Addressing the burden of obesity among disadvantaged families

The different ways in which the issue of childhood obesity can be addressed among disadvantaged families and how staff of human service organisations can support families are discussed. Efforts to improve the physical and mental health and social integration of disadvantaged families through supporting healthy lifestyles should be organisational priorities

Characteristics of the home food environment that mediate immediate and sustained increases in child fruit and vegetable consumption: mediation analysis from the Healthy Habits cluster randomised controlled trial

BACKGROUND: The home food environment can influence the development of dietary behaviours in children, and interventions that modify characteristics of the home food environment have been shown to increase children’s fruit and vegetable consumption. However to date, interventions to increase children’s fruit and vegetable consumption have generally produced only modest effects. Mediation analysis can help in the design of more efficient and effective interventions by identifying the mechanisms through which interventions have an effect. This study aimed to identify characteristics of the home food environment that mediated immediate and sustained increases in children’s fruit and vegetable consumption following the 4-week Healthy Habits telephone-based parent intervention. METHOD: Analysis was conducted using 2-month (immediate) and 12-month (sustained) follow-up data from a cluster randomised control trial of a home food environment intervention to increase the fruit and vegetable consumption of preschool children. Using recursive path analysis, a series of mediation models were created to investigate the direct and indirect effects of immediate and sustained changes to characteristics of the home food environment (fruit and vegetable availability, accessibility, parent intake, parent providing behaviour, role-modelling, mealtime eating practices, child feeding strategies, and pressure to eat), on the change in children’s fruit and vegetable consumption. RESULTS: Of the 394 participants in the randomised trial, 357 and 329 completed the 2- and 12-month follow-up respectively. The final mediation model suggests that the effect of the intervention on the children’s fruit and vegetable consumption was mediated by parent fruit and vegetable intake and parent provision of these foods at both 2- and 12-month follow-up. CONCLUSION: Analysis of data from the Healthy Habits trial suggests that two environmental variables (parental intake and parent providing) mediate the immediate and sustained effect of the intervention, and it is recommended these variables be targeted in subsequent home food environment interventions to bring about immediate and sustained changes in child fruit and vegetable intake. TRIAL REGISTRATION: ACTRN12609000820202

Interventions in sports settings to reduce alcohol consumption and alcohol-related harm: a systematic review protocol

Introduction: Alcohol consumption is a primary cause of physical, psychological and social harm to both the user and others. At both the professional and non-professional level, sports players and fans report consuming alcohol at greater levels than people not involved in sports. Limited systematic reviews have been conducted assessing interventions targeting alcohol consumption behaviour and related harms in the sporting context. Methods and analysis: The review aims to determine if interventions implemented in the sport setting decrease alcohol consumption and related harms. Participants may include all persons regardless of age or other characteristics. Studies will be included which have implemented interventions within the sport setting and have either measured: alcohol consumption, excessive alcohol consumption or intoxication or alcohol-related injury or violence. Randomised controlled trials, staggered enrolment trials, stepped-wedged trials, quasi-randomised trials, quasi-experimental trials and natural experiments will be included. Studies without a parallel comparison group will be excluded. Data will be sourced from a range of electronic databases and sources of grey literature. Two authors will independently screen all titles and abstracts of papers identified through the search strategy. Two authors will independently examine the full text of all remaining papers to determine eligibility. Two authors will independently extract data from eligible studies and independently assess risk of bias by assessing the adequacy of study characteristics. Where studies are sufficiently homogeneous, trial results will be synthesised using a fixed-effects meta-analysis. Standardised mean differences will be used for continuous outcomes and RRs will be used for binary outcomes. Dissemination: The findings of this study will be disseminated widely through mechanisms including peer-reviewed publications and conference presentations

Obesity prevention and human service organisations : a survey of managers

The work of human service organisation staff to prevent obesity by assisting disadvantaged families to eat healthily and be active is discussed. The key findings of a study to describe managers' perceptions of the healthy eating and physical activity needs of vulnerable families are highlighted

Associations between characteristics of the home food environment and fruit and vegetable intake in preschool children: A cross-sectional study

Early childhood is critical to the development of lifelong food habits. Given the high proportion of children with inadequate fruit and vegetable consumption, identification of modifiable factors associated with higher consumption may be useful in developing interventions to address this public health issue. This study aimed to identify the characteristics of the home food environment that are associated with higher fruit and vegetable consumption in a sample of Australian preschool children. A cross-sectional telephone survey was conducted with 396 parents of 3 to 5 year-old children attending 30 preschools within the Hunter region, New South Wales, Australia. Children's fruit and vegetable consumption was measured using a valid and reliable subscale from the Children's Dietary Questionnaire. Associations were investigated between children's fruit and vegetable intake and characteristics of the home food environment including parental role-modeling, parental providing behaviour, fruit and vegetable availability, fruit and vegetable accessibility, pressure to eat, family eating policies and family mealtime practices. Characteristics of the home food environment that showed evidence of an association with children's fruit and vegetable consumption in simple regression models were entered into a backwards stepwise multiple regression analysis. The multiple regression analysis used generalised linear mixed models, controlled for parental education, household income and child gender, and was adjusted for the correlation between children's fruit and vegetable consumption within a preschool. The multiple regression analysis found positive associations between children's fruit and vegetable consumption and parental fruit and vegetable intake (p = 0.005), fruit and vegetable availability (p = 0.006) and accessibility (p = 0.012), the number of occasions each day that parents provided their child with fruit and vegetables (p < 0.001), and allowing children to eat only at set meal times all or most of the time (p = 0.006). Combined, these characteristics of the home food environment accounted for 48% of the variation in the child's fruit and vegetable score. This study identified a range of modifiable characteristics within the home food environment that are associated with fruit and vegetable consumption among preschool children. Such characteristics could be considered potential targets for interventions to promote intake among children of this age

A cluster randomised controlled trial of a telephone-based intervention targeting the home food environment of preschoolers (The Healthy Habits Trial): the effect on parent fruit and vegetable consumption

AbstractBackground: The home food environment is an important setting for the development of dietary patterns in childhood. Interventions that support parents to modify the home food environment for their children, however, may also improve parent diet. The purpose of this study was to assess the impact of a telephone-based intervention targeting the home food environment of preschool children on the fruit and vegetable consumption of parents.Methods: In 2010, 394 parents of 3 &ndash; 5 year &ndash; old children from 30 preschools in the Hunter region of Australia were recruited to this cluster randomised controlled trial and were randomly assigned to an intervention or control group. Intervention group parents received four weekly 30-minute telephone calls and written resources. The scripted calls focused on; fruit and vegetable availability and accessibility, parental role-modelling, and supportive home food routines. Two items from the Australian National Nutrition Survey were used to assess the average number of serves of fruit and vegetables consumed each day by parents at baseline, and 2-, 6-, 12-, and 18-months later, using generalised estimating equations (adjusted for baseline values and clustering by preschool) and an intention-to-treat-approach.Results: At each follow-up, vegetable consumption among intervention parents significantly exceeded that of controls. At 2-months the difference was 0.71 serves (95% CI: 0.58-0.85, p &lt; 0.0001), and at 18-months the difference was 0.36 serves (95% CI: 0.10-0.61, p = 0.0067). Fruit consumption among intervention parents was found to significantly exceed consumption of control parents at the 2-,12- and 18-month follow-up, with the difference at 2-months being 0.26 serves (95% CI: 0.12-0.40, p = 0.0003), and 0.26 serves maintained at 18-months, (95% CI: 0.10-0.43, p = 0.0015).Conclusions: A four-contact telephone-based intervention that focuses on changing characteristics of preschoolers&rsquo; home food environment can increase parents&rsquo; fruit and vegetable consumption.(ANZCTR12609000820202)<br /

Management by results and facets of information: focus on the Pact for Life of Pernambuco State, Brazil

The new public management (NPM) was adopted by many countries in response to the inefficiency of the public sector and economic inertia in the 1970s. The state government of Pernambuco, Brazil, adopted the NPM ideas as a broader scope of public management. This management model has several strategic objectives and their performance indicators to measure the results. The government has been using information as a strategic element and it permeates all functions of management, policy and planning. This study chose the Pacto pela Vida – PPV (Pact for Life), which is the public security policy. As object of analysis, it offers through the information management practices, based on Braman’s information policy, the theoretical and methodological examples needed to provide evidence, as informational practices reveal the use of power. It concludes that information policy demonstrated informational and symbolic powers of the actors who have been processing and gathering information in the PPV

Interventions in sports settings to reduce risky alcohol consumption and alcohol-related harm: a systematic review

Background: Elevated levels of risky alcohol consumption and alcohol-related harm have been reported for sportspeople and supporters compared to non-sporting populations. Limited systematic reviews have been conducted to assess the effect of interventions targeting such behaviours. Methods: A review was undertaken to determine if interventions implemented in sports settings decreased alcohol consumption and related harms. Studies were included that implemented interventions within sports settings; measured alcohol consumption or alcohol-related injury or violence and were either randomised controlled trials, staggered enrolment trials, stepped-wedged trials, quasi-randomised trials, quasi-experimental trials or natural experiments. Studies without a parallel comparison group were excluded. Studies from both published and grey literature were included. Two authors independently screened potential studies against the eligibility criteria, and two authors independently extracted data from included studies and assessed risk of bias. The results of included studies were synthesised narratively. Results: The title and abstract of 6382 papers and the full text of 45 of these papers were screened for eligibility. Three studies met the inclusion criteria for the review. One of the included studies was a randomised controlled trial (RCT) of a cognitive-behavioural intervention with athletes within an Olympic training facility in the USA. The study reported a significant change in alcohol use between pre-test and follow-up between intervention and control groups. The other two studies were RCTs in community sports clubs in Ireland and Australia. The Australian study found a significant intervention effect for both risky alcohol consumption at sports clubs and overall risk of alcohol-related harm. The Irish study found no significant intervention effect. Conclusions: A limited number of studies have been conducted to assess the effect of interventions implemented in sports settings on alcohol consumption and related harms. While two of the three studies found significant intervention effects, it is difficult to determine the extent to which such effects are generalisable. Further controlled trials are required in this setting. Systematic review registration: PROSPERO CRD4201400173

Advice on healthy eating and physical activity where it is needed most : empowering home-visiting human services to provide the right information at the right time to vulnerable families

Background: Excessive weight gain adversely impacts on the health, social and economic wellbeing of children and families. The aim of this pilot study was to assess the feasibility of a practice change intervention to improve the physical activity and healthy eating support offered by staff of human service organisations during home visits. Methods: The study employed a pre-post design. Sixty nine support staff and 29 managers from human service organisations from the Hunter New England Area Health Service (HNEAHS) region of NSW participated in the trial. Research officers provided staff with healthy eating and physical activity training, telephone support and resources, and encouraged managers to adopt a healthy eating and physical activity policy, and to support their staff in providing healthy eating and physical activity guidance to families. Results: Compared to pre-intervention, support staff of human service organisations were more likely to provide healthy eating and physical activity support to client families. The intervention was found to be acceptable to staff and managers. Conclusion: The findings of this study suggest that a variety of supportive, practice change initiatives may be a feasible approach to increasing obesity prevention support provided to disadvantaged families by human service organisation staff

Validity of a self-report survey tool measuring the nutrition and physical activity environment of primary schools

Background: Valid tools measuring characteristics of the school environment associated with the physical activity and dietary behaviours of children are needed to accurately evaluate the impact of initiatives to improve school environments. The aim of this study was to assess the validity of Principal self-report of primary school healthy eating and physical activity environments. Methods: Primary school Principals (n = 42) in New South Wales, Australia were invited to complete a telephone survey of the school environment; the School Environment Assessment Tool – SEAT. Equivalent observational data were collected by pre-service teachers located within the school. The SEAT, involved 65 items that assessed food availability via canteens, vending machines and fundraisers and the presence of physical activity facilities, equipment and organised physical activities. Kappa statistics were used to assess agreement between the two measures. Results: Almost 70% of the survey demonstrated moderate to almost perfect agreement. Substantial agreement was found for 10 of 13 items assessing foods sold for fundraising, 3 of 6 items assessing physical activity facilities of the school, and both items assessing organised physical activities that occurred at recess and lunch and school sport. Limited agreement was found for items assessing foods sold through canteens and access to small screen recreation. Conclusions: The SEAT provides researchers and policy makers with a valid tool for assessing aspects of the school food and physical activity environment