Introduction: Adolescence (10-19-years) is a pivotal life stage, presenting both risks and opportunities for optimal nutrition. The World Health Organization and UNICEF are advocating for adolescents to play a central role in transforming food environments– key to the Sustainable Development Goals (SDGs). It is unknown to what extent adolescents have participated in research to improve food environments. We aimed to investigate the extent, impact and processes of adolescent participation in food environment research.

Methods: Scoping review of six databases captured studies published before 6-May-2024. Included studies addressed how adolescents participated in improving food environments, mapped through the Healthy Food Environment Policy Index: i) food composition/nutritional quality, ii) food labelling, iii) food promotion, iv) food pricing, v) food retail, vi) food trade and investment. Extent was analysed using descriptive statistics. Impact (individual/community-level) and process (barriers/enablers) were qualitatively analysed. Youth advisors informed each stage.

Results: 9648 articles were dual-screened. Eighty-nine articles (70 unique studies with 20,697 participants across 31 countries) were identified. Most studies were qualitative (60%) and conducted in high-income countries (81%). Food retail (56%) and provision (54%) were most reported, focusing on improving availability of healthy food in their local community and school. Most studies were adolescent-led (41%), however only 16% of studies included adolescents as co-researchers. Individual-level impact included improved professional skills and wellbeing. Community-level impact included presenting policy ideas to politicians and implemented policy (e.g. healthy school menus). Barriers include adolescents not being taken seriously. Trusted adult facilitators enabled a supportive environment. Using engaging participatory methods helped reduce power imbalances.

Conclusion: There is substantial evidence of adolescents participating at various research levels to transform food environments. However, evidence was limited by inconsistent socio-demographic reporting and a lack of empirical evidence of impact. Ensuring representation from culturally diverse population groups and lower-income countries is necessary to achieving the SDGs.

Objectives: We compared the prevalence of 10 long-term health conditions between the Australian-born and Eastern Mediterranean Region (EMRO) born Australian population.
Method: We used 2021 Australia census data. Age and sex-specific prevalences, Age-Standardised Prevalence (ASP) and Age-Standardised Prevalence Ratio (ASPR) were calculated for the conditions. For ASPR for country of birth Australian-born and for years arrived in Australia <10 years ago group were reference groups. For EMRO-born with the conditions, we reported their English proficiency, education, income and year of arrival.
Results: Australian-born and EMRO-born had similar ASP of heart disease (men=3.2%, women=1.8%) and stroke (men=0.7%, women=0.5%). There was a small difference in ASPs for arthritis (ASPR:0.9) and kidney disease (ASPR:1.1) among women and dementia (ASPR:1.1) among men. EMRO-born had lower ASP for asthma (ASPR women and men:0.4), cancer (ASPR women:0.6, men:0.5), and lung (ASPR women:0.4, men:0.5) and mental health conditions (ASPR women and men:0.4) and higher ASP for diabetes (ASPR:1.7). Among men, EMRO-born had lower ASP for arthritis (ASPR:0.6) and higher ASP for kidney disease (ASPR:1.4). Among women, EMRO-born had higher ASP for dementia (ASPR:1.4). EMRO-born who arrived 10≤ years ago compared with those arrived <10 years ago had higher ASP of arthritis, asthma, cancer, and lung and mental health conditions, and lower ASP of heart disease, stroke, kidney disease and dementia. The ASP for diabetes was the same in both groups. Among EMRO-born with health conditions, a range of 24.1% (people with Asthma) to 53.5% (people with Dementia) had low English proficiency, 9.4% (people with Cancer) to 23.8% (people with Dementia) did not go to school and 51.7% (people with Asthma) to 89% (people with Dementia) had a weekly income of <$500.
Conclusion: Primary, secondary and tertiary prevention strategies for chronic conditions based on the characteristics and health needs of specific migrant groups are needed to promote health equity.

Problem:
Although smoking prevalence is declining across Australia, significant health inequities persist among priority populations. For example, daily smoking prevalence is more than two times higher in remote areas compared to major cities. Vaping is also common among some priority populations. Namely, people with mental health conditions are twice as likely to vape compared to those without a mental illness (12.3% vs 5.8%).

Intervention:
Since 2017, Quitline Queensland has provided Intensive Quite Support (IQS) programs for select priority populations. The program combines telephone counselling with 12 weeks of combination nicotine replacement therapy (NRT). Three key priority groups eligible for IQS are community mental health clients, people living in regional, rural, and remote areas (RRR), and Aboriginal and Torres Strait Islander Queenslanders.

Delivery:
Quitline provides accessible, client-centred, and culturally sensitive counselling and support. The service is delivered by a team of counsellors who undergo extensive training to address the unique quitting barriers faced by priority populations, with supervision and support from senior clinicians. The service has a dedicated team of Aboriginal and Torres Strait Islander counsellors available, both men and women.

Results:
In the 2023-24 FY, Quitline registered 7,209 priority group clients, 49% of whom went on to participate in an IQS program. Most (74%) of these clients were referred by third parties and 11% were seeking quit support for exclusive vaping. RRR clients constituted the majority of IQS participants (62%). Clients who complete a Quitline program (with NRT) are six times more likely to quit smoking compared to individuals who attempt to quit unassisted. Vaping cessation data will be available in 2025 as a new evaluation framework was implemented in September 2024.

Lessons:
Leveraging existing priority population care settings drives referrals to Quitline. Future program development should strengthen referral partnerships and adapt support services based on population-specific needs and barriers.

Alcohol is one of the few modifiable risk factors for breast cancer, the most prevalent cancer among Australian women aged 45-64. Prevention initiatives centralise alcohol reduction, yet opportunities for reduction are inequitably distributed: so breast cancer prevention risks being inequitable. We present politics and policies for ‘hope’ that can make breast cancer prevention equitable.

During 149 qualitative interviews with 86 women across three studies, we asked women about the place of alcohol in daily and community life as well as perceived opportunities for reduction. Purposive sampling by social class accounted for diversity in social positioning (per economic wealth/material, cultural and social resource/s). We developed a data-driven critique of the political economy of hope, by analysing the opportunities for and implications for preventive activity experienced in the lives of women per social class. Our ‘politics for hope’ was informed by multi-disciplinary theories (health promotion, sociology, community development, and human flourishing), and then applied back to the data to understand how alcohol reduction opportunities are shaped by social class and what kind of policy changes are needed to enable equity.

Women in positions of affluence described confidence to reduce alcohol (if identified as a priority), and correlated determination to reduce with personal virtue – they did not need ‘hope’. Women in middle class positions conveyed social expectations to drink in ways which upheld gendered norms; requiring they conjure hope when reductions were challenging. Women who were resource-poor voiced hopelessness about alcohol reduction because intersecting precarities in their lives tightened reliance on drinking.

Women oppressed by social, emotional, moral and wealth economies are less likely to access – so will not benefit – from current breast cancer prevention initiatives. A politics of hope can inform prevention agendas and reshape systems-level conditions where hope, and therefore alcohol reduction, are both feasible and equitable.

Problem: At Territory and National levels, the inequity experienced by LGBTIQA+ communities, and Aboriginal and Torres Strait Islander communities, with accessing health services is well-recognised and documented. A program-level inclusivity and safety scoping review of the Community Care Program (CCP) highlighted areas where improvement was required to address barriers experienced by these communities in accessing preventive community healthcare. However, there was no plan at an organisation level to address these.

What you did: In 2022, CCP started action at a program level to address the inequitable access to our services identified from the scoping review. Two CCP inclusion action plans were developed in consultation and collaboration with communities’ stakeholders: one for LGBTIQA+ communities and one for Aboriginal and Torres Strait Islander communities. Both are designed to be living documents, updated every year in consultation with stakeholders to ensure the CCP remains accountable and committed to ongoing improvement in equity and agility of services.

Results: Strong relationships have been developed with Aboriginal and Torres Strait Islander, and LGBTQIA+ decision makers, organisations, professionals and consumers. Actions such as additional staff training, celebration of awareness days and attendance at community events have been achieved thus far. Traction and recognition of this work is evidenced by the team being awarded the Allied Health Excellence in Provision of Services to Improve Aboriginal and Torres Strait Islander Health and Wellbeing, and Allied Health Professional of the Year 2024 at the ACT 2024 Allied Health Excellence Awards.

Lessons: Don’t underestimate the power of creating ripples to improve healthcare services from the ground up. Consumer-focused relationships are powerful. You do not need to have lived experience or be a senior decision maker to improve the equity in preventive healthcare if you foster relationships, listen to and embed lived experience knowledge and are brave enough to risk making mistakes.

Note: This is not research focusing on specific Aboriginal and Torres Strait Islander people. It is a service improvement project highlighting the role that people, who do not identify with vulnerable groups, have important roles in improving the equity of healthcare as allies.

Tongan parents’ perspectives on food purchasing decision influences: a qualitative study

Introduction
An unhealthy diet is the leading preventable risk factor for the development of diet-related non-communicable diseases. Food purchasing decisions in retail settings are influenced by a range of commercial, environmental, social, economic and cultural factors and can be context specific. An understanding of the factors influencing food purchasing decisions can support the development and prioritisation of policies, but little is known about this topic in the Pacific. Our study aimed to explore the perceived influences on food purchasing decisions of Tongan parents.

Method
This qualitative study involved semi-structured interviews conducted in 2023 with 21 Tongan parents aged 27 to 51 years in Tongatapu, Tonga. Parents were asked questions relating to the factors that determine where they do their grocery shopping and what they perceived to influence their food purchasing decisions. Interview transcripts were analysed using reflexive thematic analysis.

Results
We found that some of the key factors that parents perceived as influences on how they purchase foods from retail outlets included individual level factors, such as food knowledge and food preparation and environmental factors, such as food availability and food close to where people live. Food price and affordability were the most common factors that parents reported as the largest influence on their food purchasing decision. Our findings also demonstrated the important role of social and cultural factors, such as family, friends, community and culture in influencing people’s food purchasing decisions.

Conclusions
With the prevalence of diet-related non-communicable diseases extremely high in Tonga, it is important that health promotion efforts and policies should recognize the multi-dimensional nature of the factors influencing Tongan parents’ food purchasing decisions. A multi-faceted approach should be a priority for both the government and health promotion practitioners.

Integrated Sexual Health and Blood Borne Virus Prevention Education in Mental Health  

Naomi Viret 1, Jennifer Farinella 1 

 

1 Illawarra Shoalhaven Local Health District (ISLHD), HIV and Related Programs (HARP) team 

Problem:

The 4th National Sexually Transmissible Infections (STI) Strategy 2018-2022 highlighted mental health services as a priority setting for addressing STI prevention, testing and treatment. A health promotion initiative undertaken by the Illawarra Shoalhaven Local Health District through the HIV and Related Programs (HARP) team in collaboration with the Shoalhaven Mental Health Service reflects a proactive approach to addressing STI and blood-borne viruses (BBV) prevention in the context of mental health. 

What we did:

Once every six weeks, a health promotion officer attends the Sub-Acute Mental Health Unit in Nowra, a regional town in New South Wales. During a 60-minute session, consumers are engaged in an educational session on STI and BBV including transmission, prevention, symptoms, testing and treatment. The engagement of both mental health staff and consumers in STI and BBV education sessions is crucial for building awareness and promoting a holistic approach to sexual health.  

Results: 

From 2020-2024 (inclusive) 199 consumers and multiple unit staff took part in education sessions. The completion of chlamydia and gonorrhoea urine screens, along with referrals for further support of trans and gender diverse consumers, demonstrates the practical aspect of the program. The acknowledgment that consumers feel safe in the space, learn a lot from the sessions and find them interesting reflects the program's success. Regular feedback from consumers and staff contribute to the ongoing improvement and tailoring of the educational content to meet the needs of consumers.  

Lessons:

By combining capacity building, education sessions, and practical support, the program contributes to the overall well-being of consumers by addressing STIs and BBVs. Partnering with an inpatient mental health program demonstrates a strategic approach to reaching priority populations in priority settings. 

  

Disclosure of interest statement: 

None 

The impact of place on health and wellbeing outcomes is well documented, though complex. Part of this complexity involves our ability to develop, access, or leverage social capital, which goes a great way to improve various outcomes, but is highly dependent on where we live. This holds true across the lifespan, especially for young people. For example, mental health disorders account for 49% of disease burden and injury for people aged 15-24 but this number increases in areas bereft of material and social capitals. The extent to which place influences the accumulation and mobilisation of social capital is particularly pertinent for young people who engage with place as geographic, digital, stable, and ephemeral, at a transitional and transformational point in time.

To investigate the impact of place in young peoples’ social networks, a mixed methods study incorporating ego social network and interpretative phenomenological approaches has been designed. However, the complexity of the lives of young people simultaneously operating in multiple places warranted piloting to test assumptions, tailor methods, and ensure both data collection and analysis reflected this complexity. The pilot study of young people (aged 18-25) in Melbourne, Australia, involves semi structured interviews mapping individual networks, as well as examining participants’ lived experiences of navigating and utilising their available social capital.

We present preliminary insights from the pilot study. We pay particular attention to the methodological challenges in designing research grappling with the multiplicity of places young people traverse in their daily lives.

Prevention efforts targeting ‘place’ to improve health must first examine the role place has in the lives of populations. Better understanding the ways young adults’ social networks and supports are influenced by place is the first step to a nuanced understanding upon which prevention efforts can be based.

Country SA PHN funded Cancer Council SA to conduct a six-month project in the Riverland region of SA in 2024 with culturally and linguistically diverse (CALD) communities. The project aimed to improve equitable access to cancer screening information, address unique barriers to participation, and support eligible people to complete their cancer screening tests. Key objectives included providing translated and culturally appropriate information, partnering with local organisations and businesses, enhancing connections between migrants and healthcare services, and collaborating with local GP practices to focus on screening.
Results:
• 235 CALD community members were engaged in information sessions.
• 33 allied health staff from pharmacies and medical clinics and 4 staff from Cancer Council SA received migrant cross-cultural training.
• A suite of translated video and written resources were developed and distributed.
• The project was complemented with a media and communications strategy.
• The intent to screen and knowledge of screening programs was increased for almost all information session participants.
• Partnerships were built with local community organisations, community groups, places of worship, businesses and local government to engage the community.
•Two GP practices were recruited to run data audits and patient recalls for cervical screening. Practice software was linked to the National Cancer Screening Register to assist with identifying screening eligibility.
Screening outcomes include:
• Increasing the participation of CALD women in breast screening by 18 % while the mobile screening unit was stationed in Berri.
• Two GP practices to identified 834 due or overdue patients for cervical screening, resulting in at least 81 people so far completing the test and many choosing self-collection. More patients are being booked in daily.
• Strategies such as offering bulk billing screening appointments, setting aside appointments with a dedicated GP, and phoning patients to invite them to screen have been successful in engaging patients in cervical screening.

Multi-sectorial action is urgently required to protect those at-risk across intersecting social, digital and commercial determinants of health. We contribute vital empirical evidence from users of online dating platforms (specifically Tinder given market reach and revenue: $1.91b in 2023). Our study details the negative health and wellbeing impacts that ensue from unregulated commercial capture of the dating landscape.

We interviewed 27 young people (aged 18-30) living in South Australia during 2021; asking if/how/why they use online dating platforms and how it relates to sexual and mental wellbeing. We sampled purposively for socioeconomic diversity (postcodes, education, employment, income), Tinder use (infrequent through to quite frequent) and achieved a reasonable mix of identified genders and sexualities.

Interviewees described online dating as typical social media for people their age. While ‘hook up’ encounters were sometimes desired; so were platonic and romantic relationships. Those experiencing social isolation identified online platforms as important for access to relationships. ‘Warming up’ to others through viewing profiles and ‘bantering’ was seen as useful for reducing anxiety about meeting in-person; while ‘screening out’ people who didn’t seem worthwhile or compatible was also a perceived benefit. Young people expressed that the dominance of online dating made it difficult to cultivate authentic relationships ‘offline’, and that it felt ‘gross’ to reduce people to pictures when they stopped and thought about it. Being able to stop scrolling and swiping was easier for those with better access to social determinants.

Commercial capture of digital dating is profoundly problematic; and will reproduce and intensify current (health) inequalities. Harvesting data for algorithms has innate privacy concerns but also enables inflated product pricing for those assessed as ‘less desirable’. A regulatory framework that curtails commercial entities profiting from vulnerability and addiction is desperately needed to promote equity in sexual, mental and community health.

Problem:

Equitable access to abortion and abortion after-care are fundamental to upholding the reproductive rights of pregnancy-capable people in Victoria. After abortion, isolation is frequently experienced which may have detrimental effects on the person’s mental and emotional wellbeing. For those seeking support, there is a gap in access to pro-choice post-abortion options. Many post-abortion providers hold often anti-abortion values, perpetuating shame and stigma which can harm individuals seeking support. Many people who have experienced abortion(s) do not require clinical counselling, and instead seek peer support and understanding.

What you did:

There is strong evidence that peer support groups are beneficial for improving the mental health and well-being of individuals. The Abortion Project (TAP) has established successful peer support groups in Walyalup/Fremantle and Garramilla/Darwin . The Abortion Project (TAP) and Women’s Health In the North (WHIN) partnered to form a pro-choice local face-to-face fortnightly peer support group for people who have experienced abortion(s) that live, work or study in the northern metropolitan region of Naarm/Melbourne.

Results:

So far, participants and peer facilitators report that the group provides a safe space for people with experiences of abortion to share and explore a breadth of feelings and experiences. Evaluation of the first 6-8 months of the project will be presented, which we anticipate will demonstrate that the pro-choice environment of the group helps work against abortion stigma and shame, resulting in improved mental health and wellbeing and community connections.

Lessons:

Abortion stigma and shame, often perpetuated in national and international political discourse, has a detrimental mental health impact on people who have experienced abortion(s). It is essential that abortion services and advocacy consider a holistic approach that includes before, during and after abortion. Peer support post-abortion groups are uniquely positioned to respond to the shortage of post-abortion supports and improve the mental and emotional wellbeing of people who have experienced abortion(s).