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This study aimed to explore the trend in population levels, as well as the correlates, of occupational and leisure sitting time in full-time employed Australian adults between 2007 and 2015. We used data from the 2007/08, 2011/12 and 2014/15 Australian Health Surveys, in which nationally representative samples of the Australian population were interviewed. Full-time (35 hours/week) employed respondents reported sitting time at work and during leisure on a usual workday. Trends over time and associations between socio-demographic and health-related characteristics and sitting time were analysed in the combined dataset using multivariable logistic regression models. Over 21,000 observations were included in the analyses. Across the three surveys, approximately 51% of the respondents reported 4 hours/workday occupational sitting time, 40% reported 4 hours/workday leisure sitting time, and 55% reported 7 hours/workday combined occupational and leisure sitting time. There were no clear trends over time. All potential correlates were associated with occupational sitting time and all but educational level were associated with leisure sitting time. The directions of the associations with gender, age and leisure-time physical activity were reversed for occupational sitting time and leisure sitting time. These findings show that the average levels of occupational and leisure sitting time on workdays were high but stable over the past decade. The observed differences in correlates of occupational and leisure sitting time demonstrate the need to assess and address sedentary behaviour domains separately in research and policy.

Objective To determine the association between standing time and all-cause mortality. Methods Prospective questionnaire data from 221,240 individuals from the 45 and Up Study were linked to mortality data from the New South Wales Registry of Deaths (Australia) from February 1, 2006 to June 17, 2012. Hazard ratios for all-cause mortality according to standing time at baseline were estimated in 2013 using Cox regression modelling, adjusted for sex, age, education, urban/rural residence, physical activity, sitting time, body mass index, smoking status, self-rated health and disability. Results During 937,411 person years (mean follow-up = 4.2 yr) 8009 deaths occurred. All-cause mortality hazard ratios were 0.90 (95% CI 0.85–0.95), 0.85 (95% CI 0.80–0.95), and 0.76 (95% CI 0.69–0.95) for standing 2–≤ 5 h/d, 5 – ≤ 8 h/d, or > 8 h/d respectively, compared to standing two or less hours per day. Further analyses revealed no significant interactions between standing and sex (p = 0.93), the presence/absence of cardiovascular disease or diabetes (p = 0.22), BMI (p = 0.78), physical activity (p = 0.16) and sitting time (p = 0.22). Conclusion This study showed a dose–response association between standing time and all-cause mortality in Australian adults aged 45 years and older. Increasing standing may hold promise for alleviating the health risks of prolonged sitting.

Poor nutrition and insufficient physical activity contribute to high rates of obesity. Prevalence, intention to change and co-occurrence of four health risk behaviours (inadequate fruit and vegetables, excessive dietary fat, excessive sugary beverages and inadequate physical activity in comparison to public health recommendations) were investigated in an Australian population of working adults. Participants (n=105) completed sociodemographic and stage of change questionnaires. A subsample (n=40) were assessed twice to estimate test-retest repeatability. In the full sample, 73% were female, mean age was 33.8 years and mean BMI was 23.8 kg/m(2). Eighty-seven percent of participants consumed inadequate fruit and vegetables, 43% had excessive dietary fat, 42% had excessive sugary beverages and 29% had inadequate physical activity. The proportions intending to change each behaviour were 57%, 25%, 18% and 24%, respectively. Two-thirds exhibited multiple risk behaviours and 38% intended to change multiple risk behaviours. Fruit and vegetables and dietary fat were the most commonly paired risk behaviours (39%) and the pair most intended to change (19%). Occurrence of multiple risk behaviours was associated with being male (OR 3.10, 95% CI 1.06-9.03) or overweight/obese (OR 2.66, 95% CI 1.02-6.93). Targeting two risk behaviours, particularly fruit and vegetables and dietary fat, may be appropriate when designing health promotion programs in working populations.

Objective: To examine trends in leisure time physical activity and inactivity in Australians aged 15 years or older from 1989 to 2011. Method: We used data from six Australian National Health Surveys conducted from 1989/90 to 2011/12 in which physical activity was assessed using comparable questions. Analyses examined trends in the prevalence of sufficient physical activity (≥150 minutes/week moderate-to-vigorous physical activity) and of inactivity (

Younger generations of Australians are gaining weight faster than their parents. Associated health consequences are likely to ensue unless weight gains are prevented; however, it is unclear how to effectively intervene in this population. Electronic databases for health sciences were searched from April to the end of August 2011. Nine studies were included in the review, eight in the meta-analysis, from 771 abstracts reviewed for eligibility criteria: randomized controlled trials of lifestyle interventions, published in English (1980 onward), aimed at preventing weight gain among healthy subjects 18-35 years. Mean body weight change was the primary outcome. The combined weighted mean change in intervention participants was -0.87 kg (95% CI -1.56, -0.18) and in control participants 0.86 kg (95% CI 0.14, 1.57). Post hoc meta-regression analyses revealed evidence-based interventions of 4 months or longer duration were significantly associated with greater weight loss (-1.62 [95% CI -3.21, -0.04], P = 0.045). The small number, short duration and large heterogeneity of trials means the effectiveness of lifestyle intervention for preventing young adult weight gain remains unclear. Future trials conducted over longer periods with larger samples are urgently required to develop effective programmes that will protect against weight gains in future generations.

BackgroundWhether the prevalence rates of common mental disorders can be compared across countries depends on the cultural validity of the diagnostic measures used.AimsTo investigate the prevalence of Western and indigenously defined mental disorders among Vietnamese living in Vietnam and in Australia, comparing the data with an Australian-born sample.MethodComparative analysis of three multistage population surveys, including samples drawn from a community living in the Mekong Delta region of Vietnam (n=3039), Vietnamese immigrants residing in New South Wales, Australia (n=1161), and an Australian-born population (n=7961). Western-defined mental disorders were assessed by the Composite International Diagnostic Interview (CIDI) 2.0 and included DSM–IV anxiety, mood and substance use disorders as well as the ICD–10 category of neurasthenia. The Vietnamese surveys also applied the indigenously based Phan Vietnamese Psychiatric Scale (PVPS). Functional impairment and service use were assessed.ResultsThe prevalence of CIDI mental disorders for Mekong Delta Vietnamese was 1.8% compared with 6.1% for Australian Vietnamese and 16.7% for Australians. Inclusion of PVPS mental disorders increased the prevalence rates to 8.8% for Mekong Delta Vietnamese and 11.7% for Australian Vietnamese. Concordance was moderate to good between the CIDI and the PVPS for Australian Vietnamese (area under the curve (AUC)=0.77) but low for Mekong Vietnamese (AUC=0.59). PVPS- and CIDI-defined mental disorders were associated with similar levels of functional impairment.ConclusionsCultural factors in the expression of mental distress may influence the prevalence rates of mental disorders reported across countries. The findings have implications for assessing mental health needs at an international level.

Objective To examine population trends in lifestyle walking in New South Wales (NSW), Australia between 1998 and 2006. Methods Computer Assisted Telephone Interviewing surveys were conducted in 1998 and annually from 2002 to 2006. The weighted and standardized prevalence estimates of any walking (AW) for exercise, recreation or travel (i.e. ≥ 10 min/week) and of regular walking (RW) (i.e. ≥ 150 mins/week over ≥ 5 occasions) in population sub-groups were determined for each year. Adjusted annual change was calculated using multiple regression analyses. Results The prevalence of AW was high in 1998 (80.0%, 95% CI: 79.4%–80.6%) and increased to 83.5% (95% CI: 82.7%–84.3%) in 2006. The prevalence of RW was stable between 1998 and 2003 (∼ 29%), and gradually increased between 2004 (32.9%, 95% CI: 32.0%–33.8%) and 2006 (36.5%, 95% CI: 35.4%–37.6%). The yearly increases differed in magnitude but were significant for all population sub-groups including 75 years and older, the obese, people living in remote locations and those in the most disadvantaged socio-economic status quintile. Socio-economic differential in RW was no longer significant in 2006. Conclusion Over time, everyday walking has the potential to reduce health inequalities that is due to inactivity. Public health efforts to promote active living and address obesity, as well as a rise in gasoline prices, might have contributed to this trend.

Objective: This research examined trends in physical activity reporting by Australian newspapers, and described these trends compared to coverage of obesity and tobacco. Method: The Factiva database was searched for articles published in major Australian metropolitan newspapers (1986-2006) that mentioned physical activity, obesity or tobacco smoking. Standardised frequencies compared the three health issues, and trends in reporting were estimated by using standard multiple regression models to fit linear splines with fixed knots at years 1991, 1996 and 2001 to the standardised data. Results: Physical activity received the least coverage 1986-2006, appearing in 4,988 articles, compared with 15,410 and 63,738 articles for obesity and tobacco respectively. Between 1996 and 2000, there were significant increases in the rate of coverage of physical activity (β=0.21; p

Background and Aim: Non-alcoholic fatty liver disease associated with insulin resistance is the most common cause of abnormal liver tests in clinical practice. To date, practical and effective strategies to improve the metabolic profile of this large group of patients have not been well characterised. We sought to assess the effect at 3 months of a behavior change-based lifestyle intervention on the metabolic profile of patients characterised by elevated liver enzymes. Methods: A total of 152 patients with elevated liver enzymes, central obesity and a range of metabolic risk factors were randomised to either a moderate- (6 sessions/10 weeks) or low-intensity (3 sessions/4 weeks) lifestyle counselling intervention or control group. Results: There was improvement in all metabolic risk factors in the moderate-intensity group, versus a smaller number of changes in the low-intensity intervention group and no change in any metabolic risk factors in control subjects. Reduction in liver enzymes was greatest in the moderate-intensity intervention group and least in the control group. The likelihood of elevated alanine aminotransferase (ALT) levels in both the moderate and low-intensity groups was reduced by over 70% compared to controls. The proportion of subjects achieving weight loss (≥ 2%) was significantly higher in the moderate-intensity intervention group (66%) versus the low-intensity intervention group (39%; P

Purpose This study investigated postpartum dietary behaviors among women with recent gestational diabetes mellitus (GDM), the cognitive and social factors related to these, and preferred types of lifestyle support, in order improve the development of diabetes prevention strategies for this group. Methods Participants were a random sample of 226 women diagnosed with GDM in the prior 6 to 24 months. Telephone surveys were used to evaluate dietary behaviors, self-efficacy, social support, perceived barriers to healthy eating, and preferred methods of lifestyle support. Results Only 5% of the respondents consumed 5 servings/day of vegetables and 44% consumed 2 or more servings/day of fruit. Fried food was eaten at least twice per week by 26% of women and 50% usually consumed full-fat milk. Higher vegetable consumption was associated with self-efficacy to cook healthy foods, reporting that a healthy diet is not a difficult change and that dislike of healthy foods by other household members is not a barrier. Fruit consumption was positively related to self-efficacy when busy and when not reporting a dislike of healthy foods by others at home. Advice from a dietitian and telephone support from a health educator were the most preferred forms of health assistance. Conclusions Dietary risks factors are prevalent among women with recent GDM. Confidence and skills in cooking healthy foods, along with family food preferences and time pressures, are important influences on eating habits. Dietary change programs, informed by the beliefs and circumstances of this high-risk population, need to be developed.

The prevalence of obesity continues to rise with many factors contributing to energy imbalance. Leisure-time physical activity (LTPA) has been proposed as one solution to counteract increasing energy intakes. The present study determined whether age, birth cohort and period of survey had independent effects on time, volume and energy expended in LTPA by Australian adults from 1990 to 2005. Adults were categorised into twelve age groups (5-year intervals from 20–24 years to >75 years), four survey periods (1990, 1995, 2000 and 2005) and fifteen birth cohorts (5-year intervals from pre-1916 to 1985). Time spent in three categories of LTPA was determined and metabolic equivalent (MET) values of 3·3, 4·0 and 8·0 were assigned for walking, moderate and vigorous activities, respectively, to calculate daily volume (MET minutes). Energy expended in LTPA was calculated using estimated BMR (from self-reported weight and published formulae), multiplied by the MET value. Regression models were fitted to the data. Age and period had independent effects on duration, volume and energy expenditure of LTPA for both males (P P P

Objective: To examine recent trends in sufficient physical activity among New South Wales adults aged 16 years and over. Method: Data were obtained from New South Wales population health surveys conducted in 1998 and from 2002 to 2005. Analyses examined trends in the proportions of adults achieving sufficient physical activity and trends in different modes of activity. Results: The proportion of adults achieving sufficient physical activity was stable between 1998 (47.6%) and 2002 (46.5%), declined in 2003 (44.7%), increased substantially in 2004 (50.5%), and remained steady in 2005 (51.3%). This increase was evident across different population groups. Adults who did any walking were 18 times more likely to be active than those who did no walking. Conclusion: Findings indicate that in recent years physical activity participation has begun to increase, and that this increase occurred across population segments. The increases occurred especially in walking behaviours. Implications: Given the known health benefits of being physically active, continued investment in physical activity promotion policies and programs is necessary to maintain these early gains.

Issue addressed: To assess the adherence and acceptability of a physical activity program delivered as an adjunct to the usual cognitive behavioural group therapy (CBGT) for adults with anxiety disorders. Methods: Seventy-three participants with either a generalised anxiety disorder, social phobia or panic disorder were randomised to either exercise-enhanced CBGT (CBGT+EX) or the usual CBGT plus nutrition education (CBGT+ED) group. Physical activity, stress, anxiety, depression were assessed at baseline; session attendance, compliance and satisfaction were assessed during the eight-week intervention. Results: Forty-five per cent of participants achieved the recommended levels of physical activity for health at baseline. The proportions of participants attending group meetings declined over time across both groups. In the intervention groups (CBGT+EX), a slightly higher proportion of participants attended the CBGT session than the physical activity sessions. Individuals with social phobia were significantly more likely than those with panic or generalised anxiety disorder to adhere to the physical activity program. Among the remaining adherers, most reported satisfaction with their skills development and better understanding of the benefits of physical activity. Conclusions: Time constraints and participants viewing physical activities as irrelevant or detracting them from their psychological treatment are potential factors contributing to low adherence and present as challenges in implementing a physical activity program as adjunctive to psychological treatment. Process evaluation data helped profile participants who adhered or not adhered to the physical activity program and will inform future physical activity promotion to individuals with anxiety disorders.

Background:The aim of this study was to examine the associations between characteristics of recreational activity and total physical activity (PA).Methods:Recreational activity type and number were assessed for 3,385 adult respondents to the population-based Exercise Recreation and Sport Survey and categorized as “no recreational activity,” “walking only,” “sport only,” or “combined walking and sport.” Total PA was assessed by the International Physical Activity Questionnaire and categorized as “low,” “moderate,” or “high.”Results:Odds of high total PA were 1.7 times greater among walking-only participants, 2.9 times greater among sport-only participants, and 3.3 times greater among participants in combined walking and sport compared to no recreational activity participants. Greater number of recreational activities related to increased odds of high total PA. Similar associations were observed between recreational activity and moderate total PA.Conclusion:Participants in more than one type of recreational activity were less likely to have a low-active lifestyle.

Uncertainty persists about the impact of trauma on the long-term mental health of resettled refugees. The present study aimed to assess the contributions of trauma and PTSD to overall mental disorder and related need for services amongst Vietnamese refugees resettled for over a decade in Australia. The data were compared with a survey of the host population. The study involved a probabilistic sample of Vietnamese refugees (n = 1,161) resettled in Australia for 11 years. The Australian-born sample (n = 7,961) was drawn from a national survey using the same diagnostic measure, the Composite International Diagnostic Interview (CIDI). The PTSD prevalence for both groups was 3.5% and the diagnosis was present in 50% of Vietnamese and 19% of Australians with any mental disorder(s). Trauma made the largest contribution to mental disorder in the Vietnamese (odds ratio >8), whereas amongst Australians, younger age (odds ratio >3) and trauma (odds ratio >4) each played a role. PTSD was equally disabling in both populations but Vietnamese with the disorder reported more physical, and Australians more mental disability. Approximately one in three Australians and one in 10 Vietnamese with PTSD sought help from mental health professionals. Trauma and PTSD continue to affect the mental health of Vietnamese refugees even after a decade of resettlement in Australia. The tendency of Vietnamese with PTSD to report symptoms of physical disability may create obstacles to their obtaining appropriate mental health care.

To assess the individual contributions of age, period and birth cohort to prevalence of overweight and obesity in the Australian population during 1990 to 2000. Age-period-cohort Poisson regression modelling of data from National Health Surveys conducted in Australia in 1990, 1995 and 2000. Adults aged 20 years and over. Weightings were applied to account for differences in sampling and participation rates so that the sample is representative of the entire Australian adult population. Twelve age groups, based on 5-year intervals from 20 to 24 years to greater than 75 years, three survey periods and 14 cohorts, also based on 5-year intervals from pre-1915 up to 1976–1980, were used in the analysis. The data were age-standardized to the 2000 population and body mass index (BMI) was calculated. Log-linear models, for the prevalence rates of overall overweight (BMI ⩾25) and of obesity (BMI ⩾30) were fitted to the data. Age (P

BACKGROUND: Many Pacific Island countries are in social and epidemiological transition, but there are little population data about drug and alcohol usage among adolescents in this region. METHODS: Random samples of school students aged 11-17 years completed surveys in three populations: Pohnpei State in the Federated States of Micronesia (n=1495), Tonga (n=2808) and Vanuatu (n=4474). RESULTS: Among 15-year-olds, boys in Tonga reported the highest prevalence of weekly smoking (29%), followed by boys in Pohnpei (17%). Kava use at a potentially harmful level (i.e. daily) was low in all countries. Drunkenness on two or more occasions was much more common among 15-year-old boys in Pohnpei (51%) than same-age youth in the other countries. Marijuana use was most often reported by boys (20%) and girls (20%) in Pohnpei, while solvents had been used most often by boys in Pohnpei (15%), and methylated spirits by boys in Tonga (20%). In all countries bullying of other students was independently related to regular smoking, while bullying behaviour and strong relationships with peers and others outside of the family were related to past drunkenness and use of illegal drugs in Tonga and Vanuatu. CONCLUSIONS: Overall, levels of adolescent substance use were consistently higher in Tonga and Pohnpei than in Vanuatu. These unique data provide a basis for setting priorities and evaluating action to address the health risks posed by substance use in these Pacific Island societies. Language: en

ObjectivesTo compare the prevalence of overweight and obesity among adolescents using international and ethnic-specific cut-off points and to examine patterns of physical activity and dietary behaviours.DesignCross-sectional analytical study.SettingSchools on Tongatapu, Vava'u and Hapa'ai islands in the Kingdom of Tonga.SubjectsA total of 443 school students aged 11–16 years underwent anthropometric measures of height and weight and provided self-reported measures of physical activity and dietary behaviours.ResultsMean body mass index (BMI) was higher among girls than boys (23.7 kg m− 2vs. 21.8 kg m− 2) and tended to increase with age. A total of 36.0% of boys and 53.8% of girls were overweight or obese using the international cut-off points, whereas 25.0% of boys and 37.6% of girls were classified in this way using Polynesian-specific cut-off points. Tinned mutton or beef was the food that most participants (56.9%) reported eating once or more per day. Over half of the young people did not eat taro, fruit or vegetables at least once per day. Regular physical activity outside of school hours was reported by 20.7% of respondents, and 58.2% watched 1 h or more of television per day. Physical activity participation was the only behaviour independently associated with a lower risk of overweight or obesity.ConclusionsUsing Polynesian-specific cut-off points for overweight and obesity the prevalence of these conditions was still among the highest found in adolescents. The prevalence of physical inactivity and poor dietary habits indicate that risk factors for chronic disease are well established during adolescence in Tonga.

Public health evaluation funding is limited, and hence optimal evaluation principles and methods should be applied to the assessment of communitywide programs. Since sedentary lifestyles and insufficient physical activity contribute to the overall burden of disease, efforts to encourage more walking at the whole population level are an important prevention strategy. This article describes the evaluation methods used and principles learned from four communitywide walking programs conducted by the authors. The application of evaluation design principles, formative and process evaluation, and participatory planning can contribute to the lessons of such community level interventions. Impact evaluation, optimizing research design and examination of mediators, policy, and environmental changes contribute to the scientific base for describing program effectiveness and understanding the mechanisms through which these interventions may work.

This study examined the pattern of activity energy expenditure (AEE) among New South Wales (NSW) high school students in relation to age, sex, socioeconomic status (SES), place of residence, cultural background, season, participation in moderate- and vigorous-intensity and in organized and non-organized physical activity.Methods:Cross-sectional survey of a randomly-selected sample (N = 2026). Respondents self-reported their physical activity participation during a usual week in summer and winter.Results:Boys reported greater AEE than girls and, whereas AEE was greater among grade 10 than grade 8 boys, the reverse was true for girls. Boys reported the same AEE for summer and winter, but girls reported less AEE during winter. Both boys and girls reported spending the same proportion of their AEE in vigorous-intensity (72%) compared with moderate-intensity activity (28%) and in non-organized (60%) compared with organized activity. There was no clear association between urban/rural place of residence and AEE. Although AEE tended to be positively associated with SES among girls, there was no association among boys. Girls from Asian cultural backgrounds reported much lower AEE than girls from other cultural backgrounds.Conclusion:Patterns of energy expenditure among adolescent boys and girls should be considered in developing interventions to ensure needs are adequately met.

Objective: To compare the level of agreement in results obtained from four physical activity (PA) measurement instruments that are in use in Australia and around the world. Methods: 1,280 randomly selected participants answered two sets of PA questions by telephone. 428 answered the Active Australia (AA) and National Health Surveys, 427 answered the AA and CDC Behavioural Risk Factor Surveillance System surveys (BRFSS), and 425 answered the AA survey and the short International Physical Activity Questionnaire (IPAQ). Results: Among the three pairs of survey items, the difference in mean total PA time was lowest when the AA and NHS items were asked (difference=24) (SE:17) minutes, compared with 144 (SE:21) mins for AA/BRFSS and 406 (SE:27) mins for AA/IPAQ). Correspondingly, prevalence estimates for ‘sufficiently active’ were similar for AA and NHS (56% and 55% respectively), but about 10% higher when BRFSS data were used, and about 26% higher when the IPAQ items were used, compared with estimates from the AA survey. Conclusions: The findings clearly demonstrate that there are large differences in reported PA times and hence in prevalence estimates of ‘sufficient activity’ from these four measures. Implications: It is important to consistently use the same survey for population monitoring purposes. As the AA survey has now been used three times in national surveys, its continued use for population surveys is recommended so that trend data over a longer period of time can be established.

Objectives: To compare the prevalence of anxiety and affective disorders among employed and unemployed patients and to compare the type of treatment received between the two groups for these disorders. Method: A secondary analysis of the 1997 National Survey of Mental Health and Wellbeing of Adults cross-sectional study was undertaken. Results: Unemployed adults were more likely to have symptoms of anxiety (OR = 3.09, 95% CI = 2.80–3.41) or an affective disorder (OR = 2.11, 95% CI = 1.95–2.27) or anxiety and/or affective disorders (OR = 2.53, 95% CI = 2.37–2.69). Unemployed participants with symptoms were less likely to have seen a general practitioner for treatment but when they did they received similar care to employed participants. Conclusions: These results confirm studies reported elsewhere that the prevalence of symptoms of anxiety and/or affective disorders is higher for unemployed people. The data provide further evidence that people with an anxiety and/or affective disorder who are unemployed are not seeking medical treatment. However, unlike previous research undertaken by our group, these results indicate that symptomatic adults who seek help receive comparable treatment in general practice irrespective of their employment status.

Importance Few studies have examined how different proportions of moderate and vigorous physical activity affect health outcomes. Objective To examine whether the proportion of total moderate to vigorous activity (MVPA) that is achieved through vigorous activity is associated with all-cause mortality independently of the total amount of MVPA. Design, Setting, and Participants We performed a prospective cohort study with activity data linked to all-cause mortality data from February 1, 2006, through June 15, 2014, in 204 542 adults aged 45 through 75 years from the 45 and Up population-based cohort study from New South Wales, Australia (mean [SD] follow-up, 6.52 [1.23] years). Associations between different contributions of vigorous activity to total MVPA and mortality were examined using Cox proportional hazards models, adjusted for total MVPA and sociodemographic and health covariates. Exposures Different proportions of total MVPA as vigorous activity. Physical activity was measured with the Active Australia Survey. Main Outcomes and Measures All-cause mortality during the follow-up period. Results During 1 444 927 person-years of follow-up, 7435 deaths were registered. Compared with those who reported no MVPA (crude death rate, 8.34%), the adjusted hazard ratios for all-cause mortality were 0.66 (95% CI, 0.61-0.71; crude death rate, 4.81%), 0.53 (95% CI, 0.48-0.57; crude death rate, 3.17%), and 0.46 (95% CI, 0.43-0.49; crude death rate, 2.64%) for reporting 10 through 149, 150 through 299, and 300 min/wk or more of activity, respectively. Among those who reported any MVPA, the proportion of vigorous activity revealed an inverse dose-response relationship with all-cause mortality: compared with those reporting no vigorous activity (crude death rate, 3.84%) the fully adjusted hazard ratio was 0.91 (95% CI, 0.84-0.98; crude death rate, 2.35%) in those who reported some vigorous activity (but < 30% of total activity) and 0.87 (95% CI, 0.81-0.93; crude death rate, 2.08%) among those who reported 30% or more of activity as vigorous. These associations were consistent in men and women, across categories of body mass index and volume of MVPA, and in those with and without existing cardiovascular disease or diabetes mellitus. Conclusions and Relevance Among people reporting any activity, there was an inverse dose-response relationship between proportion of vigorous activity and mortality. Our findings suggest that vigorous activities should be endorsed in clinical and public health activity guidelines to maximize the population benefits of physical activity.

This study assessed the test-retest reliability and validity of the Adolescent Physical Activity Recall Questionnaire (APARQ) among 13- and 15-yr-old Australians.Two studies were conducted using the same instrument. Self-reported participation in organized and nonorganized physical activity was summarized into four measures: a three-category measure of activity, a two-category measure, and estimated energy expenditure expressed as a continuous variable and as quintiles. The reliability study (N = 226) assessed strength of agreement for all measures between responses to two administrations of the questionnaire. The validity study (N = 2026) assessed the relationship between the APARQ and performance on the Multistage Fitness Test (MFT).Reliability study: for the three-category measure, percent agreement ranged 67-83% and weighted kappa ranged 0.33-0.71. For the two-category measure, percent agreement ranged 76-90% and kappa ranged 0.25-0.74. For energy expenditure expressed as a continuous variable, the intraclass correlations coefficients were generally greater than 0.6 for grade 10 students, but most were below 0.5 for grade 8 students. Validity study: for the three-category measure, mean laps were higher in the adequately and vigorously active categories than the inactive category for girls, but only the mean laps in the vigorously active and inactive categories were significantly different for boys. For the two-category measure, mean laps were higher in the active category than the inactive category for all groups. Correlations between energy expenditure and MFT laps were 0.15, 0.21, 0.14, and 0.39 for grade 8 boys, grade 8 girls, grade 10 boys, and grade 10 girls, respectively.The APARQ has acceptable to good reliability and acceptable validity, but further validation using other methods and in other population groups is required.

Background: Since the introduction of specified diagnostic criteria for mental disorders in the 1970s, there has been a rapid expansion in the number of large-scale mental health surveys providing population estimates of the combined prevalence of common mental disorders (most commonly involving mood, anxiety and substance use disorders). In this study we undertake a systematic review and meta-analysis of this literature. Methods: We applied an optimized search strategy across the Medline, PsycINFO, EMBASE and PubMed databases, supplemented by hand searching to identify relevant surveys. We identified 174 surveys across 63 countries providing period prevalence estimates (155 surveys) and lifetime prevalence estimates (85 surveys). Random effects meta-analysis was undertaken on logit-transformed prevalence rates to calculate pooled prevalence estimates, stratified according to methodological and substantive groupings. Results: Pooling across all studies, approximately 1 in 5 respondents (17.6%, 95% confidence interval:16.3–18.9%) were identified as meeting criteria for a common mental disorder during the 12-months preceding assessment; 29.2% (25.9–32.6%) of respondents were identified as having experienced a common mental disorder at some time during their lifetimes. A consistent gender effect in the prevalence of common mental disorder was evident; women having higher rates of mood (7.3%:4.0%) and anxiety (8.7%:4.3%) disorders during the previous 12 months and men having higher rates of substance use disorders (2.0%:7.5%), with a similar pattern for lifetime prevalence. There was also evidence of consistent regional variation in the prevalence of common mental disorder. Countries within North and South East Asia in particular displayed consistently lower one-year and lifetime prevalence estimates than other regions. One-year prevalence rates were also low among Sub-Saharan-Africa, whereas English speaking counties returned the highest lifetime prevalence estimates. Conclusions: Despite a substantial degree of inter-survey heterogeneity in the meta-analysis, the findings confirm that common mental disorders are highly prevalent globally, affecting people across all regions of the world. This research provides an important resource for modelling population needs based on global regional estimates of mental disorder. The reasons for regional variation in mental disorder require further investigation.

Background Obesity prevalence continues to increase worldwide, with significant associated chronic disease and health cost implications. Among more recent innovations in health service provision is the use of text messaging for health behaviour change interventions including weight management. This review investigates the efficacy of weight management programmes incorporating text messaging. Methods Medical and scientific databases were searched from January 1993 to October 2013. Eligibility criteria included randomised controlled trials (RCTs), pseudoRCTs and before and after studies of weight management, among healthy children and adults, that used text messaging and included a nutrition component. Data extraction and quality assessment followed guidelines from PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) and the Evidence Analysis Manual of the American Academy of Nutrition and Dietetics. Results From 512 manuscripts retrieved, 14 met the inclusion criteria (five manuscripts in children and nine in adults). Duration of interventions ranged from 1 to 24 months. Frequency of text messaging was from daily to fortnightly. Six studies in adults were included in a meta-analysis with mean body weight change as the primary outcome. The weighted mean change in body weight in intervention participants was −2.56 kg (95% confidence interval = −3.46 to −1.65) and in controls −0.37 kg (95% confidence interval = −1.22 to 0.48). Conclusions The small body of evidence indicates that text messaging interventions can promote weight loss. However, lack of long-term results indicate that further efficacy studies are required. Future investigations should elucidate the determinants, such as intervention duration, text message frequency and level of interactivity that maximise the success and cost effectiveness of the delivery medium.

Background: Recent studies have suggested there are a large number of potentially preventable deaths in Australian hospitals. Aim: This study aimed to document antecedent factors in hospital deaths in an attempt to identify potentially preventative factors. Methods: The study was conducted at three separate acute hospitals. Demographics of all deaths were recorded over a 6-month period as well as antecedent factors present within 0‐8 and 8‐48 h of all deaths including vital sign abnormalities, cardiorespiratory arrests and admission to intensive care. Separate analysis was performed on ‘not for resuscitation’ deaths. Results: There were a total of 778 deaths, of which 549 (71%) were ‘not for resuscitation’. There were 171 (22%) deaths preceded by arrest and 160 (21%) preceded by admission to intensive care. Of the remaining deaths, 30% had severely abnormal physiological abnormalities documented. This incidence was 50% in the non-do not resuscitate (DNR) subgroup. Concern about the patient’s condition was expressed in the patient’s notes by attending nursing staff and junior medical staff in approximately onethird of non-DNR deaths. Hypotension (30%) and tachypnoea (17%) were the most common antecedents in the non-DNR deaths. Conclusion: There is a high incidence of serious vital sign abnormalities in the period before potentially preventable hospital deaths. These antecedents may identify patients who would benefit from earlier intervention. (Intern Med J 2001; 31: 343‐348)

Objectives To evaluate the effectiveness of a medical emergency team (MET) in reducing the rates of selected adverse events. Design Cohort comparison study after casemix adjustment. Patients and setting All adult (> or = 14 years) patients admitted to three Australian public hospitals from 8 July to 31 December 1996. INTERVENTION STUDIED: At Hospital 1, a medical emergency team (MET) could be called for abnormal physiological parameters or staff concern. Hospitals 2 and 3 had conventional cardiac arrest teams. Main outcome measures Casemix-adjusted rates of cardiac arrest, unanticipated admission to intensive care unit (ICU), death, and the subgroup of deaths where there was no pre-existing "do not resuscitate" (DNR) order documented. Results There were 1510 adverse events identified among 50 942 admissions. The rate of unanticipated ICU admissions was less at the intervention hospital in total (casemix-adjusted odds ratios: Hospital 1, 1.00; Hospital 2, 1.59 [95% CI, 1.24-2.04]; Hospital 3, 1.73 [95% CI, 1.37-2.16]). There was no significant difference in the rates of cardiac arrest or total deaths between the three hospitals. However, one of the hospitals with a conventional cardiac arrest team had a higher death rate among patients without a DNR order. Conclusions The MET hospital had fewer unanticipated ICU/HDU admissions, with no increase in in-hospital arrest rate or total death rate. The non-DNR deaths were lower compared with one of the other hospitals; however, we did not adjust for DNR practices. We suggest that the MET concept is worthy of further study.

We studied 364 index presentations to the Emergency Department of a children's hospital with a diagnosis of asthma. The admission rate for this group of children was about 31%. We developed a parsimonious multiple logistic regression model to predict asthma hospital admission based on asthma severity indicators. We then evaluated the model's predictive ability using two methods of cross-validation, using the same sample that was used for the predictive model, and using data from a split sample. The logistic regression model had a predictive accuracy of 90% (95% confidence interval 85-95%). The sensitivity and specificity were 86% and 88%, respectively. Cross-validation models confirmed that the predictive ability of the model was stable. In studies with limited sample sizes, it is possible to validate a model without setting aside a split sample for cross-validation.

Objective: This study examines the variation in coronary heart disease (CHD) mortality and acute myocardial infarction (AMI) by socio-economic status (SES), country of birth (COB) and geography (urban/rural) in the total population of New South Wales (Australia) in 1991-95. Method: CHD deaths and AMI are from complete enumerations of deaths and hospital admissions, respectively; and population denominators are from census information. Data are examined separately by sex, and comparisons of SES groups (based on municipalities), COB and region are analysed using Poisson regression, after adjustment for age. Results: The study identified higher risk for AMI admissions and CHD mortality in lower SES populations with significant linear trends, for both sexes, adjusted for age, region and COB. According to the population attributable fractions (PAF), 23-41% of the risk of CHD occurrence is due to SES lower than the highest quartile. The higher age-adjusted risk for CHD occurrence in rural and remote populations for both sexes, compared with urban communities, was lessened by adjustment for COB, and all but abolished when also adjusted for SES. COB analysis indicated significantly lower age-adjusted AMI admissions and CHD mortality compared with the Australian-born, Conclusions: Higher risks for CHD in rural populations compared with the capital city (Sydney) are due, in part, to lower SES, lesser migrant composition. Implications: Strategies for reducing CHD differentials should consider demographic factors and the fundamental need to reduce socio-economic inequalities, as well as targeting appropriate prevention measures.

Background: A reliable indicator of the prevalence of severe asthma in the community is needed to monitor population-based asthma control strategies. We examined the potential use of asthma admissions to hospital as such an indicator. Methods: We recruited subjects from the Emergency Department (ED) of a children's hospital. The attending doctor completed the ‘physician questionnaire’ which included questions on the patient's asthma severity and interval severity/chronicity of asthma. The parent/guardian completed the ‘parent questionnaire’. It included questions on demography, asthma knowledge and attitudes, asthma history and social support. We performed univariate and multiple logistic regression to determine predictors for hospital admission. Results: Interval severity of asthma, pre-treatment severity of wheeze and low post-treatment pulse oximetry best predicted whether children presenting with asthma were admitted. Demographic variables, factors associated with access to health services and factors related to the asthma history and management were not significant predictors of admission. Discussion: At the population level, it may be possible to utilise routine hospital admission rates as an indicator of the prevalence of severe asthma in the community, especially within the context of monitoring trends in asthma prevalence. Our study was conducted in a metropolitan tertiary paediatric hospital. The reliability of hospital admission rates as indicators of the prevalence of severe asthma in other hospital settings, in different population groups and over time remains to be established.

INTRODUCTION: Findings regarding the association between overweight and all-cause mortality range from significantly lower to higher risk, compared with body-mass-index (BMI) within the "normal" range. METHODS: We examined empirically potential methodological explanations for these apparently conflicting results using questionnaire and linked mortality data from 246,314 individuals aged ≥45 years in the Australian 45 and Up Study (11,127 deaths; median follow-up 3.9 years). Hazard ratios (HR) for all-cause mortality associated with BMI were modelled according to different methods of accounting for illness at baseline, finer versus broader gradations of BMI and choice of reference group, adjusting for potential confounders. RESULTS: In analyses using the broad World Health Organization (WHO) categories, the all-cause mortality HR was significantly lower in the overweight category (25.0-29.99 kg/m²), than the normal weight (18.5-24.99 kg/m²) category. However, in analyses accounting for baseline illness, which excluded those with pre-existing illness at baseline, ever-smokers and the first 2 years of follow up, absolute age-standardised mortality rates varied up to two-fold between finer BMI categories within the WHO normal weight category; rates were lowest at 22.5-24.99 kg/m² and mortality HRs increased steadily for BMI above (p(trend)

Purpose: The purpose of the study is to determine the prevalence and associations of epiretinal membranes in a defined older Australian population and to assess their influence on visual acuity. Methods: Three thousand six hundred fifty-four persons 49 years of age or older, representing 88% of permanent residents from an area west of Sydney, underwent a detailed eye examination, including stereo retinal photography. Epiretinal membranes were diagnosed clinically and from photographic grading. Results: Signs of epiretinal membranes were found in 243 participants (7%; 95% confidence interval [CI], 6.1, 7.6), bilateral in 31 %. The prevalence was 1.9% in persons younger than 60 years of age, 7.2% in persons 60 to 69 years of age, 11.6% in persons 70 to 79 years of age, and 9.3% in persons 80 years of age and older, with slightly higher rates in women. Two stages were identified: an early form without retinal folds, termed "cellophane macular reflex" present in 4.8%, and a later stage with retinal folds, termed "preretinal macular fibrosis" (PMF), found in 2.2% of the population. Preretinal macular fibrosis, but not cellophane macular reflex, had a small, significant effect on visual acuity. Preretinal macular fibrosis was significantly associated with diabetes, after age-gender adjustment, in subjects without signs of diabetic retinopathy (odds ratio, 3.2; 95% CI, 1.4, 7.2). Preretinal macular fibrosis also was associated with increased fasting plasma glucose (odds ratio, 1.2; 95% CI, 1.1, 1.3). Epiretinal membranes were found in 16.8% of persons who had undergone cataract surgery in one or both eyes (including PMF in 3.7%), in 16.1% of retinal vein occlusion cases (PMF in 12.5%), both significantly higher rates than in subjects without these conditions ( P P = 0.17). Conclusions: This study has documented the frequency and mild effect on vision of epiretinal membranes in an older population. Diabetes was associated significantly with idiopathic cases, whereas well-known associations with past cataract surgery and retinal disease were confirmed.

Purpose: The authors explore the relationship between diabetes and open-angle glaucoma in a defined older Australian population. Methods: Three thousand six hundred fifty-four people 49 to 96 years of age, living west of Sydney, underwent a detailed eye examination. This included automated perimetry, stereo optic disc photographs, and applanation tonometry; in addition, fasting plasma glucose levels were ascertained. Glaucoma was diagnosed if matching visual field and optic disc cupping were present, without reference to intraocular pressure (IOP) level. Ocular hypertension (OH) was diagnosed if IOP in either eye was ≥ 22 mm and glaucomatous disc and visual field changes were absent. Results: Glaucoma prevalence was increased in people with diabetes, diagnosed from history or elevated fasting plasma glucose level (5.5%), compared with those without diabetes (2.8%; age-gender adjusted odds ratio [OR] 2.12, 95% confidence intervals [CI] 1.18–3.79). Ocular hypertension was also more common in people with diabetes (6.7%), compared with those without diabetes (3.5%; OR 1.86, CI 1.09–3.20). Diabetes was present in 13.0% of people with glaucoma, compared with 6.9% of those without glaucoma. This increase was highest for previously diagnosed glaucoma cases (16.7%; OR 2.82, CI 1.35–5.87). However, in 67% of such cases, glaucoma was diagnosed before the diabetes. For those not receiving glaucoma treatment, IOP was consistently slightly higher in people with diabetes, with the age-gender adjusted mean IOP 0.6 mm higher. Conclusions: The significant and consistent association between diabetes and glaucoma found in our study, which appeared independent of the effect of diabetes on IOP, suggests that there is a real association between these two diseases.

Background Studies suggest that immigrants have higher rates of anxiety-depression than compatriots in low-middle income countries and lower rates than populations in host high income countries. Elucidating the factors that underlie these stepwise variations in prevalence may throw new light on the pathogenesis of anxiety-depressive disorders globally. This study aimed to examine whether quantitative differences in exposure to, or the interaction between, risk factors account for these anxiety-depression prevalence differences amongst immigrant relative to source and host country populations. Methods Multistage population mental health surveys were conducted in three groups: 1) a Vietnamese-immigrant sample settled in Australia (n = 1161); 2) a Vietnamese source country sample residing in the Mekong Delta region (n = 3039); 3) an Australian-born host country sample (n = 7964). Multivariable logistic regression analyses compared risk factors between the Vietnamese-immigrant group and: 1) the Mekong Delta Vietnamese; and 2) the Australian-born group. Twelve month anxiety-depression diagnoses were the main outcome measures, derived from the Composite International Diagnostic Interview (CIDI), supplemented by an indigenously derived measure - the Phan Vietnamese Psychiatric Scale (PVPS) in both Vietnamese groups. Results The 12-month prevalence of anxiety-depression showed a stepwise increase across groups: Mekong Delta Vietnamese 4.8%; Vietnamese-immigrants 7.0%; Australian-born 10.2%. The two Vietnamese populations showed a similar risk profile with older age, exposure to potentially traumatic events (PTEs), multiple physical illnesses and substance use disorder (SUD) being associated with anxiety-depression, with the older Vietnamese-immigrants reporting greater exposure to these factors. The interaction between key risk factors differed fundamentally when comparing Vietnamese-immigrant and Australian-born samples. Age emerged as the major discriminator, with young Vietnamese-immigrants exhibiting particularly low rates of anxiety-depression. Conclusions The findings reported here suggest that core risk factors for anxiety-depression may be universal, but their patterning and interaction may differ according to country-of-origin. The study also highlights the importance of including both standard international and culturally-specific measures to index cross-cultural manifestations of common mental disorders.

Aim To examine associations between occupational and leisure-time sitting, physical activity and obesity in working adults. Methods We analyzed data from workers from the 2007–08 Australian National Health Survey (n = 10,785). Participants reported their activity at work (mostly sitting, standing, walking, or heavy labor), transport-related walking, leisure-time sitting and physical activity. Body mass index was objectively measured. Adjusted Cox proportional hazard regression models examined associations between occupational activity category, leisure-time sitting, physical activity and obesity risk. Results Substantial proportions of men (42%) and women (47%) mostly sit at work. Workers with sitting jobs were significantly more likely to be sufficiently active during leisure-time than workers with mostly standing, walking or heavy labor jobs (RR = 0.88, 0.80, 0.86 respectively). Workers with mostly sitting jobs had significantly higher overweight/obesity risk than workers with mostly standing jobs (RR = 0.88, 95% CI: 0.82–0.95) independent of physical activity and leisure-time sitting. Workers with leisure-time sitting of less than four hours per day had significantly lower obesity risk than workers with four or more hours per day of leisure-time sitting (RR = 0.77, 95%CI: 0.69–0.87) independent of physical activity and occupational activity. Conclusions Sitting time and physical activity are independently associated with obesity. Leisure-time sitting may have a stronger association with obesity risk than occupational sitting.

Context Intimate partner physical violence, rape, sexual assault, and stalking are pervasive and co-occurring forms of gender-based violence (GBV). An association between these forms of abuse and lifetime mental disorder and psychosocial disability among women needs to be examined. Objectives To assess the association of GBV and mental disorder, its severity and comorbidity, and psychosocial functioning among women. Design, Setting, and Participants A cross-sectional study based on the Australian National Mental Health and Well-being Survey in 2007, of 4451 women (65% response rate) aged 16 to 85 years. Main Outcome Measures The Composite International Diagnostic Interview version 3.0 of the World Health Organization's World Mental Health Survey Initiative was used to assess lifetime prevalence of any mental disorder, anxiety, mood disorder, substance use disorder, and posttraumatic stress disorder (PTSD). Also included were indices of lifetime trauma exposure, including GBV, sociodemographic characteristics, economic status, family history of mental disorder, social supports, general mental and physical functioning, quality of life, and overall disability. Results A total of 1218 women (27.4%) reported experiencing at least 1 type of GBV. For women exposed to 3 or 4 types of GBV (n = 139), the rates of mental disorders were 77.3% (odds ratio [OR], 10.06; 95% confidence interval [CI], 5.85-17.30) for anxiety disorders, 52.5% (OR, 3.59; 95% CI, 2.31-5.60) for mood disorder, 47.1% (OR, 5.61; 95% CI, 3.46-9.10) for substance use disorder, 56.2% (OR, 15.90; 95% CI, 8.32-30.20) for PTSD, 89.4% (OR, 11.00; 95% CI, 5.46-22.17) for any mental disorder, and 34.7% (OR, 14.80; 95% CI, 6.89-31.60) for suicide attempts. Gender-based violence was associated with more severe current mental disorder (OR, 4.60; 95% CI, 2.93-7.22), higher rates of 3 or more lifetime disorders (OR, 7.79; 95% CI, 6.10-9.95), physical disability (OR, 4.00; 95% CI, 1.82-8.82), mental disability (OR, 7.14; 95% CI, 2.87-17.75), impaired quality of life (OR, 2.96; 95% CI, 1.60-5.47), an increase in disability days (OR, 3.14; 95% CI, 2.43-4.05), and overall disability (OR, 2.73; 95% CI, 1.99-3.75). Conclusion Among a nationally representative sample of Australian women, GBV was significantly associated with mental health disorder, dysfunction, and disability.

We surveyed parents of children enrolled in kindergarten in 1992 in outer western Sydney and the Blue Mountains. Using parents' reports, we determined the prevalence of immunization uptake for children starting school, compared the prevalence of immunization uptake among Catholic, government and independent schools, and identified immunization providers. We also documented parental beliefs about immunization and their influence on immunization status, and identified risk factors for incomplete immunization. Nearly 89% of children were reported to be fully immunized. Immunization status did not vary significantly among the different types of school. General practitioners provided 84% of all immunizations and local councils 11%. Incomplete immunization was associated with more negative beliefs in immunization, with post-secondary education and with families who do not speak English at home. Reminder letters had little effect on immunization status.