Parallel Sessions: 2:00 3:00 p.m.

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1 Parallel Session A Room 403 Parallel Sessions: 2:00 3:00 p.m. Parallel Session B Room 404 Parallel Session C Room 405 Parallel Session D Room 406 2:00 Informing women about overdetection in breast cancer screening: RCT with two-year follow-up. Jolyn Hersch, Sydney School of Public Health 2:15 How do patients with existing cardiovascular disease differ from those at high risk who are recruited from primary health care settings into an ehealth study? Genevieve Coorey, The George Institute for Global Health 2:30 #louderthenever: How Instagram tap into marketing of 'A' cigarette brands in Indonesia. Changes to the Cervical Screening Program in Australia: exploring women s concerns and how these can be addressed. Rachael Dodd, Sydney School of Public Health The ripple effect: Evaluation of the Indigenous Marathon Foundation in Thursday Island. Rona MacNiven, Prevention Research Collaboration, Sydney School of Public Health Poor birth outcomes among Aboriginal Western Australians and smoking, alcohol and substance use. Long-term exposure to ambient particulate matter and hospital admissions. Salimi Farhad, University Centre for Rural Health Evaluation of the Make Healthy Normal Facebook page. James Kite, Prevention Research Collaboration, Sydney School of Public Health Ready-to-Use Supplementary Food (RUSF) for Children Under Two Years Old in Cambodia. What determines access to healthy food for obesity prevention in Samoa? Penny Farrell, Sydney School of Public Health Expanding the Verbal Exchange Health Literacy model: Synthesis of findings from a mixed-methods RCT. Danielle Muscat, Sydney School of Public Health Managing wisely: diagnosis and management of gastro-oesophageal reflux in infants in general practice. Ayu Astuti, Prevention Research Collaboration, Sydney School of Public Health 2:45 Framework for Standardised Assessment in Multidisciplinary Child Health Organisation. Basim Al Ansari, Sydney School of Public Health Alison Gibberd, Sydney School of Public Health Overdiagnosis in NSW due to screening mammography for breast cancer. Gemma Jacklyn, Sydney School of Public Health Bindi Borg, Sydney School of Public Health Jane Bell, Menzies Centre for Health Policy, Sydney School of Public Health

2 INFORMING WOMEN ABOUT OVERDETECTION IN BREAST CANCER SCREENING: RCT WITH TWO-YEAR FOLLOW-UP Jolyn Hersch, Jesse Jansen, Alexandra Barratt, Gemma Jacklyn, Kevin McGeechan, Les Irwig, Nehmat Houssami, Haryana Dhillon, Kirsten McCaffery Sydney School of Public Health, University of Sydney Correspondence to: Jolyn Hersch address: Jolyn Hersch is a postdoctoral researcher in the School of Public Health. Jolyn s research aims to improve health communication in order to better support people in making informed decisions that are consistent with their values. She is affiliated with Wiser Healthcare, a new research collaboration for reducing overdiagnosis and overtreatment. Background: Supporting women to make well-informed decisions about breast cancer screening requires effective communication about screening outcomes including overdetection or overdiagnosis (diagnosis and treatment of cancers that would never become clinically evident). Objectives: We investigated the effects of providing information about overdetection in a decision aid for women aged around 50 considering breast screening. Immediate post-intervention results (reported previously) showed that the intervention increased knowledge and informed choice, made screening attitudes less positive and reduced intentions to screen. We now present two-year follow-up data. Methods: We did a community-based RCT with a random cohort of women aged who had not undergone mammography in the past 2 years and had no personal or strong family history of breast cancer. We randomised 879 women to receive the intervention decision aid (evidence-based information on overdetection, breast cancer mortality reduction, and false positives) or a control decision aid (identical but without overdetection information). Two years later we assessed screening uptake, knowledge, attitudes, and future screening intentions. Results: 712 women (81% of those randomised) completed 2-year follow-up. Compared with controls, more women in the intervention group retained adequate conceptual knowledge (34% vs 20%, p<.01). Groups were similar in the proportions of women who underwent mammography during the 2-year follow-up period (50% vs 51%, p=.75), expressed positive attitudes to screening (81% vs 82%, p=.66), and reported intending to screen within the next 2-3 years (82% vs 85%, p=.25). Conclusions: A brief decision aid led to long-lasting improvement in women s understanding of potential consequences of breast screening, including overdetection. Few previous decision aid trials have demonstrated an impact persisting over such a long time frame. Although screening intentions were lower in the intervention group than among controls immediately postintervention, after 2 years we have not observed an effect on mammography uptake nor future breast screening intentions. HOW DO PATIENTS WITH EXISTING CARDIOVASCULAR DISEASE DIFFER FROM THOSE AT HIGH RISK WHO ARE RECRUITED FROM PRIMARY HEALTH CARE SETTINGS INTO AN ehealth STUDY?

3 Genevieve Coorey, Lis Neubeck, Tim Usherwood, David Peiris, Julie Redfern The George Institute for Global Health, Australia Correspondence to: Genevieve Coorey address: Genevieve s research is evaluating a consumer-focussed multi-component ehealth approach to reducing modifiable risks for cardiovascular disease in at-risk patients managed in primary care. Such strategies hold potential for other non-communicable diseases in which lifestyle-related behaviour drives disease risk. Genevieve holds degrees in Nursing, Education and Public Health. Background: Research conduct in primary care settings is challenging. More studies are needed to understand the characteristics of patients from this population who opt into research. Purpose: To determine if there are differences in demographic characteristics between patients with cardiovascular disease (CVD), or who are at high risk (defined as 5-year CVD risk >10% or having a clinically high risk condition), recruited into a study of a consumer-focussed ehealth intervention to lower vascular risk. Variables of interest included age, sex, ehealth literacy, income and education. Of further interest is the association of the latter three variables in the combined patient cohort. Methods: We analysed data from 780 consecutive adults with, or at high risk of, CVD recruited from 22 primary health care services in a large capital city. Demographic, clinical, ehealth literacy and technology uptake data were collected via face-to-face assessment and compared using chi-squared test and t-test for categorical and continuous variables, respectively. Results: There was no significant difference between clinical groups for 6 of the variables measured; however, patients at high CVD risk had higher gross income compared to those with CVD (p=0.04). Further analysis of the combined cohort showed that those with lower household income (<$1000/week) had lower ehealth literacy scores than those with higher income (>$2000/week) [26.3±7.2 vs 27.9±5.7, p=0.02]. Also, patients with fewer years of education (<6 years) had lower ehealth literacy than those with >12years of education (24.6±7.1 vs 27.8±6.2, p<0.01). Conclusion: Patients with, or at risk for, CVD had similar demographic characteristics and ehealth literacy. Within the combined cohort, lower income and fewer years of education were associated with lower ehealth literacy. Therefore, use of Internet-based interventions for CVD risk reduction warrants recognition of this accessibility gap. #LOUDERTHENEVER: HOW INSTAGRAM TAP INTO MARKETING OF 'A' CIGARETTE BRANDS IN INDONESIA Putu Ayu Swandewi Astuti 1, Mary Assunta 1,2, Becky Freeman 1,3 1 School of Public Health, School of Medicine, The University of Sydney

4 2 Cancer Council Australia 3 Preventive Research Collaboration (PRC), Charles Perkin Centre, The University of Sydney Correspondence to: Putu Ayu Swandewi Astuti (Ayu) address: past4344@uni.sydney.edu.au Putu Ayu Swandewi Astuti (Ayu) is a PhD candidate at School of Public Health, The University of Sydney. Her research is on tobacco marketing and promotion in Indonesia. She has been involved in research, capacity buildings and advocacy for tobacco control in Indonesia. Introduction: Tobacco Companies contravened Indonesian Tobacco Control Regulation (PP 109/2012) by keep sponsoring music events. One stand out event is the annual SoundrenAline concerts sponsored by PT HM Sampoerna to promote its A cigarettes Brands (A Brands). Social media such as Instagram is potential to boost tobacco companies integrated marketing in the rising penetration of internet and social media use among Indonesian youth. This study aims to describe how Instagram and the internet leverage the breadth of the A Brands marketing to reach and engage with young people. Method: A case study was conducted. Data were obtained from observation/audit survey by 4 pairs of observers who documented promotion of SoundrenAline concert, Instagram posts which were searched with specified hashtags (#) and PT HM Sampoerna reports, websites and also related news and blog post. Data were analyzed descriptively. Results: Instagram has boost promotion of the SoundrenAline events by substantial number of posts at more than 25 thousand for two main hashtags that were endorsed during the concert. Marketing activities both online and on the concert showed obvious efforts to target young people by tapping creativity, freedom of expression and engagement. Go ahead challenge and jargon such as Nanti juga Lo paham (You will get it, eventually) evokes curiosity and participation. The Tobacco Company also showed deceptive evasion to the regulation (PP 109/2012) through changes of concert name, use of Pictorial health warning (PHW) on the promotion material and age restriction to the concert and to the website. Conclusion: This case study provide evidence that Tobacco Company has embraced social media and the internet to expand cigarette marketing in Indonesia. Indonesian Government must take an immediate action to tighten tobacco advertising ban including marketing and advertising in the internet and social media. FRAMEWORK FOR STANDARDISED ASSESSMENT IN MULTIDISCIPLINARY CHILD HEALTH ORGANISATION Basim Al Ansari Sydney School of Public Health, University of Sydney Correspondence to: Basim Alansari address: baal8826@uni.sydney.edu.au

5 Basim has broad, diverse and multidisciplinary experience with formal training and education taking him from Management, Science, History and Philosophy of Science to Bioethics, Medicine, International Public Health and Health Policy. He is currently pursuing his PhD in Public Health at the University of Sydney. Research Question: How can a multidisciplinary health organisation use a framework for evidence-based standardised assessment to improve its clinical performance and evaluation processes? Research Objectives: 1. Assist with the development of standardised clinical assessment and care. 2. Inform and provide benchmarks for Systematic Improvement.3. Assist with outcome measures of clinical interventions. Research Method and Rationale: Healthcare delivery is a complex issue with many underlying variables. One of the main aspects of its complexity is the differing use of assessment by clinicians and their reporting of cases. Literature has shown that in a multidisciplinary health organisation context, this can lead to a mix of data that is not standardised or structured in ways enabling an organisational wide evaluation. Therefore, a framework for standardising care within health organisation is essential to ensure a continuous appropriate data generation and use within the organisational culture. This framework will enable both clinicians and management to evaluate every clinical assessment, intervention or program before its implementation for its relevance to the organisation as well as its validity in the specialised discipline. The clarity that such a framework brings will empower the organisation to have a participatory process where main staff contribute to decision making. The case study is a multidisciplinary health organisation that is serving rural and remote children with a risk of developmental delays in NSW. A participatory action research method is used where the researcher was embedded in the organisation. A participatory action research is utilised as an approach to evaluate the assessment programs in the organisation to assist in their improvements. First stage of the PhD consisted of: an observation of the organisation and its various services for 3 months. Then senior management was interviewed and all notes were taken during the second 3 months period. Clinical team leaders were interviewed and invited to provide feedback about the clinical tools their teams use and their justification and resources during the second 6 months. A framework for standardising care in the health organisation was created stemming from above data and relevant literature which is currently being implemented by the researcher. Next stage will be analysing the organisation s electronic medical records in a retrospective cohort study to analyse the data sets for patterns of clients demographics, diagnosis and outcomes. Results: Analysis of the organisation including a framework for standardised care within it -Tables that summarise and analyse psychometric statistics, evidence and standards. -Tables that match the findings to the context of the organisation Recommendations. Conclusion: First part of this PhD focused on understanding the context then analyse the literature to bring evidence into the specific organisational context. Studies indicate that an approach of building relevant evidence through the practical context informs adequate judgement by the organisation. The chosen topic assists directly with work already underway on service redesign, electronic medical records development and clinical governance; where it can play a part in enhancing decision making through evidence. It also provides the basis for a sustained organisation-wide approach to impact measurement. CHANGES TO THE CERVICAL SCREENING PROGRAM IN AUSTRALIA: EXPLORING WOMEN S CONCERNS AND HOW THESE CAN BE ADDRESSED Rachael H Dodd, Helena Obermair, Carissa Bonner, Jesse Jansen, Jolyn Hersch, Stacy Carter, Kirsten McCaffery

6 School of Public Health, University of Sydney Correspondence to: Rachael H Dodd address: rachael.dodd@sydney.edu.au Rachael is Postdoctoral Research Fellow who has recently joined the School of Public Health from the UK. Rachael s research interests cover the psychosocial impact of HPV, communication about HPV in head and neck cancer and cervical cancer contexts, cervical cancer screening and the HPV vaccination. The National Cervical Screening Program in Australia currently recommends that women aged 18 to 69 who have ever been sexually active, attend for regular Pap smears, every two years. From December 1st 2017, the recommendations will change to encompass a five yearly human papillomavirus (HPV) primary test, for women aged 25 to 74. This represents a reduction in screening across the population which has already sparked some public concern. An online petition opposed to these changes on the website Change.org received over signatures and nearly comments. Of comments posted between 16th February and 19thMarch 2017, a random sample of 2000 comments were analysed using content analysis. The results from this study has formed the basis for this body of research. The overarching response from women about the future changes to the National Cervical Screening Program was opposition. With this in mind, we have designed a series of studies to explore these concerns in depth and also to trial different methods of communicating the changes. A focus group study will firstly be conducted with up to 60 women aged 18-70, to explore both prior to, and following the presentation of information about the changes to the cervical screening program, reasons for and against cervical screening, attitudes towards the changes, concerns about the changes, and their information needs. The results from this study will inform the design of a quantitative experimental study, which will manipulate information given to women and assess attitudes both before and after the presentation of the information to tease out which information is most important and potent to women and what might influence their intentions for future screening participation. As many countries worldwide are implementing changes to their cervical cancer screening programs, health education in this area must address women s concerns. THE RIPPLE EFFECT: EVALUATION OF THE INDIGENOUS MARATHON FOUNDATION IN THURSDAY ISLAND Macniven R., Plater S., Dickson M., Gwynn J., Bauman A., Richards J. School of Public Health, University of Sydney Correspondence to: Rona Macniven address: rona.macniven@sydney.edu.au Rona is an SPH PhD candidate. Her research examines the benefits of physical activity for Australian Aboriginal and Torres Strait Islanders. She is investigating associations between physical activity and socio-demographic, health and lifestyle in children and adults and conducting physical activity program evaluation.

7 Objective: To examine the health and community impacts of the Indigenous Marathon Foundation (IMF), a program that uses running and local role models to promote healthy lifestyles, in a remote Torres Strait island community. Methods: Mixed methods approach. Exploratory qualitative interviews with 18 community and program stakeholders examined the influence of the IMF on the community and its broader effects and barriers and enablers to running. Data were analyzed using a grounded theory approach and thematic content analysis. A quantitative questionnaire asked 104 running participants (42 Indigenous) about their demographics, physical activity behaviors, running motivation and perceptions of program impact. Quantitative data were analyzed using descriptive statistics. Results: Interviews revealed five main themes around evidence of community readiness to adopt health lifestyles, social norms changes to increase physical activity, the importance of social support, ability of the program to reach of hard-to-reach groups and the initiation of broader healthy lifestyle beyond running. Barriers to running in the community were both personal (cultural attitudes; shyness) and environmental (costs; insufficient footpaths; hot and wet weather; dog attacks). Enablers reflected the importance of local Indigenous role models; targeting key population groups; shifting cultural barriers; improved affordability and environmental infrastructure. Most questionnaire respondents were female, had participated in both IMF activities and personal exercise. The main motivation to run was fitness. Most indicated lots of adults in their community run regularly (n=69), running has become more popular in the past three years (n=88) and IMF had an impact (n=89). Indigenous (compared to non-indigenous) participants were more likely to run to tackle health problems (p=0.03) and to have been inspired by local Indigenous role models (p=0.04). Conclusions: These findings demonstrate positive ripple effects of the IMF on running and broader health and lifestyle factors in a remote Torres Strait island community with a high initial level of community readiness. POOR BIRTH OUTCOMES AMONG ABORIGINAL WESTERN AUSTRALIANS AND SMOKING, ALCOHOL AND SUBSTANCE USE Alison J. Gibberd 1, Judy M. Simpson 1, Sandra J. Eades 2 1 School of Public Health, University of Sydney, Sydney, New South Wales, Australia 2 Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia Correspondence to: Alison Gibberd address: agib5822@uni.sydney.edu.au Alison Gibberd is a PhD student, researching perinatal outcomes across several generations of Aboriginal people in Western Australia. Prior to this, she worked as a data analyst researching survival and medical treatment for Aboriginal people diagnosed with cancer.

8 Introduction: Aboriginal infants tend to have much poorer birth outcomes than non-aboriginal infants. Aboriginal and non-aboriginal women have very different distributions of risk factors, yet studies of the relative importance of these factors within Aboriginal populations are limited. We aimed to identify the most important risks factors for poor outcomes in Aboriginal births in Western Australia. Methods: Birth, birth registrations, hospital, mental health and death records of all Aboriginal singleton births in Western Australia from 1998 to 2010 were linked. Using logistic regression with a generalized estimating equation approach, associations between four outcomes (perinatal death, small for gestational age (SGA), large for gestational age (LGA) and preterm births) and demographic factors and maternal health conditions were examined. Population attributable fractions were calculated. Results: Of 28,119 Aboriginal births, 16% of infants were SGA, 13% were preterm and 2% died perinatally. Risk factors were very common - mothers had hypertension/preeclampsia/eclampsia (HT) for 10% of births and smoked during 47% of pregnancies. Predictors of poor outcomes included demographic characteristics (parental occupations, remoteness, Aboriginality of eachparent, health insurance status and relationship status), characteristics of pregnancy (parity, maternal age, smoking and infections [urinary tract and Group B streptococcal infections]) and maternal chronic conditions (drug and alcohol use, assault against the mother, HT, diabetes and obesity). 26% of SGA births were attributed to smoking, 6% of preterm births to HT and 11% of perinatal deaths to the mother s unemployment or being a student. Conclusions: Poor birth outcomes in the Western Australia population are linked to the very high smoking rate among pregnant Aboriginal women, a risk factor which has been successfully reduced in the non-aboriginal population. They are also attributable to chronic health conditions, which were common despite the young age of the mothers. OVERDIAGNOSIS IN NSW DUE TO SCREENING MAMMOGRAPHY FOR BREAST CANCER Gemma Jacklyn, Kevin McGeechan, Stephen Morrell, Nehmat Houssami, Les irwig, Katy Bell, Alexandra Barratt School of Public Health, University of Sydney Correspondence to: Gemma Jacklyn address: gemma.jacklyn@sydney.edu.au Gemma Jacklyn is a doctoral student and Scholarly Teaching Fellow at the School of Public Health. Her interest is in better understanding the benefits and harms associated with breast cancer screening. The main focus of her research is overdiagnosis. She supports informed choice about screening and is affiliated with Wiser Healthcare, a research collaboration for reducing overdiagnosis and overtreatment. Objectives: To examine long-term trends in the incidence of early and late-stage incidence of breast cancer in NSW, Australia, from , and estimate the percentage risk of overdiagnosis attributable to the population-based screening mammography program, BreastScreen.

9 Method: We obtained individual, deidentified data on the degree of spread of breast cancer for NSW women from and examined temporal trends in the incidence of early and late-stage breastcancer. For our analyses, we defined early-stage cancer as ductal carcinoma in situ (DCIS) or localised disease, and late-stage cancer as regional or metastatic disease. Two approaches were used to estimate expected incidence in the absence of screening using an unscreened population of women older than 50 years prior to the introduction of governmentsubsidised mammography and BreastScreen ( ): 1. Poisson regression to extrapolate annual numbers of breast cancer from ; and 2. Allowing the baseline incidence to increase according to trends in a contemporary cohort of women who did not attend screening regularly (40-44 years). We then adjusted the observed estimates for hormone-replacement therapy (HRT) use, which coincided with the introduction of screening mammography. We compared the observed incidence of early and late-stage breast cancer among a population of women older than 50 years invited to screening to the expected incidence in an unscreened population. To allow for lead time bias, we included women who were older than the upper age limit of the screening program. Overdiagnosis was calculated as the difference in the observed and expected incidence of early and late-stage breast cancer, expressed as a percentage of all breast cancers detected in women invited to screening. Results: The introduction of screening mammography in NSW, Australia, has increased the incidence of early-stage breast cancer without reducing the incidence of late-stage breast cancer. The first approach found that in 2012, breast cancer was overdiagnosed in 938 women; accounting for 22% of all newly diagnosed cases (95% CI: 21.9%-22.5%).The second approach found 1,383 women were overdiagnosed; accounting for 33% of all newly diagnosed cases (95% CI: 31.2%-34.0%). Conclusions: Screening mammography was not associated with a reduction in the incidence of late-stage breast cancer in NSW, Australia. We estimate that around one quarter of all newly diagnosed DCIS and invasive breast cancer cases are overdiagnosed. LONG-TERM EXPOSURE TO AMBIENT PARTICULATE MATTER AND HOSPITALISATION FOR ASTHMA Farhad Salimi 1,2,3, Geoff Morgan 1,3, Margaret Rolfe 1, Christine Cowie 3,4,5, Ivan Hanigan 3,6, Luke Knibbs 3,7, Martin Cope 3,8, Fay Johnston 2,3, Yuming Guo 3,9, Jane Heyworth 3,10, Guy Marks 3,4,5, Bin Jalaludin 3,11 1 University Centre for Rural Health North Coast, School of Public Health, University of Sydney, Australia 2 Menzies Institute for Medical Research, University of Tasmania, Australia 3 Centre for Air quality and health Research and evaluation (NHMRC Centre of Research Excellence) 4 South West Sydney Clinical School, University of New South Wales, Sydney, Australia 5 Woolcock Institute of Medical Research, University of Sydney, Australia 6 Centre for Research and Action in Public Health, University of Canberra, Australia 7 School of Public Health, The University of Queensland, Australia 8 CSIRO Oceans & Atmosphere, PMB1, Aspendale, VIC, Australia 9 Department of Epidemiology and Preventive Medicine, Monash University, Australia

10 10 School of Population and Global Health, University of Western Australia 11 School of Public Health and Community Medicine and Ingham Institute for Applied Medical Research, University of New South Wales, Australia Correspondence to: Farhad Salimi address: Farhad joined University of Sydney as a Postdoctoral Research Associate in January Prior to joining University of Sydney, he was a postdoctoral research fellow at University of Tasmania for two years. His work focuses on the effects of exposure to air pollution on human health. Introduction: Studies have found association between short-term exposure to ambient particulate matter (PM) and hospital admission for asthma, however, the association between long-term exposure to PM and hospital admission for asthma are inconsistent. Methods: The 45 and Up cohort study includes 267,153 participants of 45 years old and above at baseline ( ) from the state of New South Wales, Australia. This study was limited to the 100,084 participants residing in the Sydney Metropolitan Region. The cohort was linked to hospital admissions data from 1 July 2001 to 30 June The first respiratory hospital admission for asthma between baseline and 30 June 2014 was considered as the main outcome. PM2.5 (PM less than 2.5 μ m in aerodynamic diameter) concentrations were estimated at the baseline residential addresses of participants using a chemical transport model blended with fixed site monitor data. Cox proportional hazard models were used to assess the associations between hospital admission for asthma and exposure to PM2.5. Results: The median and interquartile range of the estimated PM2.5 level were 4.5 and 0.8 μg.m-3respectively. PM2.5 concentrations was associated with risk of hospitalisation for asthma (HR and 95% CI per 1 μ g.m-3: 1.21; ). Conclusions: Exacerbations of asthma are associated with long-term exposure to relatively PM2.5 concentration levels. EVALUATION OF THE MAKE HEALTHY NORMAL FACEBOOK PAGE James Kite 1, Anne Grunseit 1,2, Becky Freeman 1, Michelle Maxwell 3, Vincy Li 4, John Vineberg 3 1 Prevention Research Collaboration, Sydney School of Public Health and Charles Perkins Centre, University of Sydney NSW, Australia 2 The Australian Prevention Partnership Centre, based at Level 6, Charles Perkins Centre, University of Sydney, NSW, 2006, Australia 3 NSW Office of Preventive Health, Liverpool, NSW, Australia 4 Centre for Population Health, NSW Ministry of Health, North Sydney, NSW, Australia

11 Correspondence to: James Kite address: James is currently Associate Lecturer and PhD candidate within the Prevention Research Collaboration. His work with the PRC is focused on the evaluation of social marketing and mass media campaigns, with a particular interest in the role of social media, and the interface between research and policy. The Make Healthy Normal (MHN) mass media campaign was launched by the NSW Government in 2015 and aimed to challenge the normalisation of being unhealthy and encourage adults to adopt a healthier lifestyle. The campaign is making use of Facebook as one channel to reach and engage its target audience. This study aims to evaluate MHNs Facebook page. We will be using mixed methods to evaluate the page. This includes examining the Facebook analytic data and a survey and focus groups with Facebook users, particularly those who had liked the MHN page. Collectively, these three data sources will provide information on the reach of the page and the type and style of content that garners higher or lower levels of audience engagement and why, as well as providing insights into the motivations and expectations of Facebook users when engaging with pages like MHN. The use of Facebook as part of public health campaigns is increasing but there is very little evidence available to guide the use of Facebook for this purpose and much of what is available comes from small-scale trials. This study will be one of the first to formally evaluate the use of Facebook as part of a population-level strategy. As well as assisting the NSW Government to improve the MHN page, it will begin to fill a significant gap in understanding of how social media can be used in public health campaigns. ACCEPTABILITY AND EFFICACY OF A LOCALLY-PRODUCED MULTIPLE MICRONUTRIENT-FORTIFIED READY-TO-USE SUPPLEMENTARY FOOD (RUSF) FOR CHILDREN UNDER TWO YEARS OLD IN CAMBODIA Bindi Borg 1, Dr Seema Mihrshahi 2, Dr Mark Griffin 3, Dr Arnaud Laillou 4, Dr Chamnan Chhoun 5, Daream Sok 6, Dr Frank Wieringa 7 1 School of Public Health. Sydney University. 2 Prevention Research Collaboration. Sydney University. 3 School of Public Health. University of Queensland. 4 UNICEF. Cambodia. 5 Department of Post-Harvest Technologies and Quality Control (DFPTQ). Ministry of Agriculture, Forestry and Fisheries. Cambodia. 6 DFPTQ and University of Copenhagen. Denmark. 7 UMR-204 Nutripass. IRD. France. Correspondence to: Bindi Borg address: bindi_borg@yahoo.com.au

12 Bindi Borg has been a development practitioner in West Africa, the Balkans, SE Asia and the Pacific for twenty years. She is also a breastfeeding counsellor with extensive experience in infant and young child feeding. She lived in Cambodia, where she conducted her PhD research, for over six years. Background: Cambodia s progress in combatting malnutrition has stalled. In 2014, 32% of children under five were stunted, 24% were underweight and 10% were wasted. Yet prevention and treatment of malnutrition has been limited by low acceptability and efficacy of existing supplementary and therapeutic foods. Therefore, our project developed a locally-produced Ready-to-Use Supplementary Food (RUSF). Two trials were conducted on this novel RUSF. Objectives: The first trial assessed the RUSF s acceptability to children and caregivers, compared to existing supplements, Corn-Soy Blend (CSB++) and Sprinkles micronutrient powders. The second trial assessed the RUSF s efficacy in reducing growth faltering compared to CSB++, Sprinkles and a control group. Methods: Acceptability was a crossover trial with 9-23 month-old children (n=92). Outcomes were children s consumption and caregivers ranking of foods. Efficacy was a nonblinded, cluster-randomised control trial. Healthy 6-11 month-old children (n=486) were allocated to an intervention or control group for six months. The main outcome was anthropometric status, i.e. weight-for-height, height-for-age, weight-for-age, mid-upper arm circumference (WHZ, HAZ, WAZ, MUAC). Results: In the acceptability trial, children consumed less RUSF than other foods, but it provided more kilocalories. Moreover, caregivers ranked the RUSF highly. None of the efficacy trial interventions prevented growth faltering, but children consuming RUSF faltered at a lower rate. Baseline to endline decreases in WAZ, HAZ and WHZ were least for children consuming RUSF. Increases in MUAC were greatest for CSB++. Children with lower baseline anthropometric measures had better outcomes. Conclusions: Although children in the acceptability trial ate less RUSF, it provided more energy and nutrients. Importantly, caregivers ranked it very highly. Therefore, the RUSF seemed promising. The subsequent efficacy trial suggested that neither common supplements (Sprinkles, CSB++) nor the novel RUSF could prevent growth faltering. However, in comparison to those supplements and the control group, the novel RUSF protected most against growth faltering. WHAT DETERMINES ACCESS TO HEALTHY FOOD FOR OBESITY PREVENTION IN SAMOA? Penny Farrell, Anne Marie Thow, Justin Richards, Malaefono Taua, Mamaru Awoke, Suzie Schuster, Seema Mihrshahi, Pavle Vizintin, Joel Negin Sydney School of Public Health, University of Sydney Correspondence to: Penny Farrell address: penny.farrell@sydney.edu.au Penny is a PhD Candidate at the Sydney School of Public Health and her research focuses on influencers of access to healthy food for obesity prevention in the Pacific. Penny has previously worked in health and health policy research in the government and not-for-profit sectors.

13 Background: Samoa has the third highest obesity prevalence in the world. The World Health Organization has declared obesity, diets rich in fat and sugar, and inactivity to be the greatest health threats to the Samoan population and the growing burden of consequent diseases including diabetes, cardiovascular disease and cancer is placing significant strain on its health system. Aims: Our central research question is how much power people have over what they eat both between and within households to understand the complex drivers of obesity in Samoa. Methods: We performed two complementary studies focussing on adult women: Study 1) Multivariate analysis of the 2014 Samoa Demographic and Health Survey data, highlighting the strongest sociodemographic predictors of overweight and obesity; and Study 2) In-depth qualitative study which presents a nuanced, first-hand account of the factors affecting access to a non-obesogenic diet. Results: Seventy-five percent of Samoan women aged years are obese. Obesity rates increase with wealth and only 1% of women meet the recommended level of fruit and vegetable consumption. There are compelling patterns between sociodemographic factors, food consumption and Body Mass Index. Qualitative findings highlight the recent shift from local food consumption to Western-style, energy dense foods in urban Samoa which is exacerbated by geographic, cultural and market-based issues of household food access. Discussion: Understanding sociodemographic patterns of obesity using context-specific country-level data is a way to identify those most at-risk and to develop targeted, country-specific policies for obesity prevention in the most highly affected countries. EXPANDING THE VERBAL EXCHANGE HEALTH LITERACY MODEL: SYNTHESIS OF FINDINGS FROM A MIXED-METHODS RCT Danielle M Muscat 1,2,Heather L Shepherd 2,3,Don Nutbeam 1, Suzanne Morony 1,2, Sian K Smith 5, Haryana M Dhillon 2,6, Lyndal Trevena 1,2, Andrew Hayen 4, Karen Luxford 7, Kirsten McCaffery 1,2 1 Sydney School of Public Health, The University of Sydney 2 Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney 3 Psycho-oncology Co-operative Research Group (PoCoG), School of Psychology, The University of Sydney 4 Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales 5 School of Psychology, The University of Sydney 6 Faculty of Health, University of Technology Sydney 7 Clinical Excellence Commission, NSW, Australia

14 Correspondence to: Danielle Muscat address: Danielle Muscat, B.Psych. (Hons: Class 1), is a PhD candidate in the School of Public Health, University of Sydney. Her research interests include: health literacy, decision-making, health/risk communication and patient-provider communication, with a particular focus on improving the quality of health communication and decision-making for socially disadvantaged, lower literacy populations. Background: The Verbal Exchange Health Literacy model (Harrington & Valerio, 2014) has identified distinct health literacy skills for communication between patients and providers. However, it focuses narrowly on speaking and listening skills and shared decision-making (SDM) is absent. Understanding the overlap between health literacy skills and shared decisionmaking skills is an important consideration for future verbal exchange interventions. Methods: We developed a novel health literacy program for adults with lower literacy which included an integrated SDM component. The program was delivered at 14 adult basic education centers across New South Wales in 2014 as part of a randomized controlled trial (n=308). Results from a mixed-methods analysis of the program were synthesized to build on the conceptual model of Verbal Exchange Health Literacy. Results: Our revised Verbal Exchange Health Literacy model embodies health literacy as a context-specific skill that is modifiable, rather than a static patient construct. It also includes Nutbeam s three levels of health literacy (functional, communicative and critical health literacy) to better reflect the range of health literacy skills needed for the verbal exchange, over and above listening and speaking skills. Our results showed that being able to extract information by asking relevant questions is a key aspect of communicative competence in health consultations. Contextualising and evaluating health information are also important critical health literacy skills needed to exert greater control over healthcare decisions in the verbal exchange. Discussion/implications: Insights from our health literacy program have refined the Verbal Exchange Health Literacy model to better reflect the overlapping constructs of health literacy and SDM. Empirical studies are needed to compare the fit and predictive usefulness of the original and revised models. MANAGING WISELY: DIAGNOSIS AND MANAGEMENT OF GASTRO-OESOPHAGEAL REFLUX IN INFANTS IN GENERAL PRACTICE Jane Bell, Francisco Schneuer, Christopher Harrison, Adam Elshaug, Natasha Nasser MenziesKids, Menzies Centre for Health Policy, School of Public Health, University of Sydney Correspondence to: Jane Bell address: jane.bell@sydney.edu.au

15 Jane is interested in evaluating the use of medicines, and their safety and quality use in children and young people using population-based data (Big Data). She is a Research fellow at MenziesKids, Menzies Centre for Health Policy. Background: Gastro-oesophageal reflux (reflux) in infants <1 year is common and a normal physiological condition. A more serious form of reflux, gastro-oesophageal disease (GORD) may occur, resulting in heartburn and other troublesome symptoms. In 2016, the Royal Australasian College of Physicians (RACP) identified treating infants with GORD with acid-suppressing drugs as a low value practice as these medicines are no better than placebo, and may have significant negative side effects. We aimed to evaluate the diagnosis and management of reflux and GORD in infants aged <1 year presenting to general practitioners (GPs) in Australia. Methods: We used data from a nationally representative cross-sectional survey of GPs in Australia (BEACH study) to analyse visits for reflux and GORD in infants <1 year of age between 2006 and Results: We identified 512 visits for reflux or GORD, 2.7% of all infant-related GP visits. Most visits (80.7%) were for reflux. Medicines were recommended in over half the visits for reflux or GORD (56.2%, 65.7% respectively). Proton Pump Inhibitors (PPIs), the most commonly prescribed medicine, were prescribed in 26.2% and H2-receptor antagonists in 18.9% of visits. Counselling/education for parents was provided in 35.9% of visits. Conclusion: Despite current advice against their use, medications were recommended in over half the visits to GPs for infants with reflux or GORD. Medication was more common than counselling and education of parents. These data provide a baseline against which changes in practice as a result of the RACP recommendation can be measured.