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Strugnell C, Orellana L, Crooks N, Malakellis M, Morrissey B, Rennie C, Hayward J, Bliss J, Swinburn B, Gaskin CJ, Allender S. Healthy together Victoria and childhood obesity study: effects of a large scale, community-based cluster randomised trial of a systems thinking approach for the prevention of childhood obesity among secondary school students 2014-2016. BMC Public Health 2024; 24:355. [PMID: 38308292 PMCID: PMC10835842 DOI: 10.1186/s12889-024-17906-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 01/27/2024] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Healthy Together Victoria (HTV) was a Victorian Government initiative that sought to reduce the prevalence of overweight and obesity through targeting chronic disease risk factors including physical activity, poor diet quality, smoking, and harmful alcohol use. The intervention involved a boosted workforce of > 170 local-level staff in 12 communities; employed to deliver system activation around health and wellbeing for individuals, families and communities. A cluster randomised trial (CRT) of a systems thinking approach to obesity prevention was embedded within HTV. We present the two-year changes in overweight and obesity and associated behaviours among secondary school students across Victoria, Australia. METHODS Twenty-three geographically bounded areas were randomised to intervention (12 communities) or comparison (11 communities). Randomly selected secondary schools within each community were invited to participate in the trial in 2014 and 2016. Students in Grade 8 (aged approximately 13-15 years) and Grade 10 (aged approximately 15-16 years) at participating schools were recruited using an opt-out approach across July-September 2014 and 2016. Primary outcomes were body mass index (BMI) and waist circumference. Secondary outcomes were physical activity, sedentary behaviour, diet quality, health-related quality of life, and depressive symptoms. Linear mixed models were fit to estimate the intervention effect adjusting for child/school characteristics. RESULTS There were 4242 intervention children and 2999 control children in the final analysis. For boys, the two-year change showed improvement in intervention versus control for waist circumference (difference in change: - 2.5 cm; 95% confidence interval [CI]: - 4.6, - 0.5) and consumption of sugar-sweetened beverages per day (< 1 serve: 8.5 percentage points; 95% CI: 0.6, 16.5). For girls, there were no statistically significant differences between conditions. CONCLUSIONS HTV seemed to produce favourable changes in waist circumference and sugar-sweetened beverage consumption for boys, however, no effect on BMI was observed. Although the HTV intervention was cut short, and the period between data collection points was relatively short, the changes observed in HTV contribute to the growing evidence of whole-of-community interventions targeting childhood obesity. TRIAL REGISTRATION This trial is unregistered. The intervention itself was a policy setting delivered by government and our role was the collection of data to evaluate the effect of this natural experiment. That is, this study was not a trial from the classical point of view and we were not responsible for the intervention.
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Affiliation(s)
- Claudia Strugnell
- Faculty of Health, Global Centre for Prevention Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Australia.
- Institute for Physical Activity and Nutrition, Deakin University Waterfront Campus, Geelong, Victoria, 3220, Australia.
| | - Liliana Orellana
- Faculty of Health, Biostatistics Unit, Deakin University, Geelong, Australia
| | - Nicholas Crooks
- Faculty of Health, Global Centre for Prevention Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Mary Malakellis
- Faculty of Health, Global Centre for Prevention Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Bridget Morrissey
- Faculty of Health, Global Centre for Prevention Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Claire Rennie
- Faculty of Health, Global Centre for Prevention Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Joshua Hayward
- Faculty of Health, Global Centre for Prevention Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Jo Bliss
- Faculty of Health, Global Centre for Prevention Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Boyd Swinburn
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Cadeyrn J Gaskin
- Faculty of Health, Global Centre for Prevention Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Steven Allender
- Faculty of Health, Global Centre for Prevention Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Australia
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Browne J, Becker D, Orellana L, Ryan J, Walker T, Whelan J, Alston L, Egan M, Johnson B, Rossignoli A, Crooks N, Brown AD, Bolton KA, Fraser P, Le H, Bell C, Hayward J, Sanigorski A, Backholer K, Allender S, Strugnell C. Healthy weight, health behaviours and quality of life among Aboriginal children living in regional Victoria. Aust N Z J Public Health 2022; 46:595-603. [DOI: 10.1111/1753-6405.13271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 03/01/2022] [Accepted: 05/01/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Jennifer Browne
- Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development, Faculty of Health Deakin University Geelong Victoria
| | - Denise Becker
- Biostatistics Unit, Faculty of Health Deakin University Geelong Victoria
| | - Liliana Orellana
- Biostatistics Unit, Faculty of Health Deakin University Geelong Victoria
| | - Joleen Ryan
- School of Health and Social Development, Faculty of Health Deakin University Geelong Victoria
| | - Troy Walker
- Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development, Faculty of Health Deakin University Geelong Victoria
| | - Jill Whelan
- Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development, Faculty of Health Deakin University Geelong Victoria
- School of Medicine, Faculty of Health Deakin University Geelong Victoria
| | - Laura Alston
- Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development, Faculty of Health Deakin University Geelong Victoria
- Deakin Rural Health, Faculty of Health Deakin University Warrnambool Victoria
| | - Mikaela Egan
- Victorian Aboriginal Community Controlled Health Organisation Melbourne Victoria
| | - Brittney Johnson
- Victorian Aboriginal Community Controlled Health Organisation Melbourne Victoria
| | - Amy Rossignoli
- Victorian Aboriginal Community Controlled Health Organisation Melbourne Victoria
| | - Nicholas Crooks
- Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development, Faculty of Health Deakin University Geelong Victoria
| | - Andrew D. Brown
- Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development, Faculty of Health Deakin University Geelong Victoria
| | - Kristy A. Bolton
- Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development, Faculty of Health Deakin University Geelong Victoria
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Faculty of Health Deakin University Geelong Victoria
| | - Penny Fraser
- Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development, Faculty of Health Deakin University Geelong Victoria
- School of Medicine, Faculty of Health Deakin University Geelong Victoria
| | - Ha Le
- Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development, Faculty of Health Deakin University Geelong Victoria
- Deakin Health Economics, Faculty of Health Deakin University Geelong Victoria
| | - Colin Bell
- Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development, Faculty of Health Deakin University Geelong Victoria
- School of Medicine, Faculty of Health Deakin University Geelong Victoria
| | - Josh Hayward
- Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development, Faculty of Health Deakin University Geelong Victoria
| | - Andrew Sanigorski
- Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development, Faculty of Health Deakin University Geelong Victoria
| | - Kathryn Backholer
- Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development, Faculty of Health Deakin University Geelong Victoria
| | - Steven Allender
- Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development, Faculty of Health Deakin University Geelong Victoria
- Deakin Rural Health, Faculty of Health Deakin University Warrnambool Victoria
| | - Claudia Strugnell
- Global Obesity Centre (GLOBE), Institute for Health Transformation, School of Health and Social Development, Faculty of Health Deakin University Geelong Victoria
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Crooks N, Alston L, Nichols M, Bolton KA, Allender S, Fraser P, Le H, Bliss J, Rennie C, Orellana L, Strugnell C. Association between the school physical activity environment, measured and self-reported student physical activity and active transport behaviours in Victoria, Australia. Int J Behav Nutr Phys Act 2021; 18:79. [PMID: 34158052 PMCID: PMC8220765 DOI: 10.1186/s12966-021-01151-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 06/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background Environments within schools including the physical, social-cultural and policy/practice environments have the potential to influence children’s physical activity (PA) behaviours and weight status. This Australian first study comprehensively examined the association(s) of physical, social-cultural and policy/practice environments with PA, active transport (AT) and weight status among regional primary school children. Methods Data were from two childhood obesity monitoring systems in regional Victoria, Australia. Measured height and weight were collected from students in Year 2 (aged approx. 7–8 years), Year 4 (9–10 years), and Year 6 (11–12 years). Self–reported PA behaviour, including AT were collected from students in Year 4 and 6 and a sub-sample wore an ActiGraph (wGT3X-BT) accelerometer for 7-days. A school physical activity environment audit was completed by the school principal and responses were used to calculate school physical activity environment scores (PAES) and active transport environment scores (ATES). Mixed effects logistic regression was used to assess the relationship between the proportion of students meeting the PA guidelines (≥60mins/day of moderate-to-vigorous PA) and PAES tertiles (low, medium, high) and those using AT and school ATES tertiles, controlling for gender, school size/type and socioeconomic composition. Results The analysed sample included 54/146 (37%) schools and 3360/5376 (64%) students. In stratified analysis, girls in schools with a medium PAES score were more likely to meet the objectively measured PA guideline compared to low PAES score (OR 2.3, 95%CI 1.27, 4.16). Similarly, students in schools with a medium or high ATES score had higher odds of self-reported AT (medium OR 3.15, 95%CI 1.67, 5.94; high OR 3.71, 95%CI: 1.80, 7.64). No association between PAES or ATES and weight status were observed. Self-reported AT among boys (OR 1.59, 95%CI 1.19, 2.13) and girls (OR 1.56, 95%CI 1.08, 2.27) was associated with higher odds of meeting self-reported PA guidelines on all 7-days than those who did not report using AT. Conclusions In this study of regional Victorian primary schools, PA environments were only associated with girls’ adherence to PA guidelines. School AT environments were strongly associated with students’ AT behaviours and with increased likelihood of students being physically active. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-021-01151-6.
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Affiliation(s)
- Nicholas Crooks
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, Victoria, 3220, Australia
| | - Laura Alston
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, Victoria, 3220, Australia
| | - Melanie Nichols
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, Victoria, 3220, Australia
| | - Kristy A Bolton
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, Victoria, 3220, Australia
| | - Steven Allender
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, Victoria, 3220, Australia
| | - Penny Fraser
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, Victoria, 3220, Australia
| | - Ha Le
- Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, 221 Burwood Hwy, Burwood, Geelong, Victoria, 3125, Australia
| | - Joanne Bliss
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, Victoria, 3220, Australia
| | - Claire Rennie
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, Victoria, 3220, Australia
| | - Liliana Orellana
- Biostatistics Unit, Faculty of Health, Deakin University, 221 Burwood Hwy, Burwood, Geelong, Victoria, 3125, Australia
| | - Claudia Strugnell
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, Victoria, 3220, Australia.
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Kremer P, Crooks N, Rowland B, Hall J, Toumbourou JW. Increasing compliance with alcohol service laws in community sporting clubs in Australia. Drug Alcohol Rev 2021; 41:188-196. [PMID: 33819363 DOI: 10.1111/dar.13283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 12/17/2020] [Accepted: 03/03/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Many community sporting clubs in Australia sell alcohol, but many do not comply with laws that require verification of age and forbid underage alcohol sales. This study aimed to assess the effectiveness of an intervention that incorporated sales monitoring and community awareness raising to improve compliance with alcohol service regulations in community sporting clubs. METHODS Non-randomised community trial in 'matched' intervention and comparison communities. A total of 50 sporting clubs from two metropolitan and two regional areas in Victoria, Australia, were selected, and baseline and follow-up purchase observations completed during 2018. Youth who looked underage were monitored as they attempted to purchase alcohol. Intervention clubs received feedback letters regarding staff sales behaviour. Other intervention actions included building awareness of underage supply of alcohol and media coverage of baseline observations. RESULTS Observations were completed at 46 clubs (intervention = 24; comparison = 22) at baseline and 39 (intervention = 24; comparison = 15) at follow up. Compliance was low but improved at follow up for both groups for age verification (intervention +12.5%; comparison +8.5%) and non-supply of alcohol (intervention +12.5%; comparison +10.6%); but no significant intervention effects were found. DISCUSSION AND CONCLUSIONS Findings indicated low compliance with age verification checks and underage alcohol sales laws at baseline. Promising improvements in compliance were observed at follow up; however, 'spillover' of intervention activities may have compromised ability to detect significant intervention effects. Further intervention effort and evaluation is recommended to encourage alcohol sales compliance in community sporting clubs.
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Affiliation(s)
- Peter Kremer
- Centre for Sport Research, Deakin University, Geelong, Australia
| | - Nicholas Crooks
- Global Obesity Centre, Deakin University, Geelong, Australia
| | - Bosco Rowland
- Centre for Social and Early Emotional Development, Deakin University, Geelong, Australia
| | - Jessica Hall
- Centre for Social and Early Emotional Development, Deakin University, Geelong, Australia
| | - John W Toumbourou
- Centre for Social and Early Emotional Development, Deakin University, Geelong, Australia
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Maitland N, Williams M, Jalaludin B, Allender S, Strugnell C, Brown A, Hayward J, Crooks N, Tredoux J, Li V, Wardle K. Campbelltown - Changing our Future: study protocol for a whole of system approach to childhood obesity in South Western Sydney. BMC Public Health 2019; 19:1699. [PMID: 31852528 PMCID: PMC6921477 DOI: 10.1186/s12889-019-7936-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 11/11/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND In Australia, around 67% of adults and 25% of children (5-17 years) are currently overweight or obese (Australian Bureau of Statistics, 4364.0.55.001 - National Health Survey: First Results, 2017-18, 2018). The Campbelltown - Changing our Future study will translate 'a whole of system' approach, previously trialed in rural communities in Victoria and the Australian Capital Territoty, to Campbelltown Local Government Area (LGA), a socioeconomically and ethnically diverse urban community in south western Sydney, NSW. METHODS The study intervention will use a five-step approach; 1 - set up a childhood obesity monitoring system by collecting baseline data from children in primary schools across Campbelltown LGA to give a local context to the community when developing the systems map; 2 - key stakeholders develop systems maps which inform the development of the interventions; 3 - key stakeholders and community groups identify priority areas for action and form working groups; 4 - implementation of the interventions; 5 - evaluation of the interventions. The study will adopt a longitudinal pre/post design with repeated measures at baseline, 2 years and 4 years. Both qualitative and quantitative methods will be used to collect and analyse the data. DISCUSSION Addressing childhood overweight and obesity is complex and requires a multifaceted intervention. This approach has the capacity to impact a range of factors that influence childhood overweight and obesity utilising existing capacity of multiple partners with broad community reach. Findings will develop local responses which capture the complexity of obesity at a community level and further our understanding of the interrelationships and relative importance of local factors impacting childhood overweight and obesity. This study aims to provide evidence for systems methods and approaches suitable for adaption and scaling and may provide evidence of successful community intervention elements.
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Affiliation(s)
- Nicola Maitland
- Health Promotion Service, Population Health, South Western Sydney Local Health District, Liverpool, New South Wales Australia
| | - Mandy Williams
- Health Promotion Service, Population Health, South Western Sydney Local Health District, Liverpool, New South Wales Australia
| | - Bin Jalaludin
- Population Health Intelligence, South Western Sydney Local Health District, Liverpool, New South Wales Australia
- Ingham Institute for Applied Medical Research, University of New South Wales, Sydney, New South Wales Australia
| | - Steven Allender
- Global Obesity Centre, Deakin University, Geelong, Victoria Australia
- Institute for Health Transformation, Deakin University, Geelong, Victoria Australia
| | - Claudia Strugnell
- Institute for Health Transformation, Deakin University, Geelong, Victoria Australia
| | - Andrew Brown
- Institute for Health Transformation, Deakin University, Geelong, Victoria Australia
| | - Joshua Hayward
- Institute for Health Transformation, Deakin University, Geelong, Victoria Australia
| | - Nicholas Crooks
- Institute for Health Transformation, Deakin University, Geelong, Victoria Australia
| | - Jaimie Tredoux
- Health Promotion Service, Population Health, South Western Sydney Local Health District, Liverpool, New South Wales Australia
| | - Vincy Li
- NSW Office of Preventive Health, Liverpool Hospital, Liverpool, New South Wales Australia
| | - Karen Wardle
- Health Promotion Service, Population Health, South Western Sydney Local Health District, Liverpool, New South Wales Australia
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Alston L, Crooks N, Strugnell C, Orellana L, Allender S, Rennie C, Nichols M. Associations between School Food Environments, Body Mass Index and Dietary Intakes among Regional School Students in Victoria, Australia: A Cross-Sectional Study. Int J Environ Res Public Health 2019; 16:E2916. [PMID: 31416245 PMCID: PMC6720309 DOI: 10.3390/ijerph16162916] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/06/2019] [Accepted: 08/08/2019] [Indexed: 12/17/2022]
Abstract
(1) Background: Childhood overweight and obesity is a significant and preventable problem worldwide. School environments have been suggested to be plausible targets for interventions seeking to improve the quality of children's dietary intake. The objective of this study was to determine the extent to which the current characteristics of the school food environment were associated with primary school students' dietary intake and Body Mass Index (BMI) z scores in a representative sample in regional Victoria. (2) Methods: This study included 53 schools, comprising a sample of 3,496 students in year levels two (aged 7-8 years), four (9-10 years) and six (11-12 years). Year four and six students completed dietary questionnaires. Principals from each school completed a survey on school food environment characteristics. Mixed-effects logistic regression was used to assess the relationship between students' dietary intake and school food environment scores, controlling for confounders such as socio-economic status, school size and sex. Food environment scores were also analysed against the odds of being healthy weight (defined as normal BMI z score). (3) Results: Mixed associations were found for the relationship between students' dietary intake and food environment scores. Meeting the guidelines for vegetable intake was not associated with food environment scores, but students were more likely (OR: 1.68 95% CI 1.26, 2.24) to meet the guidelines if they attended a large school (>300 enrolments) and were female (OR: 1.28 95% CI: 1.02, 1.59). Healthy weight was not associated with school food environment scores, but being a healthy weight was significantly associated with less disadvantage (OR: 1.24 95% CI 1.05, 1.45). Conclusion: In this study, the measured characteristics of school food environments did not have strong associations with dietary intakes or BMI among students.
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Affiliation(s)
- Laura Alston
- Global Obesity Centre (GLOBE), Faculty of Health, Deakin University, Geelong 3217, Victoria, Australia.
| | - Nicholas Crooks
- Global Obesity Centre (GLOBE), Faculty of Health, Deakin University, Geelong 3217, Victoria, Australia
| | - Claudia Strugnell
- Global Obesity Centre (GLOBE), Faculty of Health, Deakin University, Geelong 3217, Victoria, Australia
| | - Liliana Orellana
- Biostatistics Unit, Faculty of Health, Deakin University, Geelong 3217, Victoria, Australia
| | - Steven Allender
- Global Obesity Centre (GLOBE), Faculty of Health, Deakin University, Geelong 3217, Victoria, Australia
| | - Claire Rennie
- Cancer Council Victoria, Melbourne 3004, Victoria, Australia
| | - Melanie Nichols
- Global Obesity Centre (GLOBE), Faculty of Health, Deakin University, Geelong 3217, Victoria, Australia
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Crooks N, Strugnell C, Bell C, Allender S. Establishing a sustainable childhood obesity monitoring system in regional Victoria. Health Promot J Austr 2019; 28:96-102. [PMID: 28002719 DOI: 10.1071/he16020] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 09/19/2016] [Indexed: 11/23/2022] Open
Abstract
Issue addressed Childhood obesity poses a significant immediate and long-term burden to individuals, societies and health systems. Infrequent and inadequate monitoring has led to uncertainty about trends in childhood obesity prevalence in many countries. High-quality data, collected at regular intervals, over extended timeframes, with high response rates and timely feedback are essential to support prevention efforts. Our aim was to establish a sustainable childhood obesity monitoring system in regional Australia to collect accurate anthropometric and behavioural data, provide timely feedback to communities and build community engagement and capacity. Methods All schools from six government regions of South-West Victoria were invited to participate. Passive (opt-out) consent was used to collect measured anthropometric and self-reported behavioural data from children in years 2, 4, and 6, aged 7-12 years. Results We achieved a 70% school participation rate (n=46) and a 93% student response rate (n=2198) among government and independent schools. Results were reported within 10 weeks post data collection. Harnessing high levels of community engagement throughout the planning, data collection and reporting phases increased community capacity and data utility. Conclusions The monitoring system achieved high response rates, community engagement and community capacity building, and delivered results back to the community in a timely manner. So what? This system has the potential to provide sustainable monitoring of childhood obesity that is not dependent on external funding. The results of this monitoring will likely inform health promotion efforts in communities across the region.
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Affiliation(s)
- Nicholas Crooks
- World Health Organization's Collaborating Centre for Obesity Prevention, Centre for Population Health Research, Deakin University, Locked Bag 20001, Geelong, Vic. 3220, Australia
| | - Claudia Strugnell
- World Health Organization's Collaborating Centre for Obesity Prevention, Centre for Population Health Research, Deakin University, Locked Bag 20001, Geelong, Vic. 3220, Australia
| | - Colin Bell
- World Health Organization's Collaborating Centre for Obesity Prevention, Centre for Population Health Research, Deakin University, Locked Bag 20001, Geelong, Vic. 3220, Australia
| | - Steve Allender
- World Health Organization's Collaborating Centre for Obesity Prevention, Centre for Population Health Research, Deakin University, Locked Bag 20001, Geelong, Vic. 3220, Australia
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Hoare E, Crooks N, Hayward J, Allender S, Strugnell C. Associations between combined overweight and obesity, lifestyle behavioural risk and quality of life among Australian regional school children: baseline findings of the Goulburn Valley health behaviours monitoring study. Health Qual Life Outcomes 2019; 17:16. [PMID: 30658630 PMCID: PMC6339321 DOI: 10.1186/s12955-019-1086-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 01/07/2019] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Health related quality of life is a multi-dimensional construct of particular interest in determining the consequences of illness and disease. This study aimed to determine the relationships between overweight/obesity, and associated obesogenic risk behaviours with health related quality of life and physical, social, emotional and school sub-domains, among a large cohort of Australian primary school children. METHODS The data were derived from the Goulburn Valley Health Behaviours Monitoring study whereby a census-styled school recruitment process and high participatory opt-out (passive) procedure was employed. All primary schools in three Local Government Areas were invited to participate between July-September 2016 with 39/62 (62%) of schools participating and 1606/2034 (79%) students in Grade 2 (aged approx. 7-8 years), Grade 4 (aged approx. 9-10 years) and Grade 6 (aged approx. 11-12 years) participating. Measured height and weight were collected among participating students and older children (Grade 4 and 6) who also completed a self-report behavioural questionnaire, including the paediatric quality of life inventory. RESULTS Among 809 children aged 9 to 12 years, there were 219 (27.1%) classified as overweight/obese. Male children classified as overweight/obese reported significantly lower health related quality of life in the physical functioning and global functioning scores, compared to normal weight males. Significantly higher quality of life scores were observed among all children who met the physical activity recommendations on five out of the seven previous days. Significantly higher scores were observed among males adhering to the daily screen time recommendations, and among those meeting daily recommendations for fruit consumption. Among male school children, soft drink consumption was associated to lower health related quality of life. CONCLUSION Although cross-sectional, these findings highlight children with overweight/obesity and some underlying lifestyle behavioural risk factors, had significantly lower healthy-related quality of life, although this was observed most consistently among male school children. These findings have not previously been identified in young children and highlights the need to consider mental and emotional health in public health efforts to prevent obesity. TRIAL REGISTRATION ANZCTR Trial Registry: ACTRN12616000980437 retrospectively registered 26 July 2016.
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Affiliation(s)
- Erin Hoare
- Food & Mood Centre, IMPACT SRC, School of Medicine, Deakin University, 1 Gheringhap Street, Geelong, Australia
- Global Obesity Centre, Centre for Population Health Research, Deakin University, Geelong, Australia
| | - Nicholas Crooks
- Global Obesity Centre, Centre for Population Health Research, Deakin University, Geelong, Australia
| | - Joshua Hayward
- Global Obesity Centre, Centre for Population Health Research, Deakin University, Geelong, Australia
| | - Steven Allender
- Global Obesity Centre, Centre for Population Health Research, Deakin University, Geelong, Australia
| | - Claudia Strugnell
- Global Obesity Centre, Centre for Population Health Research, Deakin University, Geelong, Australia
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Yeung DE, Crooks N, Abraham-Igwe C. Surgeon-inserted rectus sheath catheters provide effective postlaparotomy analgesia. BMJ Mil Health 2018; 166:208. [PMID: 30573697 DOI: 10.1136/jramc-2018-001108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 11/05/2018] [Indexed: 11/03/2022]
Affiliation(s)
- Denise Ena Yeung
- General Surgery, Birmingham Heartlands Hospital Ringgold Standard Institution, Birmingham, UK
| | - N Crooks
- Anaesthesia, Birmingham Heartlands Hospital Ringgold Standard Institution, Birmingham, UK
| | - C Abraham-Igwe
- General Surgery, Birmingham Heartlands Hospital Ringgold Standard Institution, Birmingham, UK
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Kremer P, Crooks N, Rowland B, Hall J, Toumbourou JW. Underage alcohol sales in community sporting clubs. Drug Alcohol Rev 2018; 37:879-886. [DOI: 10.1111/dar.12858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 07/30/2018] [Accepted: 08/19/2018] [Indexed: 12/29/2022]
Affiliation(s)
- Peter Kremer
- Centre for Sport Research; Deakin University; Geelong Australia
| | | | - Bosco Rowland
- Centre for Social and Early Emotional Development; Deakin University; Geelong Australia
| | - Jessica Hall
- Centre for Social and Early Emotional Development; Deakin University; Geelong Australia
| | - John W. Toumbourou
- Centre for Social and Early Emotional Development; Deakin University; Geelong Australia
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Malakellis M, Hoare E, Sanigorski A, Crooks N, Allender S, Nichols M, Swinburn B, Chikwendu C, Kelly PM, Petersen S, Millar L. Authors' response to Letter to the Editor: ANZJPH-2017-220. Aust N Z J Public Health 2017; 42:215. [PMID: 29281167 DOI: 10.1111/1753-6405.12767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Mary Malakellis
- Centre for Population Health Research, Deakin University, Victoria
| | - Erin Hoare
- Centre for Population Health Research, Deakin University, Victoria
| | | | - Nicholas Crooks
- Centre for Population Health Research, Deakin University, Victoria
| | - Steven Allender
- Centre for Population Health Research, Deakin University, Victoria
| | - Melanie Nichols
- Centre for Population Health Research, Deakin University, Victoria
| | - Boyd Swinburn
- Centre for Population Health Research, Deakin University, Victoria.,Population Nutrition and Global Health, University of Auckland, New Zealand
| | - Cal Chikwendu
- Population Health Division, Health Directorate, ACT Government, Australian Capital Territory
| | - Paul M Kelly
- Population Health Division, Health Directorate, ACT Government, Australian Capital Territory.,Medical School, Australian National University, Australian Capital Territory
| | - Solveig Petersen
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Lynne Millar
- Centre for Population Health Research, Deakin University, Victoria
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12
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Coulden AE, Rickard LJ, Crooks N, Arora N. Phosphate replacement in the critically ill: potential implications for military patients. J ROY ARMY MED CORPS 2017; 164:112-115. [PMID: 29025961 DOI: 10.1136/jramc-2017-000843] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 09/20/2017] [Accepted: 09/22/2017] [Indexed: 11/03/2022]
Abstract
BACKGROUND Severe hypophosphataemia in the intensive care unit (ICU) setting has been widely associated with adverse clinical outcomes across multiple organ systems, as well as increased mortality. However, the clinical significance of mild or moderate hypophosphataemia remains uncertain. This can lead to heterogeneous phosphate replacement protocols across different institutions. The aim of this study was to assess the significance of mild and moderate hypophosphataemia on clinical outcomes across several organ systems. METHOD All patients over a 3-week period in our ICU were retrospectively analysed with admission serum phosphate compared with subsequent clinical outcomes after admission. Low serum phosphate (0.3-1.0 mmol/L), according to local protocol, was compared with normal serum phosphate (>1.0 mmol/L). RESULTS Of the 72 patients admitted to intensive therapy unit during this period, 14/72 (19%) had phosphate levels deemed low (<1.0 mmol/L) and received phosphate supplementation. No significant difference was found between groups in terms of cardiac arrhythmias (p=0.55), capillary blood glucose (p=0.08) and serum lactate (p=0.32). Low phosphate (0.3-1.0 mmol/L) was not associated with increased likelihood of requiring ventilation. Platelet count was significantly lower in the low phosphate group (p=0.008). CONCLUSION In our study, mild and moderate hypophosphataemia was not associated with adverse clinical outcome across most organ systems analysed. Given the current evidence and results of this study, we would suggest that there is a trend towards over-replacement of phosphate, representing a potential clinical safety issue as well as clear financial implications.
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Affiliation(s)
- A E Coulden
- Intensive Care, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - L J Rickard
- Intensive Care, Heart of England NHS Foundation Trust, Birmingham, UK
| | - N Crooks
- Intensive Care, Heart of England NHS Foundation Trust, Birmingham, UK
| | - N Arora
- Intensive Care, Heart of England NHS Foundation Trust, Birmingham, UK
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13
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Malakellis M, Hoare E, Sanigorski A, Crooks N, Allender S, Nichols M, Swinburn B, Chikwendu C, Kelly PM, Petersen S, Millar L. School-based systems change for obesity prevention in adolescents: outcomes of the Australian Capital Territory 'It's Your Move!'. Aust N Z J Public Health 2017; 41:490-496. [PMID: 28749562 DOI: 10.1111/1753-6405.12696] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 04/01/2017] [Accepted: 05/01/2017] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The Australian Capital Territory 'It's Your Move!' (ACT-IYM) was a three-year (2012-2014) systems intervention to prevent obesity among adolescents. METHODS The ACT-IYM project involved three intervention schools and three comparison schools and targeted secondary students aged 12-16 years. The intervention consisted of multiple initiatives at individual, community, and school policy level to support healthier nutrition and physical activity. Intervention school-specific objectives related to increasing active transport, increasing time spent physically active at school, and supporting mental wellbeing. Data were collected in 2012 and 2014 from 656 students. Anthropometric data were objectively measured and behavioural data self-reported. RESULTS Proportions of overweight or obesity were similar over time within the intervention (24.5% baseline and 22.8% follow-up) and comparison groups (31.8% baseline and 30.6% follow-up). Within schools, two of three the intervention schools showed a significant decrease in the prevalence of overweight and obesity (p<0.05). CONCLUSIONS There was some evidence of effectiveness of the systems approach to preventing obesity among adolescents. Implications for public health: The incorporation of systems thinking has been touted as the next stage in obesity prevention and public health more broadly. These findings demonstrate that the use of systems methods can be effective on a small scale.
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Affiliation(s)
- Mary Malakellis
- Centre for Population Health Research, Deakin University, Victoria
| | - Erin Hoare
- Centre for Population Health Research, Deakin University, Victoria
| | | | - Nicholas Crooks
- Centre for Population Health Research, Deakin University, Victoria
| | - Steven Allender
- Centre for Population Health Research, Deakin University, Victoria
| | - Melanie Nichols
- Centre for Population Health Research, Deakin University, Victoria
| | - Boyd Swinburn
- Centre for Population Health Research, Deakin University, Victoria.,Population Nutrition and Global Health, University of Auckland, New Zealand
| | - Cal Chikwendu
- Population Health Division, Health Directorate, ACT Government, Australian Capital Territory
| | - Paul M Kelly
- Population Health Division, Health Directorate, ACT Government, Australian Capital Territory.,Medical School, Australian National University, Australian Capital Territory
| | - Solveig Petersen
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Lynne Millar
- Centre for Population Health Research, Deakin University, Victoria
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Dzavik V, Crooks N, Ivanov J, Chan W, Osten M, Horlick E, Ing D, Barolet A, Seidelin P, Overgaard C. A HYBRID STRATEGY OF BARE METAL COMBINED WITH DRUG-ELUTING STENTING OR DRUG-ELUTING STENTING ONLY FOR MULTIVESSEL PERCUTANEOUS CORONARY INTERVENTION: Results OF LONG-TERM FOLLOW-UP. Can J Cardiol 2014. [DOI: 10.1016/j.cjca.2014.07.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Mcgeoch RJ, Choudhury A, Chan W, Sibbald M, Crooks N, Hatton R, Seidelin P, Overgaard C, Ivanov J, Dzavik V. Long term outcomes of PCI and CABG for isolated proximal LAD lesions: a real world comparison. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p2164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Chan W, Ivanov J, Kotowycz M, Sibbald M, McGeoch R, Crooks N, Hatton R, Ing D, Daly P, Mackie K, Osten M, Seidelin P, Barolet A, Overgaard C, Džavík V. Association Between Drug-Eluting Stent Type and Clinical Outcomes in Patients With and Without Renal Insufficiency Undergoing Percutaneous Coronary Intervention. Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Crooks N, Ross T, Grant S, Anmolsingh R, Gabriel A, Foggo-Osseyran A, Carroll K, Wilson C. A severe pneumonia due to methicillin resistant staphylococcus aureus clone USA 300: implications of vertical transmission. W INDIAN MED J 2012; 61:145-147. [PMID: 23155959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Staphylococcus aureus is an important pathogen in both community and healthcare associated pneumonia. We describe a case of severe pneumonia caused by the methicillin resistant Staphylococcus aureus (MRSA) clone USA 300 in a 44-year old post-partum woman and the subsequent vertical transmission of this virulent organism to her neonate.
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Affiliation(s)
- N Crooks
- Department of Medicine, King Edward VII Memorial Hospital, Bermuda
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18
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Carmichael PL, Sardar S, Crooks N, Neven P, Van Hoof I, Ugwumadu A, Bourne T, Tomas E, Hellberg P, Hewer AJ, Phillips DH. Lack of evidence from HPLC 32P-post-labelling for tamoxifen-DNA adducts in the human endometrium. Carcinogenesis 1999; 20:339-42. [PMID: 10069474 DOI: 10.1093/carcin/20.2.339] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Tamoxifen is associated with an increased incidence of endometrial cancer in women. It is also a potent carcinogen in rat liver and forms covalent DNA adducts in this tissue. A previous study exploring DNA adducts in human endometria, utilizing thin layer chromatography 32P-postlabelling, found no evidence for adducts in tamoxifen-treated women [Carmichael,P.L., Ugwumadu,A.H.N., Neven,P., Hewer,A.J., Poon,G.K. and Phillips,D.H. (1996) Cancer Res., 56, 1475-1479]. However, subsequent work utilizing HPLC 32P-post-labelling [Hemminki,K., Ranjaniemi,H., Lindahl,B. and Moberger,B. (1996) Cancer Res., 56, 4374-4377] suggested that very low levels could be detected. We have sought to investigate this question further by reproducing the HPLC methodology at two centres, and analysing endometrial DNA from 20 patients treated with 20 mg/day tamoxifen for between 22 and 65 months. Liver DNA isolated from tamoxifen-treated rats was used as a positive control. We found no convincing evidence for tamoxifen-derived DNA adducts in human endometrium. HPLC elution profiles of post-labelled DNA from tamoxifen-treated women were indistinguishable from those obtained with DNA from 14 untreated women and from six women taking toremifene, an analogue of tamoxifen.
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Affiliation(s)
- P L Carmichael
- Imperial College School of Medicine, Division of Biomedical Sciences, Molecular Toxicology, London, UK.
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