Economic evaluation of physical activity mass media campaigns across the globe: a systematic review.

BACKGROUND: Physical activity mass media campaigns can deliver physical activity messages to many people, but it remains unclear whether they offer good value for money. We aimed to investigate the cost-effectiveness, cost-utility, and costs of physical activity mass media campaigns. METHODS: A search for economic evaluations (trial- or model-based) and costing studies of physical activity mass media campaigns was performed in six electronic databases (June/2021). The authors reviewed studies independently. A GRADE style rating was used to assess the overall certainty of each modelled economic evaluation. Results were summarised via narrative synthesis. RESULTS: Twenty-five studies (five model-based economic evaluations and 20 costing studies) were included, and all were conducted in high-income countries except for one costing study that was conducted in a middle-income country. The methods and assumptions used in the model-based analyses were highly heterogeneous and the results varied, ranging from the intervention being more effective and less costly (dominant) in two models to an incremental cost of US$130,740 (2020 base year) per QALY gained. The level of certainty of the models ranged from very low (n = 2) to low (n = 3). Overall, intervention costs were poorly reported. CONCLUSIONS: There are few economic evaluations of physical activity mass media campaigns available. The level of certainty of the models was judged to be very low to low, indicating that we have very little to little confidence that the results are reliable for decision making. Therefore, it remains unclear to what extent physical activity mass media campaigns offer good value for money. Future economic evaluations should consider selecting appropriate and comprehensive measures of campaign effectiveness, clearly report the assumptions of the models and fully explore the impact of assumptions in the results. REVIEW REGISTRATION: https://bit.ly/3tKSBZ3.

Fair play? Participation equity in organised sport and physical activity among children and adolescents in high income countries: a systematic review and meta-analysis.

BACKGROUND: Physical activity and sport have numerous health benefits and participation is thought to be lower in disadvantaged children and adolescents. However, evidence for the disparity in physical activity is inconsistent, has not been reviewed recently, and for sport has never been synthesised. Our aim was to systematically review, and combine via meta-analyses, evidence of the socioeconomic disparities in physical activity and sport participation in children and adolescents in high income countries. METHODS: We conducted searches of five electronic databases using physical activity, sport, and socioeconomic disparity related terms. Two independent reviewers assessed 21,342 articles for peer-reviewed original research, published in English that assessed socioeconomic disparities in physical activity and sport participation in children and adolescents. We combined evidence from eligible studies using a structural equation modelling approach to multilevel meta-analysis. RESULTS: From the 104 eligible studies, we meta-analysed 163 effect sizes. Overall, children and adolescents living in higher socioeconomic status households were more likely to participate in sport (OR: 1.87, 95% CIs 1.38, 2.36) and participated for a longer duration (d = 0.24, 95% CIs 0.12, 0.35). The socioeconomic disparity in the duration of sport participation was greater in children (d = 0.28, 95% CIs 0.15, 0.41) compared with adolescents (d = 0.13, 95% CIs - 0.03, 0.30). Overall, children and adolescents living in higher socioeconomic status households were more likely to meet physical activity guidelines (OR: 1.21, 95% CIs 1.09, 1.33) and participated for a longer duration (d = 0.08, 95% CIs 0.02, 0.14). The socioeconomic disparity in the duration of total physical activity between low and high socioeconomic status households was greater in children (d = 0.13, 95% CIs 0.04, 0.21) compared with adolescents (d = 0.05, 95% CIs - 0.05, 0.15). There was no significant disparity in leisure time physical activity (d = 0.13, 95% CIs - 0.06, 0.32). CONCLUSIONS: There was evidence of socioeconomic disparities in sport participation and total physical activity participation among children and adolescents. Socioeconomic differences were greater in sport compared to total physical activity and greater in children compared with adolescents. These findings highlight the need importance of targeting sport programs according to socio-economic gradients, to reduce inequities in access and opportunity to organised sport.

Quality of life and associations with health-related behaviours among older adults with increased cardiovascular risk.

BACKGROUND AND AIMS: A better understanding of the relationship between cardiovascular disease risk factors and quality of life (QoL) in older age is needed to inform development of risk reduction strategies. This cross-sectional study investigated the association of QoL with health-related behaviours in older adults at risk of heart failure. METHODS AND RESULTS: Older adults (N = 328) at risk of heart failure residing in Melbourne, Australia, provided data on QoL and health-related behaviours including physical activity, diet, smoking and alcohol consumption. Multiple linear regression modelling was used to examine associations between health-related behaviours, QoL and its constituent domains. After adjustment for age, gender, body mass index and comorbidities, current smoking was found to have a negative association with the mental component score (MCS) of QoL (ß = -0.174, p ≤ 0.01), with a positive association seen between MCS and physical activity (ß = 0.130, p = 0.01). Current alcohol use had a positive association with the physical component score (PCS) (ß = 0.120, p = 0.02) and saturated fat intake consumption had a negative association with the physical functioning domain of QoL (ß = -0.105, p = 0.03) but was not associated with either PCS or MCS. CONCLUSION: Engagement of older adults at increased cardiovascular risk with behavioural risk factor modification using QoL as a driver of change may offer new opportunities to promote healthy ageing. Development of such strategies should consider that for some behaviours which are cardiovascular risk factors (alcohol intake, in particular), the positive association to QoL is complicated and needs further deliberation.

Legal strategies to improve physical activity in populations.

The World Health Assembly has adopted the World Health Organization's (WHO) recommended target of achieving a 15% reduction in physical inactivity by 2030. The WHO Global Action Plan on Physical Activity provides a framework for countries to achieve this, using a systems-based approach to address the social and environmental determinants of physical inactivity. Lack of progress in many countries indicates a need to identify new ways of addressing this public health priority. WHO continues to highlight the importance of legislative and regulatory measures within the multicomponent and multisectoral action needed to reduce physical inactivity. Yet research into the role of law for addressing physical inactivity has been limited, in contrast to the legal approaches to other major noncommunicable disease risk factors such as smoking and alcohol use. Conceptual frameworks for public health law offer a method for mapping and understanding the determinants, mechanisms and outcomes of law-making for the promotion of physical activity within populations. We describe the development and application of a framework that aligns legal strategies with the WHO Global Plan policy objectives. This new framework - the Regulatory Approaches to Movement, Physical Activity, Recreation, Transport and Sport - can help policy-makers to use the untapped potential of legal interventions to support or strengthen a whole-system response for promoting physical activity. The framework illustrates the role of legal interventions to improve physical activity and identifies opportunities for research to advance understanding, implementation and evaluation of legal responses to this issue.

L'Assemblée mondiale de la Santé a adopté l'objectif recommandé par l'Organisation mondiale de la Santé (OMS) visant à réduire l'inactivité physique de 15% d'ici 2030. L'OMS a élaboré un Plan d'action mondial pour l'activité physique, qui propose aux pays des orientations leur permettant d'atteindre cet objectif, grâce à une approche systémique qui aborde les déterminants sociaux et environnementaux à l'origine de l'inactivité physique. L'absence de progrès dans de nombreux pays indique un besoin d'identifier de nouveaux moyens de faire de cet enjeu de santé publique une priorité. L'OMS continue à souligner l'importance des mesures législatives et réglementaires au cœur de l'action multisectorielle à composantes multiples nécessaire à la promotion de l'exercice physique. Pourtant, les recherches sur la capacité de la loi à lutter contre l'inactivité physique sont limitées, contrairement aux démarches juridiques entamées vis-à-vis d'autres grands facteurs de risque de maladies non transmissibles, comme la consommation de tabac ou d'alcool. Les cadres théoriques régissant le droit sanitaire offrent des méthodes d'analyse et de compréhension des déterminants, mécanismes et impacts du travail législatif sur la promotion de l'activité physique au sein des populations. Dans cet article, nous décrivons le développement et l'application d'un cadre qui aligne les stratégies juridiques sur les objectifs politiques du Plan mondial de l'OMS. Ce cadre inédit ­ les réglementations relatives au mouvement, à l'activité physique, aux loisirs, au transport et au sport ­ peut aider les législateurs à utiliser le potentiel inexploité des interventions légales pour soutenir ou renforcer une réponse globale destinée à encourager l'exercice physique. Il illustre le rôle des interventions légales visant à améliorer l'activité physique et identifie les possibilités de recherche en vue de faire progresser la compréhension, la mise en œuvre et l'évaluation des solutions juridiques apportées à ce problème.

La Asamblea Mundial de la Salud ha adoptado el objetivo recomendado por la Organización Mundial de la Salud (OMS) de lograr una reducción del 15% de la inactividad física para 2030. El Plan de Acción Mundial de la OMS sobre la Actividad Física proporciona un marco para que los países lo logren, utilizando un enfoque basado en sistemas para abordar los determinantes sociales y ambientales de la inactividad física. La falta de progreso en muchos países indica la necesidad de identificar nuevas formas de abordar esta prioridad de salud pública. La OMS sigue destacando la importancia de las medidas legislativas y reglamentarias dentro de la acción multicomponente y multisectorial necesaria para reducir la inactividad física. Sin embargo, la investigación sobre el papel de la ley para abordar la inactividad física ha sido limitada, en contraste con los enfoques legales de otros factores de riesgo de enfermedades no transmisibles importantes, como el tabaquismo y el consumo de alcohol. Los marcos conceptuales del derecho de la salud pública ofrecen un método para trazar y comprender los determinantes, mecanismos y resultados de la elaboración de leyes para la promoción de la actividad física en las poblaciones. Describimos el desarrollo y la aplicación de un marco que alinea las estrategias legales con los objetivos políticos del Plan Global de la OMS. Este nuevo marco ­enfoques normativos del movimiento, la actividad física, el ocio, el transporte y el deporte­ puede ayudar a los responsables políticos a utilizar el potencial sin explotar de las intervenciones legales para apoyar o reforzar una respuesta de todo el sistema para promover la actividad física. El marco ilustra el papel de las intervenciones legales para mejorar la actividad física e identifica las oportunidades de investigación para avanzar en la comprensión, implementación y evaluación de las respuestas legales a este tema.

Mis-reporting of energy intake among older Australian adults: Prevalence, characteristics, and associations with quality of life.

OBJECTIVES: Mis-reporting is common in dietary assessment, leading to misinterpretation of disease risk and could be important in older adults with increased chronic disease risk. This study investigated the prevalence and characteristics of mis-reporting among older adults and its association with health outcomes including quality of life (QoL). METHODS: The study was conducted in 335 community-dwelling older adults at increased risk for cardiovascular disease, participating in the SCReening Evaluation of the Evolution of New Heart Failure Study dietary substudy. Diet was assessed using 4-day weighed food diaries, QoL measured through Short Form 36, and physical activity assessed using the European Prospective Investigation into Cancer and Nutrition physical activity questionnaire. Dietary mis-reporting was defined based on Goldberg cutoffs, using individual physical activity levels. Odds ratios were determined to establish associations between mis-reporting and health outcomes. RESULTS: The prevalence of mis-reporting among older adults was 49.3%, with 44.5% of women mis-reporting their energy intake. The study found under-reporting of energy to be associated with body mass index, specifically being overweight (odds ratio: 3.08; 95% confidence interval [CI], 1.54-6.15) and obese (odds ratio: 6.60; 95% CI, 3.05-4.26), as well as physical inactivity (odds ratio: 0.24; 95% CI, 0.14-0.43). Only physical inactivity predicted over-reporting of dietary intake (odds ratio: 7.52; 95% CI, 1.57-36.0). CONCLUSIONS: Dietary under-reporting was associated with being overweight, obese, and physically inactive in addition to the absence of comorbidities, reinforcing the need for further research in older adults to factor in dietary mis-reporting for meaningful diet-disease relationship analyses.

Lifestyle interventions for type 2 diabetes management among migrants and ethnic minorities living in industrialized countries: a systematic review and meta-analyses.

The objective of this systematic review was to determine the effectiveness of lifestyle interventions to improve the management of type 2 diabetes mellitus (T2DM) among migrants and ethnic minorities. Major searched databases included MEDLINE (via PubMed), EMBASE (via Ovid) and CINAHL. The selection of studies and data extraction followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In the meta-analysis, significant heterogeneity was detected among the studies (I2 >50%), and hence a random effects model was used. Subgroup analyses were performed to compare the effect of lifestyle interventions according to intervention approaches (peer-led vs community health workers (CHWs)-led). A total of 17 studies were included in this review which used interventions delivered by CHWs or peer supporters or combination of both. The majority of the studies assessed effectiveness of key primary (hemoglobin (HbA1c), lipids, fasting plasma glucose) and secondary outcomes (weight, body mass index, blood pressure, physical activity, alcohol consumption, tobacco smoking, food habits and healthcare utilization). Meta-analyses showed lifestyle interventions were associated with a small but statistically significant reduction in HbA1c level (-0.18%; 95% CI -0.32% to -0.04%, p=0.031). In subgroup analyses, the peer-led interventions showed relatively better HbA1c improvement than CHW-led interventions, but the difference was not statistically significant (p=0.379). Seven studies presented intervention costs, which ranged from US$131 to US$461 per participant per year. We conclude that lifestyle interventions using either CHWs or peer supporters or a combination of both have shown modest effectiveness for T2DM management among migrants of different background and origin and ethnic minorities. The evidence base is promising in terms of developing culturally appropriate, clinically sound and cost-effective intervention approaches to respond to the growing and diverse migrants and ethnic minorities affected by diabetes worldwide.

Physical activity participation and the risk of chronic diseases among South Asian adults: a systematic review and meta-analysis.

South Asia specific reviews on the role of physical activity (PA) domains on chronic disease prevention are lacking. This study aimed to systematically review published literature to identify the association between PA domains and chronic diseases and to provide summary estimates of the strength of association. Nine electronic databases were searched using the predefined inclusion criteria which included population (South Asian adults 40 years or older), exposure (PA or sedentary behaviour) and outcome (type 2 diabetes mellitus, breast cancer, colorectal cancer, coronary heart disease, stroke, vascular disease and musculoskeletal diseases and their markers). A random-effects meta-analysis was carried out for cardiometabolic outcomes whereas narrative synthesis was completed for other outcome variables. Inactive or less active South Asian adults were at 31% higher risk of being hypertensive. Likewise, the risk of cardiometabolic outcomes was 1.34 times higher among inactive adults. Household PA was found to have a protective effect  on breast cancer risk. Total and leisure time PA had a protective effect on osteoporosis among males and females respectively. Contemporary studies with a longitudinal design, representative samples, valid and reliable assessment of different domains are needed to establish the role of PA in chronic disease prevention in the region.

Physical activity participation and the risk of chronic diseases among South Asian adults: protocol for a systematic review and meta-analysis.

BACKGROUND: Chronic diseases contribute to about half of the adult disease burden in the South Asian region. Meanwhile, physical activity levels are declining despite the global evidence of its role in the prevention of chronic diseases. While there are a plethora of systematic reviews on the effects of physical activity on chronic diseases, there has not yet been a synthesis of the evidence concerning the nature of this relationship among people living in South Asian countries incorporating multiple chronic diseases and a focus on physical activity domains. The aim of this protocol is to describe the rationale and methods for a systematic review of published research to identify the association between physical activity and selected chronic diseases and their markers and analysis of the strength of association with a focus on physical activity domains among South Asian adults 40 years and older. METHODS: Nine electronic databases including Medline, PsycINFO, Embase, CENTRAL, CINAHL Plus, AgeLine, SPORTDiscus, Scopus and Web of Science will be systematically searched for papers reporting the association between physical activity and selected chronic diseases (type 2 diabetes mellitus, breast cancer, colorectal cancer, coronary heart disease, stroke, vascular diseases and musculoskeletal diseases (osteoarthritis, osteoporosis, back and neck pain)) and their markers using predefined search terms. Searches will be limited to peer-reviewed, English language papers with a quantitative design. In addition, a manual search of references of relevant systematic reviews as well as citations and references of eligible studies will also be carried out. The methodological appraisal will be performed using the National Institutes of Health quality assessment checklist for observational studies and the Effective Public Health Practice Project quality assessment tool for intervention studies. The overall quality of evidence for the study outcomes across the study designs will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. The review results will be presented in the form of narrative synthesis, and a random effects meta-analysis is planned depending on the nature of included studies and available data. DISCUSSION: This review will summarise the strength of the association between physical activity and selected chronic diseases and their markers among South Asian adults 40 years or older. The findings will provide an evidence base to guide public health policy and interventions in the South Asian region and to inform future research to address the rising burden of chronic diseases. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018096505.

Changing psychosocial determinants of physical activity and diet in women with a history of gestational diabetes mellitus.

BACKGROUND: To investigate how a behavioural lifestyle intervention influences psychosocial determinants of physical activity and dietary behaviours in a population at risk of type 2 diabetes (T2DM). METHODS: Fifty-nine women with a body mass index of ≥25 kg/m2 and a history of gestational diabetes mellitus (GDM) participated in a randomized controlled study. The intervention group (n = 29) received 2 face-to-face and 5 telephone lifestyle-counselling sessions with a health professional. The control group (n = 30) received care as usual. At baseline and 6 months, psychosocial determinants related to physical activity and diet were measured with a self-administrated questionnaire. Linear regression analyses were applied to test for intervention effects. RESULTS: The intervention was effective in improving social support (ß = 3.5, P < 0.001; ß = 2.1, P = 0.02), modifying self-efficacy (ß = -2.2, P = 0.02; ß = -4.3, P < 0.001), and reducing barriers (ß = -3.5, P = 0.01; ß = -3.8, P = 0.01) for, respectively, physical activity and diet from baseline to 6-month follow-up in the intervention group compared with the control group. The intervention reduced the following barriers to a physically active lifestyle: lack of energy and lack of motivation. Physical activity barriers like lack of time and lack of childcare were unchanged. The intervention reduced the following barriers to a healthy diet: lack of time, costs, having unhealthy snacks at home, and having cravings for sweets. CONCLUSION: This lifestyle intervention influenced psychosocial determinants relevant for overweight women with a history of gestational diabetes mellitus (GDM) in prevention of T2DM.

Reliability and Validity of Measures for Investigating the Determinants of Health Behaviors Among Women With a History of Gestational Diabetes.

AIM: Assisting women with a history of gestational diabetes mellitus (GDM) to adopt healthy lifestyles is a priority for diabetes prevention. The aim of this study was to develop and evaluate measures that can be used to assess the efficacy of behavior change interventions in this group. METHOD: Measures of psychosocial influences on physical activity and diet were derived from formative research and examination of established instruments. Item reduction by principal components analysis was undertaken following telephone survey administration to 160 women with recent GDM, and the internal reliability and construct validity of the derived scales were assessed. Test-retest reliability was assessed in another sample of 97 women. RESULTS: Scales with acceptable internal reliability were developed for physical activity outcome expectancies (α = .82), perceived barriers (α = .75), encouragement (α = .76) and self-efficacy (α = .82), weight control attitudes (α = .90), and diabetes-related fear (α = .70). Construct validity in relation to physical activity participation was found for the encouragement and self-efficacy scales. The weight control attitudes scale showed construct validity in relation to fruit and vegetable intake. The test-retest reliability of most scales was moderate to good (weighted κ = 0.55-0.69). CONCLUSION: Reliable and valid measures relevant to the psychosocial needs of women with GDM have been developed with a multiethnic population. These will assist future evidence generation, particularly in relation to the adoption of physical activity, which has been a challenging area of lifestyle intervention to date.

The correlates of chronic disease-related health literacy and its components among men: a systematic review.

BACKGROUND: Chronic diseases drive the burden of disease in many societies, particularly among men. Lifestyle behaviours are strongly associated with chronic disease development, and in a number of countries men tend to engage in more risky behaviours, and have lower health knowledge and attention to prevention, than women. This study investigated the correlates of men's health literacy and its components about major lifestyle-related diseases, namely ischaemic heart disease and type 2 diabetes mellitus, to gain evidence to guide the development of policy and programs to improve men's health. METHODS: A systematic review was undertaken of observational studies that investigated men's health literacy and its components related to ischaemic heart disease or type 2 diabetes mellitus, and their associated risk factors. The Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, PsycINFO, Embase and the Cochrane Library databases were searched for articles published since 2003. The strength of the evidence was rated using the GRADE approach. RESULTS: After screening and review of 504 articles, the search elicited nine studies for inclusion: only one study examined health literacy (nutrition literacy). The majority of included studies focused on only one component of health literacy, namely knowledge (n = 7) and personal skills (confidence) (n = 1). Twenty correlates were identified, primarily relating to the knowledge component, with the strength of the evidence for only one correlate, education, graded as being of moderate quality. The evidence for all other correlates was graded as being of low quality. CONCLUSIONS: The limited body of research identified may have resulted from a lack of consensus about the definition of health literacy, and a concordant set of validated health literacy measures. Despite these limitations, broadening the search to include components of health literacy has identified that several factors are associated with men's knowledge and awareness of ischaemic heart disease and type 2 diabetes mellitus that will assist in the development of men's health promotion strategies. However, addressing the broader knowledge gaps and controversy in the health literacy field will deliver policy and program benefits to address these major contributors to the burden of disease among men.

Investigation of a lifestyle change strategy for high-risk women with a history of gestational diabetes.

Fifty-nine women with recent gestational diabetes participated in a randomized controlled trial to assess the feasibility and efficacy of a pragmatic diabetes risk reduction intervention. Intervention participants achieved improvements in energy, total and saturated fats, and carbohydrate intake, but no change in physical activity. Recruitment was challenging and below expectations.

Public knowledge and beliefs about dementia risk reduction: a national survey of Australians.

BACKGROUND: With the dramatically increasing contribution of Alzheimer's Disease and other forms of dementia to the global burden of disease, countries are being urged to address this as a public health priority. This study investigated whether Australian adults recognise this as an important health issue, and hold beliefs and knowledge that are consistent with recommendations concerning dementia risk reduction. This research was undertaken to guide national brain health awareness and education strategies. METHODS: A cross-sectional telephone survey was undertaken of 1,003 Australians aged 20-75 years. This measured the importance placed on dementia, beliefs and confidence related to risk reduction, knowledge of risk reduction methods, and the perceived age-relevance of these. In analysis the data were stratified by sex, age, educational attainment, household income, language preference and previous exposure to dementia. Multivariable logistic regression was undertaken to identify variables independently associated with beliefs and knowledge. RESULTS: People aged 60 years and over identified dementia as very important (17.2%) more often than those aged 40-59 years (5.1%) or 20-39 years (2.1%). While 41.5% of respondents believed the risk of dementia could be reduced, 26.9% were very confident that they could achieve this. Mental activity (57.1%) was identified as beneficial much more often than physical activity (31.3%), healthy eating (23.3%) and other cardiovascular health behaviours. Women, people of English-speaking origin, and those having contact with a person with dementia, showed better knowledge of several health behaviours. CONCLUSIONS: Growing attention is being given to population risk reduction to combat the dramatic increase in the burden of disease due to dementia. In Australia many people do not yet hold beliefs and knowledge that support this, which highlights the need for concerted awareness raising that dementia is not an inevitable aspect of ageing, and for education about the role of vascular health in dementia risk reduction.

Community understanding of the preventability of major health conditions as a measure of health literacy.

OBJECTIVE: To examine health literacy in a rural community by measuring the understanding of the preventable nature of six major health conditions. DESIGN: Cross-sectional population survey. SETTING: New housing areas of Strathfieldsaye, Victoria. PARTICIPANTS: A total of 197 adults aged 18 years or older. MAIN OUTCOME MEASURES: Perceived preventability of skin cancer, lung cancer, cervical cancer, high blood pressure, heart attack and diabetes. RESULTS: Skin cancer was the only condition which most people perceived as being all or mostly preventable (50.3%). Lung cancer was perceived to be all or mostly preventable by 35.5% of respondents, high blood pressure by 34.0%, cervical cancer by 27.4%, diabetes by 25.4% and heart attack by only 14.7%. CONCLUSIONS: This study shows that there is a lack of understanding of the preventability of these health conditions. Efforts need to be directed towards improving the public's knowledge of disease prevention and to ensure that health promotion programs reach populations with the most need.

Role modelling unhealthy behaviours: food and drink sponsorship of peak sporting organisations.

ISSUE ADDRESSED: Organised sport provides an important setting for health promotion. Peak sporting organisations have a role in assisting and overseeing sports clubs, including providing funding opportunities. As such, sponsorship of these organisations may influence the funding of community sport. This study aimed to describe the nature and scope of peak sporting organisations' sponsorship, and particularly food and beverage company sponsors. METHODS: An analysis of national and state sporting organisations'websites for the nine most popular sports for children and from four Australian states and territories was conducted using a structured survey tool. Information collected included the number and type of sponsors and sponsorship policies.The nature of food and beverage sponsors was defined as more healthy or less healthy using criteria from a Delphi survey. RESULTS: 443 sponsors were identified across 55 websites. Overall, 9% of sponsors were food companies and 3% were alcohol manufacturers. The majority of food companies (63%) and alcohol manufacturers (100%) did not meet criteria as healthy sponsors. CONCLUSIONS: Sponsorship of peak sporting organisations is widespread and consists of a relatively high proportion of alcohol manufacturers and food companies, some of which produce products considered to be unhealthy.This sponsorship may influence community sport through sponsored sporting programs or by indicating sponsors' acceptability.

Self-reported confidence in recall as a predictor of validity and repeatability of physical activity questionnaire data.

BACKGROUND: Self-reported confidence ratings have been used in other research disciplines as a tool to assess data quality, and may be useful in epidemiologic studies. METHODS: We examined whether self-reported confidence in recall of physical activity was a predictor of the validity and retest reliability of physical activity measures from the European Prospective Investigation into Cancer and Nutrition (EPIC) past-year questionnaire and the International Physical Activity Questionnaire (IPAQ) last-7-day questionnaire.During 2005-2006 in Sydney, Australia, 97 men and 80 women completed both questionnaires at baseline and at 10 months and wore an accelerometer as an objective comparison measure for three 7-day periods during the same timeframe. Participants rated their confidence in recalling physical activity for each question using a 5-point scale and were dichotomized at the median confidence value. RESULTS: Participants in the high-confidence group had higher validity and repeatability coefficients than those in the low-confidence group for most comparisons. The differences were most apparent for validity of IPAQ moderate activity: Spearman correlation rho = 0.34 (95% confidence interval [CI] = 0.08 to 0.55) and 0.01 (-0.17 to 0.20) for high- and low-confidence groups, respectively; and repeatability of EPIC household activity: rho = 0.81 (0.72 to 0.87) and 0.63 (0.48 to 0.74), respectively, and IPAQ vigorous activity: rho = 0.58 (0.43 to 0.70) and 0.29 (0.07 to 0.49), respectively. Women were less likely than men to report high recall confidence of past-year activity (adjusted odds ratio = 0.38; 0.18 to 0.80). CONCLUSIONS: Confidence ratings could be useful as indicators of recall accuracy (ie, validity and repeatability) of physical activity measures, and possibly for detecting differential measurement error and identifying questionnaire items that require improvement.

Validity and repeatability of the EPIC physical activity questionnaire: a validation study using accelerometers as an objective measure.

BACKGROUND: A primary aim of the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort study is to examine the association between total physical activity levels (comprising occupational, household and recreational activity) and the incidence of cancer. We examined the validity and long-term repeatability of total physical activity measurements estimated from the past-year recall EPIC questionnaire, using accelerometers as an objective reference measure. METHODS: Participants included 100 men and 82 women aged 50-65 years. Criterion validity was assessed by comparing the physical activity estimates from the EPIC questionnaire with total activity estimated from the average of three separate 7-day accelerometer periods during the same (past-year) period. Long-term repeatability of the EPIC questionnaire was assessed by comparing the responses from the baseline and 10-month administrations. Past-year EPIC estimates were also compared with the Friedenreich Lifetime Total Physical Activity Questionnaire to examine whether recent activity reflected lifetime activity. RESULTS: Accelerometer total metabolic equivalent (MET)-hours/week were positively associated with a total physical activity index (Spearman rank correlation rho = 0.29, 95% confidence interval (CI) 0.15, 0.42) and with non-occupational activity estimated in MET-hours/week (rho = 0.21, 95% CI 0.07, 0.35). Stratified analyses suggested stronger correlations for non-occupational activity for participants who were male, had a lower BMI, were younger, or were not full-time workers, although the differences in correlations between groups were not statistically significant. The weighted kappa coefficient for repeatability of the total physical activity index was 0.62 (95% CI 0.53, 0.71). Spearman correlations for repeatability of components of activity were 0.65 (95% CI 0.55, 0.72) for total non-occupational, 0.58 (95% CI 0.48, 0.67) for recreational and 0.73 (95% CI 0.66, 0.79) for household activity. When past-year activity was compared to lifetime estimates of activity, there was fair agreement for non-occupational (rho = 0.26) activity, which was greater for household activity (rho = 0.46) than for recreational activity (rho = 0.21). CONCLUSION: Our findings suggest that the EPIC questionnaire has acceptable measurement characteristics for ranking participants according to their level of total physical activity. The questionnaire should be able to identify the presence or absence of reasonably strong aetiological associations when either recent or long-term activity is the responsible factor.

Comparison of tobacco, alcohol and illegal drug usage among school students in three Pacific Island societies.

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

Health behaviour and lifestyle of Pacific youth surveys: a resource for capacity building.

The changing global socio-economic environment over the last two decades has had significant ramifications for the health and development of youth in lower- and middle-income countries. In the Pacific region, young people are exposed to similar causes of ill-health as their peers in developed countries. This paper describes the development, implementation and major findings of the Health Behaviour and Lifestyle of Pacific Youth (HBLPY) surveys, a regional initiative to obtain representative data about health-related behaviour and needs of adolescents in Vanuatu, Tonga and the Federated States of Micronesia. The Pacific HBLPY is modelled on the WHO Europe Health Behaviour in School-aged Children (HBSC) surveys. The surveys, undertaken in 2000-2001, were built upon strong local partnerships and were undertaken with youth participation to ensure survey ownership. A regional technical group was formed to provide training and support to strengthen health survey capacity of youth and their agencies. The findings showed that tobacco was most commonly used substance, with 29.7% of 15-year-old boys and 15.7% of girls smoking weekly. Over half of the students did not engage in physical activity for at least 2 h per week; these rates are substantially lower than those usually found in Europe. Dietary habits among this group are also of concern, reflecting international trends away from highly nutritious traditional diets. The HBLPY surveys have shown that it is possible to collect population-based data in lower- and middle-income countries so that appropriate youth health programmes and policies can be developed. Implementation of an ongoing surveillance system similar to the HBLPY model in these countries warrants further investigation. Such initiatives should be supported at the regional and global level.

Physical activity is important, but can it be promoted in general practice?

The multisector approach to reducing smoking may be a good model for tackling physical activity.