Revisiting lifestyle risk index assessment in a large Australian sample: should sedentary behavior and sleep be included as additional risk factors?

OBJECTIVE: Most studies on multiple health behaviors include physical inactivity, alcohol, diet, and smoking (PADS), with few including emerging lifestyle risks such as sleep or sitting. We examined whether adding sitting and sleep to a conventional lifestyle risk index improves the prediction of cross-sectional health outcomes (self-rated health, quality of life, psychological distress, and physical function). We also explored the demographic characteristics of adults with these multiple risk behaviors. METHODS: We used baseline data of an Australian cohort study (n=191,853) conducted in 2006-2008 in New South Wales. Lifestyle risk index was operationalized as 1) PADS, 2) PADS+sitting, 3) PADS+sleep, and 4) PADS+sitting+sleep. We estimated receiver operating characteristic curve for self-reported binary health outcomes and calculated the area under the curve to illustrate how well each index classified the outcome. We used multiple logistic regression to determine the demographic characteristics of adults with multiple lifestyle risks. RESULTS: Adding sleep duration but not sitting time to the PADS index significantly improved the classification of all health outcomes. Men, those aged 45-54years, those with 10 years of education or less, and those living in regional/remote areas had higher odds of multiple risk behaviors. CONCLUSIONS: Future research on multiple health behaviors might benefit from including sleep as an additional behavior. In Australia, unhealthy lifestyles tend to cluster in adults with certain demographic characteristics.

Does playground improvement increase physical activity among children? A quasi-experimental study of a natural experiment.

Outdoor recreational spaces have the potential to increase physical activity. This study used a quasi-experimental evaluation design to determine how a playground renovation impacts usage and physical activity of children and whether the visitations correlate with children's physical activity levels and parental impressions of the playground. Observational data and intercept interviews were collected simultaneously on park use and park-based activity among playground visitors at pre- and postrenovation at an intervention and a comparison park during three 2-hour periods each day over two weeks. No detectable difference in use between parks was observed at followup. In the intervention park, attendance increased among boys, but decreased among girls although this (nonsignificant) decline was less marked than in the comparison park. Following renovation, there was no detectable difference between parks in the number of children engaged in MVPA (interaction between park and time: P = 0.73). At the intervention park, there was a significant decline in girls engaging in MVPA at followup (P = 0.04). Usage was correlated with parental/carer perceptions of playground features but not with physical activity levels. Renovations have limited the potential to increase physical activity until factors influencing usage and physical activity behavior are better understood.

Formulating a programme of repairs to structural home injury hazards in New Zealand.

Home injuries are a substantial health burden worldwide, with the home setting being at least as important as the road for injury. Focusing on common injury hazards presented by the home environment, we sought to examine the justification for significant expenditure on safety-related repairs to the housing stock. Trained inspectors assessed 961 New Zealand houses for injury hazards. Using administrative data from the Accident Compensation Corporation (the national injury insurance agency), 1328 home injuries were identified amongst the 1612 occupants of these houses over the 2006-2009 period. Telephone interviews gathered data on the location and nature of these injuries, and the attitudes of those injured to potential injury hazards in their homes. Commonly occurring injury hazards that could be repaired at modest cost were identified based on their prevalence estimated by the housing inspection, and their location with respect to the areas of the home where the injuries occurred (identified during the telephone interviews). About 38% of the home injuries studied were potentially related to a structural aspect of the home environment. Common safety hazards included the lack of working smoke detectors (65% of the sample), inadequately fenced driveways (55%), hot water temperatures measured at over 60° (49%) and poorly lit access to the house (34%). A protocol for identifying and repairing important common hazards was designed. The actual safety effects of this protocol are in the process of being examined in a randomised controlled trial.

How diverse was the leisure time physical activity of older Australians over the past decade?

OBJECTIVES: Public health recommendations for older adults highlight the need to engage in a combination of aerobic, muscle strength, flexibility and balance activities. This study characterised leisure time physical activity in older Australians (≥ 65 years), examining the diversity in reported activities DESIGN: Cross-sectional monitoring. METHODS: The Exercise Recreation and Sport Surveys (2001-2009) were combined and analysed for 22,050 elderly. RESULTS: Walking was reported by 45.6%, of those 53% engaged exclusively in walking. Prevalent sports (i.e., >1%) were bowls (9.4%), aerobics/callisthenics exercise (9.1%), golf (7.7%), swimming (6.4%), gym work (5.2%), cycling (3.2%), tennis (2.9%), dancing (2.1%), fishing (2.0%), tai chi (1.4%), weight lifting (1.2%) and yoga (1.1%). Significant gender differences were apparent. Over time, significant increases were reported in walking, aerobic/callisthenics and gym workout in both genders. In the previous year, 32.0% of older adults participated in "nil" activity, 40.6% engaged in one activity, 19.5% and 8.0% participated in two or three or more activities, respectively. Common combinations were walking with another aerobic activity. Only 2.6% reported a combination of aerobic, balance and strength activities. Multiple-activity participation increased over the years, but declined with increasing age, education and for the most disadvantaged, compared to single-activity participation. Partially or exclusively organised participation, combined, was reported by 42.5% of older adults. Women were more likely to combine mode of participation. Geographic region was associated with multiple-activity participation and organised-only participation. CONCLUSIONS: Most elderly people engage in one activity, if at all. An increase in participation in balance enhancing activities and weight training is warranted to maximize health benefits.