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The COVID-19 pandemic and related disruptions have not only affected university students’ learning and academic outcomes, but also other issues, such as food security status, mental health and employment. In Australia, international students faced additional pressures due to sudden border closures and lack of eligibility for government-provided financial support. This study explored the experiences of domestic and international university students residing in Australia during the early stages of the COVID-19 pandemic across a range of outcomes. A cross-sectional online survey was conducted between July and September 2020 at Macquarie University in Sydney, Australia. The online survey included food insecurity status, mental health (psychological distress), disruptions to study, employment and sleep. A total of 105 students (n = 66 domestic and n = 39 international) completed the survey. Respondents reported having food insecurity (41.9%) and psychological distress (52.2%, with high and very high levels), with international students reporting significantly higher food insecurity (OR = 9.86 (95% CI 3.9–24.8), p < 0.001) and psychological distress scores (t(90) = 2.68, 95% CI: 1.30 to 8.81, p = 0.009) than domestic students. About one quarter of all respondents reported disruptions to study and employment status around the time of the survey. When asked what government support should be provided for international students, ‘financial aid’ was the most frequently suggested form of support. This research may help governments and educational institutions design appropriate support, particularly financial and psychological, for both international and domestic university students.

Twitter has gained attention in recent years as a tool to use in higher education to enhance students’ learning, engagement, and reflective writing. This study explored public health students’ perceptions on the usefulness of Twitter as a learning tool, engagement with their peers, staff, and the broader public health community. Participants were Master of Public Health students from a public university based in Sydney, Australia. A mixed methods approach was used combining content analysis of tweets, an online survey and two focus groups. Students were asked to engage with Twitter by reflecting on each week’s teaching content and by liking and replying to their peers’ tweets. Participation and engagement in this task were high initially and declined toward the end of semester. Most student tweets aligned with topics taught during the semester. Survey and focus group data indicated most students had positive views on using Twitter and reported finding engagement with Twitter beneficial in obtaining current information on health promotion news and trends, increasing their professional networks and allowing them to connect with their peers and teaching staff. Results indicate Twitter is a promising interactive approach to enhance public health students’ engagement and overall learning experience, as well as being useful for professional networking. Larger scale empirical studies are needed to investigate the impact of the use of social media platforms such as Twitter to various learning outcomes longitudinally and beyond this course.

To evaluate the effect of walking promotion strategies on physical activity, pain, and function in people with musculoskeletal disorders.Intervention systematic review with meta-analysis.We performed the searches in MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and the Physiotherapy Evidence Database (PEDro) from inception to August 2019.We included randomized controlled trials evaluating interventions that promote walking in people with musculoskeletal disorders.We used the PEDro scale for assessing risk of bias and the Grading of Recommendations Assessment, Development and Evaluation approach to evaluate the quality of evidence. We expressed pooled effects for between-group differences as mean differences or standardized mean differences and 95% confidence intervals, or as risk ratios and 95% confidence intervals, using random-effects meta-analyses.Twelve eligible trials (n = 1456 participants) were identified. There was moderate- to very low-quality evidence of no difference in physical activity levels for walking promotion interventions when compared to minimal interventions, and a significant effect favoring walking promotion when compared with usual care in the short term. There was moderate-quality evidence that walking promotion was modestly effective for reducing pain and improving function compared with minimal intervention and usual care. There was no difference in pain and function for walking promotion compared to supervised exercise. Walking promotion was not associated with different rates of adverse events compared to control conditions.Strategies to promote walking did not increase physical activity in people with musculoskeletal disorders. Walking promotion was associated with small improvements in pain and function compared to minimal intervention and usual care.

AimsSedentary behaviour (particularly television (TV) viewing) is thought to be a risk factor for cardiovascular disease. We employed a negative control outcome to explore whether the association between TV viewing and heart disease mortality is explained by confounding.MethodsThe sample was drawn from the UK Biobank study and comprised 479 658 participants (aged 56.5±8.0 years; 45.7% men) followed up over a mean of 10.4 years. TV viewing was measured from self-report.ResultsThere were 1437 ischaemic heart disease (IHD) deaths, and 214 accidental deaths (employed as the negative control outcome). TV viewing was related to the following confounding variables: age, smoking, alcohol, diet, obesity, physical inactivity, cardiovascular disease and education. The confounding structures were similar for both outcomes. TV viewing (per hour/d) was associated with IHD (hazard ratio (HR)=1.30, 95% CI, 1.27 to 1.33) and accidental death (HR=1.15, 95% CI, 1.07 to 1.24) in unadjusted models. Associations were attenuated for both outcomes and were considerably converged after adjustment for confounders; IHD (HR=1.09, 95% CI, 1.06 to 1.12) and accidental death (HR=1.06, 95% CI, 0.98 to 1.15).ConclusionThe pattern of results for TV with an implausible outcome mirrored that of IHD, suggesting that observed associations between TV and heart disease are likely to be driven by confounding.

Regular physical activity benefits health across the lifespan. Women in middle-age often juggle carer and work responsibilities, are often inactive, and may benefit from tailored support to increase physical activity. Establish the acceptability, feasibility, and impact on physical activity of a scalable program for women 50+ years. This pilot trial randomized participants to immediate program access, or to a wait-list control. [Active Women over 50 Online] program included: (1) study-specific website, (2) 8 emails or 24 SMS motivation-based messages, (3) one telephone health-coaching session. Outcomes, at 3 months, were acceptability (recommend study participation, intervention uptake), feasibility (recruitment, reach, completion), intervention impact (physical activity), intervention impressions. At baseline, 62 participants of mean (SD) age 59 (±7) years took 7459 (±2424) steps/day and most (92%) reported ≥2 medical conditions. At 3 months, acceptability and impact data were available for 52 (84%) and 57 (92%) participants, respectively. Study participation was recommended by 83% of participants. Participants mostly agreed to receive health coaching (81%) and messages (87%: email = 56%, SMS = 44%), opened 82% of emails and accessed the website 4.8 times on average. Respondents reported the intervention supported their physical activity. Intervention participants were more likely to increase steps from baseline by 2000+/day (OR: 6.31, 95% CI: 1.22 to 32.70, p = .028) than controls, and trended toward more light-intensity (p = .075) and moderate-vigorous intensity physical activity (p = .11). The [Active Women over 50 Online] program demonstrated acceptability and feasibility among the target population, and effectiveness in some domains in the short term. Results warrant further testing in a full-scale RCT.Regular physical activity benefits health at all ages. Women in middle-age years often juggle carer and work responsibilities. We investigated the acceptability, feasibility, and effect of a scalable physical activity program targeting this group. Participants were randomly assigned to immediate access to the [Active Women over 50 Online] program or after a 3-month wait. [Active Women over 50 Online] program included: (1) study-specific website with information, case studies and links to physical activity opportunities, (2) email or SMS motivation-based messages, (3) telephone health-coaching session. We recruited 62 participants, who were on average aged 59 years, active, and had at least two medical conditions. At the 3-month follow-up, 83% of participants would recommend study participation. Participants who received the program immediately agreed to receive health coaching (81%) and messages (87%). They accessed an average of five web sessions each in a 3-month period and reported the program supported their physical activity. These participants were also more likely to take an average of 2000+ daily steps more than at baseline, and increased their physical activity at light, moderate, and vigorous intensities more than those who had not received the program. The high uptake, engagement, positive recommendation, and promising impact on physical activity warrants further program testing in a larger trial.

Abstract Recently revised public health guidelines acknowledge the health benefits of regular intermittent bouts of vigorous intensity incidental physical activity done as part of daily living, such as carrying shopping bags, walking uphill, and stair climbing. Despite this recognition and the advantages such lifestyle physical activity has over continuous vigorous intensity structured exercise, a scoping review we conducted revealed that current research in this area is, at best, rudimentary. Key gaps include the absence of an empirically-derived dose specification (e.g., minimum duration of lifestyle physical activity required to achieve absolute or relative vigorous intensity), lack of acceptable measurement standards, limited understanding of acute and chronic (adaptive) effects of intermittent vigorous bouts on health, and paucity of essential information necessary to develop feasible and scalable interventions (e.g., acceptability of this kind of physical activity by the public). To encourage collaboration and research agenda alignment among groups interested in this field, we propose a research framework to further understanding of vigorous intermittent lifestyle physical activity (VILPA). This framework comprises four pillars aimed at the development of: (a) an empirical definition of VILPA, (b) methods to reliably and accurately measure VILPA, (c) approaches to examine the short and long-term dose–response effects of VILPA, and (d) scalable and acceptable behavioural VILPA-promoting interventions. Graphic Abstract

Background Physical activity has many physical and mental health benefits and can delay the development of disability in older age. However, uptake of this health behaviour is sub-optimal in women in their middle and older age. This trial aims to establish the acceptability and feasibility of the Active Women over 50 programme involving online information, telephone health coaching and email or SMS support to promote physical activity behaviour change among women aged 50 years and over. Methods Sixty community-dwelling women who are insufficiently active according to national guidelines, will be recruited and randomised to 1) receive the Active Women over 50 programme or 2) a wait-list control. Active Women over 50 is a 3-month physical activity programme guided by behaviour change science, providing access to a website, one telephone-delivered health coaching session from a physiotherapist and 8 email or 24 SMS messages. The primary outcome is the proportion of participants at 3 months post-randomisation who would recommend participation in the programme to another person like themselves. Secondary outcomes are feasibility measures: rates of recruitment, retention, completeness of outcome data and uptake of telephone support; and intervention impact measures: accelerometer-assessed average steps/day, proportion of participants meeting national guidelines on moderate to vigorous physical activity; and questionnaire-assessed quality of life, exercise perceptions, mood, physical functioning and self-reported physical activity. Intervention participants will also complete a follow-up survey to assess impressions of the intervention and adoption of strategies for physical activity participation. Data will be analysed descriptively to guide the design of a larger trial. Between-group differences in secondary outcomes will be used to estimate effect sizes for sample size calculations for a fully powered randomised controlled trial. Discussion This feasibility pilot trial of an efficient eHealth and health coaching intervention guided by user input and behaviour change theory, will inform future interventions to address low physical activity participation among an under-active group at risk of future disability. Trial registration ANZCTR, ACTRN12619000490178, registered 26 March 2019

Only 5% of Australian children and adults eat enough fruit and vegetables. Two common barriers are high cost and limited access. Food co-operatives (&lsquo, co-ops&rsquo, ) may have the potential to reduce these barriers. We conducted a scoping analysis of food co-ops in the Sydney region to describe their characteristics and objectives. We also conducted a survey of members and non-members of co-ops to assess their fruit and vegetable intake using validated questions. Fifteen food co-ops were identified in the Sydney region and the most common objective was to provide cheap affordable produce. Most co-ops (61%) were in areas of high socio-economic status (SES). Members of food co-ops had a higher vegetable intake than non-members [mean difference (MD) = 0.54 serves/daily, 95% confidence interval (CI) of 0.15 to 0.93] and were also more likely to meet the recommendations for fruit and vegetable intake [odds ratio (OR) = 4.77 (95% CI = 1.15, 19.86)]. Implications of this study are that if food co-ops can be implemented on a wider scale, they hold potential for improving fruit and vegetable intakes.

Background: Physical inactivity is a key contributor to the global burden of disease and disproportionately impacts the wellbeing of people experiencing mental illness. Increases in physical activity are associated with improvements in symptoms of mental illness and reduction in cardiometabolic risk. Reliable and valid clinical tools that assess physical activity would improve evaluation of intervention studies that aim to increase physical activity and reduce sedentary behaviour in people living with mental illness. Methods: The five-item Simple Physical Activity Questionnaire (SIMPAQ) was developed by a multidisciplinary, international working group as a clinical tool to assess physical activity and sedentary behaviour in people living with mental illness. Patients with a DSM or ICD mental illness diagnoses were recruited and completed the SIMPAQ on two occasions, one week apart. Participants wore an Actigraph accelerometer and completed brief cognitive and clinical assessments. Results: Evidence of SIMPAQ validity was assessed against accelerometer-derived measures of physical activity. Data were obtained from 1010 participants. The SIMPAQ had good test-retest reliability. Correlations for moderate-vigorous physical activity was comparable to studies conducted in general population samples. Evidence of validity for the sedentary behaviour item was poor. An alternative method to calculate sedentary behaviour had stronger evidence of validity. This alternative method is recommended for use in future studies employing the SIMPAQ. Conclusions: The SIMPAQ is a brief measure of physical activity and sedentary behaviour that can be reliably and validly administered by health professionals., Universidad Pablo de Olavide de Sevilla. Departamento de Deporte e Informática

Objectives The media is a substantial vehicle for conveying public health messages to the public. This study examined the extent to which the publication of special issues in a high-impact medical journal in 2012 and 2016 generated media interest in physical activity and health in the UK and explored the main issues that were reported. Study design This is a systematic narrative review of print media. Methods Relevant print news articles were identified by searching Factiva and Google News. The timeframe of each search was 2 weeks, using the publication date of each special issue as the anchor point. Overall, 20 articles were included in the analysis for 2012 and 37 articles for 2016. Results The news media coverage was encouraging for the profile of physical activity and health. In 2012 and 2016, common themes included the benefits of physical activity and the risks of being inactive, comparisons between mortality rates from physical inactivity and smoking and the recommended volume of physical activity to benefit health. Conclusions The profile given to an issue through prestigious scientific publication is one of the levers for community attention and policy change. Efforts are needed to further use the media for improving policy, practice and public awareness, which are antecedents to population health change.

Objective: To examine the effects of different sit-stand protocols on work-time sitting and physical activity (PA) of office workers. Methods: Participants (n = 26, 77% women, mean age 42) were randomly allocated to usual sitting (control) or one of three sit-stand protocols (intervention) facilitated by height-adjustable workstations for a 4-week period between June and August 2015. Sitting, standing, and stepping time were assessed by inclinometry (activPAL); leisure-time physical activity (LTPA) by self-report. One-way analysis of covariance (ANCOVA) and post-hoc (Bonferroni) tests explored between-group differences. Results: Compared with baseline, intervention groups reduced work sitting time by 113 minutes/8-hour workday (95% confidence interval [CI] [-147,-79]) and increased work standing time by 96 minutes/8-hour workday (95% CI [67,125]) without significantly impacting LTPA/sleep time. Conclusions: Sit-stand protocols facilitated by height-adjustable workstations appear to reduce office workers' sitting time without significant adverse effects on LTPA.

BACKGROUND Active Design is a relatively new concept and evaluation on its effects on healthy behaviour is lacking. OBJECTIVE To investigate Active Design influence on workplace physical activity, sedentary behaviour, musculoskeletal complaints, and perceptions of the workplace and productivity. METHODS Participants (n = 118 adults) moving from 14 workplaces into a new building completed an online questionnaire pre- and post-move. The questions related to health behaviours (physical activity, sitting time and sleep); musculoskeletal issues; perceptions of the office environment; productivity; and engagement. RESULTS After the move, 68% of participants were located in an open plan building (21% before the move). In the new workplace participants tended to sit less during their work time (72% - 66%; p

Our objective was to describe patterns and predictors of sedentary behavior (sitting time) over 10 years among a large Canadian cohort. Data are from the Canadian Multicentre Osteoporosis Study, a prospective study of women and men randomly selected from the general population. Respondents reported socio-demographics, lifestyle behaviors and health outcomes in interviewer-administered questionnaires; weight and height were measured. Baseline data were collected between 1995 and 1997 (n = 9418; participation rate = 42%), and at 5- (n = 7648) and 10-year follow-ups (n = 5567). Total sitting time was summed across domain-specific questions at three time points and dichotomized into “low” (≤ 7 h/day) and “high” (> 7 h/day), based on recent meta-analytic evidence on time sitting and all-cause mortality. Ten-year sitting patterns were classified as “consistently high”, “consistently low”, “increased”, “decreased”, and “mixed”. Predictors of sedentary behavior patterns were explored using chi-square tests, ANOVA and logistic regression. At baseline (mean age = 62.1 years ± 13.4) average sitting was 6.9 h/day; it was 7.0 at 5- and 10-year follow-ups ( p for trend = 0.12). Overall 23% reported consistently high sitting time, 22% consistently low sitting, 14% decreased sitting, 17% increased sitting with 24% mixed patterns. Consistently high sitters were more likely to be men, university educated, full-time employed, obese, and to report consistently low physical activity levels. This is one of the first population-based studies to explore patterns of sedentary behavior (multi-domain sitting) within men and women over years. Risk classification of sitting among many adults changed during follow-up. Thus, studies of sitting and health would benefit from multiple measures of sitting over time.

Issue addressed This study examines how sedentary behaviour (too much sitting) was covered as a health issue by Australian newspapers and how physical activity was framed within this newspaper coverage. Methods Articles featuring sedentary behaviour published in Australian newspapers between 2000 and 2012 were analysed for content and framing. Main outcome measures were volume, number and content of newspaper articles; framing and types of sedentary behaviour; responsibility for the problem of and solutions to high levels of sedentary behaviour; and physical activity mentions and how it was framed within sedentary behaviour coverage. Results Out of 48 articles, prolonged sitting was framed as bad for health (52%) and specifically as health compromising for office workers (25%). Adults who sat a lot were framed as 'easy targets' for ill health (21% of headlines led with 'sitting ducks' or 'sitting targets'). Prolonged sitting was framed as an issue of individual responsibility (>90%) with less mention of environmental and sociocultural contributors. Thirty-six of 48 articles mentioned physical activity; 39% stated that being physically active does not matter if a person sits for prolonged periods of time or that the benefits of physical activity are undone by too much sitting. Conclusions News coverage should reflect the full socio-ecological model of sedentary behaviour and continually reinforce the independent and well-established benefits of health-enhancing physical activity alongside the need to limit prolonged sitting. So what? It is important that the entire 'move more, sit less, every day!' message is communicated by news media.

To illustrate how the differences in measurement protocols affect physical activity (PA) monitoring among Australian children and adolescents aged ~5-17 years, this review aimed to summarize and critically assess the most recent findings from the national and state or territory health surveillance systems and population surveys. We compared methods and results of 21 population surveys identified in an extensive web-based search conducted using the entries ‘Physical Activity’, ‘Surveillance’, ‘Monitoring’, ‘Survey’, ‘Australia’ and the names of Australian states and territories as keywords. A large variability between PA prevalence rates from different Australian national- and state-level surveys was observed, both for selfreported and pedometer-based estimates. The prevalence estimates tended to be: [i] higher among children when compared with adolescents; [ii] higher for boys than for girls when assessed using self-reports; and [iii] higher for girls than for boys when assessed using pedometers. The true prevalence of compliance with PA guidelines among children and adolescents in Australia seems to be difficult to determine. To ensure comparability of prevalence estimates, key elements of data collection and processing protocols, such as PA questionnaires, survey administration modes, survey time frames, and definitions of a ‘sufficient’ PA level, should be standardised throughout all PA surveillance systems and population surveys in Australia. Key words: motor activity, sedentary lifestyle, child, adolescent, surveillance

Background High levels of sitting are associated with increased risk of adverse health outcomes, including chronic disease. Extensive sitting at work is common, hence organisations should provide options to employees to reduce prolonged sitting. Objective To assess the efficacy and acceptability of a co-designed intervention to increase standing and reduce sitting in a public-sector office. Methods Forty-six adults participated in the quasi-experimental study (30 intervention; 16 control). The intervention involved providing sit-stand desks, prompts, workshops, and information emails to assist behavior change. Participants wore a thigh-mounted Actigraph GT3X+ for five working days and responded to an online questionnaire at baseline (BL), 6 (T1) and 13 weeks (T2) post intervention. Results Inclinometer-measured proportion of time standing increased in the intervention group from 14% (baseline) to 28% (T1) and 27% (T2) (67 minutes more standing over an 8-hour workday). Intervention participants reduced sitting time from 79% (BL) to 63% (T1 and T2), (80 minutes less sitting over an 8-hour workday). The control group showed no changes. The program was highly recommended (94%), and perceived to support behavior change (81%). Conclusions This Move More, Sit Less intervention appears to be efficacious and acceptable. Future interventions should be co-designed to ensure culturally appropriate components and higher acceptability.

ISSUE ADDRESSED Policy and environmental approaches can reduce the accessibility and purchasing of sugar-sweetened beverages (SSBs), potentially reducing overweight and obesity. This study examined the impact of a state-wide policy on removal of SSBs from sale in NSW public hospitals (launched July 2017), and explored consumer awareness and support. METHODS A convenience sample of 81 food outlets in 26 hospitals were audited for SSB availability before and after the target date for SSB removal (31 December 2017). An interviewer-administered intercept survey in 10 randomly selected hospitals (March-May 2018), assessed staff and visitors' awareness of and support for SSB removal. Descriptive and χ2 analyses assessed differences in: SSB availability; staff and visitor awareness and support. Open-ended survey responses were thematically analysed. RESULTS The proportion of outlets that removed SSBs increased from 58.0% to 96.3% (P

Objectives and importance of study: News media portrayal of public health issues influences public opinion, policy action and decision making. This study aimed to analyse the use of ‘nanny state’ frames in Australian news media coverage; identify the stakeholders invoking this frame; determine which public health–related policies attract such framing; and investigate whether ‘nanny state’ framing is directly challenged in news coverage. Study type: A qualitative framing analysis. Methods: Articles featuring the term ‘nanny state’ that were published in Australian print newspapers during matched periods between March and September in 2017 and 2018 were sourced through Factiva, coded and analysed for content and ‘nanny state’ framing. Content analysis was used to identify any public health–related issues that the terminology nanny state was applied to, and who was portrayed as imposing the nanny state. Frame analysis was used to analyse what meanings are co-presented with the phrase nanny state. Results: Out of 81 print newspaper articles that included the term ‘nanny state’, 19% linked the term to restricting personal choice or creating dissatisfaction with too many health-related rules and regulations broadly, across a range of issues, including: bike helmets, e-cigarettes, firearm restrictions, seatbelts, pool fences and smoking bans. The next most frequent links were to regulations on alcohol (17%), road safety (14%), obesity-related issues (7%) and tobacco control (6%). Of the 81 articles, 53% appeared in news publications owned by News Corporation Australia, 20% in Fairfax Media (Nine Entertainment) publications, 17% in Daily Mail and General Trust and 10% in publications owned by other organisations. Governments were the entity most frequently framed as imposing the nanny state. Most nanny state framings (73%) were negative towards public health controls and focused on policies and regulations. Nanny state was portrayed as an assault on freedom and choice (14%) and used to attack proponents of nanny state controls (11%), while few articles framed the nanny state (7%) in a favourable light. Conclusions: ‘Nanny state’ is a rhetorical device commonly used in Australian news media that may contribute to discrediting of the regulation of a range of health-related issues. News Corp publications are a major propagator of nanny state rhetoric in Australian newspaper media. Public health advocates are not commonly represented within nanny state debates within the news media.

This study evaluated the benefit of physically-active lessons for learning maths multiplication-tables. The impact of the intervention on general numeracy, physical activity (PA), aerobic fitness, body mass index (BMI) and school-day moderate to vigorous PA (MVPA) was also assessed.Randomised controlled cross-over trial.Year 3 students (n=172, mean age 8.4±0.3 years, 48% male) were recruited from 10 classes across two urban primary schools. Participants were randomly assigned to a seated classroom (Classroom) group or physically-active lessons in the playground (Playground) and crossed over to the alternative condition in the subsequent school term. The 6-week intervention comprised 3×30min sessions/week. Multiplication-tables (teacher-designed test) and general maths (standardised test) were assessed pre- and post-intervention. Aerobic fitness was assessed via the shuttle-run. Pre- to post-intervention change scores were compared for analysis and effect sizes (ES) calculated. Total PA and MVPA were assessed with accelerometers in a subset of participants.Multiplication scores improved significantly more in Playground than Classroom groups (ES=0.23; p=0.045), while no significant differences were observed in general numeracy (ES=0.05; p=0.66). Total PA and MVPA were substantially higher during Playground than Classroom lessons (ES: total PA=7.4, MVPA=6.5; p0.001) but there were no differences in PA/MVPA between the groups throughout the rest of the school day. Aerobic fitness improved more in Playground than Classroom groups (ES=0.3; p0.001) while the change in BMI was not different between groups (p=0.39).Physically-active lessons may benefit the learning of maths multiplication-tables while favourably contributing to school-day PA/MVPA.

This Supplement aims to raise awareness and knowledge of how time use surveys may be applied to studying health behaviours such as physical activity, sedentary behaviour, and eating. This commentary provides an overview and discussion of the papers in this Supplement about time use and health research, and considers possible future directions for the field.

Background Relatively little is known about how total sedentary time is accumulated in different domains and if correlates of sedentary time differ across domains. Time use surveys present a unique opportunity to study sedentary time in more detail. This study aimed to use the 2006 Dutch time use survey to 1) describe the (sedentary) time use of Dutch adults, and 2) explore socio-demographic and health-related correlates of total (non-occupational) and domain-specific sedentary time. Methods The Dutch time use survey randomly selected participants from a population-representative research sample of Dutch households. Participants reported daily activities on seven consecutive days using a time use diary and socio-demographic and health-related characteristics during telephone interviews. All reported activities were coded for activity domain (i.e. education; household; leisure; occupation; sleep; transport; voluntary work) and activity intensity (i.e. sedentary; light intensity physical activity; moderate-to-vigorous intensity physical activity). As occupational activities were not specified in sufficient detail, the intensity of these activities was unknown. We described the time spent in different domains and intensities, and assessed the socio-demographic and health-related correlates of high levels of total (non-occupational), household, leisure, and transport sedentary time using logistic regression analyses. Results The final dataset consisted of 1614 adult (18+) participants. On average, participants spent 8.0 h (61.1%) of their daily waking non-occupational time on sedentary activities. More than 87% of leisure time was spent sedentary. Men, participants aged 18–34 and 65+ years, full-time employed participants and obese participants had higher levels of total non-occupational sedentary time. The correlates of household, leisure and transport sedentary time differed by domain. Conclusions This study reports high levels of total non-occupational sitting time of Dutch adults. The large proportion of sedentary leisure activities might indicate the potential of strategies aiming to reduce leisure sedentary time. The difference in correlates across sedentary behaviour domains demonstrates the importance of targeting these domains differently in interventions and policies.

Issue addressed Ecological momentary assessment (EMA) involves repeated sampling of current behaviours and experiences in real-time at random intervals. EMA is an innovative measurement method for program evaluation, using mobile technology (e.g. smartphones) to collect valid contextual health promotion data with good compliance. The present study examined the feasibility of using EMA for measuring workplace health outcomes. Methods Twenty-two office-based adults were prompted at four random times per work-day during a 5-day period to respond to a short survey via a smartphone application. The prompting stopped when participants had either responded 12 times or the 5-day period had ended. The questions pertained to posture, task currently being undertaken, social interactions, musculoskeletal issues, mood, and perceptions of engagement and creativity. Results In total 156 responses were collected. Nine participants completed all 12 surveys; the average completion rate was 58% (7/12). The average completion time was initially 50s and reduced to 24s during the later surveys. On average the participants were sitting and standing in 79% and 14% of survey instances, respectively. The participants reported they were working alone at their desks in 68% of instances. Reported productivity and stress were on average 6 and 3 out of 10, respectively, but varied up to 6-8 points within one person, hence the method appears sensitive to temporal variations in perceptions and mood. Conclusion Given the rich real-time data, minimal participant burden and use of readily available technology, EMA has substantial potential in workplace health promotion evaluation through the measurement of participants' well being, activities, and behaviour change. So what? An in-the-moment method using readily available mobile technology to assess participants' perceptions, mood and activity that provides rich information with minimal participant burden is a promising way to evaluate future health promotion programs.

Introduction Population aging is associated with a rising burden of non-communicable disease, profoundly impacting health policy and practice. Adopting and adhering to healthy lifestyles in middle or older age can protect against morbidity and mortality. Retirement brings opportunities to reconfigure habitual lifestyles and establish new routines. This study examines the longitudinal association between retirement and a range of lifestyle risk behaviors among a large population-based sample of Australian adults. Methods Study sample included working adults aged ≥45 years at baseline (2006–2009, N=23,478–26,895). Lifestyle behaviors, including smoking, alcohol use, physical activity, diet, sedentary behavior, and sleep, were measured at both baseline and follow-up (2010). Logistic regression models estimated the odds of having each risk factor at follow-up and multiple linear regression models calculated the change in the total number of risk factors, adjusted for baseline risk and other covariates. Sociodemographic characteristics and reasons for retirement were tested as potential effect modifiers. Results During the 3.3-year follow-up, about 11% of respondents retired. Retirement was associated significantly with reduced odds of smoking (AOR=0.74); physical inactivity (AOR=0.73); excessive sitting (AOR=0.34); and at-risk sleep patterns (AOR=0.82). There was no significant association between retirement and alcohol use or fruit and vegetable consumption. Change in the total number of lifestyle risk factors differed significantly by reason for retirement. Conclusions In a large population-based Australian cohort, retirement was associated with positive lifestyle changes. Health professionals and policymakers should consider developing special programs for retirees to capitalize on the healthy transitions through retirement.

Background: Prolonged sitting is associated with increased risk of chronic diseases. Workplace programs that aim to reduce sitting time (sit less) and increase physical activity (move more) have targeted desk-based workers in corporate and university settings with promising results. However, little is known about ‘move more, sit less’ programs for workers in other types of jobs and industries, such as shift workers. This formative research examines the perceptions of a ‘sit less, move more’ program in an Australian Emergency Call Centre that operates 24 hours per day, 7 days per week. Methods: Participants were employees (N = 39, 72% female, 50% aged 36–55 years) recruited from Emergency Services control centres located in New South Wales, Australia. The ‘sit less, move more’ intervention, consisting of emails, posters and timer lights, was co-designed with the management team and tailored to the control centre environment and work practices, which already included electronic height-adjustable sit-stand workstations for all call centre staff. Participants reported their perceptions and experiences of the intervention in a self-report online questionnaire, and directly to the research team during regular site visits. Questionnaire topics included barriers and facilitators to standing while working, mental wellbeing, effects on work performance, and workplace satisfaction. Field notes and open-ended response data were analysed in an iterative process during and after data collection to identify the main themes. Results: Whilst participants already had sit-stand workstations, use of the desks in the standing position varied and sometimes were contrary to expectations (e.g, less tired standing than sitting; standing when experiencing high call stress). Participants emphasised the “challenging” and “unrelenting” nature of their work. They reported sleep issues (“always tired”), work stress (“non-stop demands”), and feeling mentally and physically drained due to shift work and length of shifts. Overall, participants liked the initiative but acknowledged that their predominantly sitting habits were entrenched and work demands took precedence. Conclusions: This study demonstrates the low acceptability of a ‘sit less, move more’ program in shift workers in high stress environments like emergency call centres. Work demands take priority and other health concerns, like poor sleep and high stress, may be more salient than the need to sit less and move more during work shifts.

BACKGROUND Occupying new, active design office buildings designed for health promotion and connectivity provides an opportunity to evaluate indoor environment effects on healthy behaviour, sedentariness and workplace perceptions. AIMS To determine if moving to a health-promoting building changed workplace physical activity, sedentary behaviour, workplace perceptions and productivity. METHODS Participants from four locations at the University of Sydney, Australia, relocated into a new active design building. After consent, participants completed an online questionnaire 2 months before moving and 2 months after. Questions related to health behaviours (physical activity and sitting time), musculoskeletal issues, perceptions of the office environment, productivity and engagement. RESULTS There were 34 participants (60% aged 25-45, 78% female, 84% employed full-time); 21 participants provided complete data. Results showed that after the move participants spent less work time sitting (83-70%; P < 0.01) and more time standing (9-21%; P < 0.01), while walking time remained unchanged. Participants reported less low back pain (P < 0.01). Sixty per cent of participants in the new workplace were in an open-plan office, compared to 16% before moving. Participants perceived the new work environment as more stimulating, better lit and ventilated, but noisier and providing less storage. No difference was reported in daily physical activity, number of stairs climbed or productivity. CONCLUSIONS Moving to an active design building appeared to have physical health-promoting effects on workers, but workers' perceptions about the new work environment varied. These results will inform future studies in other new buildings.

© 2017, © 2017 Taylor & Francis Group, LLC. The first quantitative, specific recommendations for sitting time at work were released in June 2015. This paper examines the implications of news coverage received by this position statement. Media reports about statement published May, 31–June, 29, 2015 were analyzed according to five recommendations and three caveats extracted from the guidelines’ press release. Information about how physical activity was framed and mentions of conflicts of interest were recorded. Of 58 news reports, nine reported all five recommendations in the position paper. The topline recommendation (two hours daily of standing and light activity) was reported in all articles. Alleviating musculoskeletal discomfort by sitting less was not reported by 72% of reports. Physical activity was mentioned in 32 reports: 69% said physical activity did not attenuate the risks of prolonged sitting. No reports mentioned any potential conflicts of interest despite co-author links to sit-stand desk industry. These results demonstrate the need to balance public and market demands for public health guidance around sitting; and could encourage more accurate communication of research outcomes. The physical activity component of the “move more and sit less” message requires greater efforts to raise its public salience.

Objectives Consumers routinely seek health and nutrition-related information from online sources, including social media platforms. This study identified popular online nutrition content to examine the advice and assess alignment with the Australian Guideline to Healthy Eating (AGHE). Methods We used Facebook page “likes” as an indicator of popularity to identify online nutrition and diet content. Websites and blogs associated with pages that had more than 100,000 Australian likes on 7th September 2017 were included. The dietary advice promoted was collected and compared with the AGHE across nine categories (Vegetables, Fruits, Legumes, Grains, Lean Meat, Dairy/Alternative, Fat, Sugar, Salt) Results Nine Facebook pages met the inclusion criteria. The four most-liked pages were hosted by celebrities. Only two pages and their associated websites had advice consistent with AGHE recommendations across all nine categories reviewed. The concept of “real food” was a popular theme online. While most sources advocated increasing vegetable consumption and reducing processed food, other advice was not evidence-based and frequently deviated from the AGHE. Discussion Health information seekers are exposed to a variety of online dietary information and lifestyle advice. While few public health goals are promoted, there are many contradictions, as well as deviations from the AGHE, which can create confusion among health information seekers. Public health organisations promoting AGHE on Facebook are few and not as popular. Conclusion Public health organisations need to be more engaged on popular internet platforms such as Facebook. The prevailing popular nutrition advice online may increase consumer confusion, scepticism and even avoidance of dietary advice. Proactive efforts are needed by public health organisations, in partnership social marketing experts, to create and share engaging and accurate nutrition content. Partnership with celebrities should be explored to improve reach and impact of evidence-based diet recommendations online.

Media reports of the ‘new smoking’ have proliferated with little consideration of the disease burden of emergent risk factors. We consider the example of prolonged sitting in particular. The ‘new smoking’ analogy is a powerful heuristic device that draws on the well-known dangers of tobacco smoking. Such attention-grabbing ‘factoids’ are rapidly disseminated and perpetuated,1 and can be difficult to dispel later. We quantified which health risks have been called the ‘new smoking’ and consider the epidemiological evidence for and the implications of these comparisons. We searched the Factiva database for news stories containing the phrases ‘is the new smoking’ or ‘as bad as smoking’ in 2012–2016. News stories containing these phrases were independently coded for the health risk being compared with smoking, along with article characteristics (eg, headline, name of publication, date of publication). We identified 614 unique news stories that contained the target phrases. The top 10 mentioned health risks and behaviours compared with smoking are presented in table 1. The most dominant topics were sitting and obesity, with 55% and 12% of stories, respectively. The total number of ‘new smoking’ or ‘as …

This study aimed to explore the trend in population levels, as well as the correlates, of occupational and leisure sitting time in full-time employed Australian adults between 2007 and 2015. We used data from the 2007/08, 2011/12 and 2014/15 Australian Health Surveys, in which nationally representative samples of the Australian population were interviewed. Full-time (35 hours/week) employed respondents reported sitting time at work and during leisure on a usual workday. Trends over time and associations between socio-demographic and health-related characteristics and sitting time were analysed in the combined dataset using multivariable logistic regression models. Over 21,000 observations were included in the analyses. Across the three surveys, approximately 51% of the respondents reported 4 hours/workday occupational sitting time, 40% reported 4 hours/workday leisure sitting time, and 55% reported 7 hours/workday combined occupational and leisure sitting time. There were no clear trends over time. All potential correlates were associated with occupational sitting time and all but educational level were associated with leisure sitting time. The directions of the associations with gender, age and leisure-time physical activity were reversed for occupational sitting time and leisure sitting time. These findings show that the average levels of occupational and leisure sitting time on workdays were high but stable over the past decade. The observed differences in correlates of occupational and leisure sitting time demonstrate the need to assess and address sedentary behaviour domains separately in research and policy.

Background: Sedentary behaviour is a potential risk factor for chronic-ill health and mortality, that is, independent of health-enhancing physical activity. Few studies have investigated the risk of mortality associated with multiple contexts of sedentary behaviour. Objective: To examine the prospective associations of total sitting time, TV-viewing time and occupational sitting with mortality from all causes and cardiometabolic diseases. Methods: Data from 50 817 adults aged ≥20 years from the Nord-Trøndelag Health Study 3 (HUNT3) in 2006-2008 were linked to the Norwegian Cause of Death Registry up to 31 December 2010. Cox proportional hazards models examined all-cause and cardiometabolic disease-related mortality associated with total sitting time, TV-viewing and occupational sitting, adjusting for multiple potential confounders including physical activity. Results: After mean follow-up of 3.3 years (137 315.8 person-years), 1068 deaths were recorded of which 388 were related to cardiometabolic diseases. HRs for all-cause mortality associated with total sitting time were 1.12 (95% CI 0.89 to 1.42), 1.18 (95% CI 0.90 to 1.57) and 1.65 (95% CI 1.24 to 2.21) for total sitting time 4

Objective Occupational sitting time in white-collar workers represents a prominent contributor to overall daily sitting time, which is associated with various health risks. Workplace interventions intending to reduce sitting time during work typically focus on replacing sitting with standing. The aim was to investigate and compare actual and desired proportions of time spent sitting, standing, walking, and doing physically demanding tasks at work reported by desk-based workers. Cross-sectional data were collected from German desk-based workers (n = 614; 53.3% men; 40.9 ± 13.5 years). All were interviewed about their self-reported actual and desired level of sitting, standing, walking and physically demanding tasks at work. Results Desk-based workers reported to sit 73.0%, stand 10.2%, walk 12.9% and do physically demanding tasks 3.9% of their working hours. However, the individuals desire to sit, stand, walk and do physically demand tasks significantly different [53.8% sit, 15.8% stand, 22.8% walk, physically demanding tasks (7.7%), p

Issue addressed Social marketing (SM) campaigns can be a powerful disease prevention and health promotion strategy but health-related campaigns may simply focus on the "promotions" communication activities and exclude other key characteristics of the SM approach. This paper describes the application of a checklist for identifying which lifestyle-related chronic disease prevention campaigns reported as SM actually represent key SM principles and practice. Methods A checklist of SM criteria was developed, reviewed and refined by SM and mass media campaign experts. Papers identified in searches for "social marketing" and "mass media" for obesity, diet and physical activity campaigns in the health literature were classified using the checklist. Results Using the checklist, 66.6% of papers identified in the "SM" search and 39% of papers identified from the "mass media" search were classified as SM campaigns. Inter-rater agreement for classification using the abstract only was 92.1%. Conclusions Health-related campaigns that self-identify as "social marketing" or "mass media" may not include the key characteristics of a SM approach. Published literature can provide useful guidance for developing and evaluating health-related SM campaigns, but health promotion professionals need to be able to identify what actually comprises SM in practice. SO WHAT?: SM could be a valuable strategy in comprehensive health promotion interventions, but it is often difficult for non-experts to identify published campaigns that represent a true SM approach. This paper describes the application of a checklist to assist policy makers and practitioners in appraising evidence from campaigns reflecting actual SM in practice. The checklist could also guide reporting on SM campaigns.

Background Current evidence concerning sedentary behaviour and mortality risk has used single time point assessments of sitting. Little is known about how changes in sitting levels over time affect subsequent mortality risk. Aim To examine the associations between patterns of sitting time assessed at two time points 11 years apart and risk of all-cause and cardio-metabolic disease mortality. Methods Participants were 25,651 adults aged > =20 years old from the Nord-Trøndelag Health Study with self-reported total sitting time in 1995-1997 (HUNT2) and 2006-2008 (HUNT3). Four categories characterised patterns of sitting: (1) low at HUNT2/ low at HUNT3, ‘consistently low sitting’; (2) low at HUNT2/high at HUNT3, ‘increased sitting’; (3) high at HUNT2/low at HUNT3, ‘reduced sitting’; and (4) high at HUNT2 /high at HUNT3, ‘consistently high sitting’. Associations of sitting pattern with all-cause and cardio-metabolic disease mortality were analysed using Cox regression adjusted for confounders. Results Mean follow-up was 6.2 years (158880 person-years); 1212 participants died. Compared to ‘consistently low sitting’, adjusted hazard ratios for all-cause mortality were 1.51 (95% CI: 1.28–2.78), 1.03 (95% CI: 0.88–1.20), and 1.26 (95% CI: 1.06–1.51) for ‘increased sitting’, ‘reduced sitting’ and ‘consistently high sitting’ respectively. Conclusions Examining patterns of sitting over time augments single time-point analyses of risk exposures associated with high sitting time. Whilst sitting habits can be stable over a long period, life events (e.g., changing jobs, retiring or illness) may influence sitting trajectories and therefore sitting-attributable risk. Reducing sitting may yield mortality risks comparable to a stable low-sitting pattern. © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Pokémon Go has been subject to much attention – from both the players that download the augmented reality game and the news media. Amid the exaggerated media reports, Pokémon Go may have unintended health benefits. Players have reported walking more, spending more time with family, experiencing improvements in their mental health and feeling more connected to their communities. It is hard to imagine public health researchers developing a similar game that is fun, taps into pop culture, reaches a wide target audience, makes use of physical and virtual environments, creates a sense of both competition and community, and has spin-off health benefits. Companies that endanger public health immediately recognised the value of the Pokémon Go app, and exploited it to advertise and promote consumption of unhealthy foods. Public health stakeholders need to develop mobile-based interventions within a framework that embraces pleasure, rewards, participation and community. Public health agencies need to be just as nimble and responsive as companies that are harmful to health, or forever be creating games that nobody plays.