Individual socioeconomic position, neighbourhood disadvantage and mental well-being: a cross-sectional multilevel analysis of mid-age adults.

BACKGROUND: Socioeconomic disadvantage is associated with mental illness, yet its relationship with mental well-being is unclear. Mental well-being is defined as feeling good and functioning well. Benefits of mental well-being include reduced mortality, improved immune functioning and pain tolerance, and increased physical function, pro-social behaviour, and academic and job performance. This study aims to explore the relationship between individual socioeconomic position (SEP), neighbourhood disadvantage and mental well-being in mid-age adults. METHODS: Multilevel modelling was used to analyse data collected from 7866 participants from the second (2009) wave of HABITAT (How Areas in Brisbane Influence healTh and activiTy), a longitudinal study (2007-2018) of adults aged 40-65 years living in Brisbane, Australia. Mental well-being was measured using the Warwick Edinburgh Mental Well-Being Scale (WEMWBS). Exposure measures were education, occupation, household income, and neighbourhood socioeconomic disadvantage. RESULTS: The lowest MWB scores were observed for the least educated (ß = - 1.22, 95%CI = - 1.74, - 0.71), those permanently unable to work (ß = - 5.50, 95%CI = - 6.90, - 4.10), the unemployed (ß = - 2.62, 95%CI = - 4.12, - 1.13), and members of low-income households (ß = - 3.77, 95%CI = - 4.59, - 2.94). Residents of the most disadvantaged neighbourhoods had lower MWB scores than those living in the least disadvantaged neighbourhoods, after adjustment for individual-level SEP (ß = - 0.96, 95%CI = - 1.66, - 0.28). CONCLUSIONS: Both individual-level SEP and neighbourhood disadvantage are associated with mental well-being although the association is stronger for individual-level SEP. This research highlights the need to address individual and neighbourhood-level socioeconomic determinants of mental well-being.

Establishing and implementing a health promoting school in rural Cambodia.

Few studies have used a whole-of-school approach in implementing a health promoting schools (HPS) framework. Descriptions of how HPS is being implemented, particularly in low-resourced, developing countries, are limited. This study used an exploratory case study design to examine the planning and implementation of a HPS in a rural Cambodian village. Data were collected via observations of the school, school documentation, and interviews with stakeholders (n = 9). The data were analysed inductively as an iterative process, from initial coding, through to categorizing, leading to concept mapping and then identifying the emergent themes within the stages of school development and implementation of educational and health programming. The case study demonstrated how all six components of the HPS framework can be used to plan and implement a school in a rural village in a developing country. The key elements of implementation were building local and international partnerships, local leadership, and a culture of change and participation. These elements were used to establish a non-profit school that aimed to address the stated health and educational needs of local villagers. This case study adds to the limited evidence on the HPS components and implementation methods that are being applied in low-resourced, developing countries.

Validity of objective methods for measuring sedentary behaviour in older adults: a systematic review.

BACKGROUND: The evidence showing the ill health effects of prolonged sedentary behaviour (SB) is growing. Most studies of SB in older adults have relied on self-report measures of SB. However, SB is difficult for older adults to recall and objective measures that combine accelerometry with inclinometry are now available for more accurately assessing SB. The aim of this systematic review was to assess the validity and reliability of these accelerometers for the assessment of SB in older adults. METHODS: EMBASE, PubMed and EBSCOhost databases were searched for articles published up to December 13, 2017. Articles were eligible if they: a) described reliability, calibration or validation studies of SB measurement in healthy, community-dwelling individuals, b) were published in English, Portuguese or Spanish, and c) were published or in press as journal articles in peer-reviewed journals. RESULTS: The review identified 15 studies in 17 papers. Of the included studies, 11 assessed the ActiGraph accelerometer. Of these, three examined reliability only, seven (in eight papers) examined validity only and one (in two papers) examined both. The strongest evidence from the studies reviewed is from studies that assessed the validity of the ActiGraph. These studies indicate that analysis of the data using 60-s epochs and a vertical magnitude cut-point < 200 cpm or using 30- or 60-s epochs with a machine learning algorithm provides the most valid estimates of SB. Non-wear algorithms of 90+ consecutive zeros is also suggested for the ActiGraph. CONCLUSIONS: Few studies have examined the reliability and validity of accelerometers for measuring SB in older adults. Studies to date suggest that the criteria researchers use for classifying an epoch as sedentary instead of as non-wear time (e.g., the non-wear algorithm used) may need to be different for older adults than for younger adults. The required number of hours and days of wear for valid estimates of SB in older adults was not clear from studies to date. More older-adult-specific validation studies of accelerometers are needed, to inform future guidelines on the appropriate criteria to use for analysis of data from different accelerometer brands. TRIAL REGISTRATION: PROSPERO ID# CRD42017080754 registered December 12, 2017.

Cyclists' perceptions of motorist harassment pre- to post-trial of the minimum passing distance road rule amendment in Queensland, Australia.

Issues addressed Cyclists' perceptions of harassment from motorists discourages cycling. This study examined changes in cyclists' reporting of harassment pre- to post-introduction of the Queensland trial of the minimum passing distance road rule amendment (MPD-RRA). Methods Cross-sectional online surveys of cyclists in Queensland, Australia were conducted in 2009 (pre-trial; n=1758) and 2015 (post-trial commencement; n=1997). Cyclists were asked about their experiences of harassment from motorists while cycling. Logistic regression modelling was used to examine differences in the reporting of harassment between these time periods, after adjustments for demographic characteristics and cycling behaviour. Results At both time periods, the most reported types of harassment were deliberately driving too close (causing fear or anxiety), shouting abuse and making obscene gestures or engaging in sexual harassment. The percentage of cyclists who reported tailgating by motorists increased between 2009 and 2015 (15.1% to 19.5%; P<0.001). The percentage of cyclists reporting other types of harassment did not change significantly. Conclusions Cyclists in Queensland continue to perceive harassment while cycling on the road. The amendment to the minimum passing distance rule in Queensland appears to be having a negative effect on one type of harassment but no significant effects on others. So what? Minimum passing distance rules may not be improving cyclists' perceptions of motorists' behaviours. Additional strategies are required to create a supportive environment for cycling.

Risk factors for hospital re-presentation among older adults following fragility fractures: a systematic review and meta-analysis.

BACKGROUND: Older adults hospitalized with fragility fractures are at high risk of negative events that can culminate in re-presentations to hospital emergency departments or readmissions to hospital. This systematic review aimed to identify patient, clinical, or hospital-related factors that are identifiable at the index admission and that may be associated with re-presentations to hospital emergency departments or hospital readmissions in older adults following fragility fractures. METHODS: Four electronic databases (PubMed, CINAHL, Embase, and Scopus) were searched. A suite of search terms identified peer-reviewed English-language articles that examined potential correlates of hospital re-presentation in older adults (mean age ≥ 65 years) who were discharged from hospital following treatment for fragility fractures. A three-stage screening process (titles, abstracts, full text) was conducted by two researchers independently. Participant characteristics, study design, potential correlates examined, analyses, and findings were extracted for studies included in the review. Quality and risk of bias were assessed with the Effective Public Health Practice Project Quality Assessment Tool. The strength of evidence was incorporated into a best evidence synthesis, and meta-analysis was conducted where effect pooling was possible. RESULTS: Eleven of 35 eligible studies were categorized as high quality studies. These studies reported that age, higher Cumulative Illness Rating scores, American Society of Anesthesiologists scores > 3, longer length of stay, male sex, cardiovascular disease, low post-operative hemoglobin, kidney disease, dementia and cancer were factors identified at the index admission that were predictive of subsequent re-presentation to hospital. Age was the only predictor for which pooling of effects across studies was possible: pooling was conducted for re-presentation ≤ 30 days (pooled OR, 1.27; 95 % CI, 1.14-1.43) and > 30 days (pooled OR, 1.23; 95 % CI, 1.01-1.50). CONCLUSIONS: The best-evidence synthesis, in addition to the meta-analysis, identified a range of factors that may have utility in guiding clinical practice and policy guidelines for targeted interventions to reduce the need for re-presentation to hospital among this frail clinical population. The paucity of studies investigating re-presentations to hospital emergency departments without admission was an important gap in the literature identified in this review. Key limitations were exclusion of non-English language studies and grey literature. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42015019379 .

Physical activity and quality of life in older women with a history of depressive symptoms.

Physical activity (PA) is positively associated with health-related quality of life (HRQL) in older adults. It is not evident whether this association applies to older adults with poor mental health. This study examined associations between PA and HRQL in older women with a history of depressive symptoms. Participants were 555 Australian women born in 1921-1926 who reported depressive symptoms in 1999 on a postal survey for the Australian Longitudinal Study on Women's Health. They completed additional surveys in 2002, 2005 and 2008 that assessed HRQL and weekly minutes walking, in moderate PA, and in vigorous PA. Random effects mixed models were used to examine concurrent and prospective associations between PA and each of 10 HRQL measures (eight SF-36 subscales; two composite scales). In concurrent models, higher levels of PA were associated with better HRQL (p<0.001). The strongest associations were found for the bodily pain, physical functioning, general health perceptions, social functioning and vitality measures. Associations were attenuated in prospective models, more so for mental HRQL-related scales than for physical HRQL-related scales. However, strong associations (>3 point differences) were evident for physical functioning, general health, vitality and social functioning. For women in their 70s-80s with a history of depressive symptoms, PA is positively associated with HRQL concurrently, and to a lesser extent prospectively. This study extends previous work by showing significant associations in older women with a history of depressive symptoms. Incorporating PA into depression management of older women may improve their HRQL.

The usefulness of GPS bicycle tracking data for evaluating the impact of infrastructure change on cycling behaviour.

Issue addressed A key strategy to increase active travel is the construction of bicycle infrastructure. Tools to evaluate this strategy are limited. This study assessed the usefulness of a smartphone GPS tracking system for evaluating the impact of this strategy on cycling behaviour. Methods Cycling usage data were collected from Queenslanders who used a GPS tracking app on their smartphone from 2013-2014. 'Heat' and volume maps of the data were reviewed, and GPS bicycle counts were compared with surveillance data and bicycle counts from automatic traffic-monitoring devices. Results Heat maps broadly indicated that changes in cycling occurred near infrastructure improvements. Volume maps provided changes in counts of cyclists due to these improvements although errors were noted in geographic information system (GIS) geo-coding of some GPS data. Large variations were evident in the number of cyclists using the app in different locations. These variations limited the usefulness of GPS data for assessing differences in cycling across locations. Conclusion Smartphone GPS data are useful in evaluating the impact of improved bicycle infrastructure in one location. Using GPS data to evaluate differential changes in cycling across multiple locations is problematic when there is insufficient traffic-monitoring devices available to triangulate GPS data with bicycle traffic count data. So what? The use of smartphone GPS data with other data sources is recommended for assessing how infrastructure improvements influence cycling behaviour.

Cycling for transport and recreation: associations with socio-economic position, environmental perceptions, and psychological disposition.

OBJECTIVE: Interest is growing in promoting utility cycling (i.e., for transport) as a means of incorporating daily physical activity (PA) into people's lives, but little is known about correlates of utility cycling. Our primary aim was to examine cross-sectional relationships between socio-economic characteristics, neighborhood environment perceptions and psychological disposition with utility cycling (with or without additional recreational cycling). A secondary aim was to compare these relationships with those for recreation-only cycling. METHOD: Baseline survey data (2007) from 10,233 participants in HABITAT, a multilevel longitudinal study of PA, sedentary behavior, and health in Brisbane adults aged 40-65years, were analyzed using multinomial regression modeling. RESULTS: Greater income, habitual PA, and positive beliefs about PA were associated with utility and recreation-only cycling (p<0.05). Always having vehicle access and not in the labor force were associated with recreation-only cycling (p<0.05). Some or no vehicle access, part-time employment, and perceived environmental factors (little crime, few cul-de-sacs, nearby transport and recreational destinations) were associated with utility cycling (p<0.05). CONCLUSION: Our findings suggest differences in associations between socio-economic, neighborhood perceptions and psychological factors and utility and recreation-only cycling in Brisbane residents aged 40-65years. Tailored approaches appear to be required to promote utility and recreational cycling.

How do older adults respond to active Australia physical activity questions? Lessons from cognitive interviews.

The aim of this study was to examine older adults' understanding and interpretation of a validated questionnaire for physical activity surveillance, the Active Australia Survey (AAS). To address this aim, cognitive interviewing techniques were used during face-to-face semistructured interviews with 44 adults age 65-89 years. Qualitative data analysis revealed that participants were confused with questionnaire phrasing, misunderstood the scope of activities to include in answers, and misunderstood the time frame of activities to report. They also struggled to accurately estimate the frequency and duration of their activities. Our findings suggest that AAS questions may be interpreted differently by older adults than intended by survey developers. Findings also suggest that older adults use a range of methods for calculating PA frequency and duration. The issues revealed in this study may be useful for adapting AAS for use in older community-dwelling adults.

How people construct their experience of living with secondary lymphoedema in the context of their everyday lives in Australia.

PURPOSE: The purpose of this work was to explore how men and women construct their experiences living with lymphoedema following treatment for any cancer in the context of everyday life. METHODS: The design and conduct of this qualitative study was guided by Charmaz' social constructivist grounded theory. To collect data, focus groups and telephone interviews were conducted. Audiotapes were transcribed verbatim and imported into NVivo8 to organize data and codes. Data were analyzed using key grounded theory principles of constant comparison, data saturation, and initial, focused, and theoretical coding. RESULTS: Participants were 3 men and 26 women who had developed upper- or lower-limb lymphoedema following cancer treatment. Three conceptual categories were developed during data analysis and were labeled "accidental journey," "altered normalcy," and "ebb and flow of control." "Altered normalcy" reflects the physical and psychosocial consequences of lymphoedema and its relationship to everyday life. "Accidental journey" explains the participants' experiences with the health care system, including the prevention, treatment, and management of their lymphoedema. "Ebb and flow of control" draws upon a range of individual and social elements that influenced the participants' perceived control over lymphoedema. These conceptual categories were interrelated and contributed to the core category of "sense of self," which describes their perceptions of their identity and roles. CONCLUSIONS: Results highlight the need for greater clinical and public awareness of lymphoedema as a chronic condition requiring prevention and treatment, and one that has far-reaching effects on physical and psychosocial well-being as well as overall quality of life.

How Do Older Adults Respond to Active Australia Physical Activity Questions? Lessons from Cognitive Interviews.

The aim of this study was to examine older adults' understanding and interpretation of a validated questionnaire for physical activity surveillance, the Active Australia Survey (AAS). To address this aim, cognitive interviewing techniques were used during face-to-face semi-structured interviews with 44 adults aged 65-89 years. Qualitative data analysis revealed that participants were confused with questionnaire phrasing, misunderstood the scope of activities to include in answers, and misunderstood the time frame of activities to report. They also struggled to accurately estimate the frequency and duration of their activities. Our findings suggest that AAS questions may be interpreted differently by older adults than intended by survey developers. Findings also suggest that older adults use a range of methods for calculating PA frequency and duration. The issues revealed in this study may be useful for adapting AAS for use in older community-dwelling adults.

Key influences on motivations for utility cycling (cycling for transport to and from places).

ISSUE ADDRESSED: Although increases in cycling in Brisbane are encouraging, bicycle mode share to work (the proportion of people travelling to work by bicycle) in the state of Queensland remains low. The aim of this qualitative study was to draw upon the lived experiences of Queensland cyclists to understand the main motivators for utility cycling (cycling as a means to get to and from places) and compare motivators between utility cyclists (those who cycle for utility as well as for recreation) and non-utility cyclists (those who cycle only for recreation). METHODS: For an online survey, members of a bicycle group (831 utility cyclists and 931 non-utility cyclists, aged 18-90 years) were asked to describe, unprompted, what would motivate them to engage in utility cycling (more often). Responses were coded into themes within four levels of an ecological model. RESULTS: Within an ecological model, built environment influences on motivation were grouped according to whether they related to appeal (safety), convenience (accessibility) or attractiveness (more amenities) and included adequate infrastructure for short trips, bikeway connectivity, end-of-trip facilities at public locations and easy and safe bicycle access to destinations outside of cities. A key social-cultural influence related to improved interactions among different road users. CONCLUSIONS: The built and social-cultural environments need to be more supportive of utility cycling before even current utility and non-utility cyclists will be motivated to engage (more often) in utility cycling. SO WHAT?: Additional government strategies and more and better infrastructure that support utility cycling beyond commuter cycling may encourage a utility cycling culture.

Physical activity in three regional communities in Queensland.

OBJECTIVE: To describe physical activity participation in three Queensland regional communities. DESIGN: Cross-sectional mail survey of randomly selected residents, stratified by age and sex. SETTING: Esk, Mareeba and Mount Isa. PARTICIPANTS: 1219 (58% women) adults, with a mean age 46.7 (standard deviation 14.7) years. MAIN OUTCOME MEASURES: Proportion of people inactive, meeting Australian activity guidelines (a minimum of 150 min week(-1) and five sessions week(-1) ) and walking a dog daily; time spent walking and cycling for transport; location and type of recreational physical activities. RESULTS: Overall, 18% of respondents were inactive, with the highest proportions among women (22.3%) and older adults in Mount Isa (24.3%). The proportion meeting activity guidelines was 47%, with the lowest proportion among women in Mount Isa (40.4%). Although 63% reported owning a dog, only 22% reported walking a dog daily. Few people reported walking or cycling for transport. The most common types of activities were walking, home-based exercise, running/jogging and swimming, and the most common location was at or near home. CONCLUSIONS: Physical activity levels were lower in these regional communities than the state average. The findings indicate a need for physical activity policy and intervention strategies targeting regional and rural areas. This could focus on women and older adults, dog walking and physical activity opportunities in or near the home.

Gender differences in recreational and transport cycling: a cross-sectional mixed-methods comparison of cycling patterns, motivators, and constraints.

BACKGROUND: Gender differences in cycling are well-documented. However, most analyses of gender differences make broad comparisons, with few studies modeling male and female cycling patterns separately for recreational and transport cycling. This modeling is important, in order to improve our efforts to promote cycling to women and men in countries like Australia with low rates of transport cycling. The main aim of this study was to examine gender differences in cycling patterns and in motivators and constraints to cycling, separately for recreational and transport cycling. METHODS: Adult members of a Queensland, Australia, community bicycling organization completed an online survey about their cycling patterns; cycling purposes; and personal, social and perceived environmental motivators and constraints (47% response rate). Closed and open-end questions were completed. Using the quantitative data, multivariable linear, logistic and ordinal regression models were used to examine associations between gender and cycling patterns, motivators and constraints. The qualitative data were thematically analyzed to expand upon the quantitative findings. RESULTS: In this sample of 1862 bicyclists, men were more likely than women to cycle for recreation and for transport, and they cycled for longer. Most transport cycling was for commuting, with men more likely than women to commute by bicycle. Men were more likely to cycle on-road, and women off-road. However, most men and women did not prefer to cycle on-road without designed bicycle lanes, and qualitative data indicated a strong preference by men and women for bicycle-only off-road paths. Both genders reported personal factors (health and enjoyment related) as motivators for cycling, although women were more likely to agree that other personal, social and environmental factors were also motivating. The main constraints for both genders and both cycling purposes were perceived environmental factors related to traffic conditions, motorist aggression and safety. Women, however, reported more constraints, and were more likely to report as constraints other environmental factors and personal factors. CONCLUSION: Differences found in men's and women's cycling patterns, motivators and constraints should be considered in efforts to promote cycling, particularly in efforts to increase cycling for transport.

Strategies for managing osteoarthritis.

BACKGROUND: Although there are recommendations for the management of osteoarthritis (OA), little is known about how people with OA actually manage this chronic condition. PURPOSE: The aims of this study were to identify the non-pharmacological and pharmacological therapies most commonly used for the management of hip or knee OA, in a community-based sample of adults, and to compare these with evidence-based recommendations. METHODS: A questionnaire was mailed to 2,200 adult members of Arthritis Queensland living in Brisbane, Australia. It included questions about OA symptoms, management therapies, and demographic characteristics. RESULTS: Of the 485 participants (192 men, 293 women) with hip or knee OA who completed the questionnaire, most had mild to moderate symptoms. Ninety-six percent of participants (aged 27-95 years) reported using at least one non-pharmacological therapy, and 78% reported using at least one pharmacological therapy. The most common currently used non-pharmacological strategy was range-of-motion exercises (men 52%, women 61%, p = 0.05) and the most common frequently used pharmacological strategy was glucosamine/chondroitin (men 51%, women 60%, ns). For the most highly recommended strategies, 65% of men and 54% of women had never attended an information/education course (p = 0.04), and fewer than half (46% of women and 42% of men, p = 0.03) were frequent users of anti-inflammatory agents. CONCLUSION: The findings suggest that many people with knee or hip OA do not follow the most highly endorsed of the Osteoarthritis Research Society International recommendations for management of OA. Health professionals should be encouraged to recommend evidence-based therapies to their patients.

The influence of air pollution exposure on the short- and long-term health benefits associated with active mobility: A systematic review.

Active mobility (AM), defined as walking and cycling for transportation, can improve health through increasing regular physical activity. However, these health improvements could be outweighed by harm from inhaling traffic-related air pollutants during AM participation. The interaction of AM and air pollutants on health is complex physiologically, manifesting as acute changes in health indicators that may lead to poor long-term health consequences. The aim of this study was to systematically review the current evidence of effect modification by air pollution (AP) on associations between AM and health indicators. Studies were included if they examined associations between AM and health indicators being modified by AP or, conversely, associations between AP and health indicators being modified by AM. Thirty-three studies met eligibility criteria. The main AP indicators studied were particulate matter, ultrafine particles, and nitrogen oxides. Most health indicators studied were grouped into cardiovascular and respiratory indicators. There is evidence of a reduction by AP, mainly ultrafine particles and PM2.5, in the short-term health benefits of AM. Multiple studies suggest that long-term health benefits of AM are not negatively associated with levels of the single traffic-related pollutant NO2. However, other studies reveal reduced long-term health benefits of AM in areas affected by high levels of pollutant mixtures. We recommend that future studies adopt consistent and rigorous study designs and include reporting of interaction testing, to advance understanding of the complex relationships between AM, AP, and health indicators.

Cyclists' experiences of harassment from motorists: findings from a survey of cyclists in Queensland, Australia.

OBJECTIVE: Harassment from motorists is a major constraint on cycling that has been under-researched. We examined incidence and correlates of harassment of cyclists. METHODS: Cyclists in Queensland, Australia were surveyed in 2009 about their experiences of harassment while cycling, from motor vehicle occupants. Respondents also indicated the forms of harassment they experienced. Logistic regression modeling was used to examine gender and other correlates of harassment. RESULTS: Of 1830 respondents, 76% of men and 72% of women reported harassment in the previous 12 months. The most reported forms of harassment were driving too close (66%), shouting abuse (63%), and making obscene gestures/sexual harassment (45%). Older age, overweight/obesity, less cycling experience (<2 years) and less frequent cycling (<3 days/week) were associated with less likelihood of harassment, while living in highly advantaged areas (SEIFA deciles 8 or 9), cycling for recreation, and cycling for competition were associated with increased likelihood of harassment. Gender was not associated with reports of harassment. CONCLUSIONS: Efforts to decrease harassment should include a closer examination of the circumstances that give rise to harassment, as well as fostering road environments and driver attitudes and behaviors that recognize that cyclists are legitimate road users.

A qualitative study of older adults' responses to sitting-time questions: do we get the information we want?

BACKGROUND: In the last decade, there has been increasing interest in the health effects of sedentary behavior, which is often assessed using self-report sitting-time questions. The aim of this qualitative study was to document older adults' understanding of sitting-time questions from the International Physical Activity (PA) Questionnaire (IPAQ) and the PA Scale for the Elderly (PASE). METHODS: Australian community-dwelling adults aged 65+ years answered the IPAQ and PASE sitting questions in face-to-face semi-structured interviews. IPAQ uses one open-ended question to assess sitting on a weekday in the last 7 days 'at work, at home, while doing coursework and during leisure time'; PASE uses a three-part closed question about daily leisure-time sitting in the last 7 days. Participants expressed their thoughts out loud while answering each question. They were then probed about their responses. Interviews were recorded, transcribed and coded into themes. RESULTS: Mean age of the 28 male and 27 female participants was 73 years (range 65-89). The most frequently reported activity was watching TV. For both questionnaires, many participants had difficulties understanding what activities to report. Some had difficulty understanding what activities should be classified as 'leisure-time sitting'. Some assumed they were being asked to only report activities provided as examples. Most reported activities they normally do, rather than those performed on a day in the previous week. Participants used a variety of strategies to select 'a day' for which they reported their sitting activities and to calculate sitting time on that day. Therefore, many different ways of estimating sitting time were used. Participants had particular difficulty reporting their daily sitting-time when their schedules were not consistent across days. Some participants declared the IPAQ sitting question too difficult to answer. CONCLUSION: The accuracy of older adults' self-reported sitting time is questionable given the challenges they have in answering sitting-time questions. Their responses to sitting-time questions may be more accurate if our recommendations for clarifying the sitting domains, providing examples relevant to older adults and suggesting strategies for formulating responses are incorporated. Future quantitative studies should include objective criterion measures to assess validity and reliability of these questions.

Women cycling in Queensland: Results from an observational study.

Women are less likely to ride than men in low cycling countries such as Australia. In Australia, self-reported cycling participation appears to be declining, particularly for women. This paper examines the rider and road environment correlates of women's cycling. While most earlier studies relied on self-report data to understand gender differences in cycling, this study video-recorded 24,868 riders (22 % female) at 17 sites across Queensland, Australia. The probabilities of an observed rider being female under different circumstances (e.g., speed limit, riding location, time of riding, group riding) at these sites were modelled in a binomial logistic regression framework. The likelihood of a rider being a woman was greater during the day (9am-8pm) than the early morning (5-9 a.m.); on weekends than on weekdays; in groups of two or more riders than among single riders; in lower speed zones than speed zones of 60 km/h or over; on roads with bike lanes or multiple traffic lanes or raised medians than on roads without these, and in urban areas than suburban areas. The likelihood of the rider being a woman was lower among those riding road bikes than other types of bicycles. The use of a naturalistic study design marks the key strength of this paper. Findings of this study should help better understand women's cycling patterns and preferred cycling locations, which cycling communities and organisations can use to advocate for better roads and paths that make female riders feel safe.