Australian behavioural research in cancer


Behavioural Research and Evaluation Unit (BREU), South Australia

Evaluation of the Flinders Far North Smoke-free ambassadors social marketing campaign.
Country Health SA is implementing a localised smoke-free ambassadors social marketing campaign, with the aim to reduce the prevalence of smoking among Aboriginal communities in Port Augusta, Whyalla, Flinders and Far North (rural and remote areas of South Australia). With previous experience in evaluating indigenous specific tobacco programs, Cancer Council SA has been contracted to evaluate the impact of this campaign. The model for evaluation builds on previous experience in evaluating the state-wide indigenous specific social marketing campaign, ‘Give up smokes for good’. Pre and post-surveys will be conducted with Aboriginal community members in Port Augusta, Whyalla, Quorn, Coober Pedy, Oodnadatta and Marree. A local research assistant will be employed within each of the communities to implement surveys via face-to-face interview. Consultation was undertaken in March with community representatives in each of the locations in the lead-up to data collection. Pre-surveys have been collected in Port Augusta (n=103) and data collection will begin in May for the five remaining sites, with an intended sample of 30 people from each community. Post-surveys are planned for April 2013.

Centre for Behavioural Research in Cancer (CBRC), Victoria

Can counter-advertising reduce parents’ susceptibility to nutrition content claims and sports celebrity endorsements?
Counter-advertisements challenging industry marketing messages have been effective in reducing smoking behaviour and alcohol consumption. However, they have received little consideration in relation to obesity prevention efforts targeting food marketing. This study, aimed to assess the impact of nutrition counter-advertisements on parents’ appraisals of energy-dense and nutrient-poor (EDNP) food products featuring front-of-pack (FOP) promotions. Parents of children aged 5-12 years (N=1269), who were main grocery buyers, participated in a 2×2 between-subjects web-based experiment. First, parents were randomly shown an advertisement (counter-advertisement challenging FOP promotion or control advertisement) and recorded their reactions to it. Next, parents were randomly assigned a pair of food packages from the same product category to view: a healthier control pack with no FOP promotion and an EDNP product with a FOP promotion (nutrition content claim or sports celebrity endorsement). From this pair, parents nominated which product they would prefer to buy and which they thought was healthier, then completed ratings of the EDNP product. Compared to parents who saw a control advertisement, parents who saw a counter-advertisement perceived EDNP products featuring FOP promotions to be less healthy, expressed a lower likelihood of buying such products, and were more likely to read the nutrition information panel on EDNP products before making their choices. These results suggest counter-advertising may be effective for minimising the negative influence of unhealthy food marketing and facilitating healthier food choices among parents.         

What price quitting? The price of cigarettes at which smokers say they would seriously consider trying to quit.
Deciding on an appropriate level for taxes on tobacco products is an important issue in tobacco control. This study, led by Michelle Scollo, aimed to describe the critical price points for packs for smokers of each pack size, to calculate what this would equate to in terms of price per stick, and to ascertain whether price points varied by age, socio-economic status and heaviness of smoking. A dual frame telephone survey of 586 regular smokers of factory-made cigarettes was conducted in Victoria in November 2011, with respondents asked to indicate the brand, size and cost of their usual pack and to estimate what price their preferred pack would need to reach before they would seriously consider quitting. Three-quarters of regular smokers could envisage their usual brand reaching a price at which they would seriously consider quitting, with $20 the median nominated price point for all key demographic groups. The median price point at which regular smokers would consider quitting was calculated to be 80 cents per stick, compared to the current median reported stick price of 60 cents. These results suggest that if taxes can be set high enough to ensure that the cost of the smokers’ preferred pack exceeds critical price points, this would likely prompt more people to seriously attempt quitting than if the price increased to a level even slightly below the price points.       

Newcastle Cancer Control Collaborative (New-3C) NSW

Improving psychosocial outcomes for haematological cancer patients: A RCT.
Communicating treatment options, preparing patients for cancer treatments and providing them with information about how to manage side-effects of treatment are likely to be key to helping haematological cancer patients and their families cope with a diagnosis of cancer. With funding from Cancer Institute NSW, we are undertaking a randomised control trial to examine whether access to a web-based information program and nurse-delivered telephone support is effective in reducing depression, anxiety and unmet information needs among haematological cancer patients and those supporting them. A sample of 340 adult patients newly diagnosed with acute leukaemias and high grade lymphomas and significant others, is being recruited from tertiary referral hospitals in NSW. Subjects randomly allocated to the experimental group are provided with access to a web-based program designed to provide effective communication, decisional support and adjustment. The website provides tailored information on a range of topics, including information about diagnosis, treatment options, side-effects, self-management strategies, impact of cancer on daily life, available support and complementary and alternative therapies. The intervention also includes access to a telephone helpline staffed by an experienced cancer nurse. Patients and significant others allocated to the usual care group receive care normally provided by their care team. Participants complete surveys at approximately two, four, eight and 12 weeks post-recruitment, examining levels of anxiety, depression and unmet needs, and experiences obtaining and understanding treatment information. To date, 12 participants from four hospitals are enrolled in the study.

“Smoking is a part of my life now”. A systematic review of the self-reported barriers to smoking cessation within selected socioeconomically disadvantaged groups.

The prevalence of smoking is disproportionately higher in socially disadvantaged populations. Effective interventions to reduce smoking within these groups require an understanding of the factors that prevent disadvantaged groups from stopping smoking. This study aimed to identify and synthesise the literature describing the barriers to smoking cessation within selected disadvantaged groups and classify these barriers within the Social Determinants of Health framework.

Medline, Embase, CINAHL and PsycINFO were searched for publications prior to 31 March 2011. Inclusion criteria were: qualitative or quantitative descriptions of the self-reported barriers to smoking cessation within six socially disadvantaged groups: Indigenous populations; people with a mental illness; people of low socioeconomic status; the homeless, prisoners and at risk youth. Identified barriers were categorised using the Social Determinants of Health framework.  Methodological quality was assessed using existing adapted tools. Forty two papers were included in this systematic review (16 indigenous, 8 mental illness, 11 low SES, 3 homeless, 2 prisoners). Barriers to smoking cessation included: addiction to nicotine, lack of social support, high acceptability of tobacco use within communities, stressful life situations, limited resources to quit, cultural norms and socioeconomic factors. Most barriers were common across all groups, but differed in the way in which they manifested in each group. The barriers identified by this review suggest multiple factors have compounding effects on the ability of individuals in disadvantaged groups to stop smoking. Encouragingly, many of the barriers identified are modifiable, and can be addressed by both social and health intervention programs and policies.

Centre for Behavioural Research in Cancer Control (CBRCC) Western Australia (Curtin University and Cancer Council WA)

The Workplace as a setting for obesity prevention: barriers, enablers, and the employee preferences.
Office-based workplaces encourage sedentary behaviour, increasing employees’ risk of overweight/obesity by limiting time available for physical activity and nutritious meals. As the basis for planning a program to reduce prevalence of overweight/obesity, this study aimed to identify barriers/enablers and intervention strategies relevant to health promotion in office-based workplaces.

The project consisted of three stages. Qualitative data collection consisted of four focus groups with office-based employees (n=37) and 10 telephone interviews with managers (n=10). Verbatim transcriptions of focus groups and interviews were analysed using a thematic analysis approach. Quantitative data collection consisted of an online survey with office-based employees (n=111). Data analysis included frequencies, chi square tests and multiple regression.

Qualitative data analysis informed development of the online survey. Major findings of quantitative data analysis included the following: identification of barriers/enablers as significant predictors of physical activity/nutrition behaviours in the workplace; ranking of the most and least preferred individual, environmental and policy intervention strategies; and age/gender differences in barriers/enablers and preference for strategies.    

The major benefits of the project have been: the identification of barriers/enablers for adopting/maintaining positive physical activity/nutrition behaviours in the workplace; identification of potential intervention strategies to inform development of health promotion for office-based employees; and contribution to obesity prevention in the long-term. The findings shuld assist in development of comprehensive evidence-based health promotion programs that consider environmental and policy influences, as well as the individual.

For further information, contact: Professor Peter Howat, Centre for Behavioural Research in Cancer Control, Curtin University, Western Australia.  P.howat@curtin.edu.au

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