Melbourne School of Population and Global Health - Research Publications
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ItemAntenatal mood and fetal attachment after assisted conception(Elsevier, 2007)Objective: Australian women conceiving with ART are at fourfold risk of admission to early parenting treatment programs compared to those conceiving spontaneously. The study aimed to identify prevalence and determinants of antenatal mood disturbance and other risks for early parenting difficulties after assisted conception. Design: A prospective longitudinal investigation from conception to 18 months postpartum using telephone interviews and self-report questionnaires. Setting: Melbourne IVF and Royal Women’s Hospital Reproductive Services, Victoria, Australia. Patient(s): A consecutive cohort of English-speaking women with ultrasound-confirmed ART -conceived pregnancies. Main outcome measure(s): Standardized psychometric measures of mood, quality of marital relationship, mother to fetus emotional attachment, and personality. Intervention(s): None Result(s): Of the 288 women with a confirmed pregnancy, 239 were contactable, 183 (77%) recruited and 95% completed both early and late pregnancy assessments. Participants were socioeconomically advantaged, had very good pregnancy health, exceptional marital relationships, normal personality styles and intense affectionate attachment to the fetus. Very few (< 5%) had clinically significant mood disturbance in late pregnancy. Conclusions: There were low rates of antenatal mood disturbance and other risk factors for postpartum depression. Pregnancy and motherhood might be idealised after ART conception and preparation for the realities of infant care might then be insufficient.
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ItemAssisted conception is a risk factor for postnatal mood disturbance and early parenting difficulties(Elsevier, 2005)Objective: To investigate whether assisted conception is associated with an increased risk of admission to a residential early parenting program for treatment of maternal mood disorder or infant feeding or sleeping disorders in the postpartum year. Design: Systematic audit of consecutive medical records. Setting: Masada Private Hospital Mother Baby Unit (MPHMBU), Melbourne, Australia Patients: Medical records of all mother-infant dyads admitted to MPHMBU between July 2000 and August 2002. Main outcome measures: Modes of conception and delivery of index infant, maternal and infant age on admission, multiplicity of birth, infant birthweight and Edinburgh Postnatal Depression Scale scores. Results: A total of 745 records were audited and mode of conception was recorded in 526 (70.6%) of records. Overall 6% (45 / 745) of the admitted infants had been conceived through ART compared to 1.52% in the general population (RR 4.0, 95% CI 3.0 - 5.4). Mothers who had conceived with ART were older and more likely to have had caesarean and multiple births than those who conceived spontaneously. Conclusions: Assisted conception appears to be associated with a significantly increased rate of early parenting difficulties. Women who experience assisted conception may require additional support after their babies are born.
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ItemGiving up on drugs: homeless young people and self-reported problematic drug use(Federal Legal Publications, Inc., 2006)Numerous studies have revealed high levels of drug-taking among young people experiencing homelessness. This article draws upon 20 in-depth interviews carried out as part of a five-year longitudinal study of homeless young people (Project i). It is noteworthy that almost all of those who identified their drug use as problematic gave up or reduced their level of use without treatment or professional assistance during the period of the study. The interviews provided insight into the way in which some young people experiencing homelessness view their drug use and the actions they take in light of these understandings. Here we report their stated reasons for giving up or reducing usage and identify some commonalities that may have impacted on the outcomes.
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ItemA comparison of different methods for including 'age at menopause' in analyses of the association between hormone replacement therapy use and breast cancer( 2007)Background and methodology: Late ‘age at menopause’ is a recognised risk factor for postmenopausal breast cancer and is also associated with decreased use of hormone replacement therapy (HRT). When investigating the association between HRT use and breast cancer risk it is therefore necessary to adjust for the potential confounder, ‘age at menopause’. ‘Age at menopause’, however, cannot be determined for women with a hysterectomy and ovarian conservation. Using data on 13 357 postmenopausal women in whom 396 cases of invasive breast cancer were diagnosed during 9 years of follow-up from the Melbourne Collaborative Cohort Study, we compared the estimates of relative risk of HRT use for breast cancer for three different methods of dealing with missing data: complete-case analysis single imputation and multiple imputation. Results: ‘Age at menopause’ was missing for 17% of the data. Both HRT use and ‘age at menopause’ were significant risk factors for breast cancer, although ‘age at menopause’ only marginally confounded the estimates of risk for HRT. Women with ‘age at menopause’ missing did not represent a random sample of the population. Complete-case analyses resulted in higher estimates of the risk associated with HRT use compared with the different methods of imputation. Discussion and conclusions: We recommend that analyses investigating the association between HRT and breast cancer should present the results in two ways: excluding women with ‘age at menopause’ missing and including the women using multiple imputation. For both methods, estimates of risk, with and without the adjustment of ‘age at menopause’, should be given.
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ItemA qualitative study of women's use of emergency contraception( 2005)BACKGROUND: While the use of emergency contraception (EC) is becoming more widespread in Australia, little is known about the reasons for, and the social context of, this use. METHODS: In order to explore the use of EC from the perspective of users, a qualitative study was conducted with women presenting to one of three health care settings in Melbourne, Australia for EC. RESULTS: Thirty-two women ranging in age from 18 to 45 years were interviewed. While a number of themes were discussed with the women, this paper reports on four ‘types of users’ of EC identified from the data. ‘Controllers’ experienced failure of their contraceptive method and were very uncomfortable needing EC. They changed their contraceptive strategy in an attempt to avoid needing EC in the future. ‘Thwarted controllers’ were similar to controllers except that they could not improve their contraceptive strategy due to medical or social limitations. ‘Risk takers’ saw the use of EC as a component of their overall contraceptive strategy. They did not rely on EC regularly, but were comfortable to use it occasionally when the need arose. A final group of women were ‘caught short’ by a sexual experience that was unplanned and therefore they did not manage to use their chosen contraceptive strategy. CONCLUSIONS: The findings from this study challenge the assumptions that are often made about the users of EC and highlight the need to acknowledge the different ways that women make sense of, and make decisions about, contraception.
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ItemSocio-economic pathways to diet: modelling the association between socio-economic position and food purchasing behaviour( 2006)Objectives: To examine the association between education level and food purchasing behaviour and the contribution of dietary knowledge to this relationship; and the association between household income and purchasing behaviour and the contribution made by subjective perceptions about the cost of healthy food. Design and setting: The study was conducted in Brisbane City (Australia) in 2000. The sample was selected using a stratified two-stage cluster design. Data were collected by face-to-face interview from residents of private dwellings (n ¼ 1003), and the response rate was 66.4%. Dietary knowledge was measured using a 20-item index that assessed general knowledge about food, nutrition, health and their interrelationships. Food-cost concern was measured using a three-item scale derived from principal components analysis (a ¼ 0.647). Food purchasing was measured using a 16-itemindex that reflected a household’s purchase of grocery items that were consistent (or otherwise) with dietary guideline recommendations. Associations among the variables were analysed using linear regression with adjustment for age and sex. Results: Significant associations were found between education, household income and food purchasing behaviour. Food shoppers with low levels of education, and those residing in low-income households, were least likely to purchase foods that were comparatively high in fibre and low in fat, salt and sugar. Socio-economic differences in dietary knowledge represented part of the pathway through which educational attainment exerts an influence on diet; and food purchasing differences by household income were related to diet in part via food-cost concern. Conclusions: Our findings suggest that socio-economic differences in food purchasing behaviour may contribute to the relationship between socio-economic position and food and nutrient intakes, and, by extension, to socio-economic health inequalities for diet-related disease. Further, socio-economic differences in dietary knowledge and concerns about the cost of healthy food play an important role in these relationships and hence should form the focus of future health promotion efforts directed at reducing health inequalities and encouraging the general population to improve their diets.
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ItemDoes gender modify associations between self rated health and the social and economic characteristics of local environments?( 2006)OBJECTIVES: To examine whether area level socioeconomic disadvantage and social capital have different relations with women’s and men’s self rated health. METHODS: The study used data from 15,112 respondents to the 1998 Tasmanian (Australia) healthy communities study (60% response rate) nested within 41 statistical local areas. Gender stratified analyses were conducted of the associations between the index of relative socioeconomic disadvantage (IRSD) and social capital (neighbourhood integration, neighbourhood alienation, neighbourhood safety, political participation, social trust, trust in institutions) and individual level self rated health using multilevel logistic regression analysis before (age only) and after adjustment for individual level confounders (marital status, indigenous status, income, education, occupation, smoking). The study also tested for interactions between gender and area level variables. RESULTS: IRSD was associated with poor self rated health for women (age adjusted p<0.001) and men (age adjusted p<0.001), however, the estimates attenuated when adjusted for individual level variables. Political participation and neighbourhood safety were protective for women’s self rated health but not for men’s. Interactions between gender and political participation (p = 0.010) and neighbourhood safety (p = 0.023) were significant. CONCLUSIONS: These finding suggest that women may benefit more than men from higher levels of area social capital.
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ItemArea variation in mortality in Tasmania (Australia): the contributions of socioeconomic disadvantage, social capital and geographic remoteness(Elsevier, 2006)This study investigated the association between socioeconomic disadvantage, social capital, geographic remoteness and mortality in the Australian state of Tasmania. The analysis is based on death rates among persons aged 25-74 years in 41 statistical local areas (SLA) for the period 1998-2000. Multilevel binomial regression indicated that death rates were significantly higher in disadvantaged areas. There was little support for an association between social capital and mortality, thereby contesting the often held notion that social capital is universally important for explaining variations in population health. Similarly, we found little evidence of a link between geographic remoteness and mortality, which contrasts with that found in other Australian states; this probably reflects the small size of Tasmania, and limited variation in the degree of remoteness amongst its SLA.
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ItemGood gay men don’t get “messy”: injecting drug use and gay community( 2005)This paper reports on an ethnographic exploration of gay men who inject drugs in Melbourne, Australia’s second largest city, and demonstrates a further diversification of gay men’s lives, characterized previously as living in a “post AIDS” era (Dowsett 1996a). It suggests that gay community plays a crucial part in some men’s accounts of drug use and shapes their experience of drug injection. Injection remains an abject act, which the gay community is reticent to discuss, with consequences for gay men’s health, HIV/AIDS, hepatitis C, sex, and gay community. The reticence positions drug taking (particularly drug injection) as an individual issue and as a violation of practices of self care that results both from gay men’s culture of drug use and from the experience of otherness reported by gay injectors. This paper explores emerging paradoxes for gay men in relation to sex, drugs, relationality, sociality, community, and health.
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ItemDeterminants of false positive recall in an Australian mammographic screening program(Elsevier, 2006)We conducted a case-control study (n=30128) to assess the importance of clinical (e.g. family history, age, hormone replacement therapy (HRT) use and duration) and service-related characteristics (e.g. time since introduction of Kodak MINR2000 film, year of screen) for false positive (FP) recall at BreastScreen Victoria, Australia. There was an age-adjusted upward trend in FP recall rates with year of screen at first (odds ratio (OR) 1.11, 95% confidence interval (95% CI) 1.08-1.13) and subsequent rounds (OR 1.04, 95% CI 1.01-1.06). In the multivariate analysis, the upward trend only remained for first round and age and family history also remained statistically significant at first round. At subsequent rounds the time since introduction of MINR2000, age, strong family history of breast cancer, use of HRT, recall at previous screen and previous screen at more than 27 months were all important predictors of FP recall. The rise in FP rates with year of screen at first round screening is of concern and may require further training of radiologists to improve confidence when viewing films when there is no films for comparison.