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Integration of high-dimensional tumor gene expression data with clinicopathological data can increase our understanding of disease diversity, enable retrospective patient stratification, and identify new potential biomarkers and therapeutic targets. Using a systems biology approach, we provide a holistic overview of gene co-expression networks in head and neck squamous cell carcinomas (HNSCC). Weighted gene co-expression network analysis of HNSCC RNA sequencing data from 519 patients from The Cancer Genome Atlas (TCGA) was used to determine correlates of 5-year survival, using regression tree-based optimal threshold calculations. Survival-associated gene sets were transformed to gene set scores that were assessed for correlation with clinicopathological data. We identified 8 gene co-expression modules for HNSCC tumors, each of which contained co-expressed genes associated significantly with 5-year survival. Survival-associated co-expression gene signatures correlated dominantly with tumor HPV and p16 status. Network analysis identified that survival was associated with signaling networks of infection, immunity, epithelial-mesenchymal transition (EMT), hypoxia, glycolysis, focal adhesion, extracellular matrix, MYC signaling, autophagy and transcriptional regulation. EMT-associated gene signatures were expressed dominantly in fibroblasts, and cancer-associated fibroblasts were inversely correlated with immune activity. Interestingly, a high Immune Suppression Score based on expression of 21 genes associated with immune inhibition and including immune checkpoints, cytokines and regulatory T cell factors, was also associated with increased survival probability, and was significantly higher in HPV+ HNSCC. Networks associated with HNSCC survival were further associated with survival in cervical cancer, melanoma and lung cancer. This study defines 5129 genes associated with HNSCC survival, organized into co-expressed networks, their correlation with clinicopathological data, and with gene expression data from other malignant diseases, and provides a source for the discovery of biomarkers and novel therapies for HNSCC.

RESUMENLas políticas y los planes de la ciudad juegan un papel importante en la promoción de la actividad física a través de cambios en el diseño urbano y los sistemas de transporte. Los objetivos de este estudio fue describir los cambios longitudinales y relevantes en el entorno construido para la actividad física en el tiempo libre y los viajes activos en la ciudad de Sao Paulo, Brasil, entre 2015 y 2020; describir estos cambios según las regiones de la ciudad, los ingresos de las secciones censales y las zonas de amortiguamiento alrededor de las residencias de los participantes en una cohorte. Para ello se utilizarán datos de bibliotecas públicas en línea, cotejados con las secretarías municipales y estatales específicas, se midieron plazas públicas, parques, instalaciones deportivas, clubes comunitarios, gimnasios al aire libre, ciclovías, estaciones de tren o metro, terminales de autobuses y unidades de salud. Para cuantificar estos atributos alrededor de las residencias, se adoptaron cuatro zonas de amortiguamiento diferentes: zonas de amortiguamiento radiales de 500 m y 1000 m y zonas de amortiguamiento de red de 500 m y 1000 m. Se observó un aumento en gimnasios al aire libre (+109,6%), ciclovías (+67,7%), estaciones de tren o metro, terminales de ómnibus (+15,4%), instalaciones deportivas (+12,0%) y plazas públicas (+8,7%). Sin embargo, los cambios difirieron según la región, los ingresos del distrito censal y el área residencial. Los resultados pueden servir para fomentar una discusión sobre los efectos de las políticas locales que se están ejecutando. Además, este estudio destaca desigualdades importantes en las ciudades a través de los diferentes niveles evaluados.

ABSTRACTDisadvantaged areas have higher loneliness levels than advantaged areas, though studies rarely identify objective built environment determinants of loneliness by neighbourhood disadvantage. We studied the contribution of objective walkability components (residential density, street connectivity, and land use mix) and overall walkability in the relationship between neighbourhood disadvantage and loneliness using cross-sectional data from 3778 individuals aged 48-77 years old living in 200 neighbourhoods in Brisbane, Australia. Residential density only partly contributed to the observed inequity in loneliness across neighbourhood disadvantages, among all walkability components. Moreover, the overall walkability could not explain inequity in loneliness across neighbourhood disadvantages.

ABSTRACTCities are socio-spatially patterned, yet few researchers have explored the association between walkability and house prices by neighbourhood socioeconomic disadvantage, highlighting issues about housing affordability, equity, and liveability. We aimed to determine whether walkability and house prices differed by neighbourhood socioeconomic disadvantage. To test this, we used linear regression models of house prices stratified by quintiles of neighbourhood socioeconomic disadvantage at the suburb level in metropolitan Melbourne, Australia on walkability and its components (street connectivity, dwelling density, and destination access), and public transit access. Walkability was positively associated with house prices. In the stratified regressions, destination accessibility was associated with higher house prices whilst having poor access to transit was negatively associated with house prices. The association between walkability and house prices was weakest for the most disadvantaged areas, suggesting that houses in these areas were more affordable due, in part, to a lack of amenity. Future planning could redress the relationship between walkability and house prices by making new areas walkable. Increasing densities in outer suburban areas would improve destination and transit access, and in established areas, inclusionary zoning policies could help ensure accessibility to social and affordable housing in amenity-rich areas redressing built environment inequities.

•Contemporary examination of spatial biases in residential mobility.•Three indicators of spatial biases (distance, direction, and sector) were investigated.•Estimates of the effects of spatial biases on travel behaviour.•70%, 68%, and 62% respondents experienced distance, direction and sector biases respectively.•Sector bias reduced the likelihood of switching to more sustainable mode of transport.

BackgroundIdentification of features of the neighbourhood physical environment that have a causal association with positive child development is important for promoting long-term developmental health. Previous research on these associations have been conducted at the neighbourhood level, and do not account for individual variation in exposure to these features.MethodsThis cross-sectional study utilised de-identified linked administrative data. Neighbourhood features were measured with Geographic Information Systems and identified within a 1600 m service area around the child’s home address. The study population included a random selection of 5024 Western Australian children who participated in the 2012 Australian Early Development Census (AEDC; median age 5 years, 5 months). Multi-level logistic regressions modelled the odds of children scoring in the bottom 10% on the physical, social or emotional AEDC domains as an outcome of neighbourhood features.ResultsAfter adjustment for individual and neighbourhood sociodemographic factors, lower odds of physical vulnerability were associated with increased neighbourhood residential density, presence of railway station, and higher counts of playgroups and kindergartens. Larger areas of neighbourhood home-yard space were associated with increased odds of physical and social vulnerability. Presence of high-quality green spaces was associated with lower odds of social vulnerability. Increased road traffic exposure was associated with higher odds of social and emotional vulnerability.ConclusionsThe neighbourhood physical environment has a weak but significant association with early childhood development. Future research should consider the interplay between the neighbourhood environment and proximal influences, including parenting attributes and socioeconomic status, and how they influence early child development.

Background: In high-income countries, the prevalence of physical inactivity and non-communicable diseases is high, and it is now well-established that insufficient physical activity is a risk factor for non-communicable diseases. Walking for recreation and transportation are effective means of improving population levels of physical activity. Research finds that the built environment (BE) can encourage or discourage walking behaviour, and this association varies for different age groups and sexes. This systematic review aims to synthesise longitudinal evidence to better understand how the BE affects recreational and transportation walking for different age groups (above 64 years and 18–64 years) and sexes in high-income countries. Method: We will use Scopus, PubMed, SPORTDiscus with Full Text (EBSCO), Business Source Complete (EBSCO), Art and Architecture Archive (Proquest), Avery Index to Architectural Periodicals (ProQuest), and Art, Design & Architecture Collection (ProQuest) databases to search for relevant studies. Reviewers will screen the search results according to pre-specified eligibility criteria for study inclusion in the review. Required data for the synthesis will be extracted from the included studies to answer the research questions. Further, the methodological quality of the studies included in this systematic review will be evaluated using an established instrument, and the resulting quality scores will be utilized in sensitivity analysis. The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) checklist will be followed when reporting the findings. Discussion: This review will identify BE attributes that are likely to influence transportation and recreational walking for younger and older adults and different sexes in high-income countries. The findings will help policymakers with making decisions around walkable built environments for older and younger adults and different sexes to keep them healthy. Trial registration: This protocol of the prospective systematic review is developed following PRISMA-P guidelines and is registered on the Prospective Register of Systematic Reviews (PROSPERO) (registration ID CRD42022351919).

Active travel may improve individual health as it contributes to higher levels of physical activity, particularly in an aging society. Bicycle-sharing schemes may contribute to public health by encouraging active travel.

Objectives: To compare prevalence estimates of food insecurity using a single‐item measure, with three adaptations of the United States Department of Agriculture Food Security Survey Module (USDA‐FSSM). Methods: Data were collected by postal survey, from individuals aged ≥18 years from disadvantaged suburbs of Brisbane, Australia (n= 505, 53% response). Food security status was ascertained by the Australian single‐item measure, and the 6‐, 10‐ and 18‐item versions of the USDA‐FSSM. Prevalence estimates of food insecurity and different levels of severity of food insecurity estimated by each tool were determined. Data were analysed using McNemar's test, polychoric correlation and Rasch analyses. Results: The prevalence of food insecurity was 19.5% using the single‐item measure; significantly less than the 24.4%, 22.8% and 21.1% identified using the 18‐item, 10‐item and 6‐item versions of the USDA‐FSSM, respectively. Rasch analyses revealed that overall the USDA‐FSSM may be a valid tool for the measurement of food insecurity within the current sample. Conclusion: The measure of food insecurity employed in national surveys in Australia may underestimate its prevalence and public health significance. Implications for public health: Future monitoring and surveillance efforts should seek to employ a more accurate measure as the first step in recognising the right to food for all Australians.

To compare prevalence estimates of food insecurity using a single‐item measure, with three adaptations of the United States Department of Agriculture Food Security Survey Module (USDA‐FSSM).

The neighbourhood built environment (BE) provides opportunities for regular walking for transport (WfT). Within the same city, age differences in WfT can vary significantly across neighbourhoods, although little is known about the reasons for this variation. This cross-sectional study investigated the contribution of the BE to explaining age differences in WfT across neighbourhoods.

Lower household income is one of the strongest predictors of poor health. In this viewpoint, we explore an understudied pathway between household income and health: automobile dependence. We argue that the provision of policies that reduce automobile dependence, and facilitate active and affordable modes of travel (i.e. walking, cycling and public transport), may mitigate poorer health among individuals from lower-income households. Policies and environments that support active travel are likely to have particularly strong health and economic benefits for lower-income residents.

Cohort studies have examined whether change in transport mode is associated with change in bodyweight among commuters. We complement this research by examining trends in body mass index (BMI) for men and women who used the same transport mode between 2007 and 2013, and where transport was used for any activity of daily life.

BackgroundFew studies have examined the causal relationship between transport mode and body mass index (BMI).MethodsWe examined between-person differences and within-person changes in BMI by transport mode over four time points between 2007 and 2013. Data were from the How Areas in Brisbane Influence HealTh and AcTivity project, a population-representative study of persons aged 40–65 in 2007 (baseline) residing in 200 neighbourhoods in Brisbane, Australia. The analytic sample comprised 9931 respondents who reported on their main transport for all travel purposes (work-related and non-work-related). Transport mode was measured as private motor vehicle (PMV), public transport, walking and cycling. Self-reported height and weight were used to derive BMI. Sex-specific analyses were conducted using multilevel hybrid regression before and after adjustment for time-varying and time-invariant confounders.ResultsIndependent of transport mode and after adjustment for confounders, average BMI increased significantly and linearly across the four time points for both men and women. Men and women who walked or cycled had a significantly lower BMI than their counterparts who used a PMV. BMI was nearly always lower during the time men and women walked or cycled than when they used a PMV; however, few statistically significant differences were observed. For women, BMI was significantly higher during the time they used public transport than when using a PMV.ConclusionThe findings suggest a causal association between transport mode and BMI and support calls from health authorities to promote walking and cycling for transport as a way of incorporating physical activity into everyday life to reduce the risk of chronic disease.

Globally, concerns about population growth, urbanisation, traffic congestion, climate change and rising chronic disease are prompting policy-makers and governments to prioritise policies that support local walking and increase access to public transport. These are of particular relevance for those more likely to experience transport disadvantage, such as those in socioeconomically disadvantaged areas, where transport disadvantage tends to be higher. The aim of this study was to examine associations between neighbourhood socioeconomic disadvantage and transport-related spatial measures, identified through a review of transport-related policies. It included 2460 neighbourhoods in Brisbane, Australia as defined by the 2011 Australian national census boundaries. Neighbourhood socioeconomic disadvantage was measured using a census-derived composite index. Policy-relevant spatial measures included: street connectivity, cul-de-sac length, street block length, traffic volume, public transport stops and public transport frequency. Data were analysed using binary and multinomial logistic regression. More disadvantaged neighbourhoods had significantly greater odds of being highly connected, and with cul-de-sac and street block lengths, and public transport stop access and frequencies at levels recommended by Australian urban and transport policies, although they also had higher traffic volumes. Compared with more advantaged neighbourhoods, there was no evidence that disadvantaged neighbourhoods in Brisbane experience transport disadvantage. Although these neighbourhoods have higher levels of traffic, they are more likely to comprise urban and transport design features and levels of public transport access recommended by Australian urban and transport policies. The distribution of transport-related infrastructure in Brisbane has potential to reduce health inequities; and could potentially be enhanced further by reducing exposure to traffic.

Many short trips are made by car, and replacing them with walking is a potential strategy to increase physical activity at the population level. The prevalence and correlates of walkable short car trips were examined among adults aged 18–84 years living in the state of Queensland, Australia. Participants (N=14,481) reported their travel behaviors using a 24-h travel diary in the 2009 South East Queensland Travel Survey (SEQTS). A threshold distance within which adults can walk was first identified using the SEQTS data. Consistent with previous studies, we used the 80th percentile distance in walking trips, determined for specific age groups (18–34, 35–49, 50–64, and 65–84 years) and gender, as the distance threshold. This ranged from 1.6 to 2.0km for a single trip, and 3.4 to 4.7km for a trip chain. Car trips that did not exceed the distance threshold were regarded as short trips. The study found that 7% of all car trips were short enough to be walked, and 11% of participants reported at least one short trip on the survey day either as a driver or passenger. Short car trips were more likely to be made by middle-to-older aged adults, women, those who were unemployed, those who had children in the household, those living in the middle-to-most disadvantaged areas, and those living in higher population density areas. The findings suggest a potential for some car trips to be converted into walking among some population groups in Australia. Initiatives to replace short car trips with walking may be particularly effective in higher density areas where local destinations are within a walking distance. Barriers that discourage walking will need to be addressed to facilitate walking trips among middle-to-older adults and in disadvantaged areas.

Significant global health challenges are being confronted in the 21st century, prompting calls to rethink approaches to disease prevention. A key part of the solution is city planning that reduces non-communicable diseases and road trauma while also managing rapid urbanisation. This Series of papers considers the health impacts of city planning through transport mode choices. In this, the first paper, we identify eight integrated regional and local interventions that, when combined, encourage walking, cycling, and public transport use, while reducing private motor vehicle use. These interventions are destination accessibility, equitable distribution of employment across cities, managing demand by reducing the availability and increasing the cost of parking, designing pedestrian-friendly and cycling-friendly movement networks, achieving optimum levels of residential density, reducing distance to public transport, and enhancing the desirability of active travel modes (eg, creating safe attractive neighbourhoods and safe, affordable, and convenient public transport). Together, these interventions will create healthier and more sustainable compact cities that reduce the environmental, social, and behavioural risk factors that affect lifestyle choices, levels of traffic, environmental pollution, noise, and crime. The health sector, including health ministers, must lead in advocating for integrated multisector city planning that prioritises health, sustainability, and liveability outcomes, particularly in rapidly changing low-income and middle-income countries. We recommend establishing a set of indicators to benchmark and monitor progress towards achievement of more compact cities that promote health and reduce health inequities.

Comprehensive apartment design policies have been legislated by Australian state governments to address concerns about poor design in residential buildings. These policies aim to improve apartment design and promote good health. This study examined whether: (1) residents living in apartments that implemented more minimum design requirements perceived better apartment design and amenity; and (2) increased implementation of minimum requirements and better perceptions of design were associated with positive mental wellbeing. Apartment complexes (n = 114, built 2006–2016) were sampled from Sydney, Perth, and Melbourne. Building plans and elevations were used to measure and score apartments for their implementation of 96 quantifiable policy-specific requirements and residents (n = 1072) completed a self-report survey on their apartment design and health. Multi-level linear regression models were used to account for clustered data. Residents in apartments with greater implementation of requirements for solar and daylight, indoor space, private open space, communal space and parking had more positive perceptions of their apartment in terms of natural light and winter thermal comfort, indoor space and layout, private open space, communal area quality, and parking, respectively (all p < 0.05). Perceptions of natural ventilation, summer thermal comfort, indoor space, and communal area quality were independently associated with positive mental wellbeing (all p < 0.05), but the objective implementation scores had no direct association. When implemented as intended, minimum requirements had a positive impact on perceptions of design, which were associated with mental wellbeing. The study underscores the importance of planning instruments and design review processes that increase industry uptake of minimum policy standards.

Few studies examining social determinants of depression have incorporated area level objectively measured crime combined with self-report measures of perceived crime. How these factors may interrelate with neighbourhood disadvantage is not well understood, particularly in Australia, where mental health disorders are of major concern. This study examined relationships between area-level objective crime, self-reported perceptions of crime, neighbourhood disadvantage and depression, and potential mechanisms by which these variables indirectly lead to depression.

This research identifies the impacts of residential dissonance on residential mobility behavior in transit-oriented developments (TODs) versus non-TODs in Brisbane, Australia. On the basis of the characteristics of living environments (density, diversity, connectivity, and accessibility) and the travel preferences of 4,545 individuals, respondents in 2009 were classified into one of four categories: TOD consonants, TOD dissonants, non-TOD dissonants, and non-TOD consonants. Binary logistic regression analyses were employed to identify residential mobility behavior of groups between 2009 and 2011 while controlling for time-varying covariates. The findings show that both TOD dissonants and TOD consonants move residences at an equal rate. However, TOD dissonants are more likely to move residences to their preferred non-TOD areas. In contrast, non-TOD dissonants not only move residences at a lower rate, but their rate of mobility to their preferred TOD neighborhood is also significantly lower because of costs and other associated factors. The findings suggest that development of policies for discrete land use is required to integrate non-TOD dissonant and TOD dissonant behaviors to support TOD development in Brisbane.

This research identifies the impacts of residential dissonance on residential mobility behavior in transit-oriented developments (TODs) versus non-TODs in Brisbane, Australia. On the basis of the characteristics of living environments (density, diversity, connectivity, and accessibility) and the travel preferences of 4,545 individuals, respondents in 2009 were classified into one of four categories: TOD consonants, TOD dissonants, non-TOD dissonants, and non-TOD consonants. Binary logistic regression analyses were employed to identify residential mobility behavior of groups between 2009 and 2011 while controlling for time-varying covariates. The findings show that both TOD dissonants and TOD consonants move residences at an equal rate. However, TOD dissonants are more likely to move residences to their preferred non-TOD areas. In contrast, non-TOD dissonants not only move residences at a lower rate, but their rate of mobility to their preferred TOD neighborhood is also significantly lower because of costs and other associated factors. The findings suggest that development of policies for discrete land use is required to integrate non-TOD dissonant and TOD dissonant behaviors to support TOD development in Brisbane.

To examine education differences in five‐year weight change among mid‐aged adults, and to ascertain if this may be due to socioeconomic differences in perceived weight status or weight control behaviours (WCBs).

To examine associations between individual‐, household‐ and neighbourhood‐level socioeconomic position (SEP) and harmful alcohol consumption.

Objectives:To examine education differences in five‐year weight change among mid‐aged adults, and to ascertain if this may be due to socioeconomic differences in perceived weight status or weight control behaviours (WCBs).

Aim:To examine associations between individual‐, household‐ and neighbourhood‐level socioeconomic position (SEP) and harmful alcohol consumption.

Purpose. Explore the role of the neighborhood environment in supporting walking.Design. Cross-sectional study of 10,286 residents of 200 neighborhoods. Participants were selected using a stratified two-stage cluster design. Data were collected by mail survey (68.5% response rate).Setting. Brisbane City Local Government Area, Australia, 2007.Subjects. Brisbane residents aged 40 to 65 years.Measures. Environmental: street connectivity, residential density, hilliness, tree coverage, bikeways, and streetlights within a 1-km circular buffer from each resident's home; and network distance to nearest river or coast, public transport, shop, and park. Walking: minutes walked in the previous week: <30 minutes, ≥30 to <90 minutes, ≥90 to <150 minutes, ≥150 to <300 minutes, and ≥300 minutes.Analysis. The association between each neighborhood characteristic and walking was examined using multilevel multinomial logistic regression, and the model parameters were estimated using Markov chain Monte Carlo simulation.Results. After adjustment for individual factors, the likelihood of walking for more than 300 minutes (relative to <30 minutes) was highest in areas with the most connectivity (odds ratio [OR] = 1.93; 99% confidence intervals [CI], 1.32–2.80), greatest residential density (OR = 1.47; 99% CI, 1.02–2.12), least tree coverage (OR = 1.69; 99% CI, 1.13–2.51), most bikeways (OR = 1.60; 99% CI, 1.16–2.21), and most streetlights (OR = 1.50; 99% CI, 1.07–2.11). The likelihood of walking for more than 300 minutes was also higher among those who lived closest to a river or the coast (OR = 2.06; 99% CI, 1.41–3.02).Conclusion. The likelihood of meeting (and exceeding) physical activity recommendations on the basis of walking was higher in neighborhoods with greater street connectivity and residential density, more streetlights and bikeways, closer proximity to waterways, and less tree coverage. Interventions targeting these neighborhood characteristics may lead to improved environmental quality as well as lower rates of overweight and obesity and associated chromic disease. (Am J Health Promot 2011;25[4]:e12–e21.)

AbstractPregnancy and childbirth complications are a leading cause of death and disability among women of reproductive age in developing countries. The high maternal and infant mortality rates and low uptake of antenatal and postnatal care have been topics of deliberation for researchers in the fields of medicine, public health, anthropology and sociology. Worldwide data show that, by choice or out of necessity, 47 percent of births in the developing world are assisted by Traditional Birth Attendants (TBAs) and/or family members. Since the 1970s the training of TBAs has been one of the primary single interventions undertaken by funding agencies, who assume that maternal and perinatal mortality in developing countries is high because many women deliver babies at home, assisted by TBAs or relatives. However, since the 1990s, the TBA training strategy has been increasingly seen as irrelevant, ineffective or a failure, given the evidence that the maternal mortality rate (MMR) in developing countries did not reduce. Hence, many donor agencies providing funding for TBA training in developing countries have withdrawn funds, reallocating them to providing skilled attendants during delivery. Researchers have expressed concern that a shift in policy has taken place without adequate evidence about the relevance and effectiveness of the TBA training program.The objective of this paper is to review research evidence from India and other developing countries on the relevance of TBAs by assessing their contribution to providing maternal and infant health care service at different stages of pregnancy, during and after delivery; outcomes of training; and birthing practices adopted by them in home births. This review reveals that TBAs acquire knowledge of the birth process through experience, which they bring to their practice and which they use to explain events in their local context. Certain harmful TBA practices have changed and others have been introduced into the community through training. An appropriate understanding of useful and harmful local practices in communities is therefore important background information that trainers need to know before conducting training programs in a particular area. Certain redundant birthing practices such as discarding colostrum, bathing babies immediately after birth, using unhygienic material to cut and apply on the cord and delayed weighing of babies continue to be practiced not only in home births but also in health institutions in India. This review article highlights the importance of training to improve TBAs' knowledge, together with community awareness programs. Potentially detrimental cultural beliefs need to be addressed too, when TBA training programs are initiated in order to improve maternal and child health outcomes.

Many of the self‐administered scales for measuring physical activity (PA) influences were originally developed for vigorous‐intensity exercise, focus on only one domain of influence, and have not been evaluated for both reliability and validity using population‐based samples. Objective: This study describes the factorial validity and internal reliability of scales for measuring individual‐level psychological, social, and environmental influences on leisure‐time PA among adults in the general population. Method: Constructs were identified from a literature review and formative research with a socio‐economically diverse sample. Items were generated using previously developed scales and interview data. New items were pre‐tested using reliability and principal components analyses, with data collected from a mail survey sent to a randomly selected population‐based sample. Qualitative feedback was obtained from a convenience sample and expert panel. A second mail survey provided data for principal components and reliability analyses. Results: Twenty‐eight scales were factorially derived and 24 had acceptable or marginally acceptable levels of internal consistency with Cronbach's alpha values ranging from 0.65 to 0.91. Conclusions and Implications: The 24 scales are suitable for researchers and practitioners interested in measuring individual‐level influences on PA that are consistent with Social Cognitive Theory. More research is required to assess predictive validity, sensitivity to change and test/re‐test reliability.

Many of the self‐administered scales for measuring physical activity (PA) influences were originally developed for vigorous‐intensity exercise, focus on only one domain of influence, and have not been evaluated for both reliability and validity using population‐based samples.

Objective: To examine the association between socio‐economic status (SES) and GP utilisation across Statistical Local Areas (SLAs) that differed in their geographic remoteness, and to assess whether Indigenous status and GP availability modified the association. Design: Retrospective analysis of Medicare data for all unreferred GP consultations (1996/97) for 952 SLAs comprising the six Australian States. Geographic remoteness was ascertained using the Area Remoteness Index of Australia (ARIA), and SES was measured by grouping SLAs into tertiles based on their Index of Relative Socioeconomic Disadvantage score. Main outcome measure: Age/sex standardised rates of GP utilisation for each SLA. Main results: In SLAs classified as ‘highly accessible’, rates of GP use were 10.8% higher (95% CI 5.7–16.0) in the most socio‐economically disadvantaged tertile after adjustment for Indigenous status and GP availability. A very different pattern of GP utilsation was found in ‘remote/very remote’ SLAs. After adjustment, rates of GP use in the most socio‐economically disadvantaged tertile were 25.3% lower (95% CI 5.9–40.7) than in the most advantaged tertile. Conclusions: People in socio‐economically disadvantaged metropolitan SLAs have higher rates of GP utilisation, as would be expected due to their poorer health. This is not true for people living in disadvantaged remote/very remote SLAs: in these areas, those most in need of GP services are least likely to receive them. Australia may lay claim to having a primary health care system that provides universal coverage, but we are still some way from having a system that is economically and geographically accessible to all.

Objective: To examine the association between socio‐economic status (SES) and GP utilisation across Statistical Local Areas (SLAs) that differed in their geographic remoteness, and to assess whether Indigenous status and GP availability modified the association.

Objectives: To examine the relationship between socio‐economic position and height in early adulthood. Method: A representative probability sample of Australian households (part of the 1995 National Health Survey). Data were collected by face‐to‐face interviews. Socio‐economic position was measured using occupation and family income. Participants comprised 9,577 Australian‐born males and females aged 20–24 (n=3,186), 25–29 (n=3,184), and 30–34 (n=3,207). Height was self‐reported and operationalised in terms of mean height and ‘short’ stature (defined as 1 SD below mean height for each sex‐age subgroup). Results: Graded, positive associations were found between occupation, family income, and height for males and females in each age cohort. Among males, mean height differences between blue‐collar employees and professionals were 1.1 cm to 1.5 cm (depending on age‐cohort), and for females, 1.6 cm to 2.1 cm. The corresponding height differences for males and females living in the least and most affluent families were 1.6 cm to 2.3 cm, and 1.0 cm to 2.5 cm, respectively. Persons in blue‐collar jobs and those in low‐income families were more likely to be classified as ‘short’. Conclusions and implications: Estimates of mortality risk associated with short stature suggest that these height differences translate to about a 2–5% increased risk of death for the most disadvantaged groups Given that socio‐economic height differences in adulthood have their genesis in the formative stages of biological and social development, public health intervention efforts need to focus on early life exposures and environments. The greatest reduction in height inequalities, and by extension health inequalities, is likely to flow from macro‐level public policies to alleviate poverty and minimise the social and economic divide.

To examine the relationship between socio‐economic position and height in early adulthood.

To estimate the smoking prevalence among parents of infants and examine these parents' socio‐demographic characteristics.

Objectives: To estimate the smoking prevalence among parents of infants and examine these parents' socio‐demographic characteristics. Method: The sample of all parents of infants (669 mother‐father pairs, 90 single parents) was derived from the 1995 Australian Health Survey. Data were collected by face‐to‐face interview in the respondent's home. Socio‐demographic measures include parent's age, family structure, age‐left‐school, highest post‐school qualification, occupation, and family income. Results: The overall rate of smoking among parents was 28.9% (mothers 24.7%, fathers 33.7%). The lowest rate was observed among mothers with a post‐school tertiary qualification (7.6%) and the highest among fathers aged 18–24 (49.0%). In 15.4% of two‐parent families both parents smoked, but this rate differed markedly by family income (9.9% vs. 29.7% for high and low‐income families respectively). Multiple logistic regression showed that parents who smoked were more likely to be young, minimally educated, employed in blue‐collar occupations, and resident in low‐income families. Conclusions and implications: Infants in this sample who were exposed to parental smoking were likely to be at increased risk of experiencing higher mortality and morbidity for childhood conditions related to passive smoking; more likely to experience adverse health consequences in adulthood; and may themselves take up smoking in later life. The study results pose serious challenges to our tobacco control efforts and health interventions more generally. No single policy or strategy can adequately address the problem of parental smoking. We need macro/upstream approaches that deal with the degree of social and economic inequality in society, as well as more intermediate approaches that intervene at the level of communities, families and individuals.

Background Socioeconomic inequalities in mortality have been repeatedly observed in Britain, the US, and Europe, and in some countries there is evidence that the differentials are widening. This study describes trends in socioeconomic mortality inequality in Australia for males and females aged 0–14, 15–24 and 25–64 years over the period 1985–1987 to 1995–1997.Methods Socioeconomic status (SES) was operationalized using the Index of Relative Socioeconomic Disadvantage, an area-based measure developed by the Australian Bureau of Statistics. Mortality differentials were examined using age-standardized rates, and mortality inequality was assessed using rate ratios, gini coefficients, and a measure of excess mortality.Results For both periods, and for each sex/age subgroup, death rates were highest in the most disadvantaged areas. The extent and nature of socioeconomic mortality inequality differed for males and females and for each age group: both increases and decreases in mortality inequality were observed, and for some causes, the degree of inequality remained unchanged. If it were possible to reduce death rates among the SES areas to a level equivalent to that of the least disadvantaged area, premature all-cause mortality for males in each age group would be lower by 22%, 28% and 26% respectively, and for females, 35%, 70% and 56%.Conclusions The mortality burden in the Australian population attributable to socioeconomic inequality is large, and has profound and far-reaching implications in terms of the unnecessary loss of life, the loss of potentially economically productive members of society, and increased costs for the health care system.

Background Risk of dementia and Alzheimer's disease is higher among adults with limited education, and the less educated perform poorer on cognitive function tests. This study determines whether the socioeconomic environment experienced during childhood has an impact on cognitive functioning in middle age.Methods A population-based study of eastern Finnish men (n = 496) aged 58 and 64 for whom there were data on parent's socioeconomic position (SEP), their own education level, and performance on neuropsychological tests. Cognitive function was measured using the Trail Making Test, the Selective Reminding Test, the Verbal Fluency Test, the Visual Reproduction Test, and the Mini Mental State Exam.Results We found a significant and graded association between parental SEP (combined as an index) and cognitive function both prior to and after adjustment for respondent's education. Those from more disadvantaged backgrounds exhibited the poorest performance. When the separate components of the parental SEP measure were used, father's occupation and mother's education were independently associated with the respondent's score for three and five of the tests, respectively (there was no association with father's education and mother's occupation). After adjustment for the respondent's education, father's occupation was no longer associated with respondent's test score, however, the results were essentially unchanged for mother's education.Conclusions Higher SEP during childhood and greater educational attainment are both associated with cognitive function in adulthood, with mothers and fathers each contributing to their offspring's formative cognitive development and later life cognitive ability (albeit in different ways). Improvements in both parental socioeconomic circumstances and the educational attainment of their offspring could possibly enhance cognitive function and decrease risk of dementia later in life.

Background.International research indicates that blue-collar employees typically exhibit lower rates of leisure-time physical activity. While “lack of time” and “work demands” are commonly reported barriers to activity, the extent to which time-at-work mediates the relationship between occupation and leisure-time physical activity is unclear. This study investigated the association between occupation, time spent in paid employment, and participation in leisure-time physical activity.

• Consistent with international evidence, the findings of Australian research show that socioeconomically disadvantaged groups experience significantly higher mortality and morbidity rates. • Despite marked improvements in the health of all segments of the Australian population in recent decades, during this same period there has also been an increase in socioeconomically related mortality inequalities for some conditions. • Socioeconomically disadvantaged groups are more likely to engage in health‐damaging behaviours, experience poorer psychosocial health, make less use of the healthcare system for preventive purposes, and have a more adverse risk factor profile. These are the main contributing factors to the poorer physiological health of low socioeconomic groups. • At present, our knowledge of how socioeconomic status and health are related is limited. A necessary step in improving our understanding of this issue is to draw together all the empirical evidence and use it as the basis for developing a theory of socioeconomic health inequalities. We present a conceptual framework to facilitate this process.

• Tackling socioeconomic health inequalities represents one of Australia's most challenging public health issues. • Research has demonstrated that the role of physicians and other health professionals, as advocates for change in the delivery of health services, public health policy and other community‐wide initiatives, is extremely important in reducing mortality and improving health outcomes. • Multilevel actions to reduce health inequalities should include changes to macrolevel social and economic policies; improving living and working conditions; strengthening communities for health; improving behavioural risk factors; empowering individuals and strengthening their social networks; and improving responses from the healthcare system and associated treatment services. • Australia has yet to develop a coordinated and integrated approach to addressing health disparities; however, previously successful public health interventions addressing other health issues are good starting points.