Chronic diseases and their behavioural risk factors among South Asian immigrants in Australia.

ObjectivesThe prevalence of chronic diseases among immigrants varies across different ethnic groups attributed to the disparities in their risk factors. This study aimed to explore the prevalence and correlates of chronic diseases among the rapidly growing South Asian population in Australia.MethodsAn online survey was administered (2020-2021) among South Asian immigrants in Australia. Diagnosed chronic diseases, smoking habits, physical activity, alcohol consumption, body mass index, and fruit and vegetable intake were assessed. A multivariable logistic regression model was used to examine factors associated with chronic disease.ResultsOverall, 50% of the study participants had one chronic disease and 39% had more than one chronic disease (n=282). Back pain (30%), depression (22%), diabetes (21%), hypertension (19%), and heart disease (12%) were the most reported diseases. Approximately 78% of participants were insufficiently active and 38% regularly consumed alcohol. Approximately three-quarters consumed fruits and vegetables less than once per day. Multivariable analyses showed that those who were aged more than 50years (OR=4.38, 95% CI 1.66-11.56), consumed alcohol more than once/month (OR=3.25, 95% CI 1.17-8.96), and ate less than one serving of vegetables/day (OR=2.94, 95% CI 1.19-7.26) had higher odds of having two or more chronic diseases.ConclusionsFifty percent of study participants presented with preventable diseases, signifying a substantial health burden. Public health interventions should primarily focus on reducing alcohol intake and increasing fruit and vegetable consumption, particularly among individuals of advanced age, to reduce the overall burden on the healthcare system.

Effectiveness of a parent-focused intervention targeting 24-hour movement behaviours in preschool-aged children: a randomised controlled trial.

BACKGROUND: Interventions focusing on individual behaviours (physical activity, sedentary behaviour, sleep) of preschool-aged children have been widely studied. However, there is a lack of understanding about integrated interventions that target all three 24-hour movement behaviours. This is the first study to assess the effectiveness of an intervention aimed at improving all three 24-hour movement behaviours among preschoolers in Hong Kong. METHODS: A 12-week randomised controlled trial with a 12-week follow-up was conducted. Parent-child pairs were randomised to integrated approach (targeting all three behaviours), dyadic approach (targeting physical activity and sedentary behaviour including screen time), or wait-list control group. Utilising the Internet-based delivery, this intervention consisted of education materials, workshops, and interactive questionnaires and reminders. Two intervention groups employed the same strategies, with the only difference being that the integrated approach targeted sleep in addition to physical activity and sedentary behaviour. The outcomes were preschoolers' overall 24-hour movement behaviours which were assessed by the Activity Sleep Index (ASI), movement behaviour composition, and absolute duration of movement behaviours. Generalised estimating equations were conducted to evaluate the intervention. RESULTS: A total of 147 preschoolers (4.8 ± 0.9 years old, 56.5% boys) and their parents were included. Preschoolers in all groups had a lower ASI at follow-up compared with baseline. Preschoolers in the integrated approach had a smaller decline in ASI at follow-up, compared to that in the control group (3.41; 95% confidence interval [CI] = 0.07, 6.76). Preschoolers in both intervention groups had a smaller reduction of the composition of time spent in physical activity at follow-up, and a decreased screen time at postintervention and follow-up. No significant differences were found for the sleep subcomponent. Furthermore, preschoolers in the dyadic approach had a smaller increase in the sedentary behaviour subcomponent (vs. CONTROL: - 0.21; 95% CI = - 0.37, - 0.05) at follow-up. CONCLUSIONS: Both intervention groups showed a decrease in screen time at postintervention, but there were no significant changes in other behaviours. The favourable changes observed at follow-up demonstrated the effectiveness of both intervention approaches on alleviating the decline in the composition of time spent in physical activity and reducing screen time and revealed the possible effectiveness of the integrated approach in promoting overall movement behaviours among preschoolers. TRIAL REGISTRATION: The study is prospectively registered at the Chinese Clinical Trial Registry (ChiCTR2200055958).

The Overflow Effects of Movement Behaviour Change Interventions for Children and Adolescents: A Systematic Review and Meta-Analysis of Randomised Controlled Trials.

BACKGROUND: Considering the finite time within a 24-h day, the distribution of time spent on movement behaviours has been found to be associated with health outcomes. OBJECTIVES: This systematic review and meta-analysis aimed to summarise and evaluate the overflow effects of interventions targeting a single behaviour (physical activity, sedentary behaviour/screen time, or sleep) on other non-targeted behaviours among children and adolescents. METHODS: Six databases (MEDLINE [Ovid], PsycINFO [ProQuest], EMBASE [Ovid], PubMed, Web of Science and SPORTDiscus [EBSCO]) were searched for relevant studies published before 13 May, 2024. Randomised controlled trials and clustered randomised controlled trials that targeted a single behaviour and also assessed the effects on non-targeted behaviours, comprised of healthy children under the age of 18 years, were included. Movement behaviours can be measured either objectively or subjectively. The revised Cochrane risk-of-bias tool for randomised trials was adopted to evaluate the risk of bias. RESULTS: A total of 102 studies with 45,998 participants from 21 countries were identified, and 60 of them with 26,183 participants were incorporated into the meta-analysis. The meta-analysis demonstrated that physical activity interventions led to a reduction in the proportion of each day spent in sedentary behaviour (mean difference = - 0.95% of wear time, 95% confidence interval - 1.44, - 0.45, I2 = 39%). Sedentary behaviour interventions resulted in increased standing time (mean difference = 3.87%, 95% confidence interval 1.99, 5.75, I2 = 0%). Interventions targeting screen time did not yield changes in physical activity or sleep. The findings on the effectiveness of sleep interventions on non-targeted behaviours and of physical activity interventions on sleep were inconclusive. CONCLUSIONS: Overall, the findings suggested that interventions aimed at increasing physical activity or reducing sedentary behaviour had overflow effects on non-targeted behaviours, but the effect sizes were small. Additional evidence is needed to reach definitive conclusions regarding the impact of behaviour change interventions on sleep and of the overflow effects of sleep interventions.

Challenges and strategies for navigating Australian healthcare access: experience from Chinese international students.

BACKGROUND: Australia hosts over 680,000 international students, contributing $47.8 billion to the Australian economy in 2023, and Chinese students rank first among all nationalities. However, despite their considerable numbers, research focusing on their access to healthcare services is scant. This study aimed to explore barriers and supports regarding the utilisation of healthcare services among Chinese international students studying in Australia. METHODS: Semi-structured interviews were conducted in Chinese between October and December 2023 with 25 Chinese international students (age range, 19-30; female/male, n = 18/7; undergraduate/postgraduate/doctoral, n = 1/18/6) enrolled in three Australian universities to understand the healthcare challenges they encountered and the coping strategies they recommended. These interviews were recorded, and thematic analysis was applied to the interview data. An adapted social-ecological model was used to identify barriers and pragmatic strategies to deal with the challenges at different levels. RESULTS: Chinese international students in Australia faced healthcare barriers at different levels. Individual barriers included language and cultural disparities, lack of knowledge about the healthcare system, and reluctance to seek help. Institutional barriers involved high costs, difficulties regarding appointments, and procedures related to the referral system. Policy barriers included insurance coverage and reimbursement issues. The students interviewed for this study proposed individual-level strategies, such as trying various methods to reduce language barriers, seeking information online, and using online resources and consultations. A central appointment platform and multilingual medical service were recommended from students to medical institutions, while medical service guidance and psychological support were suggested to education institutions. Higher-level strategies were also reported, which were mainly pertaining to insurance terms and coverage for overseas students and improving the accessibility of medical information. CONCLUSIONS: Our study identifies barriers to healthcare access for Chinese international students in Australia, including culture-specific challenges. To mitigate these issues, we recommend self-directed health promotion, targeted support by education institutions, enhanced cross-cultural communication and expanded telemedicine by hospitals, and attention to insurance coverage. Future research should explore optimising these approaches to improve support systems and policy frameworks.

Intense and problematic social media use and sleep difficulties of adolescents in 40 countries.

INTRODUCTION: Social media has become a ubiquitous part of everyday life; however, evidence suggests patterns of social media use can affect sleep health in children and adolescents. This study aimed to examine the associations of intense and problematic social media use (SMU) with sleep-onset difficulties in adolescence. METHODS: We analysed data from 212,613 adolescents aged 11-15 years (51.1% girls) from 40 European and North American countries that participated in the 2017/2018 Health Behaviour in School-aged Children survey. Intense SMU assessed how often respondents had online contact through social media, and problematic SMU was assessed by symptoms of addiction to social media. Sleep-onset difficulties were assessed using a self-reported item. Multilevel mixed-effects logistic regression was used to obtain the estimates. RESULTS: Sleep-onset difficulties were more common among girls than boys (27.1% vs 20.8%). Intense SMU was significantly associated with sleep-onset difficulties in boys in 17 countries and in girls in 25 countries, while problematic SMU was significantly associated in most of the participating countries. Overall, exposure to problematic SMU alone was highly associated with sleep-onset difficulties both in girls (OR 2.20, 2.04-2.38) and boys (OR 1.88, 1.73-2.04), while the association estimates for intense SMU were smaller and comparable across gender (Girls: OR 1.27, 1.23-1.31; Boys: OR 1.22, 1.18-1.27). Sensitivity analyses supported the above findings. CONCLUSIONS: Intense and/or problematic SMU were associated with sleep-onset difficulties across gender with associations being higher for problematic compared to intense SMU. Prospective research with objective measures is needed to understand the causal mechanisms underlying these relationships.

A qualitative study of career decision making among African and Asian international medical students in China: process, challenges, and strategies.

China hosts around 68,000 international medical students (IMSs) primarily from lower income countries in Africa and Asia, who have the potential to contribute to international medical services. Understanding how these IMSs make career decisions can help better address the issue of global medical workforce shortage. However, such research is limited. Our study aims to explore the career decision-making process of China-educated IMSs, the challenges they experienced and the strategies they employed.In this exploratory qualitative study, we conducted semi-structured interviews with IMSs educated in China in 2022 using purposeful sampling. Twenty virtual one-on-one interviews were conducted, and data were analysed through directed qualitative content analysis. Cognitive Information Processing (CIP) theory was applied as the guiding framework for organising and analysing the data.The career decision-making process of the participants generally followed the stages of decision-making cycle in CIP theory, with a combination of urgent migration decisions and specialisation considerations adding layers of complexity to their career trajectories. Identified challenges encompassed lack of knowledge about oneself and career options, lack of decision-making skills, concerns of contextual complexities that limited the career decision-making process, low motivation and negative thoughts. Specific challenges due to their role as IMSs arose, which were related to career information access, self-capability evaluation, degree accreditation, employment competitiveness and mental states. Participants' proposed strategies were categorised into personal and institutional aspects, providing insights into addressing these challenges.This study substantiates and expands the application of the CIP theory within the sphere of the particular cultural and educational context of IMSs educated in China. It highlights the significance of integrating migration decision-making into career guidance for IMSs, and contributes to the literature by proposing an evidence-based tiered career intervention programme for IMSs.

Adherence to 24-hour movement guidelines and their association with depressive symptoms in adolescents: Evidence from Bangladesh.

Healthy movement behaviours are associated with various physical and mental wellbeing; however, little is known about such associations in low- and middle-income countries. The aim of this study was to examine adherence to 24-hour (h) movement guidelines and their relationship with depressive symptoms in adolescents. Data were from 312 Bangladeshi adolescents aged 13-17 years (42% female). Meeting the guidelines was defined as: energy expenditure for physical activity (PA) â€‹≥ â€‹1 680 Metabolic Equivalent of Task (MET)-min/week, ≤ 2 â€‹h/day of recreational screen time (ST), and 8-10 â€‹h/night of sleep. Depressive symptoms were assessed using the 10-item Center for Epidemiological Studies Depression Scale (CESD-10) with a score of 10 or more indicating high depressive symptoms. Percentage of adolescents meeting the three recommendations was 2.2%, with 17.6% meeting two, and 31.2% meeting one recommendation. Generalized estimating equations showed that odds of having high depressive symptoms was a third (odds ratio [OR] â€‹= â€‹0.35, 95% confidence interval [CI], 0.19-0.57) for meeting the PA guidelines, and about a half (OR = 0.47, 95%CI, 0.18-0.87) for meeting the sleep guidelines. Odds of depressive symptoms reduced significantly for meeting PA and sleep (OR = 0.20, 95%CI, 0.09-0.59), or PA and ST (OR â€‹= â€‹0.24, 95%CI, 0.08-0.55) guidelines. About half of the adolescents did not meet any recommendations, which underscores the need for public health campaigns to promote adherence to the movement guidelines in this pediatric population. Further longitudinal research with larger sample size is recommended to explore the inter-relationships of these behaviours and their impact on health and wellbeing outcomes of adolescents in Bangladesh.

Physical activity, screen time and dietary behaviours in New Zealand adolescents prior to and following the onset of the COVID-19 pandemic.

BACKGROUND: Insufficient physical activity, high screen time, and unhealthy dietary patterns among adolescents may have worsened during the pandemic, but data are lacking. This study compared physical activity, screen time and fruit and vegetable intake in adolescents from Dunedin, New Zealand, 5-6 years before (Study 1) and during (Study 2) the COVID-19 pandemic. METHODS: Adolescents completed an online survey as part of the Built Environment and Active Transport to School (BEATS) studies in 2014/2015 (Study 1; n = 1,266; age: 15.3 ± 1.4 years; 54.6% female) and 2021/2022 (Study 2; n = 819; age: 15.2 ± 1.4 years; 47.4% female). The proportion of adolescents meeting guidelines for physical activity (≥ 60 min/day of moderate-to-vigorous physical activity), outside school screen time (≤ 2 h/day) and fruit and vegetable intake (> 1 serving/day for both fruit and vegetables) was calculated. Data were analysed using multivariable linear and logistic regression modelling. RESULTS: Few adolescents met recommended health behaviour guidelines. Compared to Study 1, significantly greater proportions of adolescents at Study 2 met guidelines for physical activity (16.7% vs. 23.1%; p < 0.001) and outside school screen time (13.3% vs. 18.3%; p < 0.001) while fruit and vegetable intake was not different (29.6% vs. 27.0%; p = 0.322). Compared to Study 1, average outside school screen time at Study 2 was lower on both weekdays (5.0 ± 2.9 vs. 4.6 ± 2.9; p < 0.001) and weekend days (6.9 ± 3.5 vs. 6.1 ± 3.6 h/day; p < 0.001). Reported frequency of consuming sweets was higher and soft drinks lower at Study 2 versus Study 1. CONCLUSIONS: Despite observed higher levels of physical activity and lower levels of outside school screen time during the pandemic compared to the pre-pandemic levels, few adolescents met health behaviour guidelines at both time points. Therefore, comprehensive health promotion that aims to improve physical activity levels, screen time and dietary patterns for adolescents is still necessary to prevent chronic health conditions adulthood.

Parental role-modeling on 24-hour movement behaviors among preschoolers during the COVID-19 pandemic.

INTRODUCTION: Little is known about the association between parents' and children's 24-h movement behaviors during the pandemic. This cross-sectional study examined the association between the 24-h movement behaviors of parents and their preschoolers and investigated sex differences in this association. METHODS: A total of 1740 preschoolers (4.5 ± 0.8 years old, 50.3% boys) and their parents (35.4 ± 4.9 years old, 24.3% males) in China participated in this study and provided valid and complete data. Parents completed an online survey or a written questionnaire in the period between October and December 2020. Preschoolers' and parents' movement behaviors (physical activity [PA], sedentary behavior [SB], screen time, and sleep) and demographic information were reported by the parents. Generalized linear models and logistic regression models were performed. RESULTS: Positive associations were found between parents' and preschoolers' moderate-to-vigorous intensity PA (ß = 0.28; 95% confidence interval [CI]: 0.20, 0.36), total PA (ß = 0.21; 95% CI: 0.17, 0.24), and sleep (ß = 0.05; 95% CI: 0.03, 0.06) with no apparent sex difference. No significant association was found between parents' and preschoolers' SB or screen time. Girls were more likely to meet all three 24-h movement guidelines when their parents met them (odds ratio = 2.38; 95% CI: 1.42, 4.01), but the relationship was not significant for boys. CONCLUSIONS: Parental role-modeling was positively associated with children's PA and sleep. This finding suggests that supporting parents' movement behaviors has the potential to promote a healthy lifestyle among preschoolers.

Physical activity and sedentary behaviour among south Asian immigrants in Australia.

ISSUE ADDRESSED: South Asians make up the second-largest group of immigrants in Australia and experience a higher burden of chronic diseases compared with non-immigrants. Most chronic diseases are associated with insufficient physical activity (PA) and sedentary behaviour (SB); however, studies involving PA and SB in immigrants are limited. This study aimed to explore PA and SB and associated factors among South Asian immigrants in Australia. METHODS: South Asian adult immigrants in Australia were surveyed online (from November 2020 to March 2021) about PA, SB, knowledge and barriers to PA. Logistic regressions were used to examine factors associated with insufficient PA (<150 minutes/week) and a high sitting time (>8 hours/day). RESULTS: A total of 321 participants provided complete data. Approximately 76% of participants reported insufficient PA and 27% reported high sitting time. Only 6% of participants walked or bicycled. The main reported barriers to PA were lack of time, costs, transport facilities, skills, and culturally appropriate resources. Around 52% of participants were not aware of the importance of PA. Participants with self-reported poor health and who used motorized travel were more likely to have inadequate PA. High sitting time was more common among middle-aged, overweight/obese, and middle-income participants. CONCLUSIONS: Most South Asian immigrants are insufficiently active with a lack of socio-economically appropriate PA facilities identified as a major challenge. A stronger collaboration between policymakers and community is required for sustainable solutions. SO WHAT?: Affordable and appropriate PA facilities in neighbourhoods could overcome major barriers. Also, information about PA should incorporate cultural expectations in the general recommendations to encourage participation.

Excessive Smartphone Use is Associated with Depression, Anxiety, Stress, and Sleep Quality of Australian Adults.

Problematic smartphone use has been associated with poorer mental health in different population groups; however, little is known about how levels of smartphone use were associated with mental health outcomes of adults in Australia. Using data from a cross-sectional survey among Australian adults aged 18-59 years (n = 655, Mean = 24.55 [SD = 5.59] years; 66% female), the current study aimed to examine association between problematic smartphone use and different psychological outcomes. Participants completed measures of problematic smartphone use with Mobile Phone Problem Use Scale (MPPUS), mental health outcomes with Depression, Anxiety, and Stress Scale (DASS-21), and Pittsburgh Sleep Quality Index (PSQI), in addition to some socio-demographics. Smartphone use was categorised into three groups: low-moderate, moderate-high, and high-severe. A total of 160 adults (24.4%) reported high-severe smartphone use. Multivariable linear regression analyses showed that smartphone use was inversely associated with psychological outcomes in a dose-dependent manner with high-severe smartphone uses having the most adverse effects. Compared to low-moderate use, average depression score was 3.5 points higher for moderate-high smartphone use (ß = 3.51, 95% CI: 1.63-5.40) and 6.9 points higher for high-severe smartphone use (ß = 6.91, 95% CI: 4.74-9.07). Similarly, average stress score was 3.4 points higher for moderate-high smartphone use (ß = 3.40, 95% CI: 1.75-5.06) and 7.0 points higher for high-severe smartphone use (ß = 7.02, 95% CI: 5.11-8.93). Similar association estimates were found for anxiety and sleep quality. Reducing smartphone use has the potential to optimise depression, anxiety, stress, and sleep quality; however, longitudinal research is warranted to establish directionality of the association.

Knowledge, attitude, and practice of university students towards monkeypox in Bangladesh.

The recent outbreak of viral zoonotic disease-monkeypox-caused by the monkeypox virus, has infected many people worldwide. This study aims to explore the knowledge, attitudes, and practices (KAP) concerning monkeypox among university students in Bangladesh. Data were collected using purposive snowball sampling from 887 university students through an online survey using Google Form. The participants were mostly in their twenties (M = 22.33 [SD 2.01] years), and they spent, on average, 2.59 [SD 1.91] hours/day on electronic and social media. The participants generally showed moderate knowledge (39.5%), low attitude (25.1%), and moderate practice (48.6%) toward monkeypox, with 47.6% having had a moderate KAP score. Findings further showed that personal attributes of university students, i.e., age, sex, year of schooling, residence, living status, geographical distribution, e.g., division, were statistically and significantly associated with knowledge, attitudes, and practices regarding monkeypox and overall KAP score. It is also apparent that health status, susceptibility to monkeypox, and exposure to social media were the most common factors significantly associated with knowledge, attitudes, and practices regarding monkeypox and overall KAP score. The current study's findings underscore the need for developing appropriate information, education, and communication (IEC) materials and their dissemination, which could play an important role in reducing the risk of monkeypox and similar other infectious diseases, particularly among students in Bangladesh.

Efficacy of a school-based education intervention on the consumption of fruits, vegetables and carbonated soft drinks among adolescents.

OBJECTIVES: To evaluate the efficacy of a school-based education intervention on the consumption of fruit, vegetables and carbonated soft drinks among adolescents. DESIGN: Cluster-randomised controlled trial. SETTING: Eight secondary schools from Dhaka, Bangladesh, participated in this trial and were randomly allocated to intervention (n 160) and control groups (n 160). PARTICIPANTS: A total of 320 students from 8th to 9th grades participated and completed the self-reported questionnaires at baseline, and at 8 and 12 weeks. The intervention included weekly classroom-based nutrition education sessions for students and healthy eating materials for students and parents. Repeated measures ANCOVA was used to assess the effects of the intervention. RESULTS: Daily fresh fruit intake was more frequent in the intervention (26 %) compared to the control group (3 %) at 12 weeks (p = 0·006). Participants from the intervention group also reported a significantly (P < 0·001) higher (49 %) proportion of fresh vegetable intake compared to the control group (2 %) at 12 weeks. Frequency of daily carbonated soft drinks intake decreased (25 %) in the intervention group at 12 weeks compared to baseline, while it remained unchanged in the control group; the interaction effect was observed significant (P = 0·002). CONCLUSION: Our school-based education intervention increased the daily frequency of fresh vegetables and fruit intake and decreased carbonated soft drink consumption among adolescents in the intervention group. There is a need for scaling up the intervention to engage students and empower them to develop healthy dietary habits.

Association Between Sports Participation and Psychosocial Wellbeing of Australian Children: An 8-year Longitudinal Study.

PURPOSE: Sports participation is associated with children's health and wellbeing; however, existing evidence is predominantly based on cross-sectional studies. This study examined the longitudinal association of sports participation with psychosocial wellbeing of Australian children. METHODS: Data were from five waves of the Longitudinal Study of Australian Children aged 6-7 years in 2010 (n = 4,242) and followed up until 2018. Outcomes were assessed using the Strengths and Difficulties Questionnaire and the Pediatric Quality of Life Inventory. Sports participation was measured using two items assessing regular participation in team and individual sports. RESULTS: Multilevel mixed effects modeling showed that any sports participation was beneficially associated with psychosocial wellbeing. Boys who participated in team sports had 1.78 point lower difficulties score (ß = -1.78; 95% confidence interval: --2.01,-1.55), while this was 0.58 points lower for individual sports (ß =-0.58; -0.81,-0.34). In girls, difficulties score was 1.22 point lower for team sports (ß = -1.22; -1.44,-1.00) and 0.49 point lower for individual sports (ß = -0.49; -0.71,-0.26). Sports participation was positively associated with better quality of life with team sports (ß = 4.72; 4.15,5.28 for boys; ß = 3.44; 2.87,4.00 for girls) offering more benefits than individual sports (ß = 1.00; 0.83,1.98 for boys; ß = 1.40; 0.83,1.98 for girls). Participation in both team and individual sports had the strongest benefits. Prolonged engagement in sports was associated with better psychosocial wellbeing in a dose-dependent manner. DISCUSSION: Regular participation in any sports can benefit children's wellbeing with team sports being more beneficial than individual sports. Encouraging children to regularly participate and remain engaged in sports can help to optimize their psychosocial wellbeing.

Effects of a School-Based Physical Activity Intervention on Adolescents' Mental Health: A Cluster Randomized Controlled Trial.

BACKGROUND: The aim of this study was to evaluate the effectiveness of a school-based multicomponent physical activity intervention on mental health of adolescents. METHODS: A clustered, randomized, controlled trial was employed in 8 high schools in Dhaka, Bangladesh, which were randomly assigned to either an intervention or control group; 40 students in grades 8 and 9 from each school took part in the trial (n = 160/group). Students in the intervention schools participated in a 12-week physical activity intervention with multiple components (eg, supervised circuits, lunchtime sports, health education, infographics), while control schools received no intervention. Participants completed baseline and postintervention surveys measuring depressive symptoms (Center for Epidemiologic Studies Depression Scale) and life satisfaction (Cantril Ladder), along with other sociodemographic and behavioral characteristics. Linear mixed-effects modeling was used to evaluate the intervention effects. RESULTS: Depressive symptoms in the intervention group decreased at postintervention, but remained stable in the control group. There was an increase in life satisfaction in the intervention group and a decrease in the control group. Multivariable modeling showed that students in the intervention group had a significantly lower level of depressive symptoms (ß = -4.60; 95% confidence interval, -5.76 to -3.46) and higher level of life satisfaction (ß = 1.43; 95% confidence interval, 0.77 to 2.10) compared with their counterparts in the control group. Sensitivity analyses supported the positive effects of the intervention. CONCLUSIONS: Our school-based, multicomponent physical activity intervention is effective in improving mental health indicators in adolescents. Future trials should be ramped up to include schools in rural and regional settings, using robust measures  of mental well-being.

Preventing depression in aphasia: A cluster randomized control trial of the Aphasia Action Success Knowledge (ASK) program.

BACKGROUND: Stroke patients with aphasia and their caregivers have higher incidence of depression than those without aphasia. AIMS: The objective of the study is to determine whether a tailored intervention program (Action Success Knowledge; ASK) led to better mood and quality of life (QoL) outcomes than an attention control with a 12-month end point at cluster and individual participant level. METHODS: A multi-site, pragmatic, two-level single-blind cluster randomized controlled trial compared ASK to an attention control (secondary stroke prevention program). Ten metropolitan and 10 non-metropolitan health regions were randomized. People with aphasia and their family members were recruited within 6 months post-stroke who scored ⩽12 on the Stroke Aphasic Depression Questionnaire Hospital Version-10 at screening. Each arm received manualized intervention over 6-8 weeks followed by monthly telephone calls. Blinded assessments of QoL and depression were taken at 12 months post-onset. RESULTS: Twenty clusters (health regions) were randomized. Trained speech pathologists screened 1744 people with aphasia and 373 participants consented to intervention (n = 231 people with aphasia and 142 family members). The attrition rate after consent was 26% with 86 and 85 participants with aphasia in the ASK arm and attention control arm, respectively, receiving intervention. Of those 171 who did receive treatment, only 41 met the prescribed minimum dose. Multilevel mixed effects modeling under the intention-to-treat protocol showed a significant difference on the Stroke and Aphasia Depression Questionnaire-21 (SADQ-21, N = 122, 17 clusters) in favor of the attention control (ß = -2.74, 95% confidence interval (CI) = -4.76 to -0.73, p = 0.008). Individual data analysis using a minimal detectable change score for the SADQ-21 showed the difference was not meaningful. CONCLUSION: ASK showed no benefit over attention control in improving mood and preventing depression in people with aphasia or their family members.

Integration of Mendelian randomisation and systems biology models to identify novel blood-based biomarkers for stroke.

Stroke is the second largest cause of mortality in the world. Genome-wide association studies (GWAS) have identified some genetic variants associated with stroke risk, but their putative functional causal genes are unknown. Hence, we aimed to identify putative functional causal gene biomarkers of stroke risk. We used a summary-based Mendelian randomisation (SMR) approach to identify the pleiotropic associations of genetically regulated traits (i.e., gene expression and DNA methylation) with stroke risk. Using SMR approach, we integrated cis-expression quantitative loci (cis-eQTLs) and cis-methylation quantitative loci (cis-mQTLs) data with GWAS summary statistics of stroke. We also utilised heterogeneity in dependent instruments (HEIDI) test to distinguish pleiotropy from linkage from the observed associations identified through SMR analysis. Our integrative SMR analyses and HEIDI test revealed 45 candidate biomarker genes (FDR < 0.05; PHEIDI > 0.01) that were pleiotropically or potentially causally associated with stroke risk. Of those candidate biomarker genes, 10 genes (HTRA1, PMF1, FBN2, C9orf84, COL4A1, BAG4, NEK6, SH2B3, SH3PXD2A, ACAD10) were differentially expressed in genome-wide blood transcriptomics data from stroke and healthy individuals (FDR < 0.05). Functional enrichment analysis of the identified candidate biomarker genes revealed gene ontologies and pathways involved in stroke, including "cell aging", "metal ion binding" and "oxidative damage". Based on the evidence of genetically regulated expression of genes through SMR and directly measured expression of genes in blood, our integrative analysis suggests ten genes as blood biomarkers of stroke risk. Furthermore, our study provides a better understanding of the influence of DNA methylation on the expression of genes linked to stroke risk.

Trends and determinants of organised sports participation in immigrant and Australian children: A nine-year follow-up.

OBJECTIVES: This study aimed to examine trends and determinants of organised sports participation among children of immigrant parents from low-and-middle-income countries, high-income countries, and Australian children. DESIGN: Longitudinal (nine-year follow-up). METHODS: Data were from the birth-cohort of Australian Children aged 6-15 years with follow-up between 2010 and 2018. Organised sports participation was measured using two items about regular participation in team and individual sports. Multilevel logit modelling was used to assess the determinants of organised sports participation across groups. RESULTS: Both team sports participation and individual sports participation increased between 6 and 11 years and declined between 11 and 15 years across the three groups. Children of immigrant parents from low-and-middle-income countries (OR 0.65; 95 % CI 0.57-0.74) and high-income countries (OR 0.82; 95 % CI 0.76-0.89) had lower odds of team sports participation than Australian children. Children of immigrant parents from low-and-middle-income countries had lower odds of team sports participation (OR 0.79; 95 % CI 0.69-0.90) than children of immigrant parents from high-income countries. Female children, high screen time, high psychological difficulties, increased number of siblings and low socio-economic position were identified as determinants of lower team and individual sports participation. CONCLUSIONS: The present study identified evidence of disparities in organised sports participation among children of immigrant parents and Australian children. Multilevel and multicomponent interventions to promote children's organised sports participation should be prioritised, with a focus on children of the female sex, older children, children with lower socioeconomic status, and children with higher screen time and higher psychological difficulties.

Bullying Experiences of South Asian Immigrants in Australia: a Mixed-Method Study.

Bullying is a pervasive problem faced by immigrants that negatively impacts their health and well-being. Understanding the factors that contribute to bullying and the prevalence of bullying victimisation may help to develop strategies to prevent bullying. Using a mixed-method approach, this study explored the perceptions and prevalence of bullying of South Asian immigrants living in Australia. Five focus group discussions (FGDs) were conducted to explore bullying experiences and to inform an online survey. The online survey included the California Bullying Victimisation Scale-Retrospective (CBVS-R) to measure prevalence, types, and places of bullying victimisation. Data collected from FGDs were thematically analysed while survey data were examined to identify factors associated with bullying. The main contributing factors reported by participants during FGDs were ethnic attire (clothing), religion, accent, workplace achievement, skin colour, and body shape. The online survey collected responses from 313 participants that included females (44%) and males (56%) with a mean age of 41.0 (SD ± 10.3) years. Almost 31% of participants surveyed experienced multiple bullying incidents per month with no differences observed between gender (32% in males, 31% in females). Males were mostly bullied (63%) in their workplaces while females were mostly bullied (56%) at bus or train stations. Country of birth, employment status, educational qualification, and English proficiency significantly associated with bullying experience (p < 0.001). These findings show that bullying affects male and female immigrants in different forms and settings; therefore, a large national assessment is needed to evaluate the magnitude of bullying and its consequences on immigrant health and well-being.

Different types of screen time are associated with low life satisfaction in adolescents across 37 European and North American countries.

AIMS: Prolonged screen time (ST) is a potential concern for poor wellbeing. This study aimed to examine the associations of different types of ST with life satisfaction among adolescents. METHODS: Data were from 380,446 adolescents (aged 11-15 years, 51% girls) across 37 European and North American countries who completed the 2010 and 2014 Health Behaviour in School-Aged Children surveys. Participants reported h/day during free time spent on television, electronic games, and computer/other devices. Life satisfaction was assessed using a 10-point scale (low life satisfaction ⩽5). RESULTS: Generalized additive modelling showed non-linear associations for each ST type, with low life satisfaction increasing monotonically for >1 h/day of electronic gaming or computer/other device and >2 h/day of watching television. Multilevel multivariable modelling showed that >4 h/day of watching television was associated with 26% higher odds for boys (OR 1.26; 95% CI:1.21-1.32) and 52% higher odds for girls (1.52; 1.46-1.59) of low life satisfaction than for ⩽1 h/day of television. Electronic gaming >4 h/day was associated with low life satisfaction with odds 42% higher in boys (1.42, 1.36-1.48) and 69% higher in girls (1.69, 1.61-1.76). A similar association was found for >4 h/day of computer/other device for boys (1.43, 1.37-1.49) and girls (1.71, 1.65-1.77). CONCLUSIONS: Low levels of ST may be beneficial; however, prolonged periods are associated with low life satisfaction among adolescents, in particular among girls. Results support ⩽2 h/day restriction of ST and highlight research is needed to understand underlying mechanisms of ST and wellbeing, which may not reflect active versus passive content.