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The Sydney Diabetes Prevention Program (SDPP) was a community-based type 2 diabetes prevention translational research study with screening and recruitment in the primary health care setting. We aimed to investigate the program's effectiveness in reducing risk factors for diabetes as well as the program's reach, adoption and implementation.1238 participants aged 50-65 years at high-risk of developing type 2 diabetes were recruited by primary care physicians in the greater Sydney region. The intervention, delivered by trained allied health professionals, included an initial consultation, three group sessions/individual sessions, three follow-up phone calls, and a final review at 12 months. Biomarkers and behavioural goals were compared between baseline and 12 months.At baseline, the mean age of those who entered the program was 58.8 ± 4.4 years, 63% female, and the mean body mass index was 31.6 ± 5.2 kg/m(2). There was a significant weight reduction of 2 ± 4.3 kg (p0.02) in the 850 participants who completed the 12-month follow-up accompanied by improvements in diet (total fat, saturated fat, and fibre intake) and physical activity. There were also significant reductions in waist circumference 2.6 ± 4.7 cm (p0.001) and total cholesterol -0.2 ± 0.8 mmol/L (p0.001) but not blood glucose. The diabetes risk reduction was estimated to be 30%, consistent with similar trials.This study demonstrates that a community-based lifestyle modification program is effective in reducing important risk factors for diabetes in individuals at high-risk of developing type 2 diabetes.

Aim There is strong and consistent evidence from large scale randomised controlled trials that type 2 diabetes can be prevented or delayed through lifestyle modification which improves diet quality, increases physical activity and achieves weight loss in people at risk. Worldwide, the prevalence of type 2 diabetes is increasing in individuals of Chinese descent. Culturally tailored programs are required to address the risk in the Chinese population. This paper analyses effectiveness of a culturally tailored community-based lifestyle modification program (Sydney Diabetes Prevention Program (SDPP)) targeting Mandarin speakers. The SDPP was a 12 month translational study aiming to promote increased physical activity and dietary changes. Effectiveness was assessed through the improvement of anthropometric, metabolic, physical activity and dietary outcomes and number of goals met. Methods Seventy-eight Mandarin-speaking participants at a high risk (Australian Diabetes Risk, AUSDRISK ≥ 15) of developing diabetes were recruited for this study. Results In this cohort, waist circumference, total cholesterol and fat intake significantly improved at the 12-month review. In comparison to the English-speaking stream, the Mandarin-speaking stream achieved fewer improvements in outcomes and goals. Conclusion The SDPP was not effective in reducing the risk factors associated with developing type 2 diabetes in this cohort of high risk Mandarin-speaking individuals living in Sydney.

1 ISSN 1758-1907 10.2217/DMT.12.79 © 2013 Future Medicine Ltd Diabetes Manage. (2013) 3(1), 1–4 The global diabetes epidemic continues unabated with the number of people with diabetes predicted to increase from 366 million in 2011 to 552 million by 2030 [1]. In Australia, the burden of Type 2 diabetes is increasing and diabetes is expected to become the leading cause of disease burden by 2023 [2]. It is now just over a decade since the landmark US Diabetes Prevention Program (USDPP) and Finnish Diabetes Prevention Study both found that the risk of developing Type 2 diabetes could be reduced by 58% by lifestyle modification that focused on nutrition, physical activity and modest weight loss, and, more recently, that it could be sustained [3,4]. Cost–effectiveness analyses of different strategies for screening and prevention of Type 2 diabetes suggest that screening for Type 2 diabetes and impaired glucose tolerance, followed by interventions, is cost effective [5]. Furthermore, in the USDPP, lifestyle intervention was more cost effective than pharmacological intervention [6]. The potential to prevent or delay Type 2 diabetes in high-risk individuals by lifestyle intervention has been unequivocally established (proof of concept); however, most landmark studies, conducted exclusively in primary care settings, used intensive, individualized interventions that would be difficult to roll out as population-wide programs [7]. The challenge is to translate this evidence into feasible and effective communitybased programs that can be scaled up and rolled out more broadly in existing health and community systems [8,9]. In response to the challenge, a promising range of translational research studies have emerged over the past decade. In addition to the primary care setting, several studies have demonstrated the feasibility of screening and recruiting in workplaces and community settings, together with the effectiveness of group-based interventions [10–12]. Moving from scientific discovery to population-wide implementation requires a series of steps, each building upon the achievements of the previous step, from basic research to diffusion of interventions [13]. Over the last decade the USA, Finland and other parts of Europe have been leading the way in exploring policy efficiency, availability and distribution, as well as diffusion of diabetes interventions. In these countries, governments are showing

World Diabetes Congress, Melbourne, Victoria, Australia, 2–6 December 2013 Every 2 years the International Diabetes Federation holds the World Diabetes Congress. It brings together world leaders and experts including healthcare professionals, researchers, policy-makers, pharmaceutical companies, people with diabetes, their families and their carers exchanging diverse views, perspectives, challenges and solutions with respect to the prevention, management and treatment of diabetes. Twenty years after the World Diabetes Congress in Japan, the focus was again in the western pacific region as Melbourne hosted the World Diabetes Congress from 2–6 December 2013. Over 10,000 delegates came from across the globe to hear the President of the International Diabetes Federation Sir Michael Hirst, outline the threat the world faces from diabetes – it is a global challenge requiring a global response. One of the key outcomes of the conference was the release of the Melbourne Declaration on Diabetes in which 50 Governme...

Few studies have evaluated environmental changes to promote physical activity. The impact of a local promotional campaign around a newly constructed Rail Trail in western Sydney, Australia, was assessed.Pre and post-campaign telephone surveys were used. Adults 18-55 years of age were randomly sampled from an "inner" area, residents withinor =1.5 km of the Trail, and an "outer" area, bike-owners only, 1.5-5 km from the Trail. Objective concurrent monitoring of daily bike counts was carried out.A cohort of 450 completed both interviews. A significant increase (+2.9%, McNemar P0.05) in unprompted Trail awareness was detected but post-campaign awareness was low (34%). Inner cyclists, males, and those recalling any baseline bike promotion messages were more likely to be aware of the Trail. Trail usage was higher among bike-owners than pedestrians (8.9 vs 3.3%, P = 0.014) and was moderated by proximity to the Trail. Inner cyclists increased mean cycling time by 0.19 h (SD = 1.5) while outer cyclists decreased cycling time (-0.24 h, SD = 1.6). Mean daily bike counts in the monitored areas increased significantly after the Trail launch (OR = 1.35, P = 0.0001, and OR = 1.23, P = 0.0004).The campaign reached and influenced cyclists in the inner area. For further increase in Trail usage promotional and educational programs focusing on walking for inner residents are needed.

© 2013 John Wiley & Sons, Ltd. All rights reserved. Lifestyle interventions are effective in preventing type 2 diabetes in high-risk participants. Policy makers need efficient and cost-effective strategies to screen and recruit high-risk participants into appropriate programs. Moreover, since there is a clear dose-response relationship between lifestyle modification program components and outcomes it is important to understand what factors increase adherence. Various strategies in a range of settings have been attempted, to capture high-risk people. Two Australian diabetes prevention programs were compared to identify the critical factors in recruitment and retention. A population health approach with a comprehensive social marketing strategy, telephone support, in a range of settings, particularly with program provider led strategies, holds great promise. Most programs continue be under represented with males, medically underserved and those who are socially disadvantaged. Program retention remains a challenge. Sustained multi-setting, community-wide, population health approaches targeting high-risk participants who are less likely to engage with and complete programs should be explored further.

Habitual physical activity is associated with a number of health benefits, particularly in relation to the prevention of cardiovascular disease. Psychological research has made useful contributions to the understanding of physical activity as a pattern of behaviour. We describe the behavioural epidemiology of physical activity, exercise assessment issues, and Australian data on the population prevalence and recent trends in exercise participation. We present a selective commentary on studies of the determinants of exercise participation, with examples of studies likely to be of particular relevance to psychologists. Studies of potential determinants (demographic and biological characteristics; past and present activity patterns; self-motivation; knowledge, attitudes, and beliefs; environmental characteristics) show inconsistent patterns of findings. Making better use of representative population data on physical activity, studying the role of environmental influences on participation, understandi...

Background The effectiveness of lifestyle interventions in reducing diabetes incidence has been well established. Little is known, however, about factors influencing the reach of diabetes prevention programs. This study examines the predictors of enrolment in the Sydney Diabetes Prevention Program (SDPP), a community-based diabetes prevention program conducted in general practice, New South Wales, Australia from 2008–2011. Methods SDPP was an effectiveness trial. Participating general practitioners (GPs) from three Divisions of General Practice invited individuals aged 50–65 years without known diabetes to complete the Australian Type 2 Diabetes Risk Assessment tool. Individuals at high risk of diabetes were invited to participate in a lifestyle modification program. A multivariate model using generalized estimating equations to control for clustering of enrolment outcomes by GPs was used to examine independent predictors of enrolment in the program. Predictors included age, gender, indigenous status, region of birth, socio-economic status, family history of diabetes, history of high glucose, use of anti-hypertensive medication, smoking status, fruit and vegetable intake, physical activity level and waist measurement. Results Of the 1821 eligible people identified as high risk, one third chose not to enrol in the lifestyle program. In multivariant analysis, physically inactive individuals (OR: 1.48, P = 0.004) and those with a family history of diabetes (OR: 1.67, P = 0.000) and history of high blood glucose levels (OR: 1.48, P = 0.001) were significantly more likely to enrol in the program. However, high risk individuals who smoked (OR: 0.52, P = 0.000), were born in a country with high diabetes risk (OR: 0.52, P = 0.000), were taking blood pressure lowering medications (OR: 0.80, P = 0.040) and consumed little fruit and vegetables (OR: 0.76, P = 0.047) were significantly less likely to take up the program. Conclusions Targeted strategies are likely to be needed to engage groups such as smokers and high risk ethnic groups. Further research is required to better understand factors influencing enrolment in diabetes prevention programs in the primary health care setting, both at the GP and individual level.

Physical inactivity is an important but under recognised risk factor for chronic disease. This study explored changes in general practitioners' perceptions and practices in relation to addressing physical activity from 1997-2000.In 1997 and 2000 GPs in five divisions of general practice in New South Wales were sent a questionnaire about their knowledge, confidence, perceived role, and frequency of talking to patients about physical activity.At the second survey, GPs had significantly improved their knowledge and perceived role in physical activity promotion as well as their confidence to address this risk factor. However, GPs reported discussing physical activity with similar numbers of patients in 1997 and 2000.State wide campaigns and National Heart Foundation efforts may have influenced GPs' knowledge and beliefs about physical activity, but not the extent to which they discuss this with their patients. Greater attention needs to be given to the barriers that hamper these GP efforts.

Objectives: To determine whether awareness of the moderate physical activity message and prevalence of participation changed among Australian adults between 1997 and 1999, and if changes differed across Australia. Methods: Data were compared on awareness of the moderate physical activity message and on physical activity participation from identical national physical activity surveys in 1997 and 1999. Results: In 1999, following integrated public health efforts, recognition of the Active Australia campaign was substantially higher in NSW/ACT (61.7%) than elsewhere (29.3%). Knowledge about benefits of moderate activity increased between 1997 and 1999, more so in States with public health campaigns. National participation in ‘sufficient physical activity’ declined between 1997 and 1999, from 63% to 57%, but the decline was smaller in NSW/ACT (4.4%) than in the other States (6.0%). Conclusions and implications: Declining trends in physical activity in Australia require increased public health investments, including strategic planning and public education, such as occurred in NSW (1997/98).

Cancer is a diverse group of diseases characterised by the proliferation and spread of abnormal cells. Different forms of cancer can share common risk factors; however, often a unique set of risk factors are responsible for the onset of a particular cancer. Risk factors for cancer are both inherent, such as the inherited APC gene that predisposes individuals to develop colorectal cancers; and environmental, such as excessive sun exposure, particularly in childhood, which increases the risk of developing melanoma. Some risk factors are, theoretically at least, easier to modify than others (for example, quitting smoking as compared with inheriting the APC gene). This article deals with measuring the population prevalence of risk factors for which exposure can be modified to prevent the development of cancers.

Background: Physical activity is now a public health priority, but there is only limited evidence on the effectiveness of mass-reach campaigns. Intervention: Paid and unpaid television and print-media advertising. physician mail-outs, and community-level support programs and strategies. Setting/Participants: A mass-media statewide campaign to promote regular moderate-intensity activity was conducted during February 1998. The target group was adults aged 25 to 60 who ere motivated but insufficiently active. Design: Cohort and independent-sample, cross-sectional representative population surveys, before and after the campaign. The intervention was conducted in the state of Nerv South Wales, with the other states of Australia as the comparison region. Measures: Telephone survey items on physical activity, media message awareness, physical activity knowledge, self-efficacy, and intentions. Results: Unprompted recall of the activity messages in the campaign state increased substantially from 2.1% to 20.9% (p

Background. This paper describes the study design, recruitment, measurement, and initial recruitment outcomes of Australia's largest workplace intervention trial, the National Workplace Health Project. Methods. This was a cluster-randomized trial of socio-behavioral and environmental interventions focusing on key behaviors of physical activity, healthy food choices, cigarette smoking, and alcohol consumption, as well as motivational readiness for change. Twenty worksites were randomized separately for each intervention using a two-by-two factorial design. All participants underwent a health risk appraisal and measurements were made at baseline and at 1 and 2 years. Results. The overall response rate for the baseline survey was 73% with 61% attending the health risk appraisal. The sample was predominantly male, English-speaking, married, blue-collar workers. Overall, 12% reported unsafe alcohol consumption, 26% were current smokers, 44% were physically inactive, 74% ate at most one piece of fruit per day, and 26% ate at most one serving of vegetables per day. Intervention and control conditions were similar at baseline for the primary outcomes, except that a higher proportion of the sociobehavioral intervention condition was more physically active (59%) than the corresponding control condition (53%). Conclusions. This study will permit the rigorous evaluation of the efficacy of sociobehavioral and environ mental intervention approaches to workplace health promotion. Although participants were randomized by worksite, intervention and control conditions were similar at baseline; any differences in the primary out come variables will be controlled for in the analysis.

Aim: To assess if participants who completed a 12-month lifestyle modification diabetes prevention program, reduce, increase or maintain weight two years after program is completion. Methods: Participants who completed the Sydney Diabetes Prevention Program (the ‘program’) where followed up annually for an additional two years. The program targeted 50—65-year olds at high-risk of Type 2 diabetes with a 12-month lifestyle modification program aimed at improving nutrition (decreasing total fat and saturated fat, increasing fibre), increasing physical activity and 5% weight loss (n = 1238). The mean weight loss of those who completed the program (n = 850) was 2 kg. Participants who had begun the program at least three years ago were contacted annually by computer assisted telephone interview to selfreport their diet, physical activity and weight. Results: Of the 232 participants (mean age 59.4, 68% female) eligible to be contacted the mean weight at program completion was 86.9 kg. At one year and two year follow up the response rates were 88% and 89%, respectively. The mean weight at one-year follow up was 83.1 kg (n = 183) and at two-year follow up 85.1 kg (n = 199). There were no significant differences in weight between the three time points. At the one-year follow up participants reported they were eating less fat and more fibre, however physical activity had not changed. Conclusions: Diabetes prevention programs which target individuals at high-risk of Type 2 diabetes can maintain modest weight loss. More intensive interventions may be required to increase weight loss and reduce or prevent weight gain in this population.

Skin cancer remains an important public health issue in Australia due to its high prevalence, large burden on the health system and amenability to prevention. NSW has a strong track record of successful sun protection programs. This article presents the key directions as set out in the recently released NSW Skin Cancer Prevention Strategic Plan 2001–2005. The article also provides an overview of the organisational partnerships, networks and relationships that provide the building blocks for increasing the capacity to implement skin cancer prevention programs in NSW.

There is a need for national public health action to increase fruit and vegetable consumption for the protection and prevention of chronic disease, including many cancers. There has never been a better time to advance public health nutrition in Australia.

Improved nutrition is second only to tobacco use as the most important preventable health measure. Nutrition is a key element of chronic disease prevention as diet-related disease costs Australia at least $2.5 billion per year in health-care costs and lost earnings.

Background Type 2 diabetes is a major public health problem in Australia with prevalence increasing in parallel with increasing obesity. Prevention is an essential component of strategies to reduce the diabetes burden. There is strong and consistent evidence from randomised controlled trials that type 2 diabetes can be prevented or delayed through lifestyle modification which improves diet, increases physical activity and achieves weight loss in at risk people. The current challenge is to translate this evidence into routine community settings, determine feasible and effective ways of delivering the intervention and providing on-going support to sustain successful behavioural changes. Methods/Design The Sydney Diabetes Prevention Program (SDPP) is a translational study which will be conducted in 1,550 participants aged 50-65 years (including 100 indigenous people aged 18 years and older) at high risk of future development of diabetes. Participants will be identified through a screening and recruitment program delivered through primary care and will be offered a community-based lifestyle modification intervention. The intervention comprises an initial individual session and three group sessions based on behaviour change principles and focuses on five goals: 5% weight loss, 210 min/week physical activity (aerobic and strength training exercise), limit dietary fat and saturated fat to less than 30% and 10% of energy intake respectively, and at least 15 g/1000 kcal dietary fibre. This is followed by 3-monthly contact with participants to review progress and offer ongoing lifestyle advice for 12 months. The effectiveness and costs of the program on diabetes-related risk factors will be evaluated. Main outcomes include changes in weight, physical activity, and dietary changes (fat, saturated fat and fibre intake). Secondary outcomes include changes in waist circumference, fasting plasma glucose, blood pressure, lipids, quality of life, psychological well being, medication use and health service utilization. Discussion This translational study will ascertain the reach, feasibility, effectiveness and cost-effectiveness of a lifestyle modification program delivered in a community setting through primary health care. If demonstrated to be effective, it will result in recommendations for policy change and practical methods for a wider community program for preventing or delaying the onset of type 2 diabetes in high risk people.