Public Health Research & Practice最新文献

Public spaces influence the health and safety of lesbian, gay, bisexual, trans, queer, intersex, asexual and other sexual and gender-diverse (LGBTQIA+) communities. However, there is minimal research to demonstrate the link between inclusive urban policy and planning and the wellbeing of LGBTQIA+ communities. Consequently, in this perspective, we reflect on our project, which offered foundational work for understanding LGBTQIA+ experiences of public spaces in Australia's three most populous urban centres - Sydney, Melbourne and Brisbane. Our desk-based research approach provides a five-point evaluative framework to assess how local government areas (LGAs) accommodate LGBTQIA+ communities. We then present a recommendations framework for creating more inclusive local areas and public spaces. We propose that 'usualising' queerness in public spaces can lead to increased health and wellbeing for LGBTQIA+ communities.

Objectives and importance of the study: The study investigates and documents how tobacco companies are using the revolving door between government and industry as a tactic to try to influence public health policymaking in Australia. This is the first Australian study to systematically investigate the revolving door tactic in tobacco lobbying and highlights the importance of strengthening integrity and transparency legislation and oversight bodies to eliminate the political influence of tobacco companies in Australia.

Study type: Mixed-methods including non-experimental descriptive and exploratory case studies.

Methods: To build a picture of tobacco lobbying through the revolving door in Australia, data was triangulated from multiple publicly available sources: 1) Australian federal, state and territory government lobbyist registers, 2) the online social networking platform, LinkedIn; and 3) Australian news media reports.

Results: Tobacco companies lobby the Australian government using 'in-house' employees, lobbyists working in firms acting on their behalf, and third-party allies with common interests. Almost half (48%) of internal tobacco company lobbyists had held positions in the Australian government (state, territory and/or federal) before or after working in the tobacco industry. Likewise, 55% of lobbyists acting on behalf of tobacco companies had held government positions before or after working as a lobbyist. In-house tobacco industry lobbyists, as well as those working on behalf of tobacco companies within lobbying firms, were found to have held senior governmental positions, such as a Member of Parliament (MP) or Senator, chief or deputy chief of staff, or senior advisor in a ministerial office, and many had moved into or out of government within 1 year of working for a tobacco company (56%) or as a lobbyist (48%).

Conclusions: Tobacco companies are strategically using the revolving door between the government and the tobacco industry as a key political lobbying mechanism to try to influence public health policy in Australia.

Objective: To pilot surveillance to describe environmental, personal and behavioural risk factors for people presenting to hospital emergency departments (EDs) with heat illness.

Methods: We conducted a retrospective case series and telephone interview study of people presenting to EDs across South Western Sydney, Western Sydney and Nepean Blue Mountains Local Health Districts with heat illness over the 2017/18 and 2018/19 summer periods (1 December to 28 February). We used the Public Health Rapid Emergency Disease Syndromic Surveillance (PHREDSS) 'heat problems' syndrome to identify people with heat illness and medical records to find contact details. We developed a detailed questionnaire instrument to guide the telephone interview.

Results: A total of 129 individuals presented with 'heat problems' (57 in 2017/18 and 72 in 2018/19). The median age was 44 years (range 1-89 years). Most attended hospitals via the NSW Ambulance Service (58%) or private car (40%). Of the total, 53% were classified as triage category 3 (potentially life-threatening), 27% as category 4 (potentially serious) and 16% as category 2 (imminently life-threatening). The main supplementary codes were heat exhaustion (35%), heat syncope (39%), and heat stroke (30%). The majority were discharged from the emergency department after completing treatment (73%), with 21% requiring admission. A total of 38 follow-up interviews were completed (29% response rate). Almost all individuals were exposed to heat outside their home environment: 11 (29%) were engaged in paid work, 5 (13%) in outdoor housework, and 10 (26%) in outdoor recreational activities.

Conclusion: Our pilot surveillance study successfully collected home, local environment and behavioural risk factors on a small cohort presenting with 'heat problems' to EDs in Western Sydney during the summer months. Most were exposed to heat outdoors while engaged in work or recreation outside the home, and were preventable.

Objectives: To describe the impact of universal screening for coronavirus disease 2019 (COVID-19) on passengers on cruise ships docking in Sydney, Australia, during 2022 that experienced a significant outbreak of COVID-19. Type of program or service: Cruise ship disease surveillance Methods: Case series, based on analysis of cruise ship voyages where universal screening of passengers was requested by a NSW health authority and undertaken by the cruise ship.

Results: Of 111 voyages in 2022, three fit the definition for this study. Universal screening during these voyages resulted in the detection of up to 1.8 times the number of existing COVID-19 cases, increasing attack rates of the three voyages from 14% to 24%; 13% to 28%; and 3% to 8% respectively. Case demographics showed an even gender distribution, with a majority 70 years or older. Asymptomatic case percentage ranged from 2% to 54%, with age and gender not associated with symptomatic status. Almost all cases were reported as being fully vaccinated. Genomic testing of cases showed multiple lineages of COVID-19 circulating in all three voyages.

Lessons learnt: Public health authorities, the cruise industry and passengers should be aware that a large number of unidentified cases of COVID-19 may disembark from a cruise ship that has experienced a large outbreak of the virus. These cases can seed the infection into vulnerable communities. Universal screening as part of the response to a significant outbreak will help identify cases and limit the spread of COVID-19.

Objectives and importance of the study: Most older Aboriginal peoples live in urban locations. Many of these people were displaced by the policies and practices that produced the Stolen Generations. As a result, access to 'Country' and cultural landscapes that are minimally impacted by urbanisation can be limited for older Aboriginal peoples, restricting the health and wellbeing benefits these environments promote.

Study type: Qualitative study.

Methods: Our study worked collaboratively with Aboriginal traditional cultural knowledge holders to observe and analyse how participation in a 'cultural camp' on a Yuwaalaraay sacred site in New South Wales (NSW), Australia, impacted wellbeing and connection to place among older Aboriginal people who were survivors or descendants of the Stolen Generations.

Results: Eight participants (three women; five men) attended the cultural camp and took part in the yarning circle. Thematic analysis of a yarning circle uncovered memories of traumatic experiences of institutionalisation, including abuse and loss of Country, community, and culture. Experiences of the cultural camp generated a sense of reconnection, cultural pride, wellbeing and place attachment. The sensory experience of Country emphasised a sense of belonging and healing.

Conclusions: Our findings reflect the importance of sensory-led experiences on Country for older urban Aboriginal peoples and reinforce previous evidence on the 'therapeutic' aspects of culture and natural landscapes minimally impacted by colonisation. Policies and resources supporting grassroots initiatives such as Aboriginal cultural camps are needed to ensure accessibility for older Aboriginal peoples living in urban places.

Objectives: By 2030, 60% of the global population is expected to live in urban areas. Exposure to urban environments during the first 2000 days of life can have positive or negative health outcomes across the life course. Understanding the types of urban exposures that influence health outcomes is needed to guide research priorities for public health and urban planning. This review aims to summarise the published research examining the health outcomes of all urban environmental exposures during the first 2000 days of life, identify the quantity and characteristics of research in this area, methods used, and knowledge gaps.

Methods: We conducted a scoping review using the JBI methodology for scoping reviews. Eight databases were searched for peer-reviewed primary studies. Inclusion criteria were studies that measured maternal, infant and child exposure to everyday urban environment features and conditions in cities/metropolitan areas during the first 2000 days of life and reported offspring health outcomes across the life course, including embryo, fetal/newborn, infant, child, adolescent, and adult outcomes. We used Covidence software for data screening and extraction. Study characteristics and findings were summarised using tables and narrative synthesis.

Results: We reviewed 235 articles, which included studies conducted across 41 countries, the majority in the US (n = 63). A broad range of environmental exposures were studied, spanning seven categories: air pollution; energy-based pollution; atmosphere, chemical and metal exposure; neighbourhood-built and natural environment features; neighbourhood community conditions; and residential living conditions. Air pollution was the most studied exposure type (n = 153 studies). Health outcomes were reported for all life stages except adults, with fetal/newborn outcomes the most studied life stage (n = 137).

Conclusions: We found that most research investigating urban environmental exposures in the first 2000 days and health outcomes across the life course focused on air pollution exposures and fetal/newborn health outcomes, using correlational retrospective cohort designs. Few studies included multiple environmental exposures. There is a clear need for more longitudinal research to determine the health impacts of multiple urban environmental exposures across the life course. This will assist in developing urban design and planning strategies and population health to mitigate health risks across the life course.

Objectives: To trial methods for a future longitudinal study to: a) assess how the redevelopment of a large social housing estate affects the health of tenants; and b) act on health needs identified throughout the redevelopment. Type of program or service: Self-reported health assessment with referral to community-based link worker.

Methods: Participants recruited from the tenant population completed (online or face-to-face) a health questionnaire covering self-reported health status and behaviours, housing conditions, sense of community, and demographics. Those identified as being at moderate/high risk of psychological distress and/or alcohol use disorder were contacted by a community-based link worker, who connected them with health/human services as appropriate.

Results: A total of 24 tenants were recruited for the pilot study against a target sample size of 50. The health questionnaire and referral process worked as expected, with no issues reported.

Lessons learnt: This pilot study successfully trialled methods for: a) assessing tenants' health; and b) referring those identified as being likely to have unmet health service needs to a community-based link worker, leveraging existing collaborations between academics, the local health district and community groups. Fewer tenants than expected, and none aged younger than 35 years, participated in the survey. Furthermore, the substantial number of suspicious/fraudulent responses was not anticipated. Recruitment and data collection approaches must be reviewed to address these issues if this study is to be scaled up. Although only a pilot project, we connected several tenants who had unmet health needs with a health service. While it is impossible to generalise from our small sample, the number of referrals (one-quarter of participants) indicates a potentially large unmet need for health services in the community. It highlights the importance of link workers or other person-centred integrated care interventions in social housing populations.

Objectives: To develop a Climate Change Inequality Health Impact Assessment (CCIHIA) framework for health services; to provide a systematic process for assessing potential unequal health impacts of climate change on vulnerable and marginalised populations and places; to support effective planning to address these impacts; and to develop contextually appropriate local strategies. Type of program: A collaborative interdisciplinary scoping research project involving two universities and two local health districts (LHDs) in New South Wales (NSW) to develop a CCIHIA framework. This work builds upon the health impact assessment (HIA) approach, which systematically assesses proposals' potential health and equity impacts by involving stakeholders in developing responses.

Methods: The project involved four main activities: understanding stakeholder requirements; conceptualising climate change vulnerability; considering the role of health services; and integrating findings into a conceptual framework.

Results: Stakeholders identified key functions that should be addressed across the framing, process and utility of the CCIHIA framework. The resulting conceptual framework outlines contexts and social stratification, the differential impacts of climate change (including factors influencing unequal impacts) and the health system's position, and also identifies key potential points of intervention.

Lessons learnt: The challenge of addressing the complexity of factors and resulting health impacts is reflected within the CCIHIA framework. While there are many intervention points within this framework for health services to address, many factors influencing unequal impacts are created outside the health sector's direct control. The framework's development process reflected the focus on collaboration and the interdisciplinary nature of climate change response. Ultimately, the CCIHIA framework is an assessment tool and an approach for prioritising inclusive, cross-cutting, multisector working, and problem-solving.