Study protocol for a natural experiment in a lower socioeconomic area to examine the health-related effects of refurbishment to parks including built-shade (ShadePlus).

INTRODUCTION: Parks in disadvantaged suburbs often have low quality and few amenities, which is likely to result in them being underutilised for recreation and physical activity. Refurbishment of parks, including shade, walking paths and other amenities, may have broad health-related benefits. METHODS AND ANALYSIS: The study design, methods and planned analyses for a natural experiment examining the effects of refurbishments including built-shade added to parks in disadvantaged outer suburbs of Melbourne are described. Three intervention parks and three comparison parks matched for equivalence of park and neighbourhood characteristics were selected. Using mixed methods, the outcomes will be assessed during three consecutive spring-summer periods (T1: 2013-2014; T2: 2014-2015: T3: 2015-2016). Primary outcomes included: observed park use, physical activity and shade use. Self-reported social connectedness, community engagement and psychological well-being were assessed as secondary outcomes. ETHICS AND DISSEMINATION: This study was approved by Cancer Council Victoria's Human Research Ethics Committee. Studies such as ShadePlus can improve understanding of the broader effects of park refurbishments (including physical activity levels and sun protection behaviours, as well as social connectedness and psychological well-being). The study findings will be disseminated through established urban planning and parks and recreation networks, peer review publications and conference presentations.

Methodology for the evaluation of the Stephanie Alexander Kitchen Garden program.

ISSUES ADDRESSED: Community and school cooking and gardening programs have recently increased internationally. However, despite promising indications, there is limited evidence of their effectiveness. This paper presents the evaluation framework and methods negotiated and developed to meet the information needs of all stakeholders for the Stephanie Alexander Kitchen Garden (SAKG) program, a combined cooking and gardening program implemented in selectively funded primary schools across Australia. METHODS: The evaluation used multiple aligned theoretical frameworks and models, including a public health ecological approach, principles of effective health promotion and models of experiential learning. The evaluation is a non-randomised comparison of six schools receiving the program (intervention) and six comparison schools (all government-funded primary schools) in urban and rural areas of Victoria, Australia. A mixed-methods approach was used, relying on qualitative measures to understand changes in school cultures and the experiential impacts on children, families, teachers, parents and volunteers, and quantitative measures at baseline and 1 year follow up to provide supporting information regarding patterns of change. RESULTS: The evaluation study design addressed the limitations of many existing evaluation studies of cooking or garden programs. The multistrand approach to the mixed methodology maintained the rigour of the respective methods and provided an opportunity to explore complexity in the findings. Limited sensitivity of some of the quantitative measures was identified, as well as the potential for bias in the coding of the open-ended questions. CONCLUSION: The SAKG evaluation methodology will address the need for appropriate evaluation approaches for school-based kitchen garden programs. It demonstrates the feasibility of a meaningful, comprehensive evaluation of school-based programs and also demonstrates the central role qualitative methods can have in a mixed-method evaluation. So what? This paper contributes to debate about appropriate evaluation approaches to meet the information needs of all stakeholders and will support the sharing of measures and potential comparisons between program outcomes for comparable population groups and settings.

The influence of sensitivity to reward on reactivity to alcohol-related cues.

AIMS: To investigate the role of sensitivity to reward in mediating social drinkers' reactivity to alcohol cues. DESIGN: A standard cue-reactivity paradigm was employed. Two groups of social drinkers (heavy and light) were assessed after exposure to the sight, smell and taste of a neutral cue (water) and then an alcohol cue (glass of beer). SETTING: Sessions were conducted in a laboratory based environment. PARTICIPANTS: Twenty heavy (12 males, eight females) and 18 light social drinkers (seven males, 11 females) were recruited; mean age was 23.6 years. MEASUREMENTS: The Card Arranging Reward Responsivity Objective Test (CARROT), assessing behavioural responsiveness to a monetary incentive; urge to drink; positive affect; and the BAS scales, assessing sensitivity to reward. FINDINGS: Heavy drinkers displayed a significant increase in responsivity to rewards (i.e. CARROT) and self-reported urge to drink, but not positive affect, after exposure to alcohol. For the heavy drinkers, heightened sensitivity to reward (i.e. BAS scales) was significantly related to cue-elicited urge to drink and positive affect. CONCLUSION: The results are consistent with a conditioned appetitive motivational model of alcohol use and suggest that Gray's theory of personality may be of some benefit in explaining variation in reactivity responses.

Children with persistent conduct problems who dropout of treatment.

Dropout of treatment is one of the key issues in outcome in a child and adolescent mental health service. We report two studies focusing on the treatment process and the dropout rate of children with persistent conduct problems presenting to a community mental health service, using a prospective design. The first study included 32 children and used a randomised controlled treatment design comparing a CBT approach with conjoint family therapy and an eclectic approach. The overall dropout rate was 36%. Dropout occurred significantly less frequently in the CBT group. The dropout group was associated with mothers who were younger and less educated, a poorer rating by the clinicians at the last meeting, parental dissatisfaction with the treatment service and perception that the treatment was less organised and having less behavioural tasks. In the second study we used a naturalistic follow-up design. Forty-six children were included. The overall dropout rate was 48%. Again, the children who defaulted were rated by clinicians as less likely to have improved and dropout was also significantly associated with parental perception of a less organised treatment. In both studies dropout usually occurred after assessment and at the early phase of treatment.

Effect of Western culture on women's attitudes to eating and perceptions of body shape.

OBJECTIVE: The current study investigated the effect of culture on two factors implicated in the development of eating disorders, negative attitudes toward eating and dissatisfaction with body shape. METHOD: Hong Kong-born and Australian-born women from two Australian universities were surveyed using the Eating Attitudes Test (EAT) and the Figure Rating Scale (FRS). RESULTS: Results showed no difference between the groups in eating attitudes, but significant differences in body shape perceptions, with the Australian-born reporting greater dissatisfaction. Hong Kong-born subjects were separated into two groups based on their level of Chinese identity (Western acculturized and traditional). Their EAT and FRS scores were compared to the Australian-born, with Western acculturized Hong Kong-born subjects reporting significantly lower EAT and FRS scores than the Australian-born, whereas the more traditional Hong Kong-born subjects reported equivalent scores. DISCUSSION: Main implications center around the need for a cross-culturally sensitive definition of eating disorders, the effect of level of ethnic identity on eating attitudes and body image, and the importance of developing culturally appropriate measures.

Children who are cruel to animals: a revisit.

OBJECTIVE: There is a paucity of research regarding children who are cruel to animals (CTA). Previous studies have suggested that being CTA is linked with recurrent aggression in adulthood. In this report, children with persistent conduct problems who are CTA are examined. METHOD: A clinic-referred sample of 141 children and a community sample of 36 children between the ages of 5-12 were assessed using a test battery of questionnaires for parents, teachers and the child on mental health symptoms, self-perception, demographics and psychosocial factors. Forty of the clinic-referred children and one of the community group were rated by their parents as sometimes or definitely cruel to animals. The CTA, non-CTA and community samples were compared. RESULTS: The CTA group had more conduct symptoms compared with the non-CTA group. However, the older CTA group unexpectedly reported a higher self-esteem compared with the non-CTA group. There was no significant difference between the two clinic-referred groups in gender, attention deficit hyperactivity disorder and internalising symptoms, and psychosocial factors. CONCLUSION: Being CTA is possibly a marker of a subgroup of conduct disorder which has a poor prognosis.

Alcohol exposure therapy: generalisation and changes in responsivity.

Fifty male alcohol-dependent individuals presenting for treatment were randomly assigned to either a cue exposure (CE) or control group. The experimental group were presented with 10 exposure trials to the sight and smell of alcohol, whilst the control group were presented with a neutral beverage. Following this, subjects received exposure to alcohol in a different room to examine whether extinguished responses generalised to a different environment. Results showed that only those subjects presented with the alcohol cue showed a significant reduction in cue-elicited swallowing, subjective withdrawal symptoms, arousal and urge to drink alcohol and that these extinguished responses remained diminished in magnitude in a different environment. These results provide additional support for the effectiveness of CE in reducing responsivity to alcohol cues.

Response to alcohol cues as a function of consumption level.

The response to consumption of placebo beer was studied in male social drinkers whose normal alcohol intake consisted of at least 80% beer. There was a significant correlation between change in heart rate and normal level of beer intake with heavier drinkers showing more marked declines. Similarly, heavier drinkers reported greater desire to drink following consumption of the placebo beer. Skin temperature and withdrawal scale scores showed little change and did not correlate with intake. These results suggest that the amount of experience of alcohol paired with alcohol-related cues may be an important determinant of the magnitude of the conditioned responses to those cues.

Cue reactivity in alcohol abusers: stimulus specificity and extinction of the responses.

Sixteen alcohol abusers who had completed detoxification were presented with seven different types of alcohol and non-alcohol related stimuli. The sight and smell of the alcoholic beverage most commonly consumed by each subject elicited the largest change in response for measures of heart rate, desire to drink, and self-reported withdrawal symptoms. Beverages progressively more different from the preferred one produced responses of consistently lower magnitude. In the second phase of the study, 10 subjects were exposed to 20 presentations of the sight and smell of their preferred drink. A gradual reduction in the magnitude of the response for all three measures was observed over the 20 presentations. These results were discussed in terms of a conditioning interpretation of cue reactivity. They indicate the need for cue exposure programs to be based on the particular drinking history of the individual.

Acute tolerance to alcohol: changes in subjective effects among social drinkers.

The development of acute tolerance to the subjective effects of alcohol was examined in 32 social drinkers. Measures were made of self-reported level of intoxication and responses to questions from the alcohol scale of the Addiction Research Centre Inventory. The time to peak self-reported intoxication level was found to be 20 min earlier than the time to peak blood alcohol concentration. Changes from the ascending to the descending limb of the blood alcohol curve were found with five of the ARCI questions. In all cases the proportion of alcohol-typical responses was lower on the descending portion of the curve, even though blood alcohol levels were equivalent. Further analyses examined the effects of prior drinking history on the development of acute tolerance. Peak self-reported intoxication levels were significantly lower and occurred earlier for heavier drinkers. Furthermore, for four of the five ARCI questions heavier drinkers were less likely to give an alcohol-typical response than lighter drinkers on the ascending portion of the curve.

Conditioned alcohol-like and alcohol-opposite responses in humans.

Conditioned heart rate and skin temperature responses of 12 social drinkers were observed following repeated exposure to alcohol. Each subject received alcohol for four sessions in one room and a non-alcoholic drink for four sessions in a room of quite different appearance. Alcoholic and non-alcoholic drinks were distinctive and the alcoholic content could not be determined on the basis of taste. In the final three testing sessions, placebos were presented in order to test the influence of room and drink cues separately and in combination. A conditioned heart rate response opposite in direction to the alcohol effect was elicited by room and drink cues in combination and by the room cue in isolation. These results were in accordance with the predictions of the conditioning model of tolerance. A conditioned heart rate response in the same direction as the drug effect was elicited by the drink cue presented in isolation. Similar, but non-significant changes were also obtained with skin temperature. In addition, conditioned responses occurred independently of any expectancy. The results demonstrated that the direction of conditioned drug responses may depend on the type of stimulus presented.