Policy options for endgame planning in tobacco control: a simulation modelling study.

OBJECTIVE: To investigate the potential impacts of several tobacco control interventions on adult daily smoking prevalence in the Australian state of Queensland, using a system dynamics model codeveloped with local and national stakeholders. METHODS: Eight intervention scenarios were simulated and compared with a reference scenario (business as usual), in which all tobacco control measures currently in place are maintained unchanged until the end of the simulation period (31 December 2037). FINDINGS: Under the business as usual scenario, adult daily smoking prevalence is projected to decline from 11.8% in 2017 to 5.58% in 2037. A sustained 50% increase in antismoking advertising exposure from 2018 reduces projected prevalence in 2037 by 0.80 percentage points. Similar reductions are projected with the introduction of tobacco wholesaler and retailer licensing schemes that either permit or prohibit tobacco sales by alcohol-licensed venues (0.65 and 1.73 percentage points, respectively). Increasing the minimum age of legal supply of tobacco products substantially reduces adolescent initiation, but has minimal impact on smoking prevalence in the adult population over the simulation period. Sustained reductions in antismoking advertising exposure of 50% and 100% from 2018 increase projected adult daily smoking prevalence in 2037 by 0.88 and 1.98 percentage points, respectively. CONCLUSIONS: These results suggest that any prudent approach to endgame planning should seek to build on rather than replace existing tobacco control measures that have proved effective to date. Additional interventions that can promote cessation are expected to be more successful in reducing smoking prevalence than interventions focussing exclusively on preventing initiation.

Trends in Total Physical Activity Time, Walking, and Vigorous Physical Activity Time in Queensland Adults From 2004-2018.

BACKGROUND: Health benefits of physical activity (PA) accrue with small increases in PA, with the greatest benefits for those transitioning from inactivity to any level of PA. This study examined whether self-reported PA time in Queensland adults changed between 2004 and 2018. METHODS: The Queensland government conducts regular cross-sectional telephone surveys. Between 2004 and 2018, adults aged 18-75 years answered identical questions about their weekly minutes of walking, moderate PA, and vigorous PA. Hurdle regression estimated the average annual change in weekly minutes of PA overall and by activity type, focusing on sociodemographic differences in trends. RESULTS: The sample size averaged 1764 (2004-2008) and 10,188 (2009-2018), totaling 107,171 participants aged 18-75 years. Unadjusted PA increased by 10 minutes per week per year (95% confidence interval [CI], 8.8-11.1) overall, with increases for most subgroups. Adjusted PA increased by 10.5 minutes per week per year (95% CI, 9.4-11.7). Trends differed by employment-employed adults and those not in the labor force increased by 14.3 (95% CI, 12.8-15.8) and 2.2 minutes per week per year (95% CI, 0.4-4.0), respectively, with no increase for unemployed adults. The increases were due to both an increased prevalence of doing any activity and an increased average duration among active adults. CONCLUSIONS: Since 2004, PA time has increased for Queensland adults, with substantial variability by employment status.

Including mobile-only telephone users in a statewide preventive health survey-Differences in the prevalence of health risk factors and impact on trends.

The Queensland preventive health survey is conducted annually to monitor the prevalence of behavioural risk factors in the north-east Australian state. Prompted by domestic and international trends in mobile telephone usage, the 2015 survey incorporated both mobile and landline telephone numbers from a list-based sampling frame. Estimates for landline-accessible and mobile-only respondents are compared to assess potential bias in landline-only surveys in the context of public health surveillance. Significant differences were found in subcategories of all health prevalence estimates considered (alcohol consumption, body mass index, smoking, and physical activity) from 2015 survey results. Results from Australian and international studies that have considered mobile telephone non-coverage bias are also summarised and discussed. We find that adjusting for sampling biases of telephone surveys by weighting does not fully compensate for the differences in prevalence estimates. However, predicted trends from previous years' surveys only differ significantly for the 2015 prevalence estimates of alcohol consumption. We conclude that the inclusion of mobile telephones into standard telephones surveys is important for obtaining valid, reliable and representative data to reduce bias in health prevalence estimates. Importantly, unlike some international experiences, the addition of mobiles telephones into the Queensland preventive health survey occurred before population trends were significantly affected.

Pathways between childhood trauma, intimate partner violence, and harsh parenting: findings from the UN Multi-country Study on Men and Violence in Asia and the Pacific.

BACKGROUND: Although childhood trauma and violence against women are global public health issues, few population-based data from low-income and middle-income countries exist about the links between them. We present data from the UN Multi-country Study on Men and Violence in Asia and the Pacific, exploring the pathways between different forms of childhood trauma and violence against women. METHODS: In this multicountry study, we interviewed multistage representative samples of men and women, aged 18-49 years, in Asia and the Pacific, using standardised population-based household surveys. Men were interviewed in six countries, and women in four. Respondents were asked questions about their perpetration or experience of intimate partner violence or non-partner sexual violence, childhood trauma, and harsh parenting (smacking their children as a form of discipline). We used maximum likelihood multivariate logit models to explore associations between childhood trauma and violence against women, and fitted path models to explore associations between experience and perpetration of child maltreatment. FINDINGS: Between Jan 1, 2011, and Dec 1, 2012, 10 178 men and 3106 women completed interviews in this study, with between 815 and 1812 men per site and 477 and 1103 women per site. The proportion of men who experienced any childhood trauma varied between 59% (n=478, 95% CI 54·0-63·3; Indonesia rural site) and 92% (n=791, 89·4-93·8; Bougainville, Papua New Guinea). For women, the results ranged from 44% (n=272, 37·7-50·8; Sri Lanka) to 84% (n=725, 80·7-86·8; Bougainville, Papua New Guinea). For men, all forms of childhood trauma were associated with all forms of intimate partner violence perpetration. For women, all forms of childhood trauma were associated with physical intimate partner violence, and both physical and sexual intimate partner violence. There were significant, often gendered, pathways between men's and women's perpetration and experiences of childhood trauma, physical intimate partner violence, harsh parenting, and other factors. INTERPRETATION: The data point to both a co-occurrence and a cycle of abuse, with childhood trauma leading to violence against women and further child maltreatment, which in turn increases the risk of experience or perpetration of violence during adulthood. Efforts to prevent both forms of violence would benefit from a meaningful integrated approach. Interventions should promote positive parenting, address inequality and the normalisation of violence across the life course, and transform men's power over women and children. FUNDING: Partners for Prevention. National studies were funded by the UN Population Fund in Bangladesh and China, UN Women in Cambodia and Indonesia, UN Develoment Programme in Papua New Guinea, and CARE in Sri Lanka.

Prevalence of and factors associated with male perpetration of intimate partner violence: findings from the UN Multi-country Cross-sectional Study on Men and Violence in Asia and the Pacific.

BACKGROUND: Male perpetration of intimate partner violence (IPV) is under-researched. In this Article, we present data for the prevalence of, and factors associated with, male perpetration of IPV from the UN Multi-country Cross-sectional Study on Men and Violence in Asia and the Pacific. We aimed to estimate the prevalence of perpetration of partner violence, identify factors associated with perpetration of different forms of violence, and inform prevention strategies. METHODS: We undertook standardised population-based household surveys with a multistage representative sample of men aged 18-49 years in nine sites in Bangladesh, China, Cambodia, Indonesia, Sri Lanka, and Papua New Guinea between January, 2011, and December, 2012. We built multinomial regression models of factors associated with lifetime violence perpetration: physical IPV, sexual IPV, both physical and sexual IPV, multiple emotional or economic IPV versus none, and calculated population-attributable fractions. In the analysis, we considered factors related to social characteristics, gender attitudes and relationship practices, victimisation history, psychological factors, substance misuse, and participation in violence outside the home. FINDINGS: 10,178 men completed interviews in our study (between 815 and 1812 per site). The response rate was higher than 82·5% in all sites except for urban Bangladesh (73·2%) and Sri Lanka (58·7%). The prevalence of physical or sexual IPV perpetration, or both, varied by site, between 25·4% (190/746; rural Indonesia) and 80·0% (572/714; Bougainville, Papua New Guinea). When multiple emotional or economic abuse was included, the prevalence of IPV perpetration ranged from 39·3% (409/1040; Sri Lanka) to 87·3% (623/714; Bougainville, Papua New Guinea). Factors associated with IPV perpetration varied by country and type of violence. On the basis of population-attributable fractions, we show factors related to gender and relationship practices to be most important, followed by experiences of childhood trauma, alcohol misuse and depression, low education, poverty, and involvement in gangs and fights with weapons. INTERPRETATION: Perpetration of IPV by men is highly prevalent in the general population in the sites studied. Prevention of IPV is crucial, and interventions should address gender socialisation and power relations, abuse in childhood, mental health issues, and poverty. Interventions should be tailored to respond to the specific patterns of violence in various contexts. Physical and sexual partner violence might need to be addressed in different ways. FUNDING: Partners for Prevention--a UN Development Programme, UN Population Fund, UN Women, and UN Volunteers regional joint programme for gender-based violence prevention in Asia and the Pacific; UN Population Fund Bangladesh and China; UN Women Cambodia and Indonesia; UN Development Programme in Papua New Guinea and Pacific Centre; and the Governments of Australia, the UK, Norway, and Sweden.

Prevalence of and factors associated with non-partner rape perpetration: findings from the UN Multi-country Cross-sectional Study on Men and Violence in Asia and the Pacific.

BACKGROUND: Rape perpetration is under-researched. In this study, we aimed to describe the prevalence of, and factors associated with, male perpetration of rape of non-partner women and of men, and the reasons for rape, from nine sites in Asia and the Pacific across six countries: Bangladesh, China, Cambodia, Indonesia, Papua New Guinea, and Sri Lanka. METHODS: In this cross-sectional study, undertaken in January 2011-December 2012, for each site we chose a multistage representative sample of households and interviewed one man aged 18-49 years from each. Men self-completed questions about rape perpetration. We present multinomial regression models of factors associated with single and multiple perpetrator rape and multivariable logistic regression models of factors associated with perpetration of male rape with population-attributable fractions. FINDINGS: We interviewed 10,178 men in our study (815-1812 per site). The prevalence of non-partner single perpetrator rape varied between 2·5% (28/1131; rural Bangladesh) and 26·6% (225/846; Bougainville, Papua New Guinea), multiple perpetrator rape between 1·4% (18/1246; urban Bangladesh) and 14·1% (119/846; Bougainville, Papua New Guinea), and male rape between 1·5% (13/880; Jayapura, Indonesia) and 7·7% (65/850; Bougainville, Papua New Guinea). 57·5% (587/1022) of men who raped a non-partner committed their first rape as teenagers. Frequent reasons for rape were sexual entitlement (666/909; 73·3%, 95% CI 70·3-76·0), seeking of entertainment (541/921; 58·7%, 55·0-62·4), and as a punishment (343/905; 37·9%, 34·5-41·4). Alcohol was a factor in 249 of 921 cases (27·0%, 95% CI 24·2-30·1). Associated factors included poverty, personal history of victimisation (especially in childhood), low empathy, alcohol misuse, masculinities emphasising heterosexual performance, dominance over women, and participation in gangs and related activities. Only 443 of 1933 men (22·9%, 95% CI 20·7-25·3) who had committed rape had ever been sent to prison for any period. INTERPRETATION: Rape perpetration committed by men is quite frequent in the general population in the countries studied, as it is in other countries where similar research has been undertaken, such as South Africa. Prevention of rape is essential, and interventions must focus on childhood and adolescence, and address culturally rooted male gender socialisation and power relations, abuse in childhood, and poverty. FUNDING: Partners for Prevention--a UN Development Programme, UN Population Fund, UN Women, and UN Volunteers regional joint programme for gender-based violence prevention in Asia and the Pacific; UN Population Fund Bangladesh and China; UN Women Cambodia and Indonesia; United Nations Development Programme in Papua New Guinea and Pacific Centre; and the Governments of Australia, the UK, Norway, and Sweden.