Global issues, local action: exploring local governments use of research in "tackling climate change and its impacts on health" in Victoria, Australia.

BACKGROUND: Local government plays an important role in addressing complex public health challenges. While the use of research in this work is important, it is often poorly understood. This study aimed to build knowledge about how research is used by investigating its use by local government authorities (LGAs) in Victoria, Australia in responding to a new legislative requirement to prioritise climate and health in public health planning. The role of collaboration was also explored. METHODS: Informed by Normalization Process Theory (NPT), this study adopted multiple research methods, combining data from an online survey and face-to-face interviews. Quantitative data were analysed using descriptive statistics; thematic analysis was used to analyse qualitative data. RESULTS: Participants comprised 15 interviewees, and 46 survey respondents from 40 different LGAs. Research was most commonly accessed via evidence synthesis, and largely used to inform understanding about climate and health. When and how research was used was shaped by contextual factors including legislation, community values and practical limitations of how research needed to be communicated to decision-makers. Collaboration was more commonly associated with research access than use. CONCLUSIONS: Greater investment in the production and dissemination of localised research, that identifies local issues (e.g. climate risk factors) and is tailored to the communication needs of local audiences is needed to foster more impactful research use in local public health policy.

Research evidence use in local government-led public health interventions: a systematic review.

BACKGROUND: Local governments play an important role in improving public health outcomes globally, critical to this work is applying the best-available research evidence. Despite considerable exploration of research use in knowledge translation literature, how research is practically applied by local governments remains poorly understood. This systematic review examined research evidence use in local government-led public health interventions. It focused on how research was used and the type of intervention being actioned. METHODS: Quantitative and qualitative literature published between 2000 and 2020 was searched for studies that described research evidence use by local governments in public health interventions. Studies reporting interventions developed outside of local government, including knowledge translation interventions, were excluded. Studies were categorised by intervention type and their level of description of research evidence use (where 'level 1' was the highest and 'level 3' was the lowest level of detail). FINDINGS: The search identified 5922 articles for screening. A final 34 studies across ten countries were included. Experiences of research use varied across different types of interventions. However, common themes emerged including the demand for localised research evidence, the legitimising role of research in framing public health issues, and the need for integration of different evidence sources. CONCLUSIONS: Differences in how research was used were observed across different local government public health interventions. Knowledge translation interventions aiming to increase research use in local government settings should consider known barriers and facilitators and consider contextual factors associated with different localities and interventions.

A repeated cross-sectional and longitudinal study of mental health and wellbeing during COVID-19 lockdowns in Victoria, Australia.

BACKGROUND: Population surveys across the world have examined the impact of the COVID-19 pandemic on mental health. However, few have simultaneously examined independent cross-sectional data with longitudinal data, each of which have different strengths and weaknesses and facilitate the investigation of distinct research questions. This study aimed to investigate psychological distress and life satisfaction during the first and second lockdowns in the state of Victoria, Australia, and the social factors that may be affected by lockdowns and could affect mental health. METHODS: The VicHealth Victorian Coronavirus Wellbeing Impact Study included two 20-min opt-in online panel surveys conducted in May and September 2020 in Victoria, each with a sample of 2000 adults aged 18 + . A two-part study design was used: a repeated cross-sectional study of respondents who participated in Survey One and Survey Two, followed by a longitudinal nested cohort study. The primary exposures were social solidarity, social connectedness and staying connected with family and friends. Using logistic regression modelling, we explored the associations between our exposures and primary outcomes of psychological distress and life satisfaction with and without adjustment for covariates, both cross-sectionally and longitudinally. The results from the multivariable models were summarised using adjusted Odds Ratios (aOR), 95% Confidence Intervals (CI). RESULTS: Cross-sectional results indicated that the percentage of participants with low life satisfaction was significantly higher in the second survey sample (53%) compared to the first (47%). The percentage of participants with high psychological distress was higher but not significantly different between the two survey samples (14% first survey vs 16% second survey). Longitudinal study results indicated that lower social connectedness was significantly associated with higher psychological distress (aOR:3.3; 95% CI: 1.3-8.4) and lower life satisfaction (aOR:0.2; 95% CI: 0.1-0.4). Younger adults had higher psychological distress compared to older adults (aOR:6.8; 95% CI:1.5-31.1). Unemployment at the time of the first survey was significantly associated with lower life satisfaction at the second survey (aOR:0.5; 95% CI: 0.3-0.9). CONCLUSION: This study supports the findings of other international studies. It also highlights the need to promote increased social connection and maintain it at times of isolation and separation, particularly amongst younger adults.

Australia in 2030: what is our path to health for all?

CHAPTER 1: HOW AUSTRALIA IMPROVED HEALTH EQUITY THROUGH ACTION ON THE SOCIAL DETERMINANTS OF HEALTH: Do not think that the social determinants of health equity are old hat. In reality, Australia is very far away from addressing the societal level drivers of health inequity. There is little progressive policy that touches on the conditions of daily life that matter for health, and action to redress inequities in power, money and resources is almost non-existent. In this chapter we ask you to pause this reality and come on a fantastic journey where we envisage how COVID-19 was a great disruptor and accelerator of positive progressive action. We offer glimmers of what life could be like if there was committed and real policy action on the social determinants of health equity. It is vital that the health sector assists in convening the multisectoral stakeholders necessary to turn this fantasy into reality. CHAPTER 2: ABORIGINAL AND TORRES STRAIT ISLANDER CONNECTION TO CULTURE: BUILDING STRONGER INDIVIDUAL AND COLLECTIVE WELLBEING: Aboriginal and Torres Strait Islander peoples have long maintained that culture (ie, practising, maintaining and reclaiming it) is vital to good health and wellbeing. However, this knowledge and understanding has been dismissed or described as anecdotal or intangible by Western research methods and science. As a result, Aboriginal and Torres Strait Islander culture is a poorly acknowledged determinant of health and wellbeing, despite its significant role in shaping individuals, communities and societies. By extension, the cultural determinants of health have been poorly defined until recently. However, an increasing amount of scientific evidence supports what Aboriginal and Torres Strait Islander people have always said - that strong culture plays a significant and positive role in improved health and wellbeing. Owing to known gaps in knowledge, we aim to define the cultural determinants of health and describe their relationship with the social determinants of health, to provide a full understanding of Aboriginal and Torres Strait Islander wellbeing. We provide examples of evidence on cultural determinants of health and links to improved Aboriginal and Torres Strait Islander health and wellbeing. We also discuss future research directions that will enable a deeper understanding of the cultural determinants of health for Aboriginal and Torres Strait Islander people. CHAPTER 3: PHYSICAL DETERMINANTS OF HEALTH: HEALTHY, LIVEABLE AND SUSTAINABLE COMMUNITIES: Good city planning is essential for protecting and improving human and planetary health. Until recently, however, collaboration between city planners and the public health sector has languished. We review the evidence on the health benefits of good city planning and propose an agenda for public health advocacy relating to health-promoting city planning for all by 2030. Over the next 10 years, there is an urgent need for public health leaders to collaborate with city planners - to advocate for evidence-informed policy, and to evaluate the health effects of city planning efforts. Importantly, we need integrated planning across and between all levels of government and sectors, to create healthy, liveable and sustainable cities for all. CHAPTER 4: HEALTH PROMOTION IN THE ANTHROPOCENE: THE ECOLOGICAL DETERMINANTS OF HEALTH: Human health is inextricably linked to the health of the natural environment. In this chapter, we focus on ecological determinants of health, including the urgent and critical threats to the natural environment, and opportunities for health promotion arising from the human health co-benefits of actions to protect the health of the planet. We characterise ecological determinants in the Anthropocene and provide a sobering snapshot of planetary health science, particularly the momentous climate change health impacts in Australia. We highlight Australia's position as a major fossil fuel producer and exporter, and a country lacking cohesive and timely emissions reduction policy. We offer a roadmap for action, with four priority directions, and point to a scaffold of guiding approaches - planetary health, Indigenous people's knowledge systems, ecological economics, health co-benefits and climate-resilient development. Our situation requires a paradigm shift, and this demands a recalibration of health promotion education, research and practice in Australia over the coming decade. CHAPTER 5: DISRUPTING THE COMMERCIAL DETERMINANTS OF HEALTH: Our vision for 2030 is an Australian economy that promotes optimal human and planetary health for current and future generations. To achieve this, current patterns of corporate practice and consumption of harmful commodities and services need to change. In this chapter, we suggest ways forward for Australia, focusing on pragmatic actions that can be taken now to redress the power imbalances between corporations and Australian governments and citizens. We begin by exploring how the terms of health policy making must change to protect it from conflicted commercial interests. We also examine how marketing unhealthy products and services can be more effectively regulated, and how healthier business practices can be incentivised. Finally, we make recommendations on how various public health stakeholders can hold corporations to account, to ensure that people come before profits in a healthy and prosperous future Australia. CHAPTER 6: DIGITAL DETERMINANTS OF HEALTH: THE DIGITAL TRANSFORMATION: We live in an age of rapid and exponential technological change. Extraordinary digital advancements and the fusion of technologies, such as artificial intelligence, robotics, the Internet of Things and quantum computing constitute what is often referred to as the digital revolution or the Fourth Industrial Revolution (Industry 4.0). Reflections on the future of public health and health promotion require thorough consideration of the role of digital technologies and the systems they influence. Just how the digital revolution will unfold is unknown, but it is clear that advancements and integrations of technologies will fundamentally influence our health and wellbeing in the future. The public health response must be proactive, involving many stakeholders, and thoughtfully considered to ensure equitable and ethical applications and use. CHAPTER 7: GOVERNANCE FOR HEALTH AND EQUITY: A VISION FOR OUR FUTURE: Coronavirus disease 2019 has caused many people and communities to take stock on Australia's direction in relation to health, community, jobs, environmental sustainability, income and wealth. A desire for change is in the air. This chapter imagines how changes in the way we govern our lives and what we value as a society could solve many of the issues Australia is facing - most pressingly, the climate crisis and growing economic and health inequities. We present an imagined future for 2030 where governance structures are designed to ensure transparent and fair behaviour from those in power and to increase the involvement of citizens in these decisions, including a constitutional voice for Indigenous peoples. We imagine that these changes were made by measuring social progress in new ways, ensuring taxation for public good, enshrining human rights (including to health) in legislation, and protecting and encouraging an independent media. Measures to overcome the climate crisis were adopted and democratic processes introduced in the provision of housing, education and community development.

The VicHealth Indicators population survey: methodology, prevalence of behavioural risk factors, and use in local policy.

BACKGROUND: The Victorian Health Promotion Foundation (VicHealth) is an Australian state-based government agency with a remit to promote health by targeting physical activity, diet, mental wellbeing, tobacco use and alcohol consumption. Population health data is crucial to this work. This paper reports on the measures and methods used in surveillance, examines the prevalence of risk factors in sub-populations and use of risk factor data in local policy and planning. METHODS: The VicHealth Indicators (VHI) cross-sectional population telephone survey of behavioural and attitudinal health risk factors involved interviews with 22,819 respondents aged 18 years+ from the state of Victoria in 2015. Means or percent prevalences (with 95% CIs) of indicators are presented. Statistically significant differences between the state level and sub-population estimates were deemed to exist when confidence intervals of estimates did not overlap. Use of the data in local policy was assessed through an audit of 77 Municipal Public Health and Wellbeing Plans for 2017-2021. Use in municipal plans according to the municipality's geographical region type and SES was analysed using Welch's ANOVA. RESULTS: The average vegetable intake was 2.2 serves per day, far below the national guidelines of 5 serves per day, and only 4 in 10 Victorians were sufficiently active. Young males were twice as likely to be at high risk of alcohol harm compared to the state estimate. Women were twice as likely to feel unsafe walking after dark compared to males. There was a consistent pattern of significantly less favourable results for people living in outer metropolitan areas and a socio-economic gradient was evident for most risk factors. Almost 50% of municipalities used VHI data in their local policy plans. Use of VHI data was significantly higher in high SES municipalities and significantly lower in low SES municipalities relative to the mean. CONCLUSIONS: The findings indicate the need for continued targeted action on behavioural risk factors, particularly diet and physical activity, and that more intensive policy and practice action is required to address health inequities to ensure that all Victorians can experience good health. Increased support for low SES municipality policy planning may be warranted.

Getting into the game: evaluation of the reliability, validity and utility of the Ignite Challenge scale for school-aged children with autism spectrum disorder.

PURPOSE: Evaluate reliability, concurrent validity and utility of the Ignite Challenge motor skills measure for children with autism spectrum disorder (ASD). MATERIALS/METHODS: In this measurement study, children completed the Ignite Challenge twice, 1-3 weeks apart. A physiotherapist assessor (one of seven) conducted a child's test-retest assessments and scored administration ease and child engagement (/10 visual analogue scale). A second assessor rated baseline assessment videos. Validity data (parent-report PEDI-CAT) were collected at baseline. Reliability analysis employed ICCs (95% CI) and evaluated minimum detectable change (MDC80). Pearson's correlations (r) estimated validity. RESULTS: Forty-seven children with ASD (mean 9.34 years [SD = 2.35]; 10 girls; independent social communication) were tested at baseline; 45 were retested. Ignite Challenge baseline and retest mean scores were 69.0% (SD = 17.1) and 69.5% (SD = 16.6) respectively, with excellent inter-rater/test-retest reliability (ICC = 0.96 [95% CI 0.92, 0.97] and ICC = 0.91 [95% CI 0.84, 0.95]) respectively, and MDC80 = 9.28. Administration ease and child engagement were 6.5/10 (SD = 2.4) and 6.7/10 (SD = 2.2). Ignite Challenge and PEDI-CAT Social/Mobility (n = 45) associations were r = 0.54 and 0.57. Minimal suggestions for measure revisions arose from child/assessor feedback. CONCLUSIONS: Ignite Challenge can reliably identify movement strengths and challenges of children with ASD. Use may permit more appropriate evaluation and goal setting within physical activity-based programs.

Ignite Challenge is a reliable and valid advanced motor skills measure for children with Autism Spectrum Disorder (ASD), ages 6 years and up.Ignite Challenge can be reliably scored in-person ("live") even with younger children and those requiring increased assessor attention to optimize engagement.Most children enjoyed playing the Ignite Challenge "mini games"­this positive engagement ("getting into the game") helps support assessment of their best motor performance abilities.Ignite Challenge identifies motor-related challenges that impact a child's physical activity participation, and thus informs meaningful goal setting/intervention with children with ASD.

Labels used by young people to describe mental disorders: which ones predict effective help-seeking choices?

PURPOSE: Mental disorders are common in young people, yet many do not seek help. Being able to label the problem may facilitate effective help-seeking, but it is not clear which labels are best. This study aims to examine which labels commonly used by young people are associated with a preference for recommended sources of help and treatment. METHOD: A national telephone survey was conducted with a randomly selected sample of 2,802 Australian young people aged 12-25 years. Respondents were read out one of three vignettes describing symptoms of a mental disorder, and asked a series of questions regarding labelling of the problem described and related help-seeking preferences and beliefs. Binary logistic regression analyses were used to measure the association between type of label used and help-seeking preferences and beliefs. RESULTS: Use of the accurate label to describe the problem in the vignette predicted a preference for recommended sources of help with greater consistency than any other labels commonly used by young people. Inaccurate mental health labels did predict some preferences for recommended sources of help and treatment, but not to the extent of the accurate label. Lay labels such as "stress", "paranoid" and "shy" predicted less intention to seek any help for the problem described in the vignette. CONCLUSIONS: Labelling a disorder accurately does predict a preference for recommended sources of help and a belief in the helpfulness of recommended treatments. Importantly, it is also apparent that some commonly used lay labels cannot do this and indeed may limit appropriate help-seeking and treatment acceptance.

Measuring change in adolescent physical activity: Responsiveness of a single item.

Self-report measures are frequently used to assess change in physical activity (PA) levels. Given the limited data from adolescent populations, the primary objective of this study was to examine the responsiveness of a single item measure (SIM) of PA for adolescents to detect change in moderate-to-vigorous physical activity (MVPA) using accelerometer data as the reference measure. A secondary objective was to provide further data on the validity of the measure at one point in time. The validity of the SIM to determine the number of days ≥60 minutes of MVPA was based on data from 200 participants (62% female; age: 14.0 ± 1.6 years) and analysis of change was based on data from 177 participants (65% female; age: 14.0 ± 1.6 years). Validity of change in days ≥60 minutes of MVPA was examined through agreement in classification of change between the SIM and accelerometry as the reference measurement and Spearman's correlation. Cohen's d and standardised response means were used to assess the responsiveness to change of the measure. The responsiveness of the SIM and accelerometer data were comparable and modest (0.27-0.38). The correlation for change in number of days ≥60 minutes MVPA between the SIM and accelerometery was low (r = 0.11) and the accuracy of the SIM for detecting change, using accelerometry as the reference, was only marginally above chance (53%). Therefore, the adolescent version of the SIM is adequate for assessing PA at a single time point but not recommended for assessing change.

First aid actions taken by young people for mental health problems in a close friend or family member: findings from an Australian national survey of youth.

This study examined the first aid actions taken by young people to help someone they know and care about who was experiencing a mental health problem and the characteristics of the first aid provider (respondent) and recipient which influence these first aid actions. Participants in a national survey of Australian youth (aged 12-25 years) completed a two-year follow-up phone interview based on one of the following disorders in vignettes: depression, depression with alcohol misuse, social phobia and psychosis. Participants were asked if they knew a family member or close friend who had experienced a similar problem to the vignette character since the initial interview and those who did reported on any actions taken to help the person. Of the 2005 participants interviewed, 609 (30%) reported knowing someone with a similar problem, with depression (with or without alcohol misuse) being the most common problem. Respondent age and gender, recipient gender, and type of mental health problem, all influenced first aid actions. Findings indicate that peers are a major source of support for young people with mental health problems and underscore some important areas and subgroups of young people to target for interventions to improve young people's mental health first aid skills.

The influence of stigma on young people's help-seeking intentions and beliefs about the helpfulness of various sources of help.

PURPOSE: In this study, we examined whether young people's help-seeking intentions and beliefs about the helpfulness of various sources of help are influenced by their own, and their parents' stigmatising attitudes towards young people with mental disorders. METHODS: A national telephone survey was conducted with 3,746 Australians aged 12-25 years and 2,005 of their parents. Stigmatising attitudes, help-seeking intentions, and perceived helpfulness of various sources of help were assessed in relation to four vignettes of a young person with a mental disorder (psychosis, depression, depression with alcohol misuse or social phobia). RESULTS: Unlike 'stigma perceived in others', the 'weak-not-sick', 'social distance' and 'dangerous/unpredictable' dimensions of young people's stigma were associated with both help-seeking intentions and helpfulness beliefs about various sources of help. Attributing mental disorder to a personal weakness rather than an illness was associated with less intention to seek help from a doctor and less positive beliefs about professional sources (including doctors, counsellors, and psychologists). In contrast, young adults aged 18-25 years who perceived the vignette character as more dangerous or unpredictable had greater intention to seek help from a psychiatrist and a helpline, and more positive beliefs about psychiatrists. Greater social distance was associated with less intention to seek help from informal sources and less positive beliefs about these sources. No consistent pattern of associations was found for parent stigma. CONCLUSIONS: The findings suggest that different dimensions of youth stigma differentially influence help-seeking intentions and beliefs about the helpfulness of different sources of help.

The Pros and Cons of Online Competitive Gaming: An Evidence-Based Approach to Assessing Young Players' Well-Being.

This research addresses a lack of evidence on the positive and negative health outcomes of competitive online gaming and esports, particularly among young people and adolescents. Well-being outcomes, along with mitigation strategies were measured through a cross sectional survey of Australian gamers and non-gamers aged between 12 and 24 years, and parents of the 12-17-year-olds surveyed. Adverse health consequences were associated with heavy gaming, more so than light/casual gaming, suggesting that interventions that target moderated engagement could be effective. It provides timely insights in an online gaming landscape that has rapidly evolved over the past decade, and particularly during the COVID-19 pandemic, to include the hyper-connected, highly commercialized and rapidly growing online gaming and esports sector.

Responsiveness of the single item measure to detect change in physical activity.

OBJECTIVE: The objective of this study was to evaluate the responsiveness of the single item measure (SIM) to detect change in PA when compared to hip-worn accelerometry. A secondary aim was to provide further data on validity of the measure at a single time point. METHODS: Validity of the SIM to determine the number of days of ≥30 minutes of accelerometer-derived moderate-to-vigorous physical activity (MVPA) was assessed in 120 participants (78% female, 19% male, 3% other; age: 46 ± 11 years). Analysis of change was based on change in the number of days that participants completed ≥30 minutes of MVPA determined by the SIM and accelerometry over two 7-day periods in 90 participants (age: 47±11 years). Accelerometer data were analysed as total minutes of MVPA per day (MVPA-total) and as sustained bouts of 10 minutes or more of MVPA (MVPA-bouts). Validity of the SIM to detect change in MVPA, using accelerometer data as the reference measurement, was examined through Spearman's correlation and agreement in classification of change between SIM and accelerometry. Responsiveness to change was assessed by standardised response means and Cohen's d. RESULTS: Standardised response means for PA change were moderate for the SIM (0.77), MVPA-total (0.57) and MVPA-bouts (0.79). The correlation for change in number of days ≥30 minutes MVPA between the SIM and accelerometry were small to moderate (MVPA-total: r = 0.36 and MVP-bouts: r = 0.40). The SIM displayed moderate accuracy (60%-63%), using accelerometer data as the reference measurement, in detecting increases in days ≥30 minutes of MVPA. CONCLUSION: The SIM is a potentially useful assessment tool for evaluating change in MVPA, particularly when device-based measures or longer self-report measures are not feasible.

The effect of a 12 week walking intervention on markers of insulin resistance and systemic inflammation.

OBJECTIVES: The purpose of the present study was to determine whether a community-based walking intervention, using pedometers, is effective in reducing systemic inflammatory markers. METHODS: Participants (age=49(8.9)) were recruited in Glasgow, United Kingdom, from August to December 2006 and were randomly assigned to a control (n=24; 6 males, no change in walking) and intervention group (n=24; 5 males gradually increasing walking by 3000 steps/day on 5 days of the week). Blood samples were collected at baseline, and after 12 weeks, and analysed for glucose, insulin, high sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), soluble IL-6 receptor (sIL-6R), tumour necrosis factor-alpha (TNF-alpha) and soluble TNF receptors I and II (sTNFR1 and sTNFRII). RESULTS: In the control group baseline step counts were 6356 (2953) steps/day and did not change (P>0.05) after 12 weeks, 6709 (2918) steps/day. The intervention group increased (P<0.001) step count from 6682 (3761) steps/day at baseline to 10182 (4081) steps/day at 12 weeks. Over the 12 week period there was no change in any other variables measured, in either control or intervention group. CONCLUSION: We conclude that the current community-based intervention did not affect systemic markers of inflammation or insulin sensitivity.

Perceived helpfulness of websites for mental health information: a national survey of young Australians.

BACKGROUND: Despite the high risk of developing a mental disorder during adolescence, many young people fail to receive appropriate treatment from mental health professionals. Recent studies have found certain mental health information websites have improved mental health literacy and reduced symptoms of depression. However, studies exploring young people's perceptions of such resources still remain scarce. The current paper compared young people's preference for a website with self-help books and two face-to-face services-counselling and mental health services. The factors associated with believing in the perceived helpfulness of each intervention were also explored. METHOD: A national telephone survey was carried out with 3,746 people aged 12-25 years and 2005 co-resident parents. Perceived helpfulness of each intervention was assessed in relation to four vignettes (depression, social phobia, psychosis and depression with alcohol misuse). RESULTS: Approximately 71% of respondents rated websites and books as likely to be helpful, which was less than for counselling, but more than for mental health services. Predictors of rating a website as likely to be helpful were older age (18-25 years), belief in seeking help, less social distance from peers like the one in the vignette, and being presented with the vignettes depicting either social phobia or depression with alcohol misuse. Predictors of rating a book as helpful included belief in seeking help, awareness of the national depression initiative beyondblue, less social distance, being presented with the social phobia vignette, and the belief that the person in the vignette is 'weak not sick'. CONCLUSION: Most young people are open to the idea of accessing mental health information online, especially for disorders that are often perceived as behavioural problems. These young people also believe in help-seeking in general and are more willing to associate with peers who have mental health problems.

Barriers and facilitators to physical activity participation for children with physical disability: comparing and contrasting the views of children, young people, and their clinicians.

PURPOSE: Existing research has explored the barriers and facilitators of physical activity participation for young people with disability from the perspective of young people and their families. However, little research has investigated the views of clinicians who facilitate access to physical activity programs and compared this with their child client's perspectives. METHOD: Interviews were conducted with six allied health and sports development professionals associated with a programme which supports access to recreation and sporting activities. Interviews explored facilitators and barriers to physical activity experienced by their clients. Open-ended survey questions investigating barriers and facilitators of physical activity participation were also completed by 28 young people with disability aged 10-17 years who were clients of this programme. RESULTS: The most salient facilitator of participation described by clinicians was "planning programs to promote success and inclusion." Young people described two main facilitators; "the right people make physical activity fun!" and, similar to clinicians, "appropriate and inclusive opportunities to be active." The most salient barriers identified by clinicians were "practical limitations" and "time constraints and priorities," and a novel barrier raised was "whose choice?" The "lack of accessible and inclusive opportunities" was the most pertinent barrier for young people. CONCLUSIONS: Clinicians should determine both parent and young person commitment to a physical activity before enrolment. Lack of commitment can act as a barrier to physical activity and a more appropriate intervention could focus on increasing awareness of the benefits of being active, drawing on a Stages of Change based model of service delivery. Implications for rehabilitation Rehabilitation professionals seeking to increase physical activity participation for young people with physical disability should discuss readiness and motivation to change prior to any activity/sports referral. Different behaviour change processes are required for young people and for their parents and both are important to achieve physical activity participation. Regular monitoring is important to identify on-going physical and psychological barriers to participation, even for those who were already active. Clinicians should be aware that teenagers may be more ready to be active as they develop greater independence and should raise awareness of the benefits of physical activity.

Using Health and Well-Being Apps for Behavior Change: A Systematic Search and Rating of Apps.

BACKGROUND: Smartphones have allowed for the development and use of apps. There is now a proliferation of mobile health interventions for physical activity, healthy eating, smoking and alcohol cessation or reduction, and improved mental well-being. However, the strength or potential of these apps to lead to behavior change remains uncertain. OBJECTIVE: The aim of this study was to review a large sample of healthy lifestyle apps at a single point in time (June to July 2018) to determine their potential for promoting health-related behavior change with a view to sharing this information with the public. In addition, the study sought to test a wide range of apps using a new scale, the App Behavior Change Scale (ABACUS). METHODS: Apps focusing on 5 major modifiable lifestyle behaviors were identified using a priori key search terms across the Australian Apple iTunes and Google Play stores. Lifestyle behavior categories were selected for their impact on health and included smoking, alcohol use, physical activity, nutrition, and mental well-being. Apps were included if they had an average user rating between 3 and 5, if they were updated in the last 18 months, if the description of the app included 2 of 4 behavior change features, and if they were in English. The selected behavior change apps were rated in 2 ways using previously developed rating scales: the Mobile App Rating Scale (MARS) for functionality and the ABACUS for potential to encourage behavior change. RESULTS: The initial search identified 212,352 apps. After applying the filtering criteria, 5018 apps remained. Of these, 344 were classified as behavior change apps and were reviewed and rated. Apps were given an average MARS score of 2.93 out of 5 (SD 0.58, range 1.42-4.16), indicating low-to-moderate functionality. Scores for the ABACUS ranged from 1 to 17, out of 21, with an average score of 7.8 (SD 2.8), indicating a low-to-moderate number of behavior change techniques included in apps. The ability of an app to encourage practice or rehearsal, in addition to daily activities, was the most commonly identified feature across all apps (310/344, 90.1%), whereas the second most common feature was the ability of the user to easily self-monitor behavior (289/344, 84.0%). CONCLUSIONS: The wide variety of apps included in this 2018 study and the limited number of behavior change techniques found in many apps suggest an opportunity for improvement in app design that will promote sustained and significant lifestyle behavior change and, therefore, better health. The use of the 2 scales for the review and rating of the apps was successful and provided a method that could be replicated and tested in other behavior change areas.

The effect of a pedometer-based community walking intervention "Walking for Wellbeing in the West" on physical activity levels and health outcomes: a 12-week randomized controlled trial.

BACKGROUND: Recent systematic reviews have suggested that pedometers may be effective motivational tools to promote walking. However, studies tend to be of a relatively short duration, with small clinical based samples. Further research is required to demonstrate their effectiveness in adequately powered, community based studies. OBJECTIVE: Using a randomized controlled trial design, this study assessed the impact of a 12-week graduated pedometer-based walking intervention on daily step-counts, self-reported physical activity and health outcomes in a Scottish community sample not meeting current physical activity recommendations. METHOD: Sixty-three women and 16 men (49.2 years +/- 8.8) were randomly assigned to either an intervention (physical activity consultation and 12-week pedometer-based walking program) or control (no action) group. Measures for step-counts, 7-day physical activity recall, affect, quality of life (n = 79), body mass, BMI, % body fat, waist and hip circumference (n = 76), systolic/diastolic blood pressure, total cholesterol and HDL cholesterol (n = 66) were taken at baseline and week 12. Analyses were performed on an intention to treat basis using 2-way mixed factorial analyses of variance for parametric data and Mann Whitney and Wilcoxon tests for non-parametric data. RESULTS: Significant increases were found in the intervention group for step-counts (p < .001), time spent in leisure walking (p = .02) and positive affect (p = .027). Significant decreases were found in this group for time spent in weekday (p = .003), weekend (p = .001) and total sitting (p = .001) with no corresponding changes in the control group. No significant changes in any other health outcomes were found in either group. In comparison with the control group at week 12, the intervention group reported a significantly greater number of minutes spent in leisure time (p = .008), occupational (p = .045) and total walking (p = .03), and significantly fewer minutes in time spent in weekend (p = .003) and total sitting (p = .022). CONCLUSION: A pedometer-based walking program, incorporating a physical activity consultation, is effective in promoting walking and improving positive affect over 12 weeks in community based individuals. The discussion examines possible explanations for the lack of significant changes in health outcomes. Continued follow-up of this study will examine adherence to the intervention and possible resulting effects on health outcomes.

Interventions that are helpful for depression and anxiety in young people: a comparison of clinicians' beliefs with those of youth and their parents.

BACKGROUND: The aim of the research was to assess the consensus of clinicians about the appropriate treatments for depression and anxiety in youth, to discover any major differences between clinicians' beliefs and those of young people and their parents, and to assess whether clinicians' beliefs were consistent with clinical practice guidelines for young people. METHODS: Postal surveys were carried out on the beliefs of Australian general practitioners, psychiatrists, psychologists, and mental health nurses about what are helpful interventions for depression and social phobia in a 15-year old and in a 21-year old. The clinician data were compared to findings from an earlier national survey of Australian youth aged 12-25 years and their parents. RESULTS: The clinicians showed consensus about the helpfulness of a number of professions, reducing substance use, cognitive-behavior therapy, counseling, physical activity, relaxation training, and (for social phobia) meditation. Antidepressants were generally recommended only for depression in a 21-year old. Young people and their parents showed much lower endorsement than clinicians of antidepressants and cognitive-behavior therapy, while clinicians had much lower endorsement than the public of informal supports such as family, friends and support groups. LIMITATIONS: The survey was adapted from one designed for the public and did not allow clinicians to express complex opinions. CONCLUSIONS: Clinicians show substantial consensus about appropriate treatments. However, there are some major differences in beliefs between clinicians and young people, which may be a barrier to optimal help-seeking.

First aid strategies that are helpful to young people developing a mental disorder: beliefs of health professionals compared to young people and parents.

BACKGROUND: Little is known about the best ways for a member of the public to respond when someone in their social network develops a mental disorder. Controlled trials are not feasible in this area, so expert consensus may be the best guide. METHODS: To assess expert views, postal surveys were carried out with Australian GPs, psychiatrists and psychologists listed on professional registers and with mental health nurses who were members of a professional college. These professionals were asked to rate the helpfulness of 10 potential first aid strategies for young people with one of four disorders: depression, depression with alcohol misuse, social phobia and psychosis. Data were obtained from 470 GPs, 591 psychiatrists, 736 psychologists and 522 mental health nurses, with respective response rates of 24%, 35%, 40% and 32%. Data on public views were available from an earlier telephone survey of 3746 Australian youth aged 12-25 years and 2005 of their parents, which included questions about the same strategies. RESULTS: A clear majority across the four professions believed in the helpfulness of listening to the person, suggesting professional help-seeking, making an appointment for the person to see a GP and asking about suicidal feelings. There was also a clear majority believing in the harmfulness of ignoring the person, suggesting use of alcohol to cope, and talking to them firmly. Compared to health professionals, young people and their parents were less likely to believe that asking about suicidal feelings would be helpful and more likely to believe it would be harmful. They were also less likely to believe that talking to the person firmly would be harmful. CONCLUSION: Several first aid strategies can be recommended to the public based on agreement of clinicians about their likely helpfulness. In particular, there needs to be greater public awareness of the helpfulness of asking a young person with a mental health problem about suicidal feelings.