Modelling the public health consequences of cannabis use in Australia

Aims: To detail and validate a simulation model that describes the dynamics of cannabis use, including its probable causal relationships with schizophrenia, road traffic accidents (RTA) and heroin/poly-drug use (HPU).

Methods: A Markov model with 17 health-states was constructed. Annual cycles were used to simulate the initiation of cannabis use, progression in use, reduction and complete remission. The probabilities of transition between health-states were derived from observational data. Following 10-year-old Australian children for 90 years, the model estimated age-specific prevalence for cannabis use. By applying the relative risks according to the extent of cannabis use, the age-specific prevalence of schizophrenia and HPU, and the annual RTA incidence and fatality rate were also estimated. Predictive validity of the model was tested by comparing modelled outputs with data from other credible sources. Sensitivity and scenario analyses were conducted to evaluate technical validity and face validity.

Results: The estimated cannabis use prevalence in individuals aged 10-65 years was 12.2% which comprised 27.4% weekly and 18.0% daily users. The modelled prevalence and age profile were comparable to the reported cross-sectional data. The model also provided good approximations to the prevalence of schizophrenia (Modelled: 4.75/1,000 persons vs Observed: 4.6/1,000 persons), HPU (3.2/1,000 vs 3.1/1,000) and the RTA fatality rate (8.1 per 100,000 vs 8.2 per 100,000). Sensitivity analyses and scenario analysis provided expected and explainable trends.

Conclusions: The validated model provides a valuable tool to assess the likely effectiveness and cost-effectiveness of interventions designed to affect patterns of cannabis use. It can be updated as new data becomes available and/or applied to other countries.

The health consequences of migration : meeting the health needs of displaced populations

The present scale of migration raises a number of public health challenges. In this paper, the health consequences of migration are examined among forced migrants (internally displaced people and refugees) and voluntary migrants. Alongside we also focus on the health needs of migrants in developed and developing nations. Theory and evidence are linked to document existing needs and access to health services. We argue that public health has a role to play in building social inclusiveness and equity, and make recommendations about how this process of inclusion can be facilitated.

Consequences of youth tobacco use: a review of prospective behavioural studies

Background Cigarette smoking represents a significant health problem and tobacco has been identified as causing more preventable diseases and premature deaths than any other drug. Although health consequences from smoking have been documented, there has been a surprising lack of research into behavioural consequences.

Aims To review what is known of the long-term relationship between patterns of tobacco use prior to age 18 years and behavioural consequences in adulthood.

Method A literature search of electronic abstraction services from 1980 to September 2005 was conducted. To be included in the review, studies had to have large, representative samples, be longitudinal studies with baseline age under 18 years and follow-up age 18 years or older and clarify effects due to attrition, leaving 16 articles that met the inclusion criteria. Two reviewers evaluated each paper.

Findings Adolescent tobacco use predicts a range of early adult social and health problems. Surprisingly few studies met the inclusion criteria. The limited evidence available suggests that adolescent tobacco smoking increases the likelihood of early adult tobacco use and the initiation of alcohol use or the development of alcohol-related problems. The link between adolescent tobacco use and subsequent cannabis use was not resolved convincingly from the studies summarized. The effects of tobacco use on later illicit drug use tended to fall away when adjusting for underlying risk factors. Existing studies of the effects of tobacco use on later mental health have many limitations. Nevertheless, a finding that youth tobacco use may predict subsequent mental health problems deserves further investigation. The possible effects of tobacco use on academic/social problems and sleep problems also warrant further investigation.

Conclusion This review highlights links between youth tobacco use and subsequent behavioural and mental health problems. It provides health care professionals with evidence of the possible harmful effects of youth tobacco smoking on later social, emotional, and behavioural well-being.

Global change and health - the good, the bad, and the evidence

Debates over the merits and demerits of globalisation for health are increasingly polarised. Conclusions range from globalisation being essentially positive for health, albeit with a need to smooth out some rough edges, to one of utter condemnation, with adverse effects on the majority of the world's population. Anyone wading into this debate is immediately confronted by seemingly irreconcilable differences in ideology, opinion and interests. Both camps agree that global changes are occurring, and with them many of the determinants of population health status. While some skepticism persists about whether “globalisation” has value beyond being a fashionable buzzword, most agree that we need better understanding of these changes. Two difficult questions arise: (i) What are the health impacts of these changes; and (ii) how can we respond more effectively to them? To move beyond the stand-offs that have already formed within the health community, this paper reviews the main empirical evidence that currently exists, summarises key points of debate that remain, and suggests some ways forward for the research and policy communities. In particular, there is need for an informed and inclusive debate about the positive and negative health consequences of globalisation.

An examination of the health and wellbeing of childless women : A cross-sectional exploratory study in Victoria, Australia

Background
Childlessness among Australian women is increasing. Despite this, little is known about the physical and mental health and wellbeing of childless women, particularly during the reproductive years. The aims of this exploratory study were to: 1) describe the physical and mental health and wellbeing and lifestyle behaviours of childless women who are currently within the latter part of their reproductive years (30 – 45 years of age); and 2) compare the physical and mental health and wellbeing and lifestyle behaviours of these childless women to Australian population norms.
Methods
A convenience sample of 50 women aged between 30 and 45 years were recruited to participate in a computer assisted telephone interview. The SF-36 Health Survey v2 and lifestyle indicators were collected in regards to women’s health and wellbeing. Data were analysed using descriptive statistics, t-tests for independent sample means and 95% confidence intervals for the difference between two independent proportions.
Results
Childless women in this study reported statistically significant poorer general health, vitality, social functioning and mental health when compared to the adult female population of Australia. With the exception of vegetable consumption, lifestyle behaviours were similar for the childless sample compared to the adult female population in Australia.
Conclusions
Childless women may be at a greater risk of experiencing poor physical and mental health when compared to the Australian population. A woman’s health and wellbeing during her reproductive years may have longer term health consequences and as such the health and wellbeing of childless women requires further investigation to identify and address implications for the provision of health (and other social) services for this growing population group.

"I don't eat a hamburger and large chips every day!" A qualitative study of the impact of public health messages about obesity on obese adults

Background
We are a society that is fixated on the health consequences of 'being fat'. Public health agencies play an important role in 'alerting' people about the risks that obesity poses both to individuals and to the broader society. Quantitative studies suggest people comprehend the physical health risks involved but underestimate their own risk because they do not recognise that they are obese.

Methods
This qualitative study seeks to expand on existing research by exploring obese individuals' perceptions of public health messages about risk, how they apply these messages to themselves and how their personal and social contexts and experiences may influence these perceptions. The study uses in depth interviews with a community sample of 142 obese individuals. A constant comparative method was employed to analyse the data.

Results
Personal and contextual factors influenced the ways in which individuals interpreted and applied public health messages, including their own health and wellbeing and perceptions of stigma. Individuals felt that messages were overly focused on the physical rather than emotional health consequences of obesity. Many described feeling stigmatised and blamed by the simplicity of messages and the lack of realistic solutions. Participants described the need for messages that convey the risks associated with obesity while minimising possible stigmatisation of obese individuals. This included ensuring that messages recognise the complexity of obesity and focus on encouraging healthy behaviours for individuals of all sizes.

Conclusion
This study is the first step in exploring the ways in which we understand how public health messages about obesity resonate with obese individuals in Australia. However, much more research - both qualitative and quantitative - is needed to enhance understanding of the impact of obesity messages on individuals.

Relationship between severity of obesity and mental health: an Australian community survey

Introduction
In Australia the incidence of obesity is increasing rapidly and has become a significant public health concern. In addition to the many physical consequences of obesity many studies have reported significant mental health consequences, including major depression, mood and anxiety disorders. The purpose of this study was to explore the relationship between severity of obesity and perceived mental health in an Australian community sample.

Methods
A cross-sectional survey design was used. A total of 118 participants, aged between 19 and 75 years with a body mass index (BMI) ≥ 30 kg/m2 returned a completed questionnaire. The SF-36 Health Survey, Kessler Psychological Distress Scale, Social Interaction Anxiety Scale and the Multidimensional Scale of Perceived Social Support were used.

Results
After adjusting for age, gender, perceived social support and physical health quality of life, obesity was not significantly associated with mental health quality of life (SF-36). The strongest factor influencing mental health was perceived physical health. Mediation analyses suggest that physical health mediates the relationship between obesity and mental health quality of life.

Discussion
Our findings support the view that physical health mediates the relationship between obesity and mental health. Public health interventions should focus on reducing the impact of obesity on physical health by encouraging participation in healthy lifestyles, which in turn, may improve mental wellbeing.

Young maternal age at first birth and mental health later in life: does the association vary by birth cohort?

BACKGROUND: It is well established that maternal age at childbirth has implications for women's mental health in the short term, however there has been little research regarding longer term implications and whether this association has changed over time. We investigated longer term mental health consequences for young mothers in Australia and contrasted the effects between three birth cohorts. METHODS: Using thirteen waves of data from 4262 women aged 40 years or above participating in the Household, Income and Labour Dynamics in Australia Survey, we compared the mental health of women who had their first child aged 15-19 years, 20-24 years, and 25 years and older. Mental health was measured using the mental health component summary score of the SF-36. We used random-effects linear regression models to generate estimates of the association between age at first birth and mental health, adjusted for early life socioeconomic characteristics (country of birth, parents' employment status and occupation) and later life socioeconomic characteristics (education, employment, income, housing tenure, relationship status and social support). We examined whether the association changed over time, testing for effect modification across three successive birth cohorts. RESULTS: In models adjusted for early life and later life socioeconomic characteristics, there was strong evidence of an association between teenage births and poor mental health, with mental health scores on average 2.76 to 3.96 points lower for mothers aged younger than 20 years than for mothers aged 25 years and older (Late Baby Boom (born 1936-1945): -3.96, 95% CI -5.38, -2.54; Early Baby Boom (born 1946-1955): -3.01, 95% CI -4.32, -1.69; Lucky Few (born 1956-1965): -2.76, 95% CI -4.34, -1.18), and evidence of an association for mothers aged 20-24 years compared to mothers aged 25 years and older in the most recent birth cohort only (-1.09, 95% CI -2.01, -0.17). There was some indication (though weak) that the association increased in more recent cohorts. CONCLUSION: This study highlights that young mothers, and particularly teenage mothers, are a vulnerable group at high risk of poor mental health outcomes compared to mothers aged 25 years and above, and there was some suggestion (though weak) that the health disparities increased over time.

Workplace violence in mental health: a Victorian mental health workforce survey

The international literature suggests workplace violence in mental health settings is a significant issue, yet little is known about the frequency, nature, severity and health consequences of staff exposure to violence in Australian mental health services. To address this gap, we examined these aspects of workplace violence as reported by mental health services employees in Victoria, Australia. The project used a cross-sectional, exploratory descriptive design. A random sample of 1600 Health and Community Services Union members were invited to complete a survey investigating exposure to violence in the workplace, and related psychological health outcomes. Participants comprised employees from multiple disciplines including nursing, social work, occupational therapy, psychology and administration staff. A total of 411 members responded to the survey (26% response rate). Of the total sample, 83% reported exposure to at least one form of violence in the previous 12 months. The most frequently reported form of violence was verbal abuse (80%) followed by physical violence (34%) and then bullying/mobbing (30%). Almost one in three victims of violence (33%) rated themselves as being in psychological distress, 54% of whom reported being in severe psychological distress. The more forms of violence to which victims were exposed, the greater the frequency of reports of psychological distress. Workplace violence is prevalent in mental health facilities in Victoria. The nature, severity and health impact of this violence represents a serious safety concern for mental health employees. Strategies must be considered and implemented by healthcare management and policy makers to reduce and prevent violence.

Reducing harmful traditional practices in Adjibar, Ethiopia : lessons learned from the Adjibar safe motherhood project

This paper assesses the impact of the Adjibar Safe Motherhood Project and derives lessons of value to future interventions. Amongst the participatory qualitative methods used were 15 group discussions, eight semi-structured interviews, a number of opportunistic informal discussions and observation. The information gathering was complemented by a detailed review of project documents. Field visits for data collection took place over a six day period in March 2005. The project was effective in raising awareness about maternal health, and the social, economic and health consequences of various harmful traditional practices (HTPs). It has also mobilised the community to monitor and report HTPs and has strengthened referral systems for counselling, support and treatment. A number of effective strategies were identified as having contributed to project success. These are presented using the framework offered by the Ottawa Charter for Health Promotion which presents five areas of public health action: developing personal skills; strengthening community action; building healthy public policy; re-orienting health services; and, creating supportive environments. This evaluation contributes to and strengthens the expanding body of literature about effective development practices to reduce HTPs. It demonstrates that addressing HTPs takes time and long term investment; both are necessary to enable better understanding of the social and cultural reasons for HTPs before attempting to address them, and to build the community trust necessary to overcome the natural resistance to challenging such deeply entrenched practices. The project also highlighted the importance of developing a multi pronged strategy based on engagement with a broad range of stakeholders and supportive legislation.

Climate change and social inclusion: opportunities for justice and empowerment

...the greatest untapped resource at our disposal lies in the disadvantaged Australians living in our most excluded communities. (Nicholson 2007 p. 4)

The commons are where justice and sustainability converge, where ecology and equity meet. (Shiva 2005 p. 50)

Since 1990, the Intergovernmental Panel on Climate Change (IPCC) has recognised human induced climate change to be primarily a result of burning fossil fuels and land clearing (Lee 2007). Changes to the world's climate patterns have been occurring for decades, but only in recent times has climate change arrived in our collective conscious. An onslaught of extreme weather events, destruction and failure of crops, increasing levels of water restrictions, government announcement of desalination plants. proposed increase in prices for utilities such as power and water - have ushered climate change into the Australian lexicon.

The challenges for all of us are many and varied and perhaps even unimaginable. as many propose a global reduction in annual C02 emissions of between 60-80% (compared to 1990 levels) by 2050.

We are not talking just about the re-construction of our world, but about its re-invention. Ryan (2007)

How will climate change affect us? Who is most vulnerable? What will be the features of policies and strategies to combat climate change that ensure an equitable and just response across our entire society? Are our present social-cultural justice paradigms of social exclusion and inclusion adequate in addressing the impending health consequences that are likely to result from climate change, and in supporting an equitable. harmonious and fruitful life for all population groups in the future?

This paper, written in the spirit of solution-oriented research. focusing on the causes of positive health rather than the causes of disease and other problems (Robinson & Sirard 2005). explores the possibility of a paradigm shift which imagines the social inclusion of specific population groups, not as an appended extra, but integral to the design of an equitable, sustainable low carbon society of the future.

Duly delivered : women's experiences of birth planning

Critically examines the construct of power differentials in the childbirth experiences of forty-two women following the birth of their first child. Detailed data was collected using questionnaires and in-depth interviews with women from a range of localities around the State. The research demonstrated that childbirth processes in Victoria effectively ignore the wishes of pregnant women leading to them suffering significant physical and psychological health consequences.

Elite athletes' perceptions of the effects of illicit drugs use on athletic performance

Objective: To investigate the perceived risks and benefits that elite athletes associate with illicit drugs and their beliefs concerning the effects of recreational drug use on athletic performance.

Design: Self-administered survey.

Participants: Nine hundred seventy-four elite athletes (mean age, 23 years; range, 18-30 years) were recruited from 8 national sporting organizations in Australia and the Australian Institute of Sport.

Interventions: Participants completed a self-administered survey that included questions exploring participants’ perceptions regarding the effects of illicit drug use on physical performance.

Setting: National sporting organization meetings or competitions.

Main Outcome Measures: The main outcome measure was risk perception on athletic performance associated with illicit drug use.

Results: The majority of athletes believed that illicit drug use would impact negatively on athletic performance. The main perceived effects of illicit drugs on athletic performance were physical and mental functioning. A minority of athletes indicated that drug use would not impact on physical performance when taken during the offseason or in moderation.

Conclusions: The main risks perceived in association with illicit drug use were short-term consequences, such as physical and mental functioning, rather than long-term health consequences. The current findings may contribute to the development of harm reduction strategies that communicate drug-related consequences to elite athletes in an appropriate and effective manner.

Socioeconomic status and risk factors for obesity and metabolic disorders in a population-based sample of adult females

Objectives : The association between lower socioeconomic status (SES), obesity, lifestyle choices and adverse health consequences are well documented, however to date the relationship between these variables and area-based SES (equivalised for advantage and disadvantage) has not been examined simultaneously in one population or with more than tertiary divisions of SES. We set out to examine the risk factors for obesity and metabolic disorders in the same population across quintiles of area-based SES.

Methods : We performed a descriptive cross-sectional study using existing data from a population-based random selection of women aged 20–92 years (n = 1110) recruited from the Barwon Statistical Division, South Eastern Australia.

Results : All measures of adiposity were inversely associated with SES, and remained significant after adjusting for age. Lifestyle choices associated with adiposity and poorer health, including smoking, larger serving sizes of foods, and reduced physical activity, were significantly associated with individuals from lower SES groups.

Conclusions : Greater measures of adiposity and less healthy lifestyle choices were observed in individuals from lower SES. Significant differences in body composition were identified between quintiles 1 and 5, whereas subjects in the mid quintiles had relatively similar measures. The inverse relationship between SES, obesity and less healthy lifestyle underscores the possibility that these associations may be causal and should be investigated further.