Obesity in Hong Kong Chinese preschool children: where are all the nurses?

Geographic Clustering of Fast-Food Restaurants Around Secondary Schools in Hong Kong

Introduction

Clustering of fast-food restaurants around schools facilitates fast-food consumption among students, which may cause obesity. We examined the prevalence of fast-food restaurants and identified the clusters of fast-food restaurants near secondary schools in Hong Kong.

Methods

We collected data of Western fast-food chain restaurants and 490 secondary schools in Hong Kong. Descriptive statistics and buffer analysis identified the prevalence of fast-food restaurants around the secondary schools within 400-m and 800-m buffers. Additional analyses compared schools stratified by the 3 main regions in Hong Kong, district-level population density, and median monthly household income. We used Getis-Ord GI* hot spot analysis to measure spatial clusters of fast-food restaurants around schools and Global Moran’s I to measure the spatial autocorrelation based on each school and the number of fast-food restaurants within the 400-m buffer.

Results

The average number of fast-food restaurants within 400 m and 800 m of a school was 2.0 and 6.3, respectively. Seven in 10 secondary schools had at least 1 fast-food restaurant within 400 m. The number of schools with no fast-food restaurants was higher in Hong Kong Island, considered the “rich region” in Hong Kong. Hot spots of clusters were significantly located in the high-density downtown areas. We observed significant spatial autocorrelation between fast-food restaurants and secondary schools in the areas with high density, low income, and high income (P < .001, z > 2.58).

Conclusion

Fast-food restaurants were substantially clustered around secondary schools in Hong Kong. Territory-wide studies about the health effect of fast-food clusters around schools on children and adolescents are warranted in Hong Kong.

Nursing care of overweight children: A concept analysis

AIM

To report an analysis of the concept nursing care of overweight children.

BACKGROUND

Patient care is the essence of nursing practice. Nursing professionals must define how to serve specific population groups, including overweight children, presenting real solutions to their problem. A clear conceptual analysis is necessary to unify nursing language and to contribute to nursing practice.

DESIGN

Concept analysis.

DATA SOURCES

The following databases were searched: COCHRANE, SCOPUS, LILACS, CINAHL, MEDLINE/PubMed, and CAPES Theses Library of Brazil.

REVIEW METHODS

Walker and Avant's concept analysis methodology was adopted in this study. Twenty-two articles were analyzed, and the uses, attributes, antecedents, and outcomes of the concept were identified. The nursing care assumptions proposed by Virginia Henderson comprised the theoretical referential.

RESULTS

The attributes of nursing care for overweight children included investigation, guidance, and monitoring of dietary, clinical, academic, and social aspects, along with evaluation of lifestyle and anthropometric data related to the affected children and their families.

CONCLUSION

This study enabled the construction of a defined concept for nursing care of overweight children that may be useful in the construction of a medium-range theory. Further research is recommended to verify the usefulness of the nursing approach.

Promoting healthy eating and active playtime by connecting to nature families with preschool children: evaluation of pilot study "Play&Grow"

BACKGROUND

This pilot project aimed to evaluate the "Play&Grow" program which promotes age-appropriate dietary habits and playtime healthy routines through "connectedness to nature" experiences in Hong Kong families with young children.

METHOD

Thirty-eight preschoolers (aged 33.97 ± 9.38 mo), mothers, and their domestic workers were recruited. The families attended one workshop/week for a 4-mo period, consisting of: (i) health topic; (ii) food games; (iii) nature-related outdoor activities.

RESULTS

Feeding practices, particularly Promoting and Encouragement to eat (PE) and Instrumental Feeding (IF) improved after the intervention (P = 0.008 and P = 0.016, respectively). Mother's BMI, responsibility for child's meal, child's birth weight had a bearing on the improvement of PE, r² = 0.243, F(3,33) = 3.54, P = 0.025. Domestic helper's responsibility for child's cooking and her IF practices could predict child's picky eating (r² = 0.203, F(2,34) = 4.322, P = 0.021). Mother's responsibility for child and helper's responsibility for cooking could predict child's consumption of salty foods (r² = 0.252, F(2,34) = 5.737, P = 0.007). Physical activity of caregivers improved after the intervention.

CONCLUSION

The pilot confirmed the design, protocols, evaluation instruments, and logistics of the study. Modified "Play&Grow" intervention will be conducted in a more rigorous randomized controlled trial to determine the long-term impact on obesity prevention in Hong Kong.

A randomized controlled trial for families with preschool children - promoting healthy eating and active playtime by connecting to nature

BACKGROUND

Promotion of healthy lifestyles in children focuses predominantly on proper nutrition and physical activity, elements now widely recognised as essential for a healthy life. Systematic reviews have shown that nature-related activities also enhance general well-being as reflected in increased physical activity, a healthier diet, reduced stress and better sleep. Recent research suggests that many young children in Hong Kong between the ages of two and four in Hong Kong are more sedentary than recommended and seldom participate in active play, placing them at risk of becoming overweight or obese. The proposed project aims to investigate whether connecting families to nature positively influences physical activity (i.e., active playtime) and healthy eating routines in children aged 2 to 4.

METHODS

We recently conducted a pilot study in Hong Kong to develop a programme, Play & Grow, based on the most successful evidence-based international preschool interventions. In addition to adopting the healthy eating and physical activity elements of these interventions, this project will additionally include a third novel element of Connectedness to nature: discovering nature through games and awareness of sounds, touch, smells, and temperature. To test the effectiveness of this modified intervention, a randomised controlled trial (RCT) involving 240 families with children aged 2 to 4 will be conducted. Families and children will take part in weekly one-hour activity sessions for 10-weeks. Lifestyle-related habits will be assessed before and immediately after the 10-week intervention, with follow up testing at 6 and 12 months' post intervention.

DISCUSSION

A novel measuring tool created specifically for assessing Connectedness to nature, Nature Relatedness Scale (NRS), will be validated and tested for reliability prior to the RCT. The results of the RCT are intended to be used to understand which components of the intervention are most effective. The objectives of this project will be achieved over a 30-month period and will contribute to the research that examines key components of successful healthy lifestyle promotion programmes during early childhood. We predict that the inclusion of Connectedness to nature will significantly improve recognised preschool interventions. Finally, the aim of targeting family involvement will hopefully increase the sustainability of longer-term lifestyle modifications in children.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT02715544 . Registered 22 March 2016.

Chinese parental perceptions of weight and associated health risks of young children

A mixed method was employed to determine how caregivers view preschool children’s body size and associated health risks. A survey of 505 caregivers was nested in 10 in-depth case studies of mothers. Based on the International Obesity Task Force calculation of children’s weight status, the caregivers who had underweight children overestimated their children’s weight status but the caregivers who had overweight/obese children underestimated their children’s weight status. Their estimates were substantially different from those of the caregivers of normal weight children. The mothers’ thoughts revealed the complexity of beliefs and sociocultural experiences about weight preferences and affirmed the quantitative findings.

Childhood obesity in transition zones: an analysis using structuration theory

Childhood obesity is particularly prevalent in areas that have seen rapid economic growth, urbanisation, cultural transition, and commodification of food systems. Structuration theory may illuminate the interaction between population and individual-level causes of obesity. We conducted in-depth ethnographies of six overweight/obese and four non-overweight preschool children in Hong Kong, each followed for 12-18 months. Analysis was informed by Stones' strong structuration theory. Risk factors played out differently for different children as social structures were enacted at the level of family and preschool. The network of caregiving roles and relationships around the overweight/obese child was typically weak and disjointed, and the primary caregiver appeared confused by mixed messages about what is normal, expected and legitimate behaviour. In particular, external social structures created pressure to shift childcare routines from the logic of nurturing to the logic of consumption. Our findings suggest that threats to what Giddens called ontological security in the primary caregiver may underpin the poor parenting, family stress and weak mealtime routines that mediate the relationship between an obesogenic environment and the development of obesity in a particular child. This preliminary study offers a potentially transferable approach for studying emerging epidemics of diseases of modernity in transition societies.