Application of an appearance-based intervention to improve sun protection outcomes of outdoor workers in Queensland, Australia

Outdoor workers are exposed to high levels of ultraviolet radiation (UVR) and may thus be at greater risk to experience UVR-related health effects such as skin cancer, sun burn, and cataracts. A number of intervention trials (n=14) have aimed to improve outdoor workers’ work-related sun protection cognitions and behaviours. Only one study however has reported the use of UV-photography as part of a multi-component intervention. This study was performed in the USA and showed long-term (12 months) improvements in work-related sun protection behaviours. Intervention effects of the other studies have varied greatly, depending on the population studied, intervention applied, and measurement of effect. Previous studies have not assessed whether: - Interventions are similarly effective for workers in stringent and less stringent policy organisations; - Policy effect is translated into workers’ leisure time protection; - Implemented interventions are effective in the long-term; - The facial UV-photograph technique is effective in Australian male outdoor workers without a large additional intervention package, and; - Such interventions will also affect workers’ leisure time sun-related cognitions and behaviours. Therefore, the present Protection of Outdoor Workers from Environmental Radiation [POWER]-study aimed to fill these gaps and had the objectives of: a) assessing outdoor workers’ sun-related cognitions and behaviours at work and during leisure time in stringent and less stringent sun protection policy environments; b) assessing the effect of an appearance-based intervention on workers’ risk perceptions, intentions and behaviours over time; c) assessing whether the intervention was equally effective within the two policy settings; and d) assessing the immediate post-intervention effect. Effectiveness was described in terms of changes in sun-related risk perceptions and intentions (as these factors were shown to be main precursors of behaviour change in many health promotion theories) and behaviour. The study purposefully selected and recruited two organisations with a large outdoor worker contingent in Queensland, Australia within a 40 kilometre radius of Brisbane. The two organisations differed in the stringency of implementation and reinforcement of their organisational sun protection policy. Data were collected from 154 male predominantly Australian born outdoor workers with an average age of 37 years and predominantly medium to fair skin (83%). Sun-related cognitions and behaviours of workers were assessed using self-report questionnaires at baseline and six to twelve months later. Variation in follow-up time was due to a time difference in the recruitment of the two organisations. Participants within each organisation were assigned to an intervention or control group. The intervention group participants received a one-off personalised Skin Cancer Risk Assessment Tool [SCRAT]-letter and a facial UV-photograph with detailed verbal information. This was followed by an immediate post-intervention questionnaire within three months of the start of the study. The control group only received the baseline and follow-up questionnaire. Data were analysed using a variety of techniques including: descriptive analyses, parametric and non-parametric tests, and generalised estimating equations. A 15% proportional difference observed was deemed of clinical significance, with the addition of reported statistical significance (p<0.05) where applicable. Objective 1: Assess and compare the current sun-related risk perceptions, intentions, behaviours, and policy awareness of outdoor workers in stringent and less stringent sun protection policy settings. Workers within the two organisations (stringent n=89 and less stringent n=65) were similar in their knowledge about skin cancer, self efficacy, attitudes, and social norms regarding sun protection at work and during leisure time. Participants were predominantly in favour of sun protection. Results highlighted that compared to workers in a less stringent policy organisation working for an organisation with stringent sun protection policies and practices resulted in more desirable sun protection intentions (less willing to tan p=0.03) ; actual behaviours at work (sufficient use of upper and lower body protection, headgear, and sunglasses (p<0.001 for all comparisons), and greater policy awareness (awareness of repercussions if Personal Protective Equipment (PPE) was not used, p<0.001)). However the effect of the work-related sun protection policy was found not to extend to leisure time sun protection. Objective 2: Compare changes in sun-related risk perceptions, intentions, and behaviours between the intervention and control group. The effect of the intervention was minimal and mainly resulted in a clinically significant reduction in work-related self-perceived risk of developing skin cancer in the intervention compared to the control group (16% and 32% for intervention and control group, respectively estimated their risk higher compared to other outdoor workers: , p=0.11). No other clinical significant effects were observed at 12 months follow-up. Objective 3: Assess whether the intervention was equally effective in the stringent sun protection policy organisation and the less stringent sun protection policy organisation. The appearance-based intervention resulted in a clinically significant improvement in the stringent policy intervention group participants’ intention to protect from the sun at work (workplace*time interaction, p=0.01). In addition to a reduction in their willingness to tan both at work (will tan at baseline: 17% and 61%, p=0.06, at follow-up: 54% and 33%, p=0.07, stringent and less stringent policy intervention group respectively. The workplace*time interaction was significant p<0.001) and during leisure time (will tan at baseline: 42% and 78%, p=0.01, at follow-up: 50% and 63%, p=0.43, stringent and less stringent policy intervention group respectively. The workplace*time interaction was significant p=0.01) over the course of the study compared to the less stringent policy intervention group. However, no changes in actual sun protection behaviours were found. Objective 4: Examine the effect of the intervention on level of alarm and concern regarding the health of the skin as well as sun protection behaviours in both organisations. The immediate post-intervention results showed that the stringent policy organisation participants indicated to be less alarmed (p=0.04) and concerned (p<0.01) about the health of their skin and less likely to show the facial UV-photograph to others (family p=0.03) compared to the less stringent policy participants. A clinically significantly larger proportion of participants from the stringent policy organisation reported they worried more about skin cancer (65%) and skin freckling (43%) compared to those in the less stringent policy organisation (46%,and 23% respectively , after seeing the UV-photograph). In summary the results of this study suggest that the having a stringent work-related sun protection policy was significantly related to for work-time sun protection practices, but did not extend to leisure time sun protection. This could reflect the insufficient level of sun protection found in the general Australian population during leisure time. Alternatively, reactance caused by being restricted in personal decisions through work-time policy could have contributed to lower leisure time sun protection. Finally, other factors could have also contributed to the less than optimal leisure time sun protection behaviours reported, such as unmeasured personal or cultural barriers. All these factors combined may have lead to reduced willingness to take proper preventive action during leisure time exposure. The intervention did not result in any measurable difference between the intervention and control groups in sun protection behaviours in this population, potentially due to the long lag time between the implementation of the intervention and assessment at 12-months follow-up. In addition, high levels of sun protection behaviours were found at baseline (ceiling effect) which left little room for improvement. Further, this study did not assess sunscreen use, which was the predominant behaviour assessed in previous effective appearance-based interventions trials. Additionally, previous trials were mainly conducted in female populations, whilst the POWER-study’s population was all male. The observed immediate post-intervention result could be due to more emphasis being placed on sun protection and risks related to sun exposure in the stringent policy organisation. Therefore participants from the stringent policy organisation could have been more aware of harmful effects of UVR and hence, by knowing that they usually protect adequately, not be as alarmed or concerned as the participants from the less stringent policy organisation. In conclusion, a facial UV-photograph and SCRAT-letter information alone may not achieve large changes in sun-related cognitions and behaviour, especially of assessed 6-12 months after the intervention was implemented and in workers who are already quite well protected. Differences found between workers in the present study appear to be more attributable to organisational policy. However, against a background of organisational policy, this intervention may be a useful addition to sun-related workplace health and safety programs. The study findings have been interpreted while respecting a number of limitations. These have included non-random allocation of participants due to pre-organised allocation of participants to study group in one organisation and difficulty in separating participants from either study group. Due to the transient nature of the outdoor worker population, only 105 of 154 workers available at baseline could be reached for follow-up. (attrition rate=32%). In addition the discrepancy in the time to follow-up assessment between the two organisations was a limitation of the current study. Given the caveats of this research, the following recommendations were made for future research: - Consensus should be reached to define "outdoor worker" in terms of time spent outside at work as well as in the way sun protection behaviours are measured and reported. - Future studies should implement and assess the value of the facial UV-photographs in a wide range of outdoor worker organisations and countries. - More timely and frequent follow-up assessments should be implemented in intervention studies to determine the intervention effect and to identify the best timing of booster sessions to optimise results. - Future research should continue to aim to target outdoor workers’ leisure time cognitions and behaviours and improve these if possible. Overall, policy appears to be an important factor in workers’ compliance with work-time use of sun protection. Given the evidence generated by this research, organisations employing outdoor workers should consider stringent implementation and reinforcement of a sun protection policy. Finally, more research is needed to improve ways to generate desirable behaviour in this population during leisure time.

Explaining internationalisation of small to medium sized enterprises within the Queensland food and beverage industry

The prevalence of International New Ventures (INVs) has increased during the past twenty years. Nevertheless, to date there has been no general consensus within the literature on an explanation as to the rapid internationalisation of some firms. Do they follow a similar process to other firms that internationalise based on a more ‘measured’ incremental sequential process of internationalisation. This paper proposes and tests an innovation diffusion model of the internationalisation of small firm INVs and others by drawing on key innovation diffusion models from the literature. The results of this analysis indicate that the synthesised model of export adoption is effective in explaining the internationalisation process of INVs and other firms within the Queensland Food and Beverage Industry. Significantly, the features of the original innovation diffusion models developed in the consumer behaviour literature, which had limited examination within the internationalisation literature, were confirmed. This includes the ability of firms, or specifically decision-makers, to skip stages based on previous experience.

Determination of coastal ground and surface water processes and character by use of hydrochemistry and stable isotopes, Fraser Coast, Queensland

This study was part of an integrated project developed in response to concerns regarding current and future land practices affecting water quality within coastal catchments and adjacent marine environments. Two forested coastal catchments on the Fraser Coast, Australia, were chosen as examples of low-modification areas with similar geomorphological and land-use characteristics to many other coastal zones in southeast Queensland. For this component of the overall project, organic , physico-chemical (Eh, pH and DO), ionic (Fe2+, Fe3+), and isotopic (ä13CDIC, ä15NDIN ä34SSO4) data were used to characterise waters and identify sources and processes contributing to concentrations and form of dissolved Fe, C, N and S within the ground and surface waters of these coastal catchments. Three sites with elevated Fe concentrations are discussed in detail. These included a shallow pool with intermittent interaction with the surface water drainage system, a monitoring well within a semi-confined alluvial aquifer, and a monitoring well within the fresh/saline water mixing zone adjacent to an estuary. Conceptual models of processes occurring in these environments are presented. The primary factors influencing Fe transport were; microbial reduction of Fe3+ oxyhydroxides in groundwaters and in the hyporheic zone of surface drainage systems, organic input available for microbial reduction and Fe3+ complexation, bacterial activity for reduction and oxidation, iron curtain effects where saline/fresh water mixing occurs, and variation in redox conditions with depth in ground and surface water columns. Data indicated that groundwater seepage appears a more likely source of Fe to coastal waters (during periods of low rainfall) via tidal flux. The drainage system is ephemeral and contributes little discharge to marine waters. However, data collected during a high rainfall event indicated considerable Fe loads can be transported to the estuary mouth from the catchment.

Building community resilience – learning from the 2011 floods in Southeast Queensland, Australia

The year 2010 was the wettest year on record for Queensland, Australia and the wettest year since 1974 for Southeast Queensland. The extremely heavy rain in early January 2011 fell on the catchments of heavily saturated Brisbane and Stanley Rivers systems resulting in significant runoff which rapidly produced a widespread and devastating flood event. The area of inundation was equivalent to the total land area of France and Germany combined. Over 200,000 people were affected leaving 35 people dead and 9 missing. The damage bill was estimated at over $1B and cost to the economy at over $10B with over 30,000 homes and 6,000 business flooded and 86 towns and regional centres affected. The need to disburse disaster funding in a prompt manner to the affected population was paramount to facilitate individuals getting their lives back to some normality. However, the payout of insurance claims has proved to be a major area of community anger. The ongoing impasse in payment of insurance compensation is attributed to the nature and number of claims, confusing definition of flooding and the lack or accuracy of information needed to determine individually the properties affected and legitimacy of claims. Information was not readily available at the micro-level including, extent and type of inundation, flood heights at property level and cause of damage. Events during the aftermath highlighted widespread community misconceptions concerning the technical factors associated with the flood event and the impact of such on access to legitimate compensation and assistance. Individual and community wide concerns and frustration, anger and depression, have arisen resulting from delays in the timely settlement of insurance claims. Lessons learnt during the aftermath are presented in the context of their importance as a basis for inculcating communities impacted by the flood event with resilience for the future.

Impact of the introduction of machine gaming in Queensland on minor and major bingo

Material for this paper comes from as report commissioned by the Department of Family Services, Aboriginal and Islander Affairs. The report is the result of a multi strategy research project designed to assess the impact of gaming machines on the fundraising capacity of charitable and community organisations in Queensland. The study was conducted during the 1993 calendar year. The first Queensland gaming machine was commissioned on the 11 February, 1992 at 11.30 am in Brisbane at the Kedron Wavell Services Club. Eighteen more clubs followed that week. Six months later there were gaming machines in 335 clubs, and 250 hotels and taverns, representing a state wide total of 7,974 machines in operation. The 10,000 gaming machine was commissioned on the 18 March, 1993 and the 1,000 operational gaming machine site was opened on 18th February, 1994.

New Commonwealth and Queensland workplace relations legislation : an overview

I seem to have heard a lot about thresholds lately. In fact, I sometimes feel as though I am standing at the edge of an abyss. Certainly the industrial relations systems we have come to know and love are in the process of metamorphosis but that process began a decade ago. So what is all the fuss about...

A comparison of security of tenure in Queensland and in Western Europe

Queensland residential tenancies are usually granted for up to 12 months with no guarantee of renewal. On expiration of the term, the landlord, without need to provide an explanation, can require the tenant to leave. Europeans find this unusual. As Hammar observes, to ‘never be sure whether ... you will be allowed to stay for another year ... is ok for a student, or for someone working ... but not for households’. This article informs Queensland policy makers and industry about European practices and concludes by proposing legislative amendments to realise the tenant’s security of tenure.

A cross sectional observational study of child restraint use in Queensland following changes in legislation

As part of an evaluation of the 2010 legislation for child vehicle occupants in Queensland, road-side observations of private passenger vehicles were used to estimate the proportions of children 0-under 7 years travelling in each of the 5 different restraint types (eg. forward facing child restraint). Data was collected in 4 major population centres: Brisbane, Sunshine Coast, Mackay and Townsville. Almost all children were restrained (95.1%, 95% CI 94.3-95.9%), with only 3.3% (95% CI 2.6-4.0%) clearly unrestrained and 44 (1.6%, 95% CI 1.1-2.1%) for whom restraint status could not be determined (‘unknown’). However, around 24.0% (95 CI 21.8-26.2%) of the target-aged children were deemed inappropriately restrained, primarily comprised of 3-6 year olds in seatbelts (18.7% of the 0-6 year olds, 95% CI 16.3-21.1%) or unrestrained (3.7% of the 0-6 year olds, 95% CI 2.5-4.9%) instead of booster seats. In addition, compliance appeared significantly lower for some regional locations where the proportion of children observed as completely unrestrained was relatively high and of concern

Surrogacy laws in Queensland: one step forward and two steps back?

This short article summarises some of the proposed reforms to surrogacy laws in Queensland, suggested by the Liberal National Party in 2012. The paper outlines some of the main objections that could be voiced in response to the proposed changes to the law.

Queensland Emergency Medicine Research Foundation: Special report

The development of any new profession is dependent on the development of a special body of knowledge which is the domain of the profession and key to this is the conduct of research. In 2007, as part of the settlement of an Enterprise Bargaining Agreement and following sustained lobbying by Emergency Physicians, the Queensland Government agreed to establish an Emergency Medicine Research Fund to foster the development of research activities in Emergency Medicine in Queensland. That fund is now managed by the Queensland Emergency Medicine Research Foundation. The aims of this article are to describe the strategic approaches taken by the Foundation and its first three years of experience, to describe the application of research funds and to foreshadow an evaluative framework for determining the strategic value of this community investment. The Foundation has developed a range of personnel and project support funding programs and competition for funding has increased. Ongoing evaluation will seek to determine the effectiveness of this funding strategy on improving the effectiveness of research performance and the clinical and organisational outcomes that may derive from that initiative.

An exploratory study to examine the phenomenon and practice of ambulance ramping at hospitals within the Queensland Health Southern Districts and the Queensland Ambulance Service

Background: Ambulance Ramping, defined anecdotally as a practice where patients brought to emergency departments by ambulance experience delays to admission, has become more frequent in Australian emergency departments over the last few years. Previous research has shown a link between emergency department overcrowding, ambulance diversion and adverse outcomes for patients. However, there is very little research about Ambulance Ramping. The literature has no consistent definition of Ambulance Ramping, no description of how it is managed, and limited research on the effects it has on patient and service delivery outcomes...

Becoming Partners: Partnerships reshaping preservice teachers’ preparation to teach in rural Queensland schools

Preparing preservice teachers for successful rural and remote teaching is an ongoing and significant issue that impacts on equity issues for Australian students (Sharplin, 2002) and the sustainability of rural communities (Green & Reid, 2004). Improving the preparation of preservice teachers for teaching in rural schools is a key recommendation from the Human Rights and Equal Opportunity Commission (2000). This presentation analyses how an innovative partnership between a teacher employer and a teacher education institution as a response to a mandated reform within the Improving Teacher Quality National Partnership Agreement has been established to address the important need to prepare and recruit preservice teachers to teach in rural and remote areas of Queensland.

The experiences of parents and other supervisors in a graduated driver licensing program in Queensland, Australia

Study Aims Describe how parents and other private supervisors have responded to the changes made to the Queensland graduated driver licensing system in mid-2007 Examine differences in the experiences and perceptions of the parents and non-parents Method Combination of convenience and snowball sampling Survey administered by the internet Survey conducted between July 2009 and May 2010 Approximately 15-20 minutes to complete $20 reimbursement for participation

Understanding the mechanism behind invasion of African lovegrass

African lovegrass (Eragrostis curvula) is a C4 perennial grass, native to southern Africa, that was accidentally introduced into Australia in the late 1900s as a contaminant of pasture seed. Its utility for pasture improvement and soil conservation was explored because of its recognised ability to grow in areas of low rainfall and on nutrient-poor sandy loams. Several different agronomic types have now been intentionally introduced across Australia. African lovegrass is now found in all Australian states and territories. It is a declared weed in 33 council areas of New South Wales, a declared pest plant in the ACT and Tasmania and a Regionally Prohibited Weed in 5 out of 11 regions in Victoria. Victoria has also placed it in the very serious threat category (Carr et al. 1992). In Queensland, it has yet to be declared except under local law in the Eidsvold shire (Leigh and Walton, in press).

Public realm and transport, international best practice case studies and opportunities for Brisbane

This report was prepared for Lat 27 Pty Ltd for the purpose of conducting a City Centre Public Realm and Active Transport Study for Urban Renewal Brisbane, Brisbane City Council. In this review, we highlight some key learnings and recommendations from innovative projects across the globe to inform public realm design and help facilitate active transport in subtropical Brisbane. Traditionally, Australian cities have been have been based on northern European models. This report is informed by the view that planners and urban designers must look beyond that paradigm to redefine and re-conceptualise our city in a different way, one that values our unique local identity and climate. In re-designing Brisbane’s public realm, therefore, design interventions and responses must celebrate our unique identity and outdoor lifestyle and address the subtropical climate's reality of life in warm humid summers and cool dry winters. The current period of rapid urban change, and the imperative to adapt to climate change, together offer an opportunity to prioritise and integrate design features that provide shade and shelter from sun and summer rain, open and permeable urban environments that facilitate cooling air movement, and connections to water and nature, so that the urban built form co-exists within an inviting, functional and memorable natural landscape. To inform this transformation, this review provides insight into international experiences and best practices. To date, although there is much practice-based knowledge, academic studies outlining learnings and recommendations from case studies (especially in a subtropical context) remain rare. Thus, a range of sources (industry reports, websites, journal articles and books) have been utilised.