Health Promotion International Advance Access first published online on August 10, 2007
This version published online on August 17, 2007
Health Promotion International, doi:10.1093/heapro/dam021
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Article |
Dietary, physical activity and sedentary behaviour among Australian secondary students in 2005
1Centre for Behavioural Research in Cancer, The Cancer Council Victoria, 1, Rothdowne Street, Carlton, Vic. 3053, Australia 2The Cancer Council South Australia, 202, Greenhill Road, Eastwood, SA 5063, Australia
* Corresponding author. E-mail: maree.scully{at}cancervic.org.au
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SUMMARY |
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 TOP SUMMARY INTRODUCTIONMETHODSRESULTSDISCUSSIONREFERENCES |
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The aim of this study was to provide a current assessment of Australian secondary students' self-reported dietary, physical activity and sedentary behaviour. This study also examined the relationship between television viewing and students' dietary behaviour. Data are from a cross-sectional survey of 18 486 secondary students in 2005 from all Australian states except Western Australia. Participants reported their usual daily consumption (number of serves) of vegetables and fruit; their weekly consumption of unhealthy/non-core foods including fast food meals, snack foods and high-energy drinks; their engagement in moderate-vigorous physical activity over the previous week; and hours spent using electronic media for entertainment and doing homework on school days. The study found that 20% of students were meeting the daily requirement of four serves of vegetables, whereas 39% were eating the recommended three daily serves of fruit. Consumption of unhealthy/non-core foods was high, with 46% of students having fast food meals at least twice a week, 51% eating snack foods four or more times per week and 44% having high-energy drinks four or more times per week. Fourteen per cent of students engaged in recommended levels of physical activity and 29% engaged in recommended levels of sedentary behaviour. Age and gender differences occurred for most measures, and there were some socio-economic status differences. Heavier television use was associated with lower consumption of fruit and higher consumption of unhealthy/non-core foods. On the basis of the results of this study, it appears that a significant proportion of Australian secondary students fall short of current, national dietary and physical activity recommendations for teenagers. Continual monitoring of these behaviours is essential to help inform research and policy and identify where future efforts should be directed.
Key words: diet; physical activity; sedentary behaviour; adolescents
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INTRODUCTION |
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TOPSUMMARYINTRODUCTIONMETHODSRESULTSDISCUSSIONREFERENCES |
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The prevalence of overweight and obesity among Australian children has doubled since 1985, with one in five now classified as overweight or obese (Booth et al., 2003
). Overweight children are at increased risk of becoming overweight adults (Whitaker et al., 1997) and experiencing chronic diseases such as Type 2 diabetes, heart disease, stroke and some cancers (World Health Organization, 2003). Two important factors associated with childhood obesity are high-energy diets and low levels of physical activity (Deckelbaum and Williams, 2001).
The Australian Guide to Healthy Eating (AGHE), released in 1998, recommends children aged 12–18 years old eat a minimum four serves of vegetables and three serves of fruit per day. These foods provide an important low-fat/high-fibre contribution to the diet. ‘Extra’ foods such as sweet and savoury snacks, soft drink, hamburgers and pies are not recommended for regular consumption. These unhealthy/non-core foods are generally high in salt, sugar and/or fat and should only be eaten sometimes or in small amounts (Children's Health Development Foundation and Deakin University, 1998).
In 2004, new physical activity guidelines were released advocating teenagers do at least 60 min of moderate- to vigorous-intensity physical activity every day and spend no more than 2 h/day using electronic media for entertainment (Department of Health and Ageing, 2004). Students are also expected to engage in ‘educational’ sedentary behaviour in the form of homework. Australian state education department guidelines are generally consistent with the principle that students complete about 10 min of homework a day for each grade they progress in school, to a maximum of 2 h/day in Year 12 (Queensland Department of Education and the Arts, 2004). Similar dietary, physical activity and sedentary behaviour recommendations are in place in other countries (e.g. American Academy of Pediatrics, 2001; UK Department of Health, 2004; US Department of Health and Human Services, and US Department of Agriculture, 2005).
There is a lack of recent Australian data on teenagers' dietary behaviour and physical activity levels. The last national nutrition survey was conducted in 1995, with some dietary habits information available from the 2004–2005 National Health Survey (McLennan and Podger, 1999; Australian Bureau of Statistics, 2006a). Aspects of physical activity behaviour among 15–24-year olds were assessed in the 1995 National Health Survey (Australian Bureau of Statistics, 1997); and more recently, the 2006 Survey of Children's Participation in Cultural and Leisure Activities provided data on 5–14-year-old children's participation in organized sport and selected sedentary behaviours (Australian Bureau of Statistics, 2006b). However, in each of these surveys, data for all persons aged under 15 (and for some persons aged 15–17) were obtained by parent proxy reports rather than self-reports. Furthermore, these surveys provide insufficient information to assess the extent to which teenagers are meeting the physical activity recommendations.
The aim of this study was to provide a current assessment of Australian secondary students' self-reported dietary, physical activity and sedentary behaviour. In addition, in light of studies finding heavier television use to be associated with high intake of snack foods and soft drinks and low intake of fruit and vegetables (Coon and Tucker, 2002), this study also aimed to examine the relationship between television viewing and students' dietary behaviour.
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METHODS |
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TOPSUMMARYINTRODUCTIONMETHODSRESULTSDISCUSSIONREFERENCES |
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Design and sample
Data were obtained from students participating in the 2005 Australian Secondary Students Alcohol and Drug Survey. Students from Western Australia did not participate in this arm of the study.
A stratified two-stage sample design was used to obtain a random sample of students enrolled in the three main education sectors throughout each State and Territory (i.e. government, Catholic, and independent). First, schools were randomly selected from each sector with likelihood proportional to school size. The distribution of schools in the three education sectors in each State and Territory was reflected in the sample. Two samples of schools were drawn to reflect the distinction between junior secondary (Years 7–10) and senior secondary (Years 11 and 12) campuses. Schools with fewer than 100 students enrolled were not included in the study.
At the second stage, 20 students (and six replacements) were randomly selected from each of the four year levels surveyed for the junior secondary schools, whereas 40 students (and six replacements) were sampled from each of Years 11 and 12. A total of 18 561 students aged between 12 and 17 years were surveyed (valid data, N = 18 486).
Questionnaire
The self-completion questionnaire assessed age, gender, residential postcode, smoking and use of alcohol, and illicit and prescription drugs. Supplementary questions assessed dietary, physical activity and sedentary behaviour.
Short dietary questions adapted from the 1995 National Nutrition Survey were used to measure students' usual vegetable and fruit intake. These questions have shown reasonable validity when compared to 24-hour recall of vegetable and fruit intake for adults (Rutishauser et al., 2001); their validity has not been assessed among adolescents. Students were asked how many serves of vegetables and fruit they usually eat each day. A serve of vegetables was defined as half cup cooked vegetables or one cup of salad vegetables and a serve of fruit was defined as one medium piece or two small pieces of fruit or one cup of diced pieces of fruit. Responses ranged from ‘one serve or less’ to ‘six serves or more’, with students also given the option ‘I do not eat vegetables/fruit’. Vegetable consumption was dichotomized into four or more daily serves (recommended minimum level) or not, and fruit consumption was dichotomized into three or more daily serves (recommended minimum level) or not.
Consumption of unhealthy/non-core foods was assessed by asking students how many times in the previous week they had: (i) eaten a fast food meal like McDonalds, Hungry Jacks, pizzas, fish and chips, hamburgers, meat pies, pasties, etc.; (ii) eaten a snack like a chocolate bar, a piece of cake, a packet of chips/twisties/corn chips, icecream, three to four sweet biscuits and; (iii) drank a can of soft drink (like coke, Pepsi, lemonade, Fanta), an energy drink (like Redbull, V, Wild), fruit juice or had at least two glasses of cordial in a row (not including diet or low-joule drinks). For all except one state, responses ranged from ‘once’ to ‘seven or more times’, with students also given a final option of ‘none’. In the other state, responses ranged from ‘none’ to ‘five or more times’. Fast food meal consumption was categorized as: (0) once or less; (1) twice or more; consumption of snack foods and high-energy drinks was categorized as: (0) three or less times; (1) four or more times.
To assess physical activity, students were asked: ‘How many days in the past week have you done any vigorous or moderate physical activity for a total of at least one hour (This could be made up of different activities during the day such as cycling or walking to and from school, playing sport at lunchtime or after school, doing an exercise class, doing housework, etc.)’. This question was adapted from Prochaska et al. (2001) 60 min moderate to vigorous physical activity screening measure, which has been found to provide a reliable and valid estimate of adolescents' physical activity behaviour. Responses ranged from ‘1 day’ to ‘7 days’, with students also given the option ‘No days in the last week’. Physical activity responses were dichotomized into 7 days (recommended minimum level) or not.
To assess sedentary behaviour, students were asked: ‘On an average school day, about how many hours a day do you do the following when you are not at school: (i) homework; (ii) watching TV/videos and; (iii) using Internet/playing computer games (not including computer use for homework)?’ Responses ranged from ‘none’ to ‘five or more hours’. As secondary students are generally expected to do more than 1 h of homework each day, responses were categorized as: (0) 
1 h; (1) 
2 h. The questions on television and computer use were assessed both individually and combined, and were dichotomized into 2 h (recommended maximum level) or not. Questions assessing sedentary behaviour and consumption of unhealthy/non-core foods have not been validated.
Socio-economic status (SES) was determined according to the urban index of relative disadvantage ranking as described by the Australian Bureau of Statistics (2001), based on student's home postcode. Using the national quartile values, students were categorized into low (most disadvantaged), lower-middle, upper-middle and high (least disadvantaged)-SES groups.
Procedure
Approval to conduct the study was obtained from all appropriate ethics committees and education departments as well as school principals. If a school refused then they were replaced by the school located nearest to them within the same education sector, selected (and kept in reserve) at the same time as the main sample. Following an established protocol, members of the research team administered the anonymous pencil-and-paper questionnaire to groups of up to 20 students on the school premises under exam conditions. If a student from the sample list was not present, a student from the equivalent year level on the replacement list was surveyed. Students from different year levels were surveyed together.
Data analyses
To ensure that disproportionate sampling did not bias the prevalence estimates, data were weighted by age, gender, educational sector and state to the population of students enrolled in each education sector within each state (Australian Bureau of Statistics, 2006c).
Data were analysed using STATA. Descriptive statistics were used to characterize the sample. Age was categorized into three groups (12–13, 14–15 and 16–17 years). Logistic regression analyses examined the association between gender, age and SES on dietary, physical activity and sedentary behaviour levels. The clustering of students within each school was adjusted for and robust standard errors calculated.
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RESULTS |
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TOPSUMMARYINTRODUCTIONMETHODSRESULTSDISCUSSIONREFERENCES |
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A total of 528 secondary schools (including replacement schools) were approached and 322 (61%) agreed to participate in the study. Data from 18 486 secondary students aged between 12 and 17 years were analysed. Of these, 540 students were excluded from analyses exploring SES differences due to missing postcode information (n = 189) or no index value being available for their postcode (n = 351). A summary of the demographic profile of the sample is shown in Table 1.
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Usual daily consumption of vegetables and fruit
As presented in Table 2, 20% of students met the recommended daily requirement of four or more serves of vegetables. Males were more likely than females to consume at least four serves, however, there was no significant age difference.
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Thirty-nine per cent of students reported eating the recommended three or more daily serves of fruit. Females were more likely than males to achieve this. The proportion of students consuming the recommended amount of fruit decreased with age.
When combined, only 13% of students usually consumed four or more serves of vegetables and three or more serves of fruit a day. Younger students were most likely to report meeting both dietary recommendations.
Weekly consumption of unhealthy/non-core foods
As shown in Table 2, 46% of students reported eating fast food meals at least twice in the previous week. Males were more likely than females and older students more likely than 12–13-year olds to consume fast food meals at this frequency.
Fifty-one per cent of students reported consuming snack foods four or more times in the previous week, with older students more likely to eat this amount. Around 44% reported consuming high-energy drinks at least four times in the previous week. Older students were more likely than younger students and males more likely than females to consume this amount of high-energy drinks.
Across all three unhealthy/non-core food items, consumption was highest among 16–17-year-old males.
Weekly engagement in physical activity
As Table 3 indicates, only 14% of students reported engaging in at least 60 min of moderate-vigorous activity each day in the previous week, with this proportion lowest among 16–17-year-old females (7%). Males were more likely than females and younger students more likely than 16–17-year olds to meet the physical activity recommendation.
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Engagement in sedentary behaviour
Students aged 16–17 years were more likely to spend at least 2 h doing homework on an average school day compared to younger students, as were females compared to males. This gender difference appeared to be more pronounced among older students.
Sixty-five per cent of students reported watching television for no more than 2 h on an average school day, and 75% reported spending no more than 2 h/school day using the Internet or playing computer games. However, when combined, only 29% of students reported spending no more than 2 h using electronic media for entertainment on an average school day. Females were more likely than males to be meeting the sedentary behaviour guideline. A higher proportion of 12–13-year-old males used electronic media at recommended levels compared to older male students (
2 = 19.40, df = 2, p < 0.001). Among female students, 14–15-year olds were least likely to be spending no more than 2 h/school day in front of a television and/or computer (2 = 38.02, df = 2, p < 0.001).
Socio-economic differences in dietary, physical activity and sedentary behaviour
Table 4 summarizes the socio-economic distribution of students' diet and activity behaviour. Students in the low-SES group were most likely to report eating fast food meals at least twice in the previous week. Low-SES students were also more likely than the high-SES group to consume high-energy drinks four or more times a week (2 = 14.66, df = 1, p < 0.001). SES was unrelated to the consumption of recommended quantities of vegetables and fruit, and eating snack foods four or more times a week.
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The proportion of students engaging in recommended physical activity levels was unrelated to SES. Upper middle (
2 = 7.99, df = 1, p = 0.005) and high-SES students (2 = 35.35, df = 1, p < 0.001) were more likely than the low-SES group to watch 2 h of television on an average school day. Compared to low-SES students, upper middle (2 = 8.33, df = 1, p = 0.004) and high-SES students (2 = 11.75, df = 1, p < 0.001) were also more likely to spend 2 h/school day in front of the computer. However, the proportion of students meeting the sedentary behaviour guideline did not differ significantly according to SES.
Relationship between dietary behaviour and television viewing
Table 5 shows the relationship between students' dietary behaviour and their television use on school days. After controlling for SES, physical activity and other demographic variables, students who watched at least 3 h of television on an average school day were more likely to report consuming fast food meals at least twice in the previous week, and snack foods and high-energy drinks at least four times in the previous week when compared with students who watched 2 h of television per school day.
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Students who spent at least 3 h/school day watching television were less likely to meet the daily requirement of three serves of fruit. However, eating the recommended daily serves of vegetables was unrelated to television use.
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DISCUSSION |
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TOPSUMMARYINTRODUCTIONMETHODSRESULTSDISCUSSIONREFERENCES |
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These study results suggest that a significant proportion of Australian secondary students fall short of current, national dietary and physical activity recommendations. Specifically, only one in five students were found to be consuming an adequate amount of vegetables, while <40% usually ate the daily recommended serves of fruit. Furthermore, only 14% of students participated in sufficient levels of physical activity and 29% met the sedentary behaviour guideline. Given the importance of good nutrition and physical activity for normal development and reducing chronic disease risk in later life, these results are of concern.
The overall low levels of adequate vegetable and fruit consumption in our sample reflect findings from the 2004–2005 National Health Survey where <30% of 12–14-year olds usually ate four or more daily serves of vegetables or three or more daily serves of fruit (Australian Bureau of Statistics, 2006a). Our results are also consistent with international surveys that show many adolescents do not consume appropriate quantities of vegetables and fruit (e.g. Vereecken et al., 2005; Eaton et al., 2006). It is important to note, however, that although the AGHE recommendations for vegetables includes legumes, and for fruit includes fruit juice, students in our study were not instructed to include these foods when reporting their usual consumption. Consequently, it is possible that our results may underestimate the proportion eating recommended quantities of vegetables and fruit. However, as 24-h dietary recall data from the 1995 National Nutrition Survey suggests that most children aged 10–15 years do not consume legumes (Cook et al., 2001), it is likely that any misclassification of students in regards to vegetable consumption is minimal. In addition, as fruit juices are of lower nutritional value than fresh fruit, by not including it in our assessment of fruit consumption, we can be confident that our estimate is not inflated by students who have a high fruit juice intake yet eat low amounts of fresh fruit.
The results suggest that vegetable and fruit consumption differs according to gender, with males more likely to consume the recommended quantity of vegetables and females more likely to eat an adequate amount of fruit. Most studies exploring gender differences in dietary behaviour among children and adolescents have either observed no disparities or found that females tend to have a higher or more frequent intake of fruit and/or vegetables than males (Rasmussen et al., 2006). It should be noted, however, that the magnitude of our gender effects were small relative to the low level of achievement of the dietary recommendations across the sample overall. Fruit consumption was found to decline with age, while the inverse pattern was observed for unhealthy/non-core food consumption. This apparent shift in dietary habits as students' progress through secondary school may highlight adolescents' capacity to exert greater control over their food choices as they get older and spend more time in social environments. In addition, the greater consumption of fast food and high-energy drinks among 16–17-year-old males may be due to this group having higher energy needs.
The proportion of students achieving recommended physical activity levels was very low in our sample (14%), with international physical activity prevalence rates typically higher. For example, in the Health Survey for England 2002, age- and gender-specific estimates of the proportion of adolescents participating in at least 60 min of physical activity on all 7 days preceding the survey ranged from 44 to 71% (UK Department of Health, 2004). Figures from the 2005 Youth Risk Behaviour Survey conducted in the USA were more moderate, with 36% of students physically active for at least 60 min on 5 days in the previous week (Eaton et al., 2006). Comparing prevalence rates across studies is problematic, however, due to the use of different measures and scoring protocols (Sarkin et al., 2000).
Our finding that females participate in less physical activity than males, and that physical activity declines with age, in particular among female adolescents, is consistent with previous studies conducted in Australia (Trost, 2005) and other westernized countries (Biddle et al., 2004). Reviews of research into adolescent physical activity indicate that this behaviour is complex and determined by multiple factors, including personal, social and physical environment influences (Sallis et al., 2000; Rees et al., 2006). For example, time constraints due to homework and jobs and social factors including peer pressure and teasing/bullying have been identified by teenagers as major barriers to physical activity (O'Dea, 2003). The greater demand that homework can place on senior students' time was reflected in our results. Further studies into why adolescents may or may not be engaging in recommended levels of moderate-vigorous activity are needed to help develop effective strategies that facilitate greater participation in physical activities, particularly among female adolescents.
Compared to the national recommendations that teenagers spend no more than 2 h/day using electronic media for entertainment, our results indicate over one-third of students exceed this based solely on their television viewing, whereas one in four exceed this due to their computer usage. While no information on students' sedentary behaviour on weekends was collected, prior research suggests that, on average, adolescents spend more hours per day watching television on weekends compared to weekdays (Gracey et al., 1996). Thus, it is probable that a higher proportion of students would be exceeding the sedentary behaviour guideline on weekends. Although the relationship between television viewing and body fatness among youth has been found to be statistically small (Marshall et al., 2004), being physically active is important for a range of health benefits. Thus, encouraging teenagers to spend their leisure time in more active pursuits is likely to be a positive health promotion step.
For this study, an area-based measure of SES was used to test for socio-economic differences in students' diet and activity behaviour. Although a weakness of using an area-based measure is the potential to misclassify students, the SEIFA index is generally well accepted. Students in the low-SES group were more likely to consume fast food and high-energy drinks, as well as spend time watching television and using the computer. SES differences in fast food consumption may relate to socio-economically disadvantaged groups being exposed to poorer food environments, with some studies finding a higher density of fast food outlets in more deprived areas (Reidpath et al., 2002; Block et al., 2004; Cummins et al., 2005). Strategies aimed at creating supportive environments for healthy eating in disadvantaged areas may help reduce social inequalities in teenagers' frequency of eating fast food meals.
No association between SES and students' participation in recommended activity levels was observed in our study. Although there is considerable evidence to suggest a socio-economic gradient on the prevalence of physical activity in adult populations (International Agency for Research on Cancer, 2002), mixed results have emerged for adolescents. Sallis et al.'s (2000) review found that SES was unrelated to youth physical activity. However, some more recent studies of adolescents have observed that low SES is associated with less physical activity (e.g. Lee and Cubbin, 2002; Inchley et al., 2005). Consistent evidence of such a link is needed before resources are directed towards addressing possible SES inequalities.
As found in previous studies (e.g. Coon and Tucker, 2002; Salmon et al., 2006), our results suggest a relationship between adolescents' television viewing and their dietary intake. Specifically, heavier television use was associated with lower fruit consumption and higher consumption of snacks, fast food meals and high-energy drinks. Content analyses indicate that Australian commercial networks broadcast an average of five food advertisements per hour in television, with most (81%) for unhealthy/non-core foods (Chapman et al., 2006). Consequently, it is possible that exposure to non-nutritious food advertisements may promote their consumption. However, other factors such as increased snacking while watching television and the effect of parental media habits on family food choices are also likely to explain, at least in part, the relationship between television use and adolescent dietary behaviour (Coon and Tucker, 2002; Hastings et al., 2003).
Some study limitations should be noted. Owing to the questions being added to an ongoing study of substance use among adolescents, limited space was available. Consequently, simple measures of dietary, physical activity and sedentary behaviour were used. Also, as one Australian state did not ask these questions, we do not have a complete national picture of adolescents' nutrition or physical activity. However, strengths of our study include the large sample size and non-reliance on parent proxy reports. Furthermore, to our knowledge, this is the first national survey to assess teenagers' compliance with the new physical activity recommendations.
The behaviours reported in this paper are significant public health issues. If we are to curb the morbidity and mortality associated with overweight and obesity in our community, there needs to be an increase in the proportion of young people who are eating a healthy diet and participating in adequate levels of physical activity. The Australian Government's commitment to a national children's survey in 2007 to assess nutrition, activity and weight status in this population group is an important step in this process. However, continual monitoring is essential to help inform research and policy initiatives and identify where future efforts should be directed in this vital area.
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ACKNOWLEDGEMENTS |
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This survey was a collaboration between the Cancer Councils in South Australia, Victoria, Tasmania and Queensland, and the Health Departments in each state and territory of Australia. These organizations conducted and funded the collection of data in their own state jurisdiction. The Australian Government Department of Health and Ageing also contributed to the funding of this study. Claire Davey, Centre for Behavioural Research in Cancer, The Cancer Council Victoria, co-ordinated the survey at the national level. Edith Szabo contributed to data analysis. We would like to thank the school principals, teachers and students who participated in this study.
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FOOTNOTES |
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The previously published version of this paper contained an error in the title. The manuscript number should not have been included. This has now been amended.
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