Associate Professor Melissa Kang's career has been devoted to the health and health care of adolescents and young adults. She is an academic, a clinician, and an advocate. Melissa's research has taken a population health approach, with major projects exploring access to health care, health system navigation, young people’s sexuality and sexual health (particularly sexually transmitted infections). She has skills in complex mixed method research, and high level project management expertise.
Melissa's teaching and curriculum development experience has ranged from population and public health issues for young people to micro-skill development for clinicians in engaging young people in health care. Melissa has over 20 years’ experience working in popular media as an educator and as a dynamic way to interact with and learn about young people’s health concerns.
Melissa's academic and clinical roles over 20 years have forged links between grass roots clinicians, service managers, the youth health sector, government and policy makers, educators and researchers. She is a strong advocate for young people’s rights, especially their rights to health: health literacy, health access, and youth participation.
Melissa led the NSW Health funded study Access 3 which explores the way young people navigate the health system in the digital age. This project informed the NSW Youth Health Framework 2017 - 2024. She is currently in her second term as President of the Australian Association for Adolescent Health.
Melissa is currently:
- President of the Australian Association for Adolecent Health
- a member of the Diversity Subcommittee of the Society for Adolescent Health and Medicine (USA)
- Royal Australian College of General Practitioners representative on the NSW Health HIV and STI Implementation Committee
- a member of the NSW Youth Health Policy Reference Group
- a member of the Sexual Health Medicine Network, RACGP Faculty of Specific Interests
- a member of the Children and Young People Network, RACGP FAculty of Specific Interests
- a member of the International Association for Adolescent Health
- a member of the Public Health Association of Australia
Can supervise: YES
- Youth health and wellbeing
- Sexuality, sexual and reproductive health and young people
- Sex education
- Access to health care for young people
- Vulnerable and marginalised populations of young people
- Youth homelessness
- Health literacy and young people
- Primary health care and young people
- Adolescent and Young Adult Health
- Sexuality, Sexual and Reproductive Health
Kang, MS, Skinner, SR, Sanci, L & Sawyer, S 2013, Youth Health and Adolescent Medicine, IP COmmunications, Melbourne, Australia.
Remond, L & Kang, MS 2005, Dolly Doctor: your body your life – every question answered, ACP Magazines, Sydney.
The process of prescribing changes as children move into adulthood For some medicines such as psychotropic drugs safety and efficacy are less well understood in adolescents: As adolescents mature they attain the capacity to consent to their own medical treatment An assessment of their competency will need to take into account the nature of the treatment being proposed: Parental involvement is usually beneficial particularly for adolescents with chronic or complex conditions but increasing adolescent autonomy needs to be respected: Adherence to treatment can be supported by understanding adolescent development and involving adolescents in management plans:
Lim, MSC, Cooper, S, Lewis, L, Albury, K, Chung, KSK, Bateson, D, Kang, M & Skinner, SR 2019, 'Prospective mixed methods study of online and offline social networks and the development of sexual agency in adolescence: the Social Networks and Agency Project (SNAP) protocol.', BMJ open, vol. 9, no. 5.View/Download from: Publisher's site
INTRODUCTION:Social media may play a role in adolescent sexual development. The limited research on social media use and sexual development has found both positive and negative influences. The focus of this study is on sexual agency: a positive sexual outcome. This paper describes the protocol for the Social Networks and Agency Project (SNAP) study which aims to examine the relationship between online and offline social networks and the development of healthy relationships and sexual agency in adolescence. METHODS AND ANALYSIS:The SNAP study is a mixed methods interdisciplinary longitudinal study. Over an 18-month period, adolescents aged 15-17 years at recruitment complete three questionnaires (including demographics, sexual behaviour, sexual agency and social networks); three in-depth interviews; and fortnightly online diaries describing their sexual behaviour and snapshots of their social networks that week. Longitudinal analyses will be used to describe changes in sexual behaviour and experiences over time, sexual agency, social media use, and social network patterns. Social network analysis will be used to capture relational data from which we will be able to construct sociograms from the respondent's perspective. Interview data will be analysed both in relation to emergent themes (deploying a grounded theory approach), and from a cross-disciplinary perspective. This mixed method analysis will allow for comparisons across quantitative and qualitative data, for consistency and differences, and will enhance the robustness of data interpretation and conclusions drawn, as multiple data sources are triangulated. ETHICS AND DISSEMINATION:Ethical approval was granted by the University of Sydney Human Research Ethics Committee and the Family Planning New South Wales Ethics Committee. The study will provide comprehensive, prospective information on the social and sexual development of adolescents in the age of social media and findings will be disseminated through co...
Robards, F, Kang, M, Luscombe, G, Sanci, L, Steinbeck, K, Jan, S, Hawke, C, Kong, M & Usherwood, T 2019, 'Predictors of young people's healthcare access in the digital age.', Australian and New Zealand journal of public health, vol. 43, no. 6, pp. 582-588.View/Download from: Publisher's site
OBJECTIVE:To quantify barriers to healthcare for young people (12-24 years) and identify socio-demographic correlates and predictors. METHODS:This cross-sectional survey targeted young people living in New South Wales, Australia, with oversampling of marginalised groups. Principles Component Analysis (PCA) identified clusters of barriers. Ordinal regression identified predictors of each barrier cluster. RESULTS:A total of 1,416 young people completed surveys. Participants with chronic conditions and increasing psychological distress reported a greater number of barriers. Of 11 potential barriers to visiting a health service, cost was most common (45.8%). The PCA identified three clusters: structural barriers (61.3%), attitudinal barriers (44.1%) and barriers relating to emerging autonomy (33.8%). CONCLUSIONS:Barriers to healthcare reported by young people are multi-dimensional and have changed over time. Structural barriers, especially cost, are the most prominent among young people. Approaches to overcome structural barriers need to be addressed to better support marginalised young people's healthcare access. Implications for public health: Understanding predictors of different barrier types can inform more targeted approaches to improving access. Equitable access to healthcare is a priority for early diagnosis and treatment in young people, especially reducing out of pocket costs.
Robards, F, Kang, M, Steinbeck, K, Hawke, C, Jan, S, Sanci, L, Liew, YY, Kong, M & Usherwood, T 2019, 'Health care equity and access for marginalised young people: a longitudinal qualitative study exploring health system navigation in Australia.', International journal for equity in health, vol. 18, no. 1.View/Download from: Publisher's site
BACKGROUND:Young people have unique social, emotional and developmental needs that require a welcoming and responsive health system, and policies that support their access to health care. Those who are socially or culturally marginalised may face additional challenges in navigating health care, contributing to health inequity. The aim of this study was to understand health system navigation, including the role of technology, for young people belonging to one or more marginalised groups, in order to inform youth health policy in New South Wales, Australia. METHODS:This qualitative longitudinal study involved 2-4 interviews each over 6 to 12 months with marginalised young people aged 12-24 years living in NSW. The analysis used Nvivo software and grounded theory. RESULTS:We interviewed 41 young people at baseline who were living in rural or remote areas, sexuality and/or gender diverse, refugee, homeless, and/or Aboriginal. A retention rate of over 85% was achieved. Nineteen belonged to more than one marginalised group allowing an exploration of intersectionality. General practitioners (family physicians) were the most commonly accessed service throughout the study period. Participants were ambivalent about their healthcare journeys. Qualitative analysis identified five themes: 1. Technology brings opportunities to understand, connect and engage with services 2. Healthcare journeys are shaped by decisions weighing up convenience, engagement, effectiveness and affordability. 3. Marginalised young people perceive and experience multiple forms of discrimination leading to forgone care. 4. Multiple marginalisation makes health system navigation more challenging 5. The impact of health system complexity and fragmentation may be mitigated by system knowledge and navigation support CONCLUSIONS: The compounding effects of multiple discrimination and access barriers were experienced more strongly for young people belonging to mutiple marginalised groups. We identify several...
Assifi, AR, Sullivan, EA, Kang, M & Dawson, AJ 2019, 'Adolescent abortion in 11 high-income countries including Australia: towards the establishment of a minimum data set.', Australian and New Zealand Journal of Public Health, vol. 43, no. 6, pp. 577-581.View/Download from: Publisher's site
OBJECTIVE:A major public health challenge in Australia is the lack of national adolescent abortion data. This descriptive study identifies, collates and describes publicly available adolescent abortion data in high-income countries including Australia, to describe trends over 10 years and provide recommendations for strengthening data collection. METHODS:Data were extracted from publicly available government sources that met inclusion criteria. All relevant adolescent abortion data from 2007 to 2017 were extracted from datasets and analysed. RESULTS:Eleven high-income countries were included. Incidence data for the adolescent population were available for all countries and states. Incidence of adolescent abortion over 10 years shows a downward trend in all countries. Gestational age at time of abortion was the second-most available variable. The level and type of data across all countries varied; there was a lack of age range standardisation and aggregation of gestational weeks differed, making comparisons difficult. CONCLUSION:A minimum data set of standardised abortion information will enable appropriate adolescent abortion policies and services to be developed that are informed by high quality, up-to-date intelligence. Implications for public health: Availability of data affects government's ability to adequately monitor national adolescent health outcomes and plan and evaluate appropriate reproductive health policy and services.
R Botfield, J, E Newman, C, Kang, M & B Zwi, A 2018, 'Talking to migrant and refugee young people about sexual health in general practice.', Australian journal of general practice, vol. 47, no. 8, pp. 564-569.
Young people are an important group to target with health promotion and preventive healthcare. This paper focuses on the engagement of migrant and refugee young people with sexual and reproductive healthcare in general practice.Semi-structured first interviews (n = 27; 16 female, 11 male) and follow-up interviews (n = nine; six female, three male) were undertaken with migrant and refugee young people aged 16-24 years living in Sydney.The majority of participants had seen a general practitioner (GP) for general health issues. However, most were reluctant to discuss sexual health with a practitioner whom they described as their 'family doctor', primarily because of concerns about judgement and confidentiality. Most described negative experiences with GPs for sexual health matters, including not being listened to or being rushed through the appointment.There appears to be a lack of effective engagement with migrant and refugee young people by GPs in relation to sexual health. Building the skills and confidence of GPs to work with this group and promote sexual health and wellbeing should be considered, and efforts should be made to communicate confidentiality and trustworthiness.
Robards, F, Kang, M, Tolley, K, Hawke, C, Sanci, L & Usherwood, T 2018, 'Marginalised young people's healthcare journeys: Professionals' perspectives', HEALTH EDUCATION JOURNAL, vol. 77, no. 6, pp. 692-704.View/Download from: Publisher's site
Robards, F, Kang, M, Usherwood, T & Sanci, L 2018, 'How Marginalized Young People Access, Engage With, and Navigate Health-Care Systems in the Digital Age: Systematic Review', JOURNAL OF ADOLESCENT HEALTH, vol. 62, no. 4, pp. 365-381.View/Download from: Publisher's site
Scott, K, Caldwell, P, Kang, M, McCaffery, K & Skinner, SR 2018, 'ADOLESCENTS' USE OF DR GOOGLE: HELP OR HINDRANCE?', JOURNAL OF PAEDIATRICS AND CHILD HEALTH, vol. 54, no. 11, pp. 1282-1283.View/Download from: Publisher's site
Svetaz, MV, Chulani, V, West, KJ, Voss, R, Kelley, MA, Raymond-Flesch, M, Thruston, W, Coyne-Beasley, T, Kang, M & Leung, E 2018, 'Racism and Its Harmful Effects on Nondominant Racial–Ethnic Youth and Youth-Serving Providers: A Call to Action for Organizational Change: The Society for Adolescent Health and Medicine', Journal of Adolescent Health, vol. 63, no. 2, pp. 257-261.View/Download from: Publisher's site
© 2018 Racism can exert negative effects on the self-concepts, health and well-being, and life trajectories of both nondominant racial–ethnic (NDRE) youth and youth-serving providers. In the face of growing nationalism, ethnocentrism, xenophobia, and overt expressions of racism, the Society for Adolescent Health and Medicine recognizes the critically important need to address the issue of racism and its impact on both NDRE youth and youth-serving providers. Organizations involved in clinical care delivery and health professions training and education must recognize the deleterious effects of racism on health and well-being, take strong positions against discriminatory policies, practices, and events, and take action to promote safe and affirming environments. The positions presented in this paper provide a comprehensive set of recommendations to promote routine clinical assessment of youth experiences of racism and its potential impact on self-concept, health and well-being, and for effective interventions when affected youth are identified. The positions also reflect the concerns of NDRE providers, trainees, and students potentially impacted by racism, chronic minority stress, and vicarious trauma and the imperative to create safe and affirming work and learning environments across all levels of practice, training, and education in the health professions. In this position paper, Society for Adolescent Health and Medicine affirms its commitment to foundational moral and ethical principles of justice, equity, and respect for humanity; acknowledges racism in its myriad forms; defines strategies to best promote resiliency and support the health and well-being of NDRE youth, providers, trainees, and students; and provides recommendations on the ways to best effect systemic change.
Brooks, F, Aggleton, P, Dawson, A & Kang, M 2018, 'Youth health and practical justice - Time for renewed conversation', HEALTH EDUCATION JOURNAL, vol. 77, no. 6, pp. 627-630.View/Download from: Publisher's site
Kang, M, Robards, F, Sanci, L, Steinbeck, K, Jan, S, Hawke, C, Kong, M & Usherwood, T 2017, 'Access 3 project protocol: young people and health system navigation in the digital age: a multifaceted, mixed methods study.', BMJ Open, vol. 7, no. 8, pp. 1-10.View/Download from: Publisher's site
BACKGROUND: The integration of digital technology into everyday lives of young people has become widespread. It is not known whether and how technology influences barriers and facilitators to healthcare, and whether and how young people navigate between face-to-face and virtual healthcare. To provide new knowledge essential to policy and practice, we designed a study that would explore health system access and navigation in the digital age. The study objectives are to: (1) describe experiences of young people accessing and navigating the health system in New South Wales (NSW), Australia; (2) identify barriers and facilitators to healthcare for young people and how these vary between groups; (3) describe health system inefficiencies, particularly for young people who are marginalised; (4) provide policy-relevant knowledge translation of the research data. METHODS AND ANALYSIS: This mixed methods study has four parts, including: (1) a cross-sectional survey of young people (12-24 years) residing in NSW, Australia; (2) a longitudinal, qualitative study of a subsample of marginalised young people (defined as young people who: identify as Aboriginal and/or Torres Strait Islander; are experiencing homelessness; identify as sexuality and/or gender diverse; are of refugee or vulnerable migrant background; and/or live in rural or remote NSW); (3) interviews with professionals; (4) a knowledge translation forum. ETHICS AND DISSEMINATION: Ethics approvals were sought and granted. Data collection commenced in March 2016 and will continue until June 2017. This study will gather practice and policy-relevant intelligence about contemporary experiences of young people and health services, with a unique focus on five different groups of marginalised young people, documenting their experiences over time. Access 3 will explore navigation around all levels of the health system, determine whether digital technology is integrated into this, and if so how, and will translate findings i...
Klineberg, E, Vatiliotis, V, Kang, M, Medlow, S, Sullivan, L, Cummings, M, Pringle, G & Steinbeck, K 2017, 'Health status of marginalised young people in unstable accommodation.', Journal of Paediatrics and Child Health.View/Download from: Publisher's site
AIM: More than 26 000 Australians aged 12-24 years experience homelessness, yet data on the health status of homeless youth remain limited. The aim of this study was to describe the health of young people attending a youth health service in Western Sydney who were experiencing homelessness. METHODS: Retrospective case note review for clients aged 12-25 years attending Youth Health Services in Western Sydney. Extracted data included: homelessness status; demographics; physical health issues; mental health issues; involvement with juvenile justice; and disengagement from education or employment. RESULTS: Just under half of the 180 clients attending a Youth Health Service in Western Sydney were homeless, and an additional 15 young people who were not currently homeless nominated homelessness as a presenting issue. In comparison with currently domiciled young people, homeless youth were less likely to have a regular general practitioner and more likely to nominate a physical health concern as a presenting issue, although there was no difference between groups in terms of diagnosed mental or physical health conditions. Considered as a whole, the sample showed high rates of acute physical symptoms, physical trauma, psychological distress and self-harm. CONCLUSIONS: Youth homelessness is associated with risk of both poor physical and mental health. As much of youth homelessness is hidden, health-care providers need to ensure that they inquire about homelessness status, and have an awareness of potentially complex multi-morbidities in the physical and mental health of young marginalised people presenting to health services.
Society for Adolescent Health and Medicine 2017, 'Condom Availability in Schools: A Practical Approach to the Prevention of Sexually Transmitted Infection/HIV and Unintended Pregnancy.', The Journal of adolescent health : official publication of the Society for Adolescent Medicine, vol. 60, no. 6, pp. 754-757.View/Download from: Publisher's site
Adolescents and young adults are highly impacted by sexually transmitted infections (STIs) and unplanned pregnancy in the United States and globally. Consistent and correct use of male latex condoms is associated with protection against both STIs and pregnancy. Providing adolescents and young adults with access to free condoms in schools may increase the use of condoms by improving condom availability, eliminating cost, and decreasing embarrassment associated with purchasing condoms. Studies demonstrate that condom availability in schools is associated with the increased use of condoms and improved overall sexual health. The Society for Adolescent Health and Medicine encourages schools to make condoms available to students as part of efforts to decrease rates of STIs and unplanned pregnancy in adolescents and young adults. The Society for Adolescent Health and Medicine also encourages health care providers to advocate for and support the availability of condoms in local schools.
Reath, J, Abbott, P, Dadich, A, Hosseinzadeh, H, Hu, W, Kang, M, Usherwood, T, Murray, C & Bourne, C 2016, 'Evaluation of a sexually transmissible infections education program: Lessons for general practice learning', AUSTRALIAN FAMILY PHYSICIAN, vol. 45, no. 3, pp. 123-128.
Woodland, L, Kang, M, Elliot, C, Perry, A, Eagar, S & Zwi, K 2016, 'Evaluation of a school screening programme for young people from refugee backgrounds', JOURNAL OF PAEDIATRICS AND CHILD HEALTH, vol. 52, no. 1, pp. 72-79.View/Download from: Publisher's site
Skinner, SR, Davies, C, Cooper, S, Stoney, T, Marshall, H, Jones, J, Collins, J, Hutton, H, Parrella, A, Zimet, G, Regan, DG, Whyte, P, Brotherton, JM, Richmond, P, McCaffrey, K, Garland, SM, Leask, J, Kang, M, Braunack-Mayer, A, Kaldor, J & McGeechan, K 2015, 'HPV.edu study protocol: a cluster randomised controlled evaluation of education, decisional support and logistical strategies in school-based human papillomavirus (HPV) vaccination of adolescents.', BMC Public Health, vol. 15, pp. 1-9.View/Download from: Publisher's site
The National Human Papillomavirus (HPV) Vaccination Program in Australia commenced in 2007 for females and in 2013 for males, using the quadrivalent HPV vaccine (HPV 6,11,16,18). Thus far, we have demonstrated very substantial reductions in genital warts and in the prevalence of HPV among young Australian women, providing early evidence for the success of this public health initiative. Australia has a long history of school-based vaccination programs for adolescents, with comparatively high coverage. However, it is not clear what factors promote success in a school vaccination program. The HPV.edu study aims to examine: 1) student knowledge about HPV vaccination; 2) psycho-social outcomes and 3) vaccination uptake.HPV.edu is a cluster randomised trial of a complex intervention in schools aiming to recruit 40 schools with year-8 enrolments above 100 students (approximately 4400 students). The schools will be stratified by Government, Catholic, and Independent sectors and geographical location, with up to 20 schools recruited in each of two states, Western Australia (WA) and South Australia (SA), and randomly allocated to intervention or control (usual practice). Intervention schools will receive the complex intervention which includes an adolescent intervention (education and distraction); a decisional support tool for parents and adolescents and logistical strategies (consent form returns strategies, in-school mop-up vaccination and vaccination-day guidelines). Careful process evaluation including an embedded qualitative evaluation will be undertaken to explore in depth possible mechanisms for any observed effect of the intervention on primary and secondary outcomes.This study is the first to evaluate the relative effectiveness of various strategies to promote best practice in school-based vaccination against HPV. The study aims to improve vaccination-related psychosocial outcomes, including adolescent knowledge and attitudes, decision-making involvement, self-ef...
Dadich, A, Hosseinzadeh, H, Abbott, P, Hu, W, Usherwood, T, Kang, M, Bourne, C, Murray, C & Reath, J 2014, 'Improving sexual healthcare in general practice', British Journal of Health Care Management, vol. 20, no. 7, pp. 344-349.View/Download from: Publisher's site
© 2014 MA Healthcare Ltd. Objective: Describe how different types of resources are received and perceived by primary care clinicians to improve sexual healthcare. Study design: Cross-sectional online survey of primary care clinicians in New South Wales, Australia, to evaluate the perceived impact of nine resources to promote sexual healthcare - seven were tailored to general practitioners (GPs) and two to practice nurses (PNs). Participants: 431 primary care clinicians (GPs=214; PNs=217). Main outcome measures: Awareness, use and perceived impact of the resources. Principal findings: Most GPs were aware of and used the Sexually Transmitted Infections (STI) Testing Tool; the Online STI Testing Tool GP training was perceived to improve GPs' ability to raise the topic of STIs with patients and order appropriate tests. Although the highest proportion of PNs were aware of the online STI PN training, most used the PN Postcard. The former helped to improve PNs' ability to identify at-risk patients and document sexual history. Conclusions: This study supports the need for a multimodal approach to improve the delivery of sexual healthcare in general practice. This would involve the communication of similar messages in different modes, via different channels, at different times.
Kang, M, Rochford, A, Skinner, SR, Mindel, A, Webb, M, Peat, J & Usherwood, T 2014, 'Sexual behaviour, sexually transmitted infections and attitudes to chlamydia testing among a unique national sample of young Australians: baseline data from a randomised controlled trial.', BMC Public Health, vol. 14, pp. 1-7.View/Download from: Publisher's site
BACKGROUND: Chlamydia infection is the most common notifiable sexually transmitted infection (STI) in Australia and mostly affects young people (15 - 25 years). This paper presents baseline data from a randomised controlled trial that aimed to increase chlamydia testing among sexually active young people. The objectives were to identify associations between sexual behaviour, substance use and STI history and explore attitudes to chlamydia testing. METHODS: This study was conducted in cyberspace. Study recruitment, allocation, delivery of interventions and baseline and follow up data collection all took place online. Participants were 16 - 25 years old and resided in Australia. Substance use correlates of sexual activity; predictors of history of STIs; barriers to and facilitators of chlamydia testing were analysed. RESULTS: Of 856 participants (79.1% female), 704 had experienced penetrative intercourse. Sexually active participants were more likely to smoke regularly or daily, to drink alcohol, or to have binge drunk or used marijuana or other illicit substances recently. Risk factors for having a history of any STI were 3 or more sexual partners ever, 6 or more partners in the past 12 months, condom non-use and being 20 years or older. Almost all sexually active participants said that they would have a chlamydia test if their doctor recommended it. CONCLUSIONS: Sexually active young people are at risk of STIs and may engage in substance use risk behaviours. Where one health risk behaviour is identified, it is important to seek information about others. Chlamydia testing can be facilitated by doctors and nurses recommending it. Primary care providers have a useful role in chlamydia control. TRIAL REGISTRATION: Australian and New Zealand Trials Registry ACTRN12607000582459.
Koh, CS, Kang, M & Usherwood, T 2014, ''I demand to be treated as the person I am': experiences of accessing primary health care for Australian adults who identify as gay, lesbian, bisexual, transgender or queer', SEXUAL HEALTH, vol. 11, no. 3, pp. 258-264.View/Download from: Publisher's site
Abbott, P, Dadich, A, Hosseinzadeh, H, Kang, M, Hu, W, Bourne, C, Murray, C & Reath, J 2013, 'Practice nurses and sexual health care Enhancing team care within general practice', AUSTRALIAN FAMILY PHYSICIAN, vol. 42, no. 10, pp. 729-733.
Dadich, A, Jarrett, C, Sanci, L, Kang, M & Bennett, D 2013, 'The promise of primary health reform for youth health', JOURNAL OF PAEDIATRICS AND CHILD HEALTH, vol. 49, no. 11, pp. 887-890.View/Download from: Publisher's site
Kang, M 2013, 'A young woman with vulvovaginal and urinary symptoms', Medicine Today, vol. 14, no. 12, pp. 58-59.
What are the most important steps in helping this young woman with genital symptoms, who recently commenced sexual activity? This article describes an approach to assessment and the role of STI screening in this clinical context.
Cummings, M & Kang, M 2012, 'Youth health services Improving access to primary care', AUSTRALIAN FAMILY PHYSICIAN, vol. 41, no. 5, pp. 339-341.
Cummings, M & Kang, M 2012, 'Youth health services: Improving access to primary care', Australian Family Physician, vol. 41, no. 5, pp. 338-341.
Marginalised young people are a heterogeneous group who often have multiple and complex needs. While they experience the same health problems as the broader youth population, including overweight and obesity, mental health problems, sexually transmissible infections and health risk behaviours, their access to healthcare is complicated by psychosocial factors including lack of safe or adequate housing, inadequate access to financial support, education or employment, and a mistrust of health services. This article summarises known access barriers for young people, describes a youth health services model in western Sydney, New South Wales, and demonstrates how general practitioners can work collaboratively to provide appropriate healthcare to marginalised young people.
Kang, M, Rochford, A, Skinner, R, Mindel, A, Webb, M, Peat, J & Usherwood, T 2012, 'Facilitating chlamydia testing among young people: a randomised controlled trial in cyberspace', SEXUALLY TRANSMITTED INFECTIONS, vol. 88, no. 8, pp. 568-573.View/Download from: Publisher's site
Kang, M, Skinner, R & Usherwood, T 2010, 'Interventions for young people in Australia to reduce HIV and sexually transmissible infections: a systematic review', SEXUAL HEALTH, vol. 7, no. 2, pp. 107-128.View/Download from: Publisher's site
Kang, M, Cannon, B, Remond, LC & Quine, S 2009, 'Is it normal to feel these questions ...?': a content analysis of the health concerns of adolescent girls writing to a magazine', Family Practice, vol. 26, no. 3, pp. 196-203.View/Download from: Publisher's site
Background. There is a mismatch between presenting concerns of adolescents to GPs and behaviours that lead to adolescent morbidity and mortality. Better understanding of health concerns of this target group would enhance communication between health professionals and adolescent patients. Objective. To explore and categorize the health concerns of adolescent girls sending unsolicited emails to a teenage girls' magazine. Method. We conducted a content analysis of 1000 systematic randomly selected unsolicited emails submitted to the health column of an Australian adolescent girls' magazine over a 6-month period. Results. Three main foci of concern were identified: Context of Concern, Health Issue of Concern and Advice Sought for Concern. Within Health Issue of Concern, there were five categories: body (47.5%), sex (31.9%), relationship (14.7%), mind (4.7%) and violence and/or safety (1.2%). Concerns within the body and sex categories ranged enormously, but frequently expressed intimate descriptions of anatomy, feelings, sexual practices and relationships. Many concerns occurred in the context of adolescents' relationships with others. The proportion of concerns about physical or psychological symptoms or health issues commonly associated with the adolescent age group (such as health risk behaviours, mental health, pregnancy and sexually transmitted infections) was relatively small. Conclusions. GPs and other health professionals might engage more readily with adolescent patients with a deeper understanding of the concerns that adolescents have about their bodies, relationships and overall health. Seemingly 'trivial' issues, such as normal puberty, could be used as discussion triggers in health consultations to help alleviate anxiety and build rapport.
Booth, ML, Knox, SA & Kang, M 2008, 'Encounters between adolescents and general practice in Australia', Journal of Paediatrics and Child Health, vol. 44, no. 12, pp. 699-705.View/Download from: Publisher's site
Aim: To describe the nature of the encounters between adolescents and general practice in Australia. Methods: Data collected by the Bettering the Evaluation and Care of Health programme from 19982004 were analysed. Data for 1014-yearold and 1519-year-old males and females were compared with data for 2529-year-olds. The outcome measures included: number of encounters compared with other age groups, reasons for encounter, problems managed, treatments prescribed and referrals made for key problems and types of consultations. Results: Adolescents have the lowest rate of encounter with general practice, compared with all other age groups. Respiratory, skin, musculoskeletal and unspecified (fever, injury, weakness) problems accounted for the great majority of reasons for encounter and problems managed. Management of mental health problems, preventive health care and health education were very infrequently managed problems. Standard surgery consultations were more common among adolescents than among young adults. Conclusions: Adolescents have a relatively low rate of encounter with general practice and the problems managed are primarily physical ailments. There is great scope to improve delivery of preventive health care and to increase management of mental health problems.
Ramanathan, V, Kang, M, Jeganathan, S, Jackson, E, Lagios, K & Furner, V 2008, 'Accessibility and acceptability of public sexual health clinics for adult clients in New South Wales, Australia', SEXUAL HEALTH, vol. 5, no. 3, pp. 305-306.View/Download from: Publisher's site
Zakher, B & Kang, M 2008, 'Attitudes to chlamydia screening in general practice among Australian university students: a pilot study', SEXUAL HEALTH, vol. 5, no. 4, pp. 359-363.View/Download from: Publisher's site
Kang, M & Quine, S 2007, 'Young people's concerns about sex: Unsolicited questions to a teenage radio talkback programme over three years', Sex Education, vol. 7, no. 4, pp. 407-420.View/Download from: Publisher's site
This paper describes a novel qualitative study that identified the concerns of young people about sex through a talk-back segment from 2002 to 2004 on an Australian national radio popular music programme targeting 15-24 year olds. Two hundred and thirty-one unsolicited callers (150 female and 81 male) went to air over the study period, and 212 (92%) of these asked questions relating to sexuality and sexual health. Content analysis was used to categorise the verbatim data. Four categories were identified: sexual development; sexual and reproductive health, sexual relationship issues and sexual practices. The findings suggest that young people have a wide range of concerns, many of which are very explicit. An important finding was the high proportion of questions related to concerns over relationships. The overall implication for health educators and professionals is that a broader approach to sex education is warranted.
Kang, M & Sanci, LA 2007, 'Primary health care for young people in Australia', International Journal of Adolescent Medicine and Health, vol. 19, no. 3, pp. 229-234.View/Download from: Publisher's site
This article gives an overview of the primary health care system and the evolution of adolescent medicine and health care in Australia over the past three decades. The various ways that Australian young people come into contact with different elements of primary health care are described, as well as research findings into improving young people's access to and quality of primary health care. Challenges and future directions are discussed. © Freud Publishing House Ltd.
Kang, M, Skinner, R & Foran, T 2007, 'Sex, contraception and health', AUSTRALIAN FAMILY PHYSICIAN, vol. 36, no. 8, pp. 594-+.
Skinner, SR, Kang, M & Rosenthal, SL 2007, 'Vaccinating young adults against human papillomavirus: the importance of understanding health decision-making and behaviour', SEXUAL HEALTH, vol. 4, no. 2, pp. 129-132.View/Download from: Publisher's site
Skinner, SR, Parsons, A, Kang, M, Williams, H & Fairley, C 2007, 'Sexually transmitted infections. Initiatives for prevention', International Journal of Adolescent Medicine and Health, vol. 19, no. 3, pp. 285-294.View/Download from: Publisher's site
Sexually transmissible infections (STls) are responsible for a significant burden of disease in both developed and developing countries and young people are disproportionately affected by STIs and their consequences. STI rates in young people are determined by a wide range of well documented influences. These include physiological, cognitive and behavioural factors, as well as environmental factors such as the social, and cultural context in which young people live. Despite the recognition of these influences, their complex inter-relationships are less well documented and the evidence for interventions to reduce STIs in young people is similarly less clear. This paper explores the most important factors that impact STI rates in young people in Australia and reviews interventions that have shown success, in Australia and elsewhere. In addition, promising strategies for the promotion of sexual health and reduction of STIs in young Australians, are discussed. © Freund Publishing House Ltd.
Kang, M 2006, 'Therapy update - The art of medicine', Australian Doctor, no. 20/OCT., pp. 39-40.
Kang, M, Bernard, D, Usherwood, T, Quine, S, Alperstein, G, Kerr-Roubicek, H, Elliott, A & Bennett, DL 2006, 'Towards better practice in primary health care settings for young people', Health Promotion Journal of Australia, vol. 17, no. 2, pp. 139-144.View/Download from: Publisher's site
Issue addressed: To identify and describe elements of accessibility and other dimensions of quality of primary health care for Australian young people. Methods: Five sampling frames identified relevant services and programs across New South Wales (NSW) which were then selected using purposive, convenience or snowball sampling. In-depth interviews were conducted with senior staff members, tape-recorded, transcribed, entered into the qualitative software package NUD*IST and coded under seven theme headings. Results: Interviews with 77 services across five sectors in NSW identified seven principles of better practice in youth health. These were: accessibility, evidence-based practice, youth participation, collaboration, professional development, sustainability and evaluation. Accessibility was the principle most frequently addressed and evaluation was the least frequently addressed. Many seemingly effective programs and services had been minimally evaluated for impact or outcome related to young people's access or health. Conclusions: Principles of better practice in promoting or delivering adolescent health care have strong face validity across a range of sectors and service types in a heterogeneous primary health care system. These principles are applied to varying degrees in a vast array of health and health promotion programs. Despite this, there is a clear need for impact and outcome evaluation among the majority of programs.
Kang, M, Rochford, A, Johnston, V, Jackson, J, Freedman, E, Brown, K & Mindel, A 2006, 'Prevalence of Chlamydia trachomatis infection among 'high risk' young people in New South Wales', Sexual Health, vol. 3, no. 4, pp. 253-254.View/Download from: Publisher's site
International research on homeless adolescents has found that incidence and prevalence of sexually transmissible infections is relatively high. This study reports on a chlamydia prevalence survey conducted among high-risk young people (14-25 years) in New South Wales. The participants were recruited from youth health centres, which target homeless and high-risk youth. Of 333 clients (42.6% male), 84.1% were sexually active and mean number of sexual partners over the preceding 3 months was 1.4. Among sexually active participants, 24.6% claimed to use condoms always and 25% never. Sixteen of 274 available urine samples tested positive for Chlamydia trachomatis infection. Further research is warranted to better define high-risk groups and clarify the nature of associations between various factors impacting on sexual health. Most importantly, research is now called for into effective strategies for engaging and attracting young people to screening, treatment and contact tracing. © CSIRO 2006.
Kang, MS, Bernard, D, Usherwood, T, Quine, S, Alperstein, G, Kerr-Roubicek, H, Elliott, A & Bennett, DL 2006, 'Primary health care for young people: are there models of service delivery that improve access and quality?', Youth Studies Australia, vol. 25, no. 2, pp. 49-59.
Skinner, SR & Kang, M 2006, 'Human papillomavirus prevalence in Canberra high school students: Significance for vaccination strategies and adolescent health', Sexual Health, vol. 3, no. 4, pp. 299-300.View/Download from: Publisher's site
Sanci, LA, Sawyer, SM, Kang, MSL, Haller, DM & Patton, GC 2005, 'Confidential health care for adolescents: reconciling clinical evidence with family values', MEDICAL JOURNAL OF AUSTRALIA, vol. 183, no. 8, pp. 410-414.View/Download from: Publisher's site
Bernard, D, Quine, S, Kang, M, Alperstein, G, Usherwood, T, Bennett, D & Booth, M 2004, 'Access to primary health care for Australian adolescents: How congruent are the perspectives of health service providers and young people, and does it matter?', Australian and New Zealand Journal of Public Health, vol. 28, no. 5, pp. 487-492.View/Download from: Publisher's site
Objective: To explore the extent of congruence between the views of service providers and young people (on adolescents' health concerns, barriers to accessing health services and ideal service model) in order to improve and increase the appropriateness, quality and usage of primary health care services. Methods: A qualitative data collection technique was used. During 2001/02, focus groups were conducted in urban and rural locations with adolescents (in and out of mainstream education), general practitioners, community health staff and youth health workers. Results: Service providers and young people identified a similar range of health concerns for young people, with young people adding additional issues of great importance to them that service providers felt were not in their 'domain of treatment'. There was reasonable congruence in regard to 'ideal service model' with some differences relating to methods of information delivery. However, for 'barriers to accessing services' there were major discrepancies. Conclusions: While there is some common understanding between young people and service providers on certain aspects of health services, there are clearly areas where perceptions differ. This discrepancy matters because it may adversely affect the quality of provider-adolescent interaction and the willingness of adolescents to access services. Implications: To deliver optimal health services to young people, the differences in understanding regarding services need to be addressed. Strategies could include promotion to, and encouragement of, young people to seek help, continuing professional education of providers and changes in remuneration policies.
Bernard, D, Quine, S, Kang, M, Alperstein, G, Usherwood, T, Bennett, D & Booth, M 2004, 'Access to primary health care for Australian adolescents: How congruent are the perspectives of health service providers and young people, and does it matter?', AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, vol. 28, no. 5, pp. 487-492.View/Download from: Publisher's site
Booth, ML, Bernard, D, Quine, S, Kang, MS, Usherwood, T, Alperstein, G & Bennett, DL 2004, 'Access to health care among Australian adolescents young people's perspectives and their sociodemographic distribution', JOURNAL OF ADOLESCENT HEALTH, vol. 34, no. 1, pp. 97-103.View/Download from: Publisher's site
Kang, M, Bernard, D, Booth, M, Quine, S, Alperstein, G, Usherwood, T & Bennett, D 2003, 'Access to primary health care for Australian young people: service provider perspectives', BRITISH JOURNAL OF GENERAL PRACTICE, vol. 53, no. 497, pp. 947-952.
Quine, S, Bernard, D, Booth, M, Kang, M, Usherwood, T, Alperstein, G & Bennett, D 2003, 'Health and access issues among Australian adolescents: a rural-urban comparison.', Rural and remote health, vol. 3, no. 3, p. 245.
INTRODUCTION: Previous research has reported rural-urban differences in health concerns and access issues. However, very little of this has concerned young people, and what has been published has been mainly from countries other than Australia and may not generalise to Australian youth. The study described in this paper is a subset of a larger study on health concerns and access to healthcare for younger people (12-17 years) living in New South Wales (NSW), Australia. This paper reports findings on rural-urban similarities and differences. The specific study objective was to identify and describe rural-urban differences, especially those associated with structural disadvantage. METHOD: The reported findings form part of a larger state-wide cross-sectional study of access to healthcare among NSW adolescents. Adolescents were drawn from high schools in ten of the 17 Area Health Services in NSW. These Area Health Services were selected because they represent most aspects of rural-urban NSW with respect to population characteristics and health services. Eighty-one focus groups were conducted with adolescents (35 with boys and 46 with girls), of which 56 were conducted in urban, 22 in rural and 3 in regional areas. The focus groups were tape-recorded, transcribed and analysed using the computer software package NUD*IST 4. RESULTS: The analysis revealed certain health concerns that were common to both rural and urban adolescents: use of alcohol and illicit drugs, bullying, street safety, diet and body image, sexual health, stress and depression. However, certain concerns were mentioned more frequently in rural areas (eg depression), and two concerns were raised almost exclusively by rural youth (youth suicide and teenage pregnancy). There were also structural differences in service provision: adolescents in rural areas reported disadvantage in obtaining access to healthcare (limited number of providers and lengthy waiting times); having only a limited choice of provide...
Kang, M 2002, 'An approach to adolescent drug use.', Australian family physician, vol. 31, no. 1, pp. 12-17.
BACKGROUND: Substance abuse is one of the most challenging and emotionally charged areas of general practice as it is in society at large. When this is combined with some of the difficulties in engaging the adolescent patient, it is not uncommon for the general practitioner to feel overwhelmed and unsure about how to approach the issue. OBJECTIVE: This article discusses strategies for GPs in managing adolescent patients with substance abuse, including referral services and opportunities for collaboration and a team approach. DISCUSSION: While there are good reasons to be concerned about substance abuse among adolescents and uncertainty about where to turn for specialised help, there is much the GP can do alone, and in collaboration with other services, to care for the adolescent with a substance use issue.
Kang, M 2002, 'Substance abuse in teenagers. Trends and consequences.', Australian family physician, vol. 31, no. 1, pp. 8-11.
BACKGROUND: Over the past few decades there has been growing concern about the use and abuse of alcohol and other drugs by adolescents. OBJECTIVE: To outline the trends in and consequences of adolescent substance abuse. DISCUSSION: Alcohol and tobacco remain the most often used drugs in adolescence, and are the drugs associated with greatest morbidity and mortality, but there is some evidence that the use of illicit drugs is increasing. Morbidity and mortality from substance abuse can occur directly from the effects of the drug, from the mode of administration or from environmental factors associated with drug use. Drug related deaths compromise 24% of all deaths in the 12-24 year old age group. This is likely to be an underestimate as alcohol related traffic accidents are excluded from this figure.
Kang, M 2000, 'Sex files: exploring sexuality through Dolly magazine', Youth Studies Australia, vol. 19, no. 4, pp. 28-33.
Kang, M, Alperstein, G, Dow, A, van Beek, I, Martin, C & Bennett, D 2000, 'Prevalence of tuberculosis infection among homeless young people in central and eastern Sydney', JOURNAL OF PAEDIATRICS AND CHILD HEALTH, vol. 36, no. 4, pp. 382-384.View/Download from: Publisher's site
Kang, MS & Zador, D 1993, 'Sexual behaviour and contraceptive practices of Year 10 schoolgirls in inner metropolitan Sydney', Australian Journal of Marriage and Family, vol. 14, no. 3, pp. 137-142.
Kang, MS & Rosenthal, D 2014, 'Adolescents' in Temple-Smith, M & Gifford, S (eds), Sexual Health in Australia, IP Communications, Melbourne, Australia.
Grover, S & Kang, MS 2013, 'Adolescent Gynaecology' in Youth Health and Adolescent Medicine, IP Communications.
Bennett, DL & Kang, MS 2011, 'Adolescent health and development' in Phelps, K & Hassad, C (eds), General Practice The Integrative Approach, Elsevier Australia.
The aim of the book is to provide a comprehensive General Practice text book which takes a contemporary, integrative approach to diagnosis, investigation and management of health issues and disease states encountered in the general practice ...
Kang, MS 2011, 'Adolescent Sexual Health' in Russell, D, Bradford, D & Fairley, C (eds), Sexual Health Medicine: A Clinical Approach.
Bennett, DL, Kang, MS & Chown, P 2005, 'Cultural diversity in adolescent health care' in Greydanus, DE (ed), Essentials of Adolescent Medicine, McGraw-Hill.
Bennett, DL & Kang, MS 2001, 'Adolescence' in Oates, K, Currow, K & Hu, W (eds), Child Health A Practical Manual for General Practice, MacLennan and Petty Pty Ltd.
This manual provides practical advice that recognizes the realities of general practice and the importance of the general practitioner's role in child health.
International sexual minority students, particularly men who have sex with men (MSM), experience disparities in health, including a significantly higher prevalence of HIV and other STIs and lower levels of sexual health services use. Limited research has been conducted in this population around sexual health knowledge, behaviour and services use.
A multi-language cross-sectional online survey was completed by 168 international MSM tertiary students (median age: 25 years) in New South Wales (Australia). Variables included demographics, sexual identity and behaviour, sexual health knowledge and behaviour including PrEP use as well as sexual health services use. Descriptive and correlational analyses, and binary logistic regressions were conducted.
Sexual health knowledge including routes of HIV transmission was overall high in the sample, while 20% had limited knowledge regarding pre-exposure prophylaxis (PrEP) and 28% regarding post-exposure prophylaxis (PEP). Less than half (44%) reported inconsistent condom use. PrEP use was low in the sample (14%) and not correlated with condom use. Sexual health behaviours and dimensions LGBT Community connectedness were significantly correlated with the use of different sexual health services.
This first comprehensive study among international MSM tertiary students in Australia demonstrates a high level of inconsistent condom use and low levels of PrEP use as well as strong correlations between sexual health behaviour and HIV/STI testing, and connectedness with other sexual minority men. International MSM students do not feel included in the local LGBT Community but demonstrate a strong desire to be involved. Those included were more likely to use vital sexual health services.
International MSM students are an emerging priority population for sexual health research and practice. , and future health promotion campaigns should consider incorporating strong community build...
Demant, D & Kang, M 2019, 'Effects of LGBT Community Connectedness and Participation on Sexual Health in International MSM Students', 2019 Joint Australasian Sexual Health and HIV&AIDS Conference, Perth, Australia.
Kang, M & Demant, D Australian Centre for Public and Population Health Research 2019, Sexual health among male international students who have sex with men: final research report, Ultimo, NSW, Australia.
Kang, M, Robards, F, Sanci, L, Steinbeck, K, Jan, S, Hawke, C, Luscombe, G, Kong, M & Usherwood, T Department of General Practice Westmead, The University of Sydney and the Australian Centre for Public and Population Health Research, The University of Technology Sydney, Australia 2018, Access 3: young people and the health system in the digital age - final research report., Sydney, Australia.
HARP Forum 2019 – The Millennial Edition
NSW HIV and STI Strategies Implementation Committee Meeting
Presentation at the 2018 Scientific Meeting of the NSW HIV PRevention Partnership Project
Kang, MS 2015, 'Sex, young people and chlamydia: reducing the impact'.
Genital chlamydia infection is a highly prevalent condition and disproportionately affects young people. Chlamydia screening is the major strategy for chlamydia control in developed countries. This research includes two separate, linked studies, aiming to reduce the impact of chlamydia in Australian young people by increasing chlamydia testing. The first study is a randomised controlled trial (RCT) and the second a qualitative study using in-depth interviews and discourse analysis. The RCT evaluated an email based intervention and found that those who engaged in email interaction were more likely to report chlamydia test uptake at six month follow up compared with those in the control group. Young people who completed the RCT were invited to participate in face-to-face in-depth interviews, which explored the young person's experiences of the RCT and enquired about the meanings of STIs they held. Discourse analysis of interview transcripts suggested that young people strongly uphold a medical discourse about STIs and see themselves and others as being responsible if they are safe (ie use condoms or get tested). As digital technologies continue to rapidly evolve, understanding the ways in which young people engage with them in relation to sexual health care will be important.
Department of General Practice, University of Sydney at Westmead
Academic Department of Adolescent Medicine, University of Sydney