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Introduction: Despite vulnerability to alcohol-related harms, women have historically been under-represented in alcohol research. This study examined the prevalence and characteristics of women who drink at very high-risk levels (11+ standard drinks monthly), factors associated with this consumption and comparisons with men., Methods: Secondary analyses of 2019 National Drug Strategy Household Survey data were undertaken. Significant differences by sex in the distribution of demographic and alcohol-related variables were explored using chi-squared and Mann-Whitney U tests. Binary logistic regression examined factors associated with very high-risk drinking., Results: Very high-risk drinking was reported by 10.4% of men and 3.1% of women. Compared to men, women were significantly younger with higher levels of psychological distress/mental health conditions, and were more likely to be unmarried. Both women and men engaged in a range of harm-minimisation strategies. Odds of very high-risk drinking were significantly higher for respondents who were male, younger, employed, lived in a regional/rural/remote area, psychologically distressed, smoked and used illicit drugs. Interactions with sex indicated that very high-risk drinking declined after the age of 24 for men compared to 44 for women. Being married reduced the likelihood of very high-risk drinking more greatly among women compared to men, while living in a major city reduced the likelihood among men (and not women)., Discussion and Conclusions: Very high-risk drinking is not limited to Australian men, and the women who drink at these levels have distinct profiles and factors associated with consumption., (© 2024 The Authors. Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs.)

Introduction: Despite increased prevalence of methamphetamine in road trauma, it remains unclear how its use translates to an increased risk of traffic-related harm. Exploration of psychosocial factors may thus help identify relevant predictors of dangerous driving behaviour among people who regularly consume methamphetamine., Methods: Licenced individuals who report predominant and sustained methamphetamine use (at least 1-time/month for 6 months at heaviest use) were recruited from the Australian community and via targeted campaign (Eastern Health). Psychosocial, substance use and driving behaviour data (Dula Dangerous Driving Index, DDDI) were collected via a secure anonymous online forced-entry survey platform (Qualtrics)., Results: Seventy-seven individuals (65.5 % male) aged between 20-50 years [mean = 29.7, ± Standard Deviation (SD) 6.1] were included. Most (90 %) respondents met criteria for problematic methamphetamine use [Severity of Dependency Scale (SDS) score ≥ 5], and 75 % were high-risk alcohol consumers [Alcohol Use Disorders Identification Test (AUDIT-C) score ≥ 4 for men and ≥ 3 for women]. On average, age of first methamphetamine use occurred at 23.3 years (±5.2). A best-possible subset's regression selection method with dangerous driving behaviour as the dependent variable determined the model with three predictors (alcohol use, substance dependence severity and trait anger) as most parsimonious. After controlling for substance use, trait anger strongly and positively predicted dangerous driving behaviour as measured by the DDDI ([F (3,74)  = 26.06, p < .001, adjusted R 2  = 0.50, Cohens f 2  = 0.42)., Discussion and Conclusions: Trait anger is a strong predictor of risky driving among road users who use methamphetamine. Interactions between stable negative-emotional and situational traffic and driving-related factors may increase risk of harm through greater engagement in risk-taking behaviour., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: A.C.H is supported by a Rebecca L. Cooper Al and Val Rosenstrauss Fellowship (GNT: F2021894), S.A is supported by an NHMRC Emerging Leader Fellowship (GNT: 2008193). A.M, L.A.D and R.P.O have no conflicts of interests to declare. No external funding was received by any authors for this study., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Introduction: The current paper examines the proportion of drinking occasions and total alcohol consumed that takes place at off-premise locations. Comparisons are made between high-income countries: Australia, New Zealand, England and Scotland, and across drinker-types: high-risk and lower-risk., Methods: Data were taken from the International Alcohol Control study in Australia (N = 1789), New Zealand (N = 1979), England (N = 2844) and Scotland (N = 1864). The cross-national survey measures location and beverage-specific alcohol consumption. The number of drinking occasions and mean consumption across on- and off-premise locations and the proportion of drinking occasions that high- and lower-risk drinkers had at on- and off-premise locations was estimated for each country., Results: The majority of drinking occasions among high-risk drinkers occurred at off-premise locations across all four countries; Australia 80.1%, New Zealand 72.0%, England 61.7% and Scotland 60.7%. High-risk drinkers in Australia had significantly larger proportions of drinking occasions occurring at off-premise locations compared to England and Scotland. Across all countries, high-risk drinkers and lower-risk drinkers consumed significantly larger quantities of alcohol per occasion at off-premise locations compared to on-premises locations. Finally, the majority of total alcohol consumed occurred at off-premise locations across all countries for high- and lower-risk drinkers., Discussion and Conclusions: As the accessibility to alcohol outside of licensed premises continues to increase, particularly with the expansion of home delivery services, it is important to be mindful of the high proportion of heavy drinking occasions that occur off-premise., (© 2024 The Authors. Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs.)

Background: Globally, road traffic crashes are the leading cause of death for young adults. The P Drivers Project was a trial of a behavioural change program developed for, and targeted at, young Australian drivers in their initial months of solo driving when crash risk is at its highest., Methods: In a parallel group randomised controlled trial, drivers (N = 35,109) were recruited within 100 days of obtaining their probationary licence (allowing them to drive unaccompanied) and randomised to an intervention or control group. The intervention was a 3 to 6-week multi-stage driving behaviour change program (P Drivers Program). Surveys were administered at three time points (pre-Program, approximately one month post-Program and at 12 months after). The outcome evaluation employed an on-treatment analysis comprising the 2,419 intervention and 2,810 control participants who completed all required activities, comparing self-reported crashes and police-reported casualty crashes (primary outcome), infringements, self-reported attitudes and behaviours (secondary outcomes) between groups., Results: The P Drivers Program improved awareness of crash risk factors and intentions to drive more safely, relative to the controls; effects were maintained after 12-months. However, the Program did not reduce self-reported crashes or police-reported casualty crashes. In addition, self-reported violations, errors and risky driving behaviours increased in the intervention group compared to the control group as did recorded traffic infringements. This suggests that despite the Program increasing awareness of risky behaviour in novice drivers, behaviour did not improve. This reinforces the need to collect objective measures to accompany self-reported behaviour and intentions., Conclusions: The P Drivers Program was successful in improving attitudes toward driving safety but the negative impact on behaviour, lack of effect on crashes, and the large loss to follow-up fail to support the use of a post-licensing behaviour change program to improve novice driver behaviour and reduce crashes., Trial Registration: Australian New Zealand Clinical Trials Registry: 363,293 (ANZCTR, 2012)., 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 © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: This article aims to explore the extent and nature of Australian young people's pornography exposure and access., Methods: Cross-sectional online survey of 1,985 young Australians aged 15-20 years, nationally representative of a range of demographics., Results: Exposure to pornography was reported by 86% of male and 69% of female participants. Most exposure occurred when participants were alone and at home, regardless of gender. Young men were more likely than young women to seek pornography out and to view it frequently, with over half (54%) of male participants reporting weekly use compared with 14% of female participants. On average, boys and young men saw pornography 3.2 years before their first partnered sexual experience, and girls and young women saw it 2.0 years before theirs., Conclusions: It is common for young people to see pornography years before their first partnered sexual experience., Implications for Public Health: Unintentional and deliberate exposure to pornography is common and frequent among young people. Public health strategies among young people are necessary to address the potential harms associated with pornography use, including gender-based violence and risky sexual practices., Competing Interests: Conflicts of interest The authors have no competing interests to declare., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Objective: To evaluate aged care staff's 'willingness to help an older person with risk‐taking activities' that improve quality of life ('dignity of risk'). Methods: Opportunity‐based cross‐sectional anonymous electronic survey in four Australian jurisdictions, conducted immediately after screening a short animated narrative film describing 'dignity of risk'. Survey comprised nine questions including respondent demographics, professional role, risk‐taking and outcome. Results: From 24 separate screenings, there were 929 respondents. Agreement to 'help an older person with risk‐taking activities' was associated with respondent prediction of the least severe harm occurring (OR = 2.22 [1.20, 4.12], P =.001). Conversely, respondents in non‐executive, non‐managerial roles—that is, nurses and care workers—were unlikely to agree to help with risk‐taking activities (OR 0.36‐0.49, P ≤.03). There was not an association with respondent's age grouping (P =.6). Conclusion: Staff self‐reported attitudes towards dignity of risk are important to understand to enhance in an older person's quality of life. [ABSTRACT FROM AUTHOR]

Introduction: Substance use, including drugs, alcohol and smoking have a significant health, social and economic impact. We aim to assess the rate and factors associated with treatment access among individuals with high-risk substance use., Method: This study is a cross-sectional analysis of the 2019 Australian National Drug Strategy Household Survey (N = 22,015). Participants were persons with high-risk substance use based on the Alcohol, Smoking and Substance Involvement Screening Test-Lite (ASSIST-Lite) and current smokers. We measured self-reports of past 12-month engagement in a tobacco, alcohol or other drugs treatment program., Results: Overall, 0.4% had high-risk drug use (0.3% cannabis, 0.1% meth/amphetamine or 0.1% opioids), 7.4% had high-risk alcohol use, and 14.0% currently smoked. Among high-risk users, past 12-month treatment access rates were 50.6% [22.3-78.9%] for opioids, 27.1% [8.1-46.1%] for meth/amphetamine, 14.5% [4.3-24.7%] for cannabis, 9.6% [8.1-11.0%] for alcohol and 11.7% [10.6-12.9%] for current smoking. The primary source of treatment support was information and education (12.7% drugs, 4.6% alcohol, 4.0% smoking), followed by counselling (6.7% drugs, 4.5% alcohol, 3.0% smoking). Online or internet support was accessed by 5.9% (drug) and 1.6% (alcohol) people with high-risk use. Psychological distress was associated with treatment access (drugs: odds ratio 3.03 [0.77-11.95], p = 0.111; alcohol: odds ratio 3.16 [2.20-4.56], p ≤ 0.001; smoking: odds ratio 1.95 [1.52-2.49], p ≤ 0.001)., Discussion and Conclusions: The proportion of people engaging in risky substance use who had used treatment programs remains low, especially for alcohol. Public health strategies to scale up treatment access are warranted., (© 2023 The Authors. Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs.)

Background: In Australia, a man cannot donate blood if he has had sex with another man within the past 3 months. However, this policy has been criticized as being discriminatory as it does not consider lower risk subgroups, and led to calls for modifications to the policy that more accurately distinguish risk among gay, bisexual, and other men who have sex with men (GBM)., Study Design and Methods: We used data from a nationally representative survey to estimate the proportion of GBM aged 18-74 years old who would be eligible to donate under current criteria and other scenarios., Results: Among the 5178 survey participants, 155 (3.0%) were classified as GBM based on survey responses, Among the GBM, 40.2% (95% CI 28.0%-53.7%) were eligible to donate based on current criteria, and 21.0% (95% CI 14.5%-29.5%) were ineligible due to the 3 months deferral alone. Eligibility among GBM, all men, and the population increased as criteria were removed. Under the new Australian plasma donation criteria, 73.6% (95% CI 64.4%-81.1%) of GBM, 68.4% (95% CI 65.5%-71.2%) of all men, and 60.8% (95% CI 58.8%-62.8%) of the full population were estimated to be eligible. Only 16.1% (95% CI 8.6%-28.1%) of GBM knew that the male-to-male sex deferral period is 3 months., Discussion: Changing the deferral criteria and sexual risk evaluation would lead to a higher proportion of GBM being eligible to donate blood. Knowledge of the current GBM deferral period is very low. Improved education about the current criteria and any future changes are required to improve blood donation rates., (© 2024 The Authors. Transfusion published by Wiley Periodicals LLC on behalf of AABB.)

Antisocial behaviour is described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as behaviours that demonstrate a disregard for or the violation of social norms. The age–crime curve model states that engagement in antisocial and risk-taking behaviours is prevalent during adolescence; however, further research is required to explore the applicability of this model for a selection of behaviours. A convenience sample (n = 393) was used to explore adult's retrospective profiles of engagement using the Antisocial Engagement Questionnaire. The initial ages of engagement for 45 antisocial and risk-taking behaviours in an Australian sample were recorded (overall mean age = 17.01, SD = 2.51) and evidence for the age–crime curve model documented. Significant differences were found between the mean initial ages with antisocial behaviours occurring earlier than substance-related behaviours. Prevalence rates of engagement within the sample were also documented which were used to explore repeat offending and compared with previously recorded rates of engagement. As will be discussed, these findings are important for practitioners and researchers, in addition to informing the development of interventions, and the allocation of resources. [ABSTRACT FROM AUTHOR]

Lifestyle risk behaviours-physical inactivity, poor diet, poor sleep, recreational screen time, and alcohol and tobacco use-collectively known as the "Big 6" emerge during adolescence and significantly contribute to chronic disease development into adulthood. To address this issue, the Health4Life program targeted the Big 6 risk behaviours simultaneously via a co-designed eHealth school-based multiple health behaviour change (MHBC) intervention. This study used multiple causal mediation analysis to investigate some potential mediators of Health4Life's effects on the Big 6 primary outcomes from a cluster randomised controlled trial of Health4Life among Australian school children. Mediators of knowledge, behavioural intentions, self-efficacy, and self-control were assessed. The results revealed a complex pattern of mediation effects across different outcomes. Whilst there was a direct effect of the intervention on reducing moderate-to-vigorous physical activity risk, the impact on sleep duration appeared to occur indirectly through the hypothesised mediators. Conversely, for alcohol and tobacco use, both direct and indirect effects were observed in opposite directions cancelling out the total effect (competitive partial mediation). The intervention's effects on alcohol and tobacco use highlighted complexities, suggesting the involvement of additional undetected mediators. However, little evidence supported mediation for screen time and sugar-sweetened beverage intake risk. These findings emphasise the need for tailored approaches when addressing different risk behaviours and designing effective interventions to target multiple health risk behaviours. The trial was pre-registered with the Australian and New Zealand Clinical Trials Registry: ACTRN12619000431123., (© 2023. The Author(s).)

This paper documents differences in health outcomes and behaviors between parents who raise daughters and those who raise sons. Using Australian panel data from 2001 to 2019, we use OLS regression models to show that parents with daughters are physically healthier, a result linked to a reduced tendency to engage in risky behaviors such as binge drinking and smoking. The random nature of child gender implies our outcome gaps are likely to be causal, and the estimates survive a collection of diagnostics related to identification. We search for evidence that these effects occur via a general change in risk aversion, but this hypothesis is not supported. Fathers with daughters are actually more risk-seeking in both their broader life attitudes, and in their views on financial investment. We argue that this heterogeneity may come from a "breadwinner" effect, as part of a set of gender-varying norms around socially acceptable risk-taking., (Copyright © 2023. Published by Elsevier Ltd.)

Objectives: Head injuries resulting from e-scooter use have led to calls for helmet use to be promoted or mandatory. Helmet use is mandatory for e-scooters in Australia but observational studies have reported significant levels of nonuse, particularly by riders of shared e-scooters. The aim of this study is to understand whether nonuse in the mandatory context is a consistent behavior for an individual or is situationally-influenced, and what are the factors associated with nonuse., Methods: An online survey was completed between 2022 and 2023 by 360 adult e-scooter riders in Canberra, Australia. Riders were asked whether they had worn a helmet on their last ride and how often they had not worn a helmet when riding in the last 30 days. The survey also asked about rider characteristics (demographics, frequency of e-scooter and bicycle use, perceived risk of e-scooter use, e-scooter ownership, and risky behaviors while riding), trip duration and perceptions of the helmet requirement (knowledge of and support for the law)., Results: Respondents were mostly male, young, highly educated, and full-time workers. Of the 29.1% of riders who reported riding without a helmet in the last 30 days, 24.4% had worn a helmet at least once during that period and 4.8% had consistently not worn a helmet. Younger age, shared e-scooter use and more frequent riding frequency (shared e-scooters only) were associated with helmet nonuse in the bivariate analyses but not in the logistic regression. Logistic regression showed that the independent predictors of helmet nonuse were the number of risky riding behaviors, lack of knowledge, and lack of support for the law., Conclusions: Most nonuse of helmets in a mandatory context seems to be situational, rather than consistent. Many of the factors associated with nonuse of helmets for e-scooters are similar to those reported for bicycles. Nonuse of helmets appears to be one of a number of risky behaviors performed by riders, rather than being primarily an outcome that is specific to factors associated with helmets (e.g., concerns about hygiene, discomfort or availability).

Objective: Risk‐taking is an important but understudied suicidal factor, particularly concerning women. This study examined a broad range of risk behaviours and perceptions that might aid the early detection of suicidality by clinicians and gatekeepers. Method: A purposive anonymous online survey, preferable for collecting data on stigmatised issues, produced a sample of 273 Australian/New Zealand women (aged 18–67 years) covering a broad spectrum of suicidal factors and risk‐taking behaviours. Participants completed items on risk‐taking perceptions and behavioural willingness, and the Suicidal Affect‐Behavior‐Cognition Scale. Demographic factors were controlled for in partial correlations and hierarchical regression modelling, which tested the validity of risk‐taking variables as predictors of suicidality. Results: Suicidality was positively associated with willingness to engage in infidelity, not wearing seatbelts or motorcycle helmets, and negatively associated with interpersonal risk‐taking (unwillingness to endanger social relationships). Hierarchical regression modelling revealed these risk‐taking perceptions and behaviours explained 34% of the variance in women's suicidality, after accounting for age and ethnicity. Conclusions: This study demonstrated that some types of commonplace risk‐taking, or avoidance, may serve as important indicators or warning signs for suicidal crises in women. Clinicians should consider possible underlying psychological distress when encountering these symptoms and behaviours. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to examine the effects of chief executive officer (CEO) vega on firm policies in the Australian share market based on a panel data set drawn from the 137 Australian public firms for the period 2003-2012.Design/methodology/approach To allow mutual causation between our variables, the authors use the two-stage least squares estimation method, controlling for firm fixed effects. The authors use the difference-in-differences model to test whether the 2009 Australian tax reforms may discourage high-vega CEOs to take value-enhancing risks.Findings The authors find the evidence that vega induces CEOs to adopt the riskier financial policy in the Australian capital market. This evidence is further supported by the negative association between vega and firm conservative activities including cash and hedging policies. Further, the result shows that the 2009 tax reforms reduce the CEOs’ willingness to engage in risky financial policy. This finding implies that regulators may restore the 2009 reforms’ “deferred tax point” back to its pre-2009 form.Originality/value Based on the study’s results, firms should grant CEOs more out-of-the money options with a longer time to expiration to offset the 2009 tax reforms’ negative impact on the CEO’s incentive to take value-enhancing risks. [ABSTRACT FROM AUTHOR]

Objectives: Alcohol consumption and associated risk-taking behaviors, are known issues among trainees in the Australian Defence Force. We evaluated the impact and feasibility of a 1 day injury awareness program designed to reduce alcohol-related risk-taking behavior and associated harms in young naval trainees in this pilot study. Method: One hundred eight naval trainees participated in the 1 day Prevent Alcohol and Risk related Trauma in Youth (P.A.R.T.Y.) program at a hospital in Melbourne, Australia between November 2011 and March 2013. Participants completed pre- and postprogram questionnaires, on the day of the program, that included questions on perceptions of the program and their own risk-taking behavior. Alcohol-related incidents reported on their military record were collected at 12 months postprogram. Pre- and postprogram questionnaire responses were compared using descriptive statistics. Survival analysis was used to assess the association between pre-program alcohol-related incidents and the rate of reporting of alcohol-related incidents in the 12 months after the program. Results: Fifty of the 108 (46%) participants were reported for ≥1 alcohol-related incident prior to study participation. Fifteen (14%) were reported for an alcohol-related incident within 12 months of completing the program. Participants perceived the program positively with 92% reporting that the program would definitely influence their behavior after program completion compared to 82% suggesting so before. The rate of reported alcohol-related incidents following the program was higher for participants who had a preprogram incident on record than those who did not. Conclusion: Our findings suggest that PARTY participation was associated with a change in participants’ perceptions of risk-taking behavior. We found that alcohol-related incidents after attending the P.A.R.T.Y. program occurred more frequently among participants who had prior alcohol-related incidents suggesting the program may have less impact on this group. Further work is required to establish effectiveness of the P.A.R.T.Y. program in the military setting. [ABSTRACT FROM PUBLISHER]

This article considers risk-taking associated with the popular leisure activity of beach going in Australia. It investigates the risk-taking proclivities and cultural protocols in Australian beach use which, to date, have received little research attention. Drawing on the testimonies of beachgoers, we provide a discussion on how risk can be both voluntary as well as accidental at the Australian beach. While accidental risk-taking can be attributed to a lack of beachscape safety or lack of hazard knowledge, it is often the result of peer, sociocultural and psychodynamic influences that result in the production and reproduction of a pervasive culture of risk-taking. This culture is explored via the influence of the enculturation of risk into Australian beach practices, the attenuation of safety perceptions among beachgoers, and the attraction to risky behaviours that affect those in the beach space. The reproduction of risk in Australian beach use and the feeling of attachment observed among research participants have been conceptualised as the embodied societal subject, as identified through geographic psychoanalysis. A psychoanalytic geographic interpretation of participant attitudes and beliefs concerning risk-taking and beach use has been used to theorise how the prevailing discourses and fantasies of Australian beach use shape this site-specific culture of risk. [ABSTRACT FROM AUTHOR]

Background: Reducing alcohol related harms in Australian Defence Force (ADF) trainees has been identified as a priority, but there are few evidence-based prevention programs available for the military setting. The study aims to test whether the P.A.R.T.Y. program delivered in-hospital or on-base, can reduce harmful alcohol consumption among ADF trainees.Methods/design: The study is a 3-arm randomized controlled trial, involving 953 Royal Australian Navy trainees from a single base. Trainees, aged 18 to 30 years, will be randomly assigned to the study arms: i. in-hospital P.A.R.T.Y.; ii. On-base P.A.R.T.Y.; and iii.Control Group: All groups will receive the routine ADF annual alcohol awareness training. The primary outcome is the proportion of participants reporting an Alcohol Use Disorders Identification Test (AUDIT) score of 8 or above at 12 months' post-intervention. The secondary outcome is the number of alcohol related incidents reported to the Royal Australian Navy (RAN) in the 12 months' post-intervention.Discussion: This is the first trial of the use of the P.A.R.T.Y. program in the military. If the proposed intervention proves efficacious, it may be a useful program in the early education of RAN trainees.Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12614001332617 , date of registration: 18/12/2014 'retrospectively registered'. [ABSTRACT FROM AUTHOR]

This article presents data from a survey of Early Childhood Education and Care services in Australia. The study investigated outdoor play provision in terms of space, resources and planning for risk-taking in play. Overall, the results indicate that the participating centres are well-resourced to promote physical play, but vary in terms of opportunities for risk-taking in play. Although the majority of respondents believed their centres’ environments supported risk-taking in play, there were diverse perspectives among the teachers as to behaviours that constituted risky play. Regulatory restrictions relating to heights, arrangement of gross motor equipment and having insufficient space were also identified as factors limiting opportunities for challenging play. Furthermore, inconsistency in the way regulations were interpreted and applied arose as a key factor in the diversity of experiences reported by the respondents. The findings from this study have implications for pre- and in-service training for teachers in understanding how children’s risk-taking in outdoor play might be supported and managed. [ABSTRACT FROM AUTHOR]

Background: Lifestyle risk behaviours are prevalent among adolescents and commonly co-occur, but current intervention approaches tend to focus on single risk behaviours. This study aimed to evaluate the efficacy of the eHealth intervention Health4Life in modifying six key lifestyle risk behaviours (ie, alcohol use, tobacco smoking, recreational screen time, physical inactivity, poor diet, and poor sleep, known as the Big 6) among adolescents., Methods: We conducted a cluster-randomised controlled trial in secondary schools that had a minimum of 30 year 7 students, in three Australian states. A biostatistician randomly allocated schools (1:1) to Health4Life (a six-module, web-based programme and accompanying smartphone app) or an active control group (usual health education) with the Blockrand function in R, stratified by site and school gender composition. All students aged 11-13 years who were fluent in English and attended participating schools were eligible. Teachers, students, and researchers were not masked to allocation. Primary outcomes were alcohol use, tobacco use, recreational screen time, moderate to vigorous physical activity (MVPA), sugar-sweetened beverage intake, and sleep duration at 24 months, measured by self-report surveys, and analysed in all students who were eligible at baseline. Latent growth models estimated between-group change over time. This trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12619000431123)., Findings: Between April 1, 2019, and Sept 27, 2019, we recruited 85 schools (9280 students), of which 71 schools with 6640 eligible students (36 schools [3610 students] assigned to the intervention and 35 [3030 students] to the control) completed the baseline survey. 14 schools were excluded from the final analysis or withdrew, mostly due to a lack of time. We found no between-group differences for alcohol use (odds ratio 1·24, 95% CI 0·58-2·64), smoking (1·68, 0·76-3·72), screen time (0·79, 0·59-1·06), MVPA (0·82, 0·62-1·09), sugar-sweetened beverage intake (1·02, 0·82-1·26), or sleep (0·91, 0·72-1·14) at 24 months. No adverse events were reported during this trial., Interpretation: Health4Life was not effective in modifying risk behaviours. Our results provide new knowledge about eHealth multiple health behaviour change interventions. However, further research is needed to improve efficacy., Funding: Paul Ramsay Foundation, the Australian National Health and Medical Research Council, the Australian Government Department of Health and Aged Care, and the US National Institutes of Health., Competing Interests: Declaration of interests MT and NCN are developers of OurFutures, the web-based programme (formerly Climate Schools) on which Health4Life was modelled, and are co-directors of CLIMATESchools, a company established to enable the distribution of evidence-based wellbeing resources to schools. FK-L's digital programme SHADE is the subject of licensing arrangements with Magellan Health and Cobalt Therapeutics. FK-L has not received any royalties in relation to these licensing agreements to date, but may receive some in the future. FK-L is a non-executive board member for the Orygen Medical Research Institute, is President of the Society for Mental Health Research, and is a member and Research Committee Chair of the Women in Health Science Committee for the Australian National Health and Medical Research Council. All other authors 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.)

Objective: Physical inactivity, sugar sweetened beverage consumption, alcohol use, smoking, poor sleep and excessive recreational screen time (the 'Big 6' lifestyle risk behaviours) often co-occur and are key risk factors for psychopathology. However, the best fitting latent structure of the Big 6 is unknown and links between multiple lifestyle risk behaviours and hierarchical dimensions of psychopathology have not been explored among adolescents. This study aimed to address these gaps in the literature., Methods: Confirmatory factor analysis, latent class analysis and factor mixture models were conducted among 6640 students ( M age  = 12.7 years) to identify the latent structure of the Big 6 lifestyle risk behaviours. Structural equation models were then used to examine associations with psychopathology., Results: A mixture model with three classes, capturing mean differences in a single latent factor indexing overall risk behaviours, emerged as the best fitting model. This included relatively low-risk (Class 1: 30%), moderate-risk (Class 2: 67%) and high-risk (Class 3: 3%) classes. Students high on externalizing demonstrated significantly greater odds of membership to the high-risk class (odds ratio = 8.75, 99% confidence interval = [3.30, 23.26]) and moderate-risk class (odds ratio = 2.93, 99% confidence interval = [1.43, 5.97]) in comparison to the low-risk class. Similarly, students high on internalizing demonstrated significantly higher odds of membership to the high-risk class (odds ratio = 1.89, 99% confidence interval = [1.06, 3.37]) and the moderate-risk class (odds ratio = 1.66, 99% confidence interval = [1.03, 2.67]) in comparison to the low-risk class. Associations between lower order factors of psychopathology and lifestyle risk behaviours were mostly accounted for by the more parsimonious higher order factors., Conclusion: Classes representing differences in probabilities of the Big 6 lifestyle risk behaviours relate to varying levels of hierarchical dimensions of psychopathology, suggesting multiple health behaviour change and transdiagnostic intervention approaches may be valuable for reducing risk of psychopathology.

Background and Aims: It is well understood that engagement with some forms of gambling, like EGMs, is riskier than other forms. However, while reports of associations are common, few studies have attempted to evaluate and compare the relative risk of all available forms, and none have estimated the relative contribution of each form to the total burden of gambling problems (GP) in a population., Methods: Using an aggregated dataset of national and state-based prevalence studies in Australia (N = 71,103), we estimated prevalence and unique effects of frequency of engagement on each form on GP. Two alternative numerical methods were then applied to infer the relative contribution of each form to the total amount of GP., Results: EGMs are responsible for 51%-57% of gambling problems in Australia, and 90% of gambling problems are attributable to EGMs, casino, race, and sports betting. Casino table games and EGMs are equally risky at the individual level, but the former contribute far less to problems due to low participation. Bingo and lottery play show no statistically detectable risk for GP., Discussion and Conclusion: The results illustrate which forms present the greatest population burden and illuminate the reasons why. EGMs have an outsized impact. EGM uniquely combines high risk conditional on play, with a high participation rate and a high frequency of play among participants. This is in contrast to risky but less commonly played casino games, and prevalent but non-risky forms like lotteries. We conclude that EGM regulation should be a primary focus of policy action in Australia. More innovative policy ideas relating to EGMs should be tested due to the disproportionate impact of this product type.

In many high-income countries, the proportion of adolescents who smoke, drink, or engage in other risk behaviours has declined markedly over the past 25 years. We illustrate this behavioural shift by collating and presenting previously published data (1990-2019) on smoking, alcohol use, cannabis use, early sexual initiation and juvenile crime in Australia, England, the Netherlands, New Zealand, and the USA, also providing European averages where comparable data are available. Then we explore empirical evidence for and against hypothesised causes of these declines. Specifically, we explore whether the declines across risk behaviours can be considered 1) a 'unitary trend' caused by common underlying drivers; 2) separate trends with behaviour-specific causes; or 3) the result of a 'cascade' effect, with declines in one risk behaviour causing declines in others. We find the unitary trend hypothesis has theoretical and empirical support, and there is international evidence that decreasing unstructured face-to-face time with friends is a common underlying driver. Additionally, evidence suggests that behaviour-specific factors have played a role in the decline of tobacco smoking (e.g. decreasing adolescent approval of smoking, increasing strength of tobacco control policies) and drinking (e.g. more restrictive parental rules and attitudes toward adolescent drinking, decreasing ease of access to alcohol). Finally, declining tobacco and alcohol use may have suppressed adolescent cannabis use (and perhaps other risk behaviours), but evidence for such a cascade is equivocal. We conclude that the causal factors behind the great decline in adolescent risk behaviours are multiple. While broad contextual changes appear to have reduced the opportunities for risk behaviours in general, behaviour-specific factors have also played an important role in smoking and drinking declines, and 'knock-on' effect from these behavioural domains to others are possible. Many hypothesised explanations remain to be tested empirically., 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 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Student travellers are recognised as a group at high risk of travel-related morbidity, but few previous studies have evaluated students' perceptions of or willingness to take risks during travel. Individual risk propensities may influence travellers' engagement in pre-travel healthcare and can therefore inform strategies in pre-travel risk communication. This study aimed to describe the factors influencing risk-taking willingness, risk perceptions and future health-seeking intention among student travellers., Method: We conducted a cross-sectional online survey (June-August 2021) among students enrolled at Monash University, Melbourne, Australia. Primary outcomes were travel-related risk-taking willingness and risk perceptions, measured using the health/safety items of the validated Domain-Specific Risk-Taking (DOSPERT) scale., Results: Four hundred and eighteen students completed the survey. The mean age of respondents was 25.61 years, 78% were female and 46% were born outside Australia. Greater willingness to take risks was predicted by younger age (<25 years), being Australian-born, greater travel experience (3+ trips), having previously sought PTA, and perceiving oneself at low risk of severe COVID-19. We found no significant predictors of risk perception. Increased intention to seek pre-travel advice in the future was associated with greater risk perception, younger age, and perceiving oneself at high risk of severe COVID-19., Conclusion: These findings support the rationale for a greater role of risk communication in travel medicine promotion strategies. We recommend that this could be achieved through 1) increasing risk perception by emphasising potential travel-associated risks, 2) personalising information about travel risks, 3) addressing perceived benefits of engaging in risky behaviours, and 4) reinforcing self-efficacy., Competing Interests: Declaration of competing interest The authors have declared no conflicts of interest., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Motor competence and physical activity (PA) patterns are established during the early childhood years. Early childhood education (ECE) settings are an important context for children's engagement in physically active play. This paper reports the findings from an online survey examining resources, spaces and affordances for PA and risk-taking in outdoor play provision at 245 ECE centres across Australia. Centres were generally well resourced to promote physical play and provide a diverse range of experiences that support PA and motor development, although varied in terms of opportunities for risk-taking in play. Most respondents believed the environment at their centres supported children's engagement in moderate to vigorous PA, however, regulatory restrictions relating to recommended height limits on climbing apparatus and having insufficient space were identified as factors limiting opportunities for challenging, physically active play. Outdoor space and teacher support are identified as important factors in childhood settings to promote PA and risk-taking. The emphasis on outdoor environments as a mediator of physically active play should be beneficial in directing limited resources to the provision of environments that are most likely to produce positive PA outcomes. [ABSTRACT FROM AUTHOR]

Objective: Sexually transmitted infection rates are higher among young people relative to other age groups. Despite much investigation, there is not enough research about in-the-moment factors associated with risky sexual behaviour, such as relational and situational variables. The present study sought to test a comprehensive psychosocial model of sexual risk-taking that included a range of factors: individual (emotion dysregulation, impulsivity), relational (attachment, communication), societal (norms, gender), and situational (dating application use, alcohol use)., Methods: 1244 young people aged 18 to 25 years (82.9 % women; 59.2 % single, 36.0 % in a monogamous relationship) participated in an online survey. The cross-sectional model was tested using Structural Equation Modelling., Results: Sexual communication mediated the relationship between attachment anxiety and sexual risk. However, contrary to predictions, greater sexual communication was related to higher risk. Post-hoc analysis showed that this unexpected relationship may be due to the way sexual risk was measured, as an alternative model specifying casual unprotected sex as the outcome showed no positive relationship between sexual communication and risk., Conclusion: Findings indicate that young people with anxious attachment are less confident communicating about sexual health. Measures of sexual risk focusing on specific risk activities in context yield different findings to those assessing general sexual behaviours. Findings support interventions focusing on addressing perceived sexual risk norms and the dating application context to reduce risk., 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 B.V. All rights reserved.)

School connectedness has been shown to be an important protective factor in adolescent development, which is associated with reduced risk-taking behavior. Interventions to increase students’ connectedness to school commonly incorporate aspects of teacher training. To date, however, research on connectedness has largely been based on student survey data, with no reported research addressing teachers’ perceptions of students’ connectedness and its association with student behavior. This research attempted to address this gap in the literature through in-depth interviews with 14 school teachers and staff from two Australian high schools. Findings showed that teachers perceived students’ connectedness to be important in regard to reducing problem behavior, and discussed aspects of connectedness, including fairness and discipline, feeling valued, belonging and having teacher support, and being successfully engaged in school, as being particularly important. This research enables the development of school-based intervention programs that are based on both student- and teacher-focused research. [ABSTRACT FROM PUBLISHER]

The growth in the gig economy and a preference for home delivery of meals due to COVID-19 have led to huge growth in the food delivery business internationally and consequent road safety concerns. There is increasing evidence that delivery riding is an occupation with significant road safety risks because work pressures encourage risky behaviours. However, there is little or no research that directly compares delivery and private riders. Thus, the aim of this study was to examine the impact of riding for work by comparing the observable riding behaviours of food delivery and private bicycle riders. Specifically, this investigation used decision trees to analyse the prevalence and patterns of risky riding behaviours of 2274 bicycle food delivery riders (BFDRs) and 1127 private bicycle riders observed in the inner suburbs of Brisbane, Australia. The results showed that helmet use was higher for BFDRs than private riders (99.8% versus 93.4%) but varied by company and for some companies, female BFDRs had lower wearing rates. Male BFDRs on electric bikes were more likely to wear helmets than those on standard bikes (99.7% versus 94.9%). Using a handheld mobile phone or having a mobile phone in a cradle was less common for one company (0.6%) than for the others (3.0%) or among private riders (1.8%). Among riders from the Other Companies, using a handheld mobile phone was more common on standard bikes and differed by time of day. Female BFDRs were more likely to be observed using handheld mobile phones. Overall, 24.0% of riders facing a red traffic or pedestrian signal ("red light") did not stop. This was more common among riders who rode on the footpath (Australian term for sidewalk), and particularly those who moved between the footpath and the road on electric bikes (49.5%) and among those who rode in the wrong direction in the traffic lane (55.0%). Whether the rider was a BFDR or private rider had little influence on red light running. The results suggest that BFDRs are not more likely to perform the risky behaviours examined, but that other factors such as bicycle type, gender, time of day and infrastructure appear to be more important determinants. However, the differences among companies suggest that organisational factors deserve further investigation., 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.)

Personality syndromes in animals may have adaptive benefits for survival. For example, while engaging in predator deterrence, reactive individuals tend to prioritise their own survival, while proactive individuals engage in riskier behaviours. Studies linking animal personality measured in captivity with individual fitness or behaviours in the wild are sparse, which is a gap in knowledge this study aims to address. We used playback experiments in superb fairy-wrens ( Malurus cyaneus ), a common Australian songbird with a cooperative breeding system, to assess whether three personality traits measured during short-term captivity correlated with behavioural responses in the wild to a perceived nest and adult predator, the grey currawong ( Strepera versicolor ). We used three standard measures of personality in birds: struggle responses to human handling (boldness), exploration during a novel environment test, and aggressiveness during a mirror presentation. Superb fairy-wrens showed a significantly stronger response to the predator playback than to the control (willie wagtail, Rhipidura leucophrys ) playback, suggesting that they recognised the predator playback as a threat without any accompanying visual stimulus. Birds that attacked their mirror image during the mirror presentation and those that spent a moderate amount of time close to the mirror responded more strongly to predator playback (by approaching the speaker faster and closer, spending more time near the speaker, and being more likely to alarm call) compared to those with low aggressiveness or those that spent very short or long durations close to the mirror. Neither boldness nor exploration in the novel environment test predicted playback response. Our results align with a growing number of studies across species showing the importance of animal personalities as factors for fitness and survival., Competing Interests: The authors declare there are no competing interests., (©2022 Bilby et al.)

Children of problem gamblers are at risk of harm, however, there are no population level estimates as to how many children are currently exposed to parental problem- and at-risk gambling. The current study analysed data from the Household, Income and Labour Dynamics in Australia (HILDA) Survey, a nationally representative survey, to derive the first ever national estimates of the proportion of problem, moderate, and low risk gamblers (as measured by PGSI) in the Australian parent population. It also reports how many children under 15 years of age in Australia are exposed to parental gambling across the gambling risk categories. The results show that 13.7% of all Australian families with dependent children are currently exposed to some level of gambling risk due to parental gambling, and nearly 4% of families with children are exposed to parental moderate risk or problem gambling. This corresponds to almost 200,000 children each year. The results and approach of this study will guide future examination of child wellbeing in families where parents experience problems with gambling. The results are discussed in the context of public health approaches to familial gambling harm., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Objective: To examine changes in the prevalence of six key chronic disease risk factors (the "Big 6"), from before (2019) to during (2021) the COVID-19 pandemic, among a large and geographically diverse sample of adolescents, and whether differences over time are associated with lockdown status and gender., Design: Prospective cohort study., Setting: Three Australian states (New South Wales, Queensland and Western Australia) spanning over 3000 km., Participants: 983 adolescents (baseline M age =12.6, SD=0.5, 54.8% girl) drawn from the control group of the Health4Life Study., Primary Outcomes: The prevalence of physical inactivity, poor diet (insufficient fruit and vegetable intake, high sugar-sweetened beverage intake, high discretionary food intake), poor sleep, excessive recreational screen time, alcohol use and tobacco use., Results: The prevalence of excessive recreational screen time (prevalence ratios (PR)=1.06, 95% CI=1.03 to 1.11), insufficient fruit intake (PR=1.50, 95% CI=1.26 to 1.79), and alcohol (PR=4.34, 95% CI=2.82 to 6.67) and tobacco use (PR=4.05 95% CI=1.86 to 8.84) increased over the 2-year period, with alcohol use increasing more among girls (PR=2.34, 95% CI=1.19 to 4.62). The prevalence of insufficient sleep declined across the full sample (PR=0.74, 95% CI=0.68 to 0.81); however, increased among girls (PR=1.24, 95% CI=1.10 to 1.41). The prevalence of high sugar-sweetened beverage (PR=0.61, 95% CI=0.64 to 0.83) and discretionary food consumption (PR=0.73, 95% CI=0.64 to 0.83) reduced among those subjected to stay-at-home orders, compared with those not in lockdown., Conclusion: Lifestyle risk behaviours, particularly excessive recreational screen time, poor diet, physical inactivity and poor sleep, are prevalent among adolescents. Young people must be supported to find ways to improve or maintain their health, regardless of the course of the pandemic. Targeted approaches to support groups that may be disproportionately impacted, such as adolescent girls, are needed., Trial Registration Number: Australian New Zealand Clinical Trials Registry (ACTRN12619000431123)., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

An emerging literature has identified optimal low-risk gambling limits in an effort to reduce gambling-related harm. Concerns have, however, been raised about the construction of aggregate low-risk limits that are applied to all gambling activities and there is support from gambling experts and the general public in Australia for the identification of low-risk limits for specific gambling activities. The study's aim was to identify and evaluate a set of empirically-based activity-specific limits (gambling frequency, gambling expenditure, gambling expenditure as a proportion of gross personal income, session expenditure, session duration) in a secondary analysis of Social and Economic Impact Studies of Gambling in Tasmania and the 2014 Survey on Gambling, Health and Wellbeing in the ACT. Balancing sensitivity and specificity, limits were identified for all gambling activities: EGMs (10 times per year, AUD$300/year, 0.63-1.04% of personal income, AUD$35 per session, 40 min/session), horse/dog racing (0.55% of personal income), instant scratch tickets (AUD$45/year), lotteries (0.45% of personal income), keno (4-13 times/year, AUD$45-$160/year), casino table games (AUD$345/year, 0.36-0.76% of personal income), bingo (AUD$150/year, 0.49% of personal income, AUD$17/session, 90 min/session), and sports/other event betting (14 times/year, AUD$400/year, 0.55-0.86% of personal income). These limits were exceeded by one-quarter to one-half of gamblers on these specific activities and were generally good predictors of gambling-related harm in subgroups of gamblers participating in these gambling activities and in the overall gambling sample. The limits provide gamblers, regulators, prevention workers, and researchers with simple rules of thumb in prevention efforts to reduce gambling-related harm in specific contexts., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

In this paper, we contrast the early childhood education and care aims and curriculum in Norway and Australia and the theoretical underpinnings of Norwegian and Australian pedagogy in an attempt to partially explain the different approaches to (risky) outdoor play in these two countries. We argue that Norwegian pedagogical approaches may allow teachers to theorize more about, and place greater emphasis on, physical and motor development than teachers in countries such as Australia. Evidence includes reference to theories typically used in Norwegian and Australian writing. Additionally, we examine interview data from teachers, which reveals that both groups of teachers share similar understandings of the importance of risk-taking in play, but there is more consistency between belief and practice for Norwegian than Australian teachers. We argue that the differences in alignment of belief and practice in the two countries are partly attributable to the differing theoretical bases of teachers' pedagogical approaches in each country. These findings have implications for theorizing about outdoor play and learning. In particular, we argue that early childhood teacher training programmes should include approaches based on Gibsonian and Dynamic Systems theories. [ABSTRACT FROM PUBLISHER]

Purpose: Despite recent increases in the popularity of tattooing, little is known about the prevalence and characteristics of adults who have ever been tattooed. We investigated demographic and behavioral correlates of ever getting tattooed in an adult population. Methods: Computer-assisted telephone interviews were completed by a representative sample of 8656 men and women ages 16–64 years in Australia. Results: A total of 14.5% of respondents had ever been tattooed, and 2.4% of respondents had been tattooed in the year before the interview. Men were more likely than women to report a tattoo, but the highest rates of tattooing were found among women in their 20s (29.4%). Men and women ages 20–39 were most likely to have been tattooed, as were men with lower levels of education, tradesmen, and women with live-out partners. Tattooing was also associated with risk-taking behaviours, including smoking, greater numbers of lifetime sexual partners, cannabis use (women only) and ever having depression (men only). Conclusions: Tattooing has increased in popularity during the past decade. Yet tattoos still appear to be a marker for risk-taking behavior in adults. [Copyright &y& Elsevier]

In many countries playground design is driven more by safety than developmental benefits. As risk minimisation strategies become more stringent, many researchers and practitioners are questioning whether young children are able to take sufficient risks in play in order for their play experiences to be interesting and developmentally challenging. This study examined the outdoor play choices and risk-taking behaviour of 38 children (25 boys, 13 girls) aged between 48 and 64 months from Sydney, Australia. Semi-structured interviews examined children's play preferences and playground equipment usage. Observations of play explored engagement in risk-taking behaviour. Selection of equipment indicated a strong preference for challenge and excitement. However, the dominant observed play behaviours involved little risk suggesting equipment at these parks provided few opportunities to practice mastery of skills already in their behavioural repertoire, learning new skills or building on current capabilities. The findings have implications for play provision and playground design. RESUME: Dans de nombreux pays, la securite preside davantage a la conception des cours de recreation que la preoccupation du developpement des enfants. Tandis qu'on observe une inflation des strategies de reduction des risques, un grand nombre de chercheurs et de professionnels se demandent si les jeunes enfants son capables de prendre suffisamment de risques dans leurs jeux afin de rendre ces experiences ludiques interessantes et porteuses de defis sur le plan du developpement. Cet article porte sur les choix de jeux de plein air et les comportements de prise de risque de 38 enfants (25 garcons, 13 filles) ages de 48 a 64 mois a Sydney, en Australie. Nous avons etudie, a l'aide d'entretiens semi directifs, les preferences ludiques des enfants et leur utilisation des equipements de cours de recreation. Nous avons eu recours a des observations de jeux pour investiguer leur implication dans des conduits de prises de risques. Certains equipements sont preferes pour leurs attraits et defis. Pourtant, les conduites de jeu dominantes presentent peu de prise de risques, ce qui laisse a penser que les equipements offrent peu d'occasion de maitriser les habiletes deja acquises, d' en acquerir de nouvelles ou d'en construire a partir des competences presentes. Les resultats ont des implications quant a l'offre ludique et a la conception des cours de recreation. ZUSAMMENFASSUNG: In vielen Landern ist die Anlage eines Freigelandes mehr zugunsten von Sicherheit als von Entwicklung bestimmt. Da Strategien zur Minimierung von Risiken zwingender werden, wird seitens der Forschung sowie der Praxis vielfach die Frage gestellt, ob junge Kinder genugend Risiken in einer Weise eingehen konnen, dass ihre Spielerfahrungen sowohl interessant als auch herausfordernd fur sie sind. Diese Studie untersuchte die Auswahlmoglichkeiten des Spielens im Freien sowie Risiken eingehendes Verhalten von 38 Kindern (15 Jungen, 13 Madchen) im Alter von 48 und 64 Monaten in Sydney, Australien. Mit halbstrukturierten Interviews wurden die Spielpraferenzen der Kinder und die Nutzung der Ausstattung des Freigelandes untersucht. Mit Beobachtungen wurde das Engagement in Risken eingehendem Verhalten beim Spielen exploriert. Die Auswahl der Ausstattung zeigte eine starke Praferenz fur Herausforderung und Aufregung. In die dominanten Spielverhaltensweisen, die beobachtet wurden, wurde jedoch Ausstattung dieser Parks einbebezogen, die wenig Risiken anbot und damit wenig Gelegenheiten, (1) die Beherrschung von Fertigkeiten zu zeigen, die bereits im Verhaltensrepertoire der Kinder vorhanden waren, (2) neue Fertigkeiten zu erlernen oder (3) auf vorhandenen Fertigkeiten aufzubauen. Die Ergebnisse haben Implikationen fur Spielangebote und die Planung von Spielplatzen. RESUMEN: En muchos paises el diseno de los parques de juegos es impulsado por la seguridad, mas que por las ventajas para el desarrollo. En la medida que las estrategias para minimar los riesgos son mas estrictas, muchos investigadores y practicos cuestionan si los ninos som capaces de arriesgar lo suficiente en sus juegos para que estos sean interesantes y desafiantes para el desarrollo. El estudio examina las conductas riesgosas y la eleccion de juegos al aire libre de 38 ninos (25 ninos y 13 ninas) de 48 a 64 meses de edad, de Sidney, Australia. Entrevistas semi-estructuradas examinaron las preferencias de juego de los ninos y el equipaje usado. Observaciones de juegos exploraron el envolvimiento en conductas riesgosas. Eleccion de equipajes indicaban mayores preferencias por desafios y excitacion. Sin embargo, las conductas de juegos dominantes observadas envolvian pocos riesgos, sugeriendo que el equipamiento de esos parques proporcionaban pocas oportunidades de practicar el dominio de habilidades de sus repertorios conductuales, aprendiendo nuevas habilidades o desarrollando capacidades ya existentes. Los resultados tienen implicaciones para el diseno y suministro de parques de juegos. [ABSTRACT FROM AUTHOR]

The article discusses a study which examined beliefs about the effects of substance use among gay and bisexual men in Australia. Epidemiological research suggested higher rates of substance abuse among men who have sex with men. Substance use is associated with socio-cultural aspects of gay life, including ecstasy and crystal meth use at dance parties. Results showed that most participants reported lifetime use of alcohol, cannabis, stimulants and amyl nitrite. Cognitive functioning, mood, social interaction and sexual activity were some of the themes identified regarding participants' thoughts, emotions and behaviours.

The influence of risk perceptions on risk activities of teenagers is well known, but the development of indices, which combine measures of perception as well as behavioral outcomes, has proved problematical. This article discusses the ways in which this methodological problem was tackled within a five-year, multiphase, multimethod study of factors affecting adolescent risk-taking in Tasmania, Australia, which included an intergenerational comparison of adolescents and parents. The development of the Risk Activity by Personal Risk Assessment (RAPRA) Index combines measures of perceived riskiness of 26 activities identified by young people as involving varying degrees of risk, with the degree of participation by each respondent, through a rectangular model of weights. The Personal Risk Score Category (PRISC) Index summarizes and categorizes an individual's risk-taking profile relative to the group's risk values and risk hierarchy established by the RAPRA Index. The article discusses ways in which technical problems involved in combining measures of risk perceptions and risk activities were addressed during index construction, compared with examples in the literature. Some key findings from analysis of two student and parent samples are presented as exemplars of the methods used and the results produced. Findings demonstrate the widespread nature of risk-taking among teenagers, and the similarity of levels of risk-taking between teenager and parental generations. The indices allow for detailed comparison of particular risk-taking activities and reveal differences among teenagers now compared with parents when they were teenagers, and illustrate the dynamic cultural context of risk-taking perceptions and values. [ABSTRACT FROM AUTHOR]

Objective: The objective of the present study was to quantify the relationship between acute alcohol consumption and injury severity. Methods: A cross-sectional study was conducted at the Gold Coast Hospital, Gold Coast, Queensland, Australia between October 2000 and October 2001. Data were collected from a systematic sample of patients greater than 15 years of age who presented to the ED for treatment of an injury sustained less than 24 h prior to presentation. Study participants were interviewed face to face on-site. Information obtained included: demographics details; situational variables relative to time of injury (i.e. location, activity and companions at time of injury); self-reported alcohol consumption in the 6 and 24 h prior to time of injury; usual alcohol consumption patterns; self-reported substance use in the 6 and 24 h prior to time of injury; and risk-taking behaviour. Injury severity was coded from patient medical records using the New Injury Severity Score. Results: Of 789 eligible patients presenting during the study periods, 593 were interviewed (75.2%). Patients who reported drinking above low-risk levels (odds ratio [OR] = 3.35; 95% confidence interval [CI] 1.2–9.6) or who drank beer (OR = 3.54; 95% CI 1.1–11.1) in 6 h prior to injury were significantly more likely to sustain serious than minor injury. Drinking setting and usual drinking patterns were not significantly associated with injury severity, either in crude analyses, or after adjusting for relevant variables. Conclusion: The results of the present study support the conclusion that among injured patients who presented for treatment at a large metropolitan ED, although acute alcohol consumption does not appear to be associated with minor or moderate injury, there is some evidence to suggest that acute alcohol consumption is associated with serious injury. [ABSTRACT FROM AUTHOR]

Abstract: The Adolescent Risk-Taking Questionnaire (ARQ) was designed to provide a standard measure of perceptions of risk and frequency of engaging in risky behaviour. The stability of the ARQ across cohorts and over time was assessed via confirmatory factor analysis (CFA) using data from 4112 Australian adolescents participating in a 12-month, three-wave longitudinal study. CFA of the perception scale revealed none of three models tested fit reliably across the waves. This suggests adolescent risk perceptions change over short periods of time. Although limited due to extreme non-normality, CFA of the frequency scale also indicated the original factor structure was inappropriate. These results propose adolescent risk-taking behaviour may evolve rapidly enough to warrant calibrating standard measures to each sample. [Copyright &y& Elsevier]

To address the lack of data on patterns of benzodiazepine use among injecting drug users (IDU) in Victoria and Tasmania, convenience samples of 152 Melbourne and 100 Hobart IDU were recruited from needle and syringe programme outlets and administered a structured survey on patterns of benzodiazepine use, injection-related health problems and drug use history. Most respondents had used benzodiazepines during the preceding 6 months, and more than one-third (Melbourne 36%, 95% CI, 28-44; Hobart 37%, 95% CI, 27-47) had injected benzodiazepines during this period. Diazepam was the preferred benzodiazepine for those using orally, while intravenous benzodiazepine users preferred to inject temazepam. Benzodiazepine injection for Melbourne IDU was related to greater levels of injection-related health problems. Patterns of benzodiazepine use amongst Melbourne and Hobart IDU are different to that in other Australian jurisdictions, with available data suggesting that prevalence of injection may be increasing. Ongoing monitoring of benzodiazepine injection, together with in-depth studies of supply characteristics and health impacts in jurisdictions where significant trends are detected is needed. Consideration of regulatory, supply, education and training options for the prevention of benzodiazepine injection is also indicated. [ABSTRACT FROM AUTHOR]

Aim: To assess the prevalence of modifiable health-risk behaviours among Indigenous Australian adults with diabetes attending a regional Victorian Indigenous primary-care clinic., Design: A cross-sectional observational single-site study., Methods: As part of a multi-study project we administered the Smoking, Nutrition, Alcohol consumption, Physical activity and Emotional wellbeing (SNAPE) survey tool during the study baseline visit to methodically capture health-related behavioural data in the nurse-led integrated Diabetes Education and Eye Screening (iDEES) project in a regional Indigenous primary healthcare setting between January 2018 and March 2020. This descriptive SNAPE study helps address the lack of health behaviour data for Indigenous people with diabetes., Results: Of 172 eligible adults, 135 (79%) were recruited to the iDEES study, 50 (37%) male. All participated in at least one survey. Median (range) age was 56 (46-67) years; 130 (96%) had Type 2 diabetes of median [IQR] duration 6 (2-12) years. All 135 provided smoking data; 88 (65%) completed all surveys. Forty-nine (36%) and 29 (22%) were current or former smokers, respectively; 5 (6%) met vegetable intake guidelines, 22 (25%) met fruit intake guidelines; 38 [43%] drank alcohol in the past year. On average, participants walked for ≥10 min at a time 4 days/week and sat for an average of 8 h on weekdays; 35 (40%) had minimal-mild, and 30 (34%) had moderate-severe depressive symptoms., Conclusion: Suboptimal modifiable health-risk behaviours and depressive symptoms are common in Indigenous Australian adults with diabetes., Impact: Orderly assessment and reporting of health-risk behaviours using a single multi-component survey instrument (SNAPE tool) during a nurse-led diabetes education clinical visit is feasible and efficient. Such data may facilitate personalised interventions and improve diabetes management at both individual and health service levels., (© 2022 John Wiley & Sons Ltd.)

Objective: Consumer Protection Tools (CPTs; e.g., deposit limits, timeouts) are provided by gambling sites to assist customers to gamble without harms. We aimed to understand how CPTs are used, and by which customers, which is essential to determine their effectiveness., Method: We examined the account data of 39,853 customers (median age = 33 years; 84% male) across six Australian wagering sites over 1 year (2018/07/01-2019/06/30)., Results: Most (83%) customers did not use any CPTs, with low rates of use for deposit limits (15.8%), timeouts (0.55%-1.57%), and self-exclusion tools (0.16%-0.57%) observed. Requiring customers to set a deposit limit or opt-out of setting one led to substantial increases in limit setting. Many customers who used limits later changed them, typically by increasing or removing them. Non-CPT users and deposit limit users were similar in their demographic and gambling characteristics, while comparatively, timeout and/or self-exclusion users were younger and displayed more risky gambling behaviors (e.g., higher net loss and betting frequency)., Conclusions: Our findings suggest that voluntary deposit limits have inherent limitations in addressing harmful behaviors if consumers can easily increase or remove limits. The study suggests that greater efforts are needed to encourage CPT use among a broad customer base, including default limits requiring opt-out, greater restrictions on increasing or remove limits, and more persuasive communication of the benefits of timeouts. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Introduction: Adolescent drinking has been declining in Australia over the past two decades, but this trend may be part of a broader shift towards healthier lifestyles for adolescents. We examined trends in the prevalence of multiple risky health- and school-related behaviours and outcomes to test whether this was the case., Methods: Data on multiple behaviours and outcomes were collated from Australian government agencies and other relevant sources for 10-19-year-olds from the year 2000 onward. Trends were examined descriptively., Results: Rates of substance use, youth offending and injuries due to underage driving declined over the study period. Some health-related behaviours (physical activity and diet) worsened between 2001 and 2017; however, obesity rates remained stable. Risky sexual behaviours increased in terms of early initiation of lifetime sexual intercourse and decreased condom use. However, sexual health outcomes improved with a reduction in teenage pregnancies and there was a recent decline in sexually transmitted infection rates from 2011 onward. Suicide rates and rates of major depressive disorders increased. School attendance and engagement in full-time work or study remained stable., Discussion and Conclusions: The decline in adolescent drinking does not appear to correspond with increased engagement in healthier behaviours; however, it may be related to a more risk-averse way of living. Future work could be directed towards identifying which social, economic, policy and environmental factors have impacted positive changes in risky behaviours. Public health efforts can then be directed towards behaviours or outcomes, which have not yet improved., (© 2021 Australasian Professional Society on Alcohol and other Drugs.)

Drowning is a global public health problem, but accurately estimating drowning risk remains a challenge. Coastal drowning comprises a significant proportion of the drowning burden in Australia and is influenced by a range of behavioural factors (e.g. risk perception, knowledge, attitudes and behaviours) that are poorly understood. These factors, along with those that impact exposure (e.g. coastal visitation and activity participation) all impact on drowning risk. While excellent mortality and morbidity data exists in Australia, a lack of coastal participation data presents challenges to identifying high-risk groups or activities and prioritising prevention efforts. This methods paper describes the development and evolution of an ongoing, annual, nationally representative online survey as an effective tool used to capture valuable data about the Australian population's relationship with the coast. This paper explores how the survey is structured (12-14 sections spanning multiple topics and themes), the different question types used (including open text, 4-digit responses and categorical questions), the sample size (1400-1600 respondents), sampling strategy (using demographic quota sampling which can then be post-weighted to the population if required) and how topics and themes have changed over time to enhance the quality of data collected (i.e., wording changes to enhance participant comprehension or data usability and changing issue-specific 'feature' topics of interest such as campaign evaluation). How the survey is implemented online is described, both practically through to third-party recruitment processes and ethically to maximise anonymity of respondents and ensure data quality. Interim analyses indicate the impact of considering exposure when calculating fatal drowning rates, especially by activity (e.g., crude boating drowning rate 0.12 per 100,000 population vs 0.95 per 100,000 exposed population [relative risk = 8.01; 95% confidence interval: 4.55-14.10]). This study highlights lessons learned in the process of conducting a nationally representative coastal participation survey as well as the strengths and limitations of adopting this approach. Data collected will provide more detailed information on the skills, behaviours, knowledge and attitudes of coastal activity participants. Analyses of this unique dataset will inform research that will underpin development and evaluation of coastal drowning prevention initiatives prioritising those most at risk. It is hoped that the methods detailed within this study may be useful for other countries to develop similar approaches to understanding their own population., Competing Interests: One author is a senior employee at OmniPoll Market Research company (FA), his involvement in this paper was central to describing and understanding the structure, implementation and evolution of the survey. This author has contributed his time pro bono and does not stand to benefit financially from the publication of this work – but is philosophically motivated and excited to see this dataset produce more robust research outcomes. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

The relationship between risk-taking behavior, alcohol consumption and negative alcohol-related consequences is well known. The current analyses were conducted to investigate whether alcohol mixed with energy drink (AMED) is related to risk-taking behavior and if there is a relationship between the amount of energy drink mixed with alcohol consumed, risk-taking behavior and negative alcohol-related consequences. Data from N = 1276 AMED consuming students from the Netherlands, UK and Australia who completed the same survey were evaluated. The analysis revealed that, compared to AMED occasions, on alcohol only (AO) occasions significantly more alcohol was consumed and significantly more negative alcohol-related consequences were reported. On both AO and AMED occasions, there was a strong and positive relationship between amount of alcohol consumed, level of risk-taking behavior and number of reported negative alcohol-related consequences. In contrast, the level of risk-taking behavior was not clearly related to energy drink consumption. Across risk-taking levels, differences in the amount of energy drink consumed on AMED occasions did not exceed one 250 mL serving of energy drink. When correcting for the amount of alcohol consumed, there were no statistically significant differences in the number of energy drinks consumed on AMED occasions between the risk-taking groups. In conclusion, alcohol consumption is clearly related to risk-taking behavior and experiencing negative alcohol-related consequences. In contrast, energy drink intake was not related to level of risk-taking behavior and only weakly related to the number of experienced negative alcohol-related consequences.

Galactagogues are foods, herbs or medications thought to support or increase breast milk supply. The use of galactagogues during lactation is becoming increasingly common despite limited evidence regarding effectiveness and safety, and no definitive recommendations for use in clinical practice. The aim of this study is to explore factors influencing women's decisions to use galactagogues during lactation. Twenty-two semi-structured interviews were conducted in October and November 2019 (over the telephone or in person) with participants located in most Australian states and territories, including metro and regional areas. Interviews were audio-recorded, transcribed verbatim and thematically analysed using NVivo. Analysis revealed that following a concern about breast milk supply, the decision to use galactagogues was influenced by three core and interrelated domains: access to and quality of breastfeeding support, maternal agency and determination to provide breast milk. Women revealed many problematic experiences with health care professionals that left them feeling dismissed and confused due to provision of inconsistent and insufficient information that was sometimes at odds with their desire to provide breast milk. In this instance, some women turned to galactagogues to regain agency. A range of broader dimensions influencing decision-making also emerged. These were separated into categories that emphasise distinctions relating to breast milk supply, which included: maternal emotional wellbeing, social norms and pressures, concerns about infant development, maternal physical health and lactation history, as well as those relating specifically to galactagogue use, including: desire for a guaranteed/urgent response, risk-risk trade-off, acceptance and trust, and accessibility and cost. In understanding the complexity of decision-making concerning these substances, we identify opportunities to improve breastfeeding counselling and support. We recommend that support be individually tailored to manage conflicting information, adopt communication styles that encourage trust and processes that enable shared decision-making to enhance or restore maternal agency. There is also considerable need to address evidence gaps regarding the effectiveness and safety of commonly used galactagogues, so that women can be appropriately counselled about potential benefits and harms., Competing Interests: The authors have declared that no competing interests exist

We have tracked belief in the effectiveness of HIV treatment as prevention (TasP) among Australian gay and bisexual men (GBM) since 2013. National, online cross-sectional surveys of GBM were conducted every 2 years during 2013-2019. Trends and associations were analyzed using multivariate logistic regression. Data from 4,903 survey responses were included. Belief that HIV treatment prevents transmission increased from 2.6% in 2013 to 34.6% in 2019. Belief in the effectiveness of TasP was consistently higher among HIV-positive participants than other participants. In 2019, higher levels of belief in TasP were independently associated with university education, being HIV-positive, using pre-exposure prophylaxis, knowing more HIV-positive people, being recently diagnosed with a sexually transmitted infection (STI) and use of post-exposure prophylaxis. Belief that HIV treatment prevents transmission has increased substantially among Australian GBM, but remains concentrated among HIV-positive GBM, those who know HIV-positive people, and GBM who use antiretroviral-based prevention.

Objectives: Driving under the influence (DUI) of drugs or alcohol impairs driving performance and, as a result, increases the risk of crashes. The risk of DUI is five-fold higher for young drivers (aged 18-25 years), but little is known about what determines their DUI intentions. This study applied an extended model of the Theory of Planned Behavior (TPB) to address the research question of what factors might influence young drivers' future intentions to DUI. Methods: This study used a survey obtaining data from 329 young drivers (Mage = 20.92 years, SD  = 2.16) in Australia. Beyond the standard TPB measures of attitudes, subjective norms and perceived behavioral control (PBC), the current study included demographic variables and additional predictors (i.e., moral norm, peers' norm, perceived risk, impulsivity and past DUI behavior). Results: A vast majority of the participants (85.1%) selected the maximum (9, never), meaning that they had no intention to DUI in the future. Overall, a stepwise multilevel logistic regression analysis (Step 1: demographics, Step 2: TPB measures, and Step 3: additional predictors) explained between 30.1% and 52.9% of the variance in DUI intentions. It showed past DUI behavior as the strongest predictor of DUI intention, followed by instrumental attitude and descriptive norms. Conclusions: This study explored an extended TPB model to understand young drivers' DUI intentions better. With this new knowledge of understanding the factors that influence DUI, researchers and practitioners can create interventions and strategies that are better tailored to the population of young drivers at higher risk.

The prevalence of problem gambling in many countries necessitates research that examines factors influencing excessive and addictive consumption. We consider how social capital impacts gambling participation for a large representative sample of the Australian population. Specifically, we examine the association between social capital and gambling addiction using data from the Household, Income and Labour Dynamics in Australia survey. We address the endogeneity of social capital by instrumenting for social capital using an urban/rural reversed measure of ethnic diversity. Our main findings suggest that higher levels of social capital are associated with lower gambling risks measured by the Problem Gambling Severity Index. This general finding is robust to alternative ways of measuring social capital and gambling, and alternative estimation approaches. We also find that the effect of social capital is stronger in the case of problem gamblers compared to gamblers in other risk categories.