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Witvorapong N. Healthy behaviours and productive activities among Thai older adults: A repeated cross-sectional analysis. Soc Sci Med 2018; 213:12-19. [PMID: 30055421 DOI: 10.1016/j.socscimed.2018.07.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 06/12/2018] [Accepted: 07/18/2018] [Indexed: 10/28/2022]
Abstract
Based on a nationally representative repeated cross-sectional sample of older individuals from the 2007 and 2011 Surveys of Older Persons in Thailand (n = 50,138, with the participation rate of 95.79%), this study investigates the extent to which healthy behaviours are interrelated with productive activities in old age. Healthy behaviours were represented by alcohol abstinence, tobacco abstinence, physical exercise, and consumption of a nutritious diet, encompassing all major lifestyle choices that could lower mortality risks among the general population. Productive activities were represented by social participation and labour participation, consistent with the paradigms of Active and Productive Ageing promoted by the World Health Organization. A multivariate probit model, whereby all six behaviours were jointly estimated, was explored. Conditional on pairwise combinations of the two productive activities, the probabilities of contemporaneously undertaking all four healthy behaviours were calculated. The results illustrate that the relationships among productive activities and health behaviours are inextricable and complex. Considering each of the four healthy behaviours separately, social participation and labour participation are associated with lower probabilities of abstaining from alcohol and tobacco but higher probabilities of exercising and keeping a nutritious diet among older adults. Considering all four healthy behaviours together, the productive activities are associated with a significant increase in the probability that a Thai older adult would simultaneously abstain from alcohol, abstain from tobacco, exercise, and eat healthily, compared to if the same individual undertakes neither social participation nor labour participation. This study calls for a consistent set of multiple-behaviour interventions to promote healthy and productive ageing.
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Affiliation(s)
- Nopphol Witvorapong
- Centre for Health Economics, Faculty of Economics, Chulalongkorn University, Pathumwan, Bangkok, 10330, Thailand.
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Wyatt K, Lloyd J, Creanor S, Green C, Dean SG, Hillsdon M, Abraham C, Tomlinson R, Pearson V, Taylor RS, Ryan E, Streeter A, McHugh C, Hurst A, Price L, Crathorne L, Krägeloh C, Siegert R, Logan S. Cluster randomised controlled trial and economic and process evaluation to determine the effectiveness and cost-effectiveness of a novel intervention [Healthy Lifestyles Programme (HeLP)] to prevent obesity in school children. PUBLIC HEALTH RESEARCH 2018. [DOI: 10.3310/phr06010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundApproximately one-third of children in England leave primary school overweight or obese. There is little evidence of effective obesity prevention programmes for children in this age group.ObjectiveTo determine the effectiveness and cost-effectiveness of a school-based healthy lifestyles programme in preventing obesity in children aged 9–10 years.DesignA cluster randomised controlled trial with an economic and process evaluation.SettingThirty-two primary schools in south-west England.ParticipantsChildren in Year 5 (aged 9–10 years) at recruitment and in Year 7 (aged 11–12 years) at 24 months’ post-baseline follow-up.InterventionThe Healthy Lifestyles Programme (HeLP) ran during the spring and summer terms of Year 5 into the autumn term of Year 6 and included four phases: (1) building a receptive environment, (2) a drama-based healthy lifestyles week, (3) one-to-one goal setting and (4) reinforcement activities.Main outcome measuresThe primary outcome measure was body mass index (BMI) standard deviation score (SDS) at 24 months post baseline measures (12 months post intervention). The secondary outcomes comprised waist circumference SDS, percentage body fat SDS, proportion of children overweight and obese at 18 and 24 months, accelerometer-assessed physical activity and food intake at 18 months, and cost-effectiveness.ResultsWe recruited 32 schools and 1324 children. We had a rate of 94% follow-up for the primary outcome. No difference in BMI SDS was found at 24 months [mean difference –0.02, 95% confidence interval (CI) –0.09 to 0.05] or at 18 months (mean difference –0.02, 95% CI –0.08 to 0.05) between children in the intervention schools and children in the control schools. No difference was found between the intervention and control groups in waist circumference SDS, percentage body fat SDS or physical activity levels. Self-reported dietary behaviours showed that, at 18 months, children in the intervention schools consumed fewer energy-dense snacks and had fewer negative food markers than children in the control schools. The intervention effect on negative food markers was fully mediated by ‘knowledge’ and three composite variables: ‘confidence and motivation’, ‘family approval/behaviours and child attitudes’ and ‘behaviours and strategies’. The intervention effect on energy-dense snacks was partially mediated by ‘knowledge’ and the same composite variables apart from ‘behaviours and strategies’. The cost of implementing the intervention was approximately £210 per child. The intervention was not cost-effective compared with control. The programme was delivered with high fidelity, and it engaged children, schools and families across the socioeconomic spectrum.LimitationsThe rate of response to the parent questionnaire in the process evaluation was low. Although the schools in the HeLP study included a range of levels of socioeconomic deprivation, class sizes and rural and urban settings, the number of children for whom English was an additional language was considerably lower than the national average.ConclusionsHeLP is not effective or cost-effective in preventing overweight or obesity in children aged 9–10 years.Future workOur very high levels of follow-up and fidelity of intervention delivery lead us to conclude that it is unlikely that school-based programmes targeting a single age group can ever be sufficiently intense to affect weight status. New approaches are needed that affect the school, the family and the wider environment to prevent childhood obesity.Trial registrationCurrent Controlled Trials ISRCTN15811706.FundingThis project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full inPublic Health Research; Vol. 6, No. 1. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Katrina Wyatt
- Institute for Health Research, University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter, UK
| | - Jenny Lloyd
- Institute for Health Research, University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter, UK
| | - Siobhan Creanor
- Peninsula Clinical Trials Unit and Medical Statistics, Plymouth University Peninsula Schools of Medicine & Dentistry, Plymouth, UK
| | - Colin Green
- Institute for Health Research, University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter, UK
| | - Sarah G Dean
- Institute for Health Research, University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter, UK
| | - Melvyn Hillsdon
- Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Charles Abraham
- Institute for Health Research, University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter, UK
| | | | | | - Rod S Taylor
- Institute for Health Research, University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter, UK
| | | | - Adam Streeter
- Peninsula Clinical Trials Unit and Medical Statistics, Plymouth University Peninsula Schools of Medicine & Dentistry, Plymouth, UK
| | - Camilla McHugh
- Institute for Health Research, University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter, UK
| | - Alison Hurst
- Institute for Health Research, University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter, UK
| | - Lisa Price
- Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Louise Crathorne
- Institute for Health Research, University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter, UK
| | - Chris Krägeloh
- Health Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Richard Siegert
- Health Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Stuart Logan
- Institute for Health Research, University of Exeter Medical School, South Cloisters, St Luke’s Campus, Exeter, UK
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Williams AJ, Wyatt KM, Williams CA, Logan S, Henley WE. Exploring the Potential of a School Impact on Pupil Weight Status: Exploratory Factor Analysis and Repeat Cross-Sectional Study of the National Child Measurement Programme. PLoS One 2015; 10:e0145128. [PMID: 26700027 PMCID: PMC4699206 DOI: 10.1371/journal.pone.0145128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 11/27/2015] [Indexed: 11/19/2022] Open
Abstract
Schools are common sites for obesity prevention interventions. Although many theories suggest that the school context influences weight status, there has been little empirical research. The objective of this study was to explore whether features of the school context were consistently and meaningfully associated with pupil weight status (overweight or obese). Exploratory factor analysis of routinely collected data on 319 primary schools in Devon, England, was used to identify possible school-based contextual factors. Repeated cross-sectional multilevel analysis of five years (2006/07-2010/11) of data from the National Child Measurement Programme was then used to test for consistent and meaningful associations. Four school-based contextual factors were derived which ranked schools according to deprivation, location, resource and prioritisation of physical activity. None of which were meaningfully and consistently associated with pupil weight status, across the five years. The lack of consistent associations between the factors and pupil weight status suggests that the school context is not inherently obesogenic. In contrast, incorporating findings from education research indicates that schools may be equalising weight status, and obesity prevention research, policy and practice might need to address what is happening outside schools and particularly during the school holidays.
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Affiliation(s)
- Andrew James Williams
- Farr Institute @ Scotland and Scottish Collaboration for Public Health Research and Policy, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, 20 West Richmond Street, Edinburgh EH8 9DX, United Kingdom
- Institute of Health Services Research, University of Exeter Medical School (formerly Peninsula College of Medicine and Dentistry), South Cloisters, St. Luke’s Campus, Exeter EX1 2LU, United Kingdom
- Children’s Health and Exercise Research Centre, Sport and Health Sciences, St. Luke’s Campus, University of Exeter, Exeter, EX1 2LU, United Kingdom
| | - Katrina M. Wyatt
- Institute of Health Services Research, University of Exeter Medical School (formerly Peninsula College of Medicine and Dentistry), South Cloisters, St. Luke’s Campus, Exeter EX1 2LU, United Kingdom
| | - Craig A. Williams
- Children’s Health and Exercise Research Centre, Sport and Health Sciences, St. Luke’s Campus, University of Exeter, Exeter, EX1 2LU, United Kingdom
| | - Stuart Logan
- Institute of Health Services Research, University of Exeter Medical School (formerly Peninsula College of Medicine and Dentistry), South Cloisters, St. Luke’s Campus, Exeter EX1 2LU, United Kingdom
| | - William E. Henley
- Institute of Health Services Research, University of Exeter Medical School (formerly Peninsula College of Medicine and Dentistry), College House, St. Luke’s Campus, Exeter EX1 2LU, United Kingdom
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