Supporting adolescents' participation in muscle-strengthening physical activity: protocol for the 'Resistance Training for Teens' (RT4T) hybrid type III implementation-effectiveness trial.

INTRODUCTION: In Australia, only 22% of male and 8% of female adolescents meet the muscle-strengthening physical activity guidelines, and few school-based interventions support participation in resistance training (RT). After promising findings from our effectiveness trial, we conducted a state-wide dissemination of the 'Resistance Training for Teens' (RT4T) intervention from 2015 to 2020. Despite high estimated reach, we found considerable variability in programme delivery and teachers reported numerous barriers to implementation. Supporting schools when they first adopt evidence-based programmes may strengthen programme fidelity, sustainability, and by extension, programme impact. However, the most effective implementation support model for RT4T is unclear. OBJECTIVE: To compare the effects of three implementation support models on the reach (primary outcome), dose delivered, fidelity, sustainability, impact and cost of RT4T. METHODS AND ANALYSIS: We will conduct a hybrid type III implementation-effectiveness trial involving grade 9 and 10 (aged 14-16 years) students from 90 secondary schools in New South Wales (NSW), Australia. Schools will be recruited across one cohort in 2023, stratified by school type, socioeconomic status and location, and randomised in a 1:1:1 ratio to receive one of the following levels of implementation support: (1) 'low' (training and resources), (2) 'moderate' (training and resources+external support) or 'high' (training and resources+external support+equipment). Training includes a teacher workshop related to RT4T programme content (theory and practical sessions) and the related resources. Additional support will be provided by trained project officers from five local health districts. Equipment will consist of a pack of semiportable RT equipment (ie, weighted bars, dumbbells, resistance bands and inverted pull up bar stands) valued at ~$A1000 per school. Study outcomes will be assessed at baseline (T0), 6 months (T1) and 18 months (T2). A range of quantitative (teacher logs, observations and teacher surveys) and qualitative (semistructured interviews with teachers) methods will be used to assess primary (reach) and secondary outcomes (dose delivered, fidelity, sustainability, impact and cost of RT4T). Quantitative analyses will use logistic mixed models for dichotomous outcomes, and ordinal or linear mixed effects regression models for continuous outcomes, with alpha levels set at p<0.025 for the outcomes and cost comparisons of the moderate and high support arms against the low support arm. ETHICS AND DISSEMINATION: Ethics approval has been obtained from the University of Newcastle (H-2021-0418), the NSW Department of Education (SERAP:2022215), Hunter New England Human Research Ethics Committee (2023/ETH00052) and the Catholic Schools Office. The design, conduct and reporting will adhere to the Consolidated Standards of Reporting Trials statement, the Standards for Reporting Implementation Studies statement and the Template for Intervention Description and Replication checklist. Findings will be published in open access peer-reviewed journals, key stakeholders will be provided with a detailed report. We will support ongoing dissemination of RT4T in Australian schools via professional learning for teachers. TRIAL REGISTRATION NUMBER: ACTRN12622000861752.

Respiratory pandemics, urban planning and design: A multidisciplinary rapid review of the literature.

COVID-19 is the most recent respiratory pandemic to necessitate better knowledge about city planning and design. The complex connections between cities and pandemics, however challenge traditional approaches to reviewing literature. In this article we adopted a rapid review methodology. We review the historical literature on respiratory pandemics and their documented connections to urban planning and design (both broadly defined as being concerned with cities as complex systems). Our systematic search across multidisciplinary databases returned a total of 1323 sources, with 92 articles included in the final review. Findings showed that the literature represents the multi-scalar nature of cities and pandemics - pandemics are global phenomena spread through an interconnected world, but require regional, city, local and individual responses. We characterise the literature under ten themes: scale (global to local); built environment; governance; modelling; non-pharmaceutical interventions; socioeconomic factors; system preparedness; system responses; underserved and vulnerable populations; and future-proofing urban planning and design. We conclude that the historical literature captures how city planning and design intersects with a public health response to respiratory pandemics. Our thematic framework provides parameters for future research and policy responses to the varied connections between cities and respiratory pandemics.

Demographic Predictors of Mothers' Willingness to Vaccinate Young Children Against COVID-19, Get Tested and Isolate: A Cross-Sectional Survey Before and During the Greater Sydney Lockdown 2021, Australia.

Background and Objectives: Having a COVID-19 vaccination, getting tested, and self-isolating if symptomatic are some of the most important mitigation strategies for preventing the spread of COVID-19. This study aimed to investigate whether demographic factors are associated with mothers' willingness to vaccinate their 4-year-old children against COVID-19 if a suitable vaccine becomes available or to get tested and self-isolate if they themselves have COVID-19 symptoms and whether the willingness could be influenced by the Greater Sydney lockdown 2021. Methods: A cross-sectional telephone survey was conducted between 24th February and 26th October 2021. Questions from the NSW Adult Population Health Survey and from previously published studies were used to assess family demographics, mothers' willingness to vaccinate their young children, and willingness to get tested and self-isolate if symptomatic. The survey involved 604 mothers of children aged 4 years who participated in an existing trial in Sydney, Australia. Results: Mothers were more willing to vaccinate their children when the child's father had a tertiary education or higher, with an adjusted odds ratio (AOR) of 2.60 (95% CI 1.67-4.04). Mothers who were older than 30 years or who completed the survey during the lockdown were more willing to get tested if symptomatic, with AOR 2.50 (95% CI 1.17-5.36) and AOR 3.36 (95% CI 1.41-8.02), respectively. Mothers who were married or had de-facto partners were more willing to self-isolate if symptomatic [AOR 17.15 (95% CI 3.56-82.65)]. Conclusion: Fathers' educational level, mothers' age, and marital status were associated with mothers' willingness to vaccinate their young children if a suitable vaccine were available, to get tested, and self-isolate if symptomatic respectively. The promotion of mitigation strategies for tackling the COVID-19 pandemic needs to take into account specific family demographics.

Shaping interventions to address waterpipe smoking in Arabic-speaking communities in Sydney, Australia: a qualitative study.

BACKGROUND: Waterpipe smoking is a traditional method of tobacco smoking that is being increasingly practiced worldwide. However, the research evidence describing the practice and prevalence of waterpipe smoking in Australia is limited. Arabic-speaking communities residing in an area of metropolitan Sydney identified increasing rates of waterpipe smoking as a community health concern during a tobacco intervention project. A qualitative research project was conducted to explore community perceptions about waterpipe smoking and the health promotion interventions that would be acceptable to Arabic speaking communities. METHODS: Participants from Arabic-speaking community groups and networks were recruited by trained bilingual community research assistants (BCRAs). Ten focus groups were conducted, eight by the BCRAs and two by the research team, and included a total of 88 participants. Notes were taken during the focus groups by the BCRAs and provided to the research team. The data was coded and managed using NVivo 11, and examined for themes and subthemes. RESULTS: Eleven themes were identified from the data relating to the perceptions of waterpipe smoking (practices, cultural identity, acceptability, social connectedness, knowledge and perceptions of harm, trend and fashion, availability and access) and possible health promotion interventions (health information and social marketing, health education, policy and legislation, intervention target groups and messages). Waterpipe smoking was reported to be widely practiced and was related to a number of factors including feelings of cultural identity and belonging. The study highlighted the misconceptions of harm that exist in communities about the health effects of waterpipe smoking, as well as the significant role of the family in passing on the practice of waterpipe smoking. These factors should be considered in the development of health promotion interventions. CONCLUSIONS: Our findings suggest that until waterpipe smoking is perceived as a problem, community readiness for accepting health promotion interventions will be limited. Interventions should focus on debunking the myths that contribute toward a reduced perception of harm. A culturally sensitive approach, that considers the cultural connection to waterpipe smoking, should be taken toward the development and implementation of interventions.

A Scoping Review of the Evidence on Health Promotion Interventions for Reducing Waterpipe Smoking: Implications for Practice.

Background: Waterpipe tobacco smoking is a traditional method of tobacco use, especially in the Eastern Mediterranean Region (EMR), but its prevalence is growing worldwide, especially among young people. Although often perceived as less harmful than other methods of tobacco use because the smoke passes through water, accumulating evidence shows harmful effects and that some smokers become addicted. Interventions that deglamourise and denormalise use have been recommended but little is known about the range and impact of different health prevention and promotion interventions. Methods: A scoping review of literature was undertaken to explore the breadth of literature and assess the range and impact of community based health promotion interventions for waterpipe smoking. Searches were conducted in Medline, Embase, CINAHL, Psychinfo, and the Cochrane database of systematic reviews. Interventions were classified using a health promotion framework and data extracted on the aspects of prevention/promotion addressed; key strategies employed, evidence of effectiveness or impact on behavior change as well as barriers to implementation and perceived success factors. Results: Ten studies were included in the review. They include brief interventions to increase quit rates; community campaigns to raise awareness and increase knowledge; web based health education and skill development to increase perceived risks and intention to quit; as well as studies that evaluated product labeling and opportunities for policy interventions to create healthy environments. Conclusions: The evidence base is small but growing. Brief interventions for waterpipe users, community campaigns, and web based tailored information can modify perceptions of addiction and increase intentions to quit. Product labeling may be an effective policy tool to curb waterpipe smoking. A range of policy interventions have been identified but not evaluated.

Formative research to promote the Get Healthy Information and Coaching Service (GHS) in the Australian-Chinese community.

The free, telephone-based Get Healthy Information and Coaching Service (GHS) has made sustained improvements in healthy behaviours and weight change in the Australian population, but there is poor uptake of the GHS by culturally and linguistically diverse communities. This formative research study explored the Australian-Chinese community's awareness, perceptions and experiences of the GHS and their knowledge and cultural beliefs about healthy lifestyles. Conducted in Sydney, Australia, the research included 16 Chinese community-stakeholder interviews, a cross-sectional survey of 253 Chinese community members; and a review of Chinese participant GHS data. The study revealed poor uptake (<1%) and awareness (16%) of the GHS, but good intent (86%) to use it. The need for culturally appropriate and relevant information on healthy eating and physical activity was identified. Employment of a bilingual, bicultural coach, redesign and translation of written resources and targeted promotion in partnership with community organisations were recommended.

Outdoor gyms and older adults - acceptability, enablers and barriers: a survey of park users.

Issue addressed Increasing the proportion of older adults meeting current recommendations for physical activity is important. This study aimed to determine the acceptability of outdoor gym use among older adults by assessing their outdoor gym use, intention to use, motivators, frequency and preference for use, and barriers and enablers to use. Methods Interviews were conducted with 438 consenting English speaking park users≥50 years after installation and promotion of an outdoor gym. Results Forty-two percent of older adults interviewed had used the outdoor gym. Outdoor gym users had a significantly higher proportion of local residents (χ2=10.43; P<0.01), were more frequent park users (χ2=8.75; P<0.01) and spoke a language other than English (χ2=15.44; P<0.0001) compared with general park users. Shade and different equipment types were the most cited enablers. Conclusions Outdoor gyms may be an acceptable form of physical activity for older adult park users. Installations should offer a variety of equipment types and shade. So what? Outdoor gyms are a potential equitable approach to engaging older adults in a variety of physical activity types. Social and physical benefits of outdoor gym use in high risk groups for physical inactivity should be explored.

A 3-Arm randomised controlled trial of Communicating Healthy Beginnings Advice by Telephone (CHAT) to mothers with infants to prevent childhood obesity.

BACKGROUND: With an increasing prevalence of obesity in young children globally, there is an urgent need for the development of effective early interventions. A previous Healthy Beginnings Trial using a nurse-led home visiting program has demonstrated that providing mothers with evidence-based advice can improve maternal practice regarding obesity prevention, and can reduce Body Mass Index (BMI) in the first few years of life. However, the costs for scale-up of home visiting limit its population reach. This trial aims to determine the efficacy of Communicating Healthy Beginnings Advice by Telephone (CHAT) to mothers with infants in improving infant feeding practices and preventing the early onset of childhood overweight and obesity. METHODS/DESIGN: We propose a 3-arm randomised controlled trial (RCT) with a consecutive sample of 1056 mothers with their newborn children in New South Wales (NSW) Australia. Pregnant women who are between weeks 28 and 34 of their pregnancy will be invited to participate in the CHAT trial. Informed consent will be obtained, and after baseline data collection, participants will be randomly allocated to the telephone intervention, text messaging intervention, or the control group. The intervention comprises telephone consultations or text messages, together with 6 intervention packages being mailed at specific times from the third trimester of pregnancy until 12 months post birth. The main trial outcome measures include a) duration of breastfeeding, b) timing of introduction of solids, c) nutrition behaviours, physical activity and television viewing, and d) weight and BMI z-score at 12 and 24 months, e) cost-effectiveness, as well as f) feasibility and acceptability of the interventions. DISCUSSION: The results will ascertain whether early intervention using telephone consultation or text messaging together with staged mailed intervention resources can be feasible and effective in improving infant feeding practices, physical activity and reducing children's BMI in the early years of life. If proven to be feasible, effective as well as cost-effective, the trial results will inform a series of recommendations for policy and practice related to promoting healthy infant feeding and physical activity in young children in the first years of life. TRIAL REGISTRATION: The CHAT Trial is registered with the Australian Clinical Trial Registry ( ACTRN12616001470482p ). It was registered on October 21, 2016.

Impact of an outdoor gym on park users' physical activity: A natural experiment.

This study assessed the impact of an outdoor gym installation on park users' physical activity levels and examined the characteristics of outdoor gym users. A before-after time series design was employed, consisting of nine data collection periods: three each at baseline, post outdoor gym installation, and at 12-month follow-up. Repeated observational surveys and park intercept interviews were conducted. There was a small but significant increase in senior park users engaging in moderate to vigorous physical activity at follow-up (1.6 to 5.1%; p<0.001). There were significant increases from baseline to follow-up in the outdoor gym area for: MVPA (6 to 40%; p<0.001); and seniors' use (1.4 to 6%; p<0.001). The study contributes to the limited evidence on the impact of outdoor gyms on physical activity outcomes.

Do smoke-free environment policies reduce smoking on hospital grounds? Evaluation of a smoke-free health service policy at two Sydney hospitals.

OBJECTIVE: To evaluate the compliance of hospital staff, inpatients and visitors with Sydney South West Area Health Service's Smoke-free Environment Policy. METHODS: Six sites were observed at two Sydney hospitals 2 weeks before implementation of the policy and at 2 weeks, 6 months, 12 months, 18 months and 2 years after implementation. RESULTS: There was an overall significant 36% (P≤0.05) reduction in observed smoking incidents on hospital grounds 2 years after implementation. Two years after implementation, observed smoking incidents reduced by 44% (P≤0.05) in staff, 37% (P≤0.05) in visitors and remained unchanged among inpatients. CONCLUSIONS AND IMPLICATIONS: The Smoke-free Environment Policy was effective in reducing visitors and staff observed smoking on hospital grounds, but had little effect on inpatients' smoking. Identifying strategies to effectively manage nicotine addiction and promote cessation amongst hospital inpatients remains a key priority.

Evaluation of a comprehensive tobacco control project targeting Arabic-speakers residing in south west Sydney, Australia.

Tobacco control is a health promotion priority, but there is limited evidence on the effectiveness of campaigns targeting culturally and linguistically diverse (CALD) populations. Being the largest population of non-English-speaking smokers residing in New South Wales (NSW), Australia, Arabic-speakers are a priority population for tobacco control. We report findings from baseline and post-intervention cross-sectional telephone surveys evaluating a comprehensive social marketing campaign (SMC) specifically targeting Arabic-speakers residing in south west Sydney, NSW. The project was associated with a decline in self-reported smoking prevalence from 26% at baseline to 20.7% at post (p < 0.05) and an increase in self-reported smoke-free households from 67.1% at baseline to 74.9% at post (p < 0.05). This paper contributes evidence that comprehensive SMCs targeting CALD populations can reduce smoking prevalence and influence smoking norms in CALD populations.

Tobacco control priorities for Arabic speakers: key findings from a baseline telephone survey of Arabic speakers residing in Sydney's south-west.

ISSUE ADDRESSED: The Arabic-speaking population is a priority for tobacco control in Sydney's south-west. Current smoking prevalence and smokers' preferences for evidence-based cessation therapies are reported for this population. METHODS: A telephone survey of Arabic speakers conducted in Sydney's south-west between August and November 2004 included: utilisation of tobacco products, tobacco and health knowledge, quit attempts and likelihood to use evidence-based cessation strategies. RESULTS: A 70% response rate was achieved (n=1,102). Twenty-six per cent of respondents (95% CI 23.5-28.7) self-reported being current smokers. Logistic regression analysis demonstrated that poor knowledge of the harms of smoking (AOR=7.50, 95% CI 3.20-17.59), being male (AOR=2.63, 95% CI 1.89-3.65), being aged between 40 and 59 (AOR=1.44, 95% CI 1.06-1.96) and non-tertiary educated (AOR=1.44, 95% CI 1.06-1.97) were independent predictors of self-reported smoking. Smokers' preferences for evidence-based cessation strategies included: vouchers for discounted nicotine replacement therapy (NRT) (58.8%, 95% CI 52.9-64.6), standard self-help booklet (56.6%, 95% CI 50.7-62.4) and tailored self-help written materials (mailed) (54.0%, 95% CI 48.1- 59.9). More than one-third of all current cigarette smokers (39.4%, n=108, 95% CI 33.6-45.2) indicated they had made a quit attempt in the past 12 months. CONCLUSIONS: Well-designed trials of efficacy for preferred evidence-based strategies, particularly among middle-aged male Arabic-speaking smokers, appear warranted prior to policy development and implementation.

Subsidised nicotine replacement therapy in a community pharmacy setting.

ISSUES ADDRESSED: Nicotine replacement therapies are effective, but are mostly under-utilised and often not used for an appropriate duration. The paper reports on a pilot project that used subsidies for NRT as a means to engage community pharmacists to deliver tobacco cessation to the Arabic-speaking community. METHOD: Arabic-speaking community pharmacists were recruited through direct mail-outs and trained in tobacco cessation brief intervention. Fifteen selected pharmacies recruited Arabic smokers through their pharmacies. Pharmacy follow-up was conducted three months after the program was implemented. RESULTS: A total of 65 participants attended the seminar. A total of 31 pharmacy customers received at least one packet of subsidised NRT patches. Twenty (64.5%) clients received both the first and second subsidised pack. Fifteen clients continued to use patches after the third packet, however only three clients continued the patches to the eighth pack. CONCLUSION: The pilot was successful in improving recruitment of pharmacies into training for smoking cessation counselling as well as engaging community pharmacists to deliver tobacco cessation intervention with small incentive.

Knowledge, attitudes and behaviours of caregivers regarding children's exposure to environmental tobacco smoke among Arabic and Vietnamese-speaking communities in Sydney, Australia.

OBJECTIVE: The aim of this study was to inform the design of a culturally appropriate health communication campaign addressing exposure of young children to Environmental Tobacco Smoke (ETS) in homes and cars, targeted at caregivers of children aged 0-6 years in the Arabic and Vietnamese-speaking communities in Sydney, Australia. DESIGN: Nine focus groups (five Arabic and four Vietnamese) were conducted by qualified bilingual facilitators, recorded, transcribed, then translated and analysed qualitatively. RESULTS: Results revealed concerning levels of knowledge, attitudes and behaviours regarding children's exposure to ETS. A poor understanding existed regarding what constituted passive smoking and the severity and extent of harm that ETS has on children. Smoking attitudes and behaviours described were not always consistent with the concern expressed about children's vulnerability to smoke. Initial changes in smoking patterns at home since the arrival of children were not always sustained. Despite awareness of the harm caused by smoking in the presence of their children, some caregivers continued to smoke in closed environments. Others felt it was sufficient protection to smoke in another room, with doors and/or windows open or by ensuring that visible smoke did not reach the child directly, whilst some smoked in the home or car only when children were not present. Smoking attitudes and behaviours in the presence of children were influenced by cultural and social norms associated with smoking. The desire to be sociable and hospitable often superseded concerns for children's health. CONCLUSION: The findings suggest that an effective communication campaign focusing on ETS and children in the Arabic and Vietnamese-speaking communities in Sydney should attempt to address knowledge deficits regarding ETS, as well as tackling entrenched culturally related attitudes and behaviours associated with smoking which are strongly linked to sociability and hospitality.