Television viewing time and 13-year mortality in adults with cardiovascular disease: data from the Australian Diabetes, Obesity and Lifestyle Study (AusDiab)

BACKGROUND: In the general population, excessive sedentary behaviour is associated with increased all-cause mortality. Few studies have examined this relationship in people with cardiovascular disease (CVD). Using a sample of people with CVD who were excluded from an analysis of the Australian Diabetes, Obesity and Lifestyle (AusDiab) study, we examined the relationship between sedentary behaviour and 13-year all-cause mortality.

METHODS: In the original AusDiab study, television viewing time was used as a marker of sedentary behaviour in 609 adults (≥45 years of age) with CVD. During 6,291 person-years of follow-up (median follow-up 13 years), there were 294 deaths (48% of sample). Using the time scale of attained age, the Cox proportional hazards model predicting all-cause mortality adjusted for sex, self-rated general health, leisure-time physical activity, smoking status, education, household income, body mass index, lipid levels, blood pressure, and diabetes mellitus was used.

RESULTS: Compared with a TV viewing time of <2hours per day, the fully adjusted hazard ratios for all-cause mortality were 1.18 (95% CI, 0.88 to 1.57) for ≥2 to <4hours per day and 1.52 (95% CI, 1.09 to 2.13) for >4hours per day.

CONCLUSIONS: Sedentary behaviour was associated with increased risk of all-cause mortality in people with CVD, independent of physical activity and other confounders. In addition to the promotion of regular physical activity, cardiac rehabilitation efforts which also focus on reducing sedentary behaviour may be beneficial.

Family structure and children's television viewing and physical activity

Objectives: This study aimed to examine how physical activity (PA) and television (TV) viewing time of children varied according to family structure.

Methods: In 2001, 5- to 6-yr-old (N = 296) and 10- to 12-yr-old (N = 919) children and their parents were recruited from 19 state elementary schools in Melbourne, Australia. Children's PA was objectively assessed using accelerometers worn for 8 d. Sociodemographic and family structure information and time spent watching TV was collected via questionnaire completed by parents.

Results: ANCOVA revealed that, after controlling for socioeconomic status and age of child, boys without any siblings spent more minutes per day watching TV (153.2 +/- 71.3) compared with those who have siblings (129.0 +/- 64.4, P < 0.05). There were also significant differences in TV viewing time between boys with one sibling (125.5 +/- 59.9), two siblings (141.9 +/- 70.1), or three or more siblings (111.6 +/- 62.6, P < 0.001). Girls from single-parent families (145.7 +/- 85.1) spent significantly more minutes per day watching TV compared with girls from two-parent families (125.1 +/- 67.7, P < 0.05). Girls with siblings spent more minutes per day in PA (148.3 +/- 67.7) compared with those who were an only child (131.0 +/- 58.9, P < 0.05). There were significant interactions between parental status and having a sibling, with PA, and also with TV viewing for girls and between parental status and having a brother with PA for boys. There were also significant interactions between having an older sibling and child's sex with PA and between number of siblings and sex with TV viewing.

Conclusions: Family structure may be an important source of influence on children's PA and TV viewing time. Aspects of family structure interact differently with PA and TV viewing, suggesting interventions may need to be tailored with consideration of the family structure of children.

Individual, social and home environment determinants of change in children's television viewing: the Switch-Play intervention

Understanding potential determinants of change in television (TV) viewing among children may enhance the effectiveness of programs targeting this behaviour. This study aimed to investigate the contribution of individual, social and home environment factors among 10-year-old Australian children to change in TV viewing over a 21-month period. A total of 164 children (49% boys) completed a 19-lesson (9-month) intervention program to reduce TV viewing time. Children completed self-administered surveys four times over 21 months (pre- and post-intervention, 6- and 12-month follow-up). Baseline factors associated with change in TV viewing during the intervention and follow-up periods were: ‘asking parents ≥once/week to switch off the TV and play with them’ (21.6 min/day more than those reporting <once/week, p = 0.007); being able to ‘watch just 1 h of TV per day’ (26.1 min/day less than those who could not, p = 0.010); ‘watching TV no matter what was on’ (36.6 min/day more than those who did not, p < 0.001); and ‘continuing to watch TV after their program was over’ (33.0 min/day more than those who did not, p = 0.006). With every unit increase in baseline frequency of TV viewing with family and friends, children spent on average 4.0 min/day more watching TV over the 21-month period (p = 0.047). Baseline number and placement of TVs at home did not predict change in children's TV viewing over the 21 months. Greater understanding of the family dynamics and circumstances, as well as the individual and social determinants of TV viewing, will be required if we are to develop effective strategies for reducing TV viewing in children.

Local content policy in the Australian television industry

This paper examines the impact and effectiveness of the local content scheme currently operating in the Australian Television industry. The television industry is a service industry with public good aspects. Public interest arguments have traditionally been used to support the retention (and indeed expansion) of the local content scheme since it was first introduced in 1961. These objectives have included the promotion of Australian culture, the desire to ensure a diversity of views may be heard and that diverse interests may be catered for when preferences cannot be directly gauged.

The problems associated with defining what constitutes "Australian" content are examined along with the costs and effectiveness of the local content scheme in meeting public interest concerns. The paper finds that the local content scheme has become part of a package of protection in the broadcasting industry that has resulted in valuable television licences and powerful and entrenched interests. It also shows that the local content scheme is not particularly effective in meeting it's objectives, and will become increasingly irrelevant in the light of rapidly changing technology. Other methods of meeting public objectives are suggested.

Interactive television and the role of affective usability

This paper explores the importance of designing interfaces that evoke positive feelings in the user as they interact with the interface. The use of interactive television (iTV) and affective usability illustrate how usability paradigms shift as new technology is developed. Traditional television is a more passive medium than iTV and the role of the user (or viewer) varies significantly. iTV requires more of the user and to be an active contributor because of the more interactive interaction style. Interface designers need to constantly define better ways of developing interfaces that are not only usable, but also enjoyable to use.

Physical activity and television viewing in relation to risk and undiagnosed abnormal glucose metabolism in adults

OBJECTIVE--The goal of this study was to assess the associations of physical activity time and television (TV) time with risk of "undiagnosed" abnormal glucose metabolism in Australian adults.

RESEARCH DESIGN AND METHODS--This population-based cross-sectional study using a stratified cluster design involving 42 randomly selected Census Collector Districts across Australia included 8,299 adults aged 25 years or older who were free from new type 2 diabetes and self-reported ischemic disease and did not take lipid lowering or antihypertensive drugs. Abnormal glucose metabolism (impaired fasting glycetnia [IFG], impaired glucose tolerance [IGT], or new type 2 diabetes) was based on an oral glucose tolerance test Self reported physical activity time and TV time (previous week) were assessed using interviewer administered questionnaires.

RESULTS--Alter adjustment for known confounders and TV time, the odds ratio (OR) of having abnormal glucose metabolism was 0.62 (95% CI 0.41-0.96) in men and 0.71 (0.501.00) in women for those engaged in physical activity [greater than or equal to] 2.5 h/week compared with those who were sedentary (0 h/week). The ORs of having abnormal glucose metabolism were 1.16 (0.791.70) in men and 1.49 (1.12-1.99) in women who watched TV > 14 h/week compared with those who watched [less than or equal to] 7.0 h/week. Higher TV viewing (> 14 h/week) was also associated with an increased risk of new type 2 diabetes in men and women and IGT in women compared with those watching < 14 h/week. Total physical activity of [greater than or equal to] 2.5 h/week was associated with a reduced risk of IFG, IGT, and new type 2 diabetes in both sexes: however, only the association with IGT in women was statistically significant.

CONCLUSIONS--These findings suggest a protective effect of physical activity and a deleterious effect of TV time on the risk of abnormal glucose metabolism in adults. Population strategies to reduce risk of abnormal glucose metabolism should focus on reducing sedentary behaviors such as TV time, as well as increasing physical activity.

The effects of television advertisements for junk food versus nutritious food on children's food attitudes and preferences

Television (TV) food advertising has attracted criticism for its potential role in promoting unhealthy dietary practices among children. Content analyses indicate junk food advertising is prevalent on Australian children's TV; healthy eating is rarely promoted. This paper presents (a) a cross-sectional survey examining associations between children's regular TV viewing habits and their food-related attitudes and behaviour; and (b) an experiment assessing the impact of varying combinations of TV advertisements (ads) for unhealthy and healthy foods on children's dietary knowledge, attitudes and intentions. The experimental conditions simulated possible models for regulating food ads on children's TV. Participants were 919 grade five and six students from schools in Melbourne, Australia. The survey showed that heavier TV use and more frequent commercial TV viewing were independently associated with more positive attitudes toward junk food; heavier TV use was also independently associated with higher reported junk food consumption. The experiment found that ads for nutritious foods promote selected positive attitudes and beliefs concerning these foods. Findings are discussed in light of methodological issues in media effects research and their implications for policy and practice. It is concluded that changing the food advertising environment on children's TV to one where nutritious foods are promoted and junk foods are relatively unrepresented would help to normalize and reinforce healthy eating.

Which food-related behaviours are associated with healthier intakes of fruits and vegetables among women?

Objective To examine associations between shopping, food preparation, meal and eating behaviours and fruit and vegetable intake among women.
Design Cross-sectional survey.
Setting Community-based sample from metropolitan Melbourne, Australia.
Subjects A sample of 1136 women aged 18–65 years, randomly selected from the electoral roll.
Results Food-related behaviours reflecting organisation and forward-planning, as well as enjoyment of and high perceived value of meal shopping, preparation and consumption were associated with healthier intakes of fruits and vegetables. For example, women who more frequently planned meals before they went shopping, wrote a shopping list, enjoyed food shopping, planned in the morning what they will eat for dinner that night, planned what they will eat for lunch, reported they enjoy cooking, liked trying new recipes and who reported they sometimes prepare dishes ahead of time were more likely to consume two or more servings of vegetables daily. Conversely, women who frequently found cooking a chore, spent less than 15 minutes preparing dinner, decided on the night what they will eat for dinner, ate in a fast-food restaurant, ate takeaway meals from a fast-food restaurant, ate dinner and snacks while watching television and who frequently ate on the run were less likely to eat two or more servings of vegetables daily.
Conclusions Practical strategies based on these behavioural characteristics could be trialled in interventions aimed at promoting fruit and vegetable consumption among women.

Objectively measured light-intensity physical activity is independently associated with 2-H plasma glucose

Objective: We examined the associations of objectively measured sedentary time, light-intensity physical activity, and moderate- to vigorous-intensity activity with fasting and 2-h postchallenge plasma glucose in Australian adults.

Research Design and Methods: A total of 67 men and 106 women (mean age ± SD 53.3 ± 11.9 years) without diagnosed diabetes were recruited from the 2004–2005 Australian Diabetes, Obesity, and Lifestyle (AusDiab) study. Physical activity was measured by Actigraph  accelerometers worn during waking hours for 7 consecutive days and summarized as sedentary time (accelerometer counts/min <100; average hours/day), light-intensity (counts/min 100-1951), and moderate- to vigorous-intensity (counts/min ≥1,952). An oral glucose tolerance test was used to ascertain 2-h plasma glucose and fasting plasma glucose.

Results: After adjustment for confounders (including waist circumference), sedentary time was positively associated with 2-h plasma glucose (b = 0.29, 95% CI 0.11–0.48, P = 0.002); light-intensity activity time (b = –0.25, –0.45 to –0.06, P = 0.012) and moderate- to vigorous-intensity activity time (b = –1.07, –1.77 to –0.37, P = 0.003) were negatively associated. Light-intensity activity remained significantly associated with 2-h plasma glucose following further adjustment for moderate- to vigorous-intensity activity (b = –0.22, –0.42 to –0.03, P = 0.023). Associations of all activity measures with fasting plasma glucose were nonsignificant (P > 0.05).

Conclusions: These data provide the first objective evidence that light-intensity physical activity is beneficially associated with blood glucose and that sedentary time is unfavorably associated with blood glucose. These objective data support previous findings from studies using self-report measures, and suggest that substituting light-intensity activity for television viewing or other sedentary time may be a practical and achievable preventive strategy to reduce the risk of type 2 diabetes and cardiovascular disease.

Association between the family environment and television viewing in Australian children

Aim: To describe the time children spend watching television (TV) and to assess associations between TV viewing time, the family environment and weight status.

Methods: Parents reported the amount of time children watched TV/video both for ‘the previous school day’ and ‘usually’ and described aspects of the family environment influencing TV access as part of a large cross-sectional study in the Barwon South-western region of Victoria, Australia. Child weight status was  based on measured height and weight. All data were collected in 2003/2004.

Results: A total of 1926 children aged 4–12 years participated. Parent-reported mean ± SE TV time for the previous school day was 83 ± 1.5 min. Children who lived in a family with tight rules governing TV viewing time (22%), or who never watched TV during dinner (33%), or had only one TV in the household (23%) or had no TV in their bedroom (81%) had significantly less TV time than their  counterparts. Overweight or obese children had more TV time than healthy weight children 88 ± 2.9 versus 82 ± 1.7 min per day (P = 0.04). They were also more likely to live in a household where children had a TV in their bedroom than healthy weight children (25% vs. 17%, P < 0.001).

Conclusion: Strategies to reduce TV time should be included as part of broader strategies to prevent childhood obesity. They should include messages to parents about not having a TV in children’s bedrooms, encouraging family rules restricting TV viewing, and not having the TV on during dinner.

Family and home correlates of television viewing in 12-13 year old adolescents: the Nepean study

Background
Few young people meet television viewing guidelines.
Purpose
To determine the association between factors in the family and home environment and watching television, including videos and DVDs, in early adolescence.
Methods
Cross-sectional, self-report survey of 343 adolescents aged 12–13 years (173 girls), and their parents (338 mothers, 293 fathers). Main measures were factors in the family and home environment potentially associated with adolescents spending ≥ 2 hours per day in front of the television. Factors examined included family structure, opportunities to watch television/video/DVDs, perceptions of rules and regulations on television viewing, and television viewing practices.
Results
Two-thirds of adolescents watched ≥ 2 hours television per day. Factors in the family and home environment associated with adolescents watching television ≥ 2 hours per day include adolescents who have siblings (Adjusted Odds Ratio [95%CI] AOR = 3.0 [1.2, 7.8]); access to pay television (AOR = 2.0 [1.1, 3.7]); ate snacks while watching television (AOR = 3.1 [1.8, 5.4]); co-viewed television with parents (AOR = 2.3 [1.3, 4.2]); and had mothers who watched ≥ 2 hours television per day (AOR = 2.4 [1.3, 4.6]).
Conclusion
There are factors in the family and home environment that influence the volume of television viewed by 12–13 year olds. Television plays a central role in the family environment, potentially providing a means of recreation among families of young adolescents for little cost. Interventions which target family television viewing practices and those of parents, in particular, are more likely to be effective than interventions which directly target adolescent viewing times.

Television, computer use and body mass index in Australian primary school children

Objective: To investigate relationships between children's body mass index (BMI) and parent reports of children's television and video game/computer habits, controlling for other potential risk factors for paediatric obesity.

Methods: Child BMI was calculated from measured height and weight collected in 1997 as part of a large, representative, cross-sectional study of children in Victoria, Australia. Parents reported the amount of time children watched television and used video games/computers, children's eating and activity habits, parental BMI and sociodemographic details.

Results: A total of 2862 children aged 5−13 years participated. Child mean BMI z-score was significantly related to television (F = 10.2₃, P < 0.001) but not video game/computer time (F = 2.2₃, P = 0.09), but accounted for only 1 and 0.2% of total BMI variance, respectively. When parental BMI, parental education, number of siblings, food intake, organized exercise and general activity level were included, television ceased to be independently significantly related to child BMI. Using adjusted logistic regression, the odds of being overweight and obese generally increased with increasing television viewing. No relationship was found for video game/computer use.
Conclusions: A small proportion of variance in child BMI was related to television, but not video game/computer time. This was far outweighed by the influence of other variables. Causal pathways are likely to be complex and interrelated.

Screening Michael Jackson's face : reading Martin Bashir's living with Michael Jackson

The screening of Martin Bashir's Living with Michael Jackson on Australian television elicited a phenomenal amount of interest in the news media, at water coolers and on the Internet. Much of the response in the Australian print media was critical of Bashir's representation of Jackson, as well as denouncing Jackson as sad victim, warped predator and allround freakshow. This article considers these interpretations to argue that the production and consumption of 'wacko Jacko' is underpinned by the increasing instability of the natural in an age of information technologies, as well as the collapse of boundaries between documentary and fictional entertainment forms.

Gen Zeds: Arab women speaking with “still small voices”

The “Gen Zeds” of the title are female Emirati students in their early twenties at Zayed University who oscillate between the traditional Islamic culture of their families, and the highly mediated global culture they experience at university and on the Internet. In a typical week these women spend as much time on the Internet as they do in the combined activities of reading magazines, newspapers and books. They spend twice as much time on the Internet as they do watching television.

Parental awareness and attitudes about food advertising to children on Australian television

Objective: To assess parents' concern regarding television food advertising to children and the marketing methods used, their awareness of existing regulations and support for strengthening restrictions, and to determine whether these factors differ across sociodemographic groups.

Methods: A randomly selected sample of 400 parents of children under 14 years in all Australian States and Territories completed the cross-sectional telephone survey in March 2007. Data were weighted by metropolitan and regional population proportions.

Results: Parents were concerned about unhealthy food advertising to children (67.3%), use of popular personalities (67.7%), toys (76.4%), and advertising volume (79.7%). Older parents, of high socioeconomic status (SES), with fewer household televisions were more likely to be concerned. Only 47.4% of parents were aware of current regulations and those with a tertiary education were more likely to be aware: odds ratio (OR) 2.96 (95% CI: 1.55-5.65). Parents supported a change from self-regulation (92.8%), a ban on unhealthy food advertising to children (86.8%) and, to a lesser extent, a ban on all food advertising (37.3%).

Conclusions and implications: There was widespread parental concern about food advertising and strong support for tighter restrictions. Given that the existing regulations rely on complaints and awareness is low, particularly among parents with lower education levels, a system of external monitoring and enforcement is essential. Clearly more effective regulations are needed to protect children and parental support for this is high.