Parental influences on adolescent fruit consumption : the role of adolescent self-efficacy

The aims of this study were to examine whether adolescent self-efficacy mediates the associations between parental control, perceptions of the importance of healthy nutrition for child health and barriers to buying fruits and vegetables and adolescent fruit consumption using a theoretically derived explanatory model. Data were drawn from a community-based sample of 1606 adolescents in Years 7 and 9 of secondary school and their parents, from Victoria, Australia. Adolescents completed a web-based survey assessing their fruit consumption and self-efficacy for increasing fruit consumption. Parents completed a survey delivered via mail assessing parental control, perceptions and barriers to buying fruit and vegetables. Adolescent self-efficacy for increasing fruit consumption mediated the positive associations between parental control and perceptions of the importance of healthy nutrition for child health and adolescent fruit consumption. Furthermore, adolescent self-efficacy mediated the negative association between parental barriers to buying fruits and vegetables and adolescent fruit consumption. The importance of explicating the mechanisms through which parental factors influence adolescent fruit consumption not only relates to the advancement of scientific knowledge but also offers potential avenues for intervention. Future research should assess the effectiveness of methods to increase adolescent fruit consumption by focussing on both improving adolescents’ dietary self-efficacy and on targeting parental control, perceptions and barriers.

Health system reform and social capital

Jim Hyde suggests that the research on building the capacity of communities and the accumulation of social capital shows that how we organize our health systems - in both micro and macro contexts - is important. He argues that collaboration, flexibility and community participation must become central in health structures.

Precursors and correlates of anxiety trajectories from late childhood to late adolescence

The present research employed a prospective, multi-informant design to examine precursors and correlates of differing anxiety profiles from late childhood to late adolescence. The sample consisted of 626 boys and 667 girls who are participants in the Australian Temperament Project, a large, longitudinal, community-based study that has followed young people's psychosocial adjustment from infancy to adulthood. The present research analyzes data collected from the first 12 waves of data, from 4–8 months to 17 years. Parents, primary school teachers, maternal and child health nurses, and from the age of 11 onward, the young people themselves have provided survey data. Trajectory analyses revealed three distinct patterns of self-reported anxiety from late childhood to late adolescence, comprising low, moderate, and high (increasing) trajectories, which differed somewhat between boys and girls. A range of parent- and teacher-reported factors was found to be associated with these trajectories, including temperament style, behavior problems, social skills, parenting, negative family events, and peer relationships. Compared with male trajectories, female trajectories were associated with a greater variety of psychosocial variables (including parenting and externalizing problems), which may partially account for the higher prevalence of anxiety in adolescent girls compared with boys. Findings shed light on gender-specific pathways to anxiety and the need for comprehensive, integrative approaches to intervention and prevention programs.

Differences in primary health care delivery to Australia's Indigenous population : a template for use in economic evaluations

Background Health economics is increasingly used to inform resource allocation decision-making, however, there is comparatively little evidence relevant to minority groups. In part, this is due to lack of cost and effectiveness data specific to these groups upon which economic evaluations can be based. Consequently, resource allocation decisions often rely on mainstream evidence which may not be representative, resulting in inequitable funding decisions. This paper describes a method to overcome this deficiency for Australia’s Indigenous population. A template has been developed which can adapt mainstream health intervention data to the Indigenous setting.

Methods The ‘Indigenous Health Service Delivery Template’ has been constructed using mixed methods, which include literature review, stakeholder discussions and key informant interviews. The template quantifies the differences in intervention delivery between best practice primary health care for the Indigenous population via Aboriginal Community Controlled Health Services (ACCHSs), and mainstream general practitioner (GP) practices. Differences in costs and outcomes have been identified, measured and valued. This template can then be used to adapt mainstream health intervention data to allow its economic evaluation as if delivered from an ACCHS.

Results The template indicates that more resources are required in the delivery of health interventions via ACCHSs, due to their comprehensive nature. As a result, the costs of such interventions are greater, however this is accompanied by greater benefits due to improved health service access. In the example case of the polypill intervention, 58% more costs were involved in delivery via ACCHSs, with 50% more benefits. Cost-effectiveness ratios were also altered accordingly.

Conclusions The Indigenous Health Service Delivery Template reveals significant differences in the way health interventions are delivered from ACCHSs compared to mainstream GP practices. It is important that these differences are included in the conduct of economic evaluations to ensure results are relevant to Indigenous Australians. Similar techniques would be generalisable to other disadvantaged minority populations. This will allow resource allocation decision-makers access to economic evidence that more accurately represents the needs and context of disadvantaged groups, which is particularly important if addressing health inequities is a stated goal.

Investigating ‘community’ through a history of responses to asbestos-related disease in an Australian industrial region

The government of the State of Victoria has been slow to acknowledge the social costs of asbestos-related diseases (ARD) in the Latrobe Valley. Despite the emphasis on ‘community’ in the discipline of public health and in public health services since the 1970s, ARD was only recognised as a community-wide health problem because of the advocacy of people directly affected by it. An historical view of responses to ARD in a community established as an appendage to the publicly owned power industry and infused with an ethic of public service, shows that contests over the definition of ‘community’ lay at the heart of these responses. It also shows that such disputes did not arise only from the reluctance of authorities to acknowledge the problems resulting from the extensive use of asbestos in power stations. The paper highlights the political nature of the notion of ‘community’ and in doing so raises questions that have implications beyond its narrow regional focus.

Formative evaluation of baby makes 3

Baby Makes 3 was originally developed by Whitehorse Community Health Service and the City of Whitehorse as a program which seeks to prevent violence by promoting respect and equality between couples who have recently become parents for the first time. This is a significant but often stressful event in the life of families and it is not uncommon for couples to adopt ways of relating which reflect gendered norms and foster inequality.
By being offered as a program to all first-time parents by maternal and child health staff, the program in Whitehorse managed to engage with couples at this critical time, many of whom found the program enabled them to adopt greater equality in their relationships. As such, the initial Baby Makes 3 program has been found to be an effective and cost-efficient violence prevention strategy (Flynn, 2011).
The introduction of Baby Makes 3 to the Great South Coast Region is the first time this program has been implemented in a non-metropolitan setting. In addition to the original program aims, a number of additional aims and activities have been added, with the new project being known as Baby Makes 3 Plus.
Programs developed in urban contexts often face different challenges when implemented in rural and regional settings. Likewise, the factors for facilitating success may vary from those in an urban setting (Maidment and Bay, 2012). Hence, this formative evaluation aims to provide feedback on the initial implementation of the original Baby Makes 3 program in the Great South Coast Region with the expectation this will enable problems with implementation and/or opportunities for further enhancement of outcomes to be identified and appropriate action taken.

Home delivery in Southern Lao PDR: challenges to achieving MDG 4 & 5 targets

This study investigated rural Lao PDR village women's views and experiences of recent, or impeding, childbirth to better understand barriers to maternity service usage. Lao PDR has the highest maternal mortality rate (MMR) in the South-East Asian region with very low utilization rates for skilled birth assistance and health sector delivery services. The study site, Sekong, a southern Lao province, was lowest in the country on virtually all indicators of reproductive and maternal health, despite several recent maternal health service interventions. The study's aim was to gain a fuller understanding of barriers to maternity services usage to contribute towards maternity services enhancement, and district and national policy-making for progressing towards 2015 MDG 4 & 5 targets. 

Mental health service delivery : a profile of mental health non-government organisations in south-east Queensland, Australia.

Non-government organisations make a substantial contribution to the provision of mental health services; despite this, there has been little research and evaluation targeted at understanding the role played by these services within the community mental health sector. The aim of the present study was to examine the depth and breadth of services offered by these organisations in south-east Queensland, Australia, across five key aspects of reach and delivery.

Mental Health First Aid: an international programme for early intervention.

AIM: To describe the development of the Mental Health First Aid (MHFA) programme in Australia, its roll-out in other countries and evaluation studies which have been carried out. METHODS: A description of the programme's development and evaluation, its cultural adaptations and its dissemination in seven countries. RESULTS: The programme was developed in Australia in 2001. By the end of 2007, there were 600 instructors and 55,000 people trained as mental health first aiders. A number of evaluations have been carried out, including two randomized controlled trials that showed changes in knowledge, attitudes and first aid behaviours. Special adaptations of the course have been rolled out for Aboriginal and Torres Strait Islander peoples and some non-English speaking immigrant groups. The course has spread to seven other countries with varying degrees of penetration. In all countries, the programme has been initially supported by government funding. Independent evaluations have been carried out in Scotland and Ireland. CONCLUSIONS: The concept of first aid by the public for physical health crises is familiar in many countries. This has made it relatively easy to extend this approach to early intervention by members of the public for mental disorders and crises. Through MHFA training, the whole of a community can assist formal mental health services in early intervention for mental disorders.

Health-care costs of underweight, overweight and obesity: Australian population-based study

AIM: Child health varies with body mass index (BMI), but it is unknown by what age or how much this attracts additional population health-care costs. We aimed to determine the (1) cross-sectional relationships between BMI and costs across the first decade of life and (2) in longitudinal analyses, whether costs increase with duration of underweight or obesity. METHODS: Participants: Baby (n = 4230) and Kindergarten (n = 4543) cohorts in the nationally representative Longitudinal Study of Australian Children. OUTCOME: Medicare Benefits Scheme (including all general practitioner plus a large proportion of paediatrician visits) plus prescription medication costs to federal government from birth to sixth (Baby cohort) and fourth to tenth (Kindergarten cohort) birthdays. PREDICTOR: biennial BMI measurements over the same period. RESULTS: Among Australian children under 10 years of age, 5-6% were underweight, 11-18% overweight and 5-6% obese. Excess costs with low and high BMI became evident from age 4-5 years, with normal weight accruing the least, obesity the most, and underweight and overweight intermediate costs. Relative to overall between-child variation, these excess costs per child were very modest, with a maximum of $94 per year at age 4-5 years. Nonetheless, this projects to a substantial cost to government of approximately $13 million per annum for all Australian children aged less than 10 years. CONCLUSIONS: Substantial excess population costs provide further economic justification for promoting healthy body weight. However, obese children's low individual excess health-care costs mean that effective treatments are likely to increase short-term costs to the public health purse during childhood.

Is the adiposity rebound a rebound in adiposity?

OBJECTIVE: Early adiposity rebound ([AR], when body mass index [BMI] rises after reaching a nadir) strongly predicts later obesity. We investigated whether the upswing in BMI at AR is accompanied by an increase in body fat. DESIGN: Community-based cohort study. SUBJECTS: A total of 299 first-born children (49% male). Measurements. Six-monthly anthropometry and bioelectrical impedance, 4-6.5 years; lean and fat mass index (kg/m(2)) for direct comparison with BMI. Supplementary (0-2 years) weight and length measures (needed for growth curve modelling) were drawn from subjects' child health records. METHODS: AR was estimated from individually modelled BMI curves from birth to 6.5 years. Two main analyses were performed: 1) cross-sectional comparisons of BMI, fat mass index (FMI), lean mass index (LMI) and percent body fat in children with early (<5 years) and later (>5 years) rebound; and 2) investigation of linear trends in BMI, FMI, LMI and percent body fat before and after AR. Results. The 81 children (27%) experiencing early AR had higher BMI, FMI, LMI and percent fat at 6.5 years. Overall, FMI decreased steeply pre-AR, at -0.56 (0.02) kg/m(2) per year (mean [Standard Error]), then flattened post-AR to 0.07 (0.05) kg/m(2) per year. In contrast, LMI increased pre-AR (0.34 [0.01]) and steepened post-AR (0.47 [0.03] kg/m(2) per year). CONCLUSION: The 'adiposity rebound' is characterised by increasing lean mass index, coupled with cessation of the decline in fat mass index. Understanding what controls the dynamics of childhood body composition and mechanisms that delay AR could help prevent obesity.

The NICHD protocol: a review of an internationally-used evidence-based tool for training child forensic interviewers

Purpose
– The purpose of this paper is to review an evidence-based tool for training child forensic interviewers called the National Institute of Child Health and Human Development Protocol (NICHD Protocol), with a specific focus on how the Protocol is being adapted in various countries.
Design/methodology/approach
– The authors include international contributions from experienced trainers, practitioners, and scientists, who are already using the Protocol or whose national or regional procedures have been directly influenced by the NICHD Protocol research (Canada, Finland, Israel, Japan, Korea, Norway, Portugal, Scotland, and USA). Throughout the review, these experts comment on: how and when the Protocol was adopted in their country; who uses it; training procedures; challenges to implementation and translation; and other pertinent aspects. The authors aim to further promote good interviewing practice by sharing the experiences of these international experts.
Findings
– The NICHD Protocol can be easily incorporated into existing training programs worldwide and is available for free. It was originally developed in English and Hebrew and is available in several other languages.
Originality/value
– This paper reviews an evidence-based tool for training child forensic interviewers called the NICHD Protocol. It has been extensively studied and reviewed over the past 20 years. This paper is unique in that it brings together practitioners who are actually responsible for training forensic interviewers and conducting forensic interviews from all around the world.

Meeting art with art : arts-based methods enhance researcher reflexivity in research with mental health service users

This paper presents a rationale for arts-based practices in music therapy research, and provides an example of using ABR techniques in research. Arts-based materials are increasingly demonstrated to have the capacity to extend processes of reflexivity and analysis in a range of qualitative health research studies. By comparison, music therapy research studies have rarely employed arts-based methods or techniques. There is a need for more studies in music therapy that employ arts-based research to demystify and elaborate a wider range of creative approaches within music therapy inquiry. In the study described in this paper, ABR was used to reflect on the contribution of a service user in a community mental health context who participated in a focus group about his experiences of music therapy. ABR was found to offer a creative way to engage service users, and to deepen and extend the researcher's reflexivity when responding to materials created by research participants.