The article "Exploration of motivation to participate in a study of cancer-related cognitive impa... more The article "Exploration of motivation to participate in a study of cancer-related cognitive impairment among patients with newly diagnosed aggressive lymphoma:
Cancer-related cognitive impairment is an adverse consequence of cancer and its treatment. There ... more Cancer-related cognitive impairment is an adverse consequence of cancer and its treatment. There has been little research with patients with aggressive lymphoma. We describe self-reported cognitive function and neuropsychological performance data in patients with lymphoma and compare them with healthy controls and population norms. Associations between patients' neuropsychological performance, cognitive function and distress are also examined. Methods Secondary analysis of data from a longitudinal feasibility study of 30 participants with newly diagnosed aggressive lymphoma and 72 healthy controls was performed. Participants completed validated selfreport measures and neuropsychological tests before, and 6-8 weeks after chemotherapy. Healthy controls completed the FACT-Cog and neuropsychological tests at enrolment and six-months later. Mixed models were used to analyse FACT-Cog and neuropsychological test scores. Kendall's Tau provided a measure of association between global de cit and data from other measures. Results Patients and healthy controls were well matched on demographics. Differences between the two groups' neuropsychological test scores were mostly large-sized; patients' performance was poorer both before and after chemotherapy (most p < 0.001). The same pattern was observed for impact of perceived cognitive impairment on quality-of-life (both p < 0.001), but not perceived cognitive impairment or abilities (all p > 0.10). Associations between neuropsychological performance, self-reported cognitive function and distress, were trivial to small-sized (all p > 0.10). Conclusion For many patients with aggressive lymphoma, impaired neuropsychological test performance and impact of perceived impairments on quality-of-life precede chemotherapy and are sustained 6-8 weeks after chemotherapy. Our data support the need for further longitudinal studies with this population to better understand targets for interventions to address cognitive impairment. Helsinki (2013) and the principles of Good Clinical Practice and the Australian National Statement on Ethical Conduct in Human Research. Trial registration number: Australian New Zealand Clinical Trials Registry ACTRN12619001649101 on 26 th November 2019. Con ict of interest: The authors have declared no con icts of interest. Consent to participate: Informed consent was obtained from all individual participants included in the study. Consent for publication: Participants signed informed consent regarding publishing their de-identi ed data.
Objective: To assess the effect of providing free fruit and peer support in the workplace, on emp... more Objective: To assess the effect of providing free fruit and peer support in the workplace, on employees' consumption of fruits and high fat snacks at work and home. Methods: Three worksites, including 75 employees, were randomly assigned to a free fruit condition (Group A), a free fruit and peer education and modelling condition (Group B), and a control group (Group C). Groups A and B had free fruit delivered to their workplace each morning for four weeks. Consumption of fruit and high fat snacks was measured pre-and post-intervention, and after a two week maintenance period. Results: Despite a small sample, the intervention increased employees' fruit intake at work, decreased high fat snacks and was more successful in those who were not currently meeting the recommendations of two pieces of fruit per day. Peer support led to increased fruit consumption at work and sustained decreases in unhealthy snacks post-intervention. Conclusions: The provision of fruit in the workplace with peer support is a simple and effective method for improving fruit consumption at work in the short-term, particularly in those not meeting current recommendations. In addition, those participating in the intervention reduced their consumption of high fat snacks. Further research is necessary to determine whether a longer larger scale intervention can sustain dietary changes and thereby reduce risk for chronic disease in the Australian population.
Skin cancer is the most commonly diagnosed cancer for Caucasian populations worldwide (Lomas, Leo... more Skin cancer is the most commonly diagnosed cancer for Caucasian populations worldwide (Lomas, Leonardi-Bee, & Bath-Hextall, 2012). In Australia, melanoma is the most commonly diagnosed cancer for adolescents and young adults (Australian Institute of Health and Welfare [AIHW], 2011), and these groups are particularly at risk because they engage in more risky ultraviolet (UV) radiation exposure than other age groups (Hillhouse & Turrisi, 2005). Perceived improvements in appearance and increased self-confidence associated with a darker skin tone are often cited as a driving force behind deliberate sun exposure and indoor tanning (Thomas & Peñas, 2017). The tripartite influence model has been used to predict sun exposure behavior (Mingoia, Hutchinson, & Wilson, 2017) and posits that media norms promoting tanned skin as desirable lead to sun exposure through the internalization of a tanned ideal and promote appearance comparisons. Internalization occurs when media portrayals of events or people are accepted as personal goals and standards against which the self and others are judged (Thompson, Heinberg, Altabe, & Tantleff-Dunn, 1999). Consistent with this model, internalization has been found to predict sun exposure behavior (Mingoia et al., 2017). Social networking sites (SNSs) have become prominent purveyors of social norms that define aspects of attractiveness and fashion. Facebook (2018), the most popular SNS, boasts over 1 billion daily users who upload over 10 million new photos to the website per hour (Mayer-Schönberger & Cukier, 2013). Adolescents and young adults are the largest consumers of social media, with adolescents in Australia spending over 3 hr per day using SNSs (Mingoia, Hutchinson, Gleaves, Corsini, & Wilson, 2017). Use of SNSs is correlated with factors including skin tone dissatisfaction, more 820419S MSXXX10.
Men appear more likely to delay seeking medical advice for cancer symptoms, resulting in later st... more Men appear more likely to delay seeking medical advice for cancer symptoms, resulting in later stage at diagnosis and poorer health outcomes. Limited research has investigated variation in men's experiences of and responses to cancer symptoms. This study examined the psychosocial aspects of men's help-seeking for cancer symptoms, as well as potential variation across men residing in urban and rural Australia. Semi-structured interviews were conducted with men recently diagnosed with cancer (n=13). Participants' partners (n=8) were recruited to enable data triangulation. Interview schedules addressed participants' pathway to cancer treatment, cancer knowledge, masculinity, and rural living. A theoretical thematic analysis approach was used. Medical help-seeking behaviour was similar for participants residing in urban and rural areas. Five key themes and one sub-theme were identified, including: symptom factors, traditional masculine norms (sub-theme: women's health-related responsibilities), level of concern, conflicting responsibilities and access, and trust in medical professionals. Participants from rural Australia experienced greater access difficulties and noted optimism regarding symptoms. Results highlight important within-gender differences in the psychosocial barriers to help-seeking for cancer symptoms. Future research should further explore variation between men and test the predictive strength of factors.
Objective: To demonstrate test-retest reliability (reproducibility) of a new selfadministered lif... more Objective: To demonstrate test-retest reliability (reproducibility) of a new selfadministered lifetime diet questionnaire, with a focus on foods relevant to cognitive health in older age. Design: The reproducibility of dietary recall over four or five life periods was assessed by administering the questionnaire at two time points to an older cohort. The period between questionnaire administrations was 7 weeks. Polychoric correlations measured the association between recall at time 1 and time 2 and the weighted k statistic measured the level of recall agreement for food groups across the two administrations of the questionnaire. Setting: Adelaide, South Australia. Subjects: Fifty-two cognitively healthy, older-age, community-dwelling adults completed the Lifetime Diet Questionnaire; mean age 81?8 (SD 4?4) years, range 70-90 years. Results: The questionnaire showed very good reproducibility in this sample with a mean polychoric correlation coefficient of 0?81 between administration at time 1 and time 2, and an average weighted k of 0?49 for the level of recall agreement between food groups. Conclusions: The demonstrated reliability of this lifetime diet questionnaire makes it a useful tool to assess potential relationships between long-term dietary intake and laterage cognitive outcomes.
Cardiovascular disease (CVD) risk in train drivers is associated with health conditions that can ... more Cardiovascular disease (CVD) risk in train drivers is associated with health conditions that can result in sudden incapacity. Drivers are at high risk on several CVD risk factors with research suggesting that sleep may predict CVD risk, however this relationship has not yet been explored. This study investigated the link between sleep and CVD risk, in relation to hours of work day and days off sleep. N=309 Australian drivers completed a cross-sectional survey. A CVD risk score was calculated by summing scores from behavioural and biomedical risk factors. Sleep was most frequently cited as the main reason for decline in perceived health status. Main analyses showed that shorter work day sleep (M=5.79 h) was a significant predictor of increased CVD risk (p=0.013). This relationship was moderated by days off sleep, such that when days off sleep (M=8.17 h) was higher, the effect of work day sleep on CVD risk was weaker (p=0.047). Findings indicate the amount of sleep a driver obtains on non-work days may compensate for adverse health outcomes. Successful management of fatigue in safety critical occupations appears essential not only for the prevention of safety hazards, but also for the long-term health of shift workers. Further investigation is warranted.
The American Journal of Clinical Nutrition, May 1, 2018
Background: Fish oil trials in cognitively healthy older adults have yielded inconsistent results... more Background: Fish oil trials in cognitively healthy older adults have yielded inconsistent results. Supplementation may differentially affect the domains that underpin cognitive performance, and effects may differ across sex or genotype. Objective: The aim of this study was to test whether docosahexaenoic acid (DHA)-rich fish oil slows 18-mo cognitive decline in cognitively healthy elders. Design: In a double-blind, randomized, placebo-controlled, parallelgroup trial, cognitively healthy Australian community-dwelling adults (aged 65-90 y) consumed either 1720 mg DHA and 600 mg eicosapentaenoic acid or low-polyphenolic olive oil daily, as capsules, for 18 mo. Groups were allocated by permuted-block randomization and stratified by age. Cognitive assessment was conducted at baseline and then every 6 mo. Primary analyses tested the difference between groups in the rate of 18-mo cognitive change via latent growth curve models on any of the following: reasoning, working memory, short-term memory, retrieval fluency, and cognitive speed-related constructs. Treatment interactions with sex and APOE-ε4 were tested. Secondary outcomes were self-reported changes in well-being and everyday functioning, blood pressure, biomarkers of n-3 (ω-3) long-chain polyunsaturated fatty acids (LC PUFAs), lipids, glucose metabolism, inflammation, oxidative stress, DNA damage, and Mini-Mental State Examination. Results: A total of 403 people were randomly assigned. Data from those who completed baseline were analyzed (n = 390; intervention n = 194, control n = 196). Daily supplementation with 2.3 g DHA-rich fish oil for 18 mo did not maintain or improve cognitive performance. A small negative main effect was found on psychomotor speed (intervention =-0.02, 95% CI:-0.04 to 0.00; d = 0.24, P = 0.03). Treatment effects differed according to sex on retrieval fluency and some speed-based domains, including psychomotor speed, and according to APOE-ε4 carrier status on reaction time and reasoning. For secondary outcomes, treatment was associated with increased perceived cognitive mistakes (d = 0.24; P = 0.003), increased oxidative stress, and expected changes in fatty acid metabolism. Conclusions: Findings do not support supplementing older adults with fish oil to prevent cognitive decline. Treatment interactions with sex and APOE-ε4 carrier status warrant further investigation. This trial was registered at the Australia and New Zealand Clinical Trials Register (ANZCTR) as ACTRN12607000278437.
A comprehensive search of the literature for studies examining physical activity or nutrition int... more A comprehensive search of the literature for studies examining physical activity or nutrition interventions in the workplace, published between 1999 and March 2009, was conducted. This search identified 29 relevant studies. Interventions were grouped according to the theoretical framework on which the interventions were based (e.g. education, cognitive-behavioural, motivation enhancement, social influence, exercise). Weighted Cohen's d effect sizes, percentage overlap statistics, confidence intervals and fail safe Ns were calculated. Most theoretical approaches were associated with small effects. However, large effects were found for some measures of interventions using motivation enhancement. Effect sizes were larger for studies focusing on one health behaviour and for randomized controlled trials. The workplace is a suitable environment for making modest changes in the physical activity, nutrition and health of employees. Further research is necessary to determine whether these changes can be maintained in the long term.
Objective: To assess Australian consumers' perception of portion size of fast-food items and thei... more Objective: To assess Australian consumers' perception of portion size of fast-food items and their ability to estimate energy content. Design: Cross-sectional computer-based survey. Setting: Australia. Subjects: Fast-food consumers (168 male, 324 female) were asked to recall the items eaten at the most recent visit to a fast-food restaurant, rate the prospective satiety and estimate the energy content of seven fast-food or 'standard' meals relative to a 9000 kJ Guideline Daily Amount. Nine dietitians also completed the energy estimation task. Results: Ratings of prospective satiety generally aligned with the actual size of the meals and indicated that consumers perceived all meals to provide an adequate amount of food, although this differed by gender. The magnitude of the error in energy estimation by consumers was three to ten times that of the dietitians. In both males and females, the average error in energy estimation for the fast-food meals (females: mean 3911 (SD 1998) kJ; males: mean 3382 (SD 1957) kJ) was significantly (P , 0?001) larger than for the standard meals (females: mean 2607 (SD 1623) kJ; males: mean 2754 (SD 1652) kJ). In women, error in energy estimation for fast-food items predicted actual energy intake from fast-food items (b 5 0?16, P , 0?01). Conclusions: Knowledge of the energy content of standard and fast-food meals in fast-food consumers in Australia is poor. Awareness of dietary energy should be a focus of health promotion if nutrition information, in its current format, is going to alter behaviour.
This study explores rural South Australians' barriers to help-seeking for skin cancer detection. ... more This study explores rural South Australians' barriers to help-seeking for skin cancer detection. A total of 201 randomly selected rural adults (18-94 years, 66% female) were presented with a skin-cancer-related scenario via telephone and were asked the extent to which various barriers would impede their help-seeking, based on an amended version of the Barriers to Help-Seeking Scale. Older (≥63 years) and less educated participants endorsed barriers more strongly than their younger, more educated counterparts in the following domains; "Concrete barriers and distrust of caregivers", "Emotional control", "Minimising problem and Normalisation", "Need for control and self-reliance" (every domain other than "Privacy"). Socioeconomic disadvantage, gender, and farmer status did not predict stronger overall barriers, but some gender and occupation-related differences were detected at the item level. Farmers were also more likely to endorse the "Minimising problem and normalization" domain than their non-farmer working rural counterparts. Widely endorsed barriers included the tendency to minimise the problem, a desire to remain in control/not be influenced by others, reluctance to show emotion or complain, and having concerns about privacy or waiting times.
Limiting exposure to sunlight during childhood can significantly reduce the risk of skin cancer. ... more Limiting exposure to sunlight during childhood can significantly reduce the risk of skin cancer. This was the first national study to assess the sun protection policies and practices of early childhood services across Australia. It also examined the key predictors of services' sun protection practices. In 2007, 1017 respondents completed a self-administered survey about the sun protection policies and practices in their early childhood service (response rate of 59%). Most (95%) had a written sun protection policy. The most common policy inclusions were hat wearing (91%), sunscreen use (87%) and enforcement of policy (97%). Less frequently reported inclusions were protective clothing (69%), information for parents/caregivers (58%) and regular reviews/ updates of policies (65%). Basic sun protection practices (e.g. required any type of hat and sunscreen use) were more commonly reported than extensive practices (required protective clothing or regularly applied sunscreen). Higher sun protection policy scores, being a formal childcare service as opposed to a kindergarten/pre-school and having SunSmart status as opposed to not, were associated with higher sun protection practice scores (P < 0.001). Sun protection policies may be improved through encouraging services to have more specific policy inclusions and to model their policies on the SunSmart Early Childhood Program.
Objective: To identify key predictors of fast-food consumption from a range of demographic, attit... more Objective: To identify key predictors of fast-food consumption from a range of demographic, attitudinal, personality and lifestyle variables. Methods: We analysed data from a nationwide survey (n 5 20 527) conducted in Australia by Nielsen Media Research. Items assessing frequency of fast-food consumption at (1) eat in and (2) take away were regressed onto 12 demographic, seven media consumption, and 23 psychological and lifestyle variables, the latter derived from factor analysis of responses to 107 attitudinal and behavioural items. Results: Stepwise multiple regression analyses explained 29.6% of the variance for frequency of takeaway and 9.6% of the variance for frequency of eat-in consumption of fast foods. Predictors of more frequent consumption of fast food at take away (and, to a lesser extent, eat in) included lower age-especially under 45 years, relative indifference to health consequences of behaviour, greater household income, more exposure to advertising, greater receptiveness to advertising, lesser allocation of time for eating, and greater allocation of time to home entertainment. There were no effects for occupational status or education level. Conclusions: The effects for age suggest that fast-food takeaway consumption is associated with a general cultural shift in eating practices; individual differences in attitudinal and lifestyle characteristics constitute additional, cumulative, predictive factors. The role of advertising and the reasons for the lesser explanatory value of the eat-in models are important targets for further research.
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Purpose: People affected by cancer who live in rural Australia experience inferior survival compa... more Purpose: People affected by cancer who live in rural Australia experience inferior survival compared to their urban counterparts. This study determines whether self-reported physical and mental health, as well as health-promoting behaviours, also differ between rural and urban Australian adults with a history of cancer. Methods: Weighted, representative population data were collected via the South Australian Monitoring and Surveillance System between 1 January 2010 and 1 June 2015. Data for participants with a history of cancer (n= 4,295) were analysed with adjustment for survey year, gender, age-group, education, income, family structure, work status, country of birth and arealevel relative socioeconomic disadvantage (SEIFA). Results: Cancer risk factors and co-morbid physical and mental health issues were prevalent among cancer survivors regardless of residential location. In unadjusted analyses, rural survivors were more likely than urban survivors to be obese and be physically inactive. They were equally likely to experience other comorbidities (diabetes, chronic obstructive pulmonary disease, cardiovascular disease, arthritis or osteoporosis). With adjustment for SEIFA, rural/urban differences in obesity and physical activity disappeared. Rural survivors were more likely to have trust in their communities, less likely to report high/very high distress, but equally likely to report a mental health condition, both with and without adjustment for SEIFA. Conclusions: There is a need for deeper understanding of the impact of relative socioeconomic disadvantage on health (particularly physical activity and obesity) in rural settings and the development of accessible and culturally appropriate interventions to address rural cancer survivors' specific needs and risk factors.
Background: Some studies have suggested an association between omega-3 long-chain polyunsaturated... more Background: Some studies have suggested an association between omega-3 long-chain polyunsaturated fatty acids (n-3 LC PUFAs) and better cognitive outcomes in older adults. To date, only two randomised, controlled trials have assessed the effect of n-3 LC PUFA supplementation on cognitive function in older cognitively healthy populations. Of these trials only one found a benefit, in the subgroup carrying the ApoE-ε4 allele. The benefits of n-3 LC PUFA supplementation on cognitive function in older normal populations thus still remain unclear. The main objective of the current study was to provide a comprehensive assessment of the potential of n-3 LC PUFAs to slow cognitive decline in normal elderly people, and included ApoE-ε4 allele carriage as a potential moderating factor. The detailed methodology of the trial is reported herein. Methods: The study was a parallel, 18-month, randomised, double-blind, placebo-controlled intervention with assessment at baseline and repeated 6-monthly. Participants (N = 391, 53.7% female) aged 65-90 years, Englishspeaking and with normal cognitive function, were recruited from metropolitan Adelaide, South Australia. Participants in the intervention arm received capsules containing fish-oil at a daily dosage of 1720 mg of docosahexaenoic acid and 600 mg of eicosapentaenoic acid while the placebo arm received the equivalent amount of olive oil in their capsules. The primary outcome is rate of change in cognitive performance, as measured by latent variables for the cognitive constructs (encompassing Reasoning, Working Memory, Short-term Memory, Retrieval Fluency, Inhibition, Simple and Choice-Reaction Time, Perceptual Speed, Odd-man-out Reaction Time, Speed of Memory Scanning, and Psychomotor Speed) and assessed by latent growth curve modeling. Secondary outcomes are change in the Mini-mental State Examination, functional capacity and well-being (including health status, depression, mood, and self-report cognitive functioning), blood pressure, and biomarkers of n-3 LC PUFA status, glucose, lipid metabolism, inflammation, oxidative stress, and DNA damage.
Summary Alcohol consumption by Australian women during midlife has been increasing. Health promot... more Summary Alcohol consumption by Australian women during midlife has been increasing. Health promotion efforts to reduce alcohol consumption in order to reduce alcohol-related disease risk compete with the social contexts and value of alcohol in women’s lives. This paper draws on 50 qualitative interviews with midlife women (45–64 years of age) from different social classes living in South Australia in order to gain an understanding of how and why women might justify their relationships with alcohol. Social class shaped and characterized the different types of relationships with alcohol available to women, structuring their logic for consuming alcohol and their ability to consider reducing (or ‘breaking up with’) alcohol. We identified more agentic relationships with alcohol in the narratives of affluent women. We identified a tendency for less control over alcohol-related decisions in the narratives of women with less privileged life chances, suggesting greater challenges in changing...
Few studies have directly targeted nonparticipants in colorectal cancer screening to identify eff... more Few studies have directly targeted nonparticipants in colorectal cancer screening to identify effective engagement strategies. We undertook a randomized controlled trial that targeted nonparticipants in a previous trial of average-risk subjects which compared participation rates for mailed invitations offering a fecal test, a blood test or a choice of either. Nonparticipants (n = 899) were randomized to be offered a kit containing a fecal immunochemical test (FIT), directions on how to arrange a blood DNA test, or the option of doing either. Screening participation was assessed 12 weeks after the offer. To assess the cognitive and attitudinal variables related to participation and invitee choice, invitees were surveyed after 12 weeks, and associations were investigated using multinomial logistic regression. Participation rates were similar between groups (P = 0.88): 12.0% for FIT (35/292), 13.3% for the blood test (39/293), and 13.4% for choice (39/290). Within the choice group, par...
In this article, we explore how women in different social classes had differential access to reso... more In this article, we explore how women in different social classes had differential access to resources and services to enhance their 'wellness'-resulting in classed roles in alcohol consumption. We analyse data from a qualitative study on alcohol by midlife women in South Australia and employ the analogy of a 'toolkit' in order to understand the structural patterning of 'wellness tools'. Bourdieu's relational model of class guides our exploration of women's inequitable opportunities for wellness. Higher social class women had 'choices' facilitated by bulging wellness toolkits, such as yoga, exercise and healthy eating regimens-alcohol consumption was not essential to promoting 'wellness' and did not have an important place in their toolkits. Middle-class women had less well-stocked toolkits and consumed alcohol in a 'compensation approach' with other wellness tools. Alcohol consumption received positive recognition and was a legitimised form of enjoyment, fun and socialising, which needed counterbalancing with healthy activities. Working-class women had sparse toolkits-other than alcohol-which was a tool for dealing with life's difficulties. Their focus was less on 'promoting wellness' and more on 'managing challenging circumstances'. Our social class-based analysis is nestled within the sociology of consumption and sociological critiques of the wellness industry.
The article "Exploration of motivation to participate in a study of cancer-related cognitive impa... more The article "Exploration of motivation to participate in a study of cancer-related cognitive impairment among patients with newly diagnosed aggressive lymphoma:
Cancer-related cognitive impairment is an adverse consequence of cancer and its treatment. There ... more Cancer-related cognitive impairment is an adverse consequence of cancer and its treatment. There has been little research with patients with aggressive lymphoma. We describe self-reported cognitive function and neuropsychological performance data in patients with lymphoma and compare them with healthy controls and population norms. Associations between patients' neuropsychological performance, cognitive function and distress are also examined. Methods Secondary analysis of data from a longitudinal feasibility study of 30 participants with newly diagnosed aggressive lymphoma and 72 healthy controls was performed. Participants completed validated selfreport measures and neuropsychological tests before, and 6-8 weeks after chemotherapy. Healthy controls completed the FACT-Cog and neuropsychological tests at enrolment and six-months later. Mixed models were used to analyse FACT-Cog and neuropsychological test scores. Kendall's Tau provided a measure of association between global de cit and data from other measures. Results Patients and healthy controls were well matched on demographics. Differences between the two groups' neuropsychological test scores were mostly large-sized; patients' performance was poorer both before and after chemotherapy (most p < 0.001). The same pattern was observed for impact of perceived cognitive impairment on quality-of-life (both p < 0.001), but not perceived cognitive impairment or abilities (all p > 0.10). Associations between neuropsychological performance, self-reported cognitive function and distress, were trivial to small-sized (all p > 0.10). Conclusion For many patients with aggressive lymphoma, impaired neuropsychological test performance and impact of perceived impairments on quality-of-life precede chemotherapy and are sustained 6-8 weeks after chemotherapy. Our data support the need for further longitudinal studies with this population to better understand targets for interventions to address cognitive impairment. Helsinki (2013) and the principles of Good Clinical Practice and the Australian National Statement on Ethical Conduct in Human Research. Trial registration number: Australian New Zealand Clinical Trials Registry ACTRN12619001649101 on 26 th November 2019. Con ict of interest: The authors have declared no con icts of interest. Consent to participate: Informed consent was obtained from all individual participants included in the study. Consent for publication: Participants signed informed consent regarding publishing their de-identi ed data.
Objective: To assess the effect of providing free fruit and peer support in the workplace, on emp... more Objective: To assess the effect of providing free fruit and peer support in the workplace, on employees' consumption of fruits and high fat snacks at work and home. Methods: Three worksites, including 75 employees, were randomly assigned to a free fruit condition (Group A), a free fruit and peer education and modelling condition (Group B), and a control group (Group C). Groups A and B had free fruit delivered to their workplace each morning for four weeks. Consumption of fruit and high fat snacks was measured pre-and post-intervention, and after a two week maintenance period. Results: Despite a small sample, the intervention increased employees' fruit intake at work, decreased high fat snacks and was more successful in those who were not currently meeting the recommendations of two pieces of fruit per day. Peer support led to increased fruit consumption at work and sustained decreases in unhealthy snacks post-intervention. Conclusions: The provision of fruit in the workplace with peer support is a simple and effective method for improving fruit consumption at work in the short-term, particularly in those not meeting current recommendations. In addition, those participating in the intervention reduced their consumption of high fat snacks. Further research is necessary to determine whether a longer larger scale intervention can sustain dietary changes and thereby reduce risk for chronic disease in the Australian population.
Skin cancer is the most commonly diagnosed cancer for Caucasian populations worldwide (Lomas, Leo... more Skin cancer is the most commonly diagnosed cancer for Caucasian populations worldwide (Lomas, Leonardi-Bee, & Bath-Hextall, 2012). In Australia, melanoma is the most commonly diagnosed cancer for adolescents and young adults (Australian Institute of Health and Welfare [AIHW], 2011), and these groups are particularly at risk because they engage in more risky ultraviolet (UV) radiation exposure than other age groups (Hillhouse & Turrisi, 2005). Perceived improvements in appearance and increased self-confidence associated with a darker skin tone are often cited as a driving force behind deliberate sun exposure and indoor tanning (Thomas & Peñas, 2017). The tripartite influence model has been used to predict sun exposure behavior (Mingoia, Hutchinson, & Wilson, 2017) and posits that media norms promoting tanned skin as desirable lead to sun exposure through the internalization of a tanned ideal and promote appearance comparisons. Internalization occurs when media portrayals of events or people are accepted as personal goals and standards against which the self and others are judged (Thompson, Heinberg, Altabe, & Tantleff-Dunn, 1999). Consistent with this model, internalization has been found to predict sun exposure behavior (Mingoia et al., 2017). Social networking sites (SNSs) have become prominent purveyors of social norms that define aspects of attractiveness and fashion. Facebook (2018), the most popular SNS, boasts over 1 billion daily users who upload over 10 million new photos to the website per hour (Mayer-Schönberger & Cukier, 2013). Adolescents and young adults are the largest consumers of social media, with adolescents in Australia spending over 3 hr per day using SNSs (Mingoia, Hutchinson, Gleaves, Corsini, & Wilson, 2017). Use of SNSs is correlated with factors including skin tone dissatisfaction, more 820419S MSXXX10.
Men appear more likely to delay seeking medical advice for cancer symptoms, resulting in later st... more Men appear more likely to delay seeking medical advice for cancer symptoms, resulting in later stage at diagnosis and poorer health outcomes. Limited research has investigated variation in men's experiences of and responses to cancer symptoms. This study examined the psychosocial aspects of men's help-seeking for cancer symptoms, as well as potential variation across men residing in urban and rural Australia. Semi-structured interviews were conducted with men recently diagnosed with cancer (n=13). Participants' partners (n=8) were recruited to enable data triangulation. Interview schedules addressed participants' pathway to cancer treatment, cancer knowledge, masculinity, and rural living. A theoretical thematic analysis approach was used. Medical help-seeking behaviour was similar for participants residing in urban and rural areas. Five key themes and one sub-theme were identified, including: symptom factors, traditional masculine norms (sub-theme: women's health-related responsibilities), level of concern, conflicting responsibilities and access, and trust in medical professionals. Participants from rural Australia experienced greater access difficulties and noted optimism regarding symptoms. Results highlight important within-gender differences in the psychosocial barriers to help-seeking for cancer symptoms. Future research should further explore variation between men and test the predictive strength of factors.
Objective: To demonstrate test-retest reliability (reproducibility) of a new selfadministered lif... more Objective: To demonstrate test-retest reliability (reproducibility) of a new selfadministered lifetime diet questionnaire, with a focus on foods relevant to cognitive health in older age. Design: The reproducibility of dietary recall over four or five life periods was assessed by administering the questionnaire at two time points to an older cohort. The period between questionnaire administrations was 7 weeks. Polychoric correlations measured the association between recall at time 1 and time 2 and the weighted k statistic measured the level of recall agreement for food groups across the two administrations of the questionnaire. Setting: Adelaide, South Australia. Subjects: Fifty-two cognitively healthy, older-age, community-dwelling adults completed the Lifetime Diet Questionnaire; mean age 81?8 (SD 4?4) years, range 70-90 years. Results: The questionnaire showed very good reproducibility in this sample with a mean polychoric correlation coefficient of 0?81 between administration at time 1 and time 2, and an average weighted k of 0?49 for the level of recall agreement between food groups. Conclusions: The demonstrated reliability of this lifetime diet questionnaire makes it a useful tool to assess potential relationships between long-term dietary intake and laterage cognitive outcomes.
Cardiovascular disease (CVD) risk in train drivers is associated with health conditions that can ... more Cardiovascular disease (CVD) risk in train drivers is associated with health conditions that can result in sudden incapacity. Drivers are at high risk on several CVD risk factors with research suggesting that sleep may predict CVD risk, however this relationship has not yet been explored. This study investigated the link between sleep and CVD risk, in relation to hours of work day and days off sleep. N=309 Australian drivers completed a cross-sectional survey. A CVD risk score was calculated by summing scores from behavioural and biomedical risk factors. Sleep was most frequently cited as the main reason for decline in perceived health status. Main analyses showed that shorter work day sleep (M=5.79 h) was a significant predictor of increased CVD risk (p=0.013). This relationship was moderated by days off sleep, such that when days off sleep (M=8.17 h) was higher, the effect of work day sleep on CVD risk was weaker (p=0.047). Findings indicate the amount of sleep a driver obtains on non-work days may compensate for adverse health outcomes. Successful management of fatigue in safety critical occupations appears essential not only for the prevention of safety hazards, but also for the long-term health of shift workers. Further investigation is warranted.
The American Journal of Clinical Nutrition, May 1, 2018
Background: Fish oil trials in cognitively healthy older adults have yielded inconsistent results... more Background: Fish oil trials in cognitively healthy older adults have yielded inconsistent results. Supplementation may differentially affect the domains that underpin cognitive performance, and effects may differ across sex or genotype. Objective: The aim of this study was to test whether docosahexaenoic acid (DHA)-rich fish oil slows 18-mo cognitive decline in cognitively healthy elders. Design: In a double-blind, randomized, placebo-controlled, parallelgroup trial, cognitively healthy Australian community-dwelling adults (aged 65-90 y) consumed either 1720 mg DHA and 600 mg eicosapentaenoic acid or low-polyphenolic olive oil daily, as capsules, for 18 mo. Groups were allocated by permuted-block randomization and stratified by age. Cognitive assessment was conducted at baseline and then every 6 mo. Primary analyses tested the difference between groups in the rate of 18-mo cognitive change via latent growth curve models on any of the following: reasoning, working memory, short-term memory, retrieval fluency, and cognitive speed-related constructs. Treatment interactions with sex and APOE-ε4 were tested. Secondary outcomes were self-reported changes in well-being and everyday functioning, blood pressure, biomarkers of n-3 (ω-3) long-chain polyunsaturated fatty acids (LC PUFAs), lipids, glucose metabolism, inflammation, oxidative stress, DNA damage, and Mini-Mental State Examination. Results: A total of 403 people were randomly assigned. Data from those who completed baseline were analyzed (n = 390; intervention n = 194, control n = 196). Daily supplementation with 2.3 g DHA-rich fish oil for 18 mo did not maintain or improve cognitive performance. A small negative main effect was found on psychomotor speed (intervention =-0.02, 95% CI:-0.04 to 0.00; d = 0.24, P = 0.03). Treatment effects differed according to sex on retrieval fluency and some speed-based domains, including psychomotor speed, and according to APOE-ε4 carrier status on reaction time and reasoning. For secondary outcomes, treatment was associated with increased perceived cognitive mistakes (d = 0.24; P = 0.003), increased oxidative stress, and expected changes in fatty acid metabolism. Conclusions: Findings do not support supplementing older adults with fish oil to prevent cognitive decline. Treatment interactions with sex and APOE-ε4 carrier status warrant further investigation. This trial was registered at the Australia and New Zealand Clinical Trials Register (ANZCTR) as ACTRN12607000278437.
A comprehensive search of the literature for studies examining physical activity or nutrition int... more A comprehensive search of the literature for studies examining physical activity or nutrition interventions in the workplace, published between 1999 and March 2009, was conducted. This search identified 29 relevant studies. Interventions were grouped according to the theoretical framework on which the interventions were based (e.g. education, cognitive-behavioural, motivation enhancement, social influence, exercise). Weighted Cohen's d effect sizes, percentage overlap statistics, confidence intervals and fail safe Ns were calculated. Most theoretical approaches were associated with small effects. However, large effects were found for some measures of interventions using motivation enhancement. Effect sizes were larger for studies focusing on one health behaviour and for randomized controlled trials. The workplace is a suitable environment for making modest changes in the physical activity, nutrition and health of employees. Further research is necessary to determine whether these changes can be maintained in the long term.
Objective: To assess Australian consumers' perception of portion size of fast-food items and thei... more Objective: To assess Australian consumers' perception of portion size of fast-food items and their ability to estimate energy content. Design: Cross-sectional computer-based survey. Setting: Australia. Subjects: Fast-food consumers (168 male, 324 female) were asked to recall the items eaten at the most recent visit to a fast-food restaurant, rate the prospective satiety and estimate the energy content of seven fast-food or 'standard' meals relative to a 9000 kJ Guideline Daily Amount. Nine dietitians also completed the energy estimation task. Results: Ratings of prospective satiety generally aligned with the actual size of the meals and indicated that consumers perceived all meals to provide an adequate amount of food, although this differed by gender. The magnitude of the error in energy estimation by consumers was three to ten times that of the dietitians. In both males and females, the average error in energy estimation for the fast-food meals (females: mean 3911 (SD 1998) kJ; males: mean 3382 (SD 1957) kJ) was significantly (P , 0?001) larger than for the standard meals (females: mean 2607 (SD 1623) kJ; males: mean 2754 (SD 1652) kJ). In women, error in energy estimation for fast-food items predicted actual energy intake from fast-food items (b 5 0?16, P , 0?01). Conclusions: Knowledge of the energy content of standard and fast-food meals in fast-food consumers in Australia is poor. Awareness of dietary energy should be a focus of health promotion if nutrition information, in its current format, is going to alter behaviour.
This study explores rural South Australians' barriers to help-seeking for skin cancer detection. ... more This study explores rural South Australians' barriers to help-seeking for skin cancer detection. A total of 201 randomly selected rural adults (18-94 years, 66% female) were presented with a skin-cancer-related scenario via telephone and were asked the extent to which various barriers would impede their help-seeking, based on an amended version of the Barriers to Help-Seeking Scale. Older (≥63 years) and less educated participants endorsed barriers more strongly than their younger, more educated counterparts in the following domains; "Concrete barriers and distrust of caregivers", "Emotional control", "Minimising problem and Normalisation", "Need for control and self-reliance" (every domain other than "Privacy"). Socioeconomic disadvantage, gender, and farmer status did not predict stronger overall barriers, but some gender and occupation-related differences were detected at the item level. Farmers were also more likely to endorse the "Minimising problem and normalization" domain than their non-farmer working rural counterparts. Widely endorsed barriers included the tendency to minimise the problem, a desire to remain in control/not be influenced by others, reluctance to show emotion or complain, and having concerns about privacy or waiting times.
Limiting exposure to sunlight during childhood can significantly reduce the risk of skin cancer. ... more Limiting exposure to sunlight during childhood can significantly reduce the risk of skin cancer. This was the first national study to assess the sun protection policies and practices of early childhood services across Australia. It also examined the key predictors of services' sun protection practices. In 2007, 1017 respondents completed a self-administered survey about the sun protection policies and practices in their early childhood service (response rate of 59%). Most (95%) had a written sun protection policy. The most common policy inclusions were hat wearing (91%), sunscreen use (87%) and enforcement of policy (97%). Less frequently reported inclusions were protective clothing (69%), information for parents/caregivers (58%) and regular reviews/ updates of policies (65%). Basic sun protection practices (e.g. required any type of hat and sunscreen use) were more commonly reported than extensive practices (required protective clothing or regularly applied sunscreen). Higher sun protection policy scores, being a formal childcare service as opposed to a kindergarten/pre-school and having SunSmart status as opposed to not, were associated with higher sun protection practice scores (P < 0.001). Sun protection policies may be improved through encouraging services to have more specific policy inclusions and to model their policies on the SunSmart Early Childhood Program.
Objective: To identify key predictors of fast-food consumption from a range of demographic, attit... more Objective: To identify key predictors of fast-food consumption from a range of demographic, attitudinal, personality and lifestyle variables. Methods: We analysed data from a nationwide survey (n 5 20 527) conducted in Australia by Nielsen Media Research. Items assessing frequency of fast-food consumption at (1) eat in and (2) take away were regressed onto 12 demographic, seven media consumption, and 23 psychological and lifestyle variables, the latter derived from factor analysis of responses to 107 attitudinal and behavioural items. Results: Stepwise multiple regression analyses explained 29.6% of the variance for frequency of takeaway and 9.6% of the variance for frequency of eat-in consumption of fast foods. Predictors of more frequent consumption of fast food at take away (and, to a lesser extent, eat in) included lower age-especially under 45 years, relative indifference to health consequences of behaviour, greater household income, more exposure to advertising, greater receptiveness to advertising, lesser allocation of time for eating, and greater allocation of time to home entertainment. There were no effects for occupational status or education level. Conclusions: The effects for age suggest that fast-food takeaway consumption is associated with a general cultural shift in eating practices; individual differences in attitudinal and lifestyle characteristics constitute additional, cumulative, predictive factors. The role of advertising and the reasons for the lesser explanatory value of the eat-in models are important targets for further research.
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Purpose: People affected by cancer who live in rural Australia experience inferior survival compa... more Purpose: People affected by cancer who live in rural Australia experience inferior survival compared to their urban counterparts. This study determines whether self-reported physical and mental health, as well as health-promoting behaviours, also differ between rural and urban Australian adults with a history of cancer. Methods: Weighted, representative population data were collected via the South Australian Monitoring and Surveillance System between 1 January 2010 and 1 June 2015. Data for participants with a history of cancer (n= 4,295) were analysed with adjustment for survey year, gender, age-group, education, income, family structure, work status, country of birth and arealevel relative socioeconomic disadvantage (SEIFA). Results: Cancer risk factors and co-morbid physical and mental health issues were prevalent among cancer survivors regardless of residential location. In unadjusted analyses, rural survivors were more likely than urban survivors to be obese and be physically inactive. They were equally likely to experience other comorbidities (diabetes, chronic obstructive pulmonary disease, cardiovascular disease, arthritis or osteoporosis). With adjustment for SEIFA, rural/urban differences in obesity and physical activity disappeared. Rural survivors were more likely to have trust in their communities, less likely to report high/very high distress, but equally likely to report a mental health condition, both with and without adjustment for SEIFA. Conclusions: There is a need for deeper understanding of the impact of relative socioeconomic disadvantage on health (particularly physical activity and obesity) in rural settings and the development of accessible and culturally appropriate interventions to address rural cancer survivors' specific needs and risk factors.
Background: Some studies have suggested an association between omega-3 long-chain polyunsaturated... more Background: Some studies have suggested an association between omega-3 long-chain polyunsaturated fatty acids (n-3 LC PUFAs) and better cognitive outcomes in older adults. To date, only two randomised, controlled trials have assessed the effect of n-3 LC PUFA supplementation on cognitive function in older cognitively healthy populations. Of these trials only one found a benefit, in the subgroup carrying the ApoE-ε4 allele. The benefits of n-3 LC PUFA supplementation on cognitive function in older normal populations thus still remain unclear. The main objective of the current study was to provide a comprehensive assessment of the potential of n-3 LC PUFAs to slow cognitive decline in normal elderly people, and included ApoE-ε4 allele carriage as a potential moderating factor. The detailed methodology of the trial is reported herein. Methods: The study was a parallel, 18-month, randomised, double-blind, placebo-controlled intervention with assessment at baseline and repeated 6-monthly. Participants (N = 391, 53.7% female) aged 65-90 years, Englishspeaking and with normal cognitive function, were recruited from metropolitan Adelaide, South Australia. Participants in the intervention arm received capsules containing fish-oil at a daily dosage of 1720 mg of docosahexaenoic acid and 600 mg of eicosapentaenoic acid while the placebo arm received the equivalent amount of olive oil in their capsules. The primary outcome is rate of change in cognitive performance, as measured by latent variables for the cognitive constructs (encompassing Reasoning, Working Memory, Short-term Memory, Retrieval Fluency, Inhibition, Simple and Choice-Reaction Time, Perceptual Speed, Odd-man-out Reaction Time, Speed of Memory Scanning, and Psychomotor Speed) and assessed by latent growth curve modeling. Secondary outcomes are change in the Mini-mental State Examination, functional capacity and well-being (including health status, depression, mood, and self-report cognitive functioning), blood pressure, and biomarkers of n-3 LC PUFA status, glucose, lipid metabolism, inflammation, oxidative stress, and DNA damage.
Summary Alcohol consumption by Australian women during midlife has been increasing. Health promot... more Summary Alcohol consumption by Australian women during midlife has been increasing. Health promotion efforts to reduce alcohol consumption in order to reduce alcohol-related disease risk compete with the social contexts and value of alcohol in women’s lives. This paper draws on 50 qualitative interviews with midlife women (45–64 years of age) from different social classes living in South Australia in order to gain an understanding of how and why women might justify their relationships with alcohol. Social class shaped and characterized the different types of relationships with alcohol available to women, structuring their logic for consuming alcohol and their ability to consider reducing (or ‘breaking up with’) alcohol. We identified more agentic relationships with alcohol in the narratives of affluent women. We identified a tendency for less control over alcohol-related decisions in the narratives of women with less privileged life chances, suggesting greater challenges in changing...
Few studies have directly targeted nonparticipants in colorectal cancer screening to identify eff... more Few studies have directly targeted nonparticipants in colorectal cancer screening to identify effective engagement strategies. We undertook a randomized controlled trial that targeted nonparticipants in a previous trial of average-risk subjects which compared participation rates for mailed invitations offering a fecal test, a blood test or a choice of either. Nonparticipants (n = 899) were randomized to be offered a kit containing a fecal immunochemical test (FIT), directions on how to arrange a blood DNA test, or the option of doing either. Screening participation was assessed 12 weeks after the offer. To assess the cognitive and attitudinal variables related to participation and invitee choice, invitees were surveyed after 12 weeks, and associations were investigated using multinomial logistic regression. Participation rates were similar between groups (P = 0.88): 12.0% for FIT (35/292), 13.3% for the blood test (39/293), and 13.4% for choice (39/290). Within the choice group, par...
In this article, we explore how women in different social classes had differential access to reso... more In this article, we explore how women in different social classes had differential access to resources and services to enhance their 'wellness'-resulting in classed roles in alcohol consumption. We analyse data from a qualitative study on alcohol by midlife women in South Australia and employ the analogy of a 'toolkit' in order to understand the structural patterning of 'wellness tools'. Bourdieu's relational model of class guides our exploration of women's inequitable opportunities for wellness. Higher social class women had 'choices' facilitated by bulging wellness toolkits, such as yoga, exercise and healthy eating regimens-alcohol consumption was not essential to promoting 'wellness' and did not have an important place in their toolkits. Middle-class women had less well-stocked toolkits and consumed alcohol in a 'compensation approach' with other wellness tools. Alcohol consumption received positive recognition and was a legitimised form of enjoyment, fun and socialising, which needed counterbalancing with healthy activities. Working-class women had sparse toolkits-other than alcohol-which was a tool for dealing with life's difficulties. Their focus was less on 'promoting wellness' and more on 'managing challenging circumstances'. Our social class-based analysis is nestled within the sociology of consumption and sociological critiques of the wellness industry.
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