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Hooper P, Giles-Corti B, Knuiman M. Evaluating the Implementation and Active Living Impacts of a State Government Planning Policy Designed to Create Walkable Neighborhoods in Perth, Western Australia. Am J Health Promot 2014; 28:S5-18. [DOI: 10.4278/ajhp.130503-quan-226] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. Evaluate the implementation of a government planning policy (Liveable Neighbourhoods Guidelines) and its impacts on residents' walking behaviors. Design. Cross-sectional study of participants from the RESIDential Environments project (RESIDE). Setting. Nineteen “liveable” and 17 “conventionally designed” housing developments across Perth, Western Australia. Subjects. Five hundred ninety-four participants from RESIDE who resided in 36 housing developments. Measures. Developed in geographic information systems to assess the on-ground implementation of 43 policy requirements. Policy compliance was defined as the degree to which construction of the developments adhered to the standards outlined. Walking behaviors were measured using the Neighborhood Physical Activity Questionnaire. K-means cluster analyses identified groups of homogeneous developments with respect to policy implementation. Analysis. Logistic regression with generalized estimating equations estimated the odds ratios (ORs) and 95% confidence intervals (95% CIs) for the likelihood of undertaking any and ≥ 60 minutes of transport and recreational walking associated with (1) policy compliance and (2) different clusters of developments. Results. There were few significant differences in on-ground outcomes between the two development types. Despite incomplete implementation, the odds of walking for transport increased with overall levels of policy compliance (OR= 1.53, 95% CI 1.13–2.08) and compliance with the community design (OR = 1.3, 95% CI 1.13–1.42), movement network (OR = 2.49, 95% CI 1.38–4.50), and lot layout elements (OR = 1.26, 95% CI 1.06–1.50). Conclusion. Consistent with the aims of the policy, residents in walkable (i.e., liveable) neighborhoods may be more physically active.
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Villanueva K, Knuiman M, Koohsari MJ, Hickey S, Foster S, Badland H, Nathan A, Bull F, Giles-Corti B. People living in hilly residential areas in metropolitan Perth have less diabetes: spurious association or important environmental determinant? Int J Health Geogr 2013; 12:59. [PMID: 24359514 PMCID: PMC3878017 DOI: 10.1186/1476-072x-12-59] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 12/16/2013] [Indexed: 12/17/2022] Open
Abstract
Background Variations in ‘slope’ (how steep or flat the ground is) may be good for health. As walking up hills is a physiologically vigorous physical activity and can contribute to weight control, greater neighbourhood slopes may provide a protective barrier to weight gain, and help prevent Type 2 diabetes onset. We explored whether living in ‘hilly’ neighbourhoods was associated with diabetes prevalence among the Australian adult population. Methods Participants (≥25 years; n = 11,406) who completed the Western Australian Health and Wellbeing Surveillance System Survey (2003–2009) were asked whether or not they had medically-diagnosed diabetes. Geographic Information Systems (GIS) software was used to calculate a neighbourhood mean slope score, and other built environment measures at 1600 m around each participant’s home. Logistic regression models were used to predict the odds of self-reported diabetes after progressive adjustment for individual measures (i.e., age, sex), socioeconomic status (i.e., education, income), built environment, destinations, nutrition, and amount of walking. Results After full adjustment, the odds of self-reported diabetes was 0.72 (95% CI 0.55-0.95) and 0.52 (95% CI 0.39-0.69) for adults living in neighbourhoods with moderate and higher levels of slope, respectively, compared with adults living in neighbourhoods with the lowest levels of slope. The odds of having diabetes was 13% lower (odds ratio 0.87; 95% CI 0.80-0.94) for each increase of one percent in mean slope. Conclusions Living in a hilly neighbourhood may be protective of diabetes onset or this finding is spurious. Nevertheless, the results are promising and have implications for future research and the practice of flattening land in new housing developments.
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Villanueva K, Knuiman M, Nathan A, Giles-Corti B, Christian H, Foster S, Bull F. The impact of neighborhood walkability on walking: does it differ across adult life stage and does neighborhood buffer size matter? Health Place 2013; 25:43-6. [PMID: 24239702 DOI: 10.1016/j.healthplace.2013.10.005] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 10/07/2013] [Accepted: 10/13/2013] [Indexed: 10/26/2022]
Abstract
We explored the impact of neighborhood walkability on young adults, early-middle adults, middle-aged adults, and older adults' walking across different neighborhood buffers. Participants completed the Western Australian Health and Wellbeing Surveillance System Survey (2003-2009) and were allocated a neighborhood walkability score at 200m, 400m, 800m, and 1600m around their home. We found little difference in strength of associations across neighborhood size buffers for all life stages. We conclude that neighborhood walkability supports more walking regardless of adult life stage and is relevant for small (e.g., 200m) and larger (e.g., 1600m) neighborhood buffers.
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Bell L, Hung J, Knuiman M, Divitini M, Beilby J, Hunter M, Mollison L, Thompson P, McQuillan B, Davis E. Body mass index and waist circumference: relationship to cardiometabolic risk factors in children--Busselton Health Study 2005-2007. J Paediatr Child Health 2013; 49:955-962. [PMID: 23802746 DOI: 10.1111/jpc.12298] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/28/2013] [Indexed: 01/08/2023]
Abstract
AIM This study aims to analyse the continuous relationship of each cardiometabolic risk factor with body mass index (BMI) and waist circumference percentiles in a population-based sample of children. METHODS A cross-sectional sample of 996 school children aged 6-16.9 years in Busselton, Western Australia, (2005-2007) had anthropometry and fasting blood tests for total cholesterol, high density lipoprotein, low density lipoprotein, triglycerides, glucose, insulin, high-sensitive C-reactive protein, liver function tests and adiponectin. Age- and menarche (for girls)-adjusted means of each risk factor were related to BMI and waist circumference centiles across the full normal-overweight-obese range. RESULTS The correlations between BMI and waist circumference (boys 0.91 and girls 0.91) and between BMI z-score and waist z-score (boys 0.80 and girls 0.82) were high. An increase in insulin across all centile groups (for BMI and waist circumference) was found in both sexes. An increase was found for diastolic blood pressure and systolic blood pressure z-score, high density lipoprotein, high-sensitive C-reactive protein, alanine transaminase and gamma-glutamyltransferase in only the centile groups >85% for BMI and waist circumference for both sexes. Mixed and sex-discordant results were found for triglycerides, adiponectin and glucose. CONCLUSION There are important differences in the relationships between increasing BMI/adiposity, and each comorbidity and these relationships can differ between boys and girls. This information has implications for screening and management of adiposity-related cardiometabolic risk factors in children and for public health initiatives to reduce future burden of cardiovascular disease.
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Davies C, Knuiman M, Pikora T, Rosenberg M. Health in arts: are arts settings better than sports settings for promoting anti-smoking messages? Perspect Public Health 2013; 135:145-51. [PMID: 24132328 DOI: 10.1177/1757913913502475] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM Tobacco smoking is a leading cause of preventable mortality and morbidity. Since 1991, the Western Australian Health Promotion Foundation (Healthway) has sponsored the arts and sport in exchange for cigarette smoke-free events, smoke-free policies and the promotion of anti-smoking messages (e.g. Quit, Smoke Free or Smarter than Smoking). As health promoters often look for innovative and effective settings to advocate health, and as the approach of sponsoring the arts to promote health to the general population is uncommon, the purpose of this study was to evaluate the effectiveness of 'health in arts' by measuring the cognitive impact (message awareness, comprehension, acceptance and intention) of promoting anti-smoking messages at arts events, and comparing findings to sports events, a more traditional health promotion setting. METHOD A secondary analysis of the 2004-2009 Healthway Sponsorship Monitor data was conducted. A total of 12 arts events (n = 592 respondents) and 9 sports events (n = 420 respondents) sponsored by Healthway to promote an anti-smoking message were evaluated. The study was cross-sectional in design. Participants were residents of Western Australia aged 15 years or above and attended events as part of an audience or as a spectator. Descriptive and regression analyses were conducted. RESULTS After adjustment for demographic variables, smoking status and clustering, arts events were found to be as effective in promoting anti-smoking message awareness, comprehension and acceptance and twice as effective on intention to act (p = .03) compared with sports events. CONCLUSION This study provides evidence of the effectiveness of arts sponsorship to promote health to the general population, that is, health in arts. Promoting an anti-smoking message in arts settings was as, or more, effective than in sports settings. Results suggest that the arts should be utilised to communicate and reinforce anti-smoking messages to the general population. The suitability of the arts to promote other types of health messages should be investigated further.
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Hung J, Teng THK, Finn J, Knuiman M, Briffa T, Stewart S, Sanfilippo FM, Ridout S, Hobbs M. Trends from 1996 to 2007 in incidence and mortality outcomes of heart failure after acute myocardial infarction: a population-based study of 20,812 patients with first acute myocardial infarction in Western Australia. J Am Heart Assoc 2013; 2:e000172. [PMID: 24103569 PMCID: PMC3835218 DOI: 10.1161/jaha.113.000172] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background Advances in treatment for acute myocardial infarction (AMI) are likely to have had a beneficial impact on the incidence of and deaths attributable to heart failure (HF) complicating AMI, although limited data are available to support this contention. Methods and Results Western Australian linked administrative health data were used to identify 20 812 consecutive patients, aged 40 to 84 years, without prior HF hospitalized with an index (first) AMI between 1996 and 2007. We assessed the temporal incidence of and adjusted odds ratio/hazard ratio for death associated with HF concurrent with AMI admission and within 1 year after discharge. Concurrent HF comprised 75% of incident HF cases. Between the periods 1996–1998 and 2005–2007, the prevalence of HF after AMI declined from 28.1% to 16.5%, with an adjusted odds ratio of 0.50 (95% CI, 0.44 to 0.55). The crude 28‐day case‐fatality rate for patients with concurrent HF declined marginally from 20.5% to 15.9% (P<0.05) compared with those without concurrent HF, in whom the case‐fatality rate declined from 11.0% to 4.8% (P<0.001). Concurrent HF was associated with a multivariate‐adjusted odds ratio of 2.2 for 28‐day mortality and a hazard ratio of 2.2 for 1‐year mortality in 28‐day survivors. Occurrence of HF within 90 days of the index AMI was associated with an adjusted hazard ratio of 2.7 for 1‐year mortality in 90‐day survivors. Conclusions Despite encouraging declines in the incidence of HF complicating AMI, it remains a common problem with high mortality. Increased attention to these high‐risk patients is needed given the lack of improvement in their long‐term prognosis.
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James A, Hunter M, Straker L, Beilby J, Bucks R, Davis T, Eikelboom RH, Hillman D, Hui J, Hung J, Knuiman M, Mackey DA, Newton RU, Palmer LJ, Musk AWB. Rationale, design and methods for a community-based study of clustering and cumulative effects of chronic disease processes and their effects on ageing: the Busselton healthy ageing study. BMC Public Health 2013; 13:936. [PMID: 24099269 PMCID: PMC3852572 DOI: 10.1186/1471-2458-13-936] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 09/13/2013] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The global trend of increased life expectancy and increased prevalence of chronic and degenerative diseases will impact on health systems. To identify effective intervention and prevention strategies, greater understanding of the risk factors for and cumulative effects of chronic disease processes and their effects on function and quality of life is needed.The Busselton Healthy Ageing Study aims to enhance understanding of ageing by relating the clustering and interactions of common chronic conditions in adults to function. Longitudinal (3-5 yearly) follow-up is planned. METHODS/DESIGN Phase I (recruitment) is a cross-sectional community-based prospective cohort study involving up to 4,000 'Baby Boomers' (born from 1946 to 1964) living in the Busselton Shire, Western Australia. The study protocol involves a detailed, self-administered health and risk factor questionnaire and a range of physical assessments including body composition and bone density measurements, cardiovascular profiling (blood pressure, ECG and brachial pulse wave velocity), retinal photography, tonometry, auto-refraction, spirometry and bronchodilator responsiveness, skin allergy prick tests, sleep apnoea screening, tympanometry and audiometry, grip strength, mobility, balance and leg extensor strength. Cognitive function and reserve, semantic memory, and pre-morbid intelligence are assessed. Participants provide a fasting blood sample for assessment of lipids, blood glucose, C-reactive protein and renal and liver function, and RNA, DNA and serum are stored. Clinically relevant results are provided to all participants. The prevalence of risk factors, symptoms and diagnosed illness will be calculated and the burden of illness will be estimated based on the observed relationships and clustering of symptoms and illness within individuals. Risk factors for combinations of illness will be compared with those for single illnesses and the relation of combinations of illness and symptoms to cognitive and physical function will be estimated. DISCUSSION This study will enable a thorough characterization of multiple disease processes and their risk factors within a community-based sample of individuals to determine their singular, interactive and cumulative effects on ageing. The project will provide novel cross-sectional data and establish a cohort that will be used for longitudinal analyses of the genetic, lifestyle and environmental factors that determine whether an individual ages well or with impairment.
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Nedkoff L, Knuiman M, Hung J, Sanfilippo FM, Katzenellenbogen JM, Briffa TG. Concordance between administrative health data and medical records for diabetes status in coronary heart disease patients: a retrospective linked data study. BMC Med Res Methodol 2013; 13:121. [PMID: 24079345 PMCID: PMC3849847 DOI: 10.1186/1471-2288-13-121] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 09/26/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Administrative data are a valuable source of estimates of diabetes prevalence for groups such as coronary heart disease (CHD) patients. The primary aim of this study was to measure concordance between medical records and linked administrative health data for recording diabetes in CHD patients, and to assess temporal differences in concordance. Secondary aims were to determine the optimal lookback period for identifying diabetes in this patient group, whether concordance differed for Indigenous people, and to identify predictors of false positives and negatives in administrative data. METHODS A population representative sample of 3943 CHD patients hospitalized in Western Australia in 1998 and 2002-04 were selected, and designated according to the International Classification of Diseases (ICD) version in use at the time (ICD-9 and ICD-10 respectively). Crude prevalence and concordance were compared for the two samples. Concordance measures were estimated from administrative data comparing diabetes status recorded on the selected CHD admission ('index admission') and on any hospitalization in the previous 1, 2, 5, 10 or 15 years, against hospital medical records. Potential modifiers of agreement were determined using chi-square tests and multivariable logistic regression models. RESULTS Identification of diabetes on the index CHD admission was underestimated more in the ICD-10 than ICD-9 sample (sensitivity 81.5% versus 91.1%, underestimation 15.1% versus 4.4% respectively). Sensitivity increased to 89.6% in the ICD-10 period using at least 10 years of hospitalization history. Sensitivity was higher and specificity lower in Indigenous patients, and followed a similar pattern of improving concordance with increasing lookback period. Characteristics associated with false negatives for diabetes on the index CHD hospital admission were elective admission, in-hospital death, principal diagnosis, and in the ICD-10 period only, fewer recorded comorbidities. CONCLUSIONS The accuracy of identifying diabetes status in CHD patients is improved in linked administrative health data by using at least 10 years of hospitalization history. Use of this method would reduce bias when measuring temporal trends in diabetes prevalence in this patient group. Concordance measures are as reliable in Indigenous as non-Indigenous patients.
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Badland H, Knuiman M, Hooper P, Giles-Corti B. Socio-ecological predictors of the uptake of cycling for recreation and transport in adults: results from the RESIDE study. Prev Med 2013; 57:396-9. [PMID: 23792583 DOI: 10.1016/j.ypmed.2013.06.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 06/04/2013] [Accepted: 06/09/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To examine the uptake of cycling for recreation and transport, and relate these behaviors to individual, social, and environmental exposures over time. METHOD Data were drawn from 909 adults in Time 2 (T2) (2005-2006) and Time 3 (T3) (2007-2008) of the RESIDE study (Australia). Demographics, perceptions of self-efficacy and social support related to cycling, neighborhood environment perceptions, and objective measures of the neighborhood were measured at T2. These were compared with uptake of cycling for recreation and transport at T3. RESULTS At T3, 54 (5.9%) had taken up cycling for recreation and 44 (4.8%) for transport. Positive perceptions of self-efficacy at T2 were consistently positively associated with the uptake of cycling for either purpose at T3. Respondents living in higher walkable neighborhoods (OR=1.63; 95% CI=1.02-2.62) or with higher objectively measured street connectivity (OR=1.80; 95% CI=1.05-3.07) were more likely to start cycling for recreation when compared with their reference groups. No significant relationships existed between objective measures of the neighborhood and uptake of cycling for transport. CONCLUSION Interventions focusing on enhancing self-efficacy and generating social support will likely positively influence both cycling for recreation and transport; and providing infrastructure that creates physically supportive neighborhoods may increase cycling levels.
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Müller-Riemenschneider F, Pereira G, Villanueva K, Christian H, Knuiman M, Giles-Corti B, Bull FC. Neighborhood walkability and cardiometabolic risk factors in Australian adults: an observational study. BMC Public Health 2013; 13:755. [PMID: 23947939 PMCID: PMC3844350 DOI: 10.1186/1471-2458-13-755] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2012] [Accepted: 06/28/2013] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Studies repeatedly highlight associations between the built environment and physical activity, particularly walking. Fewer studies have examined associations with cardiometabolic risk factors, with associations with obesity inconsistent and scarce evidence examining associations with other cardiometabolic risk factors. We aim to investigate the association between neighborhood walkability and the prevalence of obesity, hypertension, hypercholesterolaemia, and type-2 diabetes mellitus. METHODS Cross-sectional study of 5,970 adults in Western Australia. Walkability was measured objectively for a 1,600 m and 800 m neighborhood buffer. Logistic regression was used to assess associations overall and by sex, adjusting for socio-demographic factors. Mediation by physical activity and sedentary behavior was investigated. RESULTS Individuals living in high compared with less walkable areas were less likely to be obese (1,600 m OR: 0.84, 95% CI: 0.7 to 1; 800 m OR: 0.75, 95% CI: 0.62 to 0.9) and had lower odds of type-2 diabetes mellitus at the 800 m buffer (800 m OR: 0.69, 95% CI: 0.51 to 0.93). There was little evidence for an association between walkability and hypertension or hypercholesterolaemia. The only significant evidence of any difference in the associations in men and women was a stronger association with type-2 diabetes mellitus at the 800 m buffer in men. Associations with obesity and diabetes attenuated when additionally adjusting for physical activity and sedentary behavior but the overall association with obesity remained significant at the 800 m buffer (800 m OR: 0.78, 95% CI: 0.64 to 0.96). CONCLUSIONS A protective association between neighborhood walkability and obesity was observed. Neighborhood walkability may also be protective of type-2 diabetes mellitus, particularly in men. No association with hypertension or hypercholesterolaemia was found. This warrants further investigation. Findings contribute towards the accumulating evidence that city planning and policy related strategies aimed at creating supportive environments could play an important role in the prevention of chronic diseases.
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Christian H, Knuiman M, Bull F, Timperio A, Foster S, Divitini M, Middleton N, Giles-Corti B. A new urban planning code's impact on walking: the residential environments project. Am J Public Health 2013; 103:1219-28. [PMID: 23678917 PMCID: PMC3682616 DOI: 10.2105/ajph.2013.301230] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2013] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined whether people moving into a housing development designed according to a state government livable neighborhoods subdivision code engage in more walking than do people who move to other types of developments. METHODS In a natural experiment of 1813 people building homes in 73 new housing developments in Perth, Western Australia, we surveyed participants before and then 12 and 36 months after moving. We measured self-reported walking using the Neighborhood Physical Activity Questionnaire and collected perceptions of the environment and self-selection factors. We calculated objective measures of the built environment using a Geographic Information System. RESULTS After relocation, participants in livable versus conventional developments had greater street connectivity, residential density, land use mix, and access to destinations and more positive perceptions of their neighborhood (all P < .05). However, there were no significant differences in walking over time by type of development (P > .05). CONCLUSIONS Implementation of the Livable Neighborhoods Guidelines produced more supportive environments; however, the level of intervention was insufficient to encourage more walking. Evaluations of new urban planning policies need to incorporate longer term follow-up to allow time for new neighborhoods to develop.
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Pereira G, Christian H, Foster S, Boruff BJ, Bull F, Knuiman M, Giles-Corti B. The association between neighborhood greenness and weight status: an observational study in Perth Western Australia. Environ Health 2013; 12:49. [PMID: 23783002 PMCID: PMC3710261 DOI: 10.1186/1476-069x-12-49] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 04/17/2013] [Indexed: 05/22/2023]
Abstract
BACKGROUND Few studies have examined the relationship between weight status and objectively measured neighborhood greenness and no study has examined this relationship across the different stages of adulthood. This research was an investigation of weight status and neighborhood greenness using objectively measured satellite remote sensing for a large population representative sample. METHOD Cross-sectional study of 10,208 young adults (16-24 years), mid-age adults (25-64 years) and older adults (65+ years) from a population representative sample for the period 2004-2009 in Perth, Western Australia. Neighborhood greenness was ascertained for a 1600m road network service area around each participant's address using the mean and standard deviation of the Normalized Difference Vegetation Index (NDVI) obtained from remote sensing. Multiple logistic regression was used to assess associations with weight status (overweight-or-obese, obese) adjusted for socio-demographics and health-related behaviors. RESULTS The adjusted odds ratio (OR) comparing obesity in the highest to the lowest tertile of mean greenness was 0.78 (95% CI 0.69-0.89). For the same comparison, the OR for overweight-or-obese was similar, 0.84 (95% CI 0.76-0.92). The OR comparing obesity in the highest to lowest tertile of variation in greenness was 0.75 (95% CI 0.66-0.85). For the same comparison, the OR for overweight-or-obese was similar, 0.75 (95% CI 0.68-0.82). CONCLUSION Higher levels and greater variation of neighborhood greenness are associated with lower odds of obesity among adults of all ages. Research examining neighborhood characteristics correlated with variability in greenness will help better understand these relationships.
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Peters KE, Beilby J, Cadby G, Warrington NM, Bruce DG, Davis WA, Davis TM, Wiltshire S, Knuiman M, McQuillan BM, Palmer LJ, Thompson PL, Hung J. A comprehensive investigation of variants in genes encoding adiponectin (ADIPOQ) and its receptors (ADIPOR1/R2), and their association with serum adiponectin, type 2 diabetes, insulin resistance and the metabolic syndrome. BMC MEDICAL GENETICS 2013; 14:15. [PMID: 23351195 PMCID: PMC3598639 DOI: 10.1186/1471-2350-14-15] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 01/17/2013] [Indexed: 12/18/2022]
Abstract
Background Low levels of serum adiponectin have been linked to central obesity, insulin resistance, metabolic syndrome, and type 2 diabetes. Variants in ADIPOQ, the gene encoding adiponectin, have been shown to influence serum adiponectin concentration, and along with variants in the adiponectin receptors (ADIPOR1 and ADIPOR2) have been implicated in metabolic syndrome and type 2 diabetes. This study aimed to comprehensively investigate the association of common variants in ADIPOQ, ADIPOR1 and ADIPOR2 with serum adiponectin and insulin resistance syndromes in a large cohort of European-Australian individuals. Methods Sixty-four tagging single nucleotide polymorphisms in ADIPOQ, ADIPOR1 and ADIPOR2 were genotyped in two general population cohorts consisting of 2,355 subjects, and one cohort of 967 subjects with type 2 diabetes. The association of tagSNPs with outcomes were evaluated using linear or logistic modelling. Meta-analysis of the three cohorts was performed by random-effects modelling. Results Meta-analysis revealed nine genotyped tagSNPs in ADIPOQ significantly associated with serum adiponectin across all cohorts after adjustment for age, gender and BMI, including rs10937273, rs12637534, rs1648707, rs16861209, rs822395, rs17366568, rs3774261, rs6444175 and rs17373414. The results of haplotype-based analyses were also consistent. Overall, the variants in the ADIPOQ gene explained <5% of the variance in serum adiponectin concentration. None of the ADIPOR1/R2 tagSNPs were associated with serum adiponectin. There was no association between any of the genetic variants and insulin resistance or metabolic syndrome. A multi-SNP genotypic risk score for ADIPOQ alleles revealed an association with 3 independent SNPs, rs12637534, rs16861209, rs17366568 and type 2 diabetes after adjusting for adiponectin levels (OR=0.86, 95% CI=(0.75, 0.99), P=0.0134). Conclusions Genetic variation in ADIPOQ, but not its receptors, was associated with altered serum adiponectin. However, genetic variation in ADIPOQ and its receptors does not appear to contribute to the risk of insulin resistance or metabolic syndrome but did for type 2 diabetes in a European-Australian population.
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Villanueva K, Pereira G, Knuiman M, Bull F, Wood L, Christian H, Foster S, Boruff BJ, Beesley B, Hickey S, Joyce S, Nathan A, Saarloos D, Giles-Corti B. The impact of the built environment on health across the life course: design of a cross-sectional data linkage study. BMJ Open 2013; 3:bmjopen-2012-002482. [PMID: 23325897 PMCID: PMC3549251 DOI: 10.1136/bmjopen-2012-002482] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The built environment is increasingly recognised as being associated with health outcomes. Relationships between the built environment and health differ among age groups, especially between children and adults, but also between younger, mid-age and older adults. Yet few address differences across life stage groups within a single population study. Moreover, existing research mostly focuses on physical activity behaviours, with few studying objective clinical and mental health outcomes. The Life Course Built Environment and Health (LCBEH) project explores the impact of the built environment on self-reported and objectively measured health outcomes in a random sample of people across the life course. METHODS AND ANALYSIS This cross-sectional data linkage study involves 15 954 children (0-15 years), young adults (16-24 years), adults (25-64 years) and older adults (65+years) from the Perth metropolitan region who completed the Health and Wellbeing Surveillance System survey administered by the Department of Health of Western Australia from 2003 to 2009. Survey data were linked to Western Australia's (WA) Hospital Morbidity Database System (hospital admission) and Mental Health Information System (mental health system outpatient) data. Participants' residential address was geocoded and features of their 'neighbourhood' were measured using Geographic Information Systems software. Associations between the built environment and self-reported and clinical health outcomes will be explored across varying geographic scales and life stages. ETHICS AND DISSEMINATION The University of Western Australia's Human Research Ethics Committee and the Department of Health of Western Australia approved the study protocol (#2010/1). Findings will be published in peer-reviewed journals and presented at local, national and international conferences, thus contributing to the evidence base informing the design of healthy neighbourhoods for all residents.
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Nedkoff L, Briffa T, Knuiman M, Hung J. Trends in Gender- and Age-Specific Rates of First Myocardial Infarction in Adults With and Without Diabetes Between 1998 and 2010 in Western Australia. Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.05.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lewin G, De San Miguel K, Knuiman M, Alan J, Boldy D, Hendrie D, Vandermeulen S. A randomised controlled trial of the Home Independence Program, an Australian restorative home-care programme for older adults. HEALTH & SOCIAL CARE IN THE COMMUNITY 2013; 21:69-78. [PMID: 23009672 DOI: 10.1111/j.1365-2524.2012.01088.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
A randomised controlled trial was conducted to test the effectiveness of the Home Independence Program (HIP), a restorative home-care programme for older adults, in reducing the need for ongoing services. Between June 2005 and August 2007, 750 older adults referred to a home-care service for assistance with their personal care participated in the study and received HIP or 'usual' home-care services. Service outcomes were compared at 3 and 12 months. Subgroups of 150 from each group were also compared on functional and quality of life measures. Data were analysed by 'intention-to-treat' and 'as-treated'. The intention-to-treat analysis showed at 3 and 12 months that the HIP group was significantly less likely to need ongoing personal care [Odds ratio (OR) = 0.18, 95% CI = 0.13-0.26, P < 0.001; OR = 0.22, 95% CI = 0.15-0.32, P < 0.001]. Both subgroups showed improvements on the individual outcome measures over time with the only significant differences being found at 12 months for Instrumental Activities of Daily Living (IADL) in the as-treated analysis. Contamination of the control group by an increased emphasis on independence across the home-care agency involved, together with other methodological problems encountered, is thought to account for the few differences between groups in individual outcomes. Despite no difference between the groups over time in their overall ADL scores, a significantly smaller proportion of the HIP group required assistance with bathing/showering, the most common reason for referral, at 3 and 12 months. The results support earlier findings that participating in a short-term restorative programme appears to reduce the need for ongoing home care. The implementation of such programmes more broadly throughout Australia could substantially offset the projected increase in demand for home care associated with the five-fold projected increase in numbers of the oldest old expected over the next 40 years.
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92
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Teng T, Katzenellenbogen J, Thompson S, Sanfilippo F, Hobbs M, Geelhoed E, Knuiman M, Hung J. Rurality Does Matter for Heart Failure Outcomes in Western Australia. Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.05.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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93
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Barnes R, Bauman A, Giles-Corti B, Knuiman M, Rosenberg M. Motivated to walk but nowhere to walk to: Moderation of a mass media campaign by mix of local destinations. J Sci Med Sport 2012. [DOI: 10.1016/j.jsams.2012.11.505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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94
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Bell L, Davis E, Knuiman M, Divitini M, Beilby J, Hunter M, Hung J. Lipids in Australian children: cause for concern? 2005-2007 Busselton Health Study. J Paediatr Child Health 2012; 48:E172-7. [PMID: 22998088 DOI: 10.1111/j.1440-1754.2012.02575.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To report the current lipid status of Australian school children from a population-based sample and compare this to international and Australian data. METHODS A cross section of school children aged 6 to 16.9 years in Busselton, Western Australia (WA) between 2005 and 2007 had fasting lipids tested. The first analysis compares the Busselton sample to data recommended by the American Academy of Paediatrics (AAP) 2008. The second analysis compares the Busselton sample to data from the Schools Physical Activity and Nutrition Survey (SPANS) study, New South Wales (NSW), Australia, 2004 and the 1985 Australian Health and Fitness Survey (AHFS). The third analysis applies laboratory-reported cut-points in WA to report percentages over 'healthy desirable norms'. RESULTS Analysis 1: higher levels of total cholesterol and triglycerides in Busselton children compared to AAP data source. Boys had higher low-density lipoprotein (LDL) levels. Analysis 2: comparable rates of dyslipidaemia to SPANS 2004 but lower rates compared to the AHFS, 1985. Analysis 3: total and LDL-cholesterol above recommended range in 32.7% and 19.4% of boys and 38.2% and 24.6% of girls. CONCLUSION In a large population-based sample of Australian school children, we found a higher frequency of abnormal lipid profiles when compared to American data. In addition, many children have levels outside reported healthy norms for Australian children. Research tracking lipid profiles of Australian children into adulthood is needed to understand the association of these levels with future cardiovascular risk.
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95
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Katzenellenbogen J, Sanfilippo F, Briffa T, Hobbs M, Knuiman M, Dimer L, Taylor K, Thompson S. Factors Associated with Discharge Against Medical Advice within Year of First-Ever IHD Hospital Admissions in Aboriginal and Non-Aboriginal Western Australians. Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.07.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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96
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Davies CR, Rosenberg M, Knuiman M, Ferguson R, Pikora T, Slatter N. Defining arts engagement for population-based health research: Art forms, activities and level of engagement. Arts Health 2012. [DOI: 10.1080/17533015.2012.656201] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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97
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Mills C, Knuiman M, Rosenberg M, Wood L, Ferguson R. Are the arts an effective setting for promoting health messages? Perspect Public Health 2012; 133:116-21. [PMID: 22891050 DOI: 10.1177/1757913911419895] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM Individuals can contribute to their own well-being through the adoption of positive health behaviours and the avoidance of negative health behaviours. The promotion of health messages is a cognitive strategy used to influence the adoption of health-enhancing behaviours. Since 1991, arts organizations have been sponsored by the Western Australian Health Promotion Foundation (Healthway) to promote anti-smoking, safe alcohol consumption, physical activity, sun protection and nutrition messages to the general population. The aim of this study was to evaluate the effectiveness of arts sponsorship to promote health messages and therefore gauge the effectiveness of the arts as a communication channel to promote health to the general population. METHODS A secondary analysis of the Healthway Survey of Community Recreation and Health data was conducted. The data were collected via a telephone survey of Western Australian adults aged 16-69 years. Overall, 1997 respondents participated in this study, a response rate of 59%. The analysis included a descriptive investigation, followed by logistic regression analyses of message awareness by those engaged and not engaged in the arts for sponsored anti-smoking, safe alcohol consumption, physical activity, sun protection and nutrition messages. RESULTS Overall, 68% of those surveyed were classified as engaged in the arts, either as a participant, attendee or member of an arts organization. In general, those engaged in the arts were significantly more likely to recall health messages relating to physical activity (adjusted OR = 1.9), sun protection (OR = 1.8) nutrition (OR = 1.5), safe alcohol consumption (OR = 1.5) and anti-smoking (adjusted OR = 1.3) than those not engaged in the arts. CONCLUSIONS Findings from this study suggest the arts have merit beyond intrinsic artistic value and are a viable means of promoting health messages to the general population.
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98
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Nedkoff L, Briffa TG, Knuiman M, Hung J, Norman PE, Hankey GJ, Thompson PL, Geelhoed E, Sanfilippo FM, Hickling S, Bremner A, Hobbs M. Temporal trends in the incidence and recurrence of hospitalised atherothrombotic disease in an Australian population, 2000–07: data linkage study. Heart 2012; 98:1449-56. [DOI: 10.1136/heartjnl-2012-302181] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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99
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Pereira G, Foster S, Martin K, Christian H, Boruff BJ, Knuiman M, Giles-Corti B. The association between neighborhood greenness and cardiovascular disease: an observational study. BMC Public Health 2012; 12:466. [PMID: 22720780 PMCID: PMC3476430 DOI: 10.1186/1471-2458-12-466] [Citation(s) in RCA: 123] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Accepted: 06/21/2012] [Indexed: 11/30/2022] Open
Abstract
Background Previous studies have demonstrated links between cardiovascular disease and physical inactivity and poor air quality, which are both associated with neighborhood greenness. However, no studies have directly investigated neighborhood greenness in relation to coronary heart disease risk. We investigated the effect of neighborhood greenness on both self-reported and hospital admissions of coronary heart disease or stroke, accounting for ambient air quality, socio-demographic, behavioral and biological factors. Method Cross-sectional study of 11,404 adults obtained from a population representative sample for the period 2003–2009 in Perth, Western Australia. Neighborhood greenness was ascertained for a 1600 m service area surrounding the residential address using the mean and standard deviation of the Normalized Difference Vegetation Index (NDVI) obtained from remote sensing. Logistic regression was used to assess associations with medically diagnosed and hospitalization for coronary heart disease or stroke. Results The odds of hospitalization for heart disease or stroke was 37% (95% CI: 8%, 57%) lower among adults in neighborhoods with highly variable greenness (highest tertile) compared to those in predominantly green, or predominantly non-green neighborhoods (lowest tertile). This effect was independent of the absolute levels of neighborhood greenness. There was weaker evidence for associations with the mean level of neighborhood greenness. Conclusion Variability in neighborhood greenness is a single metric that encapsulates two potential promoters of physical activity - an aesthetically pleasing natural environment and access to urban destinations. Variability in greenness within a neighborhood was negatively associated with coronary heart disease and stroke.
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Beenackers MA, Foster S, Kamphuis CBM, Titze S, Divitini M, Knuiman M, van Lenthe FJ, Giles-Corti B. Taking up cycling after residential relocation: built environment factors. Am J Prev Med 2012; 42:610-5. [PMID: 22608378 DOI: 10.1016/j.amepre.2012.02.021] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 12/22/2011] [Accepted: 02/23/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND To successfully stimulate cycling, it is necessary to understand the factors that facilitate or inhibit cycling. Little is known about how changes in the neighborhood environment are related to changes in cycling behavior. PURPOSE This study aimed to identify environmental determinants of the uptake of cycling after relocation. METHODS The RESIDential Environment Project (RESIDE) is a longitudinal natural experiment of people moving into new housing developments in Perth (Western Australia). Self-reported usual transport and recreational cycling behavior, as well as self-reported and objective built environmental factors were measured before and after residential relocation. Participants who did not usually cycle at baseline in 2003-2004 were included in the study. Logistic regression models were used to relate changes in built environmental determinants to the probability of taking up cycling after relocation (2005-2006). Analyses were carried out in 2010-2011. RESULTS At baseline, 90% (n=1289) of the participants did not cycle for transport and 86% (n=1232) did not cycle for recreation. After relocation, 5% of the noncyclists took up transport-related cycling, and 7% took up recreational cycling. After full adjustment, the uptake of transport-related cycling was determined by an increase in objective residential density (OR=1.54, 95% CI=1.04, 2.26) and self-reported better access to parks (OR=2.60, 95% CI=1.58, 4.27) and other recreation destinations (OR=1.57, 95% CI=1.12, 2.22). Commencing recreational cycling mostly was determined by an increase in objective street connectivity (OR=1.20, 95% CI=1.06, 1.35). CONCLUSIONS Changes in the built environment may support the uptake of cycling among formerly noncycling adults.
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