Publications by authors named "George Tsourtos"

34 Publications

Various structural factors influenced early antiretroviral therapy initiation amongst HIV infected prisoners: a qualitative exploration in South Ethiopia.

BMC Public Health 2021 07 28;21(1):1463. Epub 2021 Jul 28.

College of Medicine and Public Health, Flinders University, Adelaide, Australia.

Background: Early initiation of antiretroviral therapy (ART) reduces the development of acquired immunodeficiency syndrome (AIDS), non-AIDS related comorbidities and mortality, and prevents transmission. However, the prevalence of delayed ART initiation amongst prisoners in sub-Saharan African countries is high and the contributing factors to this are relatively unknown.

Methods: Qualitative interviewing was employed to understand the prisoners' lived world with regard to initiating ART and associated barriers and facilitators in the South Ethiopian prison system. We interviewed seven (five male and two female) inmates living with HIV (ILWH) and eleven stakeholders who had a role in human immunodeficiency virus (HIV) care provision for incarcerated people. A phenomenological approach was used to analyse the interview data in which meaning attributed to the lived experiences of the participants was abstracted.

Results: In this study, participants discussed both barriers to, and facilitators of, early ART initiation during incarceration. The barriers included a lack of access to voluntary counselling and testing (VCT) services, poor linkage to care due to insufficient health staff training, uncooperative prison security systems and loss of privacy regarding disclosure of HIV status. Insufficient health staff training and uncooperative prison security systems both contributed to a loss of patient privacy, ultimately resulting in treatment refusal. Although most participants described the importance of peer education and support for enhancing HIV testing and treatment programs amongst prisoners, there had been a decline in such interventions in the correctional facilities. Service providers suggested opportunities that a prison environment offers for identification and treatment of HIV infected individuals and implementation of peer education programs.

Conclusions: Our study identified crucial barriers to and facilitators of early ART initiation amongst prisoners, a key HIV priority population group. Interventions that address the barriers while strengthening the facilitators may enhance a greater utilisation of ART.
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http://dx.doi.org/10.1186/s12889-021-11499-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8317278PMC
July 2021

The Value of Applying Ethical Principles in Telehealth Practices: Systematic Review.

J Med Internet Res 2021 03 30;23(3):e25698. Epub 2021 Mar 30.

College of Medicine and Public Health, Flinders University, Bedford Park, Australia.

Background: As the use of technology to deliver health services is increasing rapidly and has further intensified during the COVID-19 pandemic, these initiatives may fail if ethical impacts are not fully identified and acted upon by practitioners. Ignoring the ethical impacts of information and communication technology health service delivery creates an unintended risk for patients and can lead to reduced effectiveness, noncompliance, and harm, undermining the best intentions of governments and clinicians.

Objective: Our aim was to explore how ethical considerations or impacts may be different, greater, or more variable in information and communication technology methods versus face-to-face health care delivery models, and how they may be applied in practice.

Methods: We undertook a systemic literature review to provide a critical overview of existing research into the incorporation of ethical principles into telehealth practice. Six databases were searched between March 2016 to May 2016 and again in December 2020 to provide the benefit of currency. A combination of broad terms ("ethics," "ethical," "health," and "care") with the restrictive terms of "telehealth" and "telemedicine" was used in keyword searches. Thematic analysis and synthesis of each paper was conducted, aligned to the framework developed by Beauchamp and Childress.

Results: From the 49 papers reviewed, authors identified or discussed the following ethical principles in relation to telehealth practice: autonomy (69% of authors, 34/49), professional-patient relationship (53% of authors, 26/49), nonmaleficence (41% of authors, 20/49), beneficence (39%, of authors, 19/49), and justice (39% of authors, 19/49).

Conclusions: Although a small number of studies identified ethical issues associated with telehealth practice and discussed their potential impact on service quality and effectiveness, there is limited research on how ethical principles are incorporated into clinical practice. Several studies proposed frameworks, codes of conduct, or guidelines, but there was little discussion or evidence of how these recommendations are being used to improve ethical telehealth practice.
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http://dx.doi.org/10.2196/25698DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8044738PMC
March 2021

A qualitative inquiry of professionals' perceptions of bilingualism for children with language delay.

Int J Speech Lang Pathol 2021 Feb 22:1-18. Epub 2021 Feb 22.

College of Nursing and Health Sciences, Flinders University, Adelaide, Australia.

This study aimed to understand the knowledge, attitudes and beliefs of early childhood health and education professionals on bilingualism and heritage language maintenance for children with language delay, and how their interactions with caregivers may influence the decision-making process to maintain or not maintain speaking heritage languages with children. A qualitative methodology was used to explore the research aims. Seven early childhood health and education professionals with experience working with bilingual families participated in in-depth interviews. Data were analysed using a grounded theory approach and a symbolic interactionism theoretical framework. Understandings of bilingualism and language development were strongly influenced by socially and culturally contextualised factors, such as the linguistic context in Australia. Barriers and facilitators to supporting bilingualism and helping caregivers make informed choices included: unique child and family characteristics, the level of trust in professional advice, and the level of professional agency to support knowledge and practice. Findings highlighted the need to focus on the processes involved in supporting caregivers to make informed decisions about bilingualism and heritage language maintenance for children with language delay. The need for professional development on bilingualism and language development for early childhood health and education professionals was also highlighted.
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http://dx.doi.org/10.1080/17549507.2020.1869306DOI Listing
February 2021

A systematic review and meta-analyses on initiation, adherence and outcomes of antiretroviral therapy in incarcerated people.

PLoS One 2020 18;15(5):e0233355. Epub 2020 May 18.

Medicine and Public Health, Flinders University, Adelaide, Australia.

Background: Incarcerated people are at increased risk of human immunodeficiency virus (HIV) infection relative to the general population. Despite a high burden of infection, HIV care use among prison populations is often suboptimal and varies among settings, and little evidence exists explaining the discrepancy. Therefore, this review assessed barriers to optimal use of HIV care cascade in incarcerated people.

Methods: Quantitative and qualitative studies investigating factors affecting linkage to care, ART (antiretroviral therapy) initiation, adherence and/or outcomes among inmates were systematically searched across seven databases. Studies published in English language and indexed up to 26 October 2018 were reviewed. We performed a narrative review for both quantitative and qualitative studies, and meta-analyses on selected quantitative studies. All retrieved quantitative studies were assessed for risk of bias. Meta-analyses were conducted using RevMan-5 software and pooled odds ratios were calculated using Mantel-Haenszel statistics with 95% confidence interval at a p<0.05. The review protocol has been published at the International Prospective Register of Systematic Reviews (PROSPERO; Number: CRD42019135502).

Results: Of forty-two studies included in the narrative review, eight were qualitative studies. Sixteen of the quantitative studies were eligible for meta-analyses. The narrative synthesis revealed structural factors such as: a lack of access to community standard of HIV care, particularly in resource limited countries; loss of privacy; and history of incarceration and re-incarceration as risk factors for poor HIV care use in prison populations. Among social and personal characteristics, lack of social support, stigma, discrimination, substance use, having limited knowledge about, and negative perception towards ART were the main determinants of suboptimal use of care in incarcerated people. In the meta-analyses, lower odds of ART initiation was noticed among inmates with higher baseline CD4 count (CD4 ≥500celss/mm3) (OR = 0.37, 95%CI: 0.14-0.97, I2 = 43%), new HIV diagnosis (OR = 0.07, 95%CI: 0.05-0.10, I2 = 68%), and in those who lacked belief in ART safety (OR = 0.32, 95%CI: 0.18-0.56, I2 = 0%) and efficacy (OR = 0.31, 95%CI: 0.17-0.57, I2 = 0%). Non-adherence was high among inmates who lacked social support (OR = 3.36, 95%CI: 2.03-5.56, I2 = 35%), had low self-efficiency score (OR = 2.50, 95%CI: 1.64,-3.80, I2 = 22%) and those with depressive symptoms (OR = 2.02, 95%CI: 1.34-3.02, I2 = 0%). Lower odds of viral suppression was associated with history of incarceration (OR = 0.40, 95%CI: 0.35-0.46, I2 = 0%), re-incarceration (OR = 0.09, 95%CI: 0.06-0.13, I2 = 64%) and male gender (OR = 0.55, 95%CI: 0.42-0.72, I2 = 0%). Higher odds of CD4 count <200cells/mm3 (OR = 2.01, 95%CI: 1.62, 2.50, I2 = 44%) and lower odds of viral suppression (OR = 0.20, 95%CI: 0.17-0.22, I2 = 0%) were observed during prison entry compared to those noticed during release.

Conclusion: Given the high HIV risk in prison populations and rapid movements of these people between prison and community, correctional facilities have the potential to substantially contribute to the use of HIV treatment as a prevention strategy. Thus, there is an urgent need for reviewing context specific interventions and ensuring standard of HIV care in prisons, particularly in resource limited countries.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0233355PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7233580PMC
September 2020

An exploratory study of the acceptability of indoor residual spraying for malaria control in upper western Ghana.

BMC Public Health 2020 Apr 6;20(1):465. Epub 2020 Apr 6.

Bureau of Integrated Rural Development, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana.

Background: Despite the implementation of the World Health Organisation's recommended indoor residual spraying (IRS) intervention in the upper west region of Ghana to reduce malaria morbidity and mortality, the uptake of this intervention remains low. This study explores the facilitators and barriers to the acceptability and community uptake of indoor residual spraying in a highly endemic region of Ghana.

Methods: The health belief model (HBM) and realist evaluation framework were used to inform the study. A qualitative enquiry was conducted between April to October 2016. Data were collected through focus group discussions and semi-structured interviews with program stakeholders including community members, AngloGold Ashanti malaria control (AGA Mal) spray operators, and AGA Mal officials.

Results: A total of 101 people participated in the study. Considerable barriers to community acceptance of indoor residual spraying (IRS) were found, including, dislike of spray insecticides, inadequate information, religious and cultural beliefs, perceived low efficacy of IRS, difficulties with packing, unprofessional conduct of IRS spray operators, and other operational barriers to spraying. Facilitators of IRS uptake included a perceived effectiveness of IRS in preventing malaria and reducing mosquito bites, incidental benefits, respect for authority, training and capacity building, and sensitization activities.

Conclusion: The numerous barriers to indoor residual spraying acceptance and implications show that acceptance levels could be improved. However, measures are required to address householders' concerns and streamline operational barriers to increase community uptake of indoor residual spraying.
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http://dx.doi.org/10.1186/s12889-020-08505-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7137190PMC
April 2020

Changing Epidemiology of Gonorrhea in Adelaide, South Australia.

Sex Transm Dis 2020 06;47(6):402-408

From the Flinders University, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.

Background: Gonorrhea is a significant public health concern. The changing epidemiology of gonorrhea in Australia has highlighted the need for detailed examination of surveillance data to determine population groups at greatest risk for infection.

Methods: We analyzed deidentified gonorrhea notification data for the years 2012 to 2017, in Adelaide (N = 3680), calculating age-adjusted notification and antibiotic resistance rates. Age, gender, year, sexual orientation, and socioeconomic status were assessed for associations with gonorrhea notifications using negative binomial, log binomial and spatial autoregressive models. Maps were generated to examine spatial localization of gonorrhea rates in Adelaide.

Results: Gonorrhea notification rates in Adelaide increased annually, with a 153% adjusted increase in rates from 2012 to 2017, localized to specific areas and inversely associated with income levels. The increase in rates in 2016 and 2017 was associated with young heterosexuals from low income areas. Azithromycin-resistant notifications increased significantly in 2016 in young heterosexuals. Reinfections were significantly more likely in men who have sex with men than other population groups.

Conclusions: This study demonstrates the changing epidemiology of gonorrhea in Adelaide from a largely men who have sex with men profile toward an increase in young heterosexual gonorrhea. This could be seen as a harbinger for future increases in heterosexually transmitted HIV and other sexually transmitted infections in Australia.
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http://dx.doi.org/10.1097/OLQ.0000000000001162DOI Listing
June 2020

Using a nominal group technique to approach consensus on a resilience intervention for smoking cessation in a lower socioeconomic population.

BMC Public Health 2019 Nov 27;19(1):1577. Epub 2019 Nov 27.

Flinders Human Behaviour and Health Research Unit, College of Medicine and Public Health, Bedford Park, Adelaide, South Australia, Australia.

Background: Smoking prevalence remains inequitably high for lower SES (socioeconomic status) populations. The psychosocial interactive model of resilience theorises that resilience might be 'switched on' in order to support and/or maintain smoking cessation for these populations. This study aimed to develop a Resilience Intervention for Smoking Cessation (RISC) through reviewing the extant literature around efficacious interventions for smoking cessation. Deliberative democracy principles were then used to understand lay perspectives regarding this potential smoking cessation program.

Methods: Public health databases were searched to find efficacious psycho-social resilience interventions in the peer-reviewed literature for smoking cessation amongst lower SES populations. Potential components for RISC were selected based on evidence within the literature for their effectiveness. We then employed the Nominal Group Technique (NGT) to create discussion and consensus on the most socially appropriate and feasible components from the perspective of smokers from low SES areas. The NGT included 16 people from a lower SES population in southern metropolitan Adelaide who indicated they were seriously contemplating quitting smoking or had recently quit. Data were collected from multiple Likert ratings and rankings of the interventions during the NGT workshop and analysed descriptively. The Wilcoxon signed-ranked test was used where appropriate. Qualitative data were collected from participant reflections and group discussion, and analysed thematically.

Results: Six smoking cessation interventions, likely to enhance resilience, were selected as potential constituents for RISC: mindfulness training; setting realistic goals; support groups; smoke free environments; mobile phone apps; and motivational interviewing. Consensus indicated that mindfulness training and setting realistic goals were the most acceptable resilience enhancing interventions, based on perceived usefulness and feasibility.

Conclusions: This research applied principles from deliberative democracy in order to illuminate lay knowledge regarding an appropriate and acceptable smoking cessation resilience program for a lower SES population. This process of collaborative and complex knowledge-generation is critically important to confront inequities as an ongoing challenge in public health, such as smoking cessation for disadvantaged groups. Further research should involve development and trial of this resilience program.
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http://dx.doi.org/10.1186/s12889-019-7939-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6882049PMC
November 2019

Tailoring of a Smartphone Smoking Cessation App (Kick.it) for Serious Mental Illness Populations: Qualitative Study.

JMIR Hum Factors 2019 Sep 3;6(3):e14023. Epub 2019 Sep 3.

Wellbeing and Resilience Centre, South Australian Health and Medical Research Institute, Adelaide, Australia.

Background: Smoking rates of Australians with severe mental illness (SMI) are disproportionately higher than the general population. Despite the rapid growth in mobile health (mHealth) apps, limited evidence exists to inform their design for SMI populations.

Objective: This study aimed to explore the feasibility, acceptability, and utility of adapting a novel smoking cessation app (Kick.it) to assist smokers with SMI to prevent smoking relapse and quit.

Methods: Using co-design, two in-depth interviews with 12 adult smokers and ex-smokers with SMI were conducted in this qualitative study. Stage 1 interviews explored participants' smoking-related experiences and perceptions of social support for smoking cessation, informed the development of the stage 2 interview schedule, and provided context for participants' responses to the second interview. Stage 2 interviews explored participants' perceptions of the feasibility, utility, and acceptability of the app features for SMI populations.

Results: People with SMI perceived mHealth interventions to support their quit smoking attempts as feasible, acceptable, and useful. Key emerging themes included personalization of the app to users' psychosocial needs, a caring app to mediate self-esteem and self-efficacy, an app that normalizes smoking relapse and multiple quit attempts, a strong focus on user experience to improve usability, and a social network to enhance social support for smoking cessation.

Conclusions: This study gained an in-depth understanding of the lived experiences of smoking and quitting among people with SMI and their perception of the Kick.it app features to help inform the tailoring of the app. Specific program tailoring is required to assist them in navigating the complex interactions between mental illness and smoking in relation to their psychosocial well-being and capacity to quit. This study describes the adaptations required for the Kick.it app to meet the specific needs and preferences of people with SMI. Results of this study will guide the tailoring of the Kick.it app for SMI populations. The study findings can also inform a co-design process for the future development and design of smoking cessation apps for SMI populations.
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http://dx.doi.org/10.2196/14023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6754228PMC
September 2019

The distribution and socioeconomic burden of Hepatitis C virus in South Australia: a cross-sectional study 2010-2016.

BMC Public Health 2019 May 8;19(1):527. Epub 2019 May 8.

Flinders University, GPO Box 2100, Adelaide, 5001, South Australia.

Background: Hepatitis C virus infection (HCV) is a communicable disease of increasing global importance with 1.75 million new infections and 400,000 related deaths annually. Until recently, treatment options have had low uptake and most infected people remain untreated. New Direct Acting Antiviral medications can clear the virus in around 95% of cases, with few side-effects. These medications are restricted in most countries but freely accessible in Australia, yet most people still remain untreated. This study applies a cross-sectional research design to investigate the socio-spatial distribution of HCV in South Australia, to identify vulnerable populations, and examine epidemiological factors to potentially inform future targeted strategies for improved treatment uptake.

Method: HCV surveillance data were sourced from South Australia's Communicable Diseases Control Branch and socio-economic population data from the Australian Bureau of Statistics from January 2010 to December 2016 inclusive. HCV cases were spatially mapped at postcode level. Multivariate logistic regression identified independent predictors of demographic risks for HCV notification and notification source.

Results: HCV notifications (n = 3356) were seven times more likely to be from people residing in the poorest areas with high rates of non-employment (75%; n = 1876) and injecting drug use (74%; n = 1862) reported. Notifications among Aboriginal and Torres Strait Islander people were around six times that of non-Indigenous people. HCV notifications negatively correlated (Spearman's rho - 0.426; p < 0.001) with socio-economic status (residential postcode socio-economic resources Index). History of imprisonment independently predicted HCV diagnoses in lesser economically-resourced areas (RR1.5; p < 0.001). Independent predictors of diagnosis elsewhere than in general practices were non-employment (RR 4.6; p = 0.028), being male (RR 2.5; p < 0.001), and younger than mean age at diagnosis (RR 2.1; p = 0.006).

Conclusions: Most people diagnosed with HCV were from marginalised sub-populations. Given general practitioners are pivotal to providing effective HCV treatment for many people in Australia a most concerning finding was that non-employed people were statistically less likely to be diagnosed by general practitioners. These findings highlight a need for further action aimed at improving healthcare access and treatment uptake to help reduce the burden of HCV for marginalised people, and progress the vision of eliminating HCV as a major public health threat.
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http://dx.doi.org/10.1186/s12889-019-6847-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6505114PMC
May 2019

Does Resilience Moderate the Relationship Between Stress and Smoking Status?

Subst Use Misuse 2019 13;54(3):412-425. Epub 2019 Jan 13.

a College of Medicine and Public Health , Flinders University , Adelaide , South Australia , Australia.

Background: There is a growing evidence that resilience to stress can promote nonsmoking. However, few studies have undertaken quantitative research to investigate whether resilience, generated by internal and external factors, moderates the impact of stress on the likelihood of smoking.

Objective: This study aims to help fill this knowledge gap in relation to smokers and ex-smokers, and those people who have never smoked.

Methods: A large online cross-sectional survey was administered in Australia (2015-2016) to collect data on demographic variables, levels of internal and external resilience, and stress from current and past smokers (n = 400) and those who have never-smoked (n = 921). Logistic regressions were employed to test our hypotheses.

Results: Most participants were female (82%) and ranged between 18 and 77 years. Higher levels of reported perceived stress and stress-related variables did significantly predict smoking. The combined impact of internal and external resilience factors predicted never-smoking and lessened the relationship between perceived stress and stress-related variables, and the likelihood of smoking.

Conclusion: These results are important because they suggest that the social environment should be developed to augment social support and internal properties such as developing "a strong sense of purpose in life" to encourage people not to commence smoking, rather than focus on smoking cessation.
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http://dx.doi.org/10.1080/10826084.2018.1501066DOI Listing
January 2020

The Importance of Water Typologies in Lay Entomologies of Habitat, Breeding and Dengue Risk: A Study from Northern Australia.

Trop Med Infect Dis 2018 Jun 18;3(2). Epub 2018 Jun 18.

College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide 5001, Australia.

Dengue fever is making a significant comeback globally and its control still depends largely on residents' actions. Community awareness and education are central to its management; however, programmes have had limited impact, because they are often based on short-term research and limited awareness of the socio-ecological contexts wherein local knowledge of dengue and its vectors (lay entomology) is produced and enacted in and through place. Long-term studies of lay knowledge of dengue vectors are very rare, even though they are essential to the development of effective, targeted community education campaigns and mobilisation. In this paper, we examine the popular belief that dengue vector, is ubiquitous in the north Australian landscape and demonstrate how local typologies of water are central to the reasoning underwriting this assumption. We show how these logics are fortified by people's lived experiences of mosquitoes and the watery abodes they are thought to reside in, as well as through key messages from health education. We posit that long term, context-sensitive research approaches are better able to identify, understand and later address and challenge assumptions and may be more effective at informing, empowering and mobilizing the public to combat dengue fever.
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http://dx.doi.org/10.3390/tropicalmed3020067DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6073414PMC
June 2018

Pain Self-Management: Easier Said than Done? Factors Associated with Early Dropout from Pain Self-Management in a Rural Primary Care Population.

Pain Med 2019 02;20(2):267-277

Department of Public Health, Flinders University, Adelaide, South Australia, Australia.

Objective: To explore whether psychosocial or demographic factors are associated with early dropout from pain self-management in a rural, low-socioeconomic status population.

Design: Secondary analysis of retrospective data.

Setting: Multidisciplinary pain clinic located in an outer regional area of Australia.

Subjects: One hundred eighty-six people attending a public community health center with chronic noncancer pain (mean age 54.9 years; 58.1% women; 81.7% in receipt of government benefit as their primary source of income).

Methods: Bivariate analysis and logistic regression, with early dropout as the dependent variable and a range of demographic and psychological independent variables.

Results: Following bivariate analysis, early dropout was significantly associated (P < 0.05) with male gender, younger age, history of substance use, being a past victim of assault/abuse, receiving unemployment or disability benefit, having literacy difficulties, higher pain catastrophizing score, higher daily opioid dose, and not holding a multifactorial belief about the cause of pain. Logistic regression analysis resulted in three significant predictors of dropout: substance use history (P = 0.002), past victim of assault or abuse (P = 0.029), high pain catastrophising score (P = 0.048); and one of engagement: holding a multifactorial belief about pain cause (P = 0.005).

Conclusions: In a rural, low-socioeconomic status population, addressing social stressors related to lifetime adversity may be important to increasing engagement in pain self-management. Lack of attention to these factors may increase health inequity among those most disabled by chronic pain. Further research into dropout and engagement, especially among disadvantaged populations, is recommended.
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http://dx.doi.org/10.1093/pm/pny167DOI Listing
February 2019

Retaining Traditional Dietary Practices among Greek Immigrants to Australia: The Role of Ethnic Identity.

Ecol Food Nutr 2017 Jul-Aug;56(4):312-328. Epub 2017 Jun 28.

b Department of Rehabilitation, Nutrition & Sport , La Trobe University , Melbourne , Australia.

This article explores why some Greek immigrants to Australia continue to adhere to a traditional Mediterranean diet whereas others have adopted eating behaviors characteristic of a less healthy "Australian" diet. Twelve qualitative interviews were conducted and comparisons made between individuals consuming more (n = 6) and less traditional diets (n = 6). The level of adherence to the diet was previously assessed by a diet score in a separate quantitative study (MEDIS-Australia) from which the subset of 12 participants for the present study was recruited. Analysis revealed that maintenance of a strong ethnic identity offers a pathway through which individuals retain dietary practices of their homeland.
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http://dx.doi.org/10.1080/03670244.2017.1333000DOI Listing
April 2018

The barriers and facilitators that indigenous health workers experience in their workplace and communities in providing self-management support: a multiple case study.

BMC Health Serv Res 2017 05 3;17(1):319. Epub 2017 May 3.

Flinders Human Behaviour and Health Research Unit, Department of Psychiatry, Flinders University, Margaret Tobin Centre, PO Box 2100, Adelaide, South Australia, 5001, Australia.

Background: The inequality in health outcomes between Indigenous (Throughout the paper, the term Indigenous will be used to represent both Aboriginal Australians and Torres Strait Islander Australians.) and non-Indigenous Australians continues to be a major public health issue. Chronic conditions are responsible for the majority of the gap in life expectancy for this population. Evidence suggests that chronic condition management models focusing on self-management have led to improved health outcomes in Indigenous populations. The Flinders Closing the Gap Program (FCTGP) is a chronic condition care planning tool which aims to engage Indigenous people in self-managing their chronic conditions. Indigenous health workers (IHWs) can provide culturally appropriate self-management support; however there is paucity in current literature describing specific barriers and facilitators that they may experience when attempting to deliver this support. This study aimed to explore IHWs' perceptions of the effectiveness and appropriateness of the FCTGP, as an evidence-based example of self-management support, and to explore the barriers and facilitators that IHWs experience in their workplace and communities in providing self-management support.

Methods: In-depth interviews were undertaken with five IHWs, drawn from five different states in Australia. Their selection was aided by key informants from the FCTGP training unit. Interviews were recorded and transcribed verbatim, and were analysed using thematic analysis.

Results: The following themes were identified. IHWs reported that the FCTGP was appropriate, flexible and acceptable in their communities. Facilitators included factors improving client and worker empowerment, and activities around sharing knowledge. Barriers included competing priorities that clients experience relating to social determinants of health, and negative experiences within mainstream health services. IHW burnout from time pressures, lack of support, and high staff turnover were also considered important barriers.

Conclusions: This study contributes an insight into the experiences of IHWs who are considered important stakeholders in implementation and sustainability of chronic condition management programs, including the FCTGP. Recommendations focus on supporting and supplementing the role of IHWs and identify the FCTGP as a facilitator in providing self-management support to a population with complex needs.
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http://dx.doi.org/10.1186/s12913-017-2265-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5415721PMC
May 2017

How Australian general practitioners engage in discussions about alcohol with their patients: a cross-sectional study.

BMJ Open 2016 12 1;6(12):e013921. Epub 2016 Dec 1.

Division of Health Sciences, University of South Australia, Adelaide, South Australia, Australia.

Objective: This study aimed to investigate factors that inhibit and facilitate discussion about alcohol between general practitioners (GPs) and patients.

Design: Data analysis from a cross-sectional survey.

Setting And Participants: 894 GP delegates of a national health seminar series held in five capital cities of Australia in 2014.

Main Outcome Measures: Likelihood of routine alcohol enquiry; self-assessed confidence in assessing and managing alcohol issues in primary healthcare.

Results: Most GPs (87%) reported that they were likely to routinely ask patients about their alcohol consumption and had sufficient skills to manage alcohol issues (74%). Potential barriers to enquiring about alcohol included perceptions that patients are not always honest about alcohol intake (84%) and communication difficulties (44%). 'I usually ask about alcohol' was ranked by 36% as the number one presentation likely to prompt alcohol discussion. Altered liver function test results followed by suspected clinical depression were most frequently ranked in the top three presentations. Suspicious or frequent injuries, frequent requests for sickness certificates and long-term unemployment were ranked in the top three presentations by 20% or less. Confidence in managing alcohol issues independently predicted likelihood to 'routinely ask' about alcohol consumption. Lack of time emerged as the single most important barrier to routinely asking about alcohol. Lack of time was predicted by perceptions of competing health issues in patients, fear of eliciting negative responses and lower confidence in ability to manage alcohol-related issues.

Conclusions: Improving GPs' confidence and ability to identify, assess and manage at-risk drinking through relevant education may facilitate greater uptake of alcohol-related enquiries in general practice settings. Routine establishment of brief alcohol assessments might improve confidence in managing alcohol issues, reduce the time burden in risk assessment, decrease potential stigma associated with raising alcohol issues and reduce the potential for negative responses from patients.
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http://dx.doi.org/10.1136/bmjopen-2016-013921DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5168624PMC
December 2016

"I have never experienced any problem with my health. So far, it hasn't been harmful": older Greek-Australian smokers' views on smoking: a qualitative study.

BMC Public Health 2015 Mar 29;15:304. Epub 2015 Mar 29.

Discipline of Public Health, Flinders University, GPO Box 2100, Adelaide, South Australia, 5001, Australia.

Background: Smoking tobacco products is one of the largest preventable health risk factors for older people. Greek-Australians have the highest prevalence of cigarette use in Australia for older people, but there is a lack of knowledge about Greek-Australian's perspectives on smoking cessation. The purpose of this exploratory, qualitative study was to progress the knowledge base in this area.

Methods: A qualitative study was designed to gather information on participants' perspectives about, and understanding of, their reasons for smoking and their attitudes to quitting. A snowball sampling technique was used to identify twenty Greek-Australian current smokers, aged ≥50 years. Semi-structured, face-to-face interviews were conducted with the assistance of a Greek translator. The audio-taped interviews were transcribed and then qualitative content analysis was used to categorise responses to the questions.

Results: Participants' perspectives on three broad topics were identified in the interviews: perceived benefits of smoking, perceptions of smoking and its effect on health, and barriers to cessation. Smoking behaviour was described as contributing to tiredness, and stress, and yet also was also a source of enjoyment. Level of knowledge about smoking-related diseases and the risks of smoking was very low. The number of cigarettes smoked each day, type of smoking (i.e. pipe rather than cigarettes), and previous family history of smoking were identified as indicators that limited harm flows from smoking. Most participants had a positive attitude towards smoking and described their own life experience and cultural norms as supporting smoking acceptability. Low confidence in quitting was linked to advanced age.

Conclusion: Smoking among older Greek-Australian smokers has been associated with a number of influences and these need to be addressed in smoking cessation efforts targeted at this group. Promoting knowledge about the health impacts of smoking, changing attitudes towards smoking, and ultimately, decreasing tobacco consumption are critical to the maintenance of health among older Greek Australians. Cultural and experiential influences may increase the difficulty associated with changing these outcomes, but may also serve as a framework from which to develop and implement an educational intervention tailored for older Greek-Australians.
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http://dx.doi.org/10.1186/s12889-015-1677-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4391085PMC
March 2015

Type of unit and population served matters when implementing a smoke-free policy in mental health settings: Perceptions of unit managers across England.

Int J Soc Psychiatry 2015 Nov 12;61(7):700-10. Epub 2015 Mar 12.

Flinders University, Australia

Background: Globally, smoking remains a significant issue for mental health populations. Many mental health trusts in England are facing challenges of implementing the National Institute for Health and Care Excellence guidance according to which all mental health settings, no matter the type, should be entirely smoke-free and provide comprehensive smoking cessation support.

Aim: The aim of this paper was to determine if unit type and unit manager smoking status influence mental health smoke-free policy implementation.

Method: This paper reports on the secondary analysis of data from a cross-sectional survey of 147 mental health inpatient settings in England, in 2010. The original study's main aim was to understand unit managers' perceived reasons for success or failure of smoke-free policy.

Results: Unit managers (n = 131) held a positive stance towards supporting smoke-free policy and most perceived that the policy was successful. Non-smoker unit managers were more likely to adopt complete bans than smoker unit managers, whereas smoker unit managers were more likely than non-smoker unit managers to think that stopping smoking aggravated patients' mental illness. Smoking rates for staff and patients remain high, as perceived by unit managers, regardless of unit type. Proportion of units offering nicotine replacement therapy and peer support to patients was significantly higher in locked units compared to semi-locked or residential rehabilitation. Applied strategies significantly vary by type of unit, whereas unit managers' knowledge, attitude and practices vary by their smoking status.

Discussion: There are nuanced differences in how smoke-free policy is enacted which vary by unit type. These variations recognise the differing contexts of care provision in different types of units serving different patient groups. Addressing staff smoking rates, promoting consistency of staff response to patients' smoking and providing staff education and support continue to be key strategies to successful smoke-free policy.

Conclusions: Our results demonstrate the importance of taking into account the type of unit and acuity of patients when enacting smoke-free policy and addressing staff smoking.
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http://dx.doi.org/10.1177/0020764015575799DOI Listing
November 2015

Understanding socio-cultural influences on smoking among older Greek-Australian smokers aged 50 and over: facilitators or barriers? A qualitative study.

Int J Environ Res Public Health 2015 Mar 2;12(3):2718-34. Epub 2015 Mar 2.

Discipline of Public Health, Flinders University, GPO Box 2100, Adelaide, South Australia 5001, Australia.

Smokers of all ages can benefit by quitting, but many smokers continue to smoke. Older Greek-Australian smokers, one of the largest ethnic groups in Australia, have higher rates of smoking than other groups of older Australians. This qualitative study aimed to explore older Greek-Australians' views about socio-cultural influences on their smoking. A snowball sampling technique was used to identify twenty Greek-Australian smokers (12 males and eight females), aged ≥50 years. They were recruited through the Greek Orthodox Community Center of South Australia (GOCSA). Qualitative data were collected using semi-structured face-to-face interviews. The audio-taped interviews were translated and transcribed, and then analysed using content analysis. Results suggested that smoking was considered as the "norm" by older Greek-Australian smokers. There were four groups embedded in the participants' social networks that were reported to be important in relation to either encouraging smoking or, smoking abstinence. These support groups included: family members, friends, the Greek community, and physicians. Smokers' family members (brothers) and friends were identified as facilitators of smoking whereas non-smoker family members (children and spouses) were reported as providing barriers to smoking. Different approaches were used by supporter groups to assist smokers to quit smoking-both planned and unplanned. Knowledge, planning of social and cultural supports, and addressing barriers to smoking cessation are a important part of health planning for older Greek-Australians. Social norms, including those arising from social interactions, and predisposing traits can influence smoking behaviour. Addressing the specific barriers to smoking cessation of older Greek-Australians is critical to addressing the risk for chronic disease in this group.
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http://dx.doi.org/10.3390/ijerph120302718DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4377928PMC
March 2015

Missed opportunities: a qualitative exploration of the experiences of smoking cessation interventions among socially disadvantaged pregnant women.

Women Birth 2015 Mar 29;28(1):8-15. Epub 2014 Nov 29.

Public Health, School of Health Sciences, Flinders University, Sturt Road, Bedford Park, South Australia, Australia.

Background And Aim: Pregnant women who smoke are rarely consulted in the design and evaluation of the interventions that target them. In Australia, women will typically be counselled for smoking cessation as a part of routine antenatal care. However this approach achieves only modest rates of cessation. This study aimed to privilege the perspectives of women from low socioeconomic backgrounds who are most likely to smoke during pregnancy and who are less likely to quit spontaneously.

Methods: Guided by feminist principles, in-depth interviews were undertaken with a purposive sample of six pregnant women, who resided in lower socioeconomic status areas in South Australia. Their experiences and views of being part of a smoking cessation intervention in metropolitan Adelaide were explored. Transcriptions were thematically analysed using an inductive approach and an open coding framework.

Findings: An over-arching theme of 'missed opportunities' and four inter-related sub-themes encapsulated the predominantly negative experiences of the intervention for the women. The women's interest in quitting was hindered by a didactic communication style employed by maternity care professionals. The participants' information and support needs were reported as being superficially managed by maternity care professionals or Quitline workers who provided care in routine ways.

Conclusions: These findings indicate that smoking cessation interventions and associated Quitline support needs to become more personalised and sensitive to the needs of women who face barriers posed by complex socio-economic disadvantage. These findings have important policy and practice implications for Australian public maternity care settings where smoking cessation interventions are embedded.
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http://dx.doi.org/10.1016/j.wombi.2014.11.003DOI Listing
March 2015

Is resilience relevant to smoking abstinence for Indigenous Australians?

Health Promot Int 2015 Mar 14;30(1):64-76. Epub 2014 Oct 14.

Discipline of Public Health, Flinders University, PO Box 2100, Adelaide, South Australia 5001, Australia.

The prevalence rate of tobacco smoking remains high for Australian Indigenous people despite declining rates in other Australian populations. Given many Indigenous Australians continue to experience a range of social and economic structural problems, stress could be a significant contributing factor to preventing smoking abstinence. The reasons why some Indigenous people have remained resilient to stressful adverse conditions, and not rely on smoking to cope as a consequence, may provide important insights and lessons for health promotion policy and practice. In-depth interviews were employed to collect oral histories from 31 Indigenous adults who live in metropolitan Adelaide. Participants were recruited according to smoking status (non-smokers were compared with current smokers to gain a greater depth of understanding of how some participants have abstained from smoking). Perceived levels of stress were associated with encouraging smoking behaviour. Many participants reported having different stresses compared with non-Indigenous Australians, with some participants reporting having additional stressors such as constantly experiencing racism. Resilience often occurred when participants reported drawing upon internal psychological assets such as being motivated to quit and where external social support was available. These findings are discussed in relation to a recently developed psycho-social interactive model of resilience, and how this resilience model can be improved regarding the historical and cultural context of Indigenous Australians' experience of smoking.
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http://dx.doi.org/10.1093/heapro/dau087DOI Listing
March 2015

Mental health professionals' perspectives on the implementation of smoke-free policies in psychiatric units across England.

Int J Soc Psychiatry 2015 Aug 8;61(5):465-74. Epub 2014 Oct 8.

Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, Beckenham, UK Department of Population Mental Health, University College London, UCL Partners, London, UK.

Background: The original audit on which this 2013 secondary analysis is based, was conducted in 2010. It explored implementation of smoke-free policies from the perspective of unit managers in 147 psychiatric units across England comprising a randomly selected sample of nine different unit types.

Material: Two main themes are presented: positive perspectives of smoke-free policy implementation, and barriers and problems with smoke-free policy implementation. Analysis of unit managers' experiences and perspectives found that 96% of participants thought smoke-free policy had achieved positive outcomes for staff, patients, services and care.

Discussion: Consistency of response was the most prominent factor associated with policy success. Quality of the physical environment and care delivery were clear positive outcomes which enabled the environment to be more conducive to supporting staffs' and patients' quit attempts. Lack of consistency and a prevailing culture of acceptance of smoking were identified as some of the most reported perceived continuing problems. Solutions included the need to acknowledge that this type of complex systems change takes time and ongoing staff education and training.

Conclusion: Our results demonstrate the importance of taking into account the experiences and attitudes of staff responsible for enacting smoke-free policy.
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http://dx.doi.org/10.1177/0020764014553002DOI Listing
August 2015

Exploring mothers' perspectives of an intensive home visiting program in Australia: a qualitative study.

Contemp Nurse 2013 Feb;43(2):191-200

Child and Family Health Service, Women's and Children's Health Network, Adelaide, SA, Australia.

Intensive nurse home visiting programs are an early childhood, population based intervention that target vulnerable families. Programs are dependent on the relationship between home visitor and mother to bring about change. Few studies have focused on investigating parents' perspectives of these programs using qualitative methods and none in the Australian context. The aim of this qualitative study was to explore and describe mothers' perspectives of an intensive nurse home visiting program in South Australia. Eight in-depth interviews were conducted with mothers receiving the program. The findings indicated the role of a trusting relationship between nurse and participant as well as shared decision making was central to program engagement and led to participant perceptions of increasing control over their role as parents. However, a clear distinction was made by the mothers: that they engaged in a relationship, not a program.
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http://dx.doi.org/10.5172/conu.2013.43.2.191DOI Listing
February 2013

Food stress in Adelaide: the relationship between low income and the affordability of healthy food.

J Environ Public Health 2013 29;2013:968078. Epub 2013 Jan 29.

Discipline of Public Health, Flinders University, Adelaide, SA 5001, Australia.

Healthy food is becoming increasingly expensive, and families on low incomes face a difficult financial struggle to afford healthy food. When food costs are considered, families on low incomes often face circumstances of poverty. Housing, utilities, health care, and transport are somewhat fixed in cost; however food is more flexible in cost and therefore is often compromised with less healthy, cheaper food, presenting an opportunity for families on low incomes to cut costs. Using a "Healthy Food Basket" methodology, this study costed a week's supply of healthy food for a range of family types. It found that low-income families would have to spend approximately 30% of household income on eating healthily, whereas high-income households needed to spend about 10%. The differential is explained by the cost of the food basket relative to household income (i.e., affordability). It is argued that families that spend more than 30% of household income on food could be experiencing "food stress." Moreover the high cost of healthy foods leaves low-income households vulnerable to diet-related health problems because they often have to rely on cheaper foods which are high in fat, sugar, and salt.
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http://dx.doi.org/10.1155/2013/968078DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3569900PMC
July 2013

Colorectal cancer screening in rural and remote areas: analysis of the National Bowel Cancer Screening Program data for South Australia.

Rural Remote Health 2011 12;11(2):1648. Epub 2011 May 12.

Discipline of Public Health, Flinders University, Adelaide, South Australia, Australia.

Introduction: In Australia, colorectal cancer is the second most commonly diagnosed cancer and cause of death from malignant diseases, and its incidence is rising. The aim of this article was to present an analysis of National Bowel Cancer Screening Program (NBCSP) data for rural and remote South Australia (SA), in order to identify geographical areas and population groups that may benefit from targeted approaches to increase participation rates in colorectal cancer screening.

Methods: De-identified data from the NBCSP (February 2007 to July 2008) were provided by Medicare Australia. Mapping and analysis of the NBCSP data was performed using ESRI ArcGIS (http://www.esri.com/software/arcgis/index.html) and MapInfo (http://slp.pbinsight.com/info/mipro-sem-au). Data were aggregated to postcode and Accessibility/Remoteness Index of Australia (ARIA) and participation was then mapped according to overall participation rates, sex, age, Indigenous status and Socio-Economic Indexes for Areas (SEIFA)-Index of Relative Socio-Economic Disadvantage (IRSD). The participants were South Australians who turned 55 and 65 years between 2007 and 2008 who returned the completed NBCSP test sent to them by Medicare Australia.

Results: The overall participation rate was 46.1% in rural and remote SA, although this was statistically significantly different (p<.001) according to sex (46.7% for males and 53.3% for females), age (45.2% for those 55 years, and 52% for those 65 years), socio-economic status (from 43% in 'most deprived' quintile to 50% in 'most affluent' quintile) and remoteness (45.6% for metropolitan, 46% for remote and 48.6% for rural areas). Indigenous participation was 0.5%.

Conclusions: The findings of this study suggest lower NBCSP participation rates for people from metropolitan and remote areas, compared with those from rural areas. The uptake of cancer screening is lower for older rural and remote residents, men, Indigenous people, lower socioeconomic groups and those living in the Far North subdivision of SA.
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September 2011

Additive and subtractive resilience strategies as enablers of biographical reinvention: a qualitative study of ex-smokers and never-smokers.

Soc Sci Med 2011 Apr 4;72(7):1140-8. Epub 2011 Mar 4.

Flinders University, Discipline of Public Health, G.P.O. Box 2100, Bedford Park, Adelaide, SA 5001, Australia.

The notion of developing resilience is becoming increasingly important as a way of responding to the social determinants of poor health, particularly in disadvantaged groups. It is hypothesized that resilient individuals and communities are able to 'bounce back' from the adversities they face. This paper explores the processes involved in building resilience as an outcome in relation to both quitting smoking and never smoking. The study involved 93 qualitative, oral-history interviews with participants from population groups with high and enduring smoking rates in Adelaide, Australia, and was essentially interested in how some people in these groups managed to quit or never start smoking in the face of adversities, in comparison to a group of smokers. Our key findings relate to what we call additive and subtractive resilience strategies, which focus on the practices, roles and activities that individuals either 'took on' or 'left behind' in order to quit smoking or remain abstinent. The theoretical lenses we use to understand these resilience strategies relate to biographical reinforcement and biographical reinvention, which situate the resilience strategies in a broader 'project of the self', often in relation to attempting to develop 'healthy bodies' and 'healthy biographies'.
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http://dx.doi.org/10.1016/j.socscimed.2011.01.023DOI Listing
April 2011

Equity of colorectal cancer screening: cross-sectional analysis of National Bowel Cancer Screening Program data for South Australia.

Aust N Z J Public Health 2011 Feb 9;35(1):61-5. Epub 2010 Dec 9.

Discipline of Public Health, Flinders University, South Australia.

Objective: The National Bowel Cancer Screening Program (NBCSP) is a population-based screening program based on a mailed screening invitation and immunochemical faecal occult blood test. Initial published evidence from the NBCSP concurs with international evidence on similar colorectal cancer screening programs about the unequal participation by different population sub-groups. The aim of the paper is to present an analysis of the equity of the NBCSP for South Australia, using the concept of horizontal equity, in order to identify geographical areas and population groups which may benefit from targeted approaches to increase participation rates in colorectal cancer screening.

Method: De-identified data from the NBCSP (February 2007 to July 2008) were provided by Medicare Australia. Univariate and multivariate statistical analyses were undertaken in order to identify the predictors of participation rates in the NBCSP.

Results: The overall participation rate was 46.1%, although this was statistically significantly different (p<0.001) by gender (42.6% for males and 49.5% for females), socioeconomic status (40% in most deprived quintile through to 48.1% in most affluent quintile) and remoteness (45.6% for metropolitan, 46% for remote and 48.6% for rural areas). These findings were confirmed in multivariate analyses. Of the NBCSP participants, 0.24% (CI 95% 0.20-0.30) identified themselves as Indigenous and 8% (CI 95% 7.7-8.3) reported speaking a language other than English at home.

Conclusion: Findings from this study suggest inequities in participation in the NBCSP on the basis of gender, geographical location, Indigenous status and language spoken at home.
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http://dx.doi.org/10.1111/j.1753-6405.2010.00637.xDOI Listing
February 2011

The importance of resilience and stress to maintaining smoking abstinence and cessation: a qualitative study in Australia with people diagnosed with depression.

Health Soc Care Community 2011 May 8;19(3):299-306. Epub 2010 Dec 8.

Discipline of Public Health, Flinders University, South Australia.

This study explored stress in relation to smoking and how non-smokers (never-smoked and ex-smokers) are 'resilient' to smoking in a population where there is a high prevalence of smoking (people diagnosed with depression). In-depth oral history interviews were conducted with 34 adult participants from metropolitan Adelaide, and who were medically diagnosed with depression. Participants were recruited according to their smoking status (currently smoking, ex-smoker, and never-smoked). Smoking was taken-up and maintained for a number of reasons that included perceived high levels of stress. Resilience to stress in relation to smoking was also a major theme. Non-smoking participants tended to be more resilient to stress. Ex-smokers were able to quit for a number of varied reasons during critical transition points in their lives. The never-smoked participants reported successful strategies to cope with stress but not all of them were necessarily healthy. There was often interplay between external factors and the individual's internal properties that led to a building or an erosion of resilience. Smokers and ex-smokers have indicated a strong relationship between stress and tobacco use. Ex-smokers and the never-smoked participants have demonstrated how being 'resilient' to stress can be important to smoking abstinence. The finding that external factors can interact with internal properties to build resilience in relation to stress and smoking is important for policy and practice.
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http://dx.doi.org/10.1111/j.1365-2524.2010.00973.xDOI Listing
May 2011

'I just saw it as something that would pull you down, rather than lift you up': resilience in never-smokers with mental illness.

Health Educ Res 2011 Feb 9;26(1):26-38. Epub 2010 Nov 9.

Department of Psychiatry, Flinders University, PO Box 2100, Adelaide, South Australia 5001, Australia.

Why people smoke despite the health risks is an important public health question. Equally important is why and how some people resist smoking in spite of circumstances that clearly place them at high risk of becoming smokers. This study used in-depth interviews to explore the narratives of 12 people diagnosed with mental illness, who had made conscious decisions not to smoke. This was despite most of them growing up in smoking families or being from population groups at high risk of smoking. A qualitative grounded theory methodology was used to analyse common themes around protective behaviours and attitudes within a model of resilience. Themes included strong negative reactions to smoking as children which have persisted into adulthood, strong lasting associations with smoking, a clear sense of 'self' separate from peers from an early age (internal resilience) and developing a range of coping strategies and external supports not related to smoking (external resilience). Understanding resilience holds potential lessons for health promotion and primary health care professionals supporting the prevention of smoking uptake and supporting smoking cessation by at risk groups.
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http://dx.doi.org/10.1093/her/cyq065DOI Listing
February 2011

How equitable are colorectal cancer screening programs which include FOBTs? A review of qualitative and quantitative studies.

Prev Med 2010 Apr 11;50(4):165-72. Epub 2010 Feb 11.

Discipline of Public Health, Flinders University, Australia.

Objective: To review published literature on the equity of participation in colorectal cancer screening amongst different population subgroups, in addition to identifying factors identified as barriers and facilitators to equitable screening. Studies were included in the review if they included FOBT as at least one of the screening tests.

Method: Relevant published articles were identified through systematic electronic searches of selected databases and the examination of the bibliographies of retrieved articles. Studies of the association with colorectal cancer screening test participation, barriers to equitable participation in screening, and studies examining interventional actions to facilitate screening test participation were included. Data extraction and analysis was undertaken using an approach to the synthesis of qualitative and quantitative studies called Realist Review.

Results: Sixty-three articles were identified that met the inclusion criteria. SES status, ethnicity, age and gender have been found as predictors of colorectal cancer screening test participation. This review also found that the potential for equitable cancer screening test participation may be hindered by access barriers which vary amongst population sub-groups.

Conclusion: This review provides evidence of horizontal inequity in colorectal cancer screening test participation, but limited understanding of the mechanism by which it is sustained, and few evidence-based solutions.
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http://dx.doi.org/10.1016/j.ypmed.2010.02.003DOI Listing
April 2010
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