological distress measures, quality-of-life mental health scales, and diagnoses of depression or anxiety since graduation., Results: Evidence suggests the presence of a scarring effect of graduating during a recession on the mental health of young adults, particularly significant and persistent for men. Higher unemployment rates at graduation were associated with increased risks of high psychological distress and diagnoses of depression or anxiety, and lower levels of social functioning and mental well-being among men lasting over a decade. The psychological effect was largely driven by young adults with vocational or secondary qualifications or receiving no government allowance at graduation., Conclusions: Policies should consider the psychological effect of graduating during recessions and focus particularly on vulnerable groups who are susceptible to adverse labor market conditions, such as graduates who are in cyclically sensitive occupations and have less or no work benefits and social protection., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: The study aimed to examine the consistency in factors associated with attitudes towards vaccination and MMR vaccination status., Methods: Using the nationally representative Longitudinal Study of Australian Children matched with the Australian Childhood Immunisation Register, 4,779 children were included from 2004-2005 to 2010-11. Different MMR vaccine dosages and general attitude towards vaccination were modelled individually with multinomial logit regressions, controlling for demographic, socioeconomic, and health related factors of the children and their primary carers., Results: The group with non-vaccination and negative attitudes was characterised by more siblings and older parents the group with under-vaccination but positive attitudes was characterised by younger parental age; and the group with under-vaccination and neutral attitudes was characterised by less socioeconomically advantaged areas. The presence of parental medical condition(s), being private or public renters, and higher parental education were associated with under-vaccination but not with attitudes towards vaccination, whilst parental religion was associated with attitudes towards vaccination but not reflected in the vaccine uptake., Conclusions: Vaccine attitudes were largely consistent with MRR vaccine outcomes. However, there was variation in the associations of factors with vaccine attitudes and uptake. The results have implications for different policy designs that target subgroups with consistent or inconsistent vaccination attitudes and behaviour. Parents with intentional and unintentional under-vaccination are of policy concern and require different policy solutions., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Many dietary recommendations for weight control rely on the assumption that greater core food intake will displace intake of energy-dense discretionary foods and beverages. However, there is little evidence to support these assumptions. This study examined the naturalistic relationship between daily core and discretionary energy intake, and with discretionary food and discretionary beverage intake, separately. The impact of weight status on these associations was also examined., Method: One hundred participants completed a four-day (non-consecutive) estimated food diary. Discretionary foods and beverages were identified by reference to the Australian Dietary Guidelines. Non-discretionary items were considered core items. Simultaneous-equation random effects models using disaggregated dietary data controlling for sociodemographic variables were used to determine the association between various dietary components., Result: Core energy intake correlated negatively with discretionary energy intake (cross-equation correlation, ρ = -0.49 (95% CI: -0.57, -0.39)). Its correlation with discretionary foods (-0.47 (-0.56, -0.37)) was stronger than that with discretionary beverages (-0.19 (-0.30, -0.07)) The correlation between core energy intake and discretionary energy intake was significantly stronger in participants who did not have obesity (-0.67 (-0.71, -0.50)) than those with obesity (-0.32 (-0.46, -0.17)) ( p = 0.0002)., Conclusions: Core and discretionary energy intake share an inverse and potentially bidirectional, relationship that appears to be stronger with discretionary foods than discretionary beverages. These relationships were significantly weaker in participants with obesity which may indicate less precise dietary compensation in these individuals. While strategies that promote greater intake of core foods may assist with weight maintenance in individuals of healthy weight, its impact in individuals with obesity may be limited. These strategies should be accompanied by direct messages to reduce commensurately the intake of discretionary items, with special attention paid to discretionary beverage consumption.