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Objectives: While there is consistent evidence that rural adults in Australia are less active than their urban counterparts, studies relating geographical remoteness to activity patterns in Australian adolescents have yielded inconsistent results. The aim of this study was to describe objectively and subjectively measured patterns of physical activity and sedentary behaviours across remoteness categories in a representative sample of 9–16 year old Australians. Design: Cross-sectional observational study. Methods: 2071 Australian adolescents provided self-report use of time data on four days and wore a pedometer for at least 6 days within the 2007 Australian National Children’s Nutrition and Physical Activity Survey. Comparisons of activity patterns were made across four objectively-determined remoteness categories (Major City, Inner Regional, Outer Regional and Remote), adjusting for household income, parental education and age. Results: Adolescents living in major cities self-reported 11–29 min less moderate to vigorous physical activity each day than their counterparts living in geographically more remote areas, and took 150–850 fewer steps each day. While there were no differences in time spent in sport or active transport, differences in free play participation were significant. Males in major cities also reported higher levels of screen time. Differences were somewhat more marked among males than among females. Conclusions: Activity levels among Australian adolescents show contrasting patterns of geographical differences to those found in Australian adults. Higher levels of free play among rural Australian adolescents may be due to more available space and less fear of traffic and stranger risks.

Objectives: Farmers are faced with many stressors, along with numerous barriers to accessing traditional forms of mental health support. The ifarmwell online intervention was co-designed with farmers and is informed by Acceptance and Commitment Therapy to equip farmers with transferable coping strategies, particularly to help them cope with circumstances beyond their control. We aimed to evaluate the effect of ifarmwell on farmers’ short- and long-term distress and mental wellbeing. Methods: Australian farmers (21–73 years) who registered on www.ifarmwell.com.au completed measures at the commencement of module 1 (N = 228), the end of the intervention (N = 77) and 6-months post-intervention (N = 61). Primary outcomes included distress (Kessler Psychological Distress Scale) and mental wellbeing (Mental Health Continuum – Short Form). We also examined the relationship between distress, mental wellbeing, neuroticism (Quickscales-R) and ACT-based psychological mechanisms; psychological inflexibility (Acceptance and Action Questionnaire-II), cog-nitive fusion (Cognitive Fusion Questionnaire), believability of automatic thoughts (Automatic Thoughts Questionnaire-B), coping via acceptance (4 items from the situational COPE) and mind-fulness (Five Facet Mindfulness Questionnaire-Short Form). Secondary outcomes of acceptability (Client Satisfaction Questionnaire-8) and usability (System Usability Scale) were also explored. Results: Pre- to post-intervention, farmers’ distress decreased and mental wellbeing increased. These effects were maintained at 6-month follow-up. Changes in these outcomes were greatest for participants who entered the intervention with high baseline distress (^β= −0.59, 95%CI =[−0.70, −0.47]) and low mental wellbeing (^β= −0.33, 95%CI = [−0.47, −0.19]). Decreases in distress and increases in mental wellbeing were associated with decreases in psychological inflexibility, cognitive fusion, and believability of thoughts, and increases in coping via acceptance and mindfulness. Levels of satisfaction (M = 26.92/32) and usability (M = 84.70/100) were high, and 94.6% of participants said they would recommend ifarmwell to a friend in need of similar advice and tools. Conclusions: ifarmwell is an effective and usable intervention that is likely to help farmers reduce their levels of distress and improve their mental wellbeing, by improving their psychological flexibility, ability to focus on the present and accept things beyond their control, as well as by reducing the extent to which they believe unhelpful thoughts. Refereed/Peer-reviewed

Refereed/Peer-reviewed Purpose: The aim of this research was to develop a contextually and culturally appropriate scale to assess farmers’ barriers to health-related help-seeking. Methods: An initial pool of items was developed from the academic literature and input from an expert panel of farmers, rural academics, and rural clinicians. A draft 32-item questionnaire was then developed and sent to farmers registered with FARMbase, which is an Australian national farmer database. Findings: Two hundred and seventy-four farmers completed the draft questionnaire (93.7% male, 73.7% aged 56-75 years). An exploratory factor analysis identified 6 factors; “Health Issues are a Low Priority,” “Concerns about Stigma,” “Structural Health System Barriers,” “Minimization and Normalization,” “Communication Barriers,” and “Continuity of Care.”. Test-retest reliability was examined with a further 10 farmers (90% male, Mean age = 57, SD = 5.91), who completed the questionnaire twice (at 2- to 3-week intervals). Results indicated moderate-good test-retest reliability. Conclusions: The resulting 24-item Farmer Help-Seeking Scale provides a measure of help-seeking that is specifically designed to capture the unique context, culture, and attitudes that can interfere with farmers’ help-seeking, and inform the development of strategies to increase health-service utilization in this at-risk group.

Refereed/Peer-reviewed Issue addressed: Due to the nature of their jobs, frontline aged care workers may be a population at risk of poor health and lifestyle habits. Support of their well-being through the workplace is likely to be complex. The objective of this study was to assess the effectiveness of a need-supportive program for changing physical activity and psychological well-being via the motivational processes of behavioural regulations and perceived need satisfaction. Methods: Frontline aged care workers (n = 25) participated in a single cohort, pre–post pilot trial. The program included a Motivational Interviewing style appointment, education on goal setting and self-management, the use of affect, exertion and self-pacing for regulating physical activity intensity and practical support activities. Outcomes (7-day accelerometery, 6-min walk, K10 and AQoL-8D), and motivational processes (BREQ-3 and PNSE) were measured at baseline, 3 and 9 months, and analysed using linear mixed models for repeated measures. Results: There were significant increases in perceived autonomy at 3 months (Δ.43 ± SE:.20; p =.03) and 6-min walk distance at 9 months (Δ 29.11 m ± SE: 13.75; p =.04), which appeared to be driven by the relative autonomy index (behavioural regulations in exercise questionnaire [BREQ-3]). Amotivation increased at 3 months (Δ.23 ± SE:.12; p =.05); which may have been due to low scores at baseline. No other changes were demonstrated at any timepoint. So what?: Participants demonstrated positive changes in motivational processes and physical function, however, due to the low levels of participation in the program, the program had a negligible impact at the organisational level. Future researchers and aged care organisations should aim to address factors impacting participation in well-being initiatives.

This study aimed to explore barriers and facilitators that impact on farmers' help-seeking behaviours for health and mental health concerns. Fifteen semi-structured interviews were conducted with farmers (12 male; age 51.7 +/- 12.6 years) from three rural regions in South Australia. Interviews explored demographic and farm-related characteristics, perceptions of individual (and where relevant family) health and mental health concerns and experiences, and perceived barriers of health support-seeking. Thematic analysis was used to identify key themes. Four key themes were identified relating to help-seeking; personal attitudes and beliefs, farm-related barriers, health system barriers and the provision of support from family and friends. Dominant personal attitudes included valuing independence, strength and privacy. Farm related barriers included the 'farm comes first' and the fact that 'farm work is never done'. Health system barriers included issues relating to availability of choice and access, professionals (lack of) understanding of farm life, and time and financial costs of accessing care. Provision of support from family and friends involved informal help and advice, including facilitating access to professional support. Multiple attitudinal, structural, and farm-related issues affect farmers' help-seeking. Professionals who understand farm work practices and routines are valued by farmers and this is likely to facilitate access to care. Workforce development programs and community programs that involve farmers' perspectives as consumers and co-designers, using evidence-based strategies, may assist in strengthening these relationships. Refereed/Peer-reviewed

Background: Rural Australians experience higher prevalence of several chronic diseases than metropolitan Australians and are less likely to access supportive health services. This study explored associations of sociodemographic factors and barriers to support seeking for health in a sample of rural South Australians. Methods: Participants (n = 610) from three rural regions participated in a computer-assisted telephone interview (CATI), based on the Barriers to Help Seeking Scale. Each participant reported on barriers in one of three health contexts: ‘general’ physical health, skin cancer, and mental health. Sociodemographic factors included gender, age, highest education, region of residence, and presence of chronic conditions. Chi-squared Automatic Interaction Detection (CHAID) determined independent associations of sociodemographic factors and barrier categories (high, medium and low importance). Results: Privacy was a high-importance barrier in the mental health context, particularly among participants of age < 63 years. The tendency to minimise and normalise health issues was also a high-importance barrier in the mental health context. In the physical health context, those with a chronic condition were more likely to perceive normalisation as a barrier than those without a chronic condition. Need for control and self-reliance was a high-importance barrier in the mental health context and a low-importance barrier in the skin cancer context, particularly among participants < 63 years. Structural factors and distrust of providers were high-importance barriers among those who did not complete secondary education, regardless of context. Conclusion: This study highlights the importance of a nuanced approach to promoting help-seeking in rural Australians, with message content and delivery tailored to specific health conditions and demographic circumstances. Refereed/Peer-reviewed

Issue addressed: Australian women are less likely to participate in recommended levels of weekly physical activity compared with men. Physical activity participation rates decrease with geographical remoteness. Research suggests that a lack of social support mechanisms within the home environment may act as a barrier for rural women to engage in physical activity, along with discomfort experienced within exercise environments. The purpose of this study was to explore the social conditions that facilitate or inhibit physical activity participation amongst women from two rural South Australian communities. Methods: A qualitative descriptive approach underpinned by a phenomenological methodological orientation was applied. Participants were recruited using a purposive sampling strategy before semi-structured interviews (N = 16) were conducted and prepared for thematic analysis. Results: Four inter-related themes were identified: support from others, time, expectations and available opportunities. Further contextual analysis revealed interwoven notions of physical activity spaces, time and social context within the themes. Conclusions: Multiple types of regulators interact to shape the motivational pattern of an individual. The themes identified align with self-determination, transactional and structuration theory, suggesting a need to consider human behaviour both pragmatically and conceptually. So what?: Results provide insight into social barriers and facilitators for physical activity participation and concomitantly provide the initial development of a framework for local strategic planning of health-promoting activities, and individual reflection to increase physical activity participation amongst rural women. Refereed/Peer-reviewed

Purpose: People affected by cancer who live in rural Australia experience inferior survival compared to their urban counterparts. This study determines whether self-reported physical and mental health, as well as health-promoting behaviours, also differ between rural and urban Australian adults with a history of cancer. Methods: Weighted, representative population data were collected via the South Australian Monitoring and Surveillance System between 1 January 2010 and 1 June 2015. Data for participants with a history of cancer (n = 4295) were analysed with adjustment for survey year, gender, age group, education, income, family structure, work status, country of birth and area-level relative socioeconomic disadvantage (SEIFA). Results: Cancer risk factors and co-morbid physical and mental health issues were prevalent among cancer survivors regardless of residential location. In unadjusted analyses, rural survivors were more likely than urban survivors to be obese and be physically inactive. They were equally likely to experience other co-morbidities (diabetes, chronic obstructive pulmonary disease, cardiovascular disease, arthritis or osteoporosis). With adjustment for SEIFA, rural/urban differences in obesity and physical activity disappeared. Rural survivors were more likely to have trust in their communities, less likely to report high/very high distress, but equally likely to report a mental health condition, both with and without adjustment for SEIFA. Conclusions: There is a need for deeper understanding of the impact of relative socioeconomic disadvantage on health (particularly physical activity and obesity) in rural settings and the development of accessible and culturally appropriate interventions to address rural cancer survivors’ specific needs and risk factors. Refereed/Peer-reviewed

Objectives: Rural Australian adults are consistently identified as insufficiently active, likely due to challenges implementing community-based physical activity programs in rural settings. On-line strategies to promote physical activity may be particularly effective in rural settings where isolation and scarcity of qualified support are potential barriers. The Rural Environments and Community Health (REACH) study evaluated the effectiveness of an online-delivered walking intervention among South Australian rural adults. Design: Randomised controlled study design. Methods: A twelve-week intervention, with six- and twelve-month follow-up, was conducted. Participants (n = 171; 50.6 ± 12.5 years), recruited through flyers, local newspapers and radio, were randomised to comparison or intervention groups and received a pedometer. The intervention group received access to the REACH website and personalised step goals based on ratings of perceived exertion and daily affect. The comparison group received a paper diary and generic step goals. Outcome measures were accelerometry-assessed sedentary, light (LPA) and moderate-to-vigorous (MVPA) physical activity. Linear mixed models assessed changes over the intervention and follow-ups.Results: Sedentary time decreased, and LPA and MVPA increased in both groups across the intervention(p < 0.05). The intervention group demonstrated a larger increase in LPA at six-month follow-up relative to comparison (p < 0.05). Both groups decreased sedentary time, overall and in bouts ≥30 min, between baseline and twelve-month follow-up (p < 0.05). From baseline to twelve-month follow-up, MVPA (total min and bouts ≥10 min) declined more in the comparison group than the intervention group (p < 0.05). Results: Sedentary time decreased, and LPA and MVPA increased in both groups across the intervention(p < 0.05). The intervention group demonstrated a larger increase in LPA at six-month follow-up relative to comparison (p < 0.05). Both groups decreased sedentary time, overall and in bouts ≥30 min, between baseline and twelve-month follow-up (p < 0.05). From baseline to twelve-month follow-up, MVPA (total min and bouts ≥10 min) declined more in the comparison group than the intervention group (p < 0.05). Conclusion: While increased physical activity and decreased sedentary time were observed in both groups during the intervention period, maintenance was only observed for LPA at six-month follow-up in the intervention group. By twelve-month follow-up, post-intervention improvements had largely disappeared, suggesting that additional research is needed to identify ways to improve long-term adherence. Refereed/Peer-reviewed

Abstract. Background: Suicide rates are higher in rural and remote areas of Australia compared with major cities. Aim: To evaluate the impact of a brief, community-based suicide prevention educational intervention on the attitudes and confidence of rural South Australian health and human service professionals. Method: Participants attended a 1-day suicide prevention education program, and completed a survey at four time points: baseline (T1), immediately pretraining (T2), immediately posttraining (T3), and 4-month follow-up (T4). Main outcome measures were self-reported attitudes and confidence when working with people vulnerable to suicide. Results: A total of 248 people attended the training, with 213 participants completing the survey at T1, 236 at T2, 215 at T3, and 172 at T4. There were significant improvements in 11 of the 14 attitude items between T2 and T3 (immediate change), and between T1 and T4 (maintained change). Further, there were significant improvements in all four confidence items between T2 and T3, and T1 and T4. Limitations: Despite the repeated-measures design, findings are limited by the lack of a control group. Conclusion: Findings extend the international evidence by indicating the value of brief suicide prevention education for improving health and human service professionals' attitudes and confidence in rural Australia.

Background Farming is physically and psychologically hazardous. Farmers face many barriers to help seeking from traditional physical and mental health services; however, improved internet access now provides promising avenues for offering support. Objective This study aims to co-design with farmers the content and functionality of a website that helps them adopt transferable coping strategies and test its acceptability in the broader farming population. Methods Research evidence and expert opinions were synthesized to inform key design principles. A total of 18 farmers detailed what they would like from this type of website. Intervention logic and relevant evidence-based strategies were mapped. Website content was drafted and reviewed by 2 independent mental health professionals. A total of 9 farmers provided detailed qualitative feedback on the face validity of the draft content. Subsequently, 9 farmers provided feedback on the website prototype. Following amendments and internal prototype testing and optimization, prototype usability (ie, completion rate) was examined with 157 registered website users who were (105/157, 66.9%) female, aged 21-73 years; 95.5% (149/156) residing in inner regional to very remote Australia, and 68.2% (107/157) “sheep, cattle and/or grain farmers.” Acceptability was examined with a subset of 114 users who rated at least module 1. Interviews with 108 farmers who did not complete all 5 modules helped determine why, and detailed interviews were conducted with 18 purposively sampled users. Updates were then made according to adaptive trial design methodology. Results This systematic co-design process resulted in a web-based resource based on acceptance and commitment therapy and designed to overcome barriers to engagement with traditional mental health and well-being strategies—ifarmwell. It was considered an accessible and confidential source of practical and relevant farmer-focused self-help strategies. These strategies were delivered via 5 interactive modules that include written, drawn, and audio- and video-based psychoeducation and exercises, as well as farming-related jokes, metaphors, examples, and imagery. Module 1 included distress screening and information on how to speak to general practitioners about mental health–related concerns (including a personalized conversation script). Modules were completed fortnightly. SMS text messages offered personalized support and reminders. Qualitative interviews and star ratings demonstrated high module acceptability (average 4.06/5 rating) and suggested that additional reminders, higher quality audio recordings, and shorter modules would be useful. Approximately 37.1% (52/140) of users who started module 1 completed all modules, with too busy or not got to it yet being the main reason for non-completion, and previous module acceptability not predicting subsequent module completion. Conclusions Sequential integration of research evidence, expert knowledge, and farmers’ preferences in the co-design process allowed for the development of a self-help intervention that focused on important intervention targets and was acceptable to this difficult-to-engage group. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12617000506392; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372526

Issue addressed :Suicide rates in rural Australia are almost twice as high as those in urban areas. In rural communities, football clubs are often the ‘hub’ of the community and are being explored as an avenue to deliver mental health and wellbeing promotion. The aim of this study was to explore barriers and enablers for programs promoting mental health and wellbeing through rural Australian football clubs. Method: This qualitative descriptive study included 12 individuals of 10 rural clubs affiliated with the South Australian National Football League. Recruitment occurred via emails to club secretaries/presidents. Semi‐structured telephone interviews explored mental health and wellbeing issues experienced in clubs, previous involvement with mental wellbeing programs, and potential barriers/enablers for future programs. Interviews were transcribed verbatim and analysed thematically. Results: Thematic analysis identified three themes encompassing barriers and enablers: (1) more than a football club, (2) attitudes towards mental health, and (3) what is needed to implement a program. The third theme had subthemes of resources, importance of timing, mental health initiatives and components of a program. Conclusion: Key barriers included difficulty getting people involved due to individual attitudes towards mental health, and not having the finances/resources to implement a program. Major enablers included the important role the football club serves in the community, the inclusion of speakers with credibility, and making the program engaging. So what? This study identifies key factors which may impact on community engagement and program effectiveness for mental health and wellbeing programs delivered via rural football clubs. Refereed/Peer-reviewed

ObjectiveThe purpose of the current study was to examine associations of individual and aggregated screen-based behaviours, and total sitting time, with healthy and unhealthy dietary intakes among adolescents.DesignCross-sectional study of adolescents. Participants self-reported durations of television viewing, computer use, playing electronic games (e-games), total sitting time, daily servings of fruits and vegetables, and frequency of consumption of sugar-sweetened beverages (SSB), diet beverages, fast foods and discretionary snacks. Logistic regression models were conducted to identify associations of screen-based behaviours, total screen time and total sitting time with dietary intakes.SettingVictoria, Australia.SubjectsAdolescents (n 939) in School Year 11 (mean age 16·8 years).ResultsThe results showed that watching television (≥2 h/d) was positively associated with consuming SSB and diet beverages each week and consuming discretionary snacks at least once daily, whereas computer use (≥2 h/d) was inversely associated with daily fruit and vegetable intake and positively associated with weekly fast-food consumption. Playing e-games (any) was inversely associated with daily vegetable intake and positively associated with weekly SSB consumption. Total screen (≥2 h/d) and sitting (h/d) times were inversely associated with daily fruit and vegetable consumption, with total screen time also positively associated with daily discretionary snack consumption and weekly consumption of SSB and fast foods.ConclusionsIndividual and aggregated screen-based behaviours, as well as total sitting time, are associated with a number of indicators of healthy and unhealthy dietary intake. Future research should explore whether reducing recreational screen time improves adolescents’ diets.

Aim To examine secular trends in Australian children's actual sleep time as well as the perceived importance of sleep between 1985-2004-2013. Methods Secular trends in children's sleep and their perception of the importance of sleep across three time points 1985 (N=401), 2004 (N=450) and 2013 (N=395), were examined according to socioeconomic status (SES), age and sex. The children self-reported their bed-time, wake-up time and their perceived importance of sleep, among other questions. Results There were no significant differences in sleep duration between boys and girls in any of the survey years, nor were there differences in sleep duration between SES categories at any time point. Independent of survey year, age, sex and SES, there was a graded difference in sleep duration (min) across response categories for perceived importance of sleep. Overall, trends in the perceived importance of sleep appeared to match trends in actual sleep time, but not for all subgroups. Conclusion This study indicates that the sleep duration of high SES Australian school children is returning to, or near to, baseline sleep duration observed in 1985, while the sleep duration of low SES Australian children has remained at low levels. This article is protected by copyright. All rights reserved.

Objectives Despite widespread media campaigns to encourage physical activity (PA), participation is poor among Australian adults. This study aimed to explore the prevalence of and relationships between awareness of PA recommendations and PA participation. Design Cross-sectional study of n = 2402 South Australian adults (aged ≥ 18 years) via a computer-assisted telephone interview. Methods PA recommendation awareness was determined by asking for the number of minutes of PA recommended for health benefits and whether PA is needed to make you ‘puff and pant’ to confer a health benefit. Respondents were defined as sufficiently active if they reported ≥150 min/week of PA as measured by the Active Australia Survey. Results A total of 43.0% correctly identified that 30 min of PA is recommended per day (Recommendation 1) and 43.3% correctly disagreed/strongly disagreed that PA is needed to make you ‘puff and pant’ (Recommendation 2). Overall, 60.6% of respondents were sufficiently active. Of those who correctly identified Recommendation 1, 53.2% reported participating in sufficient PA, significantly fewer than those who did not know Recommendation 1 (69.6%) (χ2 = 64.74 (4), p < 0.001). There was no difference in levels of sufficient PA between those who correctly identified Recommendation 2 and those who did not. Conclusions There was relatively low awareness of PA recommendations among South Australian adults. More research is needed in how recommendations are promoted and how they impact PA behaviours. PA recommendations are based on the best available epidemiological evidence but largely fail to guide the choices people currently make about PA. Refereed/Peer-reviewed

Objective: Little is known about how the physical environment impacts physical activity behaviour among rural populations, who are typically less active and at higher risk of chronic disease than urban dwellers. The lack of individual-level instruments to assess the physical environment in rural areas limits advancement of this field. Among rural adults, this study aimed to evaluate (a) the test-retest reliability of a self-reported questionnaire of individual-level perceptions of the physical activity environment, and (b) the stability of a self-reported physical activity questionnaire. Design: Cross-sectional questionnaire repeated twice, 2 weeks apart. The questionnaire included 94 items relating to the perceived physical environment (representing nine summary scores), demographic characteristics and physical activity. Setting: Rural Australia. Participants: Rurally residing adults (≥18 years) across three Australian states.Main outcome measures: Test-retest reliability evaluated by weighted Kappa statistics(individual items) and intra-class correlations (summary scores). Results: A total of 292 participants (20% men) completed both questionnaires, on average22 days apart. Test-retest reliability of individual items ranged from weighted Kappa 0.37-0.85 (median: 0.59). Internal reliability for five summary scores was good to excellent (Cronbach's alpha: 0.81-0.97). Test-retest reliability was good to excellent for six summary scores (intra-class correlations: 0.67-0.77). Conclusions: The findings indicated good to excellent test-retest reliability for most items, particularly “fixed” constructs for this new questionnaire measuring the perceived physical environment in rural populations. This study represents an important step towards improving measurement of physical activity environments in rural populations, potentially leading to better tailored interventions to promote active and healthy living in rural areas. Refereed/Peer-reviewed

Despite the well-established benefits of regular participation in physical activity, many Australians still fail to maintain sufficient levels. More self-determined types of motivation and more positive affect during activity have been found to be associated with the maintenance of physical activity behaviour over time. Need-supportive approaches to physical activity behaviour change have previously been shown to improve quality of motivation and psychological well-being. This paper outlines the development of a need-supportive, person-centred physical activity program for frontline aged-care workers. The program emphasises the use of self-determined methods of regulating activity intensity (affect, rating of perceived exertion and self-pacing) and is aimed at increasing physical activity behaviour and psychological well-being. The development process was undertaken in six steps using guidance from the Intervention Mapping framework: (i) an in-depth needs assessment (including qualitative interviews where information was gathered from members of the target population); (ii) formation of change objectives; (iii) selecting theory-informed and evidence-based intervention methods and planning their practical application; (iv) producing program components and materials; (v) planning program adoption and implementation, and (vi) planning for evaluation. The program is based in Self-Determination Theory (SDT) and provides tools and elements to support autonomy (the use of a collaboratively developed activity plan and participant choice in activity types), competence (action/coping planning, goal-setting and pedometers), and relatedness (the use of a motivational interviewing-inspired appointment and ongoing support in activity). Refereed/Peer-reviewed

Background Physical activity has numerous associated benefits for cancer survivors. Compared with their urban counterparts, rural Australians experience a health disadvantage, including poorer survival rate after diagnosis of cancer. Objective The aims of this study were to test the effectiveness of an online 12-week walking intervention designed for cancer survivors and explore region-specific psychological predictors of behavior change. Methods This was a quasi-randomized controlled trial of an online resource designed according to Social Cognitive Theory and Self-determination Theory, based on individualized goal setting. Measures of habitual walking, motivation, and self-efficacy were taken at baseline, postintervention, and 3-month follow-up in an intervention group (n = 46) and active control group (n = 45). The control group was provided a pedometer but did not have access to the online program. Results An increase in steps/day at 12 weeks was observed in both groups, with a larger increase in the intervention group; these increases were not sustained at the 3-month follow-up. Psychological predictors of maintained change in steps per day (motivation, barrier self-efficacy, and relapse self-efficacy) did not differ between metropolitan and rural participants. Changes in steps per day among intervention participants were predicted by changes in relapse self-efficacy and barrier self-efficacy. Conclusions The intervention was successful in increasing physical activity postintervention; however, changes were not maintained at follow-up. There were no region-specific predictors of engagement in the intervention. Implications for practice Nurses are seamlessly positioned to promote health interventions like walking. Nurses should reframe physical activity with patients so that relapse is seen as common and possibly inevitable when adopting a regular physical activity habit.

Objective: To identify subgroups of Australian adults likely to receive physical activity advice from their general practitioner and to evaluate the content of the advice provided. Methods: Participants (n=1,799), recruited from the Australian Health and Social Science panel, completed an online survey. Signal Detection Analysis was used to identify subgroups that were more/less likely to have received physical activity recommendations. Results: Overall, 18% of participants received a physical activity recommendation from their general practitioner in the past 12 months and eight unique subgroups were identified. The subgroup with the highest proportion (54%) of participants reporting that they received a physical activity recommendation was those with poor physical and mental health-related quality of life and an average daily sitting time of

Few studies have investigated physical activity changes over the transition from primary to secondary school. This study assessed change in physical activity and the psychosocial correlates across 12 months in two cohorts of adolescent girls, who were either in primary school in year 1, moving to secondary school in year 2 (Transition cohort) or an older cohort (Secondary cohort) who remained in early secondary school. Female adolescents (n = 191, 38% response rate) in South Australia self-reported physical activity and psychosocial correlates of physical activity. Changes between baseline and 12-month follow-up were assessed using paired t-tests. Multiple regression modelling identified psychosocial predictors of physical activity change. Physical activity declined in the transition but not the secondary cohort. The decline was most pronounced during school break times. Independent predictors of physical activity change were: change in enjoyment in the transition cohort, and changes in enjoyment, perceived outcomes, and friend encouragement in the secondary cohort. Transitioning from primary to secondary school is a critical period during which physical activity typically declines, particularly among females. Effective physical activity promotion in this vulnerable group will depend on a deeper understanding of the sociocultural, curricular and environmental influences on physical activity that are unique to each school context.

Refereed/Peer-reviewed

The study aimed to develop and evaluate a multicomponent school and home based physical activity (PA) intervention in children in grades 3&ndash, 7 (aged 8&ndash, 13 years) and determine the psychological variables that influence PA, 10 &times, 1 h school-based training sessions, a home-based activity program and 4 &times, 1 h lifestyle workshops for parents. PA was assessed at an intervention and nearby control school using accelerometers and self-report at 3-time points: baseline, post intervention and 10-week follow-up. Self-efficacy, self-management strategies, enjoyment, perceived barriers to PA, outcome-expectancy and social support were evaluated. The study showed 73% of the children with complete data sets at the intervention school (n = 27) did not increase device measured moderate to vigorous PA (MVPA) in the after-school period (3 p.m. to 6 p.m.) or over the whole day or during school break time immediately following the intervention or at follow-up, as compared to 70% of children with complete data sets at the control school (n = 35, p &gt, 0.05 for all). Overall, 59% of boys attained more than double the recommended 120 min of MVPA each day compared to 42% of girls (p = 0.013). At the baseline, children&rsquo, s self-reported PA in the intervention school positively correlated with: outcome expectancy (R = 0.240, p = 0.015), enjoyment (R = 0.339, p &lt, 0.001), self-efficacy (R = 0.399, p &lt, 0.001), self-management (R = 0.617, p &lt, 0.001), social support at home (R = 0.406, p &lt, 0.001), and social support at school (R = 0.407, p &lt, 0.001). Similar relationships were observed after the intervention and at follow-up. Focus groups with the children, parents and interviews with teachers identified areas for improvement of the intervention. In conclusion, while the multifaceted approach to improve PA was ineffective over the time span of the study, important predictors of PA in this sample of disadvantaged children were identified.

ObjectiveDuring the early years, parents have a major influence on children's diets and developing food choices. We investigated parenting styles as predictors of 2–5-year-old children's diets and whether general nutrition knowledge (GNK) mediated these influences.DesignCross-sectional research. Questionnaires measured demographic and lifestyle variables, family environment, parenting styles and feeding practices, child diet and GNK. Regression models tested GNK as a mediator of relationships between parenting variables and child diet (fruit/vegetable and non-core food consumption), controlling for confounders and family environment.SettingQuestionnaires were completed by main caregivers at home.SubjectsParents of children aged 2–5 years (n269).ResultsHigher child fruit/vegetable consumption was associated with lower over-reactive parenting and restriction, higher authoritative parenting and dining together as a family; with lax parenting approaching statistical significance (P= 0·083) and 19 % of variance explained by the model. GNK was not a significant predictor. Conversely, non-core food consumption was associated with higher over-reactive and lax parenting as well as child age, increased takeaway food consumption and higher television viewing; GNK had a small effect (P= 0·043) and 28 % of variance was explained by the model. GNK was a significant mediator only for authoritative parenting on non-core food (effect = −0·005).ConclusionsThese findings highlight that young children's diets may be improved by interventions targeting a range of positive and supportive parenting practices in conjunction with nutrition knowledge education for parents of young children. Further insights will come from closer attention to the nature and role of restrictive feeding practicesv. laxness and longitudinal research.

Cancer survivors are at an increased risk of experiencing physical and psychological ill-effects following cancer treatment. Rural cancer survivors are at a greater risk of future health problems following a cancer diagnosis compared to their urban counterparts. Physical activity has been targeted as a health promotion priority in cancer survivors. Research indicates that a large portion of cancer survivors do not meet physical activity recommendations. The purpose of this quasi-randomized controlled trial was to test the effectiveness of an online 12-week walking intervention designed for cancer survivors, and to explore its impact on physical health indicators and quality of life outcomes. Steps Toward Improving Diet and Exercise among cancer survivors (STRIDE) is an online resource designed according to Social Cognitive Theory and Self Determination Theory, based on individualized step goal setting. Measures of physiology, physical fitness, and quality of life were taken at the baseline, post-intervention, and three-month follow-up in an Intervention group (n = 46) and active Control group (n = 45). The Control group was provided with a pedometer but did not have access to the online program. Three-factor repeated measures ANOVAs indicated that there were improvements in physical fitness (p &lt, 0.01), systolic blood pressure (p &lt, 0.01), diastolic blood pressure (p &lt, 0.01), waist girth (p &lt, 0.01), mental health (p &lt, 0.05), social functioning (p &lt, 0.01), and general health (p &lt, 0.01), but an increase in bodily pain (p &lt, 0.01), from the baseline to week 12 and the three-month follow-up, irrespective of group allocation. Pedometer interventions, delivered with or without online support and step goal setting, show promise for improving the overall health of cancer survivors, at least in the short term.

Physical activity promotion has met with limited success across a range of demographic indicators, largely due to our poor understanding of how drivers of physical activity behaviours vary by context and setting[...].

ObjectiveTo describe the rationale, development and implementation of the quantitative component of evaluation of a multi-setting, multi-strategy, community-based childhood obesity prevention project (the eat well be active (ewba) Community Programs) and the challenges associated with this process and some potential solutions.Designewba has a quasi-experimental design with intervention and comparison communities. Baseline data were collected in 2006 and post-intervention measures will be taken from a non-matched cohort in 2009. Schoolchildren aged 10–12 years were chosen as one litmus group for evaluation purposes.SettingThirty-nine primary schools in two metropolitan and two rural communities in South Australia.SubjectsA total of 1732 10–12-year-old school students completed a nutrition and/or a physical activity questionnaire and 1637 had anthropometric measures taken; 983 parents, 286 teachers, thirty-six principals, twenty-six canteen and thirteen out-of-school-hours care (OSHC) workers completed Program-specific questionnaires developed for each of these target groups.ResultsThe overall child response rate for the study was 49 %. Sixty-five per cent, 43 %, 90 %, 90 % and 68 % of parent, teachers, principals, canteen and OSHC workers respectively, completed and returned questionnaires. A number of practical, logistical and methodological challenges were experienced when undertaking this data collection.ConclusionsLearnings from the process of quantitative baseline data collection for the ewba Community Programs can provide insights for other researchers planning similar studies with similar methods, particularly those evaluating multi-strategy programmes across multiple settings.

Two studies were conducted to examine the interactions between gender, play area, motor skills and free play activity in 8-11 year old school children. In both studies, boys were more active than girls. In boys, but not in girls, energy expenditure was greater for high-skill than for low-skill children (p = 0.0002), and increased as play area increased (p = 0.01). These results suggest that motor skills and play space are important variables in determining the free play activity of boys, but not of girls. This may be related to widely different play styles among boys and girls.

Rising youth obesity is a serious public health concern. There is a widespread view that declining physical activity is contributing to this trend. A total of 929 young South Australians (age=9-15 years) were surveyed in 1985 and 2004 on usual physical activity in several contexts, including attitudes to physical activity. Eight of 10 South Australian schools participating in the 1985 Schools Health and Fitness Survey were revisited in 2004. Comparisons were made on: organised sport, active transport, physical education (PE), playground activity, vigorous physical activity (VPA), total leisure-time physical activity (LTPA), and attitudes to PE and school sport. The questionnaire and method of administration were identical in both surveys. There were no differences between surveys in club and school sport participation, walking to school, and reported enjoyment of PE and school sport. In 2004 fewer children rode to school, but PE classes were more frequent. The percentage of children who 'sit and talk' during school breaks had increased, with a decreased percentage of older girls who 'run around' during school breaks. There was a significantly higher LTPA in MET.min in 2004 for boys, which was particularly evident at higher percentiles. There were no changes in mean or distribution of LTPA for the whole sample or girls. The percentage of respondents reporting >/=3 bouts of VPA in the previous week rose from 51% (1985) to 76% (2004). There is no consistent evidence of declining physical activity among South Australian youth. It is apparent that physical activity in some contexts has declined, while in other contexts levels are the same or higher than in 1985. This underscores the complex nature of physical activity and the influences on this behaviour.

The purpose of this study was to examine differences in cardiovascular disease (CVD) risk factors across four cross-tabulated groups of cardiorespiratory fitness and body fatness in youth.Subjects included 860 males and 755 females aged 9-15 yr from the Australian Schools Health and Fitness Survey. Participants were cross-tabulated into four groups using percent body fat and estimated maximal oxygen consumption (VO2max) to split the groups. CVD risk factors included blood pressure, triglycerides (TG), fasting total cholesterol (CHOL), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and TC:HDL-C.In males, significant differences across groups were observed for blood pressure, TG, HDL-C, LDL-C, and TC:HDL-C (P0.05). In females, significant group differences were observed for blood pressure and HDL-C (P0.05). In females, a significant difference was also evident between those in the high-fat/high-fitness group compared with the high-fat/low-fitness group for all blood pressure measures. A general trend of lower blood pressure values for both males and females in the low-fat group compared with the high-fat group was also observed. This same trend was found for males in the blood lipids. There was a linear relationship across groups for the CVD risk score for both genders. There were also significant differences between the low- and high-fat subgroups within a fitness group for both genders.The results provide evidence for the consideration of both fatness and fitness when interpreting CVD risk factors in youth, particularly among high-fat youth.

Objectives The American College of Sports Medicine and Exercise and Sports Science Australia recognise the importance of gathering a client history (subjective assessment) to inform clinical decisions for clients with chronic disease and/or disability. Despite the importance of the subjective assessment in problem-oriented exercise management, there is currently no primary evidence to indicate the important domains that should be addressed during the subjective assessment to guide safe and effective clinical decisions. Design Modified e-Delphi Methods A panel of 32 experts was recruited with a median of 12 years of experience ( Q 3 =15.5 years; Q 1 =10 years). The panel was asked to rate the importance of each domain in guiding clinical decisions on a 9-point Likert scale with consensus for inclusion or exclusion pre-defined at 80%. Results The panel of experts elected that best practice for conducting the subjective assessment was a semi-structured approach using a combination of prompts and follow-up questions. The Delphi process resulted in an initial list of 36 domains that was identified by the panel of which 23 domains reached consensus for agreement after Round 3. Conclusions The subjective assessment is important for Clinical Exercise Physiologists to provide safe and effective services. Best practice for conducting the assessment is the semi-structured approach to prompt the clinician on the domains to include. Twenty three domains have been considered as important for a Clinical Exercise Physiologist to address in a subjective assessment to implement the delivery of safe and effective exercise assessment and/or prescription.

Valid measurement of youth physical activity is important and self-report methods provide convenient assessments at the population level. There is evidence that the validity of physical activity self-report varies by weight category. The aim of this study was to assess the validity of the 3-Day Physical Activity Recall (3DPAR), separately between normal weight and overweight/obese Australian youth. Accelerometer-derived physical activity variables were compared with 3DPAR variables in 155 (77 females) 11- to 14-year-olds from Adelaide, South Australia. In the whole sample, validity coefficients for self-reported moderate and moderate to vigorous physical activity were modest (rs = 0.12-0.31) and similar across gender and weight status categories. Validity coefficients for self-reported vigorous physical activity were much stronger (rs = 0.59-0.73) among overweight/obese than among normal weight participants. The validity of the 3DPAR in this study was low in the whole sample but varied according to physical activity intensity and the weight status of the child. Specifically, the 3DPAR may be appropriate for describing vigorous intensity physical activity among overweight and obese youth.

Aim This study aimed to investigate fatigue, and its correlates, in children and adolescents with physical disabilities. Method Sixty-five young people aged 8 to 17 years (35 males, 30 females; mean age 13y 2mo, SD 2y 8mo) with mild to moderate physical disabilities (Gillette Functional Assessment Questionnaire levels 7–10) were recruited. Self-reported fatigue was measured using the PedsQL Multidimensional Fatigue Scale. Physical activity was measured using 7-day hip-worn accelerometer. Associations between fatigue, physical activity, and socio-demographic characteristics were examined using analysis of covariance, with significance (α) set at 0.05. Results were compared with normative data from other paediatric populations. Results Among children with physical disabilities, fatigue was associated with being physically inactive (F-statistic=4.42, p=0.040), female (F=4.37, p=0.042), and of low socio-economic status (F=3.94, p=0.050). Fatigue was not associated with age, weight status, or functional impairment. Young people with physical disabilities experienced high levels of fatigue compared with other paediatric health populations, and comparable to the paediatric cancer population. Interpretation Fatigue is an important issue for young people with physical disabilities. Clinicians and researchers working with this group should be mindful that fatigue is likely to impact on an individual's ability to undertake new treatment regimens or interventions. Interventions aimed at reducing fatigue are warranted. Increasing physical activity might play a role in reducing fatigue.

There is emerging evidence of socioeconomic gradients in adiposity among Australian youth. Behavioral mechanisms for these trends are unexplained.In total, 194 South Australian children (97 boys, 11.48+/-0.43 years; 97 girls, 11.60+/-0.38 years) were assessed for pubertal status, stature, weight, skinfolds and waist girth. Socioeconomic status (SES) was represented by postcode of residence (Socioeconomic Index for Areas) and parent education. Children reported moderate-to-vigorous physical activity (MVPA), TV viewing (TV) and dietary intake (daily energy intake as a ratio of predicted basal metabolic rate (DEI/BMR); and fat intake), using three x 24 h recall. Path analysis (partial least-squared method) was used to analyze the independence and interdependence of pathways linking SES, anthropometric variables and measured behaviors.SES was negatively associated with waist girth and skinfolds in girls, and waist girth in boys. In models including behavioral variables, these SES gradients in girls were largely unattenuated; accordingly, physical activity and dietary intake were not confirmed as mediators of the association of SES and girls' adiposity. In boys there was evidence that the negative relationship between SES and waist girth was mediated by fat intake.The inverse relationships between SES and girls' adiposity were unexplained by the behavioral attributes measured in this study. Mediators of SES gradients in youth adiposity remain elusive, and may require intensive methodologies to explicate.

There is ongoing debate among educators and in the community about the status of school physical education (PE), particularly in relation to more vocationally-oriented learning areas. Against a backdrop of rising youth obesity, diminishing curriculum time for PE represents a serious public health issue. This study investigated the relation ships between PE curriculum time and literacy and numeracy standards in South Australian primary schools. Schools ( n= 117) were surveyed on average time spent on PE (PEtime), and salient demographic characteristics. Average literacy and numeracy scores from a standardized statewide assessment system (State LaN), were obtained from government records. Regression modelling assessed the relationship between PEtimeand State LaN scores, independent of socioeconomic status (SES), percentage of children of non-English-speaking background (NESB), geographic location, staff age structure, and staff PE training. PEtimewas unrelated to literacy and numeracy attainment, after control for demographic variables. There was a strong positive relation ship between SES and academic attainment, while a higher proportion of younger staff predicted lower academic attainment. There was no evidence that schools with relatively high PEtimeare disadvantaging students in the traditionally academic subjects.

Aims. The overweight and obesity epidemic among children in Australia has attracted considerable attention as intervention strategies and public policy are debated. However, more information on the overweight prevalence trend is required to help understand its aetiology. In order to assist this public health crisis, we gathered every available raw dataset and other descriptive reports on the heights and weights of children over the last century. Methods. The raw datasets and datasets recreated using reported descriptive data were used to calculate the prevalence rates of overweight children aged 5 to 15 years. Results. Overweight prevalence among children was relatively low and relatively constant throughout most of the century but appears to have accelerated from about the early 1970s. Discussion. The prevalence rate for overweight and obesity among children in Australia continues to climb and we predict it will approach adult rates within the next 30 years.

The 'Learning Trail' is an innovative application of peer-mediated instruction designed to enhance student learning in large practical classes. The strategy specifically seeks to improve participants' attention to details of protocol that are often difficult to observe during teacher-centered demonstrations to large groups. Students (n=68) at the University of South Australia trialed this strategy, in which instruction in anthropometric techniques is initiated by an instructor to a group of 3-4 students and then sent in 'waves' from one student group to the next. The final group in the sequence demonstrates the techniques to the instructor, who notes any departures from technical accuracy. As each technical module is flowing from group to group, the instructor initiates the next 'wave' with the first group, and the process is repeated until all of the relevant skills are processed. The final stage is a full class discussion during which sources of technical error are identified and resolved. In this trial, students taught skinfold measurement by the peer instructed method (PI; n=33) were compared with a traditionally instructed group (TI; n=35), in which the instructor was responsible for all information transfer. For each participant, technical errors of measurement (TEM) were calculated; the intra-tester TEM as a measure of reliability, and the inter-tester TEM, in which the student's measures are compared with those of a criterion anthropometrist to give an indication of validity. There were no differences between TI and PI groups on intra-tester TEM (p=0.24), but the PI group had a lower inter-tester TEM for pooled skinfold sites (p=0.006) and for one individual site (triceps; p=0.007), but not the other three sites. The time taken to complete the whole set of instructions did not differ between delivery modes. The results of this trial suggest that the peer-mediated strategy may be more effective than teacher-centered instruction in terms of technical accuracy in anthropometry.

The present study investigated the interactions between parents' and children's physical activity levels by examining whether or not parents who exercise have children who participate in sport. Of primary interest was an investigation of trends in these interactions over time. Information was collected from 10-13 y old children in 1985 (n = 2463) and then again in 1997-99 (n = 1469), about their sports participation and their perceptions of parents' exercise habits. Boys' participation in at least one sport declined from 87% in 1985 to 76% in 1997/1999 while, among girls, participation fell from 80% to 71%. According to their children's perceptions, mothers exercising regularly fell from 36% to 31% between surveys, while fathers exercising regularly fell from 39% to 32%. Interactions between parents' and children's exercise and sports behaviours were examined employing chi-square analysis techniques. Results showed gender-specific relationships for the 1985 sample, such that active fathers were associated with increased participation in sports by boys, and inactive mothers were associated with less participation in sports by girls. These interactions seemed to diminish over time. It is possible that changes in social structures during this time may be affecting familial behaviour relationships, such as the role modelling of active behaviours.

Children of low socio-economic position (SEP) consume poorer diets than those of high SEP; however, there is limited understanding of why socio-economic gradients in diet occur. Some evidence suggests that determinants of dietary intake may differ between SEP groups. The aim of the present study was to determine whether the associations between personal and environmental variables and children's fruit and vegetable intake, and healthy dietary behaviours are moderated by SEP. A total of 395 children aged 9 to 13 years and their parents were recruited in Adelaide, South Australia. Personal and environmental dietary predictors were measured using child-completed online questionnaires and telephone interviews with parents. Dietary intake was measured using an online FFQ. First, dietary predictors were identified using correlated component regression, and subsequently tested for moderation by four SEP indicators using partial least-squares structural equation modelling. Fruit and vegetable intake and healthy behaviours were predicted by self-efficacy, attitudes and a supportive home environment. For girls, only the associations of self-efficacy with healthy behaviours were moderated by occupation. For boys, income moderated the associations of fruit and vegetable intake with attitudes, and healthy behaviours with supportive home environments. Occupation and employment moderated the associations of boys' family environments and fruit intake, and attitudes with healthy behaviours. Reducing socio-economic disparities in children's healthy dietary intake may be more successfully achieved by tailoring health promotion policies and interventions according to variables that moderate the relationships between dietary intake and SEP. Refereed/Peer-reviewed

Cancer survivorship rates have increased in developed countries largely due to population ageing and improvements in cancer care. Survivorship is a neglected phase of cancer treatment and is often associated with adverse physical and psychological effects. There is a need for broadly accessible, non-pharmacological measures that may prolong disease-free survival, reduce or alleviate co-morbidities and enhance quality of life. The aim of the Steps TowaRd Improving Diet and Exercise (STRIDE) study is to evaluate the effectiveness of an online-delivered physical activity intervention for increasing walking in cancer survivors living in metropolitan and rural areas of South Australia. This is a quasi-randomised controlled trial. The intervention period is 12-weeks with 3-month follow-up. The trial will be conducted at a university setting and community health services in South Australia. Participants will be insufficiently active and aged 18 years or older. Participants will be randomly assigned to either the intervention or control group. All participants will receive a pedometer but only the intervention group will have access to the STRIDE website where they will report steps, affect and ratings of perceived exertion (RPE) during exercise daily. Researchers will use these variables to individualise weekly step goals to increase walking. The primary outcome measure is steps per day. The secondary outcomes are a) health measures (anthropometric and physiological), b) dietary habits (consumption of core foods and non-core foods) and c) quality of life (QOL) including physical, psychological and social wellbeing. Measures will be collected at baseline, post-intervention and 3-month follow-up. This protocol describes the implementation of a trial using an online resource to assist cancer survivors to become more physically active. It is an innovative tool that uses ratings of perceived exertion and daily affect to create individualised step goals for cancer survivors. The research findings may be of relevance to public health policy makers as an efficacious and inexpensive online-delivered intervention can have widespread application and may improve physical and psychological outcomes among this vulnerable population. Findings may indicate directions for the implementation of future physical activity interventions with this population. Australian New Zealand Clinical Trials Registry: ACTRN12613000473763 .

Conclusions : Mixed results and inconsistent magnitudes of change were identified when exploring trends in different contexts of physical activity for children and adolescents over the last few decades. Taken overall, there is little evidence for a decrease in children's and adolescents' physical activity, although consistent declines in active transport highlight this context as a suitable intervention target. Design : A comprehensive literature search was completed to identify articles on the specific contexts of physical activity for inclusion in this review. Methods : Journal articles for inclusion in this narrative review were sourced from the various databases and reference lists. Most studies in this review employed self-report or proxy-report methodologies. Objectives : It is particularly important to measure trends in physical activity to identify specific contexts where physical activity may have declined and can be targeted for intervention. The aim of this review was to summarize overall physical activity trends based on objectively measured physical activity as well as trends in specific contexts (active transport, organized sport, school physical education and school play periods) using self- or proxy-reported physical activity. Results : There is limited research on temporal trends in children's and adolescents' physical activity. The few studies that employ objective measures to assess trends in physical activity indicate little change has occurred in the last 20 years. Other studies that employed self-report methods indicate organized sport trends are somewhat inconsistent across countries, however most studies reported an increase in participation. Within the limited physical education trend studies, inconsistent trends were noted. There have been consistent declines in active transport, particularly cycling. Few studies have investigated trends in physical activity and sedentary behaviour during school play periods, highlighting a need for further research. Refereed/Peer-reviewed

Objective: This study aimed to explore sleep duration in young Australians on different types of days across weight classes. Methods: Use of time and anthropometric data were collected on 8,866 nights from 3,884 9–18 year old Australians. The association between sleep duration and weight status was examined using factorial ANOVA for four day types: S-S (to bed and waking on school days); S-NS (to bed on school day and waking on non-school day); NS-NS (to bed and waking on non-school days); NS-S (to bed on non-school day and waking on school day). Results: Sleep duration varied with weight status when all day types were considered together (p=0.0012). Obese adolescents slept less than normal and underweight adolescents. However, the relationship varied for different day types; with the strongest relationship for NS-S days (on which obese children slept 65 min less than very underweight children, p

ObjectiveIn the early years of life, influential attributes are formed and may be difficult to change later in life. Early childhood is now recognised as a key target in the prevention of overweight and obesity, and the knowledge that children gain at this time about food and its health benefits may have an important influence on their dietary choices and preferences in later life. Therefore, an activity was designed using age-appropriate methods to assess nutrition knowledge of young children.DesignThe Healthy Food Knowledge Activity was developed using a list of thirty healthy and unhealthy foods and drinks generated from the Australian Guide to Healthy Eating.SettingThe activity was conducted with individual children from reception classes of South Australian schools.SubjectsChildren aged 5–6 years undertook the activity in a pilot study (n 13) and in the main study (n 192).ResultsPilot data indicated good test–retest reliability of the activity (r = 0·84, P < 0·01). In the main study, there was a good distribution of scores with acceptable skewness and kurtosis statistics. A breakdown of responses indicated good face validity, with more obvious foods being more correctly classified.ConclusionsChildren as young as 5–6 years of age can correctly identify healthy foods, and this can be measured objectively. This activity also provides interesting insights regarding misconceptions about foods that could be attributed to influences such as media advertising and that can be addressed by educators of this age group.

Objectives: While there is consistent evidence that rural adults in Australia are less active than their urban counterparts, studies relating geographical remoteness to activity patterns in Australian adolescents have yielded inconsistent results. The aim of this study was to describe objectively and subjectively measured patterns of physical activity and sedentary behaviours across remoteness categories in a representative sample of 9-16 year old Australians. Conclusions: Activity levels among Australian adolescents show contrasting patterns of geographical differences to those found in Australian adults. Higher levels of free play among rural Australian adolescents may be due to more available space and less fear of traffic and stranger risks. Design: Cross-sectional observational study. Methods: 2071 Australian adolescents provided self-report use of time data on four days and wore a pedometer for at least 6 days within the 2007 Australian National Children's Nutrition and Physical Activity Survey. Comparisons of activity patterns were made across four objectively-determined remoteness categories (Major City, Inner Regional, Outer Regional and Remote), adjusting for household income, parental education and age. Results: Adolescents living in major cities self-reported 11-29 min less moderate to vigorous physical activity each day than their counterparts living in geographically more remote areas, and took 150-850 fewer steps each day. While there were no differences in time spent in sport or active transport, differences in free play participation were significant. Males in major cities also reported higher levels of screen time. Differences were somewhat more marked among males than among females. Refereed/Peer-reviewed

Objectives: To explore children's perceptions of the factors influencing their engagement in physical activity during the "critical" lunchtime period, using a social-ecological framework. Design: This study was an in-depth descriptive qualitative design. Methods: Fifty-four South Australian children aged 10-13 years participated in same-gender focus groups. Transcripts, field notes and activity documents were analysed using content analysis. Using an inductive thematic approach, data were coded and categorised into perceived barriers and facilitators according to a social-ecological model. Results: Children identified a range of environmental, social and intrapersonal barriers and facilitators. Bullying/teasing, the school uniform and school rules were exposed as explicit barriers to lunchtime play. Other important barriers included lack of access to, and poor suitability of, space, lack of access to programs/facilities and equipment, and lack of peer and teacher support. Perceived facilitators of lunchtime physical activity centred on access to equipment, enjoyment, motivation to improve skills, and peer support and acceptance. The freedom to make up or modify rules for games was also perceived to be a facilitator of lunchtime play. Conclusions: Communicating with children has been an effective approach in uncovering perceived barriers and facilitators to lunchtime play that may not have been previously considered in the quantitative correlate literature. Lunchtime interventions targeting children's physical activity should focus on addressing the barriers perceived to be important to lunchtime play. Language: en

Organised sport among youth makes a substantial contribution to daily energy expenditure. This study investigated socioeconomic gradients in sport participation and predictors of participation. A representative sample of young South Australians (10–15 y; n = 1737) was surveyed on organised sport participation in the previous 12 months, and predictors derived from the Children's Physical Activity Correlates scale and a parent survey. Four constructs were derived: ‘is it worth it?’ (perceived outcomes); ‘am I able?’ (perceived competency); ‘reinforcing’ (parental support); and ‘enabling’ (perceived barriers, from the parent survey). Socioeconomic position (SEP) was operationalised by an area-level indicator, the Socioeconomic Indicator for Advantage (SEIFA), split into tertiles. Sport participation was higher among high (highest SEIFA tertile) compared with low (lowest SEIFA tertile) SEP children. All predictors except ‘am I able?’ were positively associated with sport participation among boys and girls. Of these predictors, the ‘enabling’ construct varied by SEP among both boys and girls, with high SEP children reporting fewer barriers to participation. High SEP girls reported higher scores on ‘reinforcing’ and ‘is it worth it?’ than their low SEP counterparts. Low SEP girls reported lower levels of both instrumental and affective support from parents to play sport. There are distinct SEP gradients in sport participation, as well as its psychosocial and environmental predictors among South Australian youth. Low SEP girls are the most disadvantaged in terms of parental support to participate in sport. Interventions targeting this vulnerable group are urgently required. Refereed/Peer-reviewed

Researchers and practitioners interested in assessing physical activity in children are often faced with the dilemma of what instrument to use. While there is a plethora of physical activity instruments to choose from, there is currently no guide regarding the suitability of common assessment instruments. The purpose of this paper is to provide a user’s guide for selecting physical activity assessment instruments appropriate for use with children and adolescents. While recommendations regarding specific instruments are not provided, the guide offers information about key attributes and considerations for the use of eight physical activity assessment approaches: heart rate monitoring; accelerometry; pedometry; direct observation; self-report; parent report; teacher report; and diaries/logs. Attributes of instruments and other factors to be considered in the selection of assessment instruments include: population (age); sample size; respondent burden; method/delivery mode; assessment time frame; physical activity information required (data output); data management; measurement error; cost (instrument and administration) and other limitations. A decision flow chart has been developed to assist researchers and practitioners to select an appropriate method of assessing physical activity. Five real-life scenarios are presented to illustrate this process in light of key instrument attributes. It is important that researchers, practitioners and policy makers understand the strengths and limitations of different methods of assessing physical activity, and are guided on selection of the most appropriate instrument/s to suit their needs. © 2008 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved. Refereed/Peer-reviewed

1.Discipline of Paediatrics, University of Adelaide, Adelaide, 5000, Australia2.Child and Adolescent Respiratory and Sleep Health Centre (CARSHC), Women’s and Children’s Hospital, North Adelaide, 5006, Australia3.Nutritional Physiology Research Centre, University of South Australia, Adelaide, 5000, Australia

Objective: To describe trends in health attitudes and self-perceptions among school-age South Australians between 1985 and 2004. Methods: The questionnaire from the 1985 Australian Schools Health and Fitness Survey was administered during 2004 in those South Australian schools that participated in the 1985 survey. Using chi square, responses were compared for 10–15 year-olds (1985, n=398; 2004, n=467) on attitudes to: visiting the doctor and dentist, smoking, sleep, diet, exercise, stress, having friends, and knowledge about fitness and health. Additionally, self-perceptions of health and fitness were compared. Results: Among boys and girls between 1985 and 2004, there were significant declines in the perceived importance of regularly visiting the dentist and doctor, but improved attitudes to being a non-smoker. Among boys, the perceived importance of sleep and diet declined between surveys. A smaller percentage of boys and girls in the latter survey perceived their current health status as ‘good’. In the lower SES sample, the percentage of girls rating healthy diet as ‘very important’ was lower in 2004. Conclusions: There have been general declines in perceived importance of many health-related behaviours among South Australian youth between 1985–2004. In contrast, the perceived importance of not smoking was higher in 2004 than 1985. Implications: The relative success of anti-smoking campaigns targeting youth suggests that health education must be accompanied by broader environmental support in order to effect positive behavioural change.

Understanding factors that influence physical activity levels of adolescents can assist the design of more effective interventions. Social support is a consistent correlate of youth physical activity but few studies have examined this in different cultural settings. Male adolescents (n=180, age=13.58+/-0.97 years) from a metropolitan single sex private school participated in this study. Habitual physical activity was estimated using the 3-day physical activity recall (3dPAR), and aspects of social support to be physically active using a specifically designed questionnaire. Comparisons were made between Anglo-Australians (n=118), whose parents were both born in Australia, and Vietnamese-Australians (n=62), whose parents were both born in Vietnam. There was a trend towards higher physical activity among Anglo-Australians, particularly on weekends. Anglo-Australians reported significantly more parental and peer support across most items pertaining to these constructs. Among the whole sample, social support variables explained 5-12% of the total explained variance in physical activity, with items pertaining to father and best friend support emerging as the strongest and most consistent predictors in multiple regression models. Among Anglo-Australians, the prediction models were relatively weak, explaining 0-9% of the total explained variance in physical activity. Prediction models for physical activity among Vietnamese-Australians were much stronger, explaining 11-32% of the total explained variance, with father's support variables contributing consistently to these models. The strong paternal influence on physical activity among Vietnamese-Australians needs to be confirmed in more diverse population groups, but results from this study suggest that interventions promoting physical activity among adolescent boys need to take into account cultural background as a moderator of widely reported social influences.

BackgroundThe lunchtime and after-school contexts are critical windows in a school day for children to be physically active. While numerous studies have investigated correlates of children's habitual physical activity, few have explored correlates of physical activity occurring at lunchtime and after-school from a social-ecological perspective. Exploring correlates that influence physical activity occurring in specific contexts can potentially improve the prediction and understanding of physical activity. Using a context-specific approach, this study investigated correlates of children's lunchtime and after-school physical activity.MethodsCross-sectional data were collected from 423 South Australian children aged 10.0-13.9 years (200 boys; 223 girls) attending 10 different schools. Lunchtime and after-school physical activity was assessed using accelerometers. Correlates were assessed using purposely developed context-specific questionnaires. Correlated Component Regression analysis was conducted to derive correlates of context-specific physical activity and determine the variance explained by prediction equations.ResultsThe model of boys' lunchtime physical activity contained 6 correlates and explained 25% of the variance. For girls, the model explained 17% variance from 9 correlates. Enjoyment of walking during lunchtime was the strongest correlate for both boys and girls. Boys' and girls' after-school physical activity models explained 20% variance from 14 correlates and 7% variance from the single item correlate, "I do an organised sport or activity after-school because it gets you fit", respectively.ConclusionsIncreasing specificity of correlate research has enabled the identification of unique features of, and a more in-depth interpretation of, lunchtime and after-school physical activity behaviour and is a potential strategy for advancing the physical activity correlate research field. The findings of this study could be used to inform and tailor gender-specific public health messages and interventions for promoting lunchtime and after-school physical activity in children.