Rural adolescent alcohol, tobacco, and illicit drug use: a comparison of students in Victoria, Australia, and Washington State, United States

Purpose: There are inconsistent research findings regarding the impact of rurality on adolescent alcohol, tobacco, and illicit substance use. Therefore, the current study reports on the effect of rurality on alcohol, tobacco, and illicit
drug use among adolescents in 2 state representative samples in 2 countries, Washington State (WA) in the United States and Victoria (VIC) in Australia.
Participants: The International Youth Development Study (IYDS) recruited representative samples of students from Grade 7 (aged 12 to 13 years) and Grade 9 (aged 14 to 15) in both states. A total of 3,729 students responded to questions about alcohol, tobacco, cannabis, and other illicit substance use (n_VIC = 1,852; n_WA = 1,877). In each state, males and females were equally represented and ages ranged from 12 to 15 years.
Methods: Data were analyzed to compare lifetime and current (past 30 days) substance use for students located in census areas classified as urban, large or small town, and rural. Findings were adjusted for school clustering and
weighted to compare prevalence at median age 14 years.
Findings: Rates of lifetime and current alcohol, tobacco, and cannabis use were significantly higher in rural compared to urban students in both states (odds ratio for current substance use = 1.31).
Conclusions: In both Washington State and Victoria, early adolescent rural students use substances more frequently than their urban counterparts. Future studies should examine factors that place rural adolescents at risk for alcohol, tobacco, and illicit drug use.

Extending the paramedic role in rural Australia : a story of flexibility and innovation

Introduction: This article identifies trends in the evolving practice of rural paramedics and describes key characteristics, roles and expected outcomes for a Rural Expanded Scope of Practice (RESP) model.

Methods: A multiple case study methodology was employed to examine the evolution of rural paramedic practice. Paramedics, volunteer ambulance officers and other health professionals were interviewed in four rural regions of south-eastern Australia where innovative models of rural paramedic practice were claimed to exist. The research team collected and thematically analysed the data using the filter of a sociological framework throughout 2005 and 2006.

Results: The study found that paramedics are increasingly becoming first line primary healthcare providers in small rural communities and developing additional professional responsibilities throughout the cycle of care.

Conclusions: Adoption of the RESP model would mean that paramedics undertake four broad activities as core components of their new role: (1) rural community engagement; (2) emergency response; (3) situated practice; and (4) primary health care. The model’s key feature is a capacity to integrate existing paramedic models with other health agencies and health professionals to ensure that paramedic care is part of a seamless system that provides patients with well-organized and high quality care. This expansion of paramedics’ scope of practice offers the potential to improve patient care and the general health of rural communities.

Engaging rural communities in health care through a paramedic expanded scope of practice

Introduction: This article explores how community engagement by paramedics in an expanded scope role contributes to both primary health care and to an overall improved emergency response capacity in rural communities. Understanding how expanded scope paramedics (ESP) can strengthen community healthcare collaborations is an important need in rural areas where low workforce numbers necessitate innovation.

Methods: Four examples of Australian rural ESP roles were studied in Tasmania, New South Wales, South Australia and Victoria to gather information on consistent elements that could inform a paramedic expanded scope model. Qualitative data were collected from semi-structured interviews with key stakeholders and organisational documents. Thematic analysis within and across cases found community engagement was a key element in the varied roles. This article relies heavily on data from the Victorian and Tasmanian case studies because community engagement was a particularly strong aspect of these cases.

Results: The ESP in the case studies increased interactions between ambulance services and rural communities with an overall benefit to health care through: increasing community response capacity; linking communities more closely to ambulance services; and increasing health promotion and illness prevention work at the community level. Leadership, management and communication skills are important for paramedics to successfully undertake expanded scope roles.

Conclusion: ESP in rural locations can improve health care beyond direct clinical skill by active community engagement that expands the capacity of other community members and strengthens links between services and communities. As health services look to gain maximum efficiency from the health workforce, understanding the intensification of effort that can be gained from practitioner and community coalitions provides important future directions.

Rural living and health-related quality of life in Australians with Parkinson's disease

Introduction: The motor and non-motor symptoms associated with idiopathic Parkinson’s disease (PD) may compromise the health-related quality of life (HRQOL) of some individuals living with this debilitating condition. Although growing evidence suggests that PD may be more prevalent in rural communities, there is little information about the life quality of these individuals. This study examines whether HRQOL ratings vary in relation to rural and metropolitan life settings.
Methods: An analytic cross-sectional study was conducted to compare the HRQOL of two separate samples of people with PD living in metropolitan Melbourne and rural Victoria. The metropolitan sample consisted of 210 individuals who had participated in the baseline assessment for an existing clinical trial. The rural sample comprised 24 participants who attended community-based rehabilitation programs and support groups in rural Victoria. Health-related quality of life was quantified using the Parkinson’s Disease Questionnaire-39 (PDQ-39).
Results: The HRQOL of participants in rural Australia differed from individuals living in a large metropolitan city (p=0.025). Participants in rural Australia reported worse overall HRQOL, after controlling for differences in disease duration. Their overall HRQOL was lower than for city dwellers. Rural living was also found to be a significant negative predictor of HRQOL (β=0.14; 95% CI -1.27 to -0.08; _p=0.027).
Conclusion: The findings of this study suggest that some people with PD living in rural Victoria perceive their HRQOL to be relatively poor. In order to minimise the debilitating consequences of this disease, further studies examining the factors that may contribute to the HRQOL of individuals living in rural and remote areas are required.

Barriers and enablers to clinical fieldwork education in rural public and private allied health practice

There is a need to maximise rural clinical fieldwork placement to build health workforce capacity. This study investigated allied health professionals' (AHPs) experience of supervising students as part of work-integrated learning in public and private rural health settings. An anonymous postal questionnaire with 30 questions was used to collect quantitative and qualitative data about the barriers and enablers that AHPs encounter when supervising students in their clinical setting. A total of 113 public and private AHPs from Southwest Victoria, Australia, returned the questionnaire. The AHPs were trained in the disciplines of occupational therapy, physiotherapy, speech pathology, dietetics, podiatry or psychology. The majority of respondents (75%) had previously supervised students. Most respondents had only provided fieldwork education in the public sector. Allied health professionals working in public and private sectors had positive experiences with clinical fieldwork education and often had increased job satisfaction while supervising students. They experienced similar enablers to involvement in clinical fieldwork education programs, however the barriers they encountered were different. The findings highlight the differing issues between rural public and private settings that need to be addressed for successful clinical fieldwork education and work-integrated learning. Strategies to address the identified barriers need to be specific to the work conditions of each setting.

Patterns of time use among regional and rural adolescent girls: associations with correlates of physical activity and health-related quality of life

OBJECTIVES: To describe patterns of time use among regional and rural adolescent girls and compare identified clusters with respect to correlates of physical activity (PA) and health-related quality of life (HRQoL).

DESIGN: Cross-sectional PA and lifestyle survey.

METHODS: Data were from Year 7-9 adolescent girls (aged 12-15 years) from 16 schools involved in a cluster-randomised trial in regional and rural Victoria, Australia (n=494). Time use data were collected using 24-h Previous Day Physical Activity Recall (PDPAR-24) questionnaire, collapsed into 17 categories of time use. Differences between time use clusters with regard to demographics, correlates of PA and HRQoL measured using PedsQL 4.0 Generic Core Scales, were investigated.

RESULTS: Two time use clusters were identified and were associated with correlates of PA and HRQoL. Girls who spent significantly more time in teams sports, non-team sports, school classes, watching TV and sleeping had higher levels of positively aligned PA correlates (e.g. self-efficacy, perceived sports competence) and HRQoL than girls characterised with high levels of computer use and video gaming. CONCLUSIONS: These findings highlight how different activity patterns of regional and rural girls affect HRQoL and can inform future intervention strategies to improve PA levels and HRQoL. Clusters characterised by low levels of PA and high computer use and video gaming require targeted interventions to address barriers to their participation.

Amalgamation of health services in South-West Victoria: reinvention or survival?

In Australia 'the hospital' has long been considered the cornerstone of small, rural health services. However, this premise has been altered significantly by the introduction of casemix loading and diagnostic-related groups that promote a rationalised output-based model of management. In the light of these changes, many rural health services have struggled to reinvent themselves by establishing a range of service models such as Multi-purpose Service (MPS) and Health Streams, while maintaining traditional models (i.e. bush nursing centres, nursing homes and aged-care facilities). These changes are about survival. This paper analyses one such case in south-west Victoria, the Macarthur and District Community Outreach Service, and compares the outcomes with other similar Victorian rural health research projects. Particular attention is paid to the nature of the health services, the management of change and the proposed health outcomes for the local rural communities. In conclusion, it is argued that this study adds to the body of knowledge surrounding the construction of models of community health and development programming, These models impact upon future rural and remote area initiatives throughout Australia.

Health status and participation in a range of activities in an Australian community

Introduction: The aim of the research was to determine the relationship between levels of participation in a community and self-assessed health status of people in a rural and regional setting.
Method: A cross-sectional design, using a mailed, self-administered questionnaire was used. Questionnaires were mailed to a random sample of people aged 18 years and over who were registered on the electoral roll of a regional city and rural area, the Barwon and Otway regions of Victoria, Australia. The sample consisted of 1752 participants: 990 females (57%), 739 males (42%) and 23 sex undisclosed (1%). The range of participants was 18-98 years, and the mean age was 50.53 years (SD = 17.19).
Results: Self-assessed physical and mental health were measured using the SF-12 scale. Participants with low incomes, and those with low self-assessed physical and mental health scores, were significantly more likely than other participants to agree with one or more of the social isolation items, indicating that they experienced some social isolation. Low levels of participation in social, sports, leisure or support activities were associated with low self-assessed physical and mental health. Disengagement with the local community was associated with low levels of self-assessed mental health. While younger people were more likely than older people to participate in social, sports, leisure or support activities, they were less involved as members of their community. Females were more likely than males to have been involved in five or more sports, leisure or support activities. Participation in civic activities was associated with high income. Levels of participation in the four different types of activities were combined (social activities, sport, leisure or support activities, community and group activities, and civic activities). Participants classified as low participators were more likely to be older participants, to have a low income and to have low scores for both physical and mental health.
Conclusions: An association was found between health and community participation in a range of activities, and between health and engagement with the community in this rural and regional population. These findings are consistent with those reported from similar research with a metropolitan population sample. The current research suggests that the groups of people of most concern in terms of low participation rates, are people who have low incomes, people aged over 65 years, people who may be defined as possessing poor physical health and people who may be defined as possessing poor mental health. The relationship between age, community participation and health is complex and needs further exploration because it is not known whether poor health reduces community participation or whether reduced community participation results in poor health. However, current research suggests that developing and implementing strategies to promote people's engagement with and involvement in their local community is one important way of promoting the health of the community as a whole.

A virtual clinic : telemetric assessment and monitoring for rural and remote areas

This article reports the establishment of a pilot ‘virtual clinic’ in a rural region of Victoria, Australia. Using low-cost videophones that work across ordinary phone lines, together with off-the-shelf (mostly automatic) clinical tools, local volunteers have been trained to mediate a virtual consultation between simulated patients and local GPs. This system has the potential to save long trips into town by such patients since the traditional ‘home visit’ is not feasible, as well as to provide regular home monitoring for those with chronic conditions. This in turn should impact favourably on ambulance deployment, sometimes enabling patients to avoid going to hospital or allowing them to come home sooner than otherwise would be the case, and generally to offer a sense of medical security to those living in isolated regions.

Rural parents, teenagers and alcohol: what are parents thinking?

INTRODUCTION: The fundamental role of alcohol in the lives of young Australians is mirrored in the level of drinking by adolescents. In 2001, more than one in four Australian adolescents aged 14-19 years consumed alcohol weekly. Teenagers in rural areas are more likely to consume alcohol than their metropolitan counterparts. Parents are key 'gatekeepers' of adolescent behaviour and as such are a salient group to consider in relation to adolescent alcohol use. The aim of this study was to explore parents' attitudes, beliefs, concerns and receptiveness to harm minimisation strategies with respect to teenage use of alcohol.

METHODS: A convenience sample of parents with adolescent children attended a series of focus groups across the north and north-western area of the State of Victoria, Australia. Schools were approached to advertise the project and invite parents to participate. Snowball sampling was used to enhance recruitment.

RESULTS: Parents described patterns of alcohol use such as 'drinking to get drunk' and the influence of both parents and peers on the consumption of alcohol by adolescents. Few parents were concerned about the long-term risks of alcohol use by teenagers; rather they were more concerned about the short-term harms, for example, road trauma and other accidents and risky behaviours such as binge drinking. Parents indicated that they perceived alcohol to be less harmful than other drugs and many indicated that alcohol was often not perceived to be a drug. A number of strategies were adopted by parents to negotiate teenagers' drinking and to minimise the risks associated with alcohol use. These included transporting teenagers to parties, providing teenagers with a mobile phone, setting clear guidelines about alcohol use and/or providing teenagers with a small amount of alcohol. These were seen by parents as strategies for reducing the risks associated with alcohol consumption. Many parents reported that they do not feel well informed about alcohol use and how and when to use harm reduction strategies.

CONCLUSIONS: Rural parents are unsure how to respond to teenagers' alcohol use and drunkenness. While some parental strategies for harm reduction (such as supplying adolescents with a small amount of alcohol) may have good face validity in reducing alcohol consumption among adolescents, these strategies are not supported by previous research findings.

Nutrition and mental health research in Australia and New Zealand: A review of progress and directions for the future

This review summarises nutrition and mental health research in Australia and New Zealand between 1986 and 2006. The method used to identify papers for inclusion was a search of computerised databases: Medline, Cinahl and Meditext 1986–2006, with subsequent bibliographical review. Key search words were nutrition, diet, mental disorder, mental illness, weight, physical health, Australia and New Zealand. Inclusion criteria included: English language, original data in peer reviewed journals, and examination of some component of nutrition in people with a mental illness. The review of thirteen papers found that the evidence base for dietetic practice in mental health has developed through small assessment and interventional research, often with multidisciplinary collaboration. Future research should include quality and outcome measures with intersectoral partnerships. Dietitians are well positioned to lead and participate in mental health research and to implement research findings to improve the nutritional status of this vulnerable group.

Nutrition and disease burden in Australia : intervening for the nation's health

Editorial on public health policy to improve health of Australians

Intervening to improve health indicators among Australian farm families

The Sustainable Farm Families project (http://www.sustainablefarmfamilies.org.au/) was a 3-year demonstration and education project designed to influence farmer behavior with respect to family health and well-being among cropping and grazing farmers in Victoria, New South Wales, and South Australia, Australia. The project was conducted by the Western District Health Service, Hamilton, Australia, in partnership with farmers; Farm Management 500 (peer discussion group); the Victorian Farmers Federation; Royal Melbourne Institute of Technology; and Land Connect. During the 3 years of the project, 128 farmers—men (70) and women (58)—were enrolled. The project utilized a combination of small group workshops, individualized health action plans, and health education opportunities to encourage farm safety and health behavior changes and to elicit sustained improvements in the following health indicators: body mass index (BMI), total cholesterol, fasting blood glucose, and blood pressure. Mean changes in these health indicators were analyzed using repeated measures analysis of variance (ANOVA) and McNemar's test compared the proportion of individuals with elevated indicators. Among participants with elevated values at baseline, the following average reductions were observed: BMI 0.44 kg/m2 (p = .0034), total cholesterol 48.7 mg/dl (p < .0001), blood glucose 10.1 mg/dl (p = .0016), systolic blood pressure 12.5 mm Hg (p < .0001), and diastolic blood pressure 5.0 mm Hg (p = .0007). The proportion of participants with elevated total cholesterol at baseline decreased after 24 months (p < .001). Such findings suggest that proactive intervention by farmer associations, rural health services, and government agencies may be an effective vehicle for promoting voluntary farm safety and health behavior change while empowering farm families to achieve measurable reductions in important health risk factors.