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Aim: The aim of this paper is to explore the perceptions, attitudes and beliefs of middle‐aged Australians around their health, lifestyle risks and chronic disease. Background: Health promotion and risk reduction are important to stem the rising prevalence of chronic disease. While there has been much emphasis on supporting these strategies in older Australians, there has been less attention on those in middle age. However, as this group age, their health will inevitably be impacted by lifestyle risk. Design: A qualitative descriptive study using semi‐structured interviews. Reporting was guided by the COREQ checklist. Methods: Thirty‐four participants aged 40–65 years were recruited across South Eastern New South Wales, Australia, using convenience sampling. Semi‐structured interviews were conducted by four registered nurses with qualitative research experience. Verbatim transcripts were analysed using thematic analysis. Results: Sixteen women and 18 men participated in the interviews. Four themes emerged, namely: adopting healthy lifestyles; denial; an impetus for change; and sustaining change. Perceptions about what constituted good health varied, with male participants being more ambivalent about their health. Impetus for change was mostly influenced by family history, awareness of health risks and identification of risks by health professionals. Participants found sustaining change challenging, particularly with regard to smoking cessation and dietary modifications. Conclusions: Understanding the perceptions of health of middle‐aged people is important and enables health professionals to engage in early behavioural change conversations that consider perceived barriers to lifestyle modification. Findings from this study emphasise the importance of discussions about lifestyle risk to reduce the future burden of chronic disease. Relevance to Clinical Practice: These findings illustrate the importance of understanding perceptions of health to guide primary health care nurses to develop person‐centred health promotion and chronic disease prevention strategies in this age group. [ABSTRACT FROM AUTHOR]

Lifestyle risk factors are antecedents to many chronic conditions and are largely modifiable. Health professional support is often sought to reduce lifestyle risk. The ongoing relationship general practice nurses typically have with patients situates them ideally to provide this support. This paper explores the barriers and facilitators to lifestyle risk communication by registered nurses (RNs) in Australian general practice. Fifteen general practice RNs from south-eastern Australia participated in semistructured interviews. Verbatim transcriptions of the audio-recorded interviews were analysed using thematic analysis. Six themes emerged in terms of perceived barriers and facilitators: educational preparation and confidence; organisational and funding arrangements; lifestyle risk prioritisation; organisational support; autonomous roles; and supporting patients' needs. Although communication about lifestyle risk factors is within the general practice nurses' scope of practice, concerted efforts fostering interdisciplinary collaboration, the prioritisation of time, funding and educational opportunities would better support this role, at the same time optimising chronic disease management and patient outcomes. General practice nurses undertake chronic disease management and discuss lifestyle risk reduction with patients. However, a concerted approach is required to support this practice. Prioritising time, funding, education, collaborative relationships and optimising the capacity for general practice nurses to work to their full scope of practice are necessary to support communication related to lifestyle risk reduction. [ABSTRACT FROM AUTHOR]

This paper describes mortality and disease patterns across five broad remoteness categories of Australia, with reference to the context in which those outcomes develop and are treated. Health and its outcomes become worse as remoteness increases. Some of this phenomenon reflects proportionally greater numbers of Aboriginal and Torres Strait Islander people in remote areas coupled with their poorer overall health outcomes; however, mortality for non-indigenous people is clearly higher outside compared with inside major cities. Migration of people seeking services likely reduces the size of interregional health disparity. Poorer health outcomes stem from worse risk factor profiles and average lower levels of income and of education, poorer physical and financial access to services, higher occupational and environmental risk, as well as factors unique to Aboriginal and Torres Strait Islander health. Little is known about the health benefits of living outside major cities. Diseases of the circulatory system and injuries account, respectively, for 40% and 18% of the excess mortality outside major cities. Death rates are declining over time in all (particularly remote) areas, but rates of death due to certain lung diseases in rural women are not, and rates of suicide have increased in remote areas. Ostensibly, prevalence of mental ill-health appears roughly similar in all remoteness areas. Dental health is poorer and disability is more prevalent outside major cities, as are a range of infectious diseases. Although pertinent, the effects on rural health of climate change and resource degradation generally have not been addressed in this paper. [ABSTRACT FROM AUTHOR]

Issue addressed The Albany Physical Activity and Nutrition (APAN) study investigated the effects of the APAN program, a home-based intervention on dietary and physical activity behaviours and chronic disease risk for rural Australian adults. This paper reports on the process evaluation to gain insight into the link between intervention elements and outcomes. Methods The APAN program comprised resources to improve participants' diet and physical activity. Printed and online resources were provided to participants, complemented by motivational interviews via telephone. Process evaluation used mixed-methods, with a sample of 201 intervention participants residing in a disadvantaged rural area. Participants were aged 50 to 69 years with, or at risk of, metabolic syndrome. Quantitative data were collected using an online survey (n=73); qualitative data were collected via telephone exit interviews with intervention completers (n=8) and non-completers (n=8), and recruitment notes recorded by research assistants. Results The attrition rate of the program was 18%; major reasons for withdrawal were health and personal issues and a loss of interest. The majority of participants found the printed resources useful, attractive, and suitable to their age group. The website was the least preferred resource. Reasons for completing the program included the desired health benefits, wanting to honour the commitment, and wanting to assist with research. Conclusions Carefully planned recruitment will reduce the burden on resources and improve uptake. Understanding reasons for attrition such as family or personal barriers and health issues will assist practitioners to support participants overcome these barriers. Given participants' preference for printed resources, and the known effectiveness of these in combination with other strategies, investigating methods to encourage use of telephone and online support should be a priority. So what? This process evaluation provided an overview of recruitment challenges and preferred intervention components. It is desirable that future work determines the most effective intervention components for rural adults at risk of chronic disease. [ABSTRACT FROM AUTHOR]

Issue addressed Get Healthy at Work (GHaW) is a statewide program to reduce chronic disease risk among NSW workers by helping them make small changes to modifiable lifestyle chronic disease risk factors and create workplace environments that support healthy lifestyles. It has two primary components: a workplace health program (WHP) for businesses and online or face-to-face Brief Health Checks (BHCs) for workers. In this paper, we discuss our evaluation to identify areas for improvement in the implementation of WHP and to assess the uptake of BHCs by workers. Methods Routinely collected WHP and BHC program data between July 2014 and February 2016 were analysed. A baseline online survey regarding workplace health promotion was conducted with 247 key contacts at registered GHaW worksites and a control group of 400 key contacts from a range of businesses. Seven telephone interviews were conducted with service provider key contacts. Results As at February 2016, 3133 worksites (from 1199 businesses) across NSW had registered for GHaW, of which 36.8% started the program. Similar proportions of GHaW (34.0%) and control (31.7%) businesses had existing WHPs. BHCs were completed by 12740 workers, and of those whose risks were assessed, 78.9% had moderate or high risk of diabetes and 33.6% had increased or high risk of cardiovascular disease. Approximately half (50.6%) of eligible BHC participants were referred to Get Healthy Information and Coaching Service (GHS) and 37.7% to Quitline. The uptake of face-to-face BHCs compared with online was significantly higher for males, people aged over 35 years, those undertaking less physical activity and those less likely to undertake active travel to work. Service providers suggested that the program's structured five-step pathway did not offer adequate flexibility to support worksites' progress through the program. Conclusions During the evaluation period, a substantial number of NSW worksites registered for GHaW but their progress was slow because of the limited flexibility offered by the program model. So what? Workplace-based health promotion programs have potential to reach people at risk of chronic disease, but the implementation of such programs need to be more flexible than traditional health promotion programs in terms of delivery modes and timeframes. [ABSTRACT FROM AUTHOR]

The objective of this paper was to determine separately the lifetime risk of drinking alcohol for chronic disease and acute injury outcomes as a basis for setting general population drinking guidelines for Australia. Relative risk data for different levels of average consumption of alcohol were combined with age, sex, and disease-specific risks of dying from an alcohol-attributable chronic disease. For injury, combinations of the number of drinks per occasion and frequency of drinking occasions were combined to model lifetime risk of death for different drinking pattern scenarios. A lifetime risk of injury death of 1 in 100 is reached for consumption levels of about three drinks daily per week for women, and three drinks five times a week for men. For chronic disease death, lifetime risk increases by about 10% with each 10-gram (one drink) increase in daily average alcohol consumption, although risks are higher for women than men, particularly at higher average consumption levels. Lifetime risks for injury and chronic disease combine to overall risk of alcohol-attributable mortality. In terms of guidelines, if a lifetime risk standard of 1 in 100 is set, then the implications of the analysis presented here are that both men and women should not exceed a volume of two drinks a day for chronic disease mortality, and for occasional drinking three or four drinks seem tolerable. Copyright © 2008 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective: The presence of one chronic disease often leads to the development of one or more other chronic diseases. This study examines whether there are significant progressions between chronic diseases and identifies the risk factors that influence them. Methods: This study used an administrative healthcare dataset sample from 29,280 hospitalized patients over 24 years (1995 to 2018, inclusive) to explore the progression of common chronic diseases and their major comorbidities. An Australian health insurance organization provided the dataset. We used the t-test to examine the statistical significance of progression between chronic diseases. A network analysis approach is followed to rank different chronic diseases contributing to disease progressions. Results: We found that few chronic diseases (e.g. cardiovascular diseases and diabetes) have a high prevalence in progressing to other chronic diseases, which is statistically significant at p ≤ 0.05. These progression frequencies significantly increase with time and age. We also found that patients' sex differently affects the disease progressions. Discussion: This study found that some chronic diseases have a high prevalence in comorbidity progressions. In addition, the progression statistics differ with time and age. The results of this study can help researchers, stakeholders, and policymakers gain insights into the disease transitions and act as a guiding tool to assess future disease burden and plan accordingly. [ABSTRACT FROM AUTHOR]

Depression is a chronic and complex condition experienced by over 300 million people worldwide. While research on the impact of nutrition on chronic physical illness is well documented, there is growing interest in the role of dietary patterns for those experiencing symptoms of depression. This study aims to examine the association of diet quality (Dietary Questionnaire for Epidemiological Studies version 2) and depressive symptoms (Centre for Epidemiological Studies for Depression short form) of young Australian women over 6 years at two time points, 2003 (n 9081, Mean age = 27·6) and 2009 (n 8199, Mean age = 33·7) using secondary data from the Australian Longitudinal Study on Women's Health. A linear mixed-effects model found a small and significant inverse association of diet quality on depressive symptoms (β = −0·03, 95 % CI (−0·04, −0·02)) after adjusting for covarying factors such as BMI, social functioning, alcohol and smoking status. These findings suggest that the continuation of a healthy dietary pattern may be protective of depressive symptoms. Caution should be applied in interpreting these findings due to the small effect sizes. More longitudinal studies are needed to assess temporal relationships between dietary quality and depression. [ABSTRACT FROM AUTHOR]

The poor physical health of people who experience severe mental illness ( SMI) is an important public health issue that has been acknowledged, yet not properly addressed. People who live with SMI perform a myriad of complex tasks in order to take care of their physical health, while receiving unpredictable levels of support and assistance from health professionals. In this qualitative study, we aimed to uncover the kinds of work people with SMI do in order to look after their physical health. In a metropolitan area in Queensland, Australia, 32 people with lived experience of SMI participated in semi-structured, face-to-face interviews. Data were digitally recorded, transcribed verbatim and open coded. They were then themed using a constant comparative process. We found that people with SMI were engaged in a 'rhythm of life with illness' that consisted of relatively short, acute and chaotic cycles of mental and physical illness, accompanied by much longer mental and physical illness recovery cycles. Participants engaged in three specific types of health-related work to manage these cycles: discovery work (and the associated role of the health professional); sense-making work to meaningfully interpret health and illness; and embedding work to become engaged self-managers of illness and producers of health. We discuss how varying levels of support from health professionals impact consumers' self-management of their physical and mental health; how health professionals influence consumers' experience of treatment burden; and implications for practice. [ABSTRACT FROM AUTHOR]

Background: Chronic diseases are highly prevalent and cluster in individuals (multimorbidity). This study investigated the association between multimorbidity and Health-Related Quality of Life (HRQoL), assessing the combination of chronic diseases highly correlated with this outcome.Methods: We conducted a household survey in 2015 in a random sample of 2912 South Australian adults (48.9 ± 18.1 years; 50.9% females), obtaining information on sociodemographics, lifestyle, and 17 chronic conditions clustered in four different groups (metabolic, cardiovascular, gastrointestinal, and musculoskeletal). Information on physical (PCS) and mental components scores (MCS) of HRQoL were assessed using the SF-12 questionnaire. Multivariable linear regression models considering individual diseases (mutually adjusted) and clusters within- and between-groups were used to test the associations.Results: Only 41% of the sample was negative for all the investigated diseases. The most prevalent conditions were osteoarthritis, obesity and hypertension, which affected one in every four individuals. PCS was markedly lower among those reporting stroke, heart failure, and osteoarthritis, but they were not associated with MCS. Direct-trend relationships were observed between the number of chronic conditions (clusters within- and between-groups) and PCS, but not with MCS. The strongest association with PCS was for musculoskeletal conditions (difference between those affected by 2+ conditions and those free of these conditions -6.7 95%CI -8.5;-5.4), and lower PCS were observed in any combination of clusters between-group including musculoskeletal diseases.Conclusion: In the context of multimorbidity, musculoskeletal diseases are a key determinant group of PCS, amplifying the association of other chronic conditions on physical but not on mental health. [ABSTRACT FROM AUTHOR]

Background: Common disease risk clusters in families due to shared genetics, exposure to environmental risk factors, and because many health behaviours are established and maintained in family environments. This randomised controlled trial will test whether the provision of a family health history (FHH) risk assessment tool increases intentions and engagement in health behaviors. Message distribution and collective behavior change within family networks will be mapped using social network analysis. The relative intervention impact will be compared between families from different ethnic backgrounds.Methods: One hundred and fifty mothers (50 Anglo-Australian, 50 Italian-Australian, 50 Vietnamese-Australian) will be recruited, with four or more other family members across three generations, including a child (aged 10-18 years). Each family is randomly assigned to intervention or control. At baseline and 6-month follow-up, all participants complete surveys to assess dietary and physical activity intentions and behaviors, attitudes towards food, and perceived disease risk. Intervention families receive a visual pedigree detailing their FHH of diabetes, heart disease, breast and bowel cancer, a health education workbook to ascertain members' disease risk (i.e. average or above average risk), and screening and primary prevention recommendations. After completion of follow-up assessments, controls will receive their pedigree and workbook. The primary hypothesis is that attitudes and lifestyle behaviors will improve more within families exposed to FHH feedback, although the extent of this improvement may vary between families from different ethnic backgrounds. Additionally, the extent of improvement in the treatment group will be moderated by the level of family disease risk, with above-average risk leading to greater improvement. A secondary aim will explore different family members' roles in message distribution and collective responses to risk using social network approaches and to compare network functioning between families with different ethnic backgrounds.Discussion: Results will guide future health promotion programs aimed at improving lifestyle factors. This research will assess whether FHH can motivate families to adopt family-level strategies to support health promoting behaviors. Secondary analyses aim to identify change agents within the family who are particularly effective in shifting normative behaviors.Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12613001033730 . Retrospectively registered: 17 September, 2013. [ABSTRACT FROM AUTHOR]

Issue Addressed: Community-based lifestyle modification programs can be a valuable strategy to reduce risk factors for chronic disease. However, few government-funded programs report their results in the peer-reviewed literature. Our aim was to report on the effectiveness of the Healthy Eating Activity and Lifestyle (HEAL) program, a program funded under the Australian government's Healthy Communities Initiative.Methods: Participants (n = 2827) were recruited to the program from a broad range of backgrounds and each week completed an hour of group-based physical activity followed by an hour of lifestyle education for 8 weeks. Physical activity, sitting time, fruit and vegetable consumption, anthropometric measures, blood pressure and functional capacity data were gathered at baseline and post-program.Results: HEAL participation resulted in significant acute improvements in frequency and volume of physical activity, reductions in daily sitting time and increases in fruit and vegetable consumption. HEAL participation led to reductions in total body mass, body mass index, waist circumference and blood pressure and to improvements in functional capacity (P < 0.001).Conclusions: Based on these findings and the coordinated approach to program delivery, the HEAL program warrants consideration as a behaviour change strategy in primary health care networks, local government or community settings. SO WHAT? These findings should inform future policy development around implementation of lifestyle modification programs; they strengthen the case for support and promotion of lifestyle modification programs to improve public health, lessening the financial and personal burden of chronic conditions. [ABSTRACT FROM AUTHOR]

Background: Obesity campaign evaluations have used campaign awareness to assess impact, yet have not compared unprompted campaign recallers, with prompted recallers and those with no campaign recall. Using data from an Australian mass-media obesity prevention campaign linking waist circumference and chronic disease we examined whether those with different degrees of campaign recall are distinct groups demographically and for subsequent campaign effects. Methods: A national cross-sectional telephone survey of randomly selected adults aged 18 to 65 years was conducted post- campaign (n = 2812) covering campaign recall, self-reported diet and physical activity (PA) and waist-measuring knowledge, behaviours and intentions to make lifestyle changes. Respondents were divided into three groups indicating campaign recall: Unprompted Recallers (n=1154); Prompted Recallers (n=1284); and No Recallers (n=374) and compared on demographic, knowledge, and behavioural risk factors for obesity/chronic disease. Results: Unprompted Recallers were more likely to speak English at home (p<.001), be in the primary campaign target group (25-45 years with children) (p<0.001) than the other two groups and to be university educated and female than the Prompted Recall group only (p=0.001). Unprompted Recallers had better knowledge about recommended waist circumference (p<.001), fruit (p=0.004), vegetable (p<0.001) and PA guidelines (p<0.001) than both the other groups. The No Recall group was less likely than the other two to be overweight/obese (46% vs 55%, p=0.020 and 54%, p=0.037), comparable on meeting fruit consumption and PA guidelines but more likely to meet vegetable intake recommendations (than Unprompted Recallers only). Conclusions: Unprompted recallers were more knowledgeable about campaign messages; behaviour change and intentions to change were stronger for the two recall groups compared with the No Recall group but not different between them. The current analysis revealed subtle differences in campaign exposure and/or attendance by different demographic subgroups that would not be apparent in a simple aware/unaware dichotomy. [ABSTRACT FROM AUTHOR]

Objectives: This article examines the link between stressful life events and illness by considering both onset and reoccurrence of chronic illnesses. Using longitudinal data, we estimate the extent to which life events increase the likelihood of depression or anxiety, type 2 diabetes, cancer, coronary heart disease, circulatory disease, asthma and emphysema among Australian adults aged ≥21 years. Methods: Longitudinal data were obtained from the nationally representative Household, Income and Labour Dynamics in Australia panel survey collected at waves 3 (2003), 7 (2007) and 9 (2009). Participants (N = 9222) answered life events questions relating to the preceding 12 months and chronic illnesses lasting (or expected to last for) 6 months. Weighted pooled and random effects logistic regressions were performed, controlling for confounders and previous illness, and also performed on subsamples delineated by reported illnesses in wave 3. Results: Work-related stress [odds ratio (OR) = 1.54, P < 0.001] was positively associated with the onset of depression or anxiety. Personal stress increased the likelihood of the onset of depression or anxiety (OR = 1.70, P < 0.001), type 2 diabetes (OR = 1.47, P < 0.05) and circulatory diseases (OR = 1.72, P < 0.05), while family-related stress increased the likelihood of the onset of heart (OR = 1.32, P < 0.01) and circulatory diseases (OR = 1.32, P < 0.05). Conclusions: Independent of personal characteristics and key health measures (body mass index, hypertension and disability), these findings suggest that work-related, personal and family-related stressful life events contribute to the development and/or course of chronic diseases. [ABSTRACT FROM PUBLISHER]

Background: Psychosocial factors are considered as risk factors for some chronic diseases. A paucity of research exists surrounding the role of perceived stress in arthritis onset. Purpose: Perceived stress as a risk factor for arthritis development was explored in an ageing cohort of Australian women. Methods: This study focused on 12,202 women from the 1946-1951 cohort who completed the Australian Longitudinal Study on Women's Health surveys in 2001, 2004 and 2007. Longitudinal associations were modelled, with and without a time lag. Results: Findings from the multivariate time lag modelling, excluding women with persistent joint pain, revealed that perceived stress predicted the onset of arthritis, with women experiencing minimal and moderate/high stress levels having a 1.7 and 2.4 times greater odds of developing arthritis 3 years later, respectively ( p's < 0.001). Conclusion: Chronically perceiving life as stressful is detrimental to future health. The findings provide support for perceived stress to be considered alongside other modifiable risk factors. [ABSTRACT FROM AUTHOR]

Aim: To investigate the relationship between socio-demographic characteristics, acculturation, weight status and dietary intake among a group of women from India and Pakistan living in Brisbane, Australia. Methods: Cross-sectional survey of a convenience sample of 22 women that collected: socio-demographic details; levels of acculturation; food intake using a specifically designed food frequency questionnaire and food diary; and anthropometric measurements. Data were compared with women from South Australia. Results: Women had a mean age of 38 years (24-50) and had been in Australia for an average of 4 years (1-25). Half (50%) of the women were categorised as overweight or obese and over two-thirds (68%) had a waist measurement indicative of a high risk of chronic disease. A higher proportion of women from Pakistan were overweight and obese compared with Indian women. Women in this sample appeared to have a higher consumption of dairy, bread and cereals, vegetables and baked goods/snacks and were more likely to consume full-fat milk compared with other Australian women. Breakfast was the meal most likely to have been 'Australianised'. Conclusion: Despite the results not reaching statistical significance, these findings do point to areas worthy of further investigation. These include the relationship between acculturation factors with dietary intake and the prevalence of overweight and obesity. Given the high prevalence of overweight and obesity in this small sample, there appears to be a need to investigate diet and physical activity in specific groups to inform the development of culturally relevant chronic disease identification and management programmes. [ABSTRACT FROM AUTHOR]

Aim: To undertake a systematic literature review to examine the effect of food cost on diet quality and risk factors for chronic disease, specifically focusing on diet-related lifestyle diseases affecting the Australian population. Methods: A search of six databases resulted in the inclusion of one systematic review, three cohort studies, 41 cross-sectional studies and four modelling studies in this review. Results: Between 2000 and 2006, the price of healthy foods has increased more than the price of less healthy foods. Healthy Food Access Basket surveys show that a healthy diet may often be unaffordable for low- and average-income households. Diets of higher energy density were associated with lower diet cost, whereas diets of higher nutrient density and nutritional quality were associated with higher diet cost. Recent studies report an inverse association between food price and food consumption. Consequently, an increase in food cost was associated with a significant reduction in weight, waist circumference, body mass index, obesity and insulin resistance. Conclusions: Manipulation of food cost may alter food consumption and therefore risk factors for chronic disease. Further longitudinal studies investigating the impact of pricing strategies on diet quality and disease risk are needed. [ABSTRACT FROM AUTHOR]

Self-management is a critical dimension in managing chronic conditions, particularly in heart failure (HF). Knowledge, attitudes and beliefs, relating to both illness and wellness, are strongly influenced by culture and ethnicity, impacting upon an individual's capacity to engage in self-care behaviours. Effective management of HF is largely dependent on facilitation of culturally informed, self-care behaviours to increase adherence to both pharmacological and non-pharmacological strategies. The Understanding the cultural experiences of individuals with chronic heart failure (CHF) in South East Health (DISCOVER) study is an exploratory, observational study investigating health patterns, information needs and the adjustment process for overseas-born people with HF living in Australia. An integrative literature review was augmented by qualitative data derived from key informant interviews, focus groups and individual interviews. A key finding of this study is that culture provides an important context to aid interpretations of attitudes, values, beliefs and behaviours, not only in illness but in health. While individual differences in attitudes and beliefs were observed among participants, common themes and issues were identified across cultural groups. Data from the DISCOVER study revealed the primacy of family and kinship ties. These relationships were important in making decisions about treatment choices and care plans. Participants also revealed the critical role of the 'family doctor' in assisting people and their families in brokering the health care system. In this study, heart disease was considered to be a significant condition but cancer was the condition that people both feared and dreaded the most, despite the high mortality rates of HF. This sample reported that religious and traditional beliefs became more important as people aged and considered their mortality. As HF is predominately a condition of ageing, the information derived from this study will assist clinicians to tailor health care service delivery for older people with HF, across multiple ethnic backgrounds. [ABSTRACT FROM AUTHOR]