Publications by authors named "Melissa Kang"

58 Publications

Australian federal, state and territory policy on the health and wellbeing of young people: A scoping review.

Health Policy 2021 Aug 31;125(8):1065-1076. Epub 2021 May 31.

Faculty of Medicine and Health, Discipline of Child and Adolescent Medicine, University of Sydney, Camperdown New South Wales 2006, Australia; The Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Westmead New South Wales Australia 2145. Electronic address:

Background: The health and wellbeing of young people are critical for the future of society but the extent to which they are addressed by overarching Australian Federal, State and Territory health policy is difficult to determine. Analysing high-level youth health policy will help establish how Australian governments are articulating and prioritising issues and may guide local and international health agendas.

Methods: This scoping review aimed to determine the extent, range and nature of Australian high-level government policy focused on the general health and wellbeing of the general population of young people. Policies published by Australian Federal, State, or Territory government departments between 2008 and 2019 were thematically analysed employing Braun and Clark's six-step recursive framework.

Findings: Twelve policy documents met inclusion criteria. Three meta-themes emerged, comprising policy development, youth health challenges, and policy goals. Policy goals fell into three ubiquitous and overarching categories focused on supporting public health, promoting equity, and improving the health system for young people.

Conclusions: A number of youth-specific health policies have been developed by Australian governments in recent years. Whilst goals and strategies are clearly articulated, more can be done to ensure a youth voice in policy development. The policy goals of supporting public health, promoting equity and improving the health system deserve consideration from other countries developing youth health policies.
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http://dx.doi.org/10.1016/j.healthpol.2021.05.017DOI Listing
August 2021

School-based HPV vaccination positively impacts parents' attitudes toward adolescent vaccination.

Vaccine 2021 Jul 12;39(30):4190-4198. Epub 2021 Jun 12.

Speciality of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia.

Introduction: This qualitative study aimed to explore parental attitudes, knowledge and decision-making about HPV vaccination for adolescents in the context of a gender-neutral school-based Australian National Immunisation Program (NIP).

Methods: Semi-structured interviews with parents of adolescents eligible for HPV vaccination were undertaken as part of an evaluation of a cluster-randomised controlled trial of a complex intervention in 40 schools (2013-2015). In this qualitative study, we purposively recruited a nested sample of parents from 11 schools across two Australian jurisdictions. Interviews explored parent knowledge and understanding of the HPV vaccine program; HPV vaccination decision-making; their adolescent's knowledge about HPV vaccination; and their adolescent's understanding about HPV vaccination, sexual awareness and behaviour. Transcripts were analysed using inductive and deductive thematic analysis.

Results: Parents' of 22 adolescents had positive attitudes towards the program; the school-based delivery platform was the key driver shaping acceptance of and decision-making about HPV vaccination. They had difficulty recalling, or did not read, HPV vaccination information sent home. Some adolescents were involved in discussions about vaccination, with parents' responsible for ultimate vaccine decision-making. All parents supported in-school education for adolescents about HPV and HPV vaccination. Parents' knowledge about HPV vaccination was limited to cervical cancer and was largely absent regarding vaccination in males.

Conclusions: Parents' positive attitudes towards the NIP and inclusion of the HPV vaccine is central to their vaccine decision-making and acceptance. More intensive communication strategies including school education opportunities are required to improve parents' knowledge of HPV-related disease and to promote vaccine decision-making with adolescents.
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http://dx.doi.org/10.1016/j.vaccine.2021.05.051DOI Listing
July 2021

Remembering more than you can say: Re-examining "amnesia" of attended attributes.

Acta Psychol (Amst) 2021 Mar 15;214:103265. Epub 2021 Feb 15.

Department of Psychology, Queen's University, Kingston, Ontario K7L 3N6, Canada.

Attribute amnesia (AA) describes a phenomenon whereby observers fail a surprise memory test which asks them to report an attribute they had just attended and used to fulfil a task goal. This finding has cast doubt on the prominent theory that attention results in encoding into working memory (WM), to which two competing explanations have been proposed: (1) task demands dictate whether attended information is encoded into WM, and (2) attended information is encoded in a weak state that does not survive the demands of the surprise memory test. To address this debate our study circumvented the limitations of a surprise memory test by embedding a second search task within a typical color-based AA search task. The search task was modified so that the attended attribute would reappear in the second search as either the target, a distractor, or not at all. Critically, our results support encoding of the attended attribute in WM though to a weaker extent than the attribute that is required for report. A second experiment confirmed that WM encoding only occurs for the attended attribute, though distractor attributes produce a bias consistent with negative priming. Our data provide novel support for a theory of memory consolidation that links the strength of a memory's representation with expectations for how it will be used in a task. Implications for the utility of this procedure in future investigations previously limited by single trial data (i.e., surprise question methodology) are discussed.
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http://dx.doi.org/10.1016/j.actpsy.2021.103265DOI Listing
March 2021

Prevalence of first adolescent pregnancy and its associated factors in sub-Saharan Africa: A multi-country analysis.

PLoS One 2021 4;16(2):e0246308. Epub 2021 Feb 4.

Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia.

Introduction: In low-and middle-income countries, pregnancy-related complications are major causes of death for young women. This study aimed to determine the prevalence of first adolescent pregnancy and its associated factors in sub-Saharan Africa.

Methods: We undertook a secondary analysis of cross-sectional data from Demographic and Health Surveys conducted in 32 sub-Saharan African countries between 2010 and 2018. We calculated the prevalence of first adolescent (aged 15 to 19 years) pregnancy in each country and examined associations between individual and contextual level factors and first adolescent pregnancy.

Results: Among all adolescents, Congo experienced the highest prevalence of first adolescent pregnancy (44.3%) and Rwanda the lowest (7.2%). However, among adolescents who had ever had sex, the prevalence ranged from 36.5% in Rwanda to 75.6% in Chad. The odds of first adolescent pregnancy was higher with increasing age, working, being married/cohabiting, having primary education only, early sexual initiation, knowledge of contraceptives, no unmet need for contraception and poorest wealth quintile. By contrast, adolescents who lived in rural areas and in the West African sub-region had lower odds of first adolescent pregnancy.

Conclusion: The prevalence of adolescent pregnancy in sub-Saharan African countries is high. Understanding the predictors of first adolescent pregnancy can facilitate the development of effective social policies such as family planning and comprehensive sex and relationship education in sub-Saharan Africa and can help ensure healthy lives and promotion of well-being for adolescents and their families and communities.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0246308PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7861528PMC
July 2021

What adolescents think of relationship portrayals on social media: a qualitative study.

Sex Health 2020 11;17(5):467-474

Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Children's Hospital Westmead Clinical School, Locked Bag 4001, corner Hawkesbury Road and Hainsworth Street, Westmead, NSW 2145, Australia.

Background Understanding the factors influencing adolescents' relationship views is important because early romantic relationships often act as precursors for relationships in adulthood. This study sought to examine the types of relationship-focused content adolescents witness on social media and how they perceive its effect on their romantic relationship beliefs.

Methods: Sixteen semistructured interviews were conducted with Australian adolescents aged 16-19 years who were purposively sampled from a larger longitudinal study. Interview transcripts were analysed qualitatively using constructivist grounded theory.

Results: Participants described the types of romantic relationship portrayals they saw on social media, including relationship-focused trends like 'Relationship Goals' and 'Insta-Couples'. Participants explained their ability to identify incomplete and unrealistic relationship portrayals, as well as the pressure to share their relationships online in the same incomplete fashion. Views regarding the influence of social media were varied, but most believed social media relationship portrayals had some level of influence on young people's relationship views; some participants believed this occurred regardless of awareness of the incompleteness of the online portrayal.

Conclusions: Although participant interview data revealed the pervasiveness of social media relationship portrayals, it also revealed the sophisticated capabilities of adolescents in critiquing online media portrayals.
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http://dx.doi.org/10.1071/SH20056DOI Listing
November 2020

Abortion care pathways and service provision for adolescents in high-income countries: A qualitative synthesis of the evidence.

PLoS One 2020 9;15(11):e0242015. Epub 2020 Nov 9.

The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, Australia.

Limited research in high-income countries (HICs) examines adolescent abortion care-seeking pathways. This review aims to examine the pathways and experiences of adolescents when seeking abortion care, and service delivery processes in provision of such care. We undertook a systematic search of the literature to identify relevant studies in HICs (2000-2020). A directed content analysis of qualitative and quantitative studies was conducted. Findings were organised to one or more of three domains of an a priori conceptual framework: context, components of abortion care and access pathway. Thirty-five studies were included. Themes classified to the Context domain included adolescent-specific and restrictive abortion legislation, mostly focused on the United States. Components of abortion care themes included confidentiality, comprehensive care, and abortion procedure. Access pathway themes included delays to access, abortion procedure information, decision-making, clinic operation and environments, and financial and transportation barriers. This review highlights issues affecting access to abortion that are particularly salient for adolescents, including additional legal barriers and challenges receiving care due to their age. Opportunities to enhance abortion access include removing legal barriers, provision of comprehensive care, enhancing the quality of information, and harnessing innovative delivery approaches offered by medical abortion.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0242015PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7652292PMC
January 2021

Intersectionality: Social Marginalisation and Self-Reported Health Status in Young People.

Int J Environ Res Public Health 2020 11 3;17(21). Epub 2020 Nov 3.

Department of General Practice, Westmead Clinical School, The University of Sydney, Westmead 2145, Australia.

Background: The aim of this study was to measure young people's health status and explore associations between health status and belonging to one or more socio-culturally marginalised group.

Methods: part of the Access 3 project, this cross-sectional survey of young people aged 12-24 years living in New South Wales, Australia, oversampled young people from one or more of the following groups: Aboriginal and or Torres Strait Islander; living in rural and remote areas; homeless; refugee; and/or, sexuality and/or gender diverse. This paper reports on findings pertaining to health status, presence of chronic health conditions, psychological distress, and wellbeing measures.

Results: 1416 participants completed the survey; 897 (63.3%) belonged to at least one marginalised group; 574 (40.5%) to one, 281 (19.8%) to two and 42 (3.0%) to three or four groups. Belonging to more marginalised groups was significantly associated with having more chronic health conditions ( = 0.001), a greater likelihood of high psychological distress ( = 0.001) and of illness or injury related absence from school or work ( < 0.05).

Conclusions: increasing marginalisation is associated with decreasing health status. Using an intersectional lens can to be a useful way to understand disadvantage for young people belonging to multiple marginalised groups.
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http://dx.doi.org/10.3390/ijerph17218104DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7663617PMC
November 2020

The relationship between having a regular general practitioner (GP) and the experience of healthcare barriers: a cross-sectional study among young people in NSW, Australia, with oversampling from marginalised groups.

BMC Fam Pract 2020 10 28;21(1):220. Epub 2020 Oct 28.

Department of General Practice, The University of Sydney, Westmead Clinical School, Sydney, Australia.

Background: Young people (12-24 years) visit general practice but may not have a 'regular' general practitioner (GP). Whether continuity of GP care influences experiences with, and barriers to, health care among young people is unknown. This paper explores the association between having a regular GP and experience of healthcare barriers and attitudes to health system navigation among young people in New South Wales (NSW), Australia.

Methods: This study was a cross-sectional survey administered either online or face-to-face in community settings. Young people living in NSW were recruited, with oversampling of those from five socio-culturally marginalised groups (those who were Aboriginal and Torres Strait Islander, homeless, of refugee background, in rural or remote locations, sexuality and/or gender diverse). In this analysis of a larger dataset, we examined associations between having a regular GP, demographic and health status variables, barriers to health care and attitudes to health system navigation, using chi-square tests and odds ratios. Content and thematic analyses were applied to free-text responses to explore young people's views about having a regular GP.

Results: One thousand four hundred and sixteen young people completed the survey between 2016 and 2017. Of these, 81.1% had seen a GP in the previous 6 months and 57.8% had a regular GP. Cost was the most frequently cited barrier (45.8%) to accessing health care generally. Those with a regular GP were less likely to cite cost and other structural barriers, feeling judged, and not knowing which service to go to. Having a regular GP was associated with having more positive attitudes to health system navigation. Free-text responses provided qualitative insights, including the importance of building a relationship with one GP.

Conclusions: General practice is the appropriate setting for preventive health care and care coordination. Having a regular GP is associated with fewer barriers and more positive attitudes to health system navigation and may provide better engagement with and coordination of care. Strategies are needed to increase the proportion of young people who have a regular GP.
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http://dx.doi.org/10.1186/s12875-020-01294-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7592545PMC
October 2020

Assessing care trajectories of adolescent females seeking early induced abortion in New South Wales: multistage, mixed-methods study protocol.

BMJ Open 2020 10 22;10(10):e039819. Epub 2020 Oct 22.

School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia.

Introduction: In Australia, New South Wales (NSW), abortion has recently been removed from the criminal code. Previous research from Australia and other high-income countries has focused on adult women's access to abortion services. This protocol describes a five-stage mixed-methods study to determine the care trajectories and experiences of adolescent females, aged 16-19 years, seeking an early induced abortion in NSW. The aims are to (1) explore the needs and perspectives of adolescent females seeking sexual and reproductive health services in NSW and (2) develop a framework for abortion service provision for adolescents in NSW.

Methods And Analysis: This study comprises: (1) semistructured qualitative interviews with key informants, individuals with diverse, in-depth experience of providing and/or supporting abortion care in NSW; (2) a cross-sectional online survey of adolescent females residing in NSW; (3) case study interviews with adolescents females who have accessed an abortion service in NSW; (4) a co-design workshop with adolescents who took part in stage 3 to develop relevant knowledge and recommendations and (5) a knowledge dissemination forum with key stakeholders.

Ethics And Dissemination: Ethics approval has been received from the University of Technology Sydney Human Research Ethics Committee for this study. Data collection commenced in March 2019 and will continue until the end of 2020. This study aims to develop a deep understanding of adolescent abortion care trajectories and experiences of abortion services in NSW. The study will deliver co-produced recommendations to improve adolescent access to abortion information and services.
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http://dx.doi.org/10.1136/bmjopen-2020-039819DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7583066PMC
October 2020

Prevention of Adolescent Pregnancy in Anglophone Sub-Saharan Africa: A Scoping Review of National Policies.

Int J Health Policy Manag 2020 Oct 5. Epub 2020 Oct 5.

Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.

Background: Despite the existence of preventive policies across sub-Saharan Africa, countries within the sub-region lead global rankings for rates of adolescent pregnancy. The aim of this scoping review was to identify and review national policies on the prevention of adolescent pregnancy in Anglophone sub-Saharan Africa.

Methods: Relevant policies were identified from searches of national government websites and the search engine Google. Recognised screening and data extraction processes were used; data were subjected to content analysis using a published Framework for Evaluating Program and Policy Design on Adolescent Reproductive Health. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews guidelines was used in reporting the review.

Results: In line with the inclusion criteria that guided the selection of relevant policies in this study, 17 of 75 national policies were suitable for the analysis. All were backed by political recognition, were government and public initiatives, acknowledged a range of determinants of adolescent pregnancy and allocated human resources to policy activities. Few specified financial resourcing. Most policies acknowledged the importance of coordination and collaboration among public and private actors. All policies had objectives that addressed adolescent pregnancy but none were measurable or included timeframes. Provision of comprehensive sexuality education and adolescent reproductive health services were the most common recommendations. Monitoring and evaluation plans were present in all the policies. However, youth involvement in policy formulation, and plans for implementation, monitoring and evaluation was scarce.

Conclusion: Overall, national policy strengths were seen in relation to their political recognition, and all aspects of policy formulation. Policy implementation strengths and weaknesses were identified, the latter in relation to clear descriptions of financial resources. Importantly, the absence of measurable and time-bound objectives or formal evaluation of policy effectiveness confounds demonstration of what has been delivered and achieved. Youth involvement was notably absent in many policies. For future policy-setting, governments and policy-makers should make efforts to engage young people in policy development and to be transparent, realistic and address the necessary financial resourcing. They should set quantifiable policy objectives that provide a basis for assessing the adoption, uptake and effectiveness of policies in relation to measurable objectives.
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http://dx.doi.org/10.34172/ijhpm.2020.185DOI Listing
October 2020

Adolescent abortion in 11 high-income countries including Australia: towards the establishment of a minimum data set.

Aust N Z J Public Health 2019 Dec 30;43(6):577-581. Epub 2019 Oct 30.

The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, New South Wales.

Objective: A major public health challenge in Australia is the lack of national adolescent abortion data. This descriptive study identifies, collates and describes publicly available adolescent abortion data in high-income countries including Australia, to describe trends over 10 years and provide recommendations for strengthening data collection.

Methods: Data were extracted from publicly available government sources that met inclusion criteria. All relevant adolescent abortion data from 2007 to 2017 were extracted from datasets and analysed.

Results: Eleven high-income countries were included. Incidence data for the adolescent population were available for all countries and states. Incidence of adolescent abortion over 10 years shows a downward trend in all countries. Gestational age at time of abortion was the second-most available variable. The level and type of data across all countries varied; there was a lack of age range standardisation and aggregation of gestational weeks differed, making comparisons difficult.

Conclusion: A minimum data set of standardised abortion information will enable appropriate adolescent abortion policies and services to be developed that are informed by high quality, up-to-date intelligence. Implications for public health: Availability of data affects government's ability to adequately monitor national adolescent health outcomes and plan and evaluate appropriate reproductive health policy and services.
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http://dx.doi.org/10.1111/1753-6405.12947DOI Listing
December 2019

Predictors of young people's healthcare access in the digital age.

Aust N Z J Public Health 2019 Dec 2;43(6):582-588. Epub 2019 Oct 2.

Department of General Practice, The University of Sydney, Westmead Clinical School, New South Wales.

Objective: To quantify barriers to healthcare for young people (12-24 years) and identify socio-demographic correlates and predictors.

Methods: This cross-sectional survey targeted young people living in New South Wales, Australia, with oversampling of marginalised groups. Principles Component Analysis (PCA) identified clusters of barriers. Ordinal regression identified predictors of each barrier cluster.

Results: A total of 1,416 young people completed surveys. Participants with chronic conditions and increasing psychological distress reported a greater number of barriers. Of 11 potential barriers to visiting a health service, cost was most common (45.8%). The PCA identified three clusters: structural barriers (61.3%), attitudinal barriers (44.1%) and barriers relating to emerging autonomy (33.8%).

Conclusions: Barriers to healthcare reported by young people are multi-dimensional and have changed over time. Structural barriers, especially cost, are the most prominent among young people. Approaches to overcome structural barriers need to be addressed to better support marginalised young people's healthcare access. Implications for public health: Understanding predictors of different barrier types can inform more targeted approaches to improving access. Equitable access to healthcare is a priority for early diagnosis and treatment in young people, especially reducing out of pocket costs.
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http://dx.doi.org/10.1111/1753-6405.12936DOI Listing
December 2019

Prospective mixed methods study of online and offline social networks and the development of sexual agency in adolescence: the Social Networks and Agency Project (SNAP) protocol.

BMJ Open 2019 05 19;9(5):e024329. Epub 2019 May 19.

Discipline of Child & Adolescent Health, Children's Hospital Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia.

Introduction: Social media may play a role in adolescent sexual development. The limited research on social media use and sexual development has found both positive and negative influences. The focus of this study is on sexual agency: a positive sexual outcome. This paper describes the protocol for the Social Networks and Agency Project (SNAP) study which aims to examine the relationship between online and offline social networks and the development of healthy relationships and sexual agency in adolescence.

Methods And Analysis: The SNAP study is a mixed methods interdisciplinary longitudinal study. Over an 18-month period, adolescents aged 15-17 years at recruitment complete three questionnaires (including demographics, sexual behaviour, sexual agency and social networks); three in-depth interviews; and fortnightly online diaries describing their sexual behaviour and snapshots of their social networks that week. Longitudinal analyses will be used to describe changes in sexual behaviour and experiences over time, sexual agency, social media use, and social network patterns. Social network analysis will be used to capture relational data from which we will be able to construct sociograms from the respondent's perspective. Interview data will be analysed both in relation to emergent themes (deploying a grounded theory approach), and from a cross-disciplinary perspective. This mixed method analysis will allow for comparisons across quantitative and qualitative data, for consistency and differences, and will enhance the robustness of data interpretation and conclusions drawn, as multiple data sources are triangulated.

Ethics And Dissemination: Ethical approval was granted by the University of Sydney Human Research Ethics Committee and the Family Planning New South Wales Ethics Committee. The study will provide comprehensive, prospective information on the social and sexual development of adolescents in the age of social media and findings will be disseminated through conference presentations and peer-reviewed publications.
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http://dx.doi.org/10.1136/bmjopen-2018-024329DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6530386PMC
May 2019

Health care equity and access for marginalised young people: a longitudinal qualitative study exploring health system navigation in Australia.

Int J Equity Health 2019 03 4;18(1):41. Epub 2019 Mar 4.

Department of General Practice, Westmead Clinical School, The University of Sydney, PO Box 154, Westmead, NSW, 2145, Australia.

Background: Young people have unique social, emotional and developmental needs that require a welcoming and responsive health system, and policies that support their access to health care. Those who are socially or culturally marginalised may face additional challenges in navigating health care, contributing to health inequity. The aim of this study was to understand health system navigation, including the role of technology, for young people belonging to one or more marginalised groups, in order to inform youth health policy in New South Wales, Australia.

Methods: This qualitative longitudinal study involved 2-4 interviews each over 6 to 12 months with marginalised young people aged 12-24 years living in NSW. The analysis used Nvivo software and grounded theory.

Results: We interviewed 41 young people at baseline who were living in rural or remote areas, sexuality and/or gender diverse, refugee, homeless, and/or Aboriginal. A retention rate of over 85% was achieved. Nineteen belonged to more than one marginalised group allowing an exploration of intersectionality. General practitioners (family physicians) were the most commonly accessed service throughout the study period. Participants were ambivalent about their healthcare journeys. Qualitative analysis identified five themes: 1. Technology brings opportunities to understand, connect and engage with services 2. Healthcare journeys are shaped by decisions weighing up convenience, engagement, effectiveness and affordability. 3. Marginalised young people perceive and experience multiple forms of discrimination leading to forgone care. 4. Multiple marginalisation makes health system navigation more challenging 5. The impact of health system complexity and fragmentation may be mitigated by system knowledge and navigation support CONCLUSIONS: The compounding effects of multiple discrimination and access barriers were experienced more strongly for young people belonging to mutiple marginalised groups. We identify several areas for improving clinical practice and policy. Integrating technology and social media into processes that facilitate access and navigation, providing respectful and welcoming services that recognise diversity, improving health literacy and involving professionals in advocacy and navigation support may help to address these issues.
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http://dx.doi.org/10.1186/s12939-019-0941-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6399978PMC
March 2019

Prescribing for adolescents.

Aust Prescr 2019 Feb 1;42(1):20-23. Epub 2019 Feb 1.

GP Synergy, Sydney.

The Process Of Prescribing Changes As Children Move Into Adulthood For Some Medicines Such As Psychotropic Drugs Safety And Efficacy Are Less Well Understood In Adolescents:

As Adolescents Mature They Attain The Capacity To Consent To Their Own Medical Treatment An Assessment Of Their Competency Will Need To Take Into Account The Nature Of The Treatment Being Proposed:

Parental Involvement Is Usually Beneficial Particularly For Adolescents With Chronic Or Complex Conditions But Increasing Adolescent Autonomy Needs To Be Respected:

Adherence To Treatment Can Be Supported By Understanding Adolescent Development And Involving Adolescents In Management Plans:
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http://dx.doi.org/10.18773/austprescr.2019.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6370610PMC
February 2019

Adolescents' Use of Dr Google: Help or Hindrance?

J Paediatr Child Health 2018 11;54(11):1282-1283

Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.

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http://dx.doi.org/10.1111/jpc.14203DOI Listing
November 2018

Talking to migrant and refugee young people about sexual health in general practice.

Aust J Gen Pract 2018 08;47(8):564-569

MB BCh, MSc, PhD, Health, Rights and Development ([email protected]), School of Social Sciences, UNSW Sydney, Kensington, NSW.

Background And Objectives: Young people are an important group to target with health promotion and preventive healthcare. This paper focuses on the engagement of migrant and refugee young people with sexual and reproductive healthcare in general practice.

Method: Semi-structured first interviews (n = 27; 16 female, 11 male) and follow-up interviews (n = nine; six female, three male) were undertaken with migrant and refugee young people aged 16-24 years living in Sydney.

Results: The majority of participants had seen a general practitioner (GP) for general health issues. However, most were reluctant to discuss sexual health with a practitioner whom they described as their 'family doctor', primarily because of concerns about judgement and confidentiality. Most described negative experiences with GPs for sexual health matters, including not being listened to or being rushed through the appointment.

Discussion: There appears to be a lack of effective engagement with migrant and refugee young people by GPs in relation to sexual health. Building the skills and confidence of GPs to work with this group and promote sexual health and wellbeing should be considered, and efforts should be made to communicate confidentiality and trustworthiness.
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http://dx.doi.org/10.31128/AJGP-02-18-4508DOI Listing
August 2018

How Marginalized Young People Access, Engage With, and Navigate Health-Care Systems in the Digital Age: Systematic Review.

J Adolesc Health 2018 04 21;62(4):365-381. Epub 2018 Feb 21.

Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Carlton, Victoria, Australia.

Purpose: This systematic review examines how marginalized young people access and engage with health services and navigate health-care systems in high-income countries.

Methods: Medline, CINAHL, PsychInfo, The University of Sydney Library database, and Google Scholar were searched to identify qualitative and quantitative original research, published from 2006 to 2017, that focused on selected definitions of marginalized young people (12 to 24 years), their parents/carers, and/or health professionals working with these populations. A thematic synthesis was undertaken identifying themes across and between groups on barriers and/or facilitators to access, engagement, and/or navigation of health-care systems.

Results: Of 1,796 articles identified, 68 studies in the final selection focused on marginalized young people who were homeless (n = 20), living in rural areas (n = 14), of refugee background (n = 11), gender and/or sexuality diverse (n = 11), indigenous (n = 4), low income (n = 4), young offenders (n = 2), or living with a disability (n = 2). Studies were from the United States, Australia, Canada, United Kingdom, New Zealand, and Portugal, including 44 qualitative, 16 quantitative, and 8 mixed-method study types. Sample sizes ranged from 3 to 1,388. Eight themes were identified relating to ability to recognize and understand health issues; service knowledge and attitudes toward help seeking; structural barriers; professionals' knowledge, skills, attitudes; service environments and structures; ability to navigate the health system; youth participation; and technology opportunities.

Conclusions: Marginalized young people experience barriers in addition to those common to all young people. Future studies should consider the role of technology in access, engagement, and health system navigation, and the impact of intersectionality between marginalized groups.
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http://dx.doi.org/10.1016/j.jadohealth.2017.10.018DOI Listing
April 2018

project protocol: young people and health system navigation in the digital age: a multifaceted, mixed methods study.

BMJ Open 2017 08 7;7(8):e017047. Epub 2017 Aug 7.

Department of General Practice, Sydney Medical School Westmead, The George Institute for Global Health, Sydney, New South Wales, Australia.

Background: The integration of digital technology into everyday lives of young people has become widespread. It is not known whether and how technology influences barriers and facilitators to healthcare, and whether and how young people navigate between face-to-face and virtual healthcare. To provide new knowledge essential to policy and practice, we designed a study that would explore health system access and navigation in the digital age. The study objectives are to: (1) describe experiences of young people accessing and navigating the health system in New South Wales (NSW), Australia; (2) identify barriers and facilitators to healthcare for young people and how these vary between groups; (3) describe health system inefficiencies, particularly for young people who are marginalised; (4) provide policy-relevant knowledge translation of the research data.

Methods And Analysis: This mixed methods study has four parts, including: (1) a cross-sectional survey of young people (12-24 years) residing in NSW, Australia; (2) a longitudinal, qualitative study of a subsample of marginalised young people (defined as young people who: identify as Aboriginal and/or Torres Strait Islander; are experiencing homelessness; identify as sexuality and/or gender diverse; are of refugee or vulnerable migrant background; and/or live in rural or remote NSW); (3) interviews with professionals; (4) a knowledge translation forum.

Ethics And Dissemination: Ethics approvals were sought and granted. Data collection commenced in March 2016 and will continue until June 2017. This study will gather practice and policy-relevant intelligence about contemporary experiences of young people and health services, with a unique focus on five different groups of marginalised young people, documenting their experiences over time. will explore navigation around all levels of the health system, determine whether digital technology is integrated into this, and if so how, and will translate findings into policy-relevant recommendations.
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http://dx.doi.org/10.1136/bmjopen-2017-017047DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5724235PMC
August 2017

Health status of marginalised young people in unstable accommodation.

J Paediatr Child Health 2017 Oct 10;53(10):995-999. Epub 2017 Jun 10.

Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia.

Aim: More than 26 000 Australians aged 12-24 years experience homelessness, yet data on the health status of homeless youth remain limited. The aim of this study was to describe the health of young people attending a youth health service in Western Sydney who were experiencing homelessness.

Methods: Retrospective case note review for clients aged 12-25 years attending Youth Health Services in Western Sydney. Extracted data included: homelessness status; demographics; physical health issues; mental health issues; involvement with juvenile justice; and disengagement from education or employment.

Results: Just under half of the 180 clients attending a Youth Health Service in Western Sydney were homeless, and an additional 15 young people who were not currently homeless nominated homelessness as a presenting issue. In comparison with currently domiciled young people, homeless youth were less likely to have a regular general practitioner and more likely to nominate a physical health concern as a presenting issue, although there was no difference between groups in terms of diagnosed mental or physical health conditions. Considered as a whole, the sample showed high rates of acute physical symptoms, physical trauma, psychological distress and self-harm.

Conclusions: Youth homelessness is associated with risk of both poor physical and mental health. As much of youth homelessness is hidden, health-care providers need to ensure that they inquire about homelessness status, and have an awareness of potentially complex multi-morbidities in the physical and mental health of young marginalised people presenting to health services.
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http://dx.doi.org/10.1111/jpc.13590DOI Listing
October 2017

Evaluation of a sexually transmissible infections education program: Lessons for general practice learning.

Aust Fam Physician 2016 Mar;45(3):123-8

MBBS, MMed, FRACGP is the Peter Brennan Chair of General Practice, School of Medicine, University of Western Sydney, New South Wales.

Background: The New South Wales (NSW) Sexually Transmissible Infections Program Unit (STIPU) produced nine resources to support the diagnosis and management of sexually transmissible infections (STIs) in general practice.

Objective: In this study, we explored the processes of developing the resources and outcomes achieved.

Methods: We analysed project documents and undertook a focus group interview with the STIPU Working Group to evaluate resource development and dissemination. Interviews with general practitioners (GPs) and practice nurses (PNs), combined with previously reported survey findings, provided an outcomes evaluation.

Results: STIPU used a rigorous, multimodal approach to develop evidence-based clinical resources. GPs and PNs received information opportunistically rather than through targeted searches unless they had a particular interest. GPs were less aware of online re-sources.

Discussion: STIPU's best practice translation of clinical guidelines could be enhanced by promotion of online resources, links through general practice software, strong engagement with general practice organisations, and developing the role of PNs.
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March 2016

Evaluation of a school screening programme for young people from refugee backgrounds.

J Paediatr Child Health 2016 Jan 29;52(1):72-9. Epub 2015 Sep 29.

Community Child Health, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia.

Aim: To describe the development of the Optimising Health and Learning Program, guided by the only available published framework for the delivery of health services to newly arrived refugee children and report on the evaluation of the programme.

Methods: We conducted process and impact evaluation using a mixed methods approach. The sample was 294 refugee young people enrolled in two Intensive English Centres in New South Wales. We collected quantitative data (demographic and clinical information) as well as qualitative data via focus groups, key informant interviews, surveys and programme documentation. Qualitative data were subjected to thematic analysis; programme documents underwent document review.

Results: There were high levels of programme participation (90%), and the yield from routine health screening was high (80% of participants screened positive for two or more health conditions). All identified programme development strategies were implemented; programme partners and participants reported satisfaction with the programme. Sixteen programme partners were identified with a high level of intersectoral collaboration reported. Significant in-kind contributions and seed funding enabled the uptake of the programme to increase from one to five Intensive English Centres over a 4-year period.

Conclusion: Process and impact evaluation identified that the programme was well implemented and met its stated objectives of increasing the detection of health conditions likely to impact on student health and learning; linkage of newly arrived students and their families with primary health care; and coordination of care across primary health and specialist services.
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http://dx.doi.org/10.1111/jpc.12989DOI Listing
January 2016

HPV.edu study protocol: a cluster randomised controlled evaluation of education, decisional support and logistical strategies in school-based human papillomavirus (HPV) vaccination of adolescents.

BMC Public Health 2015 Sep 15;15:896. Epub 2015 Sep 15.

School of Public Health, University of Sydney, Sydney, NSW, Australia.

Background: The National Human Papillomavirus (HPV) Vaccination Program in Australia commenced in 2007 for females and in 2013 for males, using the quadrivalent HPV vaccine (HPV 6,11,16,18). Thus far, we have demonstrated very substantial reductions in genital warts and in the prevalence of HPV among young Australian women, providing early evidence for the success of this public health initiative. Australia has a long history of school-based vaccination programs for adolescents, with comparatively high coverage. However, it is not clear what factors promote success in a school vaccination program. The HPV.edu study aims to examine: 1) student knowledge about HPV vaccination; 2) psycho-social outcomes and 3) vaccination uptake.

Methods/design: HPV.edu is a cluster randomised trial of a complex intervention in schools aiming to recruit 40 schools with year-8 enrolments above 100 students (approximately 4400 students). The schools will be stratified by Government, Catholic, and Independent sectors and geographical location, with up to 20 schools recruited in each of two states, Western Australia (WA) and South Australia (SA), and randomly allocated to intervention or control (usual practice). Intervention schools will receive the complex intervention which includes an adolescent intervention (education and distraction); a decisional support tool for parents and adolescents and logistical strategies (consent form returns strategies, in-school mop-up vaccination and vaccination-day guidelines). Careful process evaluation including an embedded qualitative evaluation will be undertaken to explore in depth possible mechanisms for any observed effect of the intervention on primary and secondary outcomes.

Discussion: This study is the first to evaluate the relative effectiveness of various strategies to promote best practice in school-based vaccination against HPV. The study aims to improve vaccination-related psychosocial outcomes, including adolescent knowledge and attitudes, decision-making involvement, self-efficacy, and to reduce fear and anxiety. The study also aims to improve school vaccination program logistics including reduction in time spent vaccinating adolescents and increased number of consent forms returned (regardless of decision). Less anxiety in adolescents will likely promote more efficient vaccination, which will be more acceptable to teachers, nurses and parents. Through these interventions, it is hoped that vaccination uptake will be increased.

Trial Registration: Australian and New Zealand Clinical Trials Registry, ACTRN12614000404628 , 14.04.2014.
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http://dx.doi.org/10.1186/s12889-015-2168-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4572679PMC
September 2015

The health of "emerging adults" in Australia: freedom, risk and rites of passage.

Authors:
Melissa S-L Kang

Med J Aust 2014 Nov;201(10):562-3

Discipline of General Practice, University of Sydney, Sydney, NSW, Australia.

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http://dx.doi.org/10.5694/mja14.01409DOI Listing
November 2014

'I demand to be treated as the person I am': experiences of accessing primary health care for Australian adults who identify as gay, lesbian, bisexual, transgender or queer.

Sex Health 2014 Jul;11(3):258-64

Department of General Practice, Sydney Medical School Westmead, The University of Sydney, PO Box 154, Westmead, NSW 2145, Australia.

Unlabelled: Background Individuals who identify as gay, lesbian, bisexual, transgender or queer (GLBTQ) suffer higher rates of illness and morbidity compared with the general population but may experience significant barriers to accessing primary health care.

Method: We used an online questionnaire to explore GLBTQ adults' experiences of accessing primary health care in Australia. We developed the questionnaire in consultation with individuals who belonged to or worked closely with the GLBTQ community. Questions were open-ended and sought information about four topic areas: sexual identity and its meaning, utilisation of primary health care services, disclosure of sexual identity to primary care providers and experiences of accessing primary health care. Data were analysed by coding free-text responses into themes.

Results: Ninety-nine valid responses were received. Participants were 18-60+ years old (modal age group: 20-29 years); 70% lived in cities. Of these, 49% identified as gay, 35% as lesbian, 13% as bisexual, 8% as queer and 3% as transgender. Some participants indicated more than one identity. GLBTQ-identifying adults often divided care, seeking different primary care services for different health concerns. Themes in relation to disclosure of sexual identity were: taking a rights-based position, experiences of homophobia and clinical context. Themes about access to primary health care were: diversity and heterogeneity, real or perceived discrimination, visual symbols and respect.

Conclusion: Despite diversity, GLBTQ adults experience many barriers to accessing health care due to sexual identity. General practitioners and other primary health care providers have a role in ensuring equitable access to health care.
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http://dx.doi.org/10.1071/SH14007DOI Listing
July 2014

Plasma insulin, glucose, IGF-I, IGF-II, and IGFBP-3 and risk of recurrent colorectal adenomas.

J Gastroenterol Hepatol Res 2013 Apr;2(4):531-535

Center for Gastrointestinal Biology and Disease, University of North Carolina, Chapel Hill, NC.

Aim: Insulin and insulin-like growth factors (IGF's) are associated with an increased risk of colorectal adenomas. The association with recurrent adenomas is inadequately studied. We prospectively examined the relationship between insulin biomarkers and the risk of recurrent adenomas.

Materials And Methods: Our analysis included 167 subjects with one or more adenomas detected on a baseline colonoscopy who had a surveillance colonoscopy within three to five years. We measured serum biomarkers in all subjects at baseline. ELISA was used to measure fasting plasma insulin, IGF-I, IGF-II, and IGF binding protein-3. The hexokinase assay was used to measure fasting plasma glucose by and immuno-turbidimetric assay to measure hemoglobin A1C.

Results: Subjects with recurrent adenomas were more likely to be male, overweight and have ≥3 adenomas at baseline. We found no significant associations between insulin (OR=1.6, 95% CI 0.7-3.5), glucose (OR=1.4, 95% CI 0.7-3.1), IGF-I (OR=0.7, 95% CI 0.3-1.5), IGF-II (OR=1.0, 95% CI 0.5-2.3), IGFBP-3 (OR=0.1, 95% CI 0.5-2.1), or anthropometric measures and recurrent adenomas.

Conclusion: Our results do not support a role for insulin biomarkers and recurrent colorectal adenomas.
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http://dx.doi.org/10.6051/j.issn.2224-3992.2013.02.247DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3922127PMC
April 2013

Somatic gene mutations in African Americans may predict worse outcomes in colorectal cancer.

Cancer Biomark 2013 ;13(5):359-66

Center for Gastrointestinal Biology and Disease, University of North Carolina, Chapel Hill, NC, USA.

Background And Objective: African Americans have worse outcomes in colorectal cancer (CRC) than Caucasians. We sought to determine if KRAS, BRAF and PIK3CA mutations might contribute to the racial differences in CRC outcome.

Methods: DNA was extracted from tissue microarrays made from CRC samples from 67 African Americans and 237 Caucasians. Mutations in KRAS, BRAF, and PIK3CA were evaluated by PCR sequencing. We also examined microsatellite instability (MSI) status. Associations of mutation status with tumor stage and grade were examined using a logistic regression model. Cox proportional hazards models were used to estimate the all-cause mortality associated with mutational status, race and other clinicopathologic features.

Results: KRAS mutations were more common in African Americans than among Caucasians (37% vs 21%, p=0.01) and were associated with advanced stage (unadjusted odds ratio (OR)=3.31, 95% confidence interval (CI) 1.03-10.61) and grade (unadjusted OR=5.60, 95% CI 1.01-31.95) among African Americans. Presence of BRAF mutations was also positively associated with advanced tumor stage (adjusted OR=3.99, 95%CI 1.43-11.12) and grade (adjusted OR=3.93, 95%CI 1.05-14.69). PIK3CA mutations showed a trend toward an association with an increased risk of death compared to absence of those mutations (adjusted for age, sex and CRC site HR=1.89, 95% CI 0.98-3.65). Among African Americans, the association was more evident (adjusted for age, sex and CRC site HR=3.92, 95% CI 1.03-14.93) and remained significant after adjustment for MSI-H status and combined education-income level, with HR of 12.22 (95%CI 1.32-121.38).

Conclusions: Our results suggest that African Americans may have different frequencies of somatic genetic alterations that may partially explain the worse prognosis among African Americans with CRC compared to whites.
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http://dx.doi.org/10.3233/CBM-130366DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4589188PMC
September 2014

Sexual behaviour, sexually transmitted infections and attitudes to chlamydia testing among a unique national sample of young Australians: baseline data from a randomised controlled trial.

BMC Public Health 2014 Jan 8;14:12. Epub 2014 Jan 8.

Discipline of General Practice, University of Sydney, PO Box 154, Westmead, New South Wales 2145, Australia.

Background: Chlamydia infection is the most common notifiable sexually transmitted infection (STI) in Australia and mostly affects young people (15 - 25 years). This paper presents baseline data from a randomised controlled trial that aimed to increase chlamydia testing among sexually active young people. The objectives were to identify associations between sexual behaviour, substance use and STI history and explore attitudes to chlamydia testing.

Methods: This study was conducted in cyberspace. Study recruitment, allocation, delivery of interventions and baseline and follow up data collection all took place online. Participants were 16 - 25 years old and resided in Australia. Substance use correlates of sexual activity; predictors of history of STIs; barriers to and facilitators of chlamydia testing were analysed.

Results: Of 856 participants (79.1% female), 704 had experienced penetrative intercourse. Sexually active participants were more likely to smoke regularly or daily, to drink alcohol, or to have binge drunk or used marijuana or other illicit substances recently. Risk factors for having a history of any STI were 3 or more sexual partners ever, 6 or more partners in the past 12 months, condom non-use and being 20 years or older. Almost all sexually active participants said that they would have a chlamydia test if their doctor recommended it.

Conclusions: Sexually active young people are at risk of STIs and may engage in substance use risk behaviours. Where one health risk behaviour is identified, it is important to seek information about others. Chlamydia testing can be facilitated by doctors and nurses recommending it. Primary care providers have a useful role in chlamydia control.

Trial Registration: Australian and New Zealand Trials Registry ACTRN12607000582459.
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http://dx.doi.org/10.1186/1471-2458-14-12DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3909293PMC
January 2014
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