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Wang Y, Zhang J, Feng X, Liang Y, Guan Z, Meng K. The development and validation of the hospital organizational environment scale for medical staff in China. Front Public Health 2023; 11:1118337. [PMID: 37809008 PMCID: PMC10551627 DOI: 10.3389/fpubh.2023.1118337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 09/05/2023] [Indexed: 10/10/2023] Open
Abstract
Objectives There is currently no measure of the hospital organizational environment targeting both clinicians and nurses in China. This study was conducted with the aim of developing and testing an instrument to assess the properties of the hospital organizational environment that is applicable to Chinese medical staff. Methods Items were developed based on a literature review, semi-structured interviews and an expert review and finalized based on corrected item-total correlation, content validity, construct validity, convergent validity, discriminant validity and reliability. The two samples for testing the first and final version of the Hospital Organizational Environment Scale (HOES) included 447 and 424 participants, respectively. Results The primary test, which comprised 18 items, contained four factors: hospital culture, work situation, organizational support and scientific research situation. The Cronbach's alphas were 0.935, 0.824, 0.943, and 0.920, respectively. The results of the validation test showed that the questionnaire had good validity and reliability. Conclusion The HOES is a comprehensive instrument with demonstrated validity and reliability that can be adopted among medical staff to assess the organizational environment in hospitals.
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Affiliation(s)
- Yu Wang
- School of Public Health, Capital Medical University, Beijing, China
| | - Jingwen Zhang
- School of Public Health, Capital Medical University, Beijing, China
| | - Xingmiao Feng
- School of Public Health, Capital Medical University, Beijing, China
| | - Yan Liang
- Shunyi Hospital of Beijing Traditional Chinese Medicine Hospital, Beijing, China
| | - Zhongjun Guan
- School of Public Health, Capital Medical University, Beijing, China
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Kai Meng
- School of Public Health, Capital Medical University, Beijing, China
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Erfani K, Grabowski A, Parker G, Garrity A, Peterson KE, Lee JM, Nanda U. Point of Decision Design to Address Adolescent Overweight and Obesity. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2023; 16:182-194. [PMID: 36946329 PMCID: PMC11042780 DOI: 10.1177/19375867231153365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
OBJECTIVES This study aims to utilize the point of decision design framework to understand how, where, and why adolescents and families make decisions about diet and physical activity and to explore how modifications to the environment can help to promote healthier choices and reduce obesity. BACKGROUND Child and adolescent obesity is a critical public health problem. As environmental factors are a primary contributor, understanding the role of design in our surrounding environment highlights an important area of interdisciplinary study. Design strategies have been used successfully to increase stair use and reduce sedentary behavior and can be used to further promote healthier diet and activity choices among adolescents and families. METHODS We leveraged the human-centered design-thinking process through (1) qualitative interviews and survey instruments, (2) persona and prompt development, and (3) a design workshop with multidisciplinary stakeholders. RESULTS Five personas were developed from the qualitative data and used in a design-thinking workshop. During the workshop, participants generated 12 influential factors and nine points of decision which were used to generate 33 solutions spanning the design continuum (from information and policy design to the design of urban, architectural, and interior environments) aimed at improving nutrition and physical activity among adolescents. Additionally, a tool kit was prototyped, which includes interview guides, a persona framework, and a workshop facilitation guide. CONCLUSIONS Our novel process led to the generation of design solutions that can be implemented to expand and improve upon existing interventions for childhood obesity and create environments that encourage positive health outcomes.
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Affiliation(s)
- Kimia Erfani
- A. Alfred Taubman College of Architecture and Urban Planning, University of Michigan, Ann Arbor, MI, USA
| | - Aria Grabowski
- Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Grant Parker
- A. Alfred Taubman College of Architecture and Urban Planning, University of Michigan, Ann Arbor, MI, USA
| | - Ashley Garrity
- Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA
- Division of Pediatric Endocrinology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Karen E. Peterson
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Joyce M. Lee
- Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA
- Division of Pediatric Endocrinology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Upali Nanda
- A. Alfred Taubman College of Architecture and Urban Planning, University of Michigan, Ann Arbor, MI, USA
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3
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A systematic review of existing observational tools to measure the food and physical activity environment in schools. Health Place 2020; 66:102388. [DOI: 10.1016/j.healthplace.2020.102388] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 05/17/2020] [Accepted: 06/23/2020] [Indexed: 01/18/2023]
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Azzopardi-Muscat N, Brambilla A, Caracci F, Capolongo S. Synergies in Design and Health. The role of architects and urban health planners in tackling key contemporary public health challenges. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:9-20. [PMID: 32275262 PMCID: PMC7975902 DOI: 10.23750/abm.v91i3-s.9414] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 03/24/2020] [Indexed: 12/31/2022]
Abstract
Background and aim: Important public health improvements have been achieved over the past decades, but new challenges are emerging and progress cannot be taken for granted. Urban settlements host most of the global population, but they are also sources of several threats. The aim of the paper is to investigate the role of architects and planners in contributing to overcome these critical health challenges and propose strategic actions for collaboration with the public health workforce. Methods: Taking global trends and public health challenges as starting point, a scoping literature review has been conducted to illustrate the possible synergies that architecture and public health workforce should exploit to support population health improvement and tackle key public health challenges. Results: The built environment affects climate change and public health through the use of resources, site location, and green spaces. In architecture curricula, limited space is devoted to health and vice versa. There is an urgent need for recognition of the benefits of collaboration and cross-fertilisation between public health and planning workforce from local to global levels. Conclusion: Public health is evolving from a bio-medical to a socio-anthropological approach and architects/planners have fundamental roles; further collaboration, research and training are needed.
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Affiliation(s)
- Natasha Azzopardi-Muscat
- University of Malta, Department of Health Services Management, Faculty of Health Science, Malta.
| | - Andrea Brambilla
- Politecnico di Milano, Department Architecture Built environment Construction engineering (ABC), Italy.
| | - Francesca Caracci
- University of Palermo, Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), Italy.
| | - Stefano Capolongo
- Politecnico di Milano, Department Architecture Built environment Construction engineering (ABC), Italy.
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Graziose MM, Koch PA, Wolf R, Gray HL, Trent R, Contento IR. Cafeteria noise exposure and fruit and vegetable consumption at school lunch: A cross-sectional study of elementary students. Appetite 2019; 136:130-136. [PMID: 30711485 DOI: 10.1016/j.appet.2019.01.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 01/24/2019] [Accepted: 01/29/2019] [Indexed: 10/27/2022]
Abstract
Presently in the U.S., few children meet the recommendation for daily consumption of fruits and vegetables (FV). School feeding programs have shown promise for increasing FV consumption among young children. However, several aspects of the school cafeteria environment have not been examined regarding their relationship with FV consumption. The purpose of this study was to examine the relationship between noise, selected environmental factors previously explored in the literature (i.e., recess/lunch order, the amount of time allocated for lunch, the presence of a salad bar, and number of FV items offered) and 2nd and 3rd grade students' FV consumption during lunch. A digital photography method was used to assess FV consumption among students across 40 days from 20 schools and environmental exposures, including the noise or sound pressure level of the cafeteria, were assessed during lunch. On average, students in this study consumed 0.35 (SD = 0.31) cups of fruit and 0.24 (SD = 0.29) cups of vegetables. The average noise level in cafeterias was 79.7 (SD = 4.1) Leq DbA (range 70 DbA - 84 DbA). Combined FV consumption was negatively associated with noise exposure (B = -0.017; SE = 0.004; P < 0.001) in hierarchical linear models. Among young children eating in cafeterias, increased noise levels may decrease consumption of fruits and vegetables at the school lunch meal. We hypothesize that increased noise can work in two ways to decrease FV consumption: increased socializing (i.e., talking) and/or decreased hedonic enjoyment of the school lunch meal, however future research is needed to examine these mechanisms and provide causal evidence of this effect.
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Affiliation(s)
- Matthew M Graziose
- Department of Health and Behavior Studies, Teachers College Columbia University, 525 West 120th Street, Box 137, New York, NY, 10027, USA.
| | - Pamela A Koch
- Department of Health and Behavior Studies, Teachers College Columbia University, 525 West 120th Street, Box 137, New York, NY, 10027, USA.
| | - Randi Wolf
- Department of Health and Behavior Studies, Teachers College Columbia University, 525 West 120th Street, Box 137, New York, NY, 10027, USA.
| | - Heewon L Gray
- Department of Community and Family Health, College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd, MDC56, Tampa, USA.
| | - Raynika Trent
- Department of Health and Behavior Studies, Teachers College Columbia University, 525 West 120th Street, Box 137, New York, NY, 10027, USA.
| | - Isobel R Contento
- Department of Health and Behavior Studies, Teachers College Columbia University, 525 West 120th Street, Box 137, New York, NY, 10027, USA.
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Rollings KA, Wells NM. Cafeteria assessment for elementary schools (CAFES): development, reliability testing, and predictive validity analysis. BMC Public Health 2018; 18:1154. [PMID: 30285685 PMCID: PMC6171137 DOI: 10.1186/s12889-018-6032-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 09/10/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Strategies to reduce childhood obesity and improve nutrition include creating school food environments that promote healthy eating. Despite well-documented health benefits of fruit and vegetable (FV) consumption, many U.S. school-aged children, especially low-income youth, fail to meet national dietary guidelines for FV intake. The Cafeteria Assessment for Elementary Schools (CAFES) was developed to quantify physical attributes of elementary school cafeteria environments associated with students' selection and consumption of FV. CAFES procedures require observation of the cafeteria environment where preparation, serving, and eating occur; staff interviews; photography; and scoring. METHODS CAFES development included three phases. First, assessment items were identified via a literature review, expert panel review, and pilot testing. Second, reliability testing included calculating inter-item correlations, internal consistency (Kuder-Richardson-21 coefficients), and inter-rater reliability (percent agreement) based on data collected from 50 elementary schools in low-income communities and 3187 National School Lunch Program participants in four U.S. states. At least 43% of each participating school's students qualified for free- or reduced-price meals. Third, FV servings and consumption data, obtained from lunch tray photography, and multi-level modeling were used to assess the predictive validity of CAFES. RESULTS CAFES' 198 items (grouped into 108 questions) capture four environmental scales: room (50 points), table/display (133 points), plate (4 points), and food (11 points). Internal consistency (KR-21) was 0.88 (overall), 0.80 (room), 0.72 (table), 0.83 (plate), and 0.58 (food). Room subscales include ambient environment, appearance, windows, layout/visibility, healthy signage, and kitchen/serving area. Table subscales include furniture, availability, display layout/presentation, serving method, and variety. Inter-rater reliability (percent agreement) of the final CAFES tool was 90%. Predictive validity analyses indicated that the total CAFES and four measurement scale scores were significantly associated with percentage consumed of FV served (p < .05). CONCLUSIONS CAFES offers a practical and low-cost measurement tool for school staff, design and public health practitioners, and researchers to identify critical areas for intervention; suggest low- and no-cost intervention strategies; and contribute to guidelines for cafeteria design, food presentation and layout, and operations aimed at promoting healthy eating among elementary school students.
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Affiliation(s)
- Kimberly A. Rollings
- School of Architecture, University of Notre Dame, 110 Bond Hall, Notre Dame, IN 46556 USA
| | - Nancy M. Wells
- Design + Environmental Analysis, College of Human Ecology, Cornell University, 1411 Martha Van Rensselaer Hall, Ithaca, NY 14853 USA
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7
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Comparison of the Effects of Stable and Dynamic Furniture on Physical Activity and Learning in Children. J Prim Prev 2016; 37:555-560. [PMID: 27785657 DOI: 10.1007/s10935-016-0451-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We compared the effects of traditional (stable) and non-traditional (dynamic) school furniture on children's physical activity (PA), energy expenditure (EE), information retention, and math skills. Participants were 12 students (8.3 years, 58 % boys) in grades 1-5. Participants wore an Actigraph GT3X+ accelerometer (to assess PA), and an Oxycon Mobile indirect calorimetry device (to assess EE) for 40 min (20 min for each session). Each session consisted of a nutrition lecture, multiple choice questions related to the lecture, and grade-appropriate math problems. We used paired t tests to examine differences between the stable and dynamic furniture conditions. Average activity counts were significantly greater in the dynamic than the stable furniture condition (40.82 vs. 9.81, p < 0.05). We found no significant differences between conditions for average oxygen uptake (p = 0.34), percentage of nutrition questions (p = 0.5), or math problems (p = 0.93) answered correctly. Movement was significantly greater in the dynamic than the stable furniture condition, and did not impede information acquisition or concentration. Future studies should compare the long-term effects of traditional and dynamic furniture on health and academic outcomes in schools and other settings.
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Ermetici F, Zelaschi RF, Briganti S, Dozio E, Gaeta M, Ambrogi F, Pelissero G, Tettamanti G, Corsi Romanelli MM, Carruba M, Morricone L, Malavazos AE. Association between a school-based intervention and adiposity outcomes in adolescents: The Italian "EAT" project. Obesity (Silver Spring) 2016; 24:687-95. [PMID: 26833570 DOI: 10.1002/oby.21365] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/19/2015] [Accepted: 09/21/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate whether a school-based multicomponent educational program could improve adiposity measures in middle-school adolescents. METHODS A non-randomized controlled pilot study was conducted in six state middle schools (487 adolescents, 11-15 years) in townships in an urban area around Milan, three schools (n = 262 adolescents) being assigned to the intervention group and three schools (n = 225 adolescents) to the control group. The two-school-year intervention included changes in the school environment (alternative healthy vending machines, educational posters) and individual reinforcement tools (school lessons, textbook, text messages, pedometers, re-usable water bottles). The main outcome measure was change in BMI z-score. The secondary outcomes were changes in waist-to-height ratio (WHtR) and behavioral habits. RESULTS The intervention was associated with a significant difference in BMI z-score (-0.18 ± 0.03, P<0.01) and in WHtR (-0.04 ± 0.002, P < 0.001), after controlling for baseline covariates. Subgroup analysis showed the maximum association between the intervention and the difference in BMI z-score for girls with overweight/obesity. Physical activity increased and consumption of sugar-sweetened beverages and high-energy snacks decreased in adolescents after the intervention. CONCLUSIONS A school-based multicomponent intervention conducted at both environmental and individual levels may be effective for reducing adiposity measures mainly in adolescents with overweight/obesity.
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Affiliation(s)
- Federica Ermetici
- Diabetology and Metabolic Diseases Unit, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Roberta F Zelaschi
- Diabetology and Metabolic Diseases Unit, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Silvia Briganti
- Diabetology and Metabolic Diseases Unit, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Elena Dozio
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Maddalena Gaeta
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Federico Ambrogi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Gabriele Pelissero
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Guido Tettamanti
- I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Massimiliano Marco Corsi Romanelli
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Operative Unit Service of Laboratory Medicine-1 Clinical Pathology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Michele Carruba
- Department of Medical Biotechnology and Translational Medicine, Center for Study and Research on Obesity, University of Milan, Milan, Italy
| | - Lelio Morricone
- Diabetology and Metabolic Diseases Unit, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Alexis E Malavazos
- Diabetology and Metabolic Diseases Unit, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Milan, Italy
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Brittin J, Sorensen D, Trowbridge M, Lee KK, Breithecker D, Frerichs L, Huang T. Physical Activity Design Guidelines for School Architecture. PLoS One 2015; 10:e0132597. [PMID: 26230850 PMCID: PMC4521876 DOI: 10.1371/journal.pone.0132597] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 06/16/2015] [Indexed: 11/19/2022] Open
Abstract
Increasing children's physical activity at school is a national focus in the U.S. to address childhood obesity. While research has demonstrated associations between aspects of school environments and students' physical activity, the literature currently lacks a synthesis of evidence to serve as a practical, spatially-organized resource for school designers and decision-makers, as well as to point to pertinent research opportunities. This paper describes the development of a new practical tool: Physical Activity Design Guidelines for School Architecture. Its aims are to provide architects and designers, as well as school planners, educators, and public health professionals, with strategies for making K-12 school environments conducive to healthy physical activity, and to engage scientists in transdisciplinary perspectives toward improved knowledge of the school environment's impact. We used a qualitative review process to develop evidence-based and theory-driven school design guidelines that promote increased physical activity among students. The design guidelines include specific strategies in 10 school design domains. Implementation of the guidelines is expected to enable students to adopt healthier physical activity behaviors. The tool bridges a translational gap between research and environmental design practice, and may contribute to setting new industry and education standards.
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Affiliation(s)
- Jeri Brittin
- University of Nebraska Medical Center, College of Public Health, Department of Health Promotion, Social & Behavioral Health, Omaha, NE, United States of America
| | - Dina Sorensen
- VMDO Architects, Charlottesville, VA, United States of America
| | - Matthew Trowbridge
- University of Virginia School of Medicine, Department of Emergency Medicine, Charlottesville, VA, United States of America
| | - Karen K. Lee
- New York City Department of Health and Mental Hygiene, New York, NY, United States of America
| | - Dieter Breithecker
- Federal Institute for Posture and Mobilisation Support, Wiesbaden, Germany
| | - Leah Frerichs
- University of Nebraska Medical Center, College of Public Health, Department of Health Promotion, Social & Behavioral Health, Omaha, NE, United States of America
- University of North Carolina, Chapel Hill, Center for Health Equity, Chapel Hill, NC, United States of America
| | - Terry Huang
- University of Nebraska Medical Center, College of Public Health, Department of Health Promotion, Social & Behavioral Health, Omaha, NE, United States of America
- City University of New York, School of Public Health, New York, NY, United States of America
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Frerichs L, Brittin J, Sorensen D, Trowbridge MJ, Yaroch AL, Siahpush M, Tibbits M, Huang TTK. Influence of school architecture and design on healthy eating: a review of the evidence. Am J Public Health 2015; 105:e46-57. [PMID: 25713964 PMCID: PMC4358206 DOI: 10.2105/ajph.2014.302453] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2014] [Indexed: 11/04/2022]
Abstract
We examined evidence regarding the influence of school physical environment on healthy-eating outcomes. We applied a systems perspective to examine multiple disciplines' theoretical frameworks and used a mixed-methods systematic narrative review method, considering both qualitative and quantitative sources (published through March 2014) for inclusion. We developed a causal loop diagram from 102 sources identified. We found evidence of the influence of many aspects of a school's physical environment on healthy-eating outcomes. The causal loop diagram highlights multilevel and interrelated factors and elucidates the specific roles of design and architecture in encouraging healthy eating within schools. Our review highlighted the gaps in current evidence and identified areas of research needed to refine and expand school architecture and design strategies for addressing healthy eating.
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Affiliation(s)
- Leah Frerichs
- At the time of the study, Leah Frerichs, Jeri Brittin, Amy L. Yaroch, Mohammad Siahpush, Melissa Tibbits, and Terry T.-K. Huang were with the College of Public Health, University of Nebraska Medical Center, Omaha. Dina Sorensen is with VMDO Architects, Charlottesville, VA. Matthew J. Trowbridge is with the School of Medicine, University of Virginia, Charlottesville
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11
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Wijnhoven TMA, van Raaij JMA, Sjöberg A, Eldin N, Yngve A, Kunešová M, Starc G, Rito AI, Duleva V, Hassapidou M, Martos E, Pudule I, Petrauskiene A, Sant'Angelo VF, Hovengen R, Breda J. WHO European Childhood Obesity Surveillance Initiative: School nutrition environment and body mass index in primary schools. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:11261-85. [PMID: 25361044 PMCID: PMC4245612 DOI: 10.3390/ijerph111111261] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 10/14/2014] [Accepted: 10/20/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Schools are important settings for the promotion of a healthy diet and sufficient physical activity and thus overweight prevention. OBJECTIVE To assess differences in school nutrition environment and body mass index (BMI) in primary schools between and within 12 European countries. METHODS Data from the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative (COSI) were used (1831 and 2045 schools in 2007/2008 and 2009/2010, respectively). School personnel provided information on 18 school environmental characteristics on nutrition and physical activity. A school nutrition environment score was calculated using five nutrition-related characteristics whereby higher scores correspond to higher support for a healthy school nutrition environment. Trained field workers measured children's weight and height; BMI-for-age (BMI/A) Z-scores were computed using the 2007 WHO growth reference and, for each school, the mean of the children's BMI/A Z-scores was calculated. RESULTS Large between-country differences were found in the availability of food items on the premises (e.g., fresh fruit could be obtained in 12%-95% of schools) and school nutrition environment scores (range: 0.30-0.93). Low-score countries (Bulgaria, Czech Republic, Greece, Hungary, Latvia and Lithuania) graded less than three characteristics as supportive. High-score (≥0.70) countries were Ireland, Malta, Norway, Portugal, Slovenia and Sweden. The combined absence of cold drinks containing sugar, sweet snacks and salted snacks were more observed in high-score countries than in low-score countries. Largest within-country school nutrition environment scores were found in Bulgaria, Czech Republic, Greece, Hungary, Latvia and Lithuania. All country-level BMI/A Z-scores were positive (range: 0.20-1.02), indicating higher BMI values than the 2007 WHO growth reference. With the exception of Norway and Sweden, a country-specific association between the school nutrition environment score and the school BMI/A Z-score was not observed. CONCLUSIONS Some European countries have implemented more school policies that are supportive to a healthy nutrition environment than others. However, most countries with low school nutrition environment scores also host schools with supportive school environment policies, suggesting that a uniform school policy to tackle the "unhealthy" school nutrition environment has not been implemented at the same level throughout a country and may underline the need for harmonized school policies.
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Affiliation(s)
- Trudy M A Wijnhoven
- Division of Noncommunicable Diseases and Life-Course, WHO Regional Office for Europe, UN City, Marmorvej 51, DK-2100 Copenhagen ø, Denmark.
| | - Joop M A van Raaij
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, P.O. Box 1, 3720 BA Bilthoven, The Netherlands.
| | - Agneta Sjöberg
- Department of Food and Nutrition and Sport Science, University of Gothenburg, P.O. Box 300, SE-405 30 Gothenburg, Sweden.
| | - Nazih Eldin
- Health Promotion Department, Health Service Executive, Railway Street, Navan, County Meath, Ireland.
| | - Agneta Yngve
- School of Hospitality, Culinary Arts and Meal Science, Örebro University, Campus Grythyttan, P.O. Box 1, SE-712 60 Grythyttan, Sweden.
| | - Marie Kunešová
- Obesity Management Centre, Institute of Endocrinology, Narodni 8, 11694 Prague 1, Czech Republic.
| | - Gregor Starc
- Faculty of Sport, University of Ljubljana, Gortanova 22, 1000 Ljubljana, Slovenia.
| | - Ana I Rito
- Division of Noncommunicable Diseases and Life-Course, WHO Regional Office for Europe, UN City, Marmorvej 51, DK-2100 Copenhagen ø, Denmark.
| | - Vesselka Duleva
- Division of Noncommunicable Diseases and Life-Course, WHO Regional Office for Europe, UN City, Marmorvej 51, DK-2100 Copenhagen ø, Denmark.
| | - Maria Hassapidou
- Division of Noncommunicable Diseases and Life-Course, WHO Regional Office for Europe, UN City, Marmorvej 51, DK-2100 Copenhagen ø, Denmark.
| | - Eva Martos
- Division of Noncommunicable Diseases and Life-Course, WHO Regional Office for Europe, UN City, Marmorvej 51, DK-2100 Copenhagen ø, Denmark.
| | - Iveta Pudule
- Division of Noncommunicable Diseases and Life-Course, WHO Regional Office for Europe, UN City, Marmorvej 51, DK-2100 Copenhagen ø, Denmark.
| | - Ausra Petrauskiene
- Division of Noncommunicable Diseases and Life-Course, WHO Regional Office for Europe, UN City, Marmorvej 51, DK-2100 Copenhagen ø, Denmark.
| | - Victoria Farrugia Sant'Angelo
- Division of Noncommunicable Diseases and Life-Course, WHO Regional Office for Europe, UN City, Marmorvej 51, DK-2100 Copenhagen ø, Denmark.
| | - Ragnhild Hovengen
- Division of Noncommunicable Diseases and Life-Course, WHO Regional Office for Europe, UN City, Marmorvej 51, DK-2100 Copenhagen ø, Denmark.
| | - João Breda
- Division of Noncommunicable Diseases and Life-Course, WHO Regional Office for Europe, UN City, Marmorvej 51, DK-2100 Copenhagen ø, Denmark.
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Pavelka J, Sigmund E, Hamřík Z, Kalman M. Analysis of foreign physical activity recommendations and guidelines for schools. ACTA GYMNICA 2014. [DOI: 10.5507/ag.2014.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Abstract
More than one-half of young adults aged 18-24 y have at least 1 coronary heart disease (CHD) risk factor and nearly one-quarter have advanced atherosclerotic lesions. The extent of atherosclerosis is directly correlated with the number of risk factors. Unhealthy dietary choices made by this age group contribute to weight gain and dyslipidemia. Risk factor profiles in young adulthood strongly predict long-term CHD risk. Early detection is critical to identify individuals at risk and to promote lifestyle changes before disease progression occurs. Despite the presence of risk factors and pathological changes, risk assessment and disease prevention efforts are lacking in this age group. Most young adults are not screened and are unaware of their risk. This review provides pathological evidence along with current risk factor prevalence data to demonstrate the need for early detection. Eighty percent of heart disease is preventable through diet and lifestyle, and young adults are ideal targets for prevention efforts because they are in the process of establishing lifestyle habits, which track forward into adulthood. This review aims to establish the need for increased screening, risk assessment, education, and management in young adults. These essential screening efforts should include the assessment of all CHD risk factors and lifestyle habits (diet, exercise, and smoking), blood pressure, glucose, and body mass index in addition to the traditional lipid panel for effective long-term risk reduction.
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Affiliation(s)
- Jennifer Arts
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI; and
| | | | - Ingrid E. Lofgren
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI; and
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Huang TTK, Sorensen D, Davis S, Frerichs L, Brittin J, Celentano J, Callahan K, Trowbridge MJ. Healthy eating design guidelines for school architecture. Prev Chronic Dis 2013; 10:E27. [PMID: 23449281 PMCID: PMC3592783 DOI: 10.5888/pcd10.120084] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
We developed a new tool, Healthy Eating Design Guidelines for School Architecture, to provide practitioners in architecture and public health with a practical set of spatially organized and theory-based strategies for making school environments more conducive to learning about and practicing healthy eating by optimizing physical resources and learning spaces. The design guidelines, developed through multidisciplinary collaboration, cover 10 domains of the school food environment (eg, cafeteria, kitchen, garden) and 5 core healthy eating design principles. A school redesign project in Dillwyn, Virginia, used the tool to improve the schools’ ability to adopt a healthy nutrition curriculum and promote healthy eating. The new tool, now in a pilot version, is expected to evolve as its components are tested and evaluated through public health and design research.
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Affiliation(s)
- Terry T-K Huang
- University of Nebraska Medical Center College of Public Health, Omaha, NE, USA
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Trowbridge MJ, Huang TTK, Botchwey ND, Fisher TR, Pyke C, Rodgers AB, Ballard-Barbash R. Public health and the green building industry: partnership opportunities for childhood obesity prevention. Am J Prev Med 2013; 44:489-95. [PMID: 23597813 DOI: 10.1016/j.amepre.2013.01.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 10/25/2012] [Accepted: 01/08/2013] [Indexed: 11/17/2022]
Affiliation(s)
- Matthew J Trowbridge
- Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA.
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Abstract
Pediatric obesity is a major health problem and has reached epidemiological proportions today. The present paper reviews major psychological issues in pediatric obesity from a developmental perspective. Research and literature has shown that a number of developmental, family, maternal and child factors are responsible in the genesis of pediatric obesity. Family food habits, early developmental lifestyle of the child, parenting, early family relationships and harmony all contribute towards the growth and development of a child. The present review focuses on the role of developmental psychological factors in the pathogenesis of pediatric obesity and highlights the developmental factors that must be kept in mind when evaluating a case of pediatric obesity.
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Affiliation(s)
- Gurvinder Kalra
- Department of Psychiatry, L.T.M. Medical College and L.T.M.G. Hospital, Sion, Mumbai, Maharashtra, India
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17
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Factors associated with overweight in children living in the neighbourhoods of an urban area of Brazil. Public Health Nutr 2011; 15:1056-64. [PMID: 22030258 DOI: 10.1017/s1368980011002771] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The present study aimed to investigate the individual and family determinants of being overweight among children younger than 10 years of age. DESIGN Cross-sectional survey. Direct data on children's age, food intake, physical activity, type of transportation used and anthropometric measurements, as well as the education level of the mothers, were collected by trained interviewers. SETTING Population-based study in the city of Santos, Brazil. SUBJECTS A total of 531 children under 10 years of age (302 aged <6 years, 229 aged ≥6 years), living in the city of Santos. RESULTS The overall prevalence of overweight and obesity (BMI-for-age Z-score >1) was 35·4 % for children under 6 years and 38·9 % for children aged 6-10 years. The socio-economic status of the family was associated with being overweight for both age groups. Logistic regression analysis showed that the lower the socio-economic status, the higher the likelihood of being overweight, among both younger children (OR = 7·73; P = 0·02) and older children (OR = 1·98; P = 0·04). The use of active transportation was associated with a lower likelihood of being overweight, but only among younger children (OR = 1·70; P = 0·05). CONCLUSIONS Socio-economic status seems to be an important individual-level determinant of overweight in children. Public policies should consider promoting the use of active transportation, as the results showed it to have a positive effect on reducing overweight issues. The high prevalence of overweight in younger children suggests that this age group should be a priority in health-promoting interventions.
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Bocarro JN, Kanters MA, Cerin E, Floyd MF, Casper JM, Suau LJ, McKenzie TL. School sport policy and school-based physical activity environments and their association with observed physical activity in middle school children. Health Place 2011; 18:31-8. [PMID: 21900034 DOI: 10.1016/j.healthplace.2011.08.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Revised: 07/29/2011] [Accepted: 08/10/2011] [Indexed: 10/17/2022]
Abstract
Empirical research on the effects of school sport policies on children's physical activity is limited. This study examined sport policies (intramural vs. varsity), physical settings within schools, and supervision in relation to physical activity using the System for Observing Play and Leisure in Youth (SOPLAY). Data were collected on physical activity levels of children in four middle schools. Regression analyses assessed the main effects of sport policy, type of physical activity setting, and supervision as well as interactions. Regression models were stratified by gender. Children in intramural schools were more likely to use indoor spaces and be boys. Regression models indicated that varsity sport programs were associated with lower physical activity levels among boys but not girls. Significant associations between type of physical activity settings and physical activity levels were observed only for boys. Adult supervision was not associated with children's physical activity levels. Finally, descriptive results showed athletic facilities were under-utilized in all schools.
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Affiliation(s)
- Jason N Bocarro
- Department of Parks, Recreation, and Tourism Management, North Carolina State University, Box 8004, Raleigh, NC 27695-8004, USA.
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McAdams CB. The environment and pediatric overweight: a review for nurse practitioners. ACTA ACUST UNITED AC 2011; 22:460-7. [PMID: 20854637 DOI: 10.1111/j.1745-7599.2010.00537.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE The primary aim of this article is to review environmental determinates on eating and physical activity behaviors that lead to overweight status in the pediatric population. DATA SOURCES Selected articles on pediatric obesity and overweight and federal government publications addressing pediatric overweight, physical activity, and dietary habits. CONCLUSIONS Obesity is one of the leading preventable causes of disease and death in the United States and is considered a major public health threat to Americans of all ages. An energy-dense diet coupled with low physical activity creates an environment conducive to obesity. Obesity warrants immediate attention and nurse practitioners (NPs) must implement proactive strategies to prevent the development of chronic disease in American children and adolescents. An initial key to successful prevention is identification of environmental supports and barriers that influence pediatric overweight. IMPLICATIONS FOR PRACTICE NPs must identify at-risk and overweight youth and translate current research findings into their practices. Designing and implementing age and family appropriate strategies that address positive and negative environmental influences is crucial to prevent or reduce the overweight epidemic.
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Affiliation(s)
- Cynthia B McAdams
- School of Nursing, The University of Texas at Austin, Austin, Texas, USA.
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Parrish AM, Iverson D, Russell K, Yeatman H. The development of a unique physical activity self-report for young children: challenges and lessons learned. Res Sports Med 2010; 18:71-83. [PMID: 20391248 DOI: 10.1080/15438620903423874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The number of overweight and obese children in the Western world is alarming. Efforts to impact this problem at an individual level have had little effect. Interventions that focus on the whole population may prove more successful. This study reports the development of a unique self-report picture questionnaire designed to assess playground physical activity preferences in young children (4-9 years, N = 1,881) at 14 regional Australian primary schools. Children's picture preferences were compared with observational data using the Children's Activity Scanning tool (CAST2). Results indicate that 62% to 89% of children preferred activities that were moderate or highly active; however, CAST2 data indicated that children spent only 50% to 70% of play time being active. The findings confirm that young children are able to indicate their preferences for physical activity. Important considerations in future attempts to develop a measure of physical activity in young children are discussed.
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Affiliation(s)
- Anne-Maree Parrish
- Faculty of Health and Behavioural Sciences, University of Wollongong, Northfields Ave., New South Wales 2522, Australia.
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Solution-oriented research converging efforts of promoting environmental sustainability and obesity prevention. Am J Prev Med 2009; 36:S60-2. [PMID: 19147062 DOI: 10.1016/j.amepre.2008.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2008] [Revised: 10/31/2008] [Accepted: 11/04/2008] [Indexed: 11/20/2022]
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