Behavioural Research and Evaluation (BREU), South Australia
Staying Healthy After Cancer
Given that cancer is gaining recognition as a chronic illness, Cancer Council SA offers a six-week chronic disease self-management program for people who have been diagnosed with cancer and who are not receiving medical treatment for cancer at the time. The Staying Healthy After Cancer (SHAC) program aims to enhance participants’ use of self-management behaviours and to manage the physical and emotional challenges associated with ill-health. From 2005 to 2008, SHAC program participants (n=79) completed three questionnaires; prior to participating, after the final program session and six months after completing the program. The questionnaires assessed behavioural and psychosocial outcomes addressed by the program, with responses compared to assess change. Results show that the SHAC program significantly increased participants’ ability to self-manage their illness during the course of the program. Participants saw improvement during this time in levels of fatigue, self efficacy, exercise behaviours, use of stress management techniques and goal achievement. Sustained improvements in levels of distress, fatigue, self efficacy, exercise and use of stress management techniques remained at six month follow-up.
Indigenous mass media project
While smoking rates are at approximately 21% in the South Australian community, rates remain high among Indigenous South Australians (at over 50%). Mass media has been shown to be an effective strategy to reduce smoking rates in the general community, however the impact of this media among Aboriginal People is not well understood. In consultation with the SA Aboriginal Health Council, new research has been developed in collaboration with the Centre for Behavioural Research in Cancer (Cancer Council Victoria). Funded by the SA Government, the research will investigate the impact of various television commercials on Aboriginal people. The research aims to assess the comprehension, acceptability and potential effectiveness of specific television advertisements communicating anti-smoking messages among Aboriginal people compared to non Aboriginal South Australians.
Tobacco outlet density in South Australia
South Australia does not currently restrict the number of retail outlets that sell tobacco. Studies in the alcohol literature indicate that reductions in the physical availability of alcohol products are associated with positive health and behavioural outcomes, especially in low socio-economic areas. New government funded research will be undertaken by the Tobacco Control Research and Evaluation Unit to obtain profiles of tobacco retailer density and investigate relationships between smoking rates and licence density. This research may then inform future tobacco licensing models.
Centre for Behavioural Research in Cancer (CBRC), Victoria
Second-hand smoke drift: Examining the influence of indoor smoking bans on indoor and outdoor air quality at pubs and bars
In recognition of the substantial health risks associated with second-hand tobacco smoke exposure, this study aimed to examine the influence of indoor smoking bans at pubs and bars on indoor and outdoor air quality, and to assess whether second-hand tobacco smoke drifts from outdoor smoking areas to adjacent indoor areas. Data was collected from a sample of 19 pubs and bars in Victoria that had at least one indoor area with an adjacent semi-enclosed outdoor eating/drinking area. Using TSI SidePak Personal Aerosol Monitors, concentrations of second-hand tobacco smoke were measured concurrently in indoor and outdoor areas before and after implementation of the indoor smoking ban in pubs in Victoria in 2007. We found that indoor second-hand tobacco smoke concentrations significantly reduced by 65% from pre-ban to post-ban, and that outdoor exposure to second-hand tobacco smoke also reduced significantly by 39% from pre-ban to post-ban. In addition, post-ban indoor second-hand tobacco smoke concentrations were positively and significantly associated with post-ban outdoor concentrations, suggesting that second-hand tobacco smoke was drifting from outdoors to the adjacent indoor areas. Therefore, the findings from this study indicate that although indoor smoking bans are an effective means of improving indoor and outdoor air quality in pubs and bars, the air quality of smoke-free indoor areas may be compromised by smoking in adjacent outdoor areas. These findings must be considered to ensure adequate protection of the health of employees and patrons at hospitality venues.
Does the portrayal of tanning in Australian women’s magazines relate to real women’s tanning beliefs and behaviour?
The possible role of mass media in influencing attitudes and social norms for tanning by women has received little research attention. This study aimed to examine whether exposure to tanned models in popular women’s magazines between 1987 and 2002 is associated with pro-tan attitudes, beliefs and behaviours among women in Melbourne, Australia during the same period. Content analysis data on the portrayal of tanning among 4949 female, Caucasian models sampled from spring and summer magazine issues were combined with magazine readership data to generate indices of potential exposure to social modelling of tanning via popular women’s magazines. Associations between these indices and cross-sectional telephone survey data from the same period on 5675 female teenagers’ and adults’ tanning attitudes, beliefs and behaviour were examined. Among young women, greater population exposure to tanning in young women’s magazines was associated with increased likelihood of endorsing pro-tan attitudes and beliefs. Among women of all ages, greater exposure to tanned models via the most popular women’s magazines was associated with increased likelihood of attempting to get a tan, but lower likelihood of endorsing pro-tan attitudes. These study results suggest that popular women’s magazines may promote and reflect real women’s tanning beliefs and behaviour. Thus, skin cancer prevention programs may need to develop strategies aimed at reducing pro-tan imagery in women’s magazines.
Centre for Behavioural Research in Cancer Control (CBRCC), WA
Awareness of the harms of chronic alcohol consumption on cancer risk
A literature review, funded by Cancer Council Australia, was conducted to determine knowledge of the harms of chronic alcohol consumption and cancer in the community. Alcohol is an important modifiable risk factor for some cancers. There appears to be a dose response relationship with cancer risk increasing with higher levels of alcohol consumption. Public education campaigns on alcohol have focused on the harms of acute and binge drinking, but not on the harms of chronic alcohol consumption. The evidence from Australian studies suggests that beliefs about the link between alcohol and cancer are not salient. For example, in a series of four surveys of South Australians (2004: n=2985; 2006: n=2971; 2007: n=2507; 2008: n=2824), when asked what people could eat or drink more or less of to reduce their risk of cancer, only a small proportion of respondents nominated ‘limiting or avoiding alcohol’ (6–11% in each survey). However, there appears to be a moderate level of belief that alcohol increases cancer risk, with 57% of adults in Western Australian (2008: n=830) nominating ‘alcohol’ as doing so. This belief was not strongly held with only 21% responding ‘increase a lot’. This literature review highlights the need for public education campaigns to raise public awareness of the link between alcohol consumption and cancer.
Understanding of the food industry’s voluntary ‘Percent Daily Intake Energy’ labelling system
Currently a federal review of food labelling is underway with health organisations lobbying for a mandatory ‘traffic light’ nutrition labelling system to be placed front-of-pack on all packaged foods and beverages. The Australian Food and Grocery Council is countering with its own Percentage Daily Intake (%DI), already voluntarily adopted by 180 major brands and as of March 2010, appears on 2000 products. A newly introduced variant presents a single ‘energy’ thumbnail that specifies the percentage of daily recommended kilojoules represented by a single serve of a product (%DI kJ). Australian Food and Grocery Council recommends its use where “the product is low in all core nutrients” and has since emerged on soft drinks, confectionary bars and biscuits. While a number of previous researchers have compared the comparative merits of the traffic light system versus %DI, no one has investigated the recently introduced %DI kJ variant. We were curious to know whether people had noticed it, how they interpreted it and how useful they thought it was. A series of eight focus groups was conducted, stratified by age, sex and SES, to explore its merits. Few people noticed it unprompted or understood its implications. Indeed, many interpreted the term ‘energy’ with positive associations akin to energy sports drinks, while totally missing the point of potential contribution to weight gain. A modest quantitative follow-up study (n=58) confirmed that the %DI kJ label was deemed significantly less interpretable, noticeable, a deterrent or useful than either traffic light or %DI.
Centre for Health Research & Psycho-oncology (CHeRP), NSW
Evaluation of acceptability and impact of Cancer Council NSW telephone support groups
Emotional and social support interventions, such as support groups, can facilitate positive adjustment amongst those affected by cancer. Telephone support groups (TSGs) are now being offered as an alternative to traditional face-to-face groups. We evaluated Cancer Council NSW TSGs to determine their acceptability to participants and facilitators, impact on participants’ psychosocial wellbeing and levels of burnout amongst group facilitators. One hundred and thirty six former, current or new TSG members completed a computer-assisted telephone interview assessing utility (referral sources, reasons for joining the group) and acceptability (structure, content, leadership, between member support and overall satisfaction) of the groups. New members also completed a survey assessing their psychosocial wellbeing before participating in their first group session and again 12 weeks later. All 11 group facilitators completed a burnout survey and interview exploring their experiences of the groups. Lack of access to face-to-face groups was the main reason members participated in TSG. There was a significant reduction in new members’ levels of depression and improvement in overall mental health and emotional/informational support from pre to post-group assessment. Although facilitators identified challenges (workload, skills, group size), they reported significantly lower levels of burnout compared to reference values. TSGs are highly acceptable to people affected by cancer and may contribute to improvements in some aspects of emotional wellbeing. These findings emphasise the value of including telephone based support groups as part of the suite of supportive care services available to people affected by cancer.
Coping Together: Development and pilot testing of a self-directed coping skills intervention for patients and their partners
Both patients and partners describe the acute post-diagnostic phase as an emotional rollercoaster, with overlapping reactions including shock, distress, uncertainty and denial. Although patients and partners react to a cancer diagnosis as an emotional system, few psychosocial interventions target couples; those that are available tend to be led by highly trained professionals, limiting their reach and sustainability. To overcome these limitations, researchers at CHeRP and national/international collaborators are developing a self-directed coping skills training intervention Coping-Together. Coping-Together translates the most up-to-date literature on effective coping strategies and makes it available to couples to optimise management of common physical, psychological and social cancer related challenges. The key component of Coping-Together is a workbook that presents couples with a series of behaviour therapy based worksheets, which encourage self-reflection and application of coping strategies to current situation. For instance, it provides couples with a guide to mindfulness, tips to communication between patients and their partners and health care professionals, exercises to encourage joint problem solving and guidance for couples in the seeking and sharing of cancer information. The workbook has been presented to 12 couples, with most rating it highly and reporting that the concrete coping strategies help them work through their issues. Some participants have indicated that a self-directed format is more acceptable to them than attending support groups or workshops. The efficacy of Coping-Together in optimising couples’ illness adjustment will be examined in a randomised control trial in 2011.
Viertel Centre for Research in Cancer Control (VCRCC), Queensland
Beating the blues after cancer
Approximately 35% of patients will experience persistent clinically significant distress; carers often experience even higher distress than patients. There is a need to identify patients and family members experiencing high distress and once identified, refer people to services that match their psychosocial care needs. This study is being conducted in collaboration with Cancer Council NSW to investigate support options for distressed callers to Cancer Council Helpline. It is a two arm randomised control trial with distressed patients and carers, comparing a nurse led telephone support and education session, with subsequent provision of a self-management manual, to a tele-based, psychologist delivered cognitive behavioural intervention (five sessions). Participants’ anxiety and depression, cancer specific distress, unmet supportive care needs, positive adjustment and overall quality of life are assessed at baseline and three, six and 12 months post-recruitment.
A significant outcome of this study will be recommendations about the efficacy of minimal contact self management versus tele-based psychologist delivered cognitive behavioural intervention to facilitate better psychosocial adjustment and mental health for people effected by cancer. The results of this study will provide an evidence-based, practical and applied approach to psychosocial care that can be rapidly translated into community and acute settings. Information on the potential economic value of the intervention can be used by health planners to help achieve efficient health service delivery. Participant recruitment has been excellent and data collection is expected to be completed by September 2011. So far, the study has highlighted that Cancer Council Helpline staff (NSW and Qld) are highly effective in distress screening and participant feedback has been highly positive for the support care received.
Amazon Heart Thunder: achieving personal growth through a Harley Davidson
Amazon Heart Thunder (AHT) is a 10 day Harley Davidson motorcycle ride providing a peer support adventure event for breast cancer survivors. Anecdotal reports and an earlier qualitative study indicated that AHT is a catalyst for positive life change, or post-traumatic growth (PTG). This research aimed to identify the mechanisms for which PTG occurs in this peer support environment. Quantitative results showed that upward identification with positive role models during the ride was related to increased levels of PTG. Participants had high levels of pre and post-ride PTG, and also reported high group cohesion after the ride. Levels of cancer related distress significantly decreased after the ride. Qualitative results highlighted the challenges and benefits of the ride, and also the strong connections formed with the other women and the group. Often the challenges faced during the AHT experience were also discussed as benefits. Overcoming these challenges became an achievement and promoted a sense of personal strength. For some women a new social identity was formed through a strong sense of belonging to AHT. Women also discussed PTG that had occurred after their breast cancer and after experiencing AHT. The types of changes included enjoying life and seizing opportunities, fun and freedom, improved relationships with others, personal strength, pride in self and self-nurturing.