Australian behavioural research in cancer

Behavioural Research and Evaluation Unit (BREU) Cancer Council South Australia

Does sun protection policy influence comprehensiveness of sun protection practices in primary schools?
Research has shown that the SunSmart program has contributed to a long-term increase in daily sun protective practices for students participating in the program. Primary schools with SunSmart membership have more comprehensive policies and higher compliance with sun protection practice recommendations than schools without SunSmart membership. However, in 2005, 80% of schools had a written sun protection policy, whereas 52% of schools had SunSmart status, suggesting that there may be a gap between having a written policy and meeting best practice recommendations for sun protection.

A study was conducted at Cancer Council SA based on the results of the most recent National Primary Schools Sun Protection Survey (2011/12) to examine the relationship between having a written sun protection policy (and if so, how comprehensive this policy is) and the comprehensiveness of school sun protection practices. The influence of SunSmart status and school demographics upon this relationship was also investigated. The survey was distributed to 1573 randomly selected schools nationally that catered to primary school-aged students. It was completed by 857 schools, giving a response rate of 57%. The survey included items surrounding the existence of a written sun protection policy at the school and the types of items included in the policy, as well as the school’s sun protection practices for key sun protection areas (hat-wearing, uniform, sunglasses, use of sunscreen, shade availability and consideration of UV levels for outdoor activities). 

The study found that schools with a written sun protection policy had more comprehensive sun protection practices in place than schools without a policy. This relationship was stronger for remotely located schools and for schools catering to both primary and secondary students. Furthermore, the comprehensiveness of written policy was associated with comprehensiveness of sun protection practices. Membership in Cancer Council’s National SunSmart Schools Program was found to indirectly affect comprehensiveness of sun protection practices i.e. members tended to have comprehensive written policies in place, which is strongly associated with having comprehensive practices. The findings further reinforce the importance of written sun protection policies for the implementation of comprehensive sun protective practices in primary schools and membership in the SunSmart program. The study was recently published in the journal Health Education Research.

Evaluation of the Give Up Smokes for Good campaign among Aboriginal students
Cancer Council SA is undertaking an evaluation of a school-based anti-tobacco social marketing campaign aimed at reducing smoking initiation and promoting smoking cessation among Aboriginal youth. The evaluation is being funded by Drug and Alcohol Services South Australia, who have developed the Give Up Smokes for Good social marketing campaign. This campaign is part of the Tackling Smoking program, a public health initiative that aims to reduce the smoking rate among Aboriginal communities in South Australia. 

A partnership between Drug and Alcohol Services South Australia and the Department of Education and Child Development allowed the Give Up Smokes for Good social marketing campaign to reach Aboriginal students attending the South Australian Aboriginal Sports Training Academy. As a result of the partnership, approximately 300 Aboriginal students have been exposed to the Give Up Smokes for Good campaign materials and anti-tobacco educational materials, which appear throughout the students’ workbooks.

The purpose of the evaluation is to assess whether there have been any changes in the smoking-related attitudes and behaviours of students as a result of being exposed to the campaign. The outcome of the campaign is being evaluated with a pre-post survey design. The first phase of data collection took place at the beginning of the school year. Students are currently being followed-up to take part in the post-survey. 

Centre for Behavioural Research in Cancer (CBRC), Victoria

Evaluation of tobacco plain packaging 
In December 2012, Australia became the first country to implement plain packaging of tobacco, accompanied by refreshed graphic health warnings covering 75% of the front-of-pack. Over the past two years, CBRC has been undertaking a raft of studies to evaluate aspects of the legislation. These include government-funded survey research to track responses of adult smokers and recent quitters over time, and to study early effects on adolescents, the results of which are scheduled to be reported in late 2014. CBRC has also undertaken a national panel study of tobacco retail outlets, funded by Quit Victoria, Cancer Council and other UK funders. Published papers from that dataset have so far demonstrated no change in the time taken to serve tobacco (Wakefield et al. Addiction 2013) and continued extremely low prevalence of willingness-to-sell illicit tobacco in small mixed business retail outlets (Scollo et al. Tobacco Control 2014). A third study, found a decline in the rate of cigarette pack display at outdoor café strips in Melbourne and Adelaide (which do not yet have outdoor smoking bans) with the introduction of plain packaging (Zacher et al. Addiction 2014). Overall, these early published studies suggest the plain packaging legislation is working as intended, with few of the adverse outcomes predicted by the tobacco industry. Many more papers in the pipeline from these datasets, along with the studies of other researchers, will provide further key information about the progress of the policy.  

Population-based evaluation of the WA ‘LiveLighter’ obesity campaign
The ‘LiveLighter’ campaign is targeted toward adults aged 25-64 and aims to increase awareness and understanding of the health consequences of overweight and to encourage the adoption of simple changes towards leading a healthier lifestyle. Phase I graphically depicts visceral fat of an overweight individual, while supporting ads demonstrate simple changes to increase physical activity and eat healthier. Phase II reminds viewers of this visceral imagery and focuses on the contribution of sugar-sweetened beverages to its development and ultimately disease. Phase I was launched in WA in June 2012 and Phase II in July 2013. The television campaign is complemented by cinema, radio, print and online advertising and a website ( The evaluation aimed primarily to measure proximal outcomes of campaign recall and perceived effectiveness. In addition, the population-level impact on awareness and attitudes related to diet and physical activity and more distal outcomes of contemplating and making behaviour changes. At Phase I, cross-sectional population surveys (25-49 years) were undertaken pre-campaign (May/Jun N=2013) and following the two media waves (Jul/Aug and Sept/Oct N=2010 each) in the intervention (WA) and comparison states (Victoria). Phase II employed a cohort design with a population survey of WA adults undertaken pre-campaign (May/Jun 2013 N=1504) and followed after each of the two media waves (Aug/Sept N=822 and Oct/Nov N=557). Findings have been provided to the National Heart Foundation (WA), undertaking the campaign in partnership with Cancer Council WA. 

Newcastle Cancer Control Collaborative (New-3C), NSW

Cancer patients’ preferences and priorities for health service initiatives
Consumer involvement in developing health policy and evaluating services is widely recognised as important for promoting patient-centred care, and is incorporated into National Health and Medical Research Council and Institute of Medicine guidelines. The Consumer Preferences Survey was developed to enable consumers to participate in quality evaluation activities. The electronic touch-screen survey asks participants to select up to 23 general service changes that could improve their experiences when: 1) making an appointment; 2) arriving at the clinic; 3) during an appointment; and 4) managing their condition at home. The interactive survey also allows participants to select up to 107 specific initiatives based on their previous responses. A pilot test of the survey was completed to examine patients’ preferences for health service changes and acceptability of the survey. A total of 675 individuals with a chronic illness, including 400 oncology patients, completed the survey while attending an outpatient clinic. Preliminary results suggest oncology patients select an average of two general service changes. Examples of frequently identified initiatives include: scheduling convenient appointment times; improving parking; reducing clinic wait times; providing opportunities to discuss concerns with a health care provider; providing up-to-date and personalised information on condition and treatment progress; and information about how to handle a medical emergency. Participants reported the survey was easy to complete and comprehensive. Time to complete was 8.5 minutes and 85% of participants indicated they would be willing to complete a similar survey in the future. The Consumer Preferences Survey can be used to guide patient-centred changes within health services, and provides a list of patient prioritised targets. This offers an alternative and reliable method to introduce strategic initiatives to medical oncology outpatient services with the objective of improving patient-centred care. This tool will be used in an Australian Research Council funded project conducted by the Priority Research Centre for Health Behaviour at the University of Newcastle, and Cancer Council New South Wales. 

Prevalence and predictors of anxiety and depression among haematological cancer patients
A cross-sectional study was conducted to explore the prevalence of, and factors associated with, anxiety and depression among patients with haematological cancer. Outpatients (n=304) with a confirmed diagnosis of haematological cancer were recruited from three haematology clinics across Australia. Participants completed a self-report survey which included questions about demographic characteristics, disease and treatment characteristics, and the Hospital Anxiety and Depression Scale. The prevalence of anxiety and depression among participants was 27% and 17% respectively. More specifically, 12% of haematological cancer patients reported experiencing both anxiety and depression, 15% reported anxiety only, and 5% reported depression only. Participants who had to relocate to receive treatment had almost three times the odds of reporting anxiety and/or depression compared to those who did not have to move. Former smokers also had significantly greater odds of reporting anxiety and/or depression. These findings suggest that the proportion of haematological cancer outpatients experiencing psychological distress may be much higher than in the general population. Additional psychological support may need to be provided to former smokers and to patients who have to relocate for treatment. 

Cancer Council Queensland Viertel Centre for Research in Cancer Control (VCRCC)

Survivor study
Around 128,000 new cases of cancer will be diagnosed in Australia this year, with that number set to increase to 170,000 by 2025 (Baade, Meng, Sinclair, and Youl, 2012; Smith et al. 2007). At the same time, more people are surviving cancer today than ever before – around 66 per cent of people diagnosed with cancer in Australia survive for at least five years after their diagnosis (Australian Institute of Health and Welfare, 2012). The combination of increasing cancer incidence and longer survival means that more and more people are living with a diagnosis of cancer. However, while more people are now surviving cancer, they are not necessarily surviving well. The need to understand the challenges faced by cancer survivors and how to address these is becoming more and more pressing. A significant proportion of cancer survivors experience ongoing difficulties including physical, psychological and practical problems related to the diagnosis and/or treatment of their cancer, and there remain unmet needs for supportive care. The Survivor Study is a community-based study, led by Cancer Council Queensland, assessing the needs and concerns of cancer survivors. Respondents are currently being recruited in order to investigate the emotional, physical and practical concerns of cancer survivors and whether they have received care for those concerns. Of particular interest is whether the concerns of cancer survivors and the receipt of supportive care differ based on geography. It is anticipated that the information provided will facilitate the development of improved support programs for this growing group of Australians. 

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