Heather Brown

Exercising choice: The economic determinants of physical activity behaviour of an employed population

Lack of physical activity is a major contributing factor to the worldwide obesity epidemic, and to the overall burden of disease. The deindustrialisation of developed economies and move to more sedentary employment has impacted on the opportunities of working individuals to participate in physical activity. This can have negative effects on productivity and worker health potentially influencing economic growth. Thus, it is important to determine the factors influencing the frequency of participation in physical activity for employed individuals. This paper uses a modified time allocation framework to explore this issue. We use data from the first six waves of the Household Income and Labour Dynamics of Australia survey (HILDA). The analysis examines frequency of participation in physical activity using a generalised random effects ordered probit model. We control for non-parallel cut-points between the physical activity categories and individual heterogeneity, as well as exploring differences across gender. The results indicate that there is a time trade-off between non-market work, market work, and the frequency of physical activity participation. This effect is moderated by gender. For example, dependent children have a larger negative effect on the frequency of physical activity participation for women. Education and marriage have a larger negative effect on the frequency of participation for men. The findings suggests that policies which make exercise more convenient, and hence decrease the opportunity cost of exercise, will help to encourage more frequent participation in physical activity for working adults.

Exploring the Factors Contributing to Sibling Correlations in BMI: A Study Using the Panel Study of Income Dynamics

Understanding the mechanisms contributing to correlated BMI outcomes in a social network such as siblings will help policy makers reduce the burden of disease associated with obesity. There are two potential mechanisms explaining correlated BMI outcomes in a biologically related social network: (i) time constant factors such as genetic heritability and habits formed during childhood and (ii) factors that change over time some of which are dependent on the frequency of interactions between the social network, for example, social norms shaped by the social networks shifting attitudes towards weight and behaviors related to weight, or environmental factors like opportunities for exercise. This study aims to distinguish between time constant factors from factors that are likely to change over time to gain a better understanding of the mechanisms explaining the correlation in sibling BMI. We exploit data from the Panel Study of Income Dynamics (PSID) over 1999–2007 estimating the correlation in BMI for adult siblings who currently live in separate households but grew‐up in the same household and adolescent siblings currently living in the same household to isolate the influence of factors that change over time. The findings indicate that time constant factors explain some of the overall correlation in sibling BMI for both cohorts of siblings. Factors that change over time only significantly impact on the overall correlation in BMI for adolescent siblings suggesting if there is a social network influence on correlations in BMI this is facilitated by sharing the same household.

The role of time preference in smoking cessation: a longitudinal analysis of data from the Household Income and Labour Dynamics of Australia survey, 2001-08.

AIMS Time preference describes how consideration of future events may affect present-day behavioural decisions. The aim was to establish whether time preference predicts smoking cessation in a longitudinal analysis. DESIGN Secondary analysis of data from the Household Income and Labour Dynamics of Australia survey. SETTING Australian community. PARTICIPANTS Members of the Household Income and Labour Dynamics of Australia survey panel, aged 15-64 years, who responded to at least four waves of data collection between 2001 and 2008, and reported any level of tobacco consumption at any wave. MEASUREMENTS Smoking cessation was measured using a self-report questionnaire. Time preference was measured using self-reported time-period for financial planning. A range of socio-demographic and smoking-related covariates were controlled for. FINDINGS A total of 1817 individuals were included in the analysis, representing 7913 separate observations. After controlling for socio-demographic and smoking-related covariates, the hazard ratio of quitting in those with longer versus shorter-term time preference (95% confidence intervals) = 1.28 (1.02-1.59). CONCLUSIONS Adult smokers with a longer-term time preference, who are more likely to consider future events when making present-day decisions, are more likely to quit smoking.

The NULevel trial of a scalable, technology-assisted weight loss maintenance intervention for obese adults after clinically significant weight loss: study protocol for a randomised controlled trial

BackgroundEffective weight loss interventions are widely available but, after weight loss, most individuals regain weight. This article describes the protocol for the NULevel trial evaluating the effectiveness and cost-effectiveness of a systematically developed, inexpensive, scalable, technology-assisted, behavioural intervention for weight loss maintenance (WLM) in obese adults after initial weight loss.Methods/DesignA 12-month single-centre, two-armed parallel group, participant randomised controlled superiority trial is underway, recruiting a total of 288 previously obese adults after weight loss of ≥5 % within the previous 12 months. Participants are randomly assigned to intervention or control arms, with a 1:1 allocation, stratified by sex and percentage of body weight lost (<10 % vs ≥10 %). Change in weight (kg) from baseline to 12 months is the primary outcome. Weight, other anthropometric variables and 7-day physical activity (assessed via accelerometer) measures are taken at 0 and 12 months. Questionnaires at 0, 6 and 12 months assess psychological process variables, health service use and participant costs. Participants in the intervention arm initially attend an individual face-to-face WLM consultation with an intervention facilitator and then use a mobile internet platform to self-monitor and report their diet, daily activity (via pedometer) and weight through daily weighing on wirelessly connected scales. Automated feedback via mobile phone, tailored to participants’ weight regain and goal progress is provided. Participants in the control arm receive quarterly newsletters (via links embedded in text messages) and wirelessly connected scales. Qualitative process evaluation interviews are conducted with a subsample of up to 40 randomly chosen participants. Acceptability and feasibility of procedures, cost-effectiveness, and relationships among socioeconomic variables and WLM will also be assessed.DiscussionIt is hypothesised that participants allocated to the intervention arm will show significantly lower levels of weight regain from baseline than those in the control arm. To date, this is the first WLM trial using remote real-time weight monitoring and mobile internet platforms to deliver a flexible, efficient and scalable intervention, tailored to the individual. This trial addresses a key research need and has the potential to make a vital contribution to the evidence base to inform future WLM policy and provision.Trial registrationhttp://www.isrctn.com/ISRCTN14657176 (registration date 20 March 2014).

Going the same 'weigh': spousal correlations in obesity in the United Kingdom

The obesity epidemic has received widespread media and research attention. However, the social phenomenon of obesity is still not well understood. Data from the British Household Panel Survey (BHPS) show positive and significant correlations in spousal body mass index (BMI). This article explores the three mechanisms of matching in the marriage market, social learning and shared environment to explain this correlation. We apply a novel method of testing for social learning by focusing on how the addition of individual and partner health and marriage length affects the correlation in spousal BMI. Results show the importance of matching in the marriage market in explaining correlated BMI outcomes. There is significant correlation in partner BMI even after controlling for own health, spouse health, marriage length and regional effects, suggesting evidence of a social influence. However, it does not appear to be a learning effect as the spouse health and marriage length are insignificant.

THE ROLE OF TIME PREFERENCES IN THE INTERGENERATIONAL TRANSFER OF SMOKING

Evidence suggests that maternal and offspring smoking behaviour is correlated. Little is known about the mechanisms through which this intergenerational transfer occurs. This paper explores the role of time preferences. Although time preference is likely to be heritable and correlated with health investments, its role in the intergenerational transmission of smoking has not been explored previously. This is the first paper to empirically test this. Data (2002, 2003, 2004, 2006 and 2008) from the Household, Income and Labour Dynamics in Australia are used. Estimates by using a pooled probit model show that there is not a direct effect of maternal time preference, measured in terms of financial planning horizon, on the likelihood that their offspring is a smoker. However, there is an indirect effect of maternal time preference. Sons of mothers that are smokers and have a shorter planning horizon are 6% more likely to smoke than if their mother had a longer planning horizon, and daughters of mothers that smoke with a shorter planning horizon are 7% more likely to smoke themselves than if their mother had a longer planning horizon.

Boosting health insurance coverage in developing countries: do conditional cash transfer programmes matter in Mexico?

BACKGROUND Achieving universal health insurance coverage is a goal for many developing countries. Even when universal health insurance programmes are in place, there are significant barriers to reaching the lowest socio-economic groups such as a lack of awareness of the programmes or knowledge of the benefits to participating in the insurance market. Conditional cash transfer (CCT) programmes can encourage participation through mandatory health education classes, increased contact with the health care system and cash payments to reduce costs of participating in the insurance market. OBJECTIVE To explore if participation in a CCT programme in Mexico, Oportunidades, is significantly associated with self-reported enrolment in a public health insurance programme. METHODS Cross-sectional data from 2007 collected on 29 595 Mexican households where the household head is aged between ages 15 and 60 were analysed. A logit model was used to estimate the association between Oportunidades participation and awareness of enrolment in a public health insurance programme. RESULTS Participation in the Oportunidades programme is associated with a 25% higher likelihood of being actively aware of enrolment in Seguro Popular, a public health insurance scheme for the lowest socio-economic groups. CONCLUSIONS Participation in the Oportunidades CCT programme is positively associated with awareness of enrolment in public health insurance. CCT programmes may be used to promote participation of the lowest socio-economic groups in universal public health insurance systems. This is crucial to achieving universal health insurance coverage in developing countries.

Marriage, BMI, and Wages: A Double Selection Approach

Obesity rates have been rising over the past decade. As more people become obese, the social stigma of obesity may be reduced. Marriage has typically been used as a positive signal to employers. If obese individuals possess other characteristics that are valued in the labour market they may no longer face a wage penalty for their physical appearance. This paper investigates the relationship between marital status, body mass index (BMI), and wages by estimating a double selection model that controls for selection into the labour and marriage markets using waves 14 and 16 (2004 and 2006) of the British Household Panel Survey. Results suggest that unobserved characteristics related to marriage and labour market participation are causing an upward bias on the BMI coefficients. The BMI coefficient is positive and significant for married men only in the double selection model. The findings provide evidence that unobserved characteristics related to success in the marriage and labour market may influence the relationship between BMI and wages.

Exploring the relationship between time preference, body fatness, and educational attainment

Obesity is a global health concern. This is the first study to explore if the relationship between body fatness and time preference is consistent across different ways of objectively measuring body fatness. Our second aim is to explore if there are differential associations between educational attainment and being a saver to determine if education can be used to change saving behaviour and subsequently body fatness. This paper uses data on 15,591 individuals from 2010/2011 of the Understanding Society Survey (UK) to explore the relationship between time preference, measured as being a saver and three objective measures of body fatness: BMI, percent body fatness (PBF), and waist circumference (WC). Our findings show that there is a negative relationship between the three measures of body fatness and being a saver. The strongest relationship is found for WC and being a saver for both genders. Overall, a stronger association is found for women than men. Our results suggest that differential effects by educational attainment can be found in the relationship between being a saver and body fatness. Educational interventions to improve savings behaviour and subsequently obesity may be more effective for women with lower levels of education.

A pilot feasibility trial of alcohol screening and brief intervention in the police custody setting (ACCEPT): study protocol for a cluster randomised controlled trial

BackgroundThere is evidence of an association between alcohol use and offending behaviour and around a quarter of police time is spent on alcohol-related incidents. Police custody, therefore, provides an important opportunity to intervene. This pilot trial aims to investigate whether a definitive evaluation of screening and brief interventions aimed at reducing risky drinking in arrestees is acceptable and feasible in the custody suite setting.MethodsScreening will be carried out by trained detention officers or drug and alcohol workers in four police forces across two geographical areas (North East and South West England). Detention officers (or drug and alcohol workers) will be cluster randomised to one of three conditions: screening only (control group), screening followed immediately by 10 min of manualised brief structured advice delivered by the individual responsible for screening (intervention 1) or screening followed by 10 min of manualised brief structured advice delivered by the individual responsible for screening plus the offer of a subsequent 20-min session of behaviour change counselling delivered by a trained alcohol health worker (intervention 2). Participants will be arrestees aged 18+ who screen positive on the Alcohol Use Disorders Identification Test. Participants will be followed up at 6 and 12 months post-intervention. An embedded qualitative process evaluation will explore acceptability of alcohol screening and brief intervention to staff and arrestees as well as facilitators and barriers to the delivery of such approaches in this setting.ResultsRecruitment is currently underway and due to end May 2015.ConclusionResults from this pilot trial will determine if a definitive evaluation is possible in the future and will provide stakeholder input to its design.Trial registrationReference number: ISRCTN89291046.