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Biomedical subjects

C Rissel

Publications and source records attributed to C Rissel.

At least 19 recordsLinked to original sources
PubMed1999

Obtaining resources for evidence-based public health initiatives at the local level: insights from the Central Sydney Tobacco Control Plan.

OBJECTIVE: In response to inquiries regarding the processes of developing a Tobacco Control Plan (TCP) for the Central Sydney Area Health Service (which in 1997 allocated dedicated funding of $ 800,000 over 2 1/2 years to implement the plan), this article describes the strengths and weaknesses of the TCP and outlines the process which contributed to its funding. CONCLUSIONS: Consistent with national and state priorities, the TCP recommended strategies based on best available evidence in the four action areas: reducing sales of cigarettes to minors, marketing, passive smoking and smoking cessation. Funding of this amount for a single public health issue at a local level represents a unique achievement in the application of an evidence-based approach to population health. IMPLICATIONS: Key elements of our advocacy methods included the involvement of all key primary health care and clinical stakeholders; comprehensive background research to identify evidence-based strategies; careful attention to budget options; strategic lobbying of senior staff and decision makers; the proposal for a multidisciplinary management structure for the TCP and specifications for funding allocation and evaluation. Early achievements and other reflections are discussed.

Adolescent↗
PubMed1999

Alcohol portrayal in Australian prime time television in 1990 and 1997.

OBJECTIVE: This study examines the frequency of scenes involving alcoholic and non-alcoholic drinking acts in Australian TV serials in 1990 and 1997. METHOD: In 1990 and 1997, 87.5 and 85 hours (respectively) of prime time Australian serials were video taped. Tapes were coded using a standard protocol, including visual or verbal references to alcoholic beverages and the act of consuming or preparing to consume any type of beverage. RESULTS: In 1990 and 1997, prime time viewers saw on average 2.6 acts of alcohol consumption per hour. There was a statistically significant threefold decrease in the total number of references to alcohol on prime time Australian serials (primarily accounted for by a significant reduction in the incidental depiction of alcohol), an almost halving of the number of episodes that made some reference to alcohol and less consumption of beverages (both alcoholic and non-alcoholic) in 1997 compared with 1990. CONCLUSIONS: The decrease in incidental references to alcohol was not due to an obviously more socially responsible depiction of alcohol. In both 1990 and 1997, uncritical viewers could conclude from watching Australian TV serials that alcohol is everywhere, is there to be drunk, is used and accepted by all ages and both sexes and is rarely associated with any negative consequences. IMPLICATIONS: The portrayal of health or risk-taking behaviour on television may influence the perception of viewers that certain behaviours are 'normal', common or acceptable, may encourage modelling of that behaviour and may indirectly influence the policy agenda.

Adult↗
PubMed1998

Applying a health outcomes approach in a health service unit.

An explicit focus on health outcomes has the potential to improve health if applied at the local level. However, clinical services require clear and practical support in the measurement and analysis of health outcome indicators. This paper suggests 12 steps for departments or services to take in promoting an outcomes orientation, based on our experiences in the Central Sydney Area Health Service. These include determining commitment at the service level, setting up a working group, specifying service consumers, their health problems and intervention processes, specifying desired health changes, consulting the literature and peers, identifying existing resources, pilot-testing and refining outcome measures, collecting data and responding to sub-optimal results with evidence-based interventions. The paper also reviews common criticisms of the health outcomes approach and key issues which have arisen in the course of applying these steps at the local level.

Causality↗
PubMed1998

Cardiovascular risk factors among Arabic-speaking patients attending Arabic-speaking general practitioners in Sydney, Australia: opportunities for intervention.

BACKGROUND: Australia has a high rate of cardiovascular disease mortality and also a significant proportion of migrants. Little is known about the morbidity experience or cardiovascular risk factors among the larger migrant groups, and this is especially true of the Arabic-speaking population. OBJECTIVES: The objectives of the study were to identify the health profile of Arabic-speaking people in Sydney, Australia, to explore the relationship between level of acculturation and health indicators and to identify the morbidity profile of patients presenting to Arabic-speaking general practitioners (GPs). DESIGN: Adult Arabic-speaking patients aged 18-70 years attending 20 Arabic-speaking GPs in Canterbury, Sydney, during the 2-week study period were asked to complete a self-administered questionnaire in Arabic or English while waiting to see the GP. Data on cardiovascular risk factors, level of acculturation and reasons for seeing the GP were collected. RESULTS: Data were collected from 851 patients (62% response rate). Almost three-quarters (73%) of males and 36% of females were considered overweight or obese (body mass index > 25). Of concern, 37% of males and 28% of females were smokers. Females were significantly less likely to have been tested for diabetes (p < .05) or raised blood pressure (p < 0.05) compared with females in NSW. Respondents consumed less bread per day and more fruits than in NSW overall. Respiratory complaints (flu and colds) were the most frequently reported reasons for patient encounters. Except for the youngest age group, males gave more reasons for encounters than females. CONCLUSIONS: Consecutive sampling of ethnic patients attending a GP who speaks their language holds promise as a method of needs assessment with migrant populations. Further, our results suggest that smoking and weight reduction programs are priorities in the Arabic-speaking community. These risk factors are ideal for intervention by GPs speaking the same language.

Acculturation↗
PubMed1998

A longitudinal study of smoking in year 7 and 8 students speaking English or a language other than English at home in Sydney, Australia.

OBJECTIVE: To compare the rates and predictors of smoking uptake between adolescents speaking English and those speaking a language other than English (LOTE) at home. DESIGN: A cross-sectional survey of year 7 and 8 students (aged 12 and 13 years) was conducted in 1994 and repeated 12 months later. A cohort of students was identified with respondents at baseline matched at follow up. chi 2 and logistic regression were used for analysis. SETTING: 38 schools in southern, east, and northern Sydney, Australia. SUBJECTS: Year 7 and 8 students in the schools were included and examined on two occasions, with complete data for 5947 (80%) students at baseline and 6177 (98%) students at a 12-month follow up. Records were able to be matched perfectly for 3513 respondents (59%). MAIN OUTCOME MEASURES: Smoking rates and predictors of smoking uptake among students speaking English or a LOTE at home. RESULTS: At baseline, 6.1% of students surveyed were smokers. Twelve months later, 15.8% of student surveyed were smokers. There were significantly lower smoking rates among students speaking a LOTE at home compared with those speaking English at home at baseline and at 12 months. Using matched data, for students speaking English at home, five variables were significant predictors of smoking uptake: thinking it acceptable to smoke, perceived benefits of smoking, and having a brother, sister, or close friend who smokes. For students speaking a LOTE, the only predictor was the smoking status of close friends. CONCLUSIONS: Despite the higher smoking prevalence among men with a non-English-speaking background, and the reported strong association between fathers' smoking status and smoking onset of their children, adolescents speaking a LOTE at home were significantly less likely to be smokers than their English-speaking counterparts. Thus, there would seem to be a delay of smoking onset among students speaking a LOTE at home. The smoking rates among respondents speaking a LOTE at home in this study are lower than those obtained from the studies conducted in Europe and the United States. Effective smoking prevention interventions need to be implemented at an early stage of adolescence.

Adolescent↗
PubMed1997

The development and application of a scale of acculturation.

As Australia is one of the most multicultural societies in the world, acculturation of migrants and changes in migrants' health status should be an important focus of public health research. The absence of an accepted measure of acculturation is one barrier to exploring the relationship between acculturation and health. This paper presents data from a study of 851 Arabic-speaking adults attending 20 Arabic-speaking general practitioners in Canterbury, Sydney. An eight-item scale assessing acculturation was developed with a structural equation modelling program (LISREL). This acculturation scale was based on similar scales used with Hispanic populations, was theoretically grounded and had high internal consistency and criterion-related validity. To show the application of a scale of acculturation, patients' preferences for participation in medical decision making, according to level of acculturation, were examined. After adjustment for age, sex and highest level of formal education, significant inverse associations between acculturation and preferences for patient (versus family) involvement in medical decision making were found. Mechanisms for how acculturation affects health need to be explored.

Acculturation↗
PubMed1997

Cervical screening of Arabic-speaking women in Australian general practice.

OBJECTIVE: To determine recency and predictors of cervical screening among Arabic-speaking women in Sydney, Australia. METHOD: A consecutive sample of Arabic-speaking women, attending 20 Arabic-speaking general practitioners, was asked to complete a self administered health risk questionnaire available in Arabic or English which included three questions about cervical screening knowledge and behaviour. RESULTS: Of 756 eligible women, 526 (70%) returned completed questionnaires. Of these, 69 (13%) did not know what a cervical smear was. Sixteen per cent of overseas-born compared with 2% of Australian-born women at risk had not heard of a cervical smear. Women were defined as being at risk of cervical cancer if they had both been married and not had a hysterectomy. Of 318 women at risk for cervical cancer who knew what a cervical smear was, 66% had had a smear in the last two years, a further 7% were attending for one that day while 11% had not had a smear for at least two years, 9% had never had one and 7% did not answer/could not remember. Religion, age, and residence in Australia for more than 10 years were significant and independent predictors of screening after adjustment for other variables in simultaneous logistic regression model (P = 0.002, P = 0.002, and P = 0.040 respectively). Muslim women and older women were more likely to be underscreened, and women with more than 10 years' residence in Australia were more likely to have been screened in the last two years. Acculturation, smoking status, health status, duration of relationship with participating doctor, and chronic disease were not significant predictors of a recent smear. CONCLUSION: As only 73% of women at risk had been screened in the last two years, including women attending on the day and 9% had never been screened, Arabic-speaking women should be a priority for public campaigns, particularly Muslim and older women. Studies to evaluate the effectiveness and acceptability of reminders by ethnic general practitioners are recommended.

Adolescent↗
PubMed1997

Mental health status of Iranian migrants in Sydney.

OBJECTIVE: The aim of this study was to determine the levels and predictors of psychological distress within the Iranian community in Sydney, Australia. METHOD: Participants (n = 161) were identified using snowball sampling, and a questionnaire incorporating the General Health Questionnaire (GHQ-20) and other migration-related factors was mailed to their preferred address. RESULTS: A relatively high proportion of respondents (37%) had GHQ-20 scores above the recommended threshold (4+). Students were significantly more likely to report psychological distress compared with respondents who worked full-time. A feeling that migration had contributed to their distress was also found to be significantly associated with above-threshold GHQ-20 scores. CONCLUSIONS: Iranian migrants in Sydney may need mental health programs to address migration-related distress.

Acculturation↗
PubMed1996

An outcomes approach to population health at the local level in NSW: practical problems and potential solutions.

While a health outcomes approach has the potential to improve the health status of Australians as well as health service efficiency, such a policy will be successful only if practice at the local level follows suit. This paper briefly reviews the health outcomes approach and describes how the Central Sydney Area Health Service has established a Needs Assessment & Health Outcomes Unit to help improve health outcomes. The paper discusses issues in working with population health outcomes at the local level, such as the usefulness and limitations of routinely collected data for planning and managing health services, problems of small area data, gaps in the documentation of national health goals and targets, problems of attribution of improved outcomes to specific interventions, and definition of responsibilities for action at the local level. It offers some potential solutions relevant at the local level.

Data Collection↗
PubMed1996

Toward the assessment of psychological empowerment in health promotion: initial tests of validity and reliability.

Because of the importance of empowerment in health promotion, the measurement of empowerment is a priority for health promotion research. The present study sought to develop a valid and reliable instrument to assess psychological empowerment and to resolve the theoretical question of whether psychological empowerment is a topic-specific or general construct. University of Minnesota employees (n = 160) completed two different versions of empowerment questionnaires. One of the questionnaires measured general empowerment; the other was specific to alcohol use prevention. Reasonable reliability was demonstrated in a previously developed general empowerment instrument (Cronbach's alpha coefficient of 0.84) and for an alcohol-specific instrument (Cronbach's alpha coefficient of 0.78). Construct validity for the alcohol-specific instrument was demonstrated by appropriate significant correlations between subscales and overall scores for both instruments. Predictive validity tests partially supported the concept that psychological empowerment is topic-specific, although further testing with a more representative population may be needed to resolve this question. The results suggest that the alcohol-specific psychological empowerment instrument could be used in the evaluation of community alcohol abuse prevention programmes.

Adult↗
PubMed1994

Community ownership and program continuation following a health demonstration project.

Community ownership and maintenance of heart health programs was a major study goal of the Minnesota Heart Health Program (MHHP), a community-based National Heart, Blood and Lung Institute (NIH)-funded demonstration project. A partnership between the University of Minnesota and three Upper Midwest intervention communities was initiated in 1981. Local citizen boards were instrumental in planning, implementing and incorporating programs. Through an 8 year process of community organization, training and volunteer involvement, MHHP educational program responsibility was transferred to existing community-based groups and organizations. In 1989, when federal funding was withdrawn, 70% of all heart health intervention programs initiated by MHHP were being continued by local sponsors and supported by local funds. By 1992, maintenance of programs had decreased to an average 60%. Differential results of program incorporation among the three intervention communities are presented including findings on community sectors that most frequently sponsored programs. Factors that facilitate or impede local ownership are discussed. Research on longer-term maintenance of heart health programs in the three communities continues.

Community Health Services↗
PubMed1993

Heart disease risk factors in the Vietnamese community of southwestern Sydney.

Despite low mortality from heart disease in the New South Wales Vietnamese community, the prevalence of risk factors for heart disease has been increasing. This study sought to identify the prevalence of heart disease risk factors in the Vietnamese community in southwestern Sydney. In 1991, 389 randomly selected Vietnamese-born residents of southwestern Sydney (79.2 per cent response rate) were interviewed by telephone about their risk status. Sixty-one per cent of this sample agreed to a second interview in their homes where physical measurements were taken. Smoking prevalence was high in males (53 per cent), whereas raised blood pressure (5.1 per cent), high blood cholesterol (21.1 per cent) and overweight (14.0 per cent) had a low prevalence compared to National Heart Foundation data for the general population. Interventions targeting males about smoking should be a health promotion priority, and the maintenance of the traditional Vietnamese diet should be encouraged.

Adolescent↗