Economic evaluation of a skin cancer prevention program in Australia : past achievements and future prospects

Objectives
Australia has the highest incidence of skin cancer in the world. Skin cancer prevention campaigns have been implemented in Australia for over two decades. The most notable is under the brand name, SunSmart. The aim of the current study is to assess the cost-effectiveness of SunSmart in the past and the potential cost-effectiveness of an ongoing national SunSmart program with optimal investment in the future.

Methods
An economic evaluation from a health sector perspective was conducted using the reduction in skin cancer incidence attributable to the SunSmart program modelled as the primary end-point. Historical SunSmart program expenditures were obtained from three representative states in three latitude zones, covering different levels of UVR exposure. Melanoma incidence rates from the three representative state cancer registers were used to model the health outcomes. Program effectiveness was assessed by the comparison between the well-resourced SunSmart state (Victoria) and the under-invested states (New South Wales and Queensland). Non-Melanoma Skin Cancer (NMSC) was modelled based on national survey results. 2003 was chosen as the reference year and future costs/outcomes over a 20 year time horizon were discounted at 3%.
The future level of investment in a national SunSmart was chosen to strengthen current practice by increasing current investment to a realistic and achievable level. This conservative increase in investment (expressed as ‘$ per capita’) reflected the investment level that has been achieved in Victoria over sustained periods. To model the potential cost-effectiveness of an upgraded national SunSmart program, a conservative approach was taken, whereby the same magnitude of effectiveness from 1988 to 2003 was applied to future skin cancer incidence.

Results
SunSmart in Victoria has saved 22,300 life-years, averted 27,900 disability-adjusted life-years(DALYs)(discounted) since its introduction in 1988 and achieved an incremental cost-effectiveness ratio (ICER) of $AUD 680 per life-year saved (LYS) and $AUD 540 per DALY averted. When the cost-offset from the estimated reduction in skin cancer treatment costs were taken into account, SunSmart achieved ‘dominance’. The net cost of SunSmart in the past was an estimated saving of $AUD 93 million. An upgraded national SunSmart for the next 20 years would save 91,000 life-years and avert 122,000 DALYs (discounted), involving an increased investment level from the current $AUD 0.07 per capita to the historical average of $AUD 0.28 per capita. The ICER for the upgraded SunSmart program was estimated at $AUD 940 per LYS and $AUD 700 per DALY averted. When the cost-offset is included, the program achieves dominance with a cost saving of $AUD 115 million – an estimated $AUD 2.32 return for every dollar invested between 2003 and 2022.

Conclusions
This study demonstrates that a sustained modest investment in skin cancer control is likely to be excellent value-for-money. While the available data base is certainly not prefect, key parameters would have to change dramatically for this conclusion to be challenged.

Be(ing) prepared : girl guides, colonial life, and national strength

This paper seeks to bridge a gap in feminist critique of gender and empire with regard to the founding of the Girl Guide movement in 1909. In contrast with previous studies of the Boy Scouts, which have briefly considered Guides as a mere derivative organisation, it suggests that the formation of the Guides, and printed material such as the first handbook How Girls Can Help Build Up the Empire (1912), were grounded in notions of the part which women, and girls specifically, could play in the imperial project. This paper proposes that, although tempered by an emphasis on raising children in order to prevent the “degeneration” of the British race, the Guide handbook permits increased non-domestic activity for Edwardian girls, which is justified by aims of preparing for home defence in case of foreign attack and for life in the colonies.

Homeostatic mechanism : subjective quality of life and chronic pain

Investigates the maintenance of subjective quality of life in the presence of chronic pain. A homeostatic mechanism is proposed and examined in terms of the roles of the suggested components and how these are altered by the threat of chronic pain.

Civil society, social capital and the Twelve Step group

This article examines the nature of community and family by using the concept of civil society through a Twelve Step group called Al-Anon. Al-Anon is related to Alcoholics Anonymous and is a support group for families of alcoholics. The concept of civil society is addressed by looking at its development in political philosophy and sociology. The work of Putnam, in particular, is used to understand how civil society and the associations which make it up develop social capital [Making Democracy Work: Civic Traditions in Modern Italy, Princeton University Press (1993); Journal of Democracy, 6(1), 65-78 (1995); The Responsive Community, 5(2), 18-33 (1995)]. Social capital is understood to be norms and values such as trust and reciprocity that enable sociability or social connectedness. Community, then, embodies these norms of trust and reciprocity through their development in Al-Anon. Al-Anon is studied as an example of an association in civil society. The data come from an ethnographic study in Australia and five European countries as well as in-depth interviews with women members in Australia. The article reviews the similarities and differences between the various countries as well as the form that social capital takes for individual members.

Love thy neighbour? Associations of social capital and crime with physical activity amongst women

Using a multilevel study design, this study examined the associations between social characteristics of individuals and neighbourhoods and physical activity among women. Women (n = 1405) recruited from 45 Melbourne (Australia) neighbourhoods of varying socioeconomic disadvantage provided data on social factors and leisure-time: physical activity; walking; and walking in one’s own neighbourhood. Individual level social factors were number of neighbours known and social participation. Neighbourhood-level social characteristics (interpersonal trust, norms of reciprocity, social cohesion) were derived by aggregating survey data on these constructs within neighbourhoods. Objective data on crimes within neighbourhoods were obtained from Victoria Police. In bivariable regression models, all social variables at both the individual and neighbourhood level were positively associated with odds of physical activity, walking, and walking in one’s own neighbourhood. Associations with individual social participation (associated with all three physical activity variables) and neighbourhood interpersonal trust (associated with overall physical activity only) remained significant in multivariable models. Neither neighbourhood crime against the person nor incivilities were associated with any form of physical activity. These results demonstrate that women who participated in local groups or events and, less consistently, women living in neighbourhoods where residents trusted one another, were more likely to participate in leisure-time physical activity. While redressing macro-level social and economic policies that contribute to neighbourhood inequalities remains a priority, public health initiatives aimed at promoting physical activity could consider focusing on fostering social interactions targeting both individuals and communities. Further investigation of causal mechanisms underlying these associations is required.

Social work and welfare education without discrimination : are we there yet?

The Australian Human Rights Commission (AHRC) has identified education as one of five crucial issues relating to the settlement of African Australians into the Australian community from a human rights perspective (AHRC 2009:5). In this paper I advocate that social work and welfare work in Australia are placed in important and multi dimensioned positions in relation to our complicities, responsibilities and potentialities with this educational human rights issue. As a Technical and Further Education (TAFE) welfare and University social work educator, I offer an outline of the ‘mutual respect inquiry approach’ that developed between myself and Southern Sudanese Australian students as a basis for discussion, reflection and change. I seek to stimulate thinking and action, particularly among those welfare work and social work educators, practitioners and students who identify as critical and anti-oppressive, to consider how these approaches can be realised and reshaped in practice to enhance not only Southern Sudanese Australians' right to education that is 'without discrimination', but indeed all students in our diversity.

Reflecting on contemporary accounting : teaching and learning social and critical perspectives

This paper provides a case description and analysis of an effort to enact accounting education change. The study reports on an attempt to renew the social and ethical worth of accounting education and practice in the post-Enron context of increased interest in how accounting may contribute to social responsibility and sustainability. The paper considers the organisation, aims, and content of a newly-developed unit on social and critical perspectives on accounting, and key elements of the pedagogy utilised. These include team teaching, the employment of research literature rather than a prescribed textbook, an expanded conception of accounting and accounting “knowledge”, the adoption of educational goals that encompass preparing students for economic and social life and for democratic participation, and a view that sees ethics, the environment, and society as central to accounting. It is concluded that accounting educational change must encompass the content and practice of classroom activity, but it also requires change to the self-consciousness of all actors involved. Explicit inclusion of the social, critical, environmental and ethical dimensions of accounting in our teaching and learning programs provides an avenue for academics to individually and collectively make a meaningful contribution.

The transnational corporation, corporate social responsibility and the 'outsourcing' debate

Current popular debates in the United States and Australia on the topics of 'jobless recoveries' and the 'outsourcing' of skilled IT jobs to India (most conspicuously) evidence a confusion as to the institutional role of the business firm and its obligations to the broader stakeholder community, as well as to the more specific differences between outsourcing and the spatial restructuring of corporate value-chains. This paper will take up several issues in the hope of clarifying this confusion, including the essential nature of the business firm as an economic, political and social institution; the possibilities for social responsibility and stakeholder management in large internationalised firms; and the critical distinctions between domestic and international outsourcing and spatial restructuring. Data from the 'outsourcing' debate will be referenced to illustrate the differing logics/rationalities of relevant stakeholder groups.

From Masterchef to the Arab spring via Wikileaks : social media and political change

This comparison between Bahrain and Australia shows how the main impact of social and mobile media has been in the form of facilitators of rapid political mobilization, as well as tools for everyday socializing and entertainment. Social media are both contributors to, and symptomatic of, a blurring of the boundaries between politics and entertainment, and public and private spheres, whether their users are in Australia or Bahrain, but they are not in themselves the makers of material sites of democracy or even agency.

The neighborhood social environment and body mass index among youth : a mediation analysis

Background

This study aimed to examine associations between aspects of the neighborhood social environment and body mass index (BMI) in youth both cross-sectionally and prospectively; and whether this association was mediated by physical activity, screen-time and sedentary time.
Methods

Data were collected in 2004 and 2006 in high and low socio-economic areas of Melbourne, Australia. In 2004, 185 children aged 8-9 years (47% boys) and 359 children aged 13-15 years (45% boys) participated. Parents reported their perceptions of aspects of the social environment (i.e. social networks and social trust/cohesion), and physical activity (i.e. time spent outdoors by their children; and their younger children's walking and cycling trips) and screen-time (i.e. TV viewing, computer use). The older children self-reported their walking and cycling trips and their screen-time. All children wore an accelerometer to objectively assess outside-school hours moderate- to-vigorous physical activity and sedentary time. BMI was calculated from height and weight measured in 2004 and 2006. Multilevel linear regression analyses were conducted to examine associations between the social environment and BMI. Mediation analyses using the products of coefficient method were conducted to determine whether associations between the social environment and BMI were mediated by the time spent in a range of physical activity and sedentary behaviors.
Results

Cross-sectional and prospective regression analyses showed that a more positive social network and higher social trust/cohesion was related to lower BMI among children. There was no evidence that time spent in physical activity or sedentary behaviors mediated this relation, despite significant associations between social networks and screen-time and between screen-time and BMI.
Conclusions

The findings suggest that the neighborhood social environment may be important for preventing overweight and obesity in children. Further research investigating the mechanisms through which the neighborhood social environment exerts its effect on BMI is needed.

Social identity and sound change : the case of Wo in Shanghainese

Research has shown that language change is driven on one hand by forces internal to language itself such as grammar-internal systematic pressure, and on the other hand by social motives such as social identity. Language contact presents new features, but why is it that some of them are incorporated as variation and evolving into language change, while others are not? This paper reports a study on a sound change in Shanghainese, a dialect of the Chinese language. Data were collected in natural contexts of conversation followed by a brief interview with informants to gain identity related information about them. It has found that previously negative perception of status attached to a new sound induced by language/dialect contact changed into a positive perception, and people started to identify positively with this new sound. Further, there were differences in various different age and gender groups in taking up the new sound. As a result, this sound has evolved from a nonnative alternative to a systematic variation and it is being established as a sound change. This study has thus further confirmed that social identity plays a pivotal role in driving language features into language variation and language change.

Making Connections in Geelong : migrants, social capital and growing regional cities

Migration has been increasingly used to compensate for demographic trends and skill shortages in developed countries. This has resulted in policies to encourage migration to regional areas in order to relieve pressures on liveability and infrastructure in big cities. Like many other regional cities in Victoria, Geelong actively encourages migrants from overseas, from Melbourne and from other parts of rural and regional Australia, by promoting workforce participation, and enhancing lifestyles to attract and retain a growing population. A number of countries including Australia, Canada, Italy and Spain have policies to encourage immigration to locations other than large urban centres to stimulate regional economic development and to ensure immigrants fill skill shortages in regional areas. However, migrants do not always stay long in the regional locations where they initially settle, and new migrants are needed to replace their skills. Given the Australian and Victorian government policy imperatives of encouraging regional migration there is a need to understand how migrants and their families make the social connections that contribute to wellbeing and their retention in regional areas such as Geelong. This paper emerges from a research project on this challenge at Deakin University, in Geelong It discusses some of the issues associated with regional migration and describes how a sound, theoretically informed understanding of social capital can assist employers, governments and community groups (formal and informal) to effectively assist migrants to make social connections and therefore remain in regional cities.

The social life of categories : an empirical study of term categorization

Most classification schemes in common use are actually categorization schemes which fall somewhere on a continuum between unstructured, uncontrolled lists of terms and formal classifications. Over time, terms change meaning and acquire new definitions. This paper presents the results of an approach that used the librarianship principle of consensus to form categories of terms and to relate those categories using a domain reference group. Boisot's Social Learning Cycle (SLC) was then used as a model with which to explain category variations. The single study undertaken in this investigation demonstrated the value of the SLC for explaining the variations between reference group members, and showed the potential for explaining category changes over time. This identifies areas in which consensus is breaking down or emerging, allowing for focused maintenance of categorical schemes.

A clustered randomised trial examining the effect of social marketing and community mobilisation on the age of uptake and levels of alcohol consumption by Australian adolescents

Introduction
Throughout the world, alcohol consumption is common among adolescents. Adolescent alcohol use and misuse have prognostic significance for several adverse long-term outcomes, including alcohol problems, alcohol dependence, school disengagement and illicit drug use. The aim of this study was to evaluate whether randomisation to a community mobilisation and social marketing intervention reduces the proportion of adolescents who initiate alcohol use before the Australian legal age of 18, and the frequency and amount of underage adolescent alcohol consumption.
Method and analysis
The study comprises 14 communities matched with 14 non-contiguous communities on socioeconomic status (SES), location and size. One of each pair was randomly allocated to the intervention. Baseline levels of adolescent alcohol use were estimated through school surveys initiated in 2006 (N=8500). Community mobilisation and social marketing interventions were initiated in 2011 to reduce underage alcohol supply and demand. The setting is communities in three Australian states (Victoria, Queensland and Western Australia). Students (N=2576) will complete school surveys in year 8 in 2013 (average age 12). Primary outcomes: (1) lifetime initiation and (2) monthly frequency of alcohol use. Reports of social marketing and family and community alcohol supply sources will also be assessed. Point estimates with 95% CIs will be compared for student alcohol use in intervention and control communities. Changes from 2006 to 2013 will be examined; multilevel modelling will assess whether random assignment of communities to the intervention reduced 2013 alcohol use, after accounting for community level differences. Analyses will also assess whether exposure to social marketing activities increased the intervention target of reducing alcohol supply by parents and community members.