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.

Actively disadvantaged : a foucauldian perspective of rural adolescent girls' participation in sport and physical activity

The illustriousness of sport to Australian culture has often been discussed and in rural communities it could be argued that community sporting clubs are integral, and often unparalleled, in the development of collective community identities and individual subjectivities (Tonts, 2005). Sport is considered a way of life for many rural Australians, yet social, climatic and economic factors have resulted in vast changes to the sporting landscape in rural communities, particularly for adolescent females. With the amalgamation of many community sporting clubs due to declining populations and the rationalisation of Government funding, fewer opportunities for participation in organised physical activity now exist for rural adolescent girls (Tonts & Atherley, 2005). Compounding this lack of opportunity, are questions around the types of physical activity experiences available to rural adolescent females and the impact this has on the way that rural adolescent females construct ideas around being physically active. This paper is concerned with the ways in which prevalent cultural and institutional discourses mediated through community sport and school-based physical activity impact the construction of female physically active subjectivities in rural communities.

Community based rehabilitation for people with disability in Iraq

This thesis explores the role of government and non-government organisations and international agencies in community based rehabilitation in Iraq. It examines the possibility of initiating and running community-based rehabilitation programmes for people with disability by NGOs regardless of Iraqi government commitment or participation. The research results show that implementation of CBR in Iraq is vital but not widely- spread. Non-government organisations seem more active, committed and capable in the time being to initiate, run and manage CBR programmes compared to the government of Iraq. Despite the high numbers of people with disabilities and lack of capacity to respond to their needs, there is little evidence that the Iraqi government has made efforts in adopting CBR as a cost-effective response.

Prevalence and community variation in harmful levels of family conflict witnessed by children: implications for prevention

 Abstract
Children’s reports of high family conflict consistently predict poor outcomes. The study identified criteria for high family conflict based on prospective prediction of increased risk for childhood depression. These criteria were subsequently used to establish the prevalence of high family conflict in Australian communities and to identify community correlates suitable for targeting prevention programs. Study 1 utilised a longitudinal design. Grade 6 and 8 students completed a family conflict scale (from the widely used Communities That Care survey) in 2003 and depression symptomotology were evaluated at a 1-year follow-up (International Youth Development Study, N = 1,798). Receiver-operating characteristic analysis yielded a cut-off point on a family conflict score with depression symptomatology as a criterion variable. A cut-off score of 2.5 or more (on a scale of 1 to 4) correctly identified 69 % with depression symptomology, with a specificity of 77.2 % and sensitivity at 44.3 %. Study 2 used data from an Australian national survey of Grade 6 and 8 children (Healthy Neighbourhoods Study, N = 8,256). Prevalence estimates were calculated, and multivariate logistic regression with multi-level modelling was used to establish factors associated with community variation in family conflict levels. Thirty-three percent of Australian children in 2006 were exposed to levels of family conflict that are likely to increase their future risk for depression. Significant community correlates for elevated family conflict included Indigenous Australian identification, socioeconomic disadvantage, urban and state location, maternal absence and paternal unemployment. The analysis provides indicators for targeting family-level mental health promotion programs.

Finding a place for personal growth in an Australian community singing group for older people

As in many countries, Australia is faced with an aging population. This creates challenges for the maintenance of well-being which can be enhanced by active engagement in society. Music engagement encompasses a range of social participation and has the potential to recognise the contribution of older people to their local communities. Engagement in music by older people (50+) is positively related to individual and community well-being.  Music participation can contribute to a better quality of life, particularly in relation to health and happiness. The possible forms of music engagement are myriad.

This paper focuses on two members of a mixed voluntary singing group formed by older residents of an outer suburban community in Melbourne, Australia.  This study frames music as a positive way for older people to find a place for personal growth and fulfilment in a singing group. This phenomenological qualitative single case study focuses on two members of a small singing ensemble, the Skylarkers, formed to perform at retirement villages, nursing homes and facilities for senior citizens. In this study, data were gathered by interviews and analysed using interpretative phenomenological analysis.

Two significant themes emerged. The first concerned the nature of the choir and its fluid membership and notions of self-identity. The second theme concerns the validation offered to individual members by active music participation through which they gained a sense of purpose, fulfilment and personal growth. This emphasis is unusual in discussions of community music engagement that ordinarily identify the importance of social connections. Groups such as the Skylarkers provide a place for members to continue their active engagement with music performance and music learning.

The contribution of creativity to human development in a new nation: a case study of Afalyca community art centre, Timor-Leste

This article describes the contribution of creativity to human development in the new nation of Timor-Leste, exemplified in a case study of community art centre Afalyca. By taking a creative approach to the challenges of life in his developing country, the young leader of this enterprise, Marqy da Costa, is realising his own potential more fully and offering enriching experiences to others. The impact of his centre on a range of stakeholders, including staff, participants and the wider community is discussed. For participants, the outcomes of their involvement include enjoyable opportunities for creative expression; valued recognition from national and international audiences; the broadening of life experience to encompass new possibilities for self-actualisation; skill development and income from employment and sales.

The factors that have contributed to Afalcya's creative achievements are examined. These include inspiration and assistance received from organisations and individuals in and outside of Timor, family support, and the age and gender of leaders. Also significant are founder Marqy's personal characteristics of artistic talent, social and language skills, love of learning, persistence and conciliatory approach to conflict. Barriers to the realisation of Afalcya's potential include lack of systemic recognition of the value of creativity for sustainable development, unsupportive bureaucracy and gender related restrictions of participation for women. The potential for similar initiatives to contribute to a positive future for Timorese people is explored.

The role of effective partnerships in an Australian place-based intervention to reduce race-based discrimination

Localities Embracing and Accepting Diversity (LEAD) is an ongoing place-based pilot program aimed at improving health outcomes among Aboriginal and migrant communities through increased social and economic participation. Specifically, LEAD works with mainstream organizations to prevent race-based discrimination from occurring. The partnership model of LEAD was designed to create a community intervention that was evidence-based, effective, and flexible enough to respond to local contexts and needs. LEAD's complex organizational and partnership model, in combination with an innovative approach to reducing race-based discrimination, has necessitated the use of new language and communication strategies to build genuinely collaborative partnerships. Allocating sufficient time to develop strategies aligned with this new way of doing business has been critical. However, preliminary data indicate that a varied set of partners has been integral to supporting the widespread influence of the emerging LEAD findings across partner networks in a number of different sectors.

The impact of a brief lifestyle intervention delivered by generalist community nurses (CN SNap trial)

Background
The risk factors for chronic disease, smoking, poor nutrition, hazardous alcohol consumption, physical inactivity and weight (SNAPW) are common in primary health care (PHC) affording opportunity for preventive interventions. Community nurses are an important component of PHC in Australia. However there has been little research evaluating the effectiveness of lifestyle interventions in routine community nursing practice. This study aimed to address this gap in our knowledge.

Methods
The study was a quasi-experimental trial involving four generalist community nursing (CN) services in New South Wales, Australia. Two services were randomly allocated to an ‘early intervention’ and two to a ‘late intervention’ group. Nurses in the early intervention group received training and support in identifying risk factors and offering brief lifestyle intervention for clients. Those in the late intervention group provided usual care for the first 6 months and then received training. Clients aged 30–80 years who were referred to the services between September 2009 and September 2010 were recruited prior to being seen by the nurse and baseline self-reported data collected. Data on their SNAPW risk factors, readiness to change these behaviours and advice and referral received about their risk factors in the previous 3 months were collected at baseline, 3 and 6 months. Analysis compared changes using univariate and multilevel regression techniques.

Results
804 participants were recruited from 2361 (34.1%) eligible clients. The proportion of clients who recalled receiving dietary or physical activity advice increased between baseline and 3 months in the early intervention group (from 12.9 to 23.3% and 12.3 to 19.1% respectively) as did the proportion who recalled being referred for dietary or physical activity interventions (from 9.5 to 15.6% and 5.8 to 21.0% respectively). There was no change in the late intervention group. There a shift towards greater readiness to change in those who were physically inactive in the early but not the comparison group. Clients in both groups reported being more physically active and eating more fruit and vegetables but there were no significant differences between groups at 6 months.

Conclusion
The study demonstrated that although the intervention was associated with increases in advice and referral for diet or physical activity and readiness for change in physical activity, this did not translate into significant changes in lifestyle behaviours or weight. This suggests a need to facilitate referral to more intensive long-term interventions for clients with risk factors identified by primary health care nurses.

Community languages, linguistic isolation and social exclusion in the Australian context

The detrimental impacts of social exclusion to health and well-being are well-known and are of increasing concern around the world. For many of the population sub-groups who are most at risk of social exclusion, linguistic isolation—the inability to use and understand the majority language—is a major barrier to full participation in the life of the community as well as to full integration into the society in which its members live. This paper, using data obtained from community-based research in Melbourne, Australia, will discuss the problem of linguistic isolation in the context of Australian multicultural policy and use of languages other than English among members of culturally and linguistically diverse (CALD) communities. The experience of members of two specific CALD communities, speakers of Arabic and speakers of Indonesian, will be discussed to illustrate the impacts of linguistic isolation on health and well-being and to elucidate the relationship between CALD status and social exclusion in these communities.

Pedagogy of oppressed community engagement : socially inclusive visioning of urban change

It is generally accepted that good practice in policy making and urban change initiatives requires community engagement, where community-based approaches are emphasised as a means of socially inclusive visioning. Communities expect greater transparency, accountability and engagement. This expectation is not always met, with many studies focusing on the perceived tickbox effect - where engagement is a process that has to be undertaken rather than being welcomed and embraced as an integral part of planning for urban change. This paper explores multi-disciplinary concepts and looks at ways these can be linked to community engagement in planning, particularly in larger urban Councils. In this brief glimpse at the wide variety of disciplines that could be drawn on, the paper uses information systems, teaching models, organisational theory and public policy to highlight the potential for altering concepts of community engagement. It concludes that, from these particular examples: the use of double-loop learning could help to empower the community (from organisational theory), collaboration and participation necessitate the co-ordination and exchange of information and knowledge within and between organisations (information systems), the preconception that the authority holds all the knowledge ready to be handed out to the community (teaching models) needs to be challenged, and partnerships are important in empowering people (public policy).

Stable isotope-based community metrics as a tool to identify patterns in food web structure in east African estuaries

1.Quantitative tools to describe biological communities are important for conservation and ecological management. The analysis of trophic structure can be used to quantitatively describe communities. Stable isotope analysis is useful to describe trophic organization, but statistical models that allow the identification of general patterns and comparisons between systems/sampling periods have only recently been developed. 2.Here, stable isotope-based Bayesian community-wide metrics are used to investigate patterns in trophic structure in five estuaries that differ in size, sediment yield and catchment vegetation cover (C3/C4): the Zambezi in Mozambique, the Tana in Kenya and the Rianila, the Betsiboka and Pangalanes Canal (sampled at Ambila) in Madagascar. 3.Primary producers, invertebrates and fish of different trophic ecologies were sampled at each estuary before and after the 2010–2011 wet season. Trophic length, estimated based on δ15N, varied between 3·6 (Ambila) and 4·7 levels (Zambezi) and did not vary seasonally for any estuary. Trophic structure differed the most at Ambila, where trophic diversity and trophic redundancy were lower than at the other estuaries. Among the four open estuaries, the Betsiboka and Tana (C4-dominated) had lower trophic diversity than the Zambezi and Rianila (C3-dominated), probably due to the high loads of suspended sediment, which limited the availability of aquatic sources. 4.There was seasonality in trophic structure at Ambila and Betsiboka, as trophic diversity increased and trophic redundancy decreased from the prewet to the postwet season. For Ambila, this probably resulted from the higher variability and availability of sources after the wet season, which allowed diets to diversify. For the Betsiboka, where aquatic productivity is low, this was likely due to a greater input of terrestrial material during the wet season. 5.The comparative analysis of community-wide metrics was useful to detect patterns in trophic structure and identify differences/similarities in trophic organization related to environmental conditions. However, more widespread application of these approaches across different faunal communities in contrasting ecosystems is required to allow identification of robust large-scale patterns in trophic structure. The approach used here may also find application in comparing food web organization before and after impacts or monitoring ecological recovery after rehabilitation.

Diabetes mellitus in the australian indigenous community

This report aims to investigate the higher prevalence of type 2 diabetes (T2D) among Indigenous Australians, with recommendations to Australians Health Professionals in order to increase awareness of Indigenous health peculiarities related to diabetes mellitus (DM). Diabetes has become one of the most common public health problems of the 21st century. The proportion of Aborigines Australians developing T2D is 5 to 10 times greater than non-Aborigines. Although DM in Aboriginal community is multifactorial, this report shows three perceived causes: (i) obesity and the "Thrifty Gene Hypothesis", (ii) geographical position and (iii) smoking. It concluded that the combination of these causes have increased the incidence of DM among Indigenous Australians. Therefore, the following are recommended: improvement of genetic research, improvement of medical facilities, and increased employment of Indigenous Health Professionals and improvement of anti-smoking policies.

Supporting healthy communities through sports and recreation programs

There is some evidence, in the form of critical descriptions of programs and systematic reviews, on the benefits to Aboriginal and Torres Strait Islander communities from participation in sport and recreational programs. These include some improvements in school retention, attitudes towards learning, social and cognitive skills, physical and mental health and wellbeing; increased social inclusion and cohesion; increased validation of and connection to culture; and crime reduction.Although the effects of sports and recreation programs can be powerful and transformative, these effects tend to be indirect. For example, using these programs to reduce juvenile antisocial behaviour largely work through diversion, providing alternative safe opportunities to risk taking, maintenance of social status, as wellas opportunities to build healthy relationships with Elders and links with culture.Although Indigenous Australians have lower rates of participation in sport than non-Indigenous people, surveys suggest that around one-third of Indigenous people participate in some sporting activity (ABS 2010). That makes sports a potentially powerful vehicle for encouraging Indigenous communities to look at challenging personal and community issues.Within Indigenous communities, a strong component of sport and recreation is the link with traditional culture. Cultural activities such as hunting are generally more accepted as a form of sport and recreation than traditional dance. Therefore sport and recreation are integral in understanding ‘culture’ within Indigenous communities, as well as highlighting the culture within which sport and recreation operate.