A systematic review of interventions for promoting active transportation to school

<p>Abstract</p> <p>Background</p> <p>Active transportation to school is an important contributor to the total physical activity of children and adolescents. However, active school travel has declined over time, and interventions are needed to reverse this trend. The purpose of this paper is to review intervention studies related to active school transportation to guide future intervention research.</p> <p>Methods</p> <p>A systematic review was conducted to identify intervention studies of active transportation to school published in the scientific literature through January 2010. Five electronic databases and a manual search were conducted. Detailed information was extracted, including a quantitative assessment comparing the effect sizes, and a qualitative assessment using an established evaluation tool.</p> <p>Results</p> <p>We identified 14 interventions that focused on active transportation to school. These interventions mainly focused on primary school children in the United States, Australia, and the United Kingdom. Almost all the interventions used quasi-experimental designs (10/14), and most of the interventions reported a small effect size on active transportation (6/14).</p> <p>Conclusion</p> <p>More research with higher quality study designs and measures should be conducted to further evaluate interventions and to determine the most successful strategies for increasing active transportation to school.</p

Contributions of Early Care and Education Programs to Diet Quality in Children Aged 3 to 4 Years in Central North Carolina

BACKGROUND: Parents and early care and education (ECE) are the key influencers of young children\u27s diets, but there is limited information about how each contribute to children\u27s overall diet quality. OBJECTIVE: This study aimed to determine what proportion of children\u27s dietary intake occurs within the ECE setting and whether diet quality is higher at ECE centers and, consequently, on weekdays than weekends. DESIGN: This cross-sectional analysis of a larger cluster randomized controlled trial used multiple 24-hour dietary intakes measured through a combination of the Dietary Observation in Child Care protocol and parent-reported food diaries. PARTICIPANTS/SETTING: Participants (N=840) included children aged 3 to 4 years enrolled in ECE centers in central North Carolina for whom 24-hour dietary intake was captured via observation of meals and snacks consumed at ECE and parent-report of all remaining meals and snacks. Data were collected from 2015 to 2016. MAIN OUTCOME MEASURES: Diet quality at ECE and elsewhere was evaluated using the Healthy Eating Index 2015. STATISTICAL ANALYSES PERFORMED: Mixed-effects models were used to determine differences in mean Healthy Eating Index 2015 component and total scores. Models were adjusted for children\u27s age and sex and accounted for clustering within ECE centers and families. RESULTS: Children consumed approximately 40% of daily energy, nutrients, and food groups at ECE centers. The mean total Healthy Eating Index 2015 score was higher for foods and beverages consumed at ECE centers (58.3±0.6) than elsewhere (52.5±0.6) (P \u3c 0.0001). The mean total Healthy Eating Index 2015 score was also higher on weekdays (58.5±0.5) than on weekends (51.3±0.5) (P \u3c 0.0001). CONCLUSIONS: Children consume a majority of dietary intake away from ECE centers. Overall, diet quality is low, but the quality of foods consumed by children at ECE centers is higher than that consumed elsewhere. ECE centers remain an important source of nutrition and further investigation is warranted to identify ways to support both ECE centers and families to provide healthier eating environments

Expert and Stakeholder Consensus on Priorities for Obesity Prevention Research in Early Care and Education Settings

Early childhood is a formative period for many weight-related behaviors (diet and activity), but little obesity prevention research targeting this age group has been conducted. Early care and education settings are a useful avenue for interventions targeting young children, but the limited research provides insufficient evidence upon which to base policy decisions, practice guidelines, or mobilized efforts to improve healthy eating and physical activity, and ultimately healthy weight development in these settings

A cross-sectional study of demographic, environmental and parental barriers to active school travel among children in the United States

[Background] Promoting daily routine physical activities, such as active travel to school, may have important health implications. Practitioners and policy makers must understand the variety of factors that influence whether or not a child uses active school travel. Several reviews have identified both inhibitors and promoters of active school travel, but few studies have combined these putative characteristics in one analysis. The purpose of this study is to examine associations between elementary school children’s active school travel and variables hypothesized as correlates (demographics, physical environment, perceived barriers and norms). [Methods] The current project uses the dataset from the National Evaluation of Walk to School (WTS) Project, which includes data from 4th and 5th grade children and their parents from 18 schools across the US. Measures included monthly child report of mode of school travel during the previous week (n = 10,809) and perceived barriers and social norms around active school travel by parents (n = 1,007) and children (n = 1,219). Generalized linear mixed models (GLMM) with log-link functions were used to assess bivariate and multivariate associations between hypothesized correlates and frequency of active school travel, assuming random school effect and controlling for the distance to school. [Results] The final model showed that the most relevant significant predictors of active school travel were parent’s perceived barriers, specifically child resistance (Estimate = −0.438, p < 0.0001) and safety and weather (Estimate = −0.0245, p < 0.001), as well as the school’s percentage of Hispanic students (Estimate = 0.0059, p < 0.001), after adjusting for distance and including time within school cluster as a random effect. [Conclusions] Parental concerns may be impacting children’s use of active school travel, and therefore, future interventions to promote active school travel should more actively engage parents and address these concerns. Programs like the Walk to School program, which are organized by the schools and can engage community resources such as public safety officials, could help overcome many of these perceived barriers to active transport.This study was supported by a cooperative agreement from the Centers for Disease Control and Prevention, Special Interest Project (SIP 09–02). The project was conducted out of the Center for Health Promotion and Disease Prevention, a Prevention Research Center funded through a cooperative agreement with the Centers for Disease Control and Prevention (U48-DP001944)

Measuring the Physical Activity Practices Used by Parents of Preschool Children

Parents play a critical role in shaping children’s attitudes, beliefs and behaviors, including those around physical activity and inactivity. Our ability to identify which practices effectively promote children’s physical activity and limit inactivity is limited by existing measurement instruments. This project will present a newly developed physical activity parenting practices survey, the psychometric properties of this survey’s scales, and their association with child physical activity and screen time behaviors

Translating a child care based intervention for online delivery: development and randomized pilot study of Go NAPSACC

Abstract Background As part of childhood obesity prevention initiatives, Early Care and Education (ECE) programs are being asked to implement evidence-based strategies that promote healthier eating and physical activity habits in children. Translation of evidence-based interventions into real world ECE settings often encounter barriers, including time constraints, lack of easy-to-use tools, and inflexible intervention content. This study describes translation of an evidence-based program (NAPSACC) into an online format (Go NAPSACC) and a randomized pilot study evaluating its impact on centers’ nutrition environments. Methods Go NAPSACC retained core elements and implementation strategies from the original program, but translated tools into an online, self-directed format using extensive input from the ECE community. For the pilot, local technical assistance (TA) agencies facilitated recruitment of 33 centers, which were randomized to immediate (intervention, n = 18) or delayed (control, n = 15) access groups. Center directors were oriented on Go NAPSACC tools by their local TA providers (after being trained by researchers), after which they implemented Go NAPSACC independently with minimal TA support. The Environment and Policy Assessment and Observation instrument (self-report), collected prior to and following the 4-month intervention period, was used to assess impact on centers’ nutrition environments. Process data were also collected from a sample of directors and all TA providers to evaluate program usability and implementation. Results Demographic characteristics of intervention and control centers were similar. Two centers did not complete follow-up measures, leaving 17 intervention and 14 control centers in the analytic sample. Between baseline and follow-up, intervention centers improved overall nutrition scores (Cohen’s d effect size = 0.73, p = 0.15), as well as scores for foods (effect size = 0.74, p = 0.16), beverages (effect size = 0.54, p = 0.06), and menus (effect size = 0.73, p = 0.08), but changes were not statistically significant. Conclusions Core elements of NAPSACC were effectively translated into online tools and successfully implemented by center directors. Results suggest that the online program may have retained its ability to drive change in centers’ nutrition environments using a streamlined, self-directed, and flexible implementation approach. Results need to be confirmed in a larger more definitive trial. Trial registration NCT02889198 (retrospectively registered)

Reliability and validity of the Healthy Home Survey: A tool to measure factors within homes hypothesized to relate to overweight in children

<p>Abstract</p> <p>Background</p> <p>The contribution of the environment to the obesity epidemic is well recognized. Parents have control over their home environment and can, therefore, support healthy dietary and activity habits in their children by manipulating factors such as access to energy-dense foods, availability of physical activity equipment, and restricting screen time. This paper describes the development of the Healthy Home Survey and its reliability and validity. The Healthy Home Survey was designed to assess characteristics of the home environment that are hypothesized to influence healthy weight behaviors in children including diet and physical activity.</p> <p>Methods</p> <p>We recruited 85 families with at least one child between 3–8 years. The Healthy Home Survey was administered to parents via telephone and repeated in a random sample of 45 families after 7 days. In-home observations were performed within 14 days of the first Healthy Home Survey interview. Percent agreement, Kappa statistics, Intra-class correlation coefficients and sensitivity analyses were used to evaluate reliability and validity evidence.</p> <p>Results</p> <p>Reliability and validity estimates for the Healthy Home Survey were varied, but generally high (0.22–1.00 and 0.07–0.96 respectively), with lower scores noted for perishable foods and policy items. Lower scores were likely related to actual change in the perishable foods present and the subjective nature or clarity of policy questions and response categories.</p> <p>Conclusion</p> <p>Initial testing demonstrated that the Healthy Home Survey is a feasible, reliable, and valid assessment of the home environment; however, it has also highlighted areas that need improvement. The Healthy Home Survey will be useful in future research exploring the relationship between the home environment and child weight.</p

Characteristics associated with US Walk to School programs

Participation in Walk to School (WTS) programs has grown substantially in the US since its inception; however, no attempt has been made to systematically describe program use or factors associated with implementation of environment/policy changes

Providers\u27 response to child eating behaviors: A direct observation study

Child care providers play an important role in feeding young children, yet little is known about children’s influence on providers’ feeding practices. This qualitative study examines provider and child (18 months −4 years) feeding interactions. Trained data collectors observed 200 eating occasions in 48 family child care homes and recorded providers’ responses to children’s meal and snack time behaviors. Child behaviors initiating provider feeding practices were identified and practices were coded according to higher order constructs identified in a recent feeding practices content map. Analysis examined the most common feeding practices providers used to respond to each child behavior. Providers were predominately female (100%), African-American (75%), and obese (77%) and a third of children were overweight/obese (33%). Commonly observed child behaviors were: verbal and non-verbal refusals, verbal and non-verbal acceptance, being “all done”, attempts for praise/attention, and asking for seconds. Children’s acceptance of food elicited more autonomy supportive practices vs. coercive controlling. Requests for seconds was the most common behavior, resulting in coercive controlling practices (e.g., insisting child eat certain food or clean plate). Future interventions should train providers on responding to children’s behaviors and helping children become more aware of internal satiety and hunger cues