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Introduction: A growing body of research has examined the physical, psychological, social and financial impacts of living kidney donation. However, little is known about the unique experiences or additional burdens faced by living donors from regional or remote locations. Objective: To explore the experiences of living kidney donors who live outside metropolitan centres and to determine how support services could be orientated to better meet their unique needs. Design/Setting/Participants: Seventeen living kidney donors participated in semistructured telephone interviews. Qualitative data were analysed using thematic analysis. Findings: Eight themes were identified: (1) donor's emotional well‐being is influenced by the recipient's outcome, (2) varied levels of access to medical support and other important services in rural areas, (3) travel takes a toll on time, finances and well‐being, (4) varied level of financial impact, (5) medical, emotional and social challenges, (6) both lay and health professional support is valued, (7) varied levels of knowledge and experiences accessing information and (8) a worthwhile experience overall. Conclusion: Despite many challenges, and travel adding to the complexity, rural living kidney donors generally consider it to be a worthwhile experience. The provision of additional emotional, practical and educational support would be welcomed by this group. [ABSTRACT FROM AUTHOR]

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

Approaches to weight management have traditionally focussed on caloric intake versus caloric expenditure. Despite a range of interventions based on these approaches, the proportion of overweight children and adolescents continues to rise. There are increasing indications that other factors, such as sleep duration, may be at play. This commentary on current research related to the impact of sleep duration provides an insight into the mounting evidence of its possible link to overweight in children and adolescents. Here we focus on children and adolescents as typical age cohorts in schools experiencing health and physical education programs. Children and adolescents are sleeping less than ever before, and there is now emerging evidence that sleep duration has a profound effect on weight regulating hormones leading to weight gain. It is proposed that a 24-hour view of children and adolescents be taken into account. Moreover, a reassessment of the impact of sleep deprivation may lead to extra considerations in the information and practices embodied in the HPE curricula for the growing battle against obesity. (Contains 2 tables and 3 figures.)

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

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

Farming is a physically and psychologically hazardous occupation and farmers face numerous attitudinal and structural barriers to accessing mainstream health and mental health services. As Internet access increases across rural Australia there is potential for online interventions to help overcome barriers and provide new avenues for improving farmers' mental health and wellbeing. However, little is known about how farmers perceive this approach which is problematic given the importance of building in their preferences, to ensure these interventions meet their interests and needs, and have maximum impact. The purpose of this study was to explore the scope of Australian farmers' current Internet use and their views and preferences on the design and delivery of online, mental health and wellbeing-focused interventions. Eighteen farmers (11 men and 7 women, with a median age of 45.5 years) from grain, sheep and/or cattle farms across four states of Australia participated. Telephone-based, semi-structured interviews were used to explore their current Internet use practices and preferences regarding new websites to promote farmers' mental health and wellbeing. Thematic Framework Analysis was used to analyze and organize the data. Eight key topics were discussed and several themes within each topic emerged. The first topic related to farmers' current Internet use practices (found to be sporadic, used for weather, banking, emails and research, they are open to using it for health and wellbeing, and they reported that Twitter and other social media reduces social isolation). Themes demonstrating farmers' specific preferences on four aspects of web-design included; preferred aesthetics (authenticity, reflective of farmer diversity, simple layout and font, colours of nature, mix of cartoons and real-life, positive, masculine imagery); preferred language (lay, casual tone, careful use of humour, positive/empowering); preferred technical aspects/capabilities (unreliable Internet connections, limited downloads, compatibility with multiple devices, easy to use, inclusion of music problematic, mixed opinion about inclusion of scientific references and chat features, include videos, case studies) and preferred content/focus for websites of this type (early intervention/prevention, where and how to seek more help). More broadly, contextual influences to consider (multiple pressures of farm life, time poverty, farmers' outlook is practical and outcome-driven, stigma about mental health decreasing but still exists); strategies to promote engagement (must feel engaged, know what is next, see benefits quickly) and marketing/promotion suggestions (women as advocates for men, use trusted sources to promote, emphasize that information can be accessed from privacy of own home/farm) were also highlighted by participants. Findings will help inform the development of new mental health and wellbeing-focused online interventions for farmers to maximize uptake, engagement and impact. In particular, these interventions need to be perceived as relevant and authentic, while also reflecting the diversity of the farming population, which farmers believe can be achieved by carefully considering their preferences for aesthetics, language, technological requirements and the unique farming context. • Authentic, positive (e.g. not drought), masculine, farming-related imagery in the colours of nature (particually green) favoured. • Videos, case studies, simple layouts and fonts preferred. • Lay language that is casual, positive, empowering and carefully humorous valued. • Ease of use, multiple device compatibility and the ability to operate with poor internet is important. • Exposure to multiple pressures, lack of time, practical and outcome-driven nature and stigma concerns require consideration. • There is a particular need for new online resources focusing on early intervention/prevention. [ABSTRACT FROM AUTHOR]

Background: The after-school period is potentially a "critical window" for promoting physical activity in children. The purpose of this study was to qualitatively explore children's perceptions of the factors influencing their engagement in physical activity during the after-school period as the first phase in the development of a questionnaire. Methods: Fifty-four South Australian children age 10-13 years participated in same gender focus groups. Transcripts, field notes, and activity documents were analyzed using content analysis. Through an inductive thematic approach, data were coded and categorized into perceived barriers and facilitators according to a social ecological model. Results: Children identified a number of factors, including safety in the neighborhood and home settings, distance to and from places, weather, availability of time, perceived competence, enjoyment of physical activity, peer influence, and parent influence. New insights into bullying and teasing by peers and fear of dangerous animals and objects were revealed by the children. Conclusions: In this study, hearing children's voices allowed the emergence of factors which may not be exposed using existing surveys. These findings are grounded in children's perceptions and therefore serve as a valuable contribution to the existing literature, potentially leading to improved intervention and questionnaire design. [ABSTRACT FROM AUTHOR]

Objective: Little is known about how the physical environment impacts physical activity behaviour among rural populations, who are typically less active and at higher risk of chronic disease than urban dwellers. The lack of individual-level instruments to assess the physical environment in rural areas limits advancement of this field. Among rural adults, this study aimed to evaluate (a) the test-retest reliability of a self-reported questionnaire of individual-level perceptions of the physical activity environment, and (b) the stability of a self-reported physical activity questionnaire. Design: Cross-sectional questionnaire repeated twice, 2 weeks apart. The questionnaire included 94 items relating to the perceived physical environment (representing nine summary scores), demographic characteristics and physical activity. Setting: Rural Australia. Participants: Rurally residing adults (>18 years) across three Australian states. Main outcome measures: Test-retest reliability evaluated by weighted Kappa statistics (individual items) and intra-class correlations (summary scores). Results: A total of 292 participants (20% men) completed both questionnaires, on average 22 days apart. Test-retest reliability of individual items ranged from weighted Kappa 0.37-0.85 (median: 0.59). Internal reliability for five summary scores was good to excellent (Cronbach's alpha: 0.81-0.97). Test-retest reliability was good to excellent for six summary scores (intra-class correlations: 0.67-0.77). Conclusions: The findings indicated good to excellent test-retest reliability for most items, particularly "fixed" constructs for this new questionnaire measuring the perceived physical environment in rural populations. This study represents an important step towards improving measurement of physical activity environments in rural populations, potentially leading to better tailored interventions to promote active and healthy living in rural areas. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

This study examined whether active commuting to and from school was associated with more frequent walking and cycling to other neighborhood destinations. Parents reported on free-time physical activity and frequency of active commuting among 1,643 South Australians (9-15 years), as well as their perceptions of risk associated with active commuting in the neighborhood. Groups were formed on the basis of active and motorized transport to and from school and compared on the frequency of walking and cycling to other neighborhood destinations. Those who actively commuted between home and school were approximately 30% more likely to actively commute to other neighborhood destinations, independent of age, free-time physical activity, and neighborhood risk. Active commuting to and from school is part of a broader habit of walking and cycling in the neighborhood among school age South Australians. The advantages of promoting active transport between home and school might extend beyond the energy expenditure of that journey alone. [ABSTRACT FROM AUTHOR]

Objective: The 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.Design: Cross-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.Setting: Victoria, Australia.Subjects: Adolescents (n 939) in School Year 11 (mean age 16·8 years).Results: The 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.Conclusions: Individual 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. [ABSTRACT FROM AUTHOR]

Aim: To examine secular trends in Australian children's actual sleep time as well as the perceived importance of sleep between 1985, 2004 and 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 socio-economic status (SES), age and sex. The children self-reported their bedtime, 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 (minutes) 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. [ABSTRACT FROM AUTHOR]

Objective: There is limited understanding as to why children of low socio-economic position (SEP) consume poorer diets than children of high SEP. Evidence suggests that determinants of dietary intake may differ between SEP groups. The present study aimed to determine if SEP moderated associations of personal and environmental predictors with children's non-core food and sweetened drink intakes and unhealthy dietary behaviours.Design: Children completed online questionnaires and parents completed computer-assisted telephone interviews to assess intrapersonal and environmental dietary predictors. Dietary intake was measured using an FFQ. Parents reported demographic information for maternal education, occupation and employment, and household income.Setting: Twenty-six primary schools in South Australia, Australia.Subjects: Children aged 9-13 years and their parents (n 395).Results: Multiple personal and home environment factors predicted non-core food and sweetened drink intakes, and these associations were moderated by SEP. Maternal education moderated associations of girls' sweetened drink intake with self-efficacy, cooking skills and pressure to eat, and boys' non-core food intake with monitoring, parent's self-efficacy and home environment. Maternal occupation and employment moderated associations of sweetened drink intake with attitudes, self-efficacy, pressure to eat and food availability, and non-core food intake with parents' self-efficacy and monitoring. Income moderated associations with pressure to eat and home environment.Conclusions: Identifying differences in dietary predictors between socio-economic groups informs understanding of why socio-economic gradients in dietary intake may occur. Tailoring interventions and health promotion to the particular needs of socio-economically disadvantaged children may produce more successful outcomes and reduce socio-economic disparities in dietary intake. [ABSTRACT FROM AUTHOR]

A critical period when sleep is likely to be under greatest pressure is during the senior high school years when academic demands are particularly intense with an increasing emphasis on homework. Sleep habits vary with culture as do attitudes toward academic success. What is unclear is how well students from different cultural backgrounds balance the competing demands of study and sleep and the potential consequences on their mental health. In this study, 101 Asian-Australian and 297 Caucasian-Australian senior year high school students completed a standardized omnibus questionnaire examining extracurricular activity (homework, paid work, sports, exercise, and other organized activities), sleep habits, and mental health (depressive mood, study/ interpersonal stress, and coping). Analyses revealed that sleep habits and extracurricular activity varied with culture. These differences were most evident on school nights where Asian-Australian compared to Caucasian-Australian adolescents reported later bed and rise times and shorter sleep lengths. Although the total amount of time spent on extracurricular activity was similar, Asian-Australian adolescents undertook significantly more homework after school while Caucasian-Australian adolescents spent more time undertaking paid work, sports, and exercise. Regression analyses revealed that extracurricular activity including homework was not predictive of sleep length in either Asian or Caucasian adolescents. Further analyses revealed that predictors of mental health were most evident in Caucasian-Australian adolescents. In the latter group, female gender, less time spent on nonhomework activities, shorter sleep and daytime sleepiness were associated with depressed mood while female gender, increased homework time and daytime sleepiness were associated with increased study/interpersonal stress. These findings highlight the importance of culture in understanding the role of extracurricular activity on sleep and mental health in senior school students. [ABSTRACT FROM AUTHOR]

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 YPASS: 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. [ABSTRACT FROM AUTHOR]

Background: Both reduced moderate-to-vigorous physical activity (MVPA) and increased screen time have been implicated in the aetiology of childhood overweight/obesity. This study aimed to determine which behaviour had the stronger association with overweight/obesity. Method: 2200 randomly selected 9- to 16-year-old Australians provided four 24-h use-of-time recalls. Participants were classified into weight status categories and as high or low physical active, and high or low screen time according to Australian guidelines (≥60 min MVPA; ≤120 min recreational screen time daily). Multivariate logistic regression was used to calculate the odds ratios (OR) for overweight/obesity for each screen time and MVPA category. Results: Increased likelihood of overweight or obese was often associated with high screen time (ORs, 2.13-2.55 for boys and 1.47-1.72 for girls), but only sometimes and less strongly associated with low MVPA (ORs, 0.49-2.55 for boys and 1.06-1.47 for girls). Analyses conducted for combined screen time and MVPA categories showed screen time to be a stronger indicator of weight status than physical activity, especially in boys. Conclusion: Overweight and obesity were more strongly associated with screen time than physical activity. Screen time may be an important target for interventions aimed at reducing childhood overweight and obesity. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

This study evaluated the reliability of the 5-min psychomotor vigilance task (PVT) in a single-sex Australian primary school. Seventy-five male students (mean age = 11.82 years, SD = 1.12) completed two 5-min PVTs using a Palm personal digital assistant (PDA) in (1) an isolated setting and (2) a classroom setting. Of this group of students, a subsample of 37 students completed a test-retest reliability trial within the classroom setting. Using a mixed-model analysis, there was no significant difference in the mean response time (RT) or number of lapses (RTs ≥ 500 msec) between the isolated and the classroom setting. There was, however, an order effect for the number of lapses in the isolated setting, with the number of lapses being greater if the isolated test was conducted second. Test-retest intraclass correlation coefficients (ICCs) in the classroom setting indicated moderate to high reliability (mean RT = .84, lapses = .59). Bland-Altman analysis showed no systematic difference between the two settings. Findings suggest that the 5-min PDA PVT is a reliable measure of sustained attention in the classroom setting in this sample of primary-aged schoolchildren. The results provide further evidence for the versatility of this measuring device for larger interventions outside the laboratory. [ABSTRACT FROM AUTHOR]

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

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. [ABSTRACT FROM AUTHOR]

The article presents a study trialling the feasibility of an interactive software program titled HealthScreenPro that summarizes risk profile as a health age and will be used as a prompt to increase regular physical activity (PA) in rural Australian adults. Topics include the use of health status, body mass index, waist girth, and blood pressure to categorize participants and determine their health age, and participants' belief that the strategy would motivate them to increase PA.

The article offers a study attempted to fill the unique rural‐context gap by investigating the felt needs, attitudes and perceptions of rural Australians regarding a mHealth cardiac rehabilitation (CR ) maintenance program focusing on physical activity. Topics discussed include questionnaire based on technological literacy and technological use and also explored the felt needs of the participants in relation to a mHealth physical activity maintenance CR program.

Purpose: The aim of this research was to develop a contextually and culturally appropriate scale to assess farmers' barriers to health-related help-seeking., Methods: An initial pool of items was developed from the academic literature and input from an expert panel of farmers, rural academics, and rural clinicians. A draft 32-item questionnaire was then developed and sent to farmers registered with FARMbase, which is an Australian national farmer database., Findings: Two hundred and seventy-four farmers completed the draft questionnaire (93.7% male, 73.7% aged 56-75 years). An exploratory factor analysis identified 6 factors; "Health Issues are a Low Priority," "Concerns about Stigma," "Structural Health System Barriers," "Minimization and Normalization," "Communication Barriers," and "Continuity of Care.". Test-retest reliability was examined with a further 10 farmers (90% male, Mean age = 57, SD = 5.91), who completed the questionnaire twice (at 2- to 3-week intervals). Results indicated moderate-good test-retest reliability., Conclusions: The resulting 24-item Farmer Help-Seeking Scale provides a measure of help-seeking that is specifically designed to capture the unique context, culture, and attitudes that can interfere with farmers' help-seeking, and inform the development of strategies to increase health-service utilization in this at-risk group., (© 2023 The Authors. The Journal of Rural Health published by Wiley Periodicals LLC on behalf of National Rural Health Association.)

Background: Socio-economic position (SEP) in adolescence may influence diet quality over the life course. However, knowledge of whether individual and environmental determinants of diet quality mediate the longitudinal association between SEP and diet quality is limited. This study examined whether and to what extent food-related capabilities, opportunities and motivations of adolescents mediated the longitudinal association between SEP in adolescence and diet quality in early adulthood overall and by sex., Methods: Longitudinal data (annual surveys) from 774 adolescents (16.9 years at baseline; 76% female) from ProjectADAPT (T1 (baseline), T2, T3) were used. SEP in adolescence (T1) was operationalized as highest level of parental education and area-level disadvantage (based on postcode). The Capabilities, Opportunities and Motivations for Behaviour (COM-B) model was used as a framework to inform the analysis. Determinants in adolescence (T2) included food-related activities and skills (Capability), home availability of fruit and vegetables (Opportunity) and self-efficacy (Motivation). Diet quality in early adulthood (T3) was calculated using a modified version of the Australian Dietary Guidelines Index based on brief dietary questions on intake of foods from eight food groups. Structural equation modelling was used to estimate the mediating effects of adolescents' COM-B in associations between adolescent SEP and diet quality in early adulthood overall and by sex. Standardized beta coefficients (β) and robust 95% confidence intervals (CI) were generated, adjusted for confounders (T1 age, sex, diet quality, whether still at school, and living at home) and clustering by school., Results: There was evidence of an indirect effect of area-level disadvantage on diet quality via Opportunity (β: 0.021; 95% CI: 0.003 to 0.038), but limited evidence for parental education (β: 0.018; 95% CI: -0.003 to 0.039). Opportunity mediated 60.9% of the association between area-level disadvantage and diet quality. There was no evidence of an indirect effect via Capability or Motivation for either area-level disadvantage or parental education, or in males and females separately., Conclusions: Using the COM-B model, the home availability of fruit and vegetables (Opportunity) of adolescents explained a large proportion of the association between area-level disadvantage in adolescence and diet quality in early adulthood. Interventions to address poor diet quality among adolescents with a lower SEP should prioritize environmental determinants of diet quality., (© 2023. The Author(s).)

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

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.

The study aimed to develop and evaluate a multicomponent school and home based physical activity (PA) intervention in children in grades 3-7 (aged 8-13 years) and determine the psychological variables that influence PA; 10 × 1 h school-based training sessions, a home-based activity program and 4 × 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 > 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's self-reported PA in the intervention school positively correlated with: outcome expectancy (R = 0.240, p = 0.015), enjoyment (R = 0.339, p < 0.001), self-efficacy (R = 0.399, p < 0.001), self-management (R = 0.617, p < 0.001), social support at home (R = 0.406, p < 0.001), and social support at school (R = 0.407, p < 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.

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±12.5years), 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 ≥30min, between baseline and twelve-month follow-up (p<0.05). From baseline to twelve-month follow-up, MVPA (total min and bouts ≥10min) 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., (Copyright © 2018 Sports Medicine Australia. Published by Elsevier Ltd. 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±12.4years) 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 (>30min) 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., (Copyright © 2018 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

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).

Background: The 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., Methods: Cross-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., Results: The 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., Conclusions: Increasing 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.

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 aged10-12 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.

Objective: The socio-ecological milieu of children's physical activity is changing, perhaps causing perturbations within the causal 'web' that explains physical activity behaviours. It is unclear if the relative importance of parental role modelling is changing. Accordingly, this study examined associations of child-perceived parent physical activity and children's sport participation in 1985 and 2004., Methods: In 1985 (179 girls, 211 boys) and 2004 (210 girls, 218 boys), Australian schoolchildren (9-15 years) in the same eight schools were surveyed on sport participation and perceptions of parents' physical activity., Results: In the 1985 sample, girls with active fathers played more sport. In 2004, boys and girls with active fathers or active mothers reported higher sport participation. In 1985, there were no differences in sport participation between those with both, either or neither parent active. In 2004, sport participation was highest among boys and girls with both parents active., Conclusions: These results underscore the current role of parents as socialising agents for physical activity., Implications: Intervention design should be founded on the most recent evidence of children's physical activity correlates., (© 2010 The Authors. ANZJPH © 2010 Public Health Association of Australia.)

The study aimed to establish pedometer step cut points in relation to weight status among 2,071 5-16 year old Australians. Height, weight and waist circumference were measured, and participants wore a pedometer for seven days. Pedometer values were taken as the average number of steps per day and weighted according to the ratio of weekdays to weekends. Receiver operating characteristic (ROC) curves were used to identify the optimal pedometer counts to predict overweight. Analysis of covariance (ANCOVA) was used to compare anthropometric variables across pedometer step quintiles. The ROC model for older females was nonsignificant. Optimal cut points were 12,000 for younger males, 11,000 for older males and 10,000 for younger females. These were largely confirmed by ANCOVA. The cut points were lower than previously reported for equivalent age groups. Cultural and environmental differences may necessitate population-specific guidelines to be established.

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<0.0001)., Conclusions: The association between weight status and sleep duration showed consistent gradients across weight categories, but only for certain day types., Implications: These patterns cast light on the direction of causation in the obesity-sleep duration relationship. Findings suggest that short sleep duration contributes to obesity, or that a third unidentified factor has an impact on both., (© 2010 The Authors. Journal Compilation © 2010 Public Health Association of Australia.)

Social support is a consistent correlate of youth physical activity (PA) but few studies have examined this in cultural sub-groups. Female adolescents (n=113; 13.9+/-0.6years) from a metropolitan single sex private school participated in this study. PA was estimated using the 3 Day Physical Activity Recall (3dPAR), and aspects of social support using a specifically designed questionnaire. Anglo-Australians (n=74), whose parents were both born in Australia, were compared with Vietnamese-Australians (n=39), whose parents were both born in Vietnam. There were non-significant trends towards higher engagement in all measures of PA among Anglo-Australians. Anglo-Australians perceived higher levels of social support to be physically active. In the whole sample and in cultural sub-groups, support by mothers was a consistent predictor of PA. Among Vietnamese-Australians, activities shared with the mother predicted moderate to vigorous PA. Interventions targeting PA among adolescent females should consider interactions of social support and cultural background.

There is accumulating evidence of worldwide declines in cardiorespiratory endurance (CRE) among children. To date, few studies have focused on trends in distributional characteristics of CRE performance. This study analyzed 1985 and 1997 samples of Australian children on the 1.6 km run/walk test, using a variety of descriptive and inferential statistics to compare distributions of average running speed among 10- to 11-year-olds. The analysis was conducted on 965 boys and 935 girls from 1985, and 661 boys and 553 girls from 1997. Among boys there was a significant increase in the coefficient of variation of average completion times, with a marked decrease in negative skew. This was largely attributable to the largest declines occurring in the middle percentiles, with relatively smaller declines at low (<5th) and high (>90th) percentiles. The bulk of the scores have shifted towards the left side of the distribution, reducing the skew. Among girls the distributional trends were different; there was little change in 'scatter' and skew of test scores, with declines in performance being relatively uniform across the distribution. These findings contrast with previous reports of greater declines among the lowest ranked performers on CRE tests. The observed declines in all percentiles other than the lowest and highest ranked boys suggest that mechanisms for declining fitness are widespread throughout the population and may reflect changes in environmental barriers and enablers of regular physical activity among Australian youth.

Objective: To investigate secular trends in waist girth and skinfold measures among Australian children from 1985 and 1997/2002, matched for body size., Subjects: A total of 2604 children (10-12 years old) measured in the 1985 Australian Health and Fitness Survey and in two later surveys of South Australian schoolchildren (1997/2002), were matched for age, stature, weight and body mass index (BMI). Measurements. The matched children were compared by ANOVA on waist and hip girths, waist-to-hip ratio (WHR) and abdominal and triceps skinfolds, taken by trained anthropometrists., Results: Between the survey periods, there were significant increases in waist girth, WHR, and the two skinfold measures, but more so for abdominal skinfold. The differences in abdominal skinfold, waist girth and WHR were greater for girls than boys., Conclusions: In Australian children matched for body size, there have been increases in measures of fatness and central adiposity over the last 20 years. This suggests that reported secular trends in BMI may be under-estimating the looming public health crisis.