Public opinion about smoke-free policies in bars, nightclubs and gambling venues
Public opinion related to the introduction of smoking bans in hospitality venues was examined using data from population surveys conducted annually among Victorian adults between 2000 and 2003. The data indicate strong public support for bans on smoking in bars, nightclubs and gambling venues. Over three-quarters of the sample agreed with recent legislative amendments restricting smoking in licensed and gambling venues. Approximately seven out of 10 respondents approved of the introduction of smoking bans in bars and nightclubs in 2003, while support for bans in gambling venues was higher, at around 80%. Public approval for the introduction of bans in bars, nightclubs and gaming venues increased between 2000 and 2003 among both smokers and non-smokers. Among smokers, approval for smoking bans in bars and nightclubs doubled over this period. The increase in community support for smoking bans in hospitality venues have occurred in a climate of legislative reform in tobacco control, including increasing smoking bans in public places, further restrictions on tobacco promotion, and tougher penalties for sales to minors. While current Victorian legislation places some restrictions on smoking in some hospitality venues, only a total smoking ban in all venues will fully protect patrons and staff from the hazards of exposure to tobacco smoke.
Public awareness, understanding and utilisation of ultraviolet (UV) forecasts
Australia has the highest rate of skin cancer of any country in the world with over 200,000 new cases being reported each year and over 6000 of these being potentially fatal melanomas. The Australian Bureau of Meteorology began forecasting UV radiation levels in major population centres in September 1996 using the UV Index. The literature suggests that public awareness and exposure to the UV index is high, but recall and utilisation is low. With funding from The Cancer Council WA, CBRCC aimed to assess current levels of public awareness, recall, understanding, attitude and utilisation of the UV index through six discussion groups with males and females aged between 16 to 21, 22 to 30, and 31 to 45 years. Results confirm that while awareness of the UVI is high, comprehension is poor and utilisation extremely low. A major criticism of the UVI was that forecasts rarely dip below the ‘extreme’ category throughout the Australian summer, thereby negating their predictive value. As such the groups strongly advocated new danger categorisations to suit Australian conditions. The merits of different formats from around the world for presenting the UVI were also viewed and discussed. Three new formats were developed as a result of these discussions and are in the process of being tested with 600 individuals via intercept surveys. Participants are being shown the newly developed formats illustrating various UV conditions and asked to describe appropriate sun protective behaviours for each. Responses to each format will be compared to a control allowing judgements to be made about which, if any, is the superior presentation method.
Physical activity and cancer prevention project
CBRCC was commissioned by the Cancer Council WA to investigate whether messages linking physical exercise to cancer prevention (new message) are more persuasive than messages about cardiovascular disease prevention (established message). Intercept interviews were conducted with 281 respondents aged 30-60 years screened for physical inactivity (i.e., those who did exercise regularly). Respondents were shown information about physical activity and its link either to bowel cancer or heart disease and then asked to complete a self-completion questionnaire. Perceived credibility of both messages was high but respondents in the heart disease condition achieved higher behavioural intentions than those in the bowel cancer condition. In addition the top box response was substantially lower in the bowel cancer than the heart disease condition. Perceived personal relevance of the message, particularly in top box response, was substantially lower in the bowel cancer than the heart disease condition. The study highlights the need to increase the salience of the risk of bowel cancer in the community.
Benefits of a Chronic Disease Self Management Program (CDSMP) for people affected by cancer
The CDSMP, developed by Stanford University, is a structured, six-week, peer-led program designed to increase self-efficacy skills among people with chronic illness. Randomised control trials have demonstrated health benefits for people affected by arthritis, asthma, diabetes and heart disease. The CDSMP which focuses on coping with symptoms such as depression and fatigue, may also be beneficial to people affected by cancer, but to date has not been evaluated in this population group. A qualitative evaluation study was undertaken with participants of two programs, jointly run by The Cancer Council South Australia and the Arthritis Foundation specifically for people with cancer. In-depth telephone interviews were conducted four to six weeks post course. Major outcomes for participants included: 1) a decreased sense of isolation; 2) motivation and skills to improve their health behaviours and well-being; and 3) a sense of regaining control and achievement through goal setting. The course appeared to suit people who were recovering after treatment but may not be as relevant for those still dealing with acute disease/treatment issues.
Information and support needs of people with genetic predisposition to cancer
The information and support needs, and preferred options for services to meet these needs, were accessed via a postal survey of South Australia Familial Cancer Service clients who tested positive for mutations for BRCA, HNPCC and FAP. The issues of most concern to this group that are currently not being addressed adequately related to surveillance and screening options and lifestyle choices to reduce risk. Respondents expressed a strong preference for accessing information via a specialised web site (62%), but were also interested in further follow-up with genetic counsellors (60%), and information days/evenings (51%). There was less interest in programs that focused on peer support. However the level of interest may still be sufficiently high to warrant establishing support groups (43%) or telephone peer support (32%). The needs and preferences of respondents did not vary significantly between those with BRCA mutations and those with HNPCC or FAP related mutations.
Psychological health over time in the advanced cancer setting: further findings from the Canberra Cancer Quality of Life Project
A cohort of subjects (163 patients and 136 caregivers) from The Canberra Hospital was followed for six months. Patients with advanced cancer were observed until death and censored 31 March 2003 (nine patients remained alive). As measured by the SF36, patients maintained remarkably good psychological health, consistently reporting scores within the standard norms. At week one the mental health for a matched group of 100 mean score was 75.7 (std error mean 1.48) and at week 18 it was 77.7 (std error of 1.60). A general social environment factor is being considered as the explanation. The population had higher socio-economic levels across key indicators: high education levels, high rates of home ownership (67% had fully paid for their homes, 18% only had a mortgage), high quality employment environment providing financial security with 55% currently or previously employed in the public sector (with at least some superannuation), high car ownership with 63% still able to access their own transport albeit with assistance. Social networks and emotional support were good even with restricted social functioning (SF mean scores of 62.7 at week 1 and mean scores of 60.5 at week 18), with 93% (100% males and 87.5% females) identifying somebody with whom they could share their feelings, 80% that they had family support, and two thirds indicated they could share their feelings with friends and with the doctor.
Gay Men and Tobacco Project
TCRE was commissioned to evaluate the first phase of the Gay Men and Tobacco Project, which was coordinated by Gay Men’s Health at the AIDS Council of South Australia. The aim of this project was to develop a health promotion campaign targeted specifically at gay, homosexually active, and HIV-positive men. The evaluation revealed some very positive results particularly around the final targeted campaign promotional materials, and the tailored cessation courses.
Reducing cancer patients’ psychosocial needs: a randomised controlled trial
Research has shown that a diagnosis of cancer places immense physical and psychological demands on individuals and that many have unmet psychosocial needs. A team of researchers from the Cancer Council Victoria and University of Newcastle have been awarded an NHMRC grant to assess the effectiveness of a tailored, patient-focused intervention that aims to reduce the psychosocial needs of people with cancer. The research team at the University of Newcastle is being led by Professor Rob Sanson Fisher and Dr Victoria White is leading the team at the Cancer Council Victoria. Six hundred participants, aged between 18 and 80 years, recently diagnosed with Stage I, II, IIIa, or IIIb, colorectal cancer will be recruited through the Victorian Cancer Registry. Participants will be randomly assigned to either their usual care for cancer or to an intervention, called the Pathfinder Program. Participants in this study will complete questionnaires at study entry and at six, 12, and 18-months post cancer diagnosis. These questionnaires will assess supportive care needs, psychiatric morbidity, quality of life and social support. Treatment and socio-demographic information will also be obtained. Following completion of the first, second and third questionnaires, participants in the intervention group will receive written feedback on their questionnaire responses. Intervention participants will also be assigned a Cancer Information and Support Services (CISS) trained volunteer, called a Pathfinder. The Pathfinder will provide over-the-phone support and information to the participant. They will assist the participant to identify ways to reduce their unmet needs. Pathfinders will provide ongoing support for a 12-month period. Michelle Macvean from CBRC commenced as the Project Coordinator in February 2004 and is working closely with the CISS Pathfinder Program Manager, Sarah Pratt, to plan and implement this research project and the Pathfinder support program.
Evaluation of the ‘Peer Support Program Activities for Tobacco and Smoking’
Quit SA worked in collaboration with the Peer Support Foundation to trial a package designed to address tobacco smoking in the school setting. TCRE is currently working to evaluate the impact of the program on students’ knowledge of the health effects of smoking and smoking behaviour to determine whether the resource should be implemented on a larger scale in SA peer support programs.
Evaluation of the Smoke-free Pregnancy Project
Quit SA is working in collaboration with the Women’s and Children’s Hospital and the Lyell McEwin Health Service on a project to reduce smoking prevalence amongst pregnant women in South Australia (particularly for those attending these hospitals). TCRE is currently finalising an evaluation plan for this project. The evaluation will involve population monitoring of smoking prevalence amongst pregnant women and women of childbearing age, the examination of quit rates of women attending antenatal services in the Women’s and Children’s Hospital and Lyell McEwin Health Service; the examination of quit rates of those contacting and being referred to the pregnancy specific Quitline, and a survey of staff implementing the project on their experiences.
Correctional Services Cessation Project
Quit SA has been running cessation courses and providing subsidised Nicotine Replacement Therapy for correctional services staff (both prisons and community centres) in South Australia. TCRE will be conducting telephone follow-up interviews and collating feedback forms from 50 staff who utilised these services. Quit rates and satisfaction with the services provided by Quit SA will be investigated.
Evaluation of the Smoking Cessation Project (Phase II) at Noarlunga Health Service
The Smoking Cessation program is funded by the Department of Human Services and is being implemented at Flinders Medical Centre, Repatriation General Hospital and Noarlunga Health Service and builds on a previous program at these hospitals. The program aims to integrate brief smoking cessation interventions for patients into routine health care in hospitals with linkages to general practitioners and Quit SA for further follow-up. TCRE is currently conducting an evaluation of the program at the Noarlunga Health Service.
Proactive telemarketing of a smoking cessation telephone counselling service
One-in-five Australians is a regular smoker and evidence suggests that as many as four out of five smokers want to quit. Despite the availability of support services that can be effective in helping people to quit, such as telephone helplines, only a small number of smokers seek help from these services. One solution to the low use of such services is to pro-actively contact and offer support with quitting to smokers in the community, rather than relying on smokers to take the first step in seeking help. Drs Chris Paul and Raoul Walsh, in collaboration with members of Hunter Population Health, are conducting a study which will involve proactively contacting a random sample of households and offering intensive, personalised telephone counselling to smokers to support them in the quitting process. The counselling sessions will focus on supporting those smokers ready to quit, as well as motivating other smokers not ready to quit immediately. Such a service will provide treatment access to smokers who might not otherwise seek assistance to quit, thereby greatly increasing the potential impact of quit smoking services at a community level. If the study is successful it will provide a new model for the delivery of smoking cessation services to the community. Potential intervention with all smokers, including those not currently considering quitting, will result in an increase in the number of smokers quitting, thus saving many lives. The study is funded by the National Heart Foundation and has also received the prestigious 2004 National Heart Foundation (NHF) Rudolf Gerstl Research Award at the National Heart Foundation AGM.
The impact of group music therapy with recently diagnosed breast cancer patients
Whilst music therapy is well-established in the UK, Europe and the USA, it is a relatively new profession in Australia, first established in Melbourne in the mid-70s. Studies in the area of cancer care have mainly focused on palliative care and the end stage of a patient’s life. Sarah Burns, under the supervision of Associate Professor Afaf Girgis of CHeRP and Dr Jon Adams of the Centre for Clinical Epidemiology and Biostatistics at the University of Newcastle, is undertaking an innovative study as part of her PhD to evaluate the impact of group music therapy on the psychosocial and physiological well-being of women aged 55 and over who have recently been diagnosed with breast cancer. The research will be an extension of pilot work conducted by Sarah in the United Kingdom which indicated that a one-off group music therapy session lowered levels of tension, increased levels of energy and improved the cancer patients’ mood and overall sense of well-being. A multi-method approach will be used consisting of quantitative psychosocial testing tools, physiological testing of saliva for sIgA (salivary immunoglobulin A – a marker of immunity) and salivary cortisol (a marker of stress) and qualitative participant memory-work and semi-structured interviews. It is hypothesised that participants receiving the group music therapy intervention will have better psychosocial outcomes, increased immunological functioning and decreased levels of stress post-intervention when compared to the control group. Qualitative data collected will be analysed to identify recurrent themes present and to further explore the meaning and process of each participant’s experience of group music therapy. This project will be the first of its kind to be carried out in Australia and will give more understanding of the potential benefits of an ongoing 10-week group music therapy program with recently diagnosed breast cancer patients. It will help music therapists provide a more effective service for this population, give more understanding to the medical profession of the value of music therapy in the area of cancer care and will add empirical evidence to the music therapy literature.
Colorectal cancer and quality of life
The Centre for Research in Cancer Control, in collaboration with the University of Queensland, Queensland University of Technology and the Royal Brisbane Hospital, is conducting a population-based, longitudinal study, examining the process of diagnosis, treatment outcomes and subsequent quality of life for colorectal cancer patients up to two years after diagnosis. Ultimately, the aim of this study is to provide the first comprehensive picture of the impact of diagnosis and treatment on the well-being and quality of life of colorectal cancer patients in the first two years after their diagnosis, to describe those patients most at risk from psychological distress and other sequelae, and to recommend ways in which the unmet needs of some of these patients may be addressed. Over 1200 patients are expected to participate in the study. Those who take part will complete a postal questionnaire and a telephone interview within six months of their diagnosis. The questionnaire and interview will be repeated at one year and again two years after their diagnosis. Additionally, questionnaires will be sent to participants’ doctors to elicit details related to the diagnostic process, tumour stage and site, prognostic indicators, treatment and co-morbidity. Funding is being sought to extend follow-up to five years after diagnosis.
Promoting healthy lifestyles
While the Australian population are largely aware that to maintain optimum health they should not smoke, should take regular exercise and should eat a healthy diet with a high intake of fruit and vegetables and low intake of saturated fat, about a quarter of the population still smokes, and almost half don’t get enough exercise for health benefit or have an adequate diet. Over the past 13 years, Associate Professor Eakin has evaluated programs that help patients with a variety of chronic medical conditions, including cancer, to lead healthier lifestyles. This research has shown that, while there are a substantial number of groups and classes available in metropolitan areas to help people stop smoking, exercise and eat well, those people who need it most are unlikely to avail themselves of such programs. Eakin, along with colleagues from Queensland University of Technology and the University of Queensland, was recently awarded a National Health and Medical Research Council grant to evaluate a randomised controlled trial of a telephone-delivered lifestyle intervention program for patients in remission from a variety of cancers, as well as those with type 2 diabetes and high blood pressure. Five hundred patients will be recruited from general practitioners in a disadvantaged community south of Brisbane and followed over 12 months. The intervention group will be offered telephone counselling to help improve exercise and eating habits along with supporting semi-tailored mailed information. The control group will receive feedback from their baseline assessment and untailored health information sent to them throughout the intervention period. This project will have important population health implications for the wide-scale delivery of lifestyle-intervention programs, both for cancer survivors, and for patients with other chronic conditions.
An investigation of the utility of primary care skin cancer clinics in Queensland
Skin cancer is the most common type of cancer in Australia and Australia has the highest incidence of melanoma and non-melanoma skin cancer in the world. Compared to its population, Queensland has a disproportionately high number of SCCs, BCCs and melanoma. Despite the lack of proven benefit, screening of the skin for early signs of skin cancer appears to be increasing. Primary care skin cancer clinics have emerged following identification, often by local GPs, of a perceived need within a community, for a readily accessible clinic where skin examinations are conducted. The clinics, usually staffed by GPs with a special interest in skin cancer, are designed to offer open access consultations to the community for the diagnosis and treatment of skin cancers and pigmented lesions. Potentially, by specialising in the area of skin cancer, doctors within these skin clinics may see a higher number of incident cases than doctors within general practice. At a recent national workshop on melanoma diagnosis sponsored by the National Cancer Control Initiative, it was stated that “to fully understand the role these clinics play, further information is needed on who attends these clinics, the number of consultations, the benign to malignant excision ratio, the breakdown of diagnoses and the use of photography or other forms of imaging”. To this end, a multi-centre, collaborative study is being developed by researchers from the Queensland Cancer Fund, the Queensland Institute of Medical Research and the University of Queensland, which will aim to provide detailed data on the casemix and diagnostic ability of doctors in primary care skin clinics, and to compare these with data from usual general practice. The study will document the volume and casemix of lesions examined and excised in skin clinics and usual general practice, diagnostic performance in each setting, the various determinants of clinical diagnosis and management strategy, and the characteristics of those who choose to attend skin clinics compared to general practice. This study will inform debate about the most appropriate ways to detect skin cancer in the community, and whether skin clinics are providing benefits above those able to be provided by doctors in general practice. Funding applications are pending.
CBRC has welcomed Dr Michelle Macvean, Pathfinders Project Coordinator, Vanessa White, Shade Study Research Coordinator, and Daniella Germain, QUIT Research and Evaluation Officer. Michelle is coordinating the NHMRC funded project Reducing Cancer Patients’ Psychosocial Needs, which aims to assess the effectiveness of a tailored, patient-focused intervention in reducing the psychosocial needs of people with cancer. Vanessa is coordinating the NHMRC funded project, Shade Intervention in Secondary Schools, which is designed to assess the efficacy of a shade development intervention aimed at reducing adolescents’ sun exposure. Daniella’s main focus is on the development and coordination of various projects and research papers for QUIT Victoria and CBRC.
Several researchers from CBRC presented at the recent World Conference on Health Promotion and Health Education held in Melbourne during April 2004. Dr Melanie Wakefield presented a talk entitled Think. Don’t Smoke: Are tobacco company youth smoking prevention campaigns effective? Over the past several years, Phillip Morris has commenced television advertising in many countries aimed at encouraging youth not to smoke. This presentation summarised this initiative and international research which indicates that these campaigns have been largely ineffective in influencing youth smoking, but very effective in promoting the company as a responsible citizen. Dr Suzanne Dobbinson presented the results of a recent study exploring the compliance of 30 solarium centres operating in inner Melbourne with Australian Standard recommendations for providing information about skin cancer risk to customers and restricting access to high risk groups such as people with skin that burns easily. Dr Helen Dixon presented a review of research on smoking in movies, focusing on historical product placement deals, movie content analysis and audience research. Helen’s paper was presented as part of a session on marketing by the tobacco industry. Robyn Mullins’ presentation was titled Using Quantitative and Qualitative Research to Develop Mass Media Campaigns: PapScreen Victoria, which described the methodology used in formulating a media campaign. Quantitative data was used to define an appropriate target audience for a television campaign and this information was used to help develop the brief to the advertising agency. Focus groups were then used to determine which of the proposed advertising concepts was likely to be the most effective. Quantitative evaluation of the campaign was also discussed.
Visit our website www.cancervic.org.au/cbrc for information about current CBRC research projects, details of our latest publications and access to the CBRC Research Paper Series.
Ms Kati Donovan recently completed her Masters of Public Health under supervision at CBRCC. Her thesis investigated alcohol advertising in popular magazines. The findings suggest the alcohol industry frequently violates the Alcoholic Beverages Advertising Code.
Mr Geoffrey Jalleh made a presentation entitled ‘The influence of message framing on the effectiveness of sun protection messages’ at the recent World Conference on Health Promotion and Health Education held in Melbourne in April 2004. He presented the results of a study that investigated the use of positive versus negative message framing to develop more effective communication strategies to encourage the adoption of sun-protective behaviours. A total of 836 young adults arriving at Cottesloe Beach were asked to read an information brochure using either positively or negatively framed information about sun protection and then to complete a questionnaire on their attitudes and behavioural intentions towards sun behaviours. The time participants arrived and the time they left the beach were recorded. Although respondents in both conditions spent less time in the sun than they intended, the negatively framed condition spent substantially less time in the sun than they intended compared to those in the positively framed condition: 28 versus 13 minutes.
TCRE is currently collating all research and evaluation projects conducted in the period of 2001-2004 to publish in Tobacco Control Research and Evaluation Report Volume 2. This document will be released in November this year.
Jacqueline Hickling and Sinead Quinn attended the World Conference on Health Promotion and Health Education in April and presented four posters. The topics for the posters were: Smoking and Social Inequalities in South Australia; Mounting Public Support for Smoke-free Bar and Gaming Venues in South Australia; Community Perceptions about Tobacco Control Policy and the Tobacco Industry; Quit Mass Media Campaign Comparisons: South Australia 2001-2003.
Dr Chris Paul and investigators were awarded the prestigious 2004 National Heart Foundation (NHF) Rudolf Gerstl Research Award, for their NHF-funded research grant entitled: ‘The effectiveness of pro-active telemarketing of a smoking cessation telephone counselling service’. The presentation was made at the NHF AGM in Sydney on Tuesday, 27 April.
Associate Professor Afaf Girgis and Dr Sibilah Breen from CHeRP, along with Dr Paul Glare from the Royal Prince Alfred Hospital and Amanda Neil from the University of Newcastle, have been successful in obtaining two years’ funding from the National Health and Medical Research Council – Palliative Care Research Program, for their research into the cost-effectiveness of models of supportive care coordination for patients with advanced cancer.
Associate Professor Afaf Girgis, Dr Chris Paul and Claire Johnson from CHeRP, together with external collaborators Professor David Currow (Flinders University of South Australia), Professor Linda Kristjanson, Edith Cowan University) and Amanda Neil (University of Newcastle) have also been successful in obtaining funding from the Commonwealth Department of Health and Ageing for research into the analysis of qualitative research and a national survey to inform needs-based utilisation of palliative care in Australia. This funding is to undertake the first two phases of a six-phase program of palliative care research under consideration by the Commonwealth.
CHeRP would like to welcome Dr Jiong Li who has commenced a three-year appointment as a University of Newcastle Postdoctoral Research Fellow working with CHeRP, the Discipline of Health Behaviour Sciences and Hunter Population Health. The Fellowship was competitively awarded as part of the University of Newcastle Strategic Initiative Fund Fellowship Scheme. Dr Li was previously based in Denmark where he completed his PhD research on the mortality and morbidity in bereaved parents.
The Sylvia and Charles Viertel Charitable Foundation has made a significant contribution to the Queensland Cancer Fund for the development of the Fund’s Centre for Research in Cancer Control. In recognition of the Foundation’s generous and on-going contribution, the Centre will henceforth be known as the Viertel Centre for Research in Cancer Control.
Many thanks for the contributions of Victoria White (CBRC), Owen Carter (CBRCC), Kerri Beckmann (CCCR and TRCE), Narelle Mills (CheRP) and Kate Troy (VCRCC).