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Residential areas may shape health, yet few studies are longitudinal or concurrently test relationships between multiple residential features and health. This longitudinal study concurrently assessed the contributions of multiple environmental features to 10-year change in clinically measured body mass index (BMI) and waist circumference (WC). Longitudinal data for adults (18+ years of age, n = 2253) from the north-west of Adelaide, Australia were linked to built environment measures representing the physical activity and food environment (expressed for residence-based 1600 m road-network buffers) and area education. Associations were concurrently estimated using latent growth models. In models including all environmental exposure measures, area education was associated with change in BMI and WC (protective effects). Dwelling density was associated with worsening BMI and WC but also highly correlated with area education and moderately correlated with count of fast food outlets. Public open space (POS) area was associated with worsening WC. Intersection density, land use mix, greenness, and a retail food environment index were not associated with change in BMI or WC. This study found greater dwelling density and POS area exacerbated increases in BMI and WC. Greater area education was protective against worsening body size. Interventions should consider dwelling density and POS, and target areas with low SES., Competing Interests: The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Objective: This study sought to assess whether changes in depressive symptoms, general health, and area-level socio-economic status (SES) were associated to changes over time in waist circumference and body mass index (BMI)., Methods: A total of 2871 adults (18 years or older), living in Adelaide (South Australia), were observed across three waves of data collection spanning ten years, with clinical measures of waist circumference, height and weight. Participants completed the Centre for Epidemiologic Studies Depression (CES-D) and Short Form 36 health questionnaires (SF-36 general health domain). An area-level SES measure, relative location factor, was derived from hedonic regression models using residential property features but blind to location. Growth curve models with latent variables were fitted to data., Results: Waist circumference, BMI and depressive symptoms increased over time. General health and relative location factor decreased. Worsening general health and depressive symptoms predicted worsening waist circumference and BMI trajectories in covariate-adjusted models. Diminishing relative location factor was negatively associated with waist circumference and BMI trajectories in unadjusted models only., Conclusions: Worsening depressive symptoms and general health predict increasing adiposity and suggest the development of unhealthful adiposity might be prevented by attention to negative changes in mental health and overall general health., Competing Interests: The authors declare that no competing interests exist.

Background : Perceptions of neighbourhood attributes such as proximity of food retailers that are discordant with objective measures of the same are associated with poor health behaviours and weight gain. Factors associated with discordant perceptions are likely relevant to planning more effective interventions to improve health. Purpose : Analysis of cross-sectional relationships between individual and neighbourhood factors and overestimations of walking distances to local fruit/vegetable retailers (FVR). Methods : Perceived walking times, converted to distances, between participant residences and FVR were compared with objectively-assessed road network distances calculated with a Geographic Information System for n = 1305 adults residing in Adelaide, South Australia. Differences between perceived and objective distances were expressed as 'overestimated' distances and were analysed relative to perceptions consistent with objective distances. Cross-sectional associations were evaluated between individual socio-demographic, health, and area-level characteristics and overestimated distances to FVR using multilevel logistic regression. Results : Agreement between objective and perceived distances between participants' residence and the nearest FVR was only fair (weighted kappa = 0.22). Overestimated distances to FVR were positively associated with mental well-being, and were negatively associated with household income, physical functioning, sense of community, and objective distances to greengrocers. Conclusions : Individual characteristics and features of neighbourhoods were related to overestimated distances to FVR. Sense of connectivity and shared identity may shape more accurate understandings of local resource access, and offer a focal point for tailored public health initiatives that bring people together to achieve improved health behaviour.

Objectives: To compare the biomedical health profile and morbidity of adult carers with non-carers., Methods: The North West Adelaide Health Study (NWAHS) is a representative population-based longitudinal biomedical cohort study of 4056 participants aged 18 years and over at Stage One. Informal (unpaid) carers were identified in Stage 3 of the project (2008-2010). Risk factors, chronic medical conditions and biomedical, health and demographic characteristics using self-report and blood measured variables were assessed. Data were collected through clinic visits, telephone interviews and self-completed questionnaires. Risk factors included blood pressure, cholesterol/lipids, body mass index (BMI), smoking and alcohol intake. Chronic medical conditions included cardiovascular and respiratory diseases, diabetes, and musculoskeletal conditions. Blood measured variables were routine haematology, biochemistry, Vitamin D, and the inflammatory biomarkers high sensitivity C-Reactive Protein (hs-CRP), Tumor Necrosis Factor alpha (TNFα) and Interleukin-6 (Il-6)., Results: The prevalence of carers aged 40 years and over was 10.7%, n = 191. Carers aged 40 years and over were more likely to assess their health status as fair/poor and report having diabetes, arthritis, anxiety and depression. They also reported insufficient exercise and were found to have higher BMI compared with non-carers. Significant findings from blood measured variables were lower serum Vitamin D and haemoglobin. Male carers had raised diastolic blood pressure, higher blood glucose, lower haemoglobin and albumin levels and slightly elevated levels of the inflammatory biomarkers TNFα and hs-CRP., Discussion and Conclusions: This study confirms informal carers had different biomedical profiles to non-carers that included some chronic physical illnesses. It identifies that both female and male carers showed a number of risk factors which need to be considered in future caregiver research, clinical guidelines and policy development regarding carer morbidity., Competing Interests: The authors have declared that no competing interests exist.

Background: Although Australia is a country cited as having generally low health inequalities among different socioeconomic groups, inequalities have persisted. The aim of this analysis was to highlight how inequalities have evolved over a 13 years period in South Australia (SA)., Methods: Since 2002, over 600 interviews per month have been undertaken with SA residents through a computer assisted telephone survey method (total 77,000+). Major risk factors and chronic diseases have been analyzed providing trends by two socio-economic variables: education and a proxy of income (ability to save)., Results: While income and educational gaps are reducing over time in SA, those that remain in the lower socio-economic groups have a generally higher prevalence of risk factors and chronic diseases. The health disparity gap is still relevant, although at a different extent, for all the variables considered in our study, with most appearing to be stable if not increasing over time., Conclusions: Surveillance can be a good source of information both to show the evolution of problems and to evaluate possible future interventions. Extensive effort is still required to "close the gap" of health inequalities in SA. More precisely targeted and properly implemented interventions are needed.

Background: There is growing discussion on the impact of informal caregiving on the health status and morbidity of family carers. Evidence suggests a proportion of carers may be at risk of poor health outcomes. However, there are limited population-based studies that provide representative data on specific risk factors among carers (eg, blood pressure, cholesterol, smoking status, activity and body mass index) and major chronic conditions (eg, asthma, diabetes and arthritis). This study aimed to redress that imbalance., Method: Self-reported data were from the South Australian Monitoring and Surveillance System (SAMSS), a representative cross-sectional state-wide population-based survey of 600 randomly selected persons per month. SAMSS uses computer-assisted telephone interviewing (CATI) to monitor chronic health-related problems and risk factors and to assess health outcomes. In total, 2247 family carers were identified from 35 195 participants aged 16 years and older for the 5-year period from 2010 to 2015. Logistic regression analyses examined associations of being a carer with self-reported chronic diseases and health risk factors. In addition, the population attributable risk (PAR) of being a carer was examined for selected chronic conditions., Results: The prevalence of carers was 6.4%, and peak age group for carers was 50-59 years. Adjusted ORs for chronic conditions in carers were significant for all chronic conditions examined. Although there is a high prevalence of self-reported risk factors and chronic conditions among carers compared with non-carers at the population level, PAR findings suggest that caregiving is associated with a small to moderate increased risk of having these chronic conditions., Conclusions: Monitoring of carer health and morbidity particularly 'at risk' individuals such as female carers with asthma or diabetes remains important and provides an ongoing baseline for future surveys. To achieve this, caregiver-based studies need to become part of mainstream biomedical research at both epidemiological and clinical levels., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background & Aims: There is limited data relating to the effect of the combination of nutrients on inflammation and the interactions with lifestyle factors and chronic conditions. We examined the association between nutrient patterns and inflammatory markers C-reactive protein (CRP) and interleukin 6 (IL-6) in community dwelling middle-aged and elderly Australian men., Methods: Participants (mean age 59.7 y) with complete data relating to diet and fasting serum inflammatory markers in the Men Androgen Inflammation Lifestyle Environment and Stress cohort were analysed (n = 1577 for CRP, n = 1557 for IL-6). Food intake was assessed using a food frequency questionnaire, and nutrient patterns were identified by factor analysis. Biomedical examinations were conducted in The Queen Elizabeth Hospital and Lyell McEwin Health Service. CRP and IL-6 were log transformed due to the skewed distribution. Linear regression models were used to assess the association between nutrient patterns and inflammation., Results: We generated three nutrient patterns by factor analysis. An animal-sourced pattern (animal protein, cobalamin, cholesterol and omega-6) was positively associated with CRP (p for trend across quartiles 0.057). A plant-sourced pattern (beta-carotene, vitamin A, lutein and zeaxanthin) was inversely associated with CRP (p for trend across quartiles 0.005). The association between plant-sourced pattern and CRP was stronger in participants with severe sleep apnoea, smoking (p for interaction 0.019), and participants without diabetes (p for interaction 0.238) and/or with normal triglycerides (p for interaction 0.005) and high density lipoprotein (p for interaction 0.120) compared with their counterparts. No interactions were found between the animal-sourced pattern and lifestyle factors and chronic conditions. No independent associations were found between the animal/plant-sourced pattern and IL-6. No associations were found between the vitamin B and folate pattern (total folate, thiamine, riboflavin and niacin) and inflammatory markers., Conclusions: While an animal-sourced pattern may enhance inflammation level, a plant-sourced pattern may reduce inflammation particularly in people with less healthy lifestyles and severe obstructive apnoea., (Copyright © 2016 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

There is compelling evidence that parental weight is a strong determinant of offspring weight status. The study used cross-sectional self-reported and measured data from a longitudinal cohort of Australian adults (n = 2128) from Stage 3 (2008-10) of the North West Adelaide Health Study (1999-2003, baseline n = 4056) to investigate the association between midlife parental body shape and four indicators of obesity and fat distribution. The analysis used measured body mass index (BMI), waist circumference (WC), waist hip ratio (WHR) and waist height ratio (WHtR) of adult offspring, together with pictograms for recall of parental body shape. Compared to both parents being a healthy weight, offspring were more likely to be overweight or obese if both parents were an unhealthy weight at age 40 (OR 2.14, 95% CI 1.67-2.76) and further, those participants whose mother was an unhealthy weight were more likely to be overweight or obese themselves (OR 1.50, 95% CI 1.14-1.98). There were similar but lower results for those with an overweight/obese father (OR 1.44, 95% CI 1.08-1.93). The effect of one or both parents being overweight or obese tended to be stronger for daughters than for sons across BMI, WC and WHtR. BMI showed the strongest association with parental body shape (OR 2.14), followed by WC (OR 1.78), WHtR (OR 1.71) and WHR (OR 1.45). WHtR (42-45%) and BMI (35-36%) provided the highest positive predictive values for overweight/obesity from parental body shape. Parental obesity increases the risk of obesity for adult offspring, both for overall body shape and central adiposity, particularly for daughters. Pictograms could potentially be used as a screening tool in primary care settings to promote healthy weight among young adults.

Background: The considerably lower average life expectancy of Aboriginal and Torres Strait Islander Australians, compared with non-Aboriginal and non-Torres Strait Islander Australians, has been widely reported. Prevalence data for chronic disease and health risk factors are needed to provide evidence based estimates for Australian Aboriginal and Torres Strait Islanders population health planning. Representative surveys for these populations are difficult due to complex methodology. The focus of this paper is to describe in detail the methodological challenges and resolutions of a representative South Australian Aboriginal population-based health survey., Methods: Using a stratified multi-stage sampling methodology based on the Australian Bureau of Statistics 2006 Census with culturally appropriate and epidemiological rigorous methods, 11,428 randomly selected dwellings were approached from a total of 209 census collection districts. All persons eligible for the survey identified as Aboriginal and/or Torres Strait Islander and were selected from dwellings identified as having one or more Aboriginal person(s) living there at the time of the survey., Results: Overall, the 399 interviews from an eligible sample of 691 SA Aboriginal adults yielded a response rate of 57.7%. These face-to-face interviews were conducted by ten interviewers retained from a total of 27 trained Aboriginal interviewers. Challenges were found in three main areas: identification and recruitment of participants; interviewer recruitment and retainment; and using appropriate engagement with communities. These challenges were resolved, or at least mainly overcome, by following local protocols with communities and their representatives, and reaching agreement on the process of research for Aboriginal people., Conclusions: Obtaining a representative sample of Aboriginal participants in a culturally appropriate way was methodologically challenging and required high levels of commitment and resources. Adhering to these principles has resulted in a rich and unique data set that provides an overview of the self-reported health status for Aboriginal people living in South Australia. This process provides some important principles to be followed when engaging with Aboriginal people and their communities for the purpose of health research.

Objective: The aim of this study is to describe the evolution of multimorbidity., Study Design and Setting: Data from 1854 South Australians who participated in the North West Adelaide longitudinal Health Study (NWAHS) was collected between baseline (2000-2002) and follow-up (2008-2010). Status for eight chronic diseases (CDs) was determined by biomedical measurement or self-report. Chronic disease (CD) mean age of occurrence and order of appearance was investigated., Results: The prevalence of multimorbidity increased from 32% to 64% during the 7.8±1.1 years of follow-up. The estimated mean age of onset of a new CD was significantly older for hypertension, cardiovascular disease (CVD) and chronic obstructive pulmonary disease (COPD) and younger for hypercholesterolemia, asthma and other mental problem. Hypercholesterolemia was more likely to develop as a first than as a subsequent CD (39%vs.16%, p<0.0001) while CVD (1%vs.5%, p<0.0001), diabetes (5%vs.11%, p<0.001) and COPD (6%vs.16%, p<0.0001) were less likely. The presence of mood disorders at baseline was associated with an increased risk of developing other mental disorders (36%vs.12%, p<0.0001), diabetes (18%vs.9%, p<0.01) and asthma (30%vs.21%, p<0.05)., Conclusion: Longitudinal data could be used to study the evolution of multimorbidity and could provide information on CDs mean age of occurrence, order of appearance and impact on the development of future CDs.

Objective: This study examined whether attributes of pedestrian environments moderate the relationships between access to public open spaces (POS) and adults' recreational walking., Methods: Data were collected from participants of the North West Adelaide Health Study in 2007. Recreational walking was determined using self-reported walking frequency. Measures of POS access (presence, count, and distance to the nearest POS) were assessed using a Geographic Information System. Pedestrian environmental attributes included aesthetics, walking infrastructure, barrier/traffic, crime concern, intersection density, and access to walking trails. Regression analyses examined whether associations between POS access and recreational walking were moderated by pedestrian environmental attributes., Results: The sample included 1574 participants (45% men, mean age: 55). POS access measures were not associated with recreational walking. However, aesthetics, walking infrastructure, and access to walking trail were found to moderate the POS-walking relationships. The presence of POS was associated with walking among participants with aesthetically pleasing pedestrian environments. Counter-intuitively, better access to POS was associated with recreational walking for those with poorer walking infrastructure or no access to walking trails., Conclusion: Local pedestrian environments moderate the relationships between access to POS and recreational walking. Our findings suggest the presence of complex relationships between POS availability and pedestrian environments., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: Indicators of cardiometabolic risk typically include non-clinical factors (e.g., smoking). While the incorporation of non-clinical factors can improve absolute risk prediction, it is impossible to study the contribution of non-clinical factors when they are both predictors and part of the outcome measure. Metabolic syndrome, incorporating only clinical measures, seems a solution yet provides no information on risk severity. The aims of this study were: 1) to construct two continuous clinical indices of cardiometabolic risk (cCICRs), and assess their accuracy in predicting 10-year incident cardiovascular disease and/or type 2 diabetes; and 2) to compare the predictive accuracies of these cCICRs with existing risk indicators that incorporate non-clinical factors (Framingham Risk Scores)., Methods: Data from a population-based biomedical cohort (n = 4056) were used to construct two cCICRs from waist circumference, mean arteriole pressure, fasting glucose, triglycerides and high density lipoprotein: 1) the mean of standardised risk factors (cCICR-Z); and 2) the weighted mean of the two first principal components from principal component analysis (cCICR-PCA). The predictive accuracies of the two cCICRs and the Framingham Risk Scores were assessed and compared using ROC curves., Results: Both cCICRs demonstrated moderate accuracy (AUCs 0.72 - 0.76) in predicting incident cardiovascular disease and/or type 2 diabetes, among men and women. There were no significant differences between the predictive accuracies of the cCICRs and the Framingham Risk Scores., Conclusions: cCICRs may be useful in research investigating associations between non-clinical factors and health by providing suitable alternatives to current risk indicators which include non-clinical factors.

Objective: To determine trends in alcohol consumption in South Australia., Methods: Data collection from 2003 to 2011. Time series trends overall and by age, sex, education level, and income by proportion of drinkers, mean number of drinks, drinking less than one day, drinking on six or more days per week, lifetime alcohol risk and injury risk., Results: An overall decline in the proportion of alcohol drinkers, an increase in the overall proportion of adults drinking alcohol less than one day per week. No overall change in mean number of drinks consumed per day but with differences by demographic groups., Conclusion: This study presents multiple consumption-related variables over time and has highlighted important demographic variations in alcohol consumption.

Objective: The aim of this study was to examine changes in the prevalence of use of prescribed medicines in Australian community samples., Study Design and Setting: In this study, face-to-face interviews were carried out with random, representative samples of South Australian adults, aged ≥15 years. Data on self-reported use of prescribed medicines, most commonly reported categories of prescribed medicines and use of multiple medicines for common body systems were collected. It was not possible to distinguish between medicines prescribed for acute and chronic use., Results: A total of 3015 respondents were interviewed in 2004 and 3034 in 2008, representing participation rates of 76% and 73%. There was no significant increase in the prevalence of use of ≥1 (46.8% vs 47.3%, p = 0.6) or ≥6 medicines (5.7% vs 5.5%, p = 0.7). In both years, the use of medicines was higher in women (56.7% vs 57.5%). On subgroup analyses, a significant reduction in the use of medicines was observed in respondents aged 15-24 (25.0% vs 18.5%, p = 0.01) and ≥65 years (87.7% vs 82.5%, p = 0.01), whereas use in those aged 35-44 years increased significantly (26.4% vs 33.6%, p = 0.01). The number of cardiovascular system agents (23.1% vs 24.6%, p = 0.20) and psychotropic medicines (9.8% vs 10.6%, p = 0.35) used by respondents remained unchanged while use of respiratory (7.2% vs 5.7%, p = 0.01) and musculoskeletal system medicines (8.7% vs 5.6% p= < 0.001) decreased significantly., Conclusions: In presenting what we believe is the first Australian population-based study to compare changes in prescribed medicines across the adult age spectrum, we highlight some key questions to ensure the quality use of medicines. Our findings identify a need to discuss de-prescribing, monitor practices to minimise adverse events and challenge if consumers and prescribers need to consider the costs to governments of medicines., (Copyright © 2013 John Wiley & Sons, Ltd.)

Socioeconomic status is a strong predictor of cardiovascular disease. Pulse pressure, the difference between systolic and diastolic blood pressure, has been identified as an important predictor of cardiovascular risk even after accounting for absolute measures of blood pressure. However, little is known about the social determinants of pulse pressure. The aim of this study was to examine individual- and area-level socioeconomic gradients of pulse pressure in a sample of 2,789 Australian adults. Using data from the North West Adelaide Health Study we estimated the association between pulse pressure and three indices of socioeconomic status (education, income and employment status) at the area and individual level for hypertensive and normotensive participants, using Generalized Estimating Equations. In normotensive individuals, area-level education (estimate: -0.106; 95% CI: -0.172, -0.041) and individual-level income (estimate: -1.204; 95% CI: -2.357, -0.050) and employment status (estimate: -1.971; 95% CI: -2.894, -1.048) were significant predictors of pulse pressure, even after accounting for the use of medication and lifestyle behaviors. In hypertensive individuals, only individual-level measures of socioeconomic status were significant predictors of pulse pressure (education estimate: -2.618; 95% CI: -4.878, -0.357; income estimate: -1.683, 95% CI: -3.743, 0.377; employment estimate: -2.023; 95% CI: -3.721, -0.326). Further research is needed to better understand how individual- and area-level socioeconomic status influences pulse pressure in normotensive and hypertensive individuals.

Background: Accurate monitoring of health conditions and behaviours, and health service usage in the population, using an effective and economical method is important for planning and evaluation. This study examines the reliability of questions asked in a telephone survey by conducting a test/retest analysis of a range of questions covering demographic variables, health risk factors and self-reported chronic conditions among people aged 16 years and over., Methods: A Computer Assisted Telephone Interviewing (CATI) survey on health issues of South Australians was re-administered to a random sub-sample of 154 respondents between 13-35 days (mean 17) after the original survey. Reliability between questions was assessed using Cohen's kappa and intraclass correlation coefficients., Results: Demographic questions (age, gender, number of adults and children in the household, country of birth) showed extremely high reliability (0.97 to 1.00). Health service use (ICC = 0.90 95% CI 0.86-0.93) and overall health status (Kappa = 0.60 95% CI 0.46-0.75) displayed moderate agreement. Questions relating to self-reported risk factors such as smoking (Kappa = 0.81 95% CI 0.72-0.89) and alcohol drinking (ICC 0.75 = 95% CI 0.63-0.83) behaviour showed good to excellent agreement, while questions relating to self-reported risk factors such as time spent walking for physical activity (ICC 0.47 = 95% CI 0.27-0.61), fruit (Kappa(w) = 0.60 95% CI 0.45-0.76) and vegetable consumption (Kappa(w) = 0.50 95% CI 0.32-0.69) showed only moderate agreement. Self-reported chronic conditions displayed substantial to almost perfect agreement (0.72 to 1.00) with the exception of moderate agreement for heart disease (Kappa = 0.82 95% CI 0.57-0.99)., Conclusion: These results show the questions assessed to be reliable in South Australia for estimating health conditions and monitoring health related behaviours using a CATI survey.

Background: This study examined associations of abdominal adiposity with lung function, asthma symptoms and current doctor-diagnosed asthma and mediation by insulin resistance (IR) and sleep disordered breathing (SDB)., Methods: A random sample of 2500 households was drawn from the community of Whyalla, South Australia (The Whyalla Intergenerational Study of Health, WISH February 2008 - July 2009). Seven-hundred twenty-two randomly selected adults (≥18 years) completed clinical protocols (32.2% response rate). Lung function was measured by spirometry. Post-bronchodilator FEV1/FVC was used to measure airway obstruction and reversibility of FEV1 was calculated. Current asthma was defined by self-reported doctor-diagnosis and evidence of currently active asthma. Symptom scores for asthma (CASS) and SDB were calculated. Intra-abdominal fat (IAF) was estimated using dual-energy x-ray absorptiometry (DXA). IR was calculated from fasting glucose and insulin concentrations., Results: The prevalence of current doctor-diagnosed asthma was 19.9% (95% CI 16.7 - 23.5%). The ratio of observed to expected cases given the age and sex distribution of the population was 2.4 (95%CI 2.1, 2.9). IAF was not associated with current doctor-diagnosed asthma, FEV1/FVC or FEV1 reversibility in men or women but was positively associated with CASS independent of IR and SDB in women. A 1% increase in IAF was associated with decreases of 12 mL and 20 mL in FEV1 and FVC respectively in men, and 4 mL and 7 mL respectively in women. SDB mediated 12% and 26% of these associations respectively in men but had minimal effects in women., Conclusions: In this population with an excess of doctor-diagnosed asthma, IAF was not a major factor in airway obstruction or doctor-diagnosed asthma, although women with higher IAF perceived more severe asthma symptoms which did not correlate with lower FEV1. Higher IAF was significantly associated with lower FEV1 and FVC and in men SDB mechanisms may contribute up to one quarter of this association.

Purpose: Psychological distress encompasses anxiety and depression with the previous studies showing that psychological distress is unequally distributed across population groups. This paper explores the mechanisms and processes which may affect the distribution of psychological distress, including a range of individual and community level socioeconomic determinants., Methods: Representative cross-sectional data was collected for respondents aged 16+ from July 2008 to June 2009, as a part of the South Australian Monitoring and Surveillance System (SAMSS) using Computer Assisted Telephone Interviews (CATI). Univariate and multivariate analyses (n = 5,763) were conducted to investigate the variables that were associated with psychological distress., Results: The overall prevalence of psychological distress was 8.9%. In the multivariate model, females, those aged 16-49, respondents single with children, unable to work or unemployed, with a poorer family financial situation, earning $20,000 or less, feeling safe in their home some or none of the time, feeling as though they have less then total control over life decisions and sometimes experiencing problems with transport, were significantly more likely to experience psychological distress., Conclusions: This paper has demonstrated the relationship between low-income, financial pressure, less than optimal safety and control, and high-psychological distress. It is important that the groups highlighted as vulnerable be targeted in policy, planning, and health promotion and prevention campaigns.

Objective: This study aimed to describe trends in a range of mental health indicators in South Australia where a surveillance system has been in operation since July 2002 and assess the impact of the global financial crisis (GFC)., Methods: Data were collected using a risk factor surveillance system. Participants, aged 16 years and above, were asked about doctor-diagnosed anxiety, stress or depression, suicidal ideation, psychological distress (PD), demographic and socioeconomic factors using Computer-Assisted Telephone Interviewing (CATI)., Results: Overall, there was a decreasing trend in the prevalence of PD between 2002 and 2009. Stress has decreased since 2004 although anxiety has increased. Comparing 2008 or 2009 (the economic crisis period) with 2005 or 2007, there was significant increase in anxiety for part-time workers but a decrease for full-time workers. There were significant differences for stress by various demographic variables., Conclusion: The overall prevalence of mental health conditions has not increased during the GFC. Some subgroups in the population have been disproportionately impacted by changes in mental health status. The use of a surveillance system enables rapid and specifically targeted public health and policy responses to socioeconomic and environmental stressors, and the evaluation of outcomes.

Objectives: To assess the prevalence and associations of hand symptoms in a community setting., Methods: The North West Adelaide Health Study (NWAHS) is a longitudinal cohort study of people aged ≥ 18 years. Analysis was performed in participants who completed a telephone interview, a quality of life questionnaire [the 36-item short-form health survey, (SF-36)], and the Australian/Canadian (AUSCAN) Osteoarthritis (OA) Hand Index, and underwent grip strength measurement., Results: Overall, 477 (13.7%) reported hand pain, aching, or stiffness. Of these, 169 (35.8%) had been diagnosed with hand arthritis. Women were more likely to have hand symptoms than men, as were those aged ≥ 50 years (p < 0.001). Hand symptoms were associated with lower quality of life scores (p < 0.05). Participants with hand arthritis had more severe pain, stiffness, and poorer physical functioning as reflected by higher AUSCAN scores. Grip strength was reduced in those with hand symptoms and hand arthritis (p < 0.05) and inversely associated with mean AUSCAN subscores and SF-36 physical functioning scores (p < 0.001)., Conclusions: Hand symptoms were present in 14% of the population and were more common in women and those aged ≥ 50 years. Hand symptoms were associated with reduced grip strength and reduced quality of life. Hand arthritis was associated with higher AUSCAN scores. Hand symptoms and hand arthritis have a significant impact on physical functioning and quality of life.

Objective: To examine associations between psychological distress (PD) and chronic health conditions among different age groups in a representative population sample., Methods: PD measured by the Kessler-10, and the presence of diagnosed chronic conditions were self-reported by respondents aged 18 years and over in a South Australian continuous computer-assisted telephone interviewing surveillance system from July 2002 to June 2007 (n = 26,376)., Results: The overall prevalence of PD was 9.8% (95% CI 9.5-10.2). In age-specific adjusted multivariate models, arthritis and mental health conditions remained significantly associated with PD for all age groups, cardiovascular disease was significantly associated with PD among those aged 35 years and over, asthma was associated with PD for respondents aged 50 years and over, and osteoporosis was associated with PD for 50-64 year olds. Being born outside of Australia, United Kingdom or Ireland, current smoking, low level of education, and low income also remained significantly associated with PD for all age groups., Conclusions: Young people experience a higher prevalence of PD than older age groups, irrespective of the presence of chronic conditions.

Background: There is limited information on sleep duration and obesity among Australian children. The objective of the study is to cross-sectionally examine the relationship between sleep duration and obesity in Australian children aged 5 to 15 years., Methods: Data were collected using the South Australian Monitoring and Surveillance System between January 2004 and December 2008. Each month a representative random sample of South Australians are selected from the Electronic White Pages with interviews conducted using Computer Assisted Telephone Interviewing (CATI). Within each household, the person who was last to have a birthday was selected for interview. Parents reported the number of hours their children slept each day. Obesity was defined according to the International Obesity Task Force (IOTF) definition based on BMI calculated from reported body weight and height., Results: Overall, parents of 3495 children aged 5-15 years (mean 10.7 years, 50.3% boys) were interviewed. The prevalence of obesity was 7.7% (8.9% in boys, 6.6% in girls). In multivariate analysis after adjusting for sociodemographic variables, intake of fruit and vegetables, physical activity and inactivity, the odds ratio (OR) for obesity comparing sleeping <9 hours with ≥10 hours was 2.23 (95% CI 1.04-4.76) among boys, 1.70(0.78-3.73) among girls, and 1.97(1.15-3.38) in both genders. The association between short sleep (<9 hours) and obesity was stronger in the younger age group. No significant association between short sleep and obesity was found among children aged 13-15. There was also an additive interaction between short sleep and low level of physical activity., Conclusion: Short sleep duration is associated with increased obesity in children especially among younger age groups and boys.

Objective: To identify changes in the prevalence of major depression between 1998, 2004 and 2008 in South Australia., Methods: Face-to-face Health Omnibus surveys were conducted in 1998, 2004 and 2008 with approximately 3000 participants aged 15 years and over, who were random and representative samples of the South Australian population. Each survey used the same methodology. Outcome measures were: major depression as detected by the Mood module of the Primary Care Evaluation of Mental Disorders instrument; mental health literacy by recognition and exposure to classical symptoms of depression; and health status using the SF-36 Physical and Mental Component summaries., Results: There was a significant increase in the prevalence of major depression from 6.8% (95%CI: 5.9%-7.7%) to 10.3% (95%CI: 9.2%-11.4%; χ² 24.59, p < 0.001) between 1998 and 2008. Significant increases were observed in males aged 15-29 and females aged 30-49 years. There was no significant increase in any other sub-group. The strongest predictor of major depression was health status. Participants with poor/fair mental health literacy were 37% less likely to be classified with major depression., Conclusions: The prevalence of major depression increased significantly in South Australia over the last decade and there was a reduction in mental health status and an increase in persons reporting poor health. Unexpectedly, having poor or fair mental health literacy was significantly protective for major depression. Ideally, public health initiatives should result in an improvement in health, but this did not appear to have occurred here.

Aim: To determine the prevalence, correlates and impact of shoulder pain in a population-based sample., Methods: The North West Adelaide Health Study is a representative longitudinal cohort study of people aged 18 years and over. The original sample was randomly selected and recruited by telephone interview. Overall, 3206 participants returned to the clinic during the second stage (2004-2006) and were asked to report whether they had pain, aching or stiffness on most days in either of their shoulders. Data was also collected on body mass index; shoulder range of motion, lifestyle and socioeconomic factors; the Shoulder Pain and Disability Index and the Medical Outcomes Study Short Form 36 (SF36) was used., Results: Overall, 22.3% of participants indicated that they had pain, aching or stiffness in either of their shoulders. Women, those aged 50 years and over, current smokers and those classified as obese were all significantly more likely to report shoulder pain. Respondents with shoulder pain scored lower on all domains of the SF36. In those with shoulder symptoms, women had more severe pain and worse shoulder function than men, and older people had worse shoulder function than younger people., Conclusion: Shoulder pain affects almost a quarter of people in the Australian community, with a significant detrimental impact on health-related quality of life and physical functioning.

Objective: To examine the association between soft drink consumption and mental health problems, including self-reported doctor-diagnosed anxiety, stress-related problem and depression, suicidal ideation and psychological distress, among adults in South Australia., Design: Data were collected using a risk factor surveillance system. Each month a representative random sample of South Australians was selected from the Electronic White Pages with interviews conducted using computer-assisted telephone interviewing., Setting: South Australia., Subjects: Participants were aged 16 years and above., Results: Among 4741 participants, 12.5% reported daily soft drink consumption of more than half a litre. High levels of soft drink consumption were positively associated with depression, stress-related problem, suicidal ideation, psychological distress and a current mental health condition, but not anxiety. Overall, 24.0% of those having suicidal ideation reported consuming more than half a litre of soft drink per day. In the multivariate analysis, after adjusting for sociodemographic and lifestyle factors, those who consumed more than half a litre of soft drink per day had approximately 60% greater risk of having depression, stress-related problem, suicidal ideation, psychological distress or a current mental health condition, compared with those not consuming soft drinks. The soft drink to total fluid consumption ratio had similar associations with mental health problems., Conclusions: There is a positive association between consumption of soft drinks and mental health problems among adults in South Australia.

Background: Women who have had gestational diabetes mellitus (GDM) are at increased risk of developing type 2 diabetes. Early detection and management of type 2 diabetes are important for reducing associated complications and costs., Aims: To evaluate an existing register for long-term follow-up of women who have been diagnosed with GDM., Methods: Recruitment to the GDM Recall Register began at the diabetes centres of two hospitals in South Australia from July 2002, and was expanded to include a third hospital from September 2005. Women enrolled on the Register are sent an annual letter reminding them that they are at increased risk of developing type 2 diabetes and encouraging them to get their blood glucose checked. An update form is also included for women to complete and return to the Register., Results: As at 30 June 2009, 817 women were enrolled on the Register. Of women diagnosed with GDM at the participating hospital sites, recruitment to the Register was 68.4% in 2002 and 64.4% in 2007. Of the 429 women who had been sent their first reminder letter, 46.4% had returned the update form. Of these, 56.3% had undergone a glucose test for diabetes. Two women reported developing type 2 diabetes., Conclusions: Expansion of the GDM Recall Register is likely to result in increased opportunities for early detection of diabetes for this high-risk group in South Australia, therefore allowing earlier intervention and treatment to prevent or reduce serious, costly diabetes-related complications.

Background and Objective: Socioeconomic inequalities in health have been shown to vary for different diseases and by gender. This study aimed to examine gender differences in associations between asthma and socioeconomic disadvantage., Methods: Socioeconomic variables were assessed among men and women in the North West Adelaide Health Study, a representative population cohort (n = 4060) aged 18 years and over in metropolitan South Australia. Asthma was determined from spirometry and self-reported doctor diagnosis., Results: The prevalence of asthma was 12.0% (95% CI: 11.1-13.1), and was significantly higher among women (13.5%) than men (10.5%). For participants aged 18-64 years a higher prevalence of asthma was associated with an education level of secondary school or lower, or not being in the paid labour force among men, and with a gross annual household income of $20,000 or less among women. Among socioeconomically advantaged groups, the prevalence of asthma was significantly higher among women than men., Conclusions: Socioeconomic disadvantage was associated with higher asthma prevalence, although this varied by gender depending on the indicator of socioeconomic position used. Men with low education or those not employed in the paid labour force had higher asthma prevalence than more socioeconomically advantaged men. Women with low income had higher asthma prevalence than those with higher income. Among all socioeconomically advantaged groups, and also the low-income group, women experienced a higher prevalence of asthma than men.

Objective: The aim of the present study was to examine the relationship between body mass index (BMI), mental health, and suicidal ideation in a general population., Method: Two random and representative samples were drawn from the South Australian population. The interview techniques differed, as did the measures of depression and suicidality. One involved 3034 people in face-to-face interviews, and the other involved 30 214 persons providing information via a computer-assisted telephone interviewing (CATI) system. BMI was classified according to World Health Organization criteria. In face-to-face interviews, major depression was defined by the Primary Care Evaluation of Mental Disorders (PRIME-MD) and suicidal ideation by direct enquiry. In the CATI data, psychological distress was assessed on the Kessler 10 instrument and suicidal ideation by four items on the General Health Questionnaire (GHQ). Data analysis controlled for demographic and physical health variables., Results: In the face-to-face interviews, the combined obese and morbidly obese men were significantly less likely to have major depression or suicidal ideation than those of a healthy weight. For the telephone interview-derived data, the only significant finding was for overweight women to report less psychological distress than those of a healthy weight., Conclusions: It is no longer tenable to assume that increased BMI is necessarily associated with major depression, psychological distress, or suicidal ideation. Indeed, it appears protective for some people.

Objectives: To investigate the effect of social mobility and to assess the use of socioeconomic indicators in monitoring health inequities over time, we examined the association of self-rated health with socioeconomic position over the life course., Methods: Data came from a cross-sectional telephone survey (n = 2999) that included life-course socioeconomic indicators and from a chronic disease and risk factor surveillance system (n = 26 400). Social mobility variables, each with 4 possible intergenerational trajectories, were constructed from family financial situation and housing tenure during childhood and adulthood., Results: Low socioeconomic position during both childhood and adulthood and improved financial situation in adulthood were associated with a reduced prevalence of excellent or very good health. Trends over time indicated that socioeconomic disadvantage in adulthood was associated with poorer self-rated health., Conclusions: Our results support policies aiming to improve family financial situation during childhood and housing tenure across the life course. Inclusion of life-course socioeconomic measures in surveillance systems would enable monitoring of health inequities trends among socially mobile groups.

Objectives: Our aim was to examine the effect of local area socio-economic disadvantage after accounting for individual socio-economic status (SES), and to determine if these differ between various health and risk factor variables., Methods: The North West Adelaide Health Study (NWAHS) is a biomedical representative population study of adults. The Index of Relative Socio-Economic Disadvantage (IRSD), produced from the Australian Bureau of Statistics (ABS) Census data at the level of Collector Districts (200 dwellings) was used as an indicator of local area disadvantage. Multi-level modeling techniques examined the effects of IRSD level on a variety of health outcomes and risk factors, after accounting for individual socio-economic factors., Results: Significant, independent associations were seen between IRSD and obesity, smoking, and health-related quality of life, with 5 % to 7.2 % of the variance located at the neighborhood level. No independent associations were seen between IRSD and estimated cardiovascular disease risk, diabetes, physical activity, or at-risk alcohol use., Conclusions: Aggregated area-level characteristics make modest, but significant independent contributions to smoking, obesity and quality of life, but not for other health outcomes.

Background: Measurement of socioeconomic position (SEP) over the life course in population health surveillance systems is important for examining differences in health and illness between different population groups and for monitoring the impact of policies and interventions aimed at reducing health inequities and intergenerational disadvantage over time. While face-to-face surveys are considered the gold standard of interviewing techniques, computer-assisted telephone interviewing is often preferred for cost and convenience. This study compared recall of parents' highest level of education in telephone and face-to-face surveys., Methods: Questions about father's and mother's highest education level were included in two representative population health surveys of South Australians aged 18 years and over in Spring 2004. A random sample selected from the electronic white pages (EWP) responded to a computer-assisted telephone interview (n = 2999), and a multistage clustered area sample responded to a face-to-face interview (n = 2893). A subsample of respondents in the face-to-face sample who owned a telephone that was listed in the EWP (n = 2206) was also compared to the telephone interview sample., Results: The proportion of respondents who provided information about their father's and mother's highest education level was significantly higher in the face-to-face interview (86.3% and 87.8%, respectively) than in the telephone interview (80.4% and 79.9%, respectively). Recall was also significantly higher in the subsample of respondents in the face-to-face interview who had a telephone that was listed in the EWP. Those with missing data for parents' education were more likely to be socioeconomically disadvantaged regardless of the survey mode., Conclusion: While face-to-face interviewing obtained higher item response rates for questions about parents' education, survey mode did not appear to influence the factors associated with having missing data on father's or mother's highest education level.

Objective: To determine whether the prevalence of depression, its associated quality of life, treatment and mental health literacy about depression varied according to accessibility to health services., Design: Face-to-face interviews with a random and representative sample of the South Australian population (aged >or= 15 years) were conducted between March and June 2004, with the respondents stratified using the Accessibility and Remoteness Index of Australia into categories of 'highly accessible', 'accessible', and 'moderately accessible and remote'., Results: From 4700 households selected, 3015 participants were interviewed (65.9% response rate). The prevalence of major depression and other depressions was not significantly different between each of the categories, although there was a trend for those from moderately accessible and remote areas to be less depressed overall. A significantly lower proportion of respondents from moderately accessible and remote locations reported that they had family or close friends who had suffered from symptoms consistent with depression, or that they had ever had treatment for those symptoms. However, there was no significant difference between the groups in those who had ever had or who were currently taking antidepressant medication. For those who were depressed, a significantly higher proportion from the accessible, and moderately accessible and remote regions had seen a community or district health service, social worker or other counsellor as compared with those from the highly accessible area., Conclusions: These findings indicate that depression is no more prevalent in less accessible regions of South Australia, and that when it is present, its treatment, in terms of antidepressants, which can be considered as a proxy marker for the overall management of depression, is similar to treatment in more accessible areas.

Objectives: To use representative population surveillance data to monitor and project changes in the prevalence of diabetes for different age and body mass index (BMI) groups., Study Design: Representative, annual, face-to-face South Australian Health Omnibus Surveys, 1991-2003 (n=3000 per year)., Methods: Trends in self-reported diabetes prevalence by age group and BMI were examined. Separate projections were made on the basis of predicted changes in population demography and diabetes prevalence., Results: The age-sex standardized absolute prevalence of self-reported diabetes among people aged 15 years and over increased from 3.5% in 1991 to 6.7% in 2003. If this current trend continues, the prevalence is expected to increase to 10.5% by 2016. The prevalence of diabetes was significantly higher among those classified as obese (6.5% in 1991 to 12.2% in 2003) than those with normal BMI. The greatest relative percentage increase in prevalence between 1991 and 2003 (169%) was seen among people aged 15-39 years. Taking both age group and BMI classification into account, the greatest relative percentage increases over this time were seen among those with normal BMI aged 60 years or older (148%), and those who were obese and aged less than 60 years (139%)., Conclusions: The prevalence of diabetes and obesity increased significantly between 1991 and 2003. Population ageing and an increase in diabetes prevalence in the future will further increase the burden of diabetes. Future increases in diabetes prevalence are not inevitable, however, if investments are made in public health prevention programmes, particularly those addressing obesity.

Objective: To identify changes in depression, its management and associated excess costs, between 1998 and 2004 in South Australia., Methods: A face-to-face Health Omnibus Survey was conducted in 2004 among 3015 randomly selected participants aged 15 years and over, who were a random and representative sample of the South Australian population, and this was compared with a survey conducted in 1998 that used the same methodology. The main outcome measures were prevalence of depression detected by the Mood Module of the Primary Care Evaluation of Mental Disorders (PRIME-MD); use of health services; health-related quality of life assessed by the Assessment of Quality of Life; estimates of excess costs and demographic data., Results: There was no significant change in the overall prevalence of depression, although there was a significant decrease in respondents with other depressions, and a non-significant increase in those with major depression. No significant differences in the mean number of PRIME-MD depression symptoms were reported. Greater use of predominantly non-medical treatment services and antidepressants were reported by both those with depression and those without depression. There was a marked increase in the associated excess costs of depression., Conclusions: There has been no significant improvement in the prevalence of depression and its associated morbidity and financial burden in the South Australian community between 1998 and 2004, despite a number of professional and community education programmes. It is possible that without these efforts and the increased treatment reported on in this survey, there may have been an increase in the prevalence of depression and an even greater financial burden. However, it is also possible that community services for the provision of treatment for depression have not been able to implement research strategies that have been demonstrated to be effective.

Objective: To determine, using a random telephone survey, the prevalence of various gambling activities among South Australian adults, the prevalence of adult problem gamblers using the South Oaks Gambling Screen (SOGS) instrument, and to examine the problem gamblers by demographic and health-related risk factors., Method: A random representative sample of South Australian adults selected from the Electronic White Pages. Overall, 6045 interviews were conducted (73.1% response rate) using Computer Assisted Telephone Interviewing (CATI) technology., Results: Overall, 75.6% (95% CI: 74.5-76.7) of respondents had participated in at least one gambling activity during the last 12 months and 2.0% (95% CI: 1.7-2.4) were identified to be problem gamblers. A wide range of factors was associated with problem gambling at a univariate level, when compared to frequent gamblers. The logistic regression analysis highlighted that problem gamblers were more likely to speak a language other than English, be employed part time and a smoker when compared to frequent gamblers. Problem gamblers were also more likely to have a mental health condition (according to the Kessler 10), have had suicidal thoughts and know of services for gambling problems., Conclusion: There is a wide range of characteristics associated with problem gambling in South Australia. All of these factors need addressing during policy development to assist problem gamblers.

Objective: To examine the association of health status with stage along the diabetes continuum., Design, Setting and Participants: Self-reported health status (SF-36) was assessed in the North West Adelaide Health Study, a representative population cohort (n = 4060) aged 18 years and over in metropolitan South Australia. Impaired fasting glucose (IFG), undiagnosed diabetes, diagnosed diabetes, glycaemic control and cardiovascular disease were determined from fasting blood and self-reported data., Results: The prevalence of diagnosed diabetes was 5.6% (95% CI: 4.9-6.3), with an additional 1.0% (95% CI: 0.7-1.4) previously undiagnosed. When compared to those with normal glucose, those with diabetes were significantly impaired on all SF-36 dimensions except Mental Health, and those with IFG (4.3%) were significantly impaired in terms of Physical Functioning and Bodily Pain when controlling for the effects of age, sex and cardiovascular disease. Poor glycaemic control (HbA1c >or= 7.0%) was also associated with impaired health status., Conclusions: Health status is impaired not only among those with diagnosed diabetes but also those with IFG and undiagnosed diabetes.

Introduction: There is growing evidence in Australia and elsewhere to indicate that prevalence rates of mental illness are no higher in rural and remote areas than in urban areas. However, it is generally perceived that people from rural and remote areas are at heightened risk of mental illness, because many psychosocial determinants of health are magnified by factors related to remoteness. In this study we attempt to unpack the factors guiding prevalence rates of mental illness to determine if remoteness per se is an important determinant of mental illness., Methods: Analysis of data from a cross-sectional, population-based, computer-assisted telephone interview survey in 2000. Respondents included 2545 South Australian adults, aged 18 years or more. The mental illness measure was self-reported, medically confirmed depression, anxiety or stress related problems in the previous 12 months and receiving treatment. Remoteness was determined using the Accessibility and Remoteness Index of Australia (ARIA). Psychosocial measures consisted of major stressful life events, perceived control of life events, socio-demographic characteristics and lifestyle behaviours., Results: Unadjusted odds of mental illness were lower among residents of accessible and remote/very remote areas than for those from highly accessible areas (OR [odds ratio] 0.67, 95% CI 0.50-0.91 and OR 0.73, 0.54-1.00). After controlling for the joint effects of stressful life events, perceived control of life events, socio-demographic characteristics and lifestyle behaviors, odds of mental illness did not vary by ARIA category (highly accessible [reference category]; accessible: OR 0.90 95% CI 0.60-1.31; moderately accessible: OR 0.80, 95% CI 0.45-1.43; remote/very remote: OR 0.70, 95% CI 0.44-1.03). The most important predictors of mental illness in the multivariate logistic model were female sex; smoking; low consumption of vegetables; low exercise; a physical condition; perceived lack of control with life in general, personal life, job security or health; and major stressful events such as family or domestic violence and the death of someone close., Conclusions: Remoteness per se was not associated with mental illness, either directly or indirectly, as an important confounder in stressful life event/mental illness associations. Psychosocial factors were more important determinants of mental illness.

Objectives: To examine changes in asthma prevalence in the context of other population changes between 1990 and 2003, for specific age and sex groups., Design: Cross-sectional survey based on household interviews, repeated annually., Setting and Participants: Representative samples of the South Australian population between 1990 and 2003 (around 3000 people per year)., Main Outcome Measures: Current prevalence of doctor-diagnosed asthma and other health and demographic variables potentially associated with asthma, and asthma management., Results: Response rate was over 71%. Between 1990 and 2003, asthma prevalence increased significantly, doubling in females (from 7.3% in 1990 to 14.6% in 2003), with a smaller increase in males (from 7.8% to 9.4%). Asthma also increased in all age groups, but the largest relative increases occurred in people aged 55 years and older. Logistic regression analyses showed that obesity was a major predictive variable for every age group studied. The prevalence of asthma morbidity (waking at night and days lost from usual activities because of asthma) among those with asthma showed no significant changes between 1990 and 2003. Asthma action plans (introduced on a population basis in 1992) peaked in their distribution at 42% in 1994, and then declined to half that percentage in 2003. The increase in asthma prevalence occurred at the same time as increases in population prevalence of obesity (10.3% to 18.7%) and diabetes (3.1% to 6.9%), and decline in recent vigorous exercise (42.4% to 32.7%)., Conclusions: The increase in asthma prevalence over a decade was large, but concentrated among specific sex and age groups. The increase accompanied population increases in obesity and diabetes and a decline in vigorous exercise.

Background: Analysis was undertaken on data from randomly selected participants of a bio-medical cohort study to assess representativeness. The research hypotheses was that there was no difference in participation and non-participations in terms of health-related indicators (smoking, alcohol use, body mass index, physical activity, blood pressure and cholesterol readings and overall health status) and selected socio-demographics (age, sex, area of residence, education level, marital status and work status)., Methods: Randomly selected adults were recruited into a bio-medical representative cohort study based in the north western suburbs of the capital of South Australia--Adealide. Comparison data was obtained from cross-sectional surveys of randomly selected adults in the same age range and in the same region. The cohort participants were 4060 randomly selected adults (18+ years)., Results: There were no major differences between study participants and the comparison population in terms of current smoking status, body mass index, physical activity, overall health status and proportions with current high blood pressure and cholesterol readings. Significantly more people who reported a medium to very high alcohol risk participated in the study. There were some demographic differences with study participants more likely to be in the middle level of household income and education level., Conclusion: People with risky behaviours participated in this health study in the same proportions as people without these risk factors.

Objectives: To examine the trend in obesity prevalence using annual representative cross-sectional samples of the South Australian population, to project the increase of obesity using current trends, and to examine the increase in prevalence by generational assessment., Methods: Face-to-face interviews of representative population samples of people aged 18 years and over living in South Australia from 1991 to 1998 and again in 2001 and 2003. Information on height and weight was provided by participants, in order to calculate body mass index (BMI) as a measure of obesity., Results: The proportion of respondents classified as obese according to their self-reported body mass index (BMI > or = 30 to <35) increased significantly from 8.7% in 1991 to 14.1% in 2003 (chi2 trend=79.4, p<0.001). Severe obesity (BMI > or = 35) increased significantly from 2.6% in 1991 to 5.3% in 2003 (chi2 trend=50.4, p<0.001). Current prevalence trends indicate that by 2013, the self-reported prevalence of obesity in South Australian adults will be 27.8%, with the prevalence in males being 26.4% and in females, 29.3%. Secular obesity trends indicate that younger birth cohorts had the greatest percentage increases., Conclusions: Obesity has increased significantly between 1991 and 2003, and is increasing fastest among younger adults. Multifactorial interventions at all levels of the population are required to prevent overweight and obesity and promote weight maintenance, weight loss and address the health burden of obesity.

Objective: To identify changes in mental health literacy in regard to depression between 1998 and 2004., Design and Setting: Face-to-face interviews with a random and representative sample of the South Australian population in 2004, compared with a similarly conducted survey in 1998 that used the same vignette, questions and methodology., Participants: 3015 randomly selected participants, aged 15 years and over., Main Outcome Measures: Responses to both open-ended and direct questions about symptoms and treatment options for depression., Results: The 3015 interviews conducted represented a response rate of 65.9%. Compared with 1998, in 2004 there was a significant increase in the proportion of people recognising depression in the vignette, acknowledging personal experience of depression, and perceiving professional assistance to be more helpful and less harmful. However, although more people nominated psychiatrists or psychologists as therapists of choice, the difference between 1998 and 2004 was not significant., Conclusions: There has been a significant increase in mental health literacy, at least as regards depression, in the South Australian community between 1998 and 2004. The lack of significant change in psychiatrists and/or psychologists being perceived as therapists of choice is of concern and suggests that community education about their expertise may be appropriate.

Objective: To determine whether mental illness is associated with accessibility and remoteness., Design: A cross-sectional, population-based, computer-assisted telephone interview survey, stratified by Accessibility and Remoteness Index of Australia (ARIA) categories., Setting: Secondary analysis of data collected from 2545 South Australian adults in October and November 2000., Outcome Measures: Psychological distress and depression as determined by the Kessler 10 Psychological Distress Scale, the SF-12 measure of health status, and self-reported mental illness diagnosed by a doctor in the previous 12 months., Results: Overall, mental illness prevalence estimates were similar using the three measures of psychological distress (10.5%), clinical depression (12.9%) and self-reported mental health problem (12.7%). For each measure, there was no statistically significant variation in prevalence across ARIA categories, except for a lower than expected prevalence of depression (7.7%) in the "accessible" category. There was no trend suggesting higher levels of mental illness among residents of rural and remote regions., Conclusions: The prevalence rates of psychological distress, depression and self-reported mental illness are high. However, we found no evidence that the prevalence of these conditions varies substantially across ARIA categories in South Australia. This finding may challenge existing stereotypes about higher levels of mental illness outside metropolitan Australia.

Objective: To assess prevalence of incontinence in a South Australian representative population sample and compare the health-related quality-of-life impact of incontinence with other chronic conditions., Method: The 1998 South Australian Health Omnibus Survey interviewed 3,010 male and female respondents aged 15 to 97 years (response rate 70.2%). This representative population survey included questions to determine the prevalence of urinary (stress and urge), and anal (faecal and flatus) incontinence, and other chronic conditions. Respondents also completed the MOS SF-36 questionnaire., Results: Self-reported prevalence of all types of incontinence was 26.0%. The prevalence of anal and urinary incontinence were 10.5% and 20.3% respectively, with 4.8% of respondents experiencing both. Univariate analysis found the prevalence of incontinence was statistically significantly higher among females, and those who were older, widowed, had no post-school education, and lower incomes. After adjusting for differences in age and sex, it was found that people with incontinence were significantly impaired across all dimensions of the SF-36, scoring in the lowest 42% of the population, compared with those people without incontinence. People with incontinence exhibited different SF-36 profiles to those with other chronic conditions., Conclusions: Incontinence is common in South Australia, affecting more than one-quarter of the population, particularly older women (56.2% for 60 years and over). The impact of incontinence on health-related quality of life is characteristically different to that demonstrated by other chronic conditions., Implications: In an ageing population, identification of the impact of incontinence is necessary to direct policy development and resource allocation to this area.

Objective: To compare the methodologies of and health estimates derived from two telephone household survey methods. In particular, to establish if White Pages telephone listings provide a relatively unbiased sampling frame for population health surveys., Method: In South Australia in 1998, a health survey questionnaire was administered by telephone to two randomly selected population samples. The first method used EWP (Electronic White Pages, n = 6,012), which contains all listed residential telephone numbers as the sampling frame. The results were compared to a RDD (random digit dialling, n = 3,080) sample where all listed and unlisted telephone numbers were included in the sampling frame. Demographic variables and health estimates were compared between the surveys, and then compared to a 'gold standard' door-to-door household survey conducted concurrently., Results: The response rate for EWP (83.8%) exceeded that of RDD (65.4%). More than four times as many calls were required per completed interview in RDD. Demographic profiles and health estimates were substantially similar., Conclusions: EWP requires fewer telephone calls and enables approach letters establishing the bona fides of the survey to be sent to each selected address before calling, increasing the response rate. RDD is a more inclusive sampling frame but also includes non-connected and business numbers, and offers no significant advantages in providing health estimates., Implications: There are substantial methodological and cost advantages in using EWP over RDD as the sampling, frame for population health surveys, without introducing significant bias into health estimates.

Objective: To test the reliability of telephone health survey questions., Method: A telephone survey on mental health of South Australians in 1997 was re-administered to a random sub-sample of 102 respondents between 32 and 79 days after the original survey., Results: Demographic questions (age, gender, number of adults and children in the household) showed the highest reproducibility and were almost perfect. Questions regarding health risk factors, such as smoking and drinking behaviour, showed substantial to almost perfect agreement. Co-morbidity variables were substantially reproducible where prevalence estimates were not close to zero., Conclusions: The results were comparable to findings from similar studies associated with the Behavioral Risk Factor Surveillance System (BRFSS) in the United States. The study suggests that the telephone health survey instrument used in South Australia is reliable for estimating health conditions and behaviours in the population.

Background: This study measured the prevalence of hearing impairment, and major demographic factors that influence the prevalence, in a representative South Australian adult population sample aged > or = 15 years., Methods: The study group was recruited from representative population surveys of South Australians. Participants in these surveys who reported a hearing disability were then recruited to an audiological study which measured air and bone conduction thresholds. In addition a sample of those people who reported no hearing disability were recruited to the audiological study., Results: The data reported in this study are the first in Australia to assess the prevalence of hearing impairment from a representative population survey using audiological methods. The data show that 16.6% of the South Australian population have a hearing impairment in the better ear at > or = 25 dBHTL and 22.2% in the worse ear at the same level. The results obtained in this representative sample compare well with those obtained in the British Study of Hearing, although some differences were observed., Conclusions: Overall, there are only a few studies worldwide that have audiologically assessed the impairment of hearing from a representative population sample. The overall prevalence of hearing impairment in Australia is similar to that found in Great Britain, although there are some differences between the estimates of severity of impairment and some sex differences. The corroboration of the two studies reinforces the status of hearing impairment as the most common disability of adulthood. The present study also showed that there are a large number of Australians who may benefit from a more systematic community-based rehabilitation programme including the fitting of hearing aids. Secondly, the study identified the need for health goals and targets for hearing to be based on an epidemiological approach to the problem.

Telephone interviewing is increasingly being used to obtain data on health issues. Propertly applied telephone interviewing may have considerable cost benefits, but careful thought has to be put into the design of surveys, weighting and analysis of data to avoid major sources of bias. This study is a hypothetical exercise comparing health estimates from a systematic, self-weighting, multistage, clustered, area sample of households using a face-to-face interview method, with hypothetical samples of people obtained from Random Digit Dialling and Electronic White Pages. In a comparison of the population health estimates obtained for a number of health problems in a hypothetical analysis of these samples, the confidence intervals for the estimates overlapped. Since the estimates are not statistically significantly different, it appears that well-planned, appropriately weighted and analysed telephone surveys can be a less expensive way of obtaining health information, however, some caution is expressed in using this method.

The self-reported prevalence of, and attitudes to and perceptions of, osteoporosis in the South Australian community were assessed using data collected as part of the 1995 South Australian Health Omnibus Survey (household interviews)--a clustered, self-weighting, multistage sample of households in metropolitan and country centers. The self-reported prevalence was 4.8 (95% CI: 3.7-5.8) and 1.4% (95% CI: 0.8-2.0) for women (n = 1531) and men (n = 1485) respectively. For individuals with osteoporosis, calcium was the favored treatment (52%), while 33% of women were on hormone replacement therapy. An appropriate definition of osteoporosis was given by 62% of women and 37% of men. The main risk factors were reported as lack of calcium and age. There was a significant association between knowledge of the definition of osteoporosis and identification of correct risk factors. A high perceived risk of osteoporosis was reported in 23% of women and 7% of men. Osteoporosis risk was assessed as higher in those who did not adopt recognized prevention measures. Perception of risk was not related to the individual's own risk factors. Self-reported prevalence of osteoporosis significantly underestimates the likely true prevalence and general awareness and knowledge is much lower for men than women. The importance of individual risk factors for osteoporosis are not understood by the general community.