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Bittleston H, Hocking JS, Temple-Smith M, Sanci L, Goller JL, Coombe J. What sexual and reproductive health issues do young people want to discuss with a doctor, and why haven't they done so? Findings from an online survey. Sex Reprod Healthc 2024; 40:100966. [PMID: 38522395 DOI: 10.1016/j.srhc.2024.100966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/28/2024] [Accepted: 03/19/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVE Young people are a priority group for sexual and reproductive health (SRH) care. We considered which SRH topics young Australians want to discuss with a general practitioner (GP) and explored barriers they encounter to discussing these issues. METHODS We conducted an online survey (2nd May - 21st June 2022) of Australians aged 16-29 years. Participants were asked to identify from a list of SRH topics which they wanted to discuss, but never had, with a GP. Those who selected any topic/s (with 'undiscussed SRH issues') were asked a free-text follow-up question about what prevented them from discussing issues. We explored characteristics associated with having undiscussed issues using multivariate logistic regression. Free-text comments were analysed using content analysis. RESULTS A total of 1887 people completed relevant survey questions. Most (67.1 %) were women and 48.5 % were heterosexual. Two-thirds (67.0 %) had a usual GP. Nearly half (45.6 %) had undiscussed issues. Most commonly, women wanted to discuss cervical screening and sexual problems, and men wanted to discuss sexual problems and STIs. Participants who were male, older, heterosexual, and with a usual GP were least likely to have undiscussed issues. Barriers to accessing care for SRH were identified from free-text comments, including discomfort, lack of opportunity, fear of negative outcomes, low priority of SRH issues, and perceptions about the role and expertise of GPs. CONCLUSIONS Many young people would welcome more preventative SRH care. Young people may be reassured that all issues, including sexual difficulties and dysfunction, are appropriate to discuss with a GP.
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Affiliation(s)
- H Bittleston
- Centre for Epidemiology and Biostatistics, The University of Melbourne School of Population and Global Health, Melbourne, Australia.
| | - J S Hocking
- Centre for Epidemiology and Biostatistics, The University of Melbourne School of Population and Global Health, Melbourne, Australia
| | - M Temple-Smith
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - L Sanci
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - J L Goller
- Centre for Epidemiology and Biostatistics, The University of Melbourne School of Population and Global Health, Melbourne, Australia
| | - J Coombe
- Centre for Epidemiology and Biostatistics, The University of Melbourne School of Population and Global Health, Melbourne, Australia
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Vujovich-Dunn C, Wand H, Brotherton JML, Gidding H, Sisnowski J, Lorch R, Veitch M, Sheppeard V, Effler P, Skinner SR, Venn A, Davies C, Hocking J, Whop L, Leask J, Canfell K, Sanci L, Smith M, Kang M, Temple-Smith M, Kidd M, Burns S, Selvey L, Meijer D, Ennis S, Thomson C, Lane N, Kaldor J, Guy R. Measuring school level attributable risk to support school-based HPV vaccination programs. BMC Public Health 2022; 22:822. [PMID: 35468743 PMCID: PMC9036743 DOI: 10.1186/s12889-022-13088-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 03/24/2022] [Indexed: 12/27/2022] Open
Abstract
Background In Australia in 2017, 89% of 15-year-old females and 86% of 15-year-old males had received at least one dose of the HPV vaccine. However, considerable variation in HPV vaccination initiation (dose one) across schools remains. It is important to understand the school-level characteristics most strongly associated with low initiation and their contribution to the overall between-school variation. Methods A population-based ecological analysis was conducted using school-level data for 2016 on all adolescent students eligible for HPV vaccination in three Australian jurisdictions. We conducted logistic regression to determine school-level factors associated with lower HPV vaccination initiation (< 75% dose 1 uptake) and estimated the population attributable risk (PAR) and the proportion of schools with the factor (school-level prevalence). Results The factors most strongly associated with lower initiation, and their prevalence were; small schools (OR = 9.3, 95%CI = 6.1–14.1; 33% of schools), special education schools (OR = 5.6,95%CI = 3.7–8.5; 8% of schools), higher Indigenous enrolments (OR = 2.7,95% CI:1.9–3.7; 31% of schools), lower attendance rates (OR = 2.6,95%CI = 1.7–3.7; 35% of schools), remote location (OR = 2.6,95%CI = 1.6–4.3; 6% of schools,) and lower socioeconomic area (OR = 1.8,95% CI = 1.3–2.5; 33% of schools). The highest PARs were small schools (PAR = 79%, 95%CI:76–82), higher Indigenous enrolments (PAR = 38%, 95%CI: 31–44) and lower attendance rate (PAR = 37%, 95%CI: 29–46). Conclusion This analysis suggests that initiatives to support schools that are smaller, with a higher proportion of Indigenous adolescents and lower attendance rates may contribute most to reducing the variation of HPV vaccination uptake observed at a school-level in these jurisdictions. Estimating population-level coverage at the school-level is useful to guide policy and prioritise resourcing to support school-based vaccination programs. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13088-x.
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Affiliation(s)
- C Vujovich-Dunn
- University of New South Wales, Kirby Institute, Kensington, Australia.
| | - H Wand
- University of New South Wales, Kirby Institute, Kensington, Australia
| | - J M L Brotherton
- Australian Centre for the Prevention of Cervical Cancer, Population Health, East Melbourne, Victoria, Australia.,University of Melbourne, Melbourne School of Population and Global Health, Carlton, VIC, Australia
| | - H Gidding
- University of Sydney, Northern Clinical School, Sydney, Australia.,Women and Babies Research, Kolling Institute, Northern Sydney Local Health District, Sydney, Australia.,School of Population Health, University of New South Wales, Kensington, Australia.,National Centre for Immunisation Research and Surveillance, Sydney, Australia
| | - J Sisnowski
- University of New South Wales, Kirby Institute, Kensington, Australia.,Australian National University, National Centre for Epidemiology & Population Health, Canberra, Australia
| | - R Lorch
- University of New South Wales, Kirby Institute, Kensington, Australia
| | - M Veitch
- Department of Health and Human Services, Tasmanian Government, Hobart, Australia
| | - V Sheppeard
- Communicable Diseases Branch, NSW Health, St Leonards, New South Wales, Australia.,University of Sydney, Sydney School of Public Health, Camperdown, NSW, Australia
| | - P Effler
- Communicable Disease Control Directorate, Department of Health, Western Australia, East Perth, Australia
| | - S R Skinner
- University of Sydney, Specialty of Child and Adolescent Health, Faculty of Medicine and Health, Sydney, Australia.,Children's Hospital Westmead, Sydney Children's Hospitals Network, Westmead, Australia
| | - A Venn
- Menzies Institute for Medical Research, University of Tasmania, Tasmanian, Australia
| | - C Davies
- University of Sydney, Specialty of Child and Adolescent Health, Faculty of Medicine and Health, Sydney, Australia.,Children's Hospital Westmead, Sydney Children's Hospitals Network, Westmead, Australia
| | - J Hocking
- University of Melbourne, Melbourne School of Population and Global Health, Carlton, VIC, Australia
| | - L Whop
- Australian National University, National Centre for Epidemiology & Population Health, Canberra, Australia.,Menzies School of Health Research, Charles Darwin University, Cairns, QLD, Australia
| | - J Leask
- National Centre for Immunisation Research and Surveillance, Sydney, Australia.,University of Sydney, Sydney Nursing School, Faculty of Medicine and Health, Camperdown, NSW, Australia
| | - K Canfell
- The Daffodil Centre, University of Sydney, A Joint Venture With Cancer Council NSW, Sydney, Australia
| | - L Sanci
- University of Melbourne, Medicine, Dentistry and Health Sciences, Carlton, VIC, Australia
| | - M Smith
- The Daffodil Centre, University of Sydney, A Joint Venture With Cancer Council NSW, Sydney, Australia.,School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - M Kang
- University of Sydney, Westmead Clinical School, Sydney, New South Wales, Australia
| | - M Temple-Smith
- University of Melbourne, Medicine, Dentistry and Health Sciences, Carlton, VIC, Australia
| | - M Kidd
- Flinders University, Southgate Institute for Health, Society and Equity, Bedford Park, South Australia, Australia
| | - S Burns
- Curtin University, School of Population Health, Bentley, WA, Australia
| | - L Selvey
- University of Queensland, School of Public Health, St Lucia, QLD, Australia
| | - D Meijer
- Immunisation Unit, Health Protection NSW, St Leonard's, New South Wales, Australia
| | - S Ennis
- Immunisation Unit, Health Protection NSW, St Leonard's, New South Wales, Australia
| | - C Thomson
- Communicable Disease Control Directorate, Department of Health, Western Australia, East Perth, Australia
| | - N Lane
- Department of Health and Human Services, Tasmanian Government, Hobart, Australia
| | - J Kaldor
- University of New South Wales, Kirby Institute, Kensington, Australia
| | - R Guy
- University of New South Wales, Kirby Institute, Kensington, Australia
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3
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Sisnowski J, Vujovich-Dunn C, Gidding H, Brotherton J, Wand H, Lorch R, Veitch M, Sheppeard V, Effler P, Skinner SR, Venn A, Davies C, Hocking J, Whop L, Leask J, Canfell K, Sanci L, Smith M, Kang M, Temple-Smith M, Kidd M, Burns S, Selvey L, Meijer D, Ennis S, Thomson C, Lane N, Kaldor J, Guy R. Differences in school factors associated with adolescent HPV vaccination initiation and completion coverage in three Australian states. Vaccine 2021; 39:6117-6126. [PMID: 34493408 DOI: 10.1016/j.vaccine.2021.08.076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 08/19/2021] [Accepted: 08/20/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Schools are the primary setting for the delivery of adolescent HPV vaccination in Australia. Although this strategy has achieved generally high vaccination coverage, gaps persist for reasons that are mostly unknown. This study sought to identify school-level correlates of low vaccination course initiation and completion in New South Wales, Tasmania, and Western Australia to inform initiatives to increase uptake. METHODS Initiation was defined as the number of first doses given in a school in 2016 divided by vaccine-eligible student enrolments. Completion was the number of third doses given in a school in 2015-2016 divided by the number of first doses. Low initiation and completion were defined as coverage ≤ 25thpercentile of all reporting schools. We investigated correlations between covariates using Spearman's rank correlation coefficients. Due to multicollinearity, we used univariable logistic regression to investigate associations between school characteristics and low coverage. RESULTS Median initiation was 84.7% (IQR: 75.0%-90.4%) across 1,286 schools and median completion was 93.8% (IQR: 86.0%-97.3%) across 1,295 schools. There were strong correlations between a number of school characteristics, particularly higher Indigenous student enrolments and lower attendance, increasing remoteness, higher postcode socioeconomic disadvantage, and smaller school size. Characteristics most strongly associated with low initiation in univariate analyses were small school size, location in Tasmania, and schools catering for special educational needs. Low completion was most strongly associated with schools in Tasmania and Western Australia, remote location, small size, high proportion of Indigenous student enrolments, and low attendance rates. CONCLUSION This study provides indicative evidence that characteristics of schools and school populations are associated with the likelihood of low initiation and completion of the HPV vaccination course. The findings will guide further research and help target initiatives to improve vaccination uptake in schools with profiles associated with lower coverage.
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Affiliation(s)
- J Sisnowski
- The Kirby Institute, Faculty of Medicine, University of New South Wales, Wallace Wurth Building, High St., Kensington, New South Wales, Australia; Australian National University, National Centre for Epidemiology & Population Health, Canberra, Australia.
| | - C Vujovich-Dunn
- The Kirby Institute, Faculty of Medicine, University of New South Wales, Wallace Wurth Building, High St., Kensington, New South Wales, Australia.
| | - H Gidding
- University of New South Wales, School of Public Health and Community Medicine, Kensington, Australia; National Centre for Immunisation Research and Surveillance, Westmead, Australia; The University of Sydney Northern Clinical School, St Leonards, Australia.
| | - J Brotherton
- Population Health, VCS Foundation, East Melbourne, Victoria, Australia; University of Melbourne, Melbourne School of Population and Global Health, Carlton, Victoria, Australia.
| | - H Wand
- The Kirby Institute, Faculty of Medicine, University of New South Wales, Wallace Wurth Building, High St., Kensington, New South Wales, Australia.
| | - R Lorch
- The Kirby Institute, Faculty of Medicine, University of New South Wales, Wallace Wurth Building, High St., Kensington, New South Wales, Australia.
| | - M Veitch
- Tasmanian Government, Department of Health and Human Services, Hobart, Australia.
| | - V Sheppeard
- Communicable Diseases Branch, Health Protection NSW, St Leonards, New South Wales, Australia; University of Sydney, Sydney School of Public Health, Camperdown, New South Wales, Australia.
| | - P Effler
- Communicable Disease Control Directorate, Department of Health, Western Australia, East Perth, Australia.
| | - S R Skinner
- Children's Hospital Westmead, Sydney Children's Hospitals Network, Westmead, Australia; University of Sydney, Specialty of Child and Adolescent Health, Faculty of Medicine and Health, Camperdown, New South Wales, Australia.
| | - A Venn
- Menzies Institute for Medical Research, University of Tasmania, Tasmanian, Australia.
| | - C Davies
- Children's Hospital Westmead, Sydney Children's Hospitals Network, Westmead, Australia; University of Sydney, Specialty of Child and Adolescent Health, Faculty of Medicine and Health, Camperdown, New South Wales, Australia.
| | - J Hocking
- University of Melbourne, Melbourne School of Population and Global Health, Carlton, Victoria, Australia.
| | - L Whop
- Australian National University, National Centre for Epidemiology & Population Health, Canberra, Australia; Menzies School of Health Research, Charles Darwin University, Cairns, Queensland, Australia.
| | - J Leask
- National Centre for Immunisation Research and Surveillance, Westmead, Australia; University of Sydney, Sydney Nursing School, Faculty of Medicine and Health, Camperdown, New South Wales, Australia.
| | - K Canfell
- Cancer Research Division, Cancer Council, New South Wales, Australia.
| | - L Sanci
- University of Melbourne, Medicine, Dentistry and Health Sciences, Carlton, Victoria, Australia.
| | - M Smith
- Communicable Disease Control Directorate, Department of Health, Western Australia, East Perth, Australia; Cancer Research Division, Cancer Council, New South Wales, Australia.
| | - M Kang
- University of Sydney, Westmead Clinical School, New South Wales, Australia.
| | - M Temple-Smith
- University of Melbourne, Medicine, Dentistry and Health Sciences, Carlton, Victoria, Australia.
| | - M Kidd
- Flinders University, Southgate Institute for Health, Society and Equity, South Australia, Australia.
| | - S Burns
- Curtin University, School of Population Health, Western Australia, Australia.
| | - L Selvey
- University of Queensland, School of Public Health, Queensland, Australia.
| | - D Meijer
- Immunisation Unit, Health Protection NSW, St Leonards, New South Wales, Australia.
| | - S Ennis
- Immunisation Unit, Health Protection NSW, St Leonards, New South Wales, Australia.
| | - C Thomson
- Communicable Disease Control Directorate, Department of Health, Western Australia, East Perth, Australia.
| | - N Lane
- Tasmanian Government, Department of Health and Human Services, Hobart, Australia.
| | - J Kaldor
- The Kirby Institute, Faculty of Medicine, University of New South Wales, Wallace Wurth Building, High St., Kensington, New South Wales, Australia.
| | - R Guy
- The Kirby Institute, Faculty of Medicine, University of New South Wales, Wallace Wurth Building, High St., Kensington, New South Wales, Australia.
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Currier D, Patton G, Sanci L, Sahabandu S, Spittal M, English D, Milner A, Pirkis J. Socioeconomic Disadvantage, Mental Health and Substance Use in Young Men in Emerging Adulthood. Behav Med 2021; 47:31-39. [PMID: 31241418 DOI: 10.1080/08964289.2019.1622504] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Emerging adulthood is a neglected phase of the life course in health research. Health problems and risk behaviors at this time of life can have long-term consequences for health. The 2016 Lancet Commission on Adolescent Health and Wellbeing reported that the influence of socioeconomic factors was under-researched among adolescents and young adults. Moreover, the influence of socioeconomic factors on health has been little researched specifically in emerging adult men. We aimed to investigate associations between socioeconomic disadvantage and mental health, suicidal behavior, and substance use in young adult Australian men. Logistic regression was used to examine the association between Year 12 (high school) completion and area disadvantage on mental health, suicidal behavior, and substance use in 2,281 young men age 18-25 participating in the Australian Longitudinal Study on Male Health (Ten to Men). In unadjusted analysis both Year 12 non-completion and area disadvantage were associated with multiple adverse outcomes. In adjusted analysis Year 12 non-completion, but not area disadvantage, was associated with poorer mental health, increased odds of suicidal behavior, and substance use. Retaining young men in high school and developing health-promotion strategies targeted at those who do exit education early could both improve young men's mental health and reduce suicidal behavior and substance use in emerging adulthood.
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Affiliation(s)
- D Currier
- Centre for Mental Health, The University of Melbourne
| | - G Patton
- Centre for Adolescent Health, Murdoch Childrens Research Institute
| | - L Sanci
- Department of General Practice, The University of Melbourne
| | - S Sahabandu
- Centre for Epidemiology and Biostatistics, The University of Melbourne
| | - M Spittal
- Centre for Mental Health, The University of Melbourne
| | - D English
- Centre for Epidemiology and Biostatistics, The University of Melbourne
| | - A Milner
- Centre for Health Equity, The University of Melbourne
| | - J Pirkis
- Centre for Mental Health, The University of Melbourne
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5
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McCallum Z, Wake M, Gerner B, Baur LA, Gibbons K, Gold L, Gunn J, Harris C, Naughton G, Riess C, Sanci L, Sheehan J, Ukoumunne OC, Waters E. Outcome data from the LEAP (Live, Eat and Play) trial: a randomized controlled trial of a primary care intervention for childhood overweight/mild obesity. Int J Obes (Lond) 2006; 31:630-6. [PMID: 17160087 DOI: 10.1038/sj.ijo.0803509] [Citation(s) in RCA: 140] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To reduce gain in body mass index (BMI) in overweight/mildly obese children in the primary care setting. DESIGN Randomized controlled trial (RCT) nested within a baseline cross-sectional BMI survey. SETTING Twenty nine general practices, Melbourne, Australia. PARTICIPANTS (1) BMI survey: 2112 children visiting their general practitioner (GP) April-December 2002; (2) RCT: individually randomized overweight/mildly obese (BMI z-score <3.0) children aged 5 years 0 months-9 years 11 months (82 intervention, 81 control). INTERVENTION Four standard GP consultations over 12 weeks, targeting change in nutrition, physical activity and sedentary behaviour, supported by purpose-designed family materials. MAIN OUTCOME MEASURES Primary: BMI at 9 and 15 months post-randomization. Secondary: Parent-reported child nutrition, physical activity and health status; child-reported health status, body satisfaction and appearance/self-worth. RESULTS Attrition was 10%. The adjusted mean difference (intervention-control) in BMI was -0.2 kg/m(2) (95% CI: -0.6 to 0.1; P=0.25) at 9 months and -0.0 kg/m(2) (95% CI: -0.5 to 0.5; P=1.00) at 15 months. There was a relative improvement in nutrition scores in the intervention arm at both 9 and 15 months. There was weak evidence of an increase in daily physical activity in the intervention arm. Health status and body image were similar in the trial arms. CONCLUSIONS This intervention did not result in a sustained BMI reduction, despite the improvement in parent-reported nutrition. Brief individualized solution-focused approaches may not be an effective approach to childhood overweight. Alternatively, this intervention may not have been intensive enough or the GP training may have been insufficient; however, increasing either would have significant cost and resource implications at a population level.
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Affiliation(s)
- Z McCallum
- Centre for Community Child Health, The University of Melbourne, Murdoch Childrens Research Institute, Parkville, Australia.
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Sanci L, Glover S, Coffey C. Adolescent health education programmes: theoretical principles in design and delivery. Ann Acad Med Singap 2003; 32:78-85. [PMID: 12625102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
The patterns of health need in youth have changed over the last three decades with increasing rates of psychosocial problems compromising adolescent development and affecting the patterns of morbidity and mortality in adult years. This has increased the public health interest in health promotion, early detection and preventive health care for adolescents. Yet, young people report significant barriers to accessing the health care system, and health professionals report a self-perceived lack of competency and prior training in adolescent health, especially in these areas of youth health need. There is an imperative to provide quality professional development for existing health professionals and undergraduates in adolescent health care. This paper will discuss a model of professional knowledge in adolescent health and the evidence-based principles in design and delivery of effective education programmes. It will also review the published evaluations of adolescent education programmes and outcomes that still require evaluation in the future.
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Affiliation(s)
- L Sanci
- Centre for Adolescent Health, Murdoch Children's Research Institute, Centre for Health Programme Evaluation, University of Melbourne, Australia.
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7
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Sanci L, Young D. Engaging the adolescent patient. Aust Fam Physician 1995; 24:2027-31. [PMID: 8579536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
With their knowledge of local community, families and schools, general practitioners are the ideal providers of primary health care to young people; however, doctors sometimes find it difficult to communicate with adolescents. Adolescents are often anxious and reluctant to visit a doctor. This article outlines possible approaches to the adolescent in the medical consultation that may help start the therapeutic relationship in a positive manner.
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Affiliation(s)
- L Sanci
- Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Victoria
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