Children's mental health and wellbeing and hands-on contact with nature

Research on the health and wellbeing benefits of contact with animals and plants indicates the natural environment may have significant positive psychological and physiological effects on human health and wellbeing. In terms of children, studies have demonstrated that children function better cognitively and emotionally in 'green' environments and have more creative play. In Australia as well as internationally, many schools appear to be incorporating nature-based activities into their curricula, mostly via sustainability education. Although these programs appear to be successful, few have been evaluated, particularly in terms of the potential benefits to health and wellbeing. This paper reports on a pilot survey investigating the mental health benefits of contact with nature for primary school children in Melbourne, Australia. A survey of principals and teachers was conducted in urban primary schools within a 20km radius of Melbourne. As well as gathering data on the types and extent of environmental and other nature-based activities in the sample schools, items addressing the perceptions of principals and teachers of the potential effects of these activities on children's mental health and wellbeing were also included. Despite a lower than expected response rate, some interesting findings emerged. Although preliminary, results indicate that participants' perceptions of the benefits to mental health and wellbeing from participation in hands-on nature based activities at their school are positive and encompass many aspects of mental health.

Tongan and European children`s interactions at home in urban New Zealand

Three- and four-year-old children have a range of culturally specific opportunities to develop social skills at home. In culturally diverse environments such as New Zealand, interplay between ethnic group, caregivers' expectations, and children's home interactions is important because different cultural groups share common educational and health systems. In this exploratory study, we compared three and four-year-old children's interactions with adults and older siblings in Tongan (N = 5) and European (N = 5) families who had lived in urban New Zealand for one to five generations. Adults' ideas of appropriate behaviors for their young children provided the basis for interpreting quantitative data obtained from counts of selected verbal and nonverbal behaviors, and measures of children's active involvement in their interactions. Tongan children had similar patterns of interaction with adults and older siblings. European children were more verbal and tended to elicit more ongoing interactions with adults versus siblings. We also compared the interactions of Tongan and European children directly. European children's interactions with adults were more verbal than those of Tongan children. European children were more successful at achieving ongoing interactions with adults. These cultural differences reflected caregivers' ideas of child-appropriate behavior. While all children demonstrated social skills that were important in their respective homes and communities, European children had more opportunities to develop patterns of child–adult interaction that are rewarded in New Zealand schools.

Operating a studio within a research culture: the urban heart surgery design research forum

The question of whether or not design can be considered research has perplexed schools of architecture ever since they were first introduced into universities. It was at the center of the Oxbridge union debates in the early 1900s. It formed one of the corner stones of the Oxford conference on education organized by the RIBA in 1958 (Martin 1958) and came under scrutiny again in the UK with the introduction of the Research Assessment Exercise (RAE) in 1992. While the arguments both for and against are considerable1, “in order to understand the questions and the possibilities of architectural research and to respond to the difficulties that confront us now, we have to have a model which acknowledges what schools of architecture really are, and could be, and then work with that” 2.
Drawing on professionally oriented research models, such as qualitative ‘clinical research’, from Medicine and the Health Sciences - where the processes of exploration, observation, investigation, recording and communication are conducted in-situ by the ‘practitioner-as-researcher’ 3 - the following paper outlines an initiative introduced in 1999, referred to as the ‘Urban Heart Surgery’ 4. The program actively integrates students entering their second degree program into a studio based design research culture and allows them to engage in critical discourse by working on high profile strategic design projects in three areas significant to Victoria’s future growth: Metropolitan Urbanism, Urbanism on the Periphery, and Regional Urbanism.
With a growing core of industrial and community based partnerships, including: four regional councils (Bendigo, Ballarat, Geelong and Warrnambool) and three metropolitan municipalities (Melbourne City, Port Phillip and Wyndham), the forum actively facilitates a graduate/practice research agenda through the ARC linkage grant program.

Emerging health issues: the widening challenge for population health promotion

The spectrum of tasks for health promotion has widened since the Ottawa Charter was signed. In 1986, infectious diseases still seemed in retreat, the potential extent of HIV/AIDS was unrecognized, the Green Revolution was at its height and global poverty appeared less intractable. Global climate change had not yet emerged as a major threat to development and health. Most economists forecast continuous improvement, and chronic diseases were broadly anticipated as the next major health issue. Today, although many broadly averaged measures of population health have improved, many of the determinants of global health have faltered. Many infectious diseases have emerged; others have unexpectedly reappeared. Reasons include urban crowding, environmental changes, altered sexual relations, intensified food production and increased mobility and trade. Foremost, however, is the persistence of poverty and the exacerbation of regional and global inequality. Life expectancy has unexpectedly declined in several countries. Rather than being a faint echo from an earlier time of hardship, these declines could signify the future. Relatedly, the demographic and epidemiological   transitions have faltered. In some regions, declining fertility has overshot that needed for optimal age structure, whereas elsewhere mortality increases have reduced population growth rates, despite continuing high fertility. Few, if any, Millennium Development Goals (MDG), including those for health and sustainability, seem achievable. Policy-makers generally misunderstand the link between environmental sustainability (MDG #7) and health. Many health workers also fail to realize that social cohesion and sustainability—maintenance of the Earth’s ecological and geophysical systems—is a necessary basis for health. In sum, these issues present an enormous challenge to health. Health promotion must address population health influences that transcend national boundaries and generations and engage with the development, human rights and environmental movements. The big task is to promote sustainable environmental and social conditions that bring enduring and equitable health gains.

Ischaemic heart disease and Australian immigrants: the influence of birthplace and language skills on treatment and use of health services

Admission rates for ischaemic heart disease (IHD), and the use of invasive cardiovascular procedures, separation mode and length of stay (LOS) were compared between Australians from non-English speaking background (NESB; n=8627) and English speaking background (ESB; n=13162) aged 20 years and over admitted to Victorian urban public hospitals. The study covered the period from 1993 to 1998. It was found that, compared with their ESB counterparts, the incidence of admission for acute myocardial infarction was significantly higher for NESB men and women before and after controlling for confounding factors. The age-adjusted ratios for NESB women compared with their ESB counterparts ranged from 1.23 to 1.89 for cardiac catheterisation, from 0.23 to 0.27 for percutaneous transluminal coronary angioplasty (PTCA), and from 1.04 to 1.80 for coronary artery bypass grafting (CABG).
Procedure rates were comparable in men for cardiac catheterisation and CABG but higher for PTA rates in NESB men (OR: 1.29, 95%CI: 1.11-1.50) than their ESB counterparts. Both NESB men (β=0.04, 95%CI: 0.01-0.07) and women (β=0.03, 95%CI: 0.02-0.08) experienced significantly longer hospital stays than their ESB counterparts. These findings indicate there may be systematic differences in patients’ treatment and service utilisation in Victorian public hospitals. The extent to which physicians’ bias and
patients’ choice could explain these differences requires further investigation.

The costs of a community-based intervention to promote maternal health

The costs of community-level interventions are rarely reported, although such insights are needed if intervention research is to be useful to practitioners seeking to understand what might be involved in replicating interventions in different contexts. We report the costs of a 2-year community-based intervention to promote the health of recent mothers in Victoria, Australia. Program of Resources, Information and Support for Mothers was an integrated programme of primary care and community-based strategies. It had health care professional training, health education and community development components as well as an emphasis on creating ‘mother-friendly’ environments. Costs included the programme costs [primarily the salaries of the community development officers (CDO) in the field] and also ‘induced’ costs that relate to the CDOs' successes in attracting additional resources to the intervention from the local community. The total cost averaged A$272 490 per rural community and A$313 900 per urban community, equivalent to A$172.40 and A$128.70 per mother, respectively. For every A$10 of public funds initially invested in the project, the CDOs were able to attract a further A$1–2 worth of local resources, predominantly in the form of volunteer time or donated services.

Measuring food access in Melbourne: access to healthy and fast foods by car, bus and foot in an urban municipality in Melbourne

Access to healthy food can be an important determinant of a healthy diet. This paper describes the assessment of access to healthy and unhealthy foods using a GIS accessibility programme in a large outer municipality of Melbourne. Access to a major supermarket was used as a proxy for access to a healthy diet and fast food outlet as proxy for access to unhealthy food. Our results indicated that most (>80%) residents lived within an 8–10 min car journey of a major supermarket i.e. have good access to a healthy diet. However, more advantaged areas had closer access to supermarkets, conversely less advantaged areas had closer access to fast food outlets. These findings have application for urban planners, public health practitioners and policy makers.

Urban area disadvantage and physical activity: a multilevel study in Melbourne, Australia

Objective: To estimate variation between small areas in the levels of walking, cycling, jogging, and swimming and overall physical activity and the importance of area level socioeconomic disadvantage in predicting physical activity participation.

Methods: All census collector districts (CCDs) in the 20 innermost local government areas in metropolitan Melbourne, Australia, were identified and ranked by the percentage of low income households (<$400/week) living in the CCD. Fifty CCDs were randomly selected from the least, middle, and most disadvantaged septiles of the ranked CCDs and 2349 residents (58.7% participation rate) participated in a cross sectional postal survey about physical activity. Multilevel logistic regression (adjusted for extrabinomial variation) was used to estimate area level variation in walking, cycling, jogging, and swimming and in overall physical activity participation, and the importance of area level socioeconomic disadvantage in predicting physical activity participation.

Results: There were significant variations between CCDs in all activities and in overall physical participation in age and sex adjusted models; however, after adjustment for individual SES (income, occupation, education) and area level socioeconomic disadvantage, significant differences remained only for walking (p = 0.004), cycling (p = 0.003), and swimming (p = 0.024). Living in the most socioeconomically disadvantaged areas was associated with a decreased likelihood of jogging and of having overall physical activity levels that were sufficiently active for health; these effects remained after adjustment for individual socioeconomic status (sufficiently active: OR 0.70, 95% CI 0.55 to 0.90 and jogging: OR = 0.69, 95% CI 0.51 to 0.94).

Conclusion: These research findings support the need to focus on improving local environments to increase physical activity participation.

Abbreviations: SES, socioeconomic status; CCD, census collector district

Human Health Impacts of Contaminants Found in Local Drinking Water Supply

Many contaminants are currently unregulated by the government and do not have a set limit, known as the Maximum Contaminant Level, which is dictated by cost and the best available treatment technology. The Maximum Contaminant Level Goal, on the other hand, is based solely upon health considerations and is non-enforceable. In addition to being naturally occurring, contaminants may enter drinking water supplies through industrial sources, agricultural practices, urban pollution, sprawl, and water treatment byproducts. Exposure to these contaminants is not limited to ingestion and can also occur through dermal absorption and inhalation in the shower. Health risks for the general public include skin damage, increased risk of cancer, circulatory problems, and multiple toxicities. At low levels, these contaminants generally are not harmful in our drinking water. However, children, pregnant women, and people with compromised immune systems are more vulnerable to the health risks associated with these contaminants. Vulnerable peoples should take additional precautions with drinking water. This research project was conducted in order to learn more about our local drinking water and to characterize our exposure to contaminants. We hope to increase public awareness of water quality issues by educating the local residents about their drinking water in order to promote public health and minimize exposure to some of the contaminants contained within public water supplies.

Regional and urban Victorian diabetic youth: clinical and quality-of-life outcomes

Objectives: To compare groups of urban and regional Victorian diabetic children and assess their quality of life, diabetes knowledge, access to services and metabolic control.

Methods: Forty-seven children from three regional Victorian communities (Horsham, Warrnambool and Sale; n = 16, 18 and 13, respectively) were compared with 120 age-, sex- and duration of diabetes-matched children attending the Royal Children's Hospital (RCH) diabetes clinic in Melbourne. Quality of life, diabetes knowledge, use of services, and metabolic control were assessed using the child health questionnaire (CHQ PF-50/CF-80); a diabetes-knowledge questionnaire; access to a diabetes nurse educator (DNE), dietitian and complication screening; and indices of mean HbA1C (values are taken every 3 months in the 'yearly HbA1C'), respectively.

Results: Comparisons of CHQ data showed that regional diabetic youth scored significantly lower on most subscales. The greatest deficits were seen in areas of mental health, self-esteem, parent impact (emotional) and family cohesion. Diabetes knowledge and median yearly HbA1C for patients were not significantly different between the regional and urban centres (8.1%, 8.9%, 8.4% and 8.6% at RCH, Horsham, Warrnambool and Sale, respectively). Patients in regional centres had reportedly less access to team-based diabetes care.

Conclusions: Regional youth in Victoria, with similar levels of metabolic control and diabetes knowledge as their urban counterparts, have a markedly lower quality of life, implying a negative synergy between diabetes and the demands of regional lifestyles.

Traffic safety education and health promoting school : a metropolitan and rural pilot study

Traffic Safety Education (TSE) is an important part of a school's program; however, it competes with many other components of schooling such as literacy, numeracy and a number of health areas. Hence TSE provision in Victorian schools has been somewhat fragmented and haphazard in its delivery. This small pilot study involved two metropolitan and two rural schools which attempted to link TSE into mainstream school activities through the new Victorian Essential Learning Standards (VELS) utilising the internationally accepted Health Promoting Schools (HPS) framework.
The findings of the pilot study showed that though schools face many demands, understanding and ownership of TSE is possible when administrative support, professional development and adequate planning time are made available. The report outlines several key recommendations to improve the delivery of Traffic Safety Education in Victorian schools.

How residential environments impact on health

This article describes the findings of a research study that investigated the factors (including access to nature such as parks, gardens and bodies of water) impacting on inner city high-rise residents’ health and wellbeing. The findings revealed that a range of factors impact on residents’ health and wellbeing, either directly or indirectly and suggest implications for health and community service professionals, housing management officials, park and open space managers and urban designers/planners.

Adapting to rural communities by overseas-born health professionals

Introduction
As with other multicultural nations, cultural diversity is a prominent feature of Australian society that leads to intercultural awareness and respect through citizen interactions. While this enriching multicultural interaction is clearly seen in big cities like Sydney and Melbourne, it can be very different in the Australian rural context. Living in an isolated rural area is challenging for health professionals who were brought up in urban areas, particularly those born overseas as they experience two types of cultural and social adaptation: urban into rural and native culture into new culture.

As a result of workforce shortages, many overseas trained health professionals are recruited to work in Australia, particularly in rural areas. This has given rise to various initiatives and strategies developed to support and assist these health professionals in their dual cultural and social adaptation. These include University Departments of Rural Health and Rural Clinical Schools programs as well as the Rural Workforce Agencies. However, these programs do not extend to those health professionals who were born overseas and trained in Australia as they are ‘Australian graduates’. In this paper we argue that in ways similar to those born and trained overseas, overseas-born Australian-trained health professionals may require additional support during the acculturation process and making the transition to working in rural communities.

Aim
The aim of this study is to examine some aspects of the acculturation of overseas-born Australian trained health professionals working in rural areas. This study seeks to understand the particular issues that emerge as a result of cultural difference in order to propose strategies that may more adequately prepare these Australian graduates for their rural health experience.

Method
Six overseas-born Australian-trained health professionals were invited to participate in this qualitative study using snowball sampling. The interviews were recorded with the approval of the participants. The interview data were transcribed as raw data and later coded for thematic analysis, which includes topics and themes arising from the raw data as well as from the interview questions with a focus on issues and strategies of acculturation into a rural health context.

Results/conclusion
There were different factors which facilitated or hindered the acculturation of overseas-born health professionals into a rural workforce such as professional isolation, cultural shock, family pressure, and cultural identity. The acculturation process was also affected by the quality of their perceived ‘social and cultural capital’. Different coping strategies were employed to deal with the changes in a new rural environment. The paper discusses some implications of this study with focus on how to improve the living and working conditions of overseas-born Australian-trained health professionals in order to attract them to rural Australia.

"Tell us something new!" : the response of planning and transport professionals to public health guidance on the built environment and physical activity

A large proportion of non-communicable disease can be attributed to modifiable risk factors such as poor nutrition and physical inactivity. We present data on planning and transport practitioners' perceptions and responses to government public health guidance aimed at modifying environmental factors to promote physical activity. This study was informed by questions on the role of evidence-based guidance, the views of professionals towards the guidance, the links between guidance and existing legislation and policy and the practicality of guidelines. A key informant 'snowball' sampling technique was used to recruit participants from the main professional planning organisations across England. Seventy-six people were interviewed in eight focus groups. We found that evidence-based public health guidance is a new voice in urban and town planning, although much of the advice is already reflected by the 'accepted wisdom' of these professions. Evidence-based health guidance could be a powerful driver affecting planning practice, but other legislated planning guidance may take priority for planning and transport professionals.