Effects of message framing on breast-cancer-related beliefs and behaviours: the role of mediating factors

The effects of gain-loss message framing on breast-cancer-related cognitions and behaviors were assessed among 539 women aged 30 to 70 years. The design involved a prebrochure telephone interview, followed by a brochure mailout, and a postbrochure telephone interview. The brochures contained information about breast cancer and the risk of family history. Recommended behaviors were framed to emphasize gains, losses, or were neutral; and statistical risk information was presented either positively or negatively. Measures included demographics, family history, breast self-examination (BSE) performance, BSE intention, self-efficacy in performing BSE, perceived early detection risk of breast cancer, perceived susceptibility to breast cancer, and anxiety about breast cancer. A loss-framed message led to greater positive change in BSE behavior. Interactions between framing effects and variables of issue involvement, perceived early detection risk, and self-efficacy indicated effects on behavior, but not beliefs.

Factors associated with breast and cervical cancer screening behaviours

To investigate the factors associated with the use of screening mammography for breast cancer and cervical smear tests for cervical cancer, a theoretical framework was used comprising elements from the Health Belief Model, the Theory of Reasoned Action, and illness representations from the self-regulatory model. Items reflecting older women’s illness representations about cancer and cancer screening were derived from an earlier qualitative study. Using a highly structured interview schedule, telephone interviews were conducted with 1,200 women aged 50-70 years. There were considerable similarities between the factors associated with both mammography and cervical smear test behaviours. The factors associated with screening mammography behaviour were: perceived barriers, perceived benefits, social influence, the illness representations, and marital status. The factors associated with cervical smear test behaviour were: perceived barriers, perceived benefits, emotions as a cause of cancer, feeling frightened of cancer, the illness representations, having a usual general practitioner, and being younger.

Gay men's estimates of the likelihood of HIV transmission in sexual behaviours

In 3 studies we recorded gay men's estimates of the likelihood that HIV would be transmitted in various sexual behaviours. In Study 1 (data collected 1993, n=92), the men were found to believe that transmissibility is very much greater than it actually is; that insertive unprotected anal intercourse (UAI) by an HIV-infected partner is made safer by withdrawal before ejaculation, and very much safer by withdrawal before either ejaculation or pre-ejaculation; that UAI is very much safer when an infected partner is receptive rather than insertive; that insertive oral sex by an infected partner is much less risky than even the safest variant of UAI; that HIV is less transmissible very early after infection than later on; and that risk accumulates over repeated acts of UAI less than it actually does. In Study 2 (data collected 1997/8, n=200), it was found that younger and older uninfected men generally gave similar estimates of transmissibility, but that infected men gave somewhat lower estimates than uninfected men; and that estimates were unaffected by asking the men to imagine that they themselves, rather than a hypothetical other gay man, were engaging in the behaviours. Comparison of the 1993 and 1997/8 results suggested that there had been some effect of an educational campaign warning of the dangers of withdrawal; however, there had been no effect either of a campaign warning of the dangers of receptive UAI by an infected partner, or of publicity given to the greater transmissibility of HIV shortly after infection. In Study 3 (data collected 1999, n=59), men induced into a positive mood were found to give lower estimates of transmissibility than either men induced into a neutral mood or men induced into a negative mood. It is argued that the results reveal the important contribution made to gay men's transmissibility estimates by cognitive strategies (such as the 'availability heuristic' and 'anchoring and adjustment') known to be general characteristics of human information-processing. Implications of the findings for AIDS education are discussed.

Family food environments as determinants of preschool-aged children`s eating behaviours: implications for obesity prevention policy. A review.

Children's eating behaviours are fundamental to their health. Dietary surveys indicate that children's food consumption is likely to promote a range of diet-related diseases, including overweight and obesity, which are associated with a range of psychosocial and physical disorders. With the prevalence of overweight and obesity rapidly increasing, opportunities for informed prevention have become a focus of strategy. Diet is recognised as important in the genesis of obesity. We present data that demonstrate that eating behaviours are likely to be established early in life and may be maintained into adulthood. We review literature that shows that children's eating behaviours are influenced by the family food environment. These findings suggest that the family environment should be considered in developing obesity prevention strategy for children, yet the current strategy focuses primarily on the school environment. Those factors in the family environment that appear to be important include: parental food preferences and beliefs, children's food exposure; role modelling; media exposure; and child-parent interactions around food. However, the existing data are based on small scale and unrepresentative US samples. At a population level, we have few insights regarding family food environments and consequently little information about how such environments influence children's eating behaviours and thus their risk for obesity. We suggest research that may promote a better understanding of the role of family food environments as determinants of children's eating behaviour, and consider the implications for obesity prevention in Australia. (Aust J Nutr Diet 2001;58:19-25)

Football-as-war, coach-as-general: analogy, metaphor and management implications

Sporting terms have been used as metaphor and analogy to describe and prescribe life experiences. It has been suggested that the use of sport terminology can assist in the general understanding of complex terms and situations, however, the use of sport as metaphor and analogy for many aspects of social understanding can have negative consequences. The analogy of sport and war seems to be particularly prevalent within football, irrespective of the code or culture in which it is played. This article demonstrates the popular understanding of Australian Rules ‘football as war’ through two complementary studies. The first study investigates the representation of Australian Rules football as war, specifically through the analysis of both images and text on the front covers of the sport ‘lift-out’ sections of two prominent Melbourne newspapers, The Herald Sun and The Age. The second study examines whether people interpret non-war-like images of Australian Rules football in war-like terms. Forty-five undergraduate sport marketing and management students were asked to write about one of four different images of football players and coaches interacting, which revealed that football is understood as war. Further, when prompted by an image of football players and coaches interacting, people in this study interpreted the interactions as consistently war-like. Coaches were portrayed as militaristic generals and the athletes as soldiers. Implications for management, education and practice are discussed.

Social factors and obesity: an investigation of the role of health behaviours

OBJECTIVES: This study evaluated a behavioural model of the relation between social factors and obesity, in which differences in body mass index (BMI) across sociodemographic groups were hypothesized to be attributable to social group differences in health behaviours affecting energy expenditure (physical activity, diet and alcohol consumption and weight control).

METHODS: A total of 8667 adults who participated in the 1995 Australian National Health and Nutrition Surveys provided data on a range of health factors including objectively measured height and weight, health behaviours, and social factors including family status, employment status, housing situation and migration status.

RESULTS: Social factors remained significant predictors of BMI after controlling for all health behaviours. Neither social factors alone, nor health behaviours alone, adequately explained the variance in BMI. Gender-specific interactions were found between social factors and individual health behaviours.

CONCLUSIONS: These results suggest that social factors moderate the relation between BMI and weight-related behaviours, and that the mechanisms underlying sociodemographic group differences in obesity may vary among men and women. Additional factors are likely to act in conjunction with current health behaviours to explain variation in obesity prevalence across sociodemographic groups.

Why do women of low socioeconomic status have poorer dietary behaviours than women of higher socioeconomic status? A qualitative exploration

In developed countries, persons of low socioeconomic status (SES) are generally less likely to consume diets consistent with dietary guidelines. Little is known about the mechanisms that underlie SES differences in eating behaviours. Since women are often responsible for dietary choices within households, this qualitative study investigated factors that may contribute to socioeconomic inequalities in dietary behaviour among women. Semi-structured interviews were conducted with 19 high-, 19 mid- and 18 low- SES women, recruited from Melbourne, Australia, using an area-level indicator of SES. An ecological framework, in which individual, social and environmental level influences on diet were considered, was used to guide the development of interview questions and interpretation of the data. Thematic analysis was undertaken to identify the main themes emerging from the data. Several key influences varied by SES. These included food-related values such as health consciousness, and a lack of time due to family commitments (more salient among higher SES women), as well as perceived high cost of healthy eating and lack of time due to work commitments (more important for low SES women). Reported availability of and access to good quality healthy foods did not differ strikingly across SES groups. Public health strategies aimed at reducing SES inequalities in diet might focus on promoting healthy diets that are low cost, as well as promoting time-efficient food preparation strategies for all women.

Sun exposure and sun protection behaviours among Australian adolescents: trends over time

Background
This study compared the sun exposure and sun protection behaviours of adolescent students between 1993 and 1999.

Methods
Schools from all Australian states and the two territories participated in each of the 1993, 1996, and 1999 surveys and a sample of students from years 7 to 12 were surveyed. In each of the states and territories a random sample of schools was selected within each education sector (government, Catholic, independent). The questionnaire was a self-completed booklet with questions about sunburn history during the previous summer, tan preferences, skin-type, and usual reported behaviour. Data from a total of 78,032 students were available for analysis.

Results
From 1993 to 1999 there was a significant increase in the number of students reporting sunburn during the previous summer (χ2 = 225.77, df = 2, P < 0.01). However, the percentage of students who preferred no tan at all increased over the same period (χ2 = 184.47, df = 2, P < 0.01). The percentage of students who usually or always wore clothing that covered most of their body decreased between 1993 and 1999 (χ2 = 20.46, df = 2, P < 0.01); the percentage of students usually or always wearing maximum protection sunscreen decreased over time (χ2 = 27.71, df = 2, P < 0.01). Staying in the shade increased from 1993 (26%) to 1996 (32%) but decreased slightly in 1999 (30%). Across all survey years, only 11% of students routinely followed all three protective behaviours of wearing a hat, sunscreen, and clothes that cover the body.

Conclusions
Sun protection practices among adolescents are still below optimal levels. Future educational programs require innovative approaches that aims to change attitudes toward tanning as being healthy and attractive and modify adolescent behaviours in relation to sun exposure.

A defection analysis of lapsed members of five sporting clubs : examining motivations and behaviours

The issue of defection has been examined primarily in a transactional context as opposed to subscription markets where the infrequent nature of the purchase or renewal means that retention of subscribers is often both more difficult and more crucial. This paper reports on a survey that aimed to uncover more information about the motivations and future intentions of recently lapsed subscribers. 1,011 lapsed members across four Australian Football League (AFL) clubs and one Australian National Rugby League (NRL) club were surveyed. Analysis of the responses returned suggests that although these lapsed members report that they joined to financially support and feel more involved with the club, they let their membership lapse primarily due to an inability to attend games. Despite joining for intangible, altruistic reasons, it seems that if these members could not get to games, they believed that the membership was not worth maintaining. These members were satisfied with the membership; however measures of overall level of satisfaction had only a weak positive relationship with the likelihood of members rejoining in the future. The inconsistencies in the findings challenge some conventional approaches to both the methods of researching lapsed members and the theories that are frequently used to explain behaviours. We find that simplistic entry or exit surveys are likely to be of limited value in subscription defection research and that satisfaction is unlikely to be a strong predictor of defection behaviour.

Applying GIS in physical activity research: community walkability and walking behaviours.

Physical activity provides many health benefits, including reduced risk of cardiovascular disease, Type II diabetes and some cancers. Environmental exposure factors (e.g., the built environment) are now receiving ever-increasing attention. Large-scale interdisciplinary studies on the association between attributes of local community environments and residents’ physical activity are being conducted. We will focus on findings from Australia - the Physical Activity in Localities and Community Environments (PLACE) study. PLACE is examining factors that may influence the prevalence and the social and spatial distribution of walking for transport and walking for recreation. A stratified two-stage cluster sampling strategy was used to select 32 urban communities (154 census collection districts), classified as high and low ‘walkable’ using a GISbased walkability index (dwelling density, intersection density, net retail area and land use mix) and matched for socio-economic status. We report data on a sub-sample of 1,216 residents who provided information on the perceived attributes of their community environments (e.g., dwelling density, access to services, street connectivity) and weekly minutes of walking for transport and for recreation. Moderate to strong associations were found between GIS indicators of walkability and the corresponding self-report measures. The walkability index explained the same amount of neighborhood-level variance in walking for transport as did the complete set of self-report measures. No significant associations were found with walking for recreation. Relevant GIS-based indices of walkability, for purposes other than transport need to be   developed.

The dietary, physical activity and sedentary behaviours of Victorian regional secondary school students

The aim of this study was to investigate the dietary, physical activity and sedentary behaviours of adolescents from four secondary schools in Warrnambool, regional Victoria. In 2004, a random sample of students (n=712), stratified by school year level, was generated from school enrolment databases and 443 students completed a lifestyle questionnaire. Twenty per cent of students were physically active for 60 minutes or more per day; 28 per cent used electronic media in free time for a maximum of two hours per day. Only seven per cent of students met these two Australian physical activity recommendations. Fruit, vegetables and dairy products were consumed every day by 39 per cent, 40 per cent and 71 per cent of students respectively; three serves per day of each of these foods are recommended for Australian adolescents. Compared with boys, girls were less physically active (p<0.001), consumed more fruit (p=0.011) and vegetables (p<0.001), but fewer dairy products (p<0.024). Seventeen per cent of students were overweight or obese; these students were less physically active than normal weight peers (p<0.018). The dietary, physical and sedentary behaviours of regional Victorian secondary school students in this study were inadequate when compared with Australian recommendations. Dietary and physical activity habits are still evolving in adolescence and unhealthy habits can still be changed.

Patient engagement and coaching for health: the PEACH study- a cluster randomised controlled trial using the telephone to coach people with type 2 diabetes to engage with their GPs to improve diabetes care: a study protocol.

Background
The PEACH study is based on an innovative 'telephone coaching' program that has been used effectively in a post cardiac event trial. This intervention will be tested in a General Practice setting in a pragmatic trial using existing Practice Nurses (PN) as coaches for people with type 2 diabetes (T2D). Actual clinical care often fails to achieve standards, that are based on evidence that self-management interventions (educational and psychological) and intensive pharmacotherapy improve diabetes control. Telephone coaching in our study focuses on both. This paper describes our study protocol, which aims to test whether goal focused telephone coaching in T2D can improve diabetes control and reduce the treatment gap between guideline based standards and actual clinical practice.
Methods/design
In a cluster randomised controlled trial, general practices employing Practice Nurses (PNs) are randomly allocated to an intervention or control group. We aim to recruit 546 patients with poorly controlled T2D (HbA1c >7.5%) from 42 General Practices that employ PNs in Melbourne, Australia. PNs from General Practices allocated to the intervention group will be trained in diabetes telephone coaching focusing on biochemical targets addressing both patient self-management and engaging patients to work with their General Practitioners (GPs) to intensify pharmacological treatment according to the study clinical protocol. Patients of intervention group practices will receive 8 telephone coaching sessions and one face-to-face coaching session from existing PNs over 18 months plus usual care and outcomes will be compared to the control group, who will only receive only usual care from their GPs. The primary outcome is HbA1c levels and secondary outcomes include cardiovascular disease risk factors, behavioral risk factors and process of care measures.
Discussion
Understanding how to achieve comprehensive treatment of T2D in a General Practice setting is the focus of the PEACH study. This study explores the potential role for PNs to help reduce the treatment and outcomes gap in people with T2D by using telephone coaching. The intervention, if found to be effective, has potential to be sustained and embedded within real world General Practice.

Burnout in the caring nurse: learning resilient behaviours

This paper reviews current literature to offer a discussion related to burnout, an issue that affects the entire healthcare sector, including nurses and patients. Literature suggests a correlation between moral distress and burnout in nurses. These issues are considered to be current and affect recruitment and retention of nurses. The authors propose supporting nurses by using knowledge of resilient behaviours as a means of transcending burnout and workplace stress. The authors believe that this process can be achieved through existing hospital professional development processes, for example supervision, reflective practice, in-service education and other forms of professional development.

Sun exposure and sun protection behaviours among young adult sport competitors

Objective: To explore the relationship between sun protection and physical activity in young adults (18-30 years) involved in four organised sports.

Methods: Participants (n=237) in field hockey, soccer, tennis and surf sports completed a self-administered survey on demographic and sun-protective behaviours while playing sport. Differences in sun-protective behaviour were explored by sport and by gender.

Results: Sunburn during the previous sporting season was high (69%). There were differences between sports for sunburn, sunscreen use and reapplication of sunscreen. Lifesaving had the highest rates compared with the other three sports. Hats and sunglasses worn by participants varied significantly by sports. A greater proportion of soccer and hockey players indicated they were not allowed to wear a hat or sunglasses during competition. For all sports, competition was played mainly in the open with no shade provision for competitors while they were playing. There were some gender differences within each of the sports. Female soccer and tennis players were more likely to wear sunscreen compared with males. Female hockey players were more likely to wear a hat compared with males.

Conclusions: Our findings highlight that there is still room for improvement in sun-protective behaviours among young adult sport competitors. There is a need for a systematic approach to sun protection in the sporting environments of young adults.

Implications: Health promotion efforts to increase physical activity need to be paired with sun protection messages.