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The Center for Epidemiologic Studies Depression Scale (CES-D) is frequently used in epidemiological surveys to screen for depression, especially among older adults. This article addresses the problem of non-completion of a short form of the CES-D (CESD-10) in a mailed survey of 73- to 78-year-old women enrolled in the Australian Longitudinal Study on Women's Health. Completers of the CESD-10 had more education, found it easier to manage on available income and reported better physical and mental health. The Medical Outcomes Study Short Form Health Survey (SF-36) scores for non-completers were intermediate between those for women classified as depressed and not depressed using the CESD-10. Indicators of depression had an inverted U-shaped relationship with the number of missing CESD-10 items and were most frequent for women with two to seven items missing. Future research should pay particular attention to the level of missing data in depression scales and report its potential impact on estimates of depression. (Contains 6 tables.)

Objectives: To quantify need-adjusted socioeconomic inequalities in medical and non-medical ambulatory health care in Australia and to examine the effects of specific interventions, namely concession cards and private health insurance (PHI), on equity. Methods: We used data from a 2004 survey of 10,905 Australian women aged 53 to 58 years. We modelled the association between socio-economic status and health service use--GPs, specialists, hospital doctors, allied and alternative health practitioners, and dentists--adjusting for health status and other confounding variables. We quantified inequalities using the relative index of inequality (RII) using Poisson regression. The contribution of concession cards and PHI in promoting equity/inequity was examined using mediating models. Results: There was equality in the use of GP services, but socio-economically advantaged women were more likely than disadvantaged women to use specialist (RII=1.41,95% CI:1.26-1.58), allied health (RII=1.21,1.12-1.30), alternative health (RII=1.29,1.13-1.47) and dental services (RII=1.61,1.48-1.75) after adjusting for need, and they were less likely to visit hospital doctors (RII=0.74,0.57-0.96). Concession cards reduced socio-economic inequality in GP but not specialist care. Inequality in dental and allied health services was partly explained by inequalities in PHI. Conclusions and implications: Substantial socio-economic inequity exists in use of specialist and non-medical ambulatory care in Australia. This is likely to exacerbate existing health inequalities, but is potentially amenable to change. Key words: health care inequalities, socioeconomic status, ambulatory care. doi: 10.1111/j.1753-6405.2009.00430.x

Objective To identify predictors of dietary change to and maintenance of a low-fat eating pattern (<20% energy from fat, [greater than or equal to] 5 servings fruits/vegetables daily, and [greater than or equal to] 6 servings grains daily) among a cohort of postmenopausal women. Candidate predictors included intrapersonal, in terpersonal, intervention program characteristics, and clinical center. Design Longitudinal study within the Women's Health Initiative Dietary Modification Trial. Dietary change was evaluated after 1 year of participation in the Women's Health Initiative Dietary Modification Trial, and dietary maintenance after 3 years. Subjects Postmenopausal women aged 50 to 79 years at baseline who were randomized to the intervention arm of the Women's Health Initiative Dietary Modification Trial (n=19,541). Statistical analysis Univariate and multivariate linear regression analysis was performed and associations evaluated between candidate predictors and each of the three dietary goals: percent energy from fat, fruit/vegetable servings, and grain servings. Results Year 1 (change) predictors of percent energy from fat (P<0.005) included being younger ([beta]=2.12; 70 to 79 years vs 50 to 59 years), more educated ([beta]=-.69; college vs high school), more optimistic ([beta]=-.07), attending more sessions ([beta]=-.69), and submitting more self-monitoring records ([beta]=-.74). At year 3 (maintenance), the predictors of percent energy from fat (P<0.005) included attending more sessions ([beta]=-.65) and submitting more self-monitoring scores ([beta]=-.71). The analytic model predicted 22% of the variance in fat intake at year I and 27% at year 3 (P<0.01). Conclusions The strongest predictors of dietary change and maintenance were attending intervention sessions and self-monitoring dietary intake. Novel was the finding that optimism predicted dietary change.

Objective: To measure utilisation of Enhanced Primary Care (EPC) health assessment items for women aged 75 years and over, and to describe health and socio-demographic characteristics of users and non-users. Method: Analysis of longitudinal survey and Medicare claims data from women in the Australian Longitudinal Study on Women's Health (ALSWH) aged 75 to 78 years when EPC items were introduced and who provided permission to access their Medicare records for the period 1999-2003 (n=4,646). Results: There was an increase in uptake of assessments over four years: from November 1999, 12% of eligible women had a health assessment during the following year; by October 2003, 49% had at least one health assessment ever. Few had repeat assessments. Women who visited a GP more often and who were satisfied with the number of GPs available were more likely to have an assessment in the first 12 months, and women who visited a GP more often, those taking more medications, and those caring for another were more likely to have at least one assessment in four years. Women in smaller rural and remote areas were less likely to have an assessment than women in urban areas. Conclusions: Most women are not having annual assessments and there is some geographic inequity. Key words: Health assessment, health care utilisation, ageing, rural.

Objective: To describe the risk factors for various types of attrition in three age cohorts of women in a longitudinal study and to discuss strategies to minimise attrition. Methods: Analysis of survey data from the Australian Longitudinal Study on Women's Health, collected by mailed questionnaire. In 1996, the study recruited and surveyed a national random sample of 'younger' (18-23 years, n=14,247), 'mid-age' (45-50 years, n=13,716), and 'older' women (70-75 years, n=12,432), and began a staggered cycle of mailed follow-up questionnaires: 1998 (mid-age), 1999 (older), 2000 (younger) and so on. Demographic, health and social risk factors for attrition were examined using multivariate analysis. Results: Attrition at survey 2 was highest among younger women (32%), mainly because of participants not being contactable (21%), and lower among the older (16%) and mid-age women (10%). At survey 1, the survey 2 non-respondents were more likely to report having less education, being born in a non-English-speaking country and being a current smoker, in all cohorts, and had poorer health (mid-age and older cohort) and more difficulty managing on their income (younger and mid-age). Conclusion: Although the magnitude of different types of attrition was found to differ by age, there were several risk factors for attrition that remained consistent. These findings are important to inform future studies on ways to lessen or prevent systematic loss of participants. Implications: Recruitment and follow-up methods in longitudinal studies should be tailored to maximise retention of participants at higher risk of dropout.

This study investigates the sense of belonging to a neighbourhood among 9445 women aged 73-78 years participating in the Australian Longitudinal Study on Women's Health. Thirteen items designed to measure sense of neighbourhood were included in the survey of the older women in 1999. Survey data provided a range of measures of demographic, social and health-related factors to assess scale construct validity. Factor analysis showed that seven of the items loaded on one factor that had good face validity and construct validity as a measure of the sense of neighbourhood. Two of the remaining items related to neighbourhood safety and comprised a factor. A better sense of neighbourhood was associated with better physical and mental health, lower stress, better social support and being physically active. Women who had lived longer at their present address had a better sense of belonging to their neighbourhood, as did women living in non-urban areas and who were better able to manage on their income. Feeling sale in the neighbourhood was least likely in urban areas, increased in rural townships, and was most likely in rural and remote areas. Older women living alone felt less sale, as did women who were less able to manage on their income. This study has identified two sets of items that form valid measures of aspects of the social environment of older women, namely the sense of neighbourhood and feelings of safety. These findings make a contribution to our understanding of the relationship between feelings of belonging to a neighbourhood and health in older women. Keywords: Women; Sense of neighbourhood; Safety; Healthy ageing; Australia

Complementary and Alternative Medicine (CAM) has become increasingly popular amongst healthcare consumers worldwide. As such, CAM is now an important public health issue with serious implications for healthcare organization and delivery. While previous studies have provided a profile of CAM users, there remains very limited analysis of CAM consumption over time. The purpose of this paper is to describe the changing use of CAM practitioners over time by 11,454 mid-age women in the Australian Longitudinal Study on Women's Health. Over the study period (1996-1998), 10% of women adopted the use of CAM and 9% relinquished CAM. The predominant factor found to be predictive of CAM adoption was changes in health status. Specifically, those women experiencing more illness over time are more likely to adopt CAM than those experiencing no change or better health. CAM relinquishment was associated with use of non-prescription medications, where women were more likely to relinquish CAM if they never used non-prescription medications or if they stopped taking non-prescription medications. This paper constitutes an exploratory investigation into CAM use over time. As such, there is need for further research to provide in-depth examination of the adoption and relinquishment of CAM use over a longer time period. KEYWORDS. Complementary medicine, complementary therapies, longitudinal studies, women's health

The Center for Epidemiologic Studies Depression Scale (CES-D) is frequently used in epidemiological surveys to screen for depression, especially among older adults. This article addresses the problem of non-completion of a short form of the CES-D (CESD-10) in a mailed survey of 73- to 78-year-old women enrolled in the Australian Longitudinal Study on Women's Health. Completers of the CESD-10 had more education, found it easier to manage on available income and reported better physical and mental health. The Medical Outcomes Study Short Form Health Survey (SF-36) scores for non-completers were intermediate between those for women classified as depressed and not depressed using the CESD-10. Indicators of depression had an inverted U-shaped relationship with the number of missing CESD-10 items and were most frequent for women with two to seven items missing. Future research should pay particular attention to the level of missing data in depression scales and report its potential impact on estimates of depression.

This study investigates the use of general practitioner services by women in Australia. Although there is a universal health insurance system (Medicare) in Australia, there are variations in access to services and out of pocket costs for services. Survey data from 2350 mid-age (45-50 years) and 2102 older (70-75 years) women participating in the Australian Longitudinal Study on Women's Health were linked with Medicare data to provide a range of individual and contextual variables hypothesised to explain general practitioner use. Structural equation modelling showed that physical health was the most powerful explanatory factor of general practitioner use. However, after adjusting for self-reported health, out of pocket cost per consultation was inversely associated with use of services. The out of pocket cost was generally lower for women with low socioeconomic status but cost was also directly related to geographical remoteness. Women living in more remote areas had higher out of pocket costs and poorer access to services. Women who reported better access to care were more likely to be satisfied with their most recent general practice consultation and less likely to be sceptical of the value of medical care. These results show the need for health policies that improve the equitable use of general practitioner services in Australia. [c] 2001 Elsevier Science Ltd. All rights reserved. Keywords: Women; Health service use; General practice; Australia

Objective: To assess geographical equity in the availability, accessibility and out-of-pocket costs of general practitioner (GP) services for women in Australia. Method: Data on general practice consultations during 1995 and 1996 for women aged 18-23 years (n = 5,260), 45-50 years (n = 7,898) and 70-75 years (n = 6,542) in the Australian Longitudinal Study on Women's Health were obtained from the Health Insurance Commission. A sub-study of 4,577 participants provided data on access to health services. Results: Older women were more likely to have no out-of-pocket costs for their GP consultations, but in all age groups, the proportion was lower in rural areas than in urban areas (older age: 60% rural areas, 76% capital cities; mid-age: 24% rural areas, 40% capital cities; young age: 35% rural areas, 52% capital cities). Among mid-aged women, the median out-of-pocket cost per consultation ranged from $2.11 in capital cities to $6.48 in remote areas. Women living in rural and remote areas gave lower ratings for the availability, accessibility and affordability of health services than women living in urban areas. Conclusions: This study has shown a striking gradient in financial and nonfinancial barriers to health care associated with area of residence. Implication: The geographical imbalance in the supply and distribution of GP services in Australia has long been recognised but inequities in the affordability of services must also be addressed. Longitudinal survey data and Health Insurance Commission data provide a means to evaluate policies designed to improve access to health services in rural and remote areas.

Purpose: The aim of this study is to examine the prevalence of chiropractic and osteopathy use and the profile of chiropractor/osteopath users among middle-aged Australian women. Methods: This article reports on research conducted as part of the Australian Longitudinal Study on Women's Health. The focus of this article is the middle-aged women who responded to Survey 3 in 2001 when they were between the ages of 50 and 55 years. The demographic characteristics, health status, and health service use of chiropractic/osteopathy users and nonusers were compared using χ² tests for categorical variables and t tests for continuous variables. Results: We estimate that 16% of middle-aged women consult with a chiropractor or osteopath (after adjustment for the oversampling of rural women). Area of residence, education, and employment status were all statistically significantly associated with chiropractic and osteopath use. Specifically, women who live in nonurban areas were more likely to consult a chiropractor or osteopath, compared with women who live in urban areas. Women are significantly more likely to consult with a chiropractor/osteopath if they have had a major personal injury in the previous year, and women who use chiropractic/osteopathy are also high users of 'conventional' health services. Conclusions: Chiropractic/osteopathy use among women in Australia is substantial and cannot be ignored by those providing or managing primary health care services for women. It is essential that the interface and communication between chiropractors/osteopaths and other health care providers be highlighted and maximized to establish and maintain effective overall patient coordination and management. [ABSTRACT FROM AUTHOR]

Moderate alcohol consumption has been associated with health benefits in several studies, but few studies investigating such association for elders have been done. So, we explored the relationship between alcohol intake and changes in physical health-related quality of life (HRQoL). As analyses of longitudinal HRQoL data excluding diseased participants produced overestimated results, we compared the methods with and without incorporating death and estimated valid physical HRQoL and its decline over time. Study subjects were women from the Australian Longitudinal Study on Women's Health, ages 70-75 years at Survey 1 in 1996 (n = 12,432), and were followed-up at 3 yearly intervals for 6 years. Alcohol consumption was divided into seven categories to identify harmful alcohol levels for older women. We measured Physical Component Score (PCS) of Medical Outcomes Study Short-Form (SF-36), and applied the transformed PCS incorporating death as a valid score to estimate HRQoL changes for each alcohol group with adjustment for potential confounders. Significant declines of values were observed and the values of 'non-drinker' and 'rare drinker' were lower than the other groups during 6 years in both PCS and the transformed PCS. Analysis of the PCS showed significant Alcohol x Time interaction effects for non-drinker and rare drinker groups, as the scores were overestimated towards higher values at Survey 2 due to loss to follow-up of women who died. In the transformed PCS, these interaction effects diminished, and a clearer dose-response relationship between alcohol and physical HRQoL was observed at the third survey. We examined the influence of deaths on the study conclusions with using PCS and its transformed value which included deaths. Being a nondrinker of alcohol was associated with greater risk of mortality and poorer physical HRQoL. Moderate alcohol consumption was not harmful, and may carry some health benefits for older women.