Auswahl der wissenschaftlichen Literatur zum Thema „Sex differences in education Australia“

While there is much literature suggesting reasons why there are differences between males and females with respect to computer usage, achievement and attitudes, there is a paucity of empirical research. This study discusses a meta-analysis or synthesis of empirical studies and finds small differences in attitude and no differences in achievement between males and females. Two Australian studies are then reported. One study investigated differences between male and female students, parents, and teachers in 32 schools that have been involved with computers for some time. The second study was based on a representative sample of 1000 schools throughout Australia. The research supported the conclusion of small differences in attitudes, but pointed to a polarity in that as many males as females liked computers, but many more girls ardently disliked computers. There were no differences between primary male and female students in usage and attitudes towards computers, but as the students progressed through secondary schools, the differences became marked. Various reasons for these findings are evaluated and some strategies suggested to encourage girls to use computers.

AFTER a period of dramatic growth in school completion in Australia, rates of school retention have begun to decline. At its peak in 1992 the national rate of retention to Year 12 was approximately 77 per cent. By 1995 the rate had fallen to 72 per cent. The aim of this paper is to document state, system, and social differences in the recent downturn in school completion rates in Australia. Data from the Australian Bureau of Statistics and from the Australian Youth Survey are used to look at patterns across states, school systems, geographical locations, social backgrounds, and by sex. The results suggest that during the 1990s the downturn in completion has been uneven and some groups of users which had come to rely on schooling during the 1980s for their future economic security are now turning away from school. The findings indicate a continuing need to monitor the numbers of young people completing school and their backgrounds.

While there is a growing body of research concerning the well-being of music students, burnout and engagement remain largely unexplored. Likewise, cross-national variations in approaches to music education, and different educational experiences of men and women may influence burnout and engagement. This preliminary study aimed to inform further research by establishing the levels of, and exploring cross-national and sex differences in burnout and engagement in music performance students at conservatoires in Australia, Poland and the UK ( n = 331). Self-reported levels of burnout were, typically, low to moderate. Nevertheless, one in ten students reported symptoms such that they could be classified as burned out. Australian and UK students displayed more burnout than students in Poland, although Australian students reported lower levels of reduced sense of accomplishment than Polish and UK students. Self-reported engagement was, typically, moderate to high. Students in Poland reported higher levels of engagement than those in the UK. Women displayed higher levels of global burnout and emotional/physical exhaustion, while men reported lower levels of reduced sense of accomplishment. Further research on burnout and engagement could build on this investigation to gain a better understanding of their impact and the influence of the educational experience on students’ music-related well-being.

In order to test conflicting hypotheses about the effects of coeducational versus single-sex schooling, 538 first-term Australian university students who had attended single sex or coeducational high schools were compared on a number of variables relating to sex roles. Those from the two types of schools did not differ significantly on the Australian Sex Roles Inventory or on a measure of nontraditional attitudes towards sex roles, although males and females differed in predictable ways. Most subjects, particularly those from coeducational schools, felt that coeducational schools are preferable and lead to a more natural attitude towards the opposite sex. Subjects from coeducational rather than single-sex schools said that they had more opposite-sex friends in high school and were more likely to feel that their school helped rather than hindered their everyday relations with the opposite sex and their chances for a happy marriage. However subjects did not feel that boys and girls learn or behave better in coeducational schools, and there were no differences in the percentages of subjects from the two types of schools who reported having had sexual intercourse or been in love while in high school. The single-sex schools attended tended to differ from the coeducational ones in being smaller, more urban, and more likely to be selective, which made comparisons difficult to interpret. Nevertheless it seems reasonable to conclude that coeducational schooling, at least for this selective sample, may have some advantages in fostering interactions with the opposite sex.

Background Evidence suggests a varied level of sexual health literacy (SHL) among university student populations, so we evaluated the SHL among students at the University of Tasmania. Methods: Students were invited to complete an anonymous online questionnaire during August/September 2013. SHL was assessed using the ARCSHS National Survey of Australian Secondary Students & Sexual Health (ARC) and the Sexual Health Questionnaire (SHS). Predictors of literacy scores were evaluated by linear regression. Results: The study recruited 1786 participants (8.2% of 2013 student population), of similar composition to the general university population. Female sex, older age, sexual education, and sexual experience were significant predictors of SHL. As hypothesised, students in medical/nursing disciplines had the highest SHL. Less expected were the significant differences by birthplace and religious affiliation, many of which persisted on adjustment for confounders. Compared with Australian/New Zealander students, overseas-born students had significantly lower ARC (–3.6%, P < 0.001) & SHS (–4.2%, P < 0.001); this was driven by Malaysian, Indian, and Chinese students. Compared with agnostic/atheist-identifying students, those of Buddhist (ARC: –5.4%, P = 0.014; SHS: –6.7%, P = 0.002), Hindu (ARC: –8.8%, P = 0.098; SHS: –12.2%, P = 0.027), Muslim (ARC: –16.5%, P < 0.001; SHS: –13.4%, P = 0.001) and Protestant (ARC: –2.3%, P = 0.023; SHS: –4.4%, P < 0.001) identifications had markedly lower SHL. Conclusions: This study, one of the first among university students in Australia, found a varied SHL by sex, age, sexual education and sexual experience, as well as by birthplace and religious affiliation. These findings have applications in orientation and education programs at Australian universities.

Background Previous studies have described inconsistent condom use in Chinese- and Thai-speaking female sex workers in Sydney, Australia. In the present study, we describe the demographics and safe sexual practices in the Chinese- and Thai-speaking female sex workers attending the Sydney Sexual Health Centre (SSHC) in 2014–15. Methods: A self-completed 60-item anonymous questionnaire, adapted from previous surveys conducted in 1993 and 2003, was translated into Chinese and Thai and administered to female sex workers attending the SSHC or seen on outreach. Results: In all, 488 surveys were distributed, of which 435 were returned; 43% in Chinese and 57% in Thai. Most women did not plan on sex work before their arrival in Australia. Compared with Chinese-speaking women, Thai-speaking women rated themselves higher on English language literacy, had better knowledge of the transmission of HIV and sexually transmissible infections (STIs) and were more likely to practice 100% condom use. Overall, 72% of the sex workers surveyed reported consistent condom use for vaginal sex at work. Conclusions: Consistent condom use for vaginal sex at work among Chinese- and Thai-speaking female sex workers has decreased slightly from that reported in a similar survey conducted by the SSHC in 2003, when 85% of sex workers reported consistent condom use. There are significant differences between Chinese- and Thai-speaking sex workers in terms of both knowledge and safer sex practices. Ongoing health promotion efforts should focus on providing culturally appropriate education around STIs and safe sex practices not only to workers, but also to parlour owners, managers and consumers.

BackgroundHealth and well-being are better, on average, in countries that are more equal, but less is known about how this benefit is distributed across society. Height is a widely used, objective indicator of child health and predictor of lifelong well-being. We compared the level and slope of social gradients in children’s height in high-income countries with different levels of income inequality, in order to investigate whether children growing up in all socioeconomic circumstances are healthier in more equal countries.MethodsWe conducted a coordinated analysis of data from five cohort studies from countries selected to represent different levels of income inequality (the USA, UK, Australia, the Netherlands and Sweden). We used standardised methods to compare social gradients in children’s height at age 4–6 years, by parent education status and household income. We used linear regression models and predicted height for children with the same age, sex and socioeconomic circumstances in each cohort.ResultsThe total analytic sample was 37 063 children aged 4–6 years. Gradients by parent education and household income varied between cohorts and outcomes. After adjusting for differences in age and sex, children in more equal countries (Sweden, the Netherlands) were taller at all levels of parent education and household income than children in less equal countries (USA, UK and Australia), with the greatest between-country differences among children with less educated parents and lowest household incomes.ConclusionsThe study provides preliminary evidence that children across society do better in more equal countries, with greatest benefit among children from the most disadvantaged socioeconomic groups.

AbstractObjective:To examine awareness and recall of healthy eating public education campaigns in five countries.Design:Data were cross-sectional and collected as part of the 2018 International Food Policy Study. Respondents were asked whether they had seen government healthy eating campaigns in the past year; if yes (awareness), they were asked to describe the campaign. Open-ended descriptions were coded to indicate recall of specific campaigns. Logistic models regressed awareness of healthy eating campaigns on participant country, age, sex, ethnicity, education, income adequacy and BMI. Analyses were also stratified by country.Setting:Online surveys.Participants:Participants were Nielsen panelists aged ≥18 years in Australia, Canada, Mexico, UK and the USA (n 22 463).Results:Odds of campaign awareness were higher in Mexico (50·9 %) than UK (18·2 %), Australia (17·9 %), the USA (13·0 %) and Canada (10·2 %) (P < 0·001). Awareness was also higher in UK and Australia v. Canada and the USA, and the USA v. Canada (P < 0·001). Overall, awareness was higher among males v. females and respondents with medium or high v. low education (P < 0·001 for all). Similar results were found in stratified models, although no sex difference was observed in Australia or UK (P > 0·05), and age was associated with campaign awareness in UK (P < 0·001). Common keywords in all countries included sugar/sugary drinks, fruits and vegetables, and physical activity. The top five campaigns recalled were Chécate, mídete, muévete (Mexico), PrevenIMSS (Mexico), Change4Life (UK), LiveLighter® (Australia), and Actívate, Vive Mejor (Mexico).Conclusions:In Mexico, UK and Australia, comprehensive campaigns to promote healthy lifestyles appear to have achieved broad, population-level reach.

ObjectiveTo determine whether the association between highest educational attainment and stroke differed by sex and age; and whether potential mediators of observed associations differ by sex.DesignProspective cohort study.SettingPopulation based, New South Wales, Australia.Participants253 657 stroke-free participants from the New South Wales 45 and Up Study.Outcome measuresFirst-ever stroke events, identified through linkage to hospital and mortality records.ResultsDuring mean follow-up of 4.7 years, 2031 and 1528 strokes occurred among men and women, respectively. Age-standardised stroke rate was inversely associated with education level, with the absolute risk difference between the lowest and highest education group greater among women than men. In relative terms, stroke risk was slightly more pronounced in women than men when comparing low versus high education (age-adjusted HRs: 1.41, 95% CI 1.16 to 1.71 and 1.25, 95% CI 1.07 to 1.46, respectively), but there was no clear evidence of statistical interaction. This association persisted into older age, but attenuated. Much of the increased stroke risk was explained by modifiable lifestyle factors, in both men and women.ConclusionLow education is associated with increased stroke risk in men and women, and may be marginally steeper in women than men. This disadvantage attenuates but persists into older age, particularly for women. Modifiable risk factors account for much of the excess risk from low education level. Public health policy and governmental decision-making should reflect the importance of education, for both men and women, for positive health throughout the life course.

The study is concerned with boys' literacy learning. It seeks to gauge whether the change to a single-gender class brings about any improvement in the boys' attentiveness levels during writing lessons and also to ascertain whether attentiveness is influenced by other factors associated with the learning tasks, and with the teacher's pedagogical and management practices. This study involves the scrutiny of writing lessons in three classes in Western Australian metropolitan primary school - a Year 5 co-educational class, a Year 6 allboy's class ( comprising boys from the Year 5 class) in the hands of one teacher and the same class in the hands of another. Attention levels are measured at various times during writing lessons in the three classes and the approaches taken by the three teachers in the delivery of writing lessons are closely monitored. The performance of a particular boy in these classes is also studied in the hope that a useful comparison might be made between his results and those of the classes generally. The study concludes that higher levels of attentiveness will not necessarily flow from the introduction of an all-boys' class and that teaching methods are of greater importance in this regard. However, the study does indicate that all-boys' classes are potentially advantageous in creating an environment where boys feel more assured and contented and that a possible consequence of this is a willingness on the part of boys to participate more fully in lessons. The study also highlights that any potential for greater attentiveness of boys during writing lessons is unlikely to be realized if the teacher maintains a negative view about boys' capacity to learn and achieve. Finally the study observes there is great individual difference in attentiveness of individual boys, even when there is an overall pattern of higher or lower attentiveness.

This thesis presents a set of models of enrolment behaviour in senior secondary science courses in New South Wales (Australia) schools. The models have been developed out of concerns about declining enrolments and continued sex differences in enrolments in these courses. They use the framework of the Science enrolment Model (SEM), a framework which uses an expectancy/value approach to examine the relationships between the various influences and their combined effect on enrolment behaviour. The SEM was constructed by fitting the factors which have been shown to influence enrolment behaviour in the sciences to the structure of the General Model of Academic Choice, a model of achievement related behaviour developed by Eccles and colleagues. Models were constructed for enrolment behaviour in three specialist science courses; Biology, Chemistry and Physics and two non-specialist science courses; General Science and Science for Life. These five courses account for 97 percent of enrolments in senior secondary science in New South Wales. Measures of enrolment intentions were predicted by, measures of interest, perceived career value, TER value (value as a means gaining university entrance) and a combined measure of self-concept and performance expectations. These constructs were, in turn, predicted by measures of perceptions of parent and teacher attitudes, perceptions of past performance, attributions for past performance and personality measures. The enrolment models explained between 60% and 70% of the variance in enrolment intentions in the specialist science subjects. 'Career value' was found to be a major influence on enrolment behaviour in all five subjects. The expectancy and value variables explained approximately 80 percent of the sex difference in enrolment intentions in the specialist science subjects. Career considerations accounted for between 30 percent and 50 percent of this difference
Doctor of Philosophy (PhD)

Previous research on academic dishonesty in colleges and universities has consistently shown unacceptable rates of cheating, yet inconsistent reports of sex differences in cheating. Sex differences in cheating were studied in relation to sex role orientation and attitudes towards cheating, and in light of a distinction between two types of cheating; cheating to benefit oneself and cheating to benefit another. 256 undergraduate students completed anonymous surveys to tap their sex role orientation, attitudes towards cheating, and reported frequency of cheating. Although females reported having more disapproving attitudes towards cheating than males, they reported engaging in cheating just as much as males. Sex role orientation was not directly related to cheating, but female-associated characteristics were related to attitudes towards cheating, which, in turn, were strongly related to cheating behavior. It was also found that participants reported engaging in more cheating to benefit another person than cheating to benefit themselves.
Department of Psychological Science

Thesis (M.A.)--West Virginia University, 2003.
Title from document title page. Document formatted into pages; contains viii, 50 p. Includes abstract. Includes bibliographical references (p. 28-34).

This study investigated primary school students working in mixed and single- gender groupings around a computer during technology-based lessons. In particular it observed the patterns of peer interaction that took place when students worked co-operatively in groups in lessons. In so doing, this study attempted to explain the effects of gender of the student and gender composition of the group, on peer interaction in such a situation. The study also focussed on the effect of gender groupings on the motivation of students and children's collaborative behaviours. The subjects for the study were twenty-nine students (sixteen boys and thirteen girls) in year 5/6 with an age range of ten to eleven. These students were randomly assigned to different groups: Male-Gender Croups, Female-Gender Groups and Mixed-Gender Croups. A series of lessons on finding information about endangered animals provided the context. The students were taught to use PowerPoint (Microsoft Office, 1998) to make slides on endangered animals, and Web sites were used as sources of information on endangered animals. This research method adopted was descriptive and analytical and aimed for broad as well as specific understandings. Data that was analysed included data collected through interviews and observations, as well as the quantitative analysis of Peer Interaction Categories (Lee, 1990). The results of the analyses showed whether the students' interactions were primarily task-related, collaborative, and positive or not and whether girls and boys had significantly different experiences across groups of varied gender composition in regard to the specific categories of interaction as well as the total interaction. In conclusion, the findings have led to a number of assertions which potentially can guide primary classroom practice in fostering technology-based learning.

Thesis (D.A.)--Illinois State University, 1995.
Title from title page screen, viewed May 8, 2006. Dissertation Committee: Rati Ram (chair), Anthony L. Ostrosky, Mark S. Walbert. Includes bibliographical references (leaves 63-65) and abstract. Also available in print.

This study utilizes the 10th-12th-grade panel from the National Educational Longitudinal Study (NEIS:88) to examine the gender-gap in educational expectations. The study uses regression analysis to determine whether background, academic, social, and career variables affect educational expectations differently for males and females and whether these differences can explain the gender-gap in educational expectations. Socio-economic status and having professional career aspirations have stronger effects on educational expectations for males. However, no significant sex differences were found in the effects of academic ability and achievement, parents' expectations, or peer engagement on students' educational expectations. The results also indicate that females have higher educational expectations because they have higher academic ability and achievement; parents and peers have higher expectations for them, and they are more likely to have professional career aspirations than their male peers.
Department of Sociology

AbstractThe intergenerational transmission of socio-economic status is driven to a significant extent through parents with higher socio-economic status providing advantages to their children as they move through the education system. At the same time, attainment of higher education credentials constitutes an important pathway for upwards social mobility among individuals from low socio-economic family backgrounds. Given the critical importance of higher education for socio-economic outcomes of children, this chapter focuses on young people’s journeys into and out of university. Drawing on the life course approach and opportunity pluralism theory, we present a conceptual model of the university student life cycle that splits individuals’ higher education trajectories into three distinct stages: access, participation and post-participation. Using this model as a guiding framework, we present a body of recent Australian evidence on differences in pathways through the higher education system among individuals from low and high socio-economic status (SES) backgrounds. In doing so, we pay attention to factors such as family material circumstances, students’ school experiences and post-school plans, and parental education and expectations—all of which constitute important barriers to access, participation and successful transitions out of higher education for low SES students. Overall, our results indicate that socio-economic background plays a significant role in shaping outcomes at various points of individual’s educational trajectories. This is manifested by lower chances amongst low-SES individuals to access and participate in higher education, and to find satisfying and secure employment post-graduation. Our findings bear important implications for educational and social policy.

The details of how a voluntary income management programme might work is outlined in the chapter. The chapter also explores other means of building financial capability, using developmental and educational models and insights from the research literature on poverty reduction. In considering alternatives to punitive forms of welfare conditionality, the chapter highlights some of the differences between New Zealand and Australia, as there are lessons which Australia could learn from the use of mentors and more empowering forms of budget support in the case of New Zealand. This chapter also revisits the mixed economy of welfare by suggesting that non-government organisations could play a more enabling role in the lives of low-income households if they were encouraged to work in ways that would promote a different set of assumptions and principles to improve economic security and community wellbeing. The links between economic security and well-being are elaborated, using the public health research that demonstrates that economic insecurity is a strong determinant of mental health. Drawing on insights from a range of studies and disciplines the chapter concludes with an argument for evidence informed social security policies, which will help to reframe questions of economic and social security.

I consider debates about Proposition 8, a California initiative that proposed banning same-sex marriage in 2008 after it had been legalized earlier that year. I explore family-making narratives of mothers of color in particular, in relation to political debates in news reports and letters to the editor between June and November 2008. Vociferous debate about children as symbols for the future of the nation engaged nationalist language of rights, equality, and “true Americans” on both sides. Sociopolitical fears about how legalizing same-sex marriage would affect children’s education and moral development infused sociopolitical narratives about the dangers of same-sex marriage for the United States. When the state initiative was passed on election night in November 2008, same-sex marriages were declared unlawful in the state. The simultaneous election of Barack Obama raised racial tensions about whose votes tipped which scales. I explore sociopolitical narratives of racial blame in news discussions of the political outcome.

This chapter presents the simple patterns of a two-decade study into participation in education and attainment after the age of 16, in higher education, and throughout adult learners' lives. These findings are derived from the apparent differences in attainment by various social groups, girls and boys, types of schools, regions, and countries. The indicators covered in this chapter are the differences linked to family income, differences linked to special education needs (SEN), differences linked to precise age-in-year, differences linked to ethnicity, differences linked to first language, differences linked to recorded sex, participation in higher education, and finally, adult participation in education and training.

[This paper is published in the Journal of Information Technology Education: Research, Volume 15.] This paper explores and analyses similarities and differences in ICT curricula, policies, and assessment between the Vietnamese and Australian educational systems for the final years of secondary educational level. It was found that while having a common core set of tendencies, the Australian ICT curricula, policies, and assessments differ markedly from the Vietnamese counterparts. These differences can be explained by economic and cultural factors, national-wide educational trends, ICT strategies, and their degrees of implementation in schools. We found that limited constructivist implementations are used in ICT curricula in both countries, as Australian education has high expectations in national evaluations with an emphasis on standardized tests and Vietnamese education is still entrapped in prescriptive lessons of traditional pedagogy, emphasizing transmission model of information. We found that lack of opportunities in teacher professional development in ICT training is common for both countries. While the Australian educational system still struggles, especially in providing opportunities for learning theoretical and programming aspects, multiple challenging aspects were found in the ICT content and policies of the Vietnamese educational system that call for immediate change and improvement. In this sense, Vietnamese administrators are recommended to extensively follow up their educational strategies and policies, in order to make sure that their reforms are adequately implemented in schools. In order to bridge the gap and implement adequate ICT curricula, rigorous professional training in ICT teaching is essential for both Australian and Vietnamese teachers.

This paper presents the findings of a qualitative study that explored the impact that prior intercultural experiences have in shaping preservice teachers as teachers of diversity. An online qualitative questionnaire was used to collect data from preservice teachers (n=40) enrolled in a one year graduate entry teacher education program in eastern Australia. Hammer’s (2009, 2011) Intercultural Development Continuum (IDC) was used as a framework to analyse the data. The IDC is a model of intercultural competence used to explain how people interpret cultural difference (Hammer, Bennett &amp; Wiseman, 2003). Each of the five positions on the continuum has a distinct set of perceptions and experiences around cultural differences. In presenting the results, we draw on several cases that encompass the breadth of prior intercultural experiences of the preservice teachers. Overall, the results indicate that sustained intercultural engagement over time provides opportunity for the development of greater intercultural sensitivity. While it is advocated that teacher education is well-positioned to play a key role in developing the intercultural comptetences of future teachers, the paper highlights the challenges in providing learning opportunities that allow preservice teachers to practice new ideas, challenge old ideas and reflect on the process of becoming inclusive educators.

Background: Comprehensive Sexuality Education (CSE) plays an important role in preparing safe and productive lives of adolescents through understanding about HIV/ AIDS, sexually transmitted infections, unintended pregnancy, gender-based violence, and gender disparity. This scoping review aimed to investigate the appropriate method of sex education and information for adolescents. Subjects and Method: A scoping review method was conducted in eight stages including (1) Identification of study problems; (2) Determining priority problem and study question; (3) Determining framework; (4) Literature searching; (5) Article selec­tion; (6) Critical appraisal; (7) Data extraction; and (8) Mapping. The research question was identified using population, exposure, and outcome(s) (PEOS) framework. The search included PubMed, ScienceDirect, Wiley Online Library, ProQuest, and EBSCO databases. The inclusion criteria were English-language and full-text articles published between 2009 and 2019. A total of 460 articles was obtained from the searched database. After the review process, twenty articles were eligible for this review. The data were reported by the PRISMA flow chart. Results: Eleven articles from developing countries (Nigeria, Thailand, Iran, California, Vietnam, Spain, South Africa, Indonesia) and nine articles from developed countries (USA, England, Australia) met the inclusion criteria with quantitative (cross-sectional, quasi-experiments, cohort, RCT) and qualitative design studies. The findings discussed available sources of sex education for adolescents including peers, school, media, and other adults. Digital media (internet and TV) contributed as preferable sources for adolescents. The parents and teacher’s involvement in providing sex education remained inadequate. Inappropriate sources of sex education like invalid information from the internet and other adults caused negative consequences on the sexual and reproductive health of children and adolescents. Conclusion: Parents-school partnership strategies play an important role in delivering appropriate information about sex education for children and adolescents. Keywords: digital media, sex education, parents, schools, adolescents Correspondence: Yustika Rahmawati Pratami. Jl. Siliwangi No. 63, Nogotirto, Gamping, Sleman, Yogyakarta, 55292. Email: yustikarahmawati068@gmail.com. Mobile: +6282198915596. DOI: https://doi.org/10.26911/the7thicph.02.27

Background Lung cancer is the number one cause of cancer death worldwide.(1) It is the fifth most commonly diagnosed cancer in Australia (12,741 cases diagnosed in 2018) and the leading cause of cancer death.(2) The number of years of potential life lost to lung cancer in Australia is estimated to be 58,450, similar to that of colorectal and breast cancer combined.(3) While tobacco control strategies are most effective for disease prevention in the general population, early detection via low dose computed tomography (LDCT) screening in high-risk populations is a viable option for detecting asymptomatic disease in current (13%) and former (24%) Australian smokers.(4) The purpose of this Evidence Check review is to identify and analyse existing and emerging evidence for LDCT lung cancer screening in high-risk individuals to guide future program and policy planning. Evidence Check questions This review aimed to address the following questions: 1. What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? 2. What is the evidence of potential harms from lung cancer screening for higher-risk individuals? 3. What are the main components of recent major lung cancer screening programs or trials? 4. What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Summary of methods The authors searched the peer-reviewed literature across three databases (MEDLINE, PsycINFO and Embase) for existing systematic reviews and original studies published between 1 January 2009 and 8 August 2019. Fifteen systematic reviews (of which 8 were contemporary) and 64 original publications met the inclusion criteria set across the four questions. Key findings Question 1: What is the evidence for the effectiveness of lung cancer screening for higher-risk individuals? There is sufficient evidence from systematic reviews and meta-analyses of combined (pooled) data from screening trials (of high-risk individuals) to indicate that LDCT examination is clinically effective in reducing lung cancer mortality. In 2011, the landmark National Lung Cancer Screening Trial (NLST, a large-scale randomised controlled trial [RCT] conducted in the US) reported a 20% (95% CI 6.8% – 26.7%; P=0.004) relative reduction in mortality among long-term heavy smokers over three rounds of annual screening. High-risk eligibility criteria was defined as people aged 55–74 years with a smoking history of ≥30 pack-years (years in which a smoker has consumed 20-plus cigarettes each day) and, for former smokers, ≥30 pack-years and have quit within the past 15 years.(5) All-cause mortality was reduced by 6.7% (95% CI, 1.2% – 13.6%; P=0.02). Initial data from the second landmark RCT, the NEderlands-Leuvens Longkanker Screenings ONderzoek (known as the NELSON trial), have found an even greater reduction of 26% (95% CI, 9% – 41%) in lung cancer mortality, with full trial results yet to be published.(6, 7) Pooled analyses, including several smaller-scale European LDCT screening trials insufficiently powered in their own right, collectively demonstrate a statistically significant reduction in lung cancer mortality (RR 0.82, 95% CI 0.73–0.91).(8) Despite the reduction in all-cause mortality found in the NLST, pooled analyses of seven trials found no statistically significant difference in all-cause mortality (RR 0.95, 95% CI 0.90–1.00).(8) However, cancer-specific mortality is currently the most relevant outcome in cancer screening trials. These seven trials demonstrated a significantly greater proportion of early stage cancers in LDCT groups compared with controls (RR 2.08, 95% CI 1.43–3.03). Thus, when considering results across mortality outcomes and early stage cancers diagnosed, LDCT screening is considered to be clinically effective. Question 2: What is the evidence of potential harms from lung cancer screening for higher-risk individuals? The harms of LDCT lung cancer screening include false positive tests and the consequences of unnecessary invasive follow-up procedures for conditions that are eventually diagnosed as benign. While LDCT screening leads to an increased frequency of invasive procedures, it does not result in greater mortality soon after an invasive procedure (in trial settings when compared with the control arm).(8) Overdiagnosis, exposure to radiation, psychological distress and an impact on quality of life are other known harms. Systematic review evidence indicates the benefits of LDCT screening are likely to outweigh the harms. The potential harms are likely to be reduced as refinements are made to LDCT screening protocols through: i) the application of risk predication models (e.g. the PLCOm2012), which enable a more accurate selection of the high-risk population through the use of specific criteria (beyond age and smoking history); ii) the use of nodule management algorithms (e.g. Lung-RADS, PanCan), which assist in the diagnostic evaluation of screen-detected nodules and cancers (e.g. more precise volumetric assessment of nodules); and, iii) more judicious selection of patients for invasive procedures. Recent evidence suggests a positive LDCT result may transiently increase psychological distress but does not have long-term adverse effects on psychological distress or health-related quality of life (HRQoL). With regards to smoking cessation, there is no evidence to suggest screening participation invokes a false sense of assurance in smokers, nor a reduction in motivation to quit. The NELSON and Danish trials found no difference in smoking cessation rates between LDCT screening and control groups. Higher net cessation rates, compared with general population, suggest those who participate in screening trials may already be motivated to quit. Question 3: What are the main components of recent major lung cancer screening programs or trials? There are no systematic reviews that capture the main components of recent major lung cancer screening trials and programs. We extracted evidence from original studies and clinical guidance documents and organised this into key groups to form a concise set of components for potential implementation of a national lung cancer screening program in Australia: 1. Identifying the high-risk population: recruitment, eligibility, selection and referral 2. Educating the public, people at high risk and healthcare providers; this includes creating awareness of lung cancer, the benefits and harms of LDCT screening, and shared decision-making 3. Components necessary for health services to deliver a screening program: a. Planning phase: e.g. human resources to coordinate the program, electronic data systems that integrate medical records information and link to an established national registry b. Implementation phase: e.g. human and technological resources required to conduct LDCT examinations, interpretation of reports and communication of results to participants c. Monitoring and evaluation phase: e.g. monitoring outcomes across patients, radiological reporting, compliance with established standards and a quality assurance program 4. Data reporting and research, e.g. audit and feedback to multidisciplinary teams, reporting outcomes to enhance international research into LDCT screening 5. Incorporation of smoking cessation interventions, e.g. specific programs designed for LDCT screening or referral to existing community or hospital-based services that deliver cessation interventions. Most original studies are single-institution evaluations that contain descriptive data about the processes required to establish and implement a high-risk population-based screening program. Across all studies there is a consistent message as to the challenges and complexities of establishing LDCT screening programs to attract people at high risk who will receive the greatest benefits from participation. With regards to smoking cessation, evidence from one systematic review indicates the optimal strategy for incorporating smoking cessation interventions into a LDCT screening program is unclear. There is widespread agreement that LDCT screening attendance presents a ‘teachable moment’ for cessation advice, especially among those people who receive a positive scan result. Smoking cessation is an area of significant research investment; for instance, eight US-based clinical trials are now underway that aim to address how best to design and deliver cessation programs within large-scale LDCT screening programs.(9) Question 4: What is the cost-effectiveness of lung cancer screening programs (include studies of cost–utility)? Assessing the value or cost-effectiveness of LDCT screening involves a complex interplay of factors including data on effectiveness and costs, and institutional context. A key input is data about the effectiveness of potential and current screening programs with respect to case detection, and the likely outcomes of treating those cases sooner (in the presence of LDCT screening) as opposed to later (in the absence of LDCT screening). Evidence about the cost-effectiveness of LDCT screening programs has been summarised in two systematic reviews. We identified a further 13 studies—five modelling studies, one discrete choice experiment and seven articles—that used a variety of methods to assess cost-effectiveness. Three modelling studies indicated LDCT screening was cost-effective in the settings of the US and Europe. Two studies—one from Australia and one from New Zealand—reported LDCT screening would not be cost-effective using NLST-like protocols. We anticipate that, following the full publication of the NELSON trial, cost-effectiveness studies will likely be updated with new data that reduce uncertainty about factors that influence modelling outcomes, including the findings of indeterminate nodules. Gaps in the evidence There is a large and accessible body of evidence as to the effectiveness (Q1) and harms (Q2) of LDCT screening for lung cancer. Nevertheless, there are significant gaps in the evidence about the program components that are required to implement an effective LDCT screening program (Q3). Questions about LDCT screening acceptability and feasibility were not explicitly included in the scope. However, as the evidence is based primarily on US programs and UK pilot studies, the relevance to the local setting requires careful consideration. The Queensland Lung Cancer Screening Study provides feasibility data about clinical aspects of LDCT screening but little about program design. The International Lung Screening Trial is still in the recruitment phase and findings are not yet available for inclusion in this Evidence Check. The Australian Population Based Screening Framework was developed to “inform decision-makers on the key issues to be considered when assessing potential screening programs in Australia”.(10) As the Framework is specific to population-based, rather than high-risk, screening programs, there is a lack of clarity about transferability of criteria. However, the Framework criteria do stipulate that a screening program must be acceptable to “important subgroups such as target participants who are from culturally and linguistically diverse backgrounds, Aboriginal and Torres Strait Islander people, people from disadvantaged groups and people with a disability”.(10) An extensive search of the literature highlighted that there is very little information about the acceptability of LDCT screening to these population groups in Australia. Yet they are part of the high-risk population.(10) There are also considerable gaps in the evidence about the cost-effectiveness of LDCT screening in different settings, including Australia. The evidence base in this area is rapidly evolving and is likely to include new data from the NELSON trial and incorporate data about the costs of targeted- and immuno-therapies as these treatments become more widely available in Australia.

Background An estimated 292 million people are living with chronic hepatitis B virus (HBV) infection globally, including 223,000 people in Australia. HBV diagnosis and linkage of people living with HBV to clinical care is suboptimal in Australia, with 27% of people living with HBV undiagnosed and 77% not receiving regular HBV clinical care. This systematic review aimed to characterize population-level interventions implemented to enhance all components of HBV care cascade and analyse the effectiveness of interventions. Review questions Question 1: What population-level interventions, programs or policy approaches have been shown to be effective in reducing the incidence of hepatitis B; and that may not yet be fully rolled out or evaluated in Australia demonstrate early effectiveness, or promise, in reducing the incidence of hepatitis B? Question 2: What population-level interventions and/or programs are effective at reducing disease burden for people in the community with hepatitis B? Methods Four bibliographic databases and 21 grey literature sources were searched. Studies were eligible for inclusion if the study population included people with or at risk of chronic HBV, and the study conducted a population-level interventions to decrease HBV incidence or disease burden or to enhance any components of HBV care cascade (i.e., diagnosis, linkage to care, treatment initiation, adherence to clinical care), or HBV vaccination coverage. Studies published in the past 10 years (since January 2012), with or without comparison groups were eligible for inclusion. Studies conducting an HBV screening intervention were eligible if they reported proportion of people participating in screening, proportion of newly diagnosed HBV (participant was unaware of their HBV status), proportion of people received HBV vaccination following screening, or proportion of participants diagnosed with chronic HBV infection who were linked to HBV clinical care. Studies were excluded if study population was less than 20 participants, intervention included a pharmaceutical intervention or a hospital-based intervention, or study was implemented in limited clinical services. The records were initially screened by title and abstract. The full texts of potentially eligible records were reviewed, and eligible studies were selected for inclusion. For each study included in analysis, the study outcome and corresponding 95% confidence intervals (95%CIs) were calculated. For studies including a comparison group, odds ratio (OR) and corresponding 95%CIs were calculated. Random effect meta-analysis models were used to calculate the pooled study outcome estimates. Stratified analyses were conducted by study setting, study population, and intervention-specific characteristics. Key findings A total of 61 studies were included in the analysis. A large majority of studies (study n=48, 79%) included single-arm studies with no concurrent control, with seven (12%) randomised controlled trials, and six (10%) non-randomised controlled studies. A total of 109 interventions were evaluated in 61 included studies. On-site or outreach HBV screening and linkage to HBV clinical care coordination were the most frequent interventions, conducted in 27 and 26 studies, respectively. Question 1 We found no studies reporting HBV incidence as the study outcome. One study conducted in remote area demonstrated that an intervention including education of pregnant women and training village health volunteers enhanced coverage of HBV birth dose vaccination (93% post-intervention, vs. 81% pre-intervention), but no data of HBV incidence among infants were reported. Question 2 Study outcomes most relevant to the HBV burden for people in the community with HBV included, HBV diagnosis, linkage to HBV care, and HBV vaccination coverage. Among randomised controlled trials aimed at enhancing HBV screening, a meta-analysis was conducted including three studies which implemented an intervention including community face-to-face education focused on HBV and/or liver cancer among migrants from high HBV prevalence areas. This analysis demonstrated a significantly higher HBV testing uptake in intervention groups with the likelihood of HBV testing 3.6 times higher among those participating in education programs compared to the control groups (OR: 3.62, 95% CI 2.72, 4.88). In another analysis, including 25 studies evaluating an intervention to enhance HBV screening, a pooled estimate of 66% of participants received HBV testing following the study intervention (95%CI: 58-75%), with high heterogeneity across studies (range: 17-98%; I-square: 99.9%). A stratified analysis by HBV screening strategy demonstrated that in the studies providing participants with on-site HBV testing, the proportion receiving HBV testing (80%, 95%CI: 72-87%) was significantly higher compared to the studies referring participants to an external site for HBV testing (54%, 95%CI: 37-71%). In the studies implementing an intervention to enhance linkage of people diagnosed with HBV infection to clinical care, the interventions included different components and varied across studies. The most common component was post-test counselling followed by assistance with scheduling clinical appointments, conducted in 52% and 38% of the studies, respectively. In meta-analysis, a pooled estimate of 73% of people with HBV infection were linked to HBV clinical care (95%CI: 64-81%), with high heterogeneity across studies (range: 28-100%; I-square: 99.2%). A stratified analysis by study population demonstrated that in the studies among general population in high prevalence countries, 94% of people (95%CI: 88-100%) who received the study intervention were linked to care, significantly higher than 72% (95%CI: 61-83%) in studies among migrants from high prevalence area living in a country with low prevalence. In 19 studies, HBV vaccination uptake was assessed after an intervention, among which one study assessed birth dose vaccination among infants, one study assessed vaccination in elementary school children and 17 studies assessed vaccination in adults. Among studies assessing adult vaccination, a pooled estimate of 38% (95%CI: 21-56%) of people initiated vaccination, with high heterogeneity across studies (range: 0.5-93%; I square: 99.9%). A stratified analysis by HBV vaccination strategy demonstrated that in the studies providing on-site vaccination, the uptake was 78% (95%CI: 62-94%), significantly higher compared to 27% (95%CI: 13-42%) in studies referring participants to an external site for vaccination. Conclusion This systematic review identified a wide variety of interventions, mostly multi-component interventions, to enhance HBV screening, linkage to HBV clinical care, and HBV vaccination coverage. High heterogeneity was observed in effectiveness of interventions in all three domains of screening, linkage to care, and vaccination. Strategies identified to boost the effectiveness of interventions included providing on-site HBV testing and vaccination (versus referral for testing and vaccination) and including community education focussed on HBV or liver cancer in an HBV screening program. Further studies are needed to evaluate the effectiveness of more novel interventions (e.g., point of care testing) and interventions specifically including Indigenous populations, people who inject drugs, men who have sex with men, and people incarcerated.