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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

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

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.

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.

Assessment of correlates of physical activity occurring at different times of the day, locations and contexts, is imperative to understanding children’s physical activity behaviour. The purpose of this review was to identify the correlates of children’s physical activity (aged 8–14 years) occurring during the school break time and after-school periods. A review was conducted of the peer-reviewed literature, published between 1990 and January 2011. A total of 22 studies (12 school break time studies, 10 after-school studies) were included in the review. Across the 22 studies, 17 studies were cross-sectional and five studies were interventions. In the school break time studies, 39 potential correlates were identified, of which gender and age were consistently associated with school break time physical activity in two or more studies, and family affluence, access to a gym, access to four or more physical activity programs and the condition of a playing field were all associated with school break time physical activity in only one study. Access to loose and fixed equipment, playground markings, size of and access to play space and the length of school break time were all positively associated with changes in school break time physical activity in intervention studies. Thirty-six potential correlates of after-school physical activity were identified. Gender (with boys more active), younger age, lower body mass index (for females), lower TV viewing/playing video games, and greater access to facilities were associated with higher levels of after-school physical activity in two or more studies. Parent supervision was negatively associated with females’ after-school physical activity in one study. This review has revealed a relatively small number of studies investigating the school break time and after-school periods in the specified age range and only a few correlates have demonstrated a consistent association with physical activity. This highlights the infancy of this area and a need for further investigation into time-specific physical activity behaviour so that interventions designed for these specific periods can target the important correlates. Refereed/Peer-reviewed