Children's Perceptions of Healthful Eating and Physical Activity

Facilitators and barriers to healthful eating among adolescents in high-income countries: A mixed-methods systematic review

Adolescent obesity continues to be a public health challenge with poor quality diets contributing to its etiology. As part of the process to plan health promotion and policy interventions, understanding adolescents perceived facilitators and barriers to healthful eating is important. An integrative convergent mixed-methods systematic review was used to synthesize qualitative and quantitative evidence from studies among adolescents aged 10-19 years in high-income countries. Medline, Embase, PsycInfo, and Scopus were searched for peer-reviewed articles published between 2010 and 2023 and exploring adolescents' perspectives on healthful eating and contemporary contextual factors. Transformed quantitative data were integrated with qualitative data. Text was coded into subthemes and themes using an inductive approach. Key facilitators included health and physical appearance; motivation; taste; nutrition knowledge, awareness, and skills; nutrition education access; availability and accessibility of healthful foods; family; and social influences and digital media. Key barriers included taste and cravings for unhealthful foods; mood; lack of motivation, awareness, knowledge, and skills; high availability and low cost of unhealthful foods; peers and social influences; ineffective school policies; high density of fast-food outlets; unhealthful food advertising; digital influences; and time constraints. Social, behavioral, digital, and food environmental factors should be considered from an adolescent perspective in the design of education, health promotion, and policy interventions.

Explaining the personal cognitive factors affecting physical activity and nutritional behaviors in the middle-aged at risk of coronary artery disease: A directed qualitative content analysis

Background and Aims

Coronary artery disease (CAD) is the most common cardiovascular disease worldwide. Nutrition and physical activity are recognized as the major lifestyle-related behaviors to reduce the risk of noncommunicable diseases. It is essential to explain personal cognitive factors to identify potential ways to increase physical activity and improve nutritional behavior. Therefore, the present study aimed to explain the personal cognitive factors affecting physical activity and nutritional behavior in the middle-aged population at risk of a CAD.

Methods

The present qualitative study was conducted with a directed content analysis approach. A purposive sampling was used with maximum variety of sex, age, education, marital status, job, and risk factors of CAD. The data were collected through semistructured interviews with 20 middle-aged participants at the risk of CAD visiting comprehensive health centers in Bandar Abbas city. The interviews continued until data saturation.

Results

The present findings led to the identification of 4 main categories (i.e., self-efficacy, collective efficacy, outcome expectations, knowledge) and 10 subcategories.

Conclusion

It seems that to increase the self-efficacy, attention should be paid to individuals' past experiences, self-efficacy of action and maintenance and successful middle-aged peers. Measures should be taken to improve and strengthen it. Peer support, networking, forming online groups (in social networks), and a comprehensive use of social media can help increase collective efficacy. Expectations of positive and negative outcomes and the public knowledge can also be modified through accurate and appropriate information provided in different campaigns for awareness-raising.

TMT Labeling Reveals the Effects of Exercises on the Proteomic Characteristics of the Subcutaneous Adipose Tissue of Growing High-Fat-Diet-Fed Rats

Aim: Growing period is an important period for fat remodeling. High-fat diet and exercise are reasons for adipose tissue (AT) remodeling, but existing evidence is not enough. Therefore, the effects of moderate-intensity continuous training (MICT) and high-intensity interval training (HIIT) on the proteomic characteristics of the subcutaneous AT of growing rats on normal diet or high-fat diet (HFD) were determined. Methods: Four-week-old male Sprague-Dawley rats (n = 48) were subdivided into six groups: normal diet control group, normal diet-MICT group, normal diet-HIIT group, HFD control group, HFD-MICT group, and HFD-HIIT group. Rats in the training group ran on a treadmill 5 days a week for 8 weeks (MICT: 50 min at 60-70% VO_2max intensity; HIIT: 7 min of warm-up and recovery at 70% VO_2max intensity, 6 sets of 3 min of 30% VO_2max followed by 3 min 90% VO_2max). Following physical assessment, inguinal subcutaneous adipose tissue (sWAT) was collected for proteome analysis using tandem mass tag labeling. Results: MICT and HIIT attenuated body fat mass and lean body mass but did not affect weight gain. Proteomics revealed the impact of exercise on ribosome, spliceosome, and the pentose phosphate pathway. However, the effect was reversed on HFD and normal diet. The differentially expressed proteins (DEPs) affected by MICT were related to oxygen transport, ribosome, and spliceosome. In comparison, the DEPs affected by HIIT were related to oxygen transport, mitochondrial electron transport, and mitochondrion protein. In HFD, HIIT was more likely to cause changes in immune proteins than MICT. However, exercise did not seem to reverse the protein effects of HFD. Conclusion: The exercise stress response in the growing period was stronger but increased the energy metabolism and metabolism. MICT and HIIT can reduce fat, increase muscle percentage, and improve maximum oxygen uptake in rats fed with HFD. However, in rats with normal diet, MICT and HIIT triggered more immune responses of sWAT, especially HIIT. In addition, spliceosomes may be the key factors in AT remodeling triggered by exercise and diet.

Children's experienced and imaginary stories about lunch packs and lunch breaks: Associations and perceptions of school lunch among primary school students in Norway

This article examined Norwegian students' associations with lunch packs and lunch breaks in primary schools, highlighting the Norwegian school meal system. Empathy-based stories were used; that is, participants were asked to write on a story about a good or a bad school lunch, either based on actual experiences or imagination. The data included stories from 181 fifth graders (105 girls and 76 boys) aged 10-11 years. Additionally, this study employed a social-constructivist approach. The analysis of the stories on the lunch packs resulted in four sub-themes: food and sensory properties of food; food norms and the violation of the norms; physical and psychological consequences of (not) eating lunch; and expressions of peer-relations and family bonds. The analysis of the stories on lunch breaks resulted in two sub-themes: social interaction and simultaneous activity, and contextual factors. In the stories the lunch pack was found to evoke both enthusiasm and discontent. Students' associations and perceptions of the food were often related to how it looked, smelled, and tasted. Furthermore, a clear feature of the stories concerning lunch break in the classroom was that the students were concerned with the social aspects of the eating situation, such as interacting with classmates by chatting, watching television, or listening to music together. This study can contribute to a deeper understanding of children's experiences with a school meal system used in countries within and outside the Nordic region.

Exploring Knowledge and Perspectives of South Asian Children and Their Parents Regarding Healthy Cardiovascular Behaviors: A Qualitative Analysis

South Asian children and parents have been shown to have a higher risk for cardiovascular disease (CVD) relative to white individuals. To design interventions aimed at addressing the comparatively higher burden in South Asians, a better understanding of attitudes and perspectives regarding CVD-associated behaviors is needed. As a result, we sought to understand knowledge about CVD risk in both children and parents, and attitudes toward physical activity and diet in both the children and parents, including potential cultural influences. In-depth interviews were conducted with 13 South Asian child-and-parent dyads representing a range of child body mass index (BMI) levels, ages, and with both sexes. South Asian children and parents demonstrated good knowledge about CVD prevention; however, knowledge did not always translate into behavior. The influence of social and cultural dynamics on behavior was also highlighted. To ensure that interventions aimed at this population are effective, an understanding of the unique social dynamics that influence diet and physical activity-related behaviors is needed.

Socio-Ecological Influences on Adolescent (Aged 10-17) Alcohol Use and Unhealthy Eating Behaviours: A Systematic Review and Synthesis of Qualitative Studies

Excess body weight and risky alcohol consumption are two of the greatest contributors to global disease. Alcohol use contributes directly and indirectly to weight gain. Health behaviours cluster in adolescence and track to adulthood. This review identified and synthesised qualitative research to provide insight into common underlying factors influencing alcohol use and unhealthy eating behaviours amongst young people aged 10–17. Sixty two studies met inclusion criteria. Twenty eight studies focused on alcohol; 34 focused on eating behaviours. Informed by principles of thematic analysis and meta-ethnography, analysis yielded five themes: (1) use of alcohol and unhealthy food to overcome personal problems; (2) unhealthy eating and alcohol use as fun experiences; (3) food, but not alcohol, choices are based on taste; (4) control and restraint; and (5) demonstrating identity through alcohol and food choices. Young people faced pressure, reinforced by industry, to eat and drink in very specific ways, with clear social consequences if their attitudes or behaviour were deemed unacceptable. No qualitative studies were identified with an explicit and concurrent focus on adolescent eating behaviours and alcohol consumption. Further exploratory work is needed to examine the links between food and alcohol in young people’s emotional, social and cultural lives.

Australian children's discourses of health, nutrition and fatness

Talking to children about their health-related understandings and experiences can provide valuable information for public health practitioners who seek to improve children's dietary behaviours. To date, however, research on children's food consumption has generally prioritized the views of parents and caregivers, rather than children themselves. This paper reports results from a qualitative study that explored preadolescent children's attitudes and perceptions towards health and nutrition. 38 children aged 11-12 years, across three state government schools, took part in an individual interview or group interview. Interviews were recorded, transcribed verbatim and analysed using thematic analysis techniques. Our results indicate that children inextricably linked the concept of health to diet and physical activity. They pondered the connection between different types of foods and physical implications for the body, emphasising nutrition and physical activity as a resource for preventing the onset of chronic disease and specifically the state of 'fatness'. Children collectively overemphasised the correlation between body size and health, and expressed that people should take responsibility for healthy choices to prevent fatness. In their discussions, they referred to aesthetic elements of the body and negative consequences of obesity. Overall, we argue that children's discourses of health and nutrition are potentially problematic. Results suggest that it is important to reshape these ideas to encourage children to develop more positive relationships with food and physical activity.

A Systematic Review of Data Collection Techniques Used to Measure Preschool Children's Knowledge of and Preference for Physical Activity

Background: Early childhood has been identified as a crucial period in which children develop physical activity preferences and behaviors. Both the knowledge of and preferences for physical activity are key proximal indicators of activity choices in children. Thus, accurate data collection tools are required to measure these variables. This review evaluates the data collection techniques that have been utilised to assess preschool children’s knowledge of and preference for physical activity, and examines the validity and reliability of existing techniques. Methods: A systematic search for relevant studies published from 1980 through to December 2017 was conducted via ProQuest, CINAHL, Embase, Scopus, ERIC, PubMed, MEDLINE, and ScienceDirect. Results: Fourteen studies were eligible for inclusion in the review. The identified studies employed a limited but disparate range of techniques to assess children’s physical activity knowledge and preferences. Findings reveal that four techniques were consistently used across the reviewed studies, including: interviews, structured play-based activities, questionnaires, and observations. Only four out of 14 included studies reported the assessment of the validity of the data collection tool used, and six reported testing the measures for at least one type of reliability. Conclusion: There is a need for validated and reliable measures to assess children’s knowledge of and preference for physical activity. Greater consideration is required to align data collection techniques with the characteristics, needs and abilities of this study population.

Emphasizing the child in child health literacy research

Child health literacy is a 'hot topic' of late, as researchers and practitioners work to attain an equitable and healthy future. Health literacy emphasizes the wide range of skills that people need to access, understand, evaluate and use health information to promote good health. In light of the recognition that health literacy is an important determinant of health for adults, addressing child health literacy early on is essential to maximize future health outcomes. Meeting children's specific needs arguably includes the delivery of information that can be easily accessed and understood by younger age groups. While much academic discourse pertains to the importance of building parental health literacy, there is less literature that explicitly focuses on child-centred health literacy. On the premise that health literacy is an asset, this paper provides an argument for investing in children's health literacy by working with children to encourage meaningful contributions in research and practice.

Temporal patterns of physical activity and sedentary behavior in 10-14 year-old children on weekdays

Background

An important but often ignored aspect of physical activity (PA) and sedentary behavior (SB) is the chronological succession of activities, or temporal pattern. The main purposes of this study were (1) to investigate when certain types of PA and SB compete against each other during the course of the day and (2) compare intensity- and domain-specific activity levels during different day-segments.

Methods

The study sample consists of 211 children aged 10–14, recruited from 15 primary and 15 secondary schools. PA was assessed combining the SenseWear Mini Armband (SWM) with an electronic activity diary. The intensity- and domain-specific temporal patterns were plotted and PA differences between different day-segments (i.e., morning, school, early evening and late evening) were examined using repeated-measures ANCOVA models.

Results

Physical activity level (PAL) was highest during the early evening (2.51 MET_SWM) and school hours (2.49 MET_SWM); the late evening segment was significantly less active (2.21 MET_SWM) and showed the highest proportion of sedentary time (54 % of total time-use). Throughout the different day-segments, several domains of PA and SB competed with each other. During the critical early-evening segment, screentime (12 % of time-use) and homework (10 %) were dominant compared to activity domains of sports (4 %) and active leisure (3 %). The domain of active travel competed directly with motor travel during the morning (5 % and 6 % respectively) and early-evening segment (both 8 %).

Conclusions

Throughout the day, different aspects of PA and SB go in competition with each other, especially during the time period immediately after school. Detailed information on the temporal patterns of PA and SB of children could help health professionals to develop more effective PA interventions and promotion strategies. By making adaptations to the typical day schedule of children (e.g., through the introduction of extra-curricular PA after school hours), their daily activity levels might improve.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-2093-7) contains supplementary material, which is available to authorized users.

A Systematic Review of Data Collection Techniques Used to Measure Preschool Children's Knowledge of Food and Nutrition

OBJECTIVE

To identify and review data collection techniques used to measure preschool children's knowledge of food and nutrition.

DESIGN

A systematic review of published research guided by the Preferred Reported Items for Systematic Reviews and Meta-analyses statement.

PARTICIPANTS

Published journal articles between 1980 and 2013 reporting research involving the measurement of preschool children's (aged 3-5 years) knowledge of food and nutrition.

RESULTS

Twenty studies were eligible for inclusion. The studies reported the use of a range of innovative age-appropriate techniques to assess children's knowledge of food and nutrition. Data collection techniques were grouped under 3 broad approaches: (1) interviews, (2) use of stimulus material and prompts, and (3) structured play-based activities. Only 3 of the reviewed studies tested for both reliability (test-retest and internal consistency) and face and content validity. Only 9 of the reviewed studies reported pilot-testing their instruments before use.

CONCLUSIONS AND IMPLICATIONS

Results from this review suggest that additional research is needed to develop more valid and reliable measures to assess preschool children's knowledge of food and nutrition. Assessment tools need to be pilot-tested, refined, and adapted to suit both the specific audience and the components of the nutrition knowledge being targeted by an intervention before implementing a nutrition education program.

What do adolescents want in order to become more active?

Background

Few large studies have examined adolescents’ views about increasing their physical activity (PA) to inform PA promotion. We assessed adolescent preference for activity type, co-participants, timing and location of PA promotion and examined patterns in their views by population subgroup.

Methods

Participants (n = 457) (Mean ± SD age: 14.3 ± 0.3 years; 45.2% male) responded to questionnaire items: “What activities would you like to try or do more often?” (yes/no to 6 activity types e.g. team sports) and “I would like to do more PA …” followed by options regarding co-participants, timing and PA location (agree/disagree to 10 items). Anthropometry, demographics, accelerometer- and questionnaire-derived PA were obtained. Logistic regression was used to examine differences in views by subgroup (sex, weight status, objective PA level, parental education (SES)).

Results

Most adolescents wanted to increase participation in ≥1 type of PA (94.4%). Gym use (56.7%) and team sports (50.6%) were most popular. Girls were less likely to choose racquet sports (vs. boys OR; 95% CI 0.6;0.4-0.9) but more likely to select dancing (40.3;17.8-91.1). Preference for participation was positively associated with existing participation in a similar activity (all p < 0.02). More adolescents wanted to increase PA with friends (88.8%) than family (63.5%). A leisure centre was most popular for increased participation (81.0%), followed by home (70.0%). Participation during school time was less popular among girls (vs. boys: 0.6;0.4-0.9) and more popular among low SES participants (vs. high: 1.6;1.1-2.4). Overweight/obese adolescents were less likely to choose participation with friends (vs. normal weight 0.5;0.3-0.9).

Conclusions

Targeting adolescent PA promotion by subgroup and providing choice of PA type, co-participants, timing and PA location appears promising. Adolescents want to do more types of PA more often; interventions could increase opportunities and support to facilitate this.

Determinants of physical activity in primary school students using the health belief model

BACKGROUND

Thailand is a middle-income country in which two-thirds of children demonstrate an insufficient level of physical activity. Physical inactivity is a major risk factor for obesity and many other health-related consequences in children. Thus, it is important to understand how primary school children perceive things in their daily life as determinants of physical activity. The purpose of this study was to investigate the impact of cues, perceived benefits, and perceived barriers on the level of physical activity among primary school students.

METHODS

A cross-sectional study was conducted in Phitsanulok Province, Thailand, in 2011. Multistage sampling selected a total of 123 primary school students. The Physical Activity Questionnaire for Older Children and the Cues, Perceived Benefits, and Barriers to Physical Activity Questionnaire were used to assess the student levels of physical activity, as well as the perceived benefits, barriers, and cues to action. The association between these factors and the level of physical activity was determined by correlation statistics and confirmed by robust regression. Multivariate analysis of variance compared health belief model determinants: perceived benefits, perceived barriers, and cues to action on physical activity between male and female students. Self-administered questionnaires were validated and tested in a pilot study.

RESULTS

The level of activity among primary school children was significantly influenced by perceived barriers, such as fear of strangers when playing outdoors, bad weather, and too much homework. However, activity was not influenced by cues to action or perceived benefits. Perceived benefits, barriers, and cues to physical activity did not differ by gender.

CONCLUSION

A safe environment and fewer barriers, such as amount of homework, could enhance physical activity in primary school children.