Chronic diseases are a major threat to human health, substantially reducing quality of life (QOL). Since the COVID-19 pandemic there have been surprisingly few surveys specifically focusing on the QOL of individuals living with chronic diseases. This study addresses this gap and assesses the QOL and associated factors of those with chronic diseases in the immediate aftermath of the COVID-19 pandemic. We conducted a cross-sectional study in six cities of Hubei Province, China, from May to August 2021, using a multi-stage cluster sampling technique to select 1,560 study participants. A 12-Item Short Form Survey (SF-12) Scale assessed QOL. Multivariate linear regression analyses and the Shapley decomposition technique identified related factors and the extent of contribution to QOL. We enjoyed a very high response rate to our invitation to participate; of these 1,507 questionnaires were considered valid (96.6

OBJECTIVES:To examine the combined influence of food environment, built environment, socio-economic status and individual factors (maternal age, parity, smoking status and need for an interpreter) on maternal overweight, gestational diabetes mellitus (GDM) and large-for-gestational age (LGA) births in Australia. DESIGN:Retrospective cohort study. SETTING:Melbourne, Australia. POPULATION:163 760 singleton pregnancies/births. MAIN OUTCOMES MEASURES:Primary outcomes: maternal overweight, GDM and LGA births. METHODS:Structural equation modelling (SEM) assessed direct and indirect associations, with maternal overweight as a mediator. LCA was used to classify risk variation across socio-economic strata. RESULTS:Among 163 760 births, a higher density of unhealthy food outlets, lower liveability scores and greater socio-economic disadvantage were associated with maternal overweight. Maternal overweight strongly predicted GDM (c = 0.118, 95% CI: 0.113-0.124; p < 0.001) LGA births (c = 0.058, 95% CI: 0.053-0.059; p < 0.001), while higher liveability and walkability environments were protective against maternal overweight (c = -0.011, 95% CI: -0.019 to -0.002; p < 0.05). LCA identified a high-risk subgroup (85.1% overweight, 34.4% GDM) concentrated in socio-economically disadvantaged areas with poor access to healthy food and more walkable neighbourhoods. CONCLUSIONS:Environmental and socio-economic factors have significant independent influences on maternal overweight, GDM and LGA births. Addressing food access disparities, improving the walkability and liveability of residential areas and ensuring equitable healthcare infrastructure could reduce maternal health risks and promote better pregnancy outcomes.

INTRODUCTION:Children's health and wellbeing is influenced by the social, economic and environmental conditions in which they live, known as the social determinants of health (SDH). This study examines caregivers' socio-demographic characteristics and reports of children substantially affected by others' drinking (i.e., caregivers' interpretations of severity). METHODS:A sample of 705 adults living with children under 18 years from the 2021 Australian Alcohol's Harm to Others study indicated how much a child was negatively affected by others' drinking (excluding their own) in the past year. Responses were categorised as 'substantially affected' or 'less substantially affected'. Logistic regressions examined associations of socio-demographic characteristics and reports of substantially affected children. RESULTS:Amongst caregivers, 5.4% indicated a child was substantially affected by others' drinking in the past year. Identifying as a woman (95% CI 1.17-5.13, p = 0.017), experiencing financial stress (95% CI 2.01-7.70, p = 0.000), being a single caregiver (95% CI 1.35-6.56, p = 0.007) or living in an area with a lower Socio-Economic Indexes for Areas score (95% CI 1.03-3.94, p = 0.039) was associated with an increased likelihood of indicating a child was substantially affected by others' drinking. DISCUSSION AND CONCLUSIONS:Our findings highlight that caregiver social disadvantage is associated with indicating a child was substantially affected by others' drinking. Policies addressing alcohol consumption and social disadvantage affecting children's wellbeing are needed, particularly financial support for families experiencing financial stress and single caregivers. Larger and more targeted studies are needed to further examine SDH and outcomes for children related to others' drinking.

Relationship separation constitutes a period of significant risk for families, with many parents and children experiencing an escalation in domestic and family violence (DFV) as they move through the separation process. While research demonstrating associated risks and adverse impacts is well documented, modifiable factors associated with increased safety for this vulnerable group have received less attention. This scoping review addresses this gap. Informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping reviews (PRISMA-ScR), articles were retrieved from the Medline, PsycINFO, CINAHL, Embase, and SCOPUS databases. Results were limited to peer-reviewed articles reporting original empirical data, in English. No date restrictions were applied. In the resulting 17 eligible studies, we found inconsistent definition and measurement of safety underscored by a paucity of research focusing on safety as a primary outcome for separating families affected by DFV. Of the available evidence, socioecological factors associated with enhanced safety during this period included physical distance from the perpetrator, strategic use of technology to enhance safety, relational support, survivor-centered service support, and intentional processes to aide safety within the family law and court systems. At the individual level, parents’ active role in navigating safety for themselves and their children, particularly in the face of systemic and service barriers, appears key. Consideration is given to the interface of systems, socioecological and individual factors that may collectively promote safety from DFV during the family separation process.

ABSTRACT Background Research has linked postcode‐level sociodemographic, food and built environment factors to maternal and perinatal outcomes like overweight (BMI > 25 kg/m 2 ), gestational diabetes mellitus (GDM) and large for gestational age (LGA) birthweight. However, little is known about how these factors were influenced by the COVID‐19 pandemic. We examine how postcode‐level indicators and lockdown conditions are associated with the prevalence of maternal overweight, GDM and LGA. Materials and Methods We analysed birth records from 12 public maternity hospitals in Melbourne, integrating postcode‐level environmental indicators. Spatial regression models assessed associations between these indicators and maternal health outcomes, distinguishing between (a) the COVID‐19 lockdown and (b) post‐lockdown periods. Results We included 31 083 singleton birth records from 2020 to 2023 across 235 postcodes in Greater Melbourne. The prevalence of maternal overweight, GDM and LGA were 496, 178 and 103 per 1000 births, respectively. Maternal overweight was less prevalent in postcodes with higher median ages and socioeconomic scores, with disparities intensifying during lockdowns. GDM was more common in areas with younger, overseas‐born populations, while LGA correlated with higher median age and fewer overseas‐born residents. Notably, maternal overweight mediated the effect of socioeconomic status on GDM and LGA. Conclusions The prevalence of maternal overweight, GDM and LGA varies significantly across Melbourne, shaped by postcode‐level factors. The pandemic lockdown amplified existing health disparities. The food and built‐environment factors independently influence maternal and perinatal outcomes.

The Family DOORS Triage Tool is a self-report measure of family violence victimization and perpetration risk, completed by parties on filing or responding to a parenting matter in the Federal Circuit and Family Court of Australia (Divisions 1 and 2), collectively "the Courts." The tool and associated risk rubric inform subsequent risk response processes within the Courts. We sought to test the tool's utility and fitness-for-purpose within a new family violence response initiative by the Courts. Data from 4,175 adults, collected using the Family DOORS Triage Tool and Court intake records, were used to examine (a) self-reported family violence risk profiles and risk factor clustering; (b) the tool's acceptability across key sub-groups (using time to completion as a measure of engagement); and (c) the tool's fitness-for-purpose against the results of subsequent file review by designated court officers. Concern for one's own safety was the most frequently reported risk. Allocation to a high-risk category was associated with gender (higher for women), applicant status (higher for respondents), culturally and linguistically diverse background status, more recent separation, recent communication with the other party, and having younger children. Survey completion was fastest for those who reported high risk or identified as Aboriginal and/or Torres Strait Islander. Risk category was a strong predictor of subsequent referral to the high-risk case management pathway following assessment and file review. Parties who initially self-reported high risk but were reclassified to low/medium risk on file review were more likely to be men, to report low fear for their own safety, and to be in recent communication with their former partner. The Family DOORS Triage Tool coupled with the Court's risk rubric demonstrates high utility and acceptability to vulnerable sub-populations. The tool may provide a means to detect and respond rapidly and accurately to clusters of risk early in engagement with family court systems.

ABSTRACT Background Breast cancer remains a major public health concern in Ethiopia, with timely access to care critical for improving outcomes. This study examined factors associated with delays in the breast cancer care pathway. Methods This cross‐sectional study collected data from 458 women with histologically confirmed breast cancer between July and September 2024 at three tertiary hospitals. Data were collected through structured interviews and clinical records. Five time intervals from symptom detection to treatment initiation were analyzed using the Model of Pathways to Treatment. Factors were categorized using Andersen's Behavioral Model, and Accelerated Failure Time (AFT) models were used to estimate time ratios (TRs) with 95% confidence intervals (CIs). Results Rural residence (TR = 1.84; 95% CI: 1.20–2.80) and painless breast mass (TR = 1.94; 95% CI: 1.26–3.00) were linked to longer delays from symptom recognition to first healthcare contact. Low breast cancer literacy and consulting traditional healers before diagnosis were consistently associated with prolonged delays. Consulting ≥ 3 providers extended both intervals, from first healthcare contact to diagnosis (TR = 3.13; 95% CI: 1.96–4.98) and symptom detection to diagnosis (TR = 1.63; 95% CI: 1.02–2.62). Delays were also associated with first providers failing to suspect or refer for cancer. Longer diagnosis‐to‐treatment intervals were observed among unmarried women, low‐income groups, and those using traditional healing post‐diagnosis. Older women (≥ 60 years) experienced shorter delays in initiating treatment (TR = 0.62; 95% CI: 0.41–0.93). Conclusion Delays in breast cancer care in Ethiopia are driven by individual, sociocultural, and systemic barriers. Multilevel interventions are needed to promote early detection and timely treatment.

Background:Workplace violence (WPV) was a global public health issue worldwide. Given the specificity of emergency department physicians' professional roles, the incidence of WPV was significantly higher than that of practitioners in other healthcare groups. Investigating the association between exposure to WPV and psychological health can provide a scientific basis for managers to implement precise interventions on violent incidents, thereby effectively reducing the adverse impacts of WPV. Methods:A multi-stage random sampling method was employed to conduct a questionnaire survey among 14 848 emergency department physicians across 31 provincial-level administrative regions in China from July to September 2019. This survey utilised the WPV Scale, the Maslach Burnout Inventory-Human Services Survey (MBI-HSS), and the Center for Epidemiological Studies Depression Scale (CES-D) to investigate the levels of WPV, burnout, and depressive symptoms among respondents. Data analysis were performed using STATA 17.0 and Amos 26.0 software. Results:A total of 90.40% of emergency department physicians reported experiencing at least one incident of WPV in the past year. The mean score for depressive symptoms was 16.80 ± 14.78, and the mean score for burnout was 82.94 ± 26.11. The correlation coefficients between WPV and depressive symptoms, WPV and job burnout, and depressive symptoms and job burnout were 0.444, 0.347, and 0.562, respectively (all P < 0.01). Structural equation analysis indicated that the total effect of WPV on depressive symptoms was 0.471, with a mediating effect of burnout at 0.421, accounting for 89.38% of the total effect. Conclusions:Emergency department physicians had a severe level of depressive symptoms and burnout, with burnout playing a mediating role between WPV and depressive symptoms. Therefore, future policy efforts are warranted to build a supportive work environment for emergency department physicians and consequently enhance their well-being.

Objectives Timely access to breast cancer care is critical for improving prognosis and survival, but multiple barriers can lead to prolonged intervals across the care pathway. This scoping review aims to identify the methods used to measure timeliness in breast cancer care, pinpoint specific points in the care pathway where longer time intervals are most common and categorise the factors influencing the timeliness of care in Africa.Design Scoping review followed the methodological framework for scoping reviews outlined by Arksey and O’Malley.Data sources Five electronic databases, MEDLINE, EMBASE, CINAHL, Web of science, and PsycINFO, were searched for articles published between 1999 and 2024, and the Google search engine was used to search for grey literature.Eligibility criteria for selecting studies We included studies that measured time to presentation, diagnosis or treatment within the context of breast cancer care in Africa, and/or assessed one or more of these care intervals.Data extraction and synthesis Two reviewers independently screened relevant abstracts and full texts against the selection criteria. Key themes were then synthesised narratively based on a predefined theoretical framework adapted from the Model of Pathways to Treatment and Andersen’s model of health service.Result The initial search identified 3552 articles, with 29 studies ultimately included for data charting. All the included studies drew samples from healthcare facilities. This review identified seven multidirectional key time points: symptom onset, recognising the need for help, engaging with informal care providers, presenting at a health facility, receiving a diagnosis, consulting a specialist and starting treatment. The review also revealed significant variation in the terminology used for time events and in the metrics defining time intervals. The time interval between symptom recognition and contact with a healthcare provider was the most frequently studied and was often longer than other intervals. In many African countries, traditional healers and spiritual sites were the first point of contact for many patients with breast cancer after noticing initial symptoms. There was a scarcity of research into completion of cancer treatment and follow-up, despite significant barriers in accessing and affording cancer care.Conclusion This review highlights significant variation in how timeliness of breast cancer care are defined and measured across African countries, underscoring the need for standardised tools to assess care intervals. The predominance of facility-based studies may overlook patients who never reach formal healthcare settings, pointing to a critical gap in community-level evidence. These findings emphasise the importance of adopting a systems-based approach to improve breast cancer care, one that integrates both formal and informal care pathways and actively involves patients in navigating timely access to services.

ISSUE ADDRESSED:Socioeconomic disparities in food environments significantly impact diet quality and health outcomes, yet comparative evidence between metropolitan and regional areas remains limited. We examined spatial and temporal changes in food outlet availability in Victoria, Australia from 2019 to 2023. METHODS:Geospatial data from OpenStreetMap was used to classify food outlets into healthy, less healthy, and unhealthy categories. Outlet densities were calculated within 500 m (walkable) and 2000 m (short driving) buffers from Statistical Area Level 1 centroids. Socioeconomic disparities were assessed using the Index of Relative Socio-economic Advantage and Disadvantage quintiles. Gini coefficients quantified inequality, while Kruskal-Wallis tests, Dunn's post hoc tests, and k-means clustering identified socio-spatial patterns. RESULTS:In metropolitan Melbourne, both highly disadvantaged (quintile 1) and affluent areas (quintiles 4-5) had significantly higher densities of food outlets (e.g., 2.3 vs. 2.7 healthy outlets per 1000 people within 500 m in 2023), while mid-range socioeconomic areas (quintiles 2-3) had notably lower availability. Regional Victoria exhibited similar trends, with mid-range areas consistently underserved. From 2019 to 2023, Melbourne's Gini coefficients for healthy outlet access improved slightly (0.45-0.43), whereas regional areas worsened (0.52-0.55). Clustering revealed limited healthy food availability in disadvantaged rural clusters and high densities of unhealthy options in urban regional centres. CONCLUSIONS:Food outlet availability in Victoria shows distinct non-linear socioeconomic disparities, disproportionately disadvantaging mid-range socioeconomic areas. SO WHAT:Strategic urban planning and targeted policy interventions in underserved suburban and regional locations are essential for mitigating inequalities and promoting healthier communities.

INTRODUCTION:Despite successful public health campaigns, tobacco use persists as a major cause of preventable illness and death. While tobacco taxation is recognized as an effective control strategy, concerns remain about potential financial strain on lower socioeconomic groups. This study investigates the relationship between household tobacco expenditure and financial stress in Australia, a country with high tobacco taxes and declining smoking rates. METHODS:Household data from the 2015-16 Australian Household Expenditure Survey were analyzed (N = 10 036). Financial stress was measured using a scale based on nine self-reported indicators. Respondents were asked to report if their household had experienced any of these difficulties, for example, inability to pay utility bills or going without meals. Negative binomial regression models assessed the association between tobacco expenditure share and financial stress, adjusting for sociodemographic factors, household wealth, and other expenditures. RESULTS:Financial stress was more prevalent among households that did (45.0%; (95% CI = 42.5 to 47.5)) versus did not (25.4%) purchase tobacco. All levels of tobacco expenditure were significantly associated with higher financial stress bivariably, after controlling for covariates. For instance, households in the second-lowest tobacco expenditure share quintile had a higher mean financial stress score than non-purchasing households (RR = 1.59, CI = 1.36 to 1.85, p < .001). DISCUSSION:In Australia, financial stress is prevalent among tobacco-purchasing households, and household tobacco expenditure is significantly associated with increased financial stress even at modest levels of spending, that is, the lower quintiles of tobacco expenditure. These findings underscore the need for targeted policies to mitigate financial strain and support smoking cessation among vulnerable populations.

INTRODUCTION:This paper aims to produce a comprehensive estimate of alcohol's harm to others (AHTO) from strangers among Australia adults in 2021. This survey was undertaken during COVID-19 and aims to compare AHTO results with those from 12 years before and identify differences across socio-demographics. METHODS:Cross-sectional data of 2574 Australian adults were collected in November 2021 via two survey modes: random digit dialling and the Life in Australia™ panel. Questions pertained to harms from the drinking of known and unknown others ('strangers') in the previous 12 months. Multivariable logistic regression is used to analyse differences in the experience of AHTO from strangers across age, gender and other socio-demographics. RESULTS:Under half of Australian adults reported experiencing AHTO from a stranger (42.2%) during the period of COVID-19. Women were at significantly higher odds of reporting harm than men. Significantly higher percentages of participants aged 18-49 reported harm than those 65 and over. Rates of experience of harm from strangers' drinking varied between different Australian regions. Adults engaging in less frequent risky drinking (less than 4 days a month) reported significantly greater experiences of harm than those not engaging in risky drinking in the past year. DISCUSSION AND CONCLUSIONS:The current study provides a national estimate of AHTO from strangers in Australia during the COVID-19 pandemic. Finding greater risk of experiencing AHTO from strangers among women than men differs from previous AHTO literature, and further research is required to determine if this is an emerging trend.

OBJECTIVES:To assess changes in the monthly numbers of hospital-based abortions and outpatient early medical abortions in Victoria during January 2012 - March 2022, with a particular interest in the impact of the coronavirus disease 2019 (COVID-19) pandemic.STUDY DESIGN:Population-based retrospective cohort study; time series analysis of Victorian Admitted Episodes Dataset (VAED) and Pharmaceutical Benefits Scheme (PBS) data.SETTING, PARTICIPANTS:All admitted care episodes in Victoria during 1 January 2012 - 31 March 2022 with medical abortion as the principal diagnosis; all PBS claims for mifepristone-misoprostol (MS-2 Step) during 1 January 2015 (date of listing) - 31 March 2022.MAIN OUTCOME MEASURES:Changes in monthly numbers (with 95% confidence intervals [CIs]) of admissions for hospital-based and outpatient early medical abortions during the pre-pandemic period (January 2012 - March 2020), the first full month of the COVID-19 pandemic (April 2020), and the pandemic period (May 2020 - March 2022).RESULTS:The monthly number of hospital-based abortions declined in Victoria during the pre-pandemic period (slope, -2.92 [95% CI, -3.45 to -2.38] per month); the rate of decline was greater during the pandemic period (slope, -5.74 [95% CI, -10.5 to -0.96] per month). The monthly number of outpatient early medical abortions increased during the pre-pandemic period (slope, 5.94 [95% CI, 5.34-6.34] per month); it declined during the first month of the pandemic (slope, -26.4 [95% CI, -70.1 to -17.3] per month), but did not significantly change thereafter. The total monthly number of abortions during the pandemic period did not deviate markedly from the pre-pandemic median value. The pre-pandemic declines in monthly numbers of abortions in major city hospitals, in private hospitals, or at earlier than 14 weeks' gestation intensified during the pandemic period. During January 2015 - March 2020, 14 634 of 103 496 abortions were outpatient medical abortions (14%); during the pandemic period, 11 154 of 33 056 abortions were outpatient medical abortions (33%).CONCLUSIONS:The use of outpatient early medical abortion has steadily increased in Victoria since the PBS listing of mifepristone-misoprostol, which helped ensure access to abortion during the COVID-19 pandemic. Outpatient medical abortions may eventually outnumber surgical early abortions in Victoria, but they are not always appropriate: hospitals will continue to be essential for comprehensive abortion care.

In light of ongoing global military conflicts, including the Israel-Hamas war and the Russia-Ukraine war, it is imperative to study the effects of parental military service and deployment on the health and well-being of children within military families. Emerging evidence suggests that children with a parent in service appear to face unique developmental challenges associated with the military lifestyle, which differ from those experienced by civilian children. However, there is currently limited systematic research that compares the developmental outcomes of children with serving parents to their civilian peers. Therefore, the aim of this review is to synthesize existing literature on the behavioral, social, emotional, and educational functioning of children with currently serving parents in defense forces, in comparison to their civilian counterparts. This rapid systematic review was conducted in accordance with the Joanna Briggs Institute methodology framework, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, and Cochrane Rapid Review methodological recommendations The following databases were searched: Medline, PsycINFO, CINAHL, and Cochrane Central Register of Controlled Trials. Relevant online databases were searched from February 2012 to 2022 to examine the contemporary literature. Fourteen identified published quantitative studies were identified. No qualitative studies were found, and no study reported on academic outcomes. Despite considerable sample heterogeneity across studies, military children of all ages appear to be a particularly vulnerable population. Findings suggest that children in military families experience substantially higher risk for negative psychological, social, and behavioral health outcomes than their civilian counterparts, with parental deployment increasing risk across all developmental stages (i.e., early, middle, and late childhood). Among these age groups, adolescents of currently serving members showed highest risk, particularly concerning suicidal ideation and suicidal behaviors. Implications are discussed in terms of early detection, preventative interventions, and support services for families and children with a serving parent. PROSPERO registration: CRD42022313999.

AIMS:To describe the range of effects experienced due to the drinking of people respondents know and analyze risk and protective factors for harm from the drinking of partners and household members, other relatives and friends and co-workers. DESIGN, SETTING AND PARTICIPANTS:Surveys of 2574 participants' experiences were obtained from two samples: 1000 people responded to random digitally dialled Australian mobile calls and 1574 participants responded from the Life in AustraliaTM panel survey. MEASUREMENTS:Respondents were asked whether they had been negatively affected in the previous 12 months by the drinking of persons they knew who were 'a heavy drinker or drank a lot sometimes' and the nature of these harms. Weighted logistic regressions were used to analyze differences in rates of key negative outcomes from known others' drinking by gender, age and socio-economic status. FINDINGS:Almost two thirds [60.2%; 95% confidence interval (CI) = 57.7%-62.7%] of participants reported having heavy drinkers in their lives and 21.8% (95% CI = 19.8%-23.9%) reported being negatively affected by the drinking of people they knew well in some way. Participants reported a gamut of effects, including, most commonly, adverse social effects: having to transport relatives and friends who had been drinking, role failure and faults, being emotionally hurt or neglected, serious arguments, family problems, having to care for drinkers and verbal abuse. Less commonly, respondents reported physical or sexual harm, property damage, financial stress and threats from others' drinking. Women (odds ratio = 1.49; 95% CI = 1.13-1.95), younger people, rural, Australian-born (vs. respondents born overseas in non-English speaking countries) and more frequent drinkers were more likely to report harm from a drinker they knew than their counterparts after adjusting for other variables in the model. CONCLUSIONS:Australians appear to be commonly adversely affected by the drinking of people they know. Harms from known drinkers are more likely to be experienced by women than men, particularly from the people they live with and other relatives.

OBJECTIVES:This study aimed to assess the level of public trust in general practitioners (GPs) and its association with primary care contract services (PCCS) in China. STUDY DESIGN:Cross-sectional study. METHODS:Between September and December 2021, 4158 residents across eastern, central, and western China completed a structured self-administered questionnaire. Trust was assessed using the Chinese version of Wake Forest Physician Trust Scale. Multivariable linear regression models were established to identify predictors of trust. The effect size of PCCS on trust was estimated by the average treatment effect for the treated (ATT) through propensity score matching. RESULTS:The study participants had a mean Wake Forest Physician Trust Scale score of 36.82 (standard deviation = 5.45). Enrollment with PCCS (β = 0.14, P < 0.01), Han ethnicity (β = 0.03, P < 0.05), lower educational attainment (β = -0.06, P < 0.01), higher individual monthly income (β = 0.03, P < 0.05), better self-rated health (β = 0.04, P < 0.05), chronic conditions (β = 0.07, P < 0.01), and higher familiarity with primary care services (β = 0.12, P < 0.01) and PCCS (β = 0.21, P < 0.01) were associated with higher trust in GPs. The ATT of PCCS exceeded 1 (P < 0.05). CONCLUSIONS:PCCS are associated with higher levels of trust in GPs. PCCS may become an effective tool to attract public trust in GPs, although the relationship between the two may be bi-directional.

INTRODUCTION:The current paper examines the proportion of drinking occasions and total alcohol consumed that takes place at off-premise locations. Comparisons are made between high-income countries: Australia, New Zealand, England and Scotland, and across drinker-types: high-risk and lower-risk. METHODS:Data were taken from the International Alcohol Control study in Australia (N = 1789), New Zealand (N = 1979), England (N = 2844) and Scotland (N = 1864). The cross-national survey measures location and beverage-specific alcohol consumption. The number of drinking occasions and mean consumption across on- and off-premise locations and the proportion of drinking occasions that high- and lower-risk drinkers had at on- and off-premise locations was estimated for each country. RESULTS:The majority of drinking occasions among high-risk drinkers occurred at off-premise locations across all four countries; Australia 80.1%, New Zealand 72.0%, England 61.7% and Scotland 60.7%. High-risk drinkers in Australia had significantly larger proportions of drinking occasions occurring at off-premise locations compared to England and Scotland. Across all countries, high-risk drinkers and lower-risk drinkers consumed significantly larger quantities of alcohol per occasion at off-premise locations compared to on-premises locations. Finally, the majority of total alcohol consumed occurred at off-premise locations across all countries for high- and lower-risk drinkers. DISCUSSION AND CONCLUSIONS:As the accessibility to alcohol outside of licensed premises continues to increase, particularly with the expansion of home delivery services, it is important to be mindful of the high proportion of heavy drinking occasions that occur off-premise.

Introduction Cancer is the leading cause of death worldwide, with breast cancer being one of the most commonly diagnosed types. Low-income and middle-income countries account for nearly half of all breast cancer cases and related fatalities. In Africa, mortality rates are higher and survival rates are lower compared with developed countries. Timeliness of care is a critical aspect of healthcare, but various studies and healthcare systems use different criteria and methods to measure it. Assessing the breast cancer care pathway and understanding the determinants of delayed care are essential for effective interventions. Therefore, this scoping review aims to evaluate the methods used to measure the timeliness of breast cancer care, identify specific points in the care pathway where delays are most frequently reported, and examine the factors affecting the timeliness of breast cancer care in Africa.Methods and analysis We will conduct this scoping review using the Arksey and O’Malley framework endorsed by the Joanna Briggs Institute. A scoping review of articles written in English concerning the timeliness of breast cancer care in the African context will be undertaken. Six electronic databases (MEDLINE, EMBASE, CINAHL, SCOPUS, WEB Of SCIENCE and PsycINFO) will be searched to identify published literature on timeliness of breast care in Africa. Two reviewers will independently screen the articles at both the abstract and full-text stages, guided by predetermined inclusion and exclusion criteria. The full texts of identified studies will be further examined and charted using a data extraction form guided by the Model of Pathways to Treatment framework. Publications describing the time to diagnosis and its associated factors in the contexts of breast cancer will be considered for inclusion, with no restrictions based on date of publication. Studies that are published in languages other than English and that do not focus on the timeliness of care or time-related aspects within the care pathway will be excluded. Evidence will be narratively synthesised and analysed.Ethics and dissemination Ethical approval is not needed as this scoping review does not involve collecting data from human participants. The results produced from this review will be submitted to a scientific peer-reviewed journal for publication and will be presented at scientific meetings.

AIMS:Alcohol pricing policies may reduce alcohol-related harms, yet little work has been done to model their effectiveness beyond health outcomes especially in Australia. We aim to estimate the impacts of four taxation and minimum unit pricing (MUP) interventions on selected social harms across sex and age subgroups in Australia. METHODS:We used econometrics and epidemiologic simulations using demand elasticity and risk measures. We modelled four policies including (A) uniform excise rates (UER) (based on alcohol units) (B) MUP $1.30 on all alcoholic beverages (C) UER + 10 % (D) MUP$ 1.50. People who consumed alcohol were classified as (a) moderate (≤ 14 Australian standard drinks (SDs) per week) (b) Hazardous (15-42 SDs per week for men and 14-35 ASDs for women) and (c) Harmful (> 42 SDs per week for men and > 35 ASDs for women). Outcomes were sickness absence, sickness presenteeism, unemployment, antisocial behaviours, and police-reported crimes. We used relative risk functions from meta-analysis, cohort study, cross-sectional survey, or attributable fractions from routine criminal records. We applied the potential impact fraction to estimate the reduction in social harms by age group and sex after implementation of pricing policies. RESULTS:All four modelled pricing policies resulted in a decrease in the overall mean baseline of current alcohol consumption, primarily due to fewer people drinking harmful amounts. These policies also reduced the total number of crimes and workplace harms compared to the current taxation system. These reductions were consistent across all age and sex subgroups. Specifically, sickness absence decreased by 0.2-0.4 %, alcohol-related sickness presenteeism by 7-9 %, unemployment by 0.5-0.7 %, alcohol-related antisocial behaviours by 7.3-11.1 %, and crimes by 4-6 %. Of all the policies, the implementation of a $1.50 MUP resulted in the largest reductions across most outcome measures. CONCLUSION:Our results highlight that alcohol pricing policies can address the burden of social harms in Australia. However, pricing policies should just form part of a comprehensive alcohol policy approach along with other proven policy measures such as bans on aggressive marketing of alcoholic products and enforcing the restrictions on the availability of alcohol through outlet density regulation or reduced hours of sale to have a more impact on social harms.

Setting The study aims to assess firstly, the historical (pre-2000) achievements in the control of alcohol and its adverse health consequences in the nine developed countries with mass temperance movements. Currently (post-2000), it looks at achievements in developed countries more generally, including these nine countries. Methods The study is a policy analysis conducted within an historical timeframe. This principally involves the historical impacts on government schemes regulating alcohol as well as individual alcohol consumption and its consequences. Trends since 2000 in alcohol consumption in young people in high-income temperance cultures are also examined. Results and conclusion Substantial alcohol-related public health impacts have occurred in almost all of the nine countries, either on relevant government schemes and/or individual alcohol consumption. Regarding government schemes, five of the nine temperance countries, and in part a sixth (the US), retain government store monopoly systems, offering heavily-taxed spirits with limits on their accessibility. Impacts on individual consumption in these countries, where studied, were positive. Consumption in young people since 2000 in high income countries is lower in temperance than non-temperance countries.It is concluded that temperance culture has had substantial and enduring governmental and individual public health impacts relating to alcohol consumption.