Achieving timely diagnosis of dementia across the Australian population is a critical priority to address dementia’s significant burden of disease. Early recognition and diagnosis of dementia provides access to vital services, therapies, and supports to delay and manage disease progression. Yet estimates show that approximately 50% of Australians with dementia remain undiagnosed and are living without formal support. Additionally, limited population awareness about dementia contributes to significant misunderstanding and stigma. Population misconceptions present dementia as an inevitable part of ageing and are predominantly concerned with memory loss. Despite a global impetus for earlier dementia diagnosis, there is little understanding on what leads people to seek a diagnosis.

A qualitative study explored pre-diagnostic dementia symptoms as they presented in people’s everyday lives. Semi-structured interviews were undertaken with thirty-seven people who had themselves experienced dementia symptoms or their significant others (spouse/partner, child, sibling, friend). Qualitative data was systematically mapped to the International Classification of Functioning and Disability (ICF). Descriptions of symptoms ranged widely across ICF domains and included changes to: mental and sensory functions, communication, mobility, and social reciprocity. Symptoms were described in the context of daily life, workplaces, and relationships. Key themes included the significance of retrospect and the threshold for seeking help.

The findings were further mapped to the Social Model of Health to establish dementia key action areas and priorities for health promotion and public health, including campaigns that equip individuals, workplaces, and communities to informally recognise dementia. Future work in increasing awareness about dementia and recognition of pre-diagnostic symptoms are important drivers to lower the threshold for seeking help and achieve earlier dementia diagnosis.

These priorities are being progressed through research-practice collaborations by the Centre for Research Excellence in Enhanced Dementia Diagnosis (CREEDD), working towards accurate, equitable, and fast diagnosis throughout Australia.

Context and aim: Parental provision of alcohol to children is associated with negative alcohol-related outcomes. Public health campaigns have shown promise for discouraging this practice, however limited research has examined the effectiveness of different messaging approaches. The aim of this study was to examine the performance two mass-media public health campaigns that were designed to motivate parents to abstain from providing alcohol to their underage children. The examined campaigns employed distinct strategies to achieve this – ‘I see’ utilised fear-based messaging and ‘I need you to say no’ employed a first-person narrative approach.

Methods and analysis: Parents were surveyed one year into the implementation of each campaign (‘I see’ n=308, ‘I need you to say no’ n=250), with separate survey samples for each campaign. The effects of the two campaigns on parents’ alcohol provision intentions were compared using an independent samples t-test. Two ordinal logistic generalised linear models were also used to assess whether intentions effects differed according to parents’ demographic, behavioural, and alcohol-related characteristics.

Translational outcomes: Both examined campaigns were effective, with most parents reporting that they made them less likely to provide alcohol to minors. Female parents and those who had never provided alcohol to their children were more likely to have been persuaded by the campaigns. The fear based ‘I see’ campaign was particularly effective for older parents and those who used less alcohol, whereas the ‘I need you to say no’ campaign that used a narrative approach was more effective with heavier drinkers.

Future actions: The strong performance of both campaigns highlights the crucial role of mass media campaigns for promoting stricter parenting practices around underage alcohol use. The effectiveness of mass media campaigns is likely to be maximised by implementing multiple campaigns with varying execution styles that differentially appeal to different parent subgroups.

What is the issue that requires public health action?
The need to act on the environmental and broader commercial determinants of obesity and unhealthy eating is widely recognised. Product and price promotions in supermarkets are pervasive, and are disproportionately used to promote unhealthy food and drink products. This has implications for health equity, with lower income consumers more sensitive to price promotions. Our research aimed to investigate in ‘real-time’ during supermarket shopping, people’s exposure to such promotions, and how this influenced consumer intentions, motivations, and purchasing behaviour.

What have we learned to address this issue, and how has this finding been derived?
This research utilised a novel accompanied shop method as a way of gathering insitu insights about price promotion exposure in supermarkets and how this influences purchasing. Research participants (n=21) were accompanied while they did a regular supermarket shop, and asked to describe factors influencing their purchasing choices using a ‘think aloud’ approach. Key themes that emerged from the qualitative data analysis related to unplanned purchasing in response to ‘specials’; the pervasiveness of price promotions and unhealthy product displays throughout supermarkets, and the impact of cost-of-living pressures on household shopping and eating.

How has this been used in practice?
This recently completed research adds timely weight to public health concerns about supermarkets as an obesogenic environment, and how the current promotion environment in major supermarkets influences consumers’ intended and actual purchases. Research findings have already been used in an evidence brief developed by Cancer Council WA, and will be used in other advocacy.

What actions should we take to address the issue?
The disproportionate distribution of product and price promotions on unhealthy food and drink products and clear influence of these promotions on consumers’ purchasing decisions supports the need for changes to the regulatory environment.

Aggressive promotion of harmful commodities such as unhealthy foods and alcohol contributes to non-communicable diseases such as obesity, diabetes, and some cancers. Nevertheless, harmful marketing is rarely regulated, especially in online media, mostly because of difficulties in monitoring personalised online activities. We developed SCANNER, a deep learning system to automatically detect and classify the digital marketing of harmful products (vaping and tobacco products, gambling, alcohol, and unhealthy foods high in fat, sugar, and salt) at an accuracy higher than 95%. We are conducting a study to quantify children’s and youth’s exposure to the marketing of harmful products using SCANNER. We are collecting screen recordings from 300 young people between the ages 8 -and 25-years in Australia, representing 30% of their usual digital screen time over 2 days (one weekday and one weekend day). All participants will complete a post-study survey on their recall of exposure to online marketing of harmful products. We will present the interim findings for at least 30 participants, whose data will be analysed by September 2024, quantifying children’s, and youth’s exposure to online marketing of vaping and tobacco products, gambling, alcohol, and unhealthy foods in Australia using SCANNER. Our methodological approach can support implementation and evaluation of regulations to protect children and youth from marketing of harmful products when online.

Title: Identifying determinants influencing the sustainability of health programs in Australian primary schools

Context and Aim: This Australian implementation study aims to uncover the factors that influence the sustainability of school-based physical activity and nutrition programs. The presentation will discuss findings of a distributed survey based on the Integrated Sustainability Framework. The goal is to support the longevity of school-based health programs to garner the most from their respective benefits.
Methods and research findings: A cross sectional study was undertaken with 201 Australian primary schools currently implementing physical activity and nutrition programs. Factors perceived to be influential to program sustainment were assessed using a 28-item measure of sustainability determinants developed by the research team. This reflected five domains of the Integrated Sustainability Framework. A 5-point Likert scale was used, and domain scores were calculated for each school by averaging item responses. Determinants were ranked according to their perceived influence on program sustainment. Linear mixed regressions were conducted to evaluate associations between measure domains and length of program delivery, and ordinal analysis was conducted to compare program type to categories of sustainment. Preliminary findings indicate an average program sustainability of 7.4 years, with differences observed between physical activity and nutrition programs. Top determinants influencing program sustainment varied between physical activity and nutrition programs, highlighting contextual specificity.
Translational outcomes: The study provides critical insights into sustaining school-based health programs, emphasising the need for tailored strategies to address program-specific challenges. Understanding distinct determinants enables targeted strategies to support program sustainment and maximise health outcomes.
Future actions: Future efforts should prioritise developing sustainability strategies tailored to the unique challenges faced by physical activity and nutrition programs in school settings, with emphasis on outer contextual factors such as leadership support and funding availability.
Learnings: The study underscores the importance of considering context-specific determinants in sustaining health program delivery, offering valuable lessons for policymakers and practitioners involved in school-based health initiatives. Addressing identified determinants can enhance the effectiveness and longevity of school-based physical activity and nutrition programs, contributing to improved population health outcomes.

What is the problem/issue that requires public health action? [Context and aim]

Teaching health literacy across the lifespan can combat health inequities. Birth-five years is an optimal period for growth, development and learning; hence our focus on building health literacy in the early years. Early childhood settings are ideally placed to support this learning. The Little Aussie Bugs educational resources include dialogic storybooks focusing on personal hygiene, oral health and healthy eating; developed in Western Australia and launched in 2022 to support early-years educators build health literacy among young children. This evaluation considers the effectiveness and impact of these resources.

What do we know or have we learned to address this problem/issue, and how has this finding been derived? [Methods and analysis/research findings]

Two face-to-face workshops (n=28) coached educators to use the resources. Twelve hundred resource packs were distributed Australia-wide. An online survey (n=110) and qualitative interviews (n=8) captured useability/likeability data. Majority of survey participants (77%) reported increased confidence to deliver health literacy messages. Key qualitative findings revealed educators extended their use of the resources beyond ‘story time’, noting health literacy messages resonated with children, although less experienced educators reported some challenges with the books’ dialogic nature.

How has this been used in practice? [Translational outcomes]

Educators recalled numerous examples of using these resources to reinforce health literacy messages. For example, when transitioning from playtime to mealtime, children routinely wash their hands. The key messages from the ‘When we are sick’ book helped children visualise germs washing down the sink, building their understanding of abstract concepts related to personal hygiene. An online professional learning platform is currently being piloted (n=58) to further support educators’ use of the resources.

What actions should we take in the future to address the problem/issue? [Future actions]

While using resources like the Little Aussie Bugs helps build health literacy for children, they have been uniquely augmented by providing an online professional learning platform for educators. The Little Aussie Bugs resources are now being expanded to incorporate broader health topics (e.g., healthy bones and healthy ears), providing a library of resources that engage young children and build capacity for early years educators and services.

[Context and aim]
In the last decade, alcohol consumption in Australia has been in decline, with the main drivers appearing to be increased health consciousness and changing patterns of socialising. While this is a positive development from a public health perspective, one way that alcohol suppliers are responding to this shift is by attempting to market products as ‘lighter’ and ‘healthier’ using a range of on-pack ‘better for you’ claims. The aim of this research is to investigate the range of on pack ‘better for you’ claims used across the Australian alcohol market, and the prevalence by category.

[Methods and analysis/research findings]
We analysed the presence and type of ‘better for you’ claims on approximately 6,000 products collected from three major Sydney alcohol stores in March-April 2023. ‘Better for you’ claims were classified into six major categories: nutrient content claims (e.g. low sugar), energy claims (e.g. low calorie), absence claims (e.g. no additives), natural references (e.g. natural flavours), process claims (e.g. organic), and low alcohol claims (e.g. lighter in alcohol).

Approximately one-third of products displayed some type of ‘better for you’ claim overall. Product categories that most commonly displayed claims were cider and premix, with approximately 75% of these products displaying a claim. The most common ‘better for you’ claims related to references to being natural and specific nutrients.

[Translational outcomes and Future Actions]
These findings demonstrate that ‘better for you’ claims are used on many alcohol products. Stronger regulation of these claims is vital to ensure that consumers are not misled into thinking that alcohol products can be ‘healthy’ given the recognised health harms associated with alcohol use.