Trajectories of Loneliness During Adolescence Predict Subsequent Symptoms of Depression and Positive Wellbeing

There is a need to identify the outcomes of changes in loneliness during adolescence, and to consider this within a multidimensional framework of loneliness. This study considered the effects of different trajectories of change in Isolation Loneliness and in Friendship Loneliness upon both positive wellbeing and symptoms of depression. To achieve this, 1782 (43% female; 12.92 years old at the start of the study, SD = 1.60) young people took part in a longitudinal study with four data points across 2 years. Four Isolation Loneliness trajectories and five Friendship Loneliness trajectories were identified. Youth who experienced low levels of Isolation Loneliness that subsequently increased appear to be at particular risk for poor outcomes. Similarly, initially high levels of Friendship Loneliness that decreased rapidly, or which began at a low level and only increased marginally, seem to also be a risk. Loneliness is a multi-dimensional construct and its development during adolescence impacts upon young people's depressive symptomatology and positive mental wellbeing.

Impact on help-seeking behaviours of a campaign perceived to decrease stigma and increase openness around mental health

ISSUE ADDRESSED

There is considerable evidence that public stigma around mental illness inhibits help-seeking for mental health problems. Hence there have been many interventions and campaigns designed to reduce stigma around mental illness. However, as far as could be ascertained, none of these stigma reduction interventions has reported any substantial impact of reducing stigma on people's mental health help-seeking behaviours. The aim of this paper is to report on the impact of the Act-Belong-Commit positive mental health promotion Campaign on help-seeking via increasing perceived openness around mental health and reducing perceived stigma around mental illness.

METHODS

State-wide computer assisted telephone interviews (CATIs) of the general adult population were undertaken in 2018 and 2019 (N = 600 adults per year). The questionnaire included measures of respondents' awareness of the Act-Belong-Commit Campaign, their beliefs about the Campaign's impact on mental illness stigma and openness around mental health issues, and whether they had sought help for or information about a mental health problem as a result of their exposure to the Campaign.

RESULTS

Those who believed the Act-Belong-Commit Campaign increased openness around mental health issues were significantly more likely than those not holding this belief to have sought information about mental health and to have sought help for a mental health problem as a result of their exposure to the Campaign. Those who believed the Act-Belong-Commit Campaign decreased stigma around mental illness versus those not holding this belief were significantly more likely to have sought information, and more likely, but not significantly so, to have sought help as a result of their exposure to the Campaign. Overall, the effect was slightly greater for increased openness.

CONCLUSION

As far as we are aware, these are the first reported findings of a positive impact on mental health help-seeking behaviours as a result of a population-wide mental health promotion Campaign being seen to have increased openness around mental health and decreased stigma around mental illness. SO WHAT?: These findings suggest that accompanying specific stigma reduction interventions with a broad-based, population-wide, positive mental health promotion Campaign such as the Act-Belong-Commit campaign, could amplify these interventions' impact on help-seeking by increasing openness about mental health issues.

'Nih Waangkiny Kaadatjiny': 'Listening, learning and knowing': Stakeholders' perspectives about barriers and enablers to delivering a successful physical activity program for older Aboriginal people

There is limited evidence about how physical activity (PA) programs should be provided for older Aboriginal and Torres Strait Islander peoples. Recently two groups of Aboriginal Elders on Noongar Boodja (Country) in Western Australia participated in the Ironbark PA program.

ISSUE ADDRESSED

The objective of this study was to explore the views of key stakeholders about the barriers and enablers to delivering a successful PA program and provide feedback for future program delivery.

METHODS

The research took a 'Nih (listening), Waangkiny (learning), Kaadatjiny (knowing)' approach. The lead researcher, a Noongar Wadjuk woman, conducted semi-structured interviews (n = 17) with key stakeholders: Aboriginal and non-Aboriginal workers who assisted to deliver the program, and family and local members of the communities. Data were also collected through weekly program notes and researcher diary entries. Data were analysed thematically.

RESULTS

The overarching theme highlighted that stakeholders felt a sense of building a PA program that was culturally appropriate. They reflected that the program attracted older Aboriginal people because it was designed to make them feel welcomed with a sense of belonging. Five major themes were identified: Relationships, Belonging, Program structure, Benefits of the program and Future planning. Positive changes observed in Elders' health and well-being were a source of inspiration for team workers.

CONCLUSIONS

Key enablers to delivering a PA program for older Aboriginal people are building a culturally strong program that creates a sense of belonging for the participants. SO WHAT?: Practitioners who are planning PA programs for older Aboriginal people should prioritise the development of cultural safety and security.

Perceptions of social media harms and potential management strategies: vaping case study

BACKGROUND

The social media landscape is now ubiquitous in people's everyday lives. It is a space where culture, politics, economics and sociological and public health discourses occur. There is mounting evidence that e-cigarette products are being promoted and advertised on social media, a media platform particularly popular with young people. Our research aimed to understand industry professionals' perceptions of social media harms and potential management strategies using vaping as a case study.

METHODS

A critical realist perspective guided reflexive thematic analysis of the qualitative in depth, semi structured interviews. Data collection occurred in January and February 2023 with 13 participants working in the areas of public health, digital media, law, governance, tobacco control and advocacy.

RESULTS

Two superordinate themes emerged from the data: (1) Fathoming a complex system (social media) that contained the subordinate themes of Traversing Boundaries (crossing borders, crossing sectors) and Ungovernable (global and local landscapes, vested interests, self-regulation and opacity). (2) Addressing complexity (social media)- that contained the subordinate themes of Strengthening Institutions (global to local, policy and legislation, individuals and organisations); Defanging Industry (responsibility and transparency, moderation and algorithms, complaints); and Engaging Citizens (raising awareness, framing messaging).

CONCLUSIONS

There was consensus among participants that e-cigarette related social media content can be harmful and government action is urgently needed. There was an identified need for the development of government led national-level regulatory frameworks, with government led appropriate legislation; identification of an organisation or organisations with suitable levels of regulatory power and resources to monitor, enforce and penalise noncompliant social media companies; accompanied by increased community awareness raising of harmful social media content and improved digital literacy.

The Nutritional Quality of Food Donated to a Western Australian Food Bank

Food banks provide an indispensable service to people experiencing severe food insecurity. Food banks source donations from across the food system; however, the food redistributed to clients across the developed world is nutritionally poor. This, together with the increasing prevalence of diet-related diseases and food insecurity, has prompted a focus on nutritional quality. Despite more food being distributed via food banks in Australia, the nutritional quality of donated food remains unreported. This study analyzed all food (84,996 kg (1216 products)) donated to Foodbank WA over a 5-day period using diet-, food-, and nutrient-based nutrition classification schemes (NCSs). A total of 42% (27% of total weight) of donated food products were deemed 'unsuitable' and 19% (23% by weight) were 'suitable' according to all NCSs. There was no agreement on 39% of products (50% by weight). Overall, NOVA and the Healthy Eating Research Nutrition Guidelines (HERNG) (κ = 0.521) had the highest level of agreement and the ADGs and HERNGs the lowest (κ = 0.329). The findings confirm the poor nutritional quality of food donated to food banks and the need to work with donors to improve the food they donate. Fit-for-purpose nutrition guidelines are urgently needed for Australian food banks to support them in providing nutritious food to their vulnerable clients.

Falling through the cracks: How do policies for alcohol marketing apply to zero alcohol products in Australia?

ISSUES

There is a decline in youth drinking, but also a causal link between alcohol marketing and drinking among young people. Therefore, novel alcohol marketing strategies should be scrutinised, particularly where children are exposed. This includes marketing for zero-alcohol products (ZAP) (containing 0.00% to 1.15% alcohol by volume), which has expanded considerably in recent times. This review examines how the current industry-managed regulatory approach to alcohol marketing applies to ZAPs in Western Australia.

APPROACH

The marketing mix (four Ps of marketing: product, promotion, place, price) was used as a framework to examine federal and state government policies and industry managed codes. Policies were included if they applied to marketing of alcohol products, for example, product labelling, promotion and advertising across various media, the place of purchase and pricing measures (taxation).

KEY FINDINGS

ZAPs were inconsistently defined, meaning that products between 0.05% and 1.15% alcohol by volume were covered under some but not all alcohol policy measures, and application to products under 0.5% alcohol by volume was limited.

IMPLICATIONS

Government policy should more clearly define alcohol marketing and whether ZAPs and other alcohol brand extensions should be treated in the same way as alcoholic products.

CONCLUSION

In Western Australia, the ways in which alcohol policy measures apply to ZAPs are limited and close attention must be paid to how ZAPs may provide additional marketing opportunities for the alcohol industry.

Characteristics of high- and low-risk drinkers who use online alcohol home delivery in Western Australia

INTRODUCTION

Variation in alcohol availability is an important driver of levels of consumption and harm, with recent increases in online alcohol home delivery use expanding availability. There is limited research on the impacts of these changes and the characteristics of consumers who use alcohol home delivery.

METHODS

This study presents findings from an online survey (n = 465) of Western Australian adults who had purchased alcohol for home delivery within the past 6 months. Analyses compared high-risk and low-risk drinkers on use of, and exposure to, alcohol home delivery.

RESULTS

Compared to low-risk drinkers, high-risk drinkers were significantly more likely to make more frequent online purchases (odds ratio 5.42), utilise same day delivery (odds ratio 2.91) and purchase through specialised online-only retailers (odds ratio 2.69). High-risk drinkers also reported receiving deliveries while intoxicated more often (odds ratio 11.62), and ordering alcohol for delivery to continue a current drinking session (odds ratio 7.47). High-risk drinkers also received advertising for alcohol home delivery more frequently (odds ratio 1.60) than low-risk drinkers. High-risk drinkers also ordered larger quantities of alcohol than low-risk drinkers (M = 49 vs. 32 standard drinks).

DISCUSSION AND CONCLUSIONS

Findings from this study indicate that these services are popular with high-risk drinkers and potentially undermine other policy efforts to reduce drinking. Within Australia, stronger legislation (such as mandatory delay between order and delivery) and monitoring (e.g., test purchasing for compliance) are recommended.

Promoting mental well-being in Western Australia: Act Belong Commit® mental health promotion campaign partners' perspectives

The Act Belong Commit® mental health promotion campaign aims to improve population mental well-being. Based on a social-franchising model, partnerships are sought with organizations offering 'mentally healthy activities' that foster social connectedness and mental well-being. There are four categories of partner organizations sought: Site (government agencies and health services), Associate (organizations with state-wide or national services), Community (local, grass-roots community groups) and Schools. This research explored organizational perceptions of the Act Belong Commit® Partnership Program. A purposive sample of 14 organizational representatives across all four partner categories participated in semi-structured interviews online or face-to-face between July and September 2021. Reflexive thematic analysis was used to identify three main themes: (a) A passion for promoting mental health; (b) Implementation, innovation, adaption and creation (e.g. the ability to adapt, create and deliver activities aligned with the campaign message; and (c) Future sustainability (e.g. recommendations for the sustainability of the programme). The use of reflexive thematic analysis enabled deeper insights into the complexity of the partnerships. Findings describe how the Act Belong Commit® Partnership Program supports mutually desirable objectives and extends the campaign reach. Embedded in a shared belief system that incorporates a passion for good mental health, the model supports the flexibility to adapt, create and deliver fit-for-purpose activities that promote mental well-being in the places where people live, work and play.

Longitudinal effects of dog ownership, dog acquisition, and dog loss on children's movement behaviours: findings from the PLAYCE cohort study

INTRODUCTION

Regular physical activity is important for children's physical and mental health, yet many children do not achieve recommended amounts of physical activity. Dog ownership has been associated with increased physical activity in children, however, there have been no longitudinal studies examining this relationship. This study used data from the Play Spaces and Environments for Children's Physical Activity (PLAYCE) cohort study to examine the longitudinal effects of dog ownership status on children's movement behaviours.

METHODS

Change in dog ownership from preschool (wave 1, age 2-5) to fulltime school (wave 2, age 5-7) was used as a natural experiment with four distinct dog ownership groups: continuing non-dog owners (n = 307), continuing dog owners (n = 204), dog acquired (n = 58), and dog loss (n = 31; total n = 600). Daily movement behaviours, including physical activity, sedentary time, sleep, and screen time, were measured using accelerometry and parent-report surveys. Differences between groups over time and by sex were tested using linear mixed effects regression models.

RESULTS

Girls who acquired a dog increased their light intensity activities and games by 52.0 min/day (95%CI 7.9, 96.0) and girls who lost a dog decreased their light intensity activities and games by 62.1 min/day (95%CI -119.3, -4.9) compared to no change among non-dog owners. Girls and boys who acquired a dog increased their unstructured physical activity by 6.8 (95%CI 3.2, 10.3) and 7.1 (95%CI 3.9, 10.3) occasions/week, compared to no changes among non-dog owners. Girls and boys who lost a dog reduced their unstructured physical activity by 10.2 (95%CI -15.0, -5.3) and 7.7 (95%CI -12.0, -3.5) occasions/week. Girls who lost a dog decreased their total physical activity by 46.3 min/day (95%CI -107.5, 14.8) compared to no change among non-dog owners. Continuing dog ownership was typically not associated with movement behaviours. Dog ownership group was not associated with changes in sleep and had mixed associations with screen time.

CONCLUSION

The positive influence of dog ownership on children's physical activity begins in early childhood and differs by child sex. Further research should examine the specific contributions dog-facilitated physical activity makes to children's overall physical activity, including the intensity and duration of dog walking and play.

The efficacy of the "Talk-to-Me" suicide prevention and mental health education program for tertiary students: a crossover randomised control trial

Despite suicide ideation being one of the most frequently reported health issues impacting tertiary students, there is a paucity of research evaluating the efficacy of preventive interventions aimed at improving mental health outcomes for students studying at two tertiary institutes. The current study evaluated the efficacy of the "Talk-to-Me" Mass Open Online Course (MOOC) in improving tertiary students' abilities to support the mental health of themselves and their peers via a randomised controlled trial design, comparing them to a waitlist control group. Overall, 129 tertiary students (M = 25.22 years, SD = 7.43; 80% female) undertaking a health science or education course at two Western Australian universities were randomly allocated to either "Talk-to-Me" (n = 66) or waitlist control (n = 63) groups. The participants' responses to suicidal statements (primary outcome), knowledge of mental health, generalised self-efficacy, coping skills, and overall utility of the program (secondary outcomes) were collected at three timepoints (baseline 10-weeks and 24-weeks from baseline). Assessment time and group interaction were explored using a random-effects regression model, examining changes in the primary and secondary outcomes. Intention-to-treat analysis (N = 129) at 10-weeks demonstrated a significant improvement in generalised self-efficacy for "Talk-to-Me" compared to the control group (ES = 0.36, p = .04), with only the "Talk-to-Me" participants reporting increased knowledge in responding to suicidal ideation (primary outcome). This change was sustained for 24 weeks. Findings provide preliminary evidence suggesting that the "Talk-to-Me" MOOC can effectively improve tertiary students' mental health and knowledge of how to support themselves and others in distress. ACTRN12619000630112, registered 18-03-2019, anzctr.org.au.

Describing homelessness risk among people from culturally and linguistically diverse backgrounds in Western Australia: A cluster analysis approach

ISSUE ADDRESSED

Housing is a social determinant of health. Migrants are at an increased risk of insecure housing, overcrowding, and homelessness which can lead to poor quality of life and well-being. This study aimed to identify clustering patterns of homelessness risks among people from culturally and linguistically diverse (CaLD) backgrounds in Western Australia (WA).

METHODS

Participants from CaLD backgrounds (n = 143, 81.8% male) were identified from secondary cross-sectional data sourced from Vulnerability Index Service Prioritisation Decision Assistance Tool (VI-SPDAT) surveys conducted with people experiencing homelessness in Perth, WA, between 2012 and 2020. A two-step cluster analysis was used to identify subgroups within the data, and chi-square tests compared demographic characteristics and drivers of homelessness among the determined clusters.

RESULTS

Three distinct clusters were identified and labelled as 'high-risk group' (n = 50, 35.0%), 'medium-risk group' (n = 39, 27.3%) and 'low-risk group' (n = 47, 32.9%). The most vulnerable participants (with VI-SPDAT score ≥ 10) were all clustered in the 'high-risk group'.

CONCLUSION

The analysis identified subgroups within and between CaLD populations and highlighted limitations with data collection instruments for measuring homelessness among these groups. SO WHAT?: To prevent health issues associated with homelessness and improve social determinants of health, improvements in research and service provision are recommended to facilitate equitable access to secure housing for people from CaLD populations.

Dietary risk of donated food at an Australian food bank: an audit protocol

BACKGROUND

Sufficient, safe and nutritious food is unattainable for many people experiencing severe food insecurity, putting them at dietary risk. Food banks, a growing part of the charitable food system (CFS), are the main source of food relief in developed countries. Donations of surplus, unsalable food from supermarkets, producers and manufacturers is the main source of the food supply, and this can be unpredictable, insufficient and inappropriate. The universal performance indicator of food-banking success is a weight-based measure, complemented by various initiatives to track the nutritional quality of food provided. There is currently no method that assesses the dietary risk of donated food related to nutrition and food safety. This protocol describes a method developed to identify and assess the dietary risk of donated food at an Australian food bank including the type, amount, nutrition quality, and food safety.

METHODS

An audit of all food donated to a food bank servicing one Australian state was conducted over five consecutive days in May 2022. The audit process used a mobile device to take photographs of all incoming deliveries to the food bank. The images were manually annotated to document the type of food, product information (brand and product name, variety), the donor's name, weight (kilograms), and date-marking details. Data was extracted from the photographs and assessed against pre-determined dietary risk criterion for food safety (date marking, damaged packaging, visible food spoilage) and nutrition quality according to the principles of the Australian Guide to Healthy Eating, and the NOVA classification of level of processing.

DISCUSSION

Fifteen hundred images were required to assess the dietary risk of 86,050 kg of donated food. There were 72 separate donations, largely from supermarkets and food manufacturers. Data analysis will enable identification of dietary risk, particularly for nutrition quality and food safety. This is important given the absence of food regulation for CFS donations, and the vulnerability of the client group. This protocol highlights the need for more transparency and accountability from food donors, about the food they donate.

Association of Abdominal Aortic Calcification with Peripheral Quantitative Computed Tomography Bone Measures in Older Women: The Perth Longitudinal Study of Ageing Women

We have previously shown that abdominal aortic calcification (AAC), a marker of advanced atherosclerotic disease, is weakly associated with reduced hip areal bone mineral density (aBMD). To better understand the vascular-bone health relationship, we explored this association with other key determinants of whole-bone strength and fracture risk at peripheral skeletal sites. This study examined associations of AAC with peripheral quantitative computed tomography (pQCT)-assessed total, cortical and trabecular volumetric BMD (vBMD), bone structure and strength of the radius and tibia among 648 community-dwelling older women (mean ± SD age 79.7 ± 2.5 years). We assessed associations between cross-sectional (2003) and longitudinal (progression from 1998/1999-2003) AAC assessed on lateral dual-energy X-ray absorptiometry (DXA) images with cross-sectional (2003) and longitudinal (change from 2003 to 2005) pQCT bone measures at the 4% radius and tibia, and 15% radius. Partial Spearman correlations (adjusted for age, BMI, calcium treatment) revealed no cross-sectional associations between AAC and any pQCT bone measures. AAC progression was not associated with any bone measure after adjusting for multiple comparisons, despite trends for inverse correlations with total bone area at the 4% radius (r_s =  - 0.088, p = 0.044), 4% tibia (r_s =  - 0.085, p = 0.052) and 15% radius (r_s =  - 0.101, p = 0.059). Neither AAC in 2003 nor AAC progression were associated with subsequent 2-year pQCT bone changes. ANCOVA showed no differences in bone measures between women with and without AAC or AAC progression, nor across categories of AAC extent. Collectively, these finding suggest that peripheral bone density and structure, or its changes with age, are not associated with central vascular calcification in older women.

Tobacco mythbusting-tobacco is not a major driver of foot traffic in low socio-economic small retail stores

BACKGROUND

One of the opposing arguments to restricting or banning the sale of tobacco products stem from a perception that this would adversely impact on small retail stores that rely on tobacco sales for viability. It has also been argued that purchases of tobacco leads to unplanned purchasing of other items that yield income for small store owners. This study tested the veracity of these arguments in the Australian context.

METHODS

Consumer intercept surveys (n=1487) were conducted outside a comprehensive sample of small stores (n=136) selling tobacco in lower socioeconomic suburbs. Data were collected over a 2-hour period outside each store using the same methodology (36% consumer response rate). Descriptive statistics examined the proportion of tobacco and non-tobacco purchases and most common products purchased.

RESULTS

Purchasing tobacco was the primary motivation for store visits for only 3% of consumers. The vast majority of products purchased (92%) were not tobacco, with hot food, groceries and lottery tickets most frequent. Only 8% of consumers purchased tobacco. When unplanned purchasing patterns were compared, consumers' who purchased tobacco were no more likely to buy other products.

CONCLUSION

Tobacco purchasing was rarely the reason for store visits, indicating that it is not a key driver of consumer foot traffic for small retailers. There was also no evidence that tobacco contributes to spontaneous purchases of other products that might bring retailers profit. Findings suggest that restricting the retail availability of tobacco would be unlikely to have a pronounced negative impact on small retail stores.

Translating and Evaluating a Physical Activity Program for Aboriginal Elders on Noongar Boodjar (Country) — A Longitudinal Study

Objective

The primary aim of the study was to translate and evaluate the impact of a Physical Activity (PA) program on the physical function of older Aboriginal Elders on Noongar Boodjar (Country).

Methods

A longitudinal design framed within an Indigenous methodology. Two groups, one metropolitan and one regional, of Aboriginal Elders, aged ≥45 years, participated in the Ironbark PA program. This comprised weekly strength and balance exercises followed by yarning circles. Physical function (primary outcome) and functional ability, cardiovascular risk factors (weight, waist circumference), falls efficacy and health-related quality of life were measured at baseline 6, 12 and 24 months. Data were analyzed using generalized linear mixed effects modeling.

Results

Fifty-two Elders initially enrolled and of those, n = 23 (44.2%) Elders participated regularly for 24 months. There was a 6-month gap in program delivery due to the COVID-19 pandemic. Participants made significant improvement in physical function at 12 months compared to baseline: [short physical performance battery (SPPB) at baseline, 8.85 points (95% CI 8.10, 9.61); 12 months 10.28 (95% CI 9.44, 11.13), p = 0.001: gait speed at baseline 0.81 ms⁻¹ (95% CI 0.60, 0.93); 12 months 1.14 (95% CI 1.01, 1.27), p < 0.001]. Some sustained improvement compared to baseline was still evident at 24 months after the 6-month gap in attendance [SPPB 9.60 (8.59, 10.60) p = 0.14, gait speed 1.11 (0.95, 1.26) p < 0.001]. Cardiovascular risk factors showed a non-significant improvement at 12 and 24 months compared to baseline. All participants reported that they enjoyed the program, found it culturally appropriate and would recommend it to others.

Conclusion

Older Aboriginal people showed sustained improvements in physical function after engaging in a culturally appropriate PA program. Culturally appropriate PA programs provide safety, security and choice for older Aboriginal people to engage in evidence-based PA.

Dental professionals' perspectives working with Aboriginal children in Western Australia: a qualitative study

BACKGROUND

The disproportionate burden of oral disease in Aboriginal children and the issues in accessing mainstream dental services are well documented. Yet little is known about dental professionals' perspectives in providing oral care for Aboriginal children. This paper presents findings from a study exploring such perspectives.

METHODS

Semi-structured interviews were carried out in Western Australia following purposive sampling of non-Aboriginal dentists, dental clinic assistants (dental nurses) and oral health therapists/dental hygienists. Interviews were recorded, transcribed and analysed guided by grounded theory for key themes related to the topic.

RESULTS

Findings included a service delivery model sometimes unresponsive to Aboriginal families' needs; dental professionals' limited education and training to work with confidence and cultural sensitivity with Aboriginal patients and socioeconomic influences on Aboriginal children's poor oral health considered outside dental professionals' remit of care.

DISCUSSION

Findings suggest oral health policies and practices and dental professionals' education and training need reviewing for how well such policies support dental professionals in an Aboriginal context. This includes engaging with Aboriginal stakeholders, working effectively with Aboriginal families, and developing shared understandings about what is needed to increase access to care and improve oral health outcomes for Aboriginal children.

Exploring the potential for planning support systems to bridge the research-translation gap between public health and urban planning

BACKGROUND

There is consensus that planning professionals need clearer guidance on the features that are likely to produce optimal community-wide health benefits. However, much of this evidence resides in academic literature and not in tools accessible to the diverse group of professionals shaping our cities. Incorporating health-related metrics into the planning support systems (PSS) provides an opportunity to apply empirical evidence on built environment relationships with health-related outcomes to inform real-world land use and transportation planning decisions. This paper explores the role of planning support systems (PSS) to facilitate the translation and application of health evidence into urban planning and design practices to create healthy, liveable communities.

METHODS

A review of PSS software and a literature review of studies featuring a PSS modelling built environmental features and health impact assessment for designing and creating healthy urban areas was undertaken. Customising existing software, a health impact PSS (the Urban Health Check) was then piloted with a real-world planning application to evaluate the usefulness and benefits of a health impact PSS for demonstrating and communicating potential health impacts of design scenarios in planning practice.

RESULTS

Eleven PSS software applications were identified, of which three were identified as having the capability to undertake health impact analyses. Three studies met the inclusion criteria of presenting a planning support system customised to support health impact assessment with health impacts modelled or estimated due to changes to the built environment. Evaluation results indicated the Urban Health Check PSS helped in four key areas: visualisation of how the neighbourhood would change in response to a proposed plan; understanding how a plan could benefit the community; Communicate and improve understanding health of planning and design decisions that positively impact health outcomes.

CONCLUSIONS

The use of health-impact PSS have the potential to be transformative for the translation and application of health evidence into planning policy and practice, providing those responsible for the policy and practice of designing and creating our communities with access to quantifiable, evidence-based information about how their decisions might impact community health.

A gender-sensitised weight-loss and healthy living program for men with overweight and obesity in Australian Football League settings (Aussie-FIT): A pilot randomised controlled trial

BACKGROUND

Recent evidence shows that sport settings can act as a powerful draw to engage men in weight loss. The primary objective of this pilot study was to test the feasibility of delivering and to evaluate preliminary efficacy of Aussie-FIT, a weight-loss program for men with overweight/obesity delivered in Australian Football League (AFL) settings, in preparation for a future definitive trial.

METHODS AND FINDINGS

This 6-month pilot trial took place in Perth, Australia. Participants were overweight/obese (Body Mass Index [BMI] ≥ 28 kg/m2), middle-aged (35-65 years old) men. Participants were recruited in May 2018, and the intervention took place between June and December 2018. The intervention involved 12 weekly 90-min face-to-face sessions, incorporating physical activity, nutrition, and behaviour change information and practical activities delivered by coaches at 2 clubs. Data were collected at baseline and immediately postintervention. For trial feasibility purposes, 6-month follow-ups were completed. Outcomes were differences in weight loss (primary outcome) and recruitment and retention rates, self-reported measures (for example, psychological well-being), device-measured physical activity, waist size, and blood pressure at 3 months. Within 3 days of advertising at each club, 426 men registered interest; 306 (72%) were eligible. Men were selected on a first-come first-served basis (n = 130; M age = 45.8, SD = 8; M BMI = 34.48 kg/m2, SD = 4.87) and randomised by a blinded researcher. Trial retention was 86% and 63% at 3- and 6-month follow-ups (respectively). No adverse events were reported. At 3 months, mean difference in weight between groups, adjusted for baseline weight and group, was 3.3 kg (95% CI 1.9, 4.8) in favour of the intervention group (p < 0.001). The intervention group's moderate-to-vigorous physical activity (MVPA) was higher than the control group by 8.54 min/day (95% CI 1.37, 15.71, p = 0.02). MVPA among men attracted to Aussie-FIT was high at baseline (intervention arm 35.61 min/day, control arm 38.38 min/day), which may have limited the scope for improvement.

CONCLUSIONS

Aussie-FIT was feasible to deliver; participants increased physical activity, decreased weight, and reported improvements in other outcomes. Issues with retention were a limitation of this trial. In a future, fully powered randomised controlled trial (RCT), retention could be improved by conducting assessments outside of holiday seasons.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry: ACTRN12617000515392.

Influences of club connectedness among young adults in Western Australian community-based sports clubs

BACKGROUND

Along with physical benefits, community-based sport provides opportunities to enhance connectedness, an important protective factor of social and emotional health. However, young Australians participating in sport have been found to drink alcohol at higher levels than their non-sporting peers, and many clubs serve unhealthy food and beverages. This study explored the association between the dependent variable, level of alcohol consumption (AUDIT-C) and connectedness to club and other health behaviours among young people aged 18-30 years who play club sport in Western Australia.

METHODS

An online cross sectional survey measured levels of alcohol consumption (AUDIT-C), alcohol-related harm, connectedness (including volunteering and team cohesion), mental wellbeing, healthy food options and club sponsorship among young adults aged 18-30 years involved in sports clubs in Western Australia (n = 242). Relationships and association between the dependent variable (AUDIT-C) and independent variables were assessed.

RESULTS

Male sportspeople were more likely to drink alcohol at high-risk levels than females (p < .001), and respondents belonging to a club that received alcohol-related sponsorship were more likely to drink at high-risk levels (p = .019). Females were significantly more likely to want healthy food and beverage options provided at their clubs (p = 0.011). When all factors were considered team cohesion (p = 0.02), alcohol expectations (p = < .001), occurrences of experienced alcohol-related harm (p = <.001) and length of club membership (p = 0.18) were significant predictors of high-risk AUDIT-C (R2 = .34, adjusted R2 = .33, F (4, 156) = 20.43, p = <.001). High-risk AUDIT-C and club connectedness predicted strong team cohesion (R2 = .39, adjusted R2 = .39, F (2, 166) = 53.74, p = <.001).

CONCLUSIONS

Findings from this study may inform policy and practice to enhance healthy behaviours among young adults participating in community sports clubs in Australia and other countries.

Exploring network structure and the role of key stakeholders to understand the obesity prevention system in an Australian metropolitan health service: study protocol

INTRODUCTION

Little progress has been made to address the increasing obesity prevalence over the past few decades, and there is growing concern about the far-reaching consequences for health and well-being related to obesity on a global scale. Systems thinking is emerging as a suitable approach for obesity prevention, as it allows health researchers, practitioners and policy-makers to systematically synthesise existing data, expose gaps, inform priority setting and identify leverage points in the system. The aim of this study is to trial a systems thinking approach to better understand the local obesity prevention system, and identify gaps and viable opportunities for health promotion activities to strengthen obesity prevention efforts in an Australian metropolitan health service.

METHODS AND ANALYSIS

A mixed methods design will be undertaken in a metropolitan health service area in Perth, Western Australia in 2019-2020. A systems inventory audit will be used to identify physical activity, nutrition and overweight/obesity prevention activities taking place in the study area. An organisational network survey will be administered, and a social network analysis undertaken to examine relationships between organisations in the network. The relationships and interactions will compare the level and type of interactions each organisation has within the network. Parameters including density, centrality and betweenness will be computed using UCINET and Netdraw.

ETHICS AND DISSEMINATION

Ethics approval has been obtained from the Curtin University Human Research Ethics Committee (approval number HRE2017-0862). Results will be reviewed with members of the advisory group, submitted to relevant journals and presented at relevant conferences to health promotion practitioners and policy-makers. The area health service, as co-producers of the research, will use findings to inform policy and strategy across the study area.

Image-Based Dietary Assessment and Tailored Feedback Using Mobile Technology: Mediating Behavior Change in Young Adults

Assessing the implementation of nutrition interventions is important to identify characteristics and dietary patterns of individuals who benefit most. The aim was to report on young adults' experiences of receiving dietary feedback text messaging intervention. Diet was captured using an image-based 4-day mobile food recordTM application (mFRTM) and assessed to formulate two tailored feedback text messages on fruit and vegetables and energy-dense nutrient-poor (EDNP) foods and beverages. At 6-months 143 participants completed a second mFRTM and a questionnaire evaluating the dietary feedback. Participants who agreed the text messages made them think about how much vegetables they ate were more likely to increase their intake by at least half a serve than those who disagreed [odds ratio (OR) = 4.28, 95% Confidence Interval (CI): 1.76 to 10.39]. Those who agreed the text messages made them think about how much EDNP foods they ate, were twice as likely to decrease their intake by over half a serve (OR = 2.39, 95%CI: 1.12 to 5.25) than those who disagreed. Undertaking detailed dietary assessment ensured the tailored feedback was constructive and relevant. Personal contemplation about vegetable and EDNP food intake appears to be a mediator of dietary change in young adults.

Support for e-cigarette regulations among Australian young adults

BACKGROUND

Surveying support for various regulatory options relating to e-cigarettes can assist policymakers to identify those that have broad support and are therefore likely to be easier to implement. However, data on support for potential e-cigarette regulations in Australia are limited. To inform regulatory efforts, the present study assessed attitudes to the regulation of e-cigarettes among Australian young adults, the most prevalent users of e-cigarettes and therefore the most likely population segment to be affected by e-cigarette regulations.

METHODS

A total of 1116 Australians aged 18 to 25 years (59% female) completed an online survey where they were presented with various statements relating to the regulation of e-cigarettes and asked to report on the extent to which they agreed or disagreed with each. Statements presented either a restrictive or non-restrictive approach to e-cigarette regulation.

RESULTS

Across all statements, 10-22% of respondents responded "don't know" while 23-35% neither agreed nor disagreed, indicating general ambivalence. There was a moderate level of support (33-37%) for regulating e-cigarette sales/use and treating e-cigarettes like tobacco products. Only 20% of respondents were in favour of allowing the use of e-cigarettes in smoke-free areas. Smokers, e-cigarette users, and those who did not believe in the harms associated with e-cigarettes were typically less likely than other respondents to support restrictive approaches.

CONCLUSIONS

The young Australian adults surveyed were somewhat supportive of restrictions around the sale and use of e-cigarettes, but generally opposed outright bans and any need for a prescription from a medical practitioner. Increasing awareness of the harms associated with the use of e-cigarettes represents a potential strategy to gaining regulatory support.

Protocol for a gender-sensitised weight loss and healthy living programme for overweight and obese men delivered in Australian football league settings (Aussie-FIT): A feasibility and pilot randomised controlled trial

INTRODUCTION

Overweight and obesity are highly prevalent among Australian men. Professional sports settings can act as a powerful 'hook' to engage men in weight loss programmes; the Football Fans in Training programme delivered in professional UK soccer clubs was successful and cost-effective in helping men lose weight. The Australian Football League (AFL) is a potentially attractive setting to engage men in a weight loss programme. We aim to develop, pilot and evaluate the feasibility of a weight loss intervention for overweight/obese middle-aged men, delivered in AFL settings, to promote weight loss and healthier lifestyles and determine its suitability for a future randomised control trial.

METHODS AND ANALYSIS

120 overweight/obese male fans will complete baseline physical and psychological health measures and objective measures of physical activity (PA), weight, waist size and blood pressure prior to randomisation into the intervention or waitlist comparison group. The intervention group will receive 12 weekly 90 min workshops incorporating PA, nutrition education, behaviour change techniques and principles of effective motivation. Four community coaches will be trained to deliver Aussie-FIT at two AFL clubs in Western Australia. Measurements will be repeated in both groups at 3 months (post-intervention) and 6 months (follow-up). Outcomes will include programme uptake, attendance, changes in lifestyle and weight variables to inform power calculations for a future definitive trial, fidelity of programme delivery, acceptability, satisfaction with the programme and perceptions of effectiveness. We will also determine trial feasibility and potential to gather cost-effectiveness data.

ETHICS AND DISSEMINATION

Ethics approval was granted by Curtin University's Human Research Ethics Committee (HREC2017-0458). Results will be disseminated via peer-reviewed publications, conference presentations and reports. A multicomponent dissemination strategy will include targeted translation and stakeholder engagement events to establish strategies for sustainability and policy change.

TRIAL REGISTRATION NUMBER

ACTRN12617000515392; Pre-results.

Alignment of Supermarket Own Brand Foods' Front-of-Pack Nutrition Labelling with Measures of Nutritional Quality: An Australian Perspective

Two voluntary front-of-pack nutrition labels (FOPNL) are present in Australia: the government-led Health Star Ratings (HSR) and food industry-led Daily Intake Guide (DIG). Australia's two largest supermarkets are key supporters of HSR, pledging uptake on all supermarket own brand foods (SOBF). This study aimed to examine prevalence of FOPNL on SOBF, and alignment with patterns of nutritional quality. Photographic audits of all SOBF present in three large supermarkets were conducted in Perth, Western Australia, in 2017. Foods were classified as nutritious or nutrient-poor based on the Australian Guide to Healthy Eating (AGTHE), NOVA level of food processing, and HSR score. Most (81.5%) SOBF featured FOPNL, with only 55.1% displaying HSR. HSR was present on 69.2% of Coles, 54.0% of Woolworths, and none of IGA SOBF. Half (51.3%) of SOBF were classified as nutritious using the AGTHE, but using NOVA, 56.9% were ultra-processed foods. Nutrient-poor and ultra-processed SOBF were more likely than nutritious foods to include HSR, yet many of these foods achieved HSR scores of 2.5 stars or above, implying they were a healthy choice. Supermarkets have a powerful position in the Australian food system, and they could do more to support healthy food selection through responsible FOPNL.

Protocol for the residents in action pilot cluster randomised controlled trial (RiAT): evaluating a behaviour change intervention to promote walking, reduce sitting and improve mental health in physically inactive older adults in retirement villages

INTRODUCTION

Ageing is accompanied by increased risks of chronic disease, declined functioning and increased dependency. Physical activity is critical to retaining health and independence, but the majority of older people are insufficiently physically active to achieve these benefits and have high levels of sedentary (sitting) time. Activity programmes are often offered in retirement villages; however, their uptake is limited. Furthermore, although the physical environment in and around these villages can play an important role in decisions to be physically active, its role is often overlooked by research in these settings. We aim to develop, implement and evaluate a proof-of-concept motivationally embellished intervention designed to increase walking, reduce sitting and improve mental health in residents in retirement villages.

METHODS AND ANALYSIS

This will be a 16-week pilot intervention using a cluster randomised design with retirement villages as the unit of randomisation and residents as the unit of assessment. Fourteen retirement villages around Perth, Western Australia, will be recruited for the intervention. Objective audits of neighbourhood environments around each village will be completed using the Pathway Environmental Audit Tool. Seven villages will be randomised to the experimental arm and seven to the control arm. Only participants in the experimental arm will receive motivational training. All outcomes will be assessed at baseline, end of intervention and 6-month follow-up. Changes in physical activity levels, sitting time and mental health will be examined. Multilevel modelling will be used to analyse the data. A mixed methods process evaluation will also be conducted.

ETHICS AND DISSEMINATION

Ethics approval was granted by Curtin University's Human Research Ethics Committee (HREC2016-0187). The results of the study will be disseminated via peer-reviewed publications, conference presentations and reports to, and seminars with, stakeholders.

TRIAL REGISTRATION

The trial is registered with the Australian New Zealand Clinical Trials Registry: ACTRN12616001177448.

Influence of the day care, home and neighbourhood environment on young children's physical activity and health: protocol for the PLAYCE observational study

INTRODUCTION

The early years are a critical period in a child's health and development, yet most preschool children fail to meet physical activity guidelines. Outside of the home and neighbourhood, children spend a large proportion of time within early childhood education and care (ECEC) services such as long day care. Research is required to determine how the design of day care outdoor (and indoor) spaces provides opportunities or constraints for physical activity. A significant evidence gap surrounds what objectively measured attributes of the home and neighbourhood environment influence preschoolers' physical activity. The PLAY Spaces & Environments for Children's Physical Activity (PLAYCE) study will empirically investigate the relative and cumulative influence of the day care, home and neighbourhood environment on preschoolers' physical activity.

METHODS AND ANALYSIS

The PLAYCE study is a cross-sectional observational study (April 2015 to April 2018) of 2400 children aged 2-5 years attending long day care in metropolitan Perth, Western Australia. Accelerometers will measure physical activity with indoor physical activity measured using radio frequency identification. Global positioning systems will be used to determine outdoor location of physical activity around the home and neighbourhood for a subsample (n=310). The day care environment will be objectively measured using a validated audit tool. Other potential individual, social and physical environmental influences on preschoolers' physical activity will be collected by geographic information systems measures, parent and day care educator surveys.

ETHICS AND DISSEMINATION

Ethical approval has been granted by The University of Western Australia Human Ethics Research Committee, approval number RA/4/1/7417. Findings will be published in international peer-reviewed journals and presented at international conferences. Key findings will be disseminated to stakeholders, collaborators, policymakers and practitioners working in the ECEC sector. Day care centre directors and parents will be given a summary report of the key findings.

Geographic consistency in dominant, non-typeable Haemophilus influenzae genotypes colonising four distinct Australian paediatric groups: a cohort study

Non-typeable Haemophilus influenzae (NTHi)-associated ear and respiratory diseases (including pneumonia) represent a major health burden in many parts of the world. NTHi strains retrieved from the upper airways commonly reflect those found in the lower airways. Despite growing genomic and genotyping data on NTHi, there remains a limited understanding of global and regional NTHi population structures. The aim of this study was to determine whether nasopharyngeal carriage in four Australian paediatric groups at varying risk of NTHi colonisation was dominated by the same NTHi genotypes. Genotyping data generated by PCR-ribotyping were evaluated for 3070 NTHi isolates colonising the nasopharynges of Aboriginal and non-Aboriginal children enrolled in four longitudinal studies in three separate urban and remote regions of Australia. Several NTHi PCR-ribotypes dominated in nasopharyngeal carriage, irrespective of study setting. Principal coordinates analysis confirmed a cluster of common PCR-ribotypes among all cohorts. In conclusion, we identified dominant PCR-ribotypes common to geographically disparate Australian paediatric populations. Future genomic analyses will shed further light on the precise factors underlying the dominance of certain NTHi strains in nasopharyngeal carriage.

Development of a Kinect Software Tool to Classify Movements during Active Video Gaming

While it has been established that using full body motion to play active video games results in increased levels of energy expenditure, there is little information on the classification of human movement during active video game play in relationship to fundamental movement skills. The aim of this study was to validate software utilising Kinect sensor motion capture technology to recognise fundamental movement skills (FMS), during active video game play. Two human assessors rated jumping and side-stepping and these assessments were compared to the Kinect Action Recognition Tool (KART), to establish a level of agreement and determine the number of movements completed during five minutes of active video game play, for 43 children (m = 12 years 7 months ± 1 year 6 months). During five minutes of active video game play, inter-rater reliability, when examining the two human raters, was found to be higher for the jump (r = 0.94, p < .01) than the sidestep (r = 0.87, p < .01), although both were excellent. Excellent reliability was also found between human raters and the KART system for the jump (r = 0.84, p, .01) and moderate reliability for sidestep (r = 0.6983, p < .01) during game play, demonstrating that both humans and KART had higher agreement for jumps than sidesteps in the game play condition. The results of the study provide confidence that the Kinect sensor can be used to count the number of jumps and sidestep during five minutes of active video game play with a similar level of accuracy as human raters. However, in contrast to humans, the KART system required a fraction of the time to analyse and tabulate the results.

Relationships between psychosocial outcomes in adolescents who are obese and their parents during a multi-disciplinary family-based healthy lifestyle intervention: One-year follow-up of a waitlist controlled trial (Curtin University's Activity, Food and Attitudes Program)

BACKGROUND

Limited studies have investigated relationships in psychosocial outcomes between adolescents who are obese and their parents and how psychosocial outcomes change during participation in a physical activity and healthy eating intervention. This study examined both adolescent and parent psychosocial outcomes while participating in a one - year multi-disciplinary family-based intervention: Curtin University's Activity, Food, and Attitudes Program (CAFAP).

METHODS

Following a waitlist control period, the intervention was delivered to adolescent (n = 56, ages 11-16) and parent participants over 8 weeks, with one-year maintenance follow-up. Adolescent depression and quality of life, family functioning, and parent depression, anxiety, and stress were assessed at six time points: baseline and prior to intervention (e.g., waitlist control period), immediately following intervention, and at 3, 6, and 12 months post-intervention. Relationships between adolescent and parent psychosocial outcomes were assessed using Spearman correlations and changes in both adolescent and parent outcomes were assessed using linear mixed models. Changes in adolescent psychosocial outcomes were compared to changes in behavioural (physical activity and healthy eating) and physical (weight) outcomes using independent samples t-tests.

RESULTS

The majority of psychosocial outcomes were significantly correlated between adolescents and parents across the one-year follow-up. Adolescent depression, psychosocial and physical quality of life outcomes significantly improved before or following intervention and were maintained at 6-months or one-year follow-up. Parent symptoms of depression, anxiety, and stress were reduced during waitlist and primarily remained improved. Changes in adolescent psychosocial outcomes were shown to be partially associated with behavioural changes and independent of physical changes.

CONCLUSIONS

Adolescents in CAFAP improved psychosocial and physical quality of life and reversed the typical trajectory of depressive symptoms in adolescents who are obese during a one-year maintenance period. CAFAP was also effective at maintaining reductions in parent symptoms of depression, anxiety, and stress demonstrated during the waitlist period.

TRIAL REGISTRATION

The trial was registered with the Australian and New Zealand Clinical Trials Registry (No. 12611001187932 ).