Neville Owen

The association between television viewing and overweight among Australian adults participating in varying levels of leisure-time physical activity.

OBJECTIVES: To investigate the effect of physical activity on the association between television viewing and overweight (body mass index (BMI) ≥25 kg/m2).DESIGN: Cross-sectional study administered by interview to adults randomly selected from the electronic white pages.SUBJECTS: 3392 adults (64% response rate) from a representative population sample in the State of New South Wales, Australia.MEASUREMENTS: Self-reported height and weight, two-week leisure-time physical activity recall, one-week average television viewing recall.RESULTS: BMI and physical activity patterns were both associated with hours of television watched. Compared to those participants who reported watching less than one hour of television per day, those watching 1 to 2.5 hours were 93% more likely to be overweight (BMI≥25 kg/m2), those watching 2.5 to 4 hours were 183% more likely to be overweight, those watching more than 4 hours per day were four times more likely to be overweight. Physical activity was not directly associated with being overweight, but an interaction between activity and television watching was present. Respondents in the low, moderate and high physical activity categories who reported watching more than 4 hours of television per day were twice as likely to be overweight compared to those who watched less than one hour of television per day, irrespective of physical activity participation.CONCLUSIONS: With approximately half the Australian adult population overweight or obese, these findings indicate that public health strategies to reduce overweight and prevent weight gain may need to focus on reducing sedentary behaviours such as television viewing in addition to increasing physical activity.

Effects of workplace smoking bans on cigarette consumption.

A sample of staff working in the Australian Public Service (n = 2113) were surveyed two to four weeks before a mandated total ban on workplace smoking was introduced, and again five to six months later. Among the 391 smokers on whom complete data were available, the workplace smoking bans were associated with reduced rates of smoking, particularly among heavier smokers where the reduction in consumption was over 25 percent.

Work-site cardiovascular risk reduction: a randomized trial of health risk assessment, education, counseling, and incentives.

OBJECTIVES This study reports an efficacy trial of four work-site health promotion programs. It was predicted that strategies making use of behavioral counseling would produce a greater reduction in cardiovascular disease risk factors than screening and educational strategies. METHODS Twenty-eight work sites were randomly allocated to a health risk assessment, risk factor education, behavioral counseling, or behavioral counseling plus incentives intervention. Participants were assessed before the intervention and at 3, 6, and 12 months. RESULTS Compared with the average of the health risk assessment and risk factor education conditions, there were significantly higher validated continuous smoking cessation rates and smaller increases in body mass index and estimated percentage of body fat in the two behavioral counseling conditions. The behavioral counseling condition was associated with a greater reduction in mean blood pressure than was the behavioral counseling plus incentives condition. On average among all groups, there was a short-term increase in aerobic capacity followed by a return to baseline levels. CONCLUSIONS Work-site interventions that use behavioral approaches can produce lasting changes in some cardiovascular risk factors and, if implemented routinely, can have a significant public health impact.

Predicting attempts and sustained cessation of smoking after the introduction of workplace smoking bans.

Examined predictors of smoking cessation attempts and predictors of the outcome of those attempts after the introduction of a workplace smoking ban. Smokers were surveyed in the month before the ban came into force, and variables collected at that time were used to predict outcomes 6 months later. Data from 491 respondents who were smokers at the time of the initial survey were used, and a set of potential predictor variables was chosen on both theoretical and empirical grounds. Making a cessation attempt was predicted by the strength of desire to quit and, to less extent, by not having been subject to extensive restrictions on smoking before the mandated ban, having tried to quit before, perceiving oneself high in ability to quit, and being worried about smoke at work. For the outcome of cessation attempts among those who tried, success was best predicted by low levels of a composite habit strength variable and, to less extent, by desire to quit, no previous attempts to quit, the existence of social supports for quitting, and educational status. Although cognitive variables were important in predicting attempts, they played only a minor role in predicting maintenance. Behavioral and environmental variables contributed slightly to prediction of attempts and strongly to prediction of maintenance.

The relationship between body mass index and waist circumference: implications for estimates of the population prevalence of overweight.

OBJECTIVE: Body mass index (BMI) based on self‐reported height and weight is a systematically biased, but acceptable measure of adiposity and is commonly used in population surveys. Recent studies indicate that abdominal obesity is more strongly associated with obesity‐related health problems than is adiposity measured by BMI. The purpose of this study was to determine the relationships of both measured and self‐reported BMI with measured waist circumference in a randomly selected sample of Australian adults.DESIGN: Cross‐sectional survey with self‐reported and laboratory‐based measures of adiposity.SUBJECTS: 1140 randomly‐selected Australian adults aged 18–78 y resident in the city of Adelaide, South Australia.MEASUREMENTS: Data on self‐reported and measured height and weight as well as measured waist circumference were drawn from the Pilot Survey of the Fitness of Australians database. The proportion of men and women with acceptable BMI (BMI≤25 kg/m2) and with excess abdominal adiposity (≥94 cm for men and ≥80 cm for women) was determined. Differences in the prevalence of overweight based on BMI alone or BMI and waist circumference were also determined.RESULTS: Compared with the prevalence based on self‐reported BMI alone, the prevalence of overweight among men based on self‐reported BMI and waist circumference combined was 2.4%, 5.3%, 19.1% and 7.5% greater for men aged 18–39 y, 40–59 y, 60–78 y and for all men, respectively. Among women, compared with the prevalence based on self‐reported BMI alone, the prevalence of overweight based on the combined measures was 9.9%, 24.0%, 33.3% and 20.6% greater for women aged 18–39 y, 40–59 y, 60–78 y and for all women, respectively.CONCLUSIONS: If waist circumference is used as the criterion, then the prevalence of overweight among Australian adults, and probably other Caucasian populations, may be significantly greater than indicated by surveys relying on self‐reported height and weight. The development of valid self‐reported measures of waist circumference for use in population surveys may allow more accurate epidemiological monitoring of overweight and obesity.

Serial mass-media campaigns to promote physical activity: reinforcing or redundant?

Changes associated with two serial, nationwide, mass-media-based campaigns to promote physical activity conducted by the National Heart Foundation of Australia in 1990 and 1991 were examined. Surveys conducted before and after each campaign found statistically significant differences in message awareness (46% vs 71% in 1990; 63% vs 74% in 1991). In 1990, there were significant increases in walking, particularly among older people, and in intentions to exercise. No such changes were apparent in 1991. In the case of these two campaigns, conducted 1 year apart, the second may have been redundant.

Can psychiatric and chemical dependency treatment units be smoke free

The feasibility and appropriateness of establishing smoke-free psychiatric and chemical dependency treatment units are topics of recent interest. This paper reviews the literature on the implementation of smoke-free policies in psychiatric and chemical dependency treatment units. Several issues are addressed including (a) the concerns raised by treatment staff regarding the implementation of a smoke-free policy, (b) the effects of involuntary smoking cessation or reduction on the treatment and/or recovery of patients, (c) the utilization of smoking cessation interventions by patients and staff, and (d) the effects of a smoke-free environment on the smoking behavior of patients and staff. It is concluded that a smoke-free environment is a reasonable and achievable goal in these settings. However, the implementation of a smoke-free policy in chemical dependency treatment units has met with several more problems than those observed in psychiatric settings. Recommendations for further clinical research and program implementation are offered.

Changes in acceptance of workplace smoking bans following their implementation: a prospective study.

Recent cross-sectional and retrospective studies suggest that the attitudes of employees toward workplace smoking bans may become more positive after the bans have been introduced. Using a prospective design, we found that the attitudes of nonsmokers, ex-smokers, and smokers became more favorable over the 6 months following the introduction of smoking bans to Australian Government Offices. The magnitude of changes in approval ratings was greatest for smokers, but smokers were also more likely to disapprove of the bans before and after their introduction than were nonsmokers and ex-smokers. Among smokers, there was a strong relationship between the extent to which they saw themselves inconvenienced by the bans and the extent to which they disapproved of them. Overall, the bans were accepted and viewed in a positive light, but there was nevertheless a significant minority of smokers who remained disgruntled with them. Some ways in which the concerns of this subgroup of smokers may be addressed are considered.

Associations of social status and health-related beliefs with dietary fat and fiber densities

BACKGROUND Lower social status groups have higher mortality rates from some diet-related diseases and higher dietary fat and lower dietary fiber intakes. Such dietary patterns have been found to be related to social status, environmental influences, and health-related beliefs and expectations. METHODS Associations of social status and diet-related and health-related beliefs and expectations with dietary fat and fiber densities were examined in a population sample of 874 respondents to a postal questionnaire. A food frequency listing of 172 foods was used to assess usual dietary intake. RESULTS More positive beliefs and expectations were associated with lower dietary fat and higher dietary fiber densities in univariate models; beliefs and expectations differed little between social status groups. In multivariate models, stronger perceptions of external influences on food choices, fewer perceived barriers to eating a healthy diet, and social status were independently associated with low dietary fat density. Diet-related and health-related beliefs and perceptions of external influences on food choices, but not social status, were independently associated with high dietary fiber density. The belief that diet is a major cause of stroke, diabetes, and hypertension was weakly associated with the dietary fiber density of lower social status groups. CONCLUSIONS Social status and perceptions of external influences on dietary choice, as well as personal beliefs, have independent associations with food intake. Although exclusive targeting of lower social status groups is not indicated, interventions to increase dietary fiber intake should address expectations, attitudes, and beliefs about dietary fiber and health and perceptions of external influences on food choices, especially among lower status groups; interventions to lower dietary fat intake should address a broad range of external and social factors, as well as personal beliefs.

Smoking cessation by mail: A comparison of standard and personalized correspondence course formats

Self-Instructional behavior-change programs for reducing risks to health are potentially widely available, acceptable and cost-effective. This paper reports outcomes of a smoking cessation program administered by mail. Two hundred and eight smokers were allocated systematically to a quit kit control condition (n = 40), to a standard correspondence course (n = 86) and to a personalized correspondence course prepared with the aid of a microcomputer (n = 82). There were significantly higher rates of abstinence after the course for correspondence course participants compared to controls, but these differences did not persist at three-month and nine-month follow-ups. There were no differences between the personalized and standard courses on abstinence rates, number of cigarettes smoked per day, or return of feedback forms on each lesson. There were associations between self-efficacy strength and reduced rates of smoking, and active participation in the course was associated with lower smoking rates.