Evidence on Effective Interventions - Lightweight at Best!” by- Lesley King & Debra Hector

One of the fellow Prevention Centers with CPAH, the Center for Overweight and Obesity (COO) participated in the Collaborative Centre for Aboriginal Health Promotion (CCAHP) Forum - Physical Activity and Nutrition held March 20. The forum focuses on Aboriginal Health Promotion to assist the sector in developing a coordinated approach in a number of focus areas and on Nutrition and Physical Activity in Aboriginal Communities. The event attracted over 100 delegates from rural, remote and urban areas who represented research centers, Aboriginal Medical Services and Area Health Services. I find myself fascinated with Aboriginal issues as they seem to parallel the American Indian health concerns. The forum series is supported by the Cancer Council of NSW, the Cancer Institute and the National Heart Foundation of Australia (NSW).

The aim of the forum was to:

• develop a coordinated approach to nutrition and physical activity within Aboriginal communities across NSW
• showcase programs in these areas
• highlight best practice and evidence based research in the area.

.The forum aimed to:

• Promote existing healthy weight interventions, evidence and health promotion programs specific to Aboriginal communities
• Provide people working in Aboriginal health promotion with the opportunity to network and collaborate
• Develop a strategic approach to nutrition & physical activity for Aboriginal communities in NSW

A particular topic that captured my interest was a session titled “Evidence on Effective Interventions - Lightweight at Best!” by- Lesley King & Debra Hector (Centre for Overweight & Obesity (COO)). In brief, her presentation covered the following:

After reading over the presentation the following is the summary of evidence:

There is a lack of evaluated programs

Nearly all interventions are based on a “Healthy Lifestyle” approach

Most involved nutrition and PA interventions or messages

Interventions were based on community cultural events

Only 3 programs had weight as an outcome measure

Evidence based interventions must include:

Socially based activities and sports-PA if done solely for the benefit of the individual, is often seen as shameful or as disconnecting individuals from ties to their social world

Traditional Foods in Community Gardens

Reduce dependence on outsiders

Keep money within the community

Fit within relationship and obligation systems

Address issues of self-worth and pride

Interventions included-Our games, Our Health

Project driven by and targeted the whole community

Indigenous holistic approach to health

Initial focus was men’s and older people’s health –changed focus to school children

Revival of traditional games – from Choopadoo: Games from the Dreamtime

No comprehensive evaluation

Conclusion

Focus has been on programs in rural and remote Aboriginal communities – yet the majority of Aboriginal people live in urban regions where the prevalence of obesity is highest

Accessible, culturally appropriate and relevant programs need to be developed for indigenous people living in urban, rural and remote locations

More programs, more research and more evaluation!

Successful interventions occur when they are a response to the expressed needs of the Community rather than a response to the health agency’s agenda

Community involvement from the beginning creates empowerment

A flexible and relaxed approach is necessary

Community relevance, acceptance and accessibility is paramount

Community ownership and management of the programs is particularly important

The 2002 General Social Survey (GSS)

Adrian asked me to look into the GSS and this is what I found!

Overview-the main purpose of the supplementary topics in the 2002 GSS is to provide specific detailed information to policy makers.

• First survey of this type
• Conducted by the ABS
• Intended to be repeated every 4 years (March-July 2002)
• Much of the content unchanged, to enable changes over time to be measured (hallelujah!) and
• A flexible component to enable the inclusion of contemporary and emerging issues in each survey cycle.

The aims of the GSS are to:

• present data on a range of social dimensions of the Australian community at a single point in time
• by collecting data on a range of topics from the same individual, enable analysis of the interrelationship of social circumstances and outcomes, including the exploration of multiple advantage and disadvantage
• provide a base for comparing social circumstances and outcomes over time and across population groups

Evolvement:

• ABS undertook extensive consultation with key government users at both State and Commonwealth level
• Many Stakeholders
• Review found considerable interest in a general social survey and support from many users
• many social phenomena are inter-related and social policy is becoming less sectoral as a consequence
• surveys which allow inter-relationships between different aspects of people's lives to be explored are important

Information Collected:

• Details of health and disability, housing, education, labour force, transport, crime, and indicators of family and community involvement
• economic items (income and selected assets, liabilities and financial stress indicators)
• demographics
• Three supplementary topics
• extent of computer and internet access,
• attendance at cultural and sporting events, and
• participation in sport or other physical activity.

Purpose-the key objectives of the GSS are:

• to collect data from a range of areas of social concern, to allow information to be connected in ways not generally available, for use in developing broad-based social policy; and
• to provide national and state level estimates, recognizing state/territory responsibilities in many areas of social concern.

GSS obtains strategic information about the factors that determine outcomes such as health, living standards or social cohesion through the inter-relationships between different aspects of peoples' lives. For example:

• the social context of crime victimization;
• the relationship between the growing use of information technology and other areas of peoples' lives;
• the relationship of 'non-standard' (or precarious) employment with a range of social determinants and outcomes;
• the complex set of inter-relationships between individuals and their environments that influences health and well-being outcomes, such as financial stress and financial security;
• the material living standards that families achieve from the range of human and economic resources at their disposal; and
• the relationships between the strength of peoples' social networks and other areas of well-being.

The GSS also:

• provides overlap between question sets in the GSS and the more detailed Special Supplementary Surveys (SSSs) conducted by the ABS, to enable connections to be made;
• provides a foundation for, and a link with, the National Aboriginal and Torres Strait Islander Social Survey;
• regularly provide a general picture of the social characteristics of Australia's adult population;
• compare the circumstances of a wide range of population groups; and
• measure changes over time.

The survey includes:

• All usual residents aged 18 years and over living in private dwellings.
• Urban and rural areas only. The exclusion of people living in remote and sparsely settled areas only has a minor impact on aggregate national and State level estimates.
• survey results are weighted to include persons living in these areas. In the Northern Territory, however, persons living in remote and sparsely settled areas account for over 20% of the population, and the survey results are not weighted to include persons living in sparsely populated areas.

Exclusions from the scope of the survey:

• Visitors to private dwellings are excluded, as are persons in institutions (such as hospitals and nursing homes) and special dwellings (such as hotels and boarding houses).
• non-Australian diplomatic staff and non-Australian members of their households;
• members of non-Australian defence forces stationed in Australia and their dependents; and
• overseas visitors whose usual place of residence is outside Australia.

Main outputs
Most data from the GSS will be available at the person level for persons aged 18 years and over. Certain data will also be compiled in relation to income units and households.

Core topics:

Demographic/core Age Sex Social marital status Registered marital status Family type Household type Relationship in household Number and age of people in household State or Territory of usual residence Capital city/balance of State Accessibility/Remoteness Index for Australia (ARIA) Socio-Economic Indexes For Areas (SEIFA) Country of birth Year of arrival Main language other than English spoken at home Proficiency in spoken English Health Self assessed health status Disability status Housing Tenure type (household) Landlord type (household) Rent/mortgage payments (household) Education Highest educational attainment Field of study Full-time/part-time study for qualification Type of educational institution Work Labour force status Number of employed persons in household Retirement status Occupation Multiple job holder Hours usually worked Full time/part time status Status in employment Leave entitlements in main job Expected future duration in current job

Income Income (personal, income unit and household) Main source of income (personal, income unit and household) Type of government pension/allowance Time on government support Financial stress Unable to borrow in an emergency (household) Cash flow problems (household) Dissaving (household) Assets and liabilities Value of home (household) Value of mortgage against home (household) Equity in home (household) Selected investments (household) Consumer debt (household) Information technology Use of a computer at home Frequency of internet access Type of internet activity Government services accessed via internet Transport Access to motor vehicles Perceived level of difficulty with transport Travel time to work Family and community Support for children outside household Support for others outside household Contact with family/friends Social activities Stressors Ability to ask for small favours Support in time of crisis Voluntary work Crime Victim of violent crime (assault) Victim of property crime (household) Feelings of safety at home

Supplementary topics:

Information technology Household use of IT at home Household access to technologies Access to a computer at home Access to the Internet at home Frequency of Internet access at home Intention to have Internet access at home Personal use of IT Use of a computer at home/work/other locations Type of computer activity Use of the Internet at home/work/other locations Type of Internet activity Technologies used to work from home Frequency of Internet access at home/work/ other locations Financial services accessed via telephone

Culture and recreation Culture/Leisure activities and venues Cultural/leisure activities or venues attended Frequency of attendance at specified cultural/leisure activity or venue Sporting events Sporting events attended Frequency of attendance at specified sporting event Physical recreation activities Participation in physical activity for exercise/recreation/sport Capacity in which participated in each activity Frequency of participation in each activity

Classifications:
The GSS will use standard ABS data items and classifications where appropriate. Major classifications to be used include:

· Australian Standard Classification of Education (ASCED);

· Australian Standard Classification of Occupations (ASCO);

· Standard Australian Classification of Countries (SACC); and

· Standard Australian Classification of Languages (ASCL).

GEOGRAPHIC DETAIL:

New South Wales
Victoria
Queensland
South Australia
Western Australia
Tasmania
Northern Territory
ACT
Part of State Metropolitan
Part of State Extra-Metropolitan

COLLECTION HISTORY

Although the 2002 survey was the first GSS, some of the information collected had previously been included in a range of more specific ABS surveys. These include:

· Household Expenditure Survey;

· Survey of Income and Housing Costs;

· Australian Housing Survey;

· Survey of Disability Ageing and Carers;

· Survey of Education, Training and Information Technology;

· National Health Survey;

· Voluntary Work Survey;

· Crime and Safety Survey;

· Survey of Employment Arrangements and Superannuation;

· Labour Force Survey;

· Survey of Attendance at Selected Culture/Leisure Venues; and

· Survey of Sports Attendance.

Data availability comments

Results from the survey were made available in December 2003 in the form of a national level publication. The 2002 GSS Microdata has been available since 30th July 2004.

http://www.abs.gov.au/AUSSTATS/abs@.nsf/d36c95a5d2ce6cedca257098008362c8/bcca017fd0cdb8feca256dff007f9b88/$FILE/ATTJXZJL/GSS%20Output%20data%20items_2002.pdf

Summary of 2002 Results-The publication also provides information to assist users in interpreting and using the results of the survey, including descriptions of the survey design and methodology and notes on the quality of estimates and their comparability with data from other ABS surveys. 15,500 people aged 18 years and over across all states and territories of Australia.

· Information was collected about both the individuals being interviewed and about the households in which they lived.

Health and disability

The majority of Australians (84% of persons aged 18 years or over) consider themselves to be in good, very good or excellent health. The proportion of persons reporting fair or poor health generally increased with age, from 7% of those in the 18-24 and 25-34 years age groups to 38% of those aged 75 years or over.

Personal health appears to be correlated with household income. Of those persons in the lowest quintile (i.e. the bottom 20% of people ranked by their equivalised gross household incomes), 35% assessed their health as fair or poor, compared to only 6% for those in the highest quintile.
Of Australians aged 18 years or over, 40% (5,758,000 people) had a disability or long-term health condition with the rate increasing with age, from 23% of persons aged 18-24 years to 80% of persons aged 75 years or over. The proportion of people with a disability or long-term health condition involving one or more core activity limitations increased from 4% for those aged 18-24 years to 36% among those aged 75 years or over.

The proportion of people who assessed their health as good or better and had no disability or long-term health condition was highest in the 18-24 year age group (74%), falling as age increased to only 19% in the 75 years or over age group.

Transport:

Lack of access to transport due to problems of affordability, safety, availability, convenience, and appropriateness of the type of transport available can act as a barrier to people's participation in the range of social, civic and economic activities of mainstream society.

Most people aged 18 years or over (84%) felt that they could easily get to the places where they needed to go; 12% felt that they sometimes had difficulty getting to such places; while 4% felt that they either could not get to places needed to go or often had difficulties in doing so.

Persons in the youngest age group (18 to 24 year olds) and the oldest age group (75 years or over) were the most likely to experience difficulties in getting access to motor vehicles or easily getting to places they needed to go.

• The majority of Australian adults (84%) considered themselves to be in good, very good or excellent health. The proportion of people reporting fair or poor health generally increased with age, from 7% of those in the 18-24 and 25-34 years age groups to 38% of those aged 75 years or over. Approximately 40% reported a disability or long-term health condition with the rate again increasing with age.

Interesting questions:

Do you have access to motor vehicle?

(4 questions) Survey of participation in sport and recreational physical activities

Whether has participated in sport or recreational physical activity in last 12 months

Types of sport or recreational PA participated in last 12 months (2 hits for walking from same question).

Walking

Bush Walking

Sorry CTL no walking an animal!

Dafna the Superwoman!

Meeting with Dafna:

BA Exercise Science, PE undergrad-Education and Dance, University in Israel

89 MPh Epi, University in Israel, Moved to US so husband could attend Cornell, had first child

95-2000 Moved back to Israel, worked for Israel CDC.-head of survey division in Health promotion

Moved to Australia, worked as a tobacco research officer for NSW, applied for job in research prevention centre. After one year (2002) approached Adrian about PhD. He said, go for it!

Dafna just submitted her dissertation, it’s huge…two very very big volumes! Jake would really really love her dissertation! She is publishing five different articles from her dissertation that is a walking specific evidence reviewed titled,

Public Health Approaches to Measurement, Surveillance

and the Promotion of Walking Amongst Australian Adults

The dissertation is distinctly split into two areas; Epidemiology and Health Promotion. The epidemiology section covers the evidence of walking as a benefit; it is descriptive in nature and looks at the areas of prescriptive, travel and utilitarian walking.

The Health Promotion discusses how walking can be promoted through rails to trails programs, media, and work sites.

I'll post more information on the PE blog about the Walk to School paper that we reviewed for PE about 3 weeks ago!

Meeting w/ Dr. Hidde van der Ploeg

This week I met with Dr. Hidde van der Ploeg, a graduate of Vrije Universiteit Amsterdam. He's been with CPAH for approximately 1.5 years, he was hired at the same time a Heather and has 2.5 years remaining. We discussed his Time Use research, he currently has 2 projects he's working on.
He is collecting 10 days of data on 100-200 people using the new little "baby MTI's." He is very happy with the smaller units as they are far easier to download with a USB port and there is no need calibrate! The unit is charged via the USB and can manage to hold a charge for 14 days. When epochs are set at 10 second intervals you can collect data for 10 weeks and expect accurate information, however, the unit will need to be charged every 2 weeks.
Subjects wear the monitor for 10 days, diary (see attached) information is reported on days 2, nine and ten. Half of the subjects are asked to complete the IPAC questionnaire (a 7 day recall). Hidde will be looking at time spent in sedentary, light, and moderate-vigorous activities, he's looking for a coefficient of .80 Hmmmmmmmmmmm, sound familiar? We talked extensively about the test/retest methodology used for the time use diaries.
His second research project involves looking at the reliability and validity of physical activity measures in the Austrailian Bureau of Statistics data. Years reported include 1992, 1997 and 2006; currently he is looking at 1997 and 2006 has not been released. The information he is looking at is similar to our Household Travel Survey. He is lookiing at kids active commuting behavior for 71,81, 91,97 and then the survey contiunes every 3 years thereafter. He said that the methodology changed several times over the years and it is not looking to promising.

Trends in sufficient PA in NSW (1998-2005)

CPAH has prepared a report on the trends in sufficient physical activity in NSW between 1998 and 2005, which was launched by the Health Minister on Tuesday.

If you would like to know more about the report, please visit the CPAH website at
http://www.cpah.health.usyd.edu.au/research/reports.php

Week 2

Feeling much more settled now! Managed to find my way on the bus in the shortest amount of time.
The gang here at CPAH is very friendly and they have invited me to do sport two times per week and for all the after work functions. The family will be joining the crew for an Australian Rules Football tourney at the end of March! Should be great fun...I understand it's a mix between soccer and football...a bunch of sweaty tough guys!

Theme of the day- Never let data get in the way of a business project. Think Global!

My second day at CPAH involved a staff meeting where I was introduced to all the staff and I spoke a bit about my research focus/es. Following is an incomplete list that I will have to update as I do not have all the details on each of the individuals.

Adeline Yaw-from Australia, Administrative staff, she’s the Barb Mattingly of CPAH
^Cathy Kiernan-from Australia, Administrative Staff, Financial Wizard
*Dafna Merom -from Israel, PhD PA Epidemiologist, and her work may be most closely related with my interests, here are just a few of her publications:

Effect of Australia’s Walk to Work Day campaign on adults’ active commuting and physical activity … - group of 2 »
D Merom, Y Miller, S Lymer, A Bauman - Am J Health Promot, 2005 - apt.allenpress.com
... Commuting and Physical Activity Behavior. Dafna Merom, a Yvette Miller,
a Sharyn Lymer, a and Adrian Bauman a a Dafna Merom is with ...
Cited by 2 - Related Articles - Web Search

An environmental intervention to promote walking and cycling--the impact of a newly constructed Rail … - group of 2 »
D Merom, A Bauman, P Vita, G Close - Prev Med, 2003 - ncbi.nlm.nih.gov
... Australia. dafna.merom@swsahs.nsw.gov.au BACKGROUND: Few studies have evaluated
environmental changes to promote physical activity. ...
Cited by 12 - Related Articles - Web Search - BL Direct

Changes in accessibility and preferences predict children's future fruit and vegetable intake - group of 13 »
BM Central, C Controlled - feedback, 2005 - ijbnpa.org
... walking for transport and exercise: a novel application of time use data Catrine
Tudor-Locke, Michael Bittman, Dafna Merom, Adrian Bauman International Journal ...
Cited by 4 - Related Articles - Cached - Web Search

Correlates of Osteoporosis Among Jewish and Arab Women Aged 45-74 in Israel: National Women’s … - group of 3 »
… -Kaluski, MPH RD, A Chinich, A Ifrah, D Merom, MS … - J Gend Specif Med, 2003 - mmhc.com
... Dorit Nitzan-Kaluski, MD, RD, MPH, Ayelet Chinich, BA, Anneke Ifrah, MPH, Dafna
Merom, MPH, and Manfred S. Green, MD, PhD 17 ORIGINAL STUDY ...
Related Articles - View as HTML - Web Search

The Exercise Recreation And Sport Survey (ERASS)
D Merom, A Bauman - cpah.unsw.edu.au
... among New South Wales adults Dafna Merom, Adrian Bauman NSW Centre for Physical
Activity and Health, University of New South Wales December 2002 CPAH 03-0001 ...
Related Articles - View as HTML - Web Search

Patterns of walking for transport and exercise: a novel application of time use data - group of 2 »
TL Catrine, B Michael, M Dafna, B Adrian - International Journal of Behavioral Nutrition and Physical … - doaj.org
... time use data. Author: Tudor-Locke Catrine; Bittman Michael; Merom Dafna;
Bauman Adrian. Abstract: Abstract. Background. Walking for ...
Cached - Web Search

Test-retest Reliability of a Questionnaire to Assess Physical Environmental Factors Pertaining to … - group of 11 »
BM Central, C Controlled - feedback, 2005 - ijbnpa.org
... walking for transport and exercise: a novel application of time use data Catrine
Tudor-Locke, Michael Bittman, Dafna Merom, Adrian Bauman International Journal ...
Cited by 1 - Related Articles - Cached - Web Search

Youth at risk of physical inactivity may benefit more from activity-related support than youth not … - group of 8 »
BM Central, C Controlled - feedback, 2006 - ijbnpa.org
... walking for transport and exercise: a novel application of time use data Catrine
Tudor-Locke, Michael Bittman, Dafna Merom, Adrian Bauman International Journal ...
Related Articles - Cached - Web Search

Cycling should be on transport, health and tourism agendas - group of 2 »
SC Station - Health Promotion Journal of Australia, 2003 - abc.dotars.gov.au
... Karen Lenihan Bev Lloyd Edwina Macoun Nyanda McBride Fran McFadzen Michael McGartland
Ngaire McGaw Jeanie McKenzie Kate Merlin Dafna Merom Renee Moreton Amanda ...
Related Articles - View as HTML - Web Search

Trends in population levels of reported physical activity in Australia, 1997, 1999 and 2000 - group of 4 »
A Bauman, I Ford, T Armstrong - Canberra: Australian Sports Commission, 2001 - ausport.gov.au
... Thanks to Paul Kennett (Sport and Recreation, Qld) for useful comments, and to Dafna
Merom (Physical Activity Research Group, NSW) for the coding frames and ...
Cited by 14 - Related Articles - View as HTML - Web Search

Tribute to the Journal's Review Staff and Peer Reviewers - group of 3 »
ME Northridge - 2001 - Am Public Health Assoc
... McRuer Kenneth J Meier Michael B Meit Marcia L Meldrum Rita M Melendez Claude Ann
Mellins Michael Menchaca Francisco Mercado-Martinez Dafna Merom Michael J ...

*Heather Bowles-from TX, PhD Epidemiologist, Post Doc with Ainsworth at University of S. Carolina. Currently working on particulate levels in captured by cyclists in three different locations.
Hidda van der Ploeg-PhD Student working on evaluating time use measures for PA instruments.
^Josephine“Jo” Chau from Australia, Social coordinator/Officer-Research Asst. to Adrian, Data cleaning, monitoring, analysis of the National Trends Data
Klaus Gebel-from a Scandinavian country, PhD student built environment and PA
^Louise Farrell-Officer, NSW Health Promotion (loves to cook)
*PH Phongsavan- (level C) from Laos, PhD Health Promotion. Research areas include Social capitol income inequalities, culture and health. Before she came to CPHA she was working with UNICEF in Fiji.
Rona Macniven-From Glasgow, Professional Networks and PA advisor to CPAH staff,
Tien Chey- Biostatistician, part time also works for the Medical School

*-Program grant funded (4+ yr. appointments)
^-Capacity Building Grant (must be an Australian citizen)
The University of Sydney uses a ranking system as follows:
A-Post Doc
B-Research Faculty (not tenure track)
C-Asst. Prof.
D-Assoc. Prof.
E-Professor

The Center for Overweight and Obesity (COO) is also on the same floor with CPAH. There are five employees:
Leslie-the Adrian of the group
Michael-
Louise “Lou”- from Australia,
Caterina-
Margaret-Nutrition Epidemiologist

Last week I attended Thursday Sport which is organized by Jo! We participated in circuit training at the USYD soccer fields. There are some things that are so civil about the CPAH office; such as participating in sport with each other and offering tea and coffee at all meetings. May have to start a new ritual with our WRL when we all return! Love it here!!!

Day 1

This morning I met with :
Dr. Adrian Bauman, PhD FAFPHM
Sesquicentenary Professor of Public Health
(Behavioural Epidemiology and Health Promotion)
Director, Centre for Physical Activity and Health
Co-Director, NSW Centre for Overweight and Obesity
Co-Director, Australian Centre for Health Promotion

All that, and he wants to be called Adrian!
I have my very own cubicle (desk 14, pronounced 4-deen), phone (9036 3296), email twashing@health.usyd.edu.au wow (or in the name of James...HOLLY COW), I feel so grown up! There's one cartoon posted at my desk; it reads like this there's a man sitting at a desk wit h a sign posted "Hospital Information" and he is responding to an overweight man saying"Obesity department?...ninth floor...No elevator!
Adrian and I had a quick chat about his schedule a quick hello and he'll be off (for 2 weeks) in Europe and then presenting at the Active Living Research conference in San Diego.
We had a great discussion about the different roles I can take during my time with CPAH. There are two particular projects that came to mind for Adrian after discussing my interests during my last visit in October. The first idea is to pick up on research that was started by, Margaret Thomas, a former PhD student who went on to work at NSW administration of health. The project includes Neville Owen as a co-author. Margaret had begun looking at aggregated census data (at postal code level ), specifically the question, "How did you get to work?"
Potential answers are:

1. Foot
2. Car
3. Public Transport (Bus and/or Train)
   
4. Other

Adrian would like to look at 5 major cities in Australia (Canberra, Melbourne, Perth, Sydney, Brisbane) between the years of 1976- 2001and possibly 2006 (if the data is available). The first three cities are known for their cycling friendliness and the later two are known for walking. He is interested in how people may have changed their transport behavior over the years as well as looking at the ecological data, the SES of certain neighborhoods and how they may influence transport behavior.
The second project is working with the General Social Survey (GSS). He described the data as having interests in social capital and quality of life. The survey asks some transport questions and is known as a health survey. I'm to begin looking into the GSS and report to him everything the GSS has to offer PA researchers!
Stay tuned next time where I will offer you more information about CPAH!