Has increasing the age for child passengers to wear child restraints improved the extent to which they are used? Results from an Australian focus group and survey study.

Acknowledgement that many children in Australia travel in restraints that do not offer them the best protection has led to recent changes in legislation such that the type of restraint for children under 7 years is now specified. This paper reports the results of two studies (observational; focus group/ survey) carried out in the state of Queensland to evaluate the effectiveness of these changes to the legislation. Observations suggested that almost all of the children estimated as aged 0-12 years were restrained (95%). Analysis of the type of restraint used for target-aged children (0-6 year olds) suggests that the proportion using an age-appropriate restraint has increased by an estimated 7% since enactment of the legislation. However, around 1 in 4 children estimated as aged under 7 years were using restraints too large for good fit. Results from the survey and focus group suggested parents were supportive of the changes in legislation. Non-Indigenous parents agreed that the changes had been necessary, were effective at getting children into the right restraints, were easy to understand as well as making it clear what restraint to use with children. Moreover, they did not see the legislation as too complicated or too hard to comply with. Indigenous parents who participated in a focus group also regarded the legislation as improving children’s safety. However, they identified the cost of restraints as an important barrier to compliance. In summary, the legislation appears to have had a positive effect on compliance levels and on raising parental awareness of the need to restrain children child-specific restraints for longer. However, it would seem that an important minority of parents transition their children into larger restraints too early for optimal protection. Intervention efforts should aim to better inform these parents about appropriate ages for transition, especially from forward facing childseats. This could potentially be through use of other important transitions that occur at the same age, such as starting school. The small proportion of parents who do not restrain their children at all are also an important community sector to target. Finally, obtaining restraints presents a significant barrier to compliance for parents on limited incomes and interventions are needed to address this.

Sunscreen application thickness amongst primary school children : the children and sunscreen study

Childhood sun exposure has been associated with increased risk of developing melanoma later in life. Sunscreen, children.s preferred method of sun protection, has been shown to reduce skin cancer risk. However, the effectiveness of sunscreen is largely dependent on user compliance, such as the thickness of application. To reach the sun protection factor (SPF) sunscreen must be applied at a thickness of 2mg/cm2. It has been demonstrated that adults tend to apply less than half of the recommended 2mg/cm2. This was the first study to measure the thickness at which children apply sunscreen. We recruited 87 primary school aged children (n=87, median age 8.7, 5-12 years) from seven state schools within one Brisbane education district (32% consent rate). The children were supplied with sunscreen in three dispenser types (pump, squeeze and roll-on) and were asked to use these for one week each. We measured the weight of the sunscreen before and after use, and calculated the children.s body surface area (based on height and weight) and area to which sunscreen was applied (based on children.s self-reported body coverage of application). Combined these measurements resulted in an average thickness of sunscreen application, which was our main outcome measure. We asked parents to complete a self-administered questionnaire which captured information about potential explanatory variables. Children applied sunscreen at a median thickness of 0.48mg/cm2, significantly less than the recommended 2mg/cm2 (p<0.001). When using the roll-on dispenser (median 0.22mg/cm2), children applied significantly less sunscreen thickness, compared to the pump (median 0.75mg.cm2, p<0.001), and squeeze (median 0.57mg/cm2, p<0.001) dispensers. School grade (1-7) was significantly associated with thickness of application (p=0.032), with children in the youngest grades applying the most. Other variables that were significantly associated with the outcome variable included: number of siblings (p=0.001), household annual income (p<0.001), and the number of lifetime sunburns the child had experienced (p=0.007). This work is the first to measure children.s sunscreen application thickness and demonstrates that regardless of their age or the type of dispenser that they use, children do not apply enough sunscreen to reach the advertised SPF. It is envisaged that this study will assist in the formulation of recommendations for future research, practice and policy aimed at improving childhood sun protection to reduce skin cancer incidence in the future.

Children as experts in their lives : child inclusive research [Editorial Introduction]

The focus of this special volume of CSI on research with and by children reflects a major paradigm shift in child research - a shift from a focus on the child as object of to a focus on the child as subject (and actor) in research (see Mason and Hood 2010). In his lead article in the first issue of this journal (2008), Asher Ben-Arieh highlighted the way in which the child indicators movement reflects this paradigm shift, outlining the way in which new directions in measuring and monitoring child well-being were leading to new roles for children in this process. He noted the importance of including children’s own perspectives on their well-being and argued that ‘incorporating children’s subjective perceptions is both a pre-requisite and a consequence of the changes historically in the measuring and monitoring of child well-being’ (p.13). This special issue again takes up this agenda of the child as subject in research...

Their children's first educators : parents' views about child sexual abuse prevention education

In this descriptive focus group study, we investigated parents’ views about child sexual abuse prevention education at home and in schools. Focus groups were conducted with a sample of 30 Australian adults who identified as the parent or caregiver of a child/children aged 0–5 years. The study explored (1) parents’ knowledge about child sexual abuse prevention, (2) the child sexual abuse prevention messages they provided to their children and the topics they discussed, (3) their attitudes towards child sexual abuse prevention education in schools, and (4) their preferences for content. Data analysis provided seven key themes in these four areas: knowledge (the inadequacy of their own prevention education; and how important is stranger danger now?); messages (bodies, touching, and relationships; the role of protective adults; and parent–child communication); attitudes (voice and choice); and preferences (not the nitty gritty, just the basics). The findings may be useful in assisting school authorities and providers of child sexual abuse prevention programs to better understand parents’ contributions to child sexual abuse prevention education, and their perspectives in relation to provision of school-based prevention programs.

Exploring the contested role of mandatory reporting laws in the identification of severe child abuse and neglect

Significant numbers of children are severely abused and neglected by parents and caregivers. Infants and very young children are the most vulnerable and are unable to seek help. To identify these situations and enable child protection and the provision of appropriate assistance, many jurisdictions have enacted ‘mandatory reporting laws’ requiring designated professionals such as doctors, nurses, police and teachers to report suspected cases of severe child abuse and neglect. Other jurisdictions have not adopted this legislative approach, at least partly motivated by a concern that the laws produce dramatic increases in unwarranted reports, which, it is argued, lead to investigations which infringe on people’s privacy, cause trauma to innocent parents and families, and divert scarce government resources from deserving cases. The primary purpose of this paper is to explore the extent to which opposition to mandatory reporting laws is valid based on the claim that the laws produce ‘overreporting’. The first part of this paper revisits the original mandatory reporting laws, discusses their development into various current forms, explains their relationship with policy and common law reporting obligations, and situates them in the context of their place in modern child protection systems. This part of the paper shows that in general, contemporary reporting laws have expanded far beyond their original conceptualisation, but that there is also now a deeper understanding of the nature, incidence, timing and effects of different types of severe maltreatment, an awareness that the real incidence of maltreatment is far higher than that officially recorded, and that there is strong evidence showing the majority of identified cases of severe maltreatment are the result of reports by mandated reporters. The second part of this paper discusses the apparent effect of mandatory reporting laws on ‘overreporting’ by referring to Australian government data about reporting patterns and outcomes, with a particular focus on New South Wales. It will be seen that raw descriptive data about report numbers and outcomes appear to show that reporting laws produce both desirable consequences (identification of severe cases) and problematic consequences (increased numbers of unsubstantiated reports). Yet, to explore the extent to which the data supports the overreporting claim, and because numbers of unsubstantiated reports alone cannot demonstrate overreporting, this part of the paper asks further questions of the data. Who makes reports, about which maltreatment types, and what are the outcomes of those reports? What is the nature of these reports; for example, to what extent are multiple numbers of reports made about the same child? What meaning can be attached to an ‘unsubstantiated’ report, and can such reports be used to show flaws in reporting effectiveness and problems in reporting laws? It will be suggested that available evidence from Australia is not sufficiently detailed or strong to demonstrate the overreporting claim. However, it is also apparent that, whether adopting an approach based on public health and or other principles, much better evidence about reporting needs to be collected and analyzed. As well, more nuanced research needs to be conducted to identify what can reasonably be said to constitute ‘overreports’, and efforts must be made to minimize unsatisfactory reporting practice, informed by the relevant jurisdiction’s context and aims. It is also concluded that, depending on the jurisdiction, the available data may provide useful indicators of positive, negative and unanticipated effects of specific components of the laws, and of the strengths, weaknesses and needs of the child protection system.

When individual child psychotherapy exacerbates family systems problems in child abuse cases : a clinical analysis

Children who have suffered physical or sexual abuse are as vulnerable as adult trauma victims to experience "secondary trauma", in which the reactions of the family or broader system exacerbate the child's difficulties. Three clinical cases (a 7 yr old male, an 8 yr old male, and a 7 yr old female) are presented that suggest that this secondary trauma can be made worse by either excessive or insufficient provision of individual child psychotherapy, and the way the system interprets and reacts to these clinical decisions. Types of secondary trauma and their interactions with clinical decisions are discussed. Ways of framing clinical decisions to minimize the potential secondary trauma are presented.

Child welfare policy and practice on children’s exposure to domestic violence

There are emerging movements in several countries to improve policy and practice to protect children from exposure to domestic violence. These movements have resulted in the collection of new data on EDV and the design and implementation of new child welfare policies and practices. To assist with the development of child welfare practice, this article summarizes current knowledge on the prevalence of EDV, and on child welfare services policies and practices that may hold promise for reducing the frequency and impact of EDV on children. We focus on Australia, Canada, and the United States, as these countries share a similar socio-legal context, a long history of enacting and expanding legislation about reporting of maltreatment, debates regarding the application of reporting laws to EDV, and new child welfare practices that show promise for responding more effectively to EDV.

Evaluation of the Type I child car restraints fitting service in WA

Child passenger injury remains a major road safety issue despite advances in biomechanical understanding and child restraint design. In Australia, one intervention with parents to encourage universal and consistent use of the most appropriate restraint as well as draw their attention to critical aspects of installation is the RoadWise Type 1 Child Car Restraints Fitting Service, WA. A mixed methods evaluation of this service was conducted in early 2010. Evaluation results suggest that it has been effective in ensuring good quality training of child restraint fitters. In addition, stakeholder and user satisfaction with the Service is high, with participants agreeing that the Service is valuable to the community, and fitters regarding the training course, materials and post-training support as effective. However, a continuing issue for interventions of this type is whether the parents who need them perceive this need. Evidence from the evaluation suggests that only about 25% of parents who could benefit from the Service actually use it. This may be partly due to parental perceptions that such services are not necessary or relevant to them, or to overconfidence about the ease of installing restraints correctly. Thus there is scope for improving awareness of the Service amongst groups most likely to benefit from it (e.g. new parents) and for alerting parents to the importance of correct installation and getting their self-installed restraints checked. Efforts to inform and influence parents should begin when their children are very young, preferably at or prior to birth and/or before the parent installs the first restraint.

Assessing the effectiveness of the child safety net : linkage of hospital and child protection services data on ‘maltreated’ and ‘unintentionally injured' children

-International recognition of need for public health response to child maltreatment -Need for early intervention at health system level -Important role of health professionals in identifying, reporting, documenting suspician of maltreatment -Up to 10% of all children presenting at ED’s are victims and without identification, 35% reinjured and 5% die -In Qld, mandatory reporting requirement for doctors and nurses for suspected abuse or neglect

Saying sorry in the 21st century : public apologies in a digital world

The public apology to the Forgotten Australians in late 2009 was, for many, the culmination of a long campaign for recognition and justice. The groundswell for this apology was built through a series of submissions which documented the systemic institutionalised abuse and neglect experienced by the Forgotten Australians that has resulted, for some, in life-long disadvantage and marginalisation. Interestingly it seems that rather than the official documents being the catalyst for change and prompting this public apology, it was more often the personal stories of the Forgotten Australians that resonated and over time drew out quite a torrent of support from the public leading up to, during and after the public apology, just as had been the case with the ‘Stolen Generation.’ Research suggests (cite) that the ethics of such national apologies only make sense if their personal stories are seen as a collective responsibility of society, and only carry weight if we understand and seek to Nationally address the trauma experienced by such victims. In the case of the Forgotten Australians, the National Library of Australia’s Forgotten Australians and Former Child Migrants Oral History Project and the National Museum’s Inside project demonstrate commitment to the digitisation of the Forgotten Australians’ stories in order to promote a better public understanding of their experiences, and institutionally (and therefore formally) value them with renewed social importance. Our project builds on this work not by making or collecting more stories, but by examining the role of the internet and digital technologies used in the production and dissemination of individuals’ stories that have already been created during the period of time between the tabling of the senate inquiry, Children in Institutional Care (1999 or 2003?) and a formal National apology being delivered in Federal Parliament by PM Kevin Rudd (9 Nov, 2009?). This timeframe also represents the emergent first decade of Internet use by Australians, including the rapid easily accessible digital technologies and social media tools that were at our disposal, along with the promises the technology claimed to offer — that is that more people would benefit from the social connections these technologies allegedly were giving us.

Good secrets, bad secrets : disclosure in children’s picture books about sexual child abuse

Well over 50 picture books have been published for children on the topic of sexual child abuse (Lampert & Walsh, 2010) many with the aim of teaching their very young readers how to tell the difference between good and bad secrets. This paper looks at three recent picture books for how they focus on disclosure as an end point.

Socioeconomic inequalities in weight status among mid-aged adults : the contribution of perceptions of weight status and weight-control behaviours

Background Socioeconomically-disadvantaged adults in developed countries experience a higher prevalence of a number of chronic diseases, such as cardiovascular disease, type 2 diabetes, osteoarthritis and some forms of cancer. Overweight and obesity are major risk factors for these diseases. Lower socioeconomic groups have a greater prevalence of overweight and obesity and this may contribute to their higher morbidity and mortality. International studies suggest that socioeconomic groups may differ in their self-perceptions of weight status and their engagement in weightcontrol behaviours (WCBs). Research has shown that lower socioeconomic adults are more likely to underestimate their weight status, and are less likely to engage in WCBs. This may contribute (in part) to the marked inequalities in weight status observed at the population level. There are few, and somewhat limited, Australian studies that have examined the types of weight-control strategies people adopt, the barriers to their weight control, the determinants of their perceived weight status and WCBs. Furthermore, there are no known Australian studies that have examined socioeconomic differences in these factors to better understand the reasons for socioeconomic inequalities in weight status. Hence, the overall aim of this Thesis is to examine why socioeconomically-disadvantaged group experience a greater prevalence of overweight and obesity than their more-advantaged counterparts. Methods This Thesis used data from two sources. Men and women aged 45 to 60 years were examined from both data source. First, the longitudinal Australian Diabetes, Obesity and Lifestyle (AusDiab) Study were used to advance our knowledge and understanding of socioeconomic differences in weight change, perceived weight status and WCBs. A total of 2753 participants with measured weights at both baseline (1999-2000) and follow-up (2004-2005) were included in the analyses. Percent weight change over the five-year interval was calculated and perceived weight status, WCBs and highest attained education were collected at baseline. Second, the Candidate conducted a postal questionnaire from 1013 Brisbane residents (69.8 % response rate) to investigate the relationship between socioeconomic position, determinants of perceived weight status, WCBs, and barriers and reasons to weight control. A test-retest reliability study was conducted to determine the reliability of the new measures used in the questionnaire. Most new measures had substantial to almost perfect reliability when considering either kappa coefficient or crude agreement. Results The findings from the AusDiab Study (accepted for publication in the Australian and New Zealand Journal of Public Health) showed that low-educated men and women were more likely to be obese at baseline compared to their higheducated respondents (O.R. = 1.97, 95 % C.I. = 1.30-2.98 and O.R. = 1.52, 95 % C.I. = 1.03-2.25, respectively). Over the five year follow-up period (1999-2000 to 2004- 05) there were no socioeconomic differences in weight change among men, however socioeconomically-disadvantaged women had greater weight gains. Participants perceiving themselves as overweight gained less weight than those who saw themselves as underweight or normal weight. There was no relationship between engaging in WCBs and five-year weight change. The postal questionnaire data showed that socioeconomically-disadvantaged groups were less likely to engage in WCBs. If they did engage in weight control, they were less likely to adopt exercise strategies, including moderate and vigorous physical activities but were more likely to decrease their sitting time to control their weight. Socioeconomically-disadvantaged adults reported more barriers to weight control; such as perceiving weight loss as expensive, requiring a lot of cooking skills, not being a high priority and eating differently from other people in the household. These results have been accepted for publication in Public Health Nutrition. The third manuscript (under review in Social Science and Medicine) examined socioeconomic differences in determinants of perceived weight status and reasons for weight control. The results showed that lower socioeconomic adults were more likely to specify the following reasons for weight control: they considered themselves to be too heavy, for occupational requirements, on recommendation from their doctor, family members or friends. Conversely, high-income adults were more likely to report weight control to improve their physical condition or to look more attractive compared with those on lower-incomes. There were few socioeconomic differences in the determinants of perceived weight status. Conclusions Education inequalities in overweight/obesity among men and women may be due to mis-perceptions of weight status; overweight or obese individuals in loweducated groups may not perceive their weight as problematic and therefore may not pay attention to their energy-balance behaviours. Socioeconomic groups differ in WCBs, and their reasons and perceived barriers to weight control. Health promotion programs should encourage weight control among lower socioeconomic groups. More specifically, they should encourage the engagement of physical activity or exercise and dietary strategies among disadvantaged groups. Furthermore, such programs should address potential barriers for weight control that disadvantaged groups may encounter. For example, disadvantaged groups perceive that weight control is expensive, requires cooking skills, not a high priority and eating differently from other people in the household. Lastly, health promotion programs and policies aimed at reducing overweight and obesity should be tailored to the different reasons and motivations to weight control experienced by different socioeconomic groups. Weight-control interventions targeted at higher socioeconomic groups should use improving physical condition and attractiveness as motivational goals; while, utilising social support may be more effective for encouraging weight control among lower socioeconomic groups.

Mother-child communication about sexual abuse prevention

Two hundred and twelve Australian mothers completed an online survey examining features of mother-child communication about child sexual abuse prevention. Two-thirds (67.5%) of respondents had discussed child sexual abuse prevention with their children. Proportions of mothers talking with their children about child sexual abuse prevention varied according to age range (highest for mothers with children aged 5-12 years) and only child status (lowest for mothers of only children). The number of topics discussed with their children differed according to child gender (greater number of topics discussed by mothers with both girls and boys) and age range (greater number of topics discussed by mothers with children aged 5-12 years). These findings provide new insights into mother-child communication about child sexual abuse prevention.

Evaluation of an intervention to promote protective infant feeding practices to prevent childhood obesity : outcomes of the NOURISH RCT at 14 months of age and 6 months post the first of two intervention modules

OBJECTIVE: To evaluate a universal obesity prevention intervention, which commenced at infant age 4-6 months, using outcome data assessed 6-months after completion of the first of two intervention modules and 9 months from baseline. DESIGN: Randomised controlled trial of a community-based early feeding intervention. SUBJECTS AND METHODS: 698 first-time mothers (mean age 30±5 years) with healthy term infants (51% male) aged 4.3±1.0 months at baseline. Mothers and infants were randomly allocated to self-directed access to usual care or to attend two group education modules, each delivered over three months, that provided anticipatory guidance on early feeding practices. Outcome data reported here were assessed at infant age 13.7±1.3 months. Anthropometrics were expressed as z-scores (WHO reference). Rapid weight gain was defined as change in weight-for-age z-score (WAZ) > +0.67. Maternal feeding practices were assessed via self-administered questionnaire. RESULTS: There were no differences according to group allocation on key maternal and infant characteristics. At follow up (n=598 [86%]) the intervention group infants had lower BMIZ (0.42±0.85 vs 0.23±0.93, p=0.009) and infants in the control group were more likely to show rapid weight gain from baseline to follow up (OR=1.5 CI95%1.1-2.1, p=0.014). Mothers in the control group were more likely to report using non- responsive feeding practices that fail to respond to infant satiety cues such as encouraging eating by using food as a reward (15% vs 4%, p=0.001) or using games ( 67% vs 29%, p<0.001). CONCLUSIONS: These results provide early evidence that anticipatory guidance targeting the ‘when, what and how’ of solid feeding can be effective in changing maternal feeding practices and, at least in the short term, reducing anthropometric indicators of childhood obesity risk. Analyses of outcomes at later ages are required to determine if these promising effects can be sustained.

Victims Speak: Comparing Child Sexual Abusers and Their Victims Accounts of Offence Circumstances

This article presents findings from a longitudinal study. The research aimed to explore the effectiveness of a treatment program for offenders which lasted for three years. The research design was structured around the program with interviews and psychometric testing undertaken at key points in time with the same group of respondents. View all notes that sought to evaluate a treatment program for child sexual abusers. A triangulated methodological approach was adopted drawing upon quantitative and qualitative methodological techniques. The focus here is upon one element of this research. 2 2The quantitative element of this research will be published shortly but is referred to in the following reports Davidson 2000, 2003 [research funded by the National Probation Service]. Psychometric testing was undertaken over a four-year period with the men attending the treatment program to explore shifts in the extent of denial, blame attribution, and victim empathy over time. Offender cognitive distortions, general health, and self-esteem were also explored via psychometric testing. An interview-administered survey was undertaken with all sex offenders registered with the Probation Service (those on probation and in custody) in order to gather demographic data, and 117 of 150 offenders responded. View all notes Ninety-one in-depth interviews were conducted over a four-year period with a small, nonrandom sample of twenty-one male offenders who had been convicted of sexual offenses against children. All of the men were subject to probation orders with a psychiatric condition (Criminal Justice Act, 1991). One of the aims of this element of the research was to explore the extent to which evidence of denial could be found in offenders’ accounts of offense circumstance and also to explore the extent to which offenders minimized the nature and extent of abuse perpetrated. Offenders’ accounts of offense circumstances were compared to victim statements, and stark differences emerge. These findings have considerable implications for treatment practice with sex offenders, where victims’ perceptions could be used to directly confront offender denial and minimization.