Associations of location and perceived environmental attributes with walking in neighborhoods

Purpose. Ecological models highlight the importance of environmental influences. We examined associations of coastal versus noncoastal location and perceived environmental attributes with neighborhood walking, total walking, and total activity. Methods. Telephone interviews with 800 faculty and general staff of an Australian university. Results. Men were significantly more likely to walk in their neighborhood if they lived in a coastal location (odds ratio [OR] = 1.66), and they highly rated environmental aesthetics (OR = 1.91), convenience of facilities (OR = 2.20), and access to facilities (OR = 1.98). For women, neighborhood walking was associated with high ratings of convenience (OR = 3.78) but was significantly less likely if they had high ratings for access (OR = 0.48). For total walking and total physical activity, few significant associations emerged. Conclusions. Environmental attributes were related to walking in the neighborhood but not to more general activity indices. Understanding gender-specific environmental correlates of physical activity should be a priority.

Perceived environment attributes, residential location, and walking for particular purposes

Background: Identifying environmental factors that can influence physical activity is a public health priority. We examined associations of perceived environmental attributes with walking for four different purposes: general neighborhood walking, walking for exercise, walking for pleasure, and walking to get to and from places. Methods: Participants (n =399; 57% women) were surveyed by mail. They reported place of residence, walking behaviors, and perceptions of neighborhood environmental attributes. Results: Men with the most positive perceptions of neighborhood aesthetics were significantly more likely (odds ratio [OR] =7.4) to be in the highest category of neighborhood walking. Men who perceived the weather as not inhibiting their walking were much more likely (OR= 4.7) to be high exercise walkers. Women who perceived the weather as not inhibiting their walking were significantly more likely to be high neighborhood walkers (OR=3.8) and those with moderate perceptions of accessibility were much more likely to do more walking for pleasure (OR=3.5). Conclusions: Different environmental attributes were associated with different types of walking and these differed between men and women. Approaches to increasing physical activity might usefully focus on those attributes of the local environment that might influence particular subsets of walking behavior.

Changes in smoking behaviour among young women over life stage transitions

Objective: To examine changes in smoking behaviour among young women over four life stages: leaving home; employment or attending college or university; marriage; and parenthood. Methods: Young women participating in the Australian Longitudinal Study on Women's Health completed postal questionnaires in 1996 and 2000. Results: Unmarried women who moved out of their parents' home between 1996 and 2000 had higher odds of adopting smoking than those who had not lived with their parents at either time (OR 1.8, 95% Cl 1.2-2.6). Married women had lower odds of resuming smoking after quitting (OR 0.4, 95% Cl 0.2-0.7) than unmarried women. Women who were pregnant in 2000 had higher odds of quitting smoking (OR 3.8, 95% Cl 2.5-5.6) and women who were pregnant in 1996 and not in 2000 had higher odds of starting to smoke again (OR 3.2, 95% Cl 1.6-6.2) than women who were not pregnant. The odds of being a current smoker or adopting smoking were significantly greater for women who binge drank alcohol or used cannabis and other illicit drugs. Conclusions: Adoption, maintenance and cessation of smoking among young women is strongly related to major life stage transitions, illicit drug use and alcohol consumption. Implications: Life changes such as marriage and actual or contemplated pregnancy provide opportunities for targeted interventions to help women quit smoking and not relapse after having a baby. Legislation to control smoking on licensed premises would reduce the social pressure on women to smoke.

Primary prevention of skin cancer: A review of sun protection in Australia and internationally

The incidence of skin cancer is increasing worldwide. Protecting the skin from the sun by wearing protective clothing, using a sunscreen with appropriate sun protection factor, wearing a hat, and avoiding the sun are recommended as primary preventive activities by cancer agencies. In this paper the recent data relating to skin cancer primary preventive behaviour in Australia and other countries is reviewed. Comparison of the studies in a table format summarizing the methods, objectives, participants, findings and implications may be obtained from the corresponding author. The sun protection knowledge, attitudes and behaviour patterns observed in Australia are similar in other countries, although Australian studies generally, report higher knowledge levels about skin cancer and higher levels of sun protection. The findings suggest that sunscreen is the most frequent method of sun protection used across all age groups, despite recommendations that it should be at? adjunct to other forms of protection. While young children's sun protective behaviour is largely influenced by their parents' behaviours, they are still tinder protected, and sun protective measures such as seeking shade, avoiding the sun and protective clothing need to be emphasized. Adolescents have the lowest skin protection rates of all age groups. Within the adult age range, women and people with sensitive skin were most likely to be using skin protection. However, women were also more likely than men to sunbath deliberately and to use sun-tanning booths. The relationship between skin protection knowledge and attitudes, attitudes towards tanning and skin protection behaviour needs further investigation. Further studies need to include detailed assessments of sunscreen use and application patterns, and future health promotion activities need to focus on sun protection by wearing clothing and seeking shade to avoid increases in the sunburn rates observed to date.

Family average income and body mass index above the healthy weight range among urban and rural residents in regional Mainland China

Objective: To explore the relationship between family average income (FAI; an index of socio-economic status) and body mass index (BMI; a widely used, inexpensive indicator of weight status) above the healthy weight range in a region of Mainland China. Design: Population-based cross-sectional study, conducted between October 1999 and March 2000 on a sample of regular local residents aged 35 years or older who were selected by random cluster sampling. Setting: Forty-five administrative villages selected from three urban districts and two rural counties of Nanjing municipality, Mainland China, with a regional population of 5.6 million. Subjects: In total, 29 340 subjects participated; 67.7% from urban and 32.3% from rural areas; 49.8% male and 50.2% female. The response rate among eligible participants was 90.1%. Results: The proportion of participants classified as overweight was 30.5%, while 7.8% were identified as obese. After adjusting for possible confounding variables (age, gender, area of residence, educational level, occupational and leisure-time physical activity, daily vegetable consumption and frequency of red meat intake), urban participants were more likely to be overweight or obese relative to their rural counterparts, more women than men were obese, and participants in the lowest FAI tertile were the least likely to be above the healthy weight range. Conclusions: The proportion of adults with BMI above the healthy weight range was positively related to having a higher socio-economic status (indexed by FAI) in a regional Chinese population.

Evidence for Concurrent Effects of Exposure to Environmental Cadmium and Lead on Hepatic CYP2A6 Phenotype and Renal Function Biomarkers in Non Smokers

We examined the interrelationships between phenotype of hepatic cytochrome P450 2A6 (CYP2A6), nephropathy, and exposure to cadmium and lead in a group of 118 healthy Thai men and women who had never smoked. Their urinary Cd excretion ranged from 0.05 to 2.36 mug/g creatinine, whereas their urinary Pb excretion ranged from 0.1 to 12 mug/g creatinine. Average age and Cd burden of women and men did not differ. Women, however, on average showed a 46% higher urinary Pb excretion (p < 0.001) and lower zinc status, suggested by lower average serum Zn and urinary Zn excretion compared with those in men. Cd-linked nephropathy was detected in both men and women. However, Pb-linked nephropathy was seen only in women, possibly because of higher Pb burden coupled with lower protective factors, notably of Zn (P < 0.001), in women compared with men. In men, Pb burden showed a negative association with CYP2A6 activity (adjusted beta = -0.29, p = 0.003), whereas Cd burden showed a positive association with CYP2A6 activity (adjusted beta = 0.38, p = 0.001), suggesting opposing effects of Cd and Pb on hepatic CYP2A6 phenotype. The weaker correlation between Cd burden CYP2A6 activity in women despite similarity in Cd burden between men and women is consistent with opposing effects of Pb and Cd on hepatic CYP2A6 phenotypic expression. A positive correlation between Cd-linked nephropathy (urinary N-acetyl-beta-D-glucosaminidase excretion) and CYP2A6 activity in men (r = 0.39, p = 0.002) and women (r = 0.37, p = 0.001) suggests that Cd induction of hepatic CYP2A6 expression and Cd-linked nephropathy occurred simultaneously.

Population effects on individual systolic blood pressure: A multilevel analysis of the World Health Organization MONICA project

Individuals from the same population share a number of contextual circumstances that may condition a common level of blood pressure over and above individual characteristics. Understanding this population effect is relevant for both etiologic research and prevention strategies. Using multilevel regression analyses, the authors quantified the extent to which individual differences in systolic blood pressure (SBP) could be attributed to the population level. They also investigated possible cross-level interactions between the population in which a person lived and pharmacological (antihypertensive medication) and nonpharmacological (body mass index) effects on individual SBP. They analyzed data on 23,796 men and 24,986 women aged 35-64 years from 39 worldwide Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) study populations participating in the final survey of this World Health Organization project (1989-1997). SBP was positively associated with low educational achievement, high body mass index, and use of antihypertensive medication and, for women, was negatively associated with smoking. About 7-8% of all SBP differences between subjects were attributed to the population level. However, this population effect was particularly strong (i.e., 20%) in antihypertensive medication users and overweight women. This empirical evidence of a population effect on individual SBP emphasizes the importance of developing population-wide strategies to reduce individual risk of hypertension.

Women are silver, women are diamonds: Conflicting images of women in the Cambodian print

This paper examines 116 articles related to sexual and reproductive health translated into English from the Khmer press from April 1997 to February 2004. These excerpts were found in The Mirror, a publication of the non-governmental organisation Open Forum of Cambodia, which collates Grid reviews all issues of the Khmer press on a weekly basis. Five major themes were identified: the politics of women's health, government regulation and control, the sex industry in Cambodia, rape, and the HIV epidemic. Discourse analysis of these articles in the context of other sources and experience allows a gendered exploration of the reporting of sexual and reproductive health and rights issues in Cambodia by the Khmer print media. The reports explore the contested political empowerment of women in this strongly hierarchical society, and the mechanisms used to regulate and control sexual activity. The expanding sex industry and associated sexual trafficking ore reported, together with the corruption of legal structures designed to regulate health systems and protect women and children from sexual exploitation and rope. The growing problem of AIDS and successes in reducing HIV transmission through the collaboration of sex workers in the 100% condom use policy is documented, and the tensions implicit in G Cultural representation of women that both protects and constrains women ore explored. (C) 2004 Reproductive Health Matters. All rights reserved.

Violence against young Australian women and association with reproductive events: a cross-sectional analysis of a national population sample

Objective: This study aimed to investigate associations between violence and younger women's reproductive events using Survey 1 (1996) data of the Younger cohort of the Australian Longitudinal Study of Women's Health (ALSWH). Methods: Multinomial regression, using composite variables for both violence and reproductive events, adjusting for socioeconomic variables and weighted for rural and remote areas. Results: 23.8% of 14,784 women aged 18 to 23 years reported violence; 12.6% reported non-partner violence in the previous year; and 11.2% reported ever having had a violent relationship with a partner. Of the latter group, 43% (4.8% overall) also reported violence in the past year. Compared with women reporting no violence, women reporting partner but not recent violence (OR 2.55, 95% Cl 2.10-3.09) or partner and recent violence (OR 3.96, 95% Cl 3.18-4.93) were significantly more likely to have had one or more pregnancies. Conversely, having had a pregnancy (2,561) was associated with an 80% increase in prevalence of any violence and a 230% increase in partner violence. Among women who had a pregnancy, having had a miscarriage or termination was associated with violence. Partner and recent violence is strongly associated with having had a miscarriage, whether alone (OR = 2.85, 95% Cl 1.74-4.66), with a termination (OR = 4.60, 2.26-9.35), or with birth, miscarriage and a termination (OR 4.12, 1.89-9.00). Conclusions and implications: Violence among young women of childbearing age is a factor for which doctors should be vigilant, well-trained and supported to identify and manage effectively.

The mental health country profile: Background, design and use of a systematic method of appraisal

This article describes the construction and use of a systematic structured method of mental health country situation appraisal, in order to help meet the need for conceptual tools to assist planners and policy makers develop and audit policy and implementation strategies. The tool encompasses the key domains of context, needs, resources, provisions and outcomes, and provides a framework for synthesizing key qualitative and quantitative information, flagging up gaps in knowledge, and for reviewing existing policies. It serves as an enabling tool to alert and inform policy makers, professionals and other key stakeholders about important issues which need to be considered in mental health policy development. It provides detailed country specific information in a systematic format, to facilitate global sharing of experiences of mental health reform and strategies between policy makers and other stakeholders. Lastly, it is designed to be a capacity building tool for local stakeholders to enhance situation appraisal, and multisectorial policy development and implementation.

Constraints to organizational learning during major change at a mental health services facility

This paper explains what happened during a three years long qualitative study at a mental health services organization. The study focuses on differences between espoused theory and theory in use during the implementation of a new service delivery model. This major organizational change occurred in a National policy environment of major health budget cutbacks. Primarily as a result of poor resourcing provided to bring about policy change and poor implementation of a series of termination plans, a number of constraints to learning contributed to the difficulties in implementing the new service delivery model. The study explores what occurred during the change process. Rather than blame participants of change for the poor outcomes, the study is set in a broader context of a policy environment—that of major health cutbacks.