Social disadvantage, bone mineral density and vertebral wedge deformities in the Tasmanian Older Adult Cohort

Summary The relationship between social disadvantage and bone mineral density (BMD) is complex and remains unclear; furthermore, little is known of the relationship with vertebral deformities. We observed social disadvantage to be associated with BMD for females, independent of body mass index (BMI). A lower prevalence of vertebral deformities was observed for disadvantaged males.

Introduction The relationship between social disadvantage and BMD appears complex and remains unclear, and little is known about the association between social disadvantage and vertebral wedge deformities. We examined the relationship between social disadvantage, BMD and wedge deformities in older adults from the Tasmanian Older Adult Cohort.

Methods BMD and wedge deformities were measured by dual-energy X-ray absorptiometry and associations with extreme social disadvantage was examined in 1,074 randomly recruited population-based adults (51 % female). Socioeconomic status was assessed by Socio-economic Indexes for Areas values derived from residential addresses using Australian Bureau of Statistics 2001 census data. Lifestyle variables were collected by self-report. Regression models were adjusted for age, BMI, dietary calcium, serum vitamin D (25(OH)D), smoking, alcohol, physical inactivity, calcium/vitamin D supplements, glucocorticoids and hormone therapy (females only).

Results Compared with other males, socially disadvantaged males were older (65.9 years versus 61.9 years, p = 0.008) and consumed lower dietary calcium and alcohol (both p ≤ 0.03). Socially disadvantaged females had greater BMI (29.9 ± 5.9 versus 27.6 ± 5.3, p = 0.002) and consumed less alcohol (p = 0.003) compared with other females. Socially disadvantaged males had fewer wedge deformities compared with other males (33.3 % versus 45.4 %, p = 0.05). After adjustment, social disadvantage was negatively associated with hip BMD for females (p = 0.02), but not for males (p = 0.70), and showed a trend for fewer wedge deformities for males (p = 0.06) but no association for females (p = 0.85).

Conclusions Social disadvantage appears to be associated with BMD for females, independent of BMI and other osteoporosis risk factors. A lower prevalence of vertebral deformities was observed for males of extreme social disadvantage. Further research is required to elucidate potential mechanisms for these associations.

The relationship between excessive daytime sleepiness and depressive and anxiety disorders in women

Objective: Excessive daytime sleepiness (EDS) is a common clinical symptom that affects women more than men. However, the association of excessive sleepiness with depressive and anxiety disorders in the broader population is unclear. The aim of this study was, therefore, to examine the association between excessive daytime sleepiness as measured by the Epworth Sleepiness Scale, and depressive and anxiety disorders in a population-based sample of women.

Methods: Using the Structured Clinical Interview for DSM-IV Disorders (Non-Patient) (SCID-I/NP), 944 women aged 20–97 years (median 49 years, IQR 33–65 years) were assessed for depressive and anxiety disorders as part of the Geelong Osteoporosis Study. EDS was assessed using the Epworth Sleepiness Scale (ESS, cut-off > 10). Lifestyle factors were documented by self-report, height and weight were measured, and socioeconomic status categorised according to the Index of Relative Socio-Economic Advantage and Disadvantage.

Results: Overall, 125 (13.2%) of the women were identified with EDS. EDS was associated with an increased likelihood for both current (OR = 2.11, 95% CI 1.10–4.06) and lifetime history (OR = 1.95, 95% CI 1.28–2.97) of depressive disorders, but not anxiety disorders, independent of age and alcohol consumption. These findings were not explained by antidepressant or sedative use, body mass index, physical activity, smoking, or socioeconomic status.

Conclusions: These results suggest that excessive daytime sleepiness is associated with current and lifetime depressive, but not anxiety disorders. Clinically, this highlights the need to take into account the possible bidirectional relationship between depressive disorders and excessive sleepiness when assessing mental health issues in patients with EDS.

Relationship between overweight and health-related quality of life in secondary school children in Fiji: results from a cross-sectional population-based study

Objective
To investigate the relationship between excess weight (overweight and obesity) and health-related quality of life (HRQoL) in a sample of secondary school children in Fiji, by gender, age and ethnicity.

Methods
The study comprised 8947 children from forms 3–6 (age 12–18 years) in 18 secondary schools on Viti Levu, the main island of Fiji. Body mass index (BMI) was calculated from measured height and weight, and weight status was classified according to the International Obesity Task Force recommendations. HRQoL was measured by the self-report version of the Pediatric Quality of Life Inventory 4.0.

Results
HRQoL was similar in children with obesity and normal weight. Generally, this was replicated when analyzed separately by gender and ethnicity, but age stratification revealed disparities. In 12–14-year-old children, obesity was associated with better HRQoL, owing to better social and school functioning and well-being, and in 15–18-year olds with poorer HRQoL, owing to worse physical, emotional and social functioning and well-being (Cohen’s d 0.2–0.3). Children with a BMI in the overweight range also reported a slightly lower HRQoL than children with a BMI in the normal weight range, but although statistically significant, the size of this difference was trivial (Cohen’s d <0.2).

Discussion
The results suggest that, overall there is no meaningful negative association between excess weight and HRQoL in secondary school children in Fiji. This is in contradiction to the negative relationship between excess weight and HRQoL shown in studies from other countries and cultures. The assumption that a large body size is associated with a lower quality of life cannot be held universally. Although a generally low HRQoL among children in Fiji may be masking or overriding the potential effect of excess weight on HRQoL, socio-economic and/or socio-cultural factors, may help to explain these relationships.

Mediators of the relationship between sedentary behavior and depressive symptoms amongst disadvantaged women

Statement of problem
Associations between sedentary behavior (e.g. time spent sitting watching TV/using the computer) and physical health have been well documented, however, studies are increasingly reporting a positive relationship between certain sedentary behaviors and poor mental health (e.g. depression). Little is known about the underlying factors that may explain the link between sedentary behavior and likelihood of depression. The purpose of this study was to investigate the contribution of selected intra-personal and social factors as potential mediators of the relationship between sedentary behavior and depressive symptoms among women from disadvantaged neighborhoods.
Method
Cross-sectional survey data were provided by 4065 women (aged 18–45) living in disadvantaged neighborhoods. Women self-reported their sedentary behavior (total sitting time and screen time), depressive symptoms (CES-D 10), as well as a number of intra-personal (leisure-time physical activity, diet quality, weight status) and social (social cohesion, interpersonal trust, club membership) factors.
Results
Mediating analyses, controlling for confounders, showed that women's leisure-time physical activity partly mediated the relationship between total sitting time and increased likelihood of depressive symptoms. Women's diet quality, and social cohesion partly mediated the relationship between screen time and increased likelihood of depressive symptoms.
Conclusions
Acknowledging the cross-sectional study design, findings suggest that there may be several factors that explain the increased likelihood of depressive symptoms associated with greater sedentary time. Although future studies should test the mediating relationships longitudinally, these findings may help inform interventions aimed at reducing the likelihood of depression in disadvantaged women with high sitting time.

Longitudinal predictors of frequent vegetable and fruit consumption among socio-economically disadvantaged Australian adolescents

Adequate vegetable and fruit consumption is necessary for preventing nutrition-related diseases. Socio-economically disadvantaged adolescents tend to consume relatively few vegetables and fruits. However, despite nutritional challenges associated with socio-economic disadvantage, a minority of adolescents manage to eat vegetables and fruit in quantities that are more in line with dietary recommendations. This investigation aimed to identify predictors of more frequent intakes of fruits and vegetables among adolescents over a 2-year follow-up period. Data were drawn from 521 socio-economically disadvantaged (maternal education ≤Year 10 of secondary school) Australian adolescents aged 12–15 years. Participants were recruited from 37 secondary schools and were asked to complete online surveys in 2004/2005 (baseline) and 2006/2007 (follow-up). Surveys comprised a 38-item FFQ and questions based on Social Ecological models examining intrapersonal, social and environmental influences on diet. At baseline and follow-up, respectively, 29% and 24% of adolescents frequently consumed vegetables (≥2 times/day); 33% and 36% frequently consumed fruit (≥1 time/day). In multivariable logistic regressions, baseline consumption strongly predicted consumption at follow-up. Frequently being served vegetables at dinner predicted frequent vegetable consumption. Female sex, rarely purchasing food or drink from school vending machines, and usually being expected to eat all foods served predicted frequent fruit consumption. Findings suggest nutrition promotion initiatives aimed at improving eating behaviours among this at-risk population and should focus on younger adolescents, particularly boys; improving adolescent eating behaviours at school; and encouraging families to increase home availability of healthy foods and to implement meal time rules.

Gambling participation and problem gambling severity in a stratified random survey : Findings from the second social and economic impact study of gambling in Tasmania

Demographic characteristics associated with gambling participation and problem gambling severity were investigated in a stratified random survey in Tasmania, Australia. Computer-assisted telephone interviews were conducted in March 2011 resulting in a representative sample of 4,303 Tasmanian residents aged 18 years or older. Overall, 64.8 % of Tasmanian adults reported participating in some form of gambling in the previous 12 months. The most common forms of gambling were lotteries (46.5 %), keno (24.3 %), instant scratch tickets (24.3 %), and electronic gaming machines (20.5 %). Gambling severity rates were estimated at non-gambling (34.8 %), non-problem gambling (57.4 %), low risk gambling (5.3 %), moderate risk (1.8 %), and problem gambling (.7 %). Compared to Tasmanian gamblers as a whole significantly higher annual participation rates were reported by couples with no children, those in full time paid employment, and people who did not complete secondary school. Compared to Tasmanian gamblers as a whole significantly higher gambling frequencies were reported by males, people aged 65 or older, and people who were on pensions or were unable to work. Compared to Tasmanian gamblers as a whole significantly higher gambling expenditure was reported by males. The highest average expenditure was for horse and greyhound racing ($AUD 1,556), double the next highest gambling activity electronic gaming machines ($AUD 767). Compared to Tasmanian gamblers as a whole problem gamblers were significantly younger, in paid employment, reported lower incomes, and were born in Australia. Although gambling participation rates appear to be falling, problem gambling severity rates remain stable. These changes appear to reflect a maturing gambling market and the need for population specific harm minimisation strategies. © 2014 Springer Science+Business Media New York.

Economic and social opportunity: the changing lives of Aboriginal Victorians

 This study examined Aboriginal advantage in Victoria, demonstrating that relatively rapid change is occurring on a number of socio-economic indicators. This research, including interviews with Aboriginal participants, highlighted the interdependence of Aboriginal agency and responsive societal structures as significant enablers of Indigenous progress and advancement.