Cathy Banwell

Australian women's experiences of living with hepatitis C virus: Results from a cross‐sectional survey

Background: Of the estimated 160 000 Australians currently infected with the hepatitis C virus (HCV), over one‐third are women and very few have received clinical treatment, with most managing their illness in non‐specialist settings. Little is known about the experiences of women living with HCV in the general community. The present study provides the results from the first comprehensive social survey of Australian womens experiences of living with HCV.

Body mass index and health-related behaviours in a national cohort of 87 134 Thai open university students

Background: Thailand is undergoing a health-risk transition with overweight and obesity emerging as an important population health problem. This paper reports on a study of the transition, focusing on “lifestyle” factors such as diet (fried foods, soft drinks, Western-style fast foods) and physical activity (mild, moderate, strenuous exercise, housework/gardening and screen time). Methods: A baseline survey was administered to 87 134 adult students from all regions of Thailand attending an open university. Results: 54% of the cohort was female. Participants’ median age was 29 years. By self-reported Asian standards, 16% of the sample was obese (body mass index (BMI)⩾25) and 15% overweight at risk (BMI⩾23–24.9). Men were twice as likely as women to be overweight (21% vs 9%) or obese (23% vs 10%). Obesity was associated with urban residence and doing little housework or gardening and with spending more than 4 hours a day watching television or using computers. The latter occurred among 30% of the cohort, with a population attributable fraction (PAF) suggesting that it accounts for 11% of the current problem. Daily consumption of fried food was associated with obesity, and eating fried foods every second day or daily had a PAF of nearly 20%. Conclusions: These health-related behaviours underpinning the Thai health transition are associated with increasing obesity. They are modifiable through policies addressing structural issues and with targeted health promotion activities to prevent future obesity gains. Insights into future trends in the Thai health transition can be gained as this student cohort ages.

Heading the table: parenting and the junior consumer

From the 1970s onwards, studies of the dynamics involved in family food provisioning in Britain and the USA have provided consistent evidence of the centrality of husbands and male breadwinners to food decisions. Recent studies are beginning to show the significance of children or the “junior consumer” to household food decisions. This paper reports on focus groups conducted in Australia in the mid‐1990s that support the argument that children exert considerable influence over family diets. One obvious reason for this trend lies in the activities of food retailers and advertisers/marketers, who target their goods, services and messages to children. These marketplace actors are encouraging children to identify as consumers. A less obvious explanation, and the one explored in this paper, concerns changing parenting practices. Despite the double workload of many family food providers, childrens demands are being responded to in unprecedented ways. Metaphorically, children are displacing male adults at the head of the table. The paper comments on the consequences of childrens dominance over dietary practices.

Socioeconomic status, sex, and obesity in a large national cohort of 15-87-year-old open university students in Thailand.

Background As obesity increases, middle-income countries are undergoing a health-risk transition. We examine the association between socioeconomic status (SES) and emerging obesity in Thailand, and ascertain if an inverse relationship between SES and obesity has appeared. Methods The data derived from 87 134 individuals (54% female; median age, 29 years) in a national cohort of distance-learning Open University students aged 15–87 years and living throughout Thailand. We calculated adjusted odds ratios for associations of SES with obesity (body mass index, ≥25) across 3 age groups by sex, after controlling for marital status, age, and urbanization. Results Obesity increased with age and was more prevalent among males than females (22.7% vs 9.9%); more females were underweight (21.8% vs 6.2%). Annual income was 2000 to 3000 US dollars for most participants. High SES, defined by education, income, household assets, and housing type, associated strongly with obesity—positively for males and inversely for females—especially for participants younger than 40 years. The OR for obesity associated with income was as high as 1.54 for males and as low as 0.68 for females (P for trend <0.001). Conclusions Our national Thai cohort has passed a tipping point and assumed a pattern seen in developed countries, ie, an inverse association between SES and obesity in females. We expect the overall population of Thailand to follow this pattern, as education spreads and incomes rise. A public health problem of underweight females could emerge. Recognition of these patterns is important for programs combating obesity. Many middle income countries are undergoing similar transitions.

Chewing as a social act: cultural displacement and khat consumption in the East African communities of Melbourne

In this paper we present a review of practices surrounding the consumption of khat (Catha edulis) within recent migrant communities in Melbourne from East Africa. Cultures in East Africa and the Arabian Peninsular have used khat as a stimulant since the seventh century and the practice of coming together to chew the leaves of the khat plant has acquired unique cultural importance. Based on focus-group interviews the research examines transformations taking place in the meaning of khat for East African communities within their experiences of displacement and considers how the arrival of khat might be managed in the Australian context. Emphasis is given to indigenous models and the cultural context of practices surrounding khat. This anthropology of khat use in Melbourne summarizes issues such as who chews it, traditional settings for khat gatherings, culturally defined effects of the leaf, health effects, beliefs and attitudes, levels of use, gendered attitudes and questions of dependence. These issues raise questions regarding the reception of indigenous substance use within a state that claims to be multicultural.

Rites of passage: smoking and the construction of social identity

The following article, based on a qualitative study of young women from a Melbourne suburb, is concerned with the role smoking plays in the presentation of social identity. These women, in their early teens, are viewed as being in the liminal or transitional phase of a rite of passage to adulthood. The passage to adulthood is attained with the construction of a social identity corresponding to popular notions of the feminine, which fall into the familiar categories of the bad and good woman. Smoking is one of the props in the stereotypical representation of the bad woman. Conventional anti-smoking health messages have little relevance for young women who have chosen such a social identity for themselves.

Obesity, convenience and “phood”

Purpose – With rising levels of obesity, public health attention has turned to the “obesogenic environment”, which includes the ready availability of convenience foods. We seek to provide an historical account of the popularity of convenience foods, alongside an elaboration of how international and Australian experts believe convenience food has contributed to rising rates of obesity. In this context, the paper aims to speculate about the likely success of functional foods, or “phoods”, and draw conclusions about potential implications for the obesity epidemic.Design/methodology/approach – An “expanded” Delphi survey was utilised to identify key trends underpinning the rise in obesity and experts hypotheses about how these trends have operated to promote obesity. Elaborating on these data, an historical perspective of the emergence and consolidation of convenience foods in Australian diets, with particular attention paid to foods that offer “healthy convenience”, is provided.Findings – Australian researc...

How many standard drinks are there in a glass of wine

This small study investigates how much alcohol women consume when they have a glass of wine. Hotels in an inner city suburb of Melbourne were visited and their most commonly used wine glass was measured. Three major glass distributors and the Australian Hotels Association were asked about the size of commonly used wine glasses. Eighty-six women measured and recorded the amount of alcohol they drank in a 2-week prospective beverage diary. This study shows that, on average, wine glasses used in licensed premises such as hotels are larger than a standard drink. When at home participants, on average, drank more than a standard drink when consuming wine, champagne, spirits or liqueurs, but they drank less than a standard drink when drinking beer, cider and fortified wine. Wine drinkers, who are often women, cannot rely solely on counting their glasses of wine to keep them below the recommended number of standard drinks when in social situations, such as at hotels and private dwellings. [Banwell C. How many sta...

Re-embedding trust: unravelling the construction of modern diets

Recent controversies surrounding the food industry and its contribution to diet-related illnesses provide fertile ground for re-examining where power lies in food systems. A review of the literature reveals a wide range of powerful actors, contradictory assessments about consumer power and numerous examples of producers and medical authorities expending significant effort to shape the criteria by which consumers exercise choice. Expertise from the fields of marketing, advertising, psychology and nutrition science has been marshalled for close to a century to create commodity contexts that are sympathetic to mass-produced foods. In the last quarter of the twentieth century, however, a new dynamic entered the equation: the battle between technical rationality and reflexive consumers. Consumers are questioning the credentials of foods and those who promote them and, simultaneously, are seeking hope and help from the food system. As a result, health claims have become a most important ingredient in the fight for competitive advantage. This paper describes how the re-embedding of trust in a food supply dominated by corporations is being attempted through the nutritionalization of the food supply. On the basis of two studies, the authors identify the actors, processes, ideological basis and points of resistance that comprise what they are terming an emergent ‘diets-making complex’ (DMC). By intensifying the influence of science and nutritional claims in dietary discourse, the DMC has the potential to circumscribe policy options about food and health, because appeals to individual health are obscuring a social view of the food supply.

Time limits? Reflecting and responding to time barriers for healthy, active living in Australia

Lack of time is the main reason people say they do not exercise or use public transport, so addressing time barriers is essential to achieving health promotion goals. Our aim was to investigate how time barriers are viewed by the people who develop programs to increase physical activity or use active transport. We studied five interventions and explored the interplay between views and strategies. Some views emphasized personal choice and attitudes, and strategies to address time barriers were focused on changing personal priorities or perceptions. Other views emphasized social-structural sources of time pressures, and provided pragmatic ideas to free up time. The most nuanced strategies to address time barriers were employed by programs that researched and solicited the views of potential participants. Two initiatives re-shaped their campaigns to incorporate ways to save time, and framed exercise or active transport as a means to achieve other, pressing, priorities. Time shortages also posed problems for one intervention that relied on the unpaid time of volunteers. Time-sensitive health and active transport interventions are needed, and the methods and approaches we describe could serve as useful, preliminary models.