General rightsThis document is made available in accordance with publisher policies. Please cite only the published version using the reference above. Full terms of use are available: http://www.bristol.ac.uk/pure/about/ebr-terms 1 Barriers to a healthy lifestyle post gestational-diabetes: an Australian qualitative study. 2 AbstractBackground: Overseas-born-women from certain ethnicities are at high risk of type-2 diabetes and related metabolic disorders. This study explored the barriers and facilitators to long-term healthy lifestyle recommendations among Australian-born and overseas-born-women who attended health promotion sessions at a tertiary Australian Hospital for gestational diabetes 3-4 years previously.Method; Face-to-face semi-structured interviews were conducted. Data were analyzed to identify major themes and the differing experiences of both groups of women. Conclusion.A better understanding of the barriers to healthy lifestyle by women in their everyday lives will assist in the development of culturally appropriate health promotion guidelines and strategies. Constant un-fragmented postnatal engagement by the specialised diabetes clinics and primary health care services is crucial to sustain the healthy lifestyle in the long-term for women with previous gestational-diabetes.

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Objective: To systematically review and meta-analyse evidence regarding the efficacy of electronic nicotine delivery systems (ENDS) as smoking cessation aids. Data Sources: PubMed, Scopus, Web of Science, PsycINFO, MEDLINE and Cochrane Library were searched up to February-March 2020 (PROSPERO registration CRD42020170692). Study selection: Published peer-reviewed randomised controlled trials (RCTs) of the efficacy of ENDS for sustained cessation of combustible tobacco smoking and/or nicotine use, compared with no intervention, placebo or nicotine replacement therapy (NRT) by intention-to-treat, with a minimum of four months follow-up. Data Extraction: Data were extracted independently into a pre-specified template. Risk of bias was assessed with the Cochrane Collaboration′s tool and evidence quality rated using GRADE. Data Synthesis: From 3,973 titles identified, nine RCTs were identified; 330 of 5,445 smokers randomised quit. Smoking cessation did not differ significantly for randomisation to ENDS versus: no intervention (three studies, random-effects meta-analysis RR 1.95; 95%CI 0.90-4.22); placebo (three studies, 1.61; 0.93-2.78) or NRT (three studies; 1.25; 0.74-2.11). Fixed-effects sensitivity analyses showed significant results for ENDS vs NRT (1.43; 1.10-1.86). Smokers randomised to ENDS were substantially more likely than control to use nicotine at follow-up. Overall evidence quality was low. Considering only studies without potential competing interests further limited evidence but did not materially change conclusions. Conclusions: There is insufficient evidence that ENDS are efficacious for smoking cessation compared to no intervention, placebo or NRT. Results are promising, particularly for therapeutic use, but vary according to analytic method. ENDS may lead to greater ongoing nicotine exposure than other smoking cessation methods.

SummaryObjectiveChildren of immigrants from low‐and‐middle‐income countries show excess overweight/obesity risk relative to host populations, possibly due to socioeconomic disadvantage. The present study was conducted to estimate overweight/obesity prevalence and its association with the family socioeconomic‐position in 2–11‐year‐old Australian‐born children of immigrants and Australian‐mothers.MethodsA cross‐sectional analysis of 10‐year data from the Longitudinal Study of Australian Children was undertaken. Overweight/obesity was defined according to the International Obesity Taskforce, age‐and sex‐specific BMI cut‐off‐points.ResultsApproximately 24% children aged 2–3 years (22% sons, and 25% daughters), were overweight/obese with no significant difference between children of immigrants and Australian‐mothers. Overweight/obesity prevalence consistently increased with age for sons of mothers from low‐and‐middle‐income countries but not daughters. Adjusting for the family socioeconomic‐position did not explain excess overweight/obesity in children of mothers from low‐and‐middle‐income countries. The odds of overweight/obesity in sons were significantly higher at 8–9 years (OR 1.5; p = 0.03) and 10–11 years (OR 1.5; p = 0.03) and in daughters at 4–5 years (OR 1.7; p = 0.002) when the mothers were from low‐and‐middle‐income countries.ConclusionExcess weight in children of immigrants is not due to socioeconomic disadvantage alone. Other social processes and interactions between immigrants and host cultures may be involved.

ObjectiveThis study aimed to identify body mass index (BMI) trajectories and their predictors in Australian children by their maternal immigrant status.MethodsData on 4142 children aged 2–3 years were drawn from the birth cohort of the Longitudinal Study of Australian Children. BMI was calculated according to the International Obesity Task Force cut-off points. Immigrant status was determined by the Australian Bureau of Statistics and the United Nations Development Programme, Human Development Index criteria. Latent class growth analysis estimated distinct BMI trajectories, and multinomial logistic regression analysis examined factors associated with these BMI trajectories.ResultsTwo BMI groups and six BMI trajectories were identified. The stable trajectories group included high-risk (10%, n=375), moderate-risk (5%, n=215) and low-risk (68%, n=2861) BMI trajectories. The changing trajectories group included delayed-risk (6%, n=234), gradual-risk (8%, n=314) and declining-risk (3%, n=143) BMI trajectories. We found some evidence that children of immigrants from low-and middle-income countries were more likely to have moderate-risk and high-risk BMI trajectories compared with low-risk BMI trajectory. However, these associations were insignificant in fully adjusted models. The explanatory risk factors for moderate-risk and high-risk BMI trajectory were birth weight, family socioeconomic position, and organised sports participation. Our results also suggest that 4–7 years of age may be important for the prevention of overweight/obesity in children.DiscussionA better understanding of the risk factors associated with distinct BMI trajectories in immigrant children will inform effective preventive strategies. Some of these risk factors such as non-participation in organised sports, and high screen time, may also impede the integration of immigrant children into the host culture. Obesity prevention strategies aimed at increasing physical activities in immigrant children could help deliver a social and health benefit by increasing social integration among children of immigrants and Australians.