PERU - Annual Report 2021

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Prevention Education & Research Unit Research and Education Network Western Sydney Local Health District

Annual Report 2021


Prevention Education and Research Unit (PERU) Research and Education Network, Western Sydney Local Health District Faculty of Medicine and Health, The University of Sydney PO Box 533, Westmead NSW 2145 T: +612 88906505 E: wslhd-westmead-peru@health.nsw.gov.au PERU Team Clinical Professor Smita Shah - Director Kym Rizzo Liu - Project Coordinator Emma Sainsbury - Senior Research Officer Amelia Galao - Administration Officer

Acknowledgments We appreciate the financial support from Western Sydney Primary Health Network and Mrs Patricia McAlary and family for our prevention programs in schools. Sadly, Mrs McAlary passed away on the 10th of November. Her generosity in supporting the work of our unit to effectively deliver services to schools during the pandemic will always be remembered. We thank the Blacktown, Hills, and the Mt Druitt Medical Practitioners Associations, NSW Australian Medical Association, The Office of the Advocate for Young People and Children NSW and Jennifer Michelson for their support. Special thanks to Professor Mark McLean, Helene Abouyanni and Dalia Younan and administrative staff of Research and Education Network for their ongoing guidance and support.

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Table of Contents Foreword ............................................................................................................................ 4 Prevention Education & Research Unit ........................................................................... 5 2021 at a Glance ............................................................................................................. 6 SALSA Program .............................................................................................................. 7 The Triple A Program .................................................................................................... 10 COVID-19 Support for Schools ..................................................................................... 11 Unpacking Vaping in Schools ........................................................................................ 14 Teaching........................................................................................................................ 17 Collaborations and Partnerships ................................................................................... 18 Conferences and Publications ....................................................................................... 19 Focus Areas 2022 ......................................................................................................... 21 Digital Channels ............................................................................................................ 23

Acronyms AMA NSW

Australian Medical Association, New South Wales

BMPA

Blacktown Medical Practitioners Association

FMH

Faculty of Medicine and Health

HDA

Hills Doctors Association

MDMPA

Mt Druitt Medical Practitioners Association

PERU

Prevention Education and Research Unit

REN

Research and Education Network

SALSA

Students As LifeStyle Activists

Triple A

Adolescent Asthma Action

TSANZ

The Thoracic Society of Australia and New Zealand

UNSW

University of New South Wales

WSLHD

Western Sydney Local Health District

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Foreword The experience of the last 2 years of a global pandemic has reminded us that the health of a community resides in the actions of individuals, more than in government policies or the behaviour of institutions. There has never been a more important time to harness education and community activism in the pursuit of a healthier population. The work of PERU with young people in Western Sydney is a brilliant example of empowerment of people to determine their own health and wellbeing. The PERU team are demonstrating the capacity of youth leadership and young voices to influence an entire community for good. The programs described in this report are enabling young people to set their own priorities for their health, to influence their peers and families, and to shape the wellbeing of their own communities. The concepts of empowerment, diversity and equity are strongly engaged in all the work described here. I congratulate the PERU team on another year of tremendous achievement! Professor Mark McLean Executive Director of Research, WSLHD Conjoint Professor of Medicine, Western Sydney University Honorary Professor Faculty of Medicine and Health University of Sydney

Acknowledgement of Country We acknowledge the Darug people as the traditional custodians of the land covered by Western Sydney Local Health District upon which our work was conducted, and pay respect to Elders past, present and emerging.

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Prevention Education & Research Unit We are pleased to share with you the ongoing work, achievements and highlights from the Prevention Education and Research Unit (PERU) in 2021. PERU works in partnership with schools, universities and with a range of organisations, including general practitioner associations to deliver evidence-based prevention programs and interventions to improve the health and well-being of young people. Our award-winning SALSA (Students As LifeStyle Activists) and Triple A (Adolescent Asthma Action) programs have been running in schools for more than 15 years. The programs use an empowerment approach to healthy eating, physical activity, asthma, smoking and vaping prevention and cessation. The evaluation of the programs indicate that the SALSA Program improves fruit and vegetable intake, decreases intake of sugar sweetened beverages, and increased physical activity in boys1,2. The Triple A program improves the quality of life of students with asthma, reduces asthma attacks, school absenteeism and smoking3,4. The programs continue to show results thanks to our strong partnerships with schools. In 2021, some plans for the SALSA and Triple A programs had to be postponed due to the challenges of COVID-19. Nevertheless, we delivered some key initiatives for western Sydney schools and beyond, including using innovative strategies and technology to share accurate and timely public health messages to promote COVID-19 vaccinations and vaping prevention and cessation.

PERU Team, 2021 Kym Rizzo Liu, Professor Smita Shah, Emma Sainsbury and Amelia Galao 1. 2. 3. 4.

Shrewsbury et al. Impact and cost of the peer-led Students as Lifestyle Activists programme in high schools. 2019. Foley et al. Evaluation of a peer education program on student leaders’ energy balance-related behaviors. 2017. Gibson et al., Peer-led asthma education for adolescents: impact evaluation. 1998. Shah, S et al. Effect of peer led programme for asthma education in adolescents: cluster randomized controlled trial.2001

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2021 at a Glance

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SALSA Program The Students As LifeStyle Activists (SALSA) program complements the work being done in schools through the Stage 4 NSW Personal Development, Health and Physical Education curriculum and the Wellbeing Framework. It is key to ensuring that adolescents are given the opportunity to build leadership skills whilst advocating healthy eating and increased physical activity in their school and communities.

SALSA Educator’s Workshop Two workshops were held for 20 university students volunteering from University of Sydney, UNSW, University of Western Sydney, Australian Catholic University and Macquarie University. The students were from a range of faculties including Business/Law, Engineering, Exercise Science, Medicine & Health, Pharmacy and Physiotherapy.

Project Outcomes

Evaluation survey results (n = 20)

SALSA Educators Workshop, The University of Sydney

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SALSA Peer Leader Workshops Four peer leader workshops were held in 2021, with 139 Year 9/10 students trained. COVID-19 impacted on the delivery of the SALSA program. All activities, including peer-leader’s delivery of the SALSA program and post-data collection, were cancelled.

Project Outcomes

Pre-workshop responses to “when you think about your health and wellbeing, what would you most like to learn?” (n = 137)

Mentimeter post-workshop feedback

SALSA Peer Leaders, Rooty Hill HS

SALSA Peer Leaders, Model Farms HS

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SALSA Youth Voices

SALSA Youth Voices Action Day provides an opportunity for students to share their plans and actions formulated at the leadership workshop. SALSA Youth Voices Action Day was held in Term 1, 2021, for the 2020 SALSA Peer Leaders to present their plans and actions. The audience was limited to 50.

SALSA Youth Voices Action Day

Students from three high schools presented their plans which included: Painting lines or updating new volleyball and handball courts Installation of water refill stations Replace uneven sporting grounds with artificial turf Trophies were awarded to all participating schools for their outstanding contribution.

Project Outcomes The students’ plans to install water refill stations were supported by the principals of the schools, the Mt Druitt Medical Practitioner’s Association ($6,000) and the Hills Doctors Association ($2,000). A total of eight schools will have a water refill station, resulting from advocacy by students in their school.

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The Triple A Program Triple A is a proven peer-led education program to improve asthma self-management and prevent the uptake of smoking. Peer education occurs within the school setting and involves senior students delivering the program to younger students. Triple A uses a series of structured lessons to educate younger peers about asthma, asthma management and how to resist peer pressure towards vaping and tobacco smoking. These lessons involve games, activities, videos, and a quiz show. COVID-19 limited the number of face-to-face workshops delivered in 2021. However, program manual and resources were modified to include information on adolescent vaping, and materials were translated for online delivery.

Triple A Educator’s Workshop One educator workshop was held on 18th June 2021. Fifteen students volunteered from four universities. Students were from a range of faculties including Public Health, Business/Law, Medicine & Health, Nursing, Pharmacy and Physiotherapy.

Project Outcomes

Evaluation survey results (n = 13)

“I like working with kids and I want to get into nurse education, so Triple A is a good pathway. Now I have the confidence to go into schools and know what I’m doing” Participant feedback

Triple A Educators Workshop

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COVID-19 Support for Schools To meet the needs of the school community and address vaccine concerns we held two COVID-19 information and Q&A sessions for school staff in Western Sydney.

COVID-19 Q&A sessions for school staff The Q&A sessions gave principals, teachers, and administrative staff an opportunity to meet with local general practitioners to discuss their COVID-19 concerns and have their questions answered regarding the risks and benefits of AstraZeneca, and access to AstraZeneca and Pfizer vaccines. The 60-minute sessions were held via Zoom in July and August. Over 288 school staff registered for the events and 195 attended. Over 40 COVID-19 questions were submitted for response. Questions were answered by an expert panel which included Drs Kean Seng-Lim (Mt Druitt), Hani Bittar (Glendenning), Palu Malaowalla (Rosehill) and A/Professor Michael Fasher (Blacktown), moderated by Professor Smita Shah, A/Professor Michael Burke and Kym Rizzo Liu.

Project Outcomes “People had the opportunity to ask questions of medical experts, rather than grumble and complain to each other. We were given logical and empathetic information.” Participant feedback Participant responses to the question “What did you find most useful about this session?” (n = 39)

COVID –19 information and Q&A session 11


COVID-19 Youth Voices Q&A session In the face of rapidly evolving vaccination advice for 12-to-15-year-olds and return to school plans, it was important that students were given a voice. We hosted an online COVID-19 Q&A session for western Sydney high school students in September. 118 students registered for the session and 55 attended. An expert panel of local doctors (Michael Burke, Kean-Seng Lim, Kim Loo and Michael Fasher), infectious disease experts (Associate Professor Holly Seale and Dr Archana Koirala), a psychologist (Associate Professor Frankie Merritt) and a medical student (Ms Aanchal Shankar) were on hand to answer the questions from young people. Ninety-two questions were submitted for response. Topics included COVID health effects, vaccination safety and effectiveness and return to school plans. Students were particularly interested in whether vaccinations would be made mandatory and what school activities would be permitted for vaccinated students.

Project Outcomes

Mentimeter session feedback

Mentimeter survey results

Post forum videos were produced to answer key questions submitted by students and are available on the PERU YouTube channel.

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Youth Voices: COVID-19 Video Competition There was a need for innovative strategies to promote COVID-19 vaccinations and health and wellbeing information to young people. We therefore developed a video competition to encourage student engagement, leadership and voice and partnered with UNSW and the Office of the Advocate for Children and Young People (ACYP). High school students from across NSW were invited to submit a short video entry addressing one of three topic areas: COVID-19 vaccination, looking after your wellbeing during the pandemic or tackling COVID-19 misinformation. Eighty-four video entries were received from 92 high school students (representing 43 high schools across NSW). Prizes were awarded to the top 3 video entries from within and outside of western Sydney, and the two schools with the most video entries. An additional 12 prizes were awarded under the following categories: “Courage”, “Care”, “Creativity”, “Concept” and “Critical thinking”. All winners were announced at an online ceremony attended by more than 110 people. The winning video entries are available on the PERU YouTube channel.

Project Outcomes

Evaluation survey results (n = 57)

“I’d like to thank the Prevention Education and Research Unit for recognising the need for innovative strategies to spread health and wellbeing information. Thank you for empowering the youth of Sydney to have a voice during the pandemic.” Year 12 western Sydney prize winner. Self-reported skills gained by students’ postcompetition (n = 57)

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Unpacking Vaping in Schools In response to the growing problem of adolescent vaping in local high schools the “Unpacking vaping in schools” research study was developed.

Pilot Consultation Sessions The aims of the study were to 1) explore high school students’, teachers’,

views on

e-cigarettes/vapes, and 2) determine how to effectively communicate vaping prevention messages to adolescents. We conducted pilot consultation sessions at Erskine Park High School with a group of students (n = 19), teachers (n = 24), and parents (n = 6) in Term 3, 2021 to identify key thematic areas. The sessions were a success, with students stating they appreciated the opportunity to discuss vaping in a safe environment free from judgement from peers.

Project Outcomes

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Vaping Advisory Committee To guide our work with schools to effectively address the growing problem of student vaping, we established a Vaping Advisory Committee.

The committee currently has 14 members, including: Professor Renee Bittoun (Tobacco Treatment Specialist) Dr Michael Burke (Kildare Medical Centre) Jodie Brunton (parent) Emily Goon (parent) Mark Grady (Principal, Model Farms High School) Dr Kim Loo (Riverstone Family Medical Practice) Dr Nia Luxton (Lecturer, Discipline of Physiotherapy, Australian Catholic University) Lisa Mcinally (parent and Deputy Principal of Claregate Primary School) Joshua Mcinally (student) Melissa Palermo (Manager, Alcohol and Tobacco Program, Health Promotion, NSLHD) Brenda Quayle (Principal, Erskine Park High School) Professor Bandana Saini (University of Sydney School of Pharmacy) Associate Professor Susan Towns (respiratory physician, Children’s Hospital Network) Hayati Vyas (Master of Public Health graduate) The committee met twice over Zoom during Term 4 2021. The meetings were productive, with decisions reached on vaping prevention and cessation strategies to focus on moving forward. Some strategies have already been actioned, including the Unpacking Vaping Q&A session for parents and carers.

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Unpacking Vaping Q&A Session for Parents and Carers An online Q&A session to address the growing problem of adolescent vaping was held on 1st December, 6:30 – 7:30pm. The session provided an opportunity for parents of western Sydney school students to have their vaping questions and concerns responded to by a panel of experts including respiratory physicians, and e-cigarette and smoking cessation specialists. Over 200 parents registered for the event and 90 attended. The session commenced with an introduction by Ms. Brenda Quayle, principal of Erskine Park High School. Ms Quayle painted a picture of the vaping situation in local high schools and the challenges faced by the school community in responding to this issue. Parent questions were then responded to, covering topics such as the difference between e-cigarettes and traditional cigarettes, the health effects of vaping, the legality, and what they can do to help their child stop vaping.

Project Outcomes

“Very thorough and covered a lot of material in the time allocated. Variety of speakers with relevant knowledge. We as parents need to be armed with current knowledge and information” Parent feedback.

Event promotional flyer displaying expert panel members

The session recording has been edited into 15 bitesize videos. The videos are available to view on the PERU YouTube channel. and can be shared using the hashtag #unpackingvaping.

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Teaching We facilitated Health Promotion 2.5 hr workshops online via Zoom to University of Sydney fourth year and Master of Pharmacy Students (n=228). The successful evidence based Triple A program was used as the case example for this workshop.

Teaching Outcomes

4th Year Pharmacy students Workshop

Mentimeter participant feedback

FMH, University of Sydney, Western Clinical School, Medical students Med 1 Clinical Skills Theme Respiratory Block 11/2hrs x 4 Respiratory devices hands on workshop 1hr x 3 (n=60) Respiratory Communication Revision 1hr Examination Year 1 Medical Student Multi Modal Clinical Assessments (MMCA)

PHD, Internship and Capstone students Master of Public Health, UNSW Intern, Ryan Romero, “Review of the literature on leadership programs for university students”. Master of Public Health, UNSW Intern, Sophie Wang, ‘the impact of health-promoting on university students and university environment: a scoping review.’ Fay Karpouzis, PhD, 2019-ongoing, co-supervisor, Deakin University, Melbourne. “Promoting food literacy, sustainable and healthy eating in children aged 10-12 years: Implementation and Evaluation of OzHarvest’s school-based FEAST (Food Education and Sustainability Training) Program”.

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Collaborations and Partnerships

COVID-19 Western Sydney GP and Faith-based Leaders' Network In response to the COVID-19 outbreak, we continued to meet with the faith-based community network which combined with the COVID-19 Western Sydney General Practitioner’s Network for meetings and events in 2021. The COVID-19 Q&A sessions with school staff and students, and the Unpacking Vaping Q&A session for parents and community members were supported by this group.

Research Collaborations MRFF Bushfire Study, led by Professor McIntyre, the Medical Research Future Fund, is conducting a randomized trial to determine the impact of surgical masks and P2 respirators during bushfire season on adverse respiratory outcomes among adults with lung disease. This research will provide the first clinical efficacy data on mask and respirator use for prevention of smoke-induced exacerbations of asthma and COPD in the world TRGS Gout Study- Investigator- CI A/ Professor Peter Wong. A nurse-led patient education and engagement intervention program to address the personal and economic burden of gout in Western and Southwestern Sydney

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Conferences and Publications It was a productive year of conferences, reports and publications.

Conference Presentations 1.

Triple A: Self-management of Asthma and Smoking Prevention in high school, TSANZ ASM, April 2021 [virtual]

2. Engaging High School Students during a Pandemic: Digitalisation of the SALSA program. Australian Public Health Conference, September 2021 [virtual]. Long oral presentation 3. SALSA Youth Voices: Students Leading Change in their Schools. 2021 World Congress in Adolescent Health, Lima November [virtual]. Poster presentation 4. SALSA Youth Voices: Physical Activity Advocacy in the School Environment. Australian Society for Physical Activity (ASPA), November 2021 [virtual]. Short presentation 5. Simple Changes: A Co-Designed Animation with High School Students. Digital Solutions for Adolescents Health and Wellbeing, Charles Perkins Centre, University of Sydney, 19th November 2021 [virtual]. Short presentation

Publications Reports 1. PACE Research Translational Report, 2021 2. COVID-19 Community and Faith-Based Leaders Group Report, 2020 3. Prevention Education and Research Unit Report, 2020 4. SALSA Monitoring and Evaluation Report, 2020. ISBN: 1740 801741

Peer-reviewed Journal Articles 1. R MacIntyre, P Nguyen, M Trent, H Seale, Abrar Ahmad Chughtai, Smita Shah, Guy B. Marks. Adverse Health Effects in People with and without Pre-Existing Respiratory Conditions During Bushfire Smoke Exposure in the 2019/20 Australian Summer AJRCCM https://doi.org/10.1164/rccm.202012-4471LE PubMed: 33975534 Received: December 19, 2020; Accepted: May 10, 2021 2. F. Karpouzis, R. Lindberg, A. Walsh, S. Shah, G. Abbott, J. Lai, A. Berner & K. Ball. Evaluating OzHarvest’s primary-school Food Education and Sustainability Training (FEAST) program in 10–12-year-old children in Australia: protocol for a pragmatic cluster nonrandomized controlled trial. BMC Public Health volume 21, Article number: 967 (2021)

Publications under Review Hardy, LL, Rizzo Liu, K, Sainsbury, E et al. Engaging youth voices to create supportive school environments for healthy eating and physical activity (under review with BMC Public Health).

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Media Articles 1. “Western Sydney student-made video inspires healthy teen lifestyle.” Nepean News, 19 February 2021 2. “Western Sydney student-made video inspires healthy teen lifestyle,” The Pulse, 10 Feb 2021 Edition 3. “Youth Week 2021: students take charge and look to sporting improvements”. Nepean News, 30 April 2021. 4. “COVID vaccine outreach to schoolteachers and staff”. AMA NSW Doctor, 8 September 2021. 5. “Online COVID Q&A session lets Western Sydney students raise their voices, questions and concerns”, The Pulse, 6 Oct 2021 Edition 6. “Western Sydney winners of Youth Voices COVID-19 Video Competition announced”. The Pulse, 20 Oct 2021 Edition

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Focus Areas 2022

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Digital Channels Websites

SALSA and Triple A Peer-led Leadership Programs

PERU, Research Education Network

Social Media

@PERUWSLHD

@peru_programs

@PERUWestmead

Peru Westmead

PERU: Youth Voices

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