Healthy Eating and Physical Activity Environmental and Policy Assessment – Measurement Issues and Implications

Current research has suggested that supportive healthy eating and physical activity (HEPA) policy and practice environments play a significant role in shaping the physical activity levels and eating habits of youth. Subsequently, a wide array of audit tools assessing policy and practice environment characteristics across settings that care for youth were developed. However, the extent that available audit tools accurately reflect the policy environment characteristics of the settings that care for the youth population remains unknown. Therefore, this dissertation encompasses four studies. The purpose of the first study was to examine the measurement properties of audit tools currently in use for assessing policy environment characteristics across a variety of settings that care for youth. Fifty-three individual tools that met the inclusion criteria were identified. Reliability and validity data were available for only 11 tools. Reliability coefficients (median) for individual items across tools were 0.62 (kappa), 0.88 (ICC), 74.0% (percent agreement), 0.62 (Pearson correlation) and 0.73 (Cronbach’s α). Validity coefficients (median) for individual items across tools were 0.35 (kappa), 0.98 (ICC), 0.22 (r) and 74.7% (percent agreement). The purpose of the second study was to determine the feasibility of training afterschool program (ASP) leaders to use the Healthy Afterschool Program Index - Physical Activity (HAPI-PA) and the Healthy Afterschool Program Index – Nutrition (HAPI-N) scales] accurately. Forty-four program leaders across South Carolina were recruited. Program leaders were randomized to either in-person or distance training group. Ninety percent of the items in the in-person group and 73% of the items in the distance group had a kappa ≥ 0.70 for the HAPI-PA scale. In comparison, 83% of the HAPI-N scale items in the in-person group and 67% of the items in the distance group had a kappa ≥ 0.70. Equivalency between the two training methods was established for 5 of the 11 items in the HAPI-PA scale and 3 of the 12 items in the HAPI-N scale. The purpose of the third study was to evaluate the responsiveness of the HAPI-PA and HAPI-N scales to policy and practice environment characteristics change. Twenty afterschool programs across South Carolina serving over 1700 children (5-12 years old) participated Baseline data were collected during spring 2013 and post-1 year follow-up data during spring 2014. The HAPI-PA and HAPI-N scales median and interquartile range (IQR) score improved from a baseline score of 9.5 (±5.8) to 13.5 (±2.0) for HAPI-PA and a score 6.5 (±6.5) to 21.0 (±4.0) for HAPI-N after year 1 in the intervention group. For the intervention group the HAPI-PA and HAPI-N scales effect sizes were 0.70 and 2.23, standardized response median were 0.94 and 1.45 and responsiveness index were 1.07 and 2.5, respectively. In comparison, the HAPA-PA and HAPI-N scores showed non- significant changes between baseline and year 1 follow up in the control group in both the median and IQR and using the effect size indices. The purpose of the fourth study was to examine the influence of both the physical and policy and practice environment characteristics of ASP’s settings on the HEPA behaviors of youth. A total of 1,302 children attending 20 ASPs across South Carolina wore accelerometers (ActiGraph GT3X+) for up to 4 non-consecutive days. Policy-level characteristics were evaluated using the HAPI-PA scale. Physical activity space was measured using a measuring wheel (indoor, ft2) and GIS (outdoor, acres). The structure (free-play or organized) of activity opportunities was evaluated via direct observation. For every 5000ft2 of utilized indoor activity space an additional 2.4 and 3.3 minutes/day of sedentary behavior was observed among boys and girls, respectively. A higher ratio of free-play to organized play was associated with higher indoor sedentary behavior among boys and girls (3.9 minutes/day and 10.0 minutes/day, respectively). For every one acre of outdoor activity space used, an additional 2.7 minutes/day of MVPA was observed for boys. A higher free-play to organized play ratio was associated with higher outdoor MVPA for boys and girls (4.4 and 3.4 minutes/day increase, respectively). Policy characteristics were unrelated to MVPA levels and time spent sedentary. In summer, this dissertation found that audit tools are widely used to quantify the impact of supportive HEPA policy and practice environmental characteristics across settings that care for youth, however, little effort is taken to evaluate the measurement properties of such tools. This wok showed that ASP’s site leaders are able to provide accurate information regarding their program HEPA policy and practice environment using a newly developed audit tool (i.e., the HAAND). Furthermore, the HANND instrument appears to be capable of detecting changes in the ASP’s HEPA environment. More effort should be directed towards providing ASP’s with strategies to meet current HEPA policy and practice recommendation

Health literacy research in the Eastern Mediterranean Region: an integrative review

© 2019, Swiss School of Public Health (SSPH+). Objectives: This integrative review examines health literacy research in the Eastern Mediterranean Region (EMR) and describes: (1) assessments and screening tools used to measure levels of health literacy, and (2) the focus, methods, and findings of health literacy research in the region. Methods: A total of 246 records were identified through a systematic search of online databases from 1950 to 2017, to include: ProQuest Middle East and Africa, MEDLINE, PubMed, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Academic OneFile, Web of Science, Scopus, and Google Scholar. The final sample included 49 full-text articles. Results: This research described 7 studies which used existing or new health literacy measures. Levels of health literacy in the EMR were similar to those for Europe and the United States. Low health literacy in EMR countries was more prevalent among females than males. The relationships between health literacy and knowledge, behavior and health outcomes varied across countries. Conclusions: To our knowledge, this study is the first in the EMR. Appropriately designed studies should better define health literacy needs due to variations in socioeconomic status within subregions. Future health literacy measures must consider stronger psychometric properties to guide development and validation

The Healthy Afterschool Activity and Nutrition Documentation Instrument

Policies call on afterschool programs to improve the physical activity and nutrition habits of youth attending. No tool exists to assess the extent to which the afterschool program environment meets physical activity and nutrition policies

Physical activity and healthy eating environmental audit tools in youth care settings: A systematic review

There is a growing interest in evaluating the physical activity (PA) and healthy eating (HE) policy and practice environment characteristics in settings frequented by youth (≤18 years)

Impact of community-based participatory initiative on children\u27s pedometer-determined physical activity

Abstract of poster that presented at 2013 AAHPERD National Convention & Exposition, Charlotte, NC , 23-27 April 2013

Results from the United Arab Emirates 2022 report card on physical activity for children and adolescents

Objective: The United Arab Emirates (UAE) 2022 Report Card provides a systematic evaluation of the physical activity (PA) levels of children and adolescents in the UAE. Methods: The 2022 Report Card utilized data from 2017 to 2021 to inform 10 core PA indicators that were common to the Global Matrix 4.0. Results: One in five (19%) UAE school children achieved the recommended amount of moderate-to-vigorous PA (i.e. ≥60 min/d; Total Physical Activity Grade F). Less than 1% of school children used active transport to and from school (Active Transportation Grade F). One in four (26%) secondary school children achieved the recreational screen time recommendations (i.e. ≤2 h/d; Sedentary Behaviours Grade D-). A quarter of adults reported achieving the recommended PA level (i.e. ≥150 min of moderate-intensity PA per week, or equivalent) (Family and Peers Grade D-). All school children are taught physical education (PE) by a specialist with at least a bachelor\u27s degree in PE; however, the duration of weekly PE classes varied between schools (School Grade A-). The UAE Government has invested significant funds and resources into developing and implementing strategies and facilities that will increase PA across the entire population (Government Grade B+). Organised Sport and Physical Activity, Active Play, Physical Fitness, and Community and Environment indicators were graded ‘Incomplete’ (INC) due to a lack of available data. Conclusions: Overall, PA levels remain low and sedentary behaviours remain high amongst UAE children and adolescents. The UAE Government has sustained investment in further developing PA opportunities for all children and adults which should translate to increased PA and health improvements at a population level

Association of environment and policy characteristics on children's moderate-to-vigorous physical activity and time spent sedentary in afterschool programs

Afterschool programs (ASPs) are an important setting in which to promote children’s physical activity. This study examines the association of environmental and policy characteristics on the moderate-to-vigorous physical activity (MVPA) and sedentary behavior of children attending ASPs

Accelerometer measured physical activity patterns of children during segmented school day in Abu Dhabi

Background: The overwhelming majority of United Arab Emirates (UAE) school-aged children do not meet the 60 min per day recommendation of moderate-to-vigorous physical activity (MVPA). Understanding the different school day segments contribution to children reaching this goal is a crucial step toward developing successful strategies to promote school day MVPA levels. This study aimed to objectively measure children’s’ physical activity levels and to examine the difference in physical activity levels between high active and low active children during the school day in Abu Dhabi. Methods: A total of 133 school children (56% boys; mean age 10.5 years; grades 4–7) from two elementary schools in Abu Dhabi wore accelerometers (ActiGraph GT9X Link) for up to 5 non-consecutive days during spring 2019. Children’s’ MVPA was estimated during the following school segments: class time, lunch, recess, physical education (PE), and whole school day. Children were stratified as “high active” meeting the ≥30 min/day MVPA school time guideline or “low active” accumulating \u3c 30 min/day MVPA. Results: On average children accumulated 21.8 ± 22.6 min/day of MVPA on PE days and 22.4 ± 15.9 min/day of MVPA on non-PE days. Only 19% of children met the 30 min or more of school day MVPA recommendation, with higher proportion of boys (27%) meeting such recommendation compared to girls (8%). High active boys, spent the highest percent of time in MVPA during PE (28%), followed closely by lunch (27%). In compression, high active girls spent the highest percent of time in MVPA during lunch (14.2%) followed by recess (9.1%). High active children accumulated 15.06 more minutes of MVPA during PE (p \u3c 0.001), 2 more minutes during recess (p \u3c 0.001), 3 more minutes of MVPA during lunch (p \u3c 0.001) and 5 more minutes of MVPA during class time (p \u3c 0.001). Conclusion: The overwhelming majority of school children did not meet the recommended 30 min /day MVPA during school time. Girls substantially accumulated less MVPA and more sedentary minutes across all segments during the school days compared to boys. Further research is needed to investigate school day segments contribution to children MVPA in the UAE

Usefulness of serum bilirubin and cardiorespiratory fitness as predictors of mortality in men

Elevated serum bilirubin has been suggested to reduce the risk of mortality. Cardiorespiratory fitness (CRF) has also been reported to have inverse association with all-cause and cardiovascular disease (CVD) mortality. The association between serum bilirubin, all-cause and CVD mortality and the effect of CRF on the observed association was investigated. A total of 1279 men, ages 30-82 years old, who underwent baseline medical examinations during 1974 to 1997 at the Cooper Clinic in Dallas, Texas. During an average of 17 years follow-up, 698 men died, with 253 deaths due to CVD (36%). Men in the highest bilirubin quartiles had significantly lower risk of all-cause mortality compared to men in the lowest quartiles (p for trend=0.0043), after adjusting for age and examination year. This inverse association remained significant after further adjustment for known confounders (p for trend=0.0018). Additional adjustment for treadmill time attenuated the association (p trend=0.0090). Similar patterns of association were observed between serum bilirubin quartiles and CVD mortality. CRF was inversely associated with all-cause mortality (p for trend < .0001) after adjusting for age and examination year. This inverse association also was observed after further adjusting for known confounders (p for trend=0.0004). After additional adjustment for serum bilirubin, the association between the CRF and all-cause mortality remained significant (p for trend = 0.0012). All-cause mortality and CVD mortality were significantly lower among men in the moderate to high fit quartiles in both the low and high bilirubin groups. In Conclusion both serum bilirubin level and CRF level were strongly and independently associated with all-cause and CVD mortality

Competency-based professional development training impact on physical activity promotion

Abstract of poster that presented at 2013 AAHPERD National Convention & Exposition, Charlotte, NC , 23-27 April 2013