Physical activity and sedentary behaviour among Asian and Anglo-Australian adolescents.

ISSUE ADDRESSED: Evidence suggests that physical activity (PA) and sedentary behaviour (SB) participation varies among culturally and linguistically diverse (CALD) adolescents. The present study examined differences in PA and SB among a CALD sample of Chinese Australian, South-east Asian and Anglo-Australian adolescents. METHODS: Data from 286 adolescents aged 12-16 years involved in the Chinese and Australian Adolescent Health Survey in metropolitan Melbourne, Australia, were analysed. Accelerometry outcomes included median activity counts per minute (counts x min(-1)) and minutes per day (min x day(-1)) spent in light-intensity PA (LPA), moderate-to-vigorous-intensity PA (MVPA) and sedentary time (ST). Kruskal-Wallis one-way analysis of variance and sequential multiple hierarchical linear regressions were used to examine CALD differences in PA and ST. RESULTS: Multivariate analyses of accelerometry data found Chinese Australian and South-east Asian adolescents engaged in significantly less daily MVPA (5-8 min x day(-1)) and LPA (50-58 min x day(-1); P < 0.05), but greater daily ST (40-41 min x day(-1)), than Anglo-Australian adolescents, after adjusting for age, gender and socioeconomic category. CONCLUSION: The results demonstrate lower engagement in daily MVPA and LPA and greater engagement in ST using accelerometry among Chinese Australian and South-east Asian adolescents compared with Anglo-Australian adolescents. These findings have important public health implications in furthering our understanding of CALD differences in PA and SB. SO WHAT? An understanding of the CALD differences in physical activity and sedentary behaviour among Australian adolescents has important implications for intervention planning and delivery as well as the wider health implications of these behaviours. This article furthers the current understanding of CALD adolescents' participation in physical activity and sedentary behaviour, of which limited information is available.

Associations between the purchase of healthy and fast foods and restrictions to food access: a cross-sectional study in Melbourne, Australia.

OBJECTIVE: To examine the associations between financial, physical and transport conditions that may restrict food access (which we define as food security indicators) and the purchase of fast foods and nutritious staples such as bread and milk. DESIGN: Multilevel logistic and multinomial regression analysis of cross-sectional survey data to assess associations between the three indicators of food insecurity and household food shopping adjusted for sociodemographic and socio-economic variables. SETTING: Random selection of households (n 3995) from fifty Census Collector Districts in Melbourne, Australia, in 2003. SUBJECTS: The main food shoppers in each household (n 2564). RESULTS: After adjustment for confounders, analysis showed that a greater likelihood of purchasing chain-brand fast food on a weekly basis compared with never was associated with running out of money to buy food (OR = 1·59; 95 % CI 1·08, 2·34) and reporting difficulties lifting groceries (OR = 1·77; 95 % CI 1·23, 2·54). Respondents without regular access to a car to do food shopping were less likely to purchase bread types considered more nutritious than white bread (OR = 0·75; 95 % CI 0·59, 0·95) and milk types considered more nutritious than full-cream milk (OR = 0·62; 95 % CI 0·47, 0·81). The food insecurity indicators were not associated with the purchasing of fruits, vegetables or non-chain fast food. CONCLUSIONS: Householders experiencing financial and physical barriers were more likely to frequently purchase chain fast foods while limited access to a car resulted in a lower likelihood that the nutritious options were purchased for two core food items (bread and milk). Policies and interventions that improve financial access to food and lessen the effect of physical limitations to carrying groceries may reduce the purchasing of fast foods. Further research is required on food sourcing and dietary quality among those with food access restrictions.

Understanding evidence: a statewide survey to explore evidence-informed public health decision-making in a local government setting.

BACKGROUND: The value placed on types of evidence within decision-making contexts is highly dependent on individuals, the organizations in which the work and the systems and sectors they operate in. Decision-making processes too are highly contextual. Understanding the values placed on evidence and processes guiding decision-making is crucial to designing strategies to support evidence-informed decision-making (EIDM). This paper describes how evidence is used to inform local government (LG) public health decisions. METHODS: The study used mixed methods including a cross-sectional survey and interviews. The Evidence-Informed Decision-Making Tool (EvIDenT) survey was designed to assess three key domains likely to impact on EIDM: access, confidence, and organizational culture. Other elements included the usefulness and influence of sources of evidence (people/groups and resources), skills and barriers, and facilitators to EIDM. Forty-five LGs from Victoria, Australia agreed to participate in the survey and up to four people from each organization were invited to complete the survey (n = 175). To further explore definitions of evidence and generate experiential data on EIDM practice, key informant interviews were conducted with a range of LG employees working in areas relevant to public health. RESULTS: In total, 135 responses were received (75% response rate) and 13 interviews were conducted. Analysis revealed varying levels of access, confidence and organizational culture to support EIDM. Significant relationships were found between domains: confidence, culture and access to research evidence. Some forms of evidence (e.g. community views) appeared to be used more commonly and at the expense of others (e.g. research evidence). Overall, a mixture of evidence (but more internal than external evidence) was influential in public health decision-making in councils. By comparison, a mixture of evidence (but more external than internal evidence) was deemed to be useful in public health decision-making. CONCLUSIONS: This study makes an important contribution to understanding how evidence is used within the public health LG context. TRIAL REGISTRATION: ACTRN12609000953235.

Reliability and validity of the modified Child and Adolescent Physical Activity and Nutrition Survey (CAPANS-C) questionnaire examining potential correlates of physical activity participation among Chinese-Australian youth.

BACKGROUND: To date, few questionnaires examining psychosocial influences of physical activity (PA) participation have been psychometrically tested among Culturally and Linguistically Diverse (CALD) youth. An understanding of these influences may help explain the observed differences in PA among CALD youth. Therefore, this study examined the reliability and predictive validity of a brief self-report questionnaire examining potential psychological and social correlates of physical activity among a sample of Chinese-Australian youth. METHODS: Two Chinese-weekend cultural schools from eastern metropolitan Melbourne consented to participate in this study. In total, 505 students aged 11 to 16 years were eligible for inclusion in the present study, and of these, 106 students agreed to participate (21% response rate). Participants completed at 37-item self-report questionnaire examining perceived psychological and social influences on physical activity participation twice, with a test-retest interval of 7 days. Predictive validity, internal consistency and test-retest reliability were evaluated using exploratory factor analyses, Cronbach's α coefficient, and the intraclass correlation coefficient (ICC) respectively. Predictive validity was assessed by correlating responses against duration spent in self-reported moderate-to-vigorous physical activity (MVPA). RESULTS: The exploratory factor analysis revealed a nine factor structure, with the majority of factors exhibiting high internal consistency (α ≥ 0.6). In addition, four of the nine factors had an ICC ≥ 0.6. Spearman rank-order correlations coefficients between the nine factors and self-reported minutes spent in MVPA ranged from -0.5 to 0.3 for all participants. CONCLUSION: This is the first study to examine the psychometric properties of a potential psychological and social correlates questionnaire among Chinese-Australian youth. The questionnaire was found to provide reliable estimates on a range of psychological and social influences on physical activity and evidence of predictive validity on a limited number of factors. More research is required to improve the reliability and validity of the questionnaire.

Role of expendable income and price in food choice by low income families.

The public health literature suggests that the cheapness of energy-dense foods is driving the obesity epidemic. We examined food purchases in low-income families and its relationship to the price of food and availability of funds. In-depth interviews were conducted with 22 parents with children less than 15 years of age whose major source of income was a government pension. A photo taxonomy, where participants sorted 50 photos of commonly purchased foods, was used to explore food choice. The most common food groupings used by the participants were: basic, emergency, treat and comfort. The process of food purchase was described by participants as weighing up the attributes of a food in relation to price and money available. Shoppers nominated the basic unit of measurement as quantity per unit price and the heuristic for food choice when shopping as determining "value for money" in a process of triage relating to food purchase decisions. Participants stated satiation of hunger to be the most common "value" relative to price. Given that the foods nominated as filling tended to be carbohydrate-rich staples, we suggest that public health initiatives need to acknowledge this triage process and shape interventions to promote nutrition over satiation.

Use of participatory research and photo-voice to support urban Aboriginal healthy eating.

The aim of this research was to work collaboratively with an urban Aboriginal community to understand meanings of food and food insecurity and strengthen responses to this issue. The project took place at the Wathaurong Aboriginal Cooperative in Geelong, South Eastern Australia in 2009-2010. Photo-voice research methods were used to explore meanings of food and food insecurity. This identified that food selections were influenced by family harmony, collectivism and satiation of hunger with cheap high carbohydrate and fat foods. People were also proud of their hunter-gatherer heritage and saw the Wathaurong Aboriginal Cooperative as leaders in healthy food provision. Action research cycles were used to develop responses including plates depicting healthy food portions, social cooking opportunities, development of a cooking television series and a specialised cook-book. The partnership required researchers to listen carefully to respond to needs of the Wathaurong Aboriginal Cooperative, and this meant adapting research plans to suit the local environment and community partner needs. There is potential for Aboriginal organisations to provide further leadership for healthy eating and food security through workplace food policies and partnerships with food security agencies. Use of Aboriginal nutrition knowledge to provide nutrition education may be useful in health promotion approaches.

Reliability of the modified child and adolescent physical activity and nutrition survey, physical activity (CAPANS-PA) questionnaire among Chinese-Australian youth.

BACKGROUND: Evidence suggests that differences exist in physical activity (PA) participation among Culturally and Linguistically Diverse (CALD) children and adolescents. It is possible that these differences could be influenced by variations in measurement technique and instrument reliability. However, culturally sensitive instruments for examining PA behaviour among CALD populations are lacking. This study tested the reliability of the Child and Adolescent Physical Activity and Nutrition Survey (CAPANS-PA) recall questionnaire among a sample of Chinese-Australian youth. METHODS: The psychometric property of the CAPANS-PA questionnaire was examined among a sample of 77 Chinese-Australian youth (aged 11-14 y) who completed the questionnaire twice within 7 days. Test-retest reliability of individual items and scales within the CAPANS-PA questionnaire was determined using Kappa statistics for categorical variables and intraclass correlation coefficients (ICC) for continuous variables. RESULTS: The CAPANS-PA questionnaire demonstrated acceptable test-retest reliability for frequency and duration of time spent in weekly Moderate to Vigorous Physical Activity (MVPA) (ICC ≥ 0.70) for all participants. Test-retest reliability for time spent in weekly sedentary activities was acceptable for females (ICC = 0.82) and males (ICC = 0.72). CONCLUSIONS: The results suggest the CAPANS-PA questionnaire provides reliable estimates for type, frequency and duration of MVPA participation among Chinese-Australian youth. Further investigation into the reliability of the sedentary items within the CAPANS-PA is required before these items can be used with confidence. This study is novel in that the reliability of instruments among CALD groups nationally and internationally remains sparse and this study contributes to the wider body of available psychometrically tested instruments. In addition, this study is the first to our knowledge to successfully engage and investigate the basic health enhancing behaviours of Chinese-Australian adolescents.

Reduced food access due to a lack of money, inability to lift and lack of access to a car for food shopping: a multilevel study in Melbourne, Victoria.

OBJECTIVE: To describe associations between demographic and individual and area-level socio-economic variables and restricted household food access due to lack of money, inability to lift groceries and lack of access to a car to do food shopping. DESIGN: Multilevel study of three measures of restricted food access, i.e. running out of money to buy food, inability to lift groceries and lack of access to a car for food shopping. Multilevel logistic regression was conducted to examine the risk of each of these outcomes according to demographic and socio-economic variables. SETTING: Random selection of households from fifty small areas in Melbourne, Australia, in 2003. SUBJECTS: The main food shoppers in each household (n 2564). RESULTS: A lack of money was significantly more likely among the young and in households with single adults. Difficulty lifting was more likely among the elderly and those born overseas. The youngest and highest age groups both reported reduced car access, as did those born overseas and single-adult households. All three factors were most likely among those with a lower individual or household socio-economic position. Increased levels of area disadvantage were independently associated with difficulty lifting and reduced car access. CONCLUSIONS: In Melbourne, households with lower individual socio-economic position and area disadvantage have restricted access to food because of a lack of money and/or having physical limitations due difficulty lifting or lack of access to a car for food shopping. Further research is required to explore the relationship between physical restrictions and food access.

Longitudinal study of Consumer Price Index (CPI) trends in core and non-core foods in Australia.

OBJECTIVE: This study examined trends in the price of healthy and less-healthy foods from 1989 to 2007 using the Australian Consumer Price Index (CPI). METHODS: CPI food expenditure classes were classified as 'core' or 'non-core'. Trends in the CPI were analysed to examine the rise in prices of core compared with non-core foods. RESULTS: On average, the CPI for core foods has risen at a slightly higher, though not statistically significant, rate than non-core foods. Furthermore, selected groupings reveal interesting patterns. 'Bread' has risen in price significantly more than 'cakes and biscuits', and 'milk' has risen in price significantly more than 'soft drinks, waters and juices'. CONCLUSIONS AND IMPLICATIONS: This investigation of food price trends reveals notable differences between core and non-core foods. This should be investigated further to determine the extent to which this contributes to the higher prevalence of diet-related diseases in low socio-economic groups.

A culturally appropriate diet and lifestyle intervention can successfully treat the components of metabolic syndrome in female Pakistani immigrants residing in Melbourne, Australia.

This study was designed to test the effectiveness of a culturally appropriate diet and lifestyle intervention to treat metabolic syndrome in female Pakistani immigrants residing in Melbourne, Australia. Forty Pakistani women with metabolic syndrome (aged 20-50 years) completed a 12-week culturally appropriate diet and exercise program. Results indicate that, before intervention, participants were sedentary, taking 4000 +/- 22.6 steps per day, and had an obese-classified body mass index (BMI) of 29.2 +/- 0.46 kg/m(2) (BMI was categorized in accordance with guidelines specifically designed for Asians) and high waist circumference of 132 +/- 25.95 cm. Participants were hypertensive (systolic, 135 +/- 1.3 mm Hg; diastolic, 86 +/- 0.68 mm Hg), were dyslipidemic (total cholesterol, 6.8 +/- 0.15 mmol/L; triglycerides, 2.9 +/- 0.09 mmol/L), and had elevated blood glucose (6.4 +/- 0.33 mmol/L) and fasting blood insulin (45 +/- 6.3 microU/mL) levels. After the 12-week culturally appropriate intervention, activity increased (8600 +/- 596.7 steps per day, P < .05); and BMI (27.8 +/- 0.45 kg/m(2)), blood pressure (systolic, 125 +/- 1.4 mm Hg; diastolic, 80 +/- 0.6 mm Hg), cholesterol (5.5 +/- 0.1 mmol/L), blood glucose (5.9 +/- 0.33 mmol/L), and blood insulin (24.14 +/- 1.8 microU/mL) levels were all significantly reduced (P < .05). This study revealed that the Pakistani female migrants who had metabolic syndrome and its components can successfully be treated via a culturally appropriate diet and lifestyle intervention. The success of the current program raises the possibility that other high-risk ethnic groups can also be treated with a culturally appropriate program.

The health equity dimensions of urban food systems.

There is increasing recognition that the nutrition transition sweeping the world's cities is multifaceted. Urban food and nutrition systems are beginning to share similar features, including an increase in dietary diversity, a convergence toward "Western-style" diets rich in fat and refined carbohydrate and within-country bifurcation of food supplies and dietary conventions. Unequal access to the available dietary diversity, calories, and gastronomically satisfying eating experience leads to nutritional inequalities and diet-related health inequities in rich and poor cities alike. Understanding the determinants of inequalities in food security and nutritional quality is a precondition for developing preventive policy responses. Finding common solutions to under- and overnutrition is required, the first step of which is poverty eradication through creating livelihood strategies. In many cities, thousands of positions of paid employment could be created through the establishment of sustainable and self-sufficient local food systems, including urban agriculture and food processing initiatives, food distribution centers, healthy food market services, and urban planning that provides for multiple modes of transport to food outlets. Greater engagement with the food supply may dispel many of the food anxieties affluent consumers are experiencing.

Obesity and undernutrition in sub-Saharan African immigrant and refugee children in Victoria, Australia.

The study assessed the anthropometric status of 337 sub-Saharan African children aged between 3-12 years who migrated to Australia. These children were selected using a snowball sampling method stratified by age, gender and region of origin. The prevalence rates for overweight and obesity were 18.4% (95%CI: 14 - 23%) and 8.6% (95%CI: 6% -12%) respectively. The prevalence rates for the indicators of undernutrition were: wasting 4.3% (95%CI: 1.6%-9.1%), underweight 1.2% (95%CI: 0.3%-3.0%), and stunting 0.3 (95%CI: 0.0%-1.6%). Higher prevalence of overweight/obesity was associated with lower household income level, fewer siblings, lower birth weight, western African background, and single parent households (after controlling for demographic and socio-economic factors). Higher prevalence rates for underweight and wasting were associated with lower household income and shorter lengths of stay in Australia respectively. No effect was found for child's age, gender, parental education and occupation for both obesity and undernutrition indices. In conclusion, obesity and overweight are very prevalent in SSA migrant children and undernutrition, especially wasting, was also not uncommon in this target group.

Out-of-home food outlets and area deprivation: case study in Glasgow, UK.

BACKGROUND: There is a popular belief that out-of-home eating outlets, which typically serve energy dense food, may be more commonly found in more deprived areas and that this may contribute to higher rates of obesity and related diseases in such areas. METHODS: We obtained a list of all 1301 out-of-home eating outlets in Glasgow, UK, in 2003 and mapped these at unit postcode level. We categorised them into quintiles of area deprivation using the 2004 Scottish Index of Multiple Deprivation and computed mean density of types of outlet (restaurants, fast food restaurants, cafes and takeaways), and all types combined, per 1000 population. We also estimated odds ratios for the presence of any outlets in small areas within the quintiles. RESULTS: The density of outlets, and the likelihood of having any outlets, was highest in the second most affluent quintile (Q2) and lowest in the second most deprived quintile (Q4). Mean outlets per 1,000 were 4.02 in Q2, 1.20 in Q4 and 2.03 in Q5. With Q2 as the reference, Odds Ratios for having any outlets were 0.52 (CI 0.32-0.84) in Q1, 0.50 (CI 0.31 - 0.80) in Q4 and 0.61 (CI 0.38 - 0.98) in Q5. Outlets were located in the City Centre, West End, and along arterial roads. CONCLUSION: In Glasgow those living in poorer areas are not more likely to be exposed to out-of-home eating outlets in their neighbourhoods. Health improvement policies need to be based on empirical evidence about the location of fast food outlets in specific national and local contexts, rather than on popular 'factoids'.

Foods prepared outside the home: association with selected nutrients and body mass index in adult Australians.

OBJECTIVE: To determine the proportion of energy from foods prepared outside the home (FPOH) and the relationships with energy and nutrient intakes and body mass index (BMI). DESIGN: A nutrition survey of a representative sample of the Australian population aged 18 years and over Measure used was a 24-hour dietary recall. Underreporters (energy intake/estimated basal metabolic rate (EI/BMR) <0.9) were excluded from analysis. Daily energy and selected nutrient intakes were calculated using a 1996 nutrient composition database for all foods/beverages during the 24-hour period. RESULTS: On average FPOH contributed a significant 13% to total energy intake. About a third of the sample had consumed FPOH in the last 24 hours and on average this group consumed a third of their total energy as FPOH. The relative contributions of fat (for men and women) and alcohol (for women) were significantly higher for those in the top tertile of FPOH consumers. The intakes of fibre and selected micronutrients (calcium, iron, zinc, folate and vitamin C) were significantly lower in this group. After adjustment for age and income no relationship between FPOH and BMI was observed. CONCLUSIONS: FPOH make a significant contribution to the energy intake of a third of the Australian population. FPOH contribute to poor nutritional intakes. Altering the supply of FPOH may be an effective means of improving diets at a population level.

Weight management and weight loss strategies of professional jockeys.

Jockeys are required to maintain very low body weight and precise weight control during competition. This study examined the weight loss and weight management strategies of professional horseracing jockeys in the state of Victoria, Australia. An anonymous, self-completed questionnaire was administered (55% response rate, n = 116). Almost half (43%) reported that maintaining riding weight was difficult or very difficult, with 75% routinely skipping meals. In preparation for racing, 60% reported that they typically required additional weight loss, with 81% restricting food intake in the 24 hours prior to racing. Additionally, sauna-induced sweating (29%) and diuretics (22%) were frequently employed to further aid in weight loss prior to racing. These rapid weight loss methods did not differ between the 51% of jockeys who followed a weight management plan compared to those who did not. The impact of these extreme weight loss practices on riding performance and health remains unknown.

An ecological study of the relationship between social and environmental determinants of obesity.

There is growing concern with the increasing prevalence of obesity in industrialised countries, a trend that is more apparent in the poor than in the rich. In an ecological study, the relationship between an area measure of socioeconomic status (SES) and the density of fast-food outlets was examined as one possible explanation for the phenomenon. It was found that there was a dose-response between SES and the density of fast-food outlets, with people living in areas from the poorest SES category having 2.5 times the exposure to outlets than people in the wealthiest category. The findings are discussed.