Young people's alcohol use in and around water: A scoping review of the literature

ISSUES

The surrounding social and commercial context, including alcohol advertising, heavily influences alcohol consumption. Alcohol use is a major risk factor for both fatal and non-fatal drowning, particularly for young people.

APPROACH

We conducted a scoping review to explore the peer-reviewed literature on the use of alcohol by young people (aged 15-34 years) in the context of aquatic environments. Five electronic academic databases were searched for English-language studies conducted in high-income countries and published in the last 15 years (since 2008). The MetaQAT framework was used to assess methodological quality of included studies.

KEY FINDINGS

The review included a total of 24 studies, including those addressing the prevalence of and/or risk factors for alcohol use in aquatic environments among young people (n = 13); the epidemiology of alcohol-related unintentional drowning in young people (n = 9); and interventions to reduce alcohol-related harm around water (n = 3). Findings suggest that young people commonly consume alcohol around water, particularly young men. We found multiple influences on this behaviour, including the perception of risk, location of aquatic activity and presence of others, particularly peers.

IMPLICATIONS

Understanding the literature addressing alcohol use around water among young people will assist in identifying and setting priorities for drowning prevention, including the need to mitigate the effects of alcohol advertising which promotes drinking in and around water.

CONCLUSION

There is a clear imperative to address the use of alcohol by young people in aquatic environments. These findings have key implications for public health policy, advocacy and practice.

Powerful promotions: An investigation of the teen-directed marketing power of outdoor food advertisements located near schools in Australia

ISSUE ADDRESSED

Adolescents are heavily exposed to unhealthy outdoor food advertisements near schools, however, the marketing power of these advertisements among adolescents has not yet been explored. This study aimed to investigate the teen-directed marketing features present and quantify the overall marketing power of outdoor food advertisements located near schools to explore any differences by content (ie, alcohol, discretionary, core and miscellaneous foods) school type (ie, primary, secondary, K-12) and area-level socio-economic status (SES; ie, low vs high).

METHODS

This cross-sectional study audited every outdoor food advertisement (n = 1518) within 500m of 64 randomly selected schools in Perth, Western Australia, using a teen-informed coding tool to score the marketing power of each advertisement.

RESULTS

Outdoor alcohol advertisements around schools had the highest average marketing power score and number of advertising features present. Outdoor advertisements for alcohol and discretionary foods scored significantly higher in marketing power than core food advertisements (P < .001). Outdoor alcohol advertisements around secondary schools scored significantly higher in marketing power than around primary and K-12 schools (P < .001); and outdoor advertisements for discretionary foods in low SES areas scored significantly higher in marketing power than those in high SES areas (P < .001).

CONCLUSIONS

This study found outdoor advertisements for unhealthy products, such as alcohol and discretionary foods, were more powerful than advertisements for core foods around schools. SO WHAT?: These findings strengthen the need for policies which restrict outdoor advertisements for non-core foods near schools, to reduce adolescents' exposure to powerful alcohol and discretionary food advertisements.

The built environment and child obesity: A review of Australian policies

Child obesity is a serious public health challenge affected by both individual choice and societal and environmental factors. The main modifiable risk factors for child obesity are unhealthy eating and low levels of physical activity, both influenced by aspects of the built environment. Coordinated government policy across jurisdictions, developed using strong research evidence, can enable built environments that better support healthy lifestyles. This study reviewed current Australian and Western Australian government policies to understand if and how they address the impact of the built environment on child obesity, physical activity, sedentary behavior, and diet. Current government policy documents related to the built environment and child health were analyzed using the Comprehensive Analysis of Policy on Physical Activity framework. Ten Australian and 31 Western Australian government policy documents were identified. Most referred to the role of the built environment in supporting physical activity. Very few policies mentioned the built environment's role in reducing sedentary behaviors, supporting healthy eating, and addressing obesity. Few recognized the needs of children, and none mentioned children in policy development. Future government policy development should include the voices of children and child-specific built environment features. Inter-organizational policies with transparent implementation and evaluation plans are recommended.

Awake and Alert: Examining the Portrayal of Energy Drinks on TikTok

PURPOSE

Energy drinks (EDs) are not recommended for minors' consumption due to a myriad of health risks, but marketing initiatives persist. This study explored the promotion of EDs on TikTok, a platform frequented by children and adolescents.

METHODS

197 highly viewed videos from the four top ED-related hashtags on TikTok were coded for engagement variables, user information, sponsorship status, video content, and sentiment toward EDs.

RESULTS

Of the 197 videos analyzed (combined 70 + million views), 29% disclosed sponsorship and 22% featured a child/adolescent. ED consumption appeared in 46% of videos, with 15% depicting hazardous consumption. Most videos (67%) had a positive sentiment toward EDs.

DISCUSSION

ED-related TikTok videos are positively framed, have high engagement, and are not restricted for viewing by minors. As the platform's underage user-base grows, such videos may encourage heightened consumption. Given the known health risks, effective age-gated content restrictions are needed to reduce minors' exposure.

How does the school built environment impact students' bullying behaviour? A scoping review

RATIONALE

School bullying is a public health concern affecting the physical and mental health of children and young people. While school-based interventions to prevent bullying have been developed internationally, the effectiveness of many interventions has been mixed and modest. Despite a growing recognition that the school built environment may impact bullying behaviour, few anti-bullying interventions have addressed the built environment.

OBJECTIVE

This systematic scoping review explored existing literature for evidence that the school built environment influences bullying behaviour in school students.

METHODS

The review was guided by Arksey and O'Malley's methodological framework for scoping reviews. A search of six databases (Medline, PsycINFO, ERIC, EMBASE, CINAHL Plus and The Cochrane Library) identified studies addressing primary, middle and secondary school students, bullying, school bullying locations, and school built environments. Peer-reviewed journal articles published in English prior to July 19, 2021, were included.

RESULTS

In total, 7568 documents were screened by title and abstract. Following a full-text review, 61 studies (63 articles) were selected; 43 studies identified school bullying locations, and 19 studies linked features of the school built environment to bullying behaviour. Classrooms, playgrounds, and corridors were identified as common bullying locations. Features of the school built environment linked to bullying behaviour included security cameras, architectural design, aesthetics, seating, and vandalism.

CONCLUSIONS

This review identified key school settings for anti-bullying interventions and identified gaps in existing built environment and bullying literature. Further analyses of published studies will inform anti-bullying policy and practice.

School Built Environments and Bullying Behaviour: A Conceptual Model Based on Qualitative Interviews

Interest in how the school built environment impacts bullying behaviour has gained momentum in recent years. While numerous studies have identified locations within schools where bullying frequently occurs, few studies have investigated the potential conceptual pathways linking school locations to bullying behaviour. This study aimed to (i) identify school built environment factors that may prevent or facilitate bullying behaviour in primary and secondary schools; and (ii) develop a conceptual model of potential pathways between the school built environment and bullying behaviour for future anti-bullying intervention research. Seventy individual semi-structured interviews were conducted between May and December 2020, with policymakers (n = 22), school staff (n = 12), parents (n = 18), and students (n = 18). School staff, parents and students, were recruited from six metropolitan primary and secondary schools in Perth, Western Australia. Interviews were conducted online and face-to-face using semi-structured interview guides. A thematic analysis was undertaken. Participants identified school bullying locations (e.g., locker areas, bathrooms, corridors) and built environment factors linked to bullying behaviour via (i) visibility and supervision; (ii) physical and psychological comfort and safety; and (iii) social-emotional competencies. The findings have policy and practice implications regarding the design of school built environments to prevent bullying behaviour.

Gender-Neutral Toilets: A Qualitative Exploration of Inclusive School Environments for Sexuality and Gender Diverse Youth in Western Australia

School toilets have been identified by sexuality and gender diverse (SGD) students as the least safe spaces in educational institutions. They are sites of verbal, physical and sexual victimisation. Providing gender-neutral toilets in primary and secondary schools may reduce the bullying and victimisation of SGD students, particularly those who are transgender or gender-diverse. This study explored factors influencing the inclusion of gender-neutral toilets in primary and secondary schools in Western Australia. Thirty-four interviews were conducted from May to December 2020 with policy makers or practitioners (n = 22) and school staff (n = 12) in Perth, Western Australia. Interviews were conducted online and face-to-face using semi-structured interview guides. A thematic analysis of the cross-sectional qualitative data was undertaken. School staff, policy makers, and practitioners identified school toilets as sites of bullying and victimisation of SGD youth and expressed support for gender-neutral toilets as an anti-bullying strategy. Perceived barriers to introducing gender-neutral toilets in schools included financial and spatial costs, building code compliance constraints, resistance from parents and students, privacy and confidentiality concerns, and cultural appropriateness. Including gender-neutral toilets in schools may reduce school-based bullying and victimisation, and improve the mental and physical health of SGD youth.

Children's exposure to outdoor food advertising near primary and secondary schools in Australia

ISSUE ADDRESSED

Previous research has highlighted children's frequent exposure to advertisements of unhealthy food and beverages on television. However, the food industry is increasingly utilising non-broadcast channels such as outdoor advertising (eg billboards, bus shelters, shop fronts) for product marketing. Few studies have investigated children's exposure to outdoor food advertising around primary and secondary schools. This study aimed to quantify the presence and content of outdoor food advertisements within a 500 m radius of primary and secondary schools in Perth, Western Australia.

METHODS

A cross-sectional design was used to capture outdoor advertisements within a 500 m radial buffer around the school boundary. The INFORMAS protocol for monitoring outdoor advertising around child-serving institutions was used. Sixty-four primary and secondary schools in Perth, Australia, were selected using random sampling within socio-economic and population density strata.

RESULTS

In total, 5636 outdoor advertisements were identified within a 500 m radius of all 64 schools combined and 30% were for food. Of the 1708 food advertisements, 74% were for unhealthy (non-core) food. The most frequently advertised food products were alcohol, fast food and sugar-sweetened beverages. Only 8% of food advertisements featured a healthy product. The majority of schools (75%) had at least one food advertisement within 500 m (mean 36, range 3-190). Schools in lower socio-economic areas had more food advertisements and a significantly higher proportion of unhealthy food advertisements within 250 m.

CONCLUSION

Outdoor advertising around schools constitutes a potential frequent source of children's exposure to unhealthy food and alcohol advertising. SO WHAT?: Policy interventions restricting the content of outdoor food advertising near schools are needed.

Exposure to unhealthy food and beverage advertising during the school commute in Australia

BACKGROUND

Food marketing exposure has the potential to influence children's dietary behaviours and health status, however, few studies have identified how 'obesogenic' the outdoor food marketing environment is along public transport (bus and/or train) or walking routes that children take to school.

METHODS

Audits of all outdoor advertisements present along likely train, bus and walking routes to 24 secondary schools (ie, 3 routes per school, 72 routes total) were conducted in Perth, Western Australia (WA). The size, content, type and setting of each advertisement were recorded in accordance with the International Network for Food and Obesity/non-communicable diseases Research, Monitoring and Action Support protocol for monitoring outdoor advertising.

RESULTS

Of the 4016 total advertisements observed, almost half were for food (n=1754, 44%) and of these, 80% (n=1397) advertised discretionary (non-core) foods, and 8% (n=138) advertised healthy (core) foods. On average, commuting to school by train, bus and walking exposed Perth schoolchildren to 37.1, 22 and 4.5 discretionary (non-core) food ads per one-way trip to school, respectively.

CONCLUSIONS

Children living in Perth, WA experience a high level of exposure to unhealthy outdoor food advertisements during the school commute. Policies which restrict the placement and content of outdoor advertising, could be a useful strategy in the fight against childhood obesity.

Dietary pattern trajectories across adolescence and early adulthood and their associations with childhood and parental factors

BACKGROUND

Although adolescent dietary patterns tend to be of poor quality, it is unclear whether dietary patterns established in adolescence persist into adulthood.

OBJECTIVES

We examined trajectories across adolescence and early adulthood for 2 major dietary patterns and their associations with childhood and parental factors.

METHODS

Using data from the Western Australian Pregnancy Cohort (Raine Study), intakes of 38 food groups were estimated at ages 14, 17, 20 and 22 y in 1414 participants using evaluated FFQs. Using factor analysis, 2 major dietary patterns (healthy and Western) were consistently identified across follow-ups. Sex-specific group-based modeling assessed the variation in individual dietary pattern z scores to identify group trajectories for each pattern between ages 14 and 22 y and to assess their associations with childhood and parental factors.

RESULTS

Two major trajectory groups were identified for each pattern. Between ages 14 and 22 y, a majority of the cohort (70% males, 73% females) formed a trajectory group with consistently low z scores for the healthy dietary pattern. The remainder had trajectories showing either declining (27% females) or reasonably consistent healthy dietary pattern z scores (30% males). For the Western dietary pattern, the majority formed trajectories with reasonably consistent average scores (79% males, 81% females) or low scores that declined over time. However, 21% of males had a trajectory of steady, marked increases in Western dietary pattern scores over time. A lower maternal education and higher BMI (in kg/m2) were positively associated with consistently lower scores of the healthy dietary pattern. Lower family income, family functioning score, maternal age, and being in a single-parent family were positively related to higher scores of the Western dietary pattern.

CONCLUSIONS

Poor dietary patterns established in adolescence are likely to track into early adulthood, particularly in males. This study highlights the transition between adolescence and early adulthood as a critical period and the populations that could benefit from dietary interventions.

Consumption of energy drinks is associated with depression, anxiety, and stress in young adult males: Evidence from a longitudinal cohort study

BACKGROUND

Energy drinks (EDs) claim to boost mental performance, however, few studies have examined the prospective effects of EDs on mental health. This study examined longitudinal associations between ED use and mental health symptoms in young adults aged 20 years over a 2-year period.

METHODS

Data were drawn from Gen2 (Generation 2) of the Raine Study, a prospective population-based study in Western Australia. Self-report questionnaires assessed ED consumption and mental health symptoms (Depression Anxiety Stress Scale [DASS]-21) when Gen2 participants were 20 and 22 years old. Changes in ED use and DASS-21 scores over time were analyzed and results presented for the whole sample and by sex.

RESULTS

For the whole sample (n = 429), participants who changed from being a non-ED user to an ED user had an average increase in stress scores of 2.30 (95% confidence interval [CI] = 0.04, 4.55) across the 2-year follow-up. Males, but not females who changed from being a non-ED user to an ED user had an average increase in depression, anxiety, and stress scores of 6.09 (95% CI = 3.36, 8.81), 3.76 (95% CI = 1.82, 5.70), and 3.22 (95% CI = 0.47, 5.97), respectively.

CONCLUSION

ED consumption may be a possible marker for mental health symptoms in young male adults. Practicing clinicians could consider screening for ED use in routine assessments of mental health, particularly for young males presenting with depression, anxiety, and stress symptoms.

Energy drink intake and metabolic syndrome: A prospective investigation in young adults

BACKGROUND AND AIMS

There are concerns that energy drinks (EDs) are contributing to upward trends in overweight, obesity, and cardiometabolic conditions in young people. We investigated cross-sectional and prospective associations between frequency of ED-intake in young-adults and (i) body mass index (BMI) and (ii) Metabolic Syndrome (MetS) and its components.

METHODS AND RESULTS

Participants from the Raine Study at 20-years (n = 1236) and 22 years (n = 1117) self-reported ED-intake, dietary intake, and physical activity, and had blood and anthropometric measures taken. Regression modelling examined associations between ED-intake and BMI, MetS and its components. There was a positive, but not significant, cross-sectional association with BMI and likelihood of MetS with frequent ED use at 20-years (BMI: β = 0.19; MetS: OR = 1.11) and 22-years (BMI: β = 0.51; MetS: OR = 1.28). There were no associations in the prospective analysis. After adjustment, significant associations existed between occasional ED-intake and lower HDL-cholesterol (β = -0.07) and higher fasting triglycerides (β = 0.16) at 20-years, and lower fasting triglycerides at 22-years (β = -0.10), but no significant associations in the prospective analyses.

CONCLUSION

No significant associations existed between frequency of ED-intake, and BMI, MetS or its individual components over two years (ages 20-22 years). Future studies should include volume of EDs consumed and longer follow-up.

Do Changes in the Local Food Environment Within New Residential Developments Influence the Diets of Residents? Longitudinal Results from RESIDE

Background: There is limited longitudinal evidence supporting a link between food outlet locations and dietary outcomes to inform policy and urban planning. This study examined how longitudinal changes in the local food environment within new residential developments influenced changes in adult dietary intake. Methods: Adult participant data (n = 3223 person-observations) were sourced from the RESIDential Environments (RESIDE) project across three time points between 2004 to 2012 in Perth, Western Australia. Fixed effects regression estimated the relationship between change in spatial exposure to the local food environment, individual behaviours and perceptions of the local food environment with dietary outcome variables (healthy diet score, unhealthy diet score, diet quality score and fruit/vegetable intake). Results: An increase over time in the percentage of healthy food outlets around the home was significantly (p ≤ 0.05) associated with an increase in healthy diet scores and an increase in the distance from home to the nearest café restaurant was significantly (p ≤ 0.05) associated with an increase in diet quality scores. Conclusions: Modifying the local food environment by increasing the relative proportion of healthy food outlets around the home may support healthier dietary intake.

Prevalence and pattern of energy drink intake among Australian adolescents

BACKGROUND

Energy drinks (ED) are popular among young people despite evidence of associated health risks. Research into the prevalence and pattern of ED intake among young people is sparse. The present study investigates the prevalence and pattern of ED intake among a large sample of adolescents, including how many consume them, how often, for what reasons and in what contexts.

METHODS

In 2018, all students in grades 7-12 attending 25 randomly selected Western Australian schools were invited to complete an online self-report survey about EDs.

RESULTS

Of the 3688 respondents, 51.2% reported consuming an ED. Of these 'ever consumers', 23.4% drank them monthly, 19.2% weekly and 2% every day. The average age of first intake was 10.7 years. One-fifth (19.7%) of 'ever consumers' reported consuming more than two EDs in 1 day. Reasons for ED use included taste, to boost energy levels, sport performance and studying.

CONCLUSIONS

The findings add to limited international evidence about adolescent ED use and provide valuable information to help ensure interventions to reduce intake address the underlying reasons and contexts of ED consumption.

Living liveable? RESIDE's evaluation of the "Liveable Neighborhoods" planning policy on the health supportive behaviors and wellbeing of residents in Perth, Western Australia

BACKGROUND

The RESIDential Environments (RESIDE) project is a unique longitudinal natural experiment designed to evaluate the health impacts of the "Liveable Neighbourhoods" planning policy, which was introduced by the Western Australian government to create more walkable suburbs.

OBJECTIVES

To summarize the RESIDE evidence of the impact of the planning policy on a range of health-supportive behaviours and wellbeing outcomes and to assess the consistency and direction of the estimates of associations.

METHODS

An audit of 26 RESIDE research papers (from 2003 to 2012) identified the number of positive associations (statistically significant and consistent with policy expectations), negative associations (statistically significant and inconsistent with policy expectations), and null findings from multiple-exposure models between objective and perceived measures of 20 policy design requirements and 13 health-supportive behaviors and wellbeing outcomes.

RESULTS

In total 332 eligible estimates of associations (n = 257 objective measures and n = 75 perceived measures) were identified. Positively significant findings were detected for: 57% of walking estimates with objectively measured policy design features (negative = 3%; null = 40%) (n = 115) and 54% perceived measures (negative = 0%; null = 33%) (n = 27); 42% of sense of community estimates with objectively measured of policy design features (negative = 8%; null = 50%) (n = 12) and 61% perceived measures (negative = 8%; null = 31%) (n = 13); 39% of safety or crime-related estimates with objectively measured of policy design features (negative = 22%; null = 39%) (n = 28) and 100% perceived measures (n = 7). All (n = 4) estimates for mental health outcomes with objectively measured policy-related design features were positively significant.

CONCLUSIONS

The synthesis of findings suggests that new suburban communities built in accordance with the "Liveable Neighbourhoods" policy have the potential to encourage health supportive behaviors and wellbeing outcomes including transport and recreation walking, and to create neighborhoods with a stronger sense of community where residents may feel safer.

Children’s neighbourhood physical environment and early development: an individual child level linked data study

Background

Identification of features of the neighbourhood physical environment that have a causal association with positive child development is important for promoting long-term developmental health. Previous research on these associations have been conducted at the neighbourhood level, and do not account for individual variation in exposure to these features.

Methods

This cross-sectional study utilised de-identified linked administrative data. Neighbourhood features were measured with Geographic Information Systems and identified within a 1600 m service area around the child’s home address. The study population included a random selection of 5024 Western Australian children who participated in the 2012 Australian Early Development Census (AEDC; median age 5 years, 5 months). Multi-level logistic regressions modelled the odds of children scoring in the bottom 10% on the physical, social or emotional AEDC domains as an outcome of neighbourhood features.

Results

After adjustment for individual and neighbourhood sociodemographic factors, lower odds of physical vulnerability were associated with increased neighbourhood residential density, presence of railway station, and higher counts of playgroups and kindergartens. Larger areas of neighbourhood home-yard space were associated with increased odds of physical and social vulnerability. Presence of high-quality green spaces was associated with lower odds of social vulnerability. Increased road traffic exposure was associated with higher odds of social and emotional vulnerability.

Conclusions

The neighbourhood physical environment has a weak but significant association with early childhood development. Future research should consider the interplay between the neighbourhood environment and proximal influences, including parenting attributes and socioeconomic status, and how they influence early child development.

Nature Play and Fundamental Movement Skills Training Programs Improve Childcare Educator Supportive Physical Activity Behavior

Background: Physical activity professional development programs for Early Childhood Education and Care (ECEC) educators are a viable strategy for improving preschool children’s physical activity behavior. This pilot intervention evaluated the effectiveness of ‘nature play’ and ‘fundamental movement skills’ (FMS) professional development programs on ECEC educators’ practices on physical activity. Methods: 148 ECEC educators from 20 ECEC centers took part in either the Nature play or FMS professional development programs in Perth, Western Australia. Educators self-reported their physical activity related practices at baseline and three months post-professional development training, using established items. Wilcoxon’s test and adjusted models using Mann–Whitney U tests were run at the individual educator level to examine the change between baseline and post-professional development educator physical activity behavior. Results: Educators’ self-efficacy to engage children to be active significantly increased in both the Nature play and FMS professional development programs (p < 0.05). In the Nature play professional development program, ECEC educators’ perceived time set aside for children to participate in nature-based play increased by 9.2%, and their perceived behavioral control for supporting general and nature-based play activities for preschool children increased by 5% and 10.3%, respectively (p < 0.05). However, these results were no longer significant after adjusting for educator socio-demographics. Conclusion: Both the Nature play and FMS professional development programs were effective in improving educators’ self-efficacy to engage children to be active in Nature play or FMS activities. Larger pragmatic trials are required to confirm the impact of these professional development programs on educator perceived physical activity behavior.

The evolution of local food environments within established neighbourhoods and new developments in Perth, Western Australia

Temporal changes in the location of food outlets can result in disparities in the availability and access of food across geographic areas, contributing to health inequalities. This study used mixed linear models to investigate how the location of food outlets around the home evolved over time with respect to area-level socio-economic status (SES) and urban design within established neighbourhoods and new residential developments. Food outlet data (supermarket/greengrocers, convenience stores, café restaurants and takeaway/fast food) were sourced from commercial database listings (SENSIS Pty. Ltd.) in 2004, 2006, 2007, and 2011. Using 2468 addresses from the RESIDential Environments Project (RESIDE), in Perth, Western Australia (WA), a count of each food outlet type and percentage of healthy food outlets within a 1.6 km road network buffer around the home, along with the road network distance to nearest food outlet were generated relative to each address at each time point. Proximity to and count of all food outlets increased over time in both new developments and established neighbourhoods. However, unhealthy food outlets were always in greater numbers and proximity to the home. The percentage of healthy food outlets was significantly greater in established neighbourhoods compared to new developments at all four time points. There were significantly more food outlets, and within closer proximity to the home, in established neighbourhoods compared to new developments at each time point. In established neighbourhoods, there were more convenience stores, takeaway/fast food and café restaurants, a lower percentage of healthy food outlets, and closer proximity to convenience stores in lower compared to high SES areas. In new developments there were significantly less supermarket/greengrocers, a lower percentage of healthy food outlets and greater proximity to takeaway/fast food and café restaurants in low compared to high SES areas. New developments designed according to the WA government's "Liveable Neighbourhoods Community Design Guidelines" policy had significantly more of all food outlets compared to other new developments. As such, people living in new developments, and low SES areas of Perth, may be disadvantaged with poorer access to healthy food outlets and greater exposure to unhealthy food outlets. Future urban planning and policy should focus on providing incentives that support the early development of supermarkets and healthy food outlets within new developments and low SES areas of Perth.

Food environments and dietary intakes among adults: does the type of spatial exposure measurement matter? A systematic review

BACKGROUND

The relationships between food environments and dietary intake have been assessed via a range of methodologically diverse measures of spatial exposure to food outlets, resulting in a largely inconclusive body of evidence, limiting informed policy intervention.

OBJECTIVE

This systematic review aims to evaluate the influence of methodological choice on study outcomes by examining the within-study effect of availability (e.g., counts) versus accessibility (e.g., proximity) spatial exposure measures on associations with diet.

METHODS

(PROSPERO registration: CRD42018085250). PubMed, Web of Science, Scopus and ScienceDirect databases were searched for empirical studies from 1980 to 2017, in the English language, involving adults and reporting on the statistical association between a dietary outcome and spatial exposure measures of both availability and accessibility. Studies were appraised using an eight-point quality criteria with a narrative synthesis of results.

RESULTS

A total of 205 associations and 44 relationships (i.e., multiple measures of spatial exposure relating to a particular food outlet type and dietary outcome) were extracted from 14 eligible articles. Comparative measures were dominated by counts (availability) and proximity (accessibility). Few studies compared more complex measures and all counts were derived from place-based measures of exposure. Sixteen of the 44 relationships had a significant effect involving an availability measure whilst only 8 had a significant effect from an accessibility measure. The largest effect sizes in relationships were mostly for availability measures. After stratification by scale, availability measure had the greatest effect size in 139 of the 176 pairwise comparisons. Of the 33% (68/205) of associations that reached significance, 53/68 (78%) were from availability measures. There was no relationship between study quality and reported study outcomes.

CONCLUSIONS

The limited evidence suggests that availability measures may produce significant and greater effect sizes than accessibility measures. However, both availability and accessibility measures may be important concepts of spatial exposure depending on the food outlet type and dietary outcome examined. More studies reporting on multi-method effects are required to differentiate findings by the type of spatial exposure assessment and build an evidence base regarding the appropriateness and robustness of measures under different circumstances.

Feasibility of a commercial smartphone application for dietary assessment in epidemiological research and comparison with 24-h dietary recalls

Background

Dietary assessment methods that can provide high quality data while limiting participant burden and resource requirements in epidemiological research are highly sought after and continue to evolve. The use of mobile phone technology in research has increased rapidly over the last decade and offers multiple advantages to the researcher over traditional data collection methods. This study tested the acceptability and relative validity of a commercial smart phone application (app) for use as an epidemiological dietary assessment tool, compared with a traditional dietary assessment method.

Methods

Study participants completed a 4-d food diary using a modified version of the Easy Diet Diary app and two 24-h dietary recalls during the same week, for comparison. At the end of data collection, participants completed a questionnaire on their experience with both methods. Average proportions of energy from macronutrients and fibre, iron, and calcium densities from the app and 24-h recalls were compared after log transformation, by calculating mean agreement, limits of agreement (LOA), and Pearson’s correlations. The prevalence of dietary under-reporting was compared in each method using the Goldberg method.

Results

A total of 50 adults (82% women) provided data for analysis (mean age, 31 y; mean BMI, 22.4 kg/m²; 14% overweight or obese). Participant feedback showed high levels of acceptance of the app; 83% preferred using the app to completing 24-h dietary recalls. The average difference in energy intake (mean agreement) between methods was 268 kJ/d. For all intakes except alcohol, the average difference between methods was not significantly different from zero. Most limits of agreement were within an acceptable range. The prevalence of dietary misreporting was similar in both methods.

Conclusions

These findings demonstrate good feasibility for applying this commercially-developed smartphone app in epidemiological research.

Electronic supplementary material

The online version of this article (10.1186/s12937-018-0315-4) contains supplementary material, which is available to authorized users.

Informing Intervention Strategies to Reduce Energy Drink Consumption in Young People: Findings From Qualitative Research

OBJECTIVE

To determine young people's knowledge of energy drinks (EDs), factors influencing ED consumption, and intervention strategies to decrease ED consumption in young people.

DESIGN

Eight group interviews with young people (aged 12-25 years).

SETTING

Community groups and secondary schools in Perth, Western Australia.

PARTICIPANTS

Forty-one young people, 41% of whom were male and 73% of whom consumed EDs.

PHENOMENON OF INTEREST

Factors influencing ED consumption and intervention strategies informed by young people to reduce ED consumption.

ANALYSIS

Two researchers conducted a qualitative content analysis on the data using NVivo software.

RESULTS

Facilitators of ED consumption included enhanced energy, pleasant taste, low cost, peer pressure, easy availability, and ED promotions. Barriers included negative health effects, unpleasant taste, high cost, and parents' disapproval. Strategies to reduce ED consumption included ED restrictions, changing ED packaging, increasing ED prices, reducing visibility in retail outlets, and research and education.

CONCLUSION AND IMPLICATIONS

Because many countries allow the sale of EDs to people aged <18 years, identifying ways to minimize potential harm from EDs is critical. This study provided unique insights into intervention strategies suggested by young people to reduce ED consumption. In addition to more research and education, these strategies included policy changes targeting ED sales, packaging, price, and visibility. Future research might examine the feasibility of implementing such interventions.

Understanding the relationship between dog ownership and children's physical activity and sedentary behaviour

BACKGROUND

Dog ownership is a catalyst for physical activity in adults. Given 50-70% of Australian households with children have a dog, dog-facilitated physical activity may be an effective way to increase physical activity and decrease child obesity.

OBJECTIVE

We hypothesized that children with a family dog walk more, are more physically active and are more likely to achieve recommended levels of weekly physical activity compared with children who do not have a dog.

METHOD

Cross-sectional data from the Western Australian TRravel, Environment, and Kids project (TREK) were analyzed for 1218 children aged 10-12 years. Individual and environment factors, child physical activity, walking, screen use, sedentary behaviour and dog ownership status was collected from child and parent questionnaires. Children's height and weight were measured.

RESULTS

Approximately 60% of children had a family dog. Dog ownership was associated with, on average, 29 more minutes of walking and 142 more minutes of physical activity per week (P ≤ 0.01). After adjustment, children with a dog were 49% more likely to achieve the recommended level of weekly physical activity (420 min) and 32% more likely to have walked in their neighbourhood in the last week, compared with non-dog owners (P ≤ 0.05). These relationships varied by gender. Dog ownership was not associated with screen use or weight status.

CONCLUSIONS

Dog ownership was associated with walking and physical activity, but not screen use or weight status. Within dog-owning families, the promotion of walking and active play with a dog may be a strategy to increase children's physical activity.

Application of an erythrocyte aluminum assay in the diagnosis of aluminum-associated microcytic anemia in patients undergoing dialysis and response to deferoxamine therapy

A method for measuring erythrocyte aluminum content was developed. Erythrocyte aluminum levels correlated with plasma aluminum concentrations in normal controls and in patients undergoing dialysis (r = 0.90, p less than 0.001). In vitro studies showed that erythrocyte aluminum concentrations were not altered by contamination of blood samples, which is a common problem with plasma determinations. The need for anticoagulation and rapid processing were disadvantages of this assay. In the dialysis population studied, the correlative data between mean cell volume and both plasma and erythrocyte aluminum levels (r = -0.50, p less than 0.001; and r = -0.69, p less than 0.001) and lack of correlation with serum ferritin suggested that aluminum overload and not iron deficiency was the cause of microcytic anemia. Patients undergoing continuous ambulatory peritoneal dialysis had lower plasma and erythrocyte aluminum levels and absence of microcytic anemia compared with patients undergoing hemodialysis. Therapy with deferoxamine in 13 patients with aluminum-related microcytic anemia resulted in a decrease in erythrocyte and plasma aluminum content in all patients (265.5 +/- 69.2 micrograms/L to 22.6 +/- 9.7 micrograms/L and 196 +/- 30 micrograms/L to 129 +/- 13.8 micrograms/L). The relatively smaller decrease in plasma aluminum levels suggested mobilization of aluminum from tissues other than erythrocytes. Aluminum chelation most probably occurred from premature erythrocytes, because in vitro studies showed that deferoxamine was unable to chelate aluminum from mature erythrocytes. Hemoglobin level, hematocrit measurement, and mean cell volume showed significant improvement (p less than 0.001). Ten patients showed normalized mean cell volume after 6.2 +/- 2 months of therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Psychophysiologic circadian rhythmometry on manic-depressive twins

Rhythmometry on emotionally disturbed identical twins is applied for study of possible emotional chronopathology. Several circadian rhythmic variables are apparently 24-h synchronized in both twins, during a study span associated with mania in one twin and apparently 'normal' behavior in the other. While the data span of 3 weeks does not allow validation of any desynchronization with a period quite near to 24 h in the case of a manic girl, it does not rule out the possibility of uncoupling of an adrenal cortical cycle, gauged by the circadian rhythm in urinary 17-ketosteroid excretion. The question whether circadian or other dyschronism was present, and, if so, represented a trivial corollary or, perhaps, a determinant of emotional pathology, remains unanswered. The methodology here illustrated and added tests of differences in rhythm characteristics are likely to provide answers to such questions when they are combined with therapeutic manipulations and the search for possible chronobiotic drugs.