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Despite infidelity being a highly traumatic experience, not all couples end their relationship after discovery of the affair. The present study provides insights into the experience of couples who remained together after having experienced infidelity by one partner. Narrative inquiry methods were used to undertake and analyze in-depth interviews with eligible participants from eastern Australia who responded to advertisements. The key themes acknowledged by participants as reasons for maintaining the relationship were motivation to stay together, treasuring acts of kindness, meaning making, and social support. However, the reconciliation process was tortuous and involved forgiveness, seeking counseling, managing memories, vicarious learning, and changing couple dynamics. In rebuilding the relationship, a modification often took place, resulting in a shift in the power dynamic. The article outlines professional considerations for counselors and other therapists in relation to professional practice. (Contains 1 table.)

Few studies have examined the practice wisdom of expert supervisors. This study addresses this gap by exploring how experienced supervisors manage difficulties in supervision in the context of the supervisory relationship. The supervisors were a purposive sample of 16 senior members of the profession with considerable expertise in supervision. In-depth interviews were first conducted with the supervisors. An interpersonal process recall method was then used to explore their reflections on one of their DVD-recorded supervision sessions. Analysis of transcripts was completed using a modified consensual qualitative research method. Major difficulties included the broad domains of supervisee competence and ethical behavior, supervisee characteristics, supervisor countertransference, and problems in the supervisory relationship. Supervisors managed these difficulties using 4 key approaches: relational (naming, validating, attuning, supporting, anticipating, exploring parallel process, acknowledging mistakes, and modeling); reflective (facilitating reflectivity, remaining mindful and monitoring, remaining patient and transparent, processing countertransference, seeking supervision, and case conceptualizing); confrontative (confronting tentatively, confronting directly, refusing/terminating supervision, taking formal action, referring to personal therapy, and becoming directive); and avoidant interventions (struggling on, withholding, and withdrawing). Two brief case studies illustrate the process of applying these strategies sequentially in managing difficulties. The study highlights the importance of relational strategies to maintain an effective supervisory alliance, reflective strategies--particularly when difficulties pertain to clinical material and the supervisory relationship--and confrontative strategies with unhelpful supervisee characteristics and behaviors that impede supervision. (Contains 1 table.)

The impact of parental suicide on surviving children and their family system has received inadequate research attention. Using a qualitative narrative methodology with thematic analysis, we explored the short-term and lifelong impact of parental suicide among 10 adults who, as children or adolescents, had lost a parent through suicide. The suicide triggered a wide range of structural and relational changes to the family, resulting in a cascading series of negative outcomes. These systemic issues are discussed and recommendations made about support structures for bereaved children and their families. Limitations of the study are discussed and future research directions identified.

Describes development over five years of Australia's Hunter Region Health Promoting Schools Project, noting barriers to health-promoting schools, examining the new approach to health promotion, discussing the minimum set of health-promotion actions for reducing risk behaviors (increasing knowledge and skills, modifying availability of products, changing the environment, and improving role models), and looking at the project's guiding principals. (SM)

The impact of parental suicide on surviving children and their family system has received inadequate research attention. Using a qualitative narrative methodology with thematic analysis, we explored the short-term and lifelong impact of parental suicide among 10 adults who, as children or adolescents, had lost a parent through suicide. The suicide triggered a wide range of structural and relational changes to the family, resulting in a cascading series of negative outcomes. These systemic issues are discussed and recommendations made about support structures for bereaved children and their families. Limitations of the study are discussed and future research directions identified.

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

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

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

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

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

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

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

Objectives. The provision of smoke-free areas in restaurants has been a controversial issue; the restaurant industry largely opts for a self-regulation approach. This study aimed to examine the effectiveness of self-regulation as a strategy in meeting the industry's and customers' perceived needs. Method. Restaurateur and customer perspectives on the provision of smoke-free areas in restaurants were examined by survey among 365 restaurateurs and 1327 customers in New South Wales, Australia. Results. Less than 2% of restaurants were totally smoke-free; 22% provided some smoke-free areas. Customers were much more likely than owners to think that smoke-free areas should be provided. Owners appeared to be unaware of customers' views about smoke-free areas in restaurants. Conclusions. Little evidence was found to support the effectiveness of the self-regulation policy adopted by the restaurant industry. Characteristics of restaurants and owners associated with the provision of smoke-free areas are presented and implications of the findings are discussed.(Am J Public Health. 1993;83:1284-1288), Restaurateurs and their customers in New South Wales, Australia disagree to a remarkable degree about the need to provide smoke-free restaurants or at least non-smoking areas. A study of 365 restaurateurs in two cities and 1,327 of their customers shows that customers favor non-smoking areas far more than restaurants provide them. According to the survey of restaurateurs, under 2% of restaurants prohibited smoking altogether, and only 22% provided smoke-free areas. This suggests that the policy of allowing restaurants to regulate themselves regarding provision of smoke-free areas is a failure. In contrast, nearly 90% of customers favored either separate smoking areas or a ban on smoking. Restaurant owners should pay greater attention to the needs and desires of their customers, and customers should actively demand segregation of smokers in restaurants.

Abstract Background Healthy couple relationships are fundamental to a healthy society, whereas relationship breakdown and discord are linked to a wide range of negative health and wellbeing outcomes. Two types of relationship services (couple counselling and relationship education) have demonstrated efficacy in many controlled studies but evidence of the effectiveness of community-based relationship services has lagged behind. This study protocol describes an effectiveness evaluation of the two types of community-based relationship services. The aims of the Evaluation of Couple Counselling study are to: map the profiles of clients seeking agency-based couple counselling and relationship enhancement programs in terms of socio-demographic, relationship, health, and health service use indicators; to determine 3 and 12-month outcomes for relationship satisfaction, commitment, and depression; and determine relative contributions of client and therapy factors to outcomes. Methods/Design A quasi-experimental pre-post-post evaluation design is used to assess outcomes for couples presenting for the two types of community-based relationship services. The longitudinal design involves a pre-treatment survey and two follow-up surveys at 3- and 12-months post-intervention. The study is set in eight Relationships Australia Victoria centres, across metropolitan, outer suburbs, and regional/rural sites. Relationships Australia, a non-government organisation, is the largest provider of couple counselling and relationship services in Australia. The key outcomes are couple satisfaction, relationship commitment, and depression measured by the CESD-10. Multi-level modelling will be used to account for the dyadic nature of couple data. Discussion The study protocol describes the first large scale investigation of the effectiveness of two types of relationship services to be conducted in Australia. Its significance lies in providing more detailed profiles of couples who seek relationship services, in evaluating both 3 and 12-month relationship and health outcomes, and in determining factors that best predict improvements. It builds on prior research by using a naturalistic sample, an effectiveness research design, a more robust measure of relationship satisfaction, robust health indicators, a 12-month follow-up period, and a more rigorous statistical procedure suitable for dyadic data. Findings will provide a more precise description of those seeking relationship services and factors associated with improved relationship and health outcomes.

Abstract Background While families headed by same-sex couples have achieved greater public visibility in recent years, there are still many challenges for these families in dealing with legal and community contexts that are not supportive of same-sex relationships. The Work, Love, Play study is a large longitudinal study of same-sex parents. It aims to investigate many facets of family life among this sample and examine how they change over time. The study focuses specifically on two key areas missing from the current literature: factors supporting resilience in same-sex parented families; and health and wellbeing outcomes for same-sex couples who undergo separation, including the negotiation of shared parenting arrangements post-separation. The current paper aims to provide a comprehensive overview of the design and methods of this longitudinal study and discuss its significance. Methods/Design The Work, Love, Play study is a mixed design, three wave, longitudinal cohort study of same-sex attracted parents. The sample includes lesbian, gay, bisexual and transgender parents in Australia and New Zealand (including single parents within these categories) caring for any children under the age of 18 years. The study will be conducted over six years from 2008 to 2014. Quantitative data are to be collected via three on-line surveys in 2008, 2010 and 2012 from the cohort of parents recruited in Wave1. Qualitative data will be collected via interviews with purposively selected subsamples in 2012 and 2013. Data collection began in 2008 and 355 respondents to Wave One of the study have agreed to participate in future surveys. Work is currently underway to increase this sample size. The methods and survey instruments are described. Discussion This study will make an important contribution to the existing research on same-sex parented families. Strengths of the study design include the longitudinal method, which will allow understanding of changes over time within internal family relationships and social supports. Further, the mixed method design enables triangulation of qualitative and quantitative data. A broad recruitment strategy has already enabled a large sample size with the inclusion of both gay men and lesbians.

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

Family mediation is mandated in Australia for couples in dispute over separation and parenting as a first step in dispute resolution, except where there is a history of intimate partner violence. However, validation of effective well-differentiated partner violence screening instruments suitable for mediation settings is at an early phase of development. This study contributes to calls for better violence screening instruments in the mediation context to detect a differentiated range of abusive behaviors by examining the reliability and validity of both established scales, and newly developed scales that measured intimate partner violence by partner and by self. The study also aimed to examine relationships between types of abuse, and between gender and types of abuse. A third aim was to examine associations between types of abuse and other relationship indicators such as acrimony and parenting alliance. The data reported here are part of a larger mixed method, naturalistic longitudinal study of clients attending nine family mediation centers in Victoria, Australia. The current analyses on baseline cross-sectional screening data confirmed the reliability of three subscales of the Conflict Tactics Scale (CTS2), and the reliability and validity of three new scales measuring intimidation, controlling and jealous behavior, and financial control. Most clients disclosed a history of at least one type of violence by partner: 95% reported psychological aggression, 72% controlling and jealous behavior, 50% financial control, and 35% physical assault. Higher rates of abuse perpetration were reported by partner versus by self, and gender differences were identified. There were strong associations between certain patterns of psychologically abusive behavior and both acrimony and parenting alliance. The implications for family mediation services and future research are discussed. [ABSTRACT FROM AUTHOR]

Objective University students have a high risk of psychological distress; however, few Australian studies have specifically examined the prevalence of, or risk factors for, depressive symptoms. This study aimed to examine the prevalence of depressive symptoms among university students and the characteristics of those with depressive symptoms. Method Participants were randomly selected university students at a large metropolitan university in Victoria, Australia. An online survey was administered in May 2009 to assess depressive symptoms using the Depression Anxiety Stress Scale (dependent variable) and a broad range of independent variables including students' demographic, study, psychosocial, and mental health characteristics. Hierarchical multiple regression was used to examine characteristics of those with depressive symptoms. Results Results estimated the prevalence of mild to extremely severe depressive symptoms as 39.5% among the 800 respondents, with 13% in the severe/extremely severe range. The best-fit regression model accounted for 63% of variance in depressive symptoms. Factors associated with higher depressive symptomatology included high anxiety, stress, and loneliness, low body appreciation, studying law/management, regular binge drinking, and less physical activity. Conclusions The implications of our findings include the need for further action by higher education policy and decision-makers and more integrated approaches to the development of resilience, mental health promotion, and early intervention among this vulnerable student population. [ABSTRACT FROM AUTHOR]