Area-Level Socioeconomic Gradients in Overweight and Obesity in a Community-Derived Cohort of Health Service Users - A Cross-Sectional Study.

BACKGROUND: Overweight and obesity lead to higher probability of individuals accessing primary care but adiposity estimates are rarely available at regional levels to inform health service planning. This paper analyses a large, community-derived clinical database of objectively measured body mass index (BMI) to explore relationships with area-level socioeconomic disadvantage for informing regional level planning activities. MATERIALS AND METHODS: The study included 91776 adults who had BMI objectively measured between 1 July 2009 and 30 June 2011 by a single pathology provider. Demographic data and BMI were extracted and matched to 2006 national census socioeconomic data using geocoding. Adjusted odds-ratios for overweight and obesity were calculated using sex-stratified logistic regression models with socioeconomic disadvantage of census collection district of residence as the independent variable. RESULTS: The prevalence of overweight or obesity was 79.2% (males) and 65.8% (females); increased with age to 74 years; and was higher in rural (74%) versus urban areas (71.4%) (p<0.001). Increasing socioeconomic disadvantage was associated with increasing prevalence of overweight (p<0.0001), obesity (p<0.0001) and overweight or obesity (p<0.0001) in women and obesity (p<0.0001) in men. Socioeconomic disadvantage was unrelated to overweight (p = 0.2024) and overweight or obesity (p = 0.4896) in males. CONCLUSION: It is feasible to link routinely-collected clinical data, representative of a discrete population, with geographic distribution of disadvantage, and to obtain meaningful area-level information useful for targeting interventions to improve population health. Our results demonstrate novel area-level socioeconomic gradients in overweight and obesity relevant to regional health service planning.

Exploring the nature of situational goal-based coping in early-stage breast cancer patients: A contextual approach.

PURPOSE: The psychosocial impact of breast cancer varies widely across patients and over time. Greater insight into goal-based coping processes theorised to underpin psychological resilience may inform efforts to support the maintenance and recovery of psychological wellbeing in the context of breast cancer treatment and recovery. This prospective study adopted a qualitative descriptive design to better understand the nature of situational goal-based coping in response to personal goal interference encountered across the six months following surgery for early-stage breast cancer. METHOD: Responses to specific instances of goal interference were derived from semi-structured interviews conducted at three time-points following surgery (i.e., approximately two, four, and six months post-surgery). Thematic and cross-case analytic techniques were utilised to identify broad patterns across the goal-specific response trajectories. RESULTS: Three broad response patterns were identified - goal-based coping only, combined goal-based coping and other (i.e., informed waiting and/or passive) responses, and informed waiting and/or passive responses only. Specific response patterns were further identified within each category. The majority of response trajectories incorporated the utilisation of assimilative and/or accommodative goal-based coping. CONCLUSIONS: Early-stage breast cancer patients utilised goal-based coping in response to many instances of goal-specific interference encountered during the study period. While the initial or delayed activation of these processes appeared generally adaptive, there was also evidence of maladaptive coping and blocked goal pursuit. Further insight into the nature of adaptive and maladaptive goal-based coping in this context could help oncology nurses facilitate ongoing personal goal pursuit and psychological resilience across the cancer continuum.

Investigating physical symptom burden and personal goal interference in early-stage breast cancer patients.

PURPOSE: Physical symptoms associated with breast cancer and its treatment can substantially interfere with functional outcomes and quality of life. The present study seeks to delineate the relationship between physical symptom burden and cancer-related goal interference in early-stage breast cancer patients. METHODS: Self-report questionnaires were administered to 43 eligible female patients at four time-points in the 6 months following surgery for early-stage breast cancer. Physical symptoms, cancer-related goal interference, and psychological distress were assessed at each time-point. K-means cluster analysis and independent sample t tests evaluated the relationships of interest. RESULTS: Women with a higher physical symptom burden experienced significantly higher goal interference and psychological distress than those with a lower burden at multiple time-points following surgery. CONCLUSIONS: This study provides preliminary evidence that physical symptom burden can interfere with important goal pursuit in early-stage breast cancer patients. Breast cancer survivors with ongoing challenging symptoms may require targeted psychosocial support to cope with possible goal interference and associated distress.

Patterns of health behaviours predict obesity in Australian children.

AIMS: The study aims to examine whether patterns of health behaviours (based on sleep duration, physical activity, screen time and diet) were associated with obesity in Australian children. METHODS: This paper included 1833 children aged 6-7 years (51.6% male) recruited in 2006 as part of the Longitudinal Study of Australian Children. Latent class analysis was performed to identify the presence of distinct behavioural profiles on the basis of sleep duration, physical activity, screen time and eating habits. Logistic regression was performed to examine the association between the behavioural profiles and obesity assessed at baseline and 2-year follow-up. RESULTS: Three behavioural profiles, healthy (27.7%), sedentary (24.8%) and short sleepers/unhealthy eaters (47.5%), were identified. Compared with the healthy profile, the sedentary profile (odds ratio = 1.59, 95% confidence interval (1.06-2.38)) and short sleepers/unhealthy eaters (odds ratio = 1.47 (1.03-2.13)) had elevated odds of obesity at 2-year follow-up. CONCLUSIONS: The present study identified distinct profiles of health behaviours in this sample of Australian children. These findings add to existing findings that many health behaviours co-occur and that obesity interventions should target patterns of behaviours in children.

The longitudinal relationship between sleep duration and body mass index in children: a growth mixture modeling approach.

OBJECTIVE: A growing number of studies indicate that shorter sleep durations could contribute to obesity in children. The objective of this article was to further examine the longitudinal relationship between sleep duration and body mass index (BMI) in children by using a growth mixture modeling approach. METHOD: This article used prospective data from the Longitudinal Study of Australian Children. Participants included 1079 children aged 4 to 5 years (2004) followed up until age 10 to 11 years (2010). Growth mixture modeling was performed to examine the longitudinal association between sleep duration and body mass index within distinct body mass index trajectories. RESULTS: The results indicated 3 distinct body mass index trajectories: healthy weight, early onset obesity, and later onset obesity. Longitudinal inverse associations were evident between sleep duration and body mass index in the Early Onset Trajectory. There were some associations between sleep duration and body mass index in the other trajectories. CONCLUSIONS: This article provides further insight into the longitudinal relationship between sleep duration and body mass index in children. In particular, the results indicate that shorter sleep durations are primarily associated with body mass index in children with early onset obesity.

The association between job demands/control and health in employed parents: the mediating role of work-to-family interference and enhancement.

This paper examined whether work-to-family interference (WFI) and work-to-family enhancement (WFE) mediated the association between job demands/control and self-reported mental and physical health. Data were from the Household, Income and Labor Dynamics in Australia survey and included 1,404 Australian adults aged 18-64 years at baseline; 820 participants provided data at three time points (baseline, 12-month follow-up, and 24-month follow-up). Self-report questionnaires assessed mental and physical health, WFI and WFE, and job demands/control. Mediation analyzes performed on the longitudinal data indicated that WFI mediated the relationships between job demands/control and self-reported mental and physical health. The findings have implications for improving the well-being of employees and workplace productivity.

Australian women's perceptions of breast cancer risk factors and the risk of developing breast cancer.

BACKGROUND: Numerous studies have shown that the majority of women overestimate both their own risk and the populations' risk of developing breast cancer. A number of factors have been found to correlate with perceived risk. METHODS: This paper reports on a telephone survey of a nationally representative sample of approximately 3,000 Australian women aged 30 to 69 years, conducted in 2007, and compares the findings with those of a similar survey conducted in 2003. RESULTS: There was a clear tendency for respondents to overestimate the proportion of women who will develop breast cancer during their lifetime. Approximately half the respondents perceived themselves as being at the same risk of developing breast cancer as other women their age; older respondents were more likely to perceive themselves to be at a lower than average risk. Family history was recognized as a risk factor for breast cancer, although there was evident confusion in relation to risk from paternal family history. It was also evident that the association between age and risk status is poorly understood, and misconceptions of breast cancer risk factors identified in the previous survey persisted in 2007. CONCLUSION: Overall, these results suggest that there remains an educational challenge if we seek to increase the accuracy of women's perceptions of their risk for developing breast cancer, primarily in relation to the significance of age and family history as breast cancer risk factors.

Relationships between self-rated health, quality of life and sleep duration in middle aged and elderly Australians.

OBJECTIVE: To determine whether sleep duration is associated with self-rated health and quality of life in adults residing in New South Wales, Australia. METHODS: Cross-sectional data from the 45 and Up Study were used. Sleep duration, self-rated health, quality of life and other health-related variables were assessed using a self-report questionnaire. Multinomial logistic regression models were used to examine whether sleep duration predicted self-rated health and quality of life. RESULTS: The sample included 63,408 adults aged 45-95 years. After controlling for a range of covariates, <6 h sleep (OR=1.49, 95% CI 1.31-1.70), 6 h sleep (OR=1.28, 95% CI 1.17-1.38) and ≥9 h sleep (OR=1.56, 95% CI 1.46-1.67) were associated with poorer self-rated health. Similarly, <6 h sleep (OR=1.80, 95% CI 1.57-2.07), 6 h sleep (OR=1.36, 95% CI 1.24-1.49) and ≥9 h sleep (OR=1.41, 95% CI 1.30-1.53) were associated with poorer quality of life. CONCLUSION: Short and long sleep were significantly associated with poor self-rated health and lower quality of life in this large sample of middle aged and older Australian adults. While cross-sectional, these results add weight to recent data emphasising the importance of adequate sleep in physical and mental health.

Short sleep mediates the association between long work hours and increased body mass index.

This study examined whether short sleep duration, physical activity and time spent sitting each day mediated the association between long work hours and body mass index (BMI). Participants included 16,951 middle aged Australian adults who were employed in full time work (i.e. ≥35 h a week). Data on BMI, sleep duration, work hours and other health and demographic variables were obtained through a self-report questionnaire. A multiple mediation model was tested whereby sleep duration, physical activity and amount of time spent sitting were entered as potential mediators between work hours and BMI. The results demonstrated that short sleep partially mediated the association between long work hours and increased BMI in males. In females, long work hours were indirectly related to higher BMI through short sleep. The results provide some support for the hypothesis that long work hours could contribute to obesity via a reduction in sleep duration; this warrants further investigation in prospective studies.

Occupational factors associated with 4-year weight gain in Australian adults.

OBJECTIVE: This article examined whether occupational factors predicted 4-year change in body mass index (BMI) in a sample of full-time Australian employees. METHODS: Data from 1670 full-time Australian employees were collected through the Longitudinal Study of Australian Children. Multinomial logistic regression was used to examine whether several occupational factors at baseline predicted changes in BMI at 4-year follow up; several health and demographic covariates were controlled. RESULTS: Inflexible working hours (odds ratio = 1.54, 95% confidence interval [1.14 to 2.09]) and weekend work (odds ratio = 1.33, 95% confidence interval [1.04 to 1.68]) significantly predicted increased BMI. CONCLUSIONS: This article demonstrates that certain occupational factors (ie, inflexible work hours and weekend work) significantly predicted increased BMI. Targeting these factors may play a role in combating obesity and related health problems among employees.

Is sleep duration associated with obesity in older Australian adults?

OBJECTIVES: To investigate the relationship between sleep duration and obesity in older Australian adults. METHOD: Self-reported health data were collected through the 45 and Up Study. Multinomial logistic regression models were used to test the relationship between sleep duration and body mass index, controlling for a range of demographic and health-related variables. RESULTS: The sample included 45,325 Australian adults aged 55 to 95 years. The regression models demonstrated that short and long sleep were associated with obesity in 55- to 64-year-olds but not in those aged 65 years and above. DISCUSSION: The present results suggest that the relationships between sleep duration and obesity previously reported in young and middle-aged adults are not evident in older adults. The absence of these relationships could reflect a combination of age-related factors that impact on sleep and body composition.

Sleep duration and obesity in middle-aged Australian adults.

The present study examined the association between sleep duration and obesity in 40,834 middle-aged Australian adults. Multinomial logistic regression was used to test the relationship between sleep duration and obesity while controlling for important demographic and health covariates; separate models were tested for males and females. Short sleep (i.e., <7 h a night) was found to be independently associated with obesity in males and females. To our knowledge, this is the first study to report an association between short sleep and obesity in Australian adults. Although more research is required, interventions targeting short sleep could aid obesity treatment and prevention.