Impact on help-seeking behaviours of a campaign perceived to decrease stigma and increase openness around mental health

ISSUE ADDRESSED

There is considerable evidence that public stigma around mental illness inhibits help-seeking for mental health problems. Hence there have been many interventions and campaigns designed to reduce stigma around mental illness. However, as far as could be ascertained, none of these stigma reduction interventions has reported any substantial impact of reducing stigma on people's mental health help-seeking behaviours. The aim of this paper is to report on the impact of the Act-Belong-Commit positive mental health promotion Campaign on help-seeking via increasing perceived openness around mental health and reducing perceived stigma around mental illness.

METHODS

State-wide computer assisted telephone interviews (CATIs) of the general adult population were undertaken in 2018 and 2019 (N = 600 adults per year). The questionnaire included measures of respondents' awareness of the Act-Belong-Commit Campaign, their beliefs about the Campaign's impact on mental illness stigma and openness around mental health issues, and whether they had sought help for or information about a mental health problem as a result of their exposure to the Campaign.

RESULTS

Those who believed the Act-Belong-Commit Campaign increased openness around mental health issues were significantly more likely than those not holding this belief to have sought information about mental health and to have sought help for a mental health problem as a result of their exposure to the Campaign. Those who believed the Act-Belong-Commit Campaign decreased stigma around mental illness versus those not holding this belief were significantly more likely to have sought information, and more likely, but not significantly so, to have sought help as a result of their exposure to the Campaign. Overall, the effect was slightly greater for increased openness.

CONCLUSION

As far as we are aware, these are the first reported findings of a positive impact on mental health help-seeking behaviours as a result of a population-wide mental health promotion Campaign being seen to have increased openness around mental health and decreased stigma around mental illness. SO WHAT?: These findings suggest that accompanying specific stigma reduction interventions with a broad-based, population-wide, positive mental health promotion Campaign such as the Act-Belong-Commit campaign, could amplify these interventions' impact on help-seeking by increasing openness about mental health issues.

Impact of the Act-Belong-Commit campaign on mental health help-seeking behaviour

ISSUE ADDRESSED

Despite the high prevalence of mental ill-health amongst Australians, many people do not seek help for their mental ill-health. A delay in help-seeking is associated with poorer outcomes. This study investigated the extent to which the Act-Belong-Commit mental health promotion campaign prompted people to seek information or professional help for mental ill-health.

METHODS

A sample of 1200 respondents took part in two state-wide surveys (n = 600 each). Participants aware of the Act-Belong-Commit campaign were asked questions related to information-seeking and help-seeking behaviours because of the campaign.

RESULTS

Of those aware of the campaign, 8% stated that the campaign prompted them to seek information and 4% stated that the campaign prompted them to seek help for a mental health problem. Those with a mental illness experience (MIE) were significantly more likely than those without to report that the campaign prompted them to look for information (12% vs 6%) and seek help for a mental health problem (9.5% vs 1.2%). Extrapolating these results to the total adult population of Western Australia indicated that around 120 000 adults had sought mental health information, and around 60 000 had sought help as a result of the campaign.

CONCLUSIONS

The campaign not only initiated the seeking of information or professional help for a mental health problem amongst those with no prior thoughts of such, but also prompted those who were already thinking about seeking information or getting help to act sooner than they otherwise would. SO WHAT?: Although previous research suggests that mental health literacy interventions have limited impact on help-seeking, the presented data show that the Act-Belong-Commit approach can have a significant impact on help-seeking, particularly amongst those with a MIE, which could yield substantial social and economic return on investment benefits if intensified at both the media and community grass roots levels.

Modern urbanization has reshaped the bacterial microbiome profiles of house dust in domestic environments

Background

The prevalence of allergy and other common chronic diseases is higher in developed than developing countries, and higher in urban than rural regions. Urbanization through its modification of environmental microbiomes may play a predominant role in the development of these conditions. However, no studies have been conducted to compare the microbiome in house dust among areas with different urbanization levels.

Methods

House dust from Xinxiang rural area (XR, n = 74), Xinxiang urban area (XU, n = 33), and Zhengzhou urban area (ZU, n = 32) in central China, and from Australia (AU, n = 58 [with pets AUP, n = 15, without pets AUNP, n = 43]) were collected during a summer season in China and Australia. High-throughput sequencing of 16S rDNA was employed to profile house dust bacterial communities.

Results

Settled dust collected in China was dominant with 2 bacterial phyla: Proteobacteria and Actinobacteria, while floor dust collected in Australia had a higher proportion of phylum Proteobacteria, Firmicutes, and Actinobacteria. XR dust samples presented higher bacterial richness and diversity compared with XU or ZU samples. Urbanization level (r² = 0.741 P < 0.001) had a significant correlation with the distribution of house dust bacterial community. At the genus level, there was a positive correlation (r coefficient > 0.5) between urbanization level and bacterial genera Streptococcus, Bartonella, Staphylococcus, Pseudomonas, Acinetobacter, Bacteroides, Corynebacterium_1,and Enhydrobacter and a negative correlation (r coefficient < −0.5) with Rhodanobacter.

Conclusion

There was a significant difference in house dust microbiota among different urbanization areas. The areas with a lower urbanization level presented higher dust-borne bacterial richness and diversity. Modern urbanization has a significant influence on the bacterial microbiome profiles of indoor dust.

Trends in Australian adolescents' sun-protection behaviours: implications for health campaigns

OBJECTIVE

Protecting the skin from ultraviolet (UV) radiation is critical during adolescence to reduce the risk of developing skin cancer later in life, but adolescents tend to be less likely to engage in sun-protective behaviours than adults. The present study examined changes and trends (2001/02-2011/12) in sun-protection behaviours among adolescents living in Western Australia - a region with high levels of UV radiation.

METHODS

A cross-sectional survey was conducted during 10 summers between 2001/02 and 2011/12 to investigate how often adolescents engaged in various sun-protection behaviours, including outdoor protective measures (wearing a hat, wearing protective clothing, using sunscreen, wearing sunglasses, seeking shade) and avoidance of UV radiation by staying inside.

RESULTS

Hat use significantly decreased between 2001/02 and 2011/12, whereas use of sunscreen and wearing covering clothes were unchanged in most survey years relative to 2001/02. Use of sunglasses peaked in 2006/07 and 2007/08, but returned to first survey year levels in 2011/12, while staying inside was more frequently reported from 2006/07 onwards.

CONCLUSIONS

New approaches are needed to minimise reactance responses in adolescents while fostering favourable attitudes to sun protection. Implications and opportunities for interventions to promote better sun-protection practices among adolescents are provided.

Trends in sun-protection behaviour in Australian adults 2007-2012

BACKGROUND

Almost all skin cancers are the result of overexposure to UV radiation and could be prevented by adhering to a number of simple behavioural guidelines to minimise exposure to the sun. The present study examined trends in sun-protection behaviour among adults living in Western Australia, a region with high levels of UV radiation.

METHODS

During five summers from 2008 to 2012, 2076 Western Australian adults participated in annual, cross-sectional telephone surveys that assessed how often they engaged in a range of sun-protection behaviour (seeking shade, staying inside and wearing a hat, protective clothing, sunscreen or sunglasses).

RESULTS

Apart from an increase in sunscreen use and a consistently high use of sunglasses, most sun-protection behaviour remained stable at moderate levels during the 5-year period. Seeking shade, staying inside and wearing a hat were all practised at levels ranging between 'sometimes' and 'usually' on sunny days in summer during peak UV hours, with little to no variability across the survey years. Wearing protective clothing was the least frequent behaviour across all survey years and was significantly lower in the most recent survey year relative to baseline.

CONCLUSIONS

Further efforts are required to encourage greater enactment of sun-protection behaviour, especially on the use of protective clothing and seeking shade during periods of high UV radiation.

Accuracy of resting metabolic rate prediction in overweight and obese Australian adults

OBJECTIVES

Predictive resting metabolic rate (RMR) equations in Australian populations are at least 10 years old, focused on males and do not commonly use overweight and obese weight categorisation. The aim of this study was to measure RMR via indirect calorimetry in overweight and obese Australian adults to develop population specific predictive equations and compare with other well-known international equations (Mifflin-St. Jeor, Owen and WHO/FAO/UNU).

METHODS

Retrospective data from 278 participants (154 males, 124 females: 37% overweight, 63% obese) who had attended a weight management clinic were used to develop predictive RMR equations. These were then validated against another sample (from the same clinic) of 297 participants (150 males, 147 females: 47% overweight, 53% obese), and their accuracy compared with known standard equations.

RESULTS

For the prediction sample, weight, BMI, resting VO₂ and measured RMR were significantly greater in the obese than overweight. Using the validation sample, the predictive equations met a ±10% of measured RMR criterion 42% (females), 41% (total sample) and 40% (males) of the time. Prediction accuracy was not improved by using specific overweight and obese weight category equations, or by applying the known standard equations from the literature.

CONCLUSIONS

In our sample of overweight and obese adults, RMR prediction to within ±10% of the measured value was only accurate ∼40% of the time, regardless of gender and weight classification. In clinical weight management settings direct measures of RMR should be made wherever possible.

Influence of Hormonal Profile on Resting Metabolic Rate in Normal, Overweight and Obese Individuals

AIMS

To investigate whether blood thyroid stimulating hormone (TSH), cortisol, insulin and glucose concentrations (plus glucose:insulin ratio; GIR) could improve the accuracy of resting metabolic rate (RMR) prediction in normal, overweight and obese persons.

METHODS

Predictive equations were developed and compared against indirect calorimetry measures for RMR in 217 weight-control clinic participants (n = 128 males and n = 89 females: ∼24% normal weight, ∼39% overweight and ∼37% obese).

RESULTS

Using the common accuracy criteria of the proportion of predicted RMR within ±10% of measured RMR, our equations (using age, height, weight and gender, plus the blood factors, both independently and in combination) were accurate ∼36-44% of the time, for the whole sample, and when separated by gender and weight class. Specifically, the addition of the blood hormone and glucose concentrations improved the accuracy of predicted RMR by only 1-8% (NS).

CONCLUSIONS

Including blood TSH, cortisol, insulin, glucose and GIR into RMR prediction equations did not significantly improve estimation accuracy, which in any case only met a criterion of ±10% of the measured RMR ∼40% of the time. Further work to refine the prediction of RMR is still needed, and at present, direct measurements should be made wherever possible.

Public perceptions of cancer risk factors: a Western Australian study

ISSUE ADDRESSED

People's perceptions of risk may influence health-related behaviours. The aim of this study was to investigate the perception of cancer risk factors among Western Australian adults in order to inform health promotion policies.

METHODS

Cross-sectional surveys of 2094 adults were undertaken in 2007/2008 in which respondents were asked whether they thought factors increased or decreased the risk of cancer. Factors included both established and unestablished risk factors for cancer. The distribution of perceptions was compared according to age and sex.

RESULTS

The study found high levels of endorsement for some unestablished risk factors (74-91%) and comparatively lower levels of endorsement for many established risk factors (33-80%). The established risk factors of smoking and asbestos received high levels of endorsement (94-98%).

CONCLUSION

It appears that the alignment between scientifically established risk factors and the Western Australian public's perception of cancer risk factors could be improved. SO WHAT? Health promotion strategies are needed to improve the public's awareness of cancer risk factors. The high levels of endorsement attributed to unestablished risk factors highlight the need to dispel myths surrounding cancer and to reinforce the key factors in cancer prevention. Ongoing assessment of the alignment between community perceptions of cancer risk and the scientific evidence for cancer risk is important for guiding prioritisation within public health organisations.

Predicting attitude towards performance enhancing substance use: a comprehensive test of the Sport Drug Control Model with elite Australian athletes

OBJECTIVES

This study presents a comprehensive examination of the Sport Drug Control Model via survey data of elite Australian athletes.

DESIGN

A cross-sectional nationwide mail survey.

METHODS

A mail survey of 1237 elite Australian athletes was conducted. Structural equation modelling was employed to test the model.

RESULTS

Morality (personal moral stance on performance-enhancing substances use), reference group opinion (perceived moral stance of reference group on performance-enhancing substances use) and legitimacy (perceptions of the drug testing and appeals processes) evidenced significant relationships with attitude towards performance-enhancing substances use, which in turn was positively associated with doping behaviour. The model accounted for 81% and 13% of the variance in attitude towards performance-enhancing substances use and doping behaviour, respectively.

CONCLUSIONS

These findings validate the usefulness of the Sport Drug Control Model for understanding influences on performance-enhancing substances use. Nevertheless, there is a need to survey athletes representing a broader range of competition levels and cross-cultural research to test the model's applicability to other populations of athletes.

Impact on community organisations that partnered with the Act-Belong-Commit mental health promotion campaign

ISSUE ADDRESSED

A primary aim of the pilot phase of the Act-Belong-Commit mental health promotion campaign was to form partnerships with community organisations. As a component of the broader campaign strategy, collaborating organisations promoted their activities under the Act-Belong-Commit banner in exchange for resources, promotional opportunities and capacity building in event management and funding.

METHODS

The impact of the Act-Belong-Commit campaign on the capacity and activities of collaborating organisations during the pilot phase was evaluated using self-completed mail surveys in 2006 and 2008.

RESULTS

Collaboration with the campaign had a positive impact on community organisations' capacity, including staff expertise, media publicity and funding applications. Collaborating organisations had strong positive perceptions of Act-Belong-Commit officers and all expressed a willingness to collaborate in future events and activities.

CONCLUSIONS

The partnership model used during the pilot phase of the Act-Belong-Commit campaign was successful in creating mutually beneficial exchanges with collaborating organisations. So what? Community partnerships are necessary for the effective delivery of mental health promotion campaigns at a local level. Successful partnerships involve the provision of real and valuable benefits to collaborating organisations in return for their cooperation in promoting health messages.

Online advertising by three commercial breast imaging services: message takeout and effectiveness

Mammography is widely acknowledged to be the most cost-effective technique for population screening for breast cancer. Recently in Australia, imaging modalities other than mammography, including thermography, electrical impedance, and computerised breast imaging, have been increasingly promoted as alternative methods of breast cancer screening. This study assessed the impact of three commercial breast imaging companies' promotional material upon consumers' beliefs about the effectiveness of the companies' technology in detecting breast cancer, and consumers' intentions to seek more information or consider having their breasts imaged by these modalities. Results showed 90% of respondents agreed that the companies' promotional material promoted the message that the advertised breast imaging method was effective in detecting breast cancer, and 80% agreed that the material promoted the message that the imaging method was equally or more effective than a mammogram. These findings have implications for women's preference for and uptake of alternative breast imaging services over mammography.

Predictors of positive outcomes of a school food provision policy in Australia

This study identified predictors of parents' and school principals' perceptions of the impact of a Western Australian school food policy. An initial qualitative phase involving focus groups with parents and interviews with school principals, teachers, canteen managers and Parents & Citizens Committee members provided general feedback on the policy and identified various factors that appeared to be related to its successful implementation. In the following quantitative phase of the study, 1200 parents responded to a telephone questionnaire and 310 principals responded to an internet-based questionnaire. The primary outcome variables were, respectively, the extent to which parents reported that their children's diets were healthier as a result of the policy, and the extent to which principals reported that their schools complied with the policy. Logistic regression models were generated for the parent and principal samples. Those parents reporting that their children's diets were healthier were more likely to agree that the policy reflected their beliefs and their children's dietary needs and preferences, that their child talked about the traffic light food classification system and that this system influenced their food choices in the supermarket. Those principals reporting full compliance with the policy were more likely to agree that implementing the policy was not overly difficult. Specific factors facilitating school compliance were canteen manager training and conducive kitchen setup. Provision of appropriate information and training prior to implementation may assist schools in implementing new food policies, thereby enhancing their impact beyond the school environment.

Perfectionistic profiles among elite athletes and differences in their motivational orientations

Although there is an emerging body of research that has examined perfectionistic clusters in the general population, few studies have explored such profiles in athlete samples. The purposes of this research were to explore perfectionistic profiles within a sample of elite athletes and the differences between them on key motivational variables. A sample of 423 elite athletes (179 males, 244 females) aged between 14 and 66 years (M = 25.64; SD = 8.57) from a variety of team (e.g., rowing, hockey, baseball, rugby) and individual sports (e.g., cycling, athletics, triathlon, gymnastics) completed a multisection questionnaire including measures of sport perfectionism, motivation regulation, achievement goals, and fear of failure. Cluster analyses revealed the existence of three perfectionism profiles, namely, nonperfectionists, maladaptive perfectionists, and adaptive perfectionists. Subsequent analyses generally supported the robustness of these perfectionism profiles in terms of differential motivational orientations (achievement goals, fear of failure, and motivation regulation) in hypothesized directions. Overall, the differences in motivational orientations between the three clusters supported a categorical conceptualization of perfectionism.

Using viral e-mails to distribute tobacco control advertisements: an experimental investigation

The authors' objective was to conduct a trial of viral e-mail marketing as a distribution method for tobacco control advertisements. University students (n = 200) in the state of Western Australia were randomly allocated to receive 1 of 2 e-mails with hyperlinks to tobacco control advertisements ("Toilet" and "Rubbish") emphasizing the disgusting nature of smoking. Recipients followed a hyperlink to a Web page playing Toilet or Rubbish on endless loop. Viewers were encouraged to forward the e-mail to their friends and invited to complete an online survey about the advertisement. Unique downloads for each advertisement were identified by internet provider (IP) location and tallied by date and geographical location to assess subsequent dissemination beyond the initial 200 students. There were 826 unique viewings of the advertisements averaging 26.9 viewings per day for the first fortnight, followed by a lower average of 4.1 hits per day for the next 3.5 months. IP addresses identified hits from 3 other Australian states and 7 other countries. Online surveys were completed by 103 respondents (12.5% of total hits) but included few smokers (n = 9). Significantly more respondents rated Toilet as "funny" compared with Rubbish (40% vs. 11%; p < .05), likely explaining why the former accounted for significantly more viewings than the latter (487 vs. 339; p < .001). There was a greater than fourfold return in dissemination for each initial e-mail sent but daily hits rapidly deteriorated over time. Entertainment appears to facilitate viral e-mails being forwarded onwards but only exceptionally compelling tobacco control materials are ever likely to become self-perpetuating.

An examination of the Sport Drug Control Model with elite Australian athletes

OBJECTIVE

This study presents an opportunistic examination of the theoretical tenets outlined in the Sport Drug Control Model(1) using questionnaire items from a survey of 643 elite Australian athletes.

DESIGN AND METHOD

Items in the questionnaire that related to the concepts in the model were identified and structural equation modelling was employed to test the hypothesised model.

RESULTS

Morality (cheating), benefit appraisal (performance), and threat appraisal (enforcement) evidenced the strongest relationships with attitude to doping, which in turn was positively associated with doping susceptibility. Self-esteem, perceptions of legitimacy and reference group opinions showed small non-significant associations with attitude to doping. The hypothesised model accounted for 30% and 11% of the variance in attitudes to doping and doping susceptibility, respectively.

CONCLUSION

These present findings provide support for the model even though the questionnaire items were not constructed to specifically measure concepts contained in it. Thus, the model appears useful for understanding influences on doping. Nevertheless, there is a need to further explore individual and social factors that may influence athletes' use of performance enhancing drugs.

Impact of compliance on weight loss and health profile in a very low energy diet program

BACKGROUND

Although intuitive, little data links program compliance with weight loss and health profile changes in obese Australians.

METHODS

Obese males (n=308) and females (n=734) from one clinic using a very low energy diet intervention were studied over 26 weeks. Physical and health profiles were assessed. Low compliance completed 1-12 weeks, medium 13-20 weeks and high 21-26 weeks.

OBJECTIVE

Overall, 52% achieved high compliance (females: 53%, males: 49%). Greater compliance was associated with greater weight loss and health profile changes in both genders. Mean male weight loss approximated 12 kg, 21 kg and 26 kg with low, medium and high compliance; mean female values were 8 kg, 15 kg and 20 kg. Body mass index, waist-hip ratios, and blood pressure, cholesterol, triglyceride and glucose changes were all more marked with high compliance.

DISCUSSION

Unsuprisingly, high compliance in both genders was consistently associated with more substantial reductions (>15%) of body weight and greater health profile improvements.

Efficacy of breast cancer appeals for promoting physical activity

BACKGROUND

We investigated the efficacy of breast cancer prevention messages in increasing intentions to be more active.

METHOD

We randomly assigned 200 females aged 30-60 years to a breast cancer and physical activity message or a cardiovascular disease and physical activity message.

RESULTS

The breast cancer message was more believable and slightly more motivating to increase physical activity than the cardiovascular disease message, and 72% of respondents in the breast cancer condition increased their intention to increase their physical activity.

CONCLUSION

The benefit of reducing the risk of breast cancer can be used to motivate increased physical activity in women.

When confrontational images may be counter productive: reinforcing the case for pre-testing communications in sensitive areas

ISSUE ADDRESSED

White Ribbon Day is an international campaign that encourages men to speak out about and demonstrate their opposition to violence against women by wearing a white ribbon on 25 November. This study assesses the effectiveness of a graphic confrontational image in the Australian 2006 campaign versus an alternative non-violent image to motivate men to wear a white ribbon on White Ribbon Day.

METHODS

An intercept survey was conducted with a sample of 45 males aged 30-49 years recruited in an inner city suburban shopping strip. Respondents were presented with two alternatives: a graphic 'amputated arm' image and a non-violent 'father-daughter' image. The primary dependent variable was the relative ability of the two alternatives in motivating respondents to wear a white ribbon on White Ribbon Day.

RESULTS

The vast majority of respondents nominated the 'father-daughter' as image being more motivating than the 'amputated arm' image to wear a white ribbon on White Ribbon Day: 84% vs 9%.

CONCLUSIONS

The bland 'father-daughter' image was far more motivating than the macabre/violent 'amputated arm' image in motivating men to wear a white ribbon on White Ribbon Day. This is contrary to the UNIFEM Australia and White Ribbon Day assertion that 'confrontational/provocative' images are necessary to achieve this behaviour.

Impact of smoking images in magazines on the smoking attitudes and intentions of youth: an experimental investigation

OBJECTIVE

To determine the effect of magazine incidental smoking imagery on youths' smoking intentions.

METHODS

A magazine was developed incorporating photographs of smokers (Smoking Magazine). A second version of the magazine (Non-smoking Magazine) included these photographs with the tobacco paraphernalia digitally erased. Equal numbers of smokers and non-smokers aged 14-17 years (n = 357) were randomly assigned to look through one version of the magazine and then asked a series of questions.

RESULTS

Smokers made more unprompted mention of smoking imagery than non-smokers after viewing Smoking Magazine (52% vs 34%; p<0.05). Smokers viewing Smoking Magazine were more likely to report an urge to smoke (54% vs 40%; p<0.05). Female non-smokers who viewed Smoking Magazine were more likely than those who viewed Non-smoking Magazine to state a future intention to smoke (13% vs 0%; p<0.05). Female smokers were more attracted to the male models appearing in Smoking Magazine than Non-smoking Magazine (49% vs 24%; p<0.05) and the opposite was true for female non-smokers (28% vs 52%; p<0.05). Female smokers were also marginally more likely to desire looking like the female models in Smoking Magazine (64% vs 46%; p = 0.06) but no difference was observed in the non-smoking females (46% vs 46%). Male smokers and non-smokers did not differ in their responses by magazine type.

CONCLUSIONS

Incidental positive smoking imagery in magazines can generate the same sorts of consumer effects attributed to advertising in general, including tobacco advertising. Sex specific results of our study may be explained by the choice of smoking images used.

People's beliefs about factors contributing to mental health: implications for mental health promotion

ISSUE ADDRESSED

To quantify people's perceptions of mental health identified in qualitative research and to inform mental health promotion communication strategies.

METHODS

A statewide telephone survey of 1,500 adults was conducted in Western Australia using a structured questionnaire containing both open and closed-ended questions.

RESULTS

The vast majority of people had negative (or illness) connotations to the words 'mental health', but had positive connotations to the term 'mentally healthy person'. The three factors perceived to contribute most to being mentally healthy were: having good friends to talk problems over with; keeping one's mind active; and the opportunity to have control over one's life. The three factors perceived to contribute most to being mentally unhealthy were: excessive use of alcohol or drugs; having no friends or support network; and life crises o traumas. The phrase 'being content with who you are' best summed up good mental health. Older people generally placed greater emphasis than younger people on cognitive functioning and keeping physically healthy for good mental health.

CONCLUSIONS

People's beliefs about factors influencing mental health are consistent with much of the literature. Communication components of mental health promotion interventions based on the data reported here would be viewed as credible and relevant by most people.

Western Australians' perceptions of the survivability of different cancers: implications for public education campaigns

ISSUE ADDRESSED

People's decisions about whether to participate in cancer screening and to seek treatment are related to their perceptions of the survivability of cancer. However, there is little empirical evidence to suggest people's awareness of the survivability of different cancers. The object of the present study was to determine people's estimates of the survivability of 10 cancers.

METHODS

In 2001, data were collected via computer-assisted telephone interviews with 1,501 randomly selected metropolitan and rural Western Australian adults. Participants were presented with a list of 10 cancers. Half the sample was asked to nominate the three most survivable, and half was asked to nominate the three least survivable cancers.

RESULTS

Participants' rankings of the 10 cancers in terms of perceived survivability were consistent with cancer registry data, with the exception of bone cancer which was underrated. Respondents' average estimates of five-year survival rates were also accurate (+/- 2-6%) for cancers with relatively high survival rates such as breast, cervical, prostate, and other skin cancers, with the exception of melanoma, which was underestimated (20%). However, average estimated survival rates for cancers with low survivability, such as leukaemia, lung, and stomach cancers, were substantially overestimated, being 31%, 38% and 43% higher respectively.

CONCLUSIONS

Western Australians appear to have a reasonable understanding of the relative survivability of various cancers but a poorer appreciation of actual survival rates.

Efficacy of bowel cancer appeals for promoting physical activity

ISSUE ADDRESSED

To investigate the potential efficacy of bowel cancer prevention messages in increasing intentions to be more physically active.

METHODS

A convenience sample of 281 physically inactive persons aged 30-60 years was recruited in the Perth city centre and randomly assigned to a bowel cancer and physical activity message or a heart disease and physical activity message. After reading a booklet containing information about physical activity and its link either to bowel cancer (n = 141) or cardiovascular disease (n = 140), respondents filled in a self-completion questionnaire. The main response measures were impact on intentions to be more physically active, and perceived believability and relevance of the message.

RESULTS

Perceived believability of the message was high in both conditions. Perceived personal relevance of the message was substantially lower in the bowel cancer than the cardiovascular disease condition. Overall, the cardiovascular disease condition achieved somewhat higher behavioural intentions than the bowel cancer condition.

CONCLUSIONS

The finding that two in three respondents in the bowel cancer condition had increased intention to increase their level of physical activity provides support for the potential efficacy of promoting physical activity in reducing the risk of bowel cancer.

Changes in beliefs about cancer in Western Australia, 1964–2001

OBJECTIVE

To assess changes in people's knowledge and beliefs about cancer between 1964 and 2001.

DESIGN

Questions in a 1964 survey of beliefs about cancer (randomly selected households) were replicated in a 2001 telephone survey (random-digit dialing).

SETTING

Perth, Western Australia.

PARTICIPANTS

984 and 491 participants aged 20 years or older in the 1964 and 2001 surveys, respectively (response rates, 86.8% and 47.0%).

MAIN OUTCOME MEASURES

Changes in knowledge and beliefs about cancer.

RESULTS

Between 1964 and 2001, there were major improvements in knowledge about the causes of cancer, with several myths dispelled. In 1964, the proportion of Perth residents surveyed who believed that cancer is contagious was 20% (95% CI, 18%-22%), compared with 3% (95% CI, 2%-4%) in 2001. Similarly, the proportion who believed cancer is caused by "a knock" was 25% (95% CI, 22%-28%) in 1964, compared with 1% (95% CI, 0-2%) in 2001. Cancer screening participation rates also greatly improved, from 18% (95% CI, 16%-20%) in 1964 to 77% (95% CI, 73%-81%) in 2001. Changes in participants' sources of knowledge about cancer were also evident, with family members and television increasing markedly as sources of information.

CONCLUSIONS

Improved education of the public in health matters over the past four decades appears to have had a major and positive impact on knowledge about cancer.

The word 'cancer': reframing the context to reduce anxiety arousal

This study investigated reaction to the word 'cancer' versus the phrase 'a cancer' in two ways: (1) assessing associations to the spoken words 'cancer' or 'a cancer'; and (2) presenting participants with a situation where one person says to another in print. 'I have cancer' or 'I have a cancer'. The participants were a convenience sample of 112 adults (i.e. aged 18 years or over), 55 males and 57 females, recruited via a mall intercept survey in the Perth (Western Australia) central business district. Participants were randomly assigned to either the 'cancer' condition or the 'a cancer' condition. Both methods confirmed that cancer arouses primarily negative affective responses in the vast majority of people. It was hypothesised that using 'a cancer' might lead to less negative affect associations than just the word 'cancer'. This was found to be the case for the spoken word association technique, but not for the printed cartoon technique.

Continuous tracking of the Australian National Tobacco Campaign: advertising effects on recall, recognition, cognitions, and behaviour

OBJECTIVES

To relate Australian National Tobacco Campaign advertising to outcome measures such as smokers' awareness of and reaction to the campaign, and indicators of interest in smoking cessation.

DESIGN

Continuous tracking was used to survey random cross sectional samples of the target audience via telephone interviews. Baseline measures were collected preceding each advertising phase, whereafter subjects were interviewed on a weekly basis for the entire period of each phase. Changes in outcomes could thus be inferred on a weekly basis allowing variations in advertising intensity to be monitored for effect. Three phases were evaluated variously in Melbourne, Sydney, and Adelaide.

SUBJECTS

A total of 9033 subjects aged 18-40 years were interviewed. Age and sex of the sample were evenly distributed.

RESULTS

In general, it was found that the greater the media weight, the greater the recall and recognition mediated by the message of the advertisement and the creative execution-advertisements with a clear figure ground executional format appeared more memorable than those without, and health effects advertisements were more memorable than those encouraging calls to a quitline. The relationship between various communication effects and media weight was limited by the confounding of prior activities in two of the phases.

CONCLUSIONS

Advertisements with clear figure ground executional formats and those illustrating health effects of smoking have high memorability. Future campaigns that are continuously tracked are recommended to systematically vary media weight, flighting schedules, and advertisement type, so as to maximise information about these variables and their interactions.

Creating smoke-free environments in recreational settings

To facilitate the banning of tobacco industry sponsorship, Australian health promotion foundations were established to provide health sponsorship to sport, arts, and racing organizations. Health sponsorship dollars procure health sponsorship benefits such as naming rights, signage, personal endorsement of a (health) product by a performer or player, and structural controls such as smoke-free policies. Data are presented from surveys and observations of spectators attending events sponsored by the West Australian Health Promotion Foundation (Healthway) and surveys of Healthway-sponsored organizations and the community. The results demonstrate that by using health sponsorship, Healthway increased the prevalence of smoke-free policies in recreational settings, and there was growing support for these policies. There was evidence of good compliance with smoke-free policies, thus reducing exposure to environmental tobacco smoke. The introduction of smoke-free policies in recreational settings has involved working collaboratively with sectors outside of health, taking an incremental approach to change, and gaining the support of stakeholders by communicating evaluation results.

Increasing mouthguards usage among junior rugby and basketball players

OBJECTIVE

To evaluate a Western Australian mouthguard promotion campaign, launched at the start of the 1997/98 junior rugby union and junior basketball seasons, aimed at increasing mouthguard usage at competition and training.

METHOD

A quasi-experimental field design was used to assess the impact of the mouthguard campaign on behavioural change. Observational data were collected pre- and post-campaign on mouthguard usage by players present at a rugby and basketball competition event and at a training session. Junior Australian Rules Football players were used as a control group.

RESULTS

Pre-post observational surveys showed a significantly greater increase in mouthguard usage in competition games among rugby union (77% to 84%) and basketball players (23% to 43%) compared with the control group (72% to 73%). All codes showed a post-campaign increase in mouthguard usage at training, but the intervention codes' increases were greater than the control's increase (rugby union: 29% to 40%; basketball: 11% to 36%; football: 34% to 40%).

CONCLUSIONS

The campaign had a significant and substantial effect on behaviour and provides evidence of the benefits of leveraging a sponsorship to modify the behaviour of the target group.

IMPLICATIONS

This campaign provides a model for promoting mouthguard usage in other sports among junior players.

Increasing the reach of health sponsorship: using a "sponsorship kit" to promote health

In Australia, a tobacco tax provides funding for Healthway, the Western Australian Health Promotion Foundation. Healthway provides sponsorships for the arts and racing and sporting events to replace funds previously provided by tobacco companies. These sponsorships provide visibility for Healthway and positive health messages. Normally, Healthway staff attends these events to help promote health messages. To reduce Healthway staff time spent helping event organizers promote health messages, Healthway developed a sponsor kit of promotional materials which communicate health messages without requiring Healthway staff to attend events. Recognition, awareness, comprehension, and acceptance of health messages was comparable at events that featured Healthway staff versus the sponsor kits, but the average cost of the sponsorship kits was only 40% of the cost when Healthway staff was featured.

Positive versus negative framing of a hypothetical infant immunization: the influence of involvement

Framing studies dealing with health messages show mixed results, although a tendency in favor of negative framing. Involvement has been hypothesized to account for these conflicting results. The authors selected a realistic issue (immunization of infants) deemed high or low involving depending on the respondent's circumstances: women with an infant or who were pregnant or intending to get pregnant in the next 12 months were deemed to be high involved; women in none of these categories were deemed to be low involved. A convenience sample of adult women was presented with a hypothetical "new" immunization that protected infants against respiratory complaints such as bronchitis and pneumonia Side effects (the common flu) were framed positively (90% chance of no side effects) or negatively (10% chance of side effects). The authors found positive framing to be superior for low-involved respondents, but there was no framing effect for high-involved respondents.

Effect of smoke-free policies on the behaviour of social smokers

OBJECTIVE

To test the hypothesis that proposed amendments to the Occupational Safety and Health Act making all enclosed workplaces in Western Australia smoke free would result in a decrease in cigarette consumption by patrons at nightclubs, pubs, and restaurants without adversely affecting attendance.

DESIGN

Cross sectional structured interview survey.

PARTICIPANTS AND SETTING

Patrons of several inner city pubs and nightclubs in Perth were interviewed while queuing for admission to these venues.

OUTCOME MEASURES

Current social habits, smoking habits; and how these might be affected by the proposed regulations. Persons who did not smoke daily were classified as "social smokers."

RESULTS

Half (50%) of the 374 patrons interviewed were male, 51% currently did not smoke at all, 34.3% smoked every day, and the remaining 15.7% smoked, but not every day. A clear majority (62.5%) of all 374 respondents anticipated no change to the frequency of their patronage of hospitality venues if smoke-free policies became mandatory. One in five (19.3%) indicated that they would go out more often, and 18.2% said they would go out less often. Half (52%) of daily smokers anticipated no change to their cigarette consumption, while 44.5% of daily smokers anticipated a reduction in consumption. A majority of social smokers (54%) predicted a reduction in their cigarette consumption, with 42% of these anticipating quitting.

CONCLUSIONS

One in nine (11.5%) of smokers say that adoption of smoke-free policies would prompt them to quit smoking entirely without a significant decrease in attendance at pubs and nightclubs. There can be few other initiatives as simple, cheap, and popular that would achieve so much for public health.

Executing effective road safety advertising: are big production budgets necessary?

Twelve (12) road safety television commercials (TVCs) ranging in production costs from $A15,000 to $A250,000 (current prices) were evaluated using standard advertising pre-test procedures. The twelve ads covered four road safety behaviours (speeding; drink driving; fatigue; and inattention), and included a variety of executional types within and across behaviours. One ad in each of the four behaviours was an expensive TAC and ($A200,000 or more). The testing procedure assessed respondents' self-reported impact of the ad on their future intentions to comply with the road safety behavior advocated in the ad. Just under 1000 appropriately screened motor vehicle drivers license holders were recruited via street intercept methods and randomly allocated to one of the twelve and exposure conditions. The results showed that while the two best performing ads were highly dramatic TAC ads showing graphic crash scenes, these were also the most expensive ads to produce, and, being 60 and 90 s, the most expensive to air. In several cases, 30 s low cost talking heads testimonials performed equally as well as their far more expensive counterparts. We conclude that big production budgets may not be necessary to create effective road safety advertising.

Evidence for the effectiveness of sponsorship as a health promotion tool

Health sponsorships are undertaken to achieve both structural and individual objectives. Structural objectives refer to the sponsored organisation being required to undertake activities such as the imposition of smoke free areas, or the provision of low alcohol beverages and healthy food choices at the sponsored event. Individual objectives refer to creating or reinforcing people's awareness of a health issue or message, and their beliefs, attitudes and behaviours with respect to the issue or message. This paper focuses on sponsorship's capacity to achieve individual level objectives, describing several studies undertaken by the Health Promotion Evaluation Unit (HPEU) at the University of Western Australia to evaluate the health promotion sponsorship activities of Healthway, the Western Australian Health Promotion Foundation. Given the results of evaluations of Healthway's (and other organisations') sponsorship activities, using a variety of methodologies and across a broad range of events and health issues, it is concluded that health sponsorships can be effective at increasing people's salience of a health issue, and can result in attitudinal and behavioural change.

Association of the health-promoting workplace with trade unionism and other industrial factors

PURPOSE

The study examines associations of five healthy workplace attributes with trade unionism and nine other industrial and sociodemographic factors. The aims were to illustrate the measurement of workplace health promotion indicators in Western Australia and to identify associations leading to a better understanding of determinants of the healthy workplace.

DESIGN

Personal and telephone cross-sectional surveys were performed using population-based sampling frames. The overall response rate was 72%.

SETTING

Workplaces in Western Australia.

SUBJECTS

Random samples of household respondents aged 16 to 69 years in 1992 (n = 1310) and 1994 (n = 1113).

MEASURES

Measures of association between healthy workplace attributes and trade unionism were adjusted for workplace location, size, sector, and industrial classification.

RESULTS

Trade unionism was strongly associated with healthy catering practices (adjusted OR 2.05; 95% CI 1.30 to 3.23), sun protection practices (2.66; 1.69 to 4.17), disability access (1.47; 1.10 to 1.95), and worksite health promotion programs (2.56; 2.07 to 3.17). A weak and nonsignificant association was observed with restrictive smoking policies (1.21; .95 to 1.55). Generally, healthy workplace attributes were reported less often by respondents working in rural locations, in the private sector, and at small worksites. There was no consistent relationship with sociodemographic factors, including an index of social disadvantage, but members of blue-collar occupations experienced a low prevalence of restrictive smoking policies.

CONCLUSIONS

The study raises the hypothesis, but cannot confirm, that trade unions could provide a means for employees to pursue the creation of a health-promoting workplace. Small business represents an excellent target for health promotion activities.

Banning tobacco sponsorship: replacing tobacco with health messages and creating health-promoting environments

OBJECTIVE

To evaluate the replacement of Western Australian tobacco sponsorship with health promotion sponsorship by the Western Australian Health Promotion Foundation (known as "Healthway"), following the Tobacco Control Act 1990.

DESIGN

Process measures of performance were collected from 25 tobacco replacement projects (sponsorship by Healthway of sport, racing, and arts groups previously supported by tobacco companies) and 727 other health sponsorship projects, that is, new sponsorship provided by Healthway to these groups. Cross-sectional survey data were obtained from 917 respondents at tobacco replacement and 2352 at other sponsorship venues.

SETTING

Sport, racing, and arts venues sponsored by the Western Australian Health Promotion Foundation (Healthway) in 1991-95.

MAIN OUTCOME MEASURES

Population reach, occasions of media publicity, healthy structural changes, cognitive/attitudinal impact of health messages, and the prevalence of five health-risk behaviours.

RESULTS

Tobacco replacement and other sponsorship projects achieved comparable performance in publicity for health messages and in healthy structural change, but replacement projects achieved a fourfold higher level of direct population reach for a given amount of funding. Structural change towards a smoke-free environment occurred more often in tobacco replacement projects and a permanent smoke-free policy was achieved in 47% of projects, compared with 15% in other sponsorship projects. The prevalence ratio of current smoking at tobacco replacement venues was 1.86 (95% confidence interval 1.62 to 2.04) relative to other sponsorship venues. There was evidence of higher cognitive resistance to health messages at venues previously sponsored by tobacco companies.

CONCLUSIONS

A comprehensive ban on tobacco sponsorship linked to health promotion activities funded by tobacco tax delivers potential public health benefits that exceed those achieved by prohibition of tobacco sponsorship alone. Tobacco replacement venues offer opportunities for environmental modification, promotion of anti-smoking messages, and targeting groups that are hard to reach.

Face-to-face household interviews versus telephone interviews for health surveys

The purpose of this study was to compare response distributions in health surveys for two interview modes: face-to-face household interviews and telephone interviews. There were two samples of the Perth metropolitan general population aged 16 to 69 years: a face-to-face household sample (n = 1000) and a telephone sample (n = 222). The samples were generated by probability-based methods commonly used by commercial market research organisations. The surveys occurred in August-September 1992 as part of a larger statewide survey component of a three-year evaluation of the Western Australian Health Promotion Foundation. Respondents were drawn from a two-stage cluster sample based on private dwellings for personal interviews, and from randomly selected listed and unlisted private numbers for telephone interviews. Although the samples did not differ significantly on a number of variables, the telephone sample was significantly higher in residential social status; there was significantly lower reporting of smoking and lower unsafe alcohol consumption in the telephone sample: significantly higher proportions of the telephone sample were in Prochaska's 'action' stage of change for several health behaviours; and there was significantly greater recall of health messages in the telephone sample. Health researchers should treat comparisons between different survey modes with caution, and should be aware that campaign evaluations using telephone surveys and household surveys may yield substantially different results.

The myth of "healthism" in organized sports: implications for health promotion sponsorship of sports and the arts

PURPOSE

The study examines the association of involvement in sports and arts with five health risk factors. The aims were to evaluate the argument that promotion of sports alone will achieve health objectives and to assess the suitability of sports and arts populations as targets for health promotion sponsorship.

DESIGN

Personal and telephone cross-sectional surveys were performed in Western Australia in 1992 (N = 2629) and 1994 (N = 2031).

SETTING

Sports and arts venues in Western Australia.

SUBJECTS

Random samples of household respondents aged 16 to 69 years.

MEASURES

Measures of association between risk factors and involvement in sports and the arts were adjusted for sex, age, residence, income, and other types of sports/arts involvement.

RESULTS

Spectators attending sports events, who were not members of organized sports clubs, were more likely to possess three or more risk factors than nonparticipants (OR = 1.43; 95% CI 1.20-1.70). They were more likely to report cigarette smoking, unsafe alcohol drinking, and poor sun protection practices. Sports club members had a similar profile of risk factors, except that their prevalence of smoking was reduced and they were much less likely to report inadequate physical exercise. The most elevated risk factor in sports populations was unsafe alcohol drinking (OR = 1.81 in club members, 1.88 in spectators, and 2.25 in spectators who were also members). Arts populations were less likely than average to report elevated risk factors, especially in the case of members of arts organizations who also attended arts events (for three or more risk factors, OR = 0.59; 95% CI .45-.75). However, the majority of arts respondents had at least two risk factors. Levels of inadequate exercise in arts populations were the same as those in sports populations.

CONCLUSIONS

The promotion of sports alone is unlikely to achieve health objectives. Highest priority in the use of health promotion sponsorship funds should be given to the populations attending sports events and involved as members of sports clubs. Investment in arts sponsorship is warranted, but at a lower level than health sponsorship of sports.