Issue Addressed Learning to swim reduces drowning risk and facilitates access to lifetime health benefits of aquatic activity. Amid cost-of-living pressures and disparities in swimming lesson access, further exacerbated by the COVID-19 pandemic, governments have invested in strategies to foster access and participation. This study examines the swim school industry's perceived impacts of the NSW government First Lap voucher program to subsidise swimming lessons for young children. Methods A mixed-methods approach analysed anonymous survey responses of 100 swim schools. Quantitative analysis calculated frequencies with 95% confidence intervals (95% CI), and thematic analysis was applied to open-ended qualitative responses. Results Most providers (63%) reported increased enrolment (95% CI 53%-72%) and 58% noted boosted income (95% CI 48%-67%) since program commencement. Sixty-nine percent observed more new enrolments (95% CI 60%-78%), leading to additional classes (57%; 95% CI 47%-67%) and teaching staff hours (59%; 95% CI 49%-68%). Increased pool space usage (36%; 95% CI 27%-46%) and non-teaching staff hours (36%; 95% CI 26%-45%) were noted. Key themes derived from open-ended question responses included swim schools' operational impacts (such as promotional opportunities, student retention and increased administration) and family effects, such as improved affordability and earlier enrolment. Conclusions Findings highlight benefits such as increased enrolment and income, alongside industry challenges in staffing and resourcing. Future research should explore voucher programs' impact on participant retention and long-term enrolment outcomes. So What? This study details impacts of a population-level voucher program on the aquatic industry, addressing a knowledge gap around the role and views of industry, which can inform future health promotion strategies.

BACKGROUND:Prevention of falls aids healthy ageing, but there are few Aboriginal-led and designed programs. OBJECTIVES:This study aimed to evaluate the effect of Ironbark, an Aboriginal co-designed fall prevention program, on functional mobility, a key indicator of falls. METHODS:This controlled pre-post study was conducted in organisations delivering services to Aboriginal people aged 45 years and older in New South Wales and Western Australia. A co-designed fall prevention program incorporating exercises and yarning circles targeting fall risk factors ('Ironbark Standing Strong and Tall') was compared to a social program ('Ironbark Healthy Community'). Data were collected at baseline and after 12 months of follow-up. RESULTS:The 'Ironbark Standing Strong and Tall' program was delivered at 16 sites and the 'Healthy Community' program at three. Due to lower recruitment than anticipated, combined analysis was not possible. There were significant improvements in the 'Ironbark Standing Strong and Tall' participants for the primary outcome of functional mobility (Short Performance Physical Battery; a change of 0.8 points, 95% CI: 0.4-1.1), reductions in stepping times, improvements in leg stance and increased incidental and planned exercise. There were no significant changes in falls, health-related quality of life (HRQoL) or psychological distress. Participants in the 'Healthy Community' sites had no change in functional mobility but saw declines in HRQoL, physical activity and stepping time. CONCLUSIONS:A co-designed and delivered program for older Aboriginal people, implemented in community settings aligned with stated priorities of Aboriginal older people, improved functional mobility.

ISSUE ADDRESSED:Swimming is an essential life skill for Australian children. Access to swimming lessons helps develop competence in the water. However, participation in swimming lessons among preschool-aged children has declined in recent years, particularly following the pandemic. The New South Wales Government introduced the First Lap programme to encourage preschoolers' access to swimming lessons by providing AUS$100 vouchers during the 2021-2022 and 2022-2023 financial years. The programme aimed to increase participation in early swimming education and raise parental awareness of its importance for water safety. We assessed its economic impact from a policy perspective. METHODS:We surveyed registered First Lap providers and participating families to estimate programme benefits. Costs were sourced from the state government, with outcomes reported using standard cost-benefit metrics. Subgroup analyses by Socio-Economic Indexes for Areas quantiles examined variations in programme impact across community groups. RESULTS:A total of 100 providers and 14 126 parents/carers completed the surveys. Our findings suggest direct benefits of AUS$39.3 million against costs of AUS$28 million, yielding AUS$1.40 per dollar invested. Including indirect benefits increased total returns to AUS$62.3 million, or AUS$2.23 per dollar. Benefits consistently exceeded costs in both financial periods, with returns between AUS$1.38 and AUS$2.11 in 2021-2022 and AUS$1.43 to AUS$2.38 in 2022-2023. Subgroup analysis showed direct returns from AUS$1.40 to AUS$1.43 and AUS$2.22 to AUS$2.25 across socio-economic groups. CONCLUSIONS:We found strong economic support for the programme, with significant benefits across socio-economic groups. SO WHAT?: The findings suggest that the First Lap programme, providing swimming vouchers to preschoolers, is a cost-effective initiative to help families access lessons and promote children's safety and health.

This study explores a co-production approach to develop measures to assess outcomes in sport for Positive Youth Development (PYD) programs. Using participatory methods, we engaged key stakeholders including program facilitators and School-Based Apprentice Trainees (SBATs) from Creating Chances, an Australian social enterprise delivering programs in over 150 schools to more than 10,000 students. Co-production involved two face-to-face workshops with facilitators and SBATs; stakeholder consultations with Creating Chances management and funders; and a final decision-making process involving representatives from both. In the workshops, participants identified and prioritised change domains for two key programs and assessed validated measurement instruments. Power dynamics were carefully managed through democratic mapping and voting processes, with participants reporting feeling valued. These findings demonstrate how co-production can transform evaluation in sport and development contexts, generating measures that are contextually relevant, socially responsive and reflective of end-user perspectives and complex program realities.

Background Falls are a leading cause of injury and loss of independence among older Aboriginal people. The Ironbark program is a culturally co-designed, community-based fall prevention initiative, incorporating exercises and Yarning circles, a culturally grounded form of group discussion. This paper presents a process evaluation of the program, examining fidelity and key factors influencing implementation across settings.Methods Sixteen sites across two Australian states implemented the Ironbark Standing Strong and Tall program. Process data were collected from 15 sites through structured session observations and semi-structured interviews with exercise facilitators. Fidelity and dose were assessed quantitatively, with adherence scored using a summative checklist score. Qualitative data were thematically analysed and mapped onto the Consolidated Framework for Implementation Research (CFIR).Results The program was delivered with high fidelity to 117 participants with median adherence scores consistently above 80%. Sessions were implemented as planned, with strong participant engagement in both exercise and Yarning components. Key facilitators included Aboriginal leadership, trusted site managers, program flexibility and supportive service structures. Challenges included managing varying physical abilities, maintaining engagement over time and external disruptions (e.g. Coronavirus -19 pandemic, weather). Content repetition was noted as a barrier to sustained attendance by participants in later stages. Facilitators recommended additional training, mid-program assessments and access to site-collected data. Sustainability was linked to workforce capacity and securing ongoing funding, particularly to support Aboriginal staff and transport.Conclusion This process evaluation indicated that a culturally-relevant fall prevention program for older Aboriginal people can be implemented with fidelity across community settings. Findings provide practical guidance for exercise facilitators and on sustaining and expanding the Ironbark program and inform broader efforts to embed culturally safe, community-led health programs in routine practice.

PURPOSE:Strong communication skills support Australian Aboriginal and Torres Strait Islander children's connections to community, culture, and education. Ongoing impacts of colonisation and social determinants of health may increase the likelihood of speech, language, and communication needs for Aboriginal and Torres Strait Islander children, however national data is limited. Speech-language pathology can address speech, language, and communication needs, but factors impacting access for this population are not well understood. This study aimed to establish caregiver reported prevalence of speech, language, and communication needs in Aboriginal and Torres Strait Islander children aged 0-6 years and identify facilitators and barriers to accessing support. METHOD:Mixed modelling and qualitative content analyses were used to examine data for 474 children in a national longitudinal study of Aboriginal and Torres Strait Islander children. RESULT:In total, 47.0% of children had speech, language, and communication needs between 0-6 years, with only 48.0% with speech, language, and communication needs, accessing support. Higher access was linked to caregiver-rated health, concern duration, and concerns across multiple communication domains. Key access barriers included service availability and awareness. CONCLUSION:The high prevalence of speech, language, and communication needs and limited access to support highlights the need to reduce access barriers and consider public health models of intervention that incorporate Aboriginal and Torres Strait Islander views of health.

OBJECTIVE:This study aimed to identify practitioner awareness of and adherence to clinical practice guidelines for Indigenous peoples with otitis media in Australia. METHODS:Database searches were conducted in Medline, Embase, APA PsychInfo, Scopus, Web of Science Core Collection, Academic Search Premier, and CINAHL. Studies were eligible for inclusion if they reported on practitioner awareness of or adherence to clinical practice guidelines for otitis media management for Indigenous peoples in Australia. Search terms included 'Indigenous peoples', 'otitis media', and 'guidelines'. RESULTS:Four peer-reviewed studies published between 2007 and 2020 met eligibility for inclusion. This review identified three key concepts: (1) practitioner awareness rates for the Therapeutic Guidelines were significantly higher than for the 2001 OM Guidelines, (2) practitioners self-reported higher adherence to the Therapeutic Guidelines compared with the 2001 OM Guidelines, and (3) antibiotic prescriptions for Indigenous children varied, possibly due to use of different guidelines and adherence criteria, as well as variations in geographical areas and settings. CONCLUSIONS:Practitioner adherence to clinical practice guidelines specific for Indigenous peoples with otitis media is critical to ensuring a consistent impact and, by extension, closing the gap in related life outcomes for Indigenous peoples in Australia. It is important to evaluate guideline impact through establishing current practitioner adherence rates. Furthermore, increasing awareness of culturally appropriate research approaches and availability of evaluation tools, such as the Aboriginal and Torres Strait Islander Quality Appraisal Tool, should improve the conduct of future Indigenous research.

Background Child swimming lessons are a key intervention for drowning prevention; however, participation has been severely affected by COVID-19 restrictions and cost-of-living challenges. To encourage re-engagement, the New South Wales government began providing US$100 swimming lesson vouchers. Parent/carers of eligible preschool-aged children were asked to complete a survey during voucher creation. This study aimed to examine pre-existing challenges to lesson participation among families who had not participated in the preceding 12 months.Methods Cross-sectional data from parent/carer surveys completed between December 2021 and June 2022 were analysed. Binary logistic models analysed associations between sociodemographic factors and answered affirmatively to one or more challenges to participation from a predefined list.Results Of 221 218 vouchers created, 79 553 parent/carers (36%) indicated that their child had not participated in swimming lessons in the last 12 months and responded to the question about participation challenges. Parent/carers of children with disabilities or residing in low socioeconomic areas had higher odds of indicating cost was a challenge while regional/remote families had over five times higher odds of indicating swim school availability difficulties. Families speaking a non-English language at home had over 2.5 times higher odds of thinking that their child was too young for swimming lessons, higher odds of thinking swimming lessons were not important and higher odds of indicating that COVID-19 had challenged participation.Conclusion These findings highlight how different population groups experience challenges to participation in swimming lessons. Alleviating costs and increasing lesson availability is important.

OBJECTIVE:To quantify drowning rates and fatal to non-fatal drowning ratios on public holidays, school holidays, weekdays and long weekends in New South Wales from January 2010 to June 2022. METHODS:Using a linked administrative dataset comprising ambulance (paper-based and electronic records), emergency department presentations and death registry, rates of drowning and ratios of fatal to non-fatal drowning were calculated. RESULTS:Across 4,161 total drowning incidents, public holidays (14.21 incidents/100,000 person-years) and weekends (6.77 incidents/100,000 person-years) had higher population-normalised incident rates than regular weekdays (3.18 incidents/100,000 person-years). School holidays (8.58 incidents/100,000 person-years) recorded higher rates than non-school holiday days (3.46 incidents/100,000 person-years). New Year's Day and Australia Day accounted for 4.7% of all incidents (n=197 incidents). Drowning during school holidays was higher than non-school holiday days across all seasons, aside from winter school holidays. CONCLUSIONS:Drowning risk is higher on days typically associated with greater leisure time. This study adds to the growing literature identifying temporal variation in drowning risk and is the first to use linked data. IMPLICATIONS FOR PUBLIC HEALTH:Those tasked with supervising aquatic locations and the provision of water safety messaging should consider the targeted strategies for holidays and weekends such as extended patrols and media-based risk communication.

Exercise referral schemes (ERSs) can increase physical activity participation and improve health outcomes associated with chronic disease. The success of these programs relies heavily on the active involvement of health care professionals to make referrals. In this study, we explore the barriers and facilitators that influence health care professionals’ promotion of physical activity and ERSs in New South Wales (NSW), Australia. Participants were recruited through Live Life Get Active, an existing, free ERS and health promotion charity. Semistructured interviews were conducted with 8 health care professionals. Data were analyzed using deductive and exploratory thematic analysis. Participants described their attitudes toward physical activity promotion via ERSs and barriers and facilitators to recommending physical activity programs. All participants described the importance of tailoring physical activity recommendations to their patients’ health needs, lifestyles, and preferences. While participants understood the value of ERSs, they faced consultation time constraints, limited awareness of available programs, and the need to prioritize alternative treatments for health conditions. However, participants reported their own and patients’ positive experiences with physical activity, good physical activity literacy, and a clear understanding of the potential advantages for patients were catalysts for referrals. A streamlined referral process to free programs with social components was preferred. Identified barriers to health care professionals promoting ERSs highlight the need for increased knowledge of available ERSs and physical activity programs and improved referral pathways. The findings support a focus on increasing professionals’ knowledge about exercise and reducing the gap between knowledge and action by increasing ease of exercise referral.

BACKGROUND:Water safety awareness and swimming lesson participation can reduce drowning risk among children in Australia. Providing financial support for swimming lesson participation could additionally impact knowledge and awareness among parents/carers of the importance of learning to swim as a water safety strategy. Between 2021 and 2023, the New South Wales First Lap voucher programme provided preschool-aged children (ages 3-6 years) with two $A100 vouchers, one per financial year, for swimming lessons. This study aimed to examine parent/carer changes in water safety knowledge and awareness during this programme implementation period. METHODS:This cohort study used survey responses from parents/carers who applied for First Lap vouchers and completed the survey in two consecutive years of the programme. Parents/carers were asked about their knowledge and awareness of five evidence-based strategies to help keep children safe around water, selecting 'yes' or 'no' in response to each strategy. Multinomial regressions examined changes in knowledge and awareness of parents, adjusted for sociodemographic variables. RESULTS:Parents/carers who spoke a non-English language at home were less likely to have or acquire knowledge on water safety strategies. Conversely, parents/carers living in regional/remote areas, having younger children or whose children had previously participated in swimming lessons were more likely to have or acquire water safety knowledge. CONCLUSION:The increases in knowledge of supervision as a water safety strategy in some population subgroups in this cohort of parents/carers who applied for First Lap programme vouchers suggest that the programme may have contributed to this favourable change.

OBJECTIVES:Swimming and water safety skills are a key drowning prevention intervention. However, there are disparities in engagement and participation across different population groups. In New South Wales (NSW), Australia, the government created a universal AU$100 swimming lesson voucher program for children aged 3-6 years. This study aimed to characterise the relationship between demographic factors, previous participation in swimming lessons, and voucher reach and redemption in 2022-2023. STUDY DESIGN:Program impact evaluation. METHODS:Proportional Reporting Ratios (PRRs) and binary logistic models were used to examine the relationships between self-reported demographic variables and voucher creation (reach) in the NSW population, and redemption. RESULTS:In total, 136,299 vouchers were created, and 104,913 (77.7 %) were redeemed. This represented 47.2 % and 36.3 %, respectively, of the 288,860 eligible children in NSW. PRRs for creation and redemption were lower for children living with disability and speaking non-English languages at home and living in low-socioeconomic and remote areas than for other children. Modelling revealed a strong positive relationship between previous swimming lesson participation and redemption (adjusted odds ratio; aOR 10.82, 95 % confidence interval; CI 9.21-12.71), increasing area-level socioeconomic status (most advantaged compared to least advantaged quintile: aOR 7.19, 95 % CI 5.73-9.01), and in regional/remote areas (aOR 3.10, 95 % CI 2.43-3.96). CONCLUSIONS:First Lap vouchers were created and redeemed by a large proportion of children in NSW, however uptake was lower amongst some priority groups. Program targeting is required to reach these groups, particularly those speaking non-English languages at home, living with a disability, and in the lowest socioeconomic areas.

BACKGROUND:Aquatic incident location is vital for determining drowning risk and therefore, prevention. We investigated a method to determine drowning incident location using open-source data, addressing a gap often present in existing data systems. METHODS:Global Positioning System (GPS) data for drowning-related ambulance attendances in New South Wales from 2010 to 2022 were obtained. OpenStreet Map (OSM) was used to overlay mapped water bodies like beaches, pools and natural waterways. We tested our method for matching water features from OSM, considering location differences, duplicate and overlapping entities and using drowning fatality data from 2002 to 2022 to develop a method to prioritise location when multiple locations were identified. RESULTS:Among 4161 drowning-related ambulance attendances, 3588 (86.2%) had a valid GPS location. We searched for water features within 200 m for major cities/inner regional areas, and within 500 m for outer regional/remote areas, identifying a water feature for 2579 (71.9%) locations. For most (1221; 47.3%), a single water feature was found, while 574 (22.3%) had three or more, to a maximum of eight. The aquatic location of 6.6% of incidents changed after applying the prioritisation method. DISCUSSION:Our method supplemented ambulance data with water body. This study highlights the need for a consistent approach to recording GPS data for ambulance attendances. While based on drowning fatalities, our prioritisation method resulted in few changes, emphasising the value of capturing detailed location data in other sources. CONCLUSIONS:Using GPS and open-source data, this study demonstrated the feasibility of data linkage to improve insights to inform targeted drowning prevention strategies.

Background Aboriginal community-led programmes are likely to be most effective in prevention of injury, but more evaluation is needed. This article examined participating family and community stakeholder views of the Child Injury Prevention Partnership (CHIPP) programme delivered within an existing playgroup at the Walgett Aboriginal Medical Service. Methods This codesigned, mixed-methods evaluation adopted a decolonising Indigenous methodological approach. Aboriginal staff members provided weekly reflections on implementation, and family participation data were documented. Parents/carers provided regular feedback and, along with community stakeholders, participated in postprogramme research yarning. Results During 2021, playgroup sessions were facilitated by locally trained Aboriginal early childhood staff, who offered 2 hourly sessions twice a week. CHIPP implemented safety education for both adults and children through safety yarns and resources to take home focused on water, home and road safety. Parent/carer and stakeholder research yarns revealed six themes: CHIPP was feasible and culturally acceptable for families; Playgroup enabled supportive, holistic delivery of safety messages to adults and children; CHIPP provided information and resources to equip parents and carers to help teach safety at home; Approach to teaching infants and preschoolers safety was based on building confidence through fun, engaging, age-appropriate activities; Programme topics and content were relevant for families and COVID-19 impacted programme delivery but pivoted temporarily to remote delivery. Conclusions The CHIPP programme was feasible, accessible, acceptable and demonstrated initial beneficial impact, despite implementation challenges during the COVID-19 pandemic, offering suggestions to inform other child injury prevention programmes in Aboriginal community-controlled settings.

Background : Physical activity benefits adolescent health and well-being, known holistically as social and emotional well-being (SEWB) to Aboriginal people. However, little is known about the associations between physical activity and SEWB among Aboriginal adolescents. The “Next Generation: Youth Well-Being (NextGen) Study” is a cohort study of Aboriginal people aged 10–24 years in Australia. We aimed to examine associations between physical activity and SEWB, and cultural engagement and community connection among NextGen participants. Methods : Prior to recruiting participants, partnerships and relationships were developed with Aboriginal community organizations. Participant recruitment and self-reported data collection through questionnaires using established tools were led by Aboriginal youth peer researchers. Logistic regression estimated odds ratios for engaging in higher levels of physical activity (3–7 d vs 0–2 d) according to SEWB, culture, and community factors; models were adjusted for sex, age, and state/territory. Results : Of 1154 adolescents, 517 (45%) engaged in 3 to 7 days of physical activity. Factors associated with higher odds of physical activity were having good to excellent self-rated health; higher resilience; a lower risk Strengths and Difficulties Questionnaire score; regular community group/club participation, team sport, individual sport, or church/religious activities in the past 12 months; and perception of activities for young people to do in their community. Conclusion : Physical activity participation was favorably associated with a holistic range of measures of adolescent health and well-being. These findings provide valuable insights for Aboriginal adolescent program and policy design and delivery. The follow-up of participants in this cohort study will allow for examination of causal associations.

We examined cross-sectional associations between physical activity and inflammatory markers among 1202 ethnically diverse South African young adults. Global Physical Activity Questionnaire (GPAQ), Godin Leisure-Time Exercise Questionnaire (GLTEQ) and combined heart rate and accelerometry device (ActiHeart) data were used. Participant blood samples were analysed for C-reactive protein (CRP), Interleukin-6 (IL-6) and Tumor necrosis factor (TNF-α). Associations between physical activity and inflammatory variables were calculated using regression models adjusted for age, sex, ethnicity, socioeconomic status, smoking, alcohol, body mass index and sedentary behaviour. Participants' mean age was 24.5 years (±3.1 years); 52% were female; 50% had black ethnicity; 52% were tertiary educated. Over three quarters (77%) met GPAQ guidelines and 68% were GLTEQ 'Active'. GLTEQ 'active' category participants had lower CRP and IL-6 levels compared to those in the inactive category. Those meeting the WHO GPAQ guidelines had lower CRP levels than those who did not. There was a positive association between meeting guidelines and IL-6 levels, and higher AEE was associated with higher CRP, IL-6 and TNF-α levels. Associations between physical activity and inflammation among young adults varied depending on the measure used, possibly reflecting the different ability of the three measures to distinguish different types and intensities of physical activity.