Longitudinal changes in dietary patterns during adult life

Despite the growing interest in dietary patterns, there have been few longitudinal investigations. The objective of the present study was to extend an earlier method of dietary pattern assessment to longitudinal binary data and to assess changes in patterns over time and in relation to socio-demographic covariates. A prospective national cohort of 1265 participants completed a 5 d food diary at three time-points during their adult life (at age 36 years in 1982, 43 years in 1989 and 53 years in 1999). Factor analysis identified three dietary patterns for women (fruit, vegetables and dairy; ethnic foods and alcohol; meat, potatoes and sweet foods) and two patterns in men (ethnic foods and alcohol; mixed). Trends in dietary pattern scores were calculated using random effects models. Marked changes were found in scores for all patterns between 1989 and 1999, with only the meat, potatoes and sweet foods pattern in women recording a decline. In a multiple variable model that included the three time-points, socio-demographic variables and BMI time-dependent covariates, both non-manual social class and higher education level were also strongly associated with the consumption of more items from the ethnic foods and alcohol pattern and the mixed pattern for men (P<0[middle dot]0001) and the fruit, vegetables and dairy pattern and the ethnic foods and alcohol pattern for women (P<0[middle dot]01). In conclusion, longitudinal changes in dietary patterns and across socio-economic groups can assist with targeting public health initiatives by identifying stages during adult life when interventions to improve diet would be most beneficial to health.

Dietary patterns throughout adult life are associated with body mass index, waist circumference, blood pressure, and red cell folate

Dietary patterns are important in the prevention of chronic disease; however, there are few studies that include repeat measures of dietary patterns. The objective of this study was to assess the relations between dietary patterns during adult life (at ages 36, 43, and 53 y) and risk factors for chronic disease at age 53 y. Participants of a longitudinal study of health completed a 5-d food diary at 3 occasions during adult life (n = 1265). Factor analysis was used to identify dietary patterns and a pattern score was calculated from the consumption of the food items in each dietary pattern. Means and 95% CI for dietary pattern scores were calculated for each risk factor category using random effects models adjusted for socio-demographic and health-related behaviors. In women, the fruit, vegetables, and dairy pattern was inversely associated with BMI (P < 0.004), waist circumference (P = 0.0007), blood pressure (P = 0.02), and was positively associated with red cell folate (P < 0.03). The ethnic foods and alcohol pattern was also inversely associated with blood pressure (P = 0.008), whereas the meat, potatoes and sweet foods pattern was positively associated with glycated hemoglobin (P = 0.01). In men, a mixed pattern was inversely associated with waist circumference (P = 0.02) and blood pressure (P = 0.01), whereas there were no significant associations with the ethnic foods and alcohol pattern. Specific dietary patterns throughout adult life were associated with chronic disease risk factors.

The utility of a workplace injury instrument in prediction of workplace injury

Workplace injuries are common and destructive to persons, organisations, and society. Various instruments presently exist that are designed to assess the factors underlying workplace injury. The study reports on the construct and predictive validity of a 46-item instrument, the safety perception survey (SPS), currently used to assess safety climate in industrial organisations throughout Australia. Initially, factor analysis was conducted on the data from a sample of 1238 employees from nine organisations, which indicated a one-factor solution, was the best fit. A structural equation model (SEM) linking injury rates to the safety climate measure for 16 sub-groups of six industrial organisations indicated that the measure contributed just 23% of the variance in injury rates. Interestingly, the results indicated that the number of employees was a better and more significant predictor of injury (R² = 0.48). It is proposed that the SPS as is would need to be modified significantly from its current form to produce improvements in validity, as in its current form the survey is no more predictive of injury than organisational size. Future research into safety climate measures should incorporate predictive validity analysis on injury rates, as for many organisations; this is a performance outcome measure.

The measurement of socio-economic status: investigation of gender-and age-specific indicators in Australia: national health survey 1995

Objective: To investigate thecorrelations between age- and gender-specificmeasures of socio-economic status versus healthstatus as measured by the SF-36.

Design: Population based study.

Participants: 38187 people aged between18 to 79 years who participated in the NationalHealth Survey in 1995.

Results: Factor analysis producedconsistent results that were interpreted interms of five conceptually meaningful domains(employment, housing, migration, family unitand education). The relative rank of thefactors differs between groups and in somecases factor composition requires items to beadded or deleted from the conceptual domains.

Conclusions: Age- and gender-specific SESscores based on these factors had strongerassociations with the physical and mentalcomponents of SF-36 than either an area basedindex or scores derived from males aged 40–44years. Overall the results supported thehypothesis that SES measures composed of socialand demographic items exhibit important age-and gender-specific differences which arerelevant for health.

Which aspects of socio-economic status are related to health in mid-aged and older women?

A population-based study was conducted to validate gender- and age-specific indexes of socio-economic status (SES) and to investigate the associations between these indexes and a range of health outcomes in 2 age cohorts of women. Data from 11,637 women aged 45 to 50 and 9,510 women aged 70 to 75 were analyzed. Confirmatory factor analysis produced four domains of SES among the mid-aged cohort (employment, family unit, education, and migration) and four domains among the older cohort (family unit, income, education, and migration). Overall, the results supported the factor structures derived from another population-based study (Australian Bureau of Statistics, 1995), reinforcing the argument that SES domains differ across age groups. In general, the findings also supported the hypotheses that women with low SES would have poorer health outcomes than higher SES women, and that the magnitude of these effects would differ according to the specific SES domain and by age group, with fewer and smaller differences observed among older women. The main exception was that in the older cohort, the education domain was significantly associated with specific health conditions. Results suggest that relations between SES and health are highly complex and vary by age, SES domain, and the health outcome under study.

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.

Green products and corporate strategy : an empirical investigation

Purpose – The purpose of the study is to examine the influence of multiple factors on the green purchase intention of customers in Australia.

Design/methodology/approach – A conceptual model is proposed and was subjected to empirical verification with the use of a survey of metropolitan and regional households in Victoria, Australia. The data were analyzed using both descriptive measures and exploratory factor analysis to identify and validate the items contributing to each component in the model. AMOS structural modeling was used to estimate the measure of respondents' overall perception of green products and their intention to purchase.

Findings – The results indicate that customers' corporate perception with respect to companies placing higher priority on profitability than on reducing pollution and regulatory protection were the significant predictors of customers' negative overall perception toward green products. The only positive contribution to customers' perception was their past experience with the product. Other factors including the perception of green products, product labels, packaging, and product ingredients did not appear to influence customers' perception. The results also indicate that customers are not tolerant of lower quality and higher prices of green products.

Research limitations/implications – The knowledge of the overall perception formation about green products and its predictors provides management with the facility to identify and implement strategies that may better influence the change of attitude by customers. Corporations can also benefit from the identification of the types of information required to enable management to influence this process of perception formation.

Originality/value – The present findings contributes to an understanding of the antecedents of green purchasing and highlight that green customers rely more on personal experience with the product than the information provided by the marketer.

Construct validity of the Chinese version of the disability of the arm, shoulder and hand questionnaire (DASH-HKPWH)

The study evaluated the construct validity of the Chinese Hong Kong version of the disabilities of the arm, shoulder and hand questionnaire (DASH-HKPWH). Three hundred and thirty four patients with a broad range of upper extremity disorders were recruited into the study. Each completed DASH-HKPWH and SF-36 forms and their pain intensity (numeric pain rating scale) and grip strength were also measured. The mean DASH-HKPWH score was 40 (SD = 20). Principal component factor analysis identified a single factor, which accounted for 47% of the total variance. Pearson correlation was applied to assess convergent and divergent validity of the DASH-HKPWH by comparison with the above-mentioned subjective and objective measurements. Our findings were comparable to the DASH of other languages

Validation of comprehensive assessment of activities of daily living in stroke survivors

This study determined whether the Functional Independence Measure (FIM) and the Frenchay Activities Index (FAI) could be used together as a more comprehensive score to assess the activities of daily living (ADL) in stroke survivors. Subjects were recruited from stroke patients consecutively admitted to the inpatient neurology or rehabilitation department at a university hospital in southern Taiwan. We interviewed 209 first stroke survivors at least 1 year after stroke onset during their clinical visits, at home, or in long-term care institutions. Combinations of FIM and FAI as a comprehensive assessment of ADL were measured. All items of the FIM and the FAI were included in a non-parametric factor analysis to determine their underlying constructs. Two comprehensive functional independence scores were then computed as functions of the FIM and FAI scores. The distributional characteristics of the comprehensive scores were examined. Approximately 90% of the total variation was explained by three factors. One single factor comprised all the items from FIM, while the FAI items loaded on two other factors, suggesting that FIM supplements FAI without overlap in content. We further demonstrated that the presence of ceiling or floor effects when either the FIM or the FAI was used could be removed using combined scores of the two instruments. The FIM and the FAI assessed different domains with good construct validity. A comprehensive assessment of functional independence obtained by combining the FIM and the FAI scores is potentially more appropriate and useful for clinical and research applications in stroke patients.

Customer citizenship behaviours : towards the development of a typology

Eight types of customer citizenship behaviours were extracted from the existing marketing literature, and the more developed organisational citizenship behaviour literature. These included: positive word of mouth behaviour; suggestions for service improvements; participation in organisation events/activities; benevolent acts of service facilitation; policing of other customers; flexibility; voice and displays of relationship affiliation. Although citizenship behaviours such as positive word-ofmouth and voice have established empirical measures, the other types of customer citizenship behaviours do not. The objective of this study, therefore, was to source, adapt and derive measures for each of the eight identified citizenship behaviours. Using exploratory and confirmatory factor analysis, these measures were validated across three service contexts.

Dietary patterns of adolescents and risk of obesity and hypertension

Increasingly, measures of dietary patterns have been used to capture the complex nature of dietary intake and investigate its association with health. Certain dietary patterns may be important in the prevention of chronic disease; however, there are few investigations in adolescents. The aim of this study was to describe the dietary patterns of adolescents and their associations with sociodemographic factors, nutrient intakes, and behavioral and health outcomes. Analysis was conducted using data collected in the 1995 Australian National Nutrition Survey of participants aged 12–18 y who completed a 108-item FFQ (n = 764). Dietary patterns were identified using factor analysis and associations with sociodemographic factors and behavioral and health outcomes investigated. Factor analysis revealed 3 dietary patterns labeled a fruit, salad, cereals, and fish pattern; a high fat and sugar pattern; and a vegetables pattern, which explained 11.9, 5.9, and 3.9% of the variation in food intakes, respectively. The high fat and sugar pattern was positively associated with being male (P < 0.001), the vegetables pattern was positively associated with rural region of residence (P = 0.004), and the fruit, salad, cereals, and fish pattern was inversely associated with age (P = 0.03). Dietary patterns were not associated with socioeconomic indicators. The fruit, salad, cereals, and fish pattern was inversely associated with diastolic blood pressure (P = 0.0025) after adjustment for age, sex, and physical activity in adolescents ≥16 y. This study suggests that specific dietary patterns are already evident in adolescence and a dietary pattern rich in fruit, salad, cereals, and fish pattern may be associated with diastolic blood pressure in older adolescents.

An Australian version of the neighborhood environment walkability scale : validity evidence

This study examined validity evidence for the Australian version of the Neighborhood Environment Walkability Scale (NEWS-AU). A stratified two-stage cluster sampling design was used to recruit 2,650 adults from Adelaide (Australia). The sample was drawn from residential addresses within eight high-walkable and eight low-walkable suburbs matched for socio-economic status (SES). Neighborhood walkability was measured using Geographic Information Systems data on dwelling density, intersection density, net retail area, and land-use mix. Participants completed the NEWS-AU and reported weekly minutes of walking for transport and recreation (International Physical Activity Questionnaire [IPAQ]). Multilevel confirmatory factor analysis (MCFA) was used to define the individual- and Census Collection District (CCD)-level measurement model of the NEWS-AU. Seven individual-level and five CCD-level factors were identified. These measurement models were somewhat similar to those of the original Neighborhood Environment Walkability Scale (NEWS). Patterns of associations between the NEWS-AU factors/scales and the walking measures provided some validity evidence for the instrument.

Are perceptions of the local environment related to neighbourhood satisfaction and mental health in adults?

Background: Perceptions of environmental attributes can influence satisfaction with where people live and mental health status. We examined the association between perceived environmental characteristics, neighbourhood satisfaction, and self-rated mental health.

Methods: We report cross-sectional data from the Physical Activity in Localities and Community Environments (PLACE) study in Australia (n = 2194). Self-report data included socio-demographics, perceived attributes of the environment, neighbourhood satisfaction (NS) and mental health status. Neighbourhood SES was obtained through census data. Factor analysis was used to identify dimensions of NS. Generalized linear models were used to examine associations between NS and perceived environment characteristics and whether aspects of NS were independently associated with mental health.

Results: NS factors identified were safety and walkability, access to destinations, social network, travel network, and traffic and noise. Perceived environmental characteristics of aesthetics and greenery, land use mix – diversity, street connectivity, traffic safety, infrastructure for walking, access to services and barriers to walking were found to be positively associated with these factors. Traffic load and crime were negatively associated. Three NS factors (safety and walkability, social network, and traffic and noise) were independent predictors of mental health.

Conclusions: Neighbourhood satisfaction may mediate the association between perceived environmental characteristics and measures of mental health in adults.

Thought processes associated with reluctance in gay men to be tested for HIV

This study explored the thought processes that are associated with reluctance in gay men to be tested for HIV antibodies. The sample comprised 97 men who had not been tested for at least four years; 69 had never been tested. They were asked to imagine that someone had suggested that they be tested very soon and to identify, from the list provided, any negative thoughts prompted by this suggestion. The most commonly reported thoughts were that testing was unnecessary because risks had not been taken, that it was unnecessary because there were no symptoms, and that there was no urgency to be tested. Data were explored by means of factor analysis and comparisons across subgroups differing in risk level. The results are interpreted as indicating the use of rationalizations to buttress a decision not to be tested, the powerful influence on HIV decision-making exerted by salient perceptible features, and the ‘status quo bias’. Techniques that could be used to encourage testing in gay men are discussed.

Structural equation modelling of complex sample survey : an application to brand signalling data

The purpose of this paper is to present an empirical analysis of complex sample data with regard to the biasing effect of nonindependence of observations on standard error parameter estimates. In a two-factor confirmatory factor analysis model, using real data, we show how the bias in standard errors can be derived when the nonindependence is ignored. We demonstrate that the standard error bias produced by the nonindependence of observations can be considerable and we briefly discuss solutions to overcome the problem.