Kim Jose

Childhood and adolescent predictors of leisure time physical activity during the transition from adolescence to adulthood: a population based cohort study.

BackgroundFew studies have investigated factors that influence physical activity behavior during the transition from adolescence to adulthood. This study explores the associations of sociodemographic, behavioral, sociocultural, attitudinal and physical factors measured in childhood and adolescence with physical activity behavior during the transition from adolescence to adulthood.MethodsChildhood and adolescent data (at ages 7-15 years) were collected as part of the 1985 Australian Health and Fitness Survey and subdivided into sociodemographics (socioeconomic status, parental education), behavioral (smoking, alcohol, sports diversity, outside school sports), sociocultural (active father, active mother, any older siblings, any younger siblings, language spoken at home), attitudinal (sports/recreational competency, self-rated health, enjoyment physical education/physical activity, not enjoying school sports) and physical (BMI, time taken to run 1.6 km, long jump) factors. Physical activity between the ages 15 and 29 years was reported retrospectively using the Historical Leisure Activity Questionnaire at follow-up in 2004-2006 by 2,048 participants in the Childhood Determinants of Adult Health Study (CDAH). Australias physical activity recommendations for children and adults were used to categorize participants as persistently active, variably active or persistently inactive during the transition from adolescence to adulthood.ResultsFor females, perceived sports competency in childhood and adolescence was significantly associated with being persistently active (RR = 1.88, 95% CI = 1.39, 2.55). Smoking (RR = 0.31 CI = 0.12, 0.82) and having younger siblings (RR = 0.69 CI = 0.52, 0.93) were inversely associated with being persistently active after taking physical and attitudinal factors into account. For males, playing sport outside school (RR = 1.47 CI = 1.05, 2.08), having active fathers (RR = 1.25 CI = 1.01, 1.54) and not enjoying school sport (RR = 4.07 CI = 2.31, 7.17) were associated with being persistently active into adulthood. Time taken to complete the 1.6 km run was inversely associated with being persistently active into adulthood (RR = 0.85 CI = 0.78, 0.93) after adjusting for recreational competency.ConclusionsPerceived sports competency (females) and cardiorespiratory fitness, playing sport outside school and having active fathers (males) in childhood and adolescence were positively associated with being persistently active during the transition from adolescence to adulthood.

The support needs of patients waiting for publicly funded bariatric surgery - implications for health service planners

The objective of this study was to investigate the experience of waiting for publicly funded bariatric surgery in an Australian tertiary healthcare setting. Focus groups and individual interviews involving people waiting for or who had undergone publicly funded bariatric surgery were audio‐recorded, transcribed and analysed thematically. A total of 11 women and 6 men engaged in one of six focus groups in 2014, and an additional 10 women and 9 men were interviewed in 2015. Mean age was 53 years (range 23–66); mean waiting time was 6 years (range 0–12), and mean time since surgery was 4 years (range 0–11). Waiting was commonly reported as emotionally challenging (e.g. frustrating, depressing, stressful) and often associated with weight gain (despite weight‐loss attempts) and deteriorating physical health (e.g. development of new or worsening obesity‐related comorbidity or decline in mobility) or psychological health (e.g. development of or worsening depression). Peer support, health and mental health counselling, integrated care and better communication about waitlist position and management (e.g. patient prioritization) were identified support needs. Even if wait times cannot be reduced, better peer and health professional supports, together with better communication from health departments, may improve the experience or outcomes of waiting and confer quality‐of‐life gains irrespective of weight loss.

Tasmania’s child and family centres: a place-based early childhood services model for families and children from pregnancy to age five

ABSTRACT Tasmania’s child and family centres (Centres) provide a single entry point to early childhood services (ECS) for children and families living in amongst the most disadvantaged communities in Australia. This study investigated the impact of Centres on parents’ use and experiences of ECS using a mixed methods approach. The results showed that Centre users made more use of ECS than did non-users. Centre users also rated their experiences of ECS more positively than non-users. For example, Centre users were more likely to report that ECS were convenient and close, committed to helping, and worked closely with one another. Centre users identified Centres as informal, accessible, responsive, non-judgemental and supportive places where they felt valued, respected and safe. Parents experienced Centres as welcoming places that were helping them to develop positive child, family, school and community connections. These qualities appeared critical for facilitating parental access and engagement in ECS.

Partnering Healthy@Work: an Australian university—government partnership facilitating policy-relevant research

Research funding is increasingly supporting collaborations between knowledge users and researchers. Partnering Healthy@Work (pH@W), an inaugural recipient of funding through Australias Partnership for Better Health Grants scheme, was a 5-year partnership between the Menzies Institute for Medical Research, University of Tasmania and the Tasmanian State Service (TSS). The partnerships purpose was to evaluate a comprehensive workplace health promotion programme (Healthy@Work) targeting 30 000 public sector employees; generating new knowledge and influencing workplace health promotion policy and decision-making. This mixed methods study evaluates the partnership between policy-makers and academics and identifies strategies that enabled pH@W to deliver key project outcomes. A pH@W document review was conducted, two partnership assessment tools completed and semi-structured interviews conducted with key policy-makers and academics. Analysis of the partnership assessment tools and interviews found that pH@W had reached a strong level of collaboration. Policy-relevant knowledge was generated about the health of TSS employees and their engagement with workplace health promotion. Knowledge exchange of a conceptual and instrumental nature occurred and was facilitated by the shared grant application, clear governance structures, joint planning, regular information exchange between researchers and policy-makers and research student placements in the TSS. Flexibility and acknowledgement of different priorities and perspectives of partner organizations were identified as critical factors for enabling effective partnership working and research relevance. Academic-policy-maker partnerships can be a powerful mechanism for improving policy relevance of research, but need to incorporate strategies that facilitate regular input from researchers and policy-makers in order to achieve this.

Understanding the gendered nature of weight loss surgery: insights from an Australian qualitative study

ABSTRACT Internationally, weight loss surgery is primarily undertaken by women (75%). This difference has been attributed to the appearance concerns of women which is a simplistic and unsatisfactory explanation. The study aims to explore the way gender influences the processes leading up to surgery and life after surgery providing important new insights into the differences in uptake of weight loss surgery between men and women. Ten single-gender focus groups were conducted in Australia in 2014 (Women = 32, Men = 17). Aspects of particular importance for understanding the gendered nature of weight loss surgery include different understandings of the mechanisms that contribute to weight gain, the relationship with food, experiences of having a big body and approaches to disclosure of surgery. To maximise outcomes following surgery, health services and supports need to give greater consideration to the way gender influences experiences for men and women pre and post-surgery.

Barriers and facilitators to participation in workplace health promotion (WHP) activities: results from a cross-sectional survey of public-sector employees in Tasmania, Australia

Issue addressed Workplaces are promising settings for health promotion, yet employee participation in workplace health promotion (WHP) activities is often low or variable. This study explored facilitating factors and barriers associated with participation in WHP activities that formed part of a comprehensive WHP initiative run within the Tasmanian State Service (TSS) between 2009 and 2013. Methods TSS employee (n=3228) completed surveys in 2013. Data included sociodemographic characteristics, employee-perceived availability of WHP activities, employee-reported participation in WHP activities, and facilitators and barriers to participation. Ordinal log-link regression was used in cross-sectional analyses. Results Significant associations were found for all facilitating factors and participation. Respondents who felt their organisation placed a high priority on WHP, who believed that management supported participation or that the activities could improve their health were more likely to participate. Time- and health-related barriers were associated with participation in fewer activities. All associations were independent of age, sex, work schedule and employee-perceived availability of programs. Part-time and shift-work patterns, and location of activities were additionally identified barriers. Conclusion Facilitating factors relating to implementation, peer and environmental support, were associated with participation in more types of activities, time- and health-related barriers were associated with less participation. So what? Large and diverse organisations should ensure WHP efforts have manager support and adopt flexible approaches to maximise employee engagement.

Who discusses reaching a healthy weight with a general practitioner? Findings from the 2014–15 Australian National Health Survey

OBJECTIVE General practitioners (GPs) can positively impact upon patient intentions to lose weight and weight management, and are important in the referral pathway to specialist weight-loss programs and surgical interventions. The aim of this study was to investigate the characteristics and proportions of Australians who report talking to a GP about weight management. METHODS Cross-sectional data from 15,329 participants aged 15 years and over in the 2014-15 Australian National Health Survey were used. Proportions (with 95% confidence intervals (95%CI)) of respondents who reported discussing reaching a healthy weight with a GP in the previous 12 months were estimated, categorised by demographic, social and health characteristics. RESULTS We found that 10.8% (95%CI:9.8-11.8) of overweight participants, 24.4% (95%CI:22.7-26.4) with Class 1 obesity (30≤BMI <35kg/m2) and 41.8% (95%CI:38.3-45.3) with Classes II/III obesity (BMI≥35kg/m2) reported discussing weight with a GP. Higher proportions of respondents with Class II/Class III obesity and poor/fair self-reported health (50.2%, 95%CI:43.3-57.0), or high/very high levels of psychological distress (53.3%, 95%CI:43.7-61.4), or diabetes (64.8%, 95%CI:51.9-77.3) reported discussing weight. As age, number of GP visits, or comorbid conditions increased, the proportions of people who discussed their weight with a GP also increased, across all weight classes. CONCLUSIONS While discussions are more likely with increasing BMI and comorbidities, most Australians with overweight and obesity appear to be missing opportunities to discuss reaching a healthy weight with their GP. Policies, training and education programs to encourage this dialogue could lead to earlier and more beneficial weight-related interventions.

Tasmania’s child and family centres building parenting capability: a mixed methods study

ABSTRACT Tasmania’s Child and Family Centres (Centres) provide a single entry point to early childhood services (ECS) and aim to improve the health and well-being, education and care of Tasmania’s children through supporting families and carers. This mixed methods study investigated the impact of Centres on parents’ confidence and competence. Centre users reported a slightly lower overall sense of parenting competence than non-users. There was no difference between Centre users and non-users in how they felt overall as a parent. Compared to non-Centre users, Centre users were more likely to report that ECS helped them develop new parenting skills. Centres supported parenting practices through a range of formal (i.e. parenting courses) and informal (i.e. role modelling) strategies. Centre users indicated that the combination of formal and informal parenting supports worked together to assist them build new parenting skills. The Centre model and partnership approach facilitates the development of positive parenting practices.

A qualitative study of the role of Australian general practitioners in the surgical management of obesity

General practitioners (GPs) are increasingly managing patients with class 2 and 3 obesity (body mass index [BMI] > 35 and 40 kg/m2, respectively). Bariatric surgery is considered for patients with class 2 obesity and comorbidities or class 3 obesity where sustained weight loss using non‐surgical interventions has not been achieved. In Australia, GPs facilitate access to surgery through referral processes, but the nature of GP involvement in bariatric pre‐ and post‐surgery care is currently unclear. This qualitative study involved 10 in‐depth interviews with GPs and 20 interviews with adults who had all undergone laparoscopic adjustable gastric banding (LAGB) for weight management in Tasmania, Australia. Interviews were transcribed and analysed thematically. Referrals for bariatric surgery commonly occurred at the patients request or to manage comorbidity. Consistent with previous studies, for GPs, referral patterns were influenced by previous case experience and patients’ financial considerations. Accessibility of surgery was also a consideration. Post‐surgery, there was a lack of clarity about the role of GPs, with patients generally preferring the surgical team to manage the LAGB. In bariatric surgery, patient preference for surgery, access and comorbidity are key drivers for referral and post‐surgical monitoring and support. Greater role clarity and enhanced collaboration between surgeons, GPs and patients following surgery is likely to enhance the experience and outcomes for patients.

Young adult perceptions of Australia's physical activity recommendations for adults.

ISSUES ADDRESSED Physical activity recommendations for adults worldwide advise participation in moderate-intensity physical activity, such as walking, on most days of the week. Younger adults report the lowest prevalence of walking. This mixed-methods study explores the salience of Australias activity recommendations around moderate-intensity physical activity, particularly walking, for young Australian adults. METHODS Semistructured interviews were conducted with 24 young Australians aged 17-25 years. During interviews, Australias physical activity recommendations for adults were explained to participants, highlighting the inclusion of moderate-intensity physical activity such as walking. Participants were asked to comment on the recommendations and walking for physical activity and exercise. Data from interviews underwent an iterative thematic form of analysis. Participants also completed the International Physical Activity Questionnaire (IPAQ) and were asked to complete a pedometer diary. RESULTS No participant was classified as sedentary; twenty three participants reported walking for transport and nine for leisure (IPAQ). During interviews, the majority of participants (n=20) did not identify walking as physical activity or exercise. Participants focussed on the cardiorespiratory (fitness) benefits associated with physical activity and believed walking was of insufficient intensity to achieve these benefits at their age. CONCLUSIONS Walking was considered an everyday activity and of insufficient intensity to achieve any health or fitness benefits. SO WHAT?: The belief that only vigorous physical activity conveys any fitness benefits may act as a barrier to participation in moderate-intensity physical activity such as walking, particularly among sedentary young people.