Mr Dominic Cavenagh

In Australia, nearly half of births involve labour interventions. Prior research in this area has relied on cross-sectional and administrative health data and has not considered biopsychosocial factors. The current study examined direct and indirect associations between biopsychosocial factors and labour interventions using 19¿years of population-based prospective data. The study included singleton babies among primiparous women of the 1973¿1978 cohort of the Australian Longitudinal Study on Women's Health. Data from 5459 women who started labour were analysed using path analysis. 42.2% of babies were born without intervention (episiotomy, instrumental, or caesarean delivery): Thirty-seven percent reported vaginal birth with episiotomy and instrumental birth interventions, 18% reported an unplanned caesarean section without episiotomy and/or instrumental interventions, and 3% reported unplanned caesarean section after episiotomy and/or instrumental interventions. Vaginal births with episiotomy and/or instrumental interventions were more likely among women with chronic hypertension (RRR(95%-CI):1.50(1.12¿2.01)), a perceived length of labour of more than 36¿h (RRR(95%-CI):1.86(1.45¿2.39)), private health insurance (RRR(95%-CI):1.61(1.41¿1.85)) and induced labour (RRR(95%-CI):1.69(1.46¿1.94)). Risk factors of unplanned caesarean section without episiotomy and/or instrumental birth intervention included being overweight (RRR(95%-CI):1.30(1.07¿1.58)) or obese prepregnancy (RRR(95%-CI):1.63(1.28¿2.08)), aged = 35¿years (RRR(95%-CI):1.87(1.46¿2.41)), having short stature (< 154¿cm) (RRR(95%-CI):1.68(1.16¿2.42)), a perceived length of labour of more than 36¿h (RRR(95%-CI):3.26(2.50¿4.24)), private health insurance (RRR(95%-CI):1.38(1.17¿1.64)), and induced labour (RRR(95%-CI):2.56(2.16¿3.05)). Prevention and management of hypertension, diabetes, and obesity during preconception and/or antenatal care are keys for reducing labour interventions and strengthening the evidence-base around delivery of best practice obstetric care.

Background: Adverse childhood experiences have been linked to poor health and adverse health behavior in adulthood. Objective: This study aimed to estimate the prevalence of adverse childhood experiences among young Australian women (aged 20¿25) and examine associations between adverse childhood experiences and adult health behaviors and physical and mental health. Participants and Settings: Data were from the 1989-95 cohort of the Australian Longitudinal Study on Women's Health, who completed the Adverse Childhood Experiences Scale at Survey 3 in 2015 (N = 8609). Methods: Outcomes included: self-rated health, sexual health, psychological distress, depression, anxiety, suicide ideation, self-harm, substance abuse (drinking, smoking, illicit drugs), severe obesity, and exercise. Prevalence of childhood adversities were presented, with the association between childhood adversity and outcomes evaluated using log-binomial multivariable regressions (99% CI). Results: While 59% of women reported experiencing at least one childhood adversity, 10% of participants reported adverse childhood experiences across four or more categories, indicating a significant burden of risk for young Australian women. Women reporting four or more categories had higher rates of poor physical health (adjPR = 1.79, 99% CI = 1.51¿2.12), sexually transmitted infections (adjPR = 1.36, 99% CI = 1.11¿1.67), and poor mental health (adjPR = 2.78, 99% CI = 2.34¿3.32), and increased rates of severe obesity (adjPR = 2.14, 99% CI = 1.61¿2.86) and smoking (adjPR = 2.23, 99% CI = 1.89¿2.64). Conclusion: Using nationally representative data, this study shows adverse childhood experiences directly impact physical and mental health, and health behaviors in adulthood among young Australian women. The management of health and wellbeing in adulthood should look beyond the contemporaneous factors, incorporating a focus on how childhood adversity may negatively influence health behavior, health and wellbeing in later life.

Objective: To cross-sectionally examine heavy episodic drinking (HED) and pre-loading with alcohol among young Australian women in relation to the alcohol-induced adverse outcomes of memory loss, vomiting and injury. Methods: A total of 7,800 participants, aged 20¿25 years, from the 1989¿95 cohort of the Australian Longitudinal Study on Women's Health answered all questions on alcohol use, reported drinking alcohol in the previous year and were not pregnant at the third survey in 2015. Log-binomial models were used to estimate prevalence ratios for adverse outcomes associated with increased frequency of HED and pre-loading. Results: The majority of participants reported HED (83.4%) and/or pre-loading (65.6%), which had a moderate correlation (r=0.646). Just over half (55.2%) of participants experienced at least one adverse event, with vomiting being most common. As the frequency of HED or pre-loading increased, so did the risk of an adverse outcome. Conclusions: Both HED and pre-loading pose a risk to young Australian women, and that risk rises with increased frequency. Implications for public health: Although HED has been a target of public health policy and interventions, pre-loading has received limited attention. In addition to addressing HED, there is a need to consider the risk posed by pre-loading, a related, yet unique risky drinking behaviour.