Prediction of alcohol-related harm from controlled drinking strategies and alcohol consumption trajectories.

AIMS: To establish predictors of age 21 alcohol-related harm from prior drinking patterns, current levels of alcohol consumption and use of controlled drinking strategies. PARTICIPANTS: One thousand, five hundred and ninety-six students recruited from an initial sample of 3300 during their final year of high school in 1993. DESIGN: Longitudinal follow-up across five waves of data collection. SETTING: Post high school in Victoria, Australia. MEASUREMENTS: Self-administered surveys examining a range of health behaviours, including alcohol consumption patterns and related behaviour. FINDINGS: Drinking behaviours at age 21 were found to be strongly predicted by drinking trajectories established through the transition from high school. Multivariate regression analysis revealed that alcohol-related harms at age 21 were reduced where current levels of alcohol use fell within limits recommended in Australian national guidelines. After controlling for this effect it was found that the range of strategies employed by participants to control alcohol use maintained a small protective influence. Post-high-school drinking trajectories continued to demonstrate a significant effect after controlling for current behaviours. FINDINGS: revealed that over one quarter of males and females drank alcohol, but on a less-than-weekly basis. This pattern of alcohol use demonstrated considerable stability through the post-school transition and was associated with a low level of subsequent harm at age 21. CONCLUSIONS: Future research should investigate whether encouraging more Australian adolescents to drink alcohol on a less-than-weekly basis may be a practical intervention target for reducing alcohol-related harms.

Psychological responses of patients receiving a diagnosis of cancer.

BACKGROUND: Current recommendations on how to break bad news are primarily based on expert opinion. Little is known about the association between communication practices and patients' psychological response. PATIENTS AND METHODS: One-hundred and thirty-one patients with newly diagnosed melanoma were surveyed 4 months after the initial consultation at the Sydney Melanoma Unit regarding their communication experiences and their satisfaction with these experiences. They completed the Hospital Anxiety and Depression Scale (HADS) at this time, and 4 and 13 months later. RESULTS: Both patients' satisfaction with communication and their psychological morbidity were found to be associated with particular communication practices. Practices linked to lower anxiety included preparing the patient for a possible diagnosis of cancer; having the people wanted by the patient present to hear the diagnosis; giving the patient as much information about the diagnosis as desired; providing written information; presenting the information clearly; discussing the patient's questions the same day; talking about the patient's feelings; and being reassuring. Practices linked with lower levels of depression included using the word 'cancer'; discussing the severity of the situation, life expectancy and how the cancer might affect other aspects of life; and encouraging the patient to be involved in treatment decisions. CONCLUSIONS: This study provided preliminary evidence that communication strategies recommended in the literature produce positive patient outcomes. Further studies are needed which document actual communication.

Hearing the bad news of a cancer diagnosis: the Australian melanoma patient's perspective.

BACKGROUND: In the past, recommendations on how to break the bad news of a cancer diagnosis have been based on expert opinion. Recently, consensus-based guidelines for medical practitioners have been developed. The objective of this work is to investigate patient preferences for communication practices and to identify any disparities between these guidelines, patient preferences and patient recollections of hearing their diagnosis. PATIENTS AND METHODS: A consecutive sample of 131 newly diagnosed melanoma patients were surveyed approximately 4 months after initial diagnosis to document their preferences and recollections of their communication experiences. RESULTS: Of the 'breaking bad news' recommendations investigated, patients did not strongly endorse the doctor helping tell others of the diagnosis or telling the patient about cancer support services. Very few patients expressed a preference for having another health professional present. One communication feature, the patient feeling confident about getting the best treatment, was endorsed as 'very important' but does not feature in published guidelines. The most notable disparities between guidelines and the reported experiences of patients related to perceived delays in receiving the diagnosis, and having adequate opportunity to ask their clinician questions. CONCLUSION: Current Australian recommendations on how to communicate a diagnosis of cancer were generally supported by the patients' expressed preferences, but several modifications are proposed. IMPLICATIONS: Suggestions are offered to help overcome the disparities identified between recommendations and patients' preferences when a diagnosis of cancer is being communicated.

Trends in sun protection behaviour among Australian young adults.

OBJECTIVE: To study changes in sun protection behaviour, exposure and sunburn that occur from late adolescence to young adulthood. METHOD: A longitudinal design was used to survey a cohort on their sun-protection behaviour from the middle of their final year at school to more than three years after finishing school. RESULTS: Males reported higher exposure, less use of sunscreen and deeper tans than females. Yet males wore hats more frequently. People with skin that just burnt were more likely to protect themselves from the sun than people with skin that tanned. Longitudinally, the level of reported exposure and the depth of tan declined, frequency of covering up, hat wearing and sunscreen use remained unchanged, and a slight U-shaped trend was observed for sunburn. CONCLUSIONS: Young adulthood may be an important time where deteriorating trends for sun protection found in the teen years are averted. Males are at greater risk of sun exposure than females. IMPLICATIONS: It is recommended that health promotion programs capitalise on the trend of improved sun-protective behaviours during the transition from adolescence to young adulthood, with a particular focus on young men.

The effectiveness of a directly mailed smoking cessation intervention to Australian discharged hospital patients.

BACKGROUND: The objective was to assess the effectiveness of a directly mailed smoking cessation intervention to discharged hospital patients. METHODS: A randomized controlled trial was used. In the 2 weeks after discharge, smokers in the intervention group were sent by mail a personally addressed letter from their medical consultant urging them to quit plus a self-help quitting manual, and smokers in the control group received usual care. Patients were surveyed about their smoking status at 6 and 12 months after discharge. A total of 1858 discharged patients responded to both questionnaires. The main outcome measures were self-reported smoking in past week at 6 and 12 months after discharge. Quitters at 12 months were biochemically tested for evidence of smoking. RESULTS: The results failed to show that smoking cessation advice directly mailed to a broad cross-section of discharged hospital patients who smoke led to smoking cessation. However, the intervention increased cessation among smokers with medical conditions for which quitting is highly relevant. In general, patients who were more likely to quit were older, had entered the hospital as an emergency case, and had a medical diagnosis for which quitting is highly relevant. CONCLUSIONS: This study suggests that hospital patients who smoke and are also diagnosed with conditions which call for quitting are more likely to quit if they receive from their consultant a personalized letter advising them to quit and a self-help manual.

How accurate is in-patient smoking status data collected by hospital admissions staff?

OBJECTIVE: To determine the validity of self-reported in-patient smoking status data collected by admissions staff. METHOD: Smoking status of new inpatients was recorded on to the computer registration screen. Urine samples collected from the patients (n = 167) were analysed for the presence of cotinine. RESULTS: Only 63% (95% CI 46%-81%) of the patients classified as smokers on the basis of urinary cotinine levels were recorded as smokers on the computerised record created by hospital admissions staff. CONCLUSIONS: Admissions staff do not obtain reliable data on smoking status. However, most patients entered as non-smokers by admissions staff but registering high cotinine levels were subsequently recorded as smokers by their doctor in their medical record. IMPLICATIONS: This study suggests that inpatients are more likely to report their smoking status accurately to their doctor than an admissions clerk, but about two-thirds of smokers will be correctly identified at admission and so could be targeted in computer-driven smoking-cessation interventions.

Measuring support for tobacco control policy in selected areas of six countries.

OBJECTIVE: To explore the validity, reliability, and applicability of using a short, psychometrically sound survey instrument to measure population attitudes toward tobacco control policies. DESIGN: Surveys. SUBJECTS AND SETTING: Student respondents attending university in Australia (n = 403), Hong Kong (n = 336), the Netherlands (n = 351), South Africa (n = 291), the United Kingdom (n = 164) and the United States (n = 241); total n = 1786. MAIN OUTCOME MEASURE: The Smoking Policy Inventory (SPI), a 35-item scale. SPI scores were adjusted for age, income, gender, and smoking status. Estimates of internal consistency and tests of factorial invariance were conducted in each sample. RESULTS: Across all six countries, the SPI was found to be highly reliable and to have a consistent factor structure, indicating that the SPI scale represents a higher order construct that assesses general attitudes about tobacco control policy with five dimensions. In general, the degree of endorsement of anti-tobacco policies as measured by the SPI reflected the extent and strength of tobacco control legislation in those countries. Dutch students were the least likely, and Australian and Hong Kong students the most likely, to support tobacco control policies. CONCLUSIONS: It is possible to develop appropriate and meaningful measurement tools for assessing support of tobacco control policies. Strong evidence was found for internal reliability and structural invariance of the SPI. The SPI may be a useful mechanism for monitoring ongoing policy initiatives, making cross-cultural comparisons, and evaluating population receptiveness to proposed policy approaches.

Instability in smoking patterns among school leavers in Victoria, Australia.

OBJECTIVE: To describe patterns of smoking in a cohort of young adults over the first 15 months after leaving school. DESIGN: A four-wave, longitudinal survey design was used to gather data. Final-year students from 93 schools completed the recruitment questionnaire at an average age of 17 years. Follow-up questionnaires were posted to their home addresses three months, nine months and 15 months after the end of school. SETTING: Victoria, Australia. PARTICIPANTS: A cohort of 1903 respondents who completed and returned all four questionnaires. MAIN OUTCOME MEASURES: Self-labelled smoking status ("heavy smoker", "light smoker", "occasional smoker", "ex-smoker", and "non-smoker"), daily cigarette consumption, and maximum daily cigarette consumption. RESULTS: At school, 72% of the sample were "non-smokers", 5% "ex-smokers", 11% "occasional", 8% "light", and 5% "heavy smokers". At 15 months after school, these proportions had shifted to 64%, 8%, 11%, 9%, and 7%, respectively. Over the study, "light smokers" and "heavy smokers" substantially increased their daily consumption; "occasional" and "ex-smokers" did not. There was relatively high stability in self-labelled smoking status at one wave and the next. However, over the four waves, 38% of the sample changed their self-labelled smoking status, and 41% of these had been "non-smokers" at school. A reduced second-order Markov chain model was found to fit this four-wave behavioural sequence. Detailed description of smoking status changes revealed greater progression to higher levels of smoking than transition to lower levels. CONCLUSIONS: There is considerable flux in smoking patterns among young adults after leaving school, suggesting an opportunity to intervene with smoking prevention programmes at this stage of development.

Do doctors stop giving quit-smoking advice when other programs are reaching their patients?

The authors attempted to determine if the self-reported practices of hospital doctors regarding smoking cessation advice to their patients, would be influenced by the introduction of a scheme in which smokers were routinely identified on admission to hospital and were subsequently mailed letters including cessation advice. The second objective was to assess the relative levels of cessation counselling among different categories of doctors. Five hundred and fifteen doctors from two large public teaching hospitals in Melbourne, Australia participated in the study. Mail-out cessation advice took place in one hospital (the intervention hospital). In both hospitals, half of the doctors were surveyed 6 weeks before the mailing had commenced, and the remaining half were surveyed 6 months after. There were no significant differences between doctors at the intervention hospital and doctors at the control hospital in the self-reported advice to patients. Most doctors "encouraged patients to quit whenever possible." However, this encouragement seemed to be limited to talking to patients about the risks of smoking. Doctors less frequently gave advice concerning how to stop smoking. Compared with other doctors, internists seemed to be the most willing to encourage patients to quit and they reported higher levels of assisting patients to quit. There was no evidence that reminding doctors regularly that their patients were receiving mailed cessation advice significantly increased or decreased doctor's reporting smoking cessation activities with their patients. Internists are more involved in smoking cessation counselling than other types of doctors.

Encouraging attendance at a screening mammography programme: determinants of response to different recruitment strategies.

OBJECTIVES: To predict attendance at a mammographic screening programme after a community health promotion campaign and attendance after a personal invitation in addition to that campaign. SETTING: A pilot mammographic screening programme in Melbourne, Australia. METHODS: Attendance was encouraged by a community health promotion campaign and one year later, a personal invitation was sent to all women who had not yet attended. Drawn from two regions of a defined area (close to and distant from the screening centre), 618 women were interviewed before the programme started, and subsequent attendance at the programme was recorded. RESULTS: Over half of the women (58%) in the sample residing close to the screening centre and 44% of women in the more distant sample attended. The personal invitation boosted attendance, particularly in the distal sample where attendance was predicted by ease of access to the programme; positive intention to attend; moderate experience of, perceived susceptibility to, concern about, and knowledge of breast cancer; adoption of other preventive health behaviours; having a job; and older age. Proximity to the programme, positive initial intentions, having heard of a mammogram, no concern about radiation from a mammogram, high personal control over health, and belonging to a club were associated with attendance after exposure to only the health promotion campaign. A personal invitation encouraged attendance among women without these characteristics. CONCLUSION: A personal invitation in addition to a community promotion campaign seems to overcome many barriers to attendance. Attendance may be further increased by informing women of the benefits of early detection and improving access to the screening centre.