Creating community action plans for obesity prevention using the ANGELO (Analysis Grid for Elements Linked to Obesity) Framework

Community-based interventions are an important component of obesity prevention efforts. The literature provides little guidance on priority-setting for obesity prevention in communities, especially for socially and culturally diverse populations. This paper reports on the process of developing prioritized, community-participatory action plans for obesity prevention projects in children and adolescents using the ANGELO (Analysis Grid for Elements Linked to Obesity) Framework. We combined stakeholder engagement processes, the ANGELO Framework (scans for environmental barriers, targeted behaviours, gaps in skills and knowledge) and workshops with key stakeholders to create action plans for six diverse obesity prevention projects in Australia (n = 3), New Zealand, Fiji and Tonga from 2002 to 2005. Some sites included sociocultural contextual analyses in the environmental scans. Target groups were under-5-year-olds (Australia), 4-12-year-olds (Australia) and 13-18-year-olds (all four countries). Over 120 potential behavioural, knowledge, skill and environmental elements were identified for prioritization leading into each 2-day workshop. Many elements were common across the diverse cultural communities; however, several unique sociocultural elements emerged in some cultural groups which informed their action plans. Youth were actively engaged in adolescent projects, allowing their needs to be incorporated into the action plans initiating the process of ownership. A common structure for the action plan promoted efficiencies in the process while allowing for community creativity and innovation. The ANGELO is a flexible and efficient way of achieving an agreed plan for obesity prevention with diverse communities. It is responsive to community needs, combines local and international knowledge and creates stakeholder ownership of the action plan.

Trends in body mass index and waist circumference among New Zealand adolescents, 1997/1998-2005

The objective of the current study is to examine changes in body mass index (BMI) and waist circumference among New Zealand adolescents between 1997/1998 and 2005. Data were drawn from two cross-sectional studies of high school students in an economically disadvantaged region of Auckland. In total, 608 adolescents from the 1998 survey and 897 adolescents from the 2005 survey participated. The prevalence of obesity increased from 19.4% in 1997/1998 to 30.7% in 2005. The mean BMI among adolescents significantly increased from 25.3 in 1997/1998 to 27.2 in 2005, with the greatest increases at the high end of the distribution. Increases in BMI did not differ by age, gender or ethnicity. The mean waist circumference increased from 76.2 cm in 1997/1998 to 89.4 cm in 2005, with increases in waist circumference measurements at all points in the distribution. The prevalence of obesity is increasing rapidly in this sample of ethnically diverse adolescents. Corresponding increases in waist circumference measurements suggest that this population of New Zealand adolescents are at increased risk for related chronic conditions.

Indices of fatness and relationships with age, ethnicity and lipids in New Zealand European, Māori and Pacific children

BACKGROUND/OBJECTIVES

To investigate the relationships between body mass index (BMI), body fatness, ethnicity, age and blood lipids.

SUBJECTS/METHOD

In a subsample (N=643) of the 2002 New Zealand Child Nutrition Survey (N=3275, age 5-14 years) consisting Māori (89 boys, 69 girls), Pacific (154 boys, 194 girls) and European (71 boys, 66 girls) ethnic groups, fat-free mass (FFM) was determined by bioimpedance analysis. FFM index (FFMI, FFM/height(2)), fat mass index (FMI, fat mass/height(2)) and percentage body fat (%BF) were derived. Plasma total cholesterol and high-density lipoprotein (HDL) cholesterol were measured in 515 (80%) of these children.

RESULTS

For the same BMI, %BF was lower in Pacific Island (P<0.0001) and Māori (P<0.0001) girls compared with European but for boys there were no ethnic differences. Cross-sectional analysis across ages using Hattori charts clearly showed sexual dimorphism with girls having a higher FMI, FFMI and BMI than boys by the age of 13 year. Both Pacific girls and boys showed upward trends in FFMI and FMI with age that were significantly higher than those of the other ethnicities. Adjusting for age, sex and ethnicity, %BF was a better predictor (R(2)=0.090, P=0.0002) of total cholesterol than BMI (R(2)=0.061, P=0.049) or waist (R(2)=0.075, P=0.013) while FFMI was the best predictor of HDL cholesterol (R(2)=0.15, P<0.0001) and waist was the best predictor of the total cholesterol/HDL cholesterol ratio (R(2)=0.17, P<0.0001).

CONCLUSIONS

Measurements of body fat and indices of body fatness additional to BMI in multiethnic paediatric populations allow changes in fat mass and FFM to be tracked and improve the ability to predict dyslipidaemia.

Short-term repeatability of a food frequency questionnaire in New Zealand children aged 1–14 y

OBJECTIVE

To evaluate the repeatability of a children's food frequency questionnaire (FFQ) by gender, ethnicity, and age group.

DESIGN

A 117-item FFQ asking about food intake patterns over the past 4 weeks was developed using food records from 428 children (204 boys and 224 girls) and the reproducibility on average 13 days apart was tested in 130 children (78 boys and 52 girls). Children were recruited using clustered probability sampling (n=103), and a convenience sample of 25 Maori children.

SETTING

Children aged 1-14 y from Auckland, Feilding and Shannon, New Zealand.

SUBJECTS

There were 71 Maori, 20 Pacific, and 39 Other children.

RESULTS

Spearman correlations between the two FFQs ranged from 0.50 for bread to 0.82 for fruit, with a median of 0.76 for spreads and nonmilk drinks, and Cronbach's coefficient alpha's ranged from 0.59 for bread to 0.92 for nonmilk drinks, with a median of 0.85 for mixed meat dishes. There were no significant differences between the two administrations, apart from reporting higher intakes of vegetables and snacks & sweets in the first FFQ. Correlation coefficients tended to be slightly higher in boys than in girls, and in Other ethnic groups compared to Maori and Pacific children. Correlations were slightly higher for the 1-4 y age group, intermediate in the 10-14 y age group, and lowest in the 5-9 y-old age group.

CONCLUSIONS

Overall, the FFQ described here shows similar or better repeatability in New Zealand children of all major ethnic groups compared to other child or adolescent FFQs.

Prevalence of iron deficiency in Auckland high school students

AIMS

To determine the frequency of iron deficiency and anaemia in high school students.

METHOD

The survey was carried out at eight Auckland high schools with a high proportion (> or =15%) of Pacific Islands students. All students in Forms 5-7 at these schools were invited to participate, and 1644 students (Pacific Island 765, Asian 350, European 295, Maori 234) had iron assessments (response rate 61%). Iron deficiency was defined as any two (or more) of the following, three: serum ferritin <12 microg/L, iron saturation <14%, or red cell distribution width >14.5%. Anaemia was defined as haemoglobin <120 g/L for females and <130 g/L for males.

RESULTS

Iron deficiency and anaemia were each ten times more common in girls (18.3% and 11.5%, respectively) than boys (1.5% and 1.4%). In females, iron deficiency was two to three times more common in Maori (25.6%), Pacific Islanders (20.9%) and Asians (15.4%) compared with Europeans (8.3 %), while anaemia was three to four times more common in Asians (15.9%), Pacific Islanders (12.1%) and Maori (11.2%) compared with Europeans (4.2%). Iron deficiency and anaemia prevalences were inversely associated with aerobic fitness, but not with age or years since menarche.

CONCLUSION

Prevalences of iron deficiency and anaemia are high in non-European female adolescents in Auckland, for reasons currently unknown.

Cardiovascular risk factors levels of Pacific people in a New Zealand multicultural workforce

AIMS

To compare cardiovascular risk factors among the major Pacific Island communities participating in a New Zealand multicultural workforce survey.

METHOD

There were 650 employed Pacific Island participants (Samoan 357, Cook Islands 177, Tongan 71, Niuean 45), aged 40-65 years, who were interviewed in a work-based, cross-sectional survey. During an oral glucose tolerance test, blood samples were collected for determination of blood glucose and serum lipids. Participants provided information on smoking and leisure time physical activity. Blood pressure, weight and height were measured and body mass index calculated. Ten-year risk of cardiovascular disease was calculated using equations from the Framingham study.

RESULTS

Among men, their ten-year risk of a cardiovascular event was similar for the four communities compared (range 11.5% to 13.2%). However, individual risk factors did vary between the ethnic groups with Cook Island men having significantly higher total cholesterol, blood pressure and urinary microalbumin than other Pacific Island ethnic groups, while Tongan men were more likely to smoke and had lower HDL levels than other groups. Among women, Samoan and Cook Island participants had significantly higher ten-year cardiovascular risk scores (5.7%) than Niuean (4.4%) and Tongan (3.7%), due primarily to elevated total cholesterol levels.

CONCLUSION

Cardiovascular risk factor levels vary between Pacific Islands communities in New Zealand. Targeted interventions to specific Pacific communities may be more beneficial than the current homogeneous prevention strategy applied to all communities.

[Use of internal fixator in injuries of the thoracic and lumbar spine]

Between 1984 and 1989 51 patients with spinal traumata received surgical treatment by means of Fixateur interne. The results of patients' postsurgical check-up were as follows: Cases with incomplete neurological dysfunctions (levels Frankel B-D)-especially lumbar-showed improvements of neurological deficiencies up to three levels Frankel after emergency decompression and stabilization. The majority of cases with complete paraplegia-especially thoracic-did not subside. This holds true even for the results of a second check-up after about three years. A correlation between the degree of stenosis of the spinal canal and the neurological dysfunctions could not be established. The results of segmental stabilization by means of internal fixator and of definitive spondylodesis by means of autogenous spongiosa were positive, as was the spine proof and the patients' postsurgical function.

[I.V. preparations in practice: a study]

In 10 hospitals a study was made about the practice of preparing i.v. admixtures. The results are presented and discussed. Improvements in drug safety are possible in closer cooperation with pharmaceutical staff.