Future predictions of body mass index and overweight prevalence in Australia, 2005-2025

To predict current and future body mass index (BMI) and prevalence of overweight and obesity in Australian children and adults based on sex, age and year of birth (cohort). These predictions are needed for population health planning and evaluation. Data were drawn from 11 cross-sectional national or state population surveys conducted in Australia between 1969 and 2004. These included representative population samples of children (n= 27,635) and adults (n= 43,447) aged 5 years or older with measured height and weight data. Multiple linear regression analyses of measured log-transformed BMI data were conducted to determine the independent effects of age and year of birth (cohort) on ln(BMI) for males and females, respectively. Regression coefficients for cohort obtained from these analyses were applied to the National Nutrition Survey 1995 data set to predict mean BMI and prevalence of overweight (BMI 25-29.99 kg/m(2)) and obesity (BMI ≥ 30 kg/m(2)) in 2005, 2015 and 2025. Based on past trends, BMI is predicted to continue to increase for both males and females and across the age span. This would result in increases in the prevalence of overweight and obesity of between 0.4 and 0.8% per year, such that by 2025 around one-third of 5-19 year olds will be overweight or obese as will 83% of males and 75% of females aged 20 years and over. The increases in prevalence and mean BMI predicted in this study will have significant impacts on disease burden, healthcare costs and need for prevention and treatment programmes.

The relevance of demographic variables in assessing student satisfaction: a study of international postgraduate students

Servicing an increasingly diverse international student community in the globally competitive education market is a challenge faced by Australian universities. Market forecasts indicate a seven-fold increase in the number of students seeking higher education overseas by 2025 (Bohm et al, 2002) and with the growing diversity and competitiveness of the industry, universities will need to focus on factors influencing student satisfaction to improve service quality where required.

This paper, using logistic regression, ANOVA, and MANOVA, investigates the influence of country, age and gender with regard to satisfaction among international postgraduate students from four Asian countries studying in universities in Victoria. The results indicate that there is an inverse relationship between age and satisfaction among postgraduate students while the gender of the students does not have an impact on satisfaction, and that significant differences are evident between the four countries investigated with respect to the levels of satisfaction.

Student satisfaction : impact of age and gender on satisfaction among international postgraduate students from Asia

Customer satisfaction is a core-marketing concept. It is considered as a major outcome of marketing activity and serves to link processes, culminating in purchase and consumption with post-purchase phenomena such as attitudinal change, customer retention, repeat purchase, brand loyalty, positive word-of-mouth communication. Student satisfaction is a strategic factor in developing a competitive advantage in the highly attractive and globally competitive international education market. Market forecasts indicate a seven-fold increase in the number of students seeking higher education overseas by 2025 and given the competitiveness of the industry, universities will need to focus on variables influencing student satisfaction in order to address areas where improvements in service quality are required.

A sample of 371 postgraduate students from China, India, Indonesia and Thailand, is investigated. The study highlights the development of a scale to measure international postgraduate student satisfaction. The scale demonstrates the importance of four predominant factors influencing university choices - Education Resources; Communication and Guidance; Customer Value and Study Outcomes; and Image, Prestige and Recognition. Using logistic regression and chi square testing, this paper investigates the impact of age and gender on satisfaction among international postgraduate students from four Asian countries studying in universities in Victoria, Australia, on theses factors. The results indicate that age has a positive relationship with satisfaction among postgraduate students while the influence of gender has no effect on influencing satisfaction among postgraduate students from Asia.

International education services: challenges for Australia

Australian universities face a challenging task of servicing an increasingly diverse international student community in the globally competitive education market. The pressure on universities to successfully negotiate the cultural diversity and improvement in service quality will continue to increase with the global expansion of the international student market. Market forecasts indicate an increase in the number of students seeking higher education overseas by 2025 to 7.2 million. The attractiveness of the international education market in the form of both pecuniary and non pecuniary benefits will continue to create a highly competitive environment for Australia requiring Australian higher education institutions to pursue well planned strategies to maintain a globally competitive position.

Student satisfaction is a key strategic variable in maintaining such a competitive position with long term benefits arising from student loyalty, positive word of mouth (WOM) communication and image of the study destinations and to meet the challenges of increasing global competition, rising student expectations of quality, service and value for money.

This paper, based on the expectancy-disconfirmation paradigm, and using logistic regression, ANOVA and chi square testing, investigates factors that influence international postgraduate students from four Asian countries studying in Australia and concludes with strategic implications for universities

Virtual experts : who's online?

There will be between 30 and 80 million online students in the world by 2025. Globally, school systems are investing huge resources in the development of online education programs in order to meet this demand. Related implications for online teaching have been largely ignored despite evidence of the greatly increased workload for online teachers and widespread student dissatisfaction with online leaming experiences. Opportunities for improving the online experience for both leamers and teachers revolve around minimizing procedural inefficiencies in dealing with large numbers of individual students, as opposed to a single class, and of enhancing students' social and cognitive engagement with leaming. Intelligent software agents that can automate many routine online tasks and some aspects of leamer interaction have enormous potential to facilitate this. These agents that can act as a personal online coach, mentor or tutor to increase the individualisation of learning. The development of evidence-based agent personas is essential if agents are to fulfil specific educational roles. CUITently there is little progress being made in this area because of the lack of an agentrole model that can be used to implement specific educational personas in agents. In this paper we discuss key foundational elements of the nature and basis for implementing elements of educational expertise in software and how this could be used in developing agent persona models for specific educational roles and a model for implementing pedagogical constructs in intelligent educational software.

Wastewater irrigation: the state of play

As demand for fresh water intensifies, wastewater is frequently being seen as a valuable resource. Furthermore, wise reuse of wastewater alleviates concerns attendant with its discharge to the environment. Globally, around 20 million ha of land are irrigated with wastewater, and this is likely to increase markedly during the next few decades as water stress intensifies. In 1995, around 2.3 billion people lived in water-stressed river basins and this could increase to 3.5 billion by 2025. We review the current status of wastewater irrigation by providing an overview of the extent of the practice throughout the world and through synthesizing the current understanding of factors influencing sustainable wastewater irrigation. A theme that emerges is that wastewater irrigation is not only more common in water-stressed regions such as the Near East, but the rationale for the practice also tends to differ between the developing and developed worlds. In developing nations, the prime drivers are livelihood dependence and food security, whereas environmental agendas appear to hold greater sway in the developed world. The following were identified as areas requiring greater understanding for the long-term sustainability of wastewater irrigation: (i) accumulation of bioavailable forms of heavy metals in soils, (ii) environmental fate of organics in wastewater-irrigated soils, (iii) influence of reuse schemes on catchment hydrology, including transport of salt loads, (iv) risk models for helminth infections (pertinent to developing nations), (v) microbiological contamination risks for aquifers and surface waters, (vi) transfer efficiencies of chemical contaminants from soil to plants, (vii) health effects of chronic exposure to chemical contaminants, and (viii) strategies for engaging the public.

A global perspective of aquaculture in the new millennium

In modern times, not many primary industries have consistently recorded high yearly growth over a period of two decades. Aquaculture has sustained a global growth, continues to grow, and is expected to increasingly fill the shortfall in aquatic food products resulting from static or declining capture fisheries and population increase well into the year 2025. Its further growth and development will have to occur under a different socio-economic milieu in the new millennium. The basic paradigm changes will be from an increased production at almost any cost, to a sustainable increase in production with minimal environmental perturbations. Despite such paradigm changes, aquaculture will increasingly contribute to food security, poverty alleviation and social equity. The contribution of aquaculture to world food supply of aquatic products has been increasing over the past 10 years, in comparison to capture fisheries, growing from 15 to 28 percent of total production between 1988 and 1997. As the bulk of aquaculture is rural and subsistence, it plays a major role as a provider of direct and indirect employment to the rural poor and, thereby, to poverty alleviation. In many developing countries, aquaculture provides opportunities for diversification on agriculture farms and productive use to otherwise idle land during certain seasons. The main cause for the upsurge in the sector has been the transformation of aquaculture from an “art” form to a “science”. This brought many advantages, ranging from less dependence on wild stock to the development of techniques that optimized yields, such as polyculture, or enabled the achievement of high yields with low inputs. Two major developments also enabled the sector to maintain growth momentum, appropriate institutional frameworks and concerted research and development. Regions or continents have many commonalities. These include the predominance of finfish among the cultivated species, and the predominance of species that feed lower in the food chain, although shrimp, which does not naturally feed high in the trophic level but is mostly reared on artificial feed, has become a significant culture commodity. Notable differences, however, include the fact that all regions, except Africa and the countries of the former USSR, have recorded a significant increase in per capita production between 1984 and 1997. While Asia continues to dominate world aquaculture in overall tonnage, as well as in every major commodity, South America has registered a very high (72.8 percent) average annual growth between 1984 and 1997. The global and regional trends over the last 20 years in the sector from a number of perspectives, such as production trends, contribution of aquaculture to aquatic food consumption etc., are evaluated. Based on these different trends and in the light of changing socio-economic conditions globally, and in particular, in developing nations, the potential changes in the sector in the new millennium are highlighted. Finally, projections are made for the next 20 years, where opportunities, constraints and strategies for achieving the targets are presented and discussed.

Impact of learning environment and learning context on student satisfaction : a comparative study of postgraduate students from Asia

The growth of the international education market with increasing export income has created a highly competitive environment among education providers worldwide. WTO reports that this market is now worth around $27 billion a year (Alderman, 2001) while IDP Australia has estimated an increase in the number of students seeking higher education overseas at 7.2 million by 2025. This alludes to the attractiveness of the international education market in the form of both pecuniary and non pecuniary benefits to provider nations and the higher educational institutions and hence the need for strategies to maintain a globally competitive position. This paper looks at the impact of the learning environment and the learning context on student satisfaction among international postgraduate students from Asia studying in Australian universities. The growing competition requires provider institutions to be highly responsive to the needs and aspirations of the diverse student community and to deliver services to create satisfaction and loyalty, which would be critical in sustaining a competitive position. The study, based on the expectancy-disconfirmation paradigm, and a model of post choice satisfaction in the educational setting, uses logistic regression, MANOVA, ANOVA and chi square testing, investigates factors relevant to student learning environment and the learning context to assess satisfaction levels of these students. The sample size used in the study is 371 and is drawn from a mail survey of five leading universities in Australia.

Let them eat cake : mobilising appetites for higher education

The Australian Government has set two targets for the nation's universities: (i) increase the proportion of people from low socioeconomic status (SES) backgrounds attending university, to 20 percent of all undergraduate students by 2020; and (ii) increase the proportion of 25 to 34 year-old Australians holding a bachelor's degree, to 40 percent by 2025. Both targets will require an increased effort by governments and universities to enable and encourage more people to access higher education, particularly more from low SES backgrounds. It will also require them to think differently about the problem. Three new concepts are now redefining the equity dimensions of higher education. Despite aspirations to expand the system, students' appetites for university are no longer a given. While universities are seeking to enrol different students in greater numbers, the challenge now is how to give greater voice to this difference. And the limited mobility of students from low SES backgrounds, including those in outer metropolitan and regional areas, is now the most significant indicator of their limited access to higher education and to social mobility. The paper outlines these new conceptions of student equity and how they are informing the research of the National Centre.

Massaging desire : disadvantaged students' aspirations for higher education.

Australia is in a challenging position. Having ridden the resources boom up and down, it now finds it has fallen back from the OECD pack in terms of the number of young adults (25 to 34 year olds) with higher education qualifications. This, coupled with a change of government, has prompted transformation in the Australian higher education system that will increasingly require research and policy to address students’ aspirations for university. Aspiration has long been considered an important condition for entry to higher education (Anderson, Boven, Fensham & Powell, 1980). However, recent policy reforms, specifically the setting of targets for significant increases in participation, now demand a rethinking of the concept. Across Australian universities, the current attainment rate for bachelor degrees among 25 to 34 year olds is around 32 per cent, while over the past twenty years the enrolment rate of students from low socioeconomic status (SES) backgrounds has stagnated at around 15 per cent (Commonwealth of Australia, 2009). In response to the Bradley Review of Australian Higher Education in 2008, the Australian Government has set ‘20/40 targets’ in a bid to increase low SES enrolment to 20 per cent by 2020, and to increase to 40 per cent by 2025 the number of 25 to 34 year olds holding bachelor degrees. This will require that around 220,000 additional students attain bachelor degrees by 2025. Given current levels of unmet demand for university entry, this overall increase in participation, and the proportional increase of low SES students in particular, will only be achievable by engaging with populations of potential students who do not currently seek university places.

Projected socioeconomic disparities in the prevalence of obesity among Australian adults

Objective: To project prevalence of normal weight, overweight and obesity by educational attainment, assuming a continuation of the observed individual weight change in the 5-year follow-up of the national population survey, the Australian Diabetes, Obesity and Lifestyle study (AusDiab; 2000–2005).

Methods: Age-specific transition probabilities between BMI categories, estimated using logistic regression, were entered into education-level-specific, incidence-based, multi-state life tables. Assuming a continuation of the weight change observed in AusDiab, these life tables estimate the prevalence of normal weight, overweight and obesity for Australian adults with low (secondary), medium (diploma) and high (degree) levels of education between 2005 and 2025.

Results: The prevalence of obesity among individuals with secondary level educational attainment is estimated to increase from 23% in 2000 to 44% in 2025. Among individuals with a degree qualification or higher, it will increase from 14% to 30%. If all current educational inequalities in weight change could be eliminated, the projected difference in the prevalence of obesity by 2025 between the highest and lowest educated categories would only be reduced by half (to a 6 percentage point difference from 14 percentage points).

Conclusion: We predict that almost half of Australian adults with low educational status will be obese by 2025. Current trends in obesity have the potential to drive an increase in the absolute difference in obesity prevalence between educational categories in future years.

Implications: Unless obesity prevention and management strategies focus specifically on narrowing social inequalities in obesity, inequalities in health are likely to widen.

Cost-effectiveness of reducing salt intake in the Pacific Islands: protocol for a before and after intervention study

Background
There is broad consensus that diets high in salt are bad for health and that reducing salt intake is a cost-effective strategy for preventing chronic diseases. The World Health Organization has been supporting the development of salt reduction strategies in the Pacific Islands where salt intakes are thought to be high. However, there are no accurate measures of salt intake in these countries. The aims of this project are to establish baseline levels of salt intake in two Pacific Island countries, implement multi-pronged, cross-sectoral salt reduction programs in both, and determine the effects and cost-effectiveness of the intervention strategies.

Methods/Design
Intervention effectiveness will be assessed from cross-sectional surveys before and after population-based salt reduction interventions in Fiji and Samoa. Baseline surveys began in July 2012 and follow-up surveys will be completed by July 2015 after a 2-year intervention period.

A three-stage stratified cluster random sampling strategy will be used for the population surveys, building on existing government surveys in each country. Data on salt intake, salt levels in foods and sources of dietary salt measured at baseline will be combined with an in-depth qualitative analysis of stakeholder views to develop and implement targeted interventions to reduce salt intake.

Discussion
Salt reduction is a global priority and all Member States of the World Health Organization have agreed on a target to reduce salt intake by 30% by 2025, as part of the global action plan to reduce the burden of non-communicable diseases. The study described by this protocol will be the first to provide a robust assessment of salt intake and the impact of salt reduction interventions in the Pacific Islands. As such, it will inform the development of strategies for other Pacific Island countries and comparable low and middle-income settings around the world.

BMI and healthcare cost impact of eliminating tax subsidy for advertising unhealthy food to youth

INTRODUCTION: Food and beverage TV advertising contributes to childhood obesity. The current tax treatment of advertising as an ordinary business expense in the U.S. subsidizes marketing of nutritionally poor foods and beverages to children. This study models the effect of a national intervention that eliminates the tax subsidy of advertising nutritionally poor foods and beverages on TV to children aged 2-19 years. METHODS: We adapted and modified the Assessing Cost Effectiveness framework and methods to create the Childhood Obesity Intervention Cost Effectiveness Study model to simulate the impact of the intervention over the 2015-2025 period for the U.S. population, including short-term effects on BMI and 10-year healthcare expenditures. We simulated uncertainty intervals (UIs) using probabilistic sensitivity analysis and discounted outcomes at 3% annually. Data were analyzed in 2014. RESULTS: We estimated the intervention would reduce an aggregate 2.13 million (95% UI=0.83 million, 3.52 million) BMI units in the population and would cost $1.16 per BMI unit reduced (95% UI=$0.51, $2.63). From 2015 to 2025, the intervention would result in $352 million (95% UI=$138 million, $581 million) in healthcare cost savings and gain 4,538 (95% UI=1,752, 7,489) quality-adjusted life-years. CONCLUSIONS: Eliminating the tax subsidy of TV advertising costs for nutritionally poor foods and beverages advertised to children and adolescents would likely be a cost-saving strategy to reduce childhood obesity and related healthcare expenditures.