Chlamydia trachomatis cases notified to public health authorities in Victoria have increased in the last decade, particularly in western Melbourne. However, the extent of testing and case ascertainment remains unknown.

A recent update to the Public Health and Wellbeing Regulations (2019) required laboratories to report all positive and negative chlamydia tests from January 2023. Using this newly available data, we calculated testing rates and percent positivity by postcode, age and sex in the Western Public Health Unit (WPHU) catchment compared to the rest of Victoria, to identify opportunities for sexually transmitted infection (STI) prevention and control.

We included tests conducted by 11 laboratories over 6 months in 2023 and population estimates from the 2021 Census. We excluded laboratories based interstate (n=18) or missing test data (n=7), and tests from postcodes outside Victoria or with missing age, sex, or postcode. Postcodes aligning with WPHU’s 8 local government areas (LGAs) were defined as being in our catchment.

A total of 199,435 tests were included. The testing rate was 45.1/1,000 people and percent positivity 5.7% in WPHU, versus 30.7/1,000 and 5.6% across Victoria. Lower testing (29.8/1,000) and higher percent positivity (12.2%) was observed in 15-19-year-olds in WPHU. Young adults had high testing rates (20-24 years: 97.3/1,000; 25-29 years: 109.6/1,000) and a relatively high proportion of those tested were positive (20-24 years: 9.3%; 25-29 years: 6.2%). Testing was lower among males than females aged 15-24 (57.1/1,000 versus 83.6/1,000), and percent positivity was higher in men of all ages (6.5% versus 4.7%). We found pockets of low testing and high percent positivity among young people in parts of Melton, Wyndham and Brimbank LGAs, with different geographic distribution between sexes.

This first analysis of chlamydia testing using newly notifiable data has found evidence of a high level of undiagnosed chlamydia in teenagers aged 15-19, and of diagnosed and undiagnosed chlamydia in adults aged 20-24, particularly men, with unequal geographic distribution. WPHU and partner organisations will use findings to direct local interventions to: increase testing among key populations; advocate for greater access to sexual health services; and engage teenagers and young people, particularly men, in STI prevention.

Context and aim:
Tuberculosis (TB) remains a global public health problem with over 10.4 million cases and 1.6 million deaths annually. In low burden countries most cases of TB disease result from progression of the latent stage, TB infection (TBI). The at-risk population for TBI in Australia includes those born overseas in high TB burden countries, persons with immune compromised conditions, and Aboriginal and Torres Strait Islander peoples. Despite the low (but inequitable) disease burden, mathematical modelling indicates that Australia is unlikely to meet the World Health Organization TB elimination targets. Innovative strategies are necessary to prevent progression to active disease. A scoping review and stakeholder survey are presented, which iteratively explore a model of care for TBI screening and treatment in primary care in Australia.

Methods and analysis/research findings:
The scoping review explored evidence for models of care for TBI screening and treatment in primary care globally. Eight databases were searched, identifying 12,536 records; 8 articles met inclusion criteria. Studies indicate that TBI screening and treatment is feasible in primary care when supported by a robust referral system and community mobilisation, strengthening partnerships across community, education, research, governments, primary and specialist care. However, challenges exist at every step of the screening care cascade. The online stakeholder survey (n=45) of clinicians, policy makers, and researchers in Australia, sought views on TBI screening and treatment in primary care. Most participants believed that primary care is best placed for screening and treatment. However, they identified the need for additional resources, staff training and incentives, and systems endorsements in primary care for eligibility to offer screening tests and prescribe TBI medications, and specialist support where needed.

Translational outcomes and Future actions:
These findings suggest that primary care in Australia is an appropriate setting for TBI screening and treatment, and may provide a means of reaching elimination targets, if necessary supporting measures are provided. Lessons learnt from the translational research will contribute to policy change. Further studies are required to establish the feasibility, acceptability, and effectiveness of systematic, targeted screening of at-risk individuals in the Australian context.

Context and aim:

Energetic play is essential for children’s development and to set lifelong positive health behaviours. Yet only one in ten children aged 3-5 years get the recommended 60 minutes of daily energetic play. Early Childhood Education and Care (ECEC) is an important setting for supporting children’s physical activity. Play Active is an evidence-informed physical activity policy intervention with implementation strategies to enable ECEC services to successfully implement their policy. Play Active is backed by 10 years of research with leading (inter)national research institutions, ECEC providers and peak bodies and organisations working in child physical activity and health.

Methods and analysis/research findings:

In 2021-22 a pragmatic trial to test the effectiveness and implementation of Play Active was conducted with 81 ECEC services (646 educators) in Perth, WA. There was a significant increase in the uptake of policy physical activity practices during the 3-month implementation period. There was high awareness of the policy recommendations (90%). Acceptability was high for both educators (83%) and directors (78%) and, fidelity and reach were high for most implementation support strategies (75%-100%).

Translational outcomes:

Play Active supports services to meet the Australian ECEC national standard: “Each child’s health and physical activity is supported and promoted”. Play Active received a further $2million to be scaled up nationally. Play Active was launched by the Federal Minister for Early Childhood Education and Youth, the Hon. Dr Anne Aly MP in April 2024. More than 80,000 Australian children from 700 ECEC services across nationally are expected to benefit through improved physical activity and health. A key focus is equitable implementation of Play Active for ECEC services who work with priority population groups.

Future actions:

Nutrition, sleep and sun protection policies are required by national ECEC regulations yet there is no guidance around how much physical activity children should have while in ECEC. Play Active addresses this policy intervention gap. A key goal is to amend national ECEC regulations to require services to have a physical activity policy and for Play Active to be a sustained national ECEC program.

Interpregnancy interval (IPI) is defined as the time between birth and commencement of the next pregnancy. Short IPI (<6-18 months) is a highly modifiable risk factor for adverse maternal, perinatal, and child health outcomes. Maternal health care is a high volume and a high-cost health service; however relatively little research has been undertaken to determine the factors that influence IPIs in high-income countries. Using a socioecological framework, this study comprehensively and systematically synthesised individual, relationship, community, and societal factors that influenced IPIs in high-income countries.

A systematic search was undertaken in CINAHL Plus, Ovid/EMBASE, Ovid/MEDLINE, Ovid/PsycINFO, ProQuest, PubMed, Scopus, Web of Science, and Google Scholar for articles published in English from January 1st 1990 to October 17th 2023. Studies were included if they reported an effect estimate for at least one determinant of birth spacing. The socioecological model was used as a guiding framework to systematically examine multilevel risk and protective factors of IPIs.

Of the 264 unique articles identified for full text review, 55 met the inclusion criteria for the final systematic review. Four levels of risk and protective factors related to short IPI were identified (individual, relationship, community, societal). The majority of the included studies reported influencing factors at the individual level (n=45), with maternal age, ethnicity, education, contraception use, and parity deemed risk factors. At the relationship level, peer influence and familial characteristics were risk factors of short IPIs. By contract, access to health care services were a protective factor for short IPIs at the community level, with social insurance provision at the societal level the most influential factor on short IPIs.

In Australia, the Royal Australian College of General Practitioners recommend a 6-week postnatal general practitioner review. However, there are no current national guidance on when, how or by whom postnatal contraceptive counselling should be provided; nor is there a national guidelines or recommendations on optimum interpregnancy intervals. The multi-dimensional factors that influence short IPIs identified in this study are crucial to providing an evidence-base to support the development of prenatal and postnatal programs that counsel women and families on optimum pregnancy spacing.

Context and Aim: Previous research has shown that children living in Perth, Western Australia, experience a high level of exposure to unhealthy outdoor food advertisements during the school commute. This exposure can have negative public health consequences given childhood weight gain has been linked to the marketing of energy-dense and nutrient-poor foods. The Children’s Rights agenda recognises that children have a right to be consulted about environments and policies that affect them. This world-first study aimed to explore schoolchildren’s lived experiences and attitudes towards the outdoor advertising that surrounds their schools.

Methods and Analysis: Seven focus groups with children aged 10 – 16 years (n=47) attending Perth schools located in areas with a high density of unhealthy outdoor advertising were conducted between July and October 2023. The focus groups explored schoolchildren’s experiences of outdoor advertising during their school commute; the influence of this advertising on their food preferences and diet; whether they thought outdoor advertising was an issue that needed addressing; and if so, strategies to reduce outdoor advertising of unhealthy food and beverages. Focus groups were recorded and transcribed verbatim. A thematic analysis of the data was undertaken in NVivo.

Findings: Study participants were aware of outdoor advertising of unhealthy food and beverages near their school, with many reporting that outdoor advertising impacted their food preferences and diet. Many participants felt it was unethical to advertise unhealthy food and beverages around schools and strongly supported restricting alcohol advertising within school precincts. Participants suggested a range of strategies to manage outdoor advertising of unhealthy food and beverages, including banning these advertisements on public transport.

Translational Outcomes: This study drew on children’s voices to create new knowledge and translation opportunities regarding the outdoor marketing of unhealthy food near schools. The study findings have informed advocacy campaigns calling on the Western Australian government to restrict all junk food and alcohol advertising on government property.

Future Actions: These findings have the potential to impact State and local government policies affecting children’s exposure to unhealthy outdoor advertising, serving as a crucial strategy in the fight against childhood obesity and reduced alcohol intake in children.

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

Estimates of multimorbidity (having 2 or more selected long-term health conditions) typically differ due to condition inclusions and cohort criteria. Previous Australian Institute of Health and Welfare (AIHW) reporting of multimorbidity has focused on 10 chronic conditions, common among older Australians.

This study used self-reported Australian Bureau of Statistics (ABS) 2022 National Health Survey (NHS) data to investigate and report on multimorbidity by demographic and geographic variables. The report builds on previous multimorbidity reporting by expanding the range of chronic conditions to include conditions commonly diagnosed at younger ages.

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]

Estimates are based on analysis of 72 long-term health conditions self-reported to the NHS, to provide a more robust estimate of multimorbidity across all ages. Prevalence estimates of multimorbidity were analysed for the 2022 reference period.
The prevalence of multimorbidity differs by age and sex. In 2022, the estimated prevalence of multimorbidity was:
• higher among females compared with males (38%, and 37%, respectively), affecting 9.7 million Australians (38%)
• higher among people aged 85 and over (79%) compared with those aged 0–14 (11%).

Routine monitoring of multimorbidity overtime is important to ensure disease prevention activities target priority populations.

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

This research will inform the Department of Health and Aged Care review into the National Strategic Framework for Chronic Conditions. Whilst the framework has previously focused on disease-specific initiatives, findings from this analysis will support holistic management of multimorbidity in Australia.

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

Broadening the scope of conditions included in multimorbidity reporting to encompass Australians of all ages will increase demographic and condition coverage and will serve as a foundation for monitoring the prevalence of multimorbidity and disease trajectory across different life stages. Utilising the multi-morbid cohort identified in this study will enable the use of linked data to investigate the variation in treatment pathways and health service use across population groups.

Context: Less than 20 per cent of evidence-based chronic disease prevention interventions are sustained beyond the withdrawal of initial support, leading to a waste of financial and resource investment in initial intervention delivery, and loss of community trust in program benefit. If we are to realise the long-term public health benefits of school physical activity interventions, ensuring their sustainment is essential. However, the continued delivery of such interventions post withdrawal of active support is a considerable challenge. To ensure intervention sustainment, we must gain an understanding of the factors influencing their ongoing delivery to develop strategies that address priority barriers. It is also crucial to ensure these strategies are theoretically-informed based on available evidence, and co-designed, with input obtained from a range of stakeholders familiar with the target setting and program development and delivery to increase the chance of successful sustainment.

Aim, methods and analysis/research findings: In consultation with content experts in implementation science, and health and education policy makers and practitioners across four Local Health Districts in New South Wales, we co-designed a multi-strategy intervention to sustain schools’ delivery of classroom physical activity breaks, using the following steps:
1. Identification of sustainment determinants via: i) systematic reviews; ii) surveys with 240 classroom teachers; and iii) interviews with school staff.
2. Identification of potential sustainment strategies: barriers were organised according to the Integrated Sustainability Framework. Potential sustainment strategies were identified through surveys with 200 teachers. Theoretical mapping was used to link possible strategies to key barriers.
3. Strategies were reviewed and refined by key stakeholders and partners to ensure their feasibility and acceptability. Final strategies were described according to a sustainment-explicit glossary.
4. Strategy delivery was operationalised using existing implementation planning tools.

Results/outcomes: Key barriers to program sustainment were lack of organisational leadership and support, organisational readiness and resources, staff turnover, perceived policy alignment and workplace socio-cultural factors. Strategies perceived most useful by teachers to support sustainment were the provision of physical activity equipment packs (85%), a handover package to upskill new staff (78%), and delivery of professional learning modules (78%). Following theoretical mapping, a multi-component intervention was developed, including: (i) centralized support; (ii) reminders; (iii) principal mandates; (iv) sharing local knowledge; (v) building coalitions to share resources; (vi) distributing educational materials; and (vii) involving end-users.

Future actions: This will be one of the first studies to test the effectiveness of a co-designed multi-component sustainability intervention to support sustainment of a school physical activity program, creating seminal evidence for policymakers and practitioners to sustain the delivery of school preventive health programs.

Context and aim:
Food environments significantly influence dietary-related health, but currently encourage intake of energy-dense, nutrient-poor foods and beverages. With dining out becoming more common, ensuring food service environments support good nutrition is a public health priority. In Australia, almost all children’s menu items at cafes/restaurants are of poor nutritional quality. This study aimed to investigate perceptions and attitudes of parents/carers and food business owners towards children’s menus to identify acceptable interventions.

Methods and research findings:
Parent/carers (n=514; mean age: 34y+/-10; 70% female) of children (2-12y) were surveyed online, and food business owners (n=15) were interviewed in Perth, Western Australia (WA). Descriptive statistics of survey items were generated, and interviews were thematically analysed. Three quarters (n=389, 76%) of participants wanted healthy items on children’s menus at cafes and restaurants. Three quarters (n=380, 74%) were supportive of a Healthy Kids’ Menu Venue Accreditation Program, an intervention adopted in other Australian states. Almost half (n=231, 45%) indicated that accreditation would increase their likelihood of dining at a food outlet. Business owners generally indicated support for an accreditation program, noting its likely appeal to diners, but some raised concerns regarding feasibility and consumer demand for healthy items.

Translational outcomes:
This study provided valuable insights into consumer and stakeholder perceptions of children’s meals in food service outlets. The clear demand for an improvement in the nutritional quality of children’s meals offered in cafes and restaurants provides justification for intervention. Food business owners’ perceptions of the barriers and enablers to providing healthy children’s meals will inform intervention strategies.

Future actions:
In WA, developing a Healthy Kids’ Menu Venue Accreditation Program is recommended. Although similar programs in other states have seen low sales of healthy items, this study suggests the need for a comprehensive feasibility assessment and implementation support. Strategies to boost the sale of healthy items should also be developed and evaluated.