Publications (17)41.34 Total impact
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Article: Effects of bushfire smoke on daily mortality and hospital admissions in Sydney, Australia.
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ABSTRACT: Little research has investigated the health effects of particulate exposure from bushfires (also called wildfires, biomass fires, or vegetation fires), and these exposures are likely to increase, for several reasons. We investigated associations of daily mortality and hospital admissions with bushfire-derived particulates, compared with particulates from urban sources in Sydney, Australia from 1994 through 2002. On days with the highest particulate matter (PM)10 concentrations, we assumed PM10 was due primarily to bushfires. We calculated the contribution of bushfire PM10 on these days by subtracting the background PM10 concentration estimated from surrounding days. We assumed PM10 on the remaining days was from usual urban sources. We implemented a Poisson model, with a bootstrap-based methodology, to select optimum smoothed covariate functions, and we estimated the effects of bushfire PM10 and urban PM10, lagged up to 3 days. We identified 32 days with extreme PM10 concentrations due to bushfires or vegetation-reduction burns. Although bushfire PM10 was consistently associated with respiratory hospital admissions, we found no consistent associations with cardiovascular admissions or with mortality. A 10 microg/m increase in bushfire PM10 was associated with a 1.24% (95% confidence interval = 0.22% to 2.27%) increase in all respiratory disease admissions (at lag 0), a 3.80% (1.40% to 6.26%) increase in chronic obstructive pulmonary disease admissions (at lag 2), and a 5.02% (1.77% to 8.37%) increase in adult asthma admissions (at lag 0). Urban PM10 was associated with all-cause and cardiovascular mortality, as well as with cardiovascular and respiratory hospital admission, and these associations were not influenced by days with extreme PM10 concentrations. PM10 from bushfires is associated primarily with respiratory morbidity, while PM10 from urban sources is associated with cardiorespiratory mortality and morbidity.Epidemiology (Cambridge, Mass.) 11/2009; 21(1):47-55. · 5.51 Impact Factor -
Article: Six year follow-up of students who participated in a school-based physical activity intervention: a longitudinal cohort study.
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ABSTRACT: The purpose of this paper was to evaluate the long-term impact of a childhood motor skill intervention on adolescent motor skills and physical activity. In 2006, we undertook a follow-up of motor skill proficiency (catch, kick, throw, vertical jump, side gallop) and physical activity in adolescents who had participated in a one-year primary school intervention Move It Groove It (MIGI) in 2000. Logistic regression models were analysed for each skill to determine whether the probability of children in the intervention group achieving mastery or near mastery was either maintained or had increased in subsequent years, relative to controls. In these models the main predictor variable was intervention status, with adjustment for gender, grade, and skill level in 2000. A general linear model, controlling for gender and grade, examined whether former intervention students spent more time in moderate-to-vigorous physical activity at follow-up than control students. Half (52%, n = 481) of the 928 MIGI participants were located in 28 schools, with 276 (57%) assessed. 52% were female, 58% in Grade 10, 40% in Grade 11 and 54% were former intervention students. At follow-up, intervention students had improved their catch ability relative to controls and were five times more likely to be able to catch: ORcatch = 5.51, CI (1.95 - 15.55), but had lost their advantage in the throw and kick: ORthrow = .43, CI (.23 - .82), ORkick = .39, CI (.20 - .78). For the other skills, intervention students appeared to maintain their advantage: ORjump = 1.14, CI (.56 - 2.34), ORgallop = 1.24, CI (.55 - 2.79). Intervention students were no more active at follow-up. Six years after the 12-month MIGI intervention, whilst intervention students had increased their advantage relative to controls in one skill, and appeared to maintain their advantage in two, they lost their advantage in two skills and were no more active than controls at follow up. More longitudinal research is needed to explore whether gains in motor skill proficiency in children can be sustained and to determine the intervention characteristics that translate to subsequent physical activity.International Journal of Behavioral Nutrition and Physical Activity 08/2009; 6:48. · 3.83 Impact Factor -
Article: Interrater objectivity for field-based fundamental motor skill assessment.
Research quarterly for exercise and sport 07/2009; 80(2):363-8. · 1.49 Impact Factor -
Article: Socioeconomic and maternal determinants of small-for-gestational age births: patterns of increasing disparity.
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ABSTRACT: To better characterize the relation between socioeconomic disadvantage and small-for-gestational age births (SGA). Analysis of data from a mandatory population-based surveillance system. Public or private hospitals and at home. All 877,951 singleton births occurring in New South Wales, Australia, between 1994 and 2004. Multilevel models were developed to determine the factors associated with babies weighing less than the 3rd percentile for gestation and gender. Odds of SGA. The risk of SGA increased with increasing socioeconomic disadvantage. Smoking accounted for approximately 40% of the increased risk associated with socioeconomic disadvantage, and delayed antenatal care approximately 5%. While the absolute rate of SGA remained stable over the study period, the odds of SGA in mothers living in the most disadvantaged areas compared to those in the least disadvantaged areas increased from approximately 1.7 to 2.2. This trend persisted after accounting for maternal smoking. The risk of SGA over this period also increased in mothers commencing antenatal care after the first trimester. After accounting for smoking, socioeconomic disadvantage and clinical conditions, mothers under 21 years of age were at reduced risk of SGA, but mothers over 35 were at increased risk. Socioeconomic disadvantage remains one of the dominant determinants of SGA, even in a developed country with universal insurance. This relation appears to be strengthening. Smoking patterns, inadequate antenatal care and clinical conditions partially account for this association and trend, however, most is mediated by other factors.Acta Obstetricia Et Gynecologica Scandinavica 04/2009; 88(5):575-83. · 1.77 Impact Factor -
Article: Does childhood motor skill proficiency predict adolescent fitness?
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ABSTRACT: To determine whether childhood fundamental motor skill proficiency predicts subsequent adolescent cardiorespiratory fitness. In 2000, children's proficiency in a battery of skills was assessed as part of an elementary school-based intervention. Participants were followed up during 2006/2007 as part of the Physical Activity and Skills Study, and cardiorespiratory fitness was measured using the Multistage Fitness Test. Linear regression was used to examine the relationship between childhood fundamental motor skill proficiency and adolescent cardiorespiratory fitness controlling for gender. Composite object control (kick, catch, throw) and locomotor skill (hop, side gallop, vertical jump) were constructed for analysis. A separate linear regression examined the ability of the sprint run to predict cardiorespiratory fitness. Of the 928 original intervention participants, 481 were in 28 schools, 276 (57%) of whom were assessed. Two hundred and forty-four students (88.4%) completed the fitness test. One hundred and twenty-seven were females (52.1%), 60.1% of whom were in grade 10 and 39.0% were in grade 11. As children, almost all 244 completed each motor assessments, except for the sprint run (n = 154, 55.8%). The mean composite skill score in 2000 was 17.7 (SD 5.1). In 2006/2007, the mean number of laps on the Multistage Fitness Test was 50.5 (SD 24.4). Object control proficiency in childhood, adjusting for gender (P = 0.000), was associated with adolescent cardiorespiratory fitness (P = 0.012), accounting for 26% of fitness variation. Children with good object control skills are more likely to become fit adolescents. Fundamental motor skill development in childhood may be an important component of interventions aiming to promote long-term fitness.Medicine and science in sports and exercise 01/2009; 40(12):2137-44. · 3.71 Impact Factor -
Article: Perceived sports competence mediates the relationship between childhood motor skill proficiency and adolescent physical activity and fitness: a longitudinal assessment.
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ABSTRACT: The purpose of this paper was to investigate whether perceived sports competence mediates the relationship between childhood motor skill proficiency and subsequent adolescent physical activity and fitness. In 2000, children's motor skill proficiency was assessed as part of a school-based physical activity intervention. In 2006/07, participants were followed up as part of the Physical Activity and Skills Study and completed assessments for perceived sports competence (Physical Self-Perception Profile), physical activity (Adolescent Physical Activity Recall Questionnaire) and cardiorespiratory fitness (Multistage Fitness Test). Structural equation modelling techniques were used to determine whether perceived sports competence mediated between childhood object control skill proficiency (composite score of kick, catch and overhand throw), and subsequent adolescent self-reported time in moderate-to-vigorous physical activity and cardiorespiratory fitness. Of 928 original intervention participants, 481 were located in 28 schools and 276 (57%) were assessed with at least one follow-up measure. Slightly more than half were female (52.4%) with a mean age of 16.4 years (range 14.2 to 18.3 yrs). Relevant assessments were completed by 250 (90.6%) students for the Physical Activity Model and 227 (82.3%) for the Fitness Model. Both hypothesised mediation models had a good fit to the observed data, with the Physical Activity Model accounting for 18% (R2 = 0.18) of physical activity variance and the Fitness Model accounting for 30% (R2 = 0.30) of fitness variance. Sex did not act as a moderator in either model. Developing a high perceived sports competence through object control skill development in childhood is important for both boys and girls in determining adolescent physical activity participation and fitness. Our findings highlight the need for interventions to target and improve the perceived sports competence of youth.International Journal of Behavioral Nutrition and Physical Activity 09/2008; 5:40. · 3.83 Impact Factor -
Article: Evaluating the effect of neighbourhood weight matrices on smoothing properties of Conditional Autoregressive (CAR) models.
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ABSTRACT: The Conditional Autoregressive (CAR) model is widely used in many small-area ecological studies to analyse outcomes measured at an areal level. There has been little evaluation of the influence of different neighbourhood weight matrix structures on the amount of smoothing performed by the CAR model. We examined this issue in detail. We created several neighbourhood weight matrices and applied them to a large dataset of births and birth defects in New South Wales (NSW), Australia within 198 Statistical Local Areas. Between the years 1995-2003, there were 17,595 geocoded birth defects and 770,638 geocoded birth records with available data. Spatio-temporal models were developed with data from 1995-2000 and their fit evaluated within the following time period: 2001-2003. We were able to create four adjacency-based weight matrices, seven distance-based weight matrices and one matrix based on similarity in terms of a key covariate (i.e. maternal age). In terms of agreement between observed and predicted relative risks, categorised in epidemiologically relevant groups, generally the distance-based matrices performed better than the adjacency-based neighbourhoods. In terms of recovering the underlying risk structure, the weight-7 model (smoothing by maternal-age 'Covariate model') was able to correctly classify 35/47 high-risk areas (sensitivity 74%) with a specificity of 47%, and the 'Gravity' model had sensitivity and specificity values of 74% and 39% respectively. We found considerable differences in the smoothing properties of the CAR model, depending on the type of neighbours specified. This in turn had an effect on the models' ability to recover the observed risk in an area. Prior to risk mapping or ecological modelling, an exploratory analysis of the neighbourhood weight matrix to guide the choice of a suitable weight matrix is recommended. Alternatively, the weight matrix can be chosen a priori based on decision-theoretic considerations including loss, cost and inferential aims.International Journal of Health Geographics 02/2007; 6:54. · 2.62 Impact Factor -
Article: DDT and human health.
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ABSTRACT: 1,1,1-Trichloro-2,2'bis(p-chlorophenyl) ethane (DDT) was the first widely used synthetic pesticide and is extremely persistent in both the environment and the human body. The introduction of DDT revolutionised agricultural production and has been credited with the elimination of malaria from the United States and Europe. However, DDT is also known to have had major environmental consequences and has been associated with dramatic declines in many animal populations. Although DDT use has generally been restricted since the early 1970s, exposure to the pesticide remains widespread. In developed countries, slow elimination from the body means a large proportion of the population still have detectable levels of DDT, or its metabolite DDE, in their serum or adipose tissue. In developing countries, the pesticide continues to be used for vector control and a significant proportion of breast-fed babies has daily intakes above recommended levels. This review considers the epidemiological evidence for possible adverse effects of human exposure to DDT. Much of this research is weakened by methodological flaws. However, recent methods in breast cancer research using nested studies in cohorts with stored biological samples have allowed a more rigorous assessment of a putative role for DDT in disease aetiology. While DDT does not appear to play a causative role in breast cancer development, there is suggestive evidence for a role in the aetiology of other conditions such as pancreatic cancer, neuropsychological dysfunction, and reproductive outcomes. Research into these and other conditions would benefit from the same rigorous approaches used in breast cancer research. Until further high quality evidence is available, it is still too early, even 60 years after the introduction of this once ubiquitous chemical, to pass judgement on the role of DDT in a number of common diseases.Science of The Total Environment 03/2006; 355(1-3):78-89. · 3.29 Impact Factor -
Article: The role of the public in the management of public health risks.
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ABSTRACT: To critique current models of public involvement in the management of public health risks. Two case studies are used to highlight the challenges of contemporary practice. Current models often result in affected communities having perceptions of risk that conflict with those responsible for risk management. This can lead to ineffective decision making. Involving the public throughout the risk assessment and risk management process may lessen conflict and result in better decisions. Those responsible for responding to public health risks should aim for transparent processes that highlight assumptions and uncertainties, and involve the public wherever possible.Australian and New Zealand Journal of Public Health 11/2004; 28(5):415-7. · 1.20 Impact Factor -
Article: Falls prevention in rural general practice: what stands the test of time and where to from here?
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ABSTRACT: General practitioner recall of the 1992-96 'Stay on Your Feet' (SOYF) program and its influence on practice were surveyed five years post-intervention to gauge sustainability of the SOYF General Practice (GP) component. A survey assessed which SOYF components were still in existence, current practice related to falls prevention, and interest in professional development. All general practitioners (GPs) situated within the boundaries of a rural Area Health Service were mailed a survey in late 2001. Response rate was 66.5% (139/209). Of 117 GPs in practice at the time of SOYF, 80.2% reported having heard of SOYF and 74.4% of those felt it had influenced practice. Half (50.9%) still had a copy of the SOYF GP resource and of those, 58.6% used it at least 'occasionally'. Three-quarters of GPs surveyed (75.2%) checked medications 'most/almost all' of the time with patients over 60 years; 46.7% assessed falls risk factors; 41.3% gave advice; and 22.6% referred to allied health practitioners. GPs indicated a strong interest in falls prevention-related professional development. There was no significant association between use of the SOYF resource package and any of the current falls prevention practices (all chi2 > 0.05). There was high recall of SOYF and a general belief that it influenced practice. There was little indication that use of the resource had any lasting influence on GPs' practices. In future, careful thought needs to go into designing a program that has potential to affect long-term change in GPs' falls prevention practice.Australian and New Zealand Journal of Public Health 10/2003; 27(5):481-5. · 1.20 Impact Factor -
Article: Health impacts of pesticide exposure in a cohort of outdoor workers.
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ABSTRACT: We compared mortality of 1,999 outdoor staff working as part of an insecticide application program during 1935-1996 with that of 1,984 outdoor workers not occupationally exposed to insecticides, and with the Australian population. Surviving subjects also completed a morbidity questionnaire. Mortality was significantly higher in both exposed and control subjects compared with the Australian population. The major cause was mortality from smoking-related diseases. Mortality was also significantly increased in exposed subjects for a number of conditions that do not appear to be the result of smoking patterns. Compared with the general Australian population, mortality over the total study period was increased for asthma [standardized mortality ratio (SMR) = 3.45; 95% confidence interval (CI), 1.39-7.10] and for diabetes (SMR = 3.57; 95% CI, 1.16-8.32 for subjects working < 5 years). Mortality from pancreatic cancer was more frequent in subjects exposed to 1,1,1-trichloro-2,2-bis(p-chlorophenyl)ethane (SMR = 5.27; 95% CI, 1.09-15.40 for subjects working < 3 years). Compared with the control population, mortality from leukemia was increased in subjects working with more modern chemicals (standardized incidence ratio = 20.90; 95% CI, 1.54-284.41 for myeloid leukemia in the highest exposure group). There was also an increase in self-reported chronic illness and asthma, and lower neuropsychologic functioning scores among surviving exposed subjects when compared with controls. Diabetes was reported more commonly by subjects reporting occupational use of herbicides. These findings lend weight to other studies suggesting an association between adverse health effects and exposure to pesticides.Environmental Health Perspectives 05/2003; 111(5):724-30. · 7.04 Impact Factor -
Article: Substance use disorders in an Australian community survey.
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ABSTRACT: A community survey of the common mental disorders in a geographically defined treatment service area was used to explore the socio-demographic correlates and service utilization of people with alcohol and drug use disorders living in the area. These data represent the most comprehensive data on substance use disorders in a defined geographic region in Australia. Alcohol and drug use disorders were most likely to be found in the young, with those aged 18-34 years being three times more likely to have an alcohol use disorder than those aged 55 years and over. A third (33%) of those people with an alcohol use disorder and 42% of those with a drug use disorder had consulted a health professional in the past 12 months for their substance use disorder.Drug and Alcohol Review 10/2002; 21(3):275-80. · 1.55 Impact Factor -
Article: A lcohol education in licensed brief intervention strategies prem ises using
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ABSTRACT: A bstract A im s. The aim of this feasibility study is to present a description of a new approach based on alcohol brief intervention strategies to intervene with at-risk drinkers in licensed premises . D esign. The data presented are from a convenience sample of tavern patrons . Setting. The intervention called Operation Drinksafe was conducted on 75 occasions in 67 licensed premises in an Australian rural area . Participants. There were 2761 voluntary participants who were provided with a personal risk assessment of their alcohol use . M easurem ents. The main measurements were the Alcohol Use Disorders Identification Test (AUDIT) combined with a blood alcohol concentration (BAC) reading . Findings. The median AUDIT score was 11.0, with 53% scoring in the hazardous range and 25% in the harmful range. For binge drinking, almost two-thirds (62%) of males drank six or more drinks once a week or more compared to 29% of females. Median BAC was 0.03 mg/100 ml with 11% of males above 0.10. Regression analysis revealed that significant predictors of alcohol-related injury were being aged less than 30 years, forgetting the previous night, having had another person express concern about your drinking, and binge drinking weekly or more . C onclusions. The program had high acceptance among licensees and their patrons. Patrons who are ready to change their at-risk drinking behaviour may benefit from this type of minimal intervention when presented in an interesting way in their drinking environments.Addiction 05/2002; 93(3):385 - 398. · 4.31 Impact Factor -
Article: Evaluating the effect of neighbourhood weight matrices on smoothing properties of Conditional Autoregressive (CAR) models
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ABSTRACT: Background The Conditional Autoregressive (CAR) model is widely used in many small-area ecological studies to analyse outcomes measured at an areal level. There has been little evaluation of the influence of different neighbourhood weight matrix structures on the amount of smoothing performed by the CAR model. We examined this issue in detail. Methods We created several neighbourhood weight matrices and applied them to a large dataset of births and birth defects in New South Wales (NSW), Australia within 198 Statistical Local Areas. Between the years 1995–2003, there were 17,595 geocoded birth defects and 770,638 geocoded birth records with available data. Spatio-temporal models were developed with data from 1995–2000 and their fit evaluated within the following time period: 2001–2003. Results We were able to create four adjacency-based weight matrices, seven distance-based weight matrices and one matrix based on similarity in terms of a key covariate (i.e. maternal age). In terms of agreement between observed and predicted relative risks, categorised in epidemiologically relevant groups, generally the distance-based matrices performed better than the adjacency-based neighbourhoods. In terms of recovering the underlying risk structure, the weight-7 model (smoothing by maternal-age 'Covariate model') was able to correctly classify 35/47 high-risk areas (sensitivity 74%) with a specificity of 47%, and the 'Gravity' model had sensitivity and specificity values of 74% and 39% respectively. Conclusion We found considerable differences in the smoothing properties of the CAR model, depending on the type of neighbours specified. This in turn had an effect on the models' ability to recover the observed risk in an area. Prior to risk mapping or ecological modelling, an exploratory analysis of the neighbourhood weight matrix to guide the choice of a suitable weight matrix is recommended. Alternatively, the weight matrix can be chosen a priori based on decision-theoretic considerations including loss, cost and inferential aims. -
Article: Alcohol brief intervention in bars and taverns: a 12-month follow-up study of Operation Drinksafe in Australia
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ABSTRACT: This study examined the effect of an alcohol brief intervention program on drinkers in bars and taverns. A 12-month follow-up was conducted with 1211 patrons who took part in a program called Operation Drinksafe involving 118 hotels and clubs in north coast New South Wales, Australia. The brief intervention took ~5 min and consisted of a personalized risk assessment using the Alcohol Use Disorders Identification Test (AUDIT) in combination with a breathalyser to determine blood alcohol concentration (BAC). At follow-up, almost half (46%) the participants reported reduced their alcohol consumption. The mean AUDIT score reduced by 15%, weekly alcohol consumption by 13% and frequency of binge drinking by 19%. Those previously drinking at ‘harmful’ levels reduced most (AUDIT 29%, consumption 22% and binge frequency 37%). Females had almost twice the odds of reducing consumption compared to males (OR 1.75, CI: 1.33–2.33) as did participants with initial consumption above the mean (OR 2.03, CI: 1.58–2.60). Older respondents showed smaller reductions than young people in composite AUDIT score, but greater reductions on consumption and binge frequency scales. Although a control group was not feasible, these findings suggest that a brief intervention program, presented in an interesting way to drinkers in bars and taverns, may effectively reduce risky alcohol consumption. Brief interventions may be particularly beneficial for those drinking at hazardous and harmful levels who are ready to change their drinking pattern. The partnership between police and health services was the cornerstone of this intervention, and helped to foster co-operation and acceptance from licensees and their customers. -
Article: Automated geocoding of routinely collected health data in New South Wales.
New South Wales Public Health Bulletin 17(3-4):33-8. -
Article: Evaluating the effect of neighbourhood weight matrices on smoothing properties of Conditional Autoregressive (CAR) models
[show abstract] [hide abstract]
ABSTRACT: Background: The Conditional Autoregressive (CAR) model is widely used in many small-area ecological studies to analyse outcomes measured at an areal level. There has been little evaluation of the influence of different neighbourhood weight matrix structures on the amount of smoothing performed by the CAR model. We examined this issue in detail. Methods: We created several neighbourhood weight matrices and applied them to a large dataset of births and birth defects in New South Wales (NSW), Australia within 198 Statistical Local Areas. Between the years 1995–2003, there were 17,595 geocoded birth defects and 770,638 geocoded birth records with available data. Spatio-temporal models were developed with data from 1995–2000 and their fit evaluated within the following time period: 2001–2003. Results: We were able to create four adjacency-based weight matrices, seven distance-based weight matrices and one matrix based on similarity in terms of a key covariate (i.e. maternal age). In terms of agreement between observed and predicted relative risks, categorised in epidemiologically relevant groups, generally the distance-based matrices performed better than the adjacency-based neighbourhoods. In terms of recovering the underlying risk structure, the weight-7 model (smoothing by maternal-age 'Covariate model') was able to correctly classify 35/47 high-risk areas (sensitivity 74%) with a specificity of 47%, and the 'Gravity' model had sensitivity and specificity values of 74% and 39% respectively. Conclusion: We found considerable differences in the smoothing properties of the CAR model, depending on the type of neighbours specified. This in turn had an effect on the models' ability to recover the observed risk in an area. Prior to risk mapping or ecological modelling, an exploratory analysis of the neighbourhood weight matrix to guide the choice of a suitable weight matrix is recommended. Alternatively, the weight matrix can be chosen a priori based on decision-theoretic considerations including loss, cost and inferential aims.
Top co-authors
Top Journals
Institutions
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2009
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New York Academy of Medicine
New York City, NY, USA -
Deakin University
Geelong, Victoria, Australia
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2007–2009
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University of Sydney
- School of Rural Health
Sydney, New South Wales, Australia
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2003–2007
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Southern Cross University
Lismore, New South Wales, Australia
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