Regional variations in walking for different purposes : the south east Queensland quality of life study

Where people are located can influence behavioral choices and health outcomes through the effects of place on health. Walking is the most commonly reported form of nonoccupational and nonhousehold physical activity for adults. It is a behavior of particular interest to those in the transportation, urban planning, and public health fields. Researchers have examined patterns of walking from both an individual perspective (psychological and social factors) and from a broader community focus (location and built environment factors). The majority of studies have examined walking in the context of urban environments. Variations within regions (urban, periurban, and rural, for example) in walking have not been previously described. We use data from a regionally based quality of life survey to examine subregional variations in walking for particular purposes. Both the social and contextual variations that may underlie these differences are considered. This is useful in helping identify particular factors that may be further investigated in disaggregated analyses using GIS methods to identify specific differences in objective attributes between subregions that may influence peoples' choices to walk, such as walking infrastructure and the availability of destinations.

Sun exposure and sun protection behaviours among young adult sport competitors

Objective: To explore the relationship between sun protection and physical activity in young adults (18-30 years) involved in four organised sports.

Methods: Participants (n=237) in field hockey, soccer, tennis and surf sports completed a self-administered survey on demographic and sun-protective behaviours while playing sport. Differences in sun-protective behaviour were explored by sport and by gender.

Results: Sunburn during the previous sporting season was high (69%). There were differences between sports for sunburn, sunscreen use and reapplication of sunscreen. Lifesaving had the highest rates compared with the other three sports. Hats and sunglasses worn by participants varied significantly by sports. A greater proportion of soccer and hockey players indicated they were not allowed to wear a hat or sunglasses during competition. For all sports, competition was played mainly in the open with no shade provision for competitors while they were playing. There were some gender differences within each of the sports. Female soccer and tennis players were more likely to wear sunscreen compared with males. Female hockey players were more likely to wear a hat compared with males.

Conclusions: Our findings highlight that there is still room for improvement in sun-protective behaviours among young adult sport competitors. There is a need for a systematic approach to sun protection in the sporting environments of young adults.

Implications: Health promotion efforts to increase physical activity need to be paired with sun protection messages.

Effects of a walking program in the psychiatric in-patient treatment setting: a cohort study.

Issue addressed: To assess the effectiveness of a walking program in a psychiatric in-patient unit. Method: In-patients at a private psychiatric unit were offered the opportunity to participate in a daily morning 40 minute walk led by an activity supervisor. After discharge, outcomes for patients who had regularly participated in the walking group (n=35) and patients who had not participated (n=49) were compared for length of stay during their period of admission and Clinical Global Impression - Severity (CGI-S) and  Depression Anxiety Stress Scales (DASS) scores measured at admission and discharge. This was a retrospective analysis of data collected routinely. Results: There were no significant differences between the two cohorts on most primary outcome measures, including length of stay, DASS scores at admission and at discharge and CGI-S scores at admission. Patients who had not participated in the walking group had a significantly lower score on a single measure, the CGI-S, than patients who had participated (p=0.001). Conclusions: This study showed no evidence that in-patients benefited from participating in the physical activity program. However, this must be  interpreted within the confines of a number of study limitations and, as such, the findings can neither support nor refute the effectiveness of physical activities.

Residential proximity to school and the active travel choices of parents

Issue addressed: Walking for transport can contribute significantly to health-enhancing physical activity. We examined the prevalence and duration of walking to and from school, together with perceived influences on doing so, among parents of primary school children. Methods: Questionnaires were completed by parents from four primary schools (one government and three private) located in south-east Queensland (n=559; 40% response rate). Results: Eighteen per cent of parents reported walking for at least 10 minutes during journeys to school. Significantly greater proportions of parents with only one car in their household, with a child who attended a government school, with no driver’s licence, who had less than 11 years of education, and lived within two kilometres of the school walked for at least 10 minutes during the school journey. Factors perceived by parents most strongly to influence walking to school were: being physically active; safety concerns for the child walking alone; not having to park; walking being the child’s preferred option; too much motor vehicle traffic; and their child’s age and level of road sense. Conclusions: Despite the overall low prevalence of walking to school by parents, health-enhancing benefits may be achieved even when other modes of transport are used in conjunction with walking.

Cigarette smoking is negatively associated with family average income among urban and rural men in regional Mainland China

Socio-economic status (SES) has a strong influence on cigarette smoking behaviour. However, as a more sensitive and realistic index of SES, family average income (FAI) has little studied regarding its association with smoking. With a response rate of 90.1%, a cross-sectional study was conducted among randomly selected urban-rural participants (n  = 29,353) between October of 2000 and March of 2001 in Nanjing, China. The proportion of male participants who were current smokers was 54.7%; for females it was 2.2%. After adjustment for possible confounding variables (area of residence, age, education, occupation) males in the middle (OR 0.76; 95% CI 0.69–0.84) and higher (OR 0.64; 95% CI 0.57–0.71) FAI tertiles had lower odds of being smokers than did males in the lower FAI tertile. There were no differences by FAI category in the odds of being an ex-smoker. Therefore, current smoking among adult males is inversely associated with family average income in a regional Chinese population. FAI may inform the targeting of campaigns or other initiatives, particularly in populations where material prosperity is low in some social groups.

Neighborhood walkability and the walking behavior of Australian adults

Background
The physical attributes of residential neighborhoods, particularly the connectedness of streets and the proximity of destinations, can influence walking behaviors. To provide the evidence for public health advocacy on activity-friendly environments, large-scale studies in different countries are needed. Associations of neighborhood physical environments with adults’ walking for transport and walking for recreation must be better understood.

Method
Walking for transport and walking for recreation were assessed with a validated survey among 2650 adults recruited from neighborhoods in an Australian city between July 2003 and June 2004, with neighborhoods selected to have either high or low walkability, based on objective measures of connectedness and proximity derived from geographic information systems (GIS) databases. The study design was stratified by area-level socioeconomic status, while analyses controlled for participant age, gender, individual-level socioeconomic status, and reasons for neighborhood self-selection.

Results
A strong independent positive association was found between weekly frequency of walking for transport and the objectively derived neighborhood walkability index. Preference for walkable neighborhoods moderated the relationship of walkability with weekly minutes, but not the frequency of walking for transport—walkability was related to higher frequency of transport walking, irrespective of neighborhood self-selection. There were no significant associations between environmental factors and walking for recreation.

Conclusions
Associations of neighborhood walkability attributes with walking for transport were confirmed in Australia. They accounted for a modest but statistically significant proportion of the total variation of the relevant walking behavior. The physical environment attributes that make up the walkability index are potentially important candidate factors for future environmental and policy initiatives designed to increase physical activity.

Does walking in the neighbourhood enhance local sociability?

The walkability of urban neighbourhoods has emerged as a strong component in policy and design models for active, liveable communities. This paper examines the proposition that more walkable neighbourhoods encourage local social interaction, a sense of community, informal social control and social cohesion; and that the relationship is explained by walking for transport or for recreation. Multilevel analyses of data from an Australian sample showed a modest association between the walkability of a neighbourhood and sense of community only. Walking for transport, but not recreation, mediated this relationship although the effect was small. These results support contentions that 'walkability' is more complex than usually defined and that factors influencing neighbourhood sociability extend beyond issues of urban form.

Promoting comprehensive sun protection policies and practices in outdoor sports: a qualitative study of perceived priorities and practicalities

Sun protection policies, environments, practices, and attitudes in sporting club contexts might be significant determinants of sun exposure among adult sporting participants. Face-to-face interviews, using standardised, open-ended questions were conducted with 20 club officials from four sports: soccer, hockey, tennis and surf lifesaving. Thematic content analysis identified a number of salient themes. Formal sun protection policies were well-implemented in surf lifesaving, but less so in soccer, hockey and tennis clubs, which often had informal sun protection practices in place. Officials perceived sun protection to be important, which was related to perceived exposure levels, the type of sport, length of time played and the season. Consistent logistical and practical considerations emerged, including limited resources, availability of shade, and lack of control over sporting facilities, uniform regulations and games scheduling. Sun protection efforts often focused on children more than adult players. Reciprocal responsibility was an important theme, where it was perceived that responsibility for sun protection should be equally shared between the club and the member. In this study it was found that reciprocal responsibility, duty of care and sport-specific practical requirements might significantly influence the success of policy, environmental and education initiatives for sun protection in sporting settings.

Thinking about difference in student supervision

Over the past decade, educators have given greater recognition to the influence of race and culture on practice and policy. Whilst educators are now including specific courses that take account of diversity, scant attention has been paid to how these issues may be addressed in student supervision. This article reports on a qualitative study examining how three experienced supervisors addressed difference in student supervision. Supervisory approaches were compared examining the supervisors' goals, focus, supervisory strategies, theoretical orientation, contribution made to student learning and the limitation of their particular approach. These findings emphasise the complexity of addressing difference in supervision, and suggest that some additional issues to address in supervision.

ACCCN national nursing workforce survey of intensive care units

A descriptive study was designed and implemented by the Australian College of Critical Care Nurses (ACCCN) Workforce Planning Advisory Committee to capture data pertaining to workforce issues of intensive care nurses. All intensive care units (ICUs) within Australia were mailed a self reporting survey. Despite a low response rate (52 per cent) and difficulty reported by respondents in gaining the appropriate data requested, the results revealed an interesting snapshot of the intensive care nursing workforce.
Types of services offered by units varied considerably; paid overtime hours were low (<2 per cent of total hours worked) and use of both part-time and agency staff was also low (10 per cent of total hours worked). Private hospitals utilised a greater proportion of part-time and agency nursing staff than public hospitals (20:10 per cent). The turnover rate for registered nursing staff was estimated at 18 per cent, with education, skill acquisition and improved communication reported as the major incentives used by managers to attract and retain staff. This study demonstrated that valuable data are currently uncaptured and recommends a more refined process of a national database to record and manage this important information for future workforce planning.

Family average income and diagnosed Type 2 diabetes in urban and rural residents in regional mainland China.

Aims: To explore the relationship between family average income (FAI; an index of socio-economic status) and Type 2 diabetes in a region of mainland China. Methods: Population-based cross-sectional study, conducted between October 2000 and March 2001 in administrative villages (n = 45) randomly selected from three urban districts and two rural counties of NanJing municipality, mainland China, with a regional population of 5.6 million. Participants were all local residents aged ≥ 35 years old (n = 29 340); 67.7% from urban areas, 32.3% from rural areas, 49.8% male and 50.2% female. Results: The response rate of eligible participants was 90.1%. The overall prevalence of self-reported Type 2 diabetes was 1.9%. After adjustment for possible confounding variables (age, gender, area of residence, body mass index, educational level, smoking status, occupational and leisure-time physical activity), participants in the higher and middle FAI categories were more than twice as likely to have Type 2 diabetes as those in the lower FAI category. Conclusions: The prevalence of Type 2 diabetes is positively related to socio-economic status (indexed by FAI) in Chinese at the population level. After controlling for potential confounding factors, people in higher socio-economic status groups are more likely to have Type 2 diabetes. These associations are consistent with other effects of epidemiological transition and identify a need for preventive initiatives.

Destinations that matter: associations with walking for transport

Associations between access to destinations and walking for transport were examined. Households (N=2650) were selected from 32 urban communities varying in walkability and socio-economic status. Respondents reported perceived proximity of destinations, transport-related walking, reasons for neighbourhood selection, and socio-demographic characteristics. Geographic Information Systems data defined objective measures of access to destinations. Measures of access to destinations were associated with transport-related walking. Associations depended on socio-demographic factors and type of destinations. Workplace proximity was the most significant contributor to transport-related walking, especially among women. Regular walking to work resulted in the accrual of sufficient physical activity for health benefits.

Socio-demographic variations in walking for transport for recreation or exercise among adult Australians.

Background: Walking is integral to strategies to promote physical activity. We identified socio-demographic variations in walking for transport, and for recreation or exercise. Methods: Representative population data (n = 3392) from Australia were collected using computer assisted telephone interviewing, to examine adults’ participation in moderate- or brisk-paced walking for transport and walking for recreation or exercise; walking “sufficient” to meet the current public health guideline (> 150 min/wk); and, the contributions of total walking to meeting the guideline for total physical activity. Results: Rates of sufficient walking for transport (10% for men, 9% for women) were lower than those for walking for recreation or exercise (14% for both genders). Few socio-demographic differences emerged. Men over age 60 y were significantly less likely (OR = 0.40) to walk for transport; men age 45 to 59 y were more likely (OR = 1.56) to walk for recreation or exercise. Walking contributed more toward meeting the current public health guideline among women (15% to 21%) than among men (6% to 8%). Conclusions: There is potential for socially equitable increases in participation, through a focus on both walking for transport and on walking for recreation or exercise; attention to gender differences would be helpful.

Small-scale randomized controlled trials need more powerful methods of mediational analysis than the Baron-Kenny method

Objective: To devise more-effective physical activity interventions, the mediating mechanisms yielding behavioral change need to be identified. The Baron–Kenny method is most commonly used, but has low statistical power and may not identify mechanisms of behavioral change in small-to-medium size studies. More powerful statistical tests are available.
Study Design and Setting: Inactive adults (N = 52) were randomized to either a print or a print-plus-telephone intervention. Walking and exercise-related social support were assessed at baseline, after the intervention, and 4 weeks later. The Baron–Kenny and three alternative methods of mediational analysis (Freedman–Schatzkin; MacKinnon et al.; bootstrap method) were used to examine the effects of social support on initial behavior change and maintenance. Results: A significant mediational effect of social support on initial behavior change was indicated by the MacKinnon et al., bootstrap, and, marginally, Freedman–Schatzkin methods, but not by the Baron–Kenny method. No significant mediational effect of social support on maintenance of walking was found. Conclusions:  Methodologically rigorous intervention studies to identify mediators of change in physical activity are costly and labor ntensive, and may not be feasible with large samples. The use of statistically powerful tests of mediational effects in small-scale studies can inform the development of more effective interventions.