Exploring COVID-19 vaccine hesitancy among young adults in Australia. A qualitative study.

Background: COVID-19 vaccine hesitancy among young adults in Australia is still poorly understood. Young adults aged 25-34 years have been identified as a population subgroup where COVID-19 vaccine-hesitant views are highly prevalent. Objective: Exploring the attitudes, thoughts, feelings and social environments affecting the decision to have or not have the vaccine can provide vital transferrable lessons in future health campaigns. Methods: A qualitative phenomenological study was conducted using semi-structured phone interviews between June 2021 and July 2021. Interview questions were adopted from the World Health Organization's guidance document 'Data for Action: Achieving High Uptake of COVID-19 Vaccines'. Participants aged 25-34 years (n = 26) were recruited via purposive and snowball sampling methods. Data were analysed thematically. Results: Overall, participants presented themselves as highly vaccine literate, understanding their social contract with society. Many participants also did not display traditional vaccine-hesitant views. Six themes specifically regarding COVID-19 vaccine hesitancy were identified, namely (1) decision-making complexities, (2) perceived risk of COVID-19 infection, (3) media's misrepresentation of COVID-19, (4) vaccine-related issues, (5) inconsistent government messaging and program execution, and (6) social benefits assessment. In addition, motivators to COVID-19 vaccine uptake were classified into three categories: (1) tangible benefits, (2) protecting others, and (3) mandates and incentives. Findings suggest the motivators for COVID-19 vaccine uptake in young adults depend on individual benefits, highlighting the importance of recognising and addressing personal concerns. Conclusion: There is a need to re-examine and redefine the meaning of vaccine hesitancy in young Australian adults. We offer an understanding of prospective challenges with vaccine hesitancy and potential solutions to address them. These include carefully tailored approaches regarding ongoing vaccine safety concerns and the expected personal benefits following vaccination. Combining these factors can aid in developing new methods of public engagement in the next public health crisis.

'It's the wild west out there': A qualitative study of the views and preparedness of health professionals in helping young adult e-cigarette users to quit.

INTRODUCTION: Young adults are attempting to quit vaping, with many accessing smoking cessation programs with a lack of reported efficacy, highlighting the need for targeted vaping cessation support. Young people report seeing health professionals as potential sources of support in the quitting process. Additionally, the current changing regulatory landscape around vaping in Australia potentially increases numbers of those seeking health professional help for cessation. However, limited research exists on health professionals' views and preparedness to assist young adults with their vaping cessation; thus, this exploratory study aimed to gain insights into their readiness to support young adults in quitting vaping. METHODS: Data were gathered via eight co-design workshops (two groups each of two hours duration and six semi-structured interviews of 1 hour duration), facilitated online with 12 health professionals. Data underwent thematic analysis. RESULTS: Health professionals expressed a need for more information in supporting young adults to quit vaping, with them presently relying on informal pathways of support and information for their practice. Participants reported a lack of evidence-based guidelines and a reluctance to prescribe nicotine vapes, expressing conflict with the changing regulatory landscape in Australia. CONCLUSIONS: Our findings identify a significant gap in health professional preparedness in supporting vaping cessation. Health professionals are working within a rapidly evolving regulatory environment and are feeling unprepared to address the widely spread issue of vaping, especially among young people. We demonstrate the critical need for guidelines and training of health professionals to enable them to better support young people in quitting vaping. IMPLICATIONS: This qualitative study offers unique insights into the views and readiness of Australian health professionals to support young people to quit vaping, specifically in the context of recent regulatory reforms. The results highlight the need for evidence-based guidance and training for health professionals to inform their vaping cessation support practice.

What methods are used to examine representation of mental ill-health on social media? A systematic review.

There has been an increasing number of papers which explore the representation of mental health on social media using various social media platforms and methodologies. It is timely to review methodologies employed in this growing body of research in order to understand their strengths and weaknesses. This systematic literature review provides a comprehensive overview and evaluation of the methods used to investigate the representation of mental ill-health on social media, shedding light on the current state of this field. Seven databases were searched with keywords related to social media, mental health, and aspects of representation (e.g., trivialisation or stigma). Of the 36 studies which met inclusion criteria, the most frequently selected social media platforms for data collection were Twitter (n = 22, 61.1%), Sina Weibo (n = 5, 13.9%) and YouTube (n = 4, 11.1%). The vast majority of studies analysed social media data using manual content analysis (n = 24, 66.7%), with limited studies employing more contemporary data analysis techniques, such as machine learning (n = 5, 13.9%). Few studies analysed visual data (n = 7, 19.4%). To enable a more complete understanding of mental ill-health representation on social media, further research is needed focussing on popular and influential image and video-based platforms, moving beyond text-based data like Twitter. Future research in this field should also employ a combination of both manual and computer-assisted approaches for analysis.

Demographics, comorbidities and risk factors for severe disease from the early SARS-CoV-2 infection cases in Queensland, Australia.

BACKGROUND: Demographics and comorbidities associated with coronavirus disease 2019 (COVID-19) severity differs between subpopulations and should be determined to aid future pandemic planning and preparedness. AIM: To describe the demographics and comorbidities of patients diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in Queensland (QLD), Australia, between January 2020 and May 2021. Also, to determine the relationship between these characteristics and disease severity based on the highest level of care. METHODS: A retrospective case series analysis was conducted using data obtained from the Notifiable Conditions System. Data on patients confirmed with SARS-CoV-2 infection in QLD were included in this analysis. Descriptive statistics and logistic regression modelling were used to analyse factors that contributed to disease severity. RESULTS: One thousand six hundred twenty-five patients with SARS-CoV-2 infection were diagnosed in the study period and analysed. The median age was 41 years and 54.3% (n = 882) were males. A total of 550 patients were hospitalised and 20 patients were admitted to the intensive care unit (ICU). In those admitted to the ICU, 95% (n = 19) were older than 45 years and 95% (n = 19) were male. Comorbidities significantly associated with hospitalisation were chronic cardiac disease (excluding hypertension) and diabetes, and for ICU admission were morbid obesity, chronic respiratory disease and chronic cardiac disease. No demographic factors were shown to be significantly associated with disease severity. CONCLUSIONS: Comorbidities associated with the highest level of COVID-19 disease severity were morbid obesity, chronic respiratory disease and cardiac disease. These data can assist with identifying high-risk patients susceptible to severe COVID-19 and can be used to facilitate preparations for future pandemics.

An Analysis of Crisis Communication Delivered by the Chief Health Officer During the COVID-19 Pandemic in Queensland, Australia.

During the first year of the COVID-19 pandemic, the state of Queensland, Australia, had relative success in containing viral transmission, presenting a unique case for potential insights into effective crisis management. Limited research exists into the communication style and effectiveness of Chief Health Officers (CHOs) throughout pandemic scenarios. Using an adapted Crisis Emergency and Risk Communication (CERC) framework based on 12 themes which indirectly assess domains of trust, credibility, transparency, and accountability. A content analysis of 107 press conferences dating from January 30th to December 24th, 2020 was conducted to analyze crisis communication style delivered by the Queensland CHO and guest speakers. Our analysis found that most communication aligned with the CERC framework, suggesting that adherence to CERC themes in crisis communication may have played an important role in the state's success. However, areas which were lacking included themes relating to efforts to address, search and gather knowledge. Analysis also revealed that some CERC themes overlapped or were missing, thus triggering the development of a modified framework to provide a more succinct coding model. Our findings demonstrate the importance communication plays in successful crisis management and the modified framework can be applied to analyze communication at national and sub-national levels.

Understanding the experiences and needs of LGBTIQA+ individuals when accessing abortion care and pregnancy options counselling: a scoping review.

BACKGROUND: Safe, accessible, and inclusive abortion care and pregnancy options counselling are essential components of sexual and reproductive health and rights. Research has documented LGBTIQA+ people are as likely, or more than likely, as the general population to experience an abortion in their lifetime yet face significant barriers to accessing abortion and related care, which undermines well-being. AIMS: The present study undertakes a scoping review of research on the needs and experiences of the LGBTIQA+ population (representing lesbian, gay, bisexual, transgender, gender diverse, intersex, queer, asexual, and questioning) when accessing abortion care, pregnancy options, and post-abortion counselling to support improved understanding of pregnant people's preferences, needs, and experiences. METHODS: The reporting of this scoping review is guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension of Scoping Reviews (PRISMA-ScR). Academic databases were searched using terms relating to gender identity and sexuality, abortion, pregnancy options, and post-abortion counselling to identify peer reviewed papers published in English. Seven publications were included in the review that described experiences of LGBTIQA+ people accessing abortion-related care. RESULTS: The included studies were predominantly conducted in the USA using quantitative and qualitative research designs. Thematic analysis highlighted participants' experiences of discrimination and exclusion in healthcare settings, healthcare avoidance, unsafe abortion, non-disclosure to providers, and poor health outcomes for LGBTIQA+ people. CONCLUSIONS: Gender-inclusive services and training for health providers is necessary to provide safe and accessible abortion care and overcome generations of mistrust held by the LGBTIQA+ community. Research into the needs of LGBTIQA+ people when accessing pregnancy options counselling is critically needed.

The Vave campaign: impact evaluation of a cancer awareness raising multi-media campaign in Samoa.

Cancer is a leading cause of premature death and disability in Samoa. Recognizing the importance of symptom awareness and early detection, the Samoa Cancer Society (SCS) developed the 'Vave' (quickly) campaign as the first multi-media cancer awareness campaign in Samoa. The campaign adopted a three-pronged community engagement approach including mass media; printed resources; and community outreach at culturally appropriate locations including churches, villages and schools. The campaign promoted three key messages: detect signs and symptoms quickly; quickly see a doctor; and quickly call SCS. To measure impact, data were collected using several methods around the outreach education sessions (pre- and post-surveys), campaign recall (survey) and Vave-related enquiries received by SCS. The findings revealed the campaign was effective in increasing awareness of cancer and importance of early detection demonstrated through community recall of campaign messages, increased enquiries to SCS and improved knowledge. However, it is of note that almost 30% of campaign recall respondents stated they were unsure or would not see a doctor if concerned about a sign of cancer. The reasons given being a lack of knowledge, lack of trust in hospitals and preference for traditional healing. This suggests more targeted culturally sensitive strategies are needed including partnering with traditional healers. Further, advocacy efforts are needed to address the structural barriers to cancer detection and treatment together with continuing education around causes and symptoms of cancer targeting the hard-to-reach communities in Samoa.

Cancer is a number one killer and cause of disability in Samoa. Identifying cancer early can lead to better health outcomes. Ability to understand signs and symptoms of cancer among community members is crucial in facilitating early detection. Recognizing this, the Samoa Cancer Society (SCS) developed the first ever multi-media cancer awareness campaign in Samoa­the 'Vave' which means 'quickly'. The campaign used mass media; printed resources; and community outreach to spread three key messages: detect signs and symptoms quickly; quickly see a doctor; and quickly call SCS. To understand how effective the campaign was, data were collected through surveys and statistics on Vave-related calls to SCS. The campaign was effective in increasing awareness of cancer and importance of early detection demonstrated through community recall of campaign messages, increased enquiries to SCS and improved knowledge. Efforts are needed to address the structural barriers to cancer early detection and continuing education targeting the hard-to-reach communities in Samoa.

Vision screening outcomes of 4-5 year-olds reflect the social gradient.

CLINICAL RELEVANCE: Children in socioeconomically disadvantaged communities often do not access follow-up eye care services when referred from vision screenings; whether this is due to lack of availability is not known. This paper highlights the need for vision and eye care for vulnerable children with practicing clinical optometrists well placed to provide vision care. BACKGROUND: Vision impairments develop from a young age and may inhibit learning experiences and impact life outcomes. Vision screening to detect and refer vision abnormalities supports children in their education and prevents minor vision impairments from worsening. This research describes outcomes from a vision screening programme for 4- to 5-year-olds delivered in Queensland, Australia. METHODS: The programme involved all prep children from participating schools in Queensland. Vision screening was conducted with the Parr 4 m Visual Acuity Test and Welch Allyn Spot Vision Screener. A cross-sectional study design was adopted. Descriptive data analyses explored the frequency of vision screening and referral outcomes. Inferential analyses examined associations between vision screening and referral outcomes with socio-economic indexes for areas (SEIFA) scores . RESULTS: Of 71,003 prep students screened, 4,855 (6.8%) received a referral recommendation. A higher proportion of children who received a referral recommendation was from more disadvantaged locations (?2 = 109.16, p < 0.001). Of the students referred, 3,017 were seen by an eye health professional. Further vision assessment of students by an eye health professional revealed that 43.3% of the referred children were diagnosed with a vision abnormality, 18.9% had no vision abnormality and 37.7% had an 'undetermined' diagnosis. A higher proportion of children confirmed with a vision abnormality were from more disadvantaged locations (?2 = 52.27, p < 0.001). CONCLUSION: It is important that vision screening programmes target disadvantaged populations and support families of children who require further health assessment to access health services.

The effect of resilience on the relationship between perceived stress and change in alcohol consumption during the COVID-19 pandemic in Queensland, Australia.

The COVID-19 pandemic has led to increased levels of stress and alcohol consumption. This study examined the effect of resilience on the relationship between stress and changes in alcohol consumption in the context of the COVID-19 pandemic in early 2020. A cross-sectional survey of 502 adults in Queensland, Australia (mean age = 45.68 (16.61)), found 23.9% of individuals had increased their alcohol consumption since the start of the pandemic. Regression modelling demonstrated a significant association between perceived stress and change in alcohol consumption. The study also revealed resilience was a moderating factor, where high levels of resilience buffered against increases in alcohol consumption associated with stress during the COVID-19 pandemic.

Beliefs about cancer causation in Samoa: results from an awareness campaign recall survey.

INTRODUCTION: Cancer is a leading cause of death in Samoa. Cultural beliefs shape attitudes towards disease and disease prevention in Pacific countries, and are a barrier to engaging in cancer screening services. METHODS: A survey of 205 Samoan adults conducted as part of the evaluation of the first cancer awareness campaign implemented in Samoa explored beliefs about cancer causation. RESULTS: Lifestyle factors associated with a departure from fa'aSamoa (traditional lifestyle) were most commonly cited as causing cancer. Cancer was also attributed to pathogens and person-to-person transmission, and, to a lesser extent, cultural beliefs including supernatural agency (spirits, God). CONCLUSION: Addressing misconceptions while integrating certain aspects of fa'aSamoa into cancer control strategies could support greater engagement in health promotion practices and screening initiatives.

"Getting better at getting better": How Sharing Mental Health Stories Can Shape Young People's Wellbeing.

Sharing lived-experience of mental ill-health is increasingly recognised as a promising youth mental health intervention. batyr is a preventative mental health organization that trains young people to share their story of mental ill-health safely through a speaker development program. This qualitative study aimed to understand how the role of batyr speakers shapes individual wellbeing, help-seeking behaviour, and stigma as well as how young people talk about mental health within their social circles. Data was collected using in-depth semi-structured interviews with 18 batyr speakers (age 18-35 years). Thematic analysis revealed five themes: Getting better at getting better, Growing towards self-acceptance, Breaking the wall by talking about mental health, Increasing connectedness and Reaching out for support. The participants reported overall improved wellbeing, as a result of increased confidence, greater self-awareness, and an increased ability to talk safely about their mental illness. Findings suggested that the program led to a reduction of self-stigma and stigma.

Who Are the Flourishing Emerging Adults on the Urban East Coast of Australia?

It is increasingly recognised that strategies to treat or prevent mental illness alone do not guarantee a mentally healthy population. Emerging adults have been identified as a particularly vulnerable population when it comes to mental health concerns. While mental illnesses are carefully monitored and researched, less is known about mental wellbeing or flourishing, that is, experience of both high hedonic and eudaimonic wellbeing. This cross-sectional study examined the prevalence of flourishing and its predictors among emerging adults in Australia. 1155 emerging adults aged 18-25 years completed a survey containing measures of wellbeing, social networks, social connectedness, health status, and socio-demographic variables. Most participants (60.4%) experienced moderate levels of wellbeing, 38.6% were flourishing and 1% were languishing (low wellbeing). Flourishers were more likely to be older, identify as Indigenous, be in a romantic relationship, study at university, perceive their family background as wealthy, rate their general health status as excellent, and have higher perceived social resources. The findings show that the majority of emerging adults are not experiencing flourishing and offer an insight into potential target groups and settings, such as vocational education colleges, for emerging adult mental health promotion. Interventions that help strengthen social resources have the potential to improve the mental wellbeing of emerging adults.

Analysis of crisis communication by the Prime Minister of Australia during the COVID-19 pandemic.

Leadership and communication capabilities of federal leaders during crises are imperative to support and guide citizens' behaviors and emotions. The following content analysis examines crisis communication delivered by the Australian Prime Minister (PM), Scott Morrison during the COVID-19 pandemic. Communication delivered over seven months starting from the first reported case of COVID-19 in Australia, was analyzed through a process of coding to identify central organizing crisis communication frames and themes and measured against eleven main themes based on principles of Crisis and Emergency Risk Communication (CERC) recommended by the WHO and US Centers for Disease Control and Prevention. Transcripts were sourced from the PM's official website and 91 communiques were analyzed. Key epidemiological indicators and public health measures were reviewed over timeframe to examine changes in communication over the pandemic. Findings indicated that PM Morrison included many features of CERC within his official messaging. Our analysis revealed that the original framework was limited in its scope to encompass certain messages and thus the allocation of new frames,'public health and medical advice' and 'assuring and commending the public and institutions', allowed for a more thorough analysis of communication during a novel global health pandemic. The temporal analysis demonstrated that the government's policy and communication temporally followed case numbers and relative threat of the virus. This study has provided an in-depth review of CERC during the first phase of the COVID-19 pandemic. New frames and themes for the current CERC framework are suggested which can be transferable to other crises in Australia and other countries.

Does Flourishing Reduce Engagement in Unhealthy and Risky Lifestyle Behaviours in Emerging Adults?

Emerging adulthood is a transitional life stage with increased probability of risky and unhealthy lifestyle behaviours that are known to have strong links with premature mortality and morbidity. Wellbeing, as a positive subjective experience, is identified as a factor that encourages self-care and may steer individuals away from risky lifestyle behaviours. Investigating wellbeing-behaviour links in the emerging adult population may increase understanding of the factors that lead to, and ways to prevent, engagement in risky behaviours. This study examines the association between flourishing, that is, the experience of both high hedonic and eudaimonic wellbeing, and a broad range of risky and unhealthy lifestyle behaviours among emerging adults in Australia. A cross-sectional survey of 1155 emerging adults aged 18-25 years measured wellbeing, socio-demographics, and six groups of lifestyle behaviours surrounding substance use, physical activity, diet, sex, sun protection, and driving. Bivariate and multivariate statistics were used to analyse the data. The findings revealed that flourishing was negatively associated with more dangerous types of risk behaviours, such as driving under the influence of drugs, and positively associated with self-care behaviours, such as healthier dietary behaviour and sun protection. If enabling emerging adults to flourish can contribute to reduced engagement in risky/unhealthy lifestyle behaviours, then promoting it is an important goal for health promotion efforts not only because flourishing is desirable in its own right, but also to bring about sustainable change in behaviour. Further research is needed to inform the designs of such interventions.

Author Correction: Economic value of protected areas via visitor mental health.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Economic value of protected areas via visitor mental health.

We evaluate methods to calculate the economic value of protected areas derived from the improved mental health of visitors. A conservative global estimate using quality-adjusted life years, a standard measure in health economics, is US$6 trillion p.a. This is an order of magnitude greater than the global value of protected area tourism, and two to three orders greater than global aggregate protected area management agency budgets. Future research should: refine this estimate using more precise methods; consider interactions between health and conservation policies and budgets at national scales; and examine links between personalities and protected area experiences at individual scale.

'This is the beginning of the new me': process evaluation of a group fitness intervention to promote wellbeing in formerly homeless individuals.

BACKGROUND: Homelessness is a persistent social issue with diverse impacts reaching far beyond individuals. Strategies and research concerning homelessness and health have largely focused on the risk factors and weaknesses of individuals. Such preoccupation has meant the potential strengths and resources within individuals, and so-called strength-based approaches have received less attention. Consequently, understanding how to effectively work with and engage this population in such interventions is limited. METHODS: The current study presents a process evaluation of an 8-week group fitness intervention in a supportive housing facility. The purpose of the intervention was to increase tenants' physical activity together with opportunities for social interaction and support to, in turn, improve physical and mental wellbeing, and ultimately help individuals re-engage in their community. The evaluation focused on seven key components: context, recruitment, reach/participation, dose delivered, dose received, satisfaction/feedback and fidelity. Data collection methods included observation, attendance records and participant and staff interviews. RESULTS: Findings indicate the intervention was appropriate, well delivered, and enjoyed by participants who highlighted the importance of the sessions for their mental wellbeing and social inclusion. The intervention being conducted on site, the trainers' ability to build good rapport with participants together with the supportive environment they created were central to successful implementation. CONCLUSION: Group fitness sessions represent a promising intervention to improve wellbeing of this population. However, the need for more personalised care when delivering fitness sessions, due to the complexity of health issues prevalent in this population, was identified. This has implications for already limited resources, including staffing. Strategies to address this are required to ensure the continuity of fitness programs. Impact evaluation to quantify changes/improvements in wellbeing would complement this work and add much to understanding the effects of participation.