Childhood obesity in Ireland: recent trends and modifiable determinants

Background: Childhood obesity is a global epidemic posing a significant threat to the health and wellbeing of children. To reverse this epidemic, it is essential that we gain a deeper understanding of the complex array of driving factors at an individual, family and wider ecological level. Using a social-ecological framework, this thesis investigates the direction, magnitude and contribution of risk factors for childhood overweight and obesity at multiple levels of influence, with a particular focus on diet and physical activity. Methods: A systematic review was conducted to describe recent trends (from 2002-2012) in childhood overweight and obesity prevalence in Irish school children from the Republic of Ireland. Two datasets (Cork Children’s Lifestyle [CCLaS] Study and the Growing Up in Ireland [GUI] Study) were used to explore determinants of childhood overweight and obesity. Individual lifestyle factors examined were diet, physical activity and sedentary behaviour. The determinants of physical activity were also explored. Family factors examined were parental weight status and household socio-economic status. The impact of food access in the local area on diet quality and body mass index (BMI) was investigated as an environmental level risk factor. Results: Between 2002 and 2012, the prevalence of childhood overweight and obesity in Ireland remained stable. There was some evidence to suggest that childhood obesity rates may have decreased slightly though one in four Irish children remained either overweight or obese. In the CCLaS study, overweight and obese children consumed more unhealthy foods than normal weight children. A diet quality score was constructed based on a previously validated adult diet score. Each one unit increase in diet quality was significantly associated with a decreased risk of childhood overweight and obesity. Individual level factors (including gender, being a member of a sports team, weight status) were more strongly associated with physical activity levels than family or environmental factors. Overweight and obese children were more sedentary and less active than normal weight children. There was a dose response relationship between time spent at moderate to vigorous physical activity (MVPA) and the risk of childhood obesity independent of sedentary time. In contrast, total sedentary time was not associated with the risk of childhood obesity independent of MVPA though screen time was associated with childhood overweight and obesity. In the GUI Study, only one in five children had 2 normal weight parents (or one normal weight parent in the case of single parent families). Having overweight and obese parents was a significant risk factor for overweight and obesity regardless of socio-economic characteristics of the household. Family income was not associated with the odds of childhood obesity but social class and parental education were important risk factors for childhood obesity. Access to food stores in the local environment did not impact dietary quality or the BMI of Irish children. However, there was some evidence to suggest that the economic resources of the family influenced diet and BMI. Discussion: Though childhood overweight and obesity rates appear to have stabilised over the previous decade, prevalence rates are unacceptably high. As expected, overweight and obesity were associated with a high energy intake and poor dietary quality. The findings also highlight strong associations between physical inactivity and the risk of overweight and obesity, with effect sizes greater than what have been typically found in adults. Important family level determinants of childhood overweight and obesity were also identified. The findings highlight the need for a multifaceted approach, targeting a range of modifiable determinants to tackle the problem. In particular, policies and interventions at the shared family environment or community level may be an effective mean of tackling this current epidemic

Short report HBSC Ireland 2014. Alcohol and cannabis use in school-children in Ireland.

The Health Behaviour in School-aged Children (HBSC) study is a cross-national research study conducted in collaboration with the World Health Organisation (WHO) Regional Office for Europe and runs on a four-year cycle. In 2014, Ireland participated for the fifth time in the HBSC study (www.nuigalway.ie/hbsc). The overall aims of the HBSC study are to gain new insight into, and increase our understanding of young people’s health and well-being, health behaviours and their social context. HBSC collects data on key indicators of health, health attitudes, and health behaviours, as well as the context of health for young people. The study is a school-based survey with information collected from students through self-completion questionnaires in classrooms. HBSC Ireland 2014 was funded by the Department of Health. This short report presents a brief analysis of alcohol and cannabis intake among Irish school-children, aged 13-17, across the country broken down by age and gender. Overall, data from 7,320 school-children aged 13-17 were analysed

The effects of individual, family and environmental factors on physical activity levels in children: a cross-sectional study.

BACKGROUND: Physical activity plays an important role in optimising physical and mental health during childhood, adolescence, and throughout adult life. This study aims to identify individual, family and environmental factors that determine physical activity levels in a population sample of children in Ireland. METHODS: Cross-sectional analysis of the first wave (2008) of the nationally representative Growing Up in Ireland study. A two-stage clustered sampling method was used where national schools served as the primary sampling unit (response rate: 82%) and age eligible children from participating schools were the secondary units (response rate: 57%). Parent reported child physical activity levels and potential covariates (parent and child reported) include favourite hobby, total screen time, sports participation and child body mass index (measured by trained researcher). Univariate and multivariate multinomial logistic regression (forward block entry) examined the association between individual, family and environmental level factors and physical activity levels. RESULTS: The children (N = 8,568) were classified as achieving low (25%), moderate (20%) or high (55%) physical activity levels. In the fully adjusted model, male gender (OR 1.64 [95% CI: 1.34-2.01]), having an active favourite hobby (OR 1.65 [95% CI: 1.31-2.08]) and membership of sports or fitness team (OR 1.90 [95% CI: 1.48-2.45]) were significantly associated with being in the high physical activity group. Exceeding two hours total screen time (OR 0.66 [95% CI: 0.52-0.85]), being overweight (OR 0.41 [95%CI: 0.27-0.61]; or obese (OR 0.68 [95%CI: 0.54-0.86]) were significantly associated with decreased odds of being in the high physical activity group. CONCLUSIONS: Individual level factors appear to predict PA levels when considered in the multiple domains. Future research should aim to use more robust objective measures to explore the usefulness of the interconnect that exists across these domains. In particular how the family and environmental settings could be useful facilitators for consistent individual level factors such as sports participation

Sugar-sweetened beverage consumption and association with weight status in Irish children: A cross-sectional study prior to the introduction of a government tax on sugar-sweetened beverages

Objective: To provide baseline evidence of sugar-sweetened beverage (SSB) consumption in a sample of Irish children prior to the introduction of the SSB tax; to identify the energy contribution of SSB to daily energy intake; and to explore the association between SSB consumption and overweight/obesity. Design: Cross-sectional study. Setting: Primary schools in Cork, Ireland in 2012. Participants: 1075 boys and girls aged 8–11 years. SSB consumption was assessed from 3-d food diaries. BMI was used to define obesity (International Obesity Taskforce definitions). Plausible energy reporters (n 724, 68 % of total sample) were classified using Schofield equation. Results: Eighty-two per cent of children with plausible energy intake consumed SSB. Mean energy intake from SSB was 485 kJ (6 % of total kJ). Mean kilojoules from SSB increased with weight status from 443 kJ for normal-weight children to 648 kJ for children with overweight/obesity (5·8 and 7·6 % of total kJ, respectively). Mean SSB intake was significantly higher in children with overweight/obesity than normal-weight children (383 and 315 ml/d). In adjusted analyses, children consuming >200 ml/d had an 80 % increased odds of overweight/obesity compared to those consuming <200 ml/d (OR 1·8, 95 % CI 1·0, 3·5). Family socioeconomic status and lifestyle determinants, including frequency of takeaway consumption and TV viewing, were also significantly associated with SSB consumption. Conclusions: SSB account for a substantial proportion of daily energy intake and are significantly associated with child overweight/obesity. This study provides baseline data from a sample of children from which the impact of the SSB tax can be benchmarked

HBSC Ireland 2014: tobacco use among 15 to 17 year olds.

The Health Behaviour in School-aged Children (HBSC) study is a cross-national research study conducted in collaboration with the World Health Organisation (WHO) Regional Office for Europe and runs on a four-year cycle. In 2014, Ireland participated for the fifth time in the HBSC study (www.nuigalway.ie/hbsc). The overall aims of the HBSC study are to gain new insight into, and increase our understanding of young people’s health and well-being, health behaviours and their social context. HBSC collects data on key indicators of health, health attitudes, and health behaviours, as well as the context of health for young people. The study is a school-based survey with information collected from students through self-completion questionnaires in classrooms. HBSC Ireland 2014 was funded by the Department of Health. The most recent HBSC Ireland study was conducted in 2014 and included 13,611 school-children from 3rd class in primary school to 5th year in post-primary school. Collectively, 230 primary and post-primary schools across Ireland participated in this study. This short report provides a descriptive analysis of the 2014 HBSC survey data in regards to tobacco use. The analysis presented below for the 2014 data consists of 1,608 children born in 1998 aged 15 years old (39.8% boys; 60.2% girls) and 3,982 children aged 15 to 17 years old (40.4% boys; 59.6% girls). The analysis is presented by gender and social class. Where overall percentages are included these are weighted to take into account the gender imbalance

The Irish Health Behaviour in School-aged Children (HBSC) study 2014.

The Health Behaviours in School Children (HBSC) survey 2014 shows that overall health levels are good. There are encouraging findings on consumption of fruit and vegetables, teeth cleaning, and a drop in smoking levels and consumption of sweets and soft drinks. However, many children said they find it easy to get cigarettes, too many children are going to bed hungry, and there are concerns about levels of cyber bullying. A total of 13,611 pupils were surveyed with questions on topics like general health, food and dietary behaviour, exercise and physical activity, self-care, smoking, use of alcohol and other substances, bullying including cyber bullying, and sexual health behaviours. Some of the key findings in the main survey include: • Reported levels of fruit and vegetable consumption have increased. • Consumption of sweets and soft drinks has decreased from 2010. • Reported levels of physical activity remained stable between 2010 and 2014. • The overall proportion of children who reported being in a physical fight has decreased from 2010. More girls and older children report being victims of cyber bullying. • There was an overall decrease in reported levels of smoking and drunkenness and an increase in levels of never drinking between 2010 and 2014. Many children reported that it is easy to buy cigarettes or get someone else to buy cigarettes for them in most shops in the area where they live and go to school. • There are still worrying levels of children going to bed hungry and skipping breakfast being reported. • More girls, older children and children from higher social classes reported brushing their teeth daily or more frequently. • 20% of children do not wear seat belts. • The percentage of 15-17 year olds who report that they have ever had sex has increased from 23% in 2010 to 27% in 2014. One key finding Substance Use: This covers tobacco, alcohol and cannabis use. There was an overall decrease in reported levels of smoking and drunkenness and an increase in levels of never drinking between 2010 and 2014. Smoking, alcohol use and cannabis use were more commonly reported among boys and older children. Exposure to second hand smoke was common at home and in the family car. Many children reported that it is easy to buy cigarettes (33% of boys, 26% of girls) or get someone else to buy cigarettes for them in most shops in the area where they live and go to school (58% of boys, 59% of girls)

HBSC Ireland 2014: alcohol and cannabis use in school-children in Ireland (updated).

The Health Behaviour in School-aged Children (HBSC) study is a cross-national research study conducted in collaboration with the World Health Organisation (WHO) Regional Office for Europe and runs on a four-year cycle. In 2014, Ireland participated for the fifth time in the HBSC study (www.nuigalway.ie/hbsc). The overall aims of the HBSC study are to gain new insight into, and increase our understanding of young people’s health and well-being, health behaviours and their social context. HBSC collects data on key indicators of health, health attitudes, and health behaviours, as well as the context of health for young people. The study is a school-based survey with information collected from students through self-completion questionnaires in classrooms. HBSC Ireland 2014 was funded by the Department of Health. The most recent HBSC Ireland study was conducted in 2014 and included 13,611 school-children from 3rd class in primary school to 5th year in post-primary school. Collectively, 230 primary and post-primary schools across Ireland participated in this study. The methods employed comply with the International HBSC protocol and are detailed in the national report from the 2014 survey see http://www.nuigalway.ie/hbsc/hbsc_2014.html. This short report presents a brief analysis of alcohol and cannabis intake among Irish school-children, aged 13-17, across the country broken down by age and gender. Overall, data from 7,320 school-children aged 13-17 were analysed

Physical activity, screen time and the risk of subjective health complaints in school-aged children

Internationally, subjective health complaints have become increasingly prevalent in children. Thus, a comprehensive understanding of the determinants of health complaints is needed to inform effective policies and strategies. This study explores if meeting physical activity and total screen time (TST) recommendations are associated with the risk of reporting health complaints weekly or more. The 2014 Irish Health Behaviour in School-aged Children study collected questionnaire data from 10,474 10–17 year olds. Children reported how often they experienced eight health complaints as less than weekly or weekly or more. Children who met moderate-to-vigorous physical activity recommendations were active for 60 min/day in the past seven days. Three types of screen based activity were categorised to reflect if children met TST recommendations of ≤ 2 h/day. Poisson regression examined the association between meeting recommendations and the risk of health complaints. The prevalence of individual health complaints ranged from 20.4–44.3% in girls and from 10.1–35.4% in boys. Overall, 5.1% (4.5–5.6%) of girls and 8.7% (7.8–9.5%) of boys met both (physical activity and TST) recommendations, while two thirds of girls (67.3%, 66.1–68.5%) and over half of boys (55.0%, 53.5–56.6%) met neither recommendation. Not meeting TST recommendations was significantly associated with the risk of reporting health complaints while associations with physical activity were less apparent. Children who did not meet either recommendation had a significantly increased risk for six of the health complaints when compared to those who met both recommendations. As health complaints and poor lifestyle behaviours were common in children, population levepeer-reviewe