Development of the Food Boost Challenge: A Participatory Action Research Approach to Enhance Vegetable and Fruit Consumption among Adolescents

Prevention of non-communicable diseases through, among other factors, increasing vegetables and fruit (V&F) intake is a cost-effective strategy for risk reduction but requires behavioral change. Such changes in adolescents benefit from their active involvement. The Food Boost Challenge (FBC) was developed using a participatory action research approach to enhance healthy eating behaviors, namely V&F products among adolescents. The FBC is an innovation process, involving adolescents, (peer) researchers, and food system partners, like non-governmental and commercial organizations. In 2021-2022, 34 partners provided both cash and in-kind contributions to join the FBC community. Phase 1 involved 200 students identifying barriers and drivers for consumption of F&V products among 1000 pre-vocational adolescents, aged 12-20 years. In phase 2, student teams submitted innovative ideas, resulting in 25 concepts fitting into ≥1 of 4 routes: (I) innovative technology for a healthy diet, (II) new food products/concepts for adolescents, (III) hotspots improving the F&V product experience, and (IV) new routes to market. In phase 3, consortia of adolescents, students, and partners were formed to develop 10 selected concepts into prototypes, and phase 4 offered teams a national platform. Results show that the FBC resonates with all stakeholders, generating valuable insights to increase F&V intake. Prototypes in all four routes have been developed. Additionally, other regions in the Netherlands have adopted the FBC approach. Overall, the FBC is an approach that transforms ideas into actionable measures and shows potential to be adapted to promote various healthy eating behaviors among school students.

The Participant Journey Map: Understanding the Design of Interactive Augmented Play Spaces

Augmented Play Spaces (APS) are (semi-) public environments where playful interaction is facilitated by enriching the existing environment with interactive technology. APS can potentially facilitate social interaction and physical activity in (semi-)public environments. In controlled settings APS show promising effects. However, people’s willingness to engage with APS in situ, depends on many factors that do not occur in aforementioned controlled settings (where participation is obvious). To be able to achieve and demonstrate the positive effects of APS when implemented in (semi-)public environments, it is important to gain more insight in how to motivate people to engage with them and better understand when and how those decisions can be influenced by certain (design) factors. The Participant Journey Map (PJM) was developed following multiple iterations. First, based on related work, and insights gained from previously developed and implemented APS, a concept of the PJM was developed. Next, to validate and refine the PJM, interviews with 6 experts with extensive experience with developing and implementing APS were conducted. The first part of these interviews focused on influential (design) factors for engaging people into APS. In the second part, experts were asked to provide feedback on the first concept of the PJM. Based on the insights from the expert interviews, the PJM was adjusted and refined. The Participant Journey Map consists of four layers: Phases, States, Transitions and Influential Factors. There are two overarching phases: ‘Onboarding’ and ‘Participation’ and 6 states a (potential) participant goes through when engaging with an APS: ‘Transit,’ ‘Awareness,’ ‘Interest,’ ‘Intention,’ ‘Participation,’ ‘Finishing.’ Transitions indicate movements between states. Influential factors are the factors that influence these transitions. The PJM supports directions for further research and the design and implementation of APS. It contributes to previous work by providing a detailed overview of a participant journey and the factors that influence motivation to engage with APS. Notable additions are the detailed overview of influential factors, the introduction of the states ‘Awareness,’ ‘Intention’ and ‘Finishing’ and the non-linear approach. This will support taking into account these often overlooked, key moments in future APS research and design projects. Additionally, suggestions for future research into the design of APS are given.

Evaluation of a school-based multicomponent behavioural intervention in deprived urban areas for children classified as overweight, obese or at risk for overweight

OBJECTIVE

This study evaluated the effect of an after-school group-based medium-intensity multicomponent behavioural intervention programme for children aged 8-12 years classified as overweight, obese or at risk for overweight on body mass index standard deviation score (BMI SDS). In accordance with standardized protocols body weight and height were measured in 195 participants (88 boys, 107 girls) at baseline and at the end of the programme. A total of 166 children derived from a school-based monitoring system served as control group. Multivariate regression analyses examined the effect of the intervention and the independent factors associated with better outcomes in the intervention group.

RESULTS

Analysis of covariance showed a significant intervention effect on BMI SDS in favour of the intervention group (b-coefficient - 0.13 ± 0.03; p < 0.01) compared with the control group. Change in BMI SDS between baseline and follow-up in the intervention group was associated with baseline age (b-coefficient 0.03 ± 0.02; p = 0.04) but was independent from gender, ethnicity, baseline BMI SDS, time between baseline and follow-up, school year and attendance rate.

Investigating longitudinal context-specific physical activity patterns in transition from primary to secondary school using accelerometers, GPS, and GIS

INTRODUCTION

Previous longitudinal studies indicate that physical activity (PA) significantly declines from primary-to secondary school, and report both changes in individual and environmental determinants of PA. In order to understand this transition and to prevent this negative trend, it is important to gather contextually rich data on possible mechanisms that drive this decline. Therefore, the aim of this study was to investigate changes of PA patterns in transition between primary and secondary school, and to add domain-specific insights of how, where, and when these changes occur.

METHODS

In total, 175 children participated in a 7-day accelerometer- and Global Positioning System (GPS) protocol at their last year of primary and their first year of secondary school. GPS data-points were overlaid with Geographical Information Systems (GIS) data using ArcGIS 10.1 software. Based on the GPS locations of individual data-points, we identified child's PA at home, school, local sports grounds, shopping centers, and other locations. Also, trips in active and passive transport were identified according to previously validated GPS speed-algorithms. Longitudinal multi-level linear mixed models were fitted adjusting for age, gender, meteorological circumstances, and the nested structure of days within children and children within schools. Outcome measures were minutes spent in light PA and moderate-to-vigorous PA, specified for the time-segments before school, during school, after school and weekend days.

RESULTS

Total PA significantly declined from primary to secondary school. Although transport-related PA increased before- and during school, decreases were found for especially afterschool time spent at sports grounds and transport-related PA during weekends.

CONCLUSIONS

This is the first study that demonstrated longitudinal changes of context- and domain-specific PA patterns in transition between primary and secondary school, based on device-assessed PA. Given the importance of this transition-period for the development of long-term PA patterns, results from this study warrant the development of evidence-based PA programs in this transition period, while acknowledging the integrative role of schools, parents, and afterschool sports providers. More specifically, the results underline the need to increase children's PA levels in primary schools, promote afterschool PA at secondary schools, and to prevent the drop-out in sports participation at secondary schools.

Investigating Motor Competence in Association with Sedentary Behavior and Physical Activity in 7- to 11-Year-Old Children

Children's motor competence (MC) has declined in the past decades, while sedentary behavior (SB) has increased. This study examined the association between MC and physical activity (PA) levels among primary schoolchildren. Demographics, body height and weight, MC (Athletic Skills Track), and PA levels (ActiGraph, GT3X+) were assessed among 595 children (291 boys, mean age = 9.1 years, SD = 1.1). MC was standardized into five categories: from very low to very high. PA levels were classified into SB, light PA (LPA), and moderate-to-vigorous PA (MVPA). Mixed-model analyses were conducted with PA levels as dependent variables and MC as the independent variable, while adjusting for age, gender, and body mass index (BMI) z-score on the individual level. A negative association between MC and SB and a positive association between MC and MVPA were found. The strength of both associations increased as children expressed lower or higher levels of MC. MC is an important correlate of both SB and MVPA, particularly for children with very high or low MC. Developing and improving children's MC may contribute to spending less time in SB and more time in MVPA, particularly for high-risk groups, i.e., children with low MC. Moreover, addressing MC development and PA promotion simultaneously might create positive feedback loops for both children's MC and PA levels.

Schoolyard Characteristics, Physical Activity, and Sedentary Behavior: Combining GPS and Accelerometry

BACKGROUND

Physical activity (PA) is decreasing among children, while sedentary behavior (SB) is increasing. Schoolyards seem suitable settings to influence children's PA behavior. This study investigated the associations between schoolyard characteristics and moderate-to-vigorous physical activity (MVPA) and SB of children aged 8-11 years at schoolyards.

METHODS

Twenty primary schools in the Netherlands were involved. A total of 257 children wore an accelerometer and global positioning system (GPS) device for 5 consecutive days to objectively assess their PA levels and presence at the schoolyard, respectively. Accelerometer and GPS data were merged using the personal activity and location measurement system. Multilevel linear regression analyses were used to study correlates of MVPA and SB at schoolyards.

RESULTS

On average, children spent 54 minutes a day at the schoolyard, 9 minutes of which were spent in MVPA and 20 minutes in SB. Boys engaged in MVPA longer than girls at the schoolyard. Fixed equipment, such as high bars and soccer goals, teacher-initiated activities, and the presence of a ball games policy were correlates of more MVPA and less SB.

CONCLUSION

Well-designed schoolyards, including PA-enhancing fixed equipment, a supportive PA climate created by teachers, and supportive schoolyard policies may contribute to increased PA and decreased SB during school recess among school-aged children.

Children's route choice during active transportation to school: difference between shortest and actual route

Background

The purpose of this study is to increase our understanding of environmental correlates that are associated with route choice during active transportation to school (ATS) by comparing characteristics of actual walking and cycling routes between home and school with the shortest possible route to school.

Methods

Children (n = 184; 86 boys, 98 girls; age range: 8–12 years) from seven schools in suburban municipalities in the Netherlands participated in the study. Actual walking and cycling routes to school were measured with a GPS-device that children wore during an entire school week. Measurements were conducted in the period April–June 2014. Route characteristics for both actual and shortest routes between home and school were determined for a buffer of 25 m from the routes and divided into four categories: Land use (residential, commercial, recreational, traffic areas), Aesthetics (presence of greenery/natural water ways along route), Traffic (safety measures such as traffic lights, zebra crossings, speed bumps) and Type of street (pedestrian, cycling, residential streets, arterial roads). Comparison of characteristics of shortest and actual routes was performed with conditional logistic regression models.

Results

Median distance of the actual walking routes was 390.1 m, whereas median distance of actual cycling routes was 673.9 m. Actual walking and cycling routes were not significantly longer than the shortest possible routes. Children mainly traveled through residential areas on their way to school (>80 % of the route). Traffic lights were found to be positively associated with route choice during ATS. Zebra crossings were less often present along the actual routes (walking: OR = 0.17, 95 % CI = 0.05–0.58; cycling: OR = 0.31, 95 % CI = 0.14–0.67), and streets with a high occurrence of accidents were less often used during cycling to school (OR = 0.57, 95 % CI = 0.43–0.76). Moreover, percentage of visible surface water along the actual route was higher compared to the shortest routes (walking: OR = 1.04, 95 % CI = 1.01–1.07; cycling: OR = 1.03, 95 % CI = 1.01–1.05).

Discussion

This study showed a novel approach to examine built environmental exposure during active transport to school. Most of the results of the study suggest that children avoid to walk or cycle along busy roads on their way to school.

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-016-0373-y) contains supplementary material, which is available to authorized users.

Natural and built environmental exposures on children's active school travel: A Dutch global positioning system-based cross-sectional study

Physical inactivity among children is on the rise. Active transport to school (ATS), namely walking and cycling there, adds to children's activity level. Little is known about how exposures along actual routes influence children's transport behavior. This study examined how natural and built environments influence mode choice among Dutch children aged 6-11 years. 623 school trips were tracked with global positioning system. Natural and built environmental exposures were determined by means of a geographic information system and their associations with children's active/passive mode choice were analyzed using mixed models. The actual commuted distance is inversely associated with ATS when only personal, traffic safety, and weather features are considered. When the model is adjusted for urban environments, the results are reversed and distance is no longer significant, whereas well-connected streets and cycling lanes are positively associated with ATS. Neither green space nor weather is significant. As distance is not apparent as a constraining travel determinant when moving through urban landscapes, planning authorities should support children's ATS by providing well-designed cities.

Physical activity in non-frail and frail older adults

Introduction

Physical activity (PA) is important for healthy ageing. Better insight into objectively measured PA levels in older adults is needed, since most previous studies employed self-report measures for PA assessment, which are associated with overestimation of PA.

Aim

This study aimed to provide insight in objectively measured indoor and outdoor PA of older adults, and in PA differences by frailty levels.

Methods

Data were collected among non-frail (N = 74) and frail (N = 10) subjects, aged 65 to 89 years. PA, measured for seven days with accelerometers and GPS-devices, was categorized into three levels of intensity (sedentary, light, and moderate-to-vigorous PA).

Results

Older adults spent most time in sedentary and light PA. Subjects spent 84.7%, 15.1% and 0.2% per day in sedentary, light and moderate-to-vigorous PA respectively. On average, older adults spent 9.8 (SD 23.7) minutes per week in moderate-to-vigorous activity, and 747.0 (SD 389.6) minutes per week in light activity. None of the subjects met the WHO recommendations of 150 weekly minutes of moderate-to-vigorous PA. Age-, sex- and health status-adjusted results revealed no differences in PA between non-frail and frail older adults. Subjects spent significantly more sedentary time at home, than not at home. Non-frail subjects spent significantly more time not at home during moderate-to-vigorous activities, than at home.

Conclusions

Objective assessment of PA in older adults revealed that most PA was of light intensity, and time spent in moderate-to-vigorous PA was very low. None of the older adults met the World Health Organization recommendations for PA. These levels of MVPA are much lower than generally reported based on self-reported PA. Future studies should employ objective methods, and age specific thresholds for healthy PA levels in older adults are needed. These results emphasize the need for effective strategies for healthy PA levels for the growing proportion of older adults.

Relationship between physical activity and the development of body mass index in children

PURPOSE

Studies estimating the contribution of physical activity (PA) to the development of body mass index (BMI) in critical periods of childhood are warranted. Therefore, we have prospectively investigated this relationship in boys and girls of the KOALA Birth Cohort study, the Netherlands, in the period around adiposity rebound (i.e., 4-9 yr old).

METHODS

PA was assessed in 470 children (231 boys, 239 girls) using accelerometers at the ages of 5 and 7 yr, and height and weight were measured at 5, 7, and 9 yr. BMI z-scores were calculated to standardize for age and sex. Leaner and heavier children were classified according to the 25th and 75th percentile of our study sample. To examine longitudinal relationships between PA and BMI z-scores, generalized estimating equation analyses were performed and stratified for sex and baseline weight status (leaner, normal weight, and heavier children).

RESULTS

In heavier children, an increment of 6.5 min of moderate to vigorous PA (MVPA) was related to a subsequent decrease of 0.03 BMI z-scores both in boys (95% confidence interval = -0.07 to -0.001) and girls (95% confidence interval = -0.05 to -0.002). Light PA was also associated with a decrease of BMI in heavier boys but not girls. In normal weight children, MVPA was associated with decrease of BMI in boys but not girls.

CONCLUSION

Increments of MVPA were associated with decreases in BMI z-score in heavier children, both boys and girls. Promoting MVPA should remain a major prevention vehicle for improving body composition in 4- to 9-yr-old children.

The value of (pre)school playgrounds for children's physical activity level: a systematic review

The (pre)school environment is an important setting to improve children's health. Especially, the (pre)school playground provides a major opportunity to intervene. This review presents an overview of the existing evidence on the value of both school and preschool playgrounds on children's health in terms of physical activity, cognitive and social outcomes. In addition, we aimed to identify which playground characteristics are the strongest correlates of beneficial effects and for which subgroups of children effects are most distinct. In total, 13 experimental and 17 observational studies have been summarized of which 10 (77%) and 16 (94%) demonstrated moderate to high methodological quality, respectively. Nearly all experimental studies (n = 11) evaluated intervention effects on time spent in different levels of physical activity during recess. Research on the effects of (pre)school playgrounds on cognitive and social outcomes is scarce (n = 2). The experimental studies generated moderate evidence for an effect of the provision of play equipment, inconclusive evidence for an effect of the use of playground markings, allocating play space and for multi-component interventions, and no evidence for an effect of decreasing playground density, the promotion of physical activity by staff and increasing recess duration on children's health. In line with this, observational studies showed positive associations between play equipment and children's physical activity level. In contrast to experimental studies, significant associations were also found between children's physical activity and a decreased playground density and increased recess duration. To confirm the findings of this review, researchers are advised to conduct more experimental studies with a randomized controlled design and to incorporate the assessment of implementation strategies and process evaluations to reveal which intervention strategies and playground characteristics are most effective.

Active transport between home and school assessed with GPS: a cross-sectional study among Dutch elementary school children

Background

Active transport to school is associated with higher levels of physical activity in children. Promotion of active transport has therefore gained attention as a potential target to increase children’s physical activity levels. Recent studies have recognized that the distance between home and school is an important predictor for active travel among children. These studies did not yet use the promising global positioning system (GPS) methods to objectively assess active transport. This study aims to explore active transport to school in relation to the distance between home and school among a sample of Dutch elementary school children, using GPS.

Methods

Seventy-nine children, aged 6-11 years, were recruited in six schools that were located in five cities in the Netherlands. All children were asked to wear a GPS receiver for one week. All measurements were conducted between December 2008 and April 2009. Based on GPS recordings, the distance of the trips between home and school were calculated. In addition, the mode of transport (i.e., walking, cycling, motorized transport) was determined using the average and maximum speed of the GPS tracks. Then, proportion of walking and cycling trips to school was determined in relation to the distance between home and school.

Results

Out of all school trips that were recorded (n = 812), 79.2% were classified as active transport. On average, active commuting trips were of a distance of 422 meters with an average speed of 5.2 km/hour. The proportion of walking trips declined significantly at increased school trip distance, whereas the proportion of cycling trips (β = 1.23, p < 0.01) and motorized transport (β = 3.61, p < 0.01) increased. Almost all GPS tracks less than 300 meters were actively commuted, while of the tracks above 900 meters, more than half was passively commuted.

Conclusions

In the current research setting, active transport between home and school was the most frequently used mode of travel. Increasing distance seems to be associated with higher levels of passive transport. These results are relevant for those involved in decisions on where to site schools and residences, as it may affect healthy behavior among children.

Correlates of physical activity in 2-year-old toddlers: the generation R study

OBJECTIVE

To describe and identify correlates of objectively measured physical activity and sedentary behavior in 2-year-old toddlers.

STUDY DESIGN

A total of 347 children participating in a birth cohort study wore a unaxial ActiGraph accelerometer during 1 weekday and 1 weekend day. Information on potential correlates was assessed by parent-reported questionnaires, delivery reports, and regular visits to child health centers. Univariate and multivariable linear regression analyses were conducted to examine the associations between potential correlates and the following physical activity outcomes: percentage of time spent in sedentary behavior, percentage of time spent in moderate-to-vigorous physical activity, and mean counts per minute.

RESULTS

A high percentage of monitored time was spent in sedentary behavior; 85.6% on weekdays and 84.5% on weekend days. Four correlates were significantly associated with at least 1 physical activity outcome in the multivariable regression models: child's sex, child's age, number of siblings, and season of measurement. The associations of gross motor development with moderate-to-vigorous physical activity and mean counts per minute approached significance. Associations of socioeconomic variables and child's body mass index z-score with physical activity outcomes were not significant.

CONCLUSION

Two-year-old toddlers spend most of their time in sedentary behavior. No modifiable correlates were identified. Further research on physical activity and associated health benefits among very young children is warranted.

Schoolyard physical activity of 6-11 year old children assessed by GPS and accelerometry

BACKGROUND

Children's current physical activity levels are disturbingly low when compared to recommended levels. This may be changed by intervening in the school environment. However, at present, it is unclear to what extent schoolyard physical activity contributes towards reaching the daily physical activity guideline. The aim of this study was to examine how long and at what intensity children are physically active at the schoolyard during different time segments of the day. Moreover, the contribution of schoolyard physical activity towards achieving the recommended guideline for daily physical activity was investigated.

METHODS

Children (n=76) between the age of 6-11 years were recruited in six different schools in five cities (>70.000 residents) in the Netherlands. During the weekdays of a regular school week, childrens' physical activity and location were measured with ActiGraph accelerometers and Travelrecorder GPS receivers. Data was collected from December 2008 to April 2009. From the data, the amount of moderate to vigorous physical activity (MVPA) on and outside the schoolyard was established. Moreover, the percentage of MVPA on the schoolyard was compared between the following segments of the day: pre-school, school, school recess, lunch break and post-school. Differences between boys and girls were compared using linear and logistic mixed-effects models.

RESULTS

On average, children spent 40.1 minutes/day on the schoolyard. During this time, boys were more active on the schoolyard, with 27.3% of their time spent as MVPA compared to 16.7% among girls (OR=2.11 [95% CI 1.54 - 2.90]). The children were most active on the schoolyard during school recess, during which boys recorded 39.5% and girls recorded 23.4% of the time as MVPA (OR=2.55 [95% CI: 1.69 - 3.85]). Although children were only present at the schoolyard for 6.1% of the total reported time, this time contributed towards 17.5% and 16.8% of boys' and girls' minutes of MVPA.

CONCLUSIONS

On the schoolyard, children's physical activity levels are higher than on average over the whole day. Physical activity levels are particularly high during school recess. The school environment seems to be an important setting for improving children's physical activity levels. Further research on the facilitators of these high activity levels may provide targets for further promotion of physical activity among children.

Outdoor play among children in relation to neighborhood characteristics: a cross-sectional neighborhood observation study

BACKGROUND

Although environmental characteristics as perceived by parents are known to be related to children's outdoor play behavior, less is known about the relation between independently measured neighborhood characteristics and outdoor play among children. The purpose of this study was to identify quantitative as well as qualitative neighborhood characteristics related to outdoor play by means of neighborhood observations.

METHODS

Questionnaires including questions on outdoor play behavior of the child were distributed among 3,651 parents of primary school children (aged 4-12 years). Furthermore, neighborhood observations were conducted in 33 Dutch neighborhoods to map neighborhood characteristics such as buildings, formal outdoor play facilities, public space, street pattern, traffic safety, social neighborhood characteristics, and general impression. Data of the questionnaires and the neighborhood observations were coupled via postal code of the respondents. Multilevel GEE analyses were performed to quantify the correlation between outdoor play and independently measured neighborhood characteristics.

RESULTS

Parental education was negatively associated with outdoor play among children. Neither the presence nor the overall quality of formal outdoor play facilities were (positively) related to outdoor play among children in this study. Rather, informal play areas such as the presence of sidewalks were related to children's outdoor play. Also, traffic safety was an important characteristic associated with outdoor play.

CONCLUSIONS

This study showed that, apart from individual factors such as parental education level, certain modifiable characteristics in the neighborhood environment (as measured by neighborhood observations) were associated with outdoor play among boys and girls of different age groups in The Netherlands. Local policy makers from different sectors can use these research findings in creating more activity-friendly neighborhoods for children.

The SQUASH was a more valid tool than the OBiN for categorizing adults according to the Dutch physical activity and the combined guideline

OBJECTIVE

To examine whether the "Short QUestionnaire to ASsess Health-enhancing physical activity" (SQUASH) and the "Injuries and Physical Activity in the Netherlands" questionnaire ("Ongevallen en Bewegen in Nederland," OBiN) were valid in assessing adherence to physical activity (PA) guidelines.

STUDY DESIGN AND SETTING

Participants (N=187) aged 20-69 years were categorized as "inactive," "semiactive," or "norm-active" according to the Dutch PA, the American College of Sports Medicine (ACSM), and the combined guideline (adhering to either or both of two other guidelines) by the questionnaires and a combined heart rate monitor and accelerometer (Actiheart). Percentage of exact agreement and maximum disagreement (difference of two categories) for the categorization between questionnaires and Actiheart was calculated.

RESULTS

The SQUASH had a significant higher agreement than the OBiN for the Dutch PA (SQUASH: 78%, OBiN: 46%; P<0.01) and combined guideline (SQUASH: 84%, OBiN: 55%; P<0.01). Both questionnaires had a low agreement regarding the ACSM guideline (SQUASH: 37%, OBiN: 34%; P=0.45). The SQUASH had a significant higher maximum disagreement than the OBiN for this guideline (SQUASH: 19.8%, OBiN 8%; P<0.01).

CONCLUSION

The SQUASH was a more valid measure than the OBiN for categorizing adults according to the Dutch PA and the combined guideline. Both questionnaires failed to correctly categorize adults according to the ACSM guideline.

Association between parenting practices and children's dietary intake, activity behavior and development of body mass index: the KOALA Birth Cohort Study

Background

Insights into the effects of energy balance-related parenting practices on children's diet and activity behavior at an early age is warranted to determine which practices should be recommended and to whom. The purpose of this study was to examine child and parent background correlates of energy balance-related parenting practices at age 5, as well as the associations of these practices with children's diet, activity behavior, and body mass index (BMI) development.

Methods

Questionnaire data originated from the KOALA Birth Cohort Study for ages 5 (N = 2026) and 7 (N = 1819). Linear regression analyses were used to examine the association of child and parent background characteristics with parenting practices (i.e., diet- and activity-related restriction, monitoring and stimulation), and to examine the associations between these parenting practices and children's diet (in terms of energy intake, dietary fiber intake, and added sugar intake) and activity behavior (i.e., physical activity and sedentary time) at age 5, as well as BMI development from age 5 to age 7. Moderation analyses were used to examine whether the associations between the parenting practices and child behavior depended on child characteristics.

Results

Several child and parent background characteristics were associated with the parenting practices. Dietary monitoring, stimulation of healthy intake and stimulation of physical activity were associated with desirable energy balance-related behaviors (i.e., dietary intake and/or activity behavior) and desirable BMI development, whereas restriction of sedentary time showed associations with undesirable behaviors and BMI development. Child eating style and weight status, but not child gender or activity style, moderated the associations between parenting practices and behavior. Dietary restriction and monitoring showed weaker, or even undesirable associations for children with a deviant eating style, whereas these practices showed associations with desirable behavior for normal eaters. By contrast, stimulation to eat healthy worked particularly well for children with a deviant eating style or a high BMI.

Conclusion

Although most energy balance-related parenting practices were associated with desirable behaviors, some practices showed associations with undesirable child behavior and weight outcomes. Only parental stimulation showed desirable associations with regard to both diet and activity behavior. The interaction between parenting and child characteristics in the association with behavior calls for parenting that is tailored to the individual child.

Clustering of dietary intake and sedentary behavior in 2-year-old children

OBJECTIVE

To examine clustering of energy balance-related behaviors (EBRBs) in young children. This is crucial because lifestyle habits are formed at an early age and track in later life. This study is the first to examine EBRB clustering in children as young as 2 years.

STUDY DESIGN

Cross-sectional data originated from the Child, Parent and Health: Lifestyle and Genetic Constitution (KOALA) Birth Cohort Study. Parents of 2578 2-year-old children completed a questionnaire. Correlation analyses, principal component analyses, and linear regression analyses were performed to examine clustering of EBRBs.

RESULTS

We found modest but consistent correlations in EBRBs. Two clusters emerged: a "sedentary-snacking cluster" and a "fiber cluster." Television viewing clustered with computer use and unhealthy dietary behaviors. Children who frequently consumed vegetables also consumed fruit and brown bread more often and white bread less often. Lower maternal education and maternal obesity were associated with high scores on the sedentary-snacking cluster, whereas higher educational level was associated with high fiber cluster scores.

CONCLUSIONS

Obesity-prone behavioral clusters are already visible in 2-year-old children and are related to maternal characteristics. The findings suggest that obesity prevention should apply an integrated approach to physical activity and dietary intake in early childhood.

Asthmatic symptoms, physical activity, and overweight in young children: a cohort study

OBJECTIVE

Prevalence of asthma and overweight has increased simultaneously during the past decades. Several studies have reported an association between these two health problems, but it is unclear whether this relation is causal. We hypothesize that children with asthmatic symptoms are less physically active, which may contribute to the development of overweight.

PATIENTS AND METHODS

The study included children from the KOALA Birth Cohort Study who were invited at 4 to 5 years of age to wear an Actigraph accelerometer for 5 days (n = 305; 152 boys). Information on wheezing was gathered by repeated questionnaires completed by parents at child ages 7 months and 1, 2, and 4 to 5 years. Questionnaires on physical activity were completed at child age 4 to 5 years, and height, weight, and abdominal circumference were measured. Accelerometer data were expressed as mean counts per minute, minutes per day performing vigorous activity, and moderate-to-vigorous physical activity during > or = 1 minute.

RESULTS

Children who had wheezed in the last 12 months showed very similar activity levels compared with children who had never wheezed. By contrast, boys who had wheezed at least once but not in the last 12 months were more physically active than boys who had never wheezed (geometric mean: 694 vs 625 cpm; adjusted geometric mean ratio: 1.11). This was not found for girls. Similar results were found in parent-reported physical activity data. No association was found between wheezing at any age and overweight at the age of 4 to 5 years.

CONCLUSIONS

These results do not support our hypothesis and previous studies that showed that wheezing children are less physically active. Our data provide no evidence that asthmatic symptoms induce a lower physical activity level and more overweight. Additional research could concentrate on the effect of physical activity and overweight on the development of asthmatic symptoms.

Determinants of activity-friendly neighborhoods for children: results from the SPACE study

PURPOSE

To examine the association between children's physical activity and factors of the built environment.

DESIGN

Cross-sectional study. Setting. Ten neighborhoods in six cities in the Netherlands.

SUBJECTS

Four hundred twenty-two children (age range, 6-11 years; 49% male).

MEASURES

Physical activity diary, neighborhood observations, and anthropometric measures.

ANALYSIS

Univariate and multivariate linear regression analyses.

RESULTS

According to univariate analyses adjusted for age, sex, body mass index, and highest level of maternal education, physical activity (> or = 3 metabolic equivalents) was significantly (p < .05) associated with the proportion of green space, with the residential density, with the general impression of activity-friendliness of the neighborhood, and with the frequency of certain types of residences (e.g., terraced houses), sports fields, water, dog waste, heavy traffic, and safe walking and cycling conditions (e.g., cycle tracks and 30-km speed zones) in the neighborhood. According to adjusted multivariate analyses, physical activity was best predicted by the frequency of parallel parking spaces in the neighborhood and by the general impression of activity-friendliness of the neighborhood (I2 = 0. 193).

CONCLUSIONS

Children's physical activity is associated with certain modifiable factors of the built environment. Longitudinal studies should examine whether there is a causal relationship.

Clinimetric review of motion sensors in children and adolescents

BACKGROUND AND OBJECTIVES

To review the clinimetric quality of motion sensors used to assess physical activity in healthy children and adolescents (2-18 years).

METHODS

A systematic literature search was performed in PubMed, Embase, and SpycINFO. The clinimetric quality of two pedometers (Digi-Walker, Pedoboy), four one-dimensional accelerometers (LSI, Caltrac, Actiwatch, CSA/ActiGraph), and three three-dimensional accelerometers (Tritrac-R3D, RT3, Tracmor2) was evaluated and compared using a 20-item checklist.

RESULTS

Overall, the quality of the studies (n = 35), and therefore the level of evidence for the reproducibility, validity, and feasibility of the motion sensors was modest (mean = 6.4 +/- 1.6 out of 14 points). There was strong evidence for a good reproducibility of the Caltrac in adolescents (12-18 years), a poor reproducibility of the Digi-Walker in children (8-12 years), a good validity of the CSA/ActiGraph in children and adolescents (8-18 years), and a good validity of the Tritrac-R3D in children (8-12 years).

CONCLUSIONS

The CSA/ActiGraph and the Caltrac are the only motion sensors in which the reproducibility, validity, and feasibility have been examined in different age groups. Further studies of the reproducibility of motion sensors in preschool children, improvement of the quality of clinimetric studies, and evaluation of the acceptability of motion sensors are warranted.