HEALTH PROMOTIONnnswlhd.health.nsw.gov.au/health-promotion/files/... · address differences in the health status of certain community groups whose health is the poorest and who are

HEALTH PROMOTION ANNUAL REPORT 2014 -2015

NORTHERN NEW SOUTH WALES LOCAL HEALTH DISTRICT

This work is copyright. It may be reproduced in whole or part for study training purposes subject to the inclusion of an acknowledgement of the source. It may not be reproduced for commercial usage or sale. Reproduction for purposes other than those indicated above, requires written permission from the NSW Ministry of Health.

© NSW Ministry of Health 2015

For further information please contact: Health Promotion Northern NSW Local Health District Locked Mail Bag 11 Lismore NSW 2480

Phone: 0266 207517 Fax: 0266 222151 July 2015

HEALTH PROMOTION ANNUAL REPORT 2014 - 2015PAGE 2

SWISH ........................................................................... 04

Childhood overweight and obesity ................................. 06

Adult overweight and obesity ........................................ 10

Tobacco ......................................................................... 15

Falls prevention .............................................................. 20

Risky drinking ................................................................ 23

Aboriginal health and equity .......................................... 26

Research, awards and communication............................ 28

Contents

We deliver sustained, effective and comprehensive initiatives that promote and support healthy lifestyles for all. Mostly this is done at a population level (for example, we aim to have our programs in more than 80% of schools) but we also recognise that we need to address differences in the health status of certain community groups whose health is the poorest and who are most likely to miss out on opportunities to be healthy. Quit for New Life is an example of how we deliver an Aboriginal specific program to pregnant Aboriginal women in addition to running Smoke Free Beginnings programs to pregnant women across the wider community.

Our funding targets the three state-wide priority areas with a number of programs to achieve outcomes:

• Healthy Weight

• Tobacco

• Falls Prevention

In addition to these three priority areas, our Special Health Promotion Funding has targeted the following:

• Alcohol

• Hearing Disadvantage in Babies

• Equity and Aboriginal Health

• Research and Evaluation

For each of these health priorities we have a set of programs and activities which aim to encourage support and monitor the adoption and maintenance of healthy living at a personal and environmental level. We work closely with partners to achieve our goals.

Our team is committed to delivering high quality evidenced based programs complemented by applied research to monitor processes and impacts, improve program efficiency and effectiveness and to contribute to new evidence.

Find us at www.nnswlhd.health.nsw.gov.au/health-promotion

Jillian Adams

Manager, Health Promotion

Health Promotion – Adding years to life and life to years

NORTHERN NSW LOCAL HEALTH DISTRICT PAGE 3

SWISH

Screening for Hearing

SWISH – State Wide Screening for Infant HearingSWISH is the program responsible for screening the hearing of all newborn babies born in Northern NSW Local Health District sites. Approximately 2 per 1,000 babies born may have a moderate, severe or profound hearing loss in one or both ears. Early detection and intervention improves outcomes for babies with hearing loss.

The SWISH (NSW State-wide Infant Screening – Hearing) program aims to identify all babies born in NSW with significant permanent bilateral hearing loss by 3 months of age, and for those children to be able to access appropriate intervention by 6 months of age. Identification of significant hearing loss is achieved through universal hearing screening of all newborns.

Early identification and intervention are important, with research suggesting that intervention commencing by 6 months of age

may result in optimal speech and language development and minimise the need for ongoing special education. If newborns do not pass hearing screening they are referred for diagnostic audiological assessment and parents are advised on appropriate intervention, e.g. hearing aids, cochlear implant. This year we ensured that 98% of babies born in LHD

facilities had hearing screening within 1 month of age (3322 babies) and all babies who needed follow up (15) were referred

for diagnostic audiology before 6 weeks of age.

• Screening takes place usually in hospital at the mother’s bed-side in the first few days after birth or at a scheduled outpatient appointment.

• The screening is performed by trained hearing screeners.

• Several small sensor pads are placed on the baby’s head and soft clicking sounds are played into the baby’s ear through an earphone.

• The sensor pads record the baby’s responses to the sounds. Results are known immediately - Pass or Refer result for each.

• Parents/guardians of babies, identified as requiring audiology, are fully supported through the process of diagnosis and intervention by the Local Health District Audiologists.

2015 Target

Screen 90% of all babies born at health service

sites


Childhood overweight and obesity

Rock climbing, Wollongbar

About the initiativeHealthy eating and physical activity in children are important to achieving a healthy weight, and good health, growth and development. Childhood overweight and obesity is complex and needs a systematic approach across multiple settings. This year we coordinated healthy eating and physical activity programs in 132 schools and 115 child care centers reaching around 20,000 children and families.

In 2014, 27.7% of children in NSW (30.0% boys and 25.2% girls) were overweight and obese compared to 33.4% in 2012. The decline between 2012 and 2014 was not statistically significant but may be an early indication of improvement. Ongoing monitoring is required to confirm whether this is the beginning of a downward trend. Health Promotion supporting healthy eating and physical activity in children is a key to establishing healthy practices in later years.

The Healthy Children Initiative includes a range of evidence based programs, in education environments to achieve the 2015 target of reducing overweight and obesity rates in children to 21%. These interventions have contributed to stabilising the increasing trend in overweight and obesity since 1985.

Success to date in Northern NSWNSW Population Health Survey shows that:

The number of children aged 2-15 years consuming the recommended daily

intake of fruit is greater in NNSW LHD than in NSW (73.3%) and Regional

NSW (71.3%)

There has been a significant increase in the proportion of children in

NSW 2-15 years who consumed the recommended daily vegetable intake

from 13.0% in 2001 to 42.7% in 2012. In 2012 NSW intakes were only

42.7%

There has been a significant decrease from 62.3% in 2005-

2006 to 4.2% in 2013-2014 in the proportion of children 5-15 years in NNSW who used electronic media

for entertainment at home for more than 2 hours a day

51.2% 41.2%77.7%

2015 Target

Reduce overweight and obesity rates of children

and young people (5-16 years) to

21%


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Graph 1: Overweight & Obesity in NSW children aged 5-16 years

Graph 3: Recommended consumption of vegetables secondary school students aged 12-17

Graph 4: Adequate physical activity children aged 5-15 years

Graph 2: Overweight & Obesity secondary school students aged 12-17

No data available for separate LHDs. No statistically significant differences between boys and girls. No statistically significant differences between 2007 and 2014.

* Only data for 2005, 2008 and 2011 available. NNSW & MNC LHD data amalgamated. NNSW & MNC LHDs level of vegetable consumption for secondary school students’ aged 12-17 in 2011 is significantly higher than for both NSW state-wide and Rural & Regional LHDs.

* Regional NSW data is skewed. Median used as it better represents skewed data. NNSW LHD level of adequate physical activity for children aged 5-15 in 2013-14 is significantly higher than the NSW level. No 95% lower and upper confidence levels (LCL & UCL) for regional NSW median data are available, so significance of differences between NNSW and regional NSW cannot be determined.

* Only data for 2005, 2008 and 2011 available. NNSW & MNC LHD data amalgamated. There are NO statistically significant differences between NNSW & MNC LHDs level of overweight and obesity for secondary school students’ aged 12-17 in 2011 and NSW state-wide and Rural & Regional LHDs levels.

Graph data ????


Targeted healthy eating and physical activity programs

Primary school age programs

Key Program elements and Status

The Munch and Move program supports the healthy development of young children by promoting physical activity, healthy eating and reducing screen-time in children attending Early Childhood Education and Care Services.

The Live Life Well @ School program aims to get more primary school students, more active, more often, as well as focusing on healthy eating habits. The program supports primary schools to include strategies for the curriculum, parents, the school environment, policies and practices that affect healthy eating and physical activity.

Go4Fun - Works with overweight/obese children and their parents to modify family lifestyles, improve parenting skills around healthy eating and activity, promote weight management; and increase children’s wellbeing and self- esteem. This is a face-to-face program, being rolled out in low socio-economic areas, with high rates of childhood overweight and obesity.

Childcare

88% participation – preschools and long day care centers (116 services)

84% of participating centres implement 70% of the desirable healthy eating and active living practices

81% participation (133 schools)

96% of participating schools are implementing

70% of the desirable healthy eating and active living practices

Over 30 Go4Fun programs have been run across Northern NSW, reaching more than 300 overweight and obese children and their families. 88% completed the program. Children achieve an average waist circumference reduction of 1.7 cm, Body Mass Index reductions, improvements in fitness and self-esteem.

85% of early childhood services participate

60% of participating centers implement


80% of all primary schools participate

60% of participating centres are implement


298 Northern NSW overweight and obese children and their families will participate by June 2014

AchievementsTargets

Early childhood

Primary school-aged children

Families


Northern NSW Childcare

Northern NSW Schools

80%of early childhood

services across NNSW participate in the

program

(116 child care services)

80%of primary schools

across NNSW participate in the

programs.

(133 schools)

Key achievements:

Key achievements:

97%

93%

87%

91%

90%

89%

undertake nutrition learning experiences

with children

have fruit, vegetable and water break

Encouraging water or age appropriate milk as drink (67.4% are currently doing this)

Putting in place written policies on physical activity (63.2% currently have one)

Including daily fundamental movement skills for 3-5 year olds (61.5% are currently doing this)

Encouraging centers to communicate with families about healthy eating and physical activity (55.4% are currently doing this)

Increase number of schools participating (71% of schools are currently doing this)

Implement a healthy eating environment (42.7% of participating schools are currently doing this)

Encourage professional development in healthy eating and physical activity (68.6% are currently doing this)

provide information to parents on physical

activity and nutrition

provide information to parents on physical

activity and nutrition

of centers have staff trained to teach Fundamental

Movement Skills to children

encourage and support professional development in

healthy eating and physical activity

Next Focus AreasTo work with the centre’s are:

Next Focus AreasTo work with the schools are:

Adapted from: NSW Ministry of Health, Snapshot Childhood Overweight and Obesity – Healthy Children Initiative, June 2014.


Adult overweight and obesity

Stand up paddle board, Kingscliff

About the initiativeHealthy eating and active living are important in achieving a healthy weight and for overall health and well-being. The rise in overweight and obesity is mostly a result of social, environmental and technological changes over the last few decades. These changes have led to environments which encourage excess energy intake and reduced energy expenditure. Even a small excess energy imbalance over time can lead to weight gain resulting in overweight and obesity.

Indicators for NNSWThe 2012 NSW Population Health Survey showed that:

15.5%60%

53.9% of adults in NSW (60%ns in NNSW) consumed 2 or serves of fruit each but only

8.9% of adults (15.5%ns NNSW) reported consuming 5 or more serves of vegetables each day

ns = no significant difference

Reducing overweight and obesity in NSW will lead to substantial population health benefit and improved quality of life through the prevention of chronic diseases, in particular diabetes, cardiovascular disease and some cancers. These diseases cost NSW $19 billion in 2008, including financial costs and indirect costs due to lost wellbeing.

Australia has seen very high levels of overweight and obesity over the past ten years. While still very high, the trend in NSW has been stable since 2009 in both males and females. In 2014, 51.1% of adults were overweight or obese (45.6% Northern NSW but not statistically significant). Rates are higher in males, with 58.3% of males being overweight or obese, compared with 43.9% of females.

The NSW Healthy Eating and Active Living Strategy 2013-2018 provides the framework to drive partnerships across government and with key stakeholders to support healthy choices in the places where people live, work and play.

TargetStabilise overweight and obesity rates in adults by 2015 then

reduce by

5% by 2020

54.7%

55.2% of NSW adults (54.7%ns NNSW) reported achieving the recommended levels of physical activity each week.


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Graph 5: Overweight & Obesity adults

Graph 7: Recommended vegetables consumption 16 years and over

Graph 8: Adequate physical activity 16 years and over

Graph 6: High body mass attributable hospitalisations for adults

* Regional NSW data is skewed. Median used as it better represents skewed data. No statistically significant differences between adult NSW state-wide and NNSW LHD data. In 2014 there were 15% more overweight & obese adults in Regional NSW than in NNSW (median rates: 60.3% and 45.6% respectively).

* Regional NSW data is skewed. Median used as it better represents skewed data. NNSW LHD level of recommended vegetable consumption in 2014 is significantly higher than the NSW level. No 95% lower and upper confidence levels (LCL & UCL) for regional NSW median data are available, so significance of differences between NNSW and regional NSW cannot be determined. In 2014 there were 4.5% more NNSW who consumed five or more serves of vegetables daily than in Regional NSW (median rates: 15.5% and 11.0% respectively).

* Regional NSW data is skewed. Median used as it better represents skewed data.No statistically significant differences between NSW state-wide and NNSW LHD data.No 95% lower and upper confidence levels (LCL & UCL) for regional NSW median data are available, so significance of differences between NNSW and regional NSW cannot be determined.

* Regional NSW data is skewed. Median used as it better represents skewed data. No statistically significant differences between NSW state-wide and NNSW LHD data. No 95% lower and upper confidence levels (LCL & UCL) for regional NSW median data are available, so significance of differences between NNSW and regional NSW cannot be determined. In 2013-14 there were 16% fewer hospitalisations attributed to high body mass in NNSW than in Regional NSW.

Graph data ????


Preventing Overweight and Obesity in New South Wales 2013-2018

Healthy Eating & Active Living Strategy:

Because of the interaction of individual, societal and environmental factors, the problem cannot be solved by the health system alone. The Healthy Eating and Active Living Strategy provide the strategic framework for whole of government action to promote healthy eating and active living and reduce overweight and obesity. The four strategic directions of the Strategy are to:

• Create environments to support healthy eating and active living;

• Deliver state-wide healthy eating and active living support programs;

• Integrate healthy eating and active living advice as part of routine service delivery; and

• Provide education and information to enable informed healthy choices.

Key program elements and statusPhysical activity and healthy eating for adults

Get Healthy is a telephone-based service supporting NSW adults make sustained improvements in healthy eating, physical activity and achieving or maintaining a healthy weight. Participants can go through a free six- month coaching program which involves 10 sessions with university qualified health coaches.

The coaching is designed to assist with goal setting, maintaining motivation, overcoming barriers and making sustainable lifestyle changes. Participants are recruited to the Service via mass media and direct mail campaigns, or health professional referral.

Get Healthy information & Coaching service

To Dec 2013, 1496 Northern NSW residents have participated in the program including 251 new participants. We had 21 referrals for health practitioners. Across NSW, those who complete the 6 month program on average lose:

• 3.8kg in weight

• 5.1cm off waist circumference

Half lost between 2.5% - 10% of their original body weight.

They also make significant improvements to physical activity and healthy eating behaviors and maintain improvements for a further 6 months.

The proportion of Aboriginal participants registering their interest has increased from 2.3% in 2009 to 4.7% in 2013.

From February 2009 to December 2013, approximately 25,000 people have participated in the Get Healthy Service.

The GHS is being used by those who are most at need including those:

• in the lowest quintiles of advantage

• in regional and remote locations

• who have a high risk of chronic disease.

Adults

AchievementsCurrent status


The Get Healthy at Work Initiative is a workplace intervention promoting organizational, cultural and environmental change, health risk assessment at work and incentives to take part in smoking cessation, physical activity and nutrition programs

CHEGS is a not-for-profit organisation, which aims to identify, develop and implement specific community education programs that support major health promotion initiatives.

A community-based healthy lifestyle and weight loss program for Aboriginal people who brings culture and communities together to improve health and well-being.

It is a team-based weight loss competition that is linked to the NSW Aboriginal Rugby League Knockout. The program supports Aboriginal communities to work together to support achievement of healthy weight.

Get Healthy at Work

CHEGS exercise programs

Koori Knockout Health Challenge

Introduced Get Healthy At Work to Work Health and Safety Coordinators at NNSW LHD

Recruit two worksites to run the program in the community

510 people participate in 51 CHEGS exercise classes in NNSW each week.

The program was run in Lismore and about 30 people registered in the Challenge. The average weight loss for all measured participants across NSW was 2.3kg and the average reduction in waist circumference was over 3cm.55% of participants followed- up reported to lose weight during the four months after the 2013 Challenge.

Get Healthy at Work is being rolled out in the community in partnership with North Coast Medicare Local

CHEGS currently offers low cost exercise classes in Tai Chi/Qigong, Gentle Exercise, Cardio Beat and a range of other programs.

In 2014, more than 800 people from 30 teams are taking part in The Knockout Health Challenge. The Challenge aims to ensure participants are supported throughout the year to adopt healthier lifestyle behaviors.

Key program elements and statusPhysical activity and healthy eating for adults

Aboriginal communities

Adults

AchievementsCurrent status


Participants make significant improvements to their:

What was achieved?

Socio-demographic profile:

increase in Aboriginal participants (2.3% in 2009 to 4.7% in 2013)

increase in male participation (19.5% in 2009 to 27.7% in 2013)

increase in participants who speak a language other than English (7.9% in 2009 to 11.2% in 2013)

More than

25,000people have enrolled

in Get Healthy (1137 in NNSW)

Weight (3.8KG decrease)

Waist Circumference (5.1 cm reduction)

BMI (1.4 KG/m2 decrease)

Fruit & vegetable

consumption (increase)

Takeaway meal consumption

weekly (decrease)

www.health.nsw.gov.au Adapted from: NSW Ministry of Health, Snapshot of Adult Overweight and Obesity, June 2014

2.4%

8.2%

3.3%

More than half are losing between

2.5-10%

of their baseline body weight.


Tobacco

Dragonfly cafe goes smoke free, Lismore

Tobacco controlThe social costs of tobacco use in NSW are high, estimated at $8.4 billion annually1. It is the largest single preventable cause of death and disease in Australia. One in every two smokers will die prematurely as a result of being a smoker. Smoking greatly increases the risk of many cancers and is a major cause of heart disease.

Exposure to second-hand tobacco smoke results in adverse health effects, including increased risk of asthma in children and sudden infant death syndrome. The 2014 NSW Population Health Survey shows that 15.6% of all adults in NSW smoke.

In Northern NSW, our rate is 19.0% but this is not statistically significantly different to the NSW rate.

The NSW Government continues to be a leader in tobacco control by regulating the sale, display and advertising of tobacco and smoking in enclosed public places and some outdoor settings.

For every dollar invested in tobacco control programs there is a two dollar savings in health care expenditure1.1 Applied Economics (2003). Returns on investment in public health. Department of Health and Ageing.

Progress to date

15.6% 36.8% 7.5% 93%

Significant decrease in the proportion of non-

aboriginal adults who are current smokers (from 22.2%

in 2002 to 15.6% in 2013)

Decrease in the proportion of aboriginal adults who are current smokers (from 40.2% in 2002 to 36.8% in 2013)

Significant decrease in the proportion of secondary school students aged 12-17 years who are current

tobacco smokers (27.3% in 1984 to 7.5% in 2011)

Nine out of ten adults now live in smoke-free homes

2015 Target

Reduce smoking rates by:

3% for all people and by

4% for Aboriginal people

by 2015


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Graph 9: Current smoking 16 years and over

Graph 11: Smoking in pregnancy

Graph 10: Current smoking by Aboriginality in NSW 16 years and over

* Regional NSW data is skewed. Median used as it better represents skewed data.No statistically significant differences between NSW state-wide and NNSW LHD data.

* Regional NSW data is skewed. Median used as it better represents skewed data.No confidence levels supplied so significance cannot be calculated.

Graph data ????


Program elements and status

We coordinate training for health professionals, youth workers and other front line professionals to assist them in their efforts to help smokers to quit.

Brief Interventions are research proven structured interactions that help reduce smoking levels. They consist of carbon monoxide level tests, followed by a structured discussion to determine participant’s level of nicotine dependence and readiness to change. After this, we provide advice, offer referral to the quit line and may offer nicotine replacement therapy samples. We target disadvantaged communities by conducting Brief Interventions (BI) at Centrelink and at Aboriginal events.

Our LHD sites are smoke free but we do not have 100% compliance. This year we conducted compliance audits in health campuses and provided reports and recommendation for WH&S committees for action to improve compliance.

There is no safe level of exposure to second-hand smoke and it causes a range of serious health problems, especially in children. Smoke free environments are also beneficial for smokers by supporting their efforts to quit and reduce the consumption of cigarettes as smoke-free environments provide fewer opportunities to smoke.

NSW is at the forefront of world class tobacco control legislation. Amendments to the Smoke-free Environment Act (SFE) 2000 have introduced a suite of tobacco reforms which prevent smoking in a number of outdoor public areas.

In July 2015, NSW will introduce Smoke Free Commercial Outdoor Dining. Awareness raising interventions for both restaurant managers, staff and customers is vital for compliance.

Public and Health Professional education

Cessation services

Smoke free health care

Second hand smoke

9 NGO staff at youth organisations trainings,

30 Child and Family Health Nurses trained.

469 Health Professionals trained through Quit 4 New Life

This year we conducted 213 brief interventions, targeting vulnerable communities.

Audits conducted in 16 sites. Reports provided to Work Health and Safety Committees and Managers for progressing recommendations

450 commercial dining businesses were contacted by mail, 35 were visited.

Media releases resulted in 3 print articles and 2 radio interviews.

Organizers of four local food festivals received individual advice and written resources.

Number of professionals trained

Number of people supported to quit.

Achieve high levels of compliance with Smoke Free Health Care.

Achieve high levels of compliance With smoke-free legislation.

Increase the proportion of adults living in smoke-free households by 0.5% per year to 2017.

Current status

Indicators & targets

Smokers

General population


The teenage years are the most common time for taking up smoking, with 80 per cent of current smokers saying they began before the age of 20 years. The earlier a person takes up smoking, the harder it is to quit. 21% of NSW secondary school students aged 12-17 Years have ever smoked compared to 68% in 1984.

Smoking rates in NSW Aboriginal communities remain high. We are working in partnership with Aboriginal Controlled Health Services to address tobacco smoking for Aboriginal people and communities in NNSW. Initiatives include; training Aboriginal Health Workers to improve skills in brief interventions and cessation advice, working together on community based tobacco control programs and supporting Aboriginal Community Controlled Health Services in their efforts to address smoking locally and evaluate their programs.

Early prevention

Partnership with Aboriginal people and communities

Six youth organisations received training and advice to assist their worksite to become smoke free and for staff to give brief interventions to young people to help them quit smoking.

67 training and education sessions were conducted and a total of 469 Health Professionals trained in Tobacco Cessation

Reduce the proportion of students who have ever smoked tobacco by1% per year to 2017.

Reduce smoking rates by 4% for Aboriginal people.

37% of NSW Aboriginal adults aged 16 years and over are current smokers compared to 40% in 2002.

Teenager and young

people

Aboriginal communities

The program supports Aboriginal women and women having an Aboriginal baby to quit smoking while pregnant and to stay quit after the birth of the baby.

The program works by:

• Providing smoking cessation support for women and household members.

• Embedding smoking cessation support into routine clinical practice.

In 2013 50% of Aboriginal mothers reported smoking during pregnancy

Quit for new life

In 2014/15:

• 64% (52) of women were referred to Quitline

• 52% (45) were provided with NRT

• 70% (60) were booked in for follow up appointments

Reduce smoking rates by 2% per year for pregnant Aboriginal women.

50% of Aboriginal pregnant women attending a service will be referred to Quitline, receive Nicotine Replacement Therapy (NRT) and will be followed up

Pregnant women


Current status



Smoke free Beginnings targets all pregnant women who smoke

Smoke free beginnings

30 Child and Family Nurses were trained to deliver brief interventions to women who smoke.

Reduce smoking rates by 0.5% for non- Aboriginal pregnant women

• in 2013 xx 9% of non-Aboriginal mothers reported smoking during pregnancy

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2007 - Smoke-free enclosed public places in pubs, clubs, nightclubs and the casino (except private gaming areas)

2008 - increased penalties for selling tobacco and non-tobacco smoking products to minors

2009 - ban on smoking in cars with children

2010 - point of sale reforms including tobacco display ban

2005 - commencement of anti-smoking campaigns in NSW2000 - smoking

banned inside restaurants and cafes 2004 - NSW announced

smoking in indoor areas or licensed premises would be phased out by July 2007

2006 - Health warnings on packaging

Amendments to the Smoke-Free Environment Act 2000 prohibiting smoking in certain public outdoor places

Current smoking NSW adults & major NSW tobacco control initiatives 1997-2013

www.health.nsw.gov.au Adapted from: NSW Ministry of Health, Snapshot of Tobacco Strategy 2012-2017 May 2014


Current status


Pregnant women


Falls prevention

Stepping On classes, Alstonville

Falls preventionFalls injury is a major cause of hospitalization and loss of independence among people aged 65 and older. But falls can be prevented. At least 2 hours per week of physical activity that incorporates exercises that challenge balance and increase strength can reduce the risk of falls by 42%. In Northern NSW our overnight falls hopitalisation rates for people aged over 65 are significantly (10%) lower than the NSWaverage but our total falls hospitalization rates are worse.

* Regional NSW data is skewed. Median used as it better represents skewed data.No confidence levels supplied so significance cannot be calculated.

Falls Prevention committees have been established to ensure all older people who are admitted to hospital are screened, assessed and managed for falls. We also work closely with many aged care services to ensure they do the same. Our CHEGS organisation runs Stepping On programs for older people in 17 locations across the Northern Rivers. In additions, CHEGS delivers a range of exercise programs offered at a reduced price for older people. These include Tai Chi and Qi Gong which are particularly useful in preventing falls. This year, we also worked with Aboriginal elders, staff and carers to increase awareness of the falls prevention messages:

Are you getting enough exercise? Do regular exercise most days of the week

Are you taking medications? Some medications make you unsteady, talk to your doctor.

Is your vision changing? Have your eyes checked

Are you deficient in calcium and vitamin D? Talk to your doctor and visit www.ostoporosis.org.au

Are your feet sore? Have your feet checked and wear comfortable firm fitting, flat shoes.

2014 TargetDeliver Stepping On

Falls Prevention program to 340

participants

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Graph 12: Total fall-related injury hospitalisations stays for persons 65+


Key program elements and achievements

Stepping On is a free program where older people attend regular group sessions facilitated by local specialist health professionals and invited guest speakers. The program covers a range of topics, including vision, medicines and practical exercises to improve strength and balance. The group-based sessions run for two hours a week for seven weeks, followed by a refresher. Stepping on is run by our Community Health Education Group (CHEGS) exercise facilitators.

CHEGS is a not-for-profit organisation, which aims to identify, develop and implement specific community education programs that support major health promotion initiatives. CHEGS currently offers low cost workshops and classes on Exercise, Tai Chi/Qigong and Stepping on Falls Prevention. CHEGS currently employs 25 Community Educators who are fully accredited and registered Fitness Instructors with Fitness Australia.

Stepping On

CHEGS exercise classes

2010-11 2894 Northern NSW Hospitalisations which is significantly lower than NSW (3129)

CHEGS delivered 34 Stepping On programs to 510 participants.

Delivered 40 programs to 550 participants

Fall related injury overnight stay hospitalizations for persons aged 65 and over.

The target for 2013/14 was to deiver 34 programs to 340 participants

Target: deliver at least 40 programs to 400 participants.

The Stepping On Program is designed for people living at home and have fallen or have a fear of falling. Stepping On helps older people maintain independence and gives them confidence to undertake their everyday activities safely and without the risk of falling.

Current status


Older people

General population

Risky drinking

Hang gliding at Cape Byron

Risky drinkingIn Australia, Alcohol misuse leads to 430 hospitalisations each day and costs $36 billion per year. Health Promotion works to reduce risky drinking in adolescence and adulthood. Risky drinking is defined as more than two standard drinks (see below) on one day over a lifetime or more than four drinks in a session.

Alcohol not only contributes to ill health but also to violence. Half the men and a third of women who are injured have been drinking at risky levels. Our Hospital Emergency Departments would welcome a reduction in risky drinking levels.

2015 Target

Reduce risky drinking to

below 25% by 2015

Reduce road fatalities to

4.3 per 100,000 by 2016

Alcohol hospitalisations in Australia 2010Source: Foundation for Alcohol Research and Education

130ml

High StrengthSpirit Nip

40% Alc Vol

1.5375ml

Full StrengthPre-mix Spirits

5% Alc Vol

1.4375ml

Full Strength4.8% Alc Vol

0.8375ml

Low Strength2.7% Alc Vol

1375ml

Mid Strength3.5% Alc Vol

1.1285ml


1.6425ml


1.5150ml

Average Restaurant

Serving of Red Wine

13% Alc Vol

1.4150ml

Average Restaurant Serving of

White Wine11.5% Alc Vol

1.430ml

Average Restaurant

Serve of Champagne12% Alc Vol

These are only an approximate number of standard drinks. Always read the container for the exact number of standard drinks.

Graph 13: Alcohol attributable hospitalisations

1000

900

800

700

600

500

400

2001

-02

2005

-06

2007

-08

2009

-10

2011

-12

2013

-14

NSW

RA

TE P

ER 1

00,0

00 P

OPU

LATI

ON

2003

-04

Rural NSW median* NNSW LHD

* Regional NSW data is skewed. Median used as it better represents skewed data. NNSW LHD level of alcohol attributable hospitalisations in 2013-14 is significantly higher than the NSW level. No 95% lower and upper confidence levels (LCL & UCL) for regional NSW median data are available, so significance of differences between NNSW and regional NSW cannot be determined.

Chronic disease and injury caused by alcohol has increased by 62% over a decade, causing 15 deaths and 430 hospitalisations each day in Australia (see left). Among men, injuries were responsible for the highest number of alcohol-related deaths (36%), followed by cancers (25%) and digestive diseases (16%).

Among women, the highest number of alcohol-attributable deaths was for heart diseases (34%) followed by cancers (31%) and injuries (12%).


Key program elements and achievements

RRISK is a resilience building program that is relevant to the social life, developmental stage and concerns of adolescents. It extends the school based drug education and road safety curriculum by providing opportunities for senior high school students to develop knowledge, attitudes and skills to reduce risk taking and develop safer celebrating strategies. The proportion of students who have ever drunk alcohol has reduced from 87% in 2005 to 71% in 2011.

Drinkcheck aims to educate people about responsible drinking through completing an interactive questionnaire about their drinking behaviour. Drinkcheck gives a brief alcohol risk assessment, then education about low risk drinking, standard drinks and drinking and driving. This year Drinkcheck was uploaded onto the Healthy North Coast website (www.healthynorthcoast.org.au/drinkcheck)

Reduce Risk Increase Student Knowledge (RRISK)

Drinkcheck

This year 30 Northern NSW High Schools participated in RRISK Program and approx. 3000 students attended the RRISK seminars.

The proportion of adults drinking at Risky levels is 31.6% for Northern NSW compared to 27.4% in NSW, but this difference is not statistically significant.

Drink check has been completed 57 times on the website. 25% of participants were in the extreme risk category.

Reduce total risky drinking to below 25% by 2015.

Reduce road fatalities to 4.3 per 100, 0000 population by 2016.

Reduce total risky drinking to below 25% by 2015.

Research conducted by the George Institute of International Health has found that participation in RRISK resulted in a 44% reduction in traffic offences including road crashes.

Current status


Adolescents

General population

Students learning the recover position,

Tweed Heads


Aboriginal health & equity

Having a laugh at Bonalbo

Aboriginal health & equityThe socio-economic status (SES) of LGAs in Northern NSW (as measured by the 2011 Index of Relative Social Disadvantage) is below the NSW average. The overall level of socio-economic disadvantage in Northern NSW contributes to higher than average levels of health problems and demand for services across the LHD.

(Northern New South Wales integrated Aboriginal Health and Well Being Plan2015-2020 January 2015).

This is a problem experienced by many LHDs not only NNSW. Supporting Health Service staff to embed health equity practice principles into the workplace can make a positive difference to long term population health outcomes for all communities across the NSW LHDs. The Health Equity E-learning course on HETI online supports thus style of practice change action.

Smoking status is considerably higher in lower SES groups especially Aboriginal and Torres Strait Islander communities. Reducing maternal smoking in Aboriginal mothers will positively influence health outcomes for Aboriginal mothers and babies in NSW. Consequently maternal reducing maternal smoking has been a major equity focus over 2014-15.

2014-15 Achievements • 213 students and Government employees accessed

the Health Promotion Healthy Equity E-learning course on HETI online over the past financial year.

• 213 tobacco Brief Interventions were conducted at Aboriginal and Torres Strait Islander community events across the NNSW LHD.

• 121 people received follow up tobacco cessation care through the Quit for new life program.

• 67 training and education sessions were conducted and a total of 469 Health Professionals trained in Tobacco Cessation and the Quit for New Life program.

• Health Promotion has worked specifically with organisations to promote Smokefree pregnancies with 34 organisation across the LHD now referring to the QFNL program.


Research, awards and communication

Research and evaluation To create the evidence base for health promotion, health promotion projects are rigorously evaluated. We evaluate if our strategies reach the intended target group and how well they achieve their aims. Crucially, the impact of our actions on policies, environments and behaviours, and where possible the health status outcomes are measured and analysed. If we can’t easily measure changes in health status, such as the proportion of children who are overweight, we research intermediate indicators, such as the amount of time spent in front of a small screen, since we know that the scientific literature gives us clear evidence that this relates to levels of overweight at a population level.

We also assist health promotion staff to conduct research into why segments of the population engage in unhealthy behaviours so that we can offer suggestions to change these behaviours, e.g. we are currently interviewingmothers about what influences how they pack lunch boxes for their children. We are also about to interview AMIHS midwives about their experience of including consistent and intensive smoking cessation to their work (see more detail on next page).

MediaHealth Promotion featured in the print radio and TV media 23 times over 2013-2014 and we averaged one post per week on the Northern Rivers LHD facebook page and one post per week on the Go4Fun facebook page. We also started an electronic newsletter for healthy children’s lunchboxes which has 700 subscribers and 40 followers on Instagram.

PublicationsReports

Molyneux M. Live Life Well @ School: onsite project officer manual. Lismore: North Coast Health Promotion, NSW Health, 2015.

Journal Publications

Barnett LM, Ridgers ND, Zask A, Salmon J. Face validity and reliability of a pictorial instrument for assessing fundamental movement skills perceived competence in young children. Journal of Science & Medicine in Sport. 2015;18(1):98-102.

Barnett LM, Zask A, Rose L, Hughes D, Adams J. Three-year follow-up of an early childhood intervention: what about physical activity and weight status? Journal of Physical Activity and Health. 2015;12(3):319 -21.

Awards

Lets Look at Lunches Maxine Molyneux and Kate Collins Win the NNSW LHD Quality Awards, 2015, Health Promotion category

Active Kyogle Winner in the Northern NSW LHD Quality Awards 2014, Building Partnerships category, Jillian Adams and Nancy Martin


Research and Evaluation - Main projects this year

The project aimed to reduce smoking rates among pregnant women and mothers of young babies. Maternity and child & family health staff were tasked with assessing smoking status and conducting brief intervention address smoking with pre and post natal women. Our team evaluated whether smoking rates changed following this intervention. After collecting data for over two years, our team has compiled a database of 3200 written surveys, 935 interviews with new mothers after the birth of their baby, and 712 new mothers around their child’s first birthday.

Every year, our teamevaluates students’ and teachers’ rating of the individual sessions of the RRISK seminars. This year we also conducted an impact evaluation, which assessed whether a peer facilitated session changed year 11 students’ confidence to engage in harmreduction and protective behaviours like providing first aid, placing someone in the recovery position, calling 000 and providing accurate information to the operator.

Established and maintained Q4NL database to collect detailed data on program participants. Developed and formatted protocols and instruments to support the program implementation.

We participated in a statewide evaluation of Go4fun. Locally, we measured anthropometric outcomes (weight, waist circumference) and behaviour change (changes in self-esteem, improvements in dietary intake, changes in physical activity levels and time spent in front of small screens) for children who attended a once a week program for ten weeks and compared the results to children who attendeda twice a week program.

Provided supervision and technical assistance with two small projects conducted by Healthy Children’s Initiative team members regarding evaluation of:

• The impact of providing schools with healthy eating and physical activity articles for newsletters, and

• Qualitative study of factors influencing parents’ packing of lunch boxes for primary school children

Provided training workshops to health promotion and other interested staff regarding understanding scientific literature and using excel.

Provided individual mentoring to staff members in the process of reviewing papers for peer reviewed journals

Smoke Free Beginnings

Reduce Risk Increase Student Knowledge (RRISK)

Quit for new life

Go4Fun

Mentored and supervised HP staff in R&E projects

Providing R&E training and mentoring to Health Promotion staff

Analysis commenced. Preliminary results presented to the health promotion team, child & family health nurses, and working group.

Analysis conducted and report produced and presented to the RRISK inter-sectorial committee.

Database operational Protocols and instruments used Provided reports and program statistics to the team

The once a week program achieved similar results to the twice a week program. This means from July 1st, 2014 all programwill operate only once a week, saving money andmaking it more convenient for families to attend.

Schools selected and data collected for 18 schools Ethics application approved and data collection commenced

Three well-attended workshops conducted.

Health promotion staff reviewed 4 papers for peer reviewed journals.

Current status

© Copyright 2015

Documents

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