Background: Vaping among Australian adolescents is an increasing public health concern associated with adverse health outcomes and future smoking initiation. Schools have an important role to play in supporting healthy behaviours, and the WHO Health Promoting Schools (HPS) Framework recommends whole-school approaches involving parents. However, limited evidence exists regarding how schools can effectively collaborate with parents to address adolescent vaping prevention and cessation.
Methods: A quantitative, cross-sectional online survey was conducted with 148 Australian parents of adolescents aged 12–18 years. Parents completed a brief survey examining vaping-related attitudes, behaviours, perceptions of school-based vaping support and awareness of school policies. Participants were recruited through convenience sampling, including social media and online advertisement.
Results: Most participants believed schools should play a role in addressing adolescent vaping (94.1%). Around one-quarter reported receiving vaping-related support from their child’s school within the last 12 months, most commonly through school communications (71.4%), educational resources for parents (64.3%) and information regarding school vaping policies (42.9%). When asked what forms of support they believed would be the most helpful, parents identified educational resources (69.9%), clearer communication regarding school vaping policies (68.8%) and information on how schools respond to student vaping incidents (56.3%). Findings suggest parents support a greater role for schools in adolescent vaping prevention and value increased communication and resources.
Conclusions: Parents strongly support schools playing an active role in addressing adolescent vaping and identified a need for greater communication, educational resources and clearer school policies. Findings highlight the importance of strengthening parent-school partnerships within the WHO HPS Framework to support vaping prevention and cessation efforts. Increased collaboration between schools and parents may enhance the delivery and effectiveness of whole-school approaches to reducing adolescent vaping.

Background: Community-based interventions (CBIs) targeting childhood obesity prevention show promise in reducing body mass index z-scores (BMIz) and improving weight-related behaviours. The Precision Evidence for Childhood Obesity Prevention Interventions (PRECIS) project analysed pooled individual level data to further explore sub-group impacts and provide intervention success factor insights.
Methods: Individual level participant data from 11 large obesity prevention CBIs conducted in Australia, New Zealand and the Pacific between 2003-2022 were collated and harmonised. Pooled analyses were conducted using multi-level linear and logistic regressions to understand intervention effects on measured anthropometric outcomes, self-reported weight-related behaviours (physical activity, sedentary behaviour and dietary intake) and health related quality of life (HRQoL). Further analyses by socio-economic position were conducted in Australian studies.
Results: Pooled analysis of participant-level data from six Australian, one New Zealand and three Pacific studies (n= 25,077 baseline; n= 22,580 end of study observations) found no overall intervention effect. Sub-group analyses found CBIs slowed weight gain in Australian studies (BMIz mean difference (md) -0.035 (95%CI -0.064, -0.007)), and among all girls (BMIz md -0.031 (95%CI -0.058, -0.003). Additionally, effectiveness was detected in studies with longitudinal design, but not repeat cross-sectional design, and for children within the healthy weight range, but not those with overweight or obesity at baseline. Within Australian studies, CBIs were more effective for students from lower compared to higher socio-economic areas (BMIz md = -0.10 (-0.18, -0.02)). Few significant results were found for behavioural outcomes. Obesity prevention CBIs had a positive impact on HRQoL, particularly in younger children, boys and those from lower socio-economic areas.
Conclusions: Obesity prevention CBIs were effective in slowing weight gain for some populations, in some settings, and were generally more effective in low compared to high socio-economic areas. Future work could focus on identifying key action areas within CBIs that contribute to intervention success.

Background 

Universities are critical settings for health promotion, with significant potential to advance health equity for staff, students, and surrounding communities. In Australia, the prevention and control of sexually transmitted infections (STIs) and blood-borne viruses (BBVs) remain an important public health priority. University communities include populations disproportionately affected by STIs/BBVs as well as those that face major barriers to seeking care. Self-testing offers an accessible alternative to clinic-based testing that can reduce these barriers.

This study aimed to explore university stakeholders' perceptions and barriers towards STI/BBV testing, to inform the design of a self-testing service.

Methods

Semi-structured interviews were conducted with students (n=6) and staff/professionals (n=5) from a Victorian university. Students were opportunistically recruited using on-campus and online advertisements, whilst snowball sampling was utilised to recruit key staff across the university. Transcripts were analysed in NVivo (v15) using Braun & Clark’s thematic analysis.

Results 

Eleven students (n=6) and staff/professionals (n=5) participated. Students ranged in age from 18 to 45 years and attended urban (n=2) and regional (n=4) campuses. Domestic (n=4) and international (n=2) students were represented alongside those who identified as sexually or gender diverse (n=4). Professional roles included health-service delivery, health and wellbeing coordination and student association representation.

Stigma and service accessibility were identified as key barriers to testing. Perceived sexual health knowledge among students was mixed, and awareness of self-testing was low, although interest was high. Participants recommended that services align with student life by being distributed in private, accessible, and non-stigmatising locations, with clear guidance on pathways to care and a balance between privacy, visibility and education, to reduce stigma.

Implications 

Universities are critical settings for health promotion, with significant potential to advance sexual health equity for priority populations in Australia. Implementing accessible self-testing services that balance privacy and support education can reduce barriers to STI/BBV testing.

Background: Globally, health services persistently struggle to create workplace environments that support the retention of Indigenous staff, undermining efforts to achieve equity in health outcomes for Indigenous communities. High rates of workplace racism are a significant factor contributing to Indigenous staff attrition from the health workforce. The aim of this review was to describe Indigenous staff views on support when they experience or witness racism within health care settings in four countries, Australia, New Zealand, Canada and the United States.

Methods: This qualitative review employed a reflexive, participatory approach involving Indigenous staff with experience working in health in the research question framing, study design, and data analysis. We searched MEDLINE, Embase, PsycINFO, Scopus, CINAHL, and Informit databases from inception to January 2026. Reference lists of relevant systematic reviews and all included studies were screened to identify additional eligible studies, and author networks were contacted to locate further unpublished or in-press data sources. Included studies were analysed using thematic analysis.

Results: Twenty-five references from Australia, Canada and New Zealand were included for analysis. We identified six main themes: community connection for healing, resisting the erosion of dignity to work freely, seeking relief from the burden of driving change, embedding organisational level responses that facilitate belonging, establishing anti-racism as multi-dimensional grounded in lived experiences, institutional failures to reject work cultures that uphold diminishing conduct.

Conclusion: This study identifies considerations for health services working to create supportive environments for Indigenous staff. Stories shared by respondents highlighted the complex interplay of support strategies at the micro, meso and macro levels established in globally accepted anti-racism frameworks. Understanding how and why staff utilise support strategies across different levels of the framework can transform organisational responses to racism and guide the development of support infrastructures that centre the needs of staff who are the targets of racism.

Aboriginal Governance
The lead author is an Aboriginal and Torres Strait Islander woman who has provided cultural and professional leadership throughout the full project life cycle for this work. Fifty percent of the author team identify as Aboriginal and Torres Strait Islander and led the conceptualisation of the review and advised on analysis and data interpretation.

Background: Understanding the impact of social media (SM) on children’s wellbeing is a key priority of policy makers, researchers, and families. Recent Australian Government age-related restrictions have further amplified this focus. This study explored children’s (8-16yr) SM use and associations with wellbeing.
Methods: Parents of 8-16-year-old children in Australia (n=660; 2025) proxy-reported: if their child used SM, daily duration, age of first use, use of six common platforms, and child wellbeing via the KIDSCREEN-10 measure. Multiple linear regression models (adjusted for age, gender, physical activity, and sleep guideline adherence) determined associations between SM use, age of first use, type of SM platform used, SM duration, and wellbeing. Models were also stratified by age (younger: 8-≤13yrs; older: 13-16yrs).
Results: On average, children (mean age: 12.15±2.54; 57% male) first used SM at 11.01yrs (±2.93). Compared to younger children, more older children used SM (90% vs 58% respectively; p<0.001) and each SM platform (e.g. 85.2% vs 57.5% used YouTube; p<0.001). Compared to older children, younger children started using SM at a younger age (10yrs vs 12yrs; p<0.001) and spent less time on SM (94 vs 222 mins/day; p<0.001). The one variable positively associated with wellbeing was age of first use: each additional year of delay in starting to use SM was associated with higher wellbeing. This was evident amongst the whole sample (B=0.52, 95%CI: 0.08, 0.96; p=0.022), and older children (B=0.78, 95%CI: 0.17, 1.40; p=0.013). There were no other associations between SM use and wellbeing.
Conclusion: Children engage in high levels of social media use, starting younger than platforms’ minimum age. Given that age of first use was positively associated with wellbeing, family and policy initiatives to delay first use may be important strategies to manage the detrimental impacts of social media on wellbeing. Longitudinal follow-up is needed to understand the long-term impacts.

Background: Although antidepressants are commonly used for the treatment of depression, adverse outcomes are common in older adults. This study aimed to investigate the long-term association between antidepressant classes and recurrent falls and fractures among older adults, while addressing confounding by indication of depression.
Methods: This study used data from a well-characterised cohort of relatively healthy community-dwelling Australian older adults aged ≥ 70 years. Participants using antidepressants at baseline were included in the exposed group, and the non-exposed group comprised participants with depressive symptoms, defined by the 10-item Center for Epidemiologic Studies scale or increased genetic susceptibility identified by polygenic risk score at baseline. Antidepressant use was treated as a time-updating exposure. Outcomes were recurrent serious falls and fractures. The Andersen-Gill model was used to estimate adjusted hazard ratios (aHRs), adjusting for potential confounders.
Results: Over a median (IQR) follow-up of 4.7 (3.8-5.7) years, 528 participants experienced recurrent serious falls and 548 experienced recurrent fractures (incidence rates 30.3 and 31.6 per 1000 person-years, respectively). Antidepressant use was associated with increased risks of recurrent serious falls (aHR = 1.44; 95%CI: 1.21-1.72) and recurrent fractures (1.32; 1.11-1.56). In analyses by antidepressant class, SSRIs were associated with a higher risk of recurrent serious falls (1.66; 1.33-2.06) and fractures (1.49; 1.20-1.85), whereas TCAs and other antidepressants were not associated with these outcomes. Effect modification was observed by social isolation for serious falls, and by obesity and osteoarthritis for fractures.
Conclusions: In this longitudinal study of community-dwelling older adults, antidepressant use, particularly SSRI use, was associated with an increased risk of serious falls and fractures. Our findings suggest that antidepressant-related fall and fracture risk in older adults may vary across antidepressant classes and individual agents. This heterogeneity should be considered when prescribing antidepressants to high-risk older adults, alongside the clinical indication, anticipated benefit, and individual susceptibility to falls and fractures.

Keywords: Antidepressants; Depression; Falls; Fractures; Geriatrics; Bone Health

Background: Screen use is ubiquitous and understanding its impact on children’s social wellbeing and development is crucial for families, allied health (e.g. Occupational Therapists) and policy makers. This study aimed to examine the associations between children’s (8-16yrs) screen use and their social skills and family functioning.
Methods: Parents (n=660) of children in Australia (8-16yrs, 43% male; 2025) proxy reported their child’s screen use (for education, social, leisure, and gaming), social skills using the Home and Community Social Behavior Scale (Social Competence subscale [peer relations, self-management/compliance]; Antisocial Behaviour subscale [defiant/disruptive, antisocial/aggressive]) and family functioning using the McMaster Family Assessment Device General Functioning subscale. Linear regression models for the whole sample and by age group (children=8-11yrs; adolescents=12-16yrs; adjusted for age, sex, physical activity and sleep recommendation adherence) examined the associations between screen time, social skills and family functioning.
Results: Screen use was very high amongst children (median mins/day=612.9 IQR 355.7-1140.0) and adolescents (median mins/day=1135.6 IQR 651.4-1140.0). The significant associations with social skills and family functioning varied by type of screen use. Amongst children only, total screen time and social screen time was associated with higher antisocial/aggressive scores (β=0.46, 95%CI 0.15,0.76; p=0.004 and β=0.54 95%CI 0.01,1.00; p=0.020 respectively), and antisocial behavioural sub-scale scores (β=0.34, 95%CI 0.05,0.62; p=0.021 and β=0.43 95%CI 0.01-0.085; p=0.047 respectively). Most positive associations were found with educational screen time: better peer relations, self-management, total social competence sub-scale and family functioning scores for children and adolescents. Amongst adolescents there were also positive associations between video game use and self-management/compliance and positive associations between all types of screen use and family functioning.
Conclusion: The impact of screen use on social skills and family functioning varies by the type of screen use. Findings emphasise the need for nuanced behaviour recommendations and age-specific strategies to manage the balance of detrimental and beneficial screen use.

Background: Poor medication adherence contributes substantially to preventable chronic disease burden and healthcare costs. Studies consistently report that psychological distress is associated with poorer adherence, yet the underlying mechanisms remain unclear. Identifying modifiable pathways is critical to informing more effective, person-centred adherence interventions within chronic disease management systems. The aim of this study was to examine multiple cognitive and affective pathways from psychological distress to medication adherence.
Methods: A cross-sectional survey of 201 Australian adults regularly taking prescribed medication for various physical and mental conditions was conducted via Prolific (58% female, mean age 37.1, SD=13.6). Participants completed a series of validated questionnaires online. Parallel multiple mediation analysis was conducted to assess the direct pathway between psychological distress and medication adherence behaviour, and indirect pathways through perceived cognitive difficulties, fatigue, and four styles of coping with stressful decisions (“vigilance”, “hypervigilance”, “buck-passing” and “procrastination”).
Results: Higher psychological distress was associated with greater perceived cognitive difficulties (β=0.534), higher levels of maladaptive decision-making coping styles (hypervigilance β=0.601; procrastination β=0.467; buck-passing β=0.245), and lower energy (β=−0.610) (all p<.001). In the multivariable analysis, the direct effect was significant, with lower psychological distress associated with greater medication adherence (β=-0.283, p=.010). Two significant indirect pathways emerged through perceived cognitive difficulties and hypervigilance, an over-engaged and anxious decision-making coping style. Lower perceived cognitive difficulties (β=-0.234, p=.013) and greater hypervigilance (β=0.309, p=.001) were associated with greater medication adherence. Model fit was acceptable (CFI=0.98, TLI=0.93, RMSEA=0.076, SRMR=0.041).
Conclusions: Psychological distress may undermine medication adherence through overlooked cognitive self-management barriers. Findings suggest multiple pathways, including perceived cognitive difficulties and highly engaged yet dysregulated decision-making processes. These results identify actionable targets and highlight opportunities for system-level approaches that better integrate mental wellbeing into adherence strategies. Future longitudinal and intervention research is needed to test whether addressing these cognitive barriers can improve adherence outcomes.

University students with disability (SWD) experience persistent inequities in health, wellbeing, and participation in higher education, highlighting the need for system-level approaches to inclusion. This program of research examined whether wellbeing support, delivered through an exercise-based relational model, can function as a mechanism for advancing disability equity within a university setting.

A mixed-methods design was used across four interconnected studies involving qualitative inquiry, co-design, intervention implementation, and evaluation. Initial interviews with SWD (n = 31) identified fragmented and reactive support systems, alongside intersecting challenges including mental health concerns, financial stress, stigma, and competing life demands. Students emphasised the importance of relational support, flexibility, and holistic, person-centred approaches to wellbeing.

These findings informed the development of the Health, Empowerment and Lifestyle Project (HELP), a 10-week individualised exercise-based wellbeing intervention delivered by Accredited Exercise Physiologists within a university setting. A quasi-experimental pre-post evaluation (n = 20) indicated improvements in self-reported mental health, disability impact, and health-related behaviours. Qualitative findings suggested key mechanisms of change including relational trust, tailored support, increased self-efficacy, and enhanced agency.

Stakeholder interviews (n = 13) with university staff and service leaders described HELP as an “equity in action” initiative addressing gaps in existing support systems. However, challenges to sustainability were identified, including fragmented service structures, resourcing constraints, and tensions between relational approaches and efficiency-driven institutional priorities.

Collectively, findings demonstrate that wellbeing operates not only as an outcome of equity but as a mechanism through which equitable participation may be enabled. This program of research advances a contextually embedded, exercise-based relational model of wellbeing support. While developed within one university setting, the findings offer transferable insights to inform the design and implementation of similar approaches in other contexts seeking to strengthen disability equity through integrated, health-promoting systems.