Increasing screening for atrial fibrillation in general practice: the Atrial Fibrillation Self-Screening, Management And guideline-Recommended Therapy (AF Self-SMART) study.

OBJECTIVE: To assess whether atrial fibrillation (AF) self-screening stations in general practice waiting rooms improve AF screening, diagnosis, and stroke risk management. DESIGN, SETTING: Intervention study (planned duration: twelve weeks) in six New South Wales general practices (two in rural locations, four in greater metropolitan Sydney), undertaken during 28 August 2020 - 5 August 2021. PARTICIPANTS: People aged 65 years or more who had not previously been diagnosed with AF, and had appointments for face-to-face GP consultations. People with valvular AF were excluded. INTERVENTION: AF self-screening station and software, integrated with practice electronic medical record programs, that identified and invited participation by eligible patients, and exported single-lead electrocardiograms and automated evaluations to patients' medical records. MAIN OUTCOME MEASURES: Screening rate; incidence of newly diagnosed AF during intervention and pre-intervention periods; prescribing of guideline-recommended anticoagulant medications. RESULTS: Across the six participating practices, 2835 of 7849 eligible patients (36.1%) had face-to-face GP appointments during the intervention period, of whom 1127 completed AF self-screening (39.8%; range by practice: 12-74%). AF was diagnosed in 49 screened patients (4.3%), 44 of whom (90%) had CHA2 DS2 -VA scores of 2 or more (high stroke risk). The incidence of newly diagnosed AF during the pre-intervention period was 11 cases per 1000 eligible patients; during the intervention period, it was 22 per 1000 eligible patients (screen-detected: 17 per 1000 eligible patients; otherwise detected: 4.6 per 1000 eligible patients). Prescribing of oral anticoagulation therapy for people newly diagnosed with AF and high stroke risk was similar during the pre-intervention (20 of 24, 83%) and intervention periods (46 of 54, 85%). CONCLUSIONS: AF self-screening in general practice waiting rooms is a feasible approach to increasing AF screening and diagnosis rates by reducing time barriers to screening by GPs. AF self-screening could reduce the number of AF-related strokes. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12620000233921 (prospective).

Predicting Cognitive, Functional, and Diagnostic Change over 4 Years Using Baseline Subjective Cognitive Complaints in the Sydney Memory and Ageing Study.

OBJECTIVE: There is limited understanding of the usefulness of subjective cognitive complaint(s) (SCC) in predicting longitudinal outcome because most studies focus solely on memory (as opposed to nonmemory cognitive) complaints, do not collect data from both participants and informants, do not control for relevant covariates, and have limited outcome measures. Therefore the authors investigate the usefulness of participant and informant SCCs in predicting change in cognition, functional abilities, and diagnostic classification of mild cognitive impairment or dementia in a community-dwelling sample over 4 years. METHODS: Nondemented participants (N = 620) in the Sydney Memory and Ageing Study aged between 70 and 90 years completed 15 memory and 9 nonmemory SCC questions. An informant completed a baseline questionnaire that included 15 memory and 4 nonmemory SCC questions relating to the participant. Neuropsychological, functional, and diagnostic assessments were carried out at baseline and again at 4-year follow-up. Cross-sectional and longitudinal analyses were carried out to determine the association between SCC indices and neuropsychological, functional, and diagnostic data while controlling for psychological measures. RESULTS: Once participant characteristics were controlled for, participant complaints were generally not predictive of cognitive or functional decline, although participant memory-specific complaints were predictive of diagnostic conversion. Informant-related memory questions were associated with global cognitive and functional decline and with diagnostic conversion over 4 years. CONCLUSION: Informant memory complaint questions were better than participant complaints in predicting cognitive and functional decline as well as diagnoses over 4 years.

The contribution of three components of nutrition knowledge to socio-economic differences in food purchasing choices.

OBJECTIVES: To assess socio-economic differences in three components of nutrition knowledge, i.e. knowledge of (i) the relationship between diet and disease, (ii) the nutrient content of foods and (iii) dietary guideline recommendations; furthermore, to determine if socio-economic differences in nutrition knowledge contribute to inequalities in food purchasing choices. DESIGN: The cross-sectional study considered household food purchasing, nutrition knowledge, socio-economic and demographic information. Household food purchasing choices were summarised by three indices, based on self-reported purchasing of sixteen groceries, nineteen fruits and twenty-one vegetables. Socio-economic position (SEP) was measured by household income and education. Associations between SEP, nutrition knowledge and food purchasing were examined using general linear models adjusted for age, gender, household type and household size. SETTING: Brisbane, Australia in 2000. SUBJECTS: Main household food shoppers (n 1003, response rate 66·4 %), located in fifty small areas (Census Collectors Districts). RESULTS: Shoppers in households of low SEP made food purchasing choices that were less consistent with dietary guideline recommendations: they were more likely to purchase grocery foods comparatively higher in salt, sugar and fat, and lower in fibre, and they purchased a narrower range of fruits and vegetables. Those of higher SEP had greater nutrition knowledge and this factor attenuated most associations between SEP and food purchasing choices. Among nutrition knowledge factors, knowledge of the relationship between diet and disease made the greatest and most consistent contribution to explaining socio-economic differences in food purchasing. CONCLUSIONS: Addressing inequalities in nutrition knowledge is likely to reduce socio-economic differences in compliance with dietary guidelines. Improving knowledge of the relationship between diet and disease appears to be a particularly relevant focus for health promotion aimed to reduce socio-economic differences in diet and related health inequalities.

General practitioners' perceptions on opportunistic single-time point screening for atrial fibrillation: A European quantitative survey.

Background: There is no clear guidance on how to implement opportunistic atrial fibrillation (AF) screening in daily clinical practice. Objectives: This study evaluated the perception of general practitioners (GPs) about value and practicalities of implementing screening for AF, focusing on opportunistic single-time point screening with a single-lead electrocardiogram (ECG) device. Methods: A descriptive cross-sectional study was conducted with a survey developed to assess overall perception concerning AF screening, feasibility of opportunistic single-lead ECG screening and implementation requirements and barriers. Results: A total of 659 responses were collected (36.1% Eastern, 33.4% Western, 12.1% Southern, 10.0% Northern Europe, 8.3% United Kingdom & Ireland). The perceived need for standardized AF screening was rated as 82.7 on a scale from 0 to 100. The vast majority (88.0%) indicated no AF screening program is established in their region. Three out of four GPs (72.1%, lowest in Eastern and Southern Europe) were equipped with a 12-lead ECG, while a single-lead ECG was less common (10.8%, highest in United Kingdom & Ireland). Three in five GPs (59.3%) feel confident ruling out AF on a single-lead ECG strip. Assistance through more education (28.7%) and a tele-healthcare service offering advice on ambiguous tracings (25.2%) would be helpful. Preferred strategies to overcome barriers like insufficient (qualified) staff, included integrating AF screening with other healthcare programs (24.9%) and algorithms to identify patients most suitable for AF screening (24.3%). Conclusion: GPs perceive a strong need for a standardized AF screening approach. Additional resources may be required to have it widely adopted into clinical practice.

Socioeconomic inequalities in occupational, leisure-time, and transport related physical activity among European adults: a systematic review.

BACKGROUND: This study systematically reviewed the evidence pertaining to socioeconomic inequalities in different domains of physical activity (PA) by European region. METHODS: Studies conducted between January 2000 and December 2010 were identified by a systematic search in Pubmed, Embase, Web of Science, Psychinfo, Sportdiscus, Sociological Abstracts, and Social Service Abstracts. English-language peer-reviewed studies undertaken in the general population of adults (18-65 years) were classified by domain of PA (total, leisure-time including sport, occupational, active transport), indicator of socioeconomic position (education, income, occupation), and European region. Distributions of reported positive, negative, and null associations were evaluated. RESULTS: A total of 131 studies met the inclusion criteria. Most studies were conducted in Scandinavia (n = 47). Leisure-time PA was the most frequently studied PA outcome (n = 112). Considerable differences in the direction of inequalities were seen for the different domains of PA. Most studies reported that those with high socioeconomic position were more physically active during leisure-time compared to those with low socioeconomic position (68% positive associations for total leisure-time PA, 76% for vigorous leisure-time PA). Occupational PA was more prevalent among the lower socioeconomic groups (63% negative associations). Socioeconomic differences in total PA and active transport PA did not show a consistent pattern (40% and 38% positive associations respectively). Some inequalities differed by European region or socioeconomic indicator, however these differences were not very pronounced. CONCLUSIONS: The direction of socioeconomic inequalities in PA in Europe differed considerably by domain of PA. The contradictory results for total PA may partly be explained by contrasting socioeconomic patterns for leisure-time PA and occupational PA.

Food insecurity among adults residing in disadvantaged urban areas: potential health and dietary consequences.

OBJECTIVE: Food insecurity is the limited or uncertain availability or access to nutritionally adequate, culturally appropriate and safe foods. Food insecurity may result in inadequate dietary intakes, overweight or obesity and the development of chronic disease. Internationally, few studies have focused on the range of potential health outcomes related to food insecurity among adults residing in disadvantaged locations and no such Australian studies exist. The objective of the present study was to investigate associations between food insecurity, sociodemographic and health factors and dietary intakes among adults residing in disadvantaged urban areas. DESIGN: Data were collected by mail survey (n 505, 53 % response rate), which ascertained information about food security status, demographic characteristics (such as age, gender, household income, education) fruit and vegetable intakes, takeaway and meat consumption, general health, depression and chronic disease. SETTING: Disadvantaged suburbs of Brisbane city, Australia, 2009. SUBJECTS: Individuals aged ≥ 20 years. RESULTS: Approximately one in four households (25 %) was food insecure. Food insecurity was associated with lower household income, poorer general health, increased health-care utilisation and depression. These associations remained after adjustment for age, gender and household income. CONCLUSIONS: Food insecurity is prevalent in urbanised disadvantaged areas in developed countries such as Australia. Low-income households are at high risk of experiencing food insecurity. Food insecurity may result in significant health burdens among the population, and this may be concentrated in socio-economically disadvantaged suburbs.

Socio-economic differences in takeaway food consumption among adults.

OBJECTIVE: To examine socio-economic differences in the frequency and types of takeaway foods consumed. DESIGN: A cross-sectional postal survey. SETTING: Participants were asked about their usual consumption of overall takeaway food (<4 times/month or ≥4 times/month) and of twenty-two specific takeaway food items (<1 time/month or ≥1 time/month); these latter foods were grouped into 'healthy' and 'less healthy' choices. Socio-economic position was measured on the basis of educational level and equivalised household income, and differences in takeaway food consumption were assessed by calculating prevalence ratios using log binomial regression. SUBJECTS: Adults aged 25-64 years from Brisbane, Australia, were randomly selected from the electoral roll (n 903; 63·7 % response rate). RESULTS: Compared with their more educated counterparts, the least educated were more regular consumers of overall takeaway food and fruit or vegetable juice and less regular consumers of sushi. For the 'less healthy' items, the least educated more regularly consumed potato chips, savoury pies, fried chicken and non-diet soft drinks; however, the least educated were less likely to consume curry. Household income was not associated with overall takeaway consumption. The lowest-income group was a more regular consumer of fruit or vegetable juice compared with the highest-income group. Among the 'less healthy' items, the lowest-income group was a more regular consumer of fried fish, ice cream and milk shakes, whereas curry was consumed less regularly. CONCLUSIONS: The frequency and types of takeaway foods consumed by socio-economically disadvantaged groups may contribute to inequalities in overweight or obesity and to chronic disease.

Socioeconomic inequalities in cardiovascular mortality and the role of childhood socioeconomic conditions and adulthood risk factors: a prospective cohort study with 17-years of follow up.

BACKGROUND: The mechanisms underlying socioeconomic inequalities in mortality from cardiovascular diseases (CVD) are largely unknown. We studied the contribution of childhood socioeconomic conditions and adulthood risk factors to inequalities in CVD mortality in adulthood. METHODS: The prospective GLOBE study was carried out in the Netherlands, with baseline data from 1991, and linked with the cause of death register in 2007. At baseline, participants reported on adulthood socioeconomic position (SEP) (own educational level), childhood socioeconomic conditions (occupational level of respondent's father), and a broad range of adulthood risk factors (health behaviours, material circumstances, psychosocial factors). This present study is based on 5,395 men and 6,306 women, and the data were analysed using Cox regression models and hazard ratios (HR). RESULTS: A low adulthood SEP was associated with increased CVD mortality for men (HR 1.84; 95% CI: 1.41-2.39) and women (HR 1.80; 95%CI: 1.04-3.10). Those with poorer childhood socioeconomic conditions were more likely to die from CVD in adulthood, but this reached statistical significance only among men with the poorest childhood socioeconomic circumstances. About half of the investigated adulthood risk factors showed significant associations with CVD mortality among both men and women, namely renting a house, experiencing financial problems, smoking, physical activity and marital status. Alcohol consumption and BMI showed a U-shaped relationship with CVD mortality among women, with the risk being significantly greater for both abstainers and heavy drinkers, and among women who were underweight or obese. Among men, being single or divorced and using sleep/anxiety drugs increased the risk of CVD mortality. In explanatory models, the largest contributor to adulthood CVD inequalities were material conditions for men (42%; 95% CI: -73 to -20) and behavioural factors for women (55%; 95% CI: -191 to -28). Simultaneous adjustment for adulthood risk factors and childhood socioeconomic conditions attenuated the HR for the lowest adulthood SEP to 1.34 (95% CI: 0.99-1.82) for men and 1.19 (95% CI: 0.65-2.15) for women. CONCLUSIONS: Adulthood material, behavioural and psychosocial factors played a major role in the explanation of adulthood SEP inequalities in CVD mortality. Childhood socioeconomic circumstances made a modest contribution, mainly via their association with adulthood risk factors. Policies and interventions to reduce health inequalities are likely to be most effective when considering the influence of socioeconomic circumstances across the entire life course and in particular, poor material conditions and unhealthy behaviours in adulthood.

Explaining socio-economic inequalities in daily smoking: a social-ecological approach.

BACKGROUND: This study assessed the contributions of individual, household and neighbourhood-level factors to socio-economic inequalities in smoking. METHODS: Data came from 2706 participants of the 2004 wave of the Dutch GLOBE study. Participants were asked about several social and material characteristics of their households, neighbourhoods and smoking in their environment. Indicators of socio-economic position were education and income. Associations with daily smoking were examined using logistic regression analyses. RESULTS: Education and income were independently associated with daily smoking (mutually adjusted odds ratios for the lowest education and income groups: odds ratio (OR): 2.87, 95% confidence interval (95% CI): 1.78-4.62; OR: 1.55, 95% CI: 1.09-2.23, respectively). Individual beliefs about smoking contributed most to the association of education with daily smoking. Individual beliefs about smoking and household material adversity contributed most to the association of income with daily smoking. We found no evidence that negative perceptions of the neighbourhood contributed to smoking inequalities. In fully adjusted models, associations between income and smoking were fully attenuated, but an independent association between education and smoking remained. CONCLUSION: Education and income were related to smoking through partly different pathways. Reducing inequalities in smoking may require a multidimensional approach targeting material and social factors, with strategies targeted towards the individual and the household level.

Staff acceptability and patient usability of a self-screening kiosk for atrial fibrillation in general practice waiting rooms.

Background: Current Australian and European guidelines recommend opportunistic screening for atrial fibrillation (AF) among patients ≥65 years, but general practitioners (GPs) report time constraints as a major barrier to achieving this. Patient self-screening stations in GP waiting rooms may increase screening rates and case detection of AF, but the acceptability of patient self-screening from the practice staff perspective, and the usability by patients, is unknown. Objective: To determine staff perspectives on AF self-screening stations and factors impacting acceptability, usability by patients, and sustainability. Methods: We performed semi-structured interviews with 20 general practice staff and observations of 22 patients while they were undertaking self-screening. Interviews were coded and data analyzed using an iterative thematic analysis approach. Results: GPs indicated high levels of acceptance of self-screening, and reported little impact on their workflow. Reception staff recognized the importance of screening for AF, but reported significant impacts on their workflow because some patients were unable to perform screening without assistance. Patient observations corroborated these findings and suggested some potential ways to improve usability. Conclusion: AF self-screening in GP waiting rooms may be a viable method to increase opportunistic screening by GPs, but the impacts on reception workflow need to be mitigated for the method to be upscaled for more widespread screening. Furthermore, more age-appropriate station design may increase patient usability and thereby also reduce impact on reception workflow.

Socio-economic differences in weight-control behaviours and barriers to weight control.

OBJECTIVE: To examine socio-economic differences in weight-control behaviours (WCB) and barriers to weight control. DESIGN: A cross-sectional study. SETTING: Data were obtained by means of a postal questionnaire. SUBJECTS: A total of 1013 men and women aged 45-60 years residing in Brisbane, Australia (69·8 % response rate). RESULTS: Binary and multinomial logistic regression analyses were performed, adjusted for age, gender and BMI. Socio-economically disadvantaged groups were less likely to engage in weight control (OR for lowest income quartile = 0·60, 95 % CI 0·39, 0·94); among those who engaged in weight control, the disadvantaged group had a likelihood of 0·52 (95 % CI 0·30, 0·90) of adopting exercise strategies, including moderate (OR = 0·56, 95 % CI 0·33, 0·96) and vigorous (OR = 0·47, 95 % CI 0·25, 0·89) physical activities, compared with their more-advantaged counterparts. However, lower socio-economic groups were more likely to decrease their sitting time to control their weight compared with their advantaged counterparts (OR for secondary school or lower education = 1·78, 95 % CI 1·11, 2·84). They were also more likely to believe that losing weight was expensive, not of high priority, required a lot of cooking skills and involved eating differently from others in the household. CONCLUSIONS: Marked socio-economic inequalities existed with regard to engaging in WCB, the type of weight-control strategies used and the perceived barriers to weight control; these differences are consistent with socio-economic gradients in weight status. These factors may need to be included in health promotion strategies that address socio-economic inequalities in weight status, as well as inequalities in weight-related health outcomes.

Atrial fibrillation self screening, management and guideline recommended therapy (AF SELF SMART): A protocol for atrial fibrillation self-screening in general practice.

BACKGROUND: Opportunistic screening for silent atrial fibrillation (AF) is recommended to reduce stroke, but screening rates are sub-optimal in general practice. We hypothesize that patient self-screening in the waiting room may improve screening and detection of AF. METHODS AND ANALYSES: This proof-of-concept study tests a purpose-designed AF self-screening station and customised software which seamlessly integrates with general practice electronic medical records and workflow. The self-screening station records a lead-1 ECG. The software automatically (1) identifies eligible patients (aged ≥65 years, no AF diagnosis) from the practice appointment diary; (2) sends eligible patients an automated SMS reminder prior to their appointment; (3) creates individualised QR code to scan at self-screening station; and (4) imports the ECG and result directly into the patients' electronic medical record. Between 5 and 8 general practices in New South Wales, Australia, will participate with an aim of 1500 patients undertaking self-screening. The main outcome measures will be the proportion of eligible patients that undertook self-screening, incidence of newly-diagnosed AF, and patient and staff experience of the self-screening process. De-identified data will be collected using a clinical audit tool, and qualitative interviews will determine patient and staff acceptability. ETHICS AND DISSEMINATION: Ethics approval was received from the University of Sydney Human Research Ethics Committee in June 2019 (Project no: 2019/382) and the University of Notre Dame Human Research Ethics Committee (Project no: 019145S) in October 2019. Results will be disseminated through various forums, including peer-reviewed publication and conference presentations.Trial registration numberACTRN12620000233921.

Socioeconomic differences in lack of recreational walking among older adults: the role of neighbourhood and individual factors.

BACKGROUND: People with a low socioeconomic status (SES) are more likely to be physically inactive than their higher status counterparts, however, the mechanisms underlying this socioeconomic gradient in physical inactivity remain largely unknown. Our aims were (1) to investigate socioeconomic differences in recreational walking among older adults and (2) to examine to what extent neighbourhood perceptions and individual cognitions regarding regular physical activity can explain these differences. METHODS: Data were obtained by a large-scale postal survey among a stratified sample of older adults (age 55-75 years) (N = 1994), residing in 147 neighbourhoods of Eindhoven and surrounding areas, in the Netherlands. Multilevel logistic regression analyses assessed associations between SES (i.e. education and income), perceptions of the social and physical neighbourhood environment, measures of individual cognitions derived from the Theory of Planned Behaviour (e.g. attitude, perceived behaviour control), and recreational walking for >/=10 minutes/week (no vs. yes). RESULTS: Participants in the lowest educational group (OR 1.67 (95% CI, 1.18-2.35)) and lowest income group (OR 1.40 (95% CI, 0.98-2.01)) were more likely to report no recreational walking than their higher status counterparts. The association between SES and recreational walking attenuated when neighbourhood aesthetics was included in the model, and largely reduced when individual cognitions were added to the model (with largest effects of attitude, and intention regarding regular physical activity). The assiation between poor neighbourhood aesthetics and no recreational walking attenuated to (borderline) insignificance when individual cognitions were taken into account. CONCLUSION: Both neighbourhood aesthetics and individual cognitions regarding physical activity contributed to the explanation of socioeconomic differences in no recreational walking. Neighbourhood aesthetics may explain the association between SES and recreational walking largely via individual cognitions towards physical activity. Intervention and policy strategies to reduce socioeconomic differences in lack of recreational walking among older adults would be most effective if they intervene on both neighbourhood perceptions as well as individual cognitions.

HABITAT: A longitudinal multilevel study of physical activity change in mid-aged adults.

BACKGROUND: Little is known about the patterns and influences of physical activity change in mid-aged adults. This study describes the design, sampling, data collection, and analytical plan of HABITAT, an innovative study of (i) physical activity change over five years (2007-2011) in adults aged 40-65 years at baseline, and (ii) the relative contribution of psychological variables, social support, neighborhood perceptions, area-level factors, and sociodemographic characteristics to physical activity change. METHODS/DESIGN: HABITAT is a longitudinal multi-level study. 1625 Census Collection Districts (CCDs) in Brisbane, Australia were ranked by their index of relative socioeconomic disadvantage score, categorized into deciles, and 20 CCDs from each decile were selected to provide 200 local areas for study inclusion. From each of the 200 CCDs, dwellings with individuals aged between 40-65 years (in 2007) were identified using electoral roll data, and approximately 85 people per CCD were selected to participate (N = 17,000). A comprehensive Geographic Information System (GIS) database has been compiled with area-level information on public transport networks, footpaths, topography, traffic volume, street lights, tree coverage, parks, public services, and recreational facilities Participants are mailed a questionnaire every two years (2007, 2009, 2011), with items assessing physical activity (general walking, moderate activity, vigorous activity, walking for transport, cycling for transport, recreational activities), sitting time, perceptions of neighborhood characteristics (traffic, pleasant surroundings, streets, footpaths, crime and safety, distance to recreational and business facilities), social support, social cohesion, activity-related cognitions (attitudes, efficacy, barriers, motivation), health, and sociodemographic characteristics. Analyses will use binary and multinomial logit regression models, as well as generalized linear latent growth models. DISCUSSION: HABITAT will provide unique information to improve our understanding of the determinants of physical activity, and to help identify "people" and "place" priority targets for public policy and health promotion aimed at increasing physical activity participation among mid-aged men and women.

Reducing Stroke Risk in Atrial Fibrillation: Adherence to Guidelines Has Improved, but Patient Persistence with Anticoagulant Therapy Remains Suboptimal.

Atrial fibrillation (AF) is a significant risk factor for avoidable stroke. Among high-risk patients with AF, stroke risk can be mitigated using oral anticoagulants (OACs), however reduction is largely contingent on physician prescription and patient persistence with OAC therapy. Over the past decade significant advances have occurred, with revisions to clinical practice guidelines relating to management of stroke risk in AF in several countries, and the introduction of non-vitamin K antagonist OACs (NOACs). This paper summarises the evolving body of research examining guideline-based clinician prescription over the past decade, and patient-level factors associated with OAC persistence. The review shows clinicians' management over the past decade has increasingly reflected guideline recommendations, with an increasing proportion of high-risk patients receiving OACs, driven by an upswing in NOACs. However, a treatment gap remains, as 25-35% of high-risk patients still do not receive OAC treatment, with great variation between countries. Reduction in stroke risk directly relates to level of OAC prescription and therapy persistence. Persistence and adherence to OAC thromboprophylaxis remains an ongoing issue, with 2-year persistence as low as 50%, again with wide variation between countries and practice settings. Multiple patient-level factors contribute to poor persistence, in addition to concerns about bleeding. Considered review of individual patient's factors and circumstances will assist clinicians to implement appropriate strategies to address poor persistence. This review highlights the interplay of both clinician's awareness of guideline recommendations and understanding of individual patient-level factors which impact adherence and persistence, which are required to reduce the incidence of preventable stroke attributable to AF.

Socioeconomic status, environmental and individual factors, and sports participation.

PURPOSE: To examine the contribution of neighborhood, household, and individual factors to socioeconomic inequalities in sports participation in a multilevel design. METHODS: Data were obtained by a large-scale postal survey among a stratified sample of the adult population (age 25-75 yr) of Eindhoven (the fifth-largest city of the Netherlands) and surrounding areas, residing in 213 neighborhoods (N = 4785; response rate 64.4%). Multilevel logistic regression analyses were performed with sports participation as a binary outcome (no vs yes); that is, respondents not doing any moderate- or high-intensity sports at least once a week were classified as nonparticipants. RESULTS: Unfavorable perceived neighborhood factors (e.g., feeling unsafe, small social network), household factors (material and social deprivation), and individual physical activity cognitions (e.g., negative outcome expectancies, low self-efficacy) were significantly associated with doing no sports and were reported more frequently among lower socioeconomic groups. Taking these factors into account reduced the odds ratios of doing no sports among the lowest educational group by 57%, from 3.99 (95% CI, 2.99-5.31) to 2.29 (95% CI, 1.70-3.07), and among the lowest income group by 67%, from 3.02 (95% CI, 2.36-3.86) to 1.66 (95% CI, 1.22-2.27). CONCLUSIONS: A combination of neighborhood, household, and individual factors can explain socioeconomic inequalities in sports participation to a large extent. Interventions and policies should focus on all three groups of factors simultaneously to yield a maximal reduction of socioeconomic inequalities in sports participation.

Single-item measure of food insecurity used in the National Health Survey may underestimate prevalence in Australia.

OBJECTIVES: To compare prevalence estimates of food insecurity using a single-item measure, with three adaptations of the United States Department of Agriculture Food Security Survey Module (USDA-FSSM). METHODS: Data were collected by postal survey, from individuals aged ≥18 years from disadvantaged suburbs of Brisbane, Australia (n= 505, 53% response). Food security status was ascertained by the Australian single-item measure, and the 6-, 10- and 18-item versions of the USDA-FSSM. Prevalence estimates of food insecurity and different levels of severity of food insecurity estimated by each tool were determined. Data were analysed using McNemar's test, polychoric correlation and Rasch analyses. RESULTS: The prevalence of food insecurity was 19.5% using the single-item measure; significantly less than the 24.4%, 22.8% and 21.1% identified using the 18-item, 10-item and 6-item versions of the USDA-FSSM, respectively. Rasch analyses revealed that overall the USDA-FSSM may be a valid tool for the measurement of food insecurity within the current sample. CONCLUSION: The measure of food insecurity employed in national surveys in Australia may underestimate its prevalence and public health significance. Implications for public health: Future monitoring and surveillance efforts should seek to employ a more accurate measure as the first step in recognising the right to food for all Australians.

Perceived environmental determinants of physical activity and fruit and vegetable consumption among high and low socioeconomic groups in the Netherlands.

A focus group study was conducted to explore how perceptions of environmental influences on health behaviours pattern across socioeconomic groups in the Netherlands. Participants perceived their spouse's and friend's health behaviour and support as highly important. People from lower socioeconomic backgrounds reported poor neighbourhood aesthetics, safety concerns and poor access to facilities as barriers for being physically active, while easy accessibility to sports facilities was mentioned by high socioeconomic participants. The availability of fruits and vegetables at home was perceived as good by all particpants. Overall, lower socioeconomic groups expressed more price concerns. Possible pathways between socioeconomic status, environmental factors and health behaviours are represented in a framework, and they should be investigated further in longitudinal research.

Higher smoking prevalence in urban compared to non-urban areas: time trends in six European countries.

We investigated differences in smoking prevalence between urban and non-urban area of residence in six Western European countries (Sweden, Finland, Denmark, Germany, Italy and Spain), and smoking prevalence trends over the period 1985-2000. In most countries, smoking prevalence was highest in urban areas, and increased with urbanization. Urban/non-urban inequalities were most pronounced among individuals with low education levels, and also among females. There were no significant differences in annual rate of change in smoking prevalence between non-urban and urban areas.