The effectiveness of living well multicultural-lifestyle management program among ethnic populations in Queensland, Australia.

ISSUE: Some migrant groups have higher risks of deaths and chronic diseases due to barriers associated with socioeconomic disadvantage, social isolation, racism, language, poor access to health services and low levels of health literacy. However, few culturally tailored interventions have targeted ethnic groups in Australia. This study evaluated the effectiveness of the Living Well Multicultural-Lifestyle Management Program (LWM-LMP) in Queensland, Australia. METHODS: The LWM-LMP was originally co-designed with the targeted communities. Participants aged ≥18 years were eligible to participate without a fee. The evaluation was a quasi-experimental design without a control group, with data collected at baseline, the end of the programme and after-programme follow-up at week 14. The programme lasted 8 weeks with one group-based session of 120 minutes delivered each week in local community venues. Each session also included time to undertake physical activity (PA). Eating and PA behaviours were self-reported. Weight, height, waist circumference and blood pressure were measured using standard protocols. RESULTS: Participants were more likely to consume ≥2 servings of fruit/day, five servings of vegetable/day, low-fat milk, processed meat, fast food, hot chips/fries, salty snacks, sweet snacks, sweet beverages less than once per week and meet the PA recommendation of ≥150 minutes/wk (P < .001) at week 8. Weight, BMI, waist circumference, waist-to-height ratio and blood pressure were also improved at week 8. Many of the changes were sustained at week 14. CONCLUSIONS: The LWM-LMP was effective in improving participants' lifestyle behaviours and cardiometabolic indicators. SO WHAT: Engaging targeted communities in designing interventions focussed on healthy personal behaviours helps with delivery and implementation. Behavioural interventions should be culturally tailored to increase their effectiveness.

Eating and physical activity behaviours among ethnic groups in Queensland, Australia.

OBJECTIVE: To examine differences in eating and physical activity behaviours among ethnic groups in Queensland, Australia, and differences in those behaviours due to the duration of residency in Australia. DESIGN: Cross-sectional study using baseline data collected for the Living Well Multicultural-Lifestyle Modification Program between October 2014 and June 2017. SETTING: Culturally and linguistically diverse communities (CALD), including Afghani, Somali, Burmese, Pacific and South Sea Islander, Sri Lankan, Sudanese and Vietnamese, living in Queensland, Australia. PARTICIPANTS: People were recruited if they were ≥18 years old and living in the targeted CALD communities. RESULTS: Burmese/Vietnamese, on average, had better eating scores in line with Australian dietary guidelines, compared with Afghani/Arabic-speaking (difference = 2·05 points, 95 % CI 1·39, 2·72), Somali/Sudanese (difference = 1·53 points, 95 % CI 0·79, 2·28) and Pacific Islander (difference = 1·46 points, 95 % CI 0·79, 2·13). Association between ethnicity and meeting the physical activity guideline was not significant. Those who stayed in Australia longer than a year were less likely to meet the physical activity guideline than those staying <1 year (OR = 0·51, 95 % CI 0·31, 0·84). There was no significant association between duration of residency in Australia and eating scores. CONCLUSIONS: Eating behaviours were significantly different among the ethnic groups in Queensland with Burmese/Vietnamese and Sri Lankan/Bhutanese having the healthiest diets. All ethnic groups were less likely to meet the physical activity guideline compared with the general Australian population. People with duration of residency of at least 1 year in Australia were less likely to meet the physical activity guideline compared with those who had shorter stays.

Iodine status of non-pregnant women and availability of food vehicles for fortification with iodine in a remote community in Gulf province, Papua New Guinea.

Adequate iodine status of women of childbearing age is essential for optimal growth and development of their offspring. The objectives of the current study were to assess the iodine status of non-pregnant women, availability and use of commercial salt, extent to which it is iodised, and availability of other industrially processed foods suitable for fortification with iodine. This prospective cross-sectional study was carried out in 2018 in a remote area in Gulf province, Papua New Guinea. Multistage cluster sampling was used to randomly select 300 women visiting local markets. Of these, 284 met study criteria of being non-pregnant and non-lactating. Single urine samples were collected from each of them. Discretionary salt intake was assessed; salt samples were collected from a sub-sample of randomly selected households. A semi-structured, pre-tested questionnaire to assess use and availability of commercial salt and other processed foods was modified and used. Salt was available on the interview day in 51.6% of households. Mean iodine content in household salt samples was 37.8 ± 11.8 ppm. Iodine content was below 30.0 ppm in 13.1% and below 15.0 ppm in 3.3% of salt samples. Mean iodine content of salt available at markets was 39.6 ± 0.52 ppm. Mean discretionary intake of salt per capita per day was 3.9 ± 1.21 g. Median UIC was 34.0 µg/L (95% CI, 30.0-38.0 ppm), indicating moderate iodine deficiency. For women with salt in the household, median UIC was 39.5 µg/L (95% CI, 32.0-47.0 µg/L), compared to median UIC of 29.0 µg/L (95% CI, 28.0-32.0 µg/L) for those without salt. This community has low consumption of iodised salt, likely due to limited access. Investigation of other industrially processed foods indicated salt is the most widely consumed processed food in this remote community, although 39.8% of households did use salty flavourings.

Differences in cardiometabolic risk markers among ethnic groups in Queensland, Australia.

Very little is known about the cardiometabolic risk of migrants who settle in Australia. This study investigated differences in cardiometabolic risk markers among ethnic groups attending a tailored healthy lifestyle program in Queensland, Australia; and differences in these markers between those living in Australia for shorter versus longer periods of time. Baseline data collected between October 2014 and June 2017 from the Living Well Multicultural-Lifestyle Modification Program were used. People living in ethnic communities in Queensland who were ≥18 years old, and not underweight were eligible to participate. Independent variables were ethnicity and length of time in Australia. Outcomes were cardiometabolic risk markers including BMI, waist circumference, weight-to-height ratio (WHtR) and hypertension. Analyses were done separately for each independent variable. Linear and logistic regressions were run for continuous and binary outcomes with differences/Odds ratios reported respectively. Multivariable analyses showed that Burmese/Vietnamese had an average BMI lower than Afghani/Arabic (3.7 points), Somalian/Sudanese (4.7 points) and Pacific Islander (11.6 points) (p < 0.001) respectively. Differences in waist circumference between Burmese/Vietnamese with Sri Lankan/Bhutanese, Afghani/Arabic, Somalian/Sudanese and Pacific Islander were 6.3, 8.4, 9.1 and 24.0 cm (p < 0.01) respectively. Although Burmese/Vietnamese also had lower average WHtR compared to the others, the differences were not significant for Somalian/Sudanese. Moreover, Sri Lankan/Bhutanese and Pacific Islander were more likely to be hypertensive compared to Burmese/Vietnamese (p < 0.05). Immigrants living in Australia >5years had on average 1.2 points higher BMI, 2.4cm larger waist circumference, and 0.02 points higher WHtR (p < 0.05) compared to those living for ≤5 years. Long-stay immigrants were also more likely to be hypertensive than short-stay immigrants (p < 0.01). In conclusion, cardiometabolic risk is significantly different among ethnic groups in Queensland with Pacific Islanders having the highest risk. Immigrants living in Australia >5 years had higher risks compared to those living in Australia for shorter periods of time.

Iodine status of children and knowledge, attitude, practice of iodised salt use in a remote community in Kerema district, Gulf province, Papua New Guinea.

Iodine deficiency is the single most common cause of preventable mental impairment in communities with suboptimal iodine intake. Objective of the present study was to assess in more detail the iodine status and knowledge, attitudes and practice (KAP) relating to use of iodised salt in a remote community in Kotidanga area, Kerema district, Gulf province, Papua New Guinea. This prospective school and community based cross-sectional study was carried out in 2017. Simple random sampling was used to select schools. Multistage sampling was used to randomly select 300 children aged 6 to 12 years, of which 289 consented to participate in the study. A single urine sample was collected from each of the consenting children, as well as a salt sample from their households. Discretionary salt intake was assessed in a sub-sample of the children's households. Salt iodine content and urinary iodine concentration (UIC) were analysed. A semi-structured modified Food and Agriculture Organisation questionnaire was used to assess KAP of three different community groups. Only 64% of households had salt on the day of data collection. Mean iodine content in household salt samples was 29.0 ± 19.1 ppm. Iodine content was below 30.0 ppm in 54.8% and below 15.0 ppm in 31.2% of salt samples. Mean per capita discretionary intake of household salt was 2.9 ± 1.8 g/day. Median UIC was 25.5 µg/L and Interquartile Range was 15.0 to 47.5 µg/L, indicating moderate status iodine nutrition. Median UIC was 34.3 µg/L for children in households with salt, compared to 15.5 µg/L for children in households without salt, indicating severe iodine deficiency in the latter group. The three community groups had limited knowledge about importance of using iodised salt and consequences of iodine deficiency on health outcomes. This remote community has limited access to adequately iodised household salt due to high cost, inappropriate packaging, storage and food preparation, resulting in iodine deficiency. Strategies to increase iodine intake are needed.

Nutritional status and dietary diversity of Kamea in Gulf Province, Papua New Guineas.

BACKGROUND AND OBJECTIVES: To assess the nutritional status of infants, children and non-pregnant women and underlying factors, dietary diversity and community food security, in the Kamea community in Gulf Province, Papua New Guinea. METHODS AND STUDY DESIGN: Prospective cross sectional study. Study population 69 infants (0-59 months), 151 children (6-12 years) and 79 non-pregnant women from 10 villages in Kotidanga Local Level Government, Kerema District, Gulf Province, Papua New Guinea. RESULTS: Among infants prevalence of moderate stunting, wasting and underweight were 38.9%, 8.3% and 44.4%, respectively; after adjusting Hb concentration for altitude, the anaemia prevalence was 53.8%. Among children prevalence of severe stunting was 21.2%; moderate stunting, wasting and underweight were 57.6%, 12.2% and 48.5%, respectively; anaemia was 30.3%; median urinary iodine concentration was 32.0 µg/L and iodine deficiency was prevalent among 88.1%. Among women, mean height, weight and BMI were 1.46±0.04 m, 43.9±5.91 kg and 20.4±2.32 kg/m2, respectively; low BMI (<18.5 kg/m2) and anaemia were prevalent among 22.8% and 35.4%, respectively; median urinary iodine concentration was 36.0 µg/L and iodine deficiency was prevalent among 80.3%. Exclusive breastfeeding was universal for young infants; complementary foods were limited in variety and frequency. Dietary diversity was limited, implementation of the universal salt iodisation strategy restricted and community food security was inadequate. CONCLUSIONS: The high prevalence of malnutrition and anaemia among the three age groups, including moderate status of iodine deficiency among women and children, are significant public health concerns. Improvements in dietary diversity, adequate use of iodised salt and community food security are needed.

Effectiveness of multicultural health workers in chronic disease prevention and self-management in culturally and linguistically diverse populations: a systematic literature review.

With a large and increasing culturally and linguistically diverse (CALD) population, the Australian health care system faces challenges in the provision of accessible culturally competent health care. Communities at higher risk of chronic disease include CALD communities. Overseas, multicultural health workers (MHWs) have been increasingly integrated in the delivery of culturally relevant primary health care to CALD communities. The objective of this systematic review was to examine the effectiveness of MHW interventions in chronic disease prevention and self-management in CALD populations with the aim to inform policy development of effective health care in CALD communities in Australia. A systematic review protocol was developed and computerised searches were conducted of multiple electronic databases from 1 January 1995 until 1 November 2010. Thirty-nine studies were identified including 31 randomised controlled trials. Many of the studies focussed on poor and underserved ethnic minorities. Several studies reported significant improvements in participants' chronic disease prevention and self-management outcomes and meta-analyses identified a positive trend associated with MHW intervention. Australian Government policies express the need for targeted inventions for CALD communities. The broader systemic application of MHWs in Australian primary health care may provide one of the most useful targeted interventions for CALD communities.

Television food advertising and the prevalence of childhood overweight and obesity: a multicountry comparison.

OBJECTIVE: To estimate the contribution of television (TV) food advertising to the prevalence of obesity among 6-11-year-old children in Australia, Great Britain (England and Scotland only), Italy, The Netherlands, Sweden and the United States. DESIGN: Data from contemporary representative studies on the prevalence of childhood obesity and on TV food advertising exposure in the above countries were entered into a mathematical simulation model. Two different effect estimators were used to calculate the reduction in prevalence of overweight and obesity in the absence of TV food advertising in each country; one based on literature and one based on experts' estimates. SETTING: Six- to eleven-year-old children in six Western countries. RESULTS: Estimates of the average exposure of children to TV food advertising range from 1.8 min/d in The Netherlands to 11.5 min/d in the United States. Its contribution to the prevalence of childhood obesity is estimated at 16%-40% in the United States, 10%-28% in Australia and Italy and 4%-18% in Great Britain, Sweden and The Netherlands. CONCLUSIONS: The contribution of TV advertising of foods and drinks to the prevalence of childhood obesity differs distinctly by country and is likely to be significant in some countries.