Letters
While the results of this survey suggest that standing meeting rooms may be an acceptable and relatively inexpensive health promotion initiative, the research is limited by the relatively low survey response rate and limited collection of demographic data. Additionally, the results may reflect a greater level of acceptability than would be found if trialled in other non-health sector workplaces.
doi: 10.1111/1753-6405.12225
Acknowledgements
More than 100 years after Herbert Durham1 tried to shine light on the underlying cause of beriberi on Christmas Island by scrutinising living conditions, diet and the socioeconomic circumstances of its populations in 1904, a price index report2 identified reasons for renewed concern about nutritional deficits of a different kind and the consequences for ill-health.
Professor David Dunstan (Baker IDI), Kate Scalzo, Juliane Peth, Mary Stewart (Cancer Council Victoria)
References 1
2
3
4
5
6
7
8
Hu FB, Li TY, Colditz GA, Willett WC, Manson JE. Television watching and other sedentary behaviors in relation to risk of obesity and type 2 diabetes mellitus in women. JAMA. 2003;289(14):1785-91. Chau JY, der Ploeg HP, van Uffelen JG, Wong J, Riphagen I, Healy GN, et al. Are workplace interventions to reduce sitting effective? A systematic review. Prev Med. 2010;51(5):352-6. Owen N, Healy GN, Matthews CE, Dunstan DW. Too much sitting: The population health science of sedentary behaviour. Exerc Sport Sci Rev. 2010;38(3): 105-13. Weller L, Corey P. The impact of excluding non-leisure energy expenditure on the relation between physical activity and mortality in women. Epidemiology. 1998;9:632-5. Katzmarzyk PT, Church TS, Craig CL, Bouchard C. Sitting time and mortality from all causes, cardiovascular disease, and cancer. Med Sci Sports Exerc. 2009;41(5): 998-1005. Howard RA, Freedman DM, Park Y, Hollenbeck A, Schatzkin A, Leitzmann MF. Physical activity, sedentary behavior, and the risk of colon and rectal cancer in the NIH-AARP Diet and Health Study. Cancer Causes Control. 2008;19(9):939-53. Gierach GL, Chang SC, Brinton LA, Lacey JV Jr, Hollenbeck AR, Schatzkin A, et al. Physical activity, sedentary behavior, and endometrial cancer risk in the NIH-AARP Diet and Health Study. Int J Cancer. 2009;124(9):2139-47. Mummery WK, Schofield GM, Steele R, Eakin EG, Brown WJ. Occupational sitting time and overweight and obesity in Australian workers. Am J Prev Med. 2005;29(2):91-7.
Correspondence to: Ms Jennifer Atkinson, People and Change, Cancer Council Victoria, 615 St Kilda Road, Melbourne, Victoria 3004; e-mail: [email protected]
292
Christmas Island over 100 years: from beriberi to nutritional deficiencies of a different kind Fabian Schwarz1 1. Christmas Island Hospital, Christmas Island, Western Australia
This report showed there is easy access for the island’s inhabitants to tax-free cigarettes and alcohol alongside poor access to affordable
fresh food. Figures 1 and 2 are examples from the local stores. As a medical practitioner working on the island, I take my Hippocratic oath seriously. I hear from too many patients, who include both locals and ‘fly-in-fly-out’ workers, that they are taking up smoking again because of low prices – here, a packet of cigarettes costs less than $3. Unsafe use of alcohol is emerging as another issue, possibly because prices of wine, beer and spirits are nearly 40% cheaper than those on the Australian mainland.2 Elsewhere, researchers examined regulatory interventions targeting the food environment and barriers/facilitators to their implementation at the Australian State Government level.3 Conflicting policies, laws or initiatives are evident on Christmas Island; for example, the subsidising of alcohol and tobacco through tax-free status while anti-
Figure 1: Vegetables for sale. Note the prices: Chinese Cabbage, $9.70; Iceberg Lettuce, $9.42; and Broccoli $11.08.
Figure 2: Fresh fruit for sale flown in every Friday. Note the prices: Fuji Apples, $8.00 per kg; Pink Lady Apples, $8.00 per kg; Green Apples, $6.00 per kg.
Australian and New Zealand Journal of Public Health © 2014 The Authors. ANZJPH © 2014 Public Health Association of Australia
2014 vol. 38 no. 3
Letters
smoking campaigns are running on national TV. Unsurprisingly, locals report a lack of trust in government processes and feel unable to influence or determine the future of their own community. Until recently, cigarettes were displayed at the cash register of most food stores on Christmas Island;4 fortunately, enforcement of current legislation prompted some change. An enormous array of alcoholic beverages is still on sale and within easy reach of customers. My patients tell me that they would rather have affordable fresh food on display. This could be realised by health policy enforcement, community and storekeeper support and appropriate subsidies.5 Locals on Christmas Island should be encouraged and enabled to choose a healthy lifestyle and spared from unnecessary health hazards that stem from subsidising tobacco and alcohol over fresh vegetables and fruit.
Acknowledgements Thank you to Professor Jeanette Ward for reviewing this letter. Thank you to Ms Rachel Oommen for her input into this letter.
References 1. Durham HE. Notes on Beri-beri in the Malay Peninsula and on Christmas Island (Indian Ocean) J Hyg (Lond). 1904;4(1):112–55. 2. Department of Infrastructure and regional Development. Indian Ocean Territories Price Index October 2012. Comparison of Commodity Prices on Christmas Island and Cocos (Keeling) Islands [Internet]. Canberra (AUST): Commonwealth of Australia; 2012 [cited 2014 May 5]. Available from: http://www. regional.gov.au/territories/publications/indian-oceanterritories-price-index-october-2012/index.aspx 3. Shill J, Mavoa H, Allender S, Lawrence M, Sacks G, Peeters A, et al. Government regulation to promote healthy food environments – a view from inside state governments. Obes Rev. 2012;13(2):162-73. 4. Christmas Island Administrator. Article on Social and Economic Impact of the Immigration Detention Centre on Christmas Island. Christmas Island Administrators Newslett. 2013;10:1. 5. Trust Nature. Expanding the Opportunities for Fruit and Vegetable Production on Christmas Island [Internet]. Byron Bay (AUST): Trust Nature; 2013 [cited 2014 May 5]. Available from: http://trustnature.com.au/ christmas_island
Correspondence to: Dr Fabian Schwarz, Department of Health, PO Box 40596, Casuarina, NT 0810; e-mail: [email protected]
doi: 10.1111/1753-6405.12226
Availability of chop-chop in Victorian tobacconists following introduction of plain packaging Michelle Scollo,1 Megan Bayly,1 Melanie Wakefield1 1. Centre for Behavioural Research in Cancer, Cancer Council Victoria
Unbranded tobacco (either loose or prerolled into cigarettes) is commonly known in Australia as chop-chop.1 Questions about use of chop-chop were included in the last three National Drug Strategy Household Surveys.2,3 Survey reports show that, of respondents aged 14 and older who had smoked in the past 12 months, 6.1% reported any current use of unbranded tobacco in 20072 and 4.9% reported current use in 2010.3 In 2010, 1.5% of smokers reported that they used unbranded tobacco “half the time or more”.3 About 60% of Australian smokers routinely buy tobacco products from supermarkets, about 20% from milk bars, newsagents and convenience stores, and 15% from tobacconists. Others buy from vending machines, bars or other retail outlets. This is in addition to small numbers of duty-free and internet purchases (personal communication, T Partos, ITC study, Cancer Council Victoria, 2013). Reports by Deloitte consulting company for Australian tobacco companies1 indicate that tobacconists are the most common source of supply of unbranded tobacco, making up about 50% of purchases in 2010 and 35% in 2011.1 Retail audits provide a means to complement data from consumer surveys on availability of illicit tobacco over time in Australia. A study by our group found very low levels of availability of unbranded tobacco in small (mixed business) retailers throughout Australia, with no indication of any increase in the eight months after the introduction of plain packaging.4 The aim of the present
Fifty-four tobacconists from 16 postcodes in metropolitan Melbourne, stratified by socioeconomic status,5 were selected from within areas sampled for a national tobacco retail monitoring study.4,6 All potentially eligible tobacconists were sampled, defined as those that had ‘tobacconist’, ‘tobacco’, or ‘cigarettes’ in their store name or signage, or were branded as a chain tobacconist. All 54 stores were open and sampled in each month of the study (February, April and July 2013), yielding 162 enquiries. A trained fieldworker entered each store and, after asking for a cheap pack of cigarettes, went on to enquire about local availability of unbranded tobacco, making sure to always use the words ‘chop-chop’ in their request. If offered chop-chop, the fieldworker declined to purchase it. The response of the retailer was noted after leaving the store. Two-thirds of tobacconists indicated that they did not know what chop-chop was, and a further 15% confused it with roll-your-own tobacco. Retailers offered to sell unbranded tobacco on just five (3%) of 162 occasions throughout the three collection months. They provided specific information as to where unbranded tobacco could be found on five occasions (3%) and vague information on a further 10 occasions (6%). One study limitation was that tobacconists may only be willing to sell illicit tobacco to customers known to them. Five retailers (9%) became suspicious of the fieldworker during the February collection period (which coincided with a time when government inspectors were actively monitoring the implementation of plain packaging legislation). Only three of the 54 retailers were suspicious about the enquiry in April and only two in July. This suggests that the mystery shopper protocol was credible and did not arouse suspicion in most instances. Fines for
Table 1: Retailer responses to enquiry about illicit tobacco by month (n=54 per month).
a) No or don’t know b) Confused with RYO tobacco Total Negative Responses (a+b) c) Gave vague information d) Gave specific information e) Offered to sell chop-chop Total Positive Responses (c+d+e) Suspicious of fieldworker
2014 vol. 38 no. 3
study was to assess the availability of illicit tobacco from specialist tobacconists in Melbourne, Victoria, following the introduction of plain packaging legislation.
February 2013 n (%) 34 (63.0%) 9 (16.7%) 43 (79.6%) 2 (3.7%) 2 (3.7%) 2 (3.7%) 6 (11.1%) 5 (9.3%)
April 2013 n (%) 34 (63.0%) 8 (14.8%) 42 (77.8%) 6 (11.1%) 2 (3.7%) 1 (1.9%) 9 (16.7%) 3 (5.6%)
Australian and New Zealand Journal of Public Health © 2014 The Authors. ANZJPH © 2014 Public Health Association of Australia
July 2013 n (%) 40 (74.1%) 7 (13.0%) 47 (87.0%) 2 (3.7%) 1 (1.9%) 2 (3.7%) 5 (9.3%) 2 (3.7%)
Total n (%) 108 (66.7%) 24 (14.8%) 132 (81.5%) 10 (6.2%) 5 (3.1%) 5 (3.1%) 20 (12.4%) 10 (6.2%)
293
While the results of this survey suggest that standing meeting rooms may be an acceptable and relatively inexpensive health promotion initiative, the research is limited by the relatively low survey response rate and limited collection of demographic data. Additionally, the results may reflect a greater level of acceptability than would be found if trialled in other non-health sector workplaces.
doi: 10.1111/1753-6405.12225
Acknowledgements
More than 100 years after Herbert Durham1 tried to shine light on the underlying cause of beriberi on Christmas Island by scrutinising living conditions, diet and the socioeconomic circumstances of its populations in 1904, a price index report2 identified reasons for renewed concern about nutritional deficits of a different kind and the consequences for ill-health.
Professor David Dunstan (Baker IDI), Kate Scalzo, Juliane Peth, Mary Stewart (Cancer Council Victoria)
References 1
2
3
4
5
6
7
8
Hu FB, Li TY, Colditz GA, Willett WC, Manson JE. Television watching and other sedentary behaviors in relation to risk of obesity and type 2 diabetes mellitus in women. JAMA. 2003;289(14):1785-91. Chau JY, der Ploeg HP, van Uffelen JG, Wong J, Riphagen I, Healy GN, et al. Are workplace interventions to reduce sitting effective? A systematic review. Prev Med. 2010;51(5):352-6. Owen N, Healy GN, Matthews CE, Dunstan DW. Too much sitting: The population health science of sedentary behaviour. Exerc Sport Sci Rev. 2010;38(3): 105-13. Weller L, Corey P. The impact of excluding non-leisure energy expenditure on the relation between physical activity and mortality in women. Epidemiology. 1998;9:632-5. Katzmarzyk PT, Church TS, Craig CL, Bouchard C. Sitting time and mortality from all causes, cardiovascular disease, and cancer. Med Sci Sports Exerc. 2009;41(5): 998-1005. Howard RA, Freedman DM, Park Y, Hollenbeck A, Schatzkin A, Leitzmann MF. Physical activity, sedentary behavior, and the risk of colon and rectal cancer in the NIH-AARP Diet and Health Study. Cancer Causes Control. 2008;19(9):939-53. Gierach GL, Chang SC, Brinton LA, Lacey JV Jr, Hollenbeck AR, Schatzkin A, et al. Physical activity, sedentary behavior, and endometrial cancer risk in the NIH-AARP Diet and Health Study. Int J Cancer. 2009;124(9):2139-47. Mummery WK, Schofield GM, Steele R, Eakin EG, Brown WJ. Occupational sitting time and overweight and obesity in Australian workers. Am J Prev Med. 2005;29(2):91-7.
Correspondence to: Ms Jennifer Atkinson, People and Change, Cancer Council Victoria, 615 St Kilda Road, Melbourne, Victoria 3004; e-mail: [email protected]
292
Christmas Island over 100 years: from beriberi to nutritional deficiencies of a different kind Fabian Schwarz1 1. Christmas Island Hospital, Christmas Island, Western Australia
This report showed there is easy access for the island’s inhabitants to tax-free cigarettes and alcohol alongside poor access to affordable
fresh food. Figures 1 and 2 are examples from the local stores. As a medical practitioner working on the island, I take my Hippocratic oath seriously. I hear from too many patients, who include both locals and ‘fly-in-fly-out’ workers, that they are taking up smoking again because of low prices – here, a packet of cigarettes costs less than $3. Unsafe use of alcohol is emerging as another issue, possibly because prices of wine, beer and spirits are nearly 40% cheaper than those on the Australian mainland.2 Elsewhere, researchers examined regulatory interventions targeting the food environment and barriers/facilitators to their implementation at the Australian State Government level.3 Conflicting policies, laws or initiatives are evident on Christmas Island; for example, the subsidising of alcohol and tobacco through tax-free status while anti-
Figure 1: Vegetables for sale. Note the prices: Chinese Cabbage, $9.70; Iceberg Lettuce, $9.42; and Broccoli $11.08.
Figure 2: Fresh fruit for sale flown in every Friday. Note the prices: Fuji Apples, $8.00 per kg; Pink Lady Apples, $8.00 per kg; Green Apples, $6.00 per kg.
Australian and New Zealand Journal of Public Health © 2014 The Authors. ANZJPH © 2014 Public Health Association of Australia
2014 vol. 38 no. 3
Letters
smoking campaigns are running on national TV. Unsurprisingly, locals report a lack of trust in government processes and feel unable to influence or determine the future of their own community. Until recently, cigarettes were displayed at the cash register of most food stores on Christmas Island;4 fortunately, enforcement of current legislation prompted some change. An enormous array of alcoholic beverages is still on sale and within easy reach of customers. My patients tell me that they would rather have affordable fresh food on display. This could be realised by health policy enforcement, community and storekeeper support and appropriate subsidies.5 Locals on Christmas Island should be encouraged and enabled to choose a healthy lifestyle and spared from unnecessary health hazards that stem from subsidising tobacco and alcohol over fresh vegetables and fruit.
Acknowledgements Thank you to Professor Jeanette Ward for reviewing this letter. Thank you to Ms Rachel Oommen for her input into this letter.
References 1. Durham HE. Notes on Beri-beri in the Malay Peninsula and on Christmas Island (Indian Ocean) J Hyg (Lond). 1904;4(1):112–55. 2. Department of Infrastructure and regional Development. Indian Ocean Territories Price Index October 2012. Comparison of Commodity Prices on Christmas Island and Cocos (Keeling) Islands [Internet]. Canberra (AUST): Commonwealth of Australia; 2012 [cited 2014 May 5]. Available from: http://www. regional.gov.au/territories/publications/indian-oceanterritories-price-index-october-2012/index.aspx 3. Shill J, Mavoa H, Allender S, Lawrence M, Sacks G, Peeters A, et al. Government regulation to promote healthy food environments – a view from inside state governments. Obes Rev. 2012;13(2):162-73. 4. Christmas Island Administrator. Article on Social and Economic Impact of the Immigration Detention Centre on Christmas Island. Christmas Island Administrators Newslett. 2013;10:1. 5. Trust Nature. Expanding the Opportunities for Fruit and Vegetable Production on Christmas Island [Internet]. Byron Bay (AUST): Trust Nature; 2013 [cited 2014 May 5]. Available from: http://trustnature.com.au/ christmas_island
Correspondence to: Dr Fabian Schwarz, Department of Health, PO Box 40596, Casuarina, NT 0810; e-mail: [email protected]
doi: 10.1111/1753-6405.12226
Availability of chop-chop in Victorian tobacconists following introduction of plain packaging Michelle Scollo,1 Megan Bayly,1 Melanie Wakefield1 1. Centre for Behavioural Research in Cancer, Cancer Council Victoria
Unbranded tobacco (either loose or prerolled into cigarettes) is commonly known in Australia as chop-chop.1 Questions about use of chop-chop were included in the last three National Drug Strategy Household Surveys.2,3 Survey reports show that, of respondents aged 14 and older who had smoked in the past 12 months, 6.1% reported any current use of unbranded tobacco in 20072 and 4.9% reported current use in 2010.3 In 2010, 1.5% of smokers reported that they used unbranded tobacco “half the time or more”.3 About 60% of Australian smokers routinely buy tobacco products from supermarkets, about 20% from milk bars, newsagents and convenience stores, and 15% from tobacconists. Others buy from vending machines, bars or other retail outlets. This is in addition to small numbers of duty-free and internet purchases (personal communication, T Partos, ITC study, Cancer Council Victoria, 2013). Reports by Deloitte consulting company for Australian tobacco companies1 indicate that tobacconists are the most common source of supply of unbranded tobacco, making up about 50% of purchases in 2010 and 35% in 2011.1 Retail audits provide a means to complement data from consumer surveys on availability of illicit tobacco over time in Australia. A study by our group found very low levels of availability of unbranded tobacco in small (mixed business) retailers throughout Australia, with no indication of any increase in the eight months after the introduction of plain packaging.4 The aim of the present
Fifty-four tobacconists from 16 postcodes in metropolitan Melbourne, stratified by socioeconomic status,5 were selected from within areas sampled for a national tobacco retail monitoring study.4,6 All potentially eligible tobacconists were sampled, defined as those that had ‘tobacconist’, ‘tobacco’, or ‘cigarettes’ in their store name or signage, or were branded as a chain tobacconist. All 54 stores were open and sampled in each month of the study (February, April and July 2013), yielding 162 enquiries. A trained fieldworker entered each store and, after asking for a cheap pack of cigarettes, went on to enquire about local availability of unbranded tobacco, making sure to always use the words ‘chop-chop’ in their request. If offered chop-chop, the fieldworker declined to purchase it. The response of the retailer was noted after leaving the store. Two-thirds of tobacconists indicated that they did not know what chop-chop was, and a further 15% confused it with roll-your-own tobacco. Retailers offered to sell unbranded tobacco on just five (3%) of 162 occasions throughout the three collection months. They provided specific information as to where unbranded tobacco could be found on five occasions (3%) and vague information on a further 10 occasions (6%). One study limitation was that tobacconists may only be willing to sell illicit tobacco to customers known to them. Five retailers (9%) became suspicious of the fieldworker during the February collection period (which coincided with a time when government inspectors were actively monitoring the implementation of plain packaging legislation). Only three of the 54 retailers were suspicious about the enquiry in April and only two in July. This suggests that the mystery shopper protocol was credible and did not arouse suspicion in most instances. Fines for
Table 1: Retailer responses to enquiry about illicit tobacco by month (n=54 per month).
a) No or don’t know b) Confused with RYO tobacco Total Negative Responses (a+b) c) Gave vague information d) Gave specific information e) Offered to sell chop-chop Total Positive Responses (c+d+e) Suspicious of fieldworker
2014 vol. 38 no. 3
study was to assess the availability of illicit tobacco from specialist tobacconists in Melbourne, Victoria, following the introduction of plain packaging legislation.
February 2013 n (%) 34 (63.0%) 9 (16.7%) 43 (79.6%) 2 (3.7%) 2 (3.7%) 2 (3.7%) 6 (11.1%) 5 (9.3%)
April 2013 n (%) 34 (63.0%) 8 (14.8%) 42 (77.8%) 6 (11.1%) 2 (3.7%) 1 (1.9%) 9 (16.7%) 3 (5.6%)
Australian and New Zealand Journal of Public Health © 2014 The Authors. ANZJPH © 2014 Public Health Association of Australia
July 2013 n (%) 40 (74.1%) 7 (13.0%) 47 (87.0%) 2 (3.7%) 1 (1.9%) 2 (3.7%) 5 (9.3%) 2 (3.7%)
Total n (%) 108 (66.7%) 24 (14.8%) 132 (81.5%) 10 (6.2%) 5 (3.1%) 5 (3.1%) 20 (12.4%) 10 (6.2%)
293
