Tracking funded health intervention research.

OBJECTIVE: To describe the research publication outputs from intervention research funded by Australia's National Health and Medical Research Council (NHMRC). DESIGN AND SETTING: Analysis of descriptive data and data on publication outputs collected between 23 July 2012 and 10 December 2013 relating to health intervention research project grants funded between 1 January 2003 and 31 December 2007. MAIN OUTCOME MEASURES: Stages of development of intervention studies (efficacy, effectiveness, replication, adaptation or dissemination of intervention); types of interventions studied; publication output per NHMRC grant; and whether interventions produced statistically significant changes in primary outcome variables. RESULTS: Most of the identified studies tested intervention efficacy or effectiveness in clinical or community settings, with few testing the later stages of intervention development, such as replication, adaptation or dissemination. Studies focused largely on chronic disease treatment and management, and encompassed various medical and allied health disciplines. Equal numbers of studies had interventions that produced statistically significant results on primary outcomes, (27) and those that did not (27). The mean number of total published articles per grant was 3.3, with 2.0 articles per grant focusing on results, and the remainder covering descriptive, exploratory or methodological aspects of intervention research. CONCLUSIONS: Our study provides a benchmark for the publication outputs of NHMRC-funded health intervention research in Australia. Research productivity is particularly important for intervention research, where findings are likely to have more immediate and direct applicability to health policy and practice. Tracking research outputs in this way provides information on whether current research investment patterns match the need for evidence about health care interventions.

'Treats', 'sometimes foods', 'junk': a qualitative study exploring 'extra foods' with parents of young children.

OBJECTIVE: The present study investigated parents' understanding and approaches to providing energy-dense and nutrient-poor 'extra foods' to pre-school children and explored variation between parents of low and high socio-economic status in relation to these issues. DESIGN: We conducted thirteen focus groups. Data were subject to framework analysis. SETTING: Child-care centres in distinctly socially disadvantaged and socially advantaged areas. SUBJECTS: Eighty-eight parents of children aged 3-5 years. RESULTS: The three most common terms parents identified to describe foods that are not 'everyday foods' were 'treats', 'sometimes foods' and 'junk'. Parents' perceptions regarding what influences them in providing food to their children included seven sub-themes: (i) the influence of the child; (ii) food-related parenting practices; (iii) health considerations; (iv) food costs and convenience; (v) external factors perceived as influencing their child; (vi) factors related to child care; and (vii) social influences and occasions. Parents' decision-making processes regarding provision of 'extra foods' related to moderation and balance. Parents generally expressed the position that as long as a child is eating healthy foods, then treats are appropriate; and for many parents, this might apply frequently. All groups described the health of their child as an influence, but parents in low socio-economic groups were more likely to describe immediate concerns (dental health, behaviour) in relation to avoiding sugar-dense food or drink. CONCLUSIONS: The belief that provision of 'extra foods' can be frequent as long as children are eating a healthy balance of foods is factored into parents' decision making. Challenging this belief may be important for reducing the consumption of 'extra foods' by young children.

Measuring the food environment in three rural towns in New South Wales, Australia.

ISSUE ADDRESSED: Food availability affects eating habits, and in the Australian context, refers to the numbers and locations of food retail and food service outlets and the types and range of foods in those outlets. The aim of this study was to assess the community and consumer food environment in three small rural towns in New South Wales, Australia. METHODS: Geographical analyses were used to measure the diversity, variety and locations of food outlets (community food environment); and checklists were used to assess the availability of selected indicator foods within food outlets (consumer food environment). RESULTS: Supermarkets provided access to the full range of healthy indicator foods, with convenience stores selling a more limited set of healthy food items. There were high numbers of take-away food outlets in each town that had no, or a limited number of, healthy food items. Energy-dense, nutrient-poor foods such as soft drinks and potato crisps were readily available across all food retail outlets in all towns. CONCLUSION: This study illustrates a valid, reliable and practical way of systematically describing food availability at a local level. The findings emphasise the ubiquity of energy-dense, nutrient-poor foods, and suggest that interventions to promote the availability of healthier food items in take-away food outlets are required. Further research is required to assess other factors which may affect residents' food access, such as cost and transport.

Role modelling unhealthy behaviours: food and drink sponsorship of peak sporting organisations.

ISSUE ADDRESSED: Organised sport provides an important setting for health promotion. Peak sporting organisations have a role in assisting and overseeing sports clubs, including providing funding opportunities. As such, sponsorship of these organisations may influence the funding of community sport. This study aimed to describe the nature and scope of peak sporting organisations' sponsorship, and particularly food and beverage company sponsors. METHODS: An analysis of national and state sporting organisations'websites for the nine most popular sports for children and from four Australian states and territories was conducted using a structured survey tool. Information collected included the number and type of sponsors and sponsorship policies.The nature of food and beverage sponsors was defined as more healthy or less healthy using criteria from a Delphi survey. RESULTS: 443 sponsors were identified across 55 websites. Overall, 9% of sponsors were food companies and 3% were alcohol manufacturers. The majority of food companies (63%) and alcohol manufacturers (100%) did not meet criteria as healthy sponsors. CONCLUSIONS: Sponsorship of peak sporting organisations is widespread and consists of a relatively high proportion of alcohol manufacturers and food companies, some of which produce products considered to be unhealthy.This sponsorship may influence community sport through sponsored sporting programs or by indicating sponsors' acceptability.

Children's consumption of energy-dense nutrient-poor foods, fruit and vegetables: are they related? An analysis of data from a cross sectional survey.

ISSUE ADDRESSED: Many children consume excessive amounts of energy-dense, nutrient-poor (EDNP) or 'extra' foods and low intakes of fruit and vegetables. The aim of this study was to examine the associations between EDNP foods and ascertain whether certain EDNP foods and beverages are more likely to be eaten in association with other EDNP foods. METHODS: A cross-sectional representative population survey of children in preschool (n=764), and of school students in Years K, 2 and 4 (n=1,560) and in Years 6, 8 and 10 (n=1,685) residing in the Hunter New England region of New South Wales, Australia. Dietary data were collected using a short food frequency questionnaire. Multivariate logistic regression models examined the association between EDNP foods and fruit and vegetable intake. Data were stratified by sex and age cohort. RESULTS: More frequent consumption of some EDNP food types was significantly associated with more frequent consumption of other EDNP foods. Fast food and soft drinks consumption were associated with each other as well as with fried potato and salty snacks; and with lower intakes of fruit and vegetables in some but not all age groups. CONCLUSION: The positive associations found between EDNP foods point towards the existence of a high-risk group of children who frequently consume a variety of EDNP foods and drinks.

Adolescent-parent interactions and communication preferences regarding body weight and weight management: a qualitative study.

BACKGROUND: This study aimed to canvass the nature of adolescent-parent interactions about weight, particularly overweight, and to explore ideas of how to foster supportive discussions regarding weight, both in the home and with family doctors. METHODS: A market research company was contracted to recruit and conduct a series of separate focus groups with adolescents and unrelated parents of adolescents from low-middle socio-economic areas in Sydney and a regional centre, Australia. Group discussions were audio recorded, transcribed, and then a qualitative content analysis of the data was performed. RESULTS: Nine focus groups were conducted; two were held with girls (n = 13), three with boys (n = 18), and four with parents (20 mothers, 12 fathers). Adolescent and parent descriptions of weight-related interactions could be classified into three distinct approaches: indirect/cautious (i.e. focus on eating or physical activity behaviors without discussing weight specifically); direct/open (i.e. body weight was discussed); and never/rarely discussing the subject. Indirect approaches were described most frequently by both adolescents and parents and were generally preferred over direct approaches. Parents and adolescents were circumspect but generally supportive of the potential role for family doctors to monitor and discuss adolescent weight status. CONCLUSIONS: These findings have implications for developing acceptable messages for adolescent and family overweight prevention and treatment interventions.

Adolescent-parent interactions and attitudes around screen time and sugary drink consumption: a qualitative study.

BACKGROUND: Little is known about how adolescents and their parents interact and talk about some of the key lifestyle behaviors that are associated with overweight and obesity, such as screen time (ST) and sugary drink (SD) consumption. This qualitative study aimed to explore adolescents' and parents' perceptions, attitudes, and interactions in regards to these topics. METHODS: Using an exploratory approach, semi-structured focus groups were conducted separately with adolescents and (unrelated) parents. Participants were recruited from low and middle socio-economic areas in the Sydney metropolitan area and a regional area of New South Wales, Australia. Transcripts were analysed using thematic analysis for each of the four content areas (adolescent-ST, adolescent-SD consumption, parents' views on adolescents' ST and parents' views on adolescents' SD consumption). RESULTS: Nine focus groups, with a total of 63 participants, were conducted. Broad themes spanned all groups: patterns of behavior; attitudes and concerns; adolescent-parent interactions; strategies for behavior change; and awareness of ST guidelines. While parents and adolescents described similar patterns of behaviour in relation to adolescents' SD consumption and ST, there were marked differences in their attitudes to these two behaviours which were also evident in the adolescent-parent interactions in the home that they described. Parents felt able to limit adolescents' access to SDs, but felt unable to control their adolescents' screen time. CONCLUSION: This study offers unique insights regarding topics rarely explored with parents or adolescents, yet which are part of everyday family life, are known to be linked to risk of weight gain, and are potentially amenable to change.

Parents of school students on childhood overweight: the Weight of Opinion Study.

AIM: The perceptions of parents of school-aged children regarding child and adolescent overweight and obesity were examined. METHOD: Parents with children in primary and secondary schools in socio-economically diverse areas across metropolitan Sydney and rural New South Wales, Australia, were recruited for focus group discussions. Content analysis was used to analyse the focus group transcripts. RESULTS: Participants were concerned about overweight among school-aged children and young people, but were reluctant to address it with their own children. The parents wanted general practitioners to raise the issue, but not other professionals or friends/relations. The participants agreed that schools had an educational role to play in both healthy eating and physical activity, but disagreed about whether schools should regulate foods brought from home or supplied at school. Parents suggested various ways of restricting marketing to children, educating parents and children, increasing opportunities for physical activity and increasing access to healthier foods. CONCLUSIONS: Parents are concerned about overweight among children and adolescents, but are reluctant to take action, and would find it difficult to be effective change agents. There are opportunities for intervention, but they must recognise the salient emotional issues associated with weight and food among parents.

Current and future costs of cancer, heart disease and stroke attributable to obesity in Australia - a comparison of two birth cohorts.

The obesity epidemic appears set to worsen the morbidity and mortality from leading causes of death in Australia - ischaemic heart disease, stroke and obesity-related cancers. The aim of this study was to compare hospital separations, deaths and direct health costs for middle-aged adults (45 to 54 years) in 2004/05 with those attaining age 45 to 54 years in 2024/25 who were born into an obesogenic environment. Using data from National Health Surveys, prevalence of obesity in 2004/05 was calculated for those born in 1950/51-59/60 and four scenarios were considered to project rates in 2024/25 for those born in 1970/71-79/80: an age-cohort model; a linear trend model; a steady state where rates increase to equal those of the older birth cohort at the same age; and a best case where rates remain at 2004/05 levels. Population attributable fractions were calculated by gender and disease using relative risks of disease from the literature, and applied to hospital separations, deaths, and direct health system costs data to estimate the proportion of each attributable to obesity. In 2024/25 the projected number of hospitalizations of 45 to 54 year olds due to the diseases of interest could be more than halved, over 200 lives rescued and $51.5 million (in 2004/05 dollars) saved if further gains in obesity in the younger birth cohort are halted. Instead, if the worst case scenario is realized there will be a more than doubling in costs (in 2004/05 dollars) compared with those born in 1950/51-59/60.

Perceptions of adolescents on overweight and obesity: the weight of opinion study.

AIM: The incidence and prevalence of overweight and obesity are rising around the world. Health promotion planning must be informed by the knowledge, perceptions, motivations and perceived needs of the target population, but little is known about how adolescents perceive overweight and obesity, its causes and solutions. METHODS: A cross-sectional, non-representative sample of 12- to 17-year-old boys and girls (n = 58) attending schools in diverse metropolitan areas and one rural area in NSW, Australia. Focus groups were conducted in 2005 and content analysis was used to identify key themes. RESULTS: The students were aware that overweight was becoming increasingly common. They perceived the negative consequences primarily in psycho-social terms, but were also aware of the long-term physical health consequences. Behaviours, appearance, motivation and self-esteem were used as criteria to judge if a person was overweight and the students distinguished between 'healthy' and 'ideal' (physically attractive) weight. The major barriers to maintaining a healthy weight were home, school and community environments in which fatty/high sugar foods were too easily accessible and where opportunities for participating in physical activity were sometimes limited. Student-identified strategies to address the issue encompassed government policy, advertising and media, schools and home. CONCLUSIONS: The students have a mature and complex understanding of overweight and its potential solutions, making them likely to be creative contributors and responsive to wide-ranging, multi-component interventions.

Are general practitioners ready and willing to tackle obesity management?

OBJECTIVE: To investigate general practitioners' (GPs') knowledge, role perception, confidence and practices of managing adult and childhood overweight and obesity, and to explore the association with GPs' attendance at Continuing Professional Development (CPD) on overweight and obesity. METHODS: In 2007, all GPs in seven Divisions of general practice in New South Wales were sent a questionnaire on GPs perceptions and practices of weight counselling. RESULTS: 646 GPs participated (40% response rate). About half of the GPs (47%) believed that only a small percentage of adults could reduce weight and maintain that loss, whereas 33% had a similar belief in relation to children. Most GPs believed that it was their role to manage weight and felt confident to do so with adults, but fewer GPs felt confident in managing children. Nevertheless, just over one-third of GPs reported they counselled more than 10 adult patients, and a similar proportion counselled more than 3 children per week. GPs who felt more confident were more likely to counsel adults (OR = 2.69, p = 0.001) and children (OR = 3.31, p < 0.001). Those who received CPD were more likely to feel confident in managing adults (OR = 1.56, p = 0.031) and children (OR = 2.19, p < 0.001). CONCLUSIONS: Although the majority of GPs believe that weight management is their role, only a small proportion regularly provided counselling. This may partly be the result of GPs confidence in managing patients, especially children. CPD on overweight and obesity may benefit GP confidence, but additional training is needed to improve GP's counselling behaviour, particularly for children.

Choice and voice: obesity debates in television news.

OBJECTIVE: To examine whether television news and current affairs coverage of overweight and obesity frames obesity in ways that support or oppose efforts to combat obesity. DESIGN AND SETTING: A content and framing analysis of a structured sample of 50 television news and current affairs items about overweight and obesity broadcast by five free-to-air television channels in New South Wales between 2 May and 31 October 2005. MAIN OUTCOME MEASURES: Dominant discourses about causes of overweight and obesity; proposed solutions and location of responsibility for the problem; the age-group focus of television items; the relative prominence of stakeholders; and the aspects of obesity which attract news attention. RESULTS: Most television items (72%) framed obesity as a problem of poor nutrition. Obesity was largely seen as the responsibility of individuals (66% of items). Just over half of news items (52%) focused only on adults while 26% focused only on children. Obesity was framed largely as a problem to be solved by individual nutritional changes, exercise and surgical and medical interventions. CONCLUSIONS: While individual lifestyle is crucial to controlling weight, the research community now recognises the importance of sociocultural and environmental factors as drivers of the obesity epidemic. However, television news portrays obesity largely as an individual problem with individual solutions centred mostly on nutrition. Media emphasis on personal responsibility and diet may detract attention from the sociopolitical and structural changes needed to tackle overweight and obesity at a population level.

Mothers of pre-school children talk about childhood overweight and obesity: The Weight Of Opinion Study.

AIM: To investigate the perceptions of parents of young children aged 2-5 years regarding childhood overweight and obesity. METHODS: Parents with children in seven pre-schools and long day-care centres from diverse socio-economic areas across metropolitan Sydney and one rural area were recruited for focus groups. Focus group transcripts were analysed using content analysis. RESULTS: Providing food was an emotional issue for the mothers in this study. They were more concerned about their young children being underweight than overweight, and this increased their stress around children's eating. Food treats were perceived as entitlements. Mothers did believe that they were responsible for their children's eating, but acknowledged the influence of other environmental factors related to food retail and marketing. Practical and safety issues limited opportunities for their children to be physically active beyond the formal child-care setting. Parents had practical suggestions for solutions to some of the barriers they experienced, and wanted support for their role. CONCLUSIONS: The emotional intensity of the mothers' perceptions about their children's eating and weight status suggests that interventions, including communications, need to go beyond information and engage with parents' emotions. Some food concerns were actually related to broader parenting issues and indicate the potential value for interventions to focus on behavioural parenting techniques. Preventive interventions need to acknowledge the issues faced by parents and support their role directly, such as through making healthy and active behaviours easily available, and indirectly, through providing local services, including early childhood services.

Australian GPs' perceptions about child and adolescent overweight and obesity: the Weight of Opinion study.

BACKGROUND: GPs can potentially play a significant role in assessing weight status, providing advice, and making referrals to address overweight and obesity and its consequences among children and adolescents. AIM: To investigate the perceptions of GPs about overweight and obesity in children and adolescents, including the extent to which they perceive it as a concern, the factors they see as causal, what actions they consider might be needed, and their sense of responsibility and self-efficacy. DESIGN OF STUDY: A cross-sectional qualitative study of GPs' perceptions. SETTING: General practice and primary health care services in the state of New South Wales, Australia. METHOD: Focus groups using a structured protocol were conducted with samples of GPs. Groups comprised a mix of male and female GPs from a range of cultural backgrounds and working in practices in low, medium and high socioeconomic areas. Data were recorded and transcribed. Content analysis was used to identify key themes. RESULTS: Many GPs are concerned about the increasing prevalence of childhood overweight and obesity. They are committed to dealing with the medical consequences, but are aware of the broad range of social causes. GPs perceived that parents are sensitive about this topic, making it difficult for them to raise the issue directly in clinical practice, unless they use lateral strategies. GPs were confident about providing advice, with some managing the problem independently, while others preferred to refer to specialised services. GPs perceived that there were significant barriers to patient compliance with advice. CONCLUSION: Whereas some GPs manage patients' lifestyle change directly, including children's weight management, others prefer to refer. Programmes, service delivery systems, and resources to support both approaches are required.

Biology teachers' attitudes to dissection and alternatives.

A survey of 5000 American middle and high school level biology teachers was completed to assess attitudes and classroom practice relating to dissection and alternative teaching methods. A preliminary sample of 494 respondents revealed that 79% of teachers used dissection to teach biology. While 72% believed that dissection was an important part of the curriculum, 17% disagreed; 69% considered dissection to be an essential hands-on activity. While 31% believed that alternatives were as good as dissection for teaching anatomy and physiology, 55% disagreed. The primary reason given for continuing dissection, rather than exclusively using alternatives, was the hands-on aspect of dissection (69%). While the majority (66%) of biology teachers favoured student choice between dissection and other learning methods, 20% disagreed. Although the effectiveness of alternative methods has been documented, and ethical arguments against dissection have been advanced, the mainstream introduction of humane alternatives to dissection requires a transformation of the beliefs, experience and practice of biology teachers.

Behavioral evaluation of the psychological welfare and environmental requirements of agricultural research animals: theory, measurement, ethics, and practical implications.

The welfare of agricultural research animals relies not only on measures of good health but also on the presence of positive emotional states and the absence of aversive or unpleasant subjective states such as fear, frustration, or association with pain. Although subjective states are not inherently observable, their interaction with motivational states can be measured through assessment of motivated behavior, which indicates the priority animals place on obtaining or avoiding specific environmental stimuli and thus allows conclusions regarding the impact of housing, husbandry, and experimental procedures on animal welfare. Preference tests and consumer demand models demonstrate that animal choices are particularly valuable when integrated with other behavioral and physiological measurements. Although descriptive assessments of apparently abnormal behavior such as stereotypies and "vacuum behaviors" provide indications of potentially impoverished environments, they should be used with some caution in drawing welfare conclusions. The development of stereotypies may in some cases be linked to psychiatric dysfunction and reflect underlying neurophysiological impairments, which have implications for the ability to perform flexible behavior and thus the quality of research data provided by this kind of behavioral measurement (e.g., in pharmaceutical research). Environmental modifications, commonly termed "enrichment," can have diverse consequences for cognitive function, physiological responses, health, psychological welfare, and research data. Simple practical modifications of housing, husbandry, and experimental design are suggested to improve the psychological welfare of agricultural research animals in accordance with the principles of refining, reducing, and replacing (the "3Rs"), which underlie US Public Health Service Policy, and prevailing public ethics.