Healthy Lifestyle Messages Research Articles

Implementation of different strategies of the “ActTeens” intervention for adolescents: a process evaluation

Multicomponent programs to promote physical activity have shown promise to help adolescents to increase physical activity levels. Although evaluation of the intervention implementation process is important, information about this evaluation is rarely reported. This observational study aimed to evaluate the implementation of a 12-week physical activity intervention program for adolescents. The ActTeens program consists of three components: (1) structured physical activity sessions; (2) self-monitoring associated with daily goal setting; (3) healthy lifestyle messages (mHealth). The evaluation of the process was carried out through observations and self-reported information from the students. Fifty-one adolescents (37.5% girls) answered the questionnaire. Overall, the reach was 73.3%, retention rate 96.3%, and satisfaction with the intervention was high (score 5). The structured sessions presented high fidelity, and good acceptability among adolescents, with an average attendance rate of 93.7%. Participants rated the sessions as enjoyable and the teacher’s role as excellent. Adherence to self-monitoring (goal setting with a pedometer) was moderate and 57.8% of adolescents reported using the device daily. In addition, adolescents reported that the use of a pedometer increased their motivation to practice physical activity (72.4%). Satisfaction with the messages was considered low, with only 37.8% agreeing that the messages promoted the adoption of a healthy lifestyle. In conclusion, the structured sessions and the self-monitoring showed good acceptability among adolescents, and these strategies were considered relevant to promote a more physically active lifestyle. However, the component mHealth, when used as a single strategy, did not aid the adoption of healthy behavior.

DEVELOPMENT OF TEXT-MESSAGING TO SUPPORT THE SOUTH AFRICAN DIABETES PREVENTION PROGRAM

Objective: Emerging evidence suggests that the addition of text-messaging to standard healthy lifestyle interventions may improve the outcomes of diabetes prevention programs (DPP). This paper describes the process of developing text-messages for people at risk of developing diabetes in low-resourced communities as part of the South African DPP (SA-DPP). Design and method: The development comprised multiple steps which included nutrition and physical activity experts, who were guided by recommended steps for developing and pre-testing text messaging for health behavior change. The steps included: 1) Message development: 44 nutrition messages and 23 exercise messages were formulated based on the existing SA-DPP curriculum and its formative research; 2) these text messages were evaluated for readability/understandability in terms of content, language, and quality of information through interviews [structured questionnaire conducted telephonically or in-person] with 75 participants from two low-resourced areas; 3) messages not well understood according to the interviews were refined by the expert panel; 4) participants from step 2 who showed the least understanding of the messages participated in three workshops to evaluate the refined text-messages; and 5) the text bank was finalized. Results: Based on the results of the readability survey, 37 of the 69 formulated text messages [24 of the 44 encouraging healthy eating, and 13 of the 23 promoting physical activity] were refined by the expert panel. Focused discussions revealed that participants still had some difficulties with terms such as “variety’’ and “diet’’, and the concept of avoiding certain foods e.g. sugar, sweets, chocolates and salty snacks and eating a “fresh’’ salad with a meal. Thus, a further seven messages were refined considering alternate terminology proposed by the participants. The final text bank includes a total of 67 messages; topics covered are on fruit, vegetables and variety in the diet (n = 15), limiting fat intake (n = 10), avoiding sugar (n = 11), avoiding salt (n = 5), promoting fibre-rich foods (n = 1), messages promoting physical activity (n = 21) and general check-in messages (n = 4). Conclusions: This paper outlines the evidenced-based and participatory process of developing understandable healthy lifestyle text messages to promote and maintain behavior change objectives of participants at risk for developing diabetes.

Weight management across pregnancy and postpartum care: The need for interprofessional education and collaboration

The journey from pregnancy to caring for a new infant is a significant experience for many women and crucial period for obesity prevention. During this time, a large portion of care is allocated to midwives and maternal and child health nurses (MCHN). These professions have the potential to play a crucial role in supporting women with weight management across pregnancy and postpartum; however, both midwives and MCHNs report barriers to doing this. Upskilling achieved through midwifery and MCHN education that equips midwives and MCHNs with the skills and knowledge to provide evidence-based advice for weight management could assist in addressing some of these barriers. Interprofessional collaboration should be fostered so healthy lifestyle messages and support are reinforced consistently by midwives and MCHNs throughout pregnancy and postpartum.

'A really good balance': Thematic analysis of stakeholders' views on classroom- and games-based positive choices interventions for primary school children.

This study explores the views of children, parents, school staff and intervention staff regarding interventions designed to promote healthy lifestyles and positive choices in primary schools in the North East of England, United Kingdom. The interventions consisted of six weekly sessions in which classroom learning was followed by physically active games. Focus groups and semi-structured interviews were conducted with a total of 45 participants and thematic analysis was performed on the resultant 26 transcripts to identify themes relating to the role of physical activity, facilitators and barriers to children’s engagement in the sessions and the perceived outcomes of intervention participation. Results indicated that participants across the four groups felt the inclusion of classroom learning and physical activity made the interventions suitable for a range of children, with the games reinforcing classroom messages and acting as a reward for their work. Central to children’s active engagement was their enjoyment, and they were felt to benefit in terms of psychosocial wellbeing and–especially when the topic of the intervention was fitness and nutrition–physical wellbeing. Overall, combined classroom- and games-based interventions were valued methods for communicating healthy lifestyle and positive choices messages to a primary school audience, though research into intervention outcomes is currently limited.

Long-term effects of comprehensive school health on health-related knowledge, attitudes, self-efficacy, health behaviours and weight status of adolescents

BackgroundAPPLE Schools is a Comprehensive School Health (CSH) project, started in schools in socioeconomically disadvantaged areas where dietary habits are poor, physical activity (PA) levels are low, and obesity rates are high. Earlier research showed program effects whereby energy intake, PA and weight status of students in APPLE Schools had reached similar levels as that of students in other schools. However, it is unknown whether the effects of CSH are sustained when children grow into adolescents. Effects of APPLE Schools on health-related knowledge, attitudes, self-efficacy, diet, PA, and weight status, seven years after the start of the project, when students were in junior high and high school were assessed. We hypothesised that APPLE School graduates and comparison school graduates will remain at similar levels for these indicators.MethodsIn the 2015/16 school year, junior high and high school graduates (grades 7–12) in Northern Alberta, Canada participated in a Youth Health Survey. Participants included graduates from APPLE elementary schools (n = 202) and comparison elementary schools (n = 338). Health-related knowledge, attitudes, self-efficacy, diet (24-h dietary recall), PA (pedometer step count) and weight status were assessed. Mixed effects regression was employed to assess differences in these outcomes between APPLE School graduates and comparison school graduates. Comparisons between elementary school (2008/09) and junior high/high school (2015/16) of self-efficacy, PA and weight status were also conducted.ResultsAPPLE School graduates did not significantly differ from comparison school graduates on any outcomes (i.e. knowledge, attitudes, self-efficacy, diet, PA, and weight status). Additionally, no significant differences existed in the comparisons between 2008/09 and 2015/16.ConclusionOur findings of no difference between the APPLE School graduates and comparison school graduates suggest that the effects of APPLE Schools may continue into adolescence or the new school environment may have an equalizing effect on the students. Since lifestyle practices are adopted throughout childhood and adolescence, and the school environment has an important influence on development, an extension of CSH initiatives into junior high/high schools should be considered. This will help to consolidate and support the continuance of healthy lifestyle messages and practices throughout childhood and adolescence.

Self-reported weight and predictors of missing responses in youth.

The aims of the present manuscript are to analyse self-reported data on weight, including the missing data, from the 2014 Scottish Health Behaviour in School-Aged Children (HBSC) Study, and to investigate whether behavioural factors related with overweight and obesity, namely dietary habits, physical activity and sedentary behaviour, are associated with weight non-response. 10839 11-, 13- and 15-year-olds participated in the cross-national 2014 Scottish HBSC Study. Weight missing data was evaluated using Little's Missing Completely at Random (MCAR) test. Afterwards, a fitted multivariate logistic regression model was used to determine all possible multivariate associations between weight response and each of the behavioural factors related with obesity. 58.9% of self-reported weight was missing, not at random (MCAR p < 0.001). Weight was self-reported less frequently by girls (19.2%) than by boys (21.9%). Participants who reported low physical activity (OR 1.2, p < 0.001), low vegetable consumption (OR 1.24, p < 0.001) and high computer gaming on weekdays (OR 1.18, p = 0.003) were more likely to not report their weight. There are groups of young people in Scotland who are less likely to report their weight. Their weight status may be of the greatest concern because of their poorer health profile, based on key behaviours associated with their non-response. Furthermore, knowing the value of a healthy weight and reinforcing healthy lifestyle messages may help raise youth awareness of how diet, physical activity and sedentary behaviours can influence weight.

Teaching children about good health? Halo effects in child-directed advertisements for unhealthy food.

Food companies often use healthy lifestyle messages in child-directed advertising, raising public health concerns about health halo effects for nutrient-poor food/drinks. Examine effects of health messages promoting nutrient-poor foods in child-directed advertising. Randomized controlled experiment (N=138). Children (7-11years) viewed three child-friendly commercials in one of three conditions: (1) health halo (unfamiliar nutrient-poor food/drink ads with healthy messages); (2) nutrient-poor food/drink ads with other messages and (3) healthy food/drink ads. They rated the commercials and advertised products, provided attitudes about exercise and nutrition and consumed and rated healthy and unhealthy snack foods. Children in the health halo condition rated the advertised nutrient-poor products as significantly healthier compared with children in other conditions (p=.003), but the other commercials did not affect children's attitudes about other advertised products (p's>.50). Child age, gender or TV viewing habits did not significantly predict their ratings (p's>.18). There was no evidence that healthy lifestyle messages and/or healthy food commercials improved children's attitudes about nutrition, exercise or healthy snack consumption. Promoting healthy lifestyle messages in child-directed commercials for nutrient-poor food/drinks likely benefits brands by increasing products' perceived healthfulness, but these ads are unlikely to positively affect children's attitudes about health and nutrition.

Perceptions of overweight by primary carers (mothers/grandmothers) of under five and elementary school-aged children in Bandung, Indonesia: a qualitative study

BackgroundThe prevalence of childhood overweight has increased in the past two decades in Indonesia. Even though prevalence is escalating, there is a lack of qualitative evidence to assist in the design and implementation of strategies to tackle this issue. This study aimed to explore the view of primary carers (mothers and grandmothers) from different socio-economic-status groups, on childhood overweight in the Greater Bandung Area, Indonesia.MethodsWe conducted 12 focus groups discussions with a total of 94 carers of under-five and 7–12 years children, from June to October 2016. We used the grounded theory approach in our analysis.ResultsThree main categories emerged: the concept of overweight, factors contributing to overweight, and awareness and feelings towards overweight children. Most carers from all SES groups defined overweight subjectively, while a few from the low SES group defined it objectively. Most carers from low and high SES groups agreed with the concept “chubbier is healthier”. All carers had some knowledge of the main factors that contribute to childhood overweight: dietary factors, activity levels and sedentary behavior, and hereditary factors. Carers from all SES groups described similar characteristics of overweight; carers from low and intermediate SES groups had mixed feelings while all high SES carers have negative feelings about overweight children, mostly related to stigma. However, carers who identified their own children as being overweight expressed sensitivity about this weight status, especially their physical abilities. Almost all carers knew their children’s current weight while less than two thirds knew their children’s height.ConclusionsThere are several policy implications. Firstly, health-related knowledge of the primary carers is of great importance and needs augmenting. To increase that knowledge, there is a role for front-line health practitioners (doctors/midwives/nurses) to be more active in educating the community. Secondly, simpler and more effective ways to disseminate healthy lifestyle messages to carers is required. Thirdly, by placing more emphasis on carers monitoring their children’s growth may encourage carers to take steps to keep their children in the healthy weight and height ranges. Fourthly, the Department of Education may need to improve the quality and quantity of physical activity in schools.

Abstract IA09: Realizing the promise of prevention (at the personal and population levels)

Abstract IA09: Realizing the promise of prevention (at the personal and population levels)

For Fit’s Sake: A Norms-Based Approach to Healthy Behaviors Through Influence of Presumed Media Influence

ABSTRACTBased on the influence of presumed media influence (IPMI) model as the theoretical framework, this study examines how injunctive norms and personal norms mediate the influence of healthy lifestyle media messages on public intentions to engage in two types of healthy lifestyle behaviors—physical activity and healthy diet. Nationally representative data collected from 1,055 adults in Singapore demonstrate partial support for the key hypotheses that make up the extended IPMI model, highlighting the importance of a norms-based approach in health communication. Our results indicate that perceived media influence on others indirectly shaped public intentions to engage in healthy lifestyle behaviors through personal norms and attitude, providing partial theoretical support for the extended IPMI model. Practical implications for health communicators in designing health campaigns media messages to motivate the public to engage in healthy lifestyle are discussed.

The Healthy Lifestyles Programme (HeLP)--an overview of and recommendations arising from the conceptualisation and development of an innovative approach to promoting healthy lifestyles for children and their families.

Despite the rise in childhood obesity, there remains a paucity of evidence for effective interventions that engage children and parents sufficiently to make and sustain lifestyle behaviour change. The Healthy Lifestyles Programme (HeLP) is a school-located obesity prevention programme, which has been developed with teachers, families and healthcare professionals. The underpinning assumption in the development of HeLP was to take a relational approach to changing behaviour, building relationships with the schools, children and their families to create supportive environments for healthy lifestyle choices. Thus, HeLP was conceptualised as a complex intervention within a complex system and developed as a dynamic, evolving set of processes to support and motivate children towards healthy behaviours. The delivery methods used are highly interactive and encourage identification with and ownership of the healthy lifestyle messages so that the children are motivated to take them home to their parents and effect change within the family. We have good evidence that HeLP engages schools and children such that they want to participate in the Programme. Results from an exploratory trial showed that the Programme is feasible and acceptable and has the potential to change behaviours and affect weight status. This paper presents an overview of and recommendations arising from the conceptualization; development and evaluation of the Healthy Lifestyles Programme as part of a special issue focusing on novel approaches to the global problem of childhood obesity.

A COMPARISON OF HEALTH UTILITY SCORES CALCULATED USING UNITED KINGDOM AND CANADIAN PREFERENCE WEIGHTS IN AN ALZHEIMER'S DISEASE SAMPLE

Background: The predicted increase in dementia prevalence over the next few decades poses enormous health and socio-economic challenges. In the absence of a cure, strategies to prevent or delay the onset of dementia within the population have been proposed as imperative. This approach is complicated, however, by the relative paucity of research evidence between modifiable risk factors and dementia, and limited knowledge of applying promotion, prevention and early intervention (PPEI) concepts to dementia. Nevertheless, several nations are attempting such an approach and Alzheimer’s Disease International (2009) recommends governments make dementia a health priority and develop national plans to deal with the disease.Methods:A number of national frameworks for dementia were identified, most included some population health approaches. Results: Common elements were: Public education campaigns to improve public and professional awareness and understanding of dementia,Promotion of early/ timely diagnosis,Increase the workforce to meet the likely increase in demand for services as a result of education, Provide sufficient guidance and support for people with dementia and their carers,Funding for research, and Strategies promoting the prevention message ’what’s good for your heart is good for your heart’ and healthy lifestyle messages (stopping smoking, eating healthily, exercising regularly). There are barriers to applying a population health approach to dementia PPEI. Identified barriers included: Difficulty in applying early intervention strategies at the individual level due to difficulties in establishing a diagnosis of dementia in the early stages, Inadequate scientific evidence regarding risk and protective factors for dementia, Attitudes and stigma, Little developmental work towards a potential population health model for dementia in Australia, and Policy barriers e.g. lack of linkage to healthy ageing, mental health or chronic disease initiatives. Conclusions: The considerable evidence that p opulation health approaches including mass marketing campaigns can improve health outcomes and save health costs suggests that such an approach to dementia may reduce the impact of the condition. A lthough barriers exist to applying such an approach to dementia, the evidence suggests that it is feasible to do so and many western countries are adopting such an approach.

Qualitative findings from an exploratory trial of the Healthy Lifestyles Programme (HeLP) and their implications for the process evaluation in the definitive trial.

BackgroundApproximately one third of 10-11 year olds in England are now overweight or obese suggesting that population approaches are urgently required. However, despite the increasing number of school-based interventions to prevent obesity, results continue to be inconsistent and it is still unclear what the necessary conditions are that lead to the sustained behaviour change required to affect weight status. The Healthy Lifestyles Programme is a theoretically informed four phase multi-component intervention which seeks to create supportive school and home environments for healthy behaviours.MethodsA process evaluation has run alongside the exploratory trial of the Healthy Lifestyles Programme to ascertain the feasibility and acceptability of; the trial design (including the trial outcomes) and the HeLP Programme and whether it is able to engage schools, children and their families. Data was collected using interviews with teachers (n = 12) and parents (n = 17) and six focus groups with children (n = 47) and a questionnaire for parents of children in the intervention schools. Interview and focus group data relating to the intervention was analysed using framework analysis.ResultsFour schools and 201 children participated in the exploratory trial. The data showed that the trial design was feasible and acceptable for schools and children. Three themes emerged for the data in relation to the acceptability and feasibility of the HeLP Programme (value, compatibility with the curriculum and enjoyment) and two themes emerged in relation to engagement (‘knowledge and awareness’ and ‘taking messages on board’). The latter could be broken down into 4 subthemes (‘initiating discussion with family and friends’, ‘acceptance of family rules’, ‘increased responsibility’ and ‘the importance of the mode and agent of delivery’). The use of highly inclusive and interactive delivery methods where the children were encouraged to identify with and take ownership of the healthy lifestyle messages were identified as important factors in motivating the children to take the messages home, seek parental support and initiate family lifestyle behaviour change.ConclusionThe process evaluation of the exploratory trial has not only provided evidence of the feasibility and acceptability of the Programme, it has also allowed an understanding of how HeLP engages schools, children and their families. These findings have informed the process evaluation for the definitive trial.

Parents as the start of the solution: a social marketing approach to understanding triggers and barriers to entering a childhood weight management service.

Childhood obesity is a sensitive subject and barriers exist with respect to accessing weight management programmes. Social marketing insight gathering provides an opportunity to understand behaviours and address these challenges. This project gained insight into the views of parents/carers on triggers and barriers to entering a childhood weight management service. Participants were identified from the public using marketing recruitment. Four focus groups were conducted with parents of school aged children (n = 27) by an experienced interviewer. Twenty two mothers, three fathers and two grandmothers participated, with half describing their child as overweight. Groups discussed health behaviours; attitudes to health messages and weight issues; and motivations, benefits and barriers with respect to accessing weight management services. Discussions were taped and transcribed. Themes were identified using framework analysis of content matrix data analysis. Participants were aware of healthy lifestyle messages, although the ability to implement these was variable. Triggers to seeking help included bullying, health concerns and inability to participate in school activities. Barriers included feeling a lack of control, desire to avoid conflict and no proven case that weight was a problem. Parents wished to be given information regarding their child's weight by a trusted person. The Internet and word of mouth were identified as methods of recruitment into a weight management service, with a focus on fitness, fun and friendliness and being free-of-charge. Insight gathering can be used to establish parental/carer opinion regarding engaging in childhood weight management services. A fun, friendly programme that is free of charge appealed to parents. Local community involvement around normalising child weight issues may boost referrals into child healthy weight interventions.

Internet marketing directed at children on food and restaurant websites in two policy environments

Food and beverage marketing has been associated with childhood obesity yet little research has examined the influence of advertising policy on children's exposure to food/beverage marketing on the Internet. The purpose of this study was to assess the influence of Quebec's Consumer Protection Act and the self-regulatory Canadian Children's Food and Beverage Advertising Initiative (CAI) on food manufacturer and restaurant websites in Canada. A content analysis of 147 French and English language food and restaurant websites was undertaken. The presence of child-directed content was assessed and an analysis of marketing features, games and activities, child protection features, and the promotion of healthy lifestyle messages was then examined on those sites with child-directed content. There were statistically no fewer French language websites (n = 22) with child-directed content compared to English language websites (n = 27). There were no statistically significant differences in the number of the various marketing features, or in the average number of marketing features between the English and French websites. There were no fewer CAI websites (n = 14) with child-directed content compared to non-CAI websites (n = 13). The CAI sites had more healthy lifestyle messages and child protection features compared to the non-CAI sites. Systematic surveillance of the Consumer Protection Act in Quebec is recommended. In the rest of Canada, the CAI needs to be significantly expanded or replaced by regulatory measures to adequately protect children from the marketing of foods/beverages high in fat, sugar, and sodium on the Internet.

Child obesity prevention in primary health care: Investigating practice nurse roles, attitudes and current practices

Overweight and obesity affects approximately 20% of Australian pre-schoolers. The general practice nurse (PN) workforce has increased in recent years; however, little is known of PN capacity and potential to provide routine advice for the prevention of child obesity. This mixed methods pilot study aims to explore the current practices, attitudes, confidence and training needs of Australian PNs surrounding child obesity prevention in the general practice setting. PNs from three Divisions of General Practice in New South Wales were invited to complete a questionnaire investigating PN roles, attitudes and practices in preventive care with a focus on child obesity. A total of 59 questionnaires were returned (response rate 22%). Semi-structured qualitative interviews were also conducted with a subsample of PNs (n = 10). Questionnaire respondent demographics were similar to that of national PN data. PNs described preventive work as enjoyable despite some perceived barriers including lack of confidence. Number of years working in general practice did not appear to strongly influence nurses' perceived barriers. Seventy per cent of PNs were interested in being more involved in conducting child health checks in practice, and 85% expressed an interest in taking part in child obesity prevention training. Findings from this pilot study suggest that PNs are interested in prevention of child obesity despite barriers to practice and low confidence levels. More research is needed to determine the effect of training on PN confidence and behaviours in providing routine healthy life-style messages for the prevention of child obesity.

Ngāti and healthy: translating diabetes prevention evidence into community action

Introduction: Type 2 diabetes mellitus (T2DM) is a major health issue in New Zealand Māori. Clinical trials have demonstrated potential for the prevention of T2DM, but whether community public health programmes aiming to prevent diabetes are effective is untested. Objective: To describe the planning and design of an intervention aiming to translate T2DM prevention clinical trial evidence into a community-wide population health intervention in a high risk predominantly Māori community. Approach: Community concerns about the diabetes burden were heard by the local diabetes nurse, herself a tribal member, and discussed with a locally raised academic. Project planning ensued. The intervention and its evaluation were designed using a participatory community development model. The planned intervention had three components: community-wide health promotion initiatives conveying healthy lifestyle messages, community education and monitoring for identified high-risk individuals and their extended families, and a structural strategy aimed at adapting local environments to support lifestyle changes. The evaluation plan involved interrupted time series surveys coupled with formative and process evaluations rather than a randomised control trial design. Discussion: Consulting communities, validating community concerns and prioritising cultural and ethical issues were key steps. Time spent developing good relationships amongst the health provider and academic research team members at the outset proved invaluable, as the team were united in addressing the project planning and implementation challenges, such as funding obstacles that arose because of our ethically and culturally appropriate non-randomised control trial evaluation design. The pre-intervention survey demonstrated high rates of diabetes (13%), insulin resistance (33%) and risk factors, and provided evidence for positive, as opposed to negative, lifestyle intervention messages. Conclusion: Community-wide lifestyle interventions have the potential to reduce rates of type 2 diabetes and other chronic diseases in high-risk communities, but require a high level of commitment from the health sector and buy-in from the community. Adequate commitment, leadership, planning and resources are essential.

Texting for Health: The Use of Participatory Methods to Develop Healthy Lifestyle Messages for Teens

To develop and test messages and a mobile phone delivery protocol designed to influence the nutrition and physical activity knowledge, attitudes, and behavior of adolescents. Nine focus groups, 4 classroom discussions, and an 8-week pilot study exploring message content, format, origin, and message delivery were conducted over 12 months using a multistage, youth-participatory approach. Youth programs at 11 locations in Arizona. Recruitment was coordinated through youth educators and leaders. Eligible teens were 12-18 years old and enrolled in youth programs between fall 2009 and 2010. Adolescent preferences for messages and delivery of messages. Qualitative data analysis procedures to generate themes from field notes. One hundred seventy-seven adolescents participated in focus groups (n = 59), discussions (n = 86), and a pilot study (n = 32). Youth preferred messages with an active voice that referenced teens and recommended specific, achievable behaviors; messages should come from nutrition professionals delivered as a text message, at a frequency of ≤ 2 messages/day. More than 300 messages and a delivery protocol were successfully developed and tested in partnership with adolescents. Future research should address scalability of texting interventions; explore dose associated with changes in knowledge, attitudes, and behaviors; and offer customized message subscription options.

Body image and obesity among Australian adolescents from indigenous and Anglo-European backgrounds: implications for health promotion and obesity prevention among Aboriginal youth

This study examines the relationship between body image and obesity, among 4367 indigenous and Anglo-European adolescents in Australia in 2006. It shows that indigenous adolescents, male and female, were more likely than their non-indigenous counterparts to desire and pursue weight gain. Indigenous males showed the greatest tendencies to gain weight and to perceive that they should build up their bodies. They also received the strongest parental advice to eat more, lose weight, do more exercise, do less exercise, and heed warnings that they were not eating enough. The percentage distribution of weight, from obese through to underweight, was not significantly different between indigenous and Anglo-European adolescents. Poor body image among obese adolescents was similar in all groups. This article concludes that indigenous Australian adolescents are more likely to desire weight gain and receive more parental and family advice about the desirability of gaining weight. Indigenous adolescents from around the world may have to grapple with conflicting cultural perceptions involving their own self-image, parental coercion and peer group pressure. Therefore, before planning and designing health education programs for indigenous young people, educators and health professionals should consider cultural attitudes lest they inadvertently create weight concerns, confuse or contradict healthy lifestyle messages.

An evaluation of the Australian Football League Central Australian Responsible Alcohol Strategy 2005–07

In 2004, the Australian Football League Central Australia (AFLCA) implemented the Responsible Alcohol Strategy (RAS), which aimed to decrease alcohol consumption at matches, and to promote healthy lifestyle messages to the youth of Central Australia participating in Australian Rules football. The evaluation adopted a pre- and post-implementation design to monitor a number of performance indicators. The evaluation analysed routinely collected data from AFLCA, its Security Company, Alice Springs Police Department and Alice Springs Hospital; we surveyed AFLCA staff, club officials and umpires; and undertook direct observation at AFLCA events. The volume of alcohol sold at matches decreased. Survey data indicate decreased alcohol related violence, improved spectator behaviour and decreased spectator attendances. Police data suggest declining alcohol-related and violent behaviours, but trends were not statistically significant. Alice Springs Hospital injury admission data indicate a non-significant interaction between year and season effect. In a community context of high alcohol consumption and high rates of interpersonal violence, the strategies implemented were successful in decreasing alcohol consumption and related undesirable behaviours at football games. However, these measures have resulted in unintended consequences: decreased numbers of spectators attending games, decreased canteen sales and falling sponsorship. The decreased revenue has raised serious issues about sustainability of the alcohol intervention, and stimulated discussions with government and others about strategies to maintain this important alcohol reduction policy.