A systematic review of culturally adapted physical activity interventions for culturally and linguistically diverse children and adolescents.

OBJECTIVE: Limited evidence shows culturally and linguistically diverse (CALD) children and adolescents are less active, compared to the general population. It is unclear, how physical activity interventions have been adapted for CALD children and adolescents to enhance engagement. This study aimed to review culturally adapted physical activity interventions targeting CALD children and adolescents. METHODS: All studies recruited children and adolescents (i.e., aged ≥5 to <18 years old) from CALD backgrounds, targeted physical activity, and included cultural adaptations. Cultural adaptations were defined as surface structures (i.e., observable characteristics of a targeted population) or deep structures (i.e., rooted in core ethnic values derived from individual cultures. RESULTS: Twenty studies were included. Ten studies used a combination of surface and deep structure adaptations. Of these 10 studies, 3 found a significant between-group difference in physical activity favouring the intervention group. Among studies (n = 6) that used surface structure adaptations (e.g., language adjustments to information sheets, consent forms, and resources), 1 found a significant intervention effect on physical activity. With studies (n = 4) that used deep structure adaptations (e.g., incorporating traditional songs and dances relevant to cultural groups), 1 study found a significant intervention effect on physical activity. CONCLUSION: A small number of studies found significant changes to increase physical activity levels. We found there is a lack of consistent evidence indicating that incorporating surface and/or deep structure adaptations result in significant changes in physical activity. Future research should focus on establishing higher quality methodology when developing culturally adapted interventions for CALD populations.

Determining priority areas for health promotion amongst Australian professional sporting organisations.

OBJECTIVES: Professional sporting organisations (PSOs) are well-positioned to promote health through their reach and standing within communities. However, the health promotion (HP) priority areas of interest of PSOs are unknown. The objectives of this study were to: identify HP priority areas amongst Australian PSOs and explore the development, implementation, and evaluation of HP programming within the identified priority areas. DESIGN: Delphi procedure with qualitative interviews. METHODS: Participants were community-focussed employees from PSOs across Australia. To identify HP priory areas, three rounds of surveys were used in a Delphi procedure. Participants were then invited to participate in semi-structured interviews focussed on the development, implementation, and evaluation of HP programmes. RESULTS: Of the 103 community employees invited to participate in the Delphi, 28 participated in at least one round and 16 completed all rounds. Overall, HP priorities fell under five main areas: access/participation in sport; general HP; physical activity promotion; community, culture, and inclusion; and support for HP initiatives. Eleven interviews were conducted, and central themes included needing support with programme design and evaluation, and the need to build employee capacity and greater inter-organisational collaboration. CONCLUSIONS: This study determined HP priority areas amongst PSOs using a consensus-generating approach. Interview findings demonstrated that community-focussed employees are committed to delivering HP programmes, but encounter difficulty with funding, employee capacity, and programme design and evaluation expertise. The findings from these interviews reveal potential avenues of collaboration between organisations that can provide expertise in design and evaluation and sporting organisations for HP programming.

Experiences of young Australian mothers with infant feeding.

BACKGROUND: Despite the overwhelming evidence of health and other benefits of breastfeeding and recommendations to breastfeed by peak health bodies, breastfeeding rates are significantly lower than recommended in Australia and globally. Young mothers are identified as being at high risk of not breastfeeding their infants according to infant feeding recommendations. This study aimed to gain an in-depth understanding of young Australian mothers' experiences of infant feeding, and to explore the factors which facilitated or hindered adherence to recommended breastfeeding practices. METHODS: Purposive and snowball sampling were used to recruit young mothers in Australia (n = 17) aged 18-25 years who had given birth to their first child within the last two years. Data were collected through semi-structured interviews via online videoconferencing. Interviews were audio-recorded, transcribed verbatim, coded, and subsequently analysed. Thematic analysis was conducted using Quirkos, a qualitative data management and analysis software. RESULTS: Four major themes were identified: Breastfeeding is challenging; Feeling judged about infant feeding choices; Experiences with breastfeeding support; and Experiences and views on breastfeeding education. Most mothers reported experiencing breastfeeding challenges, particularly those arising from lactation difficulties, yet many were able to overcome these challenges through their determination to breastfeed. Many mothers expressed perceiving judgement from others for breastfeeding in public. Some mothers who were bottle feeding their infants, whether with expressed breast milk or infant formula, felt that they were being judged for using a bottle. Many mothers reported professional, partner, family, and peer support as critical facilitators to the continuation of breastfeeding. Most mothers shared positive experiences of attending breastfeeding education sessions, but indicated the need for community education to reduce judgement toward mothers' infant feeding decisions. CONCLUSIONS: The barriers and enablers to infant feeding experienced by young mothers are similar to those experienced by mothers of all ages. Young mothers experience significant breastfeeding challenges and need support from partner, family, peers, and professionals to continue breastfeeding in line with recommendations. Breastfeeding campaigns to support young mothers should be aimed at the wider community to increase awareness of breastfeeding challenges, reduce stigma associated with breastfeeding in public, and to support mothers in their infant feeding decisions.

Effectiveness of Adult Health Promotion Interventions Delivered Through Professional Sport: Systematic Review and Meta-Analysis.

BACKGROUND: Researchers are capitalising on the strong connections that sport fans have with their teams for health promotion programmes, yet no existing systematic reviews have evaluated the effectiveness of interventions delivered through professional sport. OBJECTIVE: The aim of this study was to systematically collate, evaluate, and synthesise the evidence on health promotion interventions implemented in professional sport settings. METHODS: Randomised controlled trials reporting on adult health promotion initiatives delivered in professional sport settings were identified through electronic database searches in CINAHL, MEDLINE, SPORTDiscus, Scopus, the Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar. Data on health-related outcomes (e.g., weight, physical activity, dietary intake) were extracted and synthesised, and random effects meta-analyses were conducted to examine effects for weight and waist circumference. Risk of bias was examined using the Cochrane risk-of-bias tool for randomised controlled trials (RoB 2). RESULTS: Six studies reporting on five unique interventions met the inclusion criteria, and all included studies were gender-sensitised and exclusively targeted men. Intervention effects were observed for several health outcomes, including physical activity, dietary intake, and psychosocial health. All studies aimed to reduce weight, and for most studies (n = 4), weight was a primary outcome, either of the included study or to inform a future definitive trial. Findings from the meta-analysis revealed an overall significant difference in change in weight of - 3.2 kg (95% confidence interval [CI] - 4.6 to - 1.8) and waist circumference of - 3.9 cm (95% CI - 4.9 to - 2.8), both in favour of the intervention group at 12 weeks. Intervention effects were also reported for several other health outcomes (e.g., physical activity, dietary intake, psychosocial health); however, they were not consistently measured across the studies and thus were not meta-analysed. CONCLUSION: Health promotion interventions delivered through professional sporting organisations can significantly improve weight- and lifestyle-related health outcomes. Representation across the socioeconomic spectrum and across culturally and linguistically diverse groups was limited. As only a limited number of studies met the inclusion criteria for this review, a need exists for rigorously designed interventions, standardised intervention approaches, with long-term follow-up, and the potential for scalability. PROSPERO REGISTRATION NUMBER: CRD42019123295.

Unhealthy Lifestyle Behaviours and Psychological Distress: A Longitudinal Study of Australian Adults Aged 45 Years and Older.

Individual associations between lifestyle behaviours and mental health have been established; however, evidence on the clustering of these behaviours and the subsequent impact on mental health is limited. The purpose of this study was to examine cross-sectional and longitudinal associations between combined unhealthy lifestyle behaviours (physical activity, sitting time, sleep duration, processed meat consumption, vegetable consumption, fruit consumption, smoking status, alcohol consumption) and the development of psychological distress (measured using the Kessler Psychological Distress Scale) in a large Australian sample. Participants were 163,707 Australian adults from the 45 and Up Study. Data from baseline (2006-2009) and follow-up wave 1 (2012) were analysed using binary logistic regression. The odds of reporting high or very high psychological distress at follow-up were significantly higher for those reporting five (AOR = 2.36; 95% CI 1.41-3.97, p = 0.001) or six or more (AOR = 3.04; 95% CI 1.62-5.69, p = 0.001) unhealthy lifestyle behaviours, in comparison to those reporting no unhealthy lifestyle behaviours at baseline. These findings suggest that a holistic, multi-faceted lifestyle approach addressing multiple behaviours may be required to support and promote positive mental health and to reduce the likelihood of psychological distress.

Physical activity interventions among culturally and linguistically diverse populations: a systematic review.

OBJECTIVES: To systematically review physical activity interventions among culturally and linguistically diverse (CALD) populations and explore the strategies used to recruit CALD populations, the cultural adaptations made in these interventions, and the cultural adaptations used among successful interventions. DESIGN: Four electronic databases (Embase, MEDLINE, CENTRAL, and CINAHL) was searched in March 2017 and re-run in January 2018. Manual screening of the reference lists of the included studies was also conducted. Eligibility criteria for inclusion in the systematic review were: intervention studies (e.g. controlled and non-controlled studies), physical activity as primary outcome and as the only health behaviour targeted, culturally and linguistically diverse population of interest, published in English, and targeted adult populations (i.e. aged ≥18). RESULTS: A total of 19 articles were included in this review, comprising 15 unique studies. Most studies targeted Latino populations, published in the United States, and targeted women. An array of recruitment strategies were used, such as recruiting from religious establishments or religious and cultural events, and community organisations and events. The majority of studies made cultural adaptations to their intervention to suit the CALD population of interest, however, the level of detail of reported adjustments was limited. Successful interventions were those that generally included community consultation to inform their intervention, language adjustments, community health workers/bilingual/bicultural personnel for intervention delivery, recruitment, and data-collection, and using culturally-relevant intervention material. CONCLUSIONS: Although many studies included in this review reported increases in physical activity at follow-up, the results need to be interpreted with caution due to the lower level of methodological quality and reporting on study methodology. Future interventions designed for CALD populations should be of greater methodological quality and also provide a greater level of transparency in terms of the cultural adaptations that have been made to the intervention.

Behavioural mediators of reduced energy intake in a physical activity, diet, and sleep behaviour weight loss intervention in adults.

Reduced energy intake is a major driver of weight loss and evidence suggests that physical activity, dietary, and sleep behaviours interact to influence energy intake. Energy restriction can be challenging to sustain. Therefore to improve intervention efficacy, evaluation of how changes in physical activity, diet, and sleep behaviours mediate reduced energy intake in adults with overweight/obesity who participated in a six-month multiple-behaviour-change weight loss intervention was undertaken. This was a secondary analysis of a 3-arm randomised controlled trial. Adults with body mass index (BMI) 25-40 kg/m2 were randomised to either: a physical activity and diet intervention; physical activity, diet, and sleep intervention; or wait-list control. Physical activity, dietary intake, and sleep was measured at baseline and six-months using validated measures. The two intervention groups were pooled and compared to the control. Structural equation modelling was used to estimate the mediated effects (AB Coefficient) of the intervention on total energy intake. One hundred and sixteen adults (70% female, 44.5y, BMI 31.7 kg/m2) were enrolled and 70% (n = 81) completed the six-month assessment. The significant intervention effect on energy intake at six-months (-1011 kJ/day, 95% CI -1922, -101) was partially mediated by reduced fat intake (AB = -761.12, 95% CI -1564.25, -53.74) and reduced consumption of energy-dense, nutrient-poor foods (AB = -576.19, 95% CI -1189.23, -97.26). In this study, reducing fat intake and consumption of energy-dense, nutrient-poor foods was an effective strategy for reducing daily energy intake in adults with overweight/obesity at six-months. These strategies should be explicitly targeted in future weight loss interventions.

Feasibility and acceptability of a culturally tailored physical activity intervention for Arab-Australian women.

BACKGROUND: Despite being one of the largest migrant groups in Australia, few physical activity interventions exist for Arab-Australians. The primary aim of this study was to test the feasibility and acceptability of a 12-week culturally tailored physical activity intervention for Arab-Australian women. METHODS: This study used a single-group pretest-posttest design, and was informed by extensive formative research and consultation involving the Arab-Australian community. Participants were insufficiently active Arab-Australian women aged 35-64 with no current illness or injury that would limit physical activity participation. The intervention comprised 6 face-to-face physical activity and education sessions over 12 weeks. The intervention was conducted at 2 separate intervention sites in Western Sydney, Australia. Feasibility outcomes included recruitment, session attendance, and retention. The acceptability of the intervention was assessed through a process evaluation questionnaire completed post-intervention. Accelerometers and the short-form International Physical Activity Questionnaire were used to measure physical activity at baseline and post-intervention. Descriptive statistics were used for feasibility and acceptability outcomes, and changes in physical activity were examined using Wilcoxon signed-rank tests. RESULTS: Of the 53 women who were contacted or expressed interest, 22 were eligible and enrolled in the study. Participants were primarily recruited through direct contact by Arab-Australian community workers and by word-of-mouth. Average session attendance was 63% and the retention rate post-intervention was 68%. The culturally-related intervention components, such as the appropriateness of content, and women-only setting, were rated highly favourably (4.33 to 4.87/5). General intervention elements, such as the face-to-face delivery, knowledge and approachability of facilitators, and session structure, were also rated favourably (4.33 to 4.93/5), and the lowest scored item was the intervention session frequency (3.2/5). There were no statistically significant changes in physical activity post-intervention. CONCLUSIONS: The findings from this study highlighted factors related to recruitment and delivery that need to be considered when developing physical activity interventions for Arab-Australian women. Further research is required using a larger sample and a randomised controlled trial design to examine the longer-term impact on physical activity, and to also examine ways of increasing intervention engagement and retention among Arab-Australian women. TRIAL REGISTRATION: ANZCTR, ACTRN12618001392257. Registered 20 August 2018, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375636 .

A systematic review of qualitative studies exploring the factors influencing the physical activity levels of Arab migrants.

BACKGROUND: Evidence suggests that Arab migrant populations engage in low levels of physical activity. To our knowledge, there are no reviews that explore the perspectives of Arab migrant populations on the factors influencing physical activity. The aim of this systematic review was to thematically synthesise qualitative literature on the factors influencing physical activity among Arab migrant populations. METHODS: Five electronic databases (CINAHL, SPORTDiscus, PsychoInfo, MEDLINE, Embase) were searched in July 2018 and searched again in April 2020. A manual search in Google Scholar was also performed using keywords and the reference lists of included studies were also screened to identify further articles. The eligibility criteria for inclusion were studies that sampled adult (≥18 years) Arab migrant populations, used qualitative methodology, explored the factors influencing physical activity as a primary aim, and were published in English. The 10-item Critical Appraisal Skills Programme (CASP) checklist was used to assess methodological quality of individual studies. The results of the studies were thematically synthesised using the qualitative software Quirkos v1.6. RESULTS: A total of 15 studies were included, with the largest proportion of studies conducted in Australia, followed by the United States, Netherlands, Sweden, and then Canada. Five studies exclusively sampled Arab migrant populations in their study. A total of 7 major themes influencing physical activity among Arab migrants emerged from the synthesis: culture and religion, competing commitments and time, social factors, health-related influences, accessibility issues, outdoor environment, and the migratory experience. CONCLUSIONS: The findings of this review highlighted the various factors influencing the physical activity levels of Arab migrant adults. While many of the factors influencing physical activity are shared with those experienced by other populations (e.g., time constraints), for Arab migrant populations there are other more unique factors closely associated with culture and religion that appear to influence their levels of physical activity. The findings of this review could be used to inform the design of physical activity interventions targeting Arab migrant populations.

The perceptions, barriers and enablers to physical activity and minimising sedentary behaviour among Arab-Australian adults aged 35-64 years.

ISSUES ADDRESSED: The objective of this study was to explore the perceptions, barriers and enablers to physical activity (PA) and minimising sedentary behaviour among Arab-Australians, a group who have lower levels of PA and higher rates of certain chronic diseases when compared with the general Australian population. METHODS: A total of 28 Arab-Australians aged 35-64 years participated in one of five focus groups conducted in Western Sydney during 2017-2018, a culturally diverse region in New South Wales, Australia. Focus group duration ranged from 35-90 minutes with 4-7 participants in each group. Focus group data were recorded and transcribed verbatim and analysed using inductive thematic analysis. RESULTS: Participants had a general understanding of PA and the associated health benefits. Fewer participants were aware of the independent health effects associated with prolonged sitting. A lack of time and motivation due to work, familial duties, domestic roles and lack of effort reportedly influenced PA participation. Health was perceived to be both a barrier and an enabler to PA. Barriers related to health included pain and existing conditions and enablers included preventive and reactive measures. Social support and accessibility, such as a lack of support networks, the availability of services and costs were also discussed. Cultural and religious influences, such as traditional gender roles and the importance of gender-exclusive settings, were also important factors influencing the PA behaviours of participants. CONCLUSIONS: This study highlighted the factors that influence the PA levels and sedentary behaviour of Arab-Australian adults aged 35-64 years. SO WHAT?: The findings of this study could help inform the design and development of culturally tailored PA interventions for Arab-Australian adults.

Interventions to promote exclusive breastfeeding among young mothers: a systematic review and meta-analysis.

BACKGROUND: Exclusive breastfeeding rates in many high-income countries are considerably lower than the World Health Organization recommendations. Younger mothers are less likely than older mothers to exclusively breastfeed or to exclusively breastfeed for a long duration. This systematic review explores interventions to increase the rate of exclusive breastfeeding among young mothers in high-income countries. METHODS: A systematic search of the following databases was completed in August 2020: CINAHL, PubMed, MEDLINE, ProQuest, PsychInfo, Web of Science, Cochrane, Scopus and Embase. A manual search of the reference lists of all the included studies and published systematic reviews was also performed. The Cochrane Collaboration Risk of Bias Tool was used to assess the quality of the included studies. A random effects model meta-analyses was applied. Heterogeneity of outcomes between the studies was assessed using both the χ2 test and the I2 statistic. RESULTS: Of 955 records identified in the search, 392 duplicates were removed, and nine studies met the inclusion criteria. Seven studies were randomised controlled trial (RCTs) and two were quasi-experimental in design. Eight were conducted in the United States. The interventions included peer counselling, telephone support, massage, gift packs, financial incentive and antenatal education. Most studies included a combination of strategies, peer counselling being the most common. A meta-analysis of four of nine included studies did not detect a difference in rate of exclusive breastfeeding to 3 months postpartum (RR 1.44; 95% CI 0.82, 2.55; p = 0.204). This review is limited by the relatively few studies which met the inclusion criteria and the small sample sizes of most included studies. High rates of attrition and formula supplementation among the participants made it difficult to detect a statistically significant effect. Consistency in follow up times would enable more studies to be included in a meta-analysis. CONCLUSIONS: Peer counselling was the most promising strategy associated with higher rates of exclusive breastfeeding. However, further studies are needed to understand the breastfeeding experiences of young mothers. Young mothers should be targeted specifically in intervention studies.

Factors Influencing the Early Introduction of Sugar Sweetened Beverages among Infants: Findings from the HSHK Birth Cohort Study.

Understanding the determinants of early introduction of sugar sweetened beverages (SSBs) may assist in designing effective public health interventions to prevent childhood weight related conditions (obesity). This study explores the relationship between family/infant characteristics and the early introduction of SSBs among infants in Sydney, Australia. Mothers (n = 934) from an ongoing birth cohort study were interviewed at 8, 17, 34, and 52 weeks postpartum. Multivariable logistic regression analysis was used to identify family/infant factors independently associated with the likelihood of early introduction of SSBs (<52 weeks of age). Of the 934 mothers interviewed, 42.7% (n = 399) of infants were introduced to SSBs before 52 weeks. Mothers who were born in Vietnam (adjusted Odds Ratio (AOR) = 2.14; 95% confidence interval (CI) 1.33, 3.47), other Asian countries (AOR = 1.62; 95% CI 1.02, 2.58) as well as single mothers (AOR = 3.72; 95% CI 2.46, 5.62) had higher odds of introducing SSBs early to their infants. Mothers from highly advantaged socioeconomic background (AOR = 0.43; 95% CI 0.28, 0.68), those who breastfed their baby for 17-25 weeks (AOR = 0.60; 95% CI 0.37, 0.99), 26-51 weeks (AOR = 0.65; 95% CI 0.45, 0.94), and 52 weeks or more (AOR = 0.62; 95% CI 0.43, 0.90); and those who introduced solids between 17-25 weeks (AOR = 0.58; 95% CI 0.36, 0.91) and 26 weeks or more (AOR = 0.55; 95% CI 0.34, 0.91) had reduced odds of introducing SSBs early. Tailoring health promotion programs for these vulnerable groups may delay the introduction of SSBs.

Systematic review of randomised control trial health promotion intervention studies in the fire services: study characteristics, intervention design and impacts on health.

The objective of this study was to systematically review health promotion interventions in the fire services. Four databases were searched for articles reporting on health promotion interventions for firefighters evaluated in randomised controlled trials (RCT) and measuring efficacy on health or lifestyle behaviour outcomes. Data were extracted to create a narrative synthesis regarding study design, intervention characteristics and impact on outcomes. Risk of bias was assessed using a 13-item tool. Of 448 papers identified, after removal of duplicates, 209 were excluded based on title/abstract screening. A further 60 papers were excluded, mostly due to studies not being RCTs, not including a lifestyle behaviour intervention, or not focusing on health or lifestyle behaviour outcomes. Ten studies (reported in 11 papers) were eligible for inclusion. Six studies compared an intervention to usual practice, one compared a full intervention to a minimal intervention, one compared two exercise programmes and two compared two interventions to usual practice. Four studies evaluated structured physical activity interventions. Five studies evaluated physical activity and diet-focused behaviour change programmes, and one study included a mindfulness programme. When assessing risk of bias, three studies had low risk ratings for >8/13 items, leaving seven studies with high-risk ratings for ≥5/13 items. Eight of the 10 studies reported improvements in at least 1 outcome from baseline to final follow-up in the intervention group over a comparison group. The majority of lifestyle behaviour interventions targeted physical activity and/or diet. Findings from included studies suggest that programmes for firefighters initiated in the workplace can improve some health outcomes.

Efficacy of a Multi-component m-Health Weight-loss Intervention in Overweight and Obese Adults: A Randomised Controlled Trial.

BACKGROUND: This study compared the efficacy of two multi-component m-health interventions with a wait-list control group on body weight (primary outcome), and secondary outcomes of cardiovascular risk factors, lifestyle behaviours, and mental health. METHODS: Three-arm randomised controlled trial (Enhanced: physical activity, diet, sleep, Traditional: physical activity, diet, Control) with assessments conducted at baseline, 6 and 12 months. Participants (n = 116) were overweight or obese adults aged 19-65 (M = 44.5 [SD = 10.5]). The 6-month intervention was delivered via a smartphone app providing educational materials, goal-setting, self-monitoring and feedback, and also included one face-to-face dietary consultation, a Fitbit and scales. The trial was prospectively registered and conducted between May 2017 and September 2018. Group differences on primary and secondary outcomes were examined between the Pooled Intervention groups (Pooled Intervention = Enhanced and Traditional) and Control groups, and then between Enhanced and Traditional groups. RESULTS: Nineteen participants (16.4%) formally withdrew from the trial. Compared with the Control group, average body weight of the Pooled Intervention group did not differ at 6 (between-group difference = -0.92, (95% CI -3.33, 1.48)) or 12 months (0.00, (95% CI -2.62, 2.62)). Compared with the Control group, the Pooled Intervention group significantly increased resistance training (OR = 7.83, (95% CI 1.08, 56.63)) and reduced energy intake at 6 months (-1037.03, (-2028.84, -45.22)), and improved insomnia symptoms at 12 months (-2.59, (-4.79, -0.39)). Compared with the Traditional group, the Enhanced group had increased waist circumferences (2.69, (0.20, 5.18)) and sedentary time at 6 months (105.66, (30.83, 180.48)), and improved bed time variability at 12 months (-1.08, (-1.86, -0.29)). No other significant differences were observed between groups. CONCLUSIONS: Relative to Controls, the Pooled Intervention groups did not differ on body weight but improved resistance training, and reduced energy intake and insomnia symptom severity. No additional weight loss was apparent when targeting improvements in physical activity, diet and sleep in combination compared with physical activity and diet.

Determinants of Full Breastfeeding at 6 Months and Any Breastfeeding at 12 and 24 Months among Women in Sydney: Findings from the HSHK Birth Cohort Study.

The aim of this study was to report on breastfeeding duration up to 24 months and determine the predictors of breastfeeding duration among women in South Western Sydney, one of the most culturally diverse and socioeconomically disadvantaged regions of New South Wales (NSW), Australia. Mother-infant dyads (n = 1035) were recruited to the Healthy Smiles Healthy Kids birth cohort study. Study data were collected through telephone interviews at 2, 4, 8, 12, and 24 months postpartum. Cox proportional hazards models were used to determine factors associated with the risk of stopping full breastfeeding at six months and any breastfeeding at 12 and 24 months. The majority of mothers (92.3%) had initiated breastfeeding. At six months, 13.5% of infants were fully breastfed, while 49.9% received some breast milk. Only 25.5% and 2.9% of infants received some breast milk at 12 and 24 months, respectively. Lower maternal education level, lower socioeconomic status, full-time employment, maternal smoking during pregnancy, and caesarean delivery were associated with increased risk of stopping full breastfeeding at six months and any breastfeeding at 12 and 24 months. Older maternal age and partner's preference for breastfeeding were associated with an increased likelihood of continuing any breastfeeding at 12 and 24 months. These findings present a number of opportunities for prolonging breastfeeding duration in disadvantaged communities in NSW.

Older adults' evaluations of the standard and modified pedometer-based Green Prescription.

INTRODUCTION The Green Prescription is a primary care programme designed to increase physical activity in individuals with low activity levels. Older adults tend to engage in insufficient physical activity to obtain health-related gain. AIM To examine participants' ratings of the Healthy Steps intervention and to assess how participants rated the use of a pedometer-based Green Prescription in aiding their physical activity. METHODS In total, 330 community-dwelling older adults who have low levels of activity were randomised to receive either a standard time-based Green Prescription or a modified pedometer-based Green Prescription. Post-intervention, 259 participants completed the participant evaluation questionnaire via postal survey. Data were analysed using descriptive statistics and Chi-squared analyses. RESULTS The standard components of the Green Prescription (general practitioner consultations and telephone counselling) received similar and higher ratings across both allocation groups than the use of print materials. A pedometer-based Green Prescription was rated as being helpful in aiding physical activity. DISCUSSION This study supports the importance of general practitioners' initial role in prescribing physical activity for older adults and of ongoing telephone support for longer-term adherence. Incorporating a pedometer can be effective in helping low-active older adults initiate and maintain regular physical activity.

Psychological distress among carers and the moderating effects of social support.

BACKGROUND: Carers provide both practical and emotional support and often play an important role in coordination of care for recipients. The demands of caring may lead to increased levels of stress for the carer, which can affect mental health and quality of life. This study examined the relationship between being a carer and psychological distress (assessed using the Kessler Psychological Distress Scale [K10]), and explored the moderating effect of social support in that relationship using a large sample. METHODS: The study used data from the 45 and Up study, a large cohort study of individuals aged 45 years and over in New South Wales, Australia, and applied multiple regression methods and moderation analysis. The sample for the current study comprised 267,041 participants drawn from the baseline dataset, with valid data on the primary outcome (carer status). RESULTS: The mean age of participants was 62.73 (±11.18) years, and 4.23% and 7.13% were identified as full-time and part-time carers, respectively. Compared to non-carers, full-time carers had K10 scores that were on average, higher by 1.87, while part-time carers' K10 scores were on average higher by 1.60 points. A perception of social support reduced the strength of the relationship between carer status and psychological distress by 40% for full-time carers and 60% for part-time carers. CONCLUSIONS: The findings have important implications, for both prevention and treatment of psychological problems among carers. In terms of prevention, they suggest that public health campaigns focused on increasing awareness regarding the psychological burden faced by carers would be useful. In terms of intervention, potential treatments that focus on improving social support networks may be helpful. The results are particularly important in the current context of an ageing population in Australian and other developed countries, where caregiving is likely to play an increasing role in the care and support services.

Successes and Challenges of an IT-Based Health Behaviour Change Program to Increase Physical Activity.

Health behaviour change programs that utilise IT-based delivery have great potential to improve health. Whilst more static Web 1.0 technologies have been somewhat effective, they often failed to promote longer-term user engagement required for greater health promotion impact. With Web 2.0 technologies, however, there is potential for greater engagement and retention, through allowing individuals to determine how information is generated, modified, and shared collaboratively. The WALK 2.0 study utilised a Web 2.0-based platform to engage participants in health behaviour change aimed at increasing physical activity levels. The program included two trials: (1) a three-arm randomised controlled trial (RCT) that compared the effectiveness of Web 2.0, Web 1.0, and paper-based logbook interventions; and (2) a real-world randomised ecological trial (RET) that compared a Web 2.0 and Web 1.0 intervention. The aim of this paper is not to focus on the research trial results per se, but rather the success factors and challenges in both the RCT and RET. Both the RCT and RET demonstrated successful outcomes, with greater improvements in physical activity for the Web 2.0 groups. A range of challenges, however, were identified in designing, implementing, and evaluating such interventions. These include IT-based intervention development within a research context, the ability to establish a self-sustaining online community, the rapid pace of change in web-based technology and implications for trial design, the selection of best outcome measures for ecological trials, and managing engagement, non-usage and study attrition in real-world trials. Future research and developments in this area must look to broader research designs that allow for the ever-changing IT-user landscape and behaviour, and greater reliance on development and testing in real-world settings.

Does self-determined motivation interact with environmental contexts to influence moderate-to-vigorous physical activity during a girls' youth sport camp?

Objective: To explore whether basketball player's self-determined motivation interacts with environmental contexts and coach training to influence percentage time in moderate-to-vigorous physical activity (%MVPA). Methods: A secondary analysis of data from 76 girls (mean ± SD, 10.5 ± 1.0 years) was conducted. Players were classified as high self-determined motivation (HSDM) or low self-determined motivation (LSDM) and randomised to trained (intervention) or untrained (control) coaches. Training included 2 workshops on strategies for activity-promoting practices. Girls were exposed to environmental contexts (practices and games) led by a trained/untrained coach (depending on arm) and one without coaches (free time) daily. Girls wore accelerometers each day. Using mixed random-effects models, the influence of motivation, context and training on %MVPA was analysed. Results: Trained coaches' practices were associated with the greatest %MVPA with no difference between HSDM and LSDM players (38.28 ± 1.77%; 37.64 ± 1.80%; p = 0.66). HSDM players had significantly greater %MVPA versus LSDM players during untrained coaches' practices (23.58 ± 1.77%; 20.51 ± 1.78%; p = 0.03). During games with trained coaches, HSDM players had greater %MVPA compared to LSDM players (23.79 ± 1.76%; 18.56 ± 1.74%; p < 0.001). No between-group difference in %MVPA during free time was found (12.85 ± 0.82%; 13.39 ± 0.84%; p = 0.64). Conclusion: The impact of individual differences in self-determined motivation on %MVPA during practices was attenuated when coaches were trained to implement activity-promoting practices.