Physical activity, aerobic fitness and parental socio-economic position among adolescents: the German Health Interview and Examination Survey for Children and Adolescents 2003-2006 (KiGGS)

Cohort profile update-overview of over 35 years of research in the Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) study

PURPOSE

To provide an update on the cohort profile of the DOrtmund Nutritional and Anthropometric Longitudinally Designed (DONALD) study, including objectives, study design, methods and description of the comprehensive data pool, as well as to summarize the most important research findings of recent years.

METHODS

In 1985, the open (dynamic) cohort started to collect information on diet, growth, development, and metabolism of healthy children and adolescents in Dortmund, Germany. Detailed data are collected annually during infancy, childhood, and adolescence of the participants, including a 3-day weighed dietary record, a 24-h urine sample, anthropometric and medical examinations as well as interviews on lifestyle.

RESULTS

Even if the basic examination modules have not changed since the start over 35 years ago, the DONALD study has been continuously further developed by introducing new modules. As such, participants are also invited for follow-up examinations during adulthood since 2005, including an additional fasting blood withdrawal. Overall, 2375 (♂: 1177; ♀: 1198) participants were recruited in the DONALD study between 1985 and 2022. Data from ~ 30,700 anthropometric measurements, ~ 19,200 dietary records, ~ 10,600 24-h urine and ~ 1300 blood samples are available from an observation period of over 35 years.

CONCLUSION

The DONALD study provides a large data pool for longitudinal studies on nutrition, growth, and health in childhood and adolescence, its impact on the development of diseases in early adult life as well as dietary intake trends over more than three decades.

A cohort study of factors influencing the physical fitness of preschool children: a decision tree analysis

Objective

Based on the decision tree model, to explore the key influencing factors of children's physical fitness, rank the key influencing factors, and explain the complex interaction between the influencing factors.

Methods

A cohort study design was adopted. 1,276 children (ages 3-6) from 23 kindergartens in Nanchang, China, were chosen for the study to measure the children's physical fitness at baseline and a year later and to compare the physical fitness scores at the two stages. The study was conducted following the Chinese National Physical Fitness Testing Standard (Children Part); To identify the primary influencing factors of changes in physical fitness, a decision tree model was developed, and a questionnaire survey on birth information, feeding patterns, SB, PA, dietary nutrition, sleep, parental factors, and other relevant information was conducted.

Results

The levels of physical fitness indicators among preschool children showed a significant increase after 1 year. The accuracy of the CHAID model is 84.17%. It showed that 7 variables were strongly correlated with the physical changes of children's fitness, the order of importance of each variable was weekend PA, weekend MVPA, mother's BMI, mother's sports frequency, father's education, mother's education, and school day PA. Three factors are related to PA. Four factors are related to parental circumstances. In addition to the seven important variables mentioned, variables such as breakfast frequency on school day, puffed food, frequency of outing, school day MVPA, parental feeling of sports, father's occupation, and weekend breakfast frequency are all statistically significant leaf node variables.

Conclusion

PA, especially weekend PA, is the most critical factor in children's physical fitness improvement and the weekend MVPA should be increased to more than 30 min/d based on the improvement of weekend PA. In addition, parental factors and school day PA are also important in making decisions about changes in fitness for children. The mother's efforts to maintain a healthy BMI and engage in regular physical activity are crucial for enhancing the physical fitness of children. Additionally, other parental factors, such as the parents' educational levels and the father's occupation, can indirectly impact the level of physical fitness in children.

Associations between Dietary Patterns and Physical Activity with Physical Fitness among Adolescents in Shandong Province, China: A Cross-Sectional Study

Background: The trend of physical fitness (PF) and physical activity (PA) among Chinese adolescents is not optimistic, and unhealthy dietary behaviors are common. PA and dietary patterns (DPs) have been linked to PF in adolescents, but the associations between DPs and PF with PF in Chinese adolescents are rarely discussed. Methods: A total of 8796 adolescents aged 11–18 were enrolled from Shandong Province, China. The CNSPFS battery was applied to assess PF. PA levels and diet quality were determined using the Physical Activity Questionnaire for Adolescents and the modified Chinese Diet Quality Questionnaire, respectively. This study used factor analysis to identify DPs and linear regression models to investigate the association between PF and related factors. Results: The average PF score of the participants was 75.67. Adolescents who were girls, lived in rural areas and were active in PA performed better on the PF test (p < 0.05). Boys whose fathers were university educated or above had a higher probability of achieving higher PF scores (OR 4.36, 95% CI 1.32–14.36); however, if their mothers were university educated or above, they had a lower probability of achieving higher PF scores (OR 0.22, 95% CI 0.063–0.76). Unhealthy dietary pattern was negatively correlated with cardiorespiratory fitness in boys (OR 0.56, 95% CI 0.31–0.98). The association between unhealthy dietary pattern and girls’ BMI became significant after adjustment for PA (p < 0.05). Conclusions: Girls performed better in PF than boys. Highly educated fathers could contribute to improve the PF performance in boys. There were four DPs among adolescents in Shandong Province, and different DPs may have different effects on PF in boys and girls.

Correlation between Language Development and Motor Skills, Physical Activity, and Leisure Time Behaviour in Preschool-Aged Children

Sedentary behaviour has a negative impact on children’s physical and mental health. However, limited data are available on language development. Therefore, this pilot study aimed to analyse the associations between language development and possible predictors such as motor skills and leisure time behaviour in preschool-aged children. Methods: In this cross-sectional analysis, motor skills and speech development status were assessed in 49 healthy preschool children. Physical activity and screen time were assessed via a parental questionnaire. Results: On average, physical activity was 8.2 ± 6.5 h/week; mean screen time was 154.2 ± 136.2 min/week. A positive relationship between the results in the item ‘One-leg stand’ and ‘Phonological working memory for nonwords’ (β-coefficient −0.513; p < 0.001) resp. ‘Formation of morphological rules’ (β-coefficient −0.626; p = 0.004) was shown within backward stepwise regression. ‘Lateral jumping’, resp. ‘Sit and Reach’ were positively associated with ‘Understanding sentences’ (β-coefficient 0.519; p = 0.001 resp. β-coefficient 0.735; p = 0.002). ‘Physical inactivity’ correlated negatively with all language development subtests (each p < 0.05). Media consumption had a negative predictive effect on the subdomain ‘Understanding Sentences’ (β-coefficient −0.530, p = 0.003). Conclusions: An inactive lifestyle correlated negatively with selected subtests of language development in early childhood. These results should be verified in larger groups and longitudinally but support the need for early health promotion.

A lifestyle pattern during adolescence is associated with cardiovascular risk markers in young adults: results from the DONALD cohort study

Lifestyle score approaches combining individual lifestyle factors, e.g. favourable diet, physical activity or normal body weight, showed inverse associations with cardiovascular disease (CVD) risk. However, research mainly focussed on adult behaviour and is scarce for vulnerable time windows for adult health like adolescence. We investigated associations between an adolescent lifestyle score and CVD risk markers in young adulthood. Overall, we analysed 270 participants of the open DONALD cohort study with 1–6 complete measurements of five lifestyle factors (healthy diet, moderate-to-vigorous physical activity, sedentary behaviour, sleep duration and BMI standard deviation score) during adolescence (females: 8⋅5–15⋅5 years and males: 9⋅5–16⋅5 years). Multivariable linear regression models were used to investigate the prospective association between the adolescent lifestyle score (0–5 points) and CVD risk markers in young adulthood (18–30 years). On average, participants obtained a mean adolescent lifestyle score of 2⋅9 (0–5) points. Inverse associations between the adolescent lifestyle score and waist circumference, waist-to-height ratio and percentage of body fat were observed (4⋅1, 4⋅1 and 9⋅2 % decrease per 1 point increase in adolescent lifestyle score, respectively, P < 0⋅05). For the remaining CVD risk markers (glucose, blood lipids, blood pressure and a proinflammatory score), no associations were observed. A healthy adolescent lifestyle is particularly associated with CVD risk-related favourable anthropometric markers in adulthood. A more comprehensive understanding of lifestyle patterns in the life course might enable earlier, targeted preventive measures to assist vulnerable groups in prevention of chronic diseases.

Socioeconomic disparities in physical activity, sedentary behavior and sleep patterns among 6- to 9-year-old children from 24 countries in the WHO European region

Physical activity, sedentary behavior, and sleep are important predictors of children's health. This paper aimed to investigate socioeconomic disparities in physical activity, sedentary behavior, and sleep across the WHO European region. This cross-sectional study used data on 124,700 children aged 6 to 9 years from 24 countries participating in the WHO European Childhood Obesity Surveillance Initiative between 2015 and 2017. Socioeconomic status (SES) was measured through parental education, parental employment status, and family perceived wealth. Overall, results showed different patterns in socioeconomic disparities in children's movement behaviors across countries. In general, high SES children were more likely to use motorized transportation. Low SES children were less likely to participate in sports clubs and more likely to have more than 2 h/day of screen time. Children with low parental education had a 2.24 [95% CI 1.94-2.58] times higher risk of practising sports for less than 2 h/week. In the pooled analysis, SES was not significantly related to active play. The relationship between SES and sleep varied by the SES indicator used. Importantly, results showed that low SES is not always associated with a higher prevalence of "less healthy" behaviors. There is a great diversity in SES patterns across countries which supports the need for country-specific, targeted public health interventions.

Socioeconomic status and global physical self-concept of adolescents: a multilevel structural equation modeling approach

The global physical self-concept (GPSC) is a central part of one’s self-definition in adolescence and plays an important role in adolescents’ physical and psychological health. Socioeconomic status (SES) can be assumed to have an impact on GPSC, but this relationship has received little attention thus far. We investigated, therefore, the direct and indirect relationships between SES factors, such as parental educational level, occupational status, and family income, and adolescents’ GPSC. A sample of 966 adolescents from 47 9th-grade classes was examined. Multilevel structural equation modeling was used for the analyses. The results revealed an indirect positive effect of parental educational level on adolescents’ global physical self-concept. The effect was completely mediated by parental occupational status, parental sport participation, adolescents’ social resources, and adolescents’ physical exercise and sport activity. The tested model explained 28% of the variance in adolescents’ global physical self-concept. Implications for the development of suitable interventions to improve the global physical self-concept of adolescents are derived.

Motor skills in relation to body-mass index, physical activity, TV-watching, and socioeconomic status in German four-to-17-year-old children

BACKGROUND

The present study describes motor skills in a large sample of German children and adolescents and investigates associations with age, gender, body-mass index, physical activity, television time, and socioeconomic status.

METHODS

2,106 children (1076 boys, 1030 girls) aged 4 to 17 years performed five different motor tests for strength (pushups, standing long jump), coordination (backward balancing, jumping side-to-side) and flexibility (forward bend) within the framework of the LIFE Child study (Leipzig, Germany). Anthropometric parameters were assessed through standardized measurement. Data on physical activity, television time, and socioeconomic status were collected via questionnaires. Linear regression analyses were applied to assess relations.

RESULTS

Strength and coordination performance were higher in older than in younger children. While boys showed a higher performance in strengths tests than girls, girls performed better in flexibility and coordination during precision tasks (backward balancing). In terms of coordination under time constraint (jumping side-to-side), both genders produced similar results. Lower body-mass index, higher physical activity, and higher socioeconomic status were significantly related to better motor skills. Longer television times were significantly associated with lower performance in long jump.

CONCLUSIONS

The present findings are similar to data collected at the beginning of the century, indicating that motor skills have hardly changed in recent years. The findings furthermore suggest that children from lower social strata, children with higher body weight, and children who move little have a higher risk of developing insufficient motor skills and should therefore be given special support.

The prevalence of physical inactivity in Iranian adolescents and the impact of economic and social inequalities on it: results of a National Study in 2018

BACKGROUND

This study aims to determine the prevalence of physical inactivity in Iranian adolescents aged 10-12 years and the impact of socioeconomic inequality on it.

METHODS

In this descriptive study, the study population consisted of 10-12 years old adolescents from an Iranian population from Kurdistan, Fars and Markazi provinces in 2018. The sample size was 1590 individuals. The sampling method was cluster sampling. Data was collected using demographic questionnaire, modifiable activity questionnaire (MAQ) and socioeconomic questionnaire. Cut points on the MAQ for light activity, moderate activity and heavy activity were MET< 3, MET = 3-6 and MET> 6, respectively. Linear and logistic regression were used to estimate the final model and the Oaxaca analysis method was applied. All analyses were performed in Stata/SE 14.0.

RESULTS

Of the 1590 participants, 52.82% were male. The results showed that 25.79% of the subjects were physically inactive and 7.30% engaged in moderate physical activity during the week. The average physical activity during 1 week was more in boys than in girls (P-value< 0.05). Adolescents of mothers with secondary and high school education were more likely to have physical inactivity than mothers with a high school diploma or higher (AOR: 1.35, 95% CI: 1.02-1.77). The concentration index was -.11, indicating a greater concentration of physical inactivity in adolescents with low socioeconomic levels.

CONCLUSION

One-fourth of the study population had physical inactivity in this age group. Socioeconomic levels, parental literacy, and sex of adolescents were associated with the level of physical activity.

Lower parental socioeconomic status in childhood and adolescence predicts unhealthy health behaviour patterns in adolescence in Northern Finland

OBJECTIVES

To determine the association between parental socioeconomic status in childhood and adolescence and unhealthy health behaviour patterns among adolescents in Northern Finland.

METHODS

The sample, drawn from the Northern Finland Birth Cohort 1986 Study, consisted of 15- to 16-year-old adolescents (n = 4305). Data on socioeconomic status and health behaviours were based on questionnaires collected from cohort members and their parents during the former's childhood and adolescence. Logistic regression served to assess the association.

RESULTS

Controlling for all other factors in the model, several socioeconomic factors were found to be significant predictors of unhealthy health behaviour patterns. In childhood, father's low and medium education for boys, and mother's low or medium education as well as fathers' unemployment for girls predicted greater likelihood of engaging in unhealthy behaviour patterns. For both genders, having a stay-at-home mother in childhood (and for boys also in adolescence) protected from unhealthy health behaviour patterns. For boys, mother's and for girls, fathers' low occupational education in adolescence increased the risk of developing unhealthy patterns.

CONCLUSIONS

In the development of effective health prevention strategies, it is important to identify children and adolescents who are at risk of developing lifestyle diseases.

Physical inactivity, non-participation in sports and socioeconomic status: a large population-based study among Norwegian adolescents

Background

Physical activity in adolescence is found to promote both immediate and long-term health, as well as school- and work performance. Previous studies suggest that parental socioeconomic status (SES) may influence the level of activity, although the results are inconsistent. The objective of this study was to examine the overall level of low physical activity/sports participation and the associations with parental SES and adolescent school program in a population-based study of older adolescents.

Methods

The youth@hordalandy study, a large population-based study in Hordaland county, Norway, conducted in 2012, included 10,257 adolescents aged 16–19 years (53% girls). Physical activity was examined by self-reported overall activity, and participation in organized team- and individual sports. Predictor variables were parental SES measured by youth self-reports of family economic well-being, parental education and work affiliation and self-reported current high school program (vocational versus general studies). Age, ethnicity, and family structure were included as covariates.

Results

Girls who reported lower parental education had small, but significant higher risk for physical inactivity and non-participation in individual sports compared with their counterparts who reported higher family education (RRs ranging from 1.04 to 1.12, p < 0.01). There were some, but inconsistent, evidence of an increased risk for physical inactivity and non-participation in sports among those (and particularly boys) with lower family economic well-being. Parental work status was largely unrelated with physical inactivity/non-participation in sports. Adolescents in vocational studies had a small but significantly increased risk of physical inactivity and non-participation in sports compared with individuals in general studies (RRs ranging from 1.03 to 1.05, all p < 0.05).

Conclusions

We found some evidence of a social gradient for lower physical inactivity and non-participation in sports for adolescents. Although effect sizes were small, vocational studies was the most robust correlate for physical inactivity/non-participation in sports among the SES-variables, while the corresponding associations with parental education and family economic well-being differed by gender.

Parent-child agreement in different domains of child behavior and health

AIM

The present study aimed to investigate and compare parent-child agreement in different domains of child health and behavior.

METHODS

Data were collected between 2011 and 2019 within the framework of the LIFE Child study (Germany). Different subgroups of 10- to 12-year-old children and their parents (n (max) = 692) completed questionnaires on several health behaviors (diet, media use, physical activity, sleep), parameters of health (behavioral strengths and difficulties, psychosomatic complaints), and school grades. Agreement between child and parent reports was evaluated using weighted kappa coefficients. Furthermore, the frequencies of different types of (dis)agreement (parent report > child report, same response, child report > parent report) were assessed and checked for associations with child or parent gender.

RESULTS

Agreement between child and parent reports varied from low to almost perfect, with the greatest levels of agreement for school grades and organized physical activity, and the lowest for dizziness, sleep duration, and the consumption of potatoes. Child gender had no significant effect on parent-child agreement. In contrast, the findings suggest that parent gender had some effect on agreement levels, with higher agreement for certain psychosomatic complaints when parent reports were completed by the mother, and higher agreement for white bread consumption if they were completed by the father. For some of the questionnaire items (especially those relating to behavioral difficulties and psychosomatic complaints, but also to the consumption of individual food products and mobile phone use), the type of (dis)agreement differed depending on child or parent gender.

CONCLUSIONS

The findings suggest that the perceptions and reporting strategies of children and their parents can diverge considerably, in particular for behavior that is not easily observable or measurable.

Gesundheit und Fitness von deutschen Schulkindern

Hintergrund

Übergewicht und Bewegungsmangel stellen bei Kindern ein Risiko für kardiovaskuläre Erkrankungen dar. Das Ziel der Studie war, den kardiovaskulären Gesundheitsstatus und die Fitness deutscher Grund- und Gesamtschülerinnen und -schüler sowie mögliche Einflussfaktoren zu erfassen.

Methodik

In einer prospektiven Querschnittsstudie wurden 357 Kinder (9,6 ± 1,7 Jahre) auf kardiovaskuläre Risikofaktoren untersucht. Die Pulswellengeschwindigkeit (PWV) als Maß für die arterielle Gefäßelastizität sowie die Fahrradergometrie zur Einschätzung der Fitness wurden bestimmt.

Ergebnisse

24 % der Kinder waren übergewichtig (Body-Mass-Index, BMI >90. Perzentile) oder adipös (BMI >97. Perzentile). Nahezu alle diese Kinder litten an einer viszeralen Adipositas (99 %). Bei Kindern mit Übergewicht/Adipositas war häufiger eine geringere Gefäßelastizität nachweisbar (PWV „standard deviation score“, SDS 0,8 ± 1,0 vs. 0,2 ± 0,9 bei Kindern ohne Übergewicht, p < 0,001; PWV-Werte >95. Perzentile 24 % vs. 3 %). Das Vorliegen von Übergewicht/Adipositas, Grundschulalter, höherer Blutdruck und niedrigeres „High Density Lipoprotein“(HDL)-Cholesterin waren unabhängige Prädiktoren für geringere Gefäßelastizität. Zudem zeigten Kinder mit Übergewicht/Adipositas einen höheren systolischen Blutdruck, ein nachteiligeres Fettstoffwechselprofil, höhere Harnsäure- und Glutamat-Pyruvat-Transaminase(GPT)-Werte sowie schlechtere körperliche Fitness und einen höheren Medienkonsum. Es bestand eine signifikante Assoziation von BMI und glomerulärer Filtrationsrate.

Diskussion

Das mit erhöhtem BMI und reduzierter Fitness einhergehende kardiovaskuläre Risiko wird durch weitere Risikofaktoren für die Entwicklung eines metabolischen Syndroms verstärkt. Zusätzlich finden sich Hinweise, dass bereits strukturelle Veränderungen an den Gefäßen vorliegen. Unsere Daten legen eine umfassende Beurteilung des individuellen kardiovaskulären Risikos bei Kindern mit Übergewicht nahe und unterstreichen die Notwendigkeit, Präventionsmaßnahmen früh in den Alltag von Kindern zu implementieren, um die kardiovaskuläre Morbidität im Erwachsenenalter zu verringern.

Predictability of exercise capacity following pediatric burns: a preliminary investigation

PURPOSE

Describe the course of exercise capacity in pediatric burn patients during the initial 6 months after hospital discharge, and examine whether its recovery can be predicted from burn characteristics, sociodemographic characteristics, and/or prior assessment.

MATERIALS AND METHODS

Exercise capacity was assessed at discharge, and 6 weeks, 3 months, and 6 months after discharge using the Steep Ramp Test (SRT).

RESULTS

Twenty-four pediatric patients with burns affecting 0.1-34% of total body surface area were included. At group level, exercise capacity was low at discharge and did not reach healthy reference values within 6 months, despite significant improvement over time. At individual level, the course of exercise capacity varied widely. Six months after discharge, 48% of participants scored more than one standard deviation below healthy age- and sex-specific reference values. SRT outcomes at 6 weeks and 3 months were the best predictors of exercise capacity 6 months after discharge, explaining, respectively, 76% and 93% of variance.

CONCLUSIONS

Forty-eight percent of participants did not achieve healthy reference values of exercise capacity and were therefore considered "at risk" for diminished functioning. Our preliminary conclusion that early assessment of exercise capacity with the SRT can timely identify those patients, needs to be strengthened by further research.IMPLICATIONS FOR REHABILITATIONPediatric burns can be considered as a chronic medical condition because of the lifelong consequences.Exercise capacity is reduced following- even minor -pediatric burns.Recovery patterns vary widely: some pediatric burn patients achieve healthy levels of exercise capacity without specific intervention, while others do not.The Steep Ramp Test can be used to assess exercise capacity, identifying those "at risk" for adverse outcomes at an early stage.Patients "at risk" should be encouraged to play sports and adopt an active lifestyle.

Attention-deficit/hyperactivity disorder is associated with reduced levels of serum low-density lipoprotein cholesterol in adolescents. Data from the population-based German KiGGS study

Objectives: Attention-deficit/hyperactivity disorder (ADHD) is a multifactorial, complex and the most common neurodevelopmental disorder in childhood. In this analysis, we tested the hypothesis that altered serum lipid patterns are associated with ADHD. Methods: Using data from the nationwide, population-based German Health Interview and Examination Survey for Children and Adolescents (KiGGS), we compared serum levels of total cholesterol, high-density (HDL) and low-density lipoprotein (LDL) cholesterol, and also triglycerides, in participants with physician-diagnosed and/or suspected ADHD, as defined by a value of ≥7 on the hyperactivity-inattention subscale of the Strengths and Difficulties Questionnaire (SDQ), with non-ADHD controls. Results: Among 6,898 participants aged between 11 and 17 years, 666 (9.7%) had a physician-based diagnosis of ADHD and/or suspected ADHD. We found correlations between the parent-rated SDQ scores on the hyperactivity-inattention subscale and concentrations of triglycerides (r = 0.064, p < .001), total cholesterol (r = -0.026, p = .033), HDL cholesterol (r = -0.059, p < .001) and LDL cholesterol (r = -0.027, p = .031). In multivariate models, low serum levels of LDL cholesterol remained a significant predictor of ADHD (Exp(β) = 0.382, 95% confidence interval = 0.165-0.888, p = .025). Conclusions: Our findings in a large, nationwide and representative sample of German adolescents demonstrated a small, but significant and inverse link between LDL cholesterol levels and symptoms of ADHD. Further studies are required to decipher the biochemical mechanisms behind this relationship.

Using Oaxaca Decomposition to Study Socioeconomic Inequity of Physical Activity among Children Aged 10-12 Years: A Study in West of Iran

Background

Low physical activity (PA) is increasing public health problem. The present study aimed to determine socioeconomic inequality in PA among children aged 10-12 years old in Kurdistan, west of Iran in 2015.

Methods

The present cross-sectional study was conducted on 2506 children aged 10-12 in Sanandaj, Iran, in 2015. Data on the children's level of PA were collected using the Modifiable Activity Questionnaire. The concentration index was used to measure inequality and the Oaxaca decomposition to examine the different determinants of the inequality. The data were analyzed in Stata 13 and SPSS 20.

Results

Of the 2506 participants, 40.90% (38.97-42.82) had insufficient PA. Girls had a lower level of PA than boys (odds ratio [OR] = 0.34; 95% confidence intervals [CI]: 0.28-0.41) and it is directly related to maternal education (OR = 1.71; 95% CI: 1.18-2.47), the family's Socioeconomic status (SES) (OR = 2.18; 95% CI: 1.56-3.05), and the place of residence (OR = 1.68; 95% CI: 1.16-2.44). The concentration index for insufficient PA was -0.25 (95 CI: -0.30 to -0.21), revealing an insufficient PA in the group with a low SES. The prevalence of insufficient PA is 51.38% (95% CI: 48.45-54.31) in poor group and 28.40% (95% CI: 22.80-33.99) in the wealthier group. The Oaxaca decomposition showed maternal education and the place of residence was the most important determinants of inequality.

Conclusions

According to the findings, most of the children especially in the poor groups didn't have sufficient PA and socioeconomic factors could have the important role.

Relationship between Physical Activity, Screen Time, and Sleep Quantity and Quality in US Adolescents Aged 16⁻19

Despite the health benefits associated with physical activity (PA), screen time reduction, and sleep quantity and quality, the relationships between PA, screen time, and sleep quantity and quality remain unclear in adolescents. The present study is a cross-sectional analysis of data from adolescents aged 16–19 years who participated in the 2005–2006 National Health and Nutrition Examination Survey (n = 542). Multivariable logistic regression models, adjusted for confounders, examined the relationship between objectively measured PA, self-reported screen time, and sleep quantity and quality. Respondents who met the current PA recommendation had 50% lower odds of having sufficient sleep (≥8 h) than those not meeting the recommendation (OR = 0.50, 95% CI: 0.26, 0.94). Respondents who met the screen time recommendation (≤2 h/day) had 55% lower odds of reporting poor sleep quality than those whose screen time exceeded the recommendation (OR = 0.45, 95% CI: 0.22, 0.91), with similar patterns observed for females and males. However, males who met both PA and screen time recommendations had 73% lower odds of reporting poor sleep quality than males who met neither recommendation (OR = 0.27, 95% CI: 0.07, 0.99). In conclusion, PA and screen time are associated with sleep quantity or sleep quality in adolescents, and there are differences in these associations by sex.

Health inequalities among children and adolescents in Germany. Developments over time and trends from the KiGGS study

This study examines the extent to which health inequalities among children and adolescents in Germany have developed over the past decade. The analyses are based on data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), which are representative of the 0- to 17-year-old population in Germany. The KiGGS data were collected in three waves: the KiGGS baseline study (2003-2006), KiGGS Wave 1 (2009-2012) and KiGGS Wave 2 (2014-2017). Prevalences of five health outcomes are considered: general health, mental health problems, physical activity, the consumption of sugary soft drinks, and smoking. Moreover, it defines health inequalities in relation to differences in the socioeconomic status of the family (SES), an index derived from the parents' level of education, occupation and income, and considers both absolute and relative health inequalities. In order to do so, the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII) were calculated using linear probability or log-binomial models. Significant inequalities were identified to the detriment of young people from families with a low SES. These inequalities were particularly pronounced in the KiGGS Wave 2 data with regard to general health and the consumption of sugary soft drinks. Additionally, evidence from trend analyses for these two outcomes suggests that relative inequalities have increased. However, absolute inequalities decreased during the same period, and this also applies to smoking. The persistently high and, in some cases, widened levels of health inequalities indicate that adolescents from families with a low SES do not benefit to the same extent from disease prevention and health promotion measures for children and adolescents as young people from families with a higher SES.

Reciprocal Longitudinal Associations Between Adolescents' Media Consumption and Psychological Health

OBJECTIVE

This study investigated reciprocal longitudinal associations between media use/physical activity and adolescents' psychological health.

METHODS

Data were collected between 2011 and 2017 in the LIFE Child study in Germany. The sample included 814 10- to 17-year-old adolescents. The participants provided information on their media use per day (hours of television/video, computer/Internet, and mobile phone use), physical activity (frequency of organized and non-organized physical activity per week), behavioral difficulties (emotional problems, conduct problems, hyperactivity/inattention, peer relationship problems), and quality of life (physical and psychological well-being; satisfaction with parents, peers, and school) at 2 time points 12 months apart. Multiple regressions were applied to analyze reciprocal longitudinal associations between media use/physical activity and behavioral difficulties/quality of life.

RESULTS

Frequent use of computers/Internet at baseline was associated with an increase in internalizing behavioral difficulties (emotional problems and peer relationship problems) at follow-up. Additionally, a high frequency of computer/Internet and mobile phone use was related to a decrease in psychological well-being, whereas a high frequency of organized physical activity was linked to improved physical well-being. The analyses also revealed a link between more behavioral difficulties at baseline and increased television consumption at follow-up.

CONCLUSION

This study suggests mutual dependencies between electronic media use and psychological health over time.

Better lung function with increased handgrip strength, as well as maximum oxygen uptake, in congenital heart disease across the lifespan

Background

The respiratory benefits of muscle strength are well-known in heart-healthy populations, but recommendations and research often focus instead on aerobic fitness (peak oxygen uptake) or total activity. Independent benefits of strength thus may be underestimated, especially in congenital heart disease where perceived dangers of certain types of exercise may outweigh perceived benefits. To assess whether it is plausible that pulmonary benefits of strength in heart-healthy populations also apply in congenital heart disease, we simultaneously correlated these patients’ lung function with fitness, strength, and cardiac diagnosis.

Methods

Lung function (forced expiratory volume in one second percentage predicted (FEV1%pred)) was modeled as function of handgrip strength, congenital heart disease diagnosis, peak oxygen uptake and the interactions of handgrip with sex and diagnosis in 538 Germans (58% male, ages 6–82 years) in linear models corrected for age, sex, height and weight. Congenital heart disease diagnoses were: complex cyanotic; Fallot/Truncus arteriosus communis (common arterial trunk) (TAC); shunts; transposition of the great arteries (TGA); left heart; and other/none.

Results

Each kg of handgrip was associated with 0.74% higher FEV1%pred ( p < 0.001) and handgrip explained almost 10% of variance in FEV1%pred. While some groups had higher FEV1%pred than others ( p for global null <0.0001), all experienced similar associations with strength ( p for interaction with handgrip >0.10 for both sex and diagnosis.) Correction for peak oxygen uptake eliminated the association with congenital heart disease, but not handgrip.

Conclusion

Strength was associated with better lung function in all ages even after correction for peak oxygen uptake, regardless of sex and congenital heart disease. This suggests that strength may be at least as important for lung function as aerobic fitness. Heart-safe strength training may improve pulmonary function in congenital heart disease.

Tracking of Blood Pressure in Children and Adolescents in Germany in the Context of Risk Factors for Hypertension

Blood pressure (BP) tracking from childhood to adulthood has two aspects: the ranking stability relative to others over time and the prediction of future values. This study investigates BP tracking in children and adolescents in Germany in the context of hypertension risk factors. BP was measured and analyzed in 2542 participants of the German Health Examination Survey for Children and Adolescents (t0 2003-2006; 3 to 17-year olds) and of a six year follow-up "Motorik Modul" (t1 2009-2012; 9 to 24-year olds). BP tracking coefficients were calculated from Spearman's rank-order correlations. Predictive values and logistic regression models were used to forecast t1-BP above the hypertension threshold from t0-BP as well as from baseline and follow-up hypertension risk factors. BP tracking was moderate (0.33-0.50 for SBP and 0.19-0.39 for DBP) with no statistically significant differences between sex and age groups. Baseline hypertensive BP was the strongest independent predictor of hypertensive BP at follow-up (OR 4.3 and 3.4 for age groups 3-10 and 11-17 years) after adjusting for sex, BMI trajectories, birthweight, parental hypertension, and age-group dependent-sports/physical activity. However, the positive predictive value of baseline hypertensive BP for hypertensive BP at follow-up in 3- to 10-year olds was only 39% (34% in 11- to 17-year olds) and increased only moderately in the presence of additional risk factors. Our analysis with population-based data from Germany shows that BP in children and adolescents tracks only moderately over six years. BP in childhood is the strongest independent predictor of future BP but its predictive value is limited.

Using facilitator-receiver peer dyads matched according to socioeconomic status to promote behaviour change in overweight adolescents: a feasibility study

OBJECTIVE

To evaluate the feasibility of an innovative peer intervention promoting healthy eating and physical activity, which purposefully selected peer facilitators according to socioeconomic status to target less-advantaged overweight receivers.

SETTING

Nine high schools, two middle schools.

PARTICIPANTS

One hundred and fifty-six adolescents were approached to become facilitators, of whom 18 were trained. Thirty-two of 56 potential receivers agreed to participate.

INTERVENTION

The peer intervention was carried out in 2013-2014 and embedded in a larger trial: PRALIMAP-INÈS (Promotion de l'ALIMentation et l'Activité Physique-INEgalité de Santé). Facilitanoators were selected and trained to organise weight-control activities with specific peer receivers participating in the programme.

PRIMARY AND SECONDARY OUTCOME MEASURES

Different types of data were collected to assess demand, acceptability, implementation and practicality of the intervention. For the facilitators, this included 6 training sessions, 11 mid-programme interviews, 4 end-of-programme sessions, telephone notes and text message exchanges. All six potential receivers in one school were also interviewed. Sociodemographic and health characteristics were also analysed.

RESULTS

Agreeing to participate was more likely when asked by a peer compared with a professional (51.2% discordant pairs; p<0.02). Twelve activities, mostly based on physical activity and implemented during weekends or holidays, were carried out. The mean age of active receivers was 16 and their body mass index was higher than other participants. For both facilitators and active receivers, there were more participating girls. Qualitative analysis reveals key implementation challenges for facilitators. Interviews with the receivers highlight social difficulties, with most feeling bad about their appearance and wanting to lose weight. Those who participated in peer activities were very positive about the experience especially social support.

CONCLUSIONS

The present study suggests the peer intervention is feasible provided organisational difficulties are addressed. Good practice recommendations are formulated, including a longer training session, organising a joint meeting with the facilitators and receivers, matching dyads on place of residence and multiplying modes of contact.

TRIAL REGISTRATION NUMBER

NCT01688453.

Cross-sectional and longitudinal associations of screen time and physical activity with school performance at different types of secondary school

Background

Previous studies have already reported associations of media consumption and/or physical activity with school achievement. However, longitudinal studies investigating independent effects of physical activity and media consumption on school performance are sparse. The present study fills this research gap and, furthermore, assesses relationships of the type of secondary school with media consumption and physical activity.

Methods

The consumption of screen-based media (TV/video, game console, PC/internet, and mobile phone) and leisure physical activity (organized and non-organized) of 10 – to 17-year old adolescents participating in the LIFE Child study in Germany were related to their school grades in two major school subjects (Mathematics and German) and in Physical Education. In addition to a cross-sectional analysis at baseline (N = 850), a longitudinal analysis (N = 512) investigated the independent effects of these activities on the school grades achieved 12 months later. All associations were adjusted for age, gender, socio-economic status, year of data assessment, body-mass-index, and school grades at baseline. A further analysis investigated differences in the consumption of screen-based media and physical activity as a function of the type of secondary school (highest vs. lower secondary school).

Results

Adolescents of lower secondary schools reported a significantly higher consumption of TV/video and game consoles than adolescents attending the highest secondary school. Independently of the type of school, a better school performance in Mathematics was predicted by a lower consumption of computers/internet, and a better performance in Physical Education was predicted by a lower consumption of TV/video and a higher frequency of non-organized physical activity. However, the association between non-organized physical activity and subsequent grades in Physical Education was significant in girls only.

Conclusion

The present results suggest that media consumption has a negative effect on school achievement, whereas physical activity has a positive effect, which, however, is restricted to the subject Physical Education. Future studies might explore the relationship between media consumption and school career, for example, the choice or change of the secondary school type, in more detail.

Trial registration

LIFE Child study: ClinicalTrials.gov, clinical trial number NCT02550236

Effects of Perinatal Factors on Body Mass Index and Physical Fitness of School-age Children

Objective

To examine the effects of various maternal and neonatal perinatal factors on the child’s body mass index (BMI) and physical fitness at school-age.

Methods

Data from two registries, the SLOfit database (a national surveillance system of children’s motor and physical development) and Slovenian National Perinatal Information System (NPIS) were analysed. Perinatal data for 2,929 children born in 2008 were linked to results of SLOfit testing of these children in 2016. Linear regression analysis was used to assess the potential relationship between several perinatal factors (very preterm birth, birth mass, maternal age, hypertensive disorders of pregnancy, gestational diabetes, parity, plurality, maternal pre-pregnancy BMI, mode of delivery, presentation, Apgar score at 5 minutes, and admission to a neonatal intensive care unit (NICU)) and child’s BMI or child’s physical fitness index (PFI) at the age of eight years. We also included child’s school grade and maternal educational level in the analysis. A p value <0.05 was considered statistically significant.

Results

Children born to mothers with lower pre-pregnancy BMI and higher education had lower BMI and higher PFI (p<0.001) at school-age. Physical fitness was also inversely associated with nulliparity (p<0.001) and NICU admission (p=0.020).

Conclusions

Among all perinatal factors studied, higher maternal education and lower pre-pregnancy BMI seem to be the most significant determinants of child’s BMI and physical fitness at school-age.

Physical activity among children and adolescents in Germany. Results of the cross-sectional KiGGS Wave 2 study and trends

Self-reported data from wave 2 of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2, 2014-2017) provides the basis for assessing whether the levels of physical activity of children and adolescents in Germany meet the levels recommended by the World Health Organization (WHO). Merely 22.4% of girls and 29.4% of boys in the 3-17 age group are physically active for at least 60 minutes per day and therefore meet the WHO recommendations. Prevalence of recommended levels of physical activity decreases continuously with age, both for girls and boys. In KiGGS Wave 2, girls in the 3-10 age group met the levels of physical activity recommended by the World Health Organization significantly less often than in KiGGS Wave 1. Low levels of physical activity were highest amongst adolescent age girls, as well as among boys and girls of low socioeconomic status. The results indicate a great potential to promote physical activity.

Comparing Diet and Exercise Monitoring Using Smartphone App and Paper Diary: A Two-Phase Intervention Study

Background

There is increasing recognition that personalized approaches may be more effective in helping people establish healthier eating patterns and exercise more, and that this approach may be particularly effective in adolescents.

Objective

The objective of this study was to investigate the use of a smartphone app (FoodWiz2) in supporting healthy lifestyle choices in adolescence.

Methods

Participants (N=34: 11 male, 23 female) aged 16-19 years in full- or part-time education were recruited from sixth form colleges, schools, and other further education establishments in Norfolk and Suffolk, United Kingdom, between February and May 2015. Participants recorded food intake and exercise using a paper diary for 4-5 weeks and then used the app for the same duration. Initial nutrition education and general support were provided during the paper diary use, but the app included personalized messages sent in response to app activity. At the end of each study phase, participants completed an online questionnaire to describe their experience of using the paper diary and app.

Results

Record completion declined throughout the study, possibly affected by examination pressure. Food intake data showed increased fruit consumption and significantly reduced consumption of chocolate snacks (P=.01) and fizzy drinks (P=.002) among participants using the app. Questionnaire responses indicated that the app was generally preferred to the paper diary, in particular, the app was seen as less boring to use (P=.03) and more acceptable in social settings (P<.001).

Conclusions

This app-based approach has shown the potential for a more effective approach to improving adolescent diet and exercise levels.

Low 25(OH)-vitamin D concentrations are associated with emotional and behavioral problems in German children and adolescents

BACKGROUND

Evidence has accumulated for the association between low vitamin D serum concentrations and mental health disorders in both children and adults. We performed a cross-sectional analysis in a population-based sample of children and adolescents to detect associations between 25(OH)-vitamin D serum [25(OH)D] concentrations and scores of the five Strengths and Difficulties Questionnaire (SDQ) subscales and the total difficulties score in different age groups (age ≥3-<12 years and ≥12-<18 years).

METHODS

9068 participants of the population-based, nation-wide German Health Interview and Examination Survey for Children and Adolescents (KIGGS) with information on mental health status assessed by the SDQ and 25(OH)D levels were included in the analysis. For statistical analysis we used linear regression models stratified by gender based on different adjustment sets. For the younger subsample the analysis was additionally adjusted for the frequency of playing outside. We compared the associations based on parent- and self-ratings of the SDQ for children and adolescents aged ≥12-<18 years.

RESULTS

We found inverse associations between 25(OH)D concentrations and the subscales emotional problems, peer relationship problems and the total difficulties score in both genders after adjustment for potential confounders. The strongest associations were observed in the older subsample for parent-ratings in boys and self-ratings in girls. In the younger subsample the associations were less strong and no longer evident after adjustment for potential confounders such as migration background, socioeconomic status and frequency of playing outside.

CONCLUSION

Based on the large-scale cross-sectional study in a German population-based sample of children and adolescents we detected inverse associations between 25(OH)D concentrations and both parent- and self-rated SDQ scores of the total difficulties scale and different subscales with the strongest association in the subsample aged ≥12-<18 years for both genders. Migration background and socioeconomic status were detected as relevant confounders. Further studies-particularly in countries with comparatively low mean 25(OH)D concentrations-in childhood and adolescence are warranted. Longitudinal studies are also necessary to infer direction of effects. Finally, RCTs in children and adolescents are required to determine whether Vitamin D is beneficial for mental health.

Resting Heart Rate Percentiles and Associated Factors in Children and Adolescents

OBJECTIVES

To present population-based resting heart rate (RHR) percentiles and associated factors in children and adolescents.

STUDY DESIGN

Standardized RHR measurements with an oscillometric device were obtained from 3- to 17-year-olds who participated in the German Health Interview and Examination Survey for Children and Adolescents (n = 11 986). Age- and sex-specific RHR percentiles were derived using flexible age-dependent modeling. Linear regression was used to test associations of RHR and associated factors.

RESULTS

RHR decreased with age and mean RHR was on average 3.0 beats per minute (bpm) higher in girls than in boys (P < .01). The 95th RHR-KiGGS-percentile (P95) in boys and girls are up to 10 bpm lower than P95 based on pooled heterogeneous international studies and more similar to percentiles based on population data from NHANES (higher or lower by ≤5 bpm, depending on age). Factors independently associated with RHR in both sexes were age, SBP and height in children aged 3-10 years; and age, systolic blood pressure, and high aerobic fitness in adolescents aged 11-17 years. In girls, we further found an association between RHR and underweight (OR 3.3 and 4.7 for underweight girls aged 3-10 and 11-17, respectively, compared with normal weight girls). Associations between RHR and aerobic fitness, physical activity, and media use were stronger in boys than in girls.

CONCLUSION

This study provides population-based RHR percentiles and evidence for sex-dependent associations of cardiovascular risk factors with RHR in children and adolescents, many of which are lifestyle related.

Physical Activity Perceptions in Adolescents: A Qualitative Study Involving Photo Elicitation and Discussion Groups

Adolescence is a key period in life when most of the healthy habits that will affect health during adulthood are established. Numerous interventions based on the acquisition of regular physical activity (PA) in the adolescent population have so far yielded no success, mainly in the long term. Qualitative phenomenological research was used to identify adolescents’ perceived barriers and motivations to regular PA practice, and how they form the concept of PA through thought and action. This study constitutes an explicative design using photo elicitation (PE) and discussion group (DG) techniques to explore different aspects and meanings associated with PA, as well as their perceptions toward PA practice. The study was conducted on adolescents from a randomly selected district in Barcelona (Catalonia), Spain. Through the use of PE, a total of 67 photographs were analyzed. A DG was conducted with a group of 10 teenagers. Input from the DG was examined using interpretative phenomenological analysis. The findings show that social, familial, and environmental factors become motivational elements for the regular practice of PA. The findings observed relevant aspects linked to general barriers and to particular ones associated with young women. This study also considered implications for future interventions.

Prenatal determinants of physical activity and cardiorespiratory fitness in adolescence - Northern Finland Birth Cohort 1986 study

BACKGROUND

Lower levels of physical activity and cardiorespiratory fitness are key risk factors of chronic adult diseases. Physical activity and cardiorespiratory fitness are predicted by birth weight, but the underlying parental and pregnancy-related factors remain largely unknown. We examined how prenatal determinants are associated with physical activity and cardiorespiratory fitness in adolescence.

METHODS

Of the 16-year-old members of the population-based Northern Finland Birth Cohort 1986 (NFBC 1986), 6682 singletons with no major physical disability reported their amount of physical activity outside school hours, and 4706 completed a submaximal cycle ergometer test assessing cardiorespiratory fitness. Physical activity was expressed as metabolic equivalent hours per week (METh/week) and cardiorespiratory fitness as peak oxygen uptake (ml·kg-1·min-1). Prenatal determinants included birth weight, length of gestation, mother's and father's body mass index (BMI), maternal gestational diabetes mellitus (GDM), and maternal hypertension and smoking during pregnancy. Data were analyzed by multiple linear regression.

RESULTS

A higher birth weight and longer length of gestation predicted lower levels of physical activity and cardiorespiratory fitness at 16 years, although the association between length of gestation and physical activity was inverse U-shaped. Mother's or father's overweight or obesity before pregnancy were associated with lower levels of their offspring's physical activity and fitness in adolescence. Adjusting for maternal pregnancy disorders and the adolescent's own BMI attenuated the associations with the mother's but not the father's overweight/obesity. Furthermore, maternal GDM predicted lower cardiorespiratory fitness.

CONCLUSIONS

A high birth weight and parental overweight/obesity are associated with lower levels of both physical activity and cardiorespiratory fitness in adolescence, while maternal GDM and longer length of gestation are associated with lower cardiorespiratory fitness. Both long and short lengths of gestation predict low physical activity.

Socioeconomic indicators, obesity, and physical fitness in south Brazilian adolescents with Down syndrome

Objectives: The aim was to examine the association of potential socioeconomic indicators with obesity and physical fitness components in south Brazilian adolescents with Down syndrome. Methods: This study comprised a total of 1249 (669 boys) adolescents with Down syndrome aged 10 to 20 with complete baseline data. Socioeconomic indicators were assessed by a proxy-report questionnaire. Body mass index and physical fitness were assessed using a PROES-BR health-related fitness test battery. Results: Socioeconomic status is not associated with body mass index in adolescents with Down syndrome. In addition, two of five physical fitness variables were associated with groups of family income and paternal education level in boys, while one of five physical fitness variables were associated with groups of paternal and maternal education level in girls. Conclusion: Our results suggest that socioeconomic indicators are associated with some components of physical fitness in Brazilian adolescents with Down syndrome. These associations depend on the socioeconomic status and physical fitness components in boys and girls.

[Socioeconomic differences in physical activity in the middle-aged working population: The role of education, occupation, and income]

BACKGROUND

Regular physical activity has positive effects on health at all ages. This study aims to investigate how far physical activity and regular sports engagement, as a more specific type of physical activity, are associated with socioeconomic factors in the middle-aged working population.

METHODS

Data were obtained from 21,699 working men and women aged between 30 and 64 years who participated in the 2009 and 2010 population-based national German Health Update (GEDA) surveys conducted by the Robert Koch Institute. Besides a multi-dimensional index of socioeconomic status (SES), three single dimensions of SES (education, occupation, and income) were used to analyse socioeconomic differences in total physical activity and regular sports engagement.

RESULTS

While the prevalence of total physical activity increased with lower SES, the proportion of people with regular sports engagement decreased with lower SES. These associations remained after adjusting for age in men and women. After mutual adjustment of the three single socioeconomic dimensions, physical activity was independently associated with lower education and lower occupational status. Regular sports engagement was observed to be independently associated with higher education, higher occupational status, as well as higher income after mutual adjustment.

CONCLUSIONS

This study demonstrates significant socioeconomic differences in physical and sports activity in the middle-aged working population. Education, occupation, and income show varying independent associations with physical activity behaviour. Such differences need to be considered when identifying target groups for health-enhancing physical activity interventions.

Evaluation of screen time activities and their relationship with physical activity, overweight and socioeconomic status in children 10-12 years of age in Sanandaj, Iran: A cross-sectional study in 2015

Background: Screen time (ST), including watching television and playing electronic games are the leading cause of a growing obesity epidemic. This study aimed to evaluate ST and its association with physical activity, overweight and socioeconomic status (SES) in children 10 to 12 years of age in Sanandaj. Methods: This study was designed as a cross-sectional study, which was conducted in Sanandaj in 2015. ST and physical activity data were collected using the Modifiable Activity Questionnaire (MAQ). Overweight indices are defined based on BMI age- and gender-specific percentiles, as proposed by WHO criteria. Considering household assets data, SES was calculated using principal component analysis (PCA). The relationship between ST and different determinants was assessed using logistic regression analysis. Results: Based on the results obtained in our study, 47.28% (95% CI: 45.33-49.24) of the participants spent more than two hours a day on television and video watching and electronic games playing. People who spend greater time on ST activities, independent of their physical activities, are more susceptible to overweight and obesity (p=0.002). People in higher socioeconomic groups spent more time on watching TV and video and playing electronic games (p=0.001). There was a direct relationship between the residential area and ST (P=0.052). ST in male was found to be greater (p=0.033). In addition, ST was also lower in school-aged children whose mothers had a greater education (p=0.56). Conclusion: Based on the results of this study, it is recommended to increase the education level and knowledge of mothers and design interventions consistent with children gender and residential location so that to reduce ST and its associated outcomes in children.

[Settings-based prevention of overweight in childhood and adolescents : Theoretical foundation, determinants and intervention planning]

BACKGROUND

Childhood and adolescent overweight can still be seen as a global public health problem. Based on our socioeconomic understanding, overweight is the result of a complex interplay of a diverse array of factors acting on different levels. Hence, in addition to individual level determinants overweight prevention should also address environmental related factors as part of a holistic and integrated setting approach.

OBJECTIVE

This paper aims to discuss the setting approach with regard to overweight prevention in childhood and adolescence. In addition to a summary of environmental factors and their empirical influence on the determinants of overweight, theoretical approaches and planning models of settings-based overweight prevention are discussed.

RESULTS

While settings can be characterized as specific social-spatial subsystems (e. g. kindergarten, schools), living environments relate to complex subject-oriented environments that may include various subsystems. Direct social contexts, educational contexts and community contexts as relevant systems for young people contain different evidence-based influences that need to be taken into account in settings based overweight prevention. To support a theory-driven intervention, numerous planning models exist, which are presented here.

DISCUSSION

Given the strengthening of environments for health within the prevention law, the underlying settings approach also needs further development with regard to overweigth prevention. This includes the improvement of the theoretical foundation by aligning intervention practice of planning models, which also has a positive influence on the ability to measure its success.

Physical Activity Levels and Domains Assessed by Accelerometry in German Adolescents from GINIplus and LISAplus

BACKGROUND

Physical activity (PA) is a well-known and underused protective factor for numerous health outcomes, and interventions are hampered by lack of objective data. We combined accelerometers with diaries to estimate the contributions to total activity from different domains throughout the day and week in adolescents.

METHODS

Accelerometric and diary data from 1403 adolescents (45% male, mean age 15.6 ± 0.5 years) were combined to evaluate daily levels and domains of sedentary, light, and moderate-to-vigorous activity (MVPA) during a typical week. Freedson's cutoff points were applied to determine levels of activity. Total activity was broken down into school physical education (PE), school outside PE, transportation to school, sport, and other time.

RESULTS

About 2/3 of adolescents' time was spent sedentary, 1/3 in light activity, and about 5% in MVPA. Boys and girls averaged 46 (SD 22) and 38 (23) minutes MVPA per day. Adolescents were most active during leisure sport, spending about 30% of it in MVPA, followed by PE (about 20%) transport to school (14%) and either school class time or other time (3%). PE provided 5% of total MVPA, while leisure sport provided 16% and transportation to school 8%. School was the most sedentary part of the day with over 75% of time outside PE spent sedentary.

CONCLUSIONS

These German adolescents were typical of Europeans in showing low levels of physical activity, with significant contributions from leisure sport, transportation and school PE. Leisure sport was the most active part of the day, and participation did not vary significantly by sex, study center (region of Germany) or BMI. Transportation to school was frequent and thus accounted for a significant fraction of total MVPA. This indicates that even in a population with good access to dedicated sporting activities, frequent active transportation can add significantly to total MVPA.

The association of socio-economic factors with physical fitness and activity behaviours, spinal posture and retinal vessel parameters in first graders in urban Switzerland

Socio-economic status during childhood has been shown to be a strong predictor of adult health outcome. Therefore, we examined associations of parental educational level, household income and migrant background with physical fitness, spinal flexibility, spinal posture as well as retinal vessel diameters in children of an urban Swiss region. A total of 358 first graders of the Swiss canton Basel-Stadt (age: 7.3, SD: 0.4) were examined. Physical fitness (20 m shuttle run test, 20 m sprint, jumping sidewards and balancing backwards), spinal flexibility and spinal posture (MediMouse®, Idiag, Fehraltdorf, Switzerland) and retinal microcirculation (Static Retinal Vessel Analyzer, Imedos Systems UG, Jena, Germany) were assessed. Parental education, household income, migrant background and activity behaviour were evaluated with a questionnaire. Parental education was associated with child aerobic fitness (P = 0.03) and screen time (P < 0.001). Household income was associated with jumping sidewards (P = 0.009), balancing backwards (P = 0.03) and sports club participation (P = 0.02). Migrant background was associated with BMI (P = 0.001), body fat (P = 0.03), aerobic fitness (P = 0.007), time spent playing outdoors (P < 0.001) and screen time (P < 0.001). For spinal flexibility and retinal vessel diameter, no associations were found (0.06 < P < 0.8). Low parental education, low household income and a migrant background are associated with poor physical fitness, higher BMI and body fat percentage and low-activity behaviour.

Dietary behaviour and parental socioeconomic position among adolescents: the German Health Interview and Examination Survey for Children and Adolescents 2003-2006 (KiGGS)

Background

The positive association between parental socioeconomic position (PSEP) and health among adolescents may be partly explained by dietary behaviour. We investigated the associations between fruit intake, vegetable intake, energy-dense food intake, the Healthy Nutrition Score for Kids and Youth (HuSKY) and parental education in a nationwide, cluster-randomized sample of adolescents in Germany.

Methods

The German Health Interview and Examination Survey for Children and Adolescents 2003–2006 (KiGGS) included 17,641 individuals aged 0–17 years and their parents. Complete information on relevant variables was available for 6359 individuals in the 11–17 age group. The associations between nutrition indicators and parental education were analysed separately for boys and girls, using multivariate logistic regression analysis. Odds ratios (ORs) adjusted for age, region, income, occupation, physical activity and weight status related variables, were calculated for the associations between parental education and nutrition indicators.

Results

After full adjustment, higher parental education level was associated with lower energy-dense food intake – with an OR of 1.3 (95 % CI 1.0–1.7) for boys with secondary educated parents and 1.8 (1.4–2.3) for boys with tertiary educated parents compared to boys with primary educated parents; the corresponding ORs for girls were 1.2 (0.9–1.5) and 1.6 (1.2–2.2). Higher parental education was associated with higher fruit intake – with an OR of 1.3 (1.0–1.7) for boys with secondary educated parents and 2.0 (1.5–2.7) for boys with tertiary educated parents compared to boys with primary educated parents; the corresponding ORs for girls were 1.0 (0.8–1.4) and 1.5 (1.0–2.1). Among boys and girls with tertiary educated parents compared to those with primary educated parents an OR of 1.3 (CI boys: 1.0–1.7, CI girls: 1.0–1.6) was observed for high vegetable intake. Among boys with tertiary educated parents compared to boys with primary educated parents an OR of 1.6 (1.2–2.2) was observed for a high HuSKY; the corresponding OR for girls was 1.5 (1.1–1.9).

Conclusions

A high PSEP is associated with consumption of less energy-dense food, more fruits and vegetables and more favourable overall dietary behaviour. Preferably school-based interventions are needed to promote healthy dietary behaviour among German adolescents and a special effort is needed to reach adolescents from low-PSEP families.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-1830-2) contains supplementary material, which is available to authorized users.

Relationship of parental health-related behaviours and physical fitness in girls and boys

Aim

Physical activity (PA) and physical fitness (PF) are known to be closely connected. Various environmental and biological constraints have been shown to influence children’s PA with parents being among strong determinants of their children’s PA behaviour. However, little is known about parental influence on PF in children. Therefore, the purpose of this study was to identify the influence of parental health-related behaviours and attitudes on PF in boys and girls.

Subjects and methods

Baseline data of 1,875 primary school children (7.1 ± 0.6 years; 50 % male) were included in the analyses. Lateral jumping performance was used as a proxy for whole-body coordination and the 6-min run for cardiovascular fitness. Parental health-related behaviours, attitudes and sociodemographic variables were assessed via questionnaire. Regression analyses, adjusting for age and BMI, were performed separately for boys and girls.

Results

The final models of the regression analyses showed that children’s age and BMI are significantly related to PF. Mothers’ self-efficacy to encourage their children to be active is significantly associated with boys’ coordination and cardiovascular fitness and girls’ coordination. Mothers’ PA affects PF in boys, not in girls. Maternal smoking has a significantly negative effect on both boys’ and girls’ cardiovascular fitness.

Conclusion

This study shows that parental health-related behaviours and self-efficacy to encourage their children to be active affect children’s PF. Influencing factors, however, differ in girls and boys, and mothers seem especially influential.