Munch and Move: evaluation of a preschool healthy eating and movement skill program

<p>Abstract</p> <p>Background</p> <p>Early childhood services have been identified as a key setting for promoting healthy eating and physical activity as a means of preventing overweight and obesity. However, there is limited evidence on effective nutrition and physical activity programs in this setting. The purpose of this study was to evaluate <it>Munch and Move</it>, a low-intensity, state-wide, professional development program designed to support early childhood professionals to promote healthy eating and physical activity among children in their care.</p> <p>Methods</p> <p>The evaluation involved 15 intervention and 14 control preschools (n = 430; mean age 4.4 years) in Sydney, New South Wales, Australia and was based on a randomised-control design with pre and post evaluation of children's lunchbox contents, fundamental movement skills (FMS), preschool policies and practices and staff attitudes, knowledge and confidence related to physical activity, healthy eating and recreational screen time.</p> <p>Results</p> <p>At follow up, FMS scores for locomotor, object control and total FMS score significantly improved by 3.4, 2.1 and 5.5 points more (respectively) in the intervention group compared with the control group (P < 0.001) and the number of FMS sessions per week increased by 1.5 (P = 0.05). The lunchbox audit showed that children in the intervention group significantly reduced sweetened drinks by 0.13 serves (i.e., 46 ml) (P = 0.05).</p> <p>Conclusion</p> <p>The findings suggest that a low intensity preschool healthy weight intervention program can improve certain weight related behaviours. The findings also suggest that change to food policies are difficult to initiate mid-year and potentially a longer implementation period may be required to determine the efficacy of food policies to influence the contents of preschoolers lunchboxes.</p

What do parents and preschool staff tell us about young children's physical activity: a qualitative study

<p>Abstract</p> <p>Background</p> <p>Physical activity and small screen recreation are two modifiable behaviours associated with childhood obesity and the development of chronic health problems. Parents and preschool staff shape behaviour habits in young children. The aims of this qualitative study were to explore the attitudes, values, knowledge and understanding of parents and carers of preschool-age children in relation to physical activity and small screen recreation and to identify influences upon these behaviours.</p> <p>Methods</p> <p>This research involved a focus group study with parents and carers of the target population. A purposive sample of 39 participants (22 parents, 17 carers) participated in 9 focus groups. Participants were drawn from three populations of interest: those from lower socioeconomic status, and Middle-Eastern and Chinese communities in the Sydney (Australia) metropolitan region.</p> <p>Results</p> <p>All participants understood the value of physical activity and the impact of excessive small screen recreation but were unfamiliar with national guidelines for these behaviours. Participants described the nature and activity patterns of young children; however, the concept of activity 'intensity' in this age group was not a meaningful term. Factors which influenced young children's physical activity behaviour included the child's personality, the physical activity facilities available, and the perceived safety of their community. Factors facilitating physical activity included a child's preference for being active, positive parent or peer modelling, access to safe play areas, organised activities, preschool programs and a sense of social connectedness. Barriers to physical activity included safety concerns exacerbated by negative media stories, time restraints, financial constraints, cultural values favouring educational achievement, and safety regulations about equipment design and use within the preschool environment. Parents considered that young children are naturally 'programmed' to be active, and that society 'de-programs' this behaviour. Staff expressed concern that free, creative active play was being lost and that alternate activities were increasingly sedentary.</p> <p>Conclusion</p> <p>The findings support the relevance of the socioecological model of behavioural influences to young children's physical activity. In this age group, efforts may best be directed at emphasising national guidelines for small screen recreation and educating families and carers about the importance of creative, free play to reinforce the child's inherent nature to be active.</p

The validity and reliability of a home environment preschool-age physical activity questionnaire (Pre-PAQ)

<p>Abstract</p> <p>Background</p> <p>There is a need for valid population level measures of physical activity in young children. The aim of this paper is to report the development, and the reliability and validity, of the Preschool-age Children's Physical Activity Questionnaire (Pre-PAQ) which was designed to measure activity of preschool-age children in the home environment in population studies.</p> <p>Methods</p> <p>Pre-PAQ was completed by 103 families, and validated against accelerometry for 67 children (mean age 3.8 years, SD 0.74; males 53%). Pre-PAQ categorizes activity into five progressive levels (stationary no movement, stationary with limb or trunk movement, slow, medium, or fast-paced activity). Pre-PAQ Levels 1-2 (stationary activities) were combined for analyses. Accelerometer data were categorized for stationary, sedentary (SED), non-sedentary (non-SED), light (LPA), moderate (MPA) and vigorous (VPA) physical activity using manufacturer's advice (stationary) or the cut-points described by Sirard et al and Reilly et al. Bland-Altman methods were used to assess agreement between the questionnaire and the accelerometer measures for corresponding activity levels. Reliability of the Pre-PAQ over one week was determined using intraclass correlations (ICC) or kappa (κ) values and percentage of agreement of responses between the two questionnaire administrations.</p> <p>Results</p> <p>Pre-PAQ had good agreement with LPA (mean difference 1.9 mins.day^-1) and VPA (mean difference -4.8 mins.day^-1), was adequate for stationary activity (mean difference 7.6 mins.day^-1) and poor for sedentary activity, whether defined using the cut-points of Sirard et al (mean difference -235.4 mins.day^-1) or Reilly et al (mean difference -208.6 mins.day^-1) cut-points. Mean difference between the measures for total activity (i.e. Reilly's non-sedentary or Sirard's LMVPA) was 20.9 mins.day^-1and 45.2 mins.day^-1. The limits of agreement were wide for all categories. The reliability of Pre-PAQ question responses ranged from 0.31-1.00 (ICC (2, 1)) for continuous measures and 0.60-0.97 (κ) for categorical measures.</p> <p>Conclusions</p> <p>Pre-PAQ has acceptable validity and reliability and appears promising as a population measure of activity behavior but it requires further testing on a more broadly representative population to affirm this. Pre-PAQ fills an important niche for researchers to measure activity in preschool-age children and concurrently to measure parental, family and neighborhood factors that influence these behaviors.</p

Temporal trends and recent correlates in sedentary behaviours in Chinese children

<p>Abstract</p> <p>Background</p> <p>Sedentary behaviours (television, video and computer) are related to health outcomes independent of physical activity. Few studies have examined trends and correlates of sedentary behaviours among youth in developing nations. The current study is to examine temporal trends in sedentary behaviours and recent correlates of screen use in Chinese children during a period of economic transition.</p> <p>Methods</p> <p>Secondary analysis of China Health and Nutrition Surveys. Cross-sectional data on sedentary behaviours including screen use among children aged 6-18 years from four surveys in 1997 (n = 2,469), 2000 (n = 1,838), 2004 (n = 1,382) and 2006 (n = 1,128). Temporal trends in screen use by socio-demographic characteristics were examined. The correlates of spending more than 2 hours per day on screen time in the most recent survey data (2006, n = 986) were analysed using survey logistic regression analysis.</p> <p>Results</p> <p>Daily screen time significantly increased in each subgroup by age, sex and urban/rural residence, with the largest increase for urban boys aged 13-18 years from 0.5 hours to 1.7 hours, and for rural boys aged 6-12 years from 0.7 hours to 1.7 hours (p < 0.0001). Daily time in both homework and extracurricular cultural activity increased significantly from 2000 to 2004 but was stable from 2004 to 2006. Boys (OR: 1.41, 95%CI: 1.09 -1.82), having a TV in the bedroom (OR: 1.86, 95%CI: 1.15 - 3.01), having access to internet at home (OR: 1.93, 95%CI: 1.12 - 3.31) or at internet cafés (OR: 2.01, 95%CI: 1.21 - 3.34), or often watching TV with parents (OR: 2.27, 95%CI: 1.37 - 3.74) were all associated with being more likely to be high screen users (≥ 2 hours/day). While children aged 13-18 years (OR: 0.67, 95%CI: 0.46-0.97) were less likely to be high screen users. Children whose parents often have rules on their TV viewing (OR: 0.64, 95%CI: 0.37 - 1.10) were slightly but not significantly less likely to be high screen users.</p> <p>Conclusion</p> <p>This study confirms sedentary behaviour has increased over the last decade in Chinese children. Efforts to ensure Chinese youth meet screen time guidelines include limiting access to screen technologies and encouraging parents to monitor their own screen time and to set limits on their child's screen time.</p

Adolescent-parent interactions and communication preferences regarding body weight and weight management: a qualitative study

<p>Abstract</p> <p>Background</p> <p>This study aimed to canvass the nature of adolescent-parent interactions about weight, particularly overweight, and to explore ideas of how to foster supportive discussions regarding weight, both in the home and with family doctors.</p> <p>Methods</p> <p>A market research company was contracted to recruit and conduct a series of separate focus groups with adolescents and unrelated parents of adolescents from low-middle socio-economic areas in Sydney and a regional centre, Australia. Group discussions were audio recorded, transcribed, and then a qualitative content analysis of the data was performed.</p> <p>Results</p> <p>Nine focus groups were conducted; two were held with girls (n = 13), three with boys (n = 18), and four with parents (20 mothers, 12 fathers). Adolescent and parent descriptions of weight-related interactions could be classified into three distinct approaches: indirect/cautious (i.e. focus on eating or physical activity behaviors without discussing weight specifically); direct/open (i.e. body weight was discussed); and never/rarely discussing the subject. Indirect approaches were described most frequently by both adolescents and parents and were generally preferred over direct approaches. Parents and adolescents were circumspect but generally supportive of the potential role for family doctors to monitor and discuss adolescent weight status.</p> <p>Conclusions</p> <p>These findings have implications for developing acceptable messages for adolescent and family overweight prevention and treatment interventions.</p

Parental influences on child physical activity and screen viewing time: a population based study

Background: Parents can influence their children’s physical activity participation and screen time.This study examined the relative significance of perceived parental barriers and self-efficacy in relation to children’s physical activity participation and screen time viewing. The associations between these factors and the behaviours were analysed. Methods: Cross-sectional population survey in New South Wales, Australia of parents of pre-school (N = 764), younger (Kindergarten, Grades 2 and 4; N = 1557) and older children (Grades 6, 8 and 10; N = 1665). Parents reported barriers and self-efficacy to influence their child’s physical activity and screen time behaviours in a range of circumstances. Differences were examined by child’s sex and age group, household income, maternal education and location of residence. The duration of physical activity and screen viewing was measured by parental report for pre-school and younger children and self-report for older children. Associations between parental factors and children’s organised, non-organised and total activity and screen time were analysed. Results: Cost, lack of opportunities for participation and transport problems were the barriers most often reported, particularly by low income parents and those in rural areas. The number of barriers was inversely related to children’s time spent in organised activity, but not their non-organised activity. Higher parental self-efficacy was positively associated with organised physical activity in the younger and older children’s groups and the non-organised activity of older children. School-age children (younger and older groups) were less likely to meet physical activity guidelines when parents reported ≥4 barriers (OR 3.76, 95% CI 1.25-11.34 and OR 3.72, 95% CI 1.71-8.11 respectively). Low parental self-efficacy was also associated with the likelihood of children exceeding screen time guidelines for each age group (pre-school OR 0.62, 95% CI 0.43-0.87; young children OR 0.56, 95% CI 0.39-0.80; and older children OR 0.57, 95% CI 0.43-0.74). Conclusion: Parental barriers are associated with the time that children spend in both active and sedentary pursuits. These findings highlight family, economic and environmental factors that should be addressed in programs to promote child physical activity and tackle sedentary behaviour

Family and home correlates of television viewing in 12–13 year old adolescents: The Nepean Study

BACKGROUND: Few young people meet television viewing guidelines. PURPOSE: To determine the association between factors in the family and home environment and watching television, including videos and DVDs, in early adolescence. METHODS: Cross-sectional, self-report survey of 343 adolescents aged 12–13 years (173 girls), and their parents (338 mothers, 293 fathers). Main measures were factors in the family and home environment potentially associated with adolescents spending ≥ 2 hours per day in front of the television. Factors examined included family structure, opportunities to watch television/video/DVDs, perceptions of rules and regulations on television viewing, and television viewing practices. RESULTS: Two-thirds of adolescents watched ≥ 2 hours television per day. Factors in the family and home environment associated with adolescents watching television ≥ 2 hours per day include adolescents who have siblings (Adjusted Odds Ratio [95%CI] AOR = 3.0 [1.2, 7.8]); access to pay television (AOR = 2.0 [1.1, 3.7]); ate snacks while watching television (AOR = 3.1 [1.8, 5.4]); co-viewed television with parents (AOR = 2.3 [1.3, 4.2]); and had mothers who watched ≥ 2 hours television per day (AOR = 2.4 [1.3, 4.6]). CONCLUSION: There are factors in the family and home environment that influence the volume of television viewed by 12–13 year olds. Television plays a central role in the family environment, potentially providing a means of recreation among families of young adolescents for little cost. Interventions which target family television viewing practices and those of parents, in particular, are more likely to be effective than interventions which directly target adolescent viewing times

Promoting motor skills in low-income, ethnic children: The Physical Activity in Linguistically Diverse Communities (PALDC) nonrandomized trial

This study reports the long-term effects of a professional learning program for classroom teachers on fundamental motor skill (FMS) proficiency of primary school students from ethnically diverse backgrounds. Design: A cluster non-randomized trial using a nested cross-sectional design. Methods: The study was conducted in 8 primary schools located in disadvantaged and culturally diverse areas in Sydney, Australia. The intervention used an action learning framework, with each school developing and implementing an action plan for enhancing the teaching of FMS in their school. School teams comprised 4-5 teachers and were supported by a member of the research team. The primary outcome was total proficiency score for 7 FMS (run, jump, catch, throw, kick, leap, side gallop). Outcome data were analyzed using mixed effects models. Results: Eight-hundred and sixty-two students (82% response rate) were assessed at baseline in 2006 and 830 (82%) at follow-up in 2010. Compared with students in the control schools, there was a significantly greater increase in total motor skill proficiency among children in the intervention schools at follow-up (adjusted difference = 5.2 components, 95%CI [1.65, 8.75]; p. = 0.01) and in four of the seven motor skills. Conclusions: Training classroom teachers to develop and implement units of work based around individual FMS is a promising strategy for increasing FMS among ethnically diverse children over an extended period of time

Associations between insulin and glucose concentrations and anthropometric measures of fat mass in Australian adolescents

Background One of the most serious, yet common co-morbidities of obesity is insulin resistance, which if untreated may progress to type 2 diabetes. This paper describes the insulin and glucose concentration distributions, the prevalence of elevated insulin, the associations between insulin and body mass index (BMI), waist circumference, waist-to-height ratio (WHtR) and fat mass index in a representative sample of Australian adolescents. Methods Cross-sectional population-based study of adolescent boys and girls (N = 496, mean age 15.3 years) attending schools in metropolitan Sydney, Australia. Fasting venous blood collected and analysed for insulin and glucose concentrations. Height, weight, waist circumference measured, BMI and waist-to-height ratio calculated. Pubertal status self-reported. Results Glucose concentrations were normally distributed and were not associated with adiposity. Insulin concentrations were distributed logarithmically, were higher among girls than boys overall and within the same ranges of BMI and waist circumference, but were lower among girls than boys within the same ranges of fat mass adjusted for height. The prevalence of elevated insulin concentration (defined as \u3e 100 pmol/L) was 15.9% and 17.1% among boys and girls, respectively. Correlations between insulin concentration and BMI, waist circumference, WHtR and fat mass adjusted for height were 0.53, 0.49, 0.51 and 0.55, among boys, respectively, and 0.35, 0.40, 0.42 and 0.34, among girls, respectively. Conclusions Elevated insulin is highly correlated with adiposity in adolescents. BMI and WHtR are simple measures that can be used to identify young people who should be screened for insulin resistance and other co-morbidities