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This collection contains Honours, Masters and Ph.D by coursework theses from University of Adelaide postgraduate students within the School of Public Health. The material has been approved as making a significant contribution to knowledge.
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Item Open Access An Evaluation of the Risk Identification Checklist from the Manual Handling Code of Practice(1992) Boucaut, Rosetta Anne; Ryan, P; Gun, R; School of Public HealthManual Handling Regulations and a Code of Practice which were introduced in South Australia in January 1991, are aimed at reducing the frequency and severity of manual handling injuries sustained at work. The Code of Practice is a practical guide for employers to follow in order to comply with the Regulations, and consists of three phases: risk identification, risk assessment and risk control. The risk identification procedure involves three stages: a review of the manual handling injury statistics to determine manual handling injuries which have occurred at the workplace, consultation with employees to determine their perceptions of manual handling hazards at the workplace, and the evaluation of manual handling hazards (identified in the two preceding processes) using a Risk Identification Checklist. The Checklist is comprised of 18 questions about manual handling risk factors and is designed so that the higher the score is for a task the higher is its priority for risk assessment and control. This thesis examined the validity of the Risk Identification Checklist as a predictor of the risk of manual handling injuries by applying it to tasks performed by firefighters employed at the South Australian Metropolitan Fire Service (SAMFS). The study involved the following distinct stages: first, a review of the SAMFS injury statistics was undertaken to identify the tasks giving rise to manual handling injuries, and to categorise them according to their frequency and severity. Secondly, a manual handling questionnaire, based on the National Skills Audit of firefighter duties, was designed and administered to a representative sample of 125 SAMFS firefighters. From this, the manual handling tasks were graded according to the risk of injury as perceived by the firefighters. Thirdly, a video was produced of 23 manual handling firefighter tasks. The tasks selected for the film included tasks of a range of injury frequency and severity according to SAMFS injury statistics and of a range of hazard ratings according to the firefighters. Fourthly, the 23 manual handling tasks were shown and subsequently scored by a panel of 15 occupational health professionals using the Risk Identification Checklist. Panel members were blinded to the injury frequency, severity and firefighter hazard ranking of the tasks viewed on the video. Checklist scores for each of the tasks were obtained from each of the 15 panel members. Finally, performance of the Checklist was examined in the following ways. Intra-rater reliability was assessed by comparing the ratings of the same panellist on two separate viewings of the video. Inter-rater agreement of Checklist scores was assessed by examining the range of Checklist scores given by each of the panel members for each individual task. Subsequently, comparisons of Checklist scores were made with both the SAMFS manual handling injury statistics and the SAMFS firefighter perceptions of manual handling hazards. Results showed there was high intra-rater reliability between test/re-test gross scores (Spearman correlation coefficients ranged from 0.83 to 0.88), that is, the three panel members were consistent in their hazard ranking in separate viewings of the tasks. However although the panel members had a highly correlated rank order of the tasks, the manner in which two panellists arrived at the total score was inconsistent between viewings, that is, the 18 individual questions in the Checklist were answered differently. The inter-rater agreement of the 15 panellists was low as shown by a wide range of Checklist scores for each task. The Friedman non-parametric analysis of variance showed no significant agreement between the panel members' scores (p<0.001). There was low correlation between Checklist scores and injury frequency for the panellists as a group (Spearman correlation coefficient 0.17) and for the individual panellists (Spearman correlation coefficients ranged from -0.04 to 0.38). The majority of the panel did differentiate the tasks on the basis of severity, but the difference in the medians given to the "severe" and the "non-severe" tasks was not statistically significant for any member of the panel. The correlation of the firefighters' risk perception of the manual handling tasks and injury statistics was low both for injury frequency and for injury severity (Spearman correlation coefficients 0. 3 5 and 0 .19, respectively). · There was high correlation between the firefighters' perception of hazards and the manual handling Checklist scores (Spearman correlation coefficient 0. 76). The performance of the Risk Identification Checklist from the Manual Handling Code of Practice has been assessed and has been shown to perform poorly at the SAMFS. It is concluded that neither the use of the Risk Identification Checklist nor employees perceptions of risk as proposed in the Manual Handling Code of Practice are valid predictors of manual handling injuries. It is proposed that priorities for manual \ handling risk assessment and control should be determined from analysis of injury statistics, if the frequency and severity of manual handling injuries are to be reduced.Item Open Access Geographical variations in public perceptions and responses to heat and heatwave warnings(2016) Wolanin, Anna; Williams, Susan; School of Public HealthIntroduction: One of the most dangerous natural hazards for population health in Australia is extreme heat, particularly for vulnerable groups. Excessive and prolonged exposure to heat can cause heat stroke, heat exhaustion, heat syncope, heat cramps, and exacerbate a number of medical conditions. The experiences of regional and rural populations is an underrepresented issue in the literature on heatwaves, and there is very little research that focuses on comparisons between differing climate regions. This study aims to examine attitudes and perceptions to extreme heat and heat warnings in regional South Australia, and how this may be influenced by climate region. Understanding how populations in diverse regional areas understand and perceive their risk is vital in understanding where public health action and policy must be aimed. Methods: Existing data from a householder survey conducted in non-metropolitan South Australia (n=251) was analysed using Pearson’s Chi-Squared test, with a Fisher’s exact test for validation of results. Significance was determined at p<0.05. The population sample was coded into three climate regions (hot, warm, and mild) for comparative analyses. Results: There were a number of findings with significant associations. In the hot and warm zones respondents were more likely to indicate that they have experienced extreme heat or heatwaves often (63.2% in hot zone and 66.7% in warm zone) in recent years, compared to sometimes. The hot zone also had the highest proportion of respondents reporting an increase (32.4%) in heatwaves or extreme heat in recent years, followed by the mild zone (25%). The warm zone had the highest proportion of respondents observing a change (17.1%). Respondents in the hot zone were also more likely to agree that their own actions can reduce the risk that heatwaves present to them and their families (83.8% strongly agree or agree), and were also more likely to agree with a statement that there will be serious health consequences in their community due to heatwaves in the future (86.5% strongly agree or agree). Recall of health warnings during heat events in recent years was high across all climate regions (average 89.3%). Of those householders that did recall warnings, the majority did take the warnings very seriously or seriously. A small proportion in the warm and mild zones did not take the warnings seriously at all (13.8% and 5% respectively). Those in the mild zone were least likely to change their behaviour as a result of the warnings, with 28.6% reporting no change in behaviour. Discussion: The study findings suggest that populations in cooler zones may be underestimating their risk of negative health outcomes due to heatwaves. This is of concern as heatwaves are expected to increase in frequency and magnitude with the increasingly discernible effects of climate change. Householders in the hot zone tend to be more aware of the dangers and risks posed by heatwaves, and were more likely to change their behaviours and take warnings seriously. Despite higher levels of exposure to extreme heat, they have adapted their behaviours and attitudes to protect themselves. There was a high level of heat warning recall across all climate regions, with a general consensus that the warnings were appropriate. This indicates that warnings are being disseminated through appropriate channels, however a small proportion of the population may be at greater risk if these messages are not being delivered. This study was limited by the small sample size, with some variation in age and sex population profiles across the three climate zones. There is also the possibility of other confounding factors or mediators, such as socio-economic status, affecting the results. Conclusion: It is important to examine attitudes and responses to heat warnings in regional and rural populations because the interventions and policies developed for urban settings will not always be appropriate in other contexts. Policies and interventions need to be tailored for these communities in order to better communicate messages for better health and resilience. Climate also needs to play a role in the development of interventions, as it is clear that in some climate regions the attitudes of some community member’s may be placing themselves and their families at risk due to their underestimation of the dangers of extreme heat or heatwaves. There is a need for further research into regional and remote populations on a national level, with a focus on the role of climate on adaptation, attitudes, and responses.Item Open Access An analysis of Australian print and television media coverage of the public health message ‘alcohol causes cancer’(2016) McDonough, Joshua Henry; Eliott, Jaklin ArdathIntroduction: Alcohol is a class-1 carcinogen and is a modifiable risk factor for cancer, but public awareness of the link remains low. News media is a common and accessible source of health information in Australia, and influences public opinion and policy agenda. It is important to analyse how the alcohol causes cancer message is re-presented, as this may inform public health advocacy and identify needs and potential strategies for raising awareness through health promotion. This is the first study to compare both print and broadcast news media within this context. Methods: 1502 print articles and 96 broadcast stories published in Australia between 2005 and 2013 were located through the Factiva and Australian Health News Research Collaboration databases. Summative content analysis and descriptive statistics were used to examine the prominence and content of all stories. Thematic analysis was used to identify recurring themes and frames within stories that focused on the link between alcohol and cancer. Results: CONTENT: Most print articles were published within the main/first section of the newspaper, with half on odd pages. 95% of articles included the claim that alcohol is carcinogenic, with 5% suggesting it was either non-carcinogenic or preventative for cancer, and 1% including discussion of both. Over time, the ratio of carcinogenic to non-carcinogenic/preventative articles increased. Half of the print database consisted of stories that had been repeated. Most commonly, articles cited ‘alcohol’ as a generic descriptor while mentioning a specific type of cancer. Organisations connected to cancer were the most frequent authority source mentioned within both sets of data. In the broadcast data, stories most commonly appeared on evening news programs. 95% of the stories stated that alcohol causes cancer, with 5% suggesting alcohol is both carcinogenic and non-carcinogenic. More than half of the broadcast stories were repeated stories. THEMATIC: The alcohol causes cancer message was often framed as shocking. Connections were made between alcohol and cigarettes as both a consumable, and a public health concern. The evidence for the link between alcohol and cancer was framed as either convincing or insufficient, with differing implications drawn regarding the roles and responsibilities of health authorities. Conclusion: Information regarding the link between alcohol and cancer is available within the Australian media, but is often obscured by discussion of other health issues. Improved collaboration between health promoting organisations and journalists may facilitate greater accuracy and prominence of the alcohol causes cancer message.Item Open Access The challenges of implementing an integrated One Health surveillance system in Australia: A qualitative study(2016) Johnson, Isabella, G.R.L.; Bi, Peng; Hansen, Alana L.Background: One Health is an interdisciplinary approach to zoonotic diseases, which encourages structured collaboration and coordination between human, animal and ecological sectors. This interdisciplinary approach could be applied to zoonotic disease surveillance in Australia. Addressing zoonoses at the interface of human, animal and environmental health is considered to be the most holistic approach to zoonotic disease control. Seventy five percent of emerging infectious diseases are of animal origin, so an approach that links the health of humans, animals and the environment could provide an earlier opportunity for disease detection and therefore may help to reduce the burden of zoonotic diseases. Currently in Australia, human, animal and environmental health are managed by separate sectors with limited communication, acting as a barrier to effective and timely zoonotic responses. This study aims to explore how professionals in the field of human, animal and ecological health perceive a One Health approach to zoonotic disease surveillance, aiming to identify what the challenges are to the implementation of an integrated surveillance system in Australia. Methods and results: Using a qualitative research method, ten semi-structured interviews were conducted with experts in the areas of human, animal and ecological health in order to gain an understanding of professional opinions regarding the challenges of implementing One Health surveillance in Australia. A thematic analysis of the data was undertaken to identify recurring themes. Findings showed that the absence of a clear definition of One Health acts as a barrier to collaboration, as well as siloed approaches by different sectors restricting the ability for professionals to work collaboratively across disciplines. Understanding disease transmission as a whole, as well as understanding the role of the environment on human and animal health were considered by participants to be vital requirements for a One Health approach to be successful. Additionally, political will was considered by participants to be an essential requirement for the integration of government systems. Conclusions: This study demonstrates that for a One Health approach to be implemented in an Australian setting, those working in the fields of human, animal and ecological health must come together to agree on a ‘One Health’ definition. Restructuring of the traditional silos, which currently restrict intersectoral collaboration, could result in an improved and collective approach to zoonotic disease surveillance. This could be achieved through the establishment of a formal governance body. Regular communication may provide an avenue for interdisciplinary approaches, and could assist in overcoming the longstanding barriers of privacy and distrust between sectors. Further, developing interdisciplinary public health training in medical, environmental and veterinary degrees may encourage cross-disciplinary collaboration. Finally, illustrating the economic benefit of faster zoonotic detection will likely attract the attention of politicians, who could assist in implementing a formal and structured One Health approach in Australia.Item Open Access Review of Chinese herbal medicine in the treatment of Type 2 Diabetes(2016) Yu, Ao; Adelson, David Louis; School of Public HealthBackground Diabetes affects 422 million people and directly causes 4.9 million deaths according to global report on diabetes in 2014. By 2030, diabetes will be the 7th leading cause of death based on WHO prediction. Type 2 diabetes accounts for 90% of people with diabetes around the world. Diabetes has been recognised since ancient times and Chinese herbal medicine has been used to treat diabetes for more than 2000 years in China. An increasing number of people all over the world are trying to manage type 2 diabetes with Chinese herbal medicine. Many clinical studies have been performed and published inside China that show Chinese herbal medicine can be an effective and safe treatment for type 2 diabetes, but there are very limited clinical studies available outside China in English that report type 2 diabetes treatment with Chinese herbal medicine. Objectives To report the effectiveness and safety and evaluate the quality of the evidence of Chinese herbal medicine for the treatment of patients with type 2 diabetes mellitus. Search methods The following resources were searched for the identification of trials from 2004 to 2015: The Cochrane Library (Wiley Online Library), Web of Science, PubMed, Google Scholar, The University of Adelaide Library Research, China Academic Journals Full-text Database (Basic Search) and Heart & diabetes Institute (Baker IDI). National Resource Centre for Chinese Materia Medica and China Academy of Chinese Medical Sciences have been contacted for relevant studies. Reference lists of relevant trials and reviews were searched for potential eligible studies. Authors of relevant identified studies and experts were contacted to obtain additional references. Selection criteria Randomised controlled clinical trials with full text in English or Chinese and a minimum treatment period of eight weeks, comparing Chinese herbal medicine (alone or combined with other pharmaceuticals or other interventions) with other pharmaceutical, placebo, or other interventions (mainly diet control and exercise therapy) as treatments for type 2 diabetes. Quasi-randomised controlled trials, cluster-randomised trials and other non-randomised controlled trials such as cohort studies, case control studies, case series and case reports were not eligible for inclusion in this review. Pre-diabetes, type 2 diabetes complications, study of herb extracts, study of Chinese herb combined with acupuncture and tuina treatment, comparison of different forms of Chinese herbs and study duration less than eight weeks were also excluded in this review. Data collection and analysis All studies for inclusion were assessed and extracted in Characteristics of included studies by using standard data extraction templates. Risks of bias were evaluated based on the Cochrane Handbook for Systematic Review of Intervention. The key criteria of random sequence generation, allocation concealment, blinding of participants, incomplete outcome data, and selection reporting and other bias in the trials were assessed. Any questions were resolved by discussion with two research supervisors and/ or referring back to the original article. Main results Fifty-eight randomized clinical trials (involving 6637 type 2 diabetes patients) were included in this review. The trials compared Chinese herbal medicines either in combination with other pharmaceuticals (forty-two trials) or alone (ten trials) versus other pharmaceuticals alone or placebo (four trials). Two studies compared among three groups, one of the studies compared Chinese herbal medicine combined with other pharmaceuticals versus Chinese herbal medicine alone versus other pharmaceuticals alone. Another study compared Chinese herbal medicine alone versus pharmaceutical alone versus other interventions (mainly diet control and exercise therapy). Most trials tested various Chinese herbal medicines including individual prescriptions modified from classical formulae. Three trials only tested a single Chinese herb Huanglian (Coptidis Rhizoma) or Wuweizi (Fructus Schisandrae). Pharmaceuticals included commonly used hypoglycemic Western medicines such as metformin, sulfonylurea (glibenclamide, glimepiride, and glipizide), alpha-glucosidase inhibitor (acarbose), thiazolidinediones (rosiglitazone), and insulin etc. Other interventions mainly included diet control, exercise therapy, diabetes health education and other life style changes. The overall methodological quality in included studies was unsatisfactory. The studies were well-designed, but most studies were not reported correctly, affecting the quality of evidence. Thus, the ‘Risk of bias” domains were assessed as unclear risk in about two-thirds of the included trials due to insufficient detail to allow a definite judgement. The most valuable and important comparison to evaluate the treatment of type 2 diabetes with Chinese herbal medicine is with placebo, and only four trials were available in this review. Three studies were performed in multiple centres (2, 10 and 20) with one study including one centre outside of China. One study were randomised controlled trials with two arms. Based on available information, Chinese herbal medicines used alone or in combination with other Western hypoglycemic agents or lifestyle changes were associated with a decrease of glycated haemoglobin and blood glucose (FBG & 2h PBG), blood lipid profiles (TC, TG, LDL-C & HDL-C), weight or body mass index (BMI) and TCM clinical symptom score (which is a method of evaluating the symptoms of diabetes including dry throat and mouth, lack of strength, polyphagia, polydipsia, polyuria, shortness of breath, vexing heat in the chest, palms and soles, palpitation, insomnia etc.). A combination of Chinese herbal medicines with either other pharmaceuticals or lifestyle interventions was also associated with enhancing the therapeutic effects of other pharmaceutical by improving insulin sensitivity (HOMA-IR or ISI) in the treatment of type 2 diabetes. However, the overall evidence for effectiveness was insufficient because the studies were not reported correctly and the quality of literature in included studies was unsatisfactory. Less than half of the studies (22/58) reported adverse effects of the interventions with only one-third of the studies (19/58) providing detailed information of safety assessment, and certainly had no safety assessment comparable with western medicines. So there was very limited safety data to conclude that Chinese herbal medicines were safe for type 2 diabetes treatment based on available information. Author’s conclusions The evidence to assess the effectiveness of Chinese herbal medicine for treating type 2 diabetes was acceptable in principle (fifty-eight trials with large sample size and forty-two with brief information of randomization), but the risks of bias (uniform bias due to patients selection exclusively from TCM hospitals or patients) in most of the included studies precluded a determination with respect to the effectiveness of Chinese herbal medicine. There was also insufficient data to evaluate safety issues in most of the trials if considering long-term adverse effects of Chinese herbal medicines. (Only less than half of the studies provide information of adverse effects and most of them were performed with short durations of 8 or 12 weeks). There was limited data (four studies) to compare the effectiveness of Chinese medicine (either alone or in combination with Western medicine) with placebo. From available data, Chinese herbal medicines combined with pharmaceuticals or alone may be more effective than pharmaceutical alone at glycemic control, insulin resistance control and improvement of TCM clinical syndromes. However, the information provided by most of the studies was insufficient with respect to details to allow a definite judgement of risk of bias, which affected the evaluation of overall methodological qualities of included studies. High quality studies (Long-term well-designed studies with multiple centres and large samples) with sufficient described details about randomisation methods and safety tests are required to compare Chinese herbal medicine alone with pharmaceutical alone or placebo before any conclusions can be drawn about the effectiveness and safety of type 2 diabetes treatment with Chinese herbal medicines.Item Open Access The marketing of sugar-sweetened beverages to young people on social media(2016) Brownbill, Aimee Lee; Braunack-Mayer, Annette Joy; Miller, Caroline; School of Public HealthSugar sweetened beverage (SSB) consumption is high in Australia, particularly among adolescents and young adults. The need to reduce added sugars in the diet, with SSBs a notable contributor, is attracting increased attention from health agencies interested in curbing obesity and associated non-communicable diseases. While the marketing of unhealthy food and beverage products to children has been a focus of research and policy interest, little attention has been focused on the marketing of such products to adolescents and young adults. The increased usage and importance of social media for young people, paired with the unique opportunity provided by social media platforms for the continuous monitoring and facilitation of social interactions, consumer engagement, and peer-to-peer relationships, makes young people vulnerable to highly personalised and targeted digital marketing campaigns by the food and beverage industry. This study investigates the ways in which SSBs are marketed to people aged 13-25 years old on Facebook through a content analysis of the top SSB Facebook pages ranked by Australian followers. Using a social constructionist paradigm, descriptive and thematic analysis was conducted on all official company posts made to these pages during the 6 month period of 1 January to 30 June 2015. Results found that SSB brands share highly engaging content on Facebook which seamlessly integrates their content into the lives of young people today. Further to this, brands align their products with common sociocultural values and practices such as masculinity, femininity, friendship, and leisure, which are regarded as important by young people today. In doing so, they portray their products as having a normal place within the everyday lives of young people. This study contributes to the evidence base which shows young people are specifically targeted in the marketing of SSBs. Further to this, it adds to current literature by drawing attention to social media as a relatively new medium through which SSBs can uniquely target young people in their marketing. The findings of this research can help inform future public health policy and interventions regarding the marketing of SSBs to young people.