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Alalawi A, Blank L, Goyder E. Umbrella review of international evidence for the effectiveness of school-based physical activity interventions. PLoS One 2024; 19:e0304513. [PMID: 38870155 PMCID: PMC11175402 DOI: 10.1371/journal.pone.0304513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 05/14/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Obesity and physical inactivity among children and young people are public health concerns. Despite the wide variety of interventions available to promote physical activity, little is known about which interventions are most effective. This review aimed to evaluate the existing literature on school-based interventions that aim to increase physical activity among children and young people aged 6 to 18 years. METHODS A systematic review of reviews was undertaken. We searched for systematic reviews and meta-analyses published between December 2017 and January 2024 using databases such as PubMed, Scopus, and CINAHL. Titles and abstracts were independently screened by two reviewers, who also conducted data extraction and quality assessments. We focused on outcomes like changes in physical activity levels and body mass index to assess the effectiveness of the interventions. RESULTS A total of 23 reviews examining school-based physical activity interventions met the inclusion criteria, comprising 15 systematic reviews and 8 meta-analyses. All reviews (N = 23) were implemented in the school setting: three in primary schools, seven in secondary schools, and thirteen targeted both primary and secondary schools. The findings demonstrated that six reviews reported a statistical increase in physical activity levels among the target population, and one review found a decrease in body mass index. The most promising interventions focused on physical activity included within the school curriculum and were characterised as long-term interventions. 20 out of 23 reviews assessed the quality of primary studies. CONCLUSION Some interventions were promising in promoting physical activity among school-aged children and young people such as Daily Mile, Active Break, and Active transport while multi-component interventions seem to be positively effective in reducing BMI. Future efforts should focus on long-term, theory-driven programmes to ensure sustainable increases in physical activity.
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Affiliation(s)
- Abdullah Alalawi
- Health and Related Research, University of Sheffield, Sheffield, United Kingdom
- Al Qunfudah Health Sciences College, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Lindsay Blank
- Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Elizabeth Goyder
- Health and Related Research, University of Sheffield, Sheffield, United Kingdom
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Takens FE, Indyk I, Chinapaw MJM, Ujčič-Voortman JK, van Nassau F, Busch V. Qualitative multi-stakeholder evaluation of the adoption, implementation and sustainment of the school-based dietary intervention "Jump-in". BMC Public Health 2024; 24:1337. [PMID: 38760727 PMCID: PMC11102190 DOI: 10.1186/s12889-024-18814-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 05/09/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Comprehensive school-based programs applying the WHO Health Promoting School Model have the potential to initiate and sustain behavior change and impact health. However, since they often include intervention efforts on a school's policies, physical environment, curriculum, health care and involving parents and communities, they significantly 'intrude' on a complex system that is aimed primarily at education, not health promotion. More insights into and concrete strategies are therefore needed regarding their adoption, implementation, and sustainment processes to address the challenge to sustainable implementation of HPS initiatives in a primarily educational setting. This study consequently evaluates adoption, implementation and sustainment processes of Amsterdam's Jump-in healthy nutrition HPS intervention from a multi-stakeholder perspective. METHODS We conducted semi-structured interviews and focus groups with all involved stakeholders (n = 131), i.e., Jump-in health promotion professionals (n = 5), school principals (n = 7), at-school Jump-in coordinators (n = 7), teachers (n = 20), parents (n = 50, 9 groups) and children (n = 42, 7 groups) from 10 primary schools that enrolled in Jump-in in the school year 2016-2017. Included schools had a higher prevalence of overweight and/or obesity than the Dutch average and they were all located in Amsterdam's low-SEP neighborhoods. Data were analyzed using a directed content analysis, in which the Determinants of Innovation Model was used for obtaining theory-based predetermined codes, supplemented with new codes emerging from the data. RESULTS During intervention adoption, all stakeholders emphasized the importance of parental support, and accompanying workshops and promotional materials. Additionally, parents and teachers indicated that a shared responsibility for children's health and nuanced framing of health messages were important. During implementation, all stakeholders needed clear guidelines and support structures. Teachers and children highlighted the importance of peer influence, social norms, and uniform application of guidelines. School staff also found further tailoring of the intervention and dealing with financial constraints important. For long-term intervention sustainment, incorporating the intervention policies into the school statutes was crucial according to health promotion professionals. CONCLUSIONS This qualitative evaluation provides valuable insights into factors influencing the adoption, implementation, and sustainment processes of dietary interventions, such as the importance of transparent and consistent intervention guidelines, clear communication regarding the rationale behind intervention guidelines, and, stakeholders' involvement in decision-making.
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Affiliation(s)
- Froukje E Takens
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands.
- Amsterdam Public Health Research Institute, Health Behaviour and Chronic Diseases, Amsterdam, The Netherlands.
- Department Gezond Leven, Public Health Service of Amsterdam, Team Sarphati Amsterdam, Nieuwe Achtergracht 100, 1018 WT, Amsterdam, The Netherlands.
| | - Indira Indyk
- Department Gezond Leven, Public Health Service of Amsterdam, Team Sarphati Amsterdam, Nieuwe Achtergracht 100, 1018 WT, Amsterdam, The Netherlands.
| | - Mai J M Chinapaw
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Health Behaviour and Chronic Diseases, Amsterdam, The Netherlands
| | - Joanne K Ujčič-Voortman
- Department Gezond Leven, Public Health Service of Amsterdam, Team Sarphati Amsterdam, Nieuwe Achtergracht 100, 1018 WT, Amsterdam, The Netherlands
| | - Femke van Nassau
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Health Behaviour and Chronic Diseases, Amsterdam, The Netherlands
| | - Vincent Busch
- Department Gezond Leven, Public Health Service of Amsterdam, Team Sarphati Amsterdam, Nieuwe Achtergracht 100, 1018 WT, Amsterdam, The Netherlands
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Heerman WJ, Kenney E, Block JP, Fiechtner L, McMahon E, Kruse L, Sharifi M, Edmondson EK, Virudachalam S. A Narrative Review of Public Health Interventions for Childhood Obesity. Curr Obes Rep 2024; 13:87-97. [PMID: 38172483 DOI: 10.1007/s13679-023-00550-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE OF REVIEW Public health interventions that intervene on macrolevel systems hold the promise of reducing childhood obesity at the population level through prevention. The purpose of this review is to highlight some of the recent and best scientific evidence related to public health interventions for the prevention of childhood obesity. We provide a narrative review of scientific evidence for six categories of public health interventions and their impact on childhood obesity: federal nutrition assistance programs, programs implemented in early care and education centers, interventions to support healthy nutrition and physical activity in schools, community-based programs and policies, labeling policies and marketing to children, and taxes on sugar sweetened beverages (SSB). RECENT FINDINGS Federal nutrition assistance programs have the strongest evidence to support reduction in childhood obesity and serve populations with the highest prevalence of childhood obesity. Other interventions including SSB taxes, community-wide interventions, and interventions at schools and early care and education centers also show significant improvements in child weight status. Overall public health interventions have strong evidence to support widespread implementation in service of reducing childhood obesity rates at the population level. To effectively address the recalcitrant childhood obesity epidemic, multi-pronged solutions are needed. The current evidence for public health obesity interventions is consistent with the paradigm that recognizes the importance of macrolevel systems influences on childhood obesity: interventions that are most effective intervene at macrolevels.
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Affiliation(s)
- William J Heerman
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, USA.
| | - Erica Kenney
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Jason P Block
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, USA
| | - Lauren Fiechtner
- Division of Pediatric Gastroenterology and Nutrition, Mass General for Children, The Greater Boston Food Bank, Boston, USA
| | - Ellen McMahon
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, USA
| | - Lauren Kruse
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, USA
| | - Mona Sharifi
- Department of Pediatrics, Yale School of Medicine, New Haven, USA
| | - Emma K Edmondson
- Department of Pediatrics and Leonard Davis Institute of Health Economics at University of Pennsylvania Perelman School of Medicine, Division of General Pediatrics, PolicyLab, and Clinical Futures at Children's Hospital of Philadelphia, Philadelphia, USA
| | - Senbagam Virudachalam
- Department of Pediatrics and Leonard Davis Institute of Health Economics at University of Pennsylvania Perelman School of Medicine, Division of General Pediatrics, PolicyLab, and Clinical Futures at Children's Hospital of Philadelphia, Philadelphia, USA
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4
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Quail KR, Ward CL. Using Non-Violent Discipline Tools: Evidence Suggesting the Importance of Attunement. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7187. [PMID: 38131738 PMCID: PMC10742770 DOI: 10.3390/ijerph20247187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/07/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023]
Abstract
Training in non-violent discipline is important to prevent violence against children and ensure that their caregivers remain a safe base for them. This paper aims to deepen understanding of non-violent discipline by exploring attunement as a mechanism in the effectiveness of non-violent discipline tools. Attunement describes the sensitive responsiveness of caregivers towards their children and has been found to be central to the formation of secure attachment bonds and development of self-regulation. It includes understanding or being "in tune with" the child's needs and signals, matching these with appropriate responses. The objective of this paper is to explore attunement in relation to non-violent discipline. Peer-reviewed systematic reviews previously included in a systematic overview of evidence on non-violent discipline options were screened for information relevant to attunement. All reviews were published in English between 1999 and 2018 and offered evidence on at least one non-violent discipline tool. Although no reviews explicitly addressed attunement, evidence was found suggesting its importance in the use and effectiveness of discipline methods. Research directly investigating attunement in discipline is needed.
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Affiliation(s)
- Karen R. Quail
- Department of Psychology, Faculty of Humanities, University of Cape Town, Cape Town 7700, South Africa;
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Denova-Gutiérrez E, González-Rocha A, Méndez-Sánchez L, Araiza-Nava B, Balderas N, López G, Tolentino-Mayo L, Jauregui A, Hernández L, Unikel C, Bonvecchio A, Shamah T, Barquera S, Rivera JA. Overview of Systematic Reviews of Health Interventions for the Prevention and Treatment of Overweight and Obesity in Children. Nutrients 2023; 15:nu15030773. [PMID: 36771481 PMCID: PMC9921486 DOI: 10.3390/nu15030773] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 01/25/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023] Open
Abstract
(1) Background: The importance of studying the health interventions used to prevent and treat overweight and obesity in school-aged children is imperative. This overview aimed to summarize systematic reviews that assess the effects of school-based, family, and mixed health interventions for preventing and treating overweight and obesity in school-aged children. (2) Methods: The Cochrane Collaboration methodology and PRISMA statement were followed. A search was conducted using terms adapted to 12 databases. Systematic reviews reporting interventions in children from six to 12 years old with an outcome related to preventing or treating obesity and overweight were included. Studies with pharmacological or surgical interventions and adolescents were excluded. (3) Results: A total of 15,226 registers were identified from databases and citation searching. Of those, ten systematic reviews published between 2013 and 2022 were included. After the overlap, 331 interventions for children between 6 and 12 years old were identified, and 61.6% involved physical activity and nutrition/diet intervention. Multicomponent intervention, combining physical activity with nutrition and behavioral change, school-based plus community-based interventions may be more effective in reducing overweight and obesity in children. (4) Conclusions: Plenty of interventions for childhood overweight and obesity aimed at prevention and treatment were identified, but there is a gap in the methodological quality preventing the establishment of a certain recommendation.
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Affiliation(s)
- Edgar Denova-Gutiérrez
- Nutrition and Health Research Center, National Institute of Public Health, Cuernavaca 62100, Mexico
- Correspondence: ; Tel.: +52-5554322986
| | - Alejandra González-Rocha
- Nutrition and Health Research Center, National Institute of Public Health, Cuernavaca 62100, Mexico
| | - Lucía Méndez-Sánchez
- Clinical Epidemiology Research Unit & Cochrane Mexico UNAM Center, Hospital Infantil de Mexico Federico Gomez, Mexico City 06720, Mexico
| | - Berenice Araiza-Nava
- Clinical Epidemiology Research Unit & Cochrane Mexico UNAM Center, Hospital Infantil de Mexico Federico Gomez, Mexico City 06720, Mexico
| | - Nydia Balderas
- Nutrition and Health Research Center, National Institute of Public Health, Cuernavaca 62100, Mexico
| | - Giovanna López
- Nutrition and Health Research Center, National Institute of Public Health, Cuernavaca 62100, Mexico
| | - Lizbeth Tolentino-Mayo
- Nutrition and Health Research Center, National Institute of Public Health, Cuernavaca 62100, Mexico
| | - Alejandra Jauregui
- Nutrition and Health Research Center, National Institute of Public Health, Cuernavaca 62100, Mexico
| | - Lucia Hernández
- Nutrition and Health Research Center, National Institute of Public Health, Cuernavaca 62100, Mexico
| | - Claudia Unikel
- Departamento de Ciencias Sociales en Salud, Dirección de Investigaciones Epidemiológica y Psicosociales, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City 14370, Mexico
| | - Anabelle Bonvecchio
- Nutrition and Health Research Center, National Institute of Public Health, Cuernavaca 62100, Mexico
| | - Teresa Shamah
- Center for Research in Evaluation and Surveys, National Institute of Public Health, Cuernavaca 62100, Mexico
| | - Simón Barquera
- Nutrition and Health Research Center, National Institute of Public Health, Cuernavaca 62100, Mexico
| | - Juan A. Rivera
- Nutrition and Health Research Center, National Institute of Public Health, Cuernavaca 62100, Mexico
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Collado-Soler R, Alférez-Pastor M, Torres FL, Trigueros R, Aguilar-Parra JM, Navarro N. A Systematic Review of Healthy Nutrition Intervention Programs in Kindergarten and Primary Education. Nutrients 2023; 15:nu15030541. [PMID: 36771248 PMCID: PMC9921877 DOI: 10.3390/nu15030541] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/07/2023] [Accepted: 01/11/2023] [Indexed: 01/21/2023] Open
Abstract
Childhood obesity and overweight rates are increasing in an exponential way. This type of diet-related health problem has consequences, not only at present but also for children's future lives. For these reasons, it is very important to find a solution, which could be nutrition intervention programs. The main objective of this article is to investigate the effectiveness of nutrition intervention programs in children aged 3-12 around the world. We used SCOPUS, Web of Science, and PubMed databases to carry out this systematic review and we followed the PRISMA statement. Two authors conducted literature searches independently, finding a total of 138 articles. Finally, after a thorough screening, a total of 19 articles were selected for detailed analysis. The results show that, in general, nutrition intervention programs are effective in improving knowledge and behaviors about healthy habits, and, consequently, that the body mass index value is reduced. However, it is true that we found differences between the incomes of families and geographical areas. In conclusion, we encourage school centers to consider including these types of programs in their educational program and bring awareness of the importance of families too.
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Affiliation(s)
- Rocio Collado-Soler
- Hum-878 Research Team, Health Research Centre, Department of Psychology, University of Almería, 04120 Almería, Spain
| | - Marina Alférez-Pastor
- Hum-878 Research Team, Health Research Centre, Department of Psychology, University of Almería, 04120 Almería, Spain
| | - Francisco L. Torres
- Hum-878 Research Team, Health Research Centre, Department of Psychology, University of Almería, 04120 Almería, Spain
| | - Rubén Trigueros
- Department of Language and Education, University of Antonio de Nebrija, 28015 Madrid, Spain
- Correspondence: (R.T.); (J.M.A.-P.)
| | - Jose M. Aguilar-Parra
- Hum-878 Research Team, Health Research Centre, Department of Psychology, University of Almería, 04120 Almería, Spain
- Correspondence: (R.T.); (J.M.A.-P.)
| | - Noelia Navarro
- Hum-878 Research Team, Health Research Centre, Department of Psychology, University of Almería, 04120 Almería, Spain
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Longitudinal effects of school policies on children's eating behaviors and weight status: findings from the childhood obesity study in China megacities. Int J Obes (Lond) 2023; 47:17-23. [PMID: 36253402 DOI: 10.1038/s41366-022-01206-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 02/06/2022] [Accepted: 08/03/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To examine longitudinal effects of school policies on children's weight status and eating behaviors, and study how these effects may vary by children's age, sex, and baseline weight status in China. METHODS Data were collected in 2015, 2016, and 2017 in an open cohort of 3298 children aged 6-17, their parents, and schools in five large cities across China (Beijing, Shanghai, Xi'an, Nanjing, and Chengdu). Children's weight, height, and waist circumference were measured, and their eating behaviors were self-reported. The 1691 children with such repeated measures in ≥ two waves were included in longitudinal data analysis with mixed effects models, testing the associations. RESULTS Having school vicinity food stall policy was associated with less frequent consumption of fast food (β = -0.14, p < 0.01) and snack (β = -0.84, p < 0.01). More significant associations were found between school policies and unhealthy eating behaviors for girls and children aged 6-11 than their counterparts. Among children without overweight or central obesity at baseline, having school cafeteria food policy was associated with lower risks for overweight and obesity (OR = 0.33, 95% CI: 0.17-0.63) and central obesity (OR = 0.47, 95% CI: 0.26-0.85). This existed for girls, but not for boys. School vicinity food stall policy was associated with lower BMI (β = -0.20, 95% CI: -0.37, -0.03) among all children and in girls (β = -0.28, 95% CI: -0.50, -0.05) without overweight at baseline. CONCLUSIONS School policies could reduce children's unhealthy eating behaviors and obesity risk in megacities in China. Children's age, sex, and baseline weight status modify the effects. School policies are important to fight the growing childhood obesity epidemic.
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Castro N, Bates LC, Zieff G, Pagan Lassalle P, Faulkner J, Lark S, Hamlin M, Skidmore P, Signal TL, Williams MA, Higgins S, Stoner L. Adiposity in preadolescent children: Associations with cardiorespiratory fitness. PLoS One 2022; 17:e0275982. [PMID: 36288267 PMCID: PMC9605025 DOI: 10.1371/journal.pone.0275982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 09/26/2022] [Indexed: 11/18/2022] Open
Abstract
Lifestyle factors contribute to childhood obesity risk, however it is unclear which lifestyle factors are most strongly associated with childhood obesity. The purpose of this cross-sectional study was to simultaneously investigate the associations among dietary patterns, activity behaviors, and physical fitness with adiposity (body fat %, fat mass, body mass index [BMI], and waist to hip ratio) in preadolescent children. Preadolescent children (N = 392, 50% female, age: 9.5 ± 1.1year, BMI: 17.9 ± 3.3 kg/m2) were recruited. Body fat (%) and fat mass (kg) were measured with bioelectrical impedance analysis. Cardiorespiratory fitness (VO2 max), muscular strength (hand-grip strength), activity, sleep, and dietary pattern was assessed. Multivariable analysis revealed that cardiorespiratory fitness associated most strongly with all four indicators of adiposity (body fat (%) (β = -0.2; p < .001), fat mass (β = -0.2; p < .001), BMI (β = -0.1; p < .001) and waist to hip ratio (β = -0.2; p < .001). Additionally, fruit and vegetable consumption patterns were associated with body fat percentage, but the association was negligible (β = 0.1; p = 0.015). Therefore, future interventions should aim to promote the use of cardiorespiratory fitness as a means of reducing the obesity epidemic in children.
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Affiliation(s)
- Nicholas Castro
- School of Health and Applied Human Sciences, University of North Carolina at Wilmington, Wilmington, NC, United States of America
| | - Lauren C. Bates
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- * E-mail:
| | - Gabriel Zieff
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Patricia Pagan Lassalle
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - James Faulkner
- School of Sport, Health, and Community, University of Winchester, Winchester, United Kingdom
| | - Sally Lark
- School of Sport, Exercise, and Nutrition, Massey University, Wellington, New Zealand
| | - Michael Hamlin
- Department of Tourism, Sport and Society, Lincoln University, Christchurch, New Zealand
| | - Paula Skidmore
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - T. Leigh Signal
- Sleep-Wake Research Centre, Massey University, Wellington, New Zealand
| | - Michelle A. Williams
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, United States of America
| | - Simon Higgins
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Lee Stoner
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
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Kim T, Kwon EH. Investigating socioecological obesogenic factors in children with Autism Spectrum Disorder. Front Public Health 2022; 10:867456. [PMID: 36276345 PMCID: PMC9582449 DOI: 10.3389/fpubh.2022.867456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 09/21/2022] [Indexed: 01/21/2023] Open
Abstract
Obesity-related information in children with Autism Spectrum Disorder (ASD) is limited, and research findings are contradictory. Thus, this study aimed to use a nationwide non-clinical sample to examine the association of sociological factors with overweight status in children with ASD and reveal the degree of differences in the risk factors for overweight in children with and without ASD. The data for this cross-sectional study, based on the modified ecological system theory model, were obtained from the 2019 National Survey of Children's Health. The weighted logistic regressions were performed to determine the factors associated with overweight status in children with ASD, controlling for demographics, physical activity-related behaviors, and family and environmental conditions. A total of 529 children were identified (mean age 13.78 years, 83.21% boys). Two-parent households, less healthy parents and households, households with smokers, poor sleep quality, and greater participation in organized activities were associated with a higher likelihood of overweight in children with ASD (all P < 0.05). The determinants of obesity among children with ASD go beyond the individual level; family and community support are important. Therefore, greater attention should be directed toward the families of children with ASD and community-level administrative policies to improve quality of life by preventing or reducing obesity in children with ASD.
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Affiliation(s)
- TaeEung Kim
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - Eun Hye Kwon
- Department of Counseling, Health & Kinesiology, Texas A&M University-San Antonio, San Antonio, TX, United States
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Examining School and Neighborhood Effects of Socioeconomic Status on Childhood Obesity in the U.S. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19105831. [PMID: 35627368 PMCID: PMC9141304 DOI: 10.3390/ijerph19105831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/07/2022] [Accepted: 05/09/2022] [Indexed: 01/19/2023]
Abstract
Obesity amongst Kindergartners in Texas is above the national average, particularly among Hispanic students. Research on the impact of school and neighborhood-level SES on obesity in childhood using multilevel models is lacking. Survey data were collected from Hispanic caregivers of pre-kindergarten students in Fall 2019 (n = 237). Students were clustered in thirty-two neighborhoods and twelve schools. The dependent variable was the child’s body mass index z-score (BMIz). Covariates included the child’s sex, primary caregiver’s marital status, education level, relationship to the child, and family income. Level-two variables included neighborhood poverty and school SES. CTableross-classified multilevel linear regression models were conducted to examine the unique associations of neighborhood poverty and school SES with individual student BMIz, and how they interact. Twenty-four percent of students were classified as overweight, and five percent were classified as obese. The models resulted in a significant association between school SES and BMIz (B = −0.13; SE = 0.06; p < 0.05) and between neighborhood poverty and BMIz (B = −1.41; SE = 0.49; p < 0.01). Individual students’ BMIz decreased as school SES increased and decreased as neighborhood poverty increased. Neighborhood poverty and school SES appear to play a role in the development of obesity in childhood, although in differing directions.
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Vaivada T, Sharma N, Das JK, Salam RA, Lassi ZS, Bhutta ZA. Interventions for Health and Well-Being in School-Aged Children and Adolescents: A Way Forward. Pediatrics 2022; 149:186939. [PMID: 35503328 DOI: 10.1542/peds.2021-053852m] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/16/2022] [Indexed: 11/24/2022] Open
Abstract
The health and well-being of school-aged children has received little attention compared with younger children aged < 5 years and adolescents. In this final article in a supplement of reviews that have assessed the effectiveness of interventions for school-aged children across a variety of health-related domains (including infectious diseases, noncommunicable diseases, healthy lifestyle, mental health, unintentional injuries, and sexual and reproductive health), we summarize the main findings and offer a way forward for future research, policy, and implementation. We complement this evidence base on interventions with a summary of the literature related to enabling policies and intersectoral actions supporting school-aged child health. The school represents an important platform for both the delivery of preventive interventions and the collection of data related to child health and academic achievement, and several frameworks exist that help to facilitate the creation of a health-promoting environment at school.
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Affiliation(s)
- Tyler Vaivada
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Canada
| | - Naeha Sharma
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Canada
| | - Jai K Das
- Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Rehana A Salam
- Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Zohra S Lassi
- Robinson Research Institute and.,Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Canada.,Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan.,Department of Nutritional Sciences, University of Toronto, Toronto, Canada
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Context, importance, and process for creating a body mass index surveillance system to monitor childhood obesity within the New York City public school setting. Prev Med Rep 2022; 26:101704. [PMID: 35141118 PMCID: PMC8814642 DOI: 10.1016/j.pmedr.2022.101704] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/15/2021] [Accepted: 01/15/2022] [Indexed: 12/28/2022] Open
Abstract
The Office of School Health, a joint program of the Departments of Health and Education, administers New York City’s (NYC) body mass index (BMI) surveillance system to monitor childhood obesity. We describe the context, importance, and process for creating a multi-agency, school-based BMI surveillance system using BMI collected from annual FITNESSGRAM® physical fitness assessments conducted as part of a larger physical activity and wellness curriculum in NYC public schools. We also summarize our current system and methodology, highlighting the types of data and data sources that comprise the system and partnership between the Departments of Health and Education that enable data sharing. Strategies for addressing threats to data quality, including missing data, biologically implausible values, and imprecise/subjective weight or height equipment are discussed. We also review current and future surveillance data products, and provide recommendations for collecting, analyzing, interpreting, and reporting BMI data for childhood obesity surveillance. Collaboration between Departments of Health and Education as well as attention to safeguards of BMI reporting and data quality threats have enabled NYC to collect high quality BMI data to accurately monitor childhood obesity trends. These findings have implications for youth BMI surveillance systems in the United States and globally.
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Øvrebø B, Stea TH, Bergh IH, Bere E, Surén P, Magnus P, Juliusson PB, Wills AK. A nationwide school fruit and vegetable policy and childhood and adolescent overweight: A quasi-natural experimental study. PLoS Med 2022; 19:e1003881. [PMID: 35041660 PMCID: PMC8765663 DOI: 10.1371/journal.pmed.1003881] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 12/01/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND School free fruit and vegetable (FFV) policies are used to promote healthy dietary habits and tackle obesity; however, our understanding of their effects on weight outcomes is limited. We assess the effect of a nationwide FFV policy on childhood and adolescent weight status and explore heterogeneity by sex and socioeconomic position. METHODS AND FINDINGS This study used a quasi-natural experimental design. Between 2007 and 2014, Norwegian combined schools (grades 1-10, age 6 to 16 years) were obligated to provide FFVs while elementary schools (grades 1-7) were not. We used 4 nationwide studies (n = 11,215 children) from the Norwegian Growth Cohort with longitudinal or cross-sectional anthropometric data up to age 8.5 and 13 years to capture variation in FFV exposure. Outcomes were body mass index standard deviation score (BMISDS), overweight and obesity (OW/OB), waist circumference (WC), and weight to height ratio (WtHR) at age 8.5 years, and BMISDS and OW/OB at age 13 years. Analyses included longitudinal models of the pre- and post-exposure trajectories to estimate the policy effect. The participation rate in each cohort was >80%, and in most analyses <4% were excluded due to missing data. Estimates were adjusted for region, population density, and parental education. In pooled models additionally adjusted for pre-exposure BMISDS, there was little evidence of any benefit or unintended consequence from 1-2.5 years of exposure to the FFV policy on BMISDS, OW/OB, WC, or WtHR in either sex. For example, boys exposed to the FFV policy had a 0.05 higher BMISDS (95% CI: -0.04, 0.14), a 1.20-fold higher odds of OW/OB (95% CI: 0.86, 1.66) and a 0.3 cm bigger WC (95% CI: -0.3, 0.8); while exposed girls had a 0.04 higher BMISDS (95% CI: -0.04, 0.13), a 1.03 fold higher odds of OW/OB (95% CI: 0.75, 1.39), and a 0-cm difference in WC (95% CI: -0.6, 0.6). There was evidence of heterogeneity in the policy effect estimates at 8.5 years across cohorts and socioeconomic position; however, these results were inconsistent with other comparisons. Analysis at age 13 years, after 4 years of policy exposure, also showed little evidence of an effect on BMISDS or OW/OB. The main limitations of this study are the potential for residual confounding and exposure misclassification, despite efforts to minimize their impact on conclusions. CONCLUSIONS In this study we observed little evidence that the Norwegian nationwide FFV policy had any notable beneficial effect or unintended consequence on weight status among Norwegian children and adolescents.
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Affiliation(s)
- Bente Øvrebø
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
- Department of Health and Inequalities, Norwegian Institute of Public Health, Oslo, Norway
- Centre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, Oslo, Norway
- * E-mail:
| | - Tonje H. Stea
- Department of Health and Nursing Sciences, University of Agder, Kristiansand, Norway
- Department of Child and Adolescence Mental Health, Sørlandet Hospital, Kristiansand, Norway
| | - Ingunn H. Bergh
- Department of Health and Inequalities, Norwegian Institute of Public Health, Oslo, Norway
| | - Elling Bere
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
- Department of Health and Inequalities, Norwegian Institute of Public Health, Oslo, Norway
- Centre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, Oslo, Norway
| | - Pål Surén
- Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
| | - Per Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Petur B. Juliusson
- Department of Health Registry Research and Development, Norwegian Institute of Public Health, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Children and Youth Clinic, Haukeland University Hospital, Bergen, Norway
| | - Andrew K. Wills
- Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom
- Department of Nutrition and Public Health, University of Agder, Kristiansand, Norway
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Stylianou M, Woodforde J, Duncombe S, Kolbe-Alexander T, Gomersall S. School physical activity policies and associations with physical activity practices and behaviours: A systematic review of the literature. Health Place 2021; 73:102705. [PMID: 34844131 DOI: 10.1016/j.healthplace.2021.102705] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 09/08/2021] [Accepted: 10/24/2021] [Indexed: 01/02/2023]
Abstract
The development and implementation of school policies is considered a key strategy for the promotion of physical activity (PA) in children and adolescents. This study aimed to systematically review and synthesise existing literature focusing on the associations between formal written school-based PA policies and (a) school PA practices and (b) PA behaviours of school-aged children and adolescents. Fifty-one papers reporting on 52 studies met the eligibility criteria. All but two studies were from high income countries, most used cross-sectional designs and demonstrated fair methodological quality, and just over a third examined language aspects of policies. Findings predominantly indicated a lack of or inconclusive associations between the various characteristics examined and PA outcomes. Inconclusive associations were identified between both PA practice and behaviour outcomes and state level policies, policies focusing on PE and school-day PA, and in studies examining language aspects of policies. Inconclusive associations with both types of outcomes were more likely to be identified compared to a lack of associations in studies using self-report measures and in studies not providing information about the quality of exposure and outcome measures used. Overall, findings highlight the need for further research that acknowledges the complex relationship between school policies and PA outcomes and employs robust methodological approaches to enhance our understanding of this area.
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Affiliation(s)
- Michalis Stylianou
- School of Human Movement and Nutrition Sciences, The University of Queensland, St. Lucia, Queensland, 4072, Australia.
| | - James Woodforde
- School of Human Movement and Nutrition Sciences, The University of Queensland, St. Lucia, Queensland, 4072, Australia
| | - Stephanie Duncombe
- School of Human Movement and Nutrition Sciences, The University of Queensland, St. Lucia, Queensland, 4072, Australia
| | - Tracy Kolbe-Alexander
- School of Health & Wellbeing, University of Southern Queensland, lpswich, Queensland, 4305, Australia
| | - Sjaan Gomersall
- School of Human Movement and Nutrition Sciences, The University of Queensland, St. Lucia, Queensland, 4072, Australia; School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Queensland, 4072, Australia
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15
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A Sustainable and Global Health Perspective of the Dietary Pattern of French Population during the 1998–2015 Period from INCA Surveys. SUSTAINABILITY 2021. [DOI: 10.3390/su13137433] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
In France, the evolution of dietary pattern relative to sustainability and global health remains insufficiently studied. The objective of this study was to assess dietary changes during 1998–2015 through three generic metrics potentially related to sustainability. Food consumption data were collected from three French National Individual Study of Food Consumption surveys (INCA) for children (0–17 years) and adults (18–79 years) representative of the French population. The consumed foods were converted into plant (metric 1) and non-ultra-processed (UPF, metric 2) calories, and analyzed in meeting dietary recommended intakes (metric 3). French children and adults consumed high levels of animal and UPF calories, and nutrient deficiencies were observed in adults from the 2015 survey, e.g., fiber, EPA, DHA, magnesium, retinol, and vitamin C. In children, UPF daily calories increased from 42.8 to 45.5% and decreased in adults from 39.2 to 35.0%. In children and adults, diet revegetation was observed. While the level of physical activity decreased, overweight, obesity and type 2 diabetes prevalence increased in French adults. The French dietary pattern is not sustainable for global health unless public health policy is reinforced, with at least a twofold decrease in animal and UPF calories and improved food diversity.
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Booth E, Halliday V, Cooper RJ. Headteachers' and chairs of governors' perspectives on adolescent obesity and its prevention in English secondary school settings. J Public Health (Oxf) 2021; 43:e213-e223. [PMID: 31832667 DOI: 10.1093/pubmed/fdz151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Secondary schools are an important setting for preventing obesity in adolescence. Headteachers and chairs of governors are identified in national guidance as crucial stakeholders for school-based preventative action. Despite this, their views remain unexplored and unrepresented. METHODS A sequential mixed method study was conducted. Semi-structured interviews were undertaken with a purposive sample of 22 secondary school headteachers and chairs of governors in England. Data were thematically analysed and informed the development of a descriptive cross-sectional survey, completed by 127 participants from the same population. RESULTS Unhealthy dietary and sedentary behaviours were viewed as a more significant problem than adolescent obesity. Obesity was perceived as complex and multi-causal, and a range of stakeholders were deemed to have responsibility for its prevention, most notably parents. Support was identified for the role of secondary schools, although this was not an explicit priority and extensive internal and external barriers exist, which hinder preventative action. CONCLUSIONS Whilst secondary school settings in England remain an important setting for the prevention of adolescent obesity, it is crucial for policy makers and public health professionals to recognize the factors affecting school leaders' ability and willingness to contribute to this agenda.
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Affiliation(s)
- E Booth
- Section of Public Health, School of Health and Related Research (ScHARR), The University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
| | - V Halliday
- Section of Public Health, School of Health and Related Research (ScHARR), The University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
| | - R J Cooper
- Section of Public Health, School of Health and Related Research (ScHARR), The University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
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Effects of the Head Start Program on Socioecological Obesogenic Factors in American Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094779. [PMID: 33947141 PMCID: PMC8125499 DOI: 10.3390/ijerph18094779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 11/26/2022]
Abstract
Head Start is a nationwide developmental program for low-income families. This study aimed to investigate the association between the Head Start program and children’s BMI status, as well as their quality of life with respect to socioecological obesogenic factors. This cross-sectional study employed the Early Childhood Longitudinal Study-Kindergarten cohort (ECLS-K) in which the data were collected in 2007 and analyzed in 2019. Propensity-score matching analysis was performed to examine the association between the Head Start program and children’s BMI status, as well as the quality of life, controlling for socioecological obesogenic factors. A total of 3753 children (representing 1,284,209 at the population level) were recruited in this study (mean age: 13.69 years; girls: 49.42%). In the final matched model, the program did not have a statistically significant effect on children’s obesity. Fewer African American children participated in school-sponsored activities, perceived themselves as overweight, lived in a household with fewer family members, had less strict TV regulations, and were more likely to be overweight than their counterparts. Outcomes suggest that multiple dimensions of sociological obesogenic factors including individual, parental, familial, and community support factors affect the weight of children from low-income families and should be considered when establishing behavioral and policy interventions to thwart the childhood obesity epidemic.
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18
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Patte KA, Cole AG, Qian W, Magier M, Vine M, Leatherdale ST. Are closed campus policies associated with adolescent eating behaviours? Health Promot Chronic Dis Prev Can 2021; 41:73-84. [PMID: 33688693 PMCID: PMC8011479 DOI: 10.24095/hpcdp.41.3.02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The effectiveness of school nutrition regulations may be undermined by food environments surrounding schools. Given challenges in regulating external retail, some have recommended policies that ensure students are unable to leave school property during the day (closed campus policies; CCP). We aimed to examine whether CCP are associated with student eating behaviours. METHODS We used student and school-administrator survey data from the 60 610 Grades 9 to 12 students and 134 Canadian secondary schools that participated in Year 7 (2018/19) of the COMPASS study. Multiple ordinal regression models tested school CCP as a predictor of weekday dietary behaviours (0-5 days), controlling for student-level (grade, sex, spending money, ethnicity) and school-level (urbanicity, province, area median household income, vending machines) covariates. RESULTS CCP were reported by 16 schools. Students who attended CCP schools reported eating lunch purchased from fast food outlets or other restaurants and drinking sugar-sweetened beverages (SSBs; soft drinks and sports drinks; sweetened coffee or tea drinks) on fewer weekdays, but consumed snacks from school vending machines on more weekdays, relative to students at open campus schools. No significant differences were observed in student reports of eating home-packed or school cafeteria lunches or snacks purchased off-campus. CONCLUSION CCP may help improve adolescent diets by reducing SSB and lunchtime fast food consumption on weekdays; however, students already purchasing food may shift from off-campus to within-school options, highlighting the importance of ensuring healthy school food environments and encouraging students to bring home-prepared lunches. Future studies using experimental longitudinal designs are needed to determine the effect of CCP on various health behaviours and outcomes.
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Affiliation(s)
- Karen A Patte
- Faculty of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Adam G Cole
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Wei Qian
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Megan Magier
- Faculty of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Michelle Vine
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Scott T Leatherdale
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
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Spencer RA, Numer M, Rehman L, Kirk SFL. Picture perfect? Gazing into girls' health, physical activity, and nutrition through photovoice. Int J Qual Stud Health Well-being 2021; 16:1874771. [PMID: 33491602 PMCID: PMC7850428 DOI: 10.1080/17482631.2021.1874771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Women face contradictions regarding their health: Pressure to be feminine, but also athletic; Criticism for being too sporty or muscular, but equally so for being perceived as lazy or overweight. These complexities are perpetuated through media and discourse. Purpose: Using a feminist post-structural approach and photovoice, this study explored health, physical activity, and nutrition in adolescent girls and young women. Methods: Photovoice enables reflection, promotes dialogue, and sparks change. The process involved conducting a workshop, collecting photos, and participatory analysis sessions, which engaged the participants (n = 7, ages 13–26) in photo selection, contextualization, and codifying. Results: This resulted in three themes: First, (Breaking) Stereotypes, in which participants identified gender norms, conflicts, and contradictions; Second, Emotional Safety, or the contexts in which girls and young women feel confident and comfortable; Finally, Being Outside in Nature emerged as significant. Each theme is supported by quotations and photographs. This work suggests being outside in nature provides important context for girls and young women to feel emotionally safe, such that they may engage in the complex navigation of competing discourses surrounding health.
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Affiliation(s)
- Rebecca A Spencer
- School of Health & Human Performance, Dalhousie University , Halifax, NS, Canada
| | - Matthew Numer
- School of Health & Human Performance, Dalhousie University , Halifax, NS, Canada
| | - Laurene Rehman
- School of Health & Human Performance, Dalhousie University , Halifax, NS, Canada
| | - Sara F L Kirk
- Healthy Populations Institute, Dalhousie University , Halifax, NS, Canada
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20
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Wicherski J, Schlesinger S, Fischer F. Association between Breakfast Skipping and Body Weight-A Systematic Review and Meta-Analysis of Observational Longitudinal Studies. Nutrients 2021; 13:nu13010272. [PMID: 33477881 PMCID: PMC7832891 DOI: 10.3390/nu13010272] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/15/2021] [Accepted: 01/17/2021] [Indexed: 02/06/2023] Open
Abstract
Globally, increasing rates of obesity are one of the most important health issues. The association between breakfast skipping and body weight is contradictory between cross-sectional and interventional studies. This systematic review and meta-analysis aims to summarize this association based on observational longitudinal studies. We included prospective studies on breakfast skipping and overweight/obesity or weight change in adults. The literature was searched until September 2020 in PubMed and Web of Science. Summary risk ratios (RRs) or β coefficients with a 95% confidence interval (CI), respectively, were estimated in pairwise meta-analyses by applying a random-effects model. In total, nine studies were included in the systematic review and three of them were included in the meta-analyses. The meta-analyses indicated an 11% increased RR for overweight/obesity when breakfast was skipped on ≥3 days per week compared to ≤2 days per week (95% CI: 1.04, 1.19, n = two studies). The meta-analysis on body mass index (BMI) change displayed no difference between breakfast skipping and eating (β = −0.02; 95% CI: −0.05, 0.01; n = two studies). This study provides minimal evidence that breakfast skipping might lead to weight gain and the onset of overweight and obesity.
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Affiliation(s)
- Julia Wicherski
- School of Public Health, Bielefeld University, 33615 Bielefeld, Germany
| | - Sabrina Schlesinger
- German Diabetes Center, Institute for Biometry and Epidemiology, Leibniz Center for Diabetes Research at Heinrich Heine University, 40225 Düsseldorf, Germany
| | - Florian Fischer
- Institute of Public Health, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
- Institute of Gerontological Health Services and Nursing Research, Ravensburg-Weingarten University of Applied Sciences, 88250 Weingarten, Germany
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21
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Ruiz-Dodobara F, Busse P. Peer Networks and Intention to Consume Unhealthy Food: The Association Through Cognitive Mediators in Peruvian Adolescents. J Sch Nurs 2020; 36:376-385. [DOI: 10.1177/1059840519839118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This cross-sectional study examined the mediating role of three reasoned action approach (RAA) constructs—attitudes, perceived social pressure, and perceived behavioral control—on the relationship between peer networks and intention to consume unhealthy food. The authors examined self-reported data of a sample of 277 adolescents from public and private schools in Lima, Peru. Results revealed a total mediating effect of the reasoned action constructs; yet attitudes and perceived behavioral control, but not perceived social pressure (injunctive and descriptive norms), mediated the relationship between peer network and intention to consume unhealthy food. Explanations for these results are discussed in light of social cognitive theory and Ajzen and Fishbein’s postulates about specific attitudes. Finally, we discuss how school nurses can take advantage of RAA variables to influence food environments, use peer networks for reducing unhealthy food consumption, and organize workshops to inform parents about the mechanisms that promote junk food intake.
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Affiliation(s)
| | - Peter Busse
- Instituto de Investigación Científica, Universidad de Lima, Lima, Peru
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Proctor R, Guell C, Wyatt K, Williams AJ. What is the evidence base for integrating health and environmental approaches in the school context to nurture healthier and more environmentally aware young people? A systematic scoping review of global evidence. Health Place 2020; 64:102356. [PMID: 32838882 DOI: 10.1016/j.healthplace.2020.102356] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 04/25/2020] [Accepted: 05/11/2020] [Indexed: 11/24/2022]
Abstract
This scoping review collates empirical and gray literature that examines how schools are acting to nurture healthier and more environmentally aware young people through integrated approaches. Over the last twenty years, integration has been increasing within school contexts. Approaches include teaching and learning, physical environmental adaptations, developing ecologically focused policy, and reorienting wider school culture. We noted a developing discourse around what constitutes evidence in this emerging interdisciplinary field. Developing a better understanding of integrated approaches and an evidence base of what works and how could inform interdisciplinary collaboration and enable a clearer message to be communicated to stakeholders about how the school context can nurture healthier and more environmentally aware young people.
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Affiliation(s)
- Rachel Proctor
- European Centre for Environment & Human Health, University of Exeter Medical School, Truro, UK.
| | - Cornelia Guell
- European Centre for Environment & Human Health, University of Exeter Medical School, Truro, UK
| | - Katrina Wyatt
- Institute for Health Research, College of Medicine and Health, University of Exeter, UK
| | - Andrew James Williams
- European Centre for Environment & Human Health, University of Exeter Medical School, Truro, UK; Division of Population and Behavioural Science, School of Medicine, University of St Andrews, UK
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Browne J, Lock M, Walker T, Egan M, Backholer K. Effects of food policy actions on Indigenous Peoples' nutrition-related outcomes: a systematic review. BMJ Glob Health 2020; 5:e002442. [PMID: 32816952 PMCID: PMC7437701 DOI: 10.1136/bmjgh-2020-002442] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 06/12/2020] [Accepted: 06/18/2020] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Indigenous Peoples worldwide endure unacceptable health disparities with undernutrition and food insecurity often coexisting with obesity and chronic diseases. Policy-level actions are required to eliminate malnutrition in all its forms. However, there has been no systematic synthesis of the evidence of effectiveness of food and nutrition policies for Indigenous Peoples around the world. This review fills that gap. METHODS Eight databases were searched for peer-reviewed literature, published between 2000 and 2019. Relevant websites were searched for grey literature. Articles were included if they were original studies, published in English and included data from Indigenous Peoples from Western colonised countries, evaluated a food or nutrition policy (or intervention), and provided quantitative impact/outcome data. Study screening, data extraction and quality assessment were undertaken independently by two authors, at least one of whom was Indigenous. A narrative synthesis was undertaken with studies grouped according to the NOURISHING food policy framework. RESULTS We identified 78 studies from Canada, Australia, Aotearoa/New Zealand and the USA. Most studies evaluated targeted interventions, focused on rural or remote Indigenous communities. The most effective interventions combined educational strategies with policies targeting food price, composition and/or availability, particularly in retail and school environments. Interventions to reduce exposure to unhealthy food advertising was the only area of the NOURISHING framework not represented in the literature. Few studies examined the impact of universal food policies on Indigenous Peoples' diets, health or well-being. CONCLUSION Both targeted and universal policy action can be effective for Indigenous Peoples. Actions that modify the structures and systems governing food supply through improved availability, access and affordability of healthy foods should be prioritised. More high-quality evidence on the impact of universal food and nutrition policy actions for Indigenous Peoples is required, particularly in urban areas and in the area of food marketing.
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Affiliation(s)
- Jennifer Browne
- Deakin University, Global Obesity Centre, Institute for Health Transformation, Geelong, Victoria, Australia
| | - Mark Lock
- Deakin University, Global Obesity Centre, Institute for Health Transformation, Geelong, Victoria, Australia
| | - Troy Walker
- Deakin University, Global Obesity Centre, Institute for Health Transformation, Geelong, Victoria, Australia
| | - Mikaela Egan
- Victorian Aboriginal Community Controlled Health Organisation, Melbourne, Victoria, Australia
| | - Kathryn Backholer
- Deakin University, Global Obesity Centre, Institute for Health Transformation, Geelong, Victoria, Australia
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Goldthorpe J, Epton T, Keyworth C, Calam R, Armitage CJ. Are primary/elementary school-based interventions effective in preventing/ameliorating excess weight gain? A systematic review of systematic reviews. Obes Rev 2020; 21:e13001. [PMID: 32162477 DOI: 10.1111/obr.13001] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/21/2019] [Accepted: 12/17/2019] [Indexed: 11/30/2022]
Abstract
This systematic review of systematic reviews addresses a current gap in evidence by synthesizing findings relating to weight management interventions set entirely in primary/elementary schools targeting, diet, and/or physical activity as key strategies. Eight databases were searched for systematic reviews of trials of school-based interventions targeting children aged 4 to 12 years that looked at biometric and behavioral outcomes. From the 10 selected systematic reviews, we found that interventions designed to promote physical activity or reduce sedentary behavior were most effective for weight loss. Interventions designed to improve diet and nutrition had a small effect on behavioral and cognitive outcomes, and these outcomes could be enhanced through the use of experiential learning. The most effective interventions involved a range of stakeholders in the development process and included parents and families in implementation. This systematic review of systematic reviews offers evidence-based guidance for the development and implementation of multistrategy weight-management interventions in primary/elementary schools.
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Affiliation(s)
- Joanna Goldthorpe
- Manchester Centre for Health Psychology, Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences Coupland 1 Building, University of Manchester, M13 9PL, UK
| | - Tracy Epton
- Manchester Centre for Health Psychology, Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences Coupland 1 Building, University of Manchester, M13 9PL, UK
| | - Chris Keyworth
- Manchester Centre for Health Psychology, Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences Coupland 1 Building, University of Manchester, M13 9PL, UK
| | - Rachel Calam
- Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences, Zochonis Building, University of Manchester, M13 9PL, UK
| | - Christopher J Armitage
- Manchester Centre for Health Psychology, Division of Psychology & Mental Health, School of Health Sciences, Coupland 1 Building University of Manchester, M13 9PL, UK Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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Mannocci A, D’Egidio V, Backhaus I, Federici A, Sinopoli A, Ramirez Varela A, Villari P, La Torre G. Are There Effective Interventions to Increase Physical Activity in Children and Young People? An Umbrella Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3528. [PMID: 32443505 PMCID: PMC7277151 DOI: 10.3390/ijerph17103528] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Obesity and physical inactivity among children and young people are public health concerns. While numerous interventions to promote physical activity are available, little is known about the most effective ones. This study aimed to summarize the existing evidence on interventions that aim to increase physical activity. METHODS A systematic review of reviews was conducted. Systematic reviews and meta-analyses published from January 2010 until November 2017 were identified through PubMed, Scopus and the Cochrane Library. Two reviewers independently assessed titles and abstracts, performed data extraction and quality assessment. Outcomes as level of physical activity and body mass index were collected in order to assess the efficacy of interventions. RESULTS A total 30 studies examining physical activity interventions met the inclusion criteria, 15 systematic reviews and 15 meta-analyses. Most studies (N = 20) were implemented in the school setting, three were developed in preschool and childcare settings, two in the family context, five in the community setting and one miscellaneous context. Results showed that eight meta-analyses obtained a small increase in physical activity level, out of which five were conducted in the school, two in the family and one in the community setting. Most promising programs had the following characteristics: included physical activity in the school curriculum, were long-term interventions, involved teachers and had the support of families. CONCLUSION The majority of interventions to promote physical activity in children and young people were implemented in the school setting and were multicomponent. Further research is needed to investigate nonschool programs.
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Affiliation(s)
- Alice Mannocci
- Department of Public Health and Infectious Disease, Sapienza University of Rome, 00182 Rome, Italy; (A.M.); (I.B.); (P.V.); (G.L.T.)
| | - Valeria D’Egidio
- Department of Public Health and Infectious Disease, Sapienza University of Rome, 00182 Rome, Italy; (A.M.); (I.B.); (P.V.); (G.L.T.)
| | - Insa Backhaus
- Department of Public Health and Infectious Disease, Sapienza University of Rome, 00182 Rome, Italy; (A.M.); (I.B.); (P.V.); (G.L.T.)
| | | | | | | | - Paolo Villari
- Department of Public Health and Infectious Disease, Sapienza University of Rome, 00182 Rome, Italy; (A.M.); (I.B.); (P.V.); (G.L.T.)
| | - Giuseppe La Torre
- Department of Public Health and Infectious Disease, Sapienza University of Rome, 00182 Rome, Italy; (A.M.); (I.B.); (P.V.); (G.L.T.)
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Gelius P, Messing S, Goodwin L, Schow D, Abu-Omar K. What are effective policies for promoting physical activity? A systematic review of reviews. Prev Med Rep 2020; 18:101095. [PMID: 32346500 PMCID: PMC7182760 DOI: 10.1016/j.pmedr.2020.101095] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 01/14/2020] [Accepted: 04/04/2020] [Indexed: 11/25/2022] Open
Abstract
There is a growing need for evidence on the effectiveness of different policies to promote physical activity. We conducted a systematic literature review to collate the available evidence. We identified 57 reviews with evidence on 53 types of physical activity policies from 7 areas. There is a solid evidence base for the effectiveness of school-based and some infrastructural policies. The evidence for other (e.g. economic) policies remains insufficient.
The importance of policy for promoting physical activity (PA) is increasingly recognized by academics, and there is a push by national governments and international institutions for PA policy development and monitoring. However, our knowledge about which policies are actually effective to promote PA remains limited. This article summarizes the currently available evidence by reviewing existing reviews on the subject. Building on results from a previous scoping review on different types of PA-related evidence, we ran searches for combinations of the terms “physical activity”, “evidence”, “effect”, “review”, and “policy” in six different databases (PubMed, Scopus, SportDiscus, PsycInfo, ERIC, and IBSS). We used EPPI Reviewer 4 to further process the results and conduct an in-depth analysis. We identified 57 reviews providing evidence on 53 types of policies and seven broader groups of policies. Reviews fell into four main categories: 1) setting- and target group-specific; 2) urban design, environment and transport; 3) economic instruments; and 4) broad-range perspective. Results indicate that there is solid evidence for policy effectiveness in some areas (esp. school-based and infrastructural policies) but that the evidence in other areas is insufficient (esp. for economic policies). The available evidence provides some guidance for policy-makers regarding which policies can currently be recommended as effective. However, results also highlight some broader epistemological issues deriving from the current research. This includes the conflation of PA policies and PA interventions, the lack of appropriate tools for benchmarking individual policies, and the need to critically revisit research methodologies for collating evidence on policies.
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Affiliation(s)
- Peter Gelius
- Friedrich-Alexander University Erlangen-Nuremberg, Gebbertstraße 123b, 91058 Erlangen, Germany
| | - Sven Messing
- Friedrich-Alexander University Erlangen-Nuremberg, Gebbertstraße 123b, 91058 Erlangen, Germany
| | - Lee Goodwin
- Friedrich-Alexander University Erlangen-Nuremberg, Gebbertstraße 123b, 91058 Erlangen, Germany
| | - Diana Schow
- Friedrich-Alexander University Erlangen-Nuremberg, Gebbertstraße 123b, 91058 Erlangen, Germany
| | - Karim Abu-Omar
- Friedrich-Alexander University Erlangen-Nuremberg, Gebbertstraße 123b, 91058 Erlangen, Germany
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Narayanan N, Nagpal N, Zieve H, Vyas A, Tatum J, Ramos M, McCarter R, Lucas CT, Mietus-Snyder M. A School-Based Intervention Using Health Mentors to Address Childhood Obesity by Strengthening School Wellness Policy. Prev Chronic Dis 2019; 16:E154. [PMID: 31753082 PMCID: PMC6880918 DOI: 10.5888/pcd16.190054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE AND OBJECTIVES The objective of our study was to strengthen wellness policy in Title 1 schools by implementing a mentored behavior-change model that extends the continuum of care from academic to community settings and mobilizes existing public resources in accordance with US Preventive Services Task Force screening guidelines for childhood obesity management. INTERVENTION APPROACH Team Kid POWER! (KiPOW!) health mentors (students and trainees in medical and health-related fields) in 2 geographically and demographically distinct school districts, the District of Columbia and Orange County, California, delivered standardized health curricular modules to fifth grade classrooms, modeled healthy eating behaviors during school lunchtime, and engaged in active play at recess. EVALUATION METHODS Initial interventions in the the District of Columbia and Orange County delivered 10 sessions in which all participants received the intervention. Two subsequent interventions in Orange County, for 5 weeks (Lite) and 10 weeks (Full), included controls. Pre-post measurements of body mass index (BMI) and blood pressure were documented in all participants. A mixed linear regression model, which included a random effect for each school, estimated differences between Full and Lite interventions compared with controls, adjusting for site, sex, and baseline status of the dependent variable. RESULTS KiPOW! Full, but not KiPOW! Lite, was associated with a modest reduction in BMI percentile compared with control (KiPOW! Full, P = .04; KiPOW! Lite, P = .41), especially in Orange County (P < .001). Systolic blood pressure improved in Full (P < .046) more than in Lite interventions (P = .11), and diastolic blood pressure improved in both Full (P = .02) and Lite (P = .03) interventions. Annual renewal of the school and volunteer commitment needed to maintain KiPOW! was found to be sustainable. IMPLICATIONS FOR PUBLIC HEALTH KiPOW! is a generalizable academic-community partnership promoting face-to-face contact between students and trusted health mentors to reinforce school wellness policies and foster youth confidence in decision-making about nutrition- and activity-related behaviors to achieve reduced BMI percentile and lowered blood pressure.
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Affiliation(s)
- Nisha Narayanan
- Division of Pediatric Emergency Medicine, New York University Langone Medical Center, New York, New York
| | - Nikita Nagpal
- Department of General Pediatrics, New York University School of Medicine, Bellview Hospital Center, New York, New York
| | - Hillary Zieve
- Department of Pediatrics, Children's Hospital of Orange County, Irvine, California
| | - Aashay Vyas
- Department of General Pediatrics, Valley Children's Healthcare, Irvine, California
| | - Jonathan Tatum
- Department of General Pediatrics, Cincinnati Children's Medical Center, Cincinnati, Ohio
| | - Margarita Ramos
- Department of General Pediatrics, Children's National Hospital, Washington, District of Columbia
| | - Robert McCarter
- Division of Biostatistics and Study Methodology, Children's National Hospital, Washington, District of Columbia
| | - Candice Taylor Lucas
- Department of Pediatrics, University of California, Irvine School of Medicine, Irvine, California
- Pediatric Exercise and Genomics Research Center (PERC), University of California, Irvine School of Medicine, Irvine, California
| | - Michele Mietus-Snyder
- Center for Translational Research, Children's National Hospital, Washington, District of Columbia
- Division of Pediatric Cardiology, Children's National Hospital, Washington, District of Columbia
- George Washington University School of Medicine, Center for Translational Research, Children's National Hospital, 111 Michigan Ave NW, Washington, DC 20010.
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Duncan S, Stewart T, McPhee J, Borotkanics R, Prendergast K, Zinn C, Meredith-Jones K, Taylor R, McLachlan C, Schofield G. Efficacy of a compulsory homework programme for increasing physical activity and improving nutrition in children: a cluster randomised controlled trial. Int J Behav Nutr Phys Act 2019; 16:80. [PMID: 31488140 PMCID: PMC6729097 DOI: 10.1186/s12966-019-0840-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 08/16/2019] [Indexed: 12/02/2022] Open
Abstract
Background Most physical activity interventions in children focus on the school setting; however, children typically engage in more sedentary activities and spend more time eating when at home. The primary aim of this cluster randomised controlled trial was to investigate the effects of a compulsory, health-related homework programme on physical activity, dietary patterns, and body size in primary school-aged children. Methods A total of 675 children aged 7–10 years from 16 New Zealand primary schools participated in the Healthy Homework study. Schools were randomised into intervention and control groups (1:1 allocation). Intervention schools implemented an 8-week applied homework and in-class teaching module designed to increase physical activity and improve dietary patterns. Physical activity was the primary outcome measure, and was assessed using two sealed pedometers that monitored school- and home-based activity separately. Secondary outcome measures included screen-based sedentary time and selected dietary patterns assessed via parental proxy questionnaire. In addition, height, weight, and waist circumference were measured to obtain body mass index (BMI) and waist-to-height ratio (WHtR). All measurements were taken at baseline (T0), immediately post-intervention (T1), and 6-months post-intervention (T2). Changes in outcome measures over time were estimated using generalised linear mixed models (GLMMs) that adjusted for fixed (group, age, sex, group x time) and random (subjects nested within schools) effects. Intervention effects were also quantified using GLMMs adjusted for baseline values. Results Significant intervention effects were observed for weekday physical activity at home (T1 [P < 0.001] and T2 [P = 0.019]), weekend physical activity (T1 [P < 0.001] and T2 [P < 0.001]), BMI (T2 only [P = 0.020]) and fruit consumption (T1 only [P = 0.036]). Additional analyses revealed that the greatest improvements in physical activity occurred in children from the most socioeconomically deprived schools. No consistent effects on sedentary time, WHtR, or other dietary patterns were observed. Conclusions A compulsory health-related homework programme resulted in substantial and consistent increases in children’s physical activity – particularly outside of school and on weekends – with limited effects on body size and fruit consumption. Overall, our findings support the integration of compulsory home-focused strategies for improving health behaviours into primary education curricula. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12618000590268. Registered 17 April 2018. Electronic supplementary material The online version of this article (10.1186/s12966-019-0840-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Scott Duncan
- School of Sport and Recreation, Auckland University of Technology, Private Bag 92006, Auckland, New Zealand.
| | - Tom Stewart
- School of Sport and Recreation, Auckland University of Technology, Private Bag 92006, Auckland, New Zealand
| | - Julia McPhee
- School of Sport and Recreation, Auckland University of Technology, Private Bag 92006, Auckland, New Zealand
| | - Robert Borotkanics
- School of Sport and Recreation, Auckland University of Technology, Private Bag 92006, Auckland, New Zealand
| | - Kate Prendergast
- School of Sport and Recreation, Auckland University of Technology, Private Bag 92006, Auckland, New Zealand
| | - Caryn Zinn
- School of Sport and Recreation, Auckland University of Technology, Private Bag 92006, Auckland, New Zealand
| | - Kim Meredith-Jones
- Edgar Diabetes and Obesity Research Centre, University of Otago, PO Box 56, Dunedin, New Zealand
| | - Rachael Taylor
- Edgar Diabetes and Obesity Research Centre, University of Otago, PO Box 56, Dunedin, New Zealand
| | - Claire McLachlan
- School of Education, Federation University Australia, PO Box 663, Ballarat, VIC 3353, Victoria, Australia
| | - Grant Schofield
- School of Sport and Recreation, Auckland University of Technology, Private Bag 92006, Auckland, New Zealand
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Psaltopoulou T, Tzanninis S, Ntanasis-Stathopoulos I, Panotopoulos G, Kostopoulou M, Tzanninis IG, Tsagianni A, Sergentanis TN. Prevention and treatment of childhood and adolescent obesity: a systematic review of meta-analyses. World J Pediatr 2019; 15:350-381. [PMID: 31313240 DOI: 10.1007/s12519-019-00266-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 05/03/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND The goal of this systematic review is to synthesize the published meta-analyses assessing the role of nutritional, behavioral and physical activity factors/interventions on the prevention or treatment of pediatric and adolescent obesity. METHODS An online search was conducted in PubMed (end-of-search: September 30, 2015); English-language meta-analyses pooling observational and/or interventional studies examining weight-related indices on children and adolescents were included. RESULTS Sixty-six meta-analyses corresponding to more than 900,000 children and adolescents were retrieved. The majority of meta-analyses included interventional studies most of which referred to mixed or combined interventions, including components such as diet, physical activity and sedentary behavior reduction. Discrepancies between meta-analyses on observational and interventional studies were noted. Combined interventions including physical activity and nutritional modifications seemed to represent the most effective means for tackling childhood obesity. CONCLUSIONS Synthesis of interventional or observational evidence may yield discrepant results. The combination of enhanced physical activity and improved nutrition emerged as a promising intervention in the fight against childhood/adolescent obesity. However, further research is needed about the most effective multidimensional prevention strategy.
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Affiliation(s)
- Theodora Psaltopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 75, M. Asias Str, 115 27, Athens, Greece.
| | - Stamatios Tzanninis
- Department of Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Ioannis Ntanasis-Stathopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - George Panotopoulos
- Hellenic Association for the Study of Obesity, Metabolism and Eating Disorders (HASOMED), Athens, Greece
| | - Myrto Kostopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 75, M. Asias Str, 115 27, Athens, Greece
| | | | - Anastasia Tsagianni
- Division of Internal Medicine, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA
| | - Theodoros N Sergentanis
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 75, M. Asias Str, 115 27, Athens, Greece
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Gray HL, Buro AW, Barrera Ikan J, Wang W, Stern M. School-level factors associated with obesity: A systematic review of longitudinal studies. Obes Rev 2019; 20:1016-1032. [PMID: 31013544 DOI: 10.1111/obr.12852] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 02/16/2019] [Accepted: 02/25/2019] [Indexed: 01/27/2023]
Abstract
Although school has been an important intervention venue for obesity prevention, the role of school-level factors in obesity development or prevention has not been well-documented. This study aimed to systematically examine the current evidence on school-level factors associated with obesity outcomes in longitudinal studies. The literature search was performed in PubMed, EMBASE, CINHAL, and PsycINFO. Peer-reviewed articles using longitudinal study designs and published in English from 1991 to 2018 were eligible. Twelve articles met eligibility criteria for final systematic review. Nine studies reported significant long-term associations between school-level factors and obesity outcomes. Higher parental education, longer minutes of recess, meeting recommended recess and physical education time, higher socio-economic status, suburban compared with rural area, higher parental involvement in school, and healthful school food environment were significantly associated with lower rates of obesity or obesity trajectory. However, due to the small number of studies and heterogeneity of measures and variables used in their analytic models, the overall level of evidence from this review suggests the importance of further, systematic study. Empirically rigorous research is needed to identify additional aspects of the school context and environment that may contribute to the risk of obesity throughout the life course.
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Affiliation(s)
- Heewon L Gray
- College of Public Health, University of South Florida, Tampa, Florida
| | - Acadia W Buro
- College of Public Health, University of South Florida, Tampa, Florida
| | | | - Wei Wang
- College of Public Health, University of South Florida, Tampa, Florida.,Centre for Addiction and Mental Health, Ontario, Canada
| | - Marilyn Stern
- Department of Child & Family Studies, College of Behavioral & Community Sciences, University of South Florida, Tampa, Florida
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Weatherson KA, Locke SR, Jung ME. Exploring the effectiveness of a school-based physical activity policy in British Columbia, Canada: a mixed-methods observational study. Transl Behav Med 2019; 9:246-255. [PMID: 29800423 DOI: 10.1093/tbm/iby053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The Daily Physical Activity (DPA) policy in British Columbia requires elementary schools to help students achieve 30 min of physical activity during instructional and noninstructional time on school days. The purpose of this study was to determine how elementary teachers implement the DPA policy, and examine differences in children's light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA) at school, based on how the teacher implemented the DPA policy during the school day (provision of DPA during instructional time or only noninstructional time). In this observational mixed-methods study, 12 teachers were interviewed on their implementation approaches. Teachers provided DPA opportunities during instructional time (i.e., prescriptive implementers, n = 9) or relied on students to be active during noninstructional times (i.e., nonprescriptive, n = 3). Next, 10 students from each interviewed teacher's classroom were randomly selected to wear accelerometers for one school week. Hierarchical linear modeling was used to examine the contribution of teacher's implementation strategy on student's activity levels. t-Tests examined differences in students' activity levels between implementation groups. Teacher's DPA implementation strategy accounted for a significant proportion of variance in student's activity throughout the school day (p's < .05). The prescriptive group (n = 88) was more active (LPA and MVPA) and spent a greater proportion of their school days in MVPA during instructional time than the nonprescriptive group (n = 23). Heterogeneity in policy implementation creates variations in policy effectiveness. Students provided with opportunities to be active during instructional time may accumulate more MVPA compared with those who are not given these opportunities. Registration: Not applicable.
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Affiliation(s)
- Katie A Weatherson
- School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia, Okanagan, ART 360-1147 Research Road, Kelowna, BC, Canada
| | - Sean R Locke
- School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia, Okanagan, ART 118-1147 Research Road, Kelowna, BC, Canada
| | - Mary E Jung
- School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia, Okanagan, RHS 119-1147 Research Road, Kelowna, BC, Canada
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Messing S, Rütten A, Abu-Omar K, Ungerer-Röhrich U, Goodwin L, Burlacu I, Gediga G. How Can Physical Activity Be Promoted Among Children and Adolescents? A Systematic Review of Reviews Across Settings. Front Public Health 2019; 7:55. [PMID: 30941342 PMCID: PMC6433781 DOI: 10.3389/fpubh.2019.00055] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 02/25/2019] [Indexed: 01/22/2023] Open
Abstract
Introduction: A vast majority of children and adolescents are physically inactive. As a result, high obesity rates and related diseases have made physical activity promotion a politically relevant topic. In order to form the basis for political decision making, evidence is required regarding the efficacy and effectiveness of interventions for physical activity promotion. In contrast to previous research, this systematic review of reviews targets three key settings (family and home, childcare, school), and is among the largest to have been conducted. Methods: A systematic review of reviews was conducted as part of a large-scale project to develop national recommendations for physical activity promotion in Germany. Six electronic databases were searched and inclusion criteria were defined. Two independent reviewers screened the titles and abstracts of potentially relevant literature. 213 reviews were identified and categorised by target group. A total of 74 reviews were identified dealing with children and adolescents. Each review underwent a quality assessment. Results: 39 reviews with the highest quality and relevance were analysed. Three reviews focused on the family and home setting, 4 on the childcare setting, 28 on the school setting and 4 on other settings. Evidence revealed the key role played by parents in promoting physical activity in children within each setting. Furthermore, evidence pointed toward the efficacy of multi-component interventions in the childcare and school setting. Several evidence-based intervention strategies were identified for childcare facilities and schools. Discussion: The review of reviews identified a number of promising strategies for PA promotion among children and adolescents. Among reviews, multi-component interventions in childcare facilities and schools stand out prominently. At the same time, the review of reviews indicated that there is still a lack of studies on the efficacy of interventions that go beyond the individual level. We recommend that future research should also target community and policy level interventions and interventions other than the school setting. In order to make more specific recommendations regarding the scale-up of promising intervention strategies, further knowledge about the effectiveness, health equity and cost effectiveness of interventions is needed.
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Affiliation(s)
- Sven Messing
- Department of Sport Science and Sport, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Alfred Rütten
- Department of Sport Science and Sport, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Karim Abu-Omar
- Department of Sport Science and Sport, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | | | - Lee Goodwin
- Department of Sport Science and Sport, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Ionuţ Burlacu
- Department of Sport Science and Sport, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Günther Gediga
- Department of Psychology, University of Münster, Münster, Germany
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Kattelmann KK, Meendering JR, Hofer EJ, Merfeld CM, Olfert MD, Hagedorn RL, Colby SE, Franzen-Castle L, Moyer J, Mathews DR, White AA. The iCook 4-H Study: Report on Physical Activity and Sedentary Time in Youth Participating in a Multicomponent Program Promoting Family Cooking, Eating, and Playing Together. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2019; 51:S30-S40. [PMID: 30509553 DOI: 10.1016/j.jneb.2018.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 08/28/2018] [Accepted: 09/06/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To report physical activity and sedentary time outcomes of youth in iCook 4-H. STUDY DESIGN AND SETTING iCook 4-H was a 5-state, randomized, control-treatment, family-based childhood obesity prevention intervention promoting cooking, eating, and playing together. PARTICIPANTS AND INTERVENTION Youth aged 9-10 years and the main preparer of their meals participated in the 12-week program followed by monthly newsletters and biyearly booster sessions until 24 months. MAIN OUTCOME MEASURE(S) A total of 155 youth were fitted with an Actigraph GT3X+ accelerometer, which they wore for 7 days at baseline and 4, 12, and 24 months to measure mean daily minutes per hour of waking wear time for sedentary time (ST), light physical activity (PA) (LPA), moderate PA, vigorous PA, and moderate to vigorous PA. Self-reported PA was assessed using the Block Kids Physical Activity Screener and additional questions querying for the program goal of the frequency of family actively playing together. Linear mixed models were used to determine differences from baseline to 24 months. Significance was set at P ≤ .05. RESULTS There was a significant (P < .05) group × time interaction for LPA (adjusted interaction B estimate, 95% confidence interval; 0.18 [0.05, 0.30]) and ST (-0.15 [-0.26, -0.04]); ST increased and LPA decreased in the treatment group. There were no differences in other accelerometer-derived PA measures, self-report Block Kids Physical Activity Screener measures, or frequency of family actively playing together at any time point. CONCLUSIONS AND IMPLICATIONS iCook 4-H was a multicomponent program observing youth aged 9-10 years for 24 months that focused on enhancing cooking skills, mealtime behavior and conversation, and PA through daily family activities. Greater emphasis on developing PA skills, changing environmental factors, and increasing PA both in and after school may be needed.
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Affiliation(s)
- Kendra K Kattelmann
- Department of Health and Nutritional Sciences, South Dakota State University, Brookings, SD.
| | - Jessica R Meendering
- Department of Health and Nutritional Sciences, South Dakota State University, Brookings, SD
| | - Emily J Hofer
- Department of Health and Nutritional Sciences, South Dakota State University, Brookings, SD
| | - Chase M Merfeld
- Department of Health and Nutritional Sciences, South Dakota State University, Brookings, SD
| | - Melissa D Olfert
- Division of Animal and Nutritional Sciences in Human Nutrition and Foods, West Virginia University, Morgantown, WV
| | - Rebecca L Hagedorn
- Division of Animal and Nutritional Sciences in Human Nutrition and Foods, West Virginia University, Morgantown, WV
| | - Sarah E Colby
- Department of Nutrition, University of Tennessee, Knoxville, TN
| | - Lisa Franzen-Castle
- Nutrition and Health Sciences Department, University of Nebraska-Lincoln, Lincoln, NE
| | - Jonathan Moyer
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA
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Bramante CT, Thornton RLJ, Bennett WL, Zhang A, Wilson RF, Bass EB, Tseng E. Systematic Review of Natural Experiments for Childhood Obesity Prevention and Control. Am J Prev Med 2019; 56:147-158. [PMID: 30573143 PMCID: PMC7397557 DOI: 10.1016/j.amepre.2018.08.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 08/06/2018] [Accepted: 08/07/2018] [Indexed: 12/16/2022]
Abstract
CONTEXT The National Academy of Medicine recommends childhood obesity prevention efforts making healthier options the passive choice. This review evaluated the effectiveness of population-level policies and programs from natural experiments for childhood obesity prevention. EVIDENCE ACQUISTION The search included PubMed, CINAHL, PsycINFO, and EconLit from 2000 to 2017 for policies evaluated by natural experiments reporting childhood BMI outcomes. The studies were analyzed in 2017-2018. Interventions were classified by environmental focus (food/beverage, physical activity, or both) and stratified by setting (school, community, both). Risk of bias was evaluated for each study. EVIDENCE SYNTHESIS Of 33 natural experiments, most (73%) took place in the school setting only. The most common environmental focus in any setting was food/beverage (48%). All four studies that focused on both food/beverage and physical activity in schools demonstrated decreased prevalence of overweight/obesity or BMI z-score by 0.04-0.17. BMI decreased in all four studies in both school and community settings. The largest effect size was a decrease in BMI z-score of 0.5, but most were <0.25. The risk of bias was high for most (76%) studies. Most (63%) of the eight studies with low/medium risk of bias took place in the school setting focused on the food/beverage environment; effects on BMI were mixed. CONCLUSIONS Natural experiments evaluating school-based policies focusing on both the food/beverage and physical activity environments (versus targeting only one) consistently showed improvement in BMI. However, most studies had high risk of bias, highlighting the need for improved methods for evaluation of natural experiments for childhood obesity prevention.
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Affiliation(s)
- Carolyn T Bramante
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Rachel L J Thornton
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Wendy L Bennett
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Allen Zhang
- Johns Hopkins Evidence-Based Practice Center, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Renee F Wilson
- Johns Hopkins Evidence-Based Practice Center, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Eric B Bass
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Johns Hopkins Evidence-Based Practice Center, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Eva Tseng
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland
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Acton RB, Nguyen N, Minaker LM. School Food Policies and Student Eating Behaviors in Canada: Examination of the 2015 Cancer Risk Assessment in Youth Survey. THE JOURNAL OF SCHOOL HEALTH 2018; 88:936-944. [PMID: 30392189 DOI: 10.1111/josh.12702] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 01/11/2018] [Accepted: 07/05/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Limited evidence exists on effects of school-based nutrition policies. This study explored the influence of mandatory versus voluntary provincial school nutrition policies on student eating behaviors. METHODS A cross-sectional, school-based survey assessed student eating behaviors using self-report survey measures in a representative sample of Canadian high school students from 7 provinces (N = 12,110). Provincial school nutrition policies were characterized as mandatory or voluntary. Healthful and nonhealthful eating behaviors were analyzed across sociodemographic characteristics. Regression models were used to assess the association between policy type and eating behaviors, and to explore potential moderating variables. RESULTS Healthful and nonhealthful eating behaviors differed significantly across several sociodemographic characteristics. Overall, neither healthful nor nonhealthful eating behaviors differed significantly between schools with voluntary and mandatory nutrition policies (odds ratio [OR] = 0.83, 95% confidence interval [CI] 0.64-1.08; OR = 1.16, 95% CI 0.83-1.64). Frequency of buying lunch at school and buying lunch out moderated the association between policy enforcement level and healthful eating behaviors (p = .0472, p = .0119). Frequency of buying lunch out moderated the association between policy enforcement levels and nonhealthful eating behaviors (p = .0009). CONCLUSIONS This study documents nonhealthful components of Canadian adolescents' diets, and the results highlight important areas for future research in assessing the effectiveness of school nutrition policies.
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Affiliation(s)
- Rachel B Acton
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue, Waterloo, ON N2L 3G1, Canada
| | - Nghia Nguyen
- Propel Centre for Population Health Impact, Faculty of Applied Health Sciences, University of Waterloo, 200 University Avenue, Waterloo, ON N2L 3G1, Canada
| | - Leia M Minaker
- School of Planning, University of Waterloo, 200 University Avenue, Waterloo, Ontario N2L 3G1, Canada
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Mahendra A, Polsky JY, Robitaille É, Lefebvre M, McBrien T, Minaker LM. Status report - Geographic retail food environment measures for use in public health. HEALTH PROMOTION AND CHRONIC DISEASE PREVENTION IN CANADA-RESEARCH POLICY AND PRACTICE 2018; 37:357-362. [PMID: 29043763 DOI: 10.24095/hpcdp.37.10.06] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The Association of Public Health Epidemiologists in Ontario (APHEO) Core Indicators Work Group standardizes definitions and calculation methods for over 120 public health indicators to enhance accurate and standardized community health status reporting across public health units in Ontario. The Built Environment Subgroup is a multi-disciplinary group made up of planners, researchers, policy analysts, registered dietitians, geographic information systems (GIS) analysts and epidemiologists. The Subgroup selected and operationalized a suite of objective, standardized indicators intended to help public health units and regional health authorities assess their community retail food environments. The Subgroup proposed three indicators that use readily available data sources and GIS tools to characterize geographic access to various types of retail food outlets within neighbourhoods in urban settings. This article provides a status report on the development of these food environment indicators.
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Affiliation(s)
| | - Jane Y Polsky
- Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Éric Robitaille
- Institut national de santé publique du Québec, Montréal, Quebec, Canada
| | - Marc Lefebvre
- Sudbury & District Health Unit, Sudbury, Ontario, Canada
| | - Tina McBrien
- Region of Peel Public Health, Mississauga, Ontario, Canada
| | - Leia M Minaker
- School of Planning, University of Waterloo, Waterloo, Ontario, Canada
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Kim TE, Jang CY. The relationship between children's flourishing and being overweight. J Exerc Rehabil 2018; 14:598-605. [PMID: 30276180 PMCID: PMC6165987 DOI: 10.12965/jer.1836208.104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 07/14/2018] [Indexed: 11/22/2022] Open
Abstract
This study examined the effect of children's flourishing on the pandemic of obesity from various aspects such as age, gender, race, family, school, and community. By using a subsample of the 2011-2012 National Survey of Children's Health, the Flourishing scale analyses were performed with a total of 45,309 children. Childhood obesity was diagnosed by calculating the percentile of the body mass index. Hispanic Americans were more likely to be overweight (P<0.01). Nonoverweight children were more likely to participate in after-school activities, less likely to have sedentary behavior, more likely to miss school, to be more active, and had more of flourishing than their counterpart (P<0.01). Parent's marital and health status also positively affect children's obesity status (P<0.01). Social capital and neighbor amenities significantly affect children's weight status (P<0.01). A multifaceted understanding of the role of family, school, and community (with proving children's flourishing environment) in terms of how and what could contribute to children's obesity status is important in order to bring about positive impact.
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Affiliation(s)
- Tae Eung Kim
- Department of Applied Health Science, Indiana University, Bloomington, IN, USA
| | - Chang-Yong Jang
- Institute of Sport Science, College of Arts and Physical Education, Incheon National University, Incheon, Korea
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Saluja K, Rawal T, Bassi S, Bhaumik S, Singh A, Park MH, Kinra S, Arora M. School environment assessment tools to address behavioural risk factors of non-communicable diseases: A scoping review. Prev Med Rep 2018; 10:1-8. [PMID: 29868351 PMCID: PMC5984208 DOI: 10.1016/j.pmedr.2018.01.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 01/09/2018] [Accepted: 01/20/2018] [Indexed: 11/19/2022] Open
Abstract
We aimed to identify, describe and analyse school environment assessment (SEA) tools that address behavioural risk factors (unhealthy diet, physical inactivity, tobacco and alcohol consumption) for non-communicable diseases (NCD). We searched in MEDLINE and Web of Science, hand-searched reference lists and contacted experts. Basic characteristics, measures assessed and measurement properties (validity, reliability, usability) of identified tools were extracted. We narratively synthesized the data and used content analysis to develop a list of measures used in the SEA tools. Twenty-four SEA tools were identified, mostly from developed countries. Out of these, 15 were questionnaire based, 8 were checklists or observation based tools and one tool used a combined checklist/observation based and telephonic questionnaire approach. Only 1 SEA tool had components related to all the four NCD risk factors, 2 SEA tools has assessed three NCD risk factors (diet/nutrition, physical activity, tobacco), 10 SEA tools has assessed two NCD risk factors (diet/nutrition and physical activity) and 11 SEA tools has assessed only one of the NCD risk factor. Several measures were used in the tools to assess the four NCD risk factors, but tobacco and alcohol was sparingly included. Measurement properties were reported for 14 tools. The review provides a comprehensive list of measures used in SEA tools which could be a valuable resource to guide future development of such tools. A valid and reliable SEA tool which could simultaneously evaluate all NCD risk factors, that has been tested in different settings with varying resource availability is needed.
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Affiliation(s)
- Kiran Saluja
- Health Promotion Division, Public Health Foundation of India, India
| | - Tina Rawal
- Health Promotion Division, Public Health Foundation of India, India
| | - Shalini Bassi
- Health Promotion Division, Public Health Foundation of India, India
| | | | - Ankur Singh
- Australian Research Centre for Population Oral Health (ARCPOH), Adelaide Dental School, The University of Adelaide, Australia
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Min Hae Park
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Sanjay Kinra
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Monika Arora
- Health Promotion Division, Public Health Foundation of India, India
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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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A Multicomponent Schoolyard Intervention Targeting Children's Recess Physical Activity and Sedentary Behavior: Effects After 1 Year. J Phys Act Health 2017; 14:866-875. [PMID: 28682695 DOI: 10.1123/jpah.2016-0656] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The aim of the study was to test the 12-month effects of a multicomponent physical activity (PA) intervention at schoolyards on morning recess PA levels of sixth- and seventh-grade children in primary schools, using accelerometry and additional global positioning system data. METHODS A quasi-experimental study design was used with 20 paired intervention and control schools. Global positioning system confirmatory analyses were applied to validate attendance at schoolyards during recess. Accelerometer data from 376 children from 7 pairs of schools were included in the final analyses. Pooled intervention effectiveness was tested by multilevel linear regression analyses, whereas effectiveness of intervention components was tested by multivariate linear regression analyses. RESULTS Children exposed to the multicomponent intervention increased their time spent in light PA (+5.9%) during recess. No pooled effects on moderate to vigorous PA were found. In-depth analyses of intervention components showed that physical schoolyard interventions particularly predicted a decrease in time spent in sedentary behavior during recess at follow-up. Intervention intensity and the school's commitment to the project strengthened this effect. CONCLUSIONS The multicomponent schoolyard PA intervention was effective in making children spend a larger proportion of recess time in light PA, which was most likely the result of a shift from sedentary behavior to light PA.
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Hanneke R, Young SK. Information sources for obesity prevention policy research: a review of systematic reviews. Syst Rev 2017; 6:156. [PMID: 28789703 PMCID: PMC5549286 DOI: 10.1186/s13643-017-0543-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 07/12/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Systematic identification of evidence in health policy can be time-consuming and challenging. This study examines three questions pertaining to systematic reviews on obesity prevention policy, in order to identify the most efficient search methods: (1) What percentage of the primary studies selected for inclusion in the reviews originated in scholarly as opposed to gray literature? (2) How much of the primary scholarly literature in this topic area is indexed in PubMed/MEDLINE? (3) Which databases index the greatest number of primary studies not indexed in PubMed, and are these databases searched consistently across systematic reviews? METHODS We identified systematic reviews on obesity prevention policy and explored their search methods and citations. We determined the percentage of scholarly vs. gray literature cited, the most frequently cited journals, and whether each primary study was indexed in PubMed. We searched 21 databases for all primary study articles not indexed in PubMed to determine which database(s) indexed the highest number of these relevant articles. RESULTS In total, 21 systematic reviews were identified. Ten of the 21 systematic reviews reported searching gray literature, and 12 reviews ultimately included gray literature in their analyses. Scholarly articles accounted for 577 of the 649 total primary study papers. Of these, 495 (76%) were indexed in PubMed. Google Scholar retrieved the highest number of the remaining 82 non-PubMed scholarly articles, followed by Scopus and EconLit. The Journal of the American Dietetic Association was the most-cited journal. CONCLUSIONS Researchers can maximize search efficiency by searching a small yet targeted selection of both scholarly and gray literature resources. A highly sensitive search of PubMed and those databases that index the greatest number of relevant articles not indexed in PubMed, namely multidisciplinary and economics databases, could save considerable time and effort. When combined with a gray literature search and additional search methods, including cited reference searching and consulting with experts, this approach could help maintain broad retrieval of relevant studies while improving search efficiency. Findings also have implications for designing specialized databases for public health research.
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Affiliation(s)
- Rosie Hanneke
- Library of the Health Sciences-Chicago, University of Illinois at Chicago, 1750 W. Polk St, Chicago, IL, 60612, USA.
| | - Sabrina K Young
- Health Policy and Administration, School of Public Health, University of Illinois at Chicago, 1603 W. Taylor St, Chicago, IL, 60612, USA.,The Cancer Education and Cancer Development Program, Institute for Health Research and Policy, 1747 W. Taylor St, Chicago, IL, 60608, USA
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Olstad DL, Ancilotto R, Teychenne M, Minaker LM, Taber DR, Raine KD, Nykiforuk CIJ, Ball K. Can targeted policies reduce obesity and improve obesity-related behaviours in socioeconomically disadvantaged populations? A systematic review. Obes Rev 2017; 18:791-807. [PMID: 28434185 DOI: 10.1111/obr.12546] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 03/05/2017] [Accepted: 03/07/2017] [Indexed: 12/19/2022]
Abstract
This review synthesized evidence from controlled studies pertaining to the impact of targeted policies on anthropometric, dietary and physical activity outcomes amongst socioeconomically disadvantaged children and adults. Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Equity guidelines were followed. Eligible studies were published from 2004 to August 2015 and examined the impact of targeted policies on anthropometric, dietary and physical activity outcomes amongst socioeconomically disadvantaged populations. Twenty articles (18 studies) were included. Eight studies examined organizational policies within multi-component interventions in schools. Common elements of successful policy-containing interventions included nutritional standards, enhancements to physical education, additional physical activity opportunities, school self-assessments, and nutrition and physical activity education. Of the 10 studies of government policies, policies providing information/education and fruit and vegetable subsidies had positive impacts amongst children, but no impact amongst adults. Policies involving changes to built environments yielded nearly uniformly null findings in children and adults. Overall, the largest quantity of high-quality evidence of effectiveness was for comprehensive interventions that included school policies, and government policies targeting disadvantaged children in schools. None of the government policies targeting disadvantaged adults proved effective. Interventions during childhood may ameliorate negative obesity-related manifestations of socioeconomic disadvantage. Gaps in knowledge remain surrounding effective policies in adults, adolescents and very young children.
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Affiliation(s)
- D L Olstad
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - R Ancilotto
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - M Teychenne
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - L M Minaker
- School of Planning, Faculty of Environment, University of Waterloo, Waterloo, Ontario, Canada
| | - D R Taber
- Healthy Food America, Seattle, Washington, USA
| | - K D Raine
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - C I J Nykiforuk
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - K Ball
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
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Xie C, Wang X, Zhou C, Xu C, Chang YK. Exercise and dietary program-induced weight reduction is associated with cognitive function among obese adolescents: a longitudinal study. PeerJ 2017; 5:e3286. [PMID: 28533954 PMCID: PMC5436556 DOI: 10.7717/peerj.3286] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 04/08/2017] [Indexed: 12/18/2022] Open
Abstract
Objective The present study was to determine the effect of a combined exercise and dietary program on cognitive function as well as the relationship between the program-induced weight change and cognitive function alterations. Design The study applies a quasi-experimental design. Methods Fifty-eight adolescents with obese status (body mass index, BMI >28 kg/m2) were assigned to either an experiment (n = 30) or control group (n = 28). Participants in the experiment group received a scheduled program with a specific exercise protocol (two sessions per day, six days per week) and diet plan for four consecutive weeks; the control group was instructed to maintain their normal school activities. The primary outcome measures were anthropometric data and flanker task performance. Results The combined program led to reduced BMI with maintenance of the incongruent accuracy in the experiment group, but the incongruent accuracy decreased in the control group after the four-week period. Additionally, the change in weight status between post- and pre-test measurements was inversely correlated with the change in incongruent accuracy. Conclusion The combined exercise and dietary program resulted in decreased weight and enhanced executive function in the obese adolescents, and the weight alteration may be considered the mediator between the intervention and executive function.
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Affiliation(s)
- Chun Xie
- School of Kinesiology, Shanghai University of Sport, Shanghai, Shanghai, China
| | - Xiaochun Wang
- School of Kinesiology, Shanghai University of Sport, Shanghai, Shanghai, China
| | - Chenglin Zhou
- School of Kinesiology, Shanghai University of Sport, Shanghai, Shanghai, China
| | - Chang Xu
- School of Kinesiology, Shanghai University of Sport, Shanghai, Shanghai, China
| | - Yu-Kai Chang
- Graduate Institute of Athletics and Coaching Science, National Taiwan Sport University, Guishan Township, Taoyuan County, Taiwan
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Singh A, Bassi S, Nazar GP, Saluja K, Park M, Kinra S, Arora M. Impact of school policies on non-communicable disease risk factors - a systematic review. BMC Public Health 2017; 17:292. [PMID: 28376833 PMCID: PMC5379668 DOI: 10.1186/s12889-017-4201-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 03/25/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Globally, non-communicable diseases (NCDs) are identified as one of the leading causes of mortality. NCDs have several modifiable risk factors including unhealthy diet, physical inactivity, tobacco use and alcohol abuse. Schools provide ideal settings for health promotion, but the effectiveness of school policies in the reduction of risk factors for NCD is not clear. This study reviewed the literature on the impact of school policies on major NCD risk factors. METHODS A systematic review was conducted to identify, collate and synthesize evidence on the effectiveness of school policies on reduction of NCD risk factors. A search strategy was developed to identify the relevant studies on effectiveness of NCD policies in schools for children between the age of 6 to 18 years in Ovid Medline, EMBASE, and Web of Science. Data extraction was conducted using pre-piloted forms. Studies included in the review were assessed for methodological quality using the Effective Public Health Practice Project (EPHPP) quality assessment tool. A narrative synthesis according to the types of outcomes was conducted to present the evidence on the effectiveness of school policies. RESULTS Overall, 27 out of 2633 identified studies were included in the review. School policies were comparatively more effective in reducing unhealthy diet, tobacco use, physical inactivity and inflammatory biomarkers as opposed to anthropometric measures, overweight/obesity, and alcohol use. In total, for 103 outcomes independently evaluated within these studies, 48 outcomes (46%) had significant desirable changes when exposed to the school policies. Based on the quality assessment, 18 studies were categorized as weak, six as moderate and three as having strong methodological quality. CONCLUSION Mixed findings were observed concerning effectiveness of school policies in reducing NCD risk factors. The findings demonstrate that schools can be a good setting for initiating positive changes in reducing NCD risk factors, but more research is required with long-term follow up to study the sustainability of such changes.
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Affiliation(s)
- Ankur Singh
- Australian Research Centre for Population Oral Health (ARCPOH), Adelaide Dental School, The University of Adelaide, Adelaide, Australia
| | - Shalini Bassi
- Health Promotion Division, Public Health Foundation of India (PHFI), Plot No. 47, Sector 44, Gurgaon, Haryana 122002 India
| | - Gaurang P. Nazar
- Health Promotion Division, Public Health Foundation of India (PHFI), Plot No. 47, Sector 44, Gurgaon, Haryana 122002 India
| | - Kiran Saluja
- Health Promotion Division, Public Health Foundation of India (PHFI), Plot No. 47, Sector 44, Gurgaon, Haryana 122002 India
| | - MinHae Park
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Sanjay Kinra
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Monika Arora
- Health Promotion Division, Public Health Foundation of India (PHFI), Plot No. 47, Sector 44, Gurgaon, Haryana 122002 India
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What are the challenges in developing effective health policies for obesity? Int J Obes (Lond) 2017; 41:849-852. [PMID: 28077862 DOI: 10.1038/ijo.2017.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 10/03/2016] [Accepted: 12/13/2016] [Indexed: 12/25/2022]
Abstract
Identifying and implementing thoughtful, evidence-based (or at least evidence-informed) public health approaches to influencing obesity is a complex issue fraught with multiple challenges. These challenges begin with determining whether obesity policy approaches should be implemented. This is considered within the broader context of how common public health policy approaches may be relevant and applied to obesity. Additional challenges discussed include inconsistencies in clearly identifying obesity policy targets (for example, prevention versus treatment), selection of appropriate intervention targets and the identification and measurement of meaningful outcomes. Current policy initiatives are drawn upon to illustrate these challenges in the context of promoting solution-focused dialog aimed toward improving current initiatives and informing the development of new programs.
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Polo-Oteyza E, Ancira-Moreno M, Rosel-Pech C, Sánchez-Mendoza MT, Salinas-Martínez V, Vadillo-Ortega F. An intervention to promote physical activity in Mexican elementary school students: building public policy to prevent noncommunicable diseases. Nutr Rev 2017; 75:70-78. [PMID: 28049751 DOI: 10.1093/nutrit/nuw047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Physical activity is an important component of strategies for health promotion and prevention of noncommunicable diseases. It is also associated with decreased risk for cardiovascular disease in overweight and obese adults and children. This article addresses the initial description of a physical activity intervention for children attending public elementary schools in Mexico. The objective was to develop a replicable model based on a strategic public, private, academic, and social partnership that would have a short-term impact on the metabolic health of children and be useful for building effective public policy. Forty-nine schools (20 000 students) participated, and 5 schools were selected for evaluation. The intervention included a 30-minute supervised middle-effort interchangeable routine, 5 days a week for a complete school year, adapted for different school conditions and students of different ages. Evaluation included anthropometric measurements and biochemical markers. Actual prevalence of combined overweight and obesity in these children was 31.9%. The intervention was successfully implemented in all schools. No change in body mass index, waist circumference, or other anthropometric indicators was found. However, changes in biochemical markers showed a significant decrease in blood glucose, total cholesterol, and cholesterol-low-density lipoproteins, reflecting a positive effect on cardiovascular health indicators.
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Affiliation(s)
- Ernestina Polo-Oteyza
- E. Polo-Oteyza is with the Fondo Nestlé para la Nutrición, Fundación Mexicana para la Salud, Mexico City, Mexico. M. Ancira-Moreno, C. Rosel-Pech, and F. Vadillo-Ortega are with the Unidad de Vinculación de la Facultad de Medicina, UNAM en el Instituto Nacional de Medicina Genómica, Mexico City, Mexico. M. Teresa Sánchez-Mendoza is with the Subdirección Regional de Educación Básica Metepec, Secretaría de Educación, Gobierno del Estado de Mexico, Metepec, Mexico. V. Salinas-Martínez is with the Hospital Materno Perinatal Mónica Pretelini, Toluca, Estado de Mexico, Mexico
| | - Mónica Ancira-Moreno
- E. Polo-Oteyza is with the Fondo Nestlé para la Nutrición, Fundación Mexicana para la Salud, Mexico City, Mexico. M. Ancira-Moreno, C. Rosel-Pech, and F. Vadillo-Ortega are with the Unidad de Vinculación de la Facultad de Medicina, UNAM en el Instituto Nacional de Medicina Genómica, Mexico City, Mexico. M. Teresa Sánchez-Mendoza is with the Subdirección Regional de Educación Básica Metepec, Secretaría de Educación, Gobierno del Estado de Mexico, Metepec, Mexico. V. Salinas-Martínez is with the Hospital Materno Perinatal Mónica Pretelini, Toluca, Estado de Mexico, Mexico
| | - Cecilia Rosel-Pech
- E. Polo-Oteyza is with the Fondo Nestlé para la Nutrición, Fundación Mexicana para la Salud, Mexico City, Mexico. M. Ancira-Moreno, C. Rosel-Pech, and F. Vadillo-Ortega are with the Unidad de Vinculación de la Facultad de Medicina, UNAM en el Instituto Nacional de Medicina Genómica, Mexico City, Mexico. M. Teresa Sánchez-Mendoza is with the Subdirección Regional de Educación Básica Metepec, Secretaría de Educación, Gobierno del Estado de Mexico, Metepec, Mexico. V. Salinas-Martínez is with the Hospital Materno Perinatal Mónica Pretelini, Toluca, Estado de Mexico, Mexico
| | - María Teresa Sánchez-Mendoza
- E. Polo-Oteyza is with the Fondo Nestlé para la Nutrición, Fundación Mexicana para la Salud, Mexico City, Mexico. M. Ancira-Moreno, C. Rosel-Pech, and F. Vadillo-Ortega are with the Unidad de Vinculación de la Facultad de Medicina, UNAM en el Instituto Nacional de Medicina Genómica, Mexico City, Mexico. M. Teresa Sánchez-Mendoza is with the Subdirección Regional de Educación Básica Metepec, Secretaría de Educación, Gobierno del Estado de Mexico, Metepec, Mexico. V. Salinas-Martínez is with the Hospital Materno Perinatal Mónica Pretelini, Toluca, Estado de Mexico, Mexico
| | - Vicente Salinas-Martínez
- E. Polo-Oteyza is with the Fondo Nestlé para la Nutrición, Fundación Mexicana para la Salud, Mexico City, Mexico. M. Ancira-Moreno, C. Rosel-Pech, and F. Vadillo-Ortega are with the Unidad de Vinculación de la Facultad de Medicina, UNAM en el Instituto Nacional de Medicina Genómica, Mexico City, Mexico. M. Teresa Sánchez-Mendoza is with the Subdirección Regional de Educación Básica Metepec, Secretaría de Educación, Gobierno del Estado de Mexico, Metepec, Mexico. V. Salinas-Martínez is with the Hospital Materno Perinatal Mónica Pretelini, Toluca, Estado de Mexico, Mexico
| | - Felipe Vadillo-Ortega
- E. Polo-Oteyza is with the Fondo Nestlé para la Nutrición, Fundación Mexicana para la Salud, Mexico City, Mexico. M. Ancira-Moreno, C. Rosel-Pech, and F. Vadillo-Ortega are with the Unidad de Vinculación de la Facultad de Medicina, UNAM en el Instituto Nacional de Medicina Genómica, Mexico City, Mexico. M. Teresa Sánchez-Mendoza is with the Subdirección Regional de Educación Básica Metepec, Secretaría de Educación, Gobierno del Estado de Mexico, Metepec, Mexico. V. Salinas-Martínez is with the Hospital Materno Perinatal Mónica Pretelini, Toluca, Estado de Mexico, Mexico.
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Stiefel L, Elbel B, Prescott MP, Aneja S, Schwartz AE. School Wellness Programs: Magnitude and Distribution in New York City Public Schools. THE JOURNAL OF SCHOOL HEALTH 2017; 87:3-11. [PMID: 27917485 PMCID: PMC5142207 DOI: 10.1111/josh.12463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 03/10/2016] [Accepted: 04/26/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Public schools provide students with opportunities to participate in many discretionary, unmandated wellness programs. Little is known about the number of these programs, their distribution across schools, and the kinds of students served. We provide evidence on these questions for New York City (NYC) public schools. METHODS Data on wellness programs were collected from program websites, NYC's Office of School Food and Wellness, and direct contact with program sponsors for 2013. Programs were grouped into categories, nutrition, fitness, and comprehensive, and were combined with data on school characteristics available from NYC's Department of Education. Numbers of programs and provision of programs were analyzed for relationships with demographic and school structural characteristics, using descriptive statistics and multiple regression. RESULTS Discretionary wellness programs are numerous, at 18 programs. Little evidence supports inequity according to student race/ethnicity, income, or nativity, but high schools, new schools, co-located schools, small schools, and schools with larger proportions of inexperienced teachers are less likely to provide wellness programs. CONCLUSIONS Opportunities exist to further the reach of wellness programs in public schools by modifying them for high school adoption and building capacity in schools less likely to have the administrative support to house them.
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Affiliation(s)
- Leanna Stiefel
- New York University Wagner and Steinhardt Schools, NYU Institute for Education and Social Policy, 665 Broadway, Suite 805, New York, NY 10012
| | - Brian Elbel
- NYU Wagner and School of Medicine, 227 East 30 Street, New York, NY 10016, Phone: (212) 263-4283 Fax: (212) 501-2706,
| | - Melissa Pflugh Prescott
- School-Based Childhood Obesity Prevention Laboratory, Department of Food Science and Human Nutrition, Colorado State University, 502 West Lake Street, Fort Collins, CO 80523-1571, Phone: (970) 491-5383,
| | | | - Amy Ellen Schwartz
- The Maxwell School, Syracuse University, NYU Institute for Education and Social Policy, 665 Broadway, Suite 805, Phone: (212) 998-7405 Fax: (212) 995-4162,
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Zinkel SRJ, Berkowitz RI, Stunkard AJ, Stallings VA, Faith M, Thomas D, Schoeller DA. High energy expenditure is not protective against increased adiposity in children. Pediatr Obes 2016; 11:528-534. [PMID: 26909758 PMCID: PMC4993690 DOI: 10.1111/ijpo.12099] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 10/14/2015] [Accepted: 10/15/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Low levels of energy expenditure (TEE) may contribute to excess weight during childhood, but limited longitudinal data exist. OBJECTIVES This is to test whether low TEE during the first 6 years of life could predict excess weight status at 8 years. METHODS Total energy expenditure from doubly labelled water, weight, stature, waist circumference and fat mass and fat-free mass (FFM) in children at 0.25, 2, 4 and 6 years of age. This cohort includes individuals at high (n = 27) and low risk (n = 26) for childhood obesity, based upon whether pre-pregnant maternal obesity. A linear mixed effects model was fit to TEE. Individual variation was accounted for as a random effect. Residual TEE was calculated for age and individually averaged across time. RESULTS Fat-free mass (kg) was highly correlated (R2 = 0.91) with TEE (kcal/day), and waist circumference and sex were also significant predictors of TEE. TEE residual tracked within individuals. TEE residuals did not correlate with either BMI or %fat at age 8 years. CONCLUSION Using the residual TEE approach to identify high and low TEE during the first 6 years of life did not explain excess weight at 8 years of life in this cohort of children at high and low risk of obesity based upon maternal obesity status.
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Affiliation(s)
- Sarah RJ Zinkel
- University of Wisconsin-Madison Department of Nutritional Sciences
| | - Robert I Berkowitz
- University of Pennsylvania Perelman School of Medicine Department of Psychiatry
| | - Albert J Stunkard
- University of Pennsylvania Perelman School of Medicine Department of Psychiatry
| | | | - Myles Faith
- University of Pennsylvania Perelman School of Medicine Department of Psychiatry
| | - Diana Thomas
- Center for Quantitative Obesity Research, Montclair State University, Montclair, NJ
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Cauchi D, Glonti K, Petticrew M, Knai C. Environmental components of childhood obesity prevention interventions: an overview of systematic reviews. Obes Rev 2016; 17:1116-1130. [PMID: 27432025 DOI: 10.1111/obr.12441] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 05/05/2016] [Accepted: 05/23/2016] [Indexed: 02/05/2023]
Abstract
Childhood obesity has a complex multi-factorial aetiology grounded in environmental and individual level factors that affect behaviour and outcomes. An ecological, systems-based approach to addressing childhood obesity is increasingly being advocated. The primary aim of this review is to summarize the evidence reported in systematic reviews on the effectiveness of population-level childhood obesity prevention interventions that have an environmental component. We conducted a systematic review of reviews published since 1995, employing a standardized search strategy in nine databases. Inclusion criteria required that reviews be systematic and evaluated at least one population-level, environmental intervention in any setting aimed at preventing or reducing obesity in children (5-18 years). Sixty-three reviews were included, ten of which were of high quality. Results show modest impact of a broad range of environmental strategies on anthropometric outcomes. Systematic reviews vary in methodological quality, and not all relevant primary studies may be included in each review. To ensure relevance of our findings to practice, we also report on relevant underlying primary studies, providing policy-relevant recommendations based on the evidence reviewed. Greater standardization of review methods and reporting structures will benefit policymakers and public health professionals seeking informed decision-making.
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Affiliation(s)
- D Cauchi
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - K Glonti
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - M Petticrew
- Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - C Knai
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Hager ER, Calamaro CJ, Bentley LM, Hurley KM, Wang Y, Black MM. Nighttime Sleep Duration and Sleep Behaviors among Toddlers from Low-Income Families: Associations with Obesogenic Behaviors and Obesity and the Role of Parenting. Child Obes 2016; 12:392-400. [PMID: 27447782 PMCID: PMC5041548 DOI: 10.1089/chi.2015.0252] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Shortened sleep duration is associated with poor health and obesity among young children. Little is known about relationships among nighttime sleep duration, sleep behaviors, and obesogenic behaviors/obesity among toddlers. This study characterizes sleep behaviors/duration and examines relationships with obesogenic behaviors/obesity among toddlers from low-income families. METHODS Mothers of toddlers (age 12-32 months) were recruited from urban/suburban sites serving low-income families. Mothers provided demographic information and completed the Brief Infant Sleep Questionnaire (BISQ); a 6-item Toddler Sleep Behavior Scale was derived (TSBS-BISQ, higher score reflects more recommended behaviors). Toddler weight/length were measured; obesity defined as ≥95th percentile weight-for-length. Measures of obesogenic behaviors: physical activity [accelerometry, minutes/day in Moderate-to-Vigorous Physical Activity (MVPA)] and diet quality [24-hour recall, Healthy Eating Index 2005 (HEI-2005)]. Bivariate and adjusted multivariable models examined associations between nighttime sleep behaviors/duration and obesogenic behaviors/obesity. RESULTS Sample included 240 toddlers (mean age = 20.2 months), 55% male, 69% black, 59% urban. Toddlers spent 55.4 minutes/day in MVPA, mean HEI-2005 score was 55.4, 13% were obese. Mean sleep duration was 9.1 hours, with 35% endorsing 5-6 recommended sleep behaviors (TSBS-BISQ). In multivariable models, MVPA was positively related to sleep duration; obese toddlers had a shorter nighttime sleep duration than healthy weight toddlers [odds ratio = 0.69, p = 0.014]. Nighttime sleep duration was associated with high TSBS-BISQ scores, F = 6.1, p = 0.003. CONCLUSIONS Toddlers with a shorter nighttime sleep duration are at higher risk for obesity and inactivity. Interventions to promote healthy sleep behaviors among toddlers from low-income families may improve nighttime sleep duration and reduce obesogenic behaviors/obesity.
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Affiliation(s)
- Erin R. Hager
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD
| | | | | | - Kristen M. Hurley
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Yan Wang
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD
| | - Maureen M. Black
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD
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