Sport Participation for Academic Success: Evidence From the Longitudinal Study of Australian Children.

BACKGROUND: We aimed to identify long-term patterns of sport participation (overall, team, and individual sport) from childhood into adolescence, and to examine the association between these patterns and academic outcomes. METHODS: This cohort study used data from the Longitudinal Study of Australian Children in wave 3 (4-5 y) to wave 9 (20-21 y). The participants were a nationally representative sample of 4241 children. We conducted latent class analyses to identify sport participation trajectories and assessed the association between these trajectories and academic outcomes. RESULTS: Continued sport participation was associated with lower odds of being absent from school (OR = 0.44; 95% confidence intervals [CIs], 0.26 to 0.74), better performance on attention (B = -0.010; 95% CIs, -0.019 to -0.002) and working memory (B = -0.013; 95% CIs, -0.023 to -0.003), higher numeracy (B = 20.21; 95% CIs, 14.56 to 25.86) and literacy scores (B = 9.42; 95% CIs, 2.82 to 16.02), higher end of school academic performance (B = 3.28; 95% CIs, 1.47 to 5.09), and higher odds of studying at university (OR = 1.78; 95% CIs, 1.32 to 2.40). Team sport participation was associated with reduced absenteeism, better performance on attention and working memory, and being awarded the Higher School Certificate. Whereas individual sport participation was associated with higher literacy scores and end of school academic performance. CONCLUSIONS: Team and individual sport participation both benefit academic outcomes, but differently. Given the decline in sport participation during adolescence, these findings highlight the need to develop educational policies to establish an environment that promotes sport participation, which in turn could improve academic outcomes.

The prevalence of chronic and episodic loneliness and social isolation from a longitudinal survey.

Loneliness and social isolation, experienced more long-term, has been shown to increase mortality and lead to poorer health outcomes in specific cohorts. However, it is unclear what the prevalence of chronic loneliness and social isolation is, and which demographic groups are most at risk of reporting more chronic forms. A psychometrically validated classification system was used to identify people who met criteria for episodic and chronic loneliness and social isolation using the Household Income and Labour Dynamics in Australia (HILDA) survey waves 14-18. The prevalence of loneliness (overall 34%; 21% episodic, 13% chronic) far exceeded that of social isolation (overall 17%; 13% episodic, 4% chronic). There was consistency in the demographic characteristics (from age, sex, household type, income) of those who experienced loneliness and social isolation. However, people with a long-term health condition had an elevated risk of episodic loneliness (AOR 1.24, 95% CI 1.11-1.39) and a markedly higher risk of chronic loneliness (AOR 2.01, 95% CI 1.76-2.29), compared with those without a long-term health condition. Loneliness, both episodic and chronic subtypes, is more prevalent than social isolation. However, both chronic loneliness and social isolation remains neglected and poorly targeted within current practice and policy.

Evaluating the reach and impact of Still Six Lives: A national stillbirth public awareness campaign in Australia.

BACKGROUND: The Still Six Lives campaign aimed to increase awareness of stillbirth among Australian women and educate people about three modifiable behaviours that pregnant women could take to reduce the risk of stillbirth. The campaign used earned media, digital advertising and social media. AIM: The aim of this study is to evaluate the impact of the campaign on Australian women's awareness of stillbirth, and knowledge of the three modifiable behaviours. METHODS: The study collected process evaluation data about campaign implementation from digital platforms. The impact evaluation comprised of two components: a three-wave community survey of Australian women aged 18-50 years old, and a pre-post cross-sectional maternity service survey of pregnant women. RESULTS: The campaign gained significant reach, including 2,974,375 completed video views and 910,000 impressions via social media influencers. The community surveys had 1502 participants at baseline, 1517 mid-campaign and 1598 post-campaign. Participants were slightly more likely to have encountered messages about stillbirth after the campaign (aOR 1.30, 95% CI 1.09-1.55). There were increases in awareness of each behaviour after the campaign: be aware of baby's movements (aOR 1.26, 95% CI 1.08-1.47), quit smoking (aOR 1.27, 95% CI 1.10-1.47) and going-to-sleep on side (aOR 1.55, 95% CI 1.32-1.82). The antenatal clinic survey had 296 participants at baseline and 178 post-campaign. Post-campaign, there was an increased likelihood that women were aware of side-sleeping (aOR 3.11, 95% CI 1.74-5.56). CONCLUSIONS: The national campaign demonstrated some evidence of change in awareness of three modifiable behaviours that can reduce the risk of stillbirth.

"It Goes Hand in Hand with Us Trying to Get More Kids to Play" Stakeholder Experiences in a Sport and Active Recreation Voucher Program.

Vouchers that reduce the cost of sport and active recreation participation have been shown to increase children's and adolescent's physical activity levels. Yet, the influence of government-led voucher programs on the capacity of sport and active recreation organisations is unclear. This qualitative study explored the experiences of stakeholders in the sport and recreation sector that were engaged in implementing the New South Wales (NSW) Government's Active Kids voucher program in Australia. Semi-structured interviews were conducted with 29 sport and active recreation providers. Interview transcriptions were analysed by a multidisciplinary team using the Framework method. Overall, participants reported that the Active Kids voucher program was an acceptable intervention to address the cost barrier to participation for children and adolescents. Three main steps influenced the capacity of organisations to deliver their sport and recreation programs and the voucher program: (1) Implementation priming-alignment of the intervention aims with stakeholder priorities and early information sharing, (2) Administrative ease-enhanced technology use and establishment of simple procedures, and (3) Innovation impacts-enablement of staff and volunteers to address barriers to participation for their participants. Future voucher programs should include strategies to enhance the capacity of sport and active recreation organisations to meet program guidelines and increase innovation.

Hope and sadness: Balancing emotions in tobacco control mass media campaigns aimed at smokers.

ISSUE ADDRESSED: Australia has smoking prevalence of less than 15% among adults, but there are concerns that the rates of decline have stabilised. Sustained mass media campaigns are central to decreasing prevalence, and the emotions evoked by campaigns contribute to their impact. This study investigates the association between potential exposure to campaigns that evoke different emotions on quitting salience (thinking about quitting), quitting intentions and quitting attempts. METHODS: Data on quitting outcomes were obtained from weekly cross-sectional telephone surveys with adult smokers and recent quitters between 2013 and 2018. Campaign activity data were collated, and population-level potential campaign exposure was measured by time and dose. RESULTS: Using multivariate analyses, a positive association between potential exposure to 'hope' campaigns and thinking about quitting and intending to quit was noted, but no association was seen with quit attempts. Potential exposure to 'sadness' evoking campaigns was positively associated with quitting salience and negatively associated with quit attempts, whereas those potentially exposed to campaigns evoking multiple negative emotions (fear, guilt and sadness) were approximately 30% more likely to make a quit attempt. CONCLUSIONS: This study suggests a relationship between the emotional content of campaigns, quitting behaviours. Campaign planners should consider campaigns that evoke negative emotions for population-wide efforts to bring about quitting activity alongside hopeful campaigns that promote quitting salience and quitting intentions. The emotional content of campaigns provides an additional consideration for campaigns targeting smokers and influencing quitting activity. SO WHAT?: This study demonstrates the importance of balancing the emotional content of campaigns to ensure that campaign advertising is given the greatest chance to achieve its objectives. Utilising campaigns that evoke negative emotions appear to be needed to encourage quitting attempts but maintaining hopeful campaigns to promote thinking about quitting and intending to quit is also an important component of the mix of tobacco control campaigns.

Improving access to public physical activity events for disadvantaged communities in Australia.

BACKGROUND: Physical activity has numerous health benefits, but participation is lower in disadvantaged communities. 'parkrun' overcomes one of the main barriers for disadvantaged communities, the cost of activities, by providing a free, regular community-based physical activity event for walkers, runners and volunteers. This study assesses equity of access (in terms of distance to the nearest parkrun) stratified by socioeconomic deprivation, and identifies the optimal location for 100 new events to increase equity of access. METHODS: We combined information about population location and socioeconomic deprivation, with information about the location of 403 existing parkrun events, to assess the current level of access by deprivation quintile. We then used a two-step location-allocation analysis (minimising the sum of deprivation-weighted distances) to identify optimal regions, then optimal towns within those regions, as the ideal locations for 100 new parkrun events. RESULTS: Currently, 63.1% of the Australian population lives within 5 km of an event, and the average distance to an event is 14.5 km. A socioeconomic gradient exists, with the most deprived communities having the largest average distance to an event (27.0 km), and the least deprived communities having the best access (living an average 6.6 km from an event). Access improves considerably after the introduction of new event locations with around 68% of the population residing within 5 km of an event, and the average distance to the nearest event approximately 8 km. Most importantly, the improvement in access will be greatest for the most deprived communities (now an average 11 km from an event). CONCLUSIONS: There is a socioeconomic gradient in access to parkrun events. Strategic selection of new parkrun locations will improve equity of access to community physical activity events, and could contribute to enabling greater participation in physical activity by disadvantaged communities.

"We Don't Have to Do Things the Way They've Been Done Before"; Mixed-Method Evaluation of a National Grant Program Tackling Physical Inactivity through Sport.

National strategies are needed to continue to promote the broader benefits of participating in sport and organised physical activity to reduce physical inactivity and related disease burden. This paper employs the RE-AIM framework to evaluate the impact of the federally funded $150 million Move it AUS program in engaging inactive people in sport and physical activity through the Participation (all ages) and Better Ageing (over 65 years) funding streams. A pragmatic, mixed-methods evaluation was conducted to understand the impact of the grant on both the participants, and the funded organisations. This included participant surveys, case studies, and qualitative interviews with funded program leaders. A total of 75% of participants in the Participation stream, and 65% in the Better Ageing stream, were classified as inactive. The largest changes in overall physical activity behaviour were seen among socioeconomically disadvantaged participants and culturally and linguistically diverse participants. Seven key insights were gained from the qualitative interviews: Clarity of who, Partnerships, Communication, Program delivery, Environmental impacts, Governance, and that Physical inactivity must be a priority. The Move It AUS program successfully engaged physically inactive participants. Additional work is needed to better engage inactive people that identify as culturally and linguistically diverse, Aboriginal and/or Torres Strait Islander and those that live in disadvantaged communities in sport and physical activities. Tangible actions from the seven key insights should be adopted into workforce capability planning for the sport sector to effectively engage physically inactive communities.

Participation and dropout of Hockey New South Wales participants in 2017 and 2018: a longitudinal study.

BACKGROUND: Sports have a focus on increasing participation, which contributes to increasing population levels of physical activity, social cohesion and longevity of the sport. The primary aim of this study was to examine reasons for drop-out of a popular team sport in Australia, Field Hockey and identify opportunities to increase participation. METHODS: This longitudinal study obtained routinely collected registered player data from Hockey New South Wales over two consecutive years, and survey data from registered players who dropped out. Logistic regression models identified demographic subgroups who were more likely to drop out of sport, and the reasons for dropping out. RESULTS: In 2018, 8463 (31%) of hockey players did not return to play hockey after the previous season and 805 (10%) of these completed a survey. Specific groups who were more likely to stop playing included 5-6 years (OR: 2.1, 95% CI 1.8-2.6; reference: 12-17 years), females (OR: 1.1, 95% CI 1.0-1.2; reference: males), Indigenous (OR: 1.2, 95% CI 1.1-1.4; reference: non-Indigenous), most disadvantaged (OR: 1.1, 95% CI 1.0-1.2; reference: least disadvantaged) or regional and remote (1.1, 95% CI 1.0-1.2; reference: major cities). Top reasons for drop out were medical/age (17%), change in circumstances (16%) and high cost (13%), lack of time (13%) and lack of enjoyment (7%). CONCLUSIONS: Although Hockey successfully reaches a large proportion of underrepresented groups in sport, these groups are more likely to drop out. Sports should consult these groups to develop enjoyable, flexible, and modifiable versions of the game that are appropriate to their needs.

Physical activity and acute exercise benefit influenza vaccination response: A systematic review with individual participant data meta-analysis.

Whether the vaccine adjuvant potential of acute exercise is uniform among different populations, e.g., inactive persons, is unknown. This meta-analysis examines influenza vaccine antibody responses and the effect of physical activity, acute exercise, and their interaction. Inclusion criteria comprised randomized controlled trials with acute exercise intervention and influenza vaccination antibody measurements at baseline and 4-6 weeks, and participant baseline physical activity measurement; there were no exclusion criteria. Searching via six databases (Medline, Embase, CINAHL, Scopus, Web of Science, and Physiotherapy Evidence) and two clinical registries (WHO and NIH), nine studies were identified and assessed with the Cochrane revised risk-of-bias tool. Data analysis comprised one-stage random-effects generalized linear mixed-effects models with random intercept. Seven of nine identified studies, all of high risk of bias, provided data for 550 included participants. Clinical measures of antibody response tended to be higher in the acute-exercised participants compared to rested controls and physically active compared to inactive. Physical activity significantly increased H1 strain seroconversion (adjusted odds ratio (aOR) 1.69, 95%CI: 1.02-2.82) among all participants and titer response (aOR 1.20, 95%CI: 1.03-1.39) among the acute exercise group. Increasing age frequently reduced immunogenic responses whereas body mass index and sex had little-to-no effect. Adjuvant effects were more pronounced with interventions exercising the same arm in which the vaccination was administered. H1 response was increased by both physical activity and the acute exercise-physical activity interaction. Given the observed modifications by age and the subset analysis suggesting the benefit is more pronounced in older populations, future attention is due for acute exercise-PA interactions to impact vaccination response in the at-risk population of older adults. Further, we identify localized exercise as the likely most-effective protocol and encourage its use to augment the available evidence.

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

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

Psychometric assessment of scales for measuring loneliness and social isolation: an analysis of the household, income and labour dynamics in Australia (HILDA) survey.

BACKGROUND: Loneliness and social isolation are increasingly recognised as global public health threats, meaning that reliable and valid measures are needed to monitor these conditions at a population level. We aimed to determine if robust and practical scales could be derived for conditions such as loneliness and social isolation using items from a national survey. METHODS: We conducted psychometric analyses of ten items in two waves of the Household, Income and Labour Dynamics in Australia Survey, which included over 15,000 participants. We used the Hull method, exploratory structural equation modelling, and multidimensional item response theory analysis in a calibration sample to determine the number of factors and items within each factor. We cross-validated the factor structure using confirmatory factor analysis in a validation sample. We assessed construct validity by comparing the resulting sub-scales with measures for psychological distress and mental well-being. RESULTS: Calibration and cross-validation consistently revealed a three-factor model, with sub-scales reflecting constructs of loneliness and social isolation. Sub-scales showed high reliability and measurement invariance across waves, gender, and age. Construct validity was supported by significant correlations between the sub-scales and measures of psychological distress and mental health. Individuals who met threshold criteria for loneliness and social isolation had consistently greater odds of being psychologically distressed and having poor mental health than those who did not. CONCLUSIONS: These derived scales provide robust and practical measures of loneliness and social isolation for population-based research.

Sport Participation and Academic Performance in Children and Adolescents: A Systematic Review and Meta-analysis.

INTRODUCTION: Physical activity can improve academic performance; however, much less is known about the specific association between sport participation and academic performance, and this evidence has not been synthesized. Our aim was to systematically review and combine via meta-analyses evidence of the association between sport participation and academic performance in children and adolescents. METHODS: We conducted searches of five electronic databases using sport and academic performance related terms. We combined evidence from eligible studies using a structural equation modeling approach to multilevel meta-analysis. RESULTS: From 115 eligible studies, most of which had a high risk of bias (k = 87), we meta-analyzed 298 effect sizes. Overall, sport participation had a small positive effect on academic performance (d = 0.26, 95% confidence interval = 0.09, 0.42). Moderator analyses indicated that sports participation was most beneficial for academic performance when it was at a moderate dose (i.e., 1-2 h·wk-1), compared with no sport or a high dose of sport (3+ h·wk-1). CONCLUSIONS: Sports participation during school hours was more beneficial for academic performance compared with sport participation outside school hours. Based on mostly low-quality studies, we found some evidence that sport could positively affect academic performance in children and adolescents. It appears that sport participation of a moderate dose and at school could be used to promote academic performance. However, if this field were to inform policy, high-quality studies are needed that provide insight into the effect of dose and sport characteristics on academic performance.

Body mass Index of children and adolescent participants in a voucher program designed to incentivise participation in sport and physical activity: A cross-sectional study.

There has been limited population-level success in tackling overweight and obesity. The Active Kids program is a universal intervention that aims to increase participation in structured physical activity and sport among children and adolescents in New South Wales (NSW), Australia. This study examined the prevalence of overweight and obesity across subgroups and by social disadvantage in this large broadly representative sample. A cross-sectional study was conducted including all children (n = 671,375) who registered for an Active Kids Program voucher in 2018. The child's height and weight were obtained from an online registration form. Among children and adolescents who registered in the Active Kids Program, the prevalence of overweight and obesity was 17.2% and 7.6%, respectively. A large number of children and adolescents who lived in the most disadvantaged areas (n = 99,583; 14.8%) registered for the program. There was a clear socio-economic gradient for obesity prevalence across areas of increasing disadvantage, with children and adolescents living in the most disadvantaged area being 1.87 (95% CIs 1.82, 1.93) times more likely to be overweight or obese. The Active Kids program successfully reached a substantial proportion of children who are overweight and obese from socio-economically disadvantaged areas, providing financial support and opportunities for these children to participate in structured sport and physical activity. However, the program did not reach all children, and additional physical activity promotion strategies may be needed in a comprehensive approach. Nonetheless, these findings support government investment in reaching children who are overweight or obese with large-scale programs.

Linking sports registration information and player feedback to enhance netball participation.

BACKGROUND: Sports should endeavour to provide inclusive opportunities for all people to participate. More evidence is required to understand who joins sports clubs and what keeps participants engaged throughout their lifetime. Little is known about who plays netball or what drives participation and retention of players in netball. This study aimed to identify the sociodemographic characteristics of Netball New South Wales (NSW) members, their odds of re-registering in the sport, and explore their motivations to play, experiences during participation and the perceived benefits of playing netball. METHODS: We used longitudinal sport registration data from all Netball NSW members in 2018 and 2019. A cross-sectional online survey was sent to all players registered during the two-year study period (n = 157,152). We used logistic regression to determine the odds of individuals returning to netball in 2019 after playing in 2018 and linked the sports registration data with the survey responses, calculating frequencies and proportions. RESULTS: Netball NSW members were mostly female (98 %) and aged less than 18 years old (69 %). Netball NSW retained 68 % of members in 2019 who played the previous year. Members who were male, aged 18-44 years old, lived in low SES areas, lived in regional/remote locations, identified as Aboriginal or Torres Strait Islander, spoke a language other than English at home or were born outside Australia had lower odds of returning to play from 2018 to 2019. Survey participants (n = 10,795) rated their experience playing netball highly and reported that playing netball improved their health and wellbeing. The main reason to play netball reported was 'fun and enjoyment' while the main reason to consider quitting was the 'skill/experience of umpires and officials'. CONCLUSIONS: This study highlights the strengths of netball in engaging and retaining females, who often participate in less sport than males. The positive experiences reported by netball participants should be fostered to retain current participants throughout the lifecourse. The data provided by members should be inform strategic actions to enhance netball participation for sociodemographic groups who had greatest odds of dropout. Routine surveillance using linked registration and player feedback should be utilised by sports to enhance sport delivery and increase participation.

Comparison of costs related to infant hospitalisations for spontaneous, induced and Caesarean births: population-based cohort study.

Objective This study examined hospitalisations and associated in-patient costs for babies during the first year of life following spontaneous labour, compared with labour induction or prelabour Caesarean section, at each gestational age. Methods Birth data for singleton liveborn babies from 33 weeks gestation in New South Wales from 2005 to 2014 were linked to hospital and death data. Generalised linear models were used to examine the association between the type of labour and the length of hospitalisations and hospital costs. Results From 2005 to 2014, 598640 women gave birth to 1187451 liveborn singleton babies. The mean total length of hospitalisations and costs of hospitalisations for babies in the first year of life decreased significantly as week of gestational age increased to 39 weeks, then plateaued. Overall, the total length of hospitalisations and hospital costs were significantly (P<0.001) lower for babies born after spontaneous labour (5.6 days and A$8405 respectively) than for babies born following labour induction (6.1 days and A$9452 respectively) or prelabour Caesarean section (8.2 days and A$12320 respectively). Conclusions Babies born following spontaneous labour spend less time in hospital and have lower hospital costs than those born following labour induction or prelabour Caesarean section. Hospitalisations and costs decrease with each week of gestational age until 39 weeks. What is known about the topic? It is known that induction of labour and prelabour Caesarean sections are increasing, and this increase has changed the distribution of gestational age towards birth at earlier ages. It is also known that babies born before 39 weeks of gestation are at increased risk of mortality and morbidity. What does this paper add? This study shows that babies born following spontaneous labour spend the least amount of time in hospital and subsequently have the lowest hospital costs at each week of gestation compared with babies born following labour induction or prelabour Caesarean section. This study also shows a small but significant economic advantage of labour induction compared with prelabour Caesarean delivery. This study quantifies the mean time babies spend in hospital in their first year of life, by week of gestational age and mode of birth. What are the implications for practitioners? The findings from this study can assist clinicians in judicious decision making when balancing the risks and benefits of early planned births. Clinicians can use the results of this study to inform women who are intending to have a planned birth of risks they may not have anticipated, such as the increased risk of rehospitalisation. The finding that hospitalisations and costs continue to decline until 39 weeks gestation can be used to reinforce the importance of continuing the pregnancy beyond 37 weeks if safe to do so, even though 37 weeks is considered term.

Effects of the Active Kids voucher program on children and adolescents' physical activity: a natural experiment evaluating a state-wide intervention.

BACKGROUND: There is an urgent need for scaled-up effective interventions which overcome barriers to health-enhancing physical activity for children and adolescents. In New South Wales (NSW), Australia, the state government implemented a universal voucher program, 'Active Kids' to support the cost of structured physical activity registration for school-enrolled children aged 4.5-18 years old. The objective of this study was to understand the effects a financial incentive intervention delivered in a real-world setting has on children and adolescent's physical activity participation. METHOD: In 2018, all children and adolescents registered for an Active Kids voucher provided sociodemographic characteristics, physical activity and research consent. This prospective cohort study used an online survey with validated items to measure physical activity and other personal and social factors in children and adolescents who used an Active Kids voucher. Generalized linear mixed models were used to examine changes from registration to after voucher use at ≤8 weeks, 9-26 weeks and ≥ 6 months. RESULTS: Study participants reported increasing their days achieving physical activity guidelines from 4.0 days per week (95%CI 3.8, 4.2) at registration (n = 37,626 children) to 4.9 days per week (95%CI 4.7, 5.1) after 6 months (n = 14,118 children). Increased physical activity was observed for all sociodemographic population groups. The voucher-specific activity contributed 42.4% (95%CI 39.3, 45.5) to the total time children participated in structured physical activities outside of school. Children and adolescents who increased to, or maintained, high levels of activity were socially supported to be active, had active parent/caregivers, had better concentration and were overall happier than their low-active counterparts. CONCLUSION: The Active Kids program significantly increased children's physical activity levels and these increases continued over a six-month period. The Active Kids voucher program shows promise as a scaled-up intervention to increase children and adolescents' physical activity participation. TRIAL REGISTRATION: Australian New Zealand Clinical Trial Registry ACTRN12618000897268 , approved May 29th, 2018 - Retrospectively registered.

Is Cohort Representativeness Passé? Poststratified Associations of Lifestyle Risk Factors with Mortality in the UK Biobank.

BACKGROUND: The UK Biobank (UKB) has been used widely to examine associations between lifestyle risk factors and mortality outcomes. It is unknown whether the extremely low UKB response rate (5.5%) and lack of representativeness materially affects the magnitude and direction of effect estimates. METHODS: We used poststratification to match the UKB sample to the target population in terms of sociodemographic characteristics and prevalence of lifestyle risk factors (physical inactivity, alcohol intake, smoking, and poor diet). We compared unweighted and poststratified associations between each lifestyle risk factor and a lifestyle index score with all-cause, cardiovascular disease (CVD), and cancer mortality. We also calculated the unweighted to poststratified ratio of HR (RHR) and 95% confidence interval as a marker of effect-size difference. RESULTS: Of 371,974 UKB participants with no missing data, 302,009 had no history of CVD or cancer, corresponding to 3,298,958 person years of follow-up. Protective associations between alcohol use and CVD mortality observed in the unweighted UKB were substantially altered after poststratification, for example, from a hazard ratio (HR) of 0.63 (0.45-0.87) unweighted to 0.99 (0.65-1.50) poststratified for drinking ≥5 times/week versus never drinking. The magnitude of the poststratified all-cause mortality hazard ratio comparing least healthy with healthiest tertile of lifestyle risk factor index was 9% higher (95% confidence interval: 4%, 14%) than the unweighted estimates. CONCLUSIONS: Lack of representativeness may distort the associations of alcohol with CVD mortality, and may underestimate health hazards among those with cumulatively the least healthy lifestyles.

Strong support for broad policies to prevent childhood obesity among mothers in New South Wales, Australia.

ISSUE ADDRESSED: Support for broad policies to prevent childhood obesity is not clear. This study aimed to investigate the level of support for state government health promotion policies among mothers with infants and its associated factors. METHODS: This secondary analysis of data from 1155 mothers in NSW assessed approval for six policy options derived from public health approaches to obesity. Descriptive statistics were used to show the extent of policy approval across the cohort. Logistic regression models tested associations between perceived susceptibility and perceived severity of childhood obesity and approval of each policy option. RESULTS: The proportion of mothers who felt these policy options were 'about the right amount' (56%-68%) or 'not going far enough' (24%-36%), collectively represented 89%-95% approval of government intervention. In comparison, 5%-11% felt that these policies were 'going too far'. Factors associated with their levels of support varied between each policy option, based on mothers' characteristics and perceptions of childhood obesity. CONCLUSION: These findings indicate high support for government intervention to prevent obesity among mothers in NSW and support health promotion advocacy in this area. SO WHAT?: Governments should give due consideration to implementing each of the six policy options and prioritise the implementation of restrictions on fast food advertising in publicly owned or controlled areas.