Unintended consequences: Alcohol screening at urban Aboriginal Community Controlled Health Services was suppressed during COVID-19 lockdowns.

INTRODUCTION: Regular screening for risky drinking is important to improve the health of Aboriginal and Torres Strait Islander Australians. We explored whether the rate of screening for risky drinking using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) questions was disrupted at Aboriginal Community Controlled Health Services (ACCHS) during state-wide and territory-wide COVID-19 lockdowns in 2020. METHODS: Retrospective analysis of screening data from 22 ACCHSs located in New South Wales, the Northern Territory, Queensland, South Australia, Victoria and Western Australia. These services provide holistic and culturally appropriate primary care. A multi-level Poisson regression, including AR(1) autocorrelation, was used to predict counts of AUDIT-C screening at ACCHSs. RESULTS: AUDIT-C screening was suppressed during state-wide and territory-wide lockdowns in 2020 (incident rate ratio [IRR] 0.42 [0.29, 0.61]). The effect of lockdowns differed by service remoteness. While there was a substantial reduction in AUDIT-C screening for urban and inner regional services (IRR 0.25 [95% confidence interval (CI) 0.15, 0.42]), there was not a statistically significant change in screening at outer regional and remote (IRR 0.60 [95% CI 0.33, 1.09]) or very remote services (IRR 0.67 [95% CI 0.40, 1.11]). DISCUSSION AND CONCLUSIONS: The COVID-19 lockdowns in Australia likely suppressed rates of screening for risky drinking in urban and inner regional regions. As harm from alcohol consumption may have increased during lockdowns, policymakers should consider implementing measures to enable screening for risky drinking to continue during future lockdowns.

Five-Year Trajectories of Prescription Opioid Use.

Importance: There are known risks of using opioids for extended periods. However, less is known about the long-term trajectories of opioid use following initiation. Objective: To identify 5-year trajectories of prescription opioid use, and to examine the characteristics of each trajectory group. Design, Setting, and Participants: This population-based cohort study conducted in New South Wales, Australia, linked national pharmaceutical claims data to 10 national and state data sets to determine sociodemographic characteristics, clinical characteristics, drug use, and health services use. The cohort included adult residents (aged ≥18 years) of New South Wales who initiated a prescription opioid between July 1, 2003, and December 31, 2018. Statistical analyses were conducted from February to September 2022. Exposure: Dispensing of a prescription opioid, with no evidence of opioid dispensing in the preceding 365 days, identified from pharmaceutical claims data. Main Outcomes and Measures: The main outcome was the trajectories of monthly opioid use over 60 months from opioid initiation. Group-based trajectory modeling was used to classify these trajectories. Linked health care data sets were used to examine characteristics of individuals in different trajectory groups. Results: Among 3 474 490 individuals who initiated a prescription opioid (1 831 230 females [52.7%]; mean [SD] age, 49.7 [19.3] years), 5 trajectories of long-term opioid use were identified: very low use (75.4%), low use (16.6%), moderate decreasing to low use (2.6%), low increasing to moderate use (2.6%), and sustained use (2.8%). Compared with individuals in the very low use trajectory group, those in the sustained use trajectory group were older (age ≥65 years: 22.0% vs 58.4%); had more comorbidities, including cancer (4.1% vs 22.2%); had increased health services contact, including hospital admissions (36.9% vs 51.6%); had higher use of psychotropic (16.4% vs 42.4%) and other analgesic drugs (22.9% vs 47.3%) prior to opioid initiation, and were initiated on stronger opioids (20.0% vs 50.2%). Conclusions and relevance: Results of this cohort study suggest that most individuals commencing treatment with prescription opioids had relatively low and time-limited exposure to opioids over a 5-year period. The small proportion of individuals with sustained or increasing use was older with more comorbidities and use of psychotropic and other analgesic drugs, likely reflecting a higher prevalence of pain and treatment needs in these individuals.

Adolescent Pregnancy in South Asia: A Pooled Analysis of Demographic and Health Surveys.

Adolescent pregnancy has important health and social implications. Despite the availability of nationally representative household survey data, there are limited studies that analyze factors associated with adolescent pregnancy across countries of South Asia. This study aimed to identify factors associated with adolescent pregnancy across South Asia. This study used the most recent Demographic and Health Survey (DHS) data from six countries in South Asia: Afghanistan, Bangladesh, India, the Maldives, Nepal, and Pakistan. Pooled individual record data from 20,828 ever-married women aged 15-19 years were used for the analysis. Multivariable logistic regression analysis, informed by the World Health Organization framework on social determinants of health, was performed to examine factors associated with adolescent pregnancy. Adolescent pregnancy was highest in Afghanistan compared to Bangladesh, Nepal, Pakistan, India, and the Maldives. Multivariable analyses confirmed that being from a poor household or male-headed household, increasing maternal age, having no access to newspapers, and having no knowledge of family planning were significantly associated with adolescent pregnancy. The use or intention to use contraceptives was protective against adolescent pregnancy. To reduce adolescent pregnancy in South Asia, interventions targeting adolescents from poor households with limited access to mass media should be considered, especially those from households with an existing patriarchal structure.

Cohort profile: POPPY II - a population-based cohort examining the patterns and outcomes of prescription opioid use in New South Wales, Australia.

PURPOSE: The POPPY II cohort is an Australian state-based cohort linking data for a population of individuals prescribed opioid medicines, constructed to allow a robust examination of the long-term patterns and outcomes of prescription opioid use. PARTICIPANTS: The cohort includes 3 569 433 adult New South Wales residents who initiated a subsidised prescription opioid medicine between 2003 and 2018, identified through pharmacy dispensing data (Australian Pharmaceutical Benefits Scheme) and linked to 10 national and state datasets and registries including rich sociodemographic and medical services data. FINDINGS TO DATE: Of the 3.57 million individuals included in the cohort, 52.7% were female and 1 in 4 people were aged ≥65 years at the time of cohort entry. Approximately 6% had evidence of cancer in the year prior to cohort entry. In the 3 months prior to cohort entry, 26.9% used a non-opioid analgesic and 20.5% used a psychotropic medicine. Overall, 1 in 5 individuals were initiated on a strong opioid (20.9%). The most commonly initiated opioid was paracetamol/codeine (61.3%), followed by oxycodone (16.3%). FUTURE PLANS: The POPPY II cohort will be updated periodically, both extending the follow-up duration of the existing cohort, and including new individuals initiating opioids. The POPPY II cohort will allow a range of aspects of opioid utilisation to be studied, including long-term trajectories of opioid use, development of a data-informed method to assess time-varying opioid exposure, and a range of outcomes including mortality, transition to opioid dependence, suicide and falls. The duration of the study period will allow examination of population-level impacts of changes to opioid monitoring and access, while the size of the cohort will also allow examination of important subpopulations such as people with cancer, musculoskeletal conditions or opioid use disorder.

Evaluating clinician experience in value-based health care: the development and validation of the Clinician Experience Measure (CEM).

BACKGROUND: Clinicians' experiences of providing care constitute an important outcome for evaluating care from a value-based healthcare perspective. Yet no currently available instruments have been designed and validated for assessing clinicians' experiences. This research sought to address this important gap by developing and validating a novel instrument in a public health system in Australia. METHODS: A multi-method project was conducted using co-design with 12 clinician leaders from a range of NSW Health Local Health Districts to develop the Clinician Experience Measure (CEM). Validity and reliability analyses were conducted in two stages, first assessing face and content validity with a pool of 25 clinicians and then using psychometric analysis with data from 433 clinicians, including nurses, doctors and allied health and representing all districts within one jurisdiction in Australia. RESULTS: Data gathered from 25 clinicians via the face and content validity process indicated that the initial 31-items were relevant to the range of staff employed in the NSW state health system, with minor edits made to the survey layout and wording within two items. Psychometric analysis led to a rationalised 18-item final instrument, comprising four domains: psychological safety (4-items); quality of care (5-items); clinician engagement (4-items) and interprofessional collaboration (5-items). The 18-item four-factor model produced a good fit to the data and high levels of reliability, with factor loadings ranging from .62 to .94, with Cronbach's alpha (range: .83 to .96) and composite reliability (range: .85 to .97). CONCLUSIONS: The CEM is an instrument to capture clinicians' experiences of providing care across a health system. The CEM provides a useful tool for healthcare leaders and policy makers to benchmark and assess the impact of value-based care initiatives and direct change efforts.

Adolescent Pregnancy in South Asia: A Systematic Review of Observational Studies.

Adolescent pregnancy is a major health and social concern in South Asia. The aim of this study is to systematically review evidence on the factors associated with adolescent pregnancy in South Asia. This study was conducted using Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 guidelines. Four electronic databases: EMBASE, PubMed, CINAHL, and Scopus were searched for relevant studies on factors associated with adolescent pregnancy in South Asia published in English between January 2000 and July 2022. The quality of the included studies was assessed using 12 criteria from The National Institute of Health (NIH) Study Quality Assessment Tools for observational studies. Of the 166 articles retrieved, only 15 studies met the eligibility criteria and were included in the final analysis. Consistent factors associated with adolescent pregnancy in South Asia were low maternal education, low socioeconomic status, rural residency, and ethnic minorities. To prevent adolescent pregnancy in South Asia, concerted effort towards promoting health equity by addressing the predisposing factors associated with adolescent pregnancy is essential. This systematic review was registered with PROSPERO [CRD42022340344].

Effects of service-wide support on regularity of alcohol screening of clients in Australian Aboriginal and Torres Strait Islander Community Controlled Health Services: a cluster randomised trial.

BACKGROUND: We have previously shown that service-wide support can increase the odds of alcohol screening in any 2-month period in a cluster randomized trial of service-wide support to Aboriginal and Torres Strait Islander Community Controlled Health Services (ACCHS). Here we report an exploratory analysis on whether the resulting pattern of screening was appropriate. AIM: we assess whether that increase in screening was associated with: (i) increased first-time screening, (ii) increased annual screening, (iii) whether frequently screened clients fell into one of four risk categories as defined by national guidelines. METHODS: Setting and participants: 22 ACCHS; randomized to receive the support model in the treatment ('early-support') arm over 24-months or to the waitlist control arm. INTERVENTION: eight-component support, including training, sharing of experience, audit-and-feedback and resource support. ANALYSIS: records of clients with visits before and after start of implementation were included. Multilevel logistic modelling was used to compare (i) the odds of previously unscreened clients receiving an AUDIT-C screen, (ii) odds of clients being screened with AUDIT-C at least once annually. We describe the characteristics of a sub-cohort of clients who received four or more screens annually, including if they were in a high-risk category. RESULTS: Of the original trial sample, 43,054 met inclusion criteria, accounting for 81.7% of the screening events in the overall trial. The support did not significantly increase the odds of first-time screening (OR = 1.33, 95% CI 0.81-2.18, p = 0.25) or of annual screening (OR = 0.99, 95% CI 0.42-2.37, p = 0.98). Screening more than once annually occurred in 6240 clients. Of the 841 clients with four or more screens annually, over 50% did not fall into a high-risk category. Females were overrepresented. More males than females fell into high-risk categories. CONCLUSION: The significant increase in odds of screening observed in the main trial did not translate to significant improvement in first-time or annual screening following implementation of support. This appeared to be due to some clients being screened more frequently than annually, while more than half remained unscreened. Further strategies to improve alcohol screening should focus on appropriate screening regularity as well as overall rates, to ensure clinically useful information about alcohol consumption. Trial Registration ACTRN12618001892202, retrospectively registered 16 November 2018 https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12618001892202 .

Impact of a structured older persons health assessment on herpes zoster vaccine uptake in Australian primary care.

Vaccine uptake in adult immunisation programs is often suboptimal. We aimed to assess the impact of the structured older persons health assessment (health assessment) on herpes zoster (zoster) vaccine uptake in Australia. We used national general practice electronic medical records (MedicineInsight) of encounters with patients aged 75-79 years because these patients were age-eligible for both free zoster vaccines and health assessments in the two years following the addition of zoster vaccine to the national immunisation program (Nov 2016-Dec 2018). Due to repeated encounters, we used generalized estimating equations with each patient treated as a clustering variable to analyse the comparison of rates of zoster vaccine administration during encounters where a health assessment was provided versus encounters where the health assessment was not provided. In analyses there were 31,876 patients with a total of 266,204 eligible general practice encounters. Of the 5018 encounters where a health assessment was provided, 592 zoster vaccinations also occurred on the same day (118.0/1000 encounters); for the 261,186 encounters where no health assessment was provided, 9226 zoster vaccinations occurred (35.3/1000 encounters). Zoster vaccine was more likely to be administered during a general practice encounter with a health assessment compared to encounters without one (adjusted odds ratio 2.99; 95% CI: 2.76-3.23). In conclusion, the structured older persons health assessment, which acts as both an incentive and a reminder for healthcare providers to recommend vaccinations in adults improves uptake of zoster vaccine in eligible adults. Such interventions may have a role in improving vaccine uptake among older adults.

Support can increase use of the AUDIT-C in Australian Aboriginal Community Controlled Health Services: a cluster randomized trial.

BACKGROUND AND AIMS: Unhealthy alcohol consumption is a key concern for Aboriginal and Torres Strait Islander ('Indigenous') communities. It is important to identify and treat at-risk drinkers, to prevent harms to physical or social wellbeing. We aimed to test whether training and support for Aboriginal Community Controlled Health Service (ACCHS) staff would increase rates of alcohol screening and brief intervention. DESIGN: Cluster randomized trial. SETTING: Australia. Cases/Intervention/Measurements Twenty-two ACCHSs that see at least 1000 clients per year and use Communicare as practice management software. The study included data on 70 419 clients, training, regular data feedback, collaborative support and funding for resources ($9000). Blinding was not used. The comparator was waiting-list control (equal allocation). Alcohol Use Disorder Identification Test (AUDIT-C) screening and records of brief interventions were extracted from practice management software at 2-monthly intervals. Observations described the clinical actions taken for clients over each 2-month interval. The baseline period (28 August 2016-28 August 2017) was compared with the post-implementation period (29 August 2017-28 August 2018). We used multi-level logistic regression to test the hypotheses that clients attending a service receiving active support would be more likely to be screened with AUDIT-C (primary outcome) or to receive a brief intervention (secondary outcome). FINDINGS: We observed an increase in the odds of screening with AUDIT-C for both groups, but the increase was 5.52 [95% confidence interval (CI) = 4.31, 7.07] times larger at services receiving support. We found little evidence that the support programme increased the odds of a recorded brief intervention relative to control services (odds ratio = 2.06; 95% CI = 0.90, 4.69). Differences in baseline screening activity between treatment and control reduce the certainty of our findings. CONCLUSIONS: Providing Aboriginal Community Controlled Health Services with training and support can improve alcohol (AUDIT-C) screening rates.

Reductions in emergency department presentations associated with opioid agonist treatment vary by geographic location: A retrospective study in New South Wales, Australia.

INTRODUCTION AND AIMS: It is not known if the reduction in ED use during periods of OAT occurs across urgent and low acuity presentations. We aimed to compare the incidence and costs of urgent and low acuity ED presentations of people with opioid use disorder (OUD) in and out of opioid agonist treatment (OAT). DESIGN AND METHODS: This was a retrospective cohort study (N=24,875), using linked administrative health data from New South Wales (NSW), Australia. Urgent and low acuity ED incidence and associated costs were calculated for periods in and out of OAT. GEE models estimated the adjusted incidence rate ratio (IRR) for ED presentations. Average costs per person-day were calculated with bootstrap confidence intervals. RESULTS: Incidence of urgent presentations was lower in OAT compared to out of OAT [IRR (95%CI): 0.65 (0.61-0.69)]. In major cities, low acuity presentations were lower during OAT compared to timeout of OAT [IRR (95%CI): 0.82 (0.70-0.96)], in regional/remote areas, low acuity presentations were higher during OAT [IRR (95%CI): 2.65 (1.66-4.21)]. In major cities, average costs for low acuity presentations in OAT were 28% lower atA$0.50 (95%CI: A$0.48-A$0.52) and A$0.69 (95%CI: A$0.66-A$0.71) out of OAT, but 103% higher in regional/remote NSW, at A$2.12 (95%CI: A$1.91-A$2.34) in OAT and A$1.04 (95%CI: A$0.91-A$1.16) out of OAT. DISCUSSION AND CONCLUSIONS: OAT was associated with reductions in urgent ED presentations and associated costs among people with OUD. Geographical variation was evident for low acuity ED presentations, highlighting the need to increase access to OAT in regional/remote areas.

The impact of permissive and restrictive pharmaceutical policies on quetiapine dispensing: Evaluating a policy pendulum using interrupted time series analysis.

PURPOSE: To evaluate the impact of 2 policy changes on quetiapine dispensing in Australia: removal of prior authorisation for prescribing (policy 1: July 2007) and removal of repeat prescriptions for 25-mg quetiapine (policy 2: January 2014). METHODS: We performed an interrupted time series analysis using Pharmaceutical Benefits Scheme claims data (July 2005 to December 2015). We assessed the impact of both policies on monthly quetiapine dispensing (25 mg and >25 mg) and the impact of policy change 2 on monthly rates of 25-mg discontinuation and switching from 25 mg to other quetiapine strengths. We also estimated the impact of both policies on the proportion of people with potentially inappropriate therapy (no evidence of dose escalation) following 25-mg initiation. RESULTS: Following removal of prior authorisation, 25-mg and >25-mg quetiapine dispensing in the Pharmaceutical Benefits Scheme 10% sample increased by 11/month (95% CI: 2-21) and 14/month (95% CI: 8-20), respectively. After removing 25-mg repeats, there was a permanent decrease of 1072 (95% CI 773-1371) dispensings and an increase in discontinuation of this strength; 48% of people dispensed the 25-mg strength that discontinued, discontinued quetiapine completely; the remainder continued to use higher quetiapine strengths. We observed minimal switching to other quetiapine strengths. There was no change in inappropriate 25-mg therapy following policy change 1 and a small decrease (79% to 76%, P = 0.05) following policy change 2. CONCLUSION: More nuanced policies are needed to ensure the appropriate access to 25-mg quetiapine for dose escalation while discouraging use for indications where the evidence of risk and benefit is unclear.

Understanding barriers to fruit and vegetable intake in the Australian Longitudinal Study of Indigenous Children: a mixed-methods approach.

OBJECTIVE: To identify barriers to fruit and vegetable intake for Indigenous Australian children and quantify factors related to these barriers, to help understand why children do not meet recommendations for fruit and vegetable intake. DESIGN: We examined factors related to carer-reported barriers using multilevel Poisson models (robust variance); a key informant focus group guided our interpretation of findings. SETTING: Eleven diverse sites across Australia. SUBJECTS: Australian Indigenous children and their carers (N 1230) participating in the Longitudinal Study of Indigenous Children. RESULTS: Almost half (45 %; n 555/1230) of carers reported barriers to their children's fruit and vegetable intake. Dislike of fruit and vegetables was the most common barrier, reported by 32·9 % of carers; however, we identified few factors associated with dislike. Carers were more than ten times less likely to report barriers to accessing fruit and vegetables if they lived large cities v. very remote areas. Within urban and inner regional areas, child and carer well-being, financial security, suitable housing and community cohesion promoted access to fruit and vegetables. CONCLUSIONS: In this national Indigenous Australian sample, almost half of carers faced barriers to providing their children with a healthy diet. Both remote/outer regional carers and disadvantaged urban/inner regional carers faced problems accessing fruit and vegetables for their children. Where vegetables were accessible, children's dislike was a substantial barrier. Nutrition promotion must address the broader family, community, environmental and cultural contexts that impact nutrition, and should draw on the strengths of Indigenous families and communities.

Assessing measures of comorbidity and functional status for risk adjustment to compare hospital performance for colorectal cancer surgery: a retrospective data-linkage study.

BACKGROUND: Comparing outcomes between hospitals requires consideration of patient factors that could account for any observed differences. Adjusting for comorbid conditions is common when studying outcomes following cancer surgery, and a commonly used measure is the Charlson comorbidity index. Other measures of patient health include the ECOG performance status and the ASA physical status score. This study aimed to ascertain how frequently ECOG and ASA scores are recorded in population-based administrative data collections in New South Wales, Australia and to assess the contribution each makes in addition to the Charlson comorbidity index in risk adjustment models for comparative assessment of colorectal cancer surgery outcomes between hospitals. METHODS: We used linked administrative data to identify 6964 patients receiving surgery for colorectal cancer in 2007 and 2008. We summarised the frequency of missing data for Charlson comorbidity index, ECOG and ASA scores, and compared patient characteristics between those with and without these measures. The performance of ASA and ECOG in risk adjustment models that also included Charlson index was assessed for three binary outcomes: 12-month mortality, extended length of stay and 28-day readmission. Patient outcomes were compared between hospital peer groups using multilevel logistic regression analysis. RESULTS: The Charlson comorbidity index could be derived for all patients, ASA score was recorded for 78 % of patients and ECOG performance status recorded for only 24 % of eligible patients. Including ASA or ECOG improved the predictive ability of models, but there was no consistently best combination. The addition of ASA or ECOG did not substantially change parameter estimates for hospital peer group after adjusting for Charlson comorbidity index. CONCLUSIONS: While predictive ability of regression models is maximised by inclusion of one or both of ASA score and ECOG performance status, there is little to be gained by adding ASA or ECOG to models containing the Charlson comorbidity index to address confounding. The Charlson comorbidity index has good performance and is an appropriate measure to use in risk adjustment to compare outcomes between hospitals.

A place to call home: study protocol for a longitudinal, mixed methods evaluation of two housing first adaptations in Sydney, Australia.

BACKGROUND: This protocol describes a study evaluating two 'Housing First' programs, Platform 70 and Common Ground, presently being implemented in the inner-city region of Sydney, Australia. The Housing First approach prioritises housing individuals who are homeless in standard lease agreement tenancies as rapidly as possible to lock in the benefits from long-term accommodation, even where the person may not be seen as 'housing ready'. METHODS/DESIGN: The longitudinal, mixed methods evaluation utilises both quantitative and qualitative data collected at baseline and 12-month follow-up time points. For the quantitative component, clients of each program were invited to complete client surveys that reported on several factors associated with chronic homelessness and were hypothesised to improve under stable housing, including physical and mental health status and treatment rates, quality of life, substance use patterns, and contact with the health and criminal justice systems. Semi-structured interviews with clients and stakeholders comprised the qualitative component and focused on individual experiences with, and perceptions of, the two programs. In addition, program data on housing stability, rental subsidies and support levels provided to clients by agencies was collected and will be used in conjunction with the client survey data to undertake an economic evaluation of the two programs. DISCUSSION: This study will systematically evaluate the efficacy of a scatter site model (Platform 70) and a congregated model (Common Ground) of the Housing First approach; an examination that has not yet been made either in Australia or internationally. A clear strength of the study is its timing. It was designed and implemented as the programs in question themselves were introduced. Moreover, the programs were introduced when the Australian Government, with State and Territory support, began a more focused, coordinated response to homelessness and funded rapid expansion of innovative homelessness programs across the country, including Common Ground supportive housing developments.

Multicenter randomized trial of centralized nurse-led telephone-based care coordination to improve outcomes after surgical resection for colorectal cancer: the CONNECT intervention.

PURPOSE: To investigate the effectiveness of a centralized, nurse-delivered telephone-based service to improve care coordination and patient-reported outcomes after surgery for colorectal cancer. PATIENTS AND METHODS: Patients with a newly diagnosed colorectal cancer were randomly assigned to the CONNECT intervention or usual care. Intervention-group patients received standardized calls from the centrally based nurse 3 and 10 days and 1, 3, and 6 months after discharge from hospital. Unmet supportive care needs, experience of care coordination, unplanned readmissions, emergency department presentations, distress, and quality of life (QOL) were assessed by questionnaire at 1, 3, and 6 months. RESULTS: Of 775 patients treated at 23 public and private hospitals in Australia, 387 were randomly assigned to the intervention group and 369 to the control group. There were no significant differences between groups in unmet supportive care needs, but these were consistently low in both groups at both follow-up time points. There were no differences between the groups in emergency department presentations (10.8% v 13.8%; P = .2) or unplanned hospital readmissions (8.6% v 10.5%; P = .4) at 1 month. By 6 months, 25.6% of intervention-group patients had reported an unplanned readmission compared with 27.9% of controls (P = .5). There were no significant differences in experience of care coordination, distress, or QOL between groups at any follow-up time point. CONCLUSION: This trial failed to demonstrate substantial benefit of a centralized system to provide standardized, telephone follow-up for postoperative patients with colorectal cancer. Future interventions could investigate a more tailored approach.

Influences on consumption of soft drinks and fast foods in adolescents.

Soft drink and fast food are energy dense foodstuffs that are heavily marketed to adolescents, and are likely to be important in terms of risk of obesity. This study sought to examine the influences on soft drink and fast food consumption among adolescents as part of a cross-sectional survey of 2,719 adolescents (aged 11-16) from 93 randomly selected schools in New South Wales, Australia. Students provided information on soft drink and fast food consumption, and responded to statements examining influences over consumption. Over half of the boys and more than one third of the girls reported drinking soft drink daily, and consumption peaked in Grade 8 students. A quarter of students reported choosing soft drinks instead of water or milk, and around 40% agreed that soft drink was usually available in their homes. Availability in the home and drinking soft drinks with meals was most strongly associated with consumption in all age groups. Fast food consumption was higher among boys than girls in all age groups. Convenience and value for money yielded the strongest associations with fast food consumption in boys, while preferring fast food to meals at home and preferring to "upsize" meals were most strongly associated with consumption in girls. Interventions to reduce consumption of soft drinks should target availability in both the home and school environment by removing soft drinks and replacing them with more nutritive beverages. Fast food outlets should be encouraged to provide a greater range of healthy and competitively priced options in reasonable portions.

Costs of managing conditions associated with obesity among Australian teenagers.

AIM: To determine the health-care charges associated with monitoring and managing, over 1 year, the cases of elevated insulin concentration, elevated alanine aminotransferase concentration and dyslipidaemia due to overweight or obesity among 15-19-year-old Australian males and females. METHODS: Fasting blood samples (n= 500) were collected in 2004 from a representative population sample of adolescents (n= 496; mean age 15.3 years) attending schools in Sydney, Australia. Full service charges and Medicare expenditures for specialist medical and dietary consultations, pathology tests and radiological investigations, over 1 year, under efficient and inefficient health-care delivery models, including and excluding participants in the healthy body mass index (BMI) category. RESULTS: Under an inefficient delivery model and including all participants with elevated risk factors, the Medicare expenditure was $A305.1 million per annum (M pa). Exclusion of participants in the healthy BMI category resulted in an annual Medicare expenditure of $A170.0M pa. Under an efficient delivery model and including all participants with elevated risk factors, the Medicare expenditure was $A295.5M pa. Exclusion of participants in the healthy BMI category reduced annual Medicare expenditure to $A164.8M pa. Medicare expenditure for 15-19-year-olds would increase by 48% if only cases among overweight and obese adolescents were treated and by 85% if all cases were identified and treated. CONCLUSIONS: Short-term management of the health consequences of overweight and obesity among adolescents will increase Medicare expenditure on this group by at least 48%. Failure to treat will delay, but compound, health-care expenditure.

Physical activity among adolescents in New South Wales (Australia): 1997 and 2004.

PURPOSE: To examine secular trends, seasonal and socioeconomic differences in physical activity participation among Australian adolescents in 1997 and 2004. METHODS: Repeat cross-sectional school survey, conducted in 1997 and 2004. School students were randomly selected from grades 8 and 10 in New South Wales Australia (1997, N = 2026; 2004 N = 1771). Time spent in moderate-to-vigorous physical activity (MVPA) was assessed by self-reported participation in organized and nonorganized physical activity separately for summer and winter by sex, grade, and socioeconomic status (SES). RESULTS: Between survey periods, the proportion of students reporting > or = 60 min.d(-1) of MVPA increased, except among grade 10 boys during winter. MVPA (min.d(-1)) increased among all groups during summer school terms, during winter school terms, MVPA was relatively stable between surveys for grade 8 students but inconsistent among grade 10 students. Organized MVPA increased among all groups in both summer (19-49 min.d(-1)) and winter (7-21 min.d(-1)) school terms. Participation in nonorganized MVPA increased only during summer school terms (4-32 min.d(-1)) and decreased during winter school terms (7-17 min.d(-1)). MVPA increased consistently among students in the high-SES group compared with other SES groups, independent of season, and in some cases MVPA decreased in low-SES groups during winter school terms. CONCLUSION: Overall, the patterns of change were similar for boys and girls, with substantial increases in summer school terms and insubstantial changes during winter school terms (with the exception of a decrease among grade 10 boys). There was a direct association between change in participation in MVPA and SES, indicating that interventions are required to focus on the needs of less-advantaged students.

Effects of school milk intervention on cortical bone accretion and indicators relevant to bone metabolism in Chinese girls aged 10-12 y in Beijing.

BACKGROUND: We previously reported that increased milk consumption enhances growth and bone mineral accretion in Chinese girls aged 10-12 y. OBJECTIVE: Our objective was to evaluate the effects of milk supplementation on cortical bone accretion and to study the physiologic mechanisms underlying the observed changes in bone. DESIGN: Chinese girls aged 10 y were randomly assigned into calcium-fortified milk (Ca milk), calcium and vitamin D-fortified milk (CaD milk), and control groups according to their schools in a 24-mo school milk intervention trial. Periosteal and medullary diameters of metacarpal bone were measured at baseline and 24 mo in the Ca milk (n = 177), CaD milk (n = 210), and control (n = 219) groups. Insulin-like growth factor I (IGF-I), parathyroid hormone (PTH), bone alkaline phosphatase (BAP), osteocalcin, and deoxypyridinoline concentrations were measured at baseline and at 12 and 24 mo in the Ca milk (n = 43), CaD milk (n = 44), and control (n = 41) groups. RESULTS: After adjustment for pubertal status and clustering by school, 24-mo supplementation led to greater increases in periosteal diameter (1.2%) and cortical thickness (5.7%) and to smaller gains in medullary diameter (6.7%) than did the control (P < 0.05). The CaD milk group had lower serum BAP at 12 mo (19.9%) and lower serum PTH at 12 (46.2%) and 24 (16.4%) mo than did the control group (P < 0.05). The effect of milk supplementation on increasing IGF-I concentrations at 24 mo (16.7-23.3%) was significant in individual analyses but not after adjustment for clustering by school. CONCLUSIONS: Milk supplementation showed positive effects on periosteal and endosteal apposition of cortical bone.