Recent trends in population levels and correlates of occupational and leisure sitting time in full-time employed Australian adults.

This study aimed to explore the trend in population levels, as well as the correlates, of occupational and leisure sitting time in full-time employed Australian adults between 2007 and 2015. We used data from the 2007/08, 2011/12 and 2014/15 Australian Health Surveys, in which nationally representative samples of the Australian population were interviewed. Full-time (≥35 hours/week) employed respondents reported sitting time at work and during leisure on a usual workday. Trends over time and associations between socio-demographic and health-related characteristics and sitting time were analysed in the combined dataset using multivariable logistic regression models. Over 21,000 observations were included in the analyses. Across the three surveys, approximately 51% of the respondents reported ≥4 hours/workday occupational sitting time, 40% reported ≥4 hours/workday leisure sitting time, and 55% reported ≥7 hours/workday combined occupational and leisure sitting time. There were no clear trends over time. All potential correlates were associated with occupational sitting time and all but educational level were associated with leisure sitting time. The directions of the associations with gender, age and leisure-time physical activity were reversed for occupational sitting time and leisure sitting time. These findings show that the average levels of occupational and leisure sitting time on workdays were high but stable over the past decade. The observed differences in correlates of occupational and leisure sitting time demonstrate the need to assess and address sedentary behaviour domains separately in research and policy.

Trends in prevalence of leisure time physical activity and inactivity: results from Australian National Health Surveys 1989 to 2011.

OBJECTIVE: To examine trends in leisure time physical activity and inactivity in Australians aged 15 years or older from 1989 to 2011. METHOD: We used data from six Australian National Health Surveys conducted from 1989/90 to 2011/12 in which physical activity was assessed using comparable questions. Analyses examined trends in the prevalence of sufficient physical activity (≥150 minutes/week moderate-to-vigorous physical activity) and of inactivity (<30 minutes/week moderate-to-vigorous physical activity). RESULTS: The proportion of sufficiently active adults was 39.2% in 1989 and 40.7% in 2011 with an overall declining trend of 0.2% per year (p=0.012). The prevalence of inactivity was 38.7% in 1989 and 37.3% in 2011; the overall time trend by year was stable (OR=0.999, p=0.242). In women, sufficient physical activity decreased by 0.3% per year from 35.5% in 1989 (p=0.025); inactivity increased from 39.5% by 0.3% per year (p=0.004). In men, sufficient physical activity prevalence was 43.1% in 1989 with a steady trend; inactivity decreased from 37.9% by 0.5% per year (p<0.0001). CONCLUSIONS: The prevalence of sufficient physical activity remains low and inactivity high. Women appear to be a key target group for intervention. Public health efforts have been ineffective over two decades for improving physical activity among Australian adults. Implications for public health: This research supports calls for a national physical activity action plan given the multitude of benefits from sufficient physical activity. Maintenance of consistent physical activity questions in future National Health Surveys will facilitate long term tracking of physical activity levels in the Australian population.

Effect of Moderate to Vigorous Physical Activity on All-Cause Mortality in Middle-aged and Older Australians.

IMPORTANCE: Few studies have examined how different proportions of moderate and vigorous physical activity affect health outcomes. OBJECTIVE: To examine whether the proportion of total moderate to vigorous activity (MVPA) that is achieved through vigorous activity is associated with all-cause mortality independently of the total amount of MVPA. DESIGN, SETTING, AND PARTICIPANTS: We performed a prospective cohort study with activity data linked to all-cause mortality data from February 1, 2006, through June 15, 2014, in 204,542 adults aged 45 through 75 years from the 45 and Up population-based cohort study from New South Wales, Australia (mean [SD] follow-up, 6.52 [1.23] years). Associations between different contributions of vigorous activity to total MVPA and mortality were examined using Cox proportional hazards models, adjusted for total MVPA and sociodemographic and health covariates. EXPOSURES: Different proportions of total MVPA as vigorous activity. Physical activity was measured with the Active Australia Survey. MAIN OUTCOMES AND MEASURES: All-cause mortality during the follow-up period. RESULTS: During 1,444,927 person-years of follow-up, 7435 deaths were registered. Compared with those who reported no MVPA (crude death rate, 8.34%), the adjusted hazard ratios for all-cause mortality were 0.66 (95% CI, 0.61-0.71; crude death rate, 4.81%), 0.53 (95% CI, 0.48-0.57; crude death rate, 3.17%), and 0.46 (95% CI, 0.43-0.49; crude death rate, 2.64%) for reporting 10 through 149, 150 through 299, and 300 min/wk or more of activity, respectively. Among those who reported any MVPA, the proportion of vigorous activity revealed an inverse dose-response relationship with all-cause mortality: compared with those reporting no vigorous activity (crude death rate, 3.84%) the fully adjusted hazard ratio was 0.91 (95% CI, 0.84-0.98; crude death rate, 2.35%) in those who reported some vigorous activity (but <30% of total activity) and 0.87 (95% CI, 0.81-0.93; crude death rate, 2.08%) among those who reported 30% or more of activity as vigorous. These associations were consistent in men and women, across categories of body mass index and volume of MVPA, and in those with and without existing cardiovascular disease or diabetes mellitus. CONCLUSIONS AND RELEVANCE: Among people reporting any activity, there was an inverse dose-response relationship between proportion of vigorous activity and mortality. Our findings suggest that vigorous activities should be endorsed in clinical and public health activity guidelines to maximize the population benefits of physical activity.

Standing time and all-cause mortality in a large cohort of Australian adults.

OBJECTIVE: To determine the association between standing time and all-cause mortality. METHODS: Prospective questionnaire data from 221,240 individuals from the 45 and Up Study were linked to mortality data from the New South Wales Registry of Deaths (Australia) from February 1, 2006 to June 17, 2012. Hazard ratios for all-cause mortality according to standing time at baseline were estimated in 2013 using Cox regression modelling, adjusted for sex, age, education, urban/rural residence, physical activity, sitting time, body mass index, smoking status, self-rated health and disability. RESULTS: During 937,411 person years (mean follow-up=4.2 yr) 8009 deaths occurred. All-cause mortality hazard ratios were 0.90 (95% CI 0.85-0.95), 0.85 (95% CI 0.80-0.95), and 0.76 (95% CI 0.69-0.95) for standing 2-≤5h/d, 5-≤8h/d, or >8h/d respectively, compared to standing two or less hours per day. Further analyses revealed no significant interactions between standing and sex (p=0.93), the presence/absence of cardiovascular disease or diabetes (p=0.22), BMI (p=0.78), physical activity (p=0.16) and sitting time (p=0.22). CONCLUSION: This study showed a dose-response association between standing time and all-cause mortality in Australian adults aged 45 years and older. Increasing standing may hold promise for alleviating the health risks of prolonged sitting.

Effects of recurrent violence on post-traumatic stress disorder and severe distress in conflict-affected Timor-Leste: a 6-year longitudinal study.

BACKGROUND: Little is known about the effect of recurrent episodes of communal violence on mental health in countries recovering from mass conflict. We report results of a 6-year longitudinal study in post-conflict Timor-Leste assessing changes in mental health after a period of communal violence. METHODS: We assessed 1022 adults (600 from a rural village, 422 from an urban district) exposed to mass conflict during the Indonesian occupation after independence in 2004, and again in 2010-11, following a period of internal conflict. We took a census of all adults living at the two sites. The survey included measures of post-traumatic stress disorder, severe distress, traumatic events, poverty, ongoing conflict, and injustice. FINDINGS: 1247 (80%) of 1554 invited adults participated in the baseline survey. 1038 (89% of those eligible) were followed up. The analysis included 1022 people who had sufficient data at baseline and follow-up. The prevalence of post-traumatic stress disorder increased from 23 of 1022 (2.3%) in 2004, to 171 of 1022 (16.7%) in 2010. The prevalence of severe distress also increased, from 57 of 1022 (5.6%) in 2004, to 162 of 1022 (15.9%) in 2010. Both these outcomes were associated with disability at follow-up. Having post-traumatic stress at follow-up was associated with being a woman (odds ratio [OR] 1.63, 95% CI 1.14-2.32), experience of human rights trauma (OR 1.25, 95% CI 1.07-1.47), or exposure to murder (OR 1.71, 95% CI 1.38-2.10) during the Indonesian occupation (1975-99), human rights trauma during the period of internal violence in 2006-07 (OR 1.46, 95% CI 1.04-2.03), and ongoing family or community conflict (OR 1.80, 95% CI 1.15-2.80) or preoccupations with injustice for two or three historical periods (OR 4.06, 2.63-6.28). Severe distress at follow-up was associated with health stress (OR 1.47, 1.14-1.90), exposure to murder (OR 1.57, 1.27-1.95), and natural disaster (OR 1.65, 1.03-2.64) during the Indonesian occupation, conflict-related trauma during the internal violence (OR 1.33, 1.02-1.74), and ongoing poverty (OR 1.53, 1.36-1.72) or preoccupations with injustice for two or three historical periods (OR 2.09, 1.25-3.50). INTERPRETATION: Recurrent violence resulted in a major increase in post-traumatic stress disorder and severe distress in a community previously exposed to mass conflict. Poverty, ongoing community tensions, and persisting feelings of injustice contributed to mental disorders. The findings underscore the importance of preventing recurrent violence, alleviating poverty, and addressing injustices in countries emerging from conflict. FUNDING: Australian National Health and Medical Research Council.

The global prevalence of common mental disorders: a systematic review and meta-analysis 1980-2013.

BACKGROUND: Since the introduction of specified diagnostic criteria for mental disorders in the 1970s, there has been a rapid expansion in the number of large-scale mental health surveys providing population estimates of the combined prevalence of common mental disorders (most commonly involving mood, anxiety and substance use disorders). In this study we undertake a systematic review and meta-analysis of this literature. METHODS: We applied an optimized search strategy across the Medline, PsycINFO, EMBASE and PubMed databases, supplemented by hand searching to identify relevant surveys. We identified 174 surveys across 63 countries providing period prevalence estimates (155 surveys) and lifetime prevalence estimates (85 surveys). Random effects meta-analysis was undertaken on logit-transformed prevalence rates to calculate pooled prevalence estimates, stratified according to methodological and substantive groupings. RESULTS: Pooling across all studies, approximately 1 in 5 respondents (17.6%, 95% confidence interval:16.3-18.9%) were identified as meeting criteria for a common mental disorder during the 12-months preceding assessment; 29.2% (25.9-32.6%) of respondents were identified as having experienced a common mental disorder at some time during their lifetimes. A consistent gender effect in the prevalence of common mental disorder was evident; women having higher rates of mood (7.3%:4.0%) and anxiety (8.7%:4.3%) disorders during the previous 12 months and men having higher rates of substance use disorders (2.0%:7.5%), with a similar pattern for lifetime prevalence. There was also evidence of consistent regional variation in the prevalence of common mental disorder. Countries within North and South East Asia in particular displayed consistently lower one-year and lifetime prevalence estimates than other regions. One-year prevalence rates were also low among Sub-Saharan-Africa, whereas English speaking counties returned the highest lifetime prevalence estimates. CONCLUSIONS: Despite a substantial degree of inter-survey heterogeneity in the meta-analysis, the findings confirm that common mental disorders are highly prevalent globally, affecting people across all regions of the world. This research provides an important resource for modelling population needs based on global regional estimates of mental disorder. The reasons for regional variation in mental disorder require further investigation.

Investigation of methodological factors potentially underlying the apparently paradoxical findings on body mass index and all-cause mortality.

INTRODUCTION: Findings regarding the association between overweight and all-cause mortality range from significantly lower to higher risk, compared with body-mass-index (BMI) within the "normal" range. METHODS: We examined empirically potential methodological explanations for these apparently conflicting results using questionnaire and linked mortality data from 246,314 individuals aged ≥45 years in the Australian 45 and Up Study (11,127 deaths; median follow-up 3.9 years). Hazard ratios (HR) for all-cause mortality associated with BMI were modelled according to different methods of accounting for illness at baseline, finer versus broader gradations of BMI and choice of reference group, adjusting for potential confounders. RESULTS: In analyses using the broad World Health Organization (WHO) categories, the all-cause mortality HR was significantly lower in the overweight category (25.0-29.99 kg/m²), than the normal weight (18.5-24.99 kg/m²) category. However, in analyses accounting for baseline illness, which excluded those with pre-existing illness at baseline, ever-smokers and the first 2 years of follow up, absolute age-standardised mortality rates varied up to two-fold between finer BMI categories within the WHO normal weight category; rates were lowest at 22.5-24.99 kg/m² and mortality HRs increased steadily for BMI above (p(trend)<0.02) and below (p(trend)<0.003) this reference category. Hence, the breadth of the BMI categories used and whether or not baseline illness is accounted for explain the apparent discrepancies between reported BMI-mortality associations. CONCLUSION: Using fine BMI categories and the category with the lowest absolute rates as the reference group and accounting for the potential confounding effects of baseline illness is likely to yield the most reliable risk estimates for establishing the independent relationship of BMI to all-cause mortality. These results and those of other studies indicate that a BMI of 22.5-24.99 kg/m², not the broad "overweight" category of 25-29.99 kg/m², was associated with the most favourable mortality risk.

Patterns of risk for anxiety-depression amongst Vietnamese-immigrants: a comparison with source and host populations.

BACKGROUND: Studies suggest that immigrants have higher rates of anxiety-depression than compatriots in low-middle income countries and lower rates than populations in host high income countries. Elucidating the factors that underlie these stepwise variations in prevalence may throw new light on the pathogenesis of anxiety-depressive disorders globally. This study aimed to examine whether quantitative differences in exposure to, or the interaction between, risk factors account for these anxiety-depression prevalence differences amongst immigrant relative to source and host country populations. METHODS: Multistage population mental health surveys were conducted in three groups: 1) a Vietnamese-immigrant sample settled in Australia (n = 1161); 2) a Vietnamese source country sample residing in the Mekong Delta region (n = 3039); 3) an Australian-born host country sample (n = 7964). Multivariable logistic regression analyses compared risk factors between the Vietnamese-immigrant group and: 1) the Mekong Delta Vietnamese; and 2) the Australian-born group. Twelve month anxiety-depression diagnoses were the main outcome measures, derived from the Composite International Diagnostic Interview (CIDI), supplemented by an indigenously derived measure - the Phan Vietnamese Psychiatric Scale (PVPS) in both Vietnamese groups. RESULTS: The 12-month prevalence of anxiety-depression showed a stepwise increase across groups: Mekong Delta Vietnamese 4.8%; Vietnamese-immigrants 7.0%; Australian-born 10.2%. The two Vietnamese populations showed a similar risk profile with older age, exposure to potentially traumatic events (PTEs), multiple physical illnesses and substance use disorder (SUD) being associated with anxiety-depression, with the older Vietnamese-immigrants reporting greater exposure to these factors. The interaction between key risk factors differed fundamentally when comparing Vietnamese-immigrant and Australian-born samples. Age emerged as the major discriminator, with young Vietnamese-immigrants exhibiting particularly low rates of anxiety-depression. CONCLUSIONS: The findings reported here suggest that core risk factors for anxiety-depression may be universal, but their patterning and interaction may differ according to country-of-origin. The study also highlights the importance of including both standard international and culturally-specific measures to index cross-cultural manifestations of common mental disorders.

Daily sitting time and all-cause mortality: a meta-analysis.

OBJECTIVE: To quantify the association between daily total sitting and all-cause mortality risk and to examine dose-response relationships with and without adjustment for moderate-to-vigorous physical activity. METHODS: Studies published from 1989 to January 2013 were identified via searches of multiple databases, reference lists of systematic reviews on sitting and health, and from authors' personal literature databases. We included prospective cohort studies that had total daily sitting time as a quantitative exposure variable, all-cause mortality as the outcome and reported estimates of relative risk, or odds ratios or hazard ratios with 95% confidence intervals. Two authors independently extracted the data and summary estimates of associations were computed using random effects models. RESULTS: Six studies were included, involving data from 595,086 adults and 29,162 deaths over 3,565,569 person-years of follow-up. Study participants were mainly female, middle-aged or older adults from high-income countries; mean study quality score was 12/15 points. Associations between daily total sitting time and all-cause mortality were not linear. With physical activity adjustment, the spline model of best fit had dose-response HRs of 1.00 (95% CI: 0.98-1.03), 1.02 (95% CI: 0.99-1.05) and 1.05 (95% CI: 1.02-1.08) for every 1-hour increase in sitting time in intervals between 0-3, >3-7 and >7 h/day total sitting, respectively. This model estimated a 34% higher mortality risk for adults sitting 10 h/day, after taking physical activity into account. The overall weighted population attributable fraction for all-cause mortality for total daily sitting time was 5.9%, after adjusting for physical activity. CONCLUSIONS: Higher amounts of daily total sitting time are associated with greater risk of all-cause mortality and moderate-to-vigorous physical activity appears to attenuate the hazardous association. These findings provide a starting point for identifying a threshold on which to base clinical and public health recommendations for overall sitting time, in addition to physical activity guidelines.

Prevalence of and intention to change dietary and physical activity health risk behaviours.

Poor nutrition and insufficient physical activity contribute to high rates of obesity. Prevalence, intention to change and co-occurrence of four health risk behaviours (inadequate fruit and vegetables, excessive dietary fat, excessive sugary beverages and inadequate physical activity in comparison to public health recommendations) were investigated in an Australian population of working adults. Participants (n=105) completed sociodemographic and stage of change questionnaires. A subsample (n=40) were assessed twice to estimate test-retest repeatability. In the full sample, 73% were female, mean age was 33.8 years and mean BMI was 23.8 kg/m(2). Eighty-seven percent of participants consumed inadequate fruit and vegetables, 43% had excessive dietary fat, 42% had excessive sugary beverages and 29% had inadequate physical activity. The proportions intending to change each behaviour were 57%, 25%, 18% and 24%, respectively. Two-thirds exhibited multiple risk behaviours and 38% intended to change multiple risk behaviours. Fruit and vegetables and dietary fat were the most commonly paired risk behaviours (39%) and the pair most intended to change (19%). Occurrence of multiple risk behaviours was associated with being male (OR 3.10, 95% CI 1.06-9.03) or overweight/obese (OR 2.66, 95% CI 1.02-6.93). Targeting two risk behaviours, particularly fruit and vegetables and dietary fat, may be appropriate when designing health promotion programs in working populations.

Trauma exposure, PTSD and psychotic-like symptoms in post-conflict Timor Leste: an epidemiological survey.

BACKGROUND: Studies in developed countries indicate that psychotic-like symptoms are prevalent in the community and are related to trauma exposure and PTSD. No comparable studies have been undertaken in low-income, post-conflict countries. This study aimed to assess the prevalence of psychotic-like symptoms in conflict-affected Timor Leste and to examine whether symptoms were associated with trauma and PTSD. METHODS: The Psychosis Screening Questionnaire and the Harvard Trauma Questionnaire (assessing trauma exposure and PTSD) were administered in an epidemiological survey of 1245 adults (response rate 80.6%) in a rural and an urban setting in Timor Leste. We defined PSQ screen-positive cases as those people reporting at least one psychotic-like symptom (paranoia, hallucinations, strange experiences, thought interference, hypomania). RESULTS: The prevalence of PSQ screen-positive cases was 12 percent and these persons were more disabled. PSQ cases were more likely to reside in the urban area, experienced higher levels of trauma exposure and a greater prevalence of PTSD. PTSD only partially mediated the relationship between trauma exposure and psychotic-like symptoms. CONCLUSIONS: Psychotic-like symptoms may be prevalent in countries exposed to mass conflict. The cultural and contextual meaning of psychotic-like symptoms requires further inquiry in low-income, post-conflict settings such as Timor Leste.

Physical activity and psychological distress amongst Vietnamese living in the Mekong Delta.

OBJECTIVE: Regular physical activity may be an important contributor to psychological well-being. This link has not been explored in ethnically distinct, low- and middle-income countries (LMIC), especially in countries affected by war. This study aimed to examine the relationship between physical activity and levels of psychological distress in an epidemiological cross-representative sample of Vietnamese living in the Mekong Delta region of Vietnam. METHODS: The sample was drawn from an urban (Cn Th City) and a rural (H u Giang) region, using a multi-stage probabilistic cluster sampling frame. The measures applied included the Composite International Diagnostic Interview (CIDI 2.0) yielding 12-month prevalence rates of common mental disorders, including anxiety, mood and substance use disorders; the Phan Vietnamese Psychiatric Scale (PVPS), a culturally specific self-report measure; and the Harvard Trauma Questionnaire. The Global Physical Activity Questionnaire (GPAQ version 1) was used to measure activity. Analyses were conducted using SAS software v.9.1.3. The population was assigned to three (high, moderate and low) physical activity levels. Analyses included chi-square tests and univariable and multivariable logistic models. RESULTS: Physical activity was greater in males, the middle-aged group (30-54 years), those who were married, the rural population, less educated individuals and those who were employed. High physical activity was significantly associated with low levels of psychological distress (indexed by a combination of CIDI and PVPS cases identified) when controlling for socio-demographic factors and number of medical conditions). Membership of the lowest of the three physical activity groups was associated with a psychological distress odds ratio of 2.19 (95% CI 1.28-3.75). The results remained consistent when analyses were undertaken separately for males and females. CONCLUSIONS: Low levels of physical activity appear to be associated with greater psychological distress in the Mekong Delta of Vietnam. The association remained after adjusting for the influence of socio-demographic characteristics, exposure to past trauma, urban-rural residency and the presence of self-reported physical disorders. These data provide a foundation for exploring the role of physical activity as an adjunct to conventional interventions for common mental disorders in resource-poor LMIC countries.

Weight change in control group participants in behavioural weight loss interventions: a systematic review and meta-regression study.

BACKGROUND: Unanticipated control group improvements have been observed in intervention trials targeting various health behaviours. This phenomenon has not been studied in the context of behavioural weight loss intervention trials. The purpose of this study is to conduct a systematic review and meta-regression of behavioural weight loss interventions to quantify control group weight change, and relate the size of this effect to specific trial and sample characteristics. METHODS: Database searches identified reports of intervention trials meeting the inclusion criteria. Data on control group weight change and possible explanatory factors were abstracted and analysed descriptively and quantitatively. RESULTS: 85 trials were reviewed and 72 were included in the meta-regression. While there was no change in control group weight, control groups receiving usual care lost 1 kg more than control groups that received no intervention, beyond measurement. CONCLUSIONS: There are several possible explanations why control group changes occur in intervention trials targeting other behaviours, but not for weight loss. Control group participation may prevent weight gain, although more research is needed to confirm this hypothesis.

Predicting the impact of the 2011 conflict in Libya on population mental health: PTSD and depression prevalence and mental health service requirements.

BACKGROUND: Mental disorders are likely to be elevated in the Libyan population during the post-conflict period. We estimated cases of severe PTSD and depression and related health service requirements using modelling from existing epidemiological data and current recommended mental health service targets in low and middle income countries (LMIC's). METHODS: Post-conflict prevalence estimates were derived from models based on a previously conducted systematic review and meta-regression analysis of mental health among populations living in conflict. Political terror ratings and intensity of exposure to traumatic events were used in predictive models. Prevalence of severe cases was applied to chosen populations along with uncertainty ranges. Six populations deemed to be affected by the conflict were chosen for modelling: Misrata (population of 444,812), Benghazi (pop. 674,094), Zintan (pop. 40,000), displaced people within Tripoli/Zlitan (pop. 49,000), displaced people within Misrata (pop. 25,000) and Ras Jdir camps (pop. 3,700). Proposed targets for service coverage, resource utilisation and full-time equivalent staffing for management of severe cases of major depression and post-traumatic stress disorder (PTSD) are based on a published model for LMIC's. FINDINGS: Severe PTSD prevalence in populations exposed to a high level of political terror and traumatic events was estimated at 12.4% (95%CI 8.5-16.7) and was 19.8% (95%CI 14.0-26.3) for severe depression. Across all six populations (total population 1,236,600), the conflict could be associated with 123,200 (71,600-182,400) cases of severe PTSD and 228,100 (134,000-344,200) cases of severe depression; 50% of PTSD cases were estimated to co-occur with severe depression. Based upon service coverage targets, approximately 154 full-time equivalent staff would be required to respond to these cases sufficiently which is substantially below the current level of resource estimates for these regions. DISCUSSION: This is the first attempt to predict the mental health burden and consequent service response needs of such a conflict, and is crucially timed for Libya.

Sitting time and all-cause mortality risk in 222 497 Australian adults.

BACKGROUND: Prolonged sitting is considered detrimental to health, but evidence regarding the independent relationship of total sitting time with all-cause mortality is limited. This study aimed to determine the independent relationship of sitting time with all-cause mortality. METHODS: We linked prospective questionnaire data from 222 497 individuals 45 years or older from the 45 and Up Study to mortality data from the New South Wales Registry of Births, Deaths, and Marriages (Australia) from February 1, 2006, through December 31, 2010. Cox proportional hazards models examined all-cause mortality in relation to sitting time, adjusting for potential confounders that included sex, age, education, urban/rural residence, physical activity, body mass index, smoking status, self-rated health, and disability. RESULTS: During 621 695 person-years of follow-up (mean follow-up, 2.8 years), 5405 deaths were registered. All-cause mortality hazard ratios were 1.02 (95% CI, 0.95-1.09), 1.15 (1.06-1.25), and 1.40 (1.27-1.55) for 4 to less than 8, 8 to less than 11, and 11 or more h/d of sitting, respectively, compared with less than 4 h/d, adjusting for physical activity and other confounders. The population-attributable fraction for sitting was 6.9%. The association between sitting and all-cause mortality appeared consistent across the sexes, age groups, body mass index categories, and physical activity levels and across healthy participants compared with participants with preexisting cardiovascular disease or diabetes mellitus. CONCLUSIONS: Prolonged sitting is a risk factor for all-cause mortality, independent of physical activity. Public health programs should focus on reducing sitting time in addition to increasing physical activity levels.

Active for a day: predictors of relapse among previously active mass event participants.

BACKGROUND: To promote maintenance of sufficient physical activity (PA), better understanding of factors associated with behavioral relapse is needed. PURPOSE: To identify PA relapsers and predictors of this state in a large community sample of women who participated in 2 mass 10-km events in Ireland. METHODS: Relapsers to 'low active' were identified at 3-month follow-up, and factors associated with relapse investigated. RESULTS: 11% of the sample decreased their participation by at least 60 minutes of moderate-intensity PA per week and regressed to 'insufficiently active.' Adjusted analysis indicated relapse was associated with walking the event (OR = 1.40; 95% CI = 1.05-1.85) and not achieving tertiary education (OR = 1.49; 95% CI = 1.18-1.88). Normal-range BMI, training continuously, urban residence, and increases in self efficacy and positive perceptions of the physical environment were related to lower incidence of relapse. CONCLUSION: Education, living in an urban area, BMI, walking the event, training, and self efficacy are all associated with relapse and while mass events are a useful motivator for PA, strategies are required following events to maintain participation levels and generate a lasting public health impact.

Cross-sectional associations between occupational and leisure-time sitting, physical activity and obesity in working adults.

AIM: To examine associations between occupational and leisure-time sitting, physical activity and obesity in working adults. METHODS: We analyzed data from workers from the 2007-08 Australian National Health Survey (n=10,785). Participants reported their activity at work (mostly sitting, standing, walking, or heavy labor), transport-related walking, leisure-time sitting and physical activity. Body mass index was objectively measured. Adjusted Cox proportional hazard regression models examined associations between occupational activity category, leisure-time sitting, physical activity and obesity risk. RESULTS: Substantial proportions of men (42%) and women (47%) mostly sit at work. Workers with sitting jobs were significantly more likely to be sufficiently active during leisure-time than workers with mostly standing, walking or heavy labor jobs (RR=0.88, 0.80, 0.86 respectively). Workers with mostly sitting jobs had significantly higher overweight/obesity risk than workers with mostly standing jobs (RR=0.88, 95% CI: 0.82-0.95) independent of physical activity and leisure-time sitting. Workers with leisure-time sitting of less than four hours per day had significantly lower obesity risk than workers with four or more hours per day of leisure-time sitting (RR=0.77, 95%CI: 0.69-0.87) independent of physical activity and occupational activity. CONCLUSIONS: Sitting time and physical activity are independently associated with obesity. Leisure-time sitting may have a stronger association with obesity risk than occupational sitting.

Lifetime prevalence of gender-based violence in women and the relationship with mental disorders and psychosocial function.

CONTEXT: Intimate partner physical violence, rape, sexual assault, and stalking are pervasive and co-occurring forms of gender-based violence (GBV). An association between these forms of abuse and lifetime mental disorder and psychosocial disability among women needs to be examined. OBJECTIVES: To assess the association of GBV and mental disorder, its severity and comorbidity, and psychosocial functioning among women. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional study based on the Australian National Mental Health and Well-being Survey in 2007, of 4451 women (65% response rate) aged 16 to 85 years. MAIN OUTCOME MEASURES: The Composite International Diagnostic Interview version 3.0 of the World Health Organization's World Mental Health Survey Initiative was used to assess lifetime prevalence of any mental disorder, anxiety, mood disorder, substance use disorder, and posttraumatic stress disorder (PTSD). Also included were indices of lifetime trauma exposure, including GBV, sociodemographic characteristics, economic status, family history of mental disorder, social supports, general mental and physical functioning, quality of life, and overall disability. RESULTS: A total of 1218 women (27.4%) reported experiencing at least 1 type of GBV. For women exposed to 3 or 4 types of GBV (n = 139), the rates of mental disorders were 77.3% (odds ratio [OR], 10.06; 95% confidence interval [CI], 5.85-17.30) for anxiety disorders, 52.5% (OR, 3.59; 95% CI, 2.31-5.60) for mood disorder, 47.1% (OR, 5.61; 95% CI, 3.46-9.10) for substance use disorder, 56.2% (OR, 15.90; 95% CI, 8.32-30.20) for PTSD, 89.4% (OR, 11.00; 95% CI, 5.46-22.17) for any mental disorder, and 34.7% (OR, 14.80; 95% CI, 6.89-31.60) for suicide attempts. Gender-based violence was associated with more severe current mental disorder (OR, 4.60; 95% CI, 2.93-7.22), higher rates of 3 or more lifetime disorders (OR, 7.79; 95% CI, 6.10-9.95), physical disability (OR, 4.00; 95% CI, 1.82-8.82), mental disability (OR, 7.14; 95% CI, 2.87-17.75), impaired quality of life (OR, 2.96; 95% CI, 1.60-5.47), an increase in disability days (OR, 3.14; 95% CI, 2.43-4.05), and overall disability (OR, 2.73; 95% CI, 1.99-3.75). CONCLUSION: Among a nationally representative sample of Australian women, GBV was significantly associated with mental health disorder, dysfunction, and disability.

The role of pre-pregnancy physical activity and sedentary behaviour in the development of gestational diabetes mellitus.

Gestational diabetes mellitus (GDM) complicates approximately 3-11% of pregnancies and increases the risk on prenatal morbidity and later development of type 2 diabetes mellitus. Physical activity and sedentary behaviour are thought to play a role in the development of GDM, independent of overweight and obesity. The aim of this study was to examine the relationships between physical activity, sedentary behaviour and the development of GDM using a population-based prospective cohort study. Data from the youngest (1973-1978) cohort of the Australian Longitudinal Study on Women's Health (n=2913) were used to determine the influences of self-reported physical activity, and sedentary behaviour in 2000 and 2003 on the development of GDM over subsequent three year periods, with adjustment for socio-demographic and lifestyle factors. In this cohort of Australian women, physical activity and sedentary behaviour in 2000 and 2003 were not associated with the development of GDM in the subsequent three years. In adjusted models, odds ratios for the development of GDM were 1.92 (95% CI 1.25-2.96) for overweight women (BMI 25-30 kg/m2) and 3.11 (1.92-5.03) for obese women (BMI≥30 kg/m2) compared with normal weight women. Those with lower education and women born in an Asian country also had higher risk of developing GDM than more highly educated and Australian born women, respectively. In conclusion, pre-pregnancy physical activity and sedentary behaviour appear to be less important in the development of GDM in this cohort than overweight and obesity.