Does chief executive compensation predict financial performance or inaccurate financial reporting in listed companies: A systematic review.

Background: Financial incentives for chief executive officers (CEOs) are thought to motivate them to lead their company toward achieving important business objectives. Based on the Rousseau et al. (2019) protocol, this systematic review assesses the predictive effects of CEO incentives on certain business outcomes. Objectives: This review addresses whether CEO financial incentives predict: (1) firm financial performance and (2) financial restatement due to misreporting. Search methods: We searched nine research databases for published peer-reviewed literature (to July 23-26, 2021 and an attenuated search from those dates to July 27-31, 2023) and thirteen professional association websites for non-published gray literature (to August 2021). We also hand-searched selected relevant journals. Selection criteria: We reviewed peer-reviewed and unpublished studies available in English since 1980. Eligible studies regarding our first question assessed CEO financial incentives (1) 1 year or more before the measurement of outcomes, (2) controlled for pre-incentive firm performance or market conditions, and (3) analyzed CEO financial incentives as predictors of firm outcomes. Eligible studies regarding our second question assessed whether financial restatement had occurred and analyzed effects of CEO incentives on this outcome. Data collection and analysis: We extracted standardized regression coefficients for each effect or converted unstandardized regressions to standardized. Analyses were conducted using STATA. All studies were assessed to have moderate risk of bias. Main results: For our first question, 20 studies (15,398 firms) met our criteria for meta-analysis of effects. Bonuses, the most commonly studied incentive, had a small positive effect on next year's accounting performance metric Return on Assets (ROA, 0.046 [k = 7, 95% confidence interval (CI) = 0.014, 0.078]). The bonus effect in the market-related metric of Stock Returns (-0.026 [k = 5, 95% CI = -0.119, 0.067]) fell within a CI including 0, as did its effect on another market-related metric, Market-to-Book value (Tobin's Q, 0.028 [k = 3, 95% CI = -0.024, 0.08]). We conclude that Bonuses show no predictive effect on the following year's market-related metrics but do affect ROA. Stock Options had no effect on next year's ROA (0.027 [k = 5, 0.95% CI = 0.000, 0.052]), nor on Market-to-Book Value (Tobin's Q, 0.097 [k = 5, 95% CI = -0.027, 0.220]) or Stock Return (0.042 [k = 6, -0.033, 0.117]), indicating no predictive effect for Stock Options on either accounting or market-related performance. We sought but found too few studies to report on effects of incentives on other financial outcomes or for lags greater than 1 year. For our second question, three studies (n = 2044 firms) met our criteria. The overall effect size for CEO Incentives on Restatement (-0.09 [k = 3, 95% CI = -0.363, 0.184) fell within a CI including zero. We conclude that current evidence does not support a direct relationship between CEO financial incentives and Restatement. Authors' conclusions: This review affirms a small effect of CEO Bonuses, but no effect of Stock Options, on the accounting performance metric ROA. In contrast, neither Bonuses nor Stock Options predict a firm's market-related metrics. CEO incentives also are unrelated to Financial Restatement. Despite widespread use of CEO financial incentives, lack of evidence supporting their use, beyond the bonus-ROA effect we identify, suggests caution regarding current CEO financial incentive practice and greater consideration of alternative arrangements to enhance firm performance.

Healthcare disparities: patients' perspectives on barriers to joint replacement.

OBJECTIVE: Racial and ethnic disparities in arthroplasty utilization are evident, but the reasons are not known. We aimed to identify concerns that may contribute to barriers to arthroplasty from the patient's perspective. METHODS: We identified patients' concerns about arthroplasty by performing a mixed methods study. Themes identified during semi-structured interviews with Black and Hispanic patients with advanced symptomatic hip or knee arthritis were used to develop a questionnaire to quantify and prioritize their concerns. Multiple linear and logistic regression analyses were conducted to determine the association between race/ethnicity and the importance of each theme. Models were adjusted for sex, insurance, education, HOOS, JR/KOOS, JR, and discussion of joint replacement with a doctor. RESULTS: Interviews with eight participants reached saturation and provided five themes used to develop a survey answered by 738 (24%) participants; 75.5% White, 10.3% Black, 8.7% Hispanic, 3.9% Asian/Other. Responses were significantly different between groups (p < 0.05). Themes identified were "Trust in the surgeon" "Recovery", "Cost/Insurance", "Surgical outcome", and "Personal suitability/timing". Compared to Whites, Blacks were two-fold, Hispanics four-fold more likely to rate "Trust in the surgeon" as very/extremely important. Blacks were almost three times and Hispanics over six times more likely to rate "Recovery" as very/extremely important. CONCLUSION: We identified factors of importance to patients that may contribute to barriers to arthroplasty, with marked differences between Blacks, Hispanics, and Whites.

Preparing students to address the social determinants of health in integrated care settings.

BACKGROUND: Health professionals are increasingly being called to address the social determinants of health (SDOH) and, to do so effectively, often requires an integrated approach to care. As a result, accreditation standards across multiple professions have emphasised the importance of interprofessional education (IPE). APPROACH: This paper describes large-scale, community-engaged learning that is required annually of students from nursing, pharmacy, public health, and social work. Through a series of asynchronous and synchronous activities that are informed by the Interprofessional Education Collaborative core competencies, students are trained to be SDOH change makers who can readily adopt integrated care service delivery frameworks into their future practice. EVALUATION: Approximately 1000 students have participated in this event since the University launched its IPE curriculum in 2017. Student consistently report achievement of the course learning objectives, with 91% of students reporting that the learning activities enhanced their understanding of their professional roles/responsibilities in regards to addressing poverty and food insecurity. IMPLICATIONS: Two key lessons learned from these efforts are described, including the benefits of a trauma-informed pedagogical approach and special considerations for large-scale learning.

PROTOCOL: The effects of agricultural output market access interventions on agricultural, socio-economic and food and nutrition security outcomes in low- and middle-income countries: A systematic review.

Development agencies and international donors' efforts are increasingly focusing on better integrating poor and remote farmers into agricultural markets to address the chronic issues of rural poverty and hunger in low- and middle-income countries. Using systematic methods for information retrieval, critical appraisal and evidence synthesis, this research aims to examine evidence on the effects of five focal types of agricultural market access interventions: (i) farm-to-market transport infrastructure interventions; (ii) output market information interventions; (iii) initiatives creating new marketplaces and alternative marketing opportunities; (iv) contract farming initiatives; (v) interventions improving storage infrastructure. In this review, we will study evidence of the magnitude and direction of intervention effects on agricultural, socio-economic, and food and nutrition security outcomes. We will examine evidence of the distribution of reported effects across different contexts, interventions and sub-groups of the population (e.g., according to sex, socio-economic status, farm size, etc.). We will also report on included studies' risk of bias and on what evidence is available on intervention costs, or their cost-effectiveness. This protocol outlines this review's planned methods and the criteria for selecting and including studies in its analysis.

PROTOCOL: Value chain interventions for improving women's economic empowerment: A mixed-method systematic review.

This is the protocol for a Campbell systematic review. The objectives are as follows: The primary objective of this review is to understand as well as evaluate what approaches, strategies or interventions focused on women's engagement in agricultural value chains and markets that have led to women's economic empowerment in low-and-middle-income countries. The secondary objective of this review is to examine in which contexts are these approaches effective (or ineffective)? What are the contextual barriers and facilitators, determining the participation of women in, and benefits from, engagement in the value chain in low-and middle-income countries programme effectiveness. Finally, this review aims to refine the theory of change that describes how value chain interventions lead to women's economic empowerment using evidence drawn from both rigorous quantitative impact evaluation studies and qualitative studies.

Implementation and assessment of an end-to-end Open Science & Data Collaborations program.

As research becomes more interdisciplinary, fast-paced, data-intensive, and collaborative, there is an increasing need to share data and other research products in accordance with Open Science principles. In response to this need, we created an Open Science & Data Collaborations (OSDC) program at the Carnegie Mellon University Libraries that provides Open Science tools, training, collaboration opportunities, and community-building events to support Open Research and Open Science adoption. This program presents a unique end-to-end model for Open Science programs because it extends open science support beyond open repositories and open access publishing to the entire research lifecycle. We developed a logic model and a preliminary assessment metrics framework to evaluate the impact of the program activities based on existing data collected through event and workshop registrations and platform usage. The combination of these evaluation instruments has provided initial insight into our service productivity and impact. It will further help to answer more in-depth questions regarding the program impact, launch targeted surveys, and identify priority service areas and interesting Open Science projects.

Factors Associated with Health Inequalities in Infectious Disease Pandemics Predating COVID-19 in the United States: A Systematic Review.

Objective: Previous pandemics may offer evidence on mediating factors that contributed to disparities in infection and poor outcomes, which could inform the effort to mitigate potential unequal outcomes during the current COVID-19 pandemic. This systematic review sought to examine those factors. Methods: We searched MEDLINE, PsycINFO, and Cochrane to May 2020. We included studies examining health disparities in adult U.S. populations during infectious disease epidemics or pandemics. Two investigators screened abstracts and full text. We assessed study quality using the Newcastle/Ottawa Scale or the Critical Appraisal Skills Programme Checklist for Qualitative Studies. Results: Sixteen articles were included, of which 14 focused on health disparities during the 2009 H1N1 influenza pandemic. Studies showed that disparities during the H1N1 pandemic were more related to differential exposure to the virus than to susceptibility or access to care. Overall, pandemic-related disparities emanate primarily from inequalities in social conditions that place racial and ethnic minorities and low socioeconomic status populations at greater risk of exposure and infection, rather than individual-level factors such as health behaviors and comorbidities. Conclusions: Policy- and systems-level interventions should acknowledge and address these social determinants of heightened risk, and future research should evaluate the effects of such interventions to avoid further exacerbation of health inequities during the current and future pandemics.

A scoping review exploring reablement models of training and client assessment for older people in primary health care.

AIM: The aim of this scoping review is to explore the evidence by which community service providers have integrated reablement models of staff training and client assessment into practice. BACKGROUND: The concept of reablement, which has emerged during the last two decades globally, has recently been defined by health experts from 11 countries through a Delphi study. Reablement is seen as a way to support integrated frameworks that achieve person-centred, long-term care and assistance across community settings. International research indicates there is some evidence of developing models of reablement that include staff training and individual components of client assessment. However, evidence of integrating reablement into interdisciplinary practice continues to be sparse. METHODS: The review adopted the preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) approach. Inclusion criteria for the review related to community care, primary care, long-term care, and residential care. Populations of interest included service providers, interdisciplinary staff, trainers, and assessors. RESULTS: A total of 11 papers were reviewed. The studies varied in their approach to reablement training and client assessment frameworks. Three studies included assessment of staff well-being. All included evidence-based, person-centred components that can be integrated across health care settings. Single disciplinary approaches were used in all studies and some included training evaluation. CONCLUSION: This review has identified that currently reablement models are not yet embedded as frameworks for practice by community service providers in primary health care settings. Different programmes of training and assessment are being designed based on single disciplinary approaches and the context in which they are delivered. Further developmental work is required to integrate the components of discipline-specific training programmes within interdisciplinary frameworks. This will achieve not only an integrated framework for delivery across settings but also further the success of 'ageing in place' policy.

Leveraging microgrants to support capacity-building workshops in low- and middle-income countries for meeting the Sustainable Development Goals.

Twenty fifteen marked the year of assessment for the Millennium Development Goals (MDGs). The MDGs that achieved the greatest success were those where evidence-based practice (EBP) interventions were implemented. The ability to practice evidence-based medicine is grounded in the creation of and access to medical literature that synthesizes research findings. The role that global health literature played in the success of the MDGs demonstrates that medical libraries and librarians have a role to play in achieving the Sustainable Development Goals (SDGs). Librarians can hold capacity-building workshops that provide instruction on how to access evidence-based literature and also train health professionals to conduct synthesis research. Research findings conducted by in-country health professionals are more likely to address issues being faced by local communities and will afford the possibility of obtaining the necessary evidence-based answers that can then be used to implement policies to resolve public health issues identified in the SDGs. This paper discusses how an international team of librarians leveraged funding from a Medical Library Association/Librarians without Borders/Elsevier Foundation/Research4Life grant to hold a capacity-building workshop in Zimbabwe and follow-up online trainings. The workshop focused on accessing evidence-based resources and conducting synthesis research. Outcomes included the creation and policy implementation of evidence-based knowledge products in alignment with local needs and galvanizing a multisectoral group of key individuals who have gone on to collaborate toward the vision of creating a Zimbabwe innovation hub. Looking ahead, such grants can be leveraged to conduct capacity-building to support knowledge translation and other local training needs.

Assessment of a comprehensive naloxone education program's impact on community member knowledge and attitudes on a college campus.

Objective: Access to naloxone is a priority for reducing opioid overdose deaths. Although participants who receive naloxone training are able to successfully administer it, the impact of training on community member knowledge and attitudes has not been explored. Participants: A total of 105 participants 18 years and older at a medium-sized university completed assessments between August and December 2019. Methods: Participants were scheduled to complete a standardized 30-minute naloxone training as developed by the research team. Assessments were taken at baseline, immediately following, and three-months following education using the Opioid Overdose Knowledge Scale (OOKS) and Opioid Overdose Attitudes Scale (OOAS). Results: The primary endpoint of change from baseline to immediate post-education for total OOKS and OOAS median scores significantly improved (p < 0.001) by 31 and 34 points, respectively. Conclusions: Naloxone education provides an opportunity to improve community attitudes and reduce stigma over time.

Making the case for librarian expertise to support evidence synthesis for the sustainable development goals.

Evidence syntheses that engage librarians as co-authors produce higher-quality results than those that do not. Trained as teachers, researchers, and information managers, librarians possess expert knowledge on research methodologies and information retrieval approaches that are critical for evidence synthesis. Researchers are under increasing pressure to produce evidence syntheses to inform practice and policymaking. Many fields outside of health science and medicine, however, do not have established guidelines, processes, or methodologies. This article describes how librarians led the creation of an interdisciplinary toolkit for researchers new to evidence synthesis. The implementation of the tools, including a protocol, supported eight evidence syntheses focused on effective agricultural interventions published in a special collection in Nature Research in October 2020. This article is a step-by-step overview of the tools and process. We advocate that librarian collaboration in evidence synthesis must become the norm, not the exception. Evidence synthesis project leads without access to a qualified librarian may use this toolkit as a point of entry for production of transparent, reproducible reviews.

Preventing Unequal Health Outcomes in COVID-19: A Systematic Review of Past Interventions.

Background: We sought to identify interventions that reduced disparities in health outcomes in infectious disease outbreaks or natural disasters in the United States to understand whether these interventions could reduce health disparities in the current COVID-19 pandemic. Methods: We searched MEDLINE and other databases to May 2020 to find studies that examined interventions to mitigate health inequalities in previous infectious disease pandemics or disasters. We assessed study quality using the Newcastle-Ottawa Scale and the Critical Appraisal Skills Program (CASP) Checklist for Qualitative Studies. Results: We included 14 articles (12 studies) and 5 Centers for Disease Control (CDC) stakeholder meeting articles on pandemic influenza preparedness in marginalized populations. Studies called for intervention and engagement before pandemic or disaster onset. Several studies included interventions that could be adapted to COVID-19, including harnessing technology to reach disadvantaged populations, partnering with trusted community liaisons to deliver important messaging around disease mitigation, and using culturally specific communication methods and messages to best reach marginalized groups. Discussion: To our knowledge this is the first systematic review to examine interventions to mitigate health inequities during an infectious disease pandemic. However, given that we identified very few disparities-focused infectious disease intervention studies, we also included studies from the disaster response literature, which may not be as generalizable to the current context of COVID-19. Overall, community outreach and tailored communication are essential in disease mitigation. More research is needed to evaluate systemic interventions that target the distal determinants of poor health outcomes among marginalized populations during pandemics and natural disasters.

PROTOCOL: Searching and reporting in Campbell Collaboration systematic reviews: An assessment of current methods.

This is the protocol for a Campbell review. The aim of this study is to comprehensively assess the quality and nature of the search methods and reporting across Campbell systematic reviews. The search methods used in systematic reviews provide the foundation for establishing the body of literature from which conclusions are drawn and recommendations made. Searches should be comprehensive and reporting of search methods should be transparent and reproducible. Campbell Collaboration systematic reviews strive to adhere to the best methodological guidance available for this type of searching. The current work aims to provide a comprehensive assessment of the quality of the search methods and reporting in Campbell Collaboration systematic reviews. Our specific objectives include the following: To examine how searches are currently conducted in Campbell systematic reviews. To identify any machine learning or automation methods used, or emerging and less commonly used approaches to web searching. To examine how search strategies, search methods and search reporting adhere to the Methodological Expectations of Campbell Collaboration Intervention Reviews (MECCIR) and PRISMA guidelines. The findings will be used to identify opportunities for advancing current practices in Campbell reviews through updated guidance, peer review processes and author training and support.

Racial and Ethnic Disparities in COVID-19-Related Infections, Hospitalizations, and Deaths : A Systematic Review.

BACKGROUND: Data suggest that the effects of coronavirus disease 2019 (COVID-19) differ among U.S. racial/ethnic groups. PURPOSE: To evaluate racial/ethnic disparities in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection rates and COVID-19 outcomes, factors contributing to disparities, and interventions to reduce them. DATA SOURCES: English-language articles in MEDLINE, PsycINFO, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus, searched from inception through 31 August 2020. Gray literature sources were searched through 2 November 2020. STUDY SELECTION: Observational studies examining SARS-CoV-2 infections, hospitalizations, or deaths by race/ethnicity in U.S. settings. DATA EXTRACTION: Single-reviewer abstraction confirmed by a second reviewer; independent dual-reviewer assessment of quality and strength of evidence. DATA SYNTHESIS: 37 mostly fair-quality cohort and cross-sectional studies, 15 mostly good-quality ecological studies, and data from the Centers for Disease Control and Prevention and APM Research Lab were included. African American/Black and Hispanic populations experience disproportionately higher rates of SARS-CoV-2 infection, hospitalization, and COVID-19-related mortality compared with non-Hispanic White populations, but not higher case-fatality rates (mostly reported as in-hospital mortality) (moderate- to high-strength evidence). Asian populations experience similar outcomes to non-Hispanic White populations (low-strength evidence). Outcomes for other racial/ethnic groups have been insufficiently studied. Health care access and exposure factors may underlie the observed disparities more than susceptibility due to comorbid conditions (low-strength evidence). LIMITATIONS: Selection bias, missing race/ethnicity data, and incomplete outcome assessments in cohort and cross-sectional studies must be considered. In addition, adjustment for key demographic covariates was lacking in ecological studies. CONCLUSION: African American/Black and Hispanic populations experience disproportionately higher rates of SARS-CoV-2 infection and COVID-19-related mortality but similar rates of case fatality. Differences in health care access and exposure risk may be driving higher infection and mortality rates. PRIMARY FUNDING SOURCE: Department of Veterans Affairs, Veterans Health Administration, Health Services Research & Development. (PROSPERO: CRD42020187078).

Ecotoxicity assessment and bioconcentration of a highly brominated organophosphate ester flame retardant in two amphibian species.

Restrictions on the production and use of some highly toxic and persistent flame retardants has resulted in the increased use of alternative phosphate flame retardants that are less-well characterized. The brominated organophosphate ester flame retardant, tris(tribromoneopentyl) phosphate (CAS 19186-97-1, molecular formula C15H24Br9O4P, molecular weight 1018.47 g/mol, acronym TTBrNP) is a compound with potential to bioaccumulate and disrupt endocrine functions. To determine the toxicity of TTBrNP, two Canadian native amphibian species, Lithobates sylvaticus and L. pipiens, were acutely (embryos and Gosner stage 25 (GS25) tadpoles) or sub-chronically (GS25-41 tadpoles) exposed to the following nominal concentrations of TTBrNP: 0 (water and solvent controls), 30.6, 61.3, 122.5 and 245.0 µg/L. Note, measured concentrations declined with time (i.e., 118%-30% of nominal). There was high survival for both species after acute and sub-chronic exposures, where 75%-100% survived the exposures, respectively. There were no differences in the occurrence of abnormalities or hatchling size between controls and TTBrNP treatments for either species exposed acutely as embryos or tadpoles. Furthermore, after 30 d of sub-chronic exposure of L. pipiens tadpoles to TTBrNP there were no effects on size, developmental stage, liver somatic index or sex ratio. Bioconcentration factors were low at 26 ± 3.1 L/kg ww in tadpoles from all treatments, suggesting biotransformation or limited bioavailability via aquatic exposures. Thus, using two species of anurans at different early larval stages, we found TTBrNP up to 245 µg/L to have no overt detrimental effects on survival or morphological responses that would suggest fitness-relevant consequences.

Assessment of sublethal ecotoxicity of solvents on larvae of a model native amphibian (Lithobates pipiens).

Carrier solvents are used frequently in toxicity testing to assist hydrophobic chemicals into solution, but such solvents may have toxic effects on test subjects. Amphibians are model organisms in toxicity studies; however, little is known about the direct effects of solvents on native amphibians. Following modifications to standardized guidelines for native species, we used acute 96-hour exposures to assess the direct effects of three common solvents on survival, differences in morphology and occurrence of abnormalities of northern leopard frog larvae (Lithobates pipiens). The solvents, dimethyl sulfoxide (DMSO), ethanol (ETOH) and acetone (ACE) were used at nominal concentrations ranging from 1 to 100 µL/L. We also conducted a 30-day exposure to assess the direct chronic effects of DMSO at 1 and 5 µL/L, on larval growth, development and sex differentiation, but found no effects. Acute exposure to solvents also had no effect on the survival of larvae, but we found significant abnormalities in tadpoles acutely exposed to 100 µL/L ACE. Acute exposure to DMSO and ETOH had further concentration-dependent effects on larval morphological traits. Our study suggests that DMSO and ETOH at ≤20 µL/L may be used as solvents in amphibian ecotoxicological studies, but ACE should be limited to ≤50 µL/L in ecotoxicity studies and perhaps much less (≤10 µL/L) in studies with other amphibians, based on a review of existing literature. We emphasize pilot studies when using solvents on acute and chronic ecotoxicity tests, using native amphibians.

Erratum: Assessment of toxicity and biodistribution of recombinant AAV8 vector-mediated immunomodulatory gene therapy in mice with Pompe disease.

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PROTOCOL: Does executive compensation predict publicly traded firms' financial performance or inaccurate financial reporting?

This is the protocol for a Campbell review. The objectives are as follows: One goal of this systematic review is to identify whether incentive terms in CEO contracts predict firm financial performance over time; a second goal is to identify whether incentive terms in CEO contracts predict subsequent inaccurate financial reporting as manifest in restatement of accounting data due to errors or other distortions in reporting financial information.

Assessing performance of sequential analysis methods for active drug safety surveillance using observational data.

The routine use of sequential methods is well established in clinical studies. Recently, there has been increasing interest in applying these methods to prospectively monitor the safety of newly approved drugs through accrual of real-world data. However, the application to marketed drugs using real-world data has been limited and work is needed to determine which sequential approaches are most suited to such data. In this study, the conditional sequential sampling procedure (CSSP), a group sequential method, was compared with a log-linear model with Poisson distribution (LLMP) through a SAS procedure (PROC GENMOD) combined with an alpha-spending function on two large longitudinal US administrative health claims databases. Relative performance in identifying known drug-outcome associations was examined using a set of 50 well-studied drug-outcome pairs. The study finds that neither method correctly identified all pairs but that LLMP often provides better ability and shorter time for identifying the known drug-outcome associations with superior computational performance when compared with CSSP, albeit with more false positives. With the features of flexible confounding control and ease of implementation, LLMP may be a good alternative or complement to CSSP.

Trends in prevalence of leisure time physical activity and inactivity: results from Australian National Health Surveys 1989 to 2011.

OBJECTIVE: To examine trends in leisure time physical activity and inactivity in Australians aged 15 years or older from 1989 to 2011. METHOD: We used data from six Australian National Health Surveys conducted from 1989/90 to 2011/12 in which physical activity was assessed using comparable questions. Analyses examined trends in the prevalence of sufficient physical activity (≥150 minutes/week moderate-to-vigorous physical activity) and of inactivity (<30 minutes/week moderate-to-vigorous physical activity). RESULTS: The proportion of sufficiently active adults was 39.2% in 1989 and 40.7% in 2011 with an overall declining trend of 0.2% per year (p=0.012). The prevalence of inactivity was 38.7% in 1989 and 37.3% in 2011; the overall time trend by year was stable (OR=0.999, p=0.242). In women, sufficient physical activity decreased by 0.3% per year from 35.5% in 1989 (p=0.025); inactivity increased from 39.5% by 0.3% per year (p=0.004). In men, sufficient physical activity prevalence was 43.1% in 1989 with a steady trend; inactivity decreased from 37.9% by 0.5% per year (p<0.0001). CONCLUSIONS: The prevalence of sufficient physical activity remains low and inactivity high. Women appear to be a key target group for intervention. Public health efforts have been ineffective over two decades for improving physical activity among Australian adults. Implications for public health: This research supports calls for a national physical activity action plan given the multitude of benefits from sufficient physical activity. Maintenance of consistent physical activity questions in future National Health Surveys will facilitate long term tracking of physical activity levels in the Australian population.