Validation of a 24-h physical activity recall in indigenous and non-indigenous Australian adolescents

The purpose of this study was to evaluate the concurrent validity of a modified version of the widely used previous day physical activity recall (PDPAR24) self-report instrument in a diverse sample of Australian adolescents comprising Aboriginal and Torres Strait Islanders (A&TSI) and non-indigenous high school students. A sample of 63 A&TSI and 59 non-indigenous high school students (N = 122) from five public secondary schools participated in the study. Participants completed the PDPAR-24 after wearing a seated electronic pedometer on the previous day. Significant positive correlations were observed between the self-reported physical activity variables (mean MET level, blocks of vigorous activity, and blocks of moderate-to-vigorous physical activity) and 24-h step counts. Validity coefficients (rho) ranged from 0.29 to 0.34 (p<0.05). A significant inverse correlation was observed for self-reported screen time and 24-h step count (rho = -0.19, p<0.05). Correlations for A&TSI students were equal to or greater than those observed for non-indigenous students. The PDPAR-24 instrument is a quick, unobtrusive, and cost-effective assessment tool. that would be useful for evaluating physical activity and sedentary behaviour in population-based studies. (C) 2006 Sports Medicine Australia.

Using objective physical activity measures with youth : How many days of monitoring are needed?

Purpose The purpose of this study was to establish the minimal number of days of monitoring required for accelerometers to assess usual physical activity in children. Methods A total of 381 students (189 M, 192 F) wore a CSA 7164 uniaxial accelerometer for seven consecutive days. To examine age-related trends students were grouped as follows: Group I: grades 1-3 (N = 92); Group II: grades 4-6 (N = 98); Group III: grades 7-9 (N = 97); Group IV: grades 10-12 (N = 94). Average daily time spent in moderate-to-vigorous physical activity (MVPA) was calculated from minute-by-minute activity counts using the regression equation developed by Freedson et al. (1997). Results Compared with adolescents in grades 7 to 12, children in grades 1 to 6 exhibited less day-to-day variability in MVPA behavior. Spearman-Brown analysts indicated that between 4 and 5 d of monitoring would be necessary to a achieve a reliability of 0.80 in children, and between 8 and 9 d of monitoring would be necessary to achieve a reliability of 0.80 in adolescents. Within all grade levels, the 7-d monitoring protocol produced acceptable estimates of daily participation in MVPA (R = 0.76 (0.71-0.81) to 0.87 (0.84-0.90)). Compared with weekdays, children exhibited significantly higher levels of MVPA on weekends, whereas adolescents exhibited significantly lower levels of MVPA on weekends. Principal components analysis revealed two distinct time components for MVPA during the day for children (early morning, rest of the day), and three distinct time components for MVPA during the day for adolescents (morning, afternoon, early evening). Conclusions These results indicate that a 7-d monitoring protocol provides reliable estimates of usual physical activity behavior in children and adolescents and accounts for potentially important differences in weekend versus weekday activity behavior as well as differences in activity patterns within a given day.

Physical activity patterns of Singaporean adolescents

The purpose of this study was to document the level of physical activity and sedentary behavior in a representative sample of Singaporean adolescents. A random sample of 1,827 secondary school students from six secondary schools (929 boys, 898 girls, mean age 14.9 +/- 1.2 yr) completed the Three-Day Physical Activity Recall (3DPAR) self-report instrument. Approximately 63% of Singaporean high school students met current guidelines requiring 60 min of moderate to vigorous physical activity daily. Just over half (51.6%) met the guideline calling for regular vigorous physical activity. Across all grade levels, boys were consistently more active than girls. More than 70% of Singaporean high school students exceeded the recommended 2 hours per day of electronic media use. Collectively, these findings suggest that a significant proportion of Singaporean adolescents are not sufficiently active and are in need of programs to promote physical activity and decrease sedentary behavior.

The use of uniaxial and triaxial accelerometers to measure children's "free-play" physical activity

In order to effectively measure the physical activity of children, objective monitoring devices must be able to quantify the intermittent and nonlinear movement of free play. The purpose of this study was to investigate the validity of the Computer Science and Applications (CSA) uniaxial accelerometer and the TriTrac-R3D triaxial accelerometer with respect to their ability to measure 8 "free-play" activities of different intensity. The activities ranged from light to very vigorous in intensity and included activities such as throwing and catching, hopscotch, and basketball. Twenty-eight children, ages 9 to 11, wore a CSA and a heart rate monitor while performing the activities. Sixteen children also wore a Tritrac. Counts from the CSA, Tritrac, and heart rates corresponding to the last 3 min of the 5 min spent at each activity were averaged and used in correlation analyses. Across all 8 activities, Tritrac counts were significantly correlated with predicted MET level (r= 0.69) and heart rate (r= 0.73). Correlations between CSA output, predicted MET level (0.43), and heart rate (0.64) were also significant but were lower than those observed for the Tritrac. These data indicate that accelerometers are an appropriate methodology for measuring children's free-play physical activities.

Validation of a 3-day physical activity recall instrument in female youth

The purpose of this study was to examine the validity of the 3-Day Physical Activity Recall (3DPAR) self-report instrument in a sample of eighth and ninth grade girls (n = 70, 54.3% white, 37.1% African American). Criterion measures of physical activity were derived using the CSA 7164 accelerometer. Participants wore a CSA monitor for 7 consecutive days and completed the self-report physical activity recall for the last 3 of those days. Self-reported total METs, 30-min blocks of MVPA, and 30-min blocks of VPA were all significantly correlated with analogous CSA variables for 7 days (r = 0.35-0.51; P < 0.01) and 3 days (r = 0.27-0.46; P < 0.05) of monitoring. The results indicate that the 3DPAR is a valid instrument for assessing overall, vigorous, and moderate to vigorous physical activity in adolescent girls.

Children's understanding of the concept of physical activity

This study evaluated 4th-grade students' understanding of the concept of physical activity and assessed the effects of two interventions to enhance the students' understanding of this concept. Students were randomly assigned to 1 of 3 conditions: the video group (n = 40) watched a 5-min video describing physical activity; the verbal group (n = 42) listened to a generic description of physical activity; the control group received no instruction (n = 45). Students completed a 17-item checklist testing their understanding of the concept of physical activity. Compared to controls, students in the verbal and video group demonstrated significantly higher checklist scores, with the video group scoring significantly higher than the verbal group. Only 35.6% of the controls, compared to 52.4% and 70.0% of the verbal and video groups respectively, could classify greater than or equal to 15 of the checklist items correctly, The results indicate that, without intervention, children have a limited understanding of the concept of physical activity.

Validity of the previous day physical activity recall (PDPAR) in fifth-grade children

This study evaluated the validity of the Previous Day Physical Activity Recall (PDPAR) self-report instrument in quantifying after-school physical activity behavior in fifth-grade children. Thirty-eight fifth-grade students (mean age, 10.8 +/- 0.1; 52.6% female; 26.3% African American) from two urban elementary schools completed the PDPAR after wearing a CSA WAM 7164 accelerometer for a day. The mean within-subject correlation between self-reported MET level and total counts for each 30-min block was 0.57 (95% C.I., 0.51-0.62). Self-reported mean MET level during the after-school period and the number of 30-min blocks with activity rated at greater than or equal to 6 METs were significantly correlated with the CSA outcome variables. Validity coefficients for these variables ranged from 0.35 to 0.43 (p <.05). Correlations between the number of 30-min blocks with activity rated at greater than or equal to 3 METs and the CSA variables were positive but failed to reach statistical significance (r = 0.19-0.23). The PDPAR provides moderately valid estimates of relative participation in vigorous activity and mean MET level in fifth-grade children. Caution should be exercised when using the PDPAR to quantify moderate physical activity in preadolescent children.

Factors associated with physical activity in children attending family child care homes

Objective To determine the relationship between family child care home (FCCH) practices and characteristics, and objectively measured physical activity (PA) among children attending FCCHs. Methods FCCH practices and characteristics were assessed in 45 FCCHs in Oregon (USA) in 2010-2011 using the Nutrition and Physical Activity Self-Assessment for Child Care Instrument. Within the 45 FCCHs, 136 children between ages 2 and 5. years wore an accelerometer during child care attendance over a one-week period. Time spent in light, moderate, and vigorous PA per hour was calculated using intensity-related cut-points (Pate et al., 2006). Results FCCH characteristics and practices associated with higher levels of PA (min/h; p < 0.05) included provision of sufficient outdoor active play [32.2 (1.0) vs. 28.6 (1.3)], active play using portable play equipment [31.7 (1.0) vs. 29.3 (1.4)], the presence of a variety of fixed play equipment [32.2 (1.0) vs. 28.9 (1.3)], and suitable indoor play space [32.2 (1.0) vs. 28.6 (1.3)], engaging in active play with children [32.1 (1.1) vs. 29.6 (1.2)], and receiving activity-related training [33.1 (1.2) vs. 30.3 (1.1)]. Conclusions This is the first study to identify practices and characteristics of FCCHs that influence children's PA. These data should be considered when developing programs and policies to promote PA in FCCHs.

Advances in population surveillance for physical activity and sedentary behavior : reliability and validity of time use surveys

Many countries conduct regular national time use surveys, some of which date back as far as the 1960s. Time use surveys potentially provide more detailed and accurate national estimates of the prevalence of sedentary and physical activity behavior than more traditional self-report surveillance systems. In this study, the authors determined the reliability and validity of time use surveys for assessing sedentary and physical activity behavior. In 2006 and 2007, participants (n = 134) were recruited from work sites in the Australian state of New South Wales. Participants completed a 2-day time use diary twice, 7 days apart, and wore an accelerometer. The 2 diaries were compared for test-retest reliability, and comparison with the accelerometer determined concurrent validity. Participants with similar activity patterns during the 2 diary periods showed reliability intraclass correlations of 0.74 and 0.73 for nonoccupational sedentary behavior and moderate/vigorous physical activity, respectively. Comparison of the diary with the accelerometer showed Spearman correlations of 0.57-0.59 and 0.45-0.69 for nonoccupational sedentary behavior and moderate/vigorous physical activity, respectively. Time use surveys appear to be more valid for population surveillance of nonoccupational sedentary behavior and health-enhancing physical activity than more traditional surveillance systems. National time use surveys could be used to retrospectively study nonoccupational sedentary and physical activity behavior over the past 5 decades.

Are mothers of young children really inactive?

Australian surveys have found that only 43% of women meet the current recommendation for regular moderate physical activity, and that women who are mothers of young children are even less likely to be adequately active for health benefit. These women spend a significant proportion of their day in occupational, household and care-giving activities, which may not be ‘captured’ in conventional physical activity surveys. The purpose of this study was to compare physical activity in young mothers and age-matched controls using three different measures of physical activity. 35 women (16 mothers of young children, M) and 19 age-matched comparison women (NM) completed a survey which asked about walking to and from places, and about moderate and vigorous activity in leisure time and at work (paid and unpaid). They also kept a detailed diary of all their activities for two week-days and two week-end days, and wore a pedometer (Yamax digiwalker) on these days. Each activity in the diary was assigned an energy expenditure (EE) score based on it's intensity (Compendium of Physical Activity) and time spent in that activity. There were no differences between M and NM for pedometer steps (M: 9270 sd 2947; NM: 9768 sd 3051) or for daily energy expenditure (EE) calculated from the diaries (M: 2029 sd 189; NM: 2015 sd 169 METS.mins) or survey (M: 2079 sd 448; NM: 1495 sd 325). There was a significant correlation between pedometer steps and daily METs.mins estimated from the diaries (r = 0.35, p = 0.04); however no relationship was observed between pedometer steps and EE from the survey (r = .09, p = .56). Further analysis of the individual survey items found pedometer steps to be related to EE from walking to and from places (r = .34) and leisure time (r = .31), but not work related activity (r = -.08). There were no significant relationships between EE computed from the diaries and any of the survey questions. The three activity measures indicate that the physical activity levels of the young mothers in our sample were comparable to age-matched non-mothers. The results of the correlation analyses highlight the difficulty of assessing low-intensity work-related physical activity via self-report. Supported by Australian Commonwealth Department of Health and Aged Care.

Test-retest reliability of physical activity measures used in Australian population surveys

PURPOSE Accurate monitoring of prevalence and trends in population levels of physical activity is fundamental to the planning of health promotion and disease-prevention strategies. Test-retest reliability (repeatability) was assessed for four self-report measures of physical activity commonly used in population surveys: the Active Australia survey (AA, N=356), the short form of the International Physical Activity Questionnaire (IPAQ-S, N=104), the physical activity items in the Behavioral Risk Factor Surveillance System (BRFSS, N=127) and the physical activity items in the Australian National Health Survey (NHS, N=122). METHODS Percent agreement and Kappa statistics were used to assess the reliability of classification of activity status (where ‘active’= 150 minutes of activity per week) and sedentariness (where ‘sedentary’ = reporting no physical activity). Intraclass correlations (ICCs) were used to assess agreement on minutes of activity reported for each item of each survey and on total minutes reported in each survey. RESULTS Percent agreement scores for both activity status and sedentariness were very good on all four instruments. Overall the percent agreement between repeated surveys was between 73% (NHS) and 87% (IPAQ) for the criterion measure of achieving 150 minutes per week, and between 77% (NHS) and 89% (IPAQ) for the criterion of being sedentary. Corresponding Kappa statistics ranged from 0.46 (NHS) to 0.61 (AA) for activity status and from 0.20 (BRFSS) to 0.52 (AA) for sedentariness. For the individual items ICCs were highest for walking (0.45 to 0.56) and vigorous activity (0.22 to 0.64) and lowest for the moderate questions (0.16 to 0.44). CONCLUSION All four measures provide acceptable levels of test-retest reliability for assessing both activity status and sedentariness, and moderate reliability for assessing total minutes of activity. Supported by the Australian Commonwealth Department of Health and Ageing.

Using the Driver Behaviour Questionnaire to predict crashes and demerit point loss : does it get better with larger sample sizes?

The Driver Behaviour Questionnaire (DBQ) continues to be the most widely utilised self-report scale globally to assess crash risk and aberrant driving behaviours among motorists. However, the scale also attracts criticism regarding its perceived limited ability to accurately identify those most at risk of crash involvement. This study reports on the utilisation of the DBQ to examine the self-reported driving behaviours (and crash outcomes) of drivers in three separate Australian fleet samples (N = 443, N = 3414, & N = 4792), and whether combining the samples increases the tool’s predictive ability. Either on-line or paper versions of the questionnaire were completed by fleet employees in three organisations. Factor analytic techniques identified either three or four factor solutions (in each of the separate studies) and the combined sample produced expected factors of: (a) errors, (b) highway-code violations and (c) aggressive driving violations. Highway code violations (and mean scores) were comparable across the studies. However, across the three samples, multivariate analyses revealed that exposure to the road was the best predictor of crash involvement at work, rather than DBQ constructs. Furthermore, combining the scores to produce a sample of 8649 drivers did not improve the predictive ability of the tool for identifying crashes (e.g., 0.4% correctly identified) or for demerit point loss (0.3%). The paper outlines the major findings of this comparative sample study in regards to utilising self-report measurement tools to identify “at risk” drivers as well as the application of such data to future research endeavours.

What women want : qualitative analysis of consumer evaluations of maternity care in Queensland, Australia

Background Maternity care reform plans have been proposed at state and national levels in Australia, but the extent to which these respond to maternity care consumers’ expressed needs is unclear. This study examines open-text survey comments to identify women’s unmet needs and priorities for maternity care. It is then considered whether these needs and priorities are addressed in current reform plans. Methods Women who had a live single or multiple birth in Queensland, Australia, in 2010 (n 3,635) were invited to complete a retrospective self-report survey. In addition to questions about clinical and interpersonal maternity care experiences from pregnancy to postpartum, women were asked an open-ended question “Is there anything else you’d like to tell us about having your baby?” This paper describes a detailed thematic analysis of open-ended responses from a random selection of 150 women (10% of 1,510 who responded to the question). Results Four broad themes emerged relevant to improving women’s experiences of maternity care: quality of care (interpersonal and technical); access to choices and involvement in decision-making; unmet information needs; and dissatisfaction with the care environment. Some of these topics are reflected in current reform goals, while others provide evidence of the need for further reforms. Conclusions The findings reinforce the importance of some existing maternity reform objectives, and describe how these might best be met. Findings affirm the importance of information provision to enable informed choices; a goal of Queensland and national reform agendas. Improvement opportunities not currently specified in reform agendas were also identified, including the quality of interpersonal relationships between women and staff, particular unmet information needs (e.g., breastfeeding), and concerns regarding the care environment (e.g., crowding and long waiting times).

Relationship between EGFR expression, EGFR mutation status, and the efficacy of chemotherapy plus cetuximab in FLEX study patients with advanced non-small-cell lung cancer

INTRODUCTION: The phase III FLEX study (NCT00148798) in advanced non-small-cell lung cancer indicated that the survival benefit associated with the addition of cetuximab to cisplatin and vinorelbine was limited to patients whose tumors expressed high levels of epidermal growth factor receptor (EGFR) (immunohistochemistry score of >/=200; scale 0-300). We assessed whether the treatment effect was also modulated in FLEX study patients by tumor EGFR mutation status. METHODS: A tumor mutation screen of EGFR exons 18 to 21 included 971 of 1125 (86%) FLEX study patients. Treatment outcome in low and high EGFR expression groups was analyzed across efficacy endpoints according to tumor EGFR mutation status. RESULTS: Mutations in EGFR exons 18 to 21 were detected in 133 of 971 tumors (14%), 970 of which were also evaluable for EGFR expression level. The most common mutations were exon 19 deletions and L858R (124 of 133 patients; 93%). In the high EGFR expression group (immunohistochemistry score of >/=200), a survival benefit for the addition of cetuximab to chemotherapy was demonstrated in patients with EGFR wild-type (including T790M mutant) tumors. Although patient numbers were small, those in the high EGFR expression group whose tumors carried EGFR mutations may also have derived a survival benefit from the addition of cetuximab to chemotherapy. Response data suggested a cetuximab benefit in the high EGFR expression group regardless of EGFR mutation status. CONCLUSIONS: The survival benefit associated with the addition of cetuximab to first-line chemotherapy for advanced non-small-cell lung cancer expressing high levels of EGFR is not limited by EGFR mutation status.