PROBLEM
Obesity causes 13 types of cancer and more than 5,300 new cancer cases each year in Australia. Obesity prevention is a long-standing policy priority for Cancer Council. With obesity rates continuing to increase among Australian adults, and new research highlighting increases in obesity-related cancers among younger cohorts, the time to broaden Cancer Council’s policy focus is now.

WHAT YOU DID
In July 2024, Cancer Council, PHAA and Western Syndey University convened an obesity roundtable to work towards a comprehensive and coordinated advocacy approach on obesity prevention, treatment and management. The roundtable included stakeholders with lived experience, from public health, clinical practice, research and government to discuss coordinated action on obesity and identify priorities for advocacy and research.

RESULTS
There was broad agreement on the need for urgent comprehensive action on obesity prevention, treatment and management, and weight stigma; and support for coordinated advocacy. Whilst the State of Diabetes Mellitus in Australia 2024 report provided a glimpse of opportunity, given the impending federal election, our preferred first step of a Ministerial Roundtable to kick-start action was unlikely. Cancer Council’s obesity policy priorities were updated to add obesity treatment and management and weight stigma to prevention. We have commenced working on our advocacy plan to bring attention to the need to comprehensively address obesity and will take obesity as a key priority into the 2025 federal election and the new parliament.

LESSONS
There was some initial apprehension that including treatment and management in advocacy could jeopardise action on obesity prevention. Despite political will and strong recommendations in the National Obesity Strategy and the State of Diabetes Mellitus in Australia 2024, governments are grappling with what to prioritise. Planning to take advantage of opportunities as they arise, and preparing to launch coordinated activity when the time is right is essential to success.

Background:
Alcohol is an established and preventable carcinogen that causes at least seven types of cancer. The impact of alcohol use on the burden of cancer varies across populations and can change over time. We calculated contemporary estimates of relative risk, absolute risk, and population attributable fractions (PAFs) for cancers caused by alcohol use in Australia.

Methods:
Cox proportional hazards regressions were used to calculate hazard ratios (HR) and 95% confidence intervals (CI) for cancer incidence in relation to self-reported alcohol use (drinks/week) among 225,805 participants aged ≥45 years (2005-2009) in the New South Wales (NSW) 45 and Up Study, an Australian prospective cohort study (baseline n=267,357). Cancer cases and deaths were ascertained through record linkage to the NSW Cancer Registry and the NSW Registry of Births Deaths & Marriages to 2019. Participants with a cancer diagnosis prior to baseline were excluded. Cumulative absolute risks and PAFs for alcohol-related cancers were estimated for Australia in 2023, using the prevalence of alcohol use reported in the 2011-12 Australian Health Survey.

Results:
Over a median 11.4 years, 34,860 cancer cases were captured to 2019. Every additional seven drinks/week increased risk of colorectal cancer by 11% (HR=1.11; 95%CI=1.07-1.15), breast cancer by 12% (HR=1.12; 95%CI=1.06-1.19), upper aerodigestive tract cancer by 18% (HR=1.18; 95%CI=1.12-1.25), liver cancer by 31% (HR=1.31; 95%CI=1.19-1.44), and alcohol-related cancers combined by 13% (HR=1.13; 95%CI=1.10-1.16). By age 85 years, both men and women who consumed >10 drinks/week were estimated to have 4.9% higher cumulative absolute risk of an alcohol-related cancer compared to those consuming 0 to <1 drink/week. An estimated 6,951 cancer cases (4.2% of all cancers) were attributable to alcohol in 2023, or 7,615 cases (4.6%) accounting for cancers attributable to former drinking.

Conclusions:
The proportion of cancers attributable to alcohol use in Australia is higher than previously estimated.

Footnote:
We thank the Centre for Health Record Linkage (CHeReL, www.cherel.org.au) for the provision of linked data. We acknowledge the Sax Institute’s Secure Unified Research Environment (SURE) for the provision of secure data access. Ethics approval for this analysis was granted by the NSW Population and Health Services Research Ethics Committee (2014/08/551).

Problem:
Sexually active young people under 30 years of age are a priority population in the New South Wales Sexually Transmissible Infections (STIs) Strategy 2022 – 2026, while higher education institutions are identified as a priority setting for intervention. Caddyshack Project is a sexual health program promoting a positive approach to sex and sexuality for young people. University of Wollongong (UOW) third-year student placements are an opportunity for students in the target audience to gain experience in applying the theory and skills they learned in a professional workplace.

What you did:
Since 2016, Caddyshack Project has hosted third-year students from UOW’s Bachelor of Public Health and Bachelor of Communication and Media. Health Promotion and Graphic Design Placement projects varied from; young people’s primary care and access to condoms, Arabic community sexual health, international student sexual and reproductive health, Aboriginal sexual health training, and podcasting as digital sexual health education. STI preventative projects have used settings and community approaches to co-design.

Results:
Over 50 students have been engaged in Caddyshack placements and in doing so, had the opportunity to learn more about sexual and reproductive health topics. While students explore, problem solve and design projects within the placement, they also expand their own knowledge which can influence their sexual health literacy, behaviours, protective factors and that of their peers. Increasing knowledge and confidence of sexual health topics is key in preventing STIs, unplanned pregnancy and improving sexual experiences. Placements with Caddyshack Project have also guided student career choices with at least five students securing ongoing work in the sexual health sector.

Lessons:
Accepting student placements is mutually beneficial for the professional workplace and for the students. Students add value to program development, bringing the voice and perspective of young people. Placements in the sexual health promotion field act as effective preventative education for students, influencing their own knowledge, choices and sexual lives.

Disclosure of Interest Statement:
None

Introduction:
Sexually active young people under 30 years of age are a priority population in the New South Wales Sexually Transmissible Infection Strategy 2022 – 2026, while higher education institutions have been identified as a priority setting for sexual health intervention. Existing sexual health resources available for students are limited, lack innovative design, culturally responsive visual aesthetics, and consistent sexual and reproductive health messaging. This project aims to develop and evaluate a comprehensive sexual health and relationships resource that links to trusted online sources, The Kit.

Methods:
We explored student’s sexual health priorities through qualitative interviews with 12 male and 16 female international students aged between 18 and 49 years. Based on these findings, initial design and content evaluation was conducted on The Kit through three focus group discussions with international students. The Kit’s use and acceptability was then examined through an online survey where design aesthetics, execution, and information elements were evaluated. The survey was completed by 134 domestic and international university students (87 female, 45 male and 2 non-binary) aged between 18 and 33 years.

Results:
Students interviewed noted that cultural norms about sex inhibited their ability to access information and they had concerns about their relationship behaviours within the Australian cultural context. Some participants noted challenges with accessing trustworthy information and care and were enthusiastic about increasing access to reliable information and appropriate services. The final evaluation found that overall, most students were very positive about The Kit and focused on it being attention grabbing and aesthetically appealing, while also being informative and useful for young people.

Conclusion:
This evaluation informed ongoing refinements and wider distribution of The Kit with robust governance, funding and sustainability strategies implemented in a statewide scale-up. The settings-based, co-design model ensures that The Kit’s evolution aligns with the needs and preferences of students at higher education institutions.

Disclosure of Interest Statement:
None

Problem
To support the Victorian Government’s climate change strategies, the Victorian Climate Change and Local Government Acts require all councils to consider climate change adaptation and mitigation in their Municipal Public Health and Wellbeing Plans (MPHWP). Shade and green spaces provide multiple climate and health co-benefits including heat reduction, which supports continued physical activity, and UV protection, which supports reduced UV related harms.

However reduced UV is not currently mentioned as a co-benefit. Skin cancer is one of the most common and costly cancers and also the most preventable. We need to add UV protection as a co-benefit of shade and influence UV protective shade considerations in council’s climate change plans.

What you did
SunSmart conducted an audit of local government MPHWPs and broader council plans to determine current local priorities and explore how UV protection can be integrated into future plans and shade planning considerations. This involved searching for explicit and implied mentions of key terms related to SunSmart, UV and shade.

Results
SunSmart, skin cancer, sun protection and UV, and variations of these terms, are rarely mentioned across council plans and strategies with the exception of shade (84%) which has increased over the years. Additionally environmental themed terms have continued to dominate with most current council plans including trees (96%), public open space (97%) and climate change (99%) however these were mainly related to heat mitigation.

Lessons
Unfortunately research and action on urban greening for resilient, sustainable and healthy cities has lacked engagement with UV exposure. Shading interventions are rarely optimised for UV protection with some potentially increasing UV exposure. SunSmart will be providing tailored, evidence-informed advice to local government working with key influencers and community to support UV reduction being included a co-benefit of shade and urban greening, and ensure shade planning considerations provide effective UV protection.

Introduction: There is an urgent need for effective interventions to address e-cigarette use among adolescents, complementing Australia’s recent control measures. Peer-led, school-based interventions have shown promise in shaping social norms around tobacco use. This abstract describes the study protocol for the Breathe Easy All Together (BEAT) program, the first school-based peer-led intervention to prevent adolescent e-cigarette use in Australia. The study will evaluate the process and impact of this intervention using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework.

Methods: A pre-post test design using the RE- AIM framework will assess program impact among students in 12 high schools. Year 10 students (14–16 years) will be trained as peer leaders to deliver two 60-minute lessons to Year 7 students (11–13 years) during health education classes. Students will complete online self-report surveys before and after the program. The primary outcome measure is past 30-day e-cigarette use, with secondary outcomes including tobacco use behaviours, e-cigarette knowledge, refusal skills, and intentions to use e-cigarettes. Semi-structured interviews with school staff will assess program acceptability and factors influencing program implementation. Based on prior literature and meaningful levels of significance, the study will be powered to detect an effect size between 0.230-0.281 in Year 10 students and 0.117-0.281 in Year 7 students. Quantitative data will be analysed using Wilcoxon signed-rank tests, while qualitative data will be evaluated using Framework Analysis based on RE-AIM constructs. Qualitative feedback from school staff will provide insights into program’s feasibility and key factors that may influence broader implementation.

Results: N/A

Conclusion: The BEAT program introduces a novel peer-led approach to preventing adolescent e-cigarette use. Its potential for protecting students’ health from the risks of e-cigarette use and nicotine addiction will be assessed using a comprehensive evaluation framework. If successful, the program has the potential for broader dissemination and further evaluation.

Introduction: Occupational lung cancer is a preventable disease caused by the inhalation of lung carcinogens in the workplace. Despite increased prevalence in occupational lung cancers, the newly commencing national lung cancer screening program in Australia does not include occupation as criterion for screening. As a national healthcare priority, there is a need for a more strategic approach to research to address the prevention, detection, and management of this condition. Thus, our aim was to collaboratively identify the top research priorities for occupational lung cancer.
Method: The priority setting was conducted over stages and based on a modified James Lind Alliance framework. Stakeholders included people impacted by/at-risk of occupational lung cancers, family members/caregivers, multidisciplinary workplace safety and healthcare professionals, regulators, worker representatives, legal professionals, and researchers. Stage one involved an open-ended questionnaire which asked respondents to provide the most important issues/topics they felt research should address regarding five priority areas: exposure, prevention, screening, diagnosis, and management. Thematic analysis was used to identify key topics within each area. Stage two involved a face-to-face workshop to rank the topics and collaboratively develop targeted research questions to inform future research.
Results: 78 participants completed the questionnaire and 54 attended the face-to-face workshop. Research priorities included exposure: epidemiological studies, high-risk occupations and exposures, cumulative and combined risk factors; prevention: education, barriers and facilitators to effective prevention and control, compliance; screening: understanding who should be screened, screen criteria, screening implementation; diagnosis: attribution, education for health professionals, diagnostic techniques; and management: psychosocial impacts and support, care coordination, and compensation.
Conclusion: Findings provide insights into important research areas that are of greatest importance to key stakeholders which will be fundamental to guiding the future direction of occupational lung cancer research.

Understanding context-specific mental health determinants is necessary to better the health outcomes of stable people living with HIV (PLHIV). This research investigated depression prevalence and the factors linked to depression among stable PLHIV in Cambodia.

The study used baseline data from an 18-month quasi-experimental research by the Khmer HIV/AIDS NGO Alliance. The main aim of the parent investigation was to analyze the viability and effectiveness of a community-based ART delivery (CAD) model in providing ART services nearer to PLHIV. Bivariate and multivariate logistic regressions were conducted to find the sociodemographic, health, and psychosocial factors affecting mental health.

Overall, 19.5% of the 4089 participants had depression. Factors with increased adjusted odds of depression included being aged 30-39 years (AOR 1.73, 95% CI [1.10, 2.74]), 40-49 years (AOR 1.77, 95% CI [1.12, 2.81]) and 50-59 years (AOR 1.73, 95% CI [1.07, 2.80]), being female (AOR 1.71, 95% CI [1.37, 2.14]), having hypertension (AOR 1.57, 95% CI [1.22, 2.02]), experiencing more stigma and discrimination (AOR 2.23, 95% CI [1.85, 2.69]), having greater internal stigma (AOR 2.97, 95% CI [2.46, 3.58]) and fear of stigma and discrimination (AOR 1.69, 95% CI [1.40, 2.03]), being non-ART adherent (AOR 1.52, 95% CI [1.21, 1.91], and possessing poorer self-efficacies in physical activities (AOR 1.29, 95% CI [1.02, 1.62]) and stress management (AOR 2.44, 95% CI [1.78, 3.35]). Decreased adjusted odds of depression were observed among participants married and living together (AOR 0.57, 95% CI [0.37, 0.88]), employed as farmers or fishermen (AOR 0.75, 95% CI [0.57, 0.97]), earning US$1000-US$1999 monthly (AOR 0.81, 95% CI [0.66, 0.10]), and receiving higher social support (AOR 0.30, 95% CI [0.14, 0.68]).

Social isolation, perceptions of stigma, and discrimination, which fall under psychosocial factors, were significantly associated with depression; therefore, appropriate psychological treatment is likely to be needed to reduce the prevalence of depression.

Background: The World Health Organization has targeted the Hepatitis C virus (HCV) for elimination as a public health threat by 2030. Equitable access to HCV testing and treatment services is important in achieving this goal. Migrants often face barriers to accessing health services. Understanding HCV prevalence among migrants can support planning for elimination. This systematic review aimed to estimate HCV prevalence among migrants residing in high-income countries with low HCV prevalence.
Methods: Scopus, PubMed, PsycINFO, and Cochrane Library were searched for peer-reviewed articles published in English between 2015 and 2024. The studies’ quality was assessed using The Joanna Briggs Institute (JBI) Critical Appraisal Tools. HCV prevalence was calculated by dividing the pooled number of HCV positive cases by the pooled sample size.
Results: Thirty-seven studies were included in this review. The pooled HCV antibody (anti-HCV) and RNA prevalence was 1.5% and 0.7% among 93630 and 18507 migrants, respectively. Among studies that reported sex and age specific prevalence, the prevalence of anti-HCV was higher among males (1.6%) than females (0.4%) and among those aged 18 years and older (0.9%) than those younger than 18 years old (0.7%). Among those aged 18 years and older HCV-RNA prevalence was 0.4%. The prevalence from studies specifically on refugees and asylum seekers was higher than other studies (HCV antibody: 1.6% versus 1%, HCV-RNA: 1% versus 0.6%).
Conclusion: The total prevalence of HCV among migrants is comparable with that among the general population of the destination countries. However, given the barriers migrants especially refugees and asylum seekers face in accessing health services their access to HCV testing and treatment should be facilitated.

Introduction: Nicotine pouches are growing rapidly in popularity. Created by global tobacco companies, these products are marketed as being “cleaner”, “more discreet”, and “more convenient” than tobacco cigarettes and e-cigarettes. Despite the likely impact of nicotine pouch promotion on risk perceptions and attitudes towards the products, relatively few studies have explored these perceptions. Accordingly, we explored attitudes towards nicotine pouches as well as risk perceptions in a sample of Australian adolescents and adults.

Methods: We surveyed 1598 Australians aged 16 to 39 years, of whom 1230 reported being aware of nicotine pouches. Most had never used nicotine pouches. We asked them to report on their perceptions of the absolute and relative risks of nicotine pouch use. We also assessed their attitudes towards use.

Results: Respondents typically believed that nicotine pouches were less harmful or “about the same” as tobacco cigarettes, smokeless tobacco products, and e-cigarettes. When comparing to nicotine replacement therapies, respondents believed that nicotine pouches were equivalent in harm or reported being unsure. Most respondents agreed that using nicotine pouches is harmful to health. Attitudes towards nicotine pouch use were generally unfavourable. Perceptions and attitudes were more favourable among men, those who reported having a greater number of family members and close friends who use the products, those who were currently the products, and those who use other tobacco and nicotine products.

Conclusion: In the absence of independent studies detailing the harms of nicotine pouches, it is concerning that perceptions of these products are being formed. It is especially concerning that two in five respondents believe these products to be equivalent in harm and addictiveness compared to nicotine replacement therapies. Efforts are needed to ensure people are appropriately informed about the considerable unknowns relating to nicotine pouches.

Delivering Sexual Health and Blood Borne Virus prevention education to Aboriginal Men

Naomi Viret 1, Jennifer Farinella 1

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

Problem:
For a multitude of reasons, Aboriginal and Torres Strait Islander people experience a greater burden of disease related to Blood-Borne Viruses (BBV) and Sexually Transmitted Infections (STI).

The NSW STI Strategy 2022-2026 highlights Aboriginal people as a priority population and Aboriginal Community Controlled Health Services as a priority setting.


What we did:
Oolong House is an Aboriginal community-owned and managed residential facility on Yuin Country in Nowra, regional NSW, providing culturally appropriate drug and alcohol prevention, education, treatment and rehabilitation for Aboriginal and non-Aboriginal men.

For over 15 years, the Illawarra Shoalhaven Local Health District HIV and Related Programs (HARP) team have partnered with Oolong House to deliver quarterly STI and BBV education sessions to consumers.

The sessions meet both the identified priority population and priority setting criteria and aims to educate the residents around STI and BBV prevention and treatment, encourages STI testing (urine screen for chlamydia and gonorrhoea) and provides further information and resources for follow up post session.

Results:
From 2020-2024 (inclusive) 153 men and 12 staff took part in the sessions with 15 chlamydia and gonorrhoea screens being completed. Men who often experienced stigma and discrimination were able to safely explore information around STIs and BBVs, with one participant stating “This information is so important, I cannot wait to go home and share this knowledge with my son. Thank you for the opportunity”.

Lessons:
The sessions demonstrate the intersectionality of STI and BBV prevention, education and screening with Alcohol and Other Drug services and how priority population groups can be reached in priority settings.
The sessions are delivered by a non-Indigenous female which has not been an impediment to the session. This highlights that commitment and trust when working in culturally safe spaces on sensitive topics is crucial to success.

Disclosure of interest statement:
None

Permission to Publish:
The CEO of Oolong House, Mr Stephen Ardler, has granted permission for data to be published.