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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.

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

Physical activity has numerous associated benefits for cancer survivors. Compared to their urban counterparts, rural and remote Australians experience a health disadvantage, including poorer survival rate after the diagnosis of cancer. The purpose of this qualitative study was to (a) investigate factors that motivated or inhibited walking in rural participants during a 12-week intervention and (b) to investigate factors that motivated or inhibited physical activity behavior change three months post-intervention. Ten cancer survivors living in rural areas of South Australia participated in a 12-week computer-delivered walking-based intervention during which they reported daily steps,daily affect, and ratings of perceived exertion. Based on this information, individualized daily step goals were sent to them to increase walking. Following the intervention, participants engaged in face-to-face semi-structured interviews. Interviews were recorded, transcribed and coded using thematic analysis. Participants identified a range of physical, psychological, social, environmental,and organizational motivators and barriers. Participants appreciated the monitoring and support from the research team, but some voiced a need for better transition to post-program and many desired ongoing support to maintain their motivation. Future studies should incorporate strategies to help walking behavior to become more intrinsically motivated and therefore sustained. 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.

Purpose/objective Cardiac rehabilitation aims to reduce the likelihood of recurrent cardiac events through physical activity (PA) and education. There is limited understanding about the predictors of physical activity behavior in rural adults beyond rehabilitation. This study explored predictors of regular physical activity in rural adults, 6-12 months post cardiac rehabilitation. Research Method/Design: A self-report questionnaire (quantitative cross-sectional design) was mailed to a simple random sample of rural South Australians who previously participated in cardiac rehabilitation (n = 315). Regression modeling was adjusted for physical activity history and gender to examine psychological, social, and environmental predictors of (a) current leisure-time physical activity, self-reported through the Godin Leisure Time Exercise Questionnaire expressed as the Leisure Score Index (LSI) and the weekly frequency of physical activity bouts that cause sweating ("sweat frequency"), and (b) stage of physical activity behavior change according to the Transtheoretical Model of Behavior Change ("Stage of PA change"). Results All measures of self-efficacy (barriers, task, and relapse), social assimilation, and self-regulation predicted LSI, whereas all measures of self-efficacy and self-regulation predicted both "Stage of PA change" and "sweat frequency." Self-regulation explained the highest percentage of explained variance in LSI (31.6%) and "sweat frequency" (12.5%). Home social support additionally predicted "Stage of PA change"; there were no environmental predictors of any of the outcome measures. Conclusion Similar to urban populations, the predictors of post-cardiac-rehab physical activity among rural adults predominantly emanate from the psychological domain. Findings support the need to strengthen the focus of cardiac rehabilitation program design on self-management skills and behaviors. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Objectives Associations between objectively measured sedentary behaviour, physical activity (PA) and metabolic syndrome (MetS)-classified using three different definitions were investigated in an inactive sample of rural Australian adults. Design Quantitative, cross-sectional. Methods 171 adults (50.7 ± 12.4 years) from two rural South Australian regions underwent seven-day accelerometer activity monitoring and MetS classification using the National Cholesterol Education Program, the International Diabetes Federation and the Harmonized definitions. Associations between sedentary and activity variables and MetS (adjusted for age, sex, diet and smoking status) were modelled using logistic regression. In secondary modelling, associations of sedentary and activity outcomes for each MetS definition were assessed, adjusting for other activity and sedentary variables. Prediction differences across the definitions of MetS were directly compared using Akaike’s Information Criterion. Results Sedentary behaviour increased MetS risk, whereas light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA) reduced MetS risk, irrespective of definition. In secondary models, LPA predicted MetS independently of MVPA and total sedentary time. Time spent in sedentary bouts (>30 min) predicted MetS independently of MVPA and the number of sedentary bouts predicted MetS independently of LPA and MVPA. Prediction differences for MetS definitions failed to reach the critical threshold for difference (>10). Conclusions This study highlights the importance of sedentary behaviour and LPA on the prevalence of MetS in an inactive sample of rural Australian adults. Studies assessing the efficacy of increasing LPA on MetS in this population are needed. Minimal predictive differences across the three MetS definitions suggest evidence from previous studies can be considered cumulative.

Refereed/Peer-reviewed

This study explores rural South Australians’ barriers to help-seeking for skin cancer detection. A total of 201 randomly selected rural adults (18–94 years, 66% female) were presented with a skin-cancer-related scenario via telephone and were asked the extent to which various barriers would impede their help-seeking, based on an amended version of the Barriers to Help-Seeking Scale. Older (≥63 years) and less educated participants endorsed barriers more strongly than their younger, more educated counterparts in the following domains; “Concrete barriers and distrust of caregivers”, “Emotional control”, “Minimising problem and Normalisation”, “Need for control and self-reliance” (every domain other than “Privacy”). Socioeconomic disadvantage, gender, and farmer status did not predict stronger overall barriers, but some gender and occupation-related differences were detected at the item level. Farmers were also more likely to endorse the “Minimising problem and normalization” domain than their non-farmer working rural counterparts. Widely endorsed barriers included the tendency to minimise the problem, a desire to remain in control/not be influenced by others, reluctance to show emotion or complain, and having concerns about privacy or waiting times. Refereed/Peer-reviewed

Objective: To assess the differences between farming and non-farming rural adults in perceived barriers to mental health service use. Design: A cross-sectional survey, modified from the Barriers to Help-Seeking Scale (BHSS), was conducted using a computer-assisted telephone interview. Setting: Respondents (age 52.6 ± 11.6 years) were recruited from three rural regions of South Australia. Participants: Approximately, 78 non-farmers and 45 farmers were included in analyses. 78 retired and two unemployed participants were excluded from the analyses. Main outcome measure: Farmers and non-farmers were compared on domain scores and individual item responses from the adapted BHSS that represent 'agrarian' attitudes to support-seeking for mental health: stoicism, self-reliance, minimisation of the problem, stigma and distrust of health professionals. Results: In the analysis of domain scores, 'Need for Control and Self-Reliance' was a stronger barrier for farmers than non-farmers (P = 0.009) with a trend (P = 0.07) towards stronger barriers among farmers in the 'Minimising Problem and Resignation' domain. In the analysis of item-level responses, there was a difference (P = 0.03) between farmers and non-farmers in responses to 'I find it difficult to understand my doctor/health professional', with 24.4% of the farmers agreeing that this is a barrier compared with 15.3% of the non-farmers. Conclusion: Long-held stereotypes of stoicism and self-reliance among farmers were somewhat supported, in the context of mental health. Mental health services and professionals in rural Australia might need to adapt their practices to successfully engage this population. 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.

Objective: To explore perceptions of health among South Australian farmers. Design: Descriptive qualitative study, using semi-structured interviews. Setting: Two rural towns in the Riverland region of South Australia. Participants: Fifteen adults involved in farming within the Riverland region of South Australia, from a variety of farming industries; age range 23-70 years old; 53% male, 47% female. Main outcome measures: Perceptions and definitions of health.Results: Participants described an ecological understanding of health across individual, farm, and community domains. Participants perceived health as being able to function and complete farm work. Participants reported that farm work helped to maintain fitness, but the multiple stress and hazards associated with farming had a significant influence on health. Participants described how health was influenced by community activities and social support from friends and families. Women were reported to take a lead role in health. Conclusions: Health providers can frame interventions to resonate with the perceptions of health held by people, shaped and formed by the context of farming. Further research is needed to explore farmers'; perceptions of health in different locations, from different industries and from a range of age groups. Refereed/Peer-reviewed

Rural Australians have a higher likelihood of chronic disease than urban Australians, particularly male farmers. Chronic disease has been associated with occupational sedentary time. The aim was to validate the self-report of sedentary time in men in contrasting rural occupations. Farmers (n = 29) and office workers (n = 28), age 30–65 years, were recruited from the Riverland region of South Australia. Daily sedentary time and number of breaks in sedentary time were self-reported and measured objectively using body-worn inclinometers. Correlational analyses were conducted between self-reported and objectively measured variables, separately by occupation. There was a significant correlation between self-reported and objectively measured sedentary time in the whole sample (r = 0.44, P = 0.001). The correlation among office workers was significant (r = 0.57, P = 0.003) but not among farmers (r = 0.08, P = 0.68). There were no significant correlations between self-reported and measured number of breaks in sedentary time, for the whole sample (rho = −0.03, P = 0.83), office workers (rho = 0.17, P = 0.39) and farmers (rho = −0.22, P = 0.25). In conclusion, the validity of self-report of sedentary behaviours by farmers was poor. Further research is needed to develop better performing self-report instruments or more accessible objective measures of sedentary behaviour in this population. Refereed/Peer-reviewed

AIM: The aim was to evaluate the impact of a brief activity bout outside of the classroom on boys' attention and on-task behaviour in the classroom setting. METHODS: Fifty eight males (mean age 11.2 ± 0.6 y) were recruited from a boys' elementary school in Adelaide, South Australia. A year 5 and year 6 class were randomly assigned to four weeks of a 10 min a day Active Lesson Break, followed by four weeks as the control (Passive Lesson Break - Reading). The remaining two classes completed the study in the reverse order. Attention was quantified using a computerised psychomotor vigilance task, and on-task behaviour by direct observation. RESULTS: Neither the Active Lesson nor the Passive Lesson condition significantly affected sustained attention or on-task behaviour, and there were no significant differences between conditions. CONCLUSION: There was no impact on participants' sustained attention or on-task behaviour after a short activity break between lessons. Brief activity breaks outside the classroom do not compromise participants' on-task behaviour or attention levels upon returning to the classroom, though improvement in these variables is not seen either. However, the results suggest that active breaks are effective for accruing moderate-to-vigorous physical activity without compromising classroom behaviours This article is protected by copyright. All rights reserved. Language: en

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.

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.

Objectives The present study investigated the effectiveness of a school-based sleep education programme in improving key sleep behaviours, sleep knowledge, and sleep hygiene. Design and methods A cross-sectional cluster-randomised controlled trial with two groups (Intervention and Control) and three assessment time points [baseline, immediately post intervention (6 weeks post baseline) and follow-up (18 weeks post baseline)] was employed. A total of 296 students (mean age = 12.2 ± 0.6 years; 59% female) from 12 schools in Adelaide, South Australia, were recruited, with 149 participants in the Intervention group and 147 in the Control group. The intervention consisted of four classroom lessons delivered at weekly intervals, followed by a group project on sleep topics, which students presented at a parental information evening. Sleep patterns were assessed objectively (actigraphy, n = 175) and subjectively (time-use recall, n = 251) at three time points. Sleep knowledge and sleep hygiene ( n = 296) were also measured. Results Generalised estimating equations were used to compare changes in the Intervention and Control groups. The programme increased time in bed by 10 min ( p = 0.03) for the Intervention group relative to the Control group, due to a 10-min delay in wake time ( p = 0.00). These changes were not sustained at follow-up. There was no impact on sleep knowledge or sleep hygiene. Conclusion Investment in the sleep health of youth through sleep education is important but changes to sleep patterns are difficult to achieve. More intensive programmes, programmes with a different focus or programmes targeting different age groups may be more effective.

Background: The purpose of this study was to identify the independent association of frequency of walking trips between home and school with daily physical activity in a sample of school-aged children. Methods: Participants were 109 children (mean age = 12.05 years [±0.71]) attending nine primary schools in Adelaide, South Australia. Physical activity was derived from accelerometers with total counts as the outcome variable. Transport patterns were self-reported for each of the previous five school days. Walking trips were summed for each day and across the school week. The relationship between the number of active transport journeys andindividual school day and school week physical activity was modelled separately in boys and girls using multiple linear regression. Results: Frequency of walking was positively associated with school day and school week accelerometer counts in boys, accounting for 6% and 12% of the explained variance in total counts, respectively. There were no significant associations among girls. Conclusion: Despite sex-specific differences in associations between active transport to school and total physical activity, active transport is likely to have important ancillary benefits for development of independence and physical activity habits, and should continue to be promoted. 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.

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.

Purpose: Physical activity has been associated with improved outcomes for cancer survivors. Compared to their urban counterparts, rural Australians experience a health disadvantage, including poorer survival rates after diagnosis of cancer. The aim of this pilot feasibility study was to gain insight into the experiences of rural cancer survivors engaging in an online resource designed to increase regular walking. Conclusions: This online pedometer-based walking intervention is feasible and effectively increases motivation for walking and enhances health-related quality of life in South Australian rural cancer survivors. A randomized controlled trial of this intervention is warranted. Methods: A 6-week online lifestyle intervention was implemented among eight cancer survivors living in three rural regions of South Australia. Participants used a pedometer to monitor daily steps taken, reported daily steps using a specially designed website and were provided with daily step goals based on their affective state. Participants took part in semi-structured face-to-face interviews to gauge their impressions of the program. Data were analysed using qualitative description and content analysis to derive major themes from the interviews. Results: The program motivated participants to increase their walking and resulted in improvements in several self-reported physical and quality of life outcomes. The resource was clear and easy to navigate. The three-tiered step goal system reduced feelings of guilt if participants were unable to reach a goal. The step log and graph allowed participants to self-monitor their progress. The forum fostered social support; however, more interaction with intervention personnel was suggested. 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

Objectives: The eat well be active Community Programs (ewba) aimed to prevent obesity among children aged 0–18 years in two Australian communities from 2006 to 2010. Methods: ewba was a multi-strategy intervention in children's settings. The evaluation was quasi-experimental, including a before and after survey with intervention (INT) and non-randomised comparison (COMP) communities. Outcome measures included BMI-z score (zBMI) and overweight/obesity prevalence in children aged 4-5 years; and zBMI, waist circumference (WC) z-score and overweight/ obesity prevalence in children aged 10-12 years. Results: After 3 years, among the 4–5 years old, mean zBMI was significantly lower in both INT (−0.20, p < 0.05) and COMP (−0.15, p < 0.05), however, changes were not significantly different between INT and COMP. There was a larger reduction in overweight/obesity prevalence in INT (−6.3 %) compared to COMP (−3.7 %) (p < 0.05, χ 2 test). In the 10–12 years old, mean zBMI did not change significantly in INT or COMP. There was a significant reduction in WC z-score in INT (−0.17, p < 0.05) but not in COMP (−0.10, p = NS), although not significantly different between INT and COMP (p = 0.092). Conclusions: These findings suggest that the ewba community intervention had a moderate impact, showing modest improvements in weight status at 3-year follow-up. Refereed/Peer-reviewed

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: 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

The aim of this study was to determine the accuracy of dual-energy X-ray absorptiometry (DXA)-derived percentage fat estimates in obese adults by using four-compartment (4C) values as criterion measures. Differences between methods were also investigated in relation to the influence of fat-free mass (FFM) hydration and various anthropometric measurements. Six women and eight men (age 22-54 years, BMI 28.7-39.9 kg/m2, 4C percent body fat (%BF) 31.3-52.6%) had relative body fat (%BF) determined via DXA and a 4C method that incorporated measures of body density (BD), total body water (TBW), and bone mineral mass (BMM) via underwater weighing, deuterium dilution, and DXA, respectively. Anthropometric measurements were also undertaken: height, waist and gluteal girth, and anterior-posterior (A-P) chest depth. Values for both methods were significantly correlated (r2 = 0.894) and no significant difference (P = 0.57) was detected between the means (DXA = 41.1%BF, 4C = 41.5%BF). The slope and intercept for the regression line were not significantly different (P > 0.05) from 1 and 0, respectively. Although both methods were significantly correlated, intraindividual differences between the methods were sizable (4C-DXA, range = -3.04 to 4.01%BF) and significantly correlated with tissue thickness (chest depth) or most surrogates of tissue thickness (body mass, BMI, waist girth) but not FFM hydration and gluteal girth. DXA provided cross-sectional %BF data for obese adults without bias. However, individual data are associated with large prediction errors (4.2%BF). This error appears to be associated with tissue thickness indicating that the DXA device used may not be able to accurately account for beam hardening in obese cohorts. 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.

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.

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

Aim: This pilot study was conducted as part of an honours project and aimed to provide evidence of validity for the 3-day Physical Activity Recall (3dPAR) questionnaire in a sample of female adolescents aged 12–14 years (N = 20) for use by occupational therapists to assess adolescents’ physical activity. Methods: Participants wore a Computer Science and Applications 7164 accelerometer for seven consecutive days and completed the 3dPAR questionnaire after the recording period. Results: A significant correlation was found between self-reported total metabolic equivalents and accelerometer total counts for 3 days (r = 0.630, P

Background: To frame interventions, it is useful to understand context- and time-specific correlates of children's physical activity. To do this, we need accurate assessment of these correlates. There are currently no measures that assess correlates at all levels of the social ecological model, contain items that are specifically worded for the lunchtime and/or after-school time periods, and assess correlates that have been conceptualised and defined by children. The aim of this study was to develop and evaluate the psychometric properties of the lunchtime and after-school Youth Physical Activity Survey for Specific Settings (Y-PASS) questionnaires. Methods: The Y-PASS questionnaire was administered to 264 South Australian children (146 boys, 118 girls; mean age = 11.7 +/- 0.93 years). Factorial structure and internal consistency of the intrapersonal, sociocultural and physical environmental/policy lunchtime and after-school subscales were examined through an exploratory factor analysis. The test-retest reliability of the Y-PASS subscales was assessed over a one-week period on a subsample of children (lunchtime Y-PASS: n = 12 boys, 12 girls, mean age of 11.6 +/- 0.8 years; after-school Y-PASS: n = 9 boys, 13 girls; mean age = 11.4 +/- 0.9 years). Results: For the lunchtime Y-PASS, three factors were identified under each of the intrapersonal, sociocultural and physical environmental/policy subscales. For the after-school Y-PASS, six factors were identified in the intrapersonal subscale, four factors in the sociocultural subscale and seven factors in the physical environmental/policy subscale. Following item reduction, all subscales demonstrated acceptable internal consistency (Cronbach alpha = 0.78 - 0.85), except for the lunchtime sociocultural subscale (Cronbach alpha = 0.55). The factors and items demonstrated fair to very high test-retest reliability (ICC = 0.26 - 0.93). Conclusion: The preliminary reliability and factorial structure evidence suggests the Y-PASS correlate questionnaires are robust tools for measuring correlates of context-specific physical activity in children. The multi-dimensional factor structure provides justification for exploring physical activity correlates from a social ecological perspective and demonstrates the importance of developing items that are context specific. Further development and refinement of the Y-PASS questionnaires is recommended, including a confirmatory factor analysis and exploring the inclusion of additional items. Refereed/Peer-reviewed

9585 Background: Weight gain and inactivity after cancer are associated with poorer cancer outcomes and may predispose to chronic conditions but the prevalence of these among cancer survivors is not well defined. The objectives of this cross-sectional study were to determine whether those with history of cancer have a greater prevalence of chronic conditions and whether their lifestyle behaviours differ from cancer free controls. Methods: Cross-sectional self-reported data were obtained from adult telephone survey respondents between January 2010 and March 2012. Age and gender matched individuals who did not report a cancer diagnosis were randomly selected from the same data source as controls. Data reported included rates of cardiovascular disease, hypertension, hyperlipidaemia, diabetes, and osteoporosis, lifestyle behaviours (diet, physical activity and smoking), obesity, psychological distress and self-reported health. Between-group differences were assessed using McNemar’s test. Results: 2,103 cases and 4,185 controls were included in the analyses. Cancer cases had a higher prevalence than controls for all chronic conditions: cardiovascular disease 22.1% vs 18.4%, p=0.001; hypertension 53.3% vs 50%, p=0.015; hyperlipidaemia 47.8% vs 41.8%, p

This study examined the convergent validity of a computerized use of time diary (MARCA) relative to pedometry. Participants aged 9–16 years wore a pedometer and completed the MARCA. Comparing pedometer data and self-report data collected for the same day (n = 297 participants), the correlation (Spearman’s rho) with PAL was 0.54 and with MVPA was 0.50. Comparing mean daily step counts over 6–7 days with averaged self-report data collected on different days (n = 1713 participants) Spearman’s rho for PAL was 0.45 and for MVPA was 0.44. Thus, the MARCA showed validity similar or superior to most self-report instruments for young people.

Background Rural Australian adults are continually shown to be insufficiently active with higher prevalence of lifestyle-related diseases associated with physical inactivity compared to urban adults. This may, partly, be attributable to the challenges associated with implementing community-based physical activity programs in rural communities. There is a need for broadly accessible physical activity programs specifically tailored to the unique attributes of rural communities. The aim of the Rural Environments And Community Health (REACH) study is to evaluate the effectiveness of an online-delivered physical activity intervention for increasing regular walking among adults living in rural areas of South Australia. Methods/Design This is a randomised controlled trial. The intervention is 12-weeks with a 12-month follow-up. Participants will be insufficiently active, aged 18 to 70 years and randomly assigned to either Control or Intervention group. Participants receive a pedometer, but only the Intervention group will receive access to the purpose built REACH website where they will report steps taken, affect and ratings of perceived exertion during daily walking. These variables will be used to establish individualised step goals for increasing walking. Control participants will receive a paper diary to record their variables and generic incremental step goals. The primary outcome measures are time spent in sedentary, light and moderate-to-vigorous intensity physical activity, measured by accelerometry. Secondary outcomes include 1) health measures (anthropometric and physiological), 2) psychological well-being, 3) diet quality, and 4) correlates of physical activity (exercise self-efficacy and physical activity environments). Measures will be collected at baseline, post-intervention, 6-month and 12-month follow-up. Discussion This protocol describes the implementation of a trial testing the effectiveness of an online resource designed to assist rural Australians to become more physically active. The outcomes of this study will guide the efforts of health promotion professionals by providing evidence for a relatively inexpensive, widely accessible and effective method for increasing physical activity that can be utilized by anyone with access to the internet. Findings may indicate future directions for the implementation of physical activity and other health related interventions in rural communities. Trial registration Australian New Zealand Clinical Trials Registry: ACTR12614000927628 (registered 28 August 2014).