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<i>Objective:</i> To assess whether public understandings of inherited predisposition to colorectal cancer may undermine preparedness to respond to preventive messages. <i>Methods:</i> Structured in-depth interviews with 31 women and men, aged 50 years and over. <i>Results:</i> Most participants viewed genetic factors as prompts for taking preventive measures rather than as reasons for fatalism and inaction. They were optimistic about the potential benefits of new developments in cancer prevention and treatment. <i>Conclusions:</i> There was little evidence of perceived genetic determinism in relation to colorectal cancer, but there were some significant misunderstandings about causes, prevention and treatment. These findings have important implications for public health communications about the contribution of genetics to cancer causation.

The walkability of urban neighbourhoods has emerged as a strong component in policy and design models for active, liveable communities. This paper examines the proposition that more walkable neighbourhoods encourage local social interaction, a sense of community, informal social control and social cohesion; and that the relationship is explained by walking for transport or for recreation. Multilevel analyses of data from an Australian sample showed a modest association between the walkability of a neighbourhood and sense of community only. Walking for transport, but not recreation, mediated this relationship although the effect was small. These results support contentions that 'walkability' is more complex than usually defined and that factors influencing neighbourhood sociability extend beyond issues of urban form.

Purpose. Health promotion policy frameworks, recent theorizing, and research all emphasize understanding and mobilizing environmental influences to change particular health-related behaviors in specific settings. The workplace is a key environmental setting. The Checklist of Health Promotion Environments at Worksites (CHEW) was designed as a direct observation instrument to assess characteristics of worksite environments that are known to influence health-related behaviors. Methods. The CHEW is a 112-item checklist of workplace environmental features hypothesized to be associated, both positively and negatively, with physical activity, healthy eating, alcohol consumption, and smoking. The three environmental domains assessed are (1) physical characteristics of the worksite, (2) features of the information environment, and (3) characteristics of the immediate neighborhood around the workplace. The conceptual rationale and development studies for the CHEW are described, and data from observational studies of 20 worksites are reported. Results. The data on CHEW-derived environmental attributes showed generally good reliability and identified meaningful sets of variables that plausibly may influence health-related behaviors. With the exception of one information environment attribute, intraclass correlation coefficients ranged from 0.80 to 1.00. Descriptive statistics on selected physical and information environment characteristics indicated that vending machines, showers, bulletin boards, and signs prohibiting smoking were common across worksites. Bicycle racks, visible stairways, and signs related to alcohol consumption, nutrition, and health promotion were relatively uncommon. Conclusions. These findings illustrate the types of data on environmental attributes that can be derived, their relevance for program planning, and how they can characterize variability across worksites. The CHEW is a promising observational measure that has the potential to assess environmental influences on health behaviors and to evaluate workplace health promotion programs.

Total serum cholesterol was measured for 12,067 people as part of a community-based cholesterol screening program in New South Wales, Australia, in the fall of 1987. Forty-three percent had levels over 210 mg/dl and the average was 207 mg/dl. Those with levels over 210 mg/dl were counseled on how to reduce their cholesterol level and invited to take a second test in four to five months. Subjects were randomly allocated to one of three interventions: testing and counseling plus either 1) a reminder letter one month before the retest, 2) all of the above plus additional information on nutrition and exercise, or 3) all of the above plus a lottery ticket giving them a chance to win a microwave oven if they completed the retest. A total of 3,157 (60.8%) returned for the retest. There was no significant difference between the three intervention conditions in participation rates and a number of biometric measures. These results suggest that additional health information and prize incentives do not enhance rates of return for retest or changes in dietary and exercise behaviors within the context of a community screening program in Australia.

Purpose: To describe the process of translating an evidence-based, telephone-delivered physical activity and dietary behavior change intervention from research into practice. Design: Descriptive case study. Setting/Subjects: Nongovernment, primary medical care–based community health organization. Intervention: Telephone-delivered intervention targeting physical activity and diet in primary medical care patients. Measures/Analysis: Systematic documentation of process outcomes related to intervention adoption and adaptation. Results: Research-community partnerships were critical in facilitating translation, including (1) an initial competitive advantage within a State Health Department–funded preventive health initiative; (2) advocacy to ensure the adoption of the intervention, (3) subsequent support for the adaptation of program elements to ensure fit of the program with the community organization's objectives and capacities, while maintaining feasible elements of fidelity with the original evidence-based program; (4) the integration of program management and evaluation systems within the community organization; and (5) ongoing support for staff members responsible for program delivery and evaluation. Preliminary process evaluation of the Optimal Health Program supports the acceptability and feasibility of the program within community practice. Conclusions: Intervention characteristics central to adoption can be influenced by research-community partnerships. It is likely that evidence-based interventions will need to be adapted for delivery within the real world. Researchers should endeavor to provide training and support to ensure, as much as possible, fidelity with the original program, and that the relevant adaptations are evidence based.

Judgments concerning features of environments do not always correspond accurately with objective measures of those same features. Moreover, perceived and objectively assessed environmental attributes, including proximity of destinations, may influence walking behavior in different ways. This study compares perceived and objectively assessed distance to several different destinations and examines whether correspondence between objective and perceived distance is influenced by age, gender, neighborhood walkability, and walking behavior. Distances to most destinations close to home are overestimated, whereas distances to those farther away are underestimated. Perceived and objective distances to certain types of destinations are differentially associated with walking behavior. Perceived environmental attributes do not consistently reflect objectively assessed attributes, and both appear to have differential effects on physical activity behavior.

A large amount of time spent sitting is a newly identified health risk. Although desk-based workers spend much of their time at work sitting, little is known about how office spaces may be related to workplace sitting time. This study examined cross-sectional associations of the perceived availability of office shared spaces with workers' sitting time, and the potential role of workplace normative-social factors in the relationship. Participants ( N = 221) wore an activity monitor (activPAL3) and reported availability of shared spaces (for formal meetings, informal discussion, collaborative working), organizational norms, and workplace behavioral autonomy. No shared-space variables were associated with workplace sitting time. However, the perceived availability of sufficient informal discussion space was associated with lower levels of sitting among those who reported more-supportive organizational norms and greater behavioral autonomy. These findings highlight environmental, organizational, and psychosocial factors that will be important to address in future initiatives to reduce work place sitting time.

Neighborhood environmental attributes have been found to be associated with residents' time spent walking and in physical activity, in studies from single countries and in multiple-country investigations. There are, however, mixed findings on such environmental relationships with sedentary (sitting) time, which primarily have used evidence derived from single-country investigations with self-reported behavioral outcome measures. We examined potential relationships of neighborhood environmental attributes with objectively-assessed sedentary time using data from 5712 adults recruited from higher and lower socio-economic status neighborhoods in 12 sites in 10 countries, between 2002 and 2011. Ten perceived neighborhood attributes, derived from an internationally-validated scale, were assessed by questionnaire. Sedentary time was derived from hip-worn accelerometer data. Associations of individual environmental attributes and a composite environmental index with sedentary time were estimated using generalized additive mixed models. In fully adjusted models, higher street connectivity was significantly related to lower sedentary time. Residential density, pedestrian infrastructure and safety, and lack of barriers to walking were related to higher sedentary time. Aesthetics and safety from crime were related to less sedentary time in women only. The predicted difference in sedentary time between those with the minimum versus maximum composite environmental index values was 71 min/day. Overall, certain built environment attributes, including street connectivity, land use mix and aesthetics were found to be related to sedentary behavior in both expected and unexpected directions. Further research using context-specific measures of sedentary time is required to improve understanding of the potential role of built environment characteristics as influences on adults' sedentary behavior. ; All authors declare financial support for the submitted work from the National Cancer Institute of the United States National Institutes of Health. Data collection in Hong Kong was supported by the HK Research Grants Council GRF grants (#HKU740907H and #747807H) and HKU URC Strategic Research Theme (Public Health). US data collection and Coordinating Center processing was supported by the NIH grants R01 HL67350 (NHLBI) and R01 CA127296 (NCI). The study conducted in Bogota was funded by Colciencias grant 519_2010, Fogarty International Center (NIH) and CeiBA. The contributions of Neville Owen were supported by NHMRC Program Grant #569940, NHMRC Senior Principal Research Fellowship #1003960, and by the Victorian Government's Operational Infrastructure Support Program. The Danish study was partly funded by the Municipality of Aarhus. Data collection in the Czech Republic was supported by the grant MEYS (# MSM 6198959221). Data collection in New Zealand was supported by the Health Research Council of New Zealand grant # 07/356. Data collection in Mexico was supported by the CDC Foundation which received an unrestricted grant from The Coca-Cola Company. The UK study was funded by the Medical Research Council under the National Preventive Research Initiative. Deborah Salvo was supported by a training grant from the CDC Foundation. James F Sallis received grants and personal fees from the Robert Wood Johnson Foundation outside of submitted work, grants and non-financial support from Nike, Inc. outside of submitted work, and is a consultant and receiver of royalties from SPARK Programs of School Specialty, Inc.

Purpose: Understanding factors that influence accurate assessment of physical activity (PA) and sedentary behavior (SB) is important to measurement development, epidemiologic studies, and interventions. This study examined agreement between self-reported (International Physical Activity Questionnaire—Long Form[IPAQLF]) and accelerometry-based estimates of PA and SB across six countries and identified correlates of between-method agreement. Methods: Self-report and objective (accelerometry-based) PA and SB data were collected in 2002–2011 from 3865 adult participants in eight cities from six countries (Belgium, Czech Republic, Denmark, Spain, United Kingdom, and United States). Between-method relative agreement (correlation) and absolute disagreement (mean difference between conceptually and intensity-matched IPAQ-LF and accelerometry-based PA and SB variables) were estimated. Also, sociodemographic characteristics and PA patterns were examined as correlates of betweenmethod agreement. Results: Observed relative agreement (relationships of IPAQ-LF with accelerometry-based PA and SB variables) was small to moderate (r = 0.05–0.37) and was moderated by sociodemographic (age, sex, weight status, and education) and behavioral (PAtype) factors. The absolute disagreement was large, with participants self-reporting higher PA intensity and total time in moderate-tovigorous-intensity PA than accelerometry. Also, self-reported sitting time was lower than accelerometry-based sedentary behavior. After adjusting for sociodemographic and behavioral factors, the absolute disagreement between pairs of IPAQ-LF and accelerometry-based PA variables remained significantly different across cities/countries. Conclusions: Present findings suggest systematic cultural and/or linguistic and sociodemographic differences in absolute agreement between the IPAQ-LF and the accelerometry-based PA and SB variables. These results have implications for the interpretation of international PA and SB data and correlate/determinant studies. They call for further efforts to improve such measures. ; This work was supported by the National Cancer Institute of the National Institutes of Health (R01 CA127296). US data collection and multisite coordinating center processing was supported by the National Institutes of Health (grant nos. R01 HL67350 [NHLBI] and R01 CA127296 [National Cancer Institute] to J.F.S). E.C. is supported by an Australian Research Council Future Fellowship (FT no. 140100085). The contributions of N.O. were supported by an NHMRC Senior Principal Research Fellowship (no. 1003960) and by the Victorian Government's Operational Infrastructure Support Program. The Danish study was partly funded by the Municipality of Aarhus. Data collection in the Czech Republic was supported by the Ministry of Education, Youth and Sports (grant no. MSM 6198959221). The United Kingdom study was funded by the Medical Research Council under the National Preventive Research Initiative. The Spanish study was partially founded by the Navarra Government Health Department (grant no. 02/09).

OBJECTIVE: To examine associations of time spent sitting in cars with markers of cardio-metabolic risk in Australian adults. METHOD: Data were from 2800 participants (age range: 34-65) in the 2011-12 Australian Diabetes, Obesity and Lifestyle Study. Self-reported time spent in cars was categorized into four groups: ≤15min/day; >15 to ≤30min/day; >30 to ≤60min/day; and >60min/day. Markers of cardio-metabolic risk were body mass index (BMI), waist circumference, systolic and diastolic blood pressure, triglycerides, HDL (high-density lipoprotein)-cholesterol, fasting plasma glucose, 2-h plasma glucose, a clustered cardio-metabolic risk score, and having the metabolic syndrome or not. Multilevel linear and logistic regression analyses examined associations of car time with each cardio-metabolic risk outcome, adjusting for socio-demographic and behavioral variables and medication use for blood pressure and cholesterol/triglycerides. RESULTS: Compared to spending 15min/day or less in cars, spending more than 1h/day in cars was significantly associated with higher BMI, waist circumference, fasting plasma glucose, and clustered cardio-metabolic risk, after adjusting for socio-demographic attributes and potentially relevant behaviors including leisure-time physical activity and dietary intake. Gender interactions showed car time to be associated with higher BMI in men only. CONCLUSIONS: Prolonged time spent sitting in cars, in particular over 1h/day, was associated with higher total and central adiposity and a more-adverse cardio-metabolic risk profile. Further studies, ideally using objective measures of sitting time in cars and prospective designs, are needed to confirm the impact of car use on cardio-metabolic disease risk. ; The AusDiab study was co-coordinated by the Baker IDI Heart and Diabetes Institute. We gratefully acknowledge the support and assistance given by: K. Anstey, B. Atkins, B. Balkau, E. Barr, A. Cameron, S. Chadban, M. de Courten, A. Kavanagh, D. Magliano, S. Murray, K. Polkinghorne, J. Shaw, T. Welborn, P. Zimmet and all the study participants. For funding or logistical support, we are grateful to: National Health and Medical Research Council (NHMRC: #233200, #1007544), Australian Government Department of Health and Ageing, Abbott Australasia Pty Ltd, Alphapharm Pty Ltd, Amgen Australia, AstraZeneca, Bristol-Myers Squibb, City Health Centre-Diabetes Service-Canberra, Department of Health and Community Services – Northern Territory, Department of Health and Human Services – Tasmania, Department of Health – New South Wales, Department of Health – Western Australia, Department of Health – South Australia, Department of Human Services – Victoria, Diabetes Australia, Diabetes Australia Northern Territory, Eli Lilly Australia, Estate of the Late Edward Wilson, GlaxoSmithKline, Jack Brockhoff Foundation, Janssen-Cilag, Kidney Health Australia, Marian & FH Flack Trust, Menzies Research Institute, Merck Sharp & Dohme, Novartis Pharmaceuticals, Novo Nordisk Pharmaceuticals, Pfizer Pty Ltd, Pratt Foundation, Queensland Health, Roche Diagnostics Australia, Royal Prince Alfred Hospital, Sydney, Sanofi Aventis, and sanofi-synthelabo. Wijndaele was supported by a BHF Intermediate Basic Science Research Fellowship #FS/12/58/29709. Koohsari was supported by NHMRC Program Grant #569940. Dunstan was supported by a National Health and Medical Research Council Senior Research Fellowship (#1078360). Owen was supported by NHMRC ProgramGrant #569940, NHMRC Senior Principal Research Fellowship#1003960, and NHMRC Centre of Research Excellence#1057608. Authors from Baker IDI were supported by the Victorian Government's Operational Infrastructure Support Program. ; This is the final version of the article. It first appeared from Elsevier via http://dx.doi.org/10.1016/j.ypmed.2015.11.029

Purpose. Ecological models highlight the importance of environmental influences. We examined associations of coastal versus noncoastal location and perceived environmental attributes with neighborhood walking, total walking, and total activity. Methods. Telephone interviews with 800 faculty and general staff of an Australian university. Results. Men were significantly more likely to walk in their neighborhood if they lived in a coastal location (odds ratio [OR] = 1.66), and they highly rated environmental "aesthetics" (OR = 1.91), "convenience" of facilities (OR = 2.20), and "access" to facilities (OR = 1.98). For women, neighborhood walking was associated with high ratings of "convenience" (OR = 3.78) but was significantly less likely if they had high ratings for "access" (OR = 0.48). For total walking and total physical activity, few significant associations emerged. Conclusions. Environmental attributes were related to walking in the neighborhood but not to more general activity indices. Understanding gender-specific environmental correlates of physical activity should be a priority.

Purpose. This study examined the broader use of a print-media intervention, which was previously shown to be effective at promoting physical activity to participants recruited from a regional Australian community, as a strategy suitable for a more diverse statewide population sample. Methods. Participants were randomly selected adults who responded to a telephone interview conducted by the New South Wales Health Department and consented to participate in a randomized controlled trial. Consenters were allocated to either intervention (n = 361) or control (n = 358) conditions. The intervention, a personalized letter plus stage-targeted booklets, was sent 1 week postbaseline. Data were collected via telephone interview at baseline and 2 and 8 months and were analyzed using repeated measures analysis of variance (ANOVA) and χ2 statistics. Results. The groups were similar at baseline (mean age 43 ± 3 years; 64% women). Process evaluation showed high intervention recall (76% at 2 months) and high follow-up response rates (>85% at 8 months) were achieved. Nonsignificant increases in physical activity were observed (F 1,719 = 2.18, p = .14). Discussion. A single mailing of stage-targeted print materials was not effective in promoting increases in physical activity among participants selected from the statewide population. Future research could examine how the effectiveness of print media might be enhanced, possibly by using supplementary media, community-based prompts, or other incentives.