Paul Jagals’s research while affiliated with The University of Queensland and other places

Healthy, diverse diets are vital for life. In low/middle-income countries, however, the focus is more on food quantity rather than diet quality. This study assessed household diet diversity (HDD) in the Vietnamese Mekong Delta and its associations with household food insecurity (HFI) and household food availability (HFA) controlling for socioeconomic factors. Primary food-preparers in 552 randomly selected households in two rural provinces were interviewed about socioeconomic factors, HDD, HFI, and HFA. More than 80% of households predominantly consumed energy-dense foods, whereas less than 20% consumed nutrient-dense foods. Lower HDD was associated with HFI, lower HFA, for the Khmer ethnic minority, and low livelihood capitals (landlessness, low expenditure, debt) and low utensil scores. The study outcomes highlight the need to provide improved food and nutrition policies that increase availability and access to diverse and healthy foods as well as reduce poverty and increase incomes for at-risk rural and ethnic minority groups.

Objectives and importance Maternal and family patterns are changing, and these changes can influence birthweight. Past research and organisational reports focus on short temporal timelines or broad trends, but trends across a longer temporal period are important. The aim of this study is to assess the trends in birthweight and maternal characteristics across a 19-year period using descriptive statistics. Study type and methods Birth records (n = 1,166,055) were obtained for a 19-year period (2000–2019) and a descriptive secular trend analysis was performed. Results and conclusions Mean birthweight trended down across the study period, while rates of large for gestational age births increased. This appears to be driven by a decrease in gestational age across the period. Maternal factors, such as smoking, BMI and Indigenous status, were found to be linked with changes in mean birthweight and the proportion of small for gestational age or large for gestational age. More babies were born to older women by the end of the study period. There was a sharp rise in gestational diabetes, and more large for gestational age births to these women. Over time, the large for gestational age births started to decline, suggesting better care practices for women with gestational diabetes.

Assessing environmental impacts on health in the Pacific Basin is challenged by significantly varying data types - quantities, qualities, and paucities - because of varying geographic sizes, environments, biodiversity, ecological assets, and human population densities, with highly varied and unequal socio-economic development and capacity to respond to environmental and health challenges. We discuss three case-based methodological examples from Pacific Basin environmental health impact assessments. These methods could be used to improve environmental health evidence at all country and regional levels across a spectrum of big data availability to no data. These methods are, 1) a risk assessment of airborne particulate matter in Korea based on the chemical composition of these particulates; 2) the use of system dynamics to appraise the influences of a range of environmental health determinants on child health outcomes in remote Solomon Islands; and 3) precision environmental public health methodologies based on comprehensive data collection, analyses, and modelling (including Bayesian belief networks and spatial epidemiology) increasing precision for good environmental health decision making to prevent and control a zoonotic disease in Fiji Islands. We show that while a common theme across the three examples is the value of high quality and quantity data to support stronger policy decisions and appropriate prioritizing of investment, it is also clear that for many countries in the Pacific Basin, sufficient data will remain a challenge to inform decision makers about environmental impact on health.

Household food security in Vietnam remains tenuous. We surveyed 552 households to investigate household food insecurity (HFI) in rural districts in the Vietnamese Mekong Delta. HFI prevalence was 34.4% and 48.4% in the last month and last year, respectively. Khmer households were twice as likely to experience HFI compared to their Kinh counterparts. The primary factors associated with HFI were weak livelihood assets including lower natural, financial, and human assets (being landless, low incomes), physical and social assets (poor market access, social networks), lower kitchen utensil scores, belonging to a minority and experiencing financial, agricultural, and extreme weather shocks.

Introduction Household food insecurity and inadequate water, sanitation, and hygiene (WASH) contribute to ill health. However, the interactions between household food insecurity, WASH and health have been rarely assessed concurrently. This study investigated compounded impacts of household food insecurity and WASH on self-reported physical and mental health of adults in the Vietnamese Mekong Delta. Materials and methods This cross-sectional survey interviewed 552 households in one northern and one southern province of the Vietnamese Mekong Delta. The survey incorporated previously validated tools such as the Short Form 12-item Health Survey, Household Food Insecurity Assessment Scale, and the Access and Behavioural Outcome Indicators for Water, Sanitation, and Hygiene. Physical and mental health were quantified using the physical health composite score (PCS) and mental health composite score (MCS), respectively. These measures were the dependent variables of interest for this study. Results Statistical analysis revealed that household food insecurity and using <50 litres of water per person per day (pppd) were independently associated with lower PCS (p<0.05), after adjusting for socio-economic confounders. Household food insecurity and lack of food availability, using <50 litres of water pppd, and the use of untreated drinking water were associated with lower MCS (p<0.05), with water usage being an effect modifier of the relationship between household food insecurity and MCS. The results indicate that being food insecure and having limited potable quality water had a compounding effect on MCS, compared to being individually either food insecure or having limited water. Conclusion This study is one of only a few that have established a link between potable water availability, food insecurity and poorer physical and mental health. The results also indicate a need to validate national data with fine-scale investigations in less populous regions to evaluate national initiatives with local populations that may be at higher risk. Adopting joint dual-action policies for interventions that simultaneously address water and food insecurity should result in larger improvements in health, particularly mental health, compared to targeting either food or water insecurity in isolation.

Objectives To identify the maternal and social characteristics associated with age standardised birthweight in a modern developed setting.Methods Birth records (n = 414,478) were obtained for live, singleton births in the period 2007–2015 in Queensland, Australia. Age-standardised birth weights were calculated and a multinomial logistic regression was performed to obtain odds ratios and 95% confidence intervals for a range of maternal and social characteristics.ResultsMothers who smoke (OR 2.82, 95% CI 2.72–2.93), and mothers from Southern and Central Asia (OR 3.30, 95% CI 3.08–3.53) had the highest odds of delivering small for gestational age babies. Smoking alone accounted for 21% of low birthweight. Pre-existing diabetes (OR 5.98, 95% CI 5.12–6.99) had the highest odds ratio for large for gestational age births; however, maternal overweight and obesity accounted for 24% of all cases due to its greater prevalence in the population.Conclusion for practiceSmoking continues to be an important modifiable predictor of low birthweight. The predictors associated with large for gestational age are modifiable, with maternal overweight and obesity the largest contributor to high birthweight.SignificanceMaternal characteristics are changing alongside broader population change, with mothers often older and heavier than in previous decades. This study provides an update to the role of maternal and social characteristics in optimal birthweight within a large developed population. The present study finds a range of traditional and emerging risk factors remain important. Population attributable risk fractions show that maternal overweight and smoking are the most important modifiable risk factors for birthweight extremes (foetal macrosomia and small for gestational age, respectively). Public health efforts to address these risk factors could reduce up to 20% of birth weight extremes.

The populations in the vicinity of surface coal mining activities have a higher risk of morbidity due to diseases, such as cardiovascular, respiratory and hypertensive diseases, as well as cancer and diabetes mellitus. Despite the large and historical volume of coal production in Queensland, the main Australian coal mining state, there is little research on the association of coal mining exposures with morbidity in non-occupational populations in this region. This study explored the association of coal production (Gross Raw Output—GRO) with hospitalisations due to six disease groups in Queensland using a Bayesian spatial hierarchical analysis and considering the spatial distribution of the Local Government Areas (LGAs). There is a positive association of GRO with hospitalisations due to circulatory diseases (1.022, 99% CI: 1.002–1.043) and respiratory diseases (1.031, 95% CI: 1.001–1.062) for the whole of Queensland. A higher risk of circulatory, respiratory and chronic lower respiratory diseases is found in LGAs in northwest and central Queensland; and a higher risk of hypertensive diseases, diabetes mellitus and lung cancer is found in LGAs in north, west, and north and southeast Queensland, respectively. These findings can be used to support public health strategies to protect communities at risk. Further research is needed to identify the causal links between coal mining and morbidity in non-occupational populations in Queensland.