The University of Newcastle, Australia

Lifestyle as medicine

Associate Professor Luke Wolfenden's research into the modifiable risks of chronic health conditions and injury is helping the community to improve their overall wellbeing.

Dr Luke Wolfenden

Although chronic diseases and injuries are as common as they are costly, Associate Professor Luke Wolfenden insists most are avoidable.

'Chronic diseases and injuries can be closely linked to lifestyle choices that are very often modifiable,' he asserts.

'So things like obesity, physical inactivity, excess alcohol consumption and smoking are all important risk factors, but they obviously don't have to be.'

'If we target and modify these risks we can reduce the number of people suffering needlessly.'

The behavioural scientist is working across multiple settings to encourage these lifestyle changes, enlisting the commitment of sporting clubs, childcare centres, schools, hospital services and outpatient clinics to implement chronic disease and injury prevention initiatives. Key to his success in translating research into practice is ongoing engagement processes with policy makers and practitioners.  This communication ensures evidence-based interventions are made both widely accessible and appropriate for different settings.

'Once we develop or identify effective programs, we conduct research to find the best way of supporting oragnisations in the community to adopt and implement them,' Wolfenden explains.

'This requires close consultation and collaboration with these organisations.'

Trashing the ash

Wolfenden first began addressing the lifestyle-related risk factors contributing to chronic disease in the early 2000s.  He specifically targeted tobacco use during the four years of his PhD candidateship, working with Hunter New England Population Health and staff at the John Hunter Hospital to improve the provision of smoking cessation care to surgical patients. Undertaking a randomised control trial of a new computer-based program to do so, Wolfenden and the team also succeeded in reducing patients' risks of postoperative complications.  The project was a finalist in the health service quality awards and has since been cited in clinical practice guidelines.  It was also adopted as part of routine pre-operative management of surgical patients at the hospital.

'We noticed patients often have to sit around in waiting rooms during their preoperative appointments, so this intervention sought to use that time to help them to stop smoking before they had surgery,' he discloses.

'This has proven therapeutic benefits as well as longer-term ones, such as the prevention of cancer and cardiovascular disease.'

Hospital receptionists are responsible for referring patients to Wolfenden's program, which initially provides a 20-minute computerised behavioural counselling session for those who screen positive for tobacco use. It also assesses patients' nicotine dependence and generates a prompt for preoperative clinical staff to identify them as smokers.

'These patients are prescribed with nicotine replacement therapy,' Wolfenden details.

'They're also equipped with other take-home strategies to help stave off the smoking urges once the surgery is over.'

Doctor without borders

After receiving his PhD in 2006, Wolfenden took off for a European backpacking tour. The avid traveller's planned break from researching was cut shorter than expected though, when he landed a lecturing and mentoring role with the UK'S Cochrane Collaboration in Oxford a couple of months into his sojourn.

'I applied for the job when I was running out of money,' he laughs.

'But it was great.'

'I was lucky enough to fly around Europe and undertake training workshops with authors who'd registered their interest in writing systematic reviews with the Collaboration.'

Taking on another senior position when he returned the following year, Wolfenden found himself managing the research of Australia's largest childhood obesity prevention program.  The $12 million initiative was a collaboration with the University of Newcastle, the Hunter New England Local Health District, NSW Health and the University of Sydney.  Wolfenden was a finalist in the NSW Public Health Sector Awards for his contribution to the program.  'Good for Kids. Good for Life' was also awarded the inaugural Australian National Preventive Health Agency Research Translation award, as well as quality and innovation awards from the NSW Government.

The intervention included supporting the implementation of healthy eating and physical activity policies and practices to more than 400 schools, 350 childcare services, 200 sporting clubs, 30 community service organisations and Aboriginal communities.

'We focused on promoting healthy eating and regular exercise in children up to 12 years,' Wolfenden advises.

Findings from 'Good for Kids. Good for Life' have since informed the development of strategies used to support the statewide roll-out of the NSW Ministry of Health's Healthy Children's Initiative Programs.

Move it and chew it

Wolfenden has continued to add to this body of work around obesity prevention, leading collaboration between the University of Newcastle and Hunter New England's Population Health on a raft of innovative studies, many funded by nationally competitive grants. Again focusing mainly on children, the team's efforts have seen the translation of health promotion strategies in educational and recreational settings across the Hunter, New England and Lower Mid North Coast regions.

'One of our current projects involves encouraging primary school canteens to sell more healthy foods,' Wolfenden reveals.

'Most don't comply with mandatory school canteen policies, often because they're not aware of the policy, are not confident in product classification, or are concerned about a decline in profits.'

'So we're providing training, support from dieticians and tips on how to reduce waste and mark foods appropriately so they don't get sold below cost.'

'We're also auditing their menus and getting principals onboard.'

Another of Wolfenden's current endeavours involves looking at novel ways to get young children to be more physically active. The National Health and Medical Research Council Career Development Fellow is aiming to create interventions for childcare services that are translatable, fundable and scalable.

'The kinds of approaches many of us have used up until now to encourage children to be active in childcare have been pretty equivocal – some have worked and some haven't,' he affirms.

'They also require ongoing investments to maintain staff skill levels and ensure ongoing implementation, so there's a sustainability issue from a health promotion perspective.'

Instead, Wolfenden is electing to trial a 'simpler intervention' in a number of childcare centres across the Hunter, cutting the typical 90-minute outdoor play period into several smaller 20-30 minute chunks.

'Research suggests children are naturally physical active during these sessions, but only during the first part,' he clarifies.

'So we want to change how childcare centres schedule them.'

'Breaking them up is an easy environment change that doesn't require training and can be effortlessly incorporated into childcare accreditation standards.'

Over the limit

Wolfenden is simultaneously working with the Australian Drug Foundation to help community sports clubs manage and sell alcohol responsibly. They conducted a randomised trial of the national 'Good Sports' program that encourages sporting clubs to create family-friendly cultures, ensuring they adhere to liquor licence legislations and remove happy hours and other drinking promotions where possible.

Good Sports is Australia's largest health in sports initiative for community sports clubs, working with more than 6,500 clubs across Australia to reduce risky drinking.  The Australian Drug Foundation received $19 million in the recent Federal Budget to support the important work of this program for another four years.

'We know alcohol is consumed excessively at sporting clubs, so that's why we've chosen to target these venues,' Wolfenden says.

Following the success of the trial, the team is now in the process of adding an online maintenance strategy to the program to support the improvements made by clubs as part of an Australian Research Council Linkage Grant.

Useable discoveries

In the not-so-distant future, Wolfenden looks set to focus on two more things - getting further evidence into practice, and understanding the barriers preventing community and clinical services from adopting evidence-based practice.

'I'll be developing strategies that address both,' he acknowledges.

'We need to make sure research can inform policy and practice.'

'It's important that intervention trials are designed so they're suitable for population-wide dissemination and uptake.'