Factors influencing the willingness of community service organisation staff to provide smoking cessation support: a qualitative study.

OBJECTIVE: This study aimed to explore factors influencing community service organisation (CSO) staff members' willingness to provide tobacco cessation support to clients experiencing disadvantage. METHODS: Face-to-face semi-structured interviews were conducted with 29 staff members from seven services in the alcohol and other drugs, homelessness, and mental health sectors in Western Australia. RESULTS: The primary barriers to providing cessation support were believing that addressing smoking was not a priority relative to other issues, being a current smoker, and the lack of a formal tobacco cessation program within the organisation. Factors that appeared to be most influential in enabling the delivery of cessation support were organisational processes requiring staff to routinely ask clients about tobacco use, confidence to provide support, and being a past smoker. CONCLUSIONS: The introduction of organisational procedures that include routine cessation care should be of high priority in CSOs to help reduce smoking rates among clients. Staff may also benefit from receiving training in the provision of cessation support and education about the importance and feasibility of addressing smoking concurrently with other issues. Implications for public health: The results may inform future efforts to increase the delivery of cessation care to groups of people experiencing disadvantage and comorbidity.

Attitudinal and behavioural responses to increasing tobacco control regulation among high smoking prevalence groups: A qualitative study.

INTRODUCTION AND AIMS: Despite substantial reductions in smoking prevalence in many countries, rates remain high among people who are experiencing disadvantage. This study aimed to explore attitudinal and behavioural responses to population-wide tobacco control policies among Australian smokers experiencing disadvantage. DESIGN AND METHODS: Semi-structured qualitative interviews were conducted with 84 smokers attending community service organisations in the mental health, homelessness, and alcohol and other drug sectors. Interviewees discussed various tobacco control policies (tobacco taxes, smoke-free areas, plain packaging and graphic health warnings). The interview transcriptions were coded and thematically analysed. RESULTS: Responses to tobacco taxes were mixed. Some interviewees reported smoking less as a result of price increases, while others reallocated funds from other budget areas. Many perceived smoke-free area policies as effective, although some described strategies they use to circumvent this policy, thereby diminishing its effectiveness. Plain packaging and graphic warnings were perceived as being least effective. DISCUSSION AND CONCLUSIONS: While tobacco control policies can elicit intended attitudinal and behavioural responses, additional efforts are needed to enhance their effectiveness among smokers experiencing disadvantage. Future efforts to reduce smoking rates should address responses that diminish policy effectiveness among groups exhibiting high smoking prevalence. This could be achieved through strategies that address the specific needs of these groups, such as providing additional cessation support, enforcing existing smoke-free policies in ways that minimise inequitable effects, and addressing self-exempting beliefs.

Results of a long-term follow-up evaluation of an Australian adult nutrition education program.

BACKGROUND AND OBJECTIVES: To assess persistence of improvements in nutrition-related attitudes and behaviours 2-4 years after attending an adult nutrition education program (FOODcents). METHODS AND STUDY DESIGN: A link to an online survey was sent to 407 past FOODcents participants. The survey replicated items included in previous FOODcents evaluation surveys. In total, 87 responses were received (response rate 21%). Analyses were conducted on matched responses across 3 time points: pre, post, and follow-up. RESULTS: Improvements since baseline were maintained in confidence to buy healthy foods on a budget and a range of dietary behaviours (e.g., increased consumption of vegetables, legumes, and wholegrain products; greater use of the nutrition information available on food packages; and decreased consumption of soft drinks). There were two primary areas in which improvements were not maintained over time: reported intake of fruit and frequency of consumption of fast food. CONCLUSIONS: The results suggest that adult nutrition education can be effective in encouraging individuals to alter their food shopping processes and modify their diets. The tendency for some behavioural outcomes to be worse at follow-up than at baseline indicates that marketplace factors such as food promotion and availability may be influencing these specific dietary behaviours. This rare longitudinal study of the effects of adult nutrition education shows that this form of intervention has the potential to produce lasting improvements in attitudes and behaviours. However, such programs cannot be expected to produce large and lasting effects without support from population-level nutrition policies and programs that address macro-environmental factors that influence dietary behaviours.

Drinking Refusal Self-Efficacy and Intended Alcohol Consumption During a Mass-Attended Youth Event.

BACKGROUND: Mass-attended youth events represent a substantial public health challenge due to high levels of alcohol consumption and corresponding high rates of alcohol-related harm. Although previous research has documented the protective effect of high drinking refusal self-efficacy (DRSE) on alcohol consumption in general, there is a lack of research examining the role of DRSE in reducing consumption during mass-attended youth events and the factors associated with DRSE in these contexts. OBJECTIVES: This study aimed to identify potentially modifiable factors that influence DRSE and drinking intentions to inform interventions designed to reduce alcohol-related harm during mass-attended events. METHODS: Australian secondary school students (n = 586; 70% female) in their final two years of high school completed an online survey assessing their alcohol consumption intentions for Schoolies, their perceived degree of DRSE, and other individual and environmental factors. Path analysis was used to assess a mediational model examining factors associated with DRSE and alcohol consumption intentions. RESULTS: DRSE was found to be significantly associated with intended alcohol consumption during Schoolies. Specifically, leavers who believed they would not be able to refuse others' offers of alcoholic drinks reported significantly greater alcohol consumption intentions. Results also revealed that DRSE was enhanced in those respondents who believed there would be a variety of non-drinking activities and non-alcoholic beverages available to them during Schoolies. CONCLUSION: Results suggest the need to increase leavers' confidence in their ability to refuse unwanted alcoholic beverages and highlight the importance of providing celebration options that do not involve alcohol consumption.

Potential in-class strategies to increase children's vegetable consumption.

OBJECTIVE: The Crunch&Sip programme is a school-based nutrition initiative designed to increase the fruit, vegetable and water intakes of primary-school children. In recognition of the notable deficits in children's vegetable consumption, the present study explored the receptivity of school staff to a realignment of the Crunch&Sip programme to feature a primary focus on vegetable consumption. This involved investigating school staff members' perceptions of relevant barriers, motivators and facilitators. DESIGN: A multi-method approach was adopted that involved four focus groups and a survey (administered in paper and online formats) containing a mixture of open- and closed-ended items. SETTING: Western Australia. SUBJECTS: Staff from Western Australian schools participated in the focus groups (n 37) and survey (n 620). RESULTS: School staff were strongly supportive of modifying the Crunch&Sip programme to focus primarily on children's vegetable consumption and this was generally considered to be a feasible change to implement. Possible barriers identified included children's taste preferences and a perceived lack of parental support. Suggested strategies to overcome these barriers were education sessions for parents and children, teachers modelling vegetable consumption for their students and integrating vegetable-related topics into the school curriculum. CONCLUSIONS: School staff are likely to support the introduction of school-based nutrition programmes that specifically encourage the consumption of vegetables. Potential barriers may be overcome through strategies to engage parents and children.

The role of food shopping in later life.

By the time they reach retirement, individuals are typically highly experienced in sourcing food products and they have strong familiarity with food retailing environments. To investigate the ongoing role of food shopping in later life, the present study explored seniors' attitudes to food shopping and their food-selection behaviours through the lens of their broader lifestyles. The aim was to provide insights of relevance to the development of future efforts to optimise seniors' food shopping experiences and nutrition-related outcomes. Interviews were conducted with 75 Western Australians aged 60 + years to discuss food shopping in the context of their day-to-day lives. The sample was comprised mainly of women (n = 64) and the average age was 74 years. In general, food shopping was perceived to be a manageable but mundane part of life. The findings suggest that there has been an improvement in food retailing practices because many of the numerous areas of concern identified in previous research conducted in this geographical location a decade ago were not nominated as relevant by the interviewees. Instead, food-related issues reported to be most problematic included the difficulties associated with sourcing affordable food products that had been produced locally and that did not contain unacceptable food additives. Seniors' food shopping concerns thus appear to have changed from functional aspects of the physical store environment to product attributes that reflect the increasing industrialisation of the food industry.

Whetting disadvantaged adults' appetite for nutrition education.

OBJECTIVE: To identify the features of a nutrition education programme for disadvantaged adults deemed most attractive and useful by participants. DESIGN: A two-year, multi-method, qualitative evaluation of pre and post data collected from programme participants. Data were imported into NVivo10 for coding to facilitate a thematic analysis. SETTING: Western Australia. Participants Individuals attending the Western Australian FOODcents nutrition education programme that is designed to provide knowledge and skills needed to consume a healthy diet on a budget. Focus groups were conducted several weeks after course completion (five groups, forty-seven participants), observations were conducted during FOODcents sessions (thirty-one observation episodes, 237 participants), and open-ended questions were asked in pre-post hard-copy surveys administered in sessions (n 927) and an online survey administered on average six weeks after course completion (n 114). RESULTS: The course attributes that were found to be especially important to participants were: (i) user-friendly, practical information that could be immediately translated to their daily lives; (ii) experiential learning that involved direct contact with food products; and (iii) opportunities for social interaction. These aspects of nutrition education were described as being highly influential in the decision to participate in the course, the application of the information in their subsequent food purchase and preparation activities, and their word-of-mouth communications with others about the course. CONCLUSIONS: Incorporating aspects of most importance to participants into nutrition education programme delivery and promotion may increase joining rates, enjoyment, satisfaction with course content and, ultimately, the uptake of recommended behaviours.

Western Australian students' alcohol consumption and expenditure intentions for Schoolies.

In Australia, the immediate post-school period (known as 'Schoolies') is associated with heavy drinking and high levels of alcohol-related harm. This study investigated students' intended alcohol consumption during Schoolies to inform interventions to reduce alcohol-related harm among this group. An online survey was administered to students in their senior year of schooling. Included items related to intended daily alcohol consumption during Schoolies, amount of money intended to be spent on alcohol over the Schoolies period, and past drinking behaviour. On average, participants (n=187) anticipated that they would consume eight standard drinks per day, which is substantially higher than the recommended maximum of no more than four drinks on a single occasion. Participants intended to spend an average of A$131 on alcohol over the Schoolies period. Although higher than national guidelines, intended alcohol consumption was considerably lower than has been previously documented during Schoolies events. The substantial amounts of money expected to be spent during Schoolies suggest this group has adequate spending power to constitute an attractive target market for those offering alternative activities that are associated with lower levels of alcohol-related harm.

An investigation of young girls' responses to sexualized images.

Evidence suggests that the sexualization of girls has increased and become more explicit in recent years. However, most of the research conducted to date has focused on sexualization in adults. To address this research gap, this study explored how young Australian girls respond to and describe sexualized and non-sexualized depictions of their peers. Results from 42 girls aged 6-11 years revealed that sexualization was a perceptually salient attribute, with participants readily classifying sexualized girls as a subgroup. Participants also made distinct trait attributions based on the differences between sexualized and non-sexualized girls. The results suggest that young girls respond differently to sexualized and non-sexualized depictions of their peers and are beginning to develop stereotypes based on these depictions. As such, the implementation of media literacy programs in adolescence may be too late and efforts may be required to address this issue among younger children.

Anticipating and addressing event-specific alcohol consumption among adolescents.

BACKGROUND: Various specific events and celebrations are associated with excessive alcohol consumption and related harms. End-of-school celebrations such as Schoolies in Australia are of particular concern given high levels of documented harm among underage and young drinkers. The present study investigated high school students' expectations of their Schoolies celebrations to inform future interventions to reduce adverse outcomes among members of this vulnerable group and other young people involved in similar rites of passage. METHODS: A link to an online survey was distributed via high schools and Schoolies-related websites. The survey included qualitative questions that invited respondents to discuss (i) aspects of Schoolies they were looking forward to most and least and (ii) their perceptions of the likely consequences if they refrained from consuming alcohol during the event. In total, 435 students provided responses. RESULTS: Respondents discussed the role of Schoolies in marking their transition to adulthood. Their comments revealed a cross-temporal focus indicating that Schoolies is simultaneously symbolic of the past, present, and future. Through its ability to enhance social interaction, alcohol was perceived to have a vital role in realising the potential of this event to signify and facilitate this temporal progression. CONCLUSIONS: Results suggest interventions that treat Schoolies as an isolated event that occurs in specific locations may fail to appreciate the extent to which these events transcend time for those involved. Instead, harm reduction is likely to involve a reconceptualisation of the event among both participants and authority figures to facilitate the provision of alternative pastimes to drinking during Schoolies that yield similar social benefits.

Reverse engineering a 'responsible drinking' campaign to assess strategic intent.

BACKGROUND AND AIMS: The alcohol industry produces 'responsible drinking' advertising campaigns. There is concern that these may promote drinking while persuading governments and the general public that the industry is acting responsibly. This paper examined young people's thoughts and feelings in response to one of these campaigns in Australia. DESIGN: A qualitative analysis of introspection data provided by young drinkers after exposure to a responsible drinking advertisement produced by DrinkWise called 'How to Drink Properly'. SETTING: Perth, Western Australia. PARTICIPANTS: Forty-eight 18-21-year-old drinkers. MEASUREMENTS: The qualitative data were imported into NVivo10 and coded according to the various stages of advertising effects frameworks. A thematic analysis approach was used to identify patterns in the data relating to (i) perceptions of the source and purpose of the advertisement and (ii) any resulting attitudinal or behavioural outcomes. FINDINGS: Despite the sample comprising mainly high-risk drinkers, participants were generally unable to relate to the heavy drinkers depicted in the DrinkWise advertisement. This disassociation resulted in a perceived lack of need to modify their own drinking behaviours. Instead, the study participants found the advertisement to be entertaining and supportive of existing social norms relating to heavy drinking among members of this age group. CONCLUSIONS: The 'How to Drink Properly' advertisement by Drinkwise in Australia may reinforce existing drinking attitudes and behaviours among young drinkers.

Factors influencing young people's use of alcohol mixed with energy drinks.

A growing evidence base demonstrates the negative health outcomes associated with the consumption of energy drinks (ED) and alcohol mixed with energy drinks (AMED), especially among young people. Work to date has focused on the physiological effects of ED and AMED use and the motivations associated with consumption, typically among college students. The present study adopted an exploratory, qualitative approach with a community sample of 18-21 year olds to identify relevant barriers, motivators, and facilitators to AMED use and to explicate the decision-making processes involved. The sensitisation method was used to collect data from a cohort of 60 young adult drinkers over a period of six months via individual interviews, focus groups, and introspections. The findings indicate that there may be a general understanding of the negative consequences of AMED use, and that these consequences can constitute barriers that serve to discourage frequent consumption among young people. This outcome suggests the potential application of positive deviance and social norms approaches in interventions designed to reduce AMED use among this population segment. The results are promising in the identification of a large number of concerns among young adults relating to AMED use. These concerns can constitute the focus of future communications with this target group. The results are likely to have relevance to other countries, such as the US and the UK, that share similar alcohol cultures and where energy drinks have achieved comparable market penetration rates.

Sales promotion strategies and youth drinking in Australia.

This study employed an exploratory approach to generate detailed information about how in-store shopping experiences and exposure to sales promotion activities feature in the alcohol choices of Australian 18-21 year old drinkers. The qualitative methods of interviews, focus groups, and emailed narratives were used during 2014 to collect relevant data. The findings suggest that young drinkers' in-store shopping experiences and exposure to sales promotions influence the type, range, and quantity of alcohol purchased. In particular, the role of sales staff can be critical in increasing the amount of alcohol purchased by drawing drinkers' attention to and encouraging their participation in sales promotions. There thus appears to be an important interaction between promotional practices and young drinkers purchasing substantially larger quantities of alcohol than originally intended. Such practices need review in light of the high risk of alcohol-related harm experienced by many members of this age group.

Understanding and addressing the Schoolies phenomenon.

OBJECTIVE: This study qualitatively explored Western Australian school leavers' alcohol-related experiences during the Schoolies period to generate insights for the purpose of intervention design. This is in the context of an impending change in the age of Western Australian students completing secondary school which, for the first time, will see around half being of legal age to purchase alcohol. METHOD: Fifty-four 18-21-year-olds provided reflections via an emailed introspection on their experiences in the immediate post-school period. This provided access to the views of those who chose to attend events and consume large amounts of alcohol, those who attended events but refrained from excessive alcohol consumption, and those who elected to either avoid Schoolies events or engage in alternative celebrations. The data were coded and analysed using NVivo10. RESULTS: Three primary themes were identified that related to the perceived role of alcohol during Schoolies, the range of associated rite-of-passage rituals, and the strategies used by some Leavers to avoid alcohol and its consequences during the Schoolies period. CONCLUSION: Students and parents constitute important target groups for interventions designed to address alcohol-related harms during Schoolies. In the WA context, legislation on secondary supply and controlled purchase, as recommended by health and police authorities, could reduce harms that are likely to result from the change in the age of school leavers. Suggestions for alternative pastimes to promote to school leavers are provided.