Research outputs

Highlights

• Maternal vaccination programs are not currently equitable among pregnant Australians.
• We found that First Nations women, women who live in remote areas, and/or are from lower socio-economic backgrounds are not receiving the recommended maternal vaccinations.

Background

Pregnant women and newborns are at an increased risk of adverse effects from respiratory infections. To prevent respiratory infection and the associated adverse effects, influenza and whooping cough (pertussis) vaccines are free and recommended to all pregnant women in Australia. Aboriginal and/or Torres Strait Islander (respectfully referred to as First Nations) women and infants experience a higher incidence of respiratory illness compared to other Australian women and infants, so it is important to ensure these vaccinations are being offered. Also, information regarding maternal vaccination coverage among women from culturally and linguistically diverse populations (CALD) is very scarce. We aimed to examine the uptake of influenza and pertussis vaccinations among First Nations, CALD, and other Australian (non-Indigenous and non-CALD) pregnant women in Australia, and whether geographic and socio-economic determinants affected vaccine coverage. 

Results

Using data linkage, our research team created the largest Australian mother-infant pair cohort to examine vaccination status in pregnancy in three jurisdictions (Northern territory, Queensland and Western Australia). We found that influenza and pertussis vaccination uptake among pregnant women in Australia was impacted by living in remote regions, lower socio-economic status, and inequitable access to health care services. Results from this study found that First Nations women were less likely to have received both influenza and pertussis vaccines when compared to other Australian women. In contrast, women from CALD backgrounds were more likely to have received both maternal vaccines. Women living within high socio-economic levels, or the highest areas of advantage, were more likely to receive both vaccines. Whereas women living in remote areas were less likely to receive both pertussis and influenza vaccines. When compared to other Australians, this study found that pregnant women who identify as First Nations, live in remote areas, and/or are from lower socio-economic backgrounds are not receiving the recommended vaccinations during pregnancy. These results are concerning since influenza and pertussis vaccines are the foundation for respiratory disease prevention.

What this means

• Now that COVID-19 vaccination is recommended in pregnancy, an extension of this study is needed to establish whether the barriers we have identified in this study extend to COVID-19 as well. We plan to expand on this study to include COVID-19 vaccination estimates, and update influenza and pertussis vaccination estimates among these groups to include data from 2017-2023.
• Addressing the inequities identified in this study is a key responsibility of all levels of government. The current system of maternal vaccination monitoring is inadequate.
• Australia needs a national, maternal vaccination surveillance system that provides data on vaccine uptake in a timely and standardised way. Then areas of vaccine inequity can be identified, and resources can be mobilized to target these areas of need.

Read the article

McHugh L, Regan AK, Sarna M, Moore HC, Van Buynder P, Pereira G, Blyth CC, Lust K, Andrews RM, Crooks K, Massey P, Binks MJ. Inequity of antenatal influenza and pertussis vaccine coverage in Australia: the Links2HealthierBubs record linkage cohort study, 2012-2017. BMC Pregnancy Childbirth. 2023 May 8;23(1):314. doi: 10.1186/s12884-023-05574-w. PMID: 37150828.

Contact us

Dr Lisa McHugh
Infectious diseases and perinatal epidemiologist
NHMRC Emerging Leadership (EL1) Research Fellow
School of Public Health, Faculty of Medicine
University of Queensland
Email: l.mchugh@uq.edu.au

Acknowledgement

This research was supported by a project grant from the Australian NHMRC (GNT1141510). We would like to acknowledge Associate Investigator Heather D’Antoine for her guidance and governance over the First Nations data. This research was supported by a project grant from the Australian NHMRC (GNT1141510). We would like to acknowledge Associate Investigator Heather D’Antoine for her guidance and governance over the First Nations data.

Highlights

• Workplace relationships are critical. Our data identify a developmental process in which supports and mentorship, from both men and women, are critical to retention early in a man’s early education career.
• The building of a distinct male contribution underpins continuing career engagement for men in the early education sector.
• Increasing gender-minority numbers will not necessarily improve inclusion in the workplace, as broader gender dynamics pervade, and more men may challenge the social order and serve as disruptors.

Background

The first five years of life are the most critical for building the foundations for life-long learning, wellbeing, and health. High-quality early education led by qualified staff has been identified by the Organisation for Economic Co-operation and Development (OECD) as central to establishing positive child wellbeing, health, and education pathways throughout life. However, there remains a critical shortage of qualified staff in ECEC and a strong gender gap, with males only accounting for 2.5 % of the Australian ECEC workforce.

Despite the OECD recommending that the recruitment of male educators as one of nine strategies to tackle the workforce crisis, men are less likely to train as an ECEC educator, less likely to remain in training if they do enter, and those who do enter the workforce are more likely to leave than their female counterparts. Men exit early education at a higher rate than women due to being excluded and judged by their coworkers and the wider community. We take the unique circumstance of men clustering in a team to examine if more men working together improves their feelings of inclusion.

Resolution

We abductively analysed interviews with 10 men working in two Australian early childhood centres in which men comprised >20%, of the educators; ten times the international representation of men in the early childhood workforce. The men in our study have been in early childhood between 3-15 years. This is a story of success due to the longevity of their tenure. To support the ongoing retention of these men, the immediate workplace environment, including collegial relationships and leadership quality, needs to be addressed.

The workplace accounts provided by these men invoke high levels of emotion. There is fear of judgement and threat to their place in early education. There is a reward due to their enjoyment and contribution to children’s learning. However, there is also a challenge whereby gender dynamics come into conflict. Our data suggests that simply recruiting more men is insufficient to ensure a positive and harmonious workplace where men and women working as educators stay and thrive. Rather, tensions emerge.

Policy implications

• Diversity sensitive policy frameworks, including those relating to gender, are needed. These might specify a code of conduct that makes explicit the right of educators to fully participate in all aspects of early education work.

• Policy assertions do not incur cost. However, to be effective investment, inclusion in training, and attendant inclusive work environments may be necessary to avert loss of trained educators. Evidence in our data, and elsewhere, suggest language within ECEC centres is often gendered (Andrew, 2016). Identifying language use as a means of messaging gender attitudes should be made explicit. Inductions of new staff (regardless of their gender) undertaken by centre leadership might also include some of this information about diversity, gender, and sensitivity.

• Mentorship of new male entrants emerged as critical. This finding suggests purposeful allocation of class teams within a centre as a means by which minorities can receive emotional support and intellectual mentorship. The advocacy of leadership and the foregrounding of diverse teams rather than the ‘big brothers’ might be a more appropriate way to celebrate successful inclusion practices, for true inclusion requires respectful relationships as majority and minority groups work together.

Read the article

Victoria Sullivan, Laetitia Coles, Yuwei Xu & Karen Thorpe (2023) Men times ten: does the presence of more men support inclusion of male educators in early childhood education and care?, Gender and Education, 35:1, 18-36, DOI: 10.1080/09540253.2022.2137106

Contact us

Dr Victoria Sullivan
v.sullivan@uq.edu.au

Acknowledgement

We would like to acknowledge the support of our industry partner Goodstart Early Learning and also thank Dr Kate Liley for being a critical friend and facilitator for this research. The Australian Research Council Centre of Excellence for Children and Families over the Life Course awarded financial support. We would also like to acknowledge Dr Azhar Potia for providing statistical background data. The research team could not have done this work without the interview participants. We thank them for their time, energy, and openness.

Highlights

These findings demonstrated the plausibility of biodiversity exerting mental health effects through biological instead of psychological mechanisms alone.

They showed that the environment could directly transfer microbes to humans even during brief interactions in urban green spaces.

Moreover, human interventional studies support connections between gut microbiota as part of the pathways leading to neuropsychiatric illness.

Background

While we all agree greenspace is good for our health and well being, there is uncertainty on what aspects of greenspace exposure do the most benefit.

This is important to understand as it will determine how we design out cities of the future.

We are aware we derive benefits from increased exercise, increased sun exposure, social interactions and restorative psychological effects of greenspace. Alternate mechanisms such as exposure to microbe biodiversity should be considered and new tools may be available to examine this.

Increased exposure to microbes via greenspace may increase your mental health

We examined the literature on how greenspace improves mental health.  This examined several new techniques that are now being used to examine specific aspects of greenspace exposure.  A range of techniques are now used to enable conformation on the way exposure to a biodiverse environment introduces environmental microbes to the human skin, nose and gut.  Longer studies are now providing evidence that these may be long lasting in nature.

Policy implications

Our design of greenspace will be altered by understanding the pathways of how greenspace increases our health and wellbeing.  Increasing the time spent in greenspace and the types of greenspaces we visit could increase the mental health of the population.  This is important as this will alter the way we design our cities of the future to incorporate a range of greenspace types and make them accessible to the population.  Similarly, the rise of “green prescriptions” by health services globally (where GPs prescribe their patients nature-based activities such as community gardening and nature walk) requires stronger evidence base to ensure maximum effects from the intervention. 

Read the article

Wong, Y.S.; Osborne, N.J. Biodiversity Effects on Human Mental Health via Microbiota Alterations. Int. J. Environ. Res. Public Health 2022, 19, 11882. https:// doi.org/10.3390/ijerph191911882

Contact us

Associate Professor Nicholas Osborne
n.osborne@uq.edu.au

Acknowledgement

We thank the School of Public Health, University of Queensland, for supporting this multidisciplinary research, and numerous colleagues for stimulating discussion.

Highlights

• Research co-designed by Aboriginal and Torres Strait Islander and non-Indigenous people working in Aboriginal Community Controlled Health Organisations and research institutions, can result in a project design that responds to community need.
• Best practice tools can support the design of a project that has a strengths-based approach and is aligned with a human rights, social justice and empowerment agenda.
• The co-designed Remote Food Security Project responds to Apunipima Cape York Health Council’s call to action and Central Australian Aboriginal Congress’ research priorities. 

A call to action

Apunipima Cape York Health Council and Central Australian Aboriginal Congress have called for action to improve the unacceptably high level of food insecurity experienced by Aboriginal and Torres Strait Islander people living in the remote communities they service. This paper describes the process and tools we used to  co-design the Remote Food Security Project.

Our journey

Genuine co-design with Aboriginal and Torres Strait Islander people must occur for research to have benefit. There are few documented examples of how this has been done in practice. We used the Research for Impact Tool to inform, and the Aboriginal and Torres Strait Islander Quality Appraisal Tool to assess, our process to co-design a food security research project.

The Remote Food Security Project responds to Apunipima Cape York Health Council’s and Central Australian Aboriginal Congress’ priorities. The Project was designed to test the impact of a healthy food price discount on diet quality of mothers and children, capture people’s experience through photos and stories, and develop a community-led framework to improve food security in remote Aboriginal and Torres Strait Islander communities.

Learnings for policy, practice and research

Best practice tools can support co-design between Aboriginal and Torres Strait Islander people, organisations and those working with them, to genuinely partner in research with community benefit.

Read the article

Megan Ferguson, Emma Tonkin, Julie Brimblecombe, Amanda Lee, Bronwyn Fredericks, Katherine Cullerton, Catherine Mah, Clare Brown, Emma McMahon, Mark Chatfield, Eddie Miles, Yvonne Cadet-James. Communities Setting the Direction for Their Right to Nutritious, Affordable Food: Co-Design of the Remote Food Security Project in Australian Indigenous Communities. Int. J. Environ. Res. Public Health 2023, 20, 2396. https://doi.org/10.3390/ijerph2004236

Contact us

Megan Ferguson
megan.ferguson@uq.edu.au

Acknowledgement

This project is funded by a NHMRC Targeted Call for Research grant (1179848). The contents of the published material are solely the responsibility of the Administering Institution, a Participating Institution or individual authors and do not reflect the views of NHMRC.This project is funded by a NHMRC Targeted Call for Research grant (1179848). The contents of the published material are solely the responsibility of the Administering Institution, a Participating Institution or individual authors and do not reflect the views of NHMRC.

Highlights

• Cultural practices of Aboriginal and Torres Strait Islander people such as sharing food buffer against episodes of food insecurity.
• Despite cultural practices, such as procuring traditional food, and other coping strategies, regular episodes of food insecurity often aligned with the off week of social assistance payments.
• Food insecurity was considered ‘normal’ in remote communities.
• Energy security was coupled to food security.
• Solutions for improving food security included transport and food access, electricity rebates, making social assistance payments more regular, providing computer access and budgeting training.

Context

Food security means always having enough healthy and culturally appropriate food. Food insecurity is estimated to be 4% in the wider Australian population and 31% amongst people living in remote Aboriginal and Torres Strait Islander communities; although research shows this is likely to be a significant underestimate. This study aimed to hear Aboriginal and Torres Strait Islander parents’ and carers’ experiences of food insecurity within the family context and their suggestions for improvement in four remote Cape York and Central Australian communities.

What we found: Causes, concepts, and solutions

This study provided a deeper understanding of the complex challenges facing parents and carers experiencing food insecurity in remote communities. Descriptions of food security were centred in food sharing as an expression of family caring, having sufficient food variety and choice to ensure children ate consistently, and having a relaxed family atmosphere. Elements that described food insecurity included physical pain and emotional stress, adults going without food, seeking family help, and managing without food until payday.

People told us that the causes of food insecurity were: low income and unemployment, the cost of living remotely, the impact of sharing resources, and the impact of spending on harmful commodities and activities.

Three main concepts were shared by people we spoke to:

• cultural practices, such as family sharing, buffers food insecurity,
• there are many ways families cope with food insecurity, such as planning and procuring food for the household, and
• that people accept a degree of food insecurity as normal.

People highlighted the juggling needed between providing food and electricity for their households, and how one constantly impacts the other.

Suggestions for improving food security included electricity rebates, transport and food access, making social assistance payments more regular, providing computer access and budgeting training.

Policy implications

• Policies to advance food security should genuinely ‘listen’ to Aboriginal and Torres Strait Islander descriptions and experiences.
• Community-derived solutions must be incorporated within policies, and primarily focus on increasing access to adequate, regular, stable household income.

Read the article

Sue Booth, Caroline Deen, Kani Thompson, Sue Kleve, Ellie Chan, Leisa McCarthy, Emma Kraft, Bronwyn Fredericks, Julie Brimblecombe, Megan Ferguson. Conceptualisation, experiences and suggestions for improvement of food security amongst Aboriginal and Torres Strait Islander parents and carers in remote Australian communities. Soc Sci Med. 320 (2023) 115726

Contact us

Megan Ferguson
megan.ferguson@uq.edu.au

Acknowledgement

Thanks are extended to Aboriginal and Torres Strait Islander people who took part in the study, and the people who worked with the research team. This project is funded by a NHMRC Targeted Call for Research grant (1179848). The contents of the published material are solely the responsibility of the Administering Institution, a Participating Institution or individual authors and do not reflect the views of NHMRC.

Highlights

• Noncommunicable Diseases are a major global threat to human health.  We know that effective policy action is a successful strategy to address this issue, however evidence-based policy change has been limited in many countries.
• There are many factors that impact on the policy change process. Some are well understood, for example, the way messages are delivered. However, for others, such as who are the most trusted people to deliver policy messages, we know very little about. We sought to examine this factor in our research.
• We found that medical and health professionals were the most frequently trusted spokespeople for NCD messages.  We also found that technical expertise increased the level of trust in a spokesperson.

Background

Noncommunicable diseases (NCD) like diabetes and heart disease are a growing concern and major threat to human health.  While we know that using public policy is a successful strategy to address noncommunicable diseases, evidence-based policy change has been minimal in many countries.  Creating meaningful policy change is dependent on a number of factors including the messages people receive about a policy, this area has been studied and is well understood.  A factor that is not well understood in the policy change process is whether or not it matters who delivers the message. This is the question we sought to answer in this systematic scoping review.

Findings

We found that medical and health professionals were the most frequently trusted sources of information.  The most common reasons for why spokespeople were trusted included technical expertise, strategic engagement with stakeholders and reputation.  The findings also revealed that perceptions of trust and credibility of spokespeople can be highly dependent on population and context.

Policy implications

• As both health professionals and technical expertise were considered significant in influencing the public and policymakers, this highlights their value and potential role in future health policy communication.
• We were unable to determine the characteristics of who the public and policymakers consider trustworthy in the broad range of settings due to the paucity of studies in this space and the role of context. This has important implications for health bodies attempting to communicate with the public or policymakers about NCD prevention at any stage of the policy making process. 
• Developing more understanding about ideal characteristics of the spokesperson in varying contexts and at all stages of the policy making process may ensure more public support and uptake from policy makers for the change needed for NCD prevention.

Read the article

Demeshko A, Buckley L, Morphett K, Adam J, Meany R, Cullerton K.  Characterising trusted spokespeople in noncommunicable disease prevention: a systematic review.  Preventative Medicine Reports. 2022;29:101934 https://doi.org/10.1016/j.pmedr.2022.101934

Contact us

Dr Katherine Cullerton
k.cullerton@uq.edu.au
View UQ Researcher profile

Key points

• Ovarian cancer is often diagnosed late, requires major surgery, and has poor survival outcomes.
• Our research team investigated if the repurposing of existing safe and well-understood heart drugs can help in treating ovarian cancer.
• We found that women who took propranolol and other non-selective beta blockers at the time of surgery for ovarian cancer tended to survive longer than women who did not take these drugs.

Background

Ovarian cancer is often diagnosed late and requires major surgery. The physical and mental stress of surgery is thought to activate the body’s natural stress-inflammatory pathways – leading to increased production of adrenalin hormones (adrenalin and noradrenaline). However, these hormones are thought to stimulate growth and spread of some types of cancers. Beta blockers, a class of heart medications, have been shown in the laboratory to block the effect of these hormones reducing their ability to stimulate cancer growth and spread.

Our study team, headed by Associate Professor Susan Jordan at the University of Queensland and Associate Professor Katrina Spilsbury from the University of Notre Dame Australia, and including researchers from QIMR Berghofer Medical Research Institute, University of New South Wales, University of Melbourne, Royal Brisbane and Women’s Hospital and University of Western Australia, investigated whether safe existing drugs can be repurposed to treat ovarian cancer.  We did this by using deidentified data from Medicare, Pharmaceutical Benefits Scheme, cancer registries, the death registry and hospital data from NSW, Victoria and Western Australia to conduct our research. We then compared women with ovarian cancer who had taken beta-blockers at the time of their surgery to those that hadn’t and assessed whether this might have an effect on survival from ovarian cancer.

Findings

We identified 3,844 Australian women diagnosed with ovarian cancer from 2002 to 2014 who underwent surgery and who also may have been a candidate for beta-blocker treatment.  We followed these women to see how long they lived after surgery to treat their ovarian cancer. We found that the 67 women who were prescribed propranolol and other non-selective beta-blockers during the month they had surgery, on average, lived longer than women not prescribed the same drug did. Women, who were prescribed the more selective beta-blockers that target the heart, did not appear to have improved survival outcomes.

What this means

While clinical trials are needed to confirm our findings, the use of this safe and well-understood heart medication may improve survival for women treated surgically for ovarian cancer.

Read the article

Spilsbury K, Tuesley K, Pearson S, Coory M, Donovan P, Steer C, Stewart L, Pandeya N, Jordan S Perioperative beta blocker supply and survival in women with epithelial ovarian cancer and a history of cardiovascular conditions. Journal of Clinical Oncology (2022) doi: 10.1200/JCO.22.00097

Contact us

Associate Professor Susan Jordan
School of Public Health
Faculty of Medicine
University of Queensland
Email: s.jordan@

Acknowledgement

This research was supported by a project grant from the Australian National Health and Medical Research Council (NHMRC, APP1121151).

Highlights

• The level of support for the nutrition policies identified in this study was generally moderate to high, however policies that were felt to intrude on an individual’s personal freedom were least popular.
• There were two opposing ideas consistently voiced amongst those interviewed. The most common idea was that individuals make poor choices because they are uneducated, another idea being the existence of ‘Big Food’ as powerful and controlling people and the government
• By understanding how the public are influenced by their values and ideals, advocates and policymakers are able to use appropriate strategies to increase public support for nutrition policies.

Public narratives influence acceptance of nutrition policies

Implementing public health policy can be very challenging, one of the key reasons for this is lack of public support for particular policies. A contributing factor to poor policy support may be the way a policy is communicated to the public, it may not resonate with the audience or it may be competing with the public discourse at the time (for example, perceived interference with personal freedoms).

Support for nutrition policies, but competing ideas and values

We found that the level of support for most nutrition policies was moderate to high. There was less support for policies if interviewees felt that their personal freedoms were being impacted. There were two key competing narratives identified. Firstly, that people consume unhealthy food and drinks because of a lack of knowledge about healthy diets, focusing on individual responsibility and personal freedoms. The second key narrative was that large food corporations shape food environments and eating habits and are therefore responsible for poor dietary habits of the population. The victims in these narratives were children and farmers.

Policy implications

Several recommendations to frame policy were identified which may be helpful in shaping positive public attitude towards nutrition polices:

• Those who communicate information about nutrition policy need to move the narrative away from individual responsibility. When people blame themselves (or others) for their dietary choices, they are more likely to disregard the role of other factors like food environments.
• To engage as broad an audience as possible, advocates should incorporate the concept of fairness into they way a policy is communicated and consider using more benevolent language towards the food industry and business.
• It could be beneficial to frame policies as being beneficial to the identified victims which were children and farmers.

Read the article

Cullerton K, Patay D, Waller M, Adsett E, Lee A.  Competing public narratives in nutrition policy: insights ino the ideational barriers of public support for regulatory nutrition measures.  Health Res Policy Syst. 2022;20(1)  https://doi.org/10.1186/s12961-022-00891-6

Contact us

Dr Katherine Cullerton
k.cullerton@uq.edu.au
View UQ Researcher profile

Acknowledgement

Funding for this research was provided from the Australian Government’s Medical Research Future Fund (MRFF) (grant no. BP3). The MRFF provides funding to support health and medical research innovation, with the objective of improving the health and well-being of Australians. MRFF funding has been provided through The Australian Prevention Partnership Centre under the MRFF Boosting Preventive Health Research programme. The funding body had no involvement in the design of the study or collection, analysis and interpretation of data or in writing the manuscript.

Highlights

• Reflexivity is identified as a key professional attribute of health promotion practitioners. We have developed a pedagogical approach to ensure that our students develop the skills necessary to become reflexive practitioners.
• We explicitly teach reflexive practice and incorporate it into learning tasks and assessments throughout the course, ‘Health Promotion in Public Health’ (PUBH7034).
• Students with developed insight into their own standpoints and critical awareness around planetary health are enabled to develop key skills in health promotion, action and advocacy.

Health promotion and critical reflexivity

Health Promotion is ever evolving to meet the modern challenges of both human health and planetary health. Critical reflexivity has been identified as a key component of modern health promotion practice. Reflexivity helps practitioners to develop the skills to respond to complex challenges and advocate for change that supports the health of human communities and the planet on which our health depends. Self-reflection requires careful consideration on past actions developing insight that guides future actions. Critical reflexivity extends self-reflection to unpack the social and structural influences that shape health promotion practice. Our article describes the approaches we have used to design and deliver ‘Health Promotion in Public Health’ (PUBH7034) to explicitly teach critical reflexivity to Master of Public Health Students. Reflexivity in teaching and learning was incorporated throughout learning activities and assessments using a highly scaffolded, supportive approach for students. Students applied reflexivity to self, their research, and their practice in advocacy.

Critical reflexivity develops insight and awareness

Teaching critical reflexivity and incorporating it into all learning activities helped students to develop more self-awareness and a deeper understanding of their own personal and professional standpoints. Students’ critical reflection on their research supported the development of effective advocacy skills through identifying their own professional values aligned with strong evidence to call for transformative action in planetary health.

Policy implications

Explicitly teaching the practice and process of critical reflexivity can help students develop personal insight, support professional practice, and promote positive and impactful change in the health of people and our planet.

Read the article

Hickman AC, Johnson RL, Lawler SP. Health promoting pedagogy: Using reflexivity to support learning and action in planetary health education. Health Promot J Aust. 2022  https://doi.org/10.1002/hpja.648.

Contact us

Sheleigh Lawler
s.lawler@uq.edu.au

Amy Hickman
a.hickman@uq.edu.au

Rebecca Johnson
rebecca.johnson@uq.edu.au

Acknowledgment

The authors would like to acknowledge Britta Wigginton, Francis Nona, Emily Krusz and Karen Shelley for their support in the development and delivery of this course. They would also like to acknowledge all the students they have had the privilege of teaching and commend the students for their commitment to health promotion.