"The thing is, kids don't grow the same": Parent perspectives on preschoolers' weight and size in Soweto, South Africa.

The prevalence of overweight and obesity is high among preschool age (3-5 years) children in South Africa, and children in urban low-income settings are particularly at risk. A better understanding of how parents or caregivers of young children perceive children's weight and size, as well as contextual factors influencing perceptions, is needed to inform interventions. The aim of this study was to examine how parents of preschool children in Soweto, South Africa, view childhood obesity, and to situate these perspectives in the context of the home environment in which preschool age children in Soweto live. Semi-structured in-depth interviews were conducted with 16 parents in four neighbourhoods of Soweto. Interviews were audio-recorded, transcribed verbatim, and analysed using reflexive thematic analysis following a contextualist approach. Three themes were developed: growing differently, the 'right' way to be, and weight is not health. These themes capture parents' views on complex and reportedly inevitable causes of obesity, ideas about acceptable and preferred body sizes, and the low priority of weight per se compared to health. The findings suggest that childhood obesity prevention in South Africa needs to be done in a non-stigmatising way that recognises environmental and contextual factors, such as parents' limited sense of agency in relation to their children's health and weight, and concrete resource constraints. Environmental barriers to healthy behaviours need to be addressed in order to overcome the coexisting challenges of childhood undernutrition and obesity in urban low-income South African settings

Bedroom media, sedentary time and screen-time in children:A longitudinal analysis

Background: Having electronic media in the bedroom is cross-sectionally associated with greater screen-time in children, but few longitudinal studies exist. The aim of this study was to describe longitudinal patterns of ownership and examine cross-sectional and longitudinal associations of bedroom media with children's sedentary behaviour. Methods: Data are from the Sport, Physical activity and Eating behaviour: Environmental Determinants in Young people (SPEEDY) study, collected at 3 time-points: baseline (2007, T0; age 10.3 ± 0.3 years), 1-year (T1y) and 4-year (T4y) follow-up. For each assessment, 1512 (44.9% male), 715 (41.0% male), and 319 (48.3% male) participants provided valid accelerometer data. Outcome variables were accelerometer-assessed sedentary time and self-reported screen-time. The presence of a television or computer in the bedroom was self-reported by participants and a combined bedroom media score calculated as the sum of such items. Cross-sectional and longitudinal associations between bedroom media and each outcome were examined using multi-level linear regression. Results: Bedroom TV ownership fell from 70.9% at T0 to 42.5% at T4y. Having a TV in the bedroom (beta; 95% CI*100, T0: -1.17; -1.88, -0.46. T1y: -1.68; -2.67, -0.70) and combined bedroom media (T0: -0.76; -1.26, -0.27. T1y: -0.79; -1.51, -0.07) were negatively associated with objectively measured weekly sedentary time at T0 and T1y. Having a computer in the bedroom (beta; 95% CI, T0: 0.15; 0.02, 0.29. T4y: 0.35; 0.10, 0.60) and combined bedroom media (T0: 0.09: 0.01, 0.18. T4y: 0.20; 0.05, 0.34) were positively associated with screen-time at T0 and T4y. Relative to participants without a computer throughout the study, children that had a computer in their bedroom at T0 but not at T4y (beta; 95% CI for change in screen-time: -8.02; -12.75, -3.29) reported smaller increases in screen-time. Conclusions: The bedroom media environment changes with age and exhibits a complex relationship with children's sedentary behaviour. Modifying children's bedroom media environment may impact upon screen-time but appears unlikely to influence overall sedentary time

Engaging families in physical activity research: a family-based focus group study

Abstract Background Family-based interventions present a much-needed opportunity to increase children’s physical activity levels. However, little is known about how best to engage parents and their children in physical activity research. This study aimed to engage with the whole family to understand how best to recruit for, and retain participation in, physical activity research. Methods Families (including a ‘target’ child aged between 8 and 11 years, their parents, siblings, and others) were recruited through schools and community groups. Focus groups were conducted using a semi-structured approach (informed by a pilot session). Families were asked to order cards listing the possible benefits of, and the barriers to, being involved in physical activity research and other health promotion activities, highlighting the items they consider most relevant, and suggesting additional items. Duplicate content analysis was used to identify transcript themes and develop a coding frame. Results Eighty-two participants from 17 families participated, including 17 ‘target’ children (mean age 9.3 ± 1.1 years, 61.1 % female), 32 other children and 33 adults (including parents, grandparents, and older siblings). Social, health and educational benefits were cited as being key incentives for involvement in physical activity research, with emphasis on children experiencing new things, developing character, and increasing social contact (particularly for shy children). Children’s enjoyment was also given priority. The provision of child care or financial reward was not considered sufficiently appealing. Increased time commitment or scheduling difficulties were quoted as the most pertinent barriers to involvement (especially for families with several children), but parents commented these could be overcome if the potential value for children was clear. Conclusions Lessons learned from this work may contribute to the development of effective recruitment and retention strategies for children and their families. Making the wide range of potential benefits clear to families, providing regular feedback, and carefully considering family structure, may prove useful in achieving desired research participation. This may subsequently assist in engaging families in interventions to increase physical activity in children

How well do modelled routes to school record the environments children are exposed to?:A cross-sectional comparison of GIS modelled and GPS measured routes to school

Background The school journey may make an important contribution to children’s physical activity and provide exposure to food and physical activity environments. Typically, Geographic Information Systems (GIS) have been used to model assumed routes to school in studies, but these may differ from those actually chosen. We aimed to identify the characteristics of children and their environments that make the modelled route more or less representative of that actually taken. We compared modelled GIS routes and actual Global Positioning Systems (GPS) measured routes in a free-living sample of children using varying travel modes. Methods Participants were 175 13-14 yr old children taking part in the Sport, Physical activity and Eating behaviour: Environmental Determinants in Young people (SPEEDY) study who wore GPS units for up to 7 days. Actual routes to/from school were extracted from GPS data, and shortest routes between home and school along a road network were modelled in a GIS. Differences between them were assessed according to length, percentage overlap, and food outlet exposure using multilevel regression models. Results GIS routes underestimated route length by 21.0% overall, ranging from 6.1% among walkers to 23.2% for bus users. Among pedestrians food outlet exposure was overestimated by GIS routes by 25.4%. Certain characteristics of children and their neighbourhoods that improved the concordance between GIS and GPS route length and overlap were identified. Living in a village raised the odds of increased differences in length (odds ratio (OR) 3.36 (1.32-8.58)), while attending a more urban school raised the odds of increased percentage overlap (OR 3.98 (1.49-10.63)). However none were found for food outlet exposure. Journeys home from school increased the difference between GIS and GPS routes in terms of food outlet exposure, and this measure showed considerable within-person variation. Conclusions GIS modelled routes between home and school were not truly representative of accurate GPS measured exposure to obesogenic environments, particularly for pedestrians. While route length may be fairly well described, especially for urban populations, those living close to school, and those travelling by foot, the additional expense of acquiring GPS data seems important when assessing exposure to route environments

Equity effects of children’s physical activity interventions: a systematic scoping review

Abstract Background Differential effects of physical activity (PA) interventions across population sub-groups may contribute to inequalities in health. This systematic scoping review explored the state of the evidence on equity effects in response to interventions targeting children’s PA promotion. The aims were to assess and summarise the availability of evidence on differential intervention effects of children’s PA interventions across gender, body mass index, socioeconomic status, ethnicity, place of residence and religion. Methods Using a pre-piloted search strategy, six electronic databases were searched for controlled intervention trials, aiming to increase PA in children (6–18 years of age), that used objective forms of measurement. Screening and data extraction were conducted in duplicate. Reporting of analyses of differential effects were summarized for each equity characteristic and logistic regression analyses run to investigate intervention characteristics associated with the reporting of equity analyses. Results The literature search identified 13,052 publications and 7963 unique records. Following a duplicate screening process 125 publications representing 113 unique intervention trials were included. Although the majority of trials collected equity characteristics at baseline, few reported differential effects analyses across the equity factors of interest. All 113 included interventions reported gender at baseline with 46% of non-gender targeted interventions reporting differential effect analyses by gender. Respective figures were considerably smaller for body mass index, socioeconomic status, ethnicity, place of residence and religion. There was an increased likelihood of studying differential effects in school based interventions (OR: 2.9 [1.2–7.2]) in comparison to interventions in other settings, larger studies (per increase in 100 participants; 1.2 [1.0 – 1.4]); and where a main intervention effect on objectively measured PA was reported (3.0 [1.3–6.8]). Conclusions Despite regularly collecting relevant information at baseline, most controlled trials of PA interventions in children do not report analyses of differences in intervention effect across outlined equity characteristics. Consequently, there is a scarcity of evidence concerning the equity effects of these interventions, particularly beyond gender, and a lack of understanding of subgroups that may benefit from, or be disadvantaged by, current intervention efforts. Further evidence synthesis and primary research is needed to effectively understand the impact of PA interventions on existing behavioural inequalities within population subgroups of children. Trial registration PROSPERO (PROSPERO 2016: CRD42016034020 )

A qualitative study of health promotion in academy schools in England

BackgroundSchools are an important setting for health promotion. In England, around one third of publicly funded schools have become independent of local authorities since 2000 and are now academies, run by an academy trust. The aim of this research was to examine attitudes towards health promotion held by academy trust leaders and senior staff. The research questions were: 1. How do academy trusts in England perceive their role in health promotion amongst students? 2. How are decisions around health promotion made in academy trusts? 3. What factors inhibit and encourage health promotion in academy schools? 4. How might public health academics and practitioners best engage with academy schools to facilitate health promotion activity and research?MethodsQualitative study utilising semi-structured interviews. Twenty five academy and school leaders were purposively sampled to achieve variation in trust size and type. In addition, five respondents were recruited from public and third-sector agencies seeking to work with or influence academy trusts around health promotion. Framework analysis was used to determine emergent themes and identify relationships between themes and respondent type. Early findings were triangulated at a stakeholder event with 40 delegates from academia, local authority public health teams, and third sector organisations.ResultsThere is wide variation amongst senior academy and trust leaders in how they perceive the role of academies in promoting health and wellbeing amongst students. There is also variability in whether academy trusts responsible for more than one school adopt a centralised strategy to health promotion or allow individual schools autonomy. This was dependent on the trust leaders’ attitude and interest in health promotion rather than any perceived external accountability. Identified barriers to health promotion include financial constraints, a narrow focus on educational outcomes and school performance, and limited understanding about effective health interventions.ConclusionIn the current absence of national policy or guidance around health promotion in schools, health has variable status in academies in England. There is a need to better engage all academy trusts in health promotion and support them to implement a strategic approach to health promotion

How do short-term associations between diet quality and metabolic risk vary with age?

Abstract: Purpose: Poor diet quality is one of the key contributors to poor cardiovascular health and associated morbidity and mortality. This study aimed to assess how the short-term associations between diet quality and metabolic risk factors change with age. Methods: This longitudinal, observational study used data from the National Diet and Nutrition Survey (2008–2016) (n = 2024). Diet quality was measured using the Dietary Approaches to Stop Hypertension (DASH) index, fruit and vegetable (F&V) intake, and a F&V biomarker score. We assessed associations between measures of diet quality and a metabolic risk z score (generated from five metabolic risk factors) among those aged 11–60 years, and then tested effect modification by age group (adolescents 11–18 years, young adults 19–35 years, mid-aged adults 36–60 years). Results: Analysis across all age groups showed inverse associations between standardised DASH index and metabolic risk z score of − 0.19 (95% CI − 0.26, − 0.11). These associations were moderated by age group, with strong associations seen in mid-aged adults: − 0.27 (95% CI − 0.39, − 0.16), but associations were significantly attenuated in young adults [− 0.10 (95% CI − 0.22, 0.01)] and adolescents [0.03 (95% CI − 0.05, 0.11)]. Similar results were found for F&V intake and F&V biomarker score. Conclusions: Short-term associations between diet quality and metabolic risk are not consistent across adolescent and young adult age groups, suggesting that mechanisms by which diet impacts on metabolic risk may be acting differently in younger age groups compared to adults. Further research is warranted using longitudinal study designs and replication in different populations to understand changes in determinants of cardiometabolic health with age

How do associations between sleep duration and metabolic health differ with age in the UK general population?

Background: Despite a growing body of evidence suggesting that short sleep duration may be linked to adverse metabolic outcomes, how these associations differ between age groups remains unclear. We use eight years of data from the UK National Diet and Nutritional Survey (NDNS) (2008–2016) to analyse cross-sectional relationships between sleep duration and metabolic risk in participants aged 11–70 years. Methods: Participants (n = 2008) who provided both metabolic risk and sleep duration data were included. Self-reported sleep duration was standardised by age, to account for differences in age-related sleep requirements. A standardised metabolic risk score was constructed, comprising: waist circumference, blood pressure, serum triglycerides, serum high-density lipoprotein cholesterol, and fasting plasma glucose. Regression models were constructed across four age groups from adolescents to older adults. Results: Overall, decreased sleep duration (hrs) was associated with an increased metabolic risk (standard deviations) with significant quadratic (B:0.028 [95%CI: 0.007, 0.050]) and linear (B:-0.061 [95%CI: -0.111, -0.011]) sleep duration coefficients. When separated by age group, stronger associations were seen among mid-aged adults (36-50y) (quadratic coefficient: 0.038 [95%CI: 0.002, 0.074]) compared to other age groups (e.g. adolescents (11-18y), quadratic coefficient: -0.009 [95%CI: -0.042, 0.025]). An increased difference between weekend and weekday sleep was only associated with increased metabolic risk in adults aged 51–70 years (B:0.18 [95%CI: 0.005, 0.348]). Conclusions: Our results indicate that sleep duration is linked to adverse metabolic risk and suggest heterogeneity between age groups. Longitudinal studies with larger sample sizes are required to explore long-term effects of abnormal sleep and potential remedial benefits

Impact of adult weight management interventions on mental health: a systematic review and meta-analysis protocol

Introduction: The effects of interventions targeting weight loss on physical health are well described, yet the evidence for mental health is less clear. It is essential to better understand the impact of weight management interventions on mental health to optimise care and minimise risk of harm. We will assess the effect of behavioural weight management interventions on mental health in adults with overweight and obesity. Methods and analysis: The systematic review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance. We will include behavioural weight management interventions with a diet and/or physical activity component focusing on weight loss for adults with a body mass index ≥25 kg/m2. Randomised controlled trials (RCTs) and cluster RCTs will be the only eligible study designs. Outcomes of interest will be related to mental health. The following databases were searched from inception to 07 May 2019: MEDLINE, Embase, Cochrane database (CENTRAL), PsycINFO, ASSIA, AMED and CINAHL. The search strategy was based on four concepts: (1) adults, defined as ≥18 years, with overweight/obesity, defined as BMI ≥25kg/m², (2) weight management interventions, (3) mental health outcomes and (4) study design. The search was restricted to English-language published papers, with no other restrictions applied. Two stage screening for eligibility will be completed by two independent reviewers, with two independent reviewers completing data extraction and risk of bias assessment. Data permitting, a random-effects meta-analysis of outcomes, subgroup analyses and meta-regression will be conducted. If not appropriate, narrative synthesis and ‘levels of evidence’ assessment will be completed. Ethics and dissemination: Ethical approval is not required as primary data will not be collected. The completed systematic review will be disseminated in a peer-reviewed journal, at conferences and contribute towards the lead author’s PhD thesis. PROSPERO registration number: CRD42019131659

Cohabiting and becoming a parent: associations with changes in physical activity in the 1970 British cohort study

Abstract: Background: We examined the association between family–related life events (cohabitation/marriage and becoming a parent) and change in physical activity. Methods: Longitudinal data (n = 8045) from the 1970 British Cohort Study (30 and 34 years) were included. Life events (beginning cohabitation/marriage and becoming a parent) were reported and coded: 0 no, 1 yes, for each event occurring between 30 and 34 years. Participants reported frequency of participation in leisure-time physical activity at 30 and 34 years (Likert scale: mean change calculated ranging between − 4 and 4). Linear regression models were used to examine the association between life events and physical activity change (comparing individuals experiencing events between 30 and 34 years versus never experiencing the event - excluding participants that experienced previous events – with a final analysis sample of n = 3833 in parenthood analysis; n = 1137 in cohabitation analysis). Interaction terms were used to analyse combined parenthood and cohabitation status. Analyses were adjusted for level of education achieved, ethnicity, country of origin and other life events. ANCOVA was used to examine associations between change in physical activity and child age. Results: Compared to remaining without children, becoming a parent was associated with a greater reduction in physical activity among men [β:-0.234(95%CI:-0.396 to − 0.072)] but not women [0.126(− 0.048;0.301)]. No associations were found between cohabitation and physical activity. Men who became fathers both while cohabitating [− 0.201(− 0.383;-0.020)] and without cohabiting [− 0.937(− 1.623;-0.250)] experienced greater physical activity declines than those remaining single and without children; the decline was greatest among non-cohabiting fathers. These associations did not differ by child age. Conclusions: Parenthood appears to differentially impact physical activity for men and women; this association also differs by cohabitation status. Parenthood appears to be most detrimental to physical activity levels among men. Interventions for physical activity could target new or soon-to-be parents, especially fathers. Further analyses with device-measured physical activity data would be valuable to advance understanding of these associations