Public health policy and its behavioural outcomes

This thesis aims to explore the theme of the behavioural outcomes of public health policy, including its mediators, through work done at three different large public health organisations. Work undertaken at the Cancer Council Victoria aimed to examine tobacco brand choice and loyalty among smokers in Australia’s uniquely restrictive tobacco market. No clear association was found between tobacco control policies and brand loyalty prior to the introduction of plain packaging. Factors hypothesised to be important, including price, packaging, peer influence and health literacy did mediate brand choice according to age, income and level of addiction. These provide points to intervene with public health policy changes. Tobacco brand family switching does not appear to facilitate later quitting behaviour and therefore cannot be recommended to assist quitting. Since the introduction of the plain packaging policy there has been some downshifting to value brands, but illicit tobacco use remains rare. Plain packaging is likely contributing to the decline in smoking prevalence. At the Victorian Health Promotion Foundation (VicHealth), research was undertaken into highly caffeinated sugar-sweetened beverages known as energy drinks and related public policy. The aim was to provide the evidence base for VicHealth’s own policy and for a broader audience. Insights were gained into the physical and behavioural effects of energy drinks, including excessive use, risk-taking and aggression. The present regulatory framework is insufficient to adequately warn or protect both the general public and vulnerable sub-groups against the risks energy drinks pose. Risk mitigation policy suggestions are made, including regulatory changes and creating supportive environments. There has been little change in Australian energy drink policy since the work at VicHealth. At Communicable Diseases Prevention and Control at the Department of Health and Human Services Victoria, a review of the internal protocols for managing hepatitis B and C statutory notifications was undertaken. The aim was to improve notification handling, epidemiological data Abstract 6 collection for public health policy formulation, identification of risk factors that pose a legal risk to the department and to reduce onward transmission of disease. Processes could be enhanced in a range of areas, resulting in improved procedures for staff, interactions with notifying medical practitioners and laboratories and ultimately public health. Influenza surveillance policy and its behavioural outcomes amongst general practitioners (GPs) were also reviewed. The aim was to investigate if the policy of allowing GPs in Victoria’s sentinel surveillance system to choose which patients with a clinical diagnosis of influenza-like illness to test for influenza was a source of bias. Between 2007 to 2014 GPs were consistent in their sampling within each influenza season and between seasons – there was no evidence of temporal systematic error. This diverse range of projects covered both the internal policies of a range of large public health organisations and the effects of policy on the behaviour of medical practitioners, laboratories, industry, vulnerable groups and the wider community. Policy should consider regulation and its implementation, price, peer influence, health literacy, supportive environments and systems to impact public health through affecting the behaviour of all of these groups.