Understanding environmental influences on nutrition and physical activity behaviors: where should we look and what should we count?

Research interest in the influence of environmental factors on nutrition and physical activity behaviors has surged internationally in recent years. This is evident from a rapidly expanding literature and facilitated by advances in methodological and analytical approaches to assessing multiple levels of influence on health behaviors. However, a number of conceptual challenges complicate research endeavours in this field. The purpose of this paper is to provide a 'state of the science' overview of evidence regarding environmental influences on nutrition and physical activity behaviors. We focus particularly on a number of key conceptual and methodological issues, including: a consideration of how the environment is defined; the selection and operationalization of environmental exposures; and the importance of integrating existing understanding of individual influences on behavior with the emerging data on the role of the environment. We draw on examples from the published literature including our own research studies to illustrate these issues. We conclude by proposing a research agenda to progress understanding of the influences of the environment on population nutrition and physical activity behaviors.

Evaluation of a brief pilot nutrition and exercise intervention for the prevention of weight gain in general practice patients

Objective To pilot-test a brief written prescription recommending lifestyle changes delivered by general practitioners (GPs) to their patients.

Design The Active Nutrition Script (ANS) included five nutrition messages and personalised exercise advice for a healthy lifestyle and/or the prevention of weight gain. GPs were asked to administer 10 scripts over 4 weeks to 10 adult patients with a body mass index (BMI) of between 23 and 30 kg m− 2. Information recorded on the script consisted of patients' weight, height, waist circumference, gender and date of birth, type and frequency of physical activity prescribed, and the selected nutrition messages. GPs also recorded reasons for administering the script. Interviews recorded GPs views on using the script.

Setting General practices located across greater Melbourne.

Subjects and results Nineteen GPs (63% female) provided a median of nine scripts over 4 weeks. Scripts were administered to 145 patients (mean age: 54 ± 13.2 years, mean BMI: 31.7 ± 6.3 kg m− 2; 57% female), 52% of whom were classified as obese (BMI >30 kg m− 2). GPs cited ‘weight reduction’ as a reason for writing the script for 78% of patients. All interviewed GPs (90%, n = 17) indicated that the messages were clear and simple to deliver.

Conclusions GPs found the ANS provided clear nutrition messages that were simple to deliver. However, GPs administered the script to obese patients for weight loss rather than to prevent weight gain among the target group. This has important implications for future health promotion interventions designed for general practice.

In the shadow of the volcanoes: the impact of intervention on the nutrition and health status of Rwandan refugee children in Zaire two years from the exodus

Objective: To evaluate the public health and nutritional situation of refugee children in Katale camp, Eastern Zaire, after two years of nutritional and health intervention from 1994 to 1996.
Design: Cross-sectional survey using a two-stage cluster sampling method. Anthropometric data were collected from 28 May 1996 to 4 June 1996. Retrospective review of food basket monitoring data over the preceding six months and the United Nations High Commission for Refugees' weekly mortality data was conducted. Measles immunisation coverage data were surveyed simultaneously, using child health records.
Main outcome measures: Nutritional status measured by weight-for-height index (W/H), measles immunisation status, average daily energy content of the general food ration and crude mortality rate.
Setting: Katale refugee camp, Zaire, June 1996.
Analysis: Weight-for-height index and proportion of immunised children were computed using EPINUT, part of EPINFO computer package.
Results: Malnutrition was found to be most prevalent in children aged six to 29 months old (W/H < -2 Z-score and/or oedema: 6.2%; 95% CI: 3.4%, 10.6%), among whom the malnutrition rate was almost double the overall malnutrition prevalence (W/H < -2 Z-score and/or oedema: 3.5% (95% CI: 1.5%, 7.2%). The general food ration, although conforming to the World Food Program minimum standards of adequacy in terms of variety (being composed of cereals, oil, beans, blended cereal and legume mixes and salt), provided only 6240 kJ on average (95% CI: 5040, 7140 kJ) per person per day, thus meeting only 57% to 84% of the minimum energy requirements for an adult, and falling well below the needs for sub groups with higher nutritional requirements such as children, pregnant and breastfeeding women and the sick. Measles immunisation coverage in children nine to 59 months was 88.6%. The crude mortality rate was found to be 0.3 per 10 000 per day. Refugees received 15 litres of clean water per person per day.
Conclusion: Public health interventions in Katale camp 1994 to 1996 had reduced mortality and morbidity rates dramatically. This was not reflected in the malnutrition rates for children under five years, that remained stable after an initial fall despite two years of nutritional intervention. The factors contributed to this were related to an inadequate general food ration (due to food shortages), lack of ability to supplement the diet, (due to economic restrictions that were imposed in the camp) and inequities in the food distribution process (due to food being siphoned off by camp leaders for military purposes).

An analysis of CSI/FBI and AusCERT surveys

The paper responds to the release of both the AusCERT and CSI/FBI computer crime and security surveys with a comparison of the results between the two countries' respondents. Overall both surveys show the trend that most organisations employ security technologies but half of them still experience incidents which compromise their security. These incidents have significant quantifiable losses but despite these organisations are still loathed to report to law enforcement agencies for various reasons. These include the impression that law enforcement agencies are not interested, and the negative publicity such incidents can cause in their aftermath.

The effect of attitudes and experience on respondent answers to demographic questions in on-line surveys

Survey response rates and response quality are declining in most markets, threatening the viability of many established research techniques. One attempt to combat this has been to make survey completion more convenient for respondents, with on-line surveys being an example of this. This paper looks at respondent attitudes to demographic questions in on-line surveys – questions that are crucial for many analysis practices and yet often have the highest non-completion rates. The exploratory survey conducted here (n=198) examined attitudes towards surveys and empirically examined the reasons behind non-completion and intentions to give misleading information. The results suggest that general attitudes towards providing demographic data in on-line surveys are related to the likely response behaviour, and the more uncomfortable someone claims to be with providing this data, the more likely they will be to either omit a response or exit the survey altogether. Past experience with on-line surveys increases the chances of respondents answering completely and accurately and in most cases, significantly reduces the likelihood of exiting the survey completely if asked these questions. Finally, there is some evidence that providing broad categorical response options is preferred to more specific categories or open text boxes, and this may represent the best technique for improving response rates and quality.

Response rates in telephone surveys: managing contactability

Telephone interviewing is the major data collection method for the market research industry. Although social trends such as mobile phones and call screening make it harder to contact people, better technology and contact regimes can assist companies to ameliorate the situation. A study of fieldwork managers responsible for over 75% of all phone interviews in Australia revealed limited use of contact enhancing strategies such as longer survey periods and more callbacks. Commercial imperatives for timely surveys and a lack of end-user concern for response rate issues, along with costs concerns, were believed to be responsible.

Reaching the invisible : overcoming sampling barriers in GLB research via web surveys

Sampling is fundamental to the credibility of any empirical investigation, and this is no different for the area of Gay, Lesbian and Bisexual (GLB) research. In fact, it would not be an overstatement to say that publication of GLB research into high quality and mainstream journals has been limited in part because of sampling issues. The purpose of this paper is to raise awareness of the unique sampling problems posed by GLB resaerch and to offer solutions to these through the use of web surveys and recruitment strategies. In particular, we provide data which show that, contrary to voiced concerns, when employed with a rigorous recruitment strategy, web surveys increase rather than reduce sampling coverage. Further, we provide evidence that the web survey technique can yield data of comparable quality to that obtained with a hard-copy survey. The paper concludes with strategies researchers can adopt to overcome barriers in obtaining a diverse GLB sample.

Change in the prevalence of overweight and obesity among young Australian, 1969-1997

BACKGROUND: Effective public policy requires information on the prevalence of overweight and obesity. OBJECTIVE: We determined changes in the population prevalence of overweight and obesity among young Australians (aged 7-15 y) from 1969 to 1985 to 1997. DESIGN: Data from 5 independent population surveys were analyzed: the Australian Youth Fitness Survey, 1969; the Australian Health and Fitness Survey, 1985; the South Australian Schools Fitness and Physical Activity Survey, 1997; the New South Wales Schools Fitness and Physical Activity Survey, 1997; and the Health of Young Victorians Study, 1997. Measured body mass index was used as the index of adiposity, and recently published body mass index cutoff values were used to categorize each subject as nonoverweight, overweight, obese, or either overweight or obese. RESULTS: For 1985-1997, the population prevalence of overweight increased by 60-70%, obesity increased 2-4-fold, and the combined overweight and obesity categories doubled. The findings were consistent across data sets and between the sexes. For 1969-1985, there was no change in the prevalence of overweight or obesity among girls, but among boys the prevalence of overweight increased by 35%, the prevalence of obesity trebled, and the prevalence of overweight and obesity combined increased by 60%. CONCLUSIONS: The data show that in 1985-1997, the prevalence of overweight and obesity combined doubled and that of obesity trebled among young Australians, but the increase over the previous 16 y was far smaller. These results should increase our sense of urgency in identifying and implementing effective responses to this major threat to public health.

Beyond satisfaction surveys: the development of an evaluation process for a postgraduate transferable skills program

Leadership, professional and other transferable skills are embedded in the expected attributes of Australian research postgraduates at the successful completion of their degrees. This paper reports on the development of an evaluation process for a postgraduate transferable skills program at The University of Melbourne, Australia. Existing and emerging evaluation practices and processes are examined in light of the literature on what constitutes 'good' evaluation of the type of program under consideration. The development of the process to go beyond the commonly used participant satisfaction surveys and to improve evaluation practices is described in detail. The results of the evaluation to date are provided and discussed in terms of their usefulness in incorporating particular improvements to the program. The implications for the evaluation of other programs of this type are considered.

Migrants getting fat in Australia: acculturation and its effects on the nutrition and physical activity of African migrants to developed countries

Obesity is a significant health problem in Australia and other developed countries and acculturation is one fo the many risk factors. This new book summarizes acculturation and anthropometric outcomes among sub-Saharan African migrants in Australia. The book further examines the relationship between acculturation and food, energy and nutrient intake and physical activity. Some policy recommendations are proposed.

Associations between the home food environment and obesity-promoting eating behaviors in adolescence

Objective: This study examines relationships between multiple aspects of the home food environment and obesity-promoting characteristics of 12- to 13-year-old adolescents' diets, specifically frequency of consumption of high-energy fluids, sweet snacks, savory snacks, and take-out foods.

Research Methods: This was a cross-sectional study including 347 adolescents 12 to 13 years of age and their parents. Data were collected via self-completed surveys. The adolescents' diets were assessed using a Food Frequency Questionnaire derived from existing age-appropriate National Nutrition Survey data. An extensive range of domains within the home food environment were assessed. Bivariate linear regression analyses were run split by gender. Forced entry multiple linear regression analyses (adjusting for all variables significant in bivariate analyses as well as for maternal education) were also performed, stratified by the sex of the child.

Results: The influence of mothers, either as models for eating behaviors or as the providers of food, was pervasive. Mothers' intake of high-energy fluids (p = 0.003), sweet snacks (p = 0.010), savory snacks (p = 0.008), and take-out food (p = 0.007) was positively associated with boys' intake of all these foods. In addition, mothers' intake of high-energy fluids was positively associated with daughters' consumption of these drinks (p = 0.025). Furthermore, availability of unhealthy foods at home was positively associated with girls' sweet snack (p = 0.001), girls' savory snack (p < 0.001), boys' savory snack (p = 0.002), and, in the bivariate analyses, girls' high-energy fluid consumption (p = 0.002).

Discussion: This study of home food environment influences on adolescent diet highlights the pervasive influence of mothers in determining adolescents' obesity-promoting eating, providing direction for obesity prevention strategies and future research.

The impact of security surveys within Australia and New Zealand

Information security is portrayed as a global problem that impacts all countries that are considered as part of the Information Society. Recent surveys show that there are increased concerns about computer crime. The paper will focus upon recent national security surveys from Australia and New Zealand and the trends that this research shows. Is it fair to assume the security practices are the same all over the world? The paper looks at security practices from a number of different countries perspectives and shows that security practices are not generic and vary from country to country. The paper will also evaluate the worth that National Security Surveys have in the field of Information Security Surveys.

Evidence-based nutrition and cardiovascular disease in the Asia-Pacific region

The Asia-Pacific region is undergoing a major change in both food and health patterns, with a connection between the two more than likely. Evidence for certain traditional Asia-Pacific foods as protective agents against chronic non-communicable disease and cardiovascular disease (CVD), in particular, is growing at a time when their usage diminishes. The nature of the evidence to establish relevant Asia-Pacific food-health linkages will include randomised placebo-controlled clinical trials, but is much more extensive and meaningful. Okinawans have probably achieved one of the most successful food cultures from a health point of view and serve as a reference point for the Asia-Pacific region. The expert working party has produced, in November 2000, the 'Okinawan Recommendations on Nutrition and CVD in the Asia-Pacific region'.

Demographic differences in usage and attitudes to milk

Declining milk consumption is a potential public health problem because milk provides nutrients that are not abundant in other foods. Identification of the factors that may influence milk consumption may lead to development of interventions to promote more healthful behaviours.

Attitudes and beliefs about food appear to be strong predictors of dietary behaviour. The objective of this study was to survey a random sample of consumers in regard to their milk consumption and attitudes and beliefs about milk. Two telephone surveys were conducted one year apart. The questionnaire included attitude items that reflected the main themes of consumers' interest in milk.

The respondents' attitudes were complex and were related to demographics and milk consumption. In general, people's concerns about milk related to what was important in their lives; what threatened them physically and emotionally. Women held more positive attitudes, but they were concerned about the fat content of milk. Men were less aware of milk's nutritional benefits and, as a result, were less appreciative of its value.

The findings from this investigation provide an opportunity to develop appropriate public health initiatives to promote the consumption of high calcium foods and to address the barriers to drinking milk. Nutrition communications in collaboration with other health agencies and the milk industry could support these initiatives.

Dietary patterns of Australian adults and their association with socio-economic status: results from the 1995 national nutrition survey

Objective: To describe dietary patterns among men and women in the Australian population, and to explore how these varied according to socioeconomic status (SES).

Design: A cross-sectional self-report population survey, the 1995 Australian National Nutrition Survey (NNS), was used.

Setting: Private dwelling sample, covering urban and rural areas across Australia.

Subjects: Data provided by 6680 adults aged 18-64 who participated in the NNS were used in the analyses.

Methods: Factor analyses were used to analyse data from a Food Frequency Questionnaire (FFQ) completed by participants. Associations between SES and dietary pattens were assessed using ANOVA.

Results: Separate factor analyses of the FFQ data for men and women revealed 15 factors, accounting for approximately 50% of the variance in both men's and women's dietary patterns. Several gender and SES differences in food patterns were observed. Lower SES males more frequently consumed 'tropical fruits', 'protein foods', and 'offal and canned fish', while high SES males more often ate 'breakfast cereals' and 'wholemeal bread'. Lower SES females more often ate 'traditional vegetables', 'meat dishes' and 'pasta, rice and other mixed foods', while high SES females more frequently ate 'ethnic vegetables' and 'breakfast cereal/muesli'.

Conclusions: These findings contribute to a better understanding of the dietary patterns that underscore gender-specific SES differences in nutrient intakes. Analyses of the type employed in this study will facilitate the development of interventions aimed at modifying overall eating patterns, rather than specific components of the diet.