Parental Influence on Models of Primary Prevention of Cardiovascular Disease in Children

Preventive Cardiovascular Measures in Children with Elevated Blood Pressure

Cardiovascular diseases are the leading cause of morbidity and mortality in developed countries and are becoming increasingly significant in developing nations. Many cardiovascular risk factors originate early in life, even prenatally. Elevated blood pressure and hypertension are gaining attention in paediatrics due to their rising prevalence and impact on early cardiovascular risk in adulthood. Along with non-modifiable risk factors for hypertension, several modifiable factors can be addressed through primordial and primary prevention, emphasising lifestyle modifications. When these measures fail and elevated blood pressure develops, early detection is crucial (secondary prevention). Regular blood pressure measurement, a simple and non-invasive procedure, should be a standard practice in paediatric clinical settings. Diagnosing elevated blood pressure and hypertension should adhere to recommended guidelines. Lifestyle modifications are the first-line therapy for primary hypertension in children; if a secondary cause is identified, targeted treatment can be implemented, but a healthy lifestyle remains essential. The early detection and treatment of high-risk blood pressure enable timely interventions to prevent complications (tertiary prevention). Collectively, these preventive measures aim to reduce the incidence of cardiovascular disease in adulthood. Furthermore, quaternary prevention seeks to avoid unnecessary or harmful medical interventions including unwarranted examinations and pharmacotherapy. This underscores the importance of accurate diagnosis and treatment of elevated blood pressure and hypertension and emphasises the need for primordial and primary prevention to minimise unnecessary clinical interventions.

Parental practices and children's lifestyle correlates of childhood overweight/obesity in Europe: The Feel4Diabetes study

BACKGROUND

Parental influences on children's eating and physical activity (PA) and consequently on their weight are fundamental. The present study aimed to identify the predominant correlates of childhood overweight/obesity among a variety of parental practices and children's lifestyle indices in a large sample of children in Europe.

METHODS

Families from low socio-economic status regions were recruited through schools, located in six European countries (Belgium, Finland, Greece, Spain, Bulgaria and Hungary). Seven thousand three hundred ninety-seven children 4-12 years old and their parents were selected using the FINDRISC-questionnaire. Parental practices assessed included parental role modelling, permissiveness and reward. Children's dietary intake and lifestyle behaviours were assessed through parent-reported questionnaires.

RESULTS

Regarding parental practices, it was revealed that being sometimes (odds ratio [OR] = 1.26; 95% confidence interval [CI] = 1.10-1.43) or rarely (OR = 1.43; 95% CI = 1.21-1.69) physically active with the child was associated with greater overweight/obesity risk, whereas rare permission of computer/mobile/tablet (OR = 0.81; 95% CI = 0.67-0.98) and sometimes (OR = 0.77; 95% CI = 0.68-0.88) or rare (OR = 0.77; 95% CI = 0.66-0.91) reward with PA were associated with lower risk. Regarding children's lifestyle factors, consuming > 3 cups/week fresh fruit juices (OR = 1.28; 95% CI = 1.13-1.45), skipping breakfast (OR = 1.37; 95% CI = 1.17-1.61), absence of 1 h of daily PA (OR = 1.40; 95% CI = 1.24-1.58) and increased daily screen time (ST) (OR = 1.23; 95% CI = 1.09-1.39) were associated with greater overweight/obesity risk. All the variables were adjusted for maternal education, child's sex and age.

CONCLUSIONS

These findings emphasize the necessity of family-centered approaches in health promotion and obesity prevention programs for children. Such programs should focus on parents as the primary role models in exerting positive influence and encouraging healthy eating habits, PA, and ST behaviors in their children, which in turn, may have a substantial impact on children's overall weight status.

Parents' Perceptions on Barriers and Facilitators of Physical Activity among Schoolchildren: A Qualitative Study

Given that physical activity (PA) plays an important role in early childhood, understanding the factors that affect the practice of PA at an early age could help develop effective strategies for overcoming barriers and increasing activity levels in this age group. A qualitative study was conducted based on grounded theory aimed at exploring the perceptions of mothers and fathers from Cuenca and Ciudad Real (Castilla La Mancha, Spain) regarding barriers and facilitators of physical activity of their children during the adiposity rebound period. Data were collected using focus groups involving 46 parents of children in the 3rd grade of pre-school and 1st grade of elementary school. During the analysis, the socio-ecological model and grounded theory were used. The barriers encountered were the preferences of children for sedentary activities (individual factors), academic tasks as a main priority of parents, the influence of older siblings and the unfavorable school environment (microsystem), the lack of family conciliation (mesosystem), and barriers related to the built environment or lack of facilities for physical activity (exosystem). Facilitators were the preferences for active games (individual factors), parental models including the co-participation of parents in activities, the influence of friends, living in large homes, the support provided by teachers and the school (microsystem), living in rural areas, having sufficient facilities, favorable weather conditions (exosystem), and the existence of free or subsidized activities (macro system). Programs aimed at promoting PA in early childhood should include strategies that address contextual factors and not only focus on individual factors related to the child.

Physical activity behaviors in parents of children with disabilities: A systematic review

BACKGROUND

Even though it has been widely known that parents influence physical activity (PA) behaviors of children without disabilities, there is no consensus about the effects of parents on PA behaviors of children with disabilities.

AIMS

The purpose of this study was to systematically review published literature examining the effects of parents on PA behaviors of children with disabilities.

METHODS

A systematic literature search was performed in three databases.

OUTCOMES AND RESULTS

The search identified 13 studies which met predetermined inclusion criteria. Of the 13 studies, 10 studies were conducted in United States and Canada. The remaining three studies were from three different countries: Italy, Australia, and Hong Kong. From the 13 studies, 24 parental factors were identified and categorized into four different dimensions: a) participating in PA intervention (four factors included), b) parental support (three factors included), c) parental PA role modeling (five factors included), and d) parental importance of child's PA (three factors included). Six factors across three dimensions (i.e., participating in PA intervention, parental support, parental importance of their child's PA) were significantly and positively associated with PA behaviors in children with disabilities, but no factor in parental PA role modeling was significantly associated with PA behaviors in children with disabilities.

CONCLUSIONS AND IMPLICATIONS

The associations between parental factors and PA behaviors in children with disabilities varied depending on the dimensions of the parental factors. Further studies are warranted to confirm the association between parental factors and PA behaviors in children with disabilities, including cross-cultural comparisons.

Parents' and Teachers' Perceptions of Physical Activity in Schools: A Meta-Ethnography

The aim of this meta-ethnographic study was to analyze parents' and teachers' perceptions of barriers and facilitators to physical activity in children. Facilitators were the benefits of physical activity, modeling, participation, children's preferences, and factors supporting active transport. Barriers were quantifying the physical activity, parents' lack of time, the cost of activities, bad weather, traffic, long distances, and the lack of facilities and safety. The level of physical activity does not depend exclusively on individual factors related to the child; rather, barriers and facilitators are influenced by the social and school context and the physical and built environment. It is important that school nurses understand these contextual factors, so that they can take these into consideration when designing their intervention programs.

Effectiveness of family-based weight management interventions for children with overweight and obesity: an umbrella review

OBJECTIVES

The objective of the review was to synthesize the effectiveness and strategies used in family-based behavioral childhood obesity interventions in improving child weight-related outcomes.

INTRODUCTION

Family-based interventions are common practice in the treatment of childhood obesity. Research suggests that direct parental involvement can improve child weight-related outcomes. However, challenges remain in assessing the effects of family-based interventions on child weight and weight-related behavior due to the lack of quality programs and diversity of treatment strategies.

INCLUSION CRITERIA

The review included systematic reviews and/or meta-analyses of family-based behavioral interventions in children aged ≤18 who were classified as overweight and/or obese, and which reported child weight related outcomes, such as body mass index (BMI), body fat percentage and waist circumferences.

METHODS

Seven databases were searched from 1990 to May 2016 to identify English language publications. Reference lists of included reviews and relevant registers were also searched for additional reviews. All included systematic reviews were critically appraised by two reviewers independently. Data extracted included characteristics of included systematic reviews and weight-related outcomes reported. Data synthesis involved categorizing the interventions into seven categories and presented findings in narrative and tabular format. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

RESULTS

The umbrella review included 14 systematic reviews (low to moderate methodological quality), published between 2004 and 2015, including 47 independent trials ranging from one month to seven years follow-up conducted in more than 16 countries. The majority of reviews (93%) reported weight outcomes of children aged six to 13 years. All reviews except one indicated that family-based interventions were successful in improving child weight and/or weight-related behavior. Five reviews highlighted that parent-only interventions had similar (n = 4) or greater (n = 1) effectiveness compared to parent-child interventions. Effective interventions employed parent-targeted strategies, including nutrition and physical activity education sessions, positive parenting skills, role modelling and child behavior management to encourage positive healthy eating/exercise behaviors in children and/or whole family.

CONCLUSIONS

Family-based interventions targeting parents, alone or with their child, are effective for child weight management. Due to the lack of high quality evidence, especially in emerging parent-only interventions, further research is warranted. Health practitioners can work with parents as agents of change and focus on fostering positive parenting skills, such as monitoring, reinforcement, role modelling, and providing a nurturing environment, in order to support health behaviors in their children. Future research needs to explore whether parent-only interventions are more cost-effective compared to parent-child interventions, and to include larger populations, longer intervention duration and follow-up.

Trajectories of Physical Activity Among Adolescents in the Transition From Primary to Secondary School

Research on physical activity (PA) behavior reveals an overall decrease worldwide from early childhood and throughout adulthood. The ability to illuminate which factors promote activity for whom and in which phase of life, therefore, becomes a key concept in extending our understanding of individuals' physical activity trajectories. Accordingly, this study investigates latent trajectories of objectively measured PA in adolescents (n = 306) over 3 years from ages 13 to 15. Further, it was tested whether eagerness for physical activity, perceived athletic competence, and parental support were associated with the different trajectories of PA. Latent class growth analysis revealed two PA trajectories (trajectory 1: "decrease from very high" and trajectory 2: "steeper decrease from high"). Trajectory 1 had a higher PA level at baseline and less PA decline than trajectory 2. Trajectory 1, "decrease from very high," was associated with higher levels of eagerness for physical activity and perception of competence at all three time points. Furthermore, the effect size of differences between trajectory 1, "decrease from very high," and trajectory 2, "steeper decrease from high," increased from baseline (age 13, seventh grade) to posttest (age 15, ninth grade). This finding indicates a stronger experience of PA as enjoyable, personally relevant, and self-confirming behavior (i.e., "I regard myself as a person who exercises") within the most active adolescents and even stronger as they get older. Consistent with previous research, the PA level declined from seventh to ninth grade. Being more eager for PA and perceiving oneself more as athletically competent is related to higher levels of PA. This highlights the importance of optimizing environmental factors that increase adolescents' experience of eagerness for physical activity and physical athletic competence.

Childhood cancer survivors report preferring lifestyle interventions delivered in person rather than online: An adolescent and parent perspective

BACKGROUND

Maintaining a healthy lifestyle can protect adolescent survivors of pediatric cancer against chronic diseases such as obesity and cardiovascular disease. In this study, we examined the attitudes of adolescent survivors of pediatric cancer and their parents toward improving lifestyle behaviors after cancer treatment, including their preferences for intervention delivery and perceived barriers and benefits to healthy eating and exercise.

METHODS

We recruited adolescent survivors of childhood cancer aged 11-19 years and their parents, from two hospitals. Participants completed a questionnaire via mail or at routine oncology clinic visits.

RESULTS

Thirty-three adolescents (response rate 39%, mean age 15, 61% male) and 32 parents (representing 30 parent-child dyads) participated. Parents were significantly more interested in having their child participate in a lifestyle intervention than adolescents (41% of adolescents and 72% of parents, P = .012). Both groups preferred that the survivor receive lifestyle support face to face rather than online. Adolescents preferred to involve their friends (39% of adolescents and 19% of parents) whereas parents preferred to involve the family in a lifestyle intervention (15% of adolescents and 47% of parents, P = .006). Adolescents and their parents perceived a dislike of the taste of fruits and vegetables, fatigue, lack of motivation, and fear of injury as barriers to change. They perceived that keeping healthy and having more energy were benefits to participation. Participants indicated that interventions that provide face-to-face personal training and dietary education at a local gym would be well accepted.

CONCLUSIONS

Adolescents who have had cancer in childhood have a preference for face-to-face contact with health professionals to overcome the barriers to participation in a lifestyle intervention.

Does Eagerness for Physical Activity Matter? The Association Between Eagerness and Physical Activity Among Adolescents

This study investigated the association between perceived parental support and eagerness for physical activity (EPA) among adolescents, and the association between EPA and physical activity. We further examined whether perceived athletic competence (PAC) mediates a presumed association between EPA and physical activity level, when controlling for gender. This study included 320 adolescents (aged 12-13) from 18 schools in two medium-sized Norwegian municipalities. Questionnaires and accelerometers were assessed during spring 2017. Structural equation modeling was applied to examine the associations. Standard regression coefficients are presented. Data demonstrated that perceived parental support was positively associated with EPA (β = 0.52), and eagerness was positively associated with PAC (β = 0.52). Both EPA (β = 0.20) and PAC (β = 0.24) were also positively associated with moderate to vigorous physical activity (MVPA). When mediating the relationship between EPA and MVPA, through PAC, the effect on MVPA increased (from β = 0.20 to β = 0.32). Analysis revealed that 87% of the adolescents fulfilled the national health recommendations for physical activity. This study highlights the relevance of EPA and PAC in studies of physical activity among adolescents, and the impact of perceived parental support for adolescents' EPA and physical activity level.

Sports Practices and Cardiovascular Risk in Teenagers

Background

Cardiovascular diseases are the leading cause of deaths in the world, and many events could be prevented by healthy life habits.

Objectives

To compare the occurrence of cardiovascular risk factors in adolescents enrolled at public schools in the city of Rio de Janeiro, including a renowned school for sport practices.

Methods

Cross-sectional study, convenience sampling of 422 students enrolled at the Experimental Olympic Gymnasium (EOG) and at Figueiredo Pimentel School (FP). Using descriptive analyses, continuous variables were expressed as mean and standard deviation or median and interquartile ranges, and the Student's t-test or the chi-square test, respectively, was used for comparisons. The sports were classified according to the metabolic equivalent of task (MET) (below or above 5).

Results

We included 274 students enrolled at the EOG and 148 at FP. Mean age was similar between schools -12.5 ± 1.6 years at FP and 12.6 ± 0.9 at the EOG; 65.5% of the students at FP and 43.8% of the students at the EOG were female (p < 0.01). Significant differences in the prevalence of hypertension (20% vs. 6.3%, p < 0.01) and borderline cholesterol levels (27.7% vs. 17.3%, p = 0.01) were found between FP and EOG students, respectively.

Conclusion

High prevalence of hypertension, overweight/obesity and altered blood lipid profile was found in this group of adolescents. Regular sports training program combined with little influence of their eating habits outside school may contribute to a better metabolic profile and reduction in cardiovascular risk factors in students. Public health measures are also need.

Lifestyles and socio-cultural factors among children aged 6-8 years from five Italian towns: the MAPEC_LIFE study cohort

BACKGROUND

Lifestyles profoundly determine the quality of an individual's health and life since his childhood. Many diseases in adulthood are avoidable if health-risk behaviors are identified and improved at an early stage of life. The aim of the present research was to characterize a cohort of children aged 6-8 years selected in order to perform an epidemiological molecular study (the MAPEC_LIFE study), investigate lifestyles of the children that could have effect on their health status, and assess possible association between lifestyles and socio-cultural factors.

METHODS

A questionnaire composed of 148 questions was administered in two different seasons to parents of children attending 18 primary schools in five Italian cities (Torino, Brescia, Pisa, Perugia and Lecce) to obtain information regarding the criteria for exclusion from the study, demographic, anthropometric and health information on the children, as well as some aspects on their lifestyles and parental characteristics. The results were analyzed in order to assess the frequency of specific conditions among the different seasons and cities and the association between lifestyles and socio-economic factors.

RESULTS

The final cohort was composed of 1,164 children (50.9 boys, 95.4% born in Italy). Frequency of some factors appeared different in terms of the survey season (physical activity in the open air, the ways of cooking certain foods) and among the various cities (parents' level of education and rate of employment, sport, traffic near the home, type of heating, exposure to passive smoking, ways of cooking certain foods). Exposure to passive smoking and cooking fumes, obesity, residence in areas with heavy traffic, frequency of outdoor play and consumption of barbecued and fried foods were higher among children living in families with low educational and/or occupational level while children doing sports and consuming toasted bread were more frequent in families with high socio-economic level.

CONCLUSIONS

The socio-economic level seems to affect the lifestyles of children enrolled in the study including those that could cause health effects. Many factors are linked to the geographical area and may depend on environmental, cultural and social aspects of the city of residence.

Family social capital and health - a systematic review and redirection

The level (or scale) at which social capital can be conceptualised and measured ranges potentially from the macro-level (regional or country level), to the meso-level (neighbourhoods, workplaces, schools), down to the individual level. However, one glaring gap in the conceptualisation of social capital within the empirical literature has been the level of the family. Our aim in this review is to examine the family as the 'missing level' in studies on social capital and health. To do so, we conducted a systematic review on the use and measurement of this notion in the health literature, with the final intention of articulating a direction for future research in the field. Our findings are consistent with the notion that family social capital is multidimensional and that its components have distinct effects on health outcomes. Further investigation is needed to understand the mechanisms through which family social capital is related to health, as well as determining the most valid ways to measure family social capital.

Gender differences in the pathways of family factors influencing children's oral health behaviours: a cross-sectional study of primary school students in Beijing, China

OBJECTIVE

Research on what family factors influence children's oral health behaviours (COHB) in developing countries is limited, and there have been no path analyses accounting for gender differences in these factors. Thus, our study evaluated gender differences in COHB including the influencing pathways of family factors in China.

MATERIALS AND METHODS

Through multistage cluster sampling, 915 pairs of mothers and children from six public elementary schools in Beijing completed self-administered questionnaires regarding COHB, parents' modelling behaviours (PMB), parents' controlling behaviours (PCB), parents' oral health knowledge and attitudes (PKA), and children's oral health knowledge and attitudes (CKA). The influencing factors were analysed using path analysis.

RESULTS

Compared with boys, girls showed significantly better performance in drinking less carbonated drinks regularly (8.6% vs. 16.9%). For both genders, PMB shad a significant direct influence on COHB, while PKA had an indirect influence through PMB. In the boys' model, PKA indirectly influenced COHB through CKA. In the girls' model, socioeconomic status had a positive direct effect on COHB.

CONCLUSIONS

The gender differences were not as large as expected. Given that slightly different influential factors for COHB exist between boys and girls, interventions should take note of the similarities and differences in pathways.

Effectiveness of family-based weight management interventions in childhood obesity: an umbrella review protocol

REVIEW QUESTION/OBJECTIVE

The main objective of this umbrella review is to identify the effectiveness of family-based interventions that target overweight or obesity in children aged 18 years and under. The umbrella review intends to compare and summarize existing systematic reviews of experimental studies that address a range of family-based interventions for overweight children. Family-based is defined as the involvement of first- or second-degree relatives or carers who are cohabiting under one roof. The second objective of this umbrella review is to identify strategies that are effective in improving children's body weight or body mass index (primary outcomes) and, where applicable, changes in child/family behavior, including dietary intake or physical activity.The review questions are as follows: What is the effectiveness of family-based behavioral or lifestyle weight management interventions for overweight children? What are the strategies or characteristics of effective interventions in combating child obesity?

Adolescent's perceptions of parental influences on physical activity

BACKGROUND

Youth physical activity engagement is a key component of contemporary health promotion strategies. Parents have potential to influence the physical activity behaviours of their children. The purpose of this study was to explore associations between adolescent self-reported physical activity, parent physical activity and perceptions of parental influence as measured by the Children's Physical Activity Correlates (CPAC) questionnaire.

METHODS

This investigation included a total of 146 adolescents and their parents. Self-reported measures of physical activity were obtained using the International Physical Activity Questionnaire for Adolescents and International Physical Activity Questionnaire for adolescents and their parents respectively. Adolescent perceptions of parental role modelling, support, and encouragement were measured with the parental influences scales of the CPAC.

RESULTS

Ordinary least squares regression indicated that perceptions of parental role modelling (β=197.41, 95% CI 34.33-360.49, p=0.031) was positively associated with adolescent self-reported moderate-to-vigorous physical activity with the overall model accounting for a small amount of the variance (R2=0.076).

CONCLUSION

These results are in agreement with previous research indicating that parents play a small, albeit vital role in the physical activity engagement of their children. Public health campaigns with the aim of promoting youth physical activity should endeavour to incorporate parents into their interventions.

Deaf Adolescents' Learning of Cardiovascular Health Information: Sources and Access Challenges

Deaf individuals have more cardiovascular risks than the general population that are believed to be related to their cardiovascular health knowledge disparities. This phenomenological study describes where 20 deaf sign language-using adolescents from Rochester, New York, many who possess many positive characteristics to support their health literacy, learn cardiovascular health information and their lived experiences accessing health information. The goal is to ultimately use this information to improve the delivery of cardiovascular health education to this population and other deaf adolescents at a higher risk for weak health literacy. Deaf bilingual researchers interviewed deaf adolescents, transcribed and coded the data, and described the findings. Five major sources of cardiovascular health information were identified including family, health education teachers, healthcare providers, printed materials, and informal sources. Despite possessing advantageous characteristics contributing to stronger health literacy, study participants described significant challenges with accessing health information from each source. They also demonstrated inconsistencies in their cardiovascular health knowledge, especially regarding heart attack, stroke, and cholesterol. These findings suggest a great need for additional public funding to research deaf adolescents' informal health-related learning, develop accessible and culturally appropriate health surveys and health education programming, improve interpreter education, and disseminate information through social media.

Association between family factors and children's oral health behaviors--a cross-sectional comparative study of permanent resident and migrant children in large cities in China

OBJECTIVES

To examine the association of family factors on oral health behaviors of children and compare them between permanent residents and migrant children.

METHODS

A total of 3015 children in grades 4, 5, and 6 from 16 elementary schools and their parents in Beijing and Guangzhou, China, were selected through multistage stratified cluster random sampling. Questionnaires constructed for this study were self-completed by children and parents to collect information on children's oral health behaviors (COHB), parents' modeling behaviors (PMB), parents' direct controlling behaviors (PDCB), parents' indirect controlling behaviors (PICB), parents' oral health knowledge and attitudes (POHKA), and children's oral health knowledge and attitudes (COHKA). Correlation analysis and path analysis were used to explore the correlation between COHB and PMB, as well as the effects of family factors [socioeconomic status (SES), PMB, PDCB, PICB, and POHKA on COHB].

RESULTS

Considering all participants, the rates of behavioral similarities of parents and children were 63.8-86.1%, all showing statistical significance. For family factors included, PMB, SES, PICB, and POHKA demonstrated positive relationships with COHB with standardized coefficients of 0.200, 0.122, 0.040, and 0.059 in residents and 0.160, 0.121, 0.090, and 0.041 in migrants, respectively. Family SES was associated with COHB directly and indirectly to a similar degree. In migrants, the relationship between COHKA and COHB was greater than that between PMB and COHB. COHB scores were higher in younger children. In residents, the relationship between PMB and COHB was greater than that between COHKA and COHB. COHB scores were slightly higher in older children indirectly influenced by increases in COHKA.

CONCLUSIONS

Parents' behaviors shared relatively high similarities with COHB and family factors were associated with COHB greatly. The relationship between PMB and COHB was less than that between COHKA and COHB in migrants. The association between family factors and COHB in disadvantaged populations should be considered when designing children's health education programs.

Reducing youth screen time: qualitative metasynthesis of findings on barriers and facilitators

OBJECTIVE

An integrated perspective on the relevant qualitative findings on the experience of screen time in youth can inform the development of hypotheses to be tested in future research and can guide the development of interventions to decrease sedentary behavior. The purpose of this qualitative metasynthesis was to explore parent, youth, and educational professionals' perceptions of barriers to, and facilitators of, reducing youth screen time.

METHOD

Qualitative metasynthesis techniques were used to analyze and synthesize 15 qualitative studies of screen time among youth (11-18 years) meeting inclusion criteria. The phrases, quotes, and/or author interpretations (i.e., theme or subtheme) were recorded in a data display matrix to facilitate article comparisons. Codes were collapsed into 23 categories of similar conceptual meaning and 3 overarching themes were derived using thematic analysis procedures.

RESULTS

Study sample sizes ranged from 6 to 270 participants from 6 countries. Data collection methods included focus groups (n = 6), interviews (n = 4), focus group and interviews (n = 4), and naturalistic observation (n = 1) with youth and/or parents. Data analysis techniques included thematic analysis (n = 9), content analysis (n = 3), grounded theory (n = 1), observation (n = 1), and interpretive phenomenological analysis (n = 1). Three thematic categories were identified: (a) youth's norms-screen time is an integral part of daily life, and facilitates opportunities for entertainment, social interaction, and escapism; (b) family dynamics and parental roles-parents are conflicted and send mixed messages about the appropriate uses and amounts of screen time; and, (c) resources and environment-engagement in screen time is dependent on school, community, neighborhood, and home environmental contexts.

CONCLUSIONS

Screen time is an established norm in many youth cultures, presenting barriers to behavior change. Parents recognize the importance of reducing youth screen time, but model and promote engagement themselves. For youth and parents, mutually agreed rules, limits, and parental monitoring of screen time were perceived as likely to be effective.

Feasibility and effectiveness of drop-off spots to promote walking to school

Background

Drop-off spots are locations in the proximity of primary schools where parents can drop off or pick up their child. From these drop-off spots children can walk to and from school. This pilot study aimed to investigate the feasibility and effectiveness of drop-off spots and to evaluate how drop-off spots are perceived by school principals, teachers and parents of 6-to-12-year old children.

Methods

First, a feasibility questionnaire was completed (n = 216) to obtain parental opinions towards the implementation of drop-off spots. A drop-off spot was organized (500–800 m distance from school) in two primary schools. A within-subject design was used to compare children’s (n = 58) step counts and number of walking trips during usual conditions (baseline) and during implementation of a drop-off spot (intervention). Three-level (class-participant-condition) linear regression models were used to determine intervention effects. After the intervention, 2 school principals, 7 teachers and 44 parents filled out a process evaluation questionnaire.

Results

Prior to the intervention, 96% expressed the need for adult supervision during the route to school. Positive significant intervention effects were found for step counts before/after school hours (+732 step counts/day; X² = 12.2; p < 0.001) and number of walking trips to/from school (+2 trips/week; X² = 52.9; p < 0.001). No intervention effect was found for total step counts/day (X² = 2.0; p = 0.16). The intervention was positively perceived by the school principals and parents, but teachers expressed doubts regarding future implementation.

Conclusion

This pilot study showed that implementing drop-off spots might be an effective intervention to promote children’s walking to school. Implementing drop-off spots does not require major efforts from the schools and schools can choose how and when they organize drop-off spots. However, motivating teachers and involving other volunteers (e.g. parents, grandparents) may be needed. Future studies should investigate the feasibility and effectiveness of drop-off spots in a larger sample of schools.

Changes in leisure activity among young people aged 15–18 years in Hungary: physical activity, media-consumption and smoking

Introduction: Young people are more and more inactive, which has numerous well-known negative effects on their health. Several studies indicate that inactive lifestyle disposes people to sit in front of the television, which increases agression and decreases the willingness of reading. There is also a strong link between inactivity and an increase of body mass, deterioration of anthropometric parameters, and deviant behaviour. Aims: The aim of the study was to find out, on the basis of two cross-sectional surveys, the changes occurred within eight years in the free-time activity of Hungarian young people aged between 15 and 19 years. Methods: Data obtained from two surveys conducted by the National Institute for Family and Social Policy, Hungary in 2000 and 2008 including 1780 and 2018 young people, respectively, were analysed and compared. Results: The number of young people regularly involved in sport activity increased significantly, while their media-consumption failed to decrease. Physically active young people are more health-conscious, but regular sporting activity did not expel smoking, which was associated with a sedentary lifestyle and television watching. Conclusions: These data reveal new responses of a new generation; watching televison still takes the largest part of their free time activity, but use of computers, and participation in social activities are not necessarily increase sedentary lifestyle and deviant habits. Internet has positive effects on the regularity of their physical activity. Orv. Hetil., 2013, 154, 581–589.

What helps children to be more active and less sedentary? Perceptions of mothers living in disadvantaged neighbourhoods

BACKGROUND

  Increasing children's participation in physical activity and decreasing time spent in sedentary behaviours is of great importance to public health. Despite living in disadvantaged neighbourhoods, some children manage to engage in health-promoting physical activity and avoid high levels of screen-based activities (i.e. watching TV, computer use and playing electronic games). Understanding how these children manage to do well and whether there are unique features of their home or neighbourhood that explain their success is important for informing strategies targeting less active and more sedentary children. The aim of this qualitative study was to gain in-depth insights from mothers regarding their child's resilience to low physical activity and high screen-time.

METHODS

  Semi-structured face-to-face interviews were conducted with 38 mothers of children who lived in disadvantaged neighbourhoods in urban and rural areas of Victoria, Australia. The interviews were designed to gain in-depth insights about perceived individual, social and physical environmental factors influencing resilience to low physical activity and high screen-time.

RESULTS

  Themes relating to physical activity that emerged from the interviews included: parental encouragement, support and modelling; sports culture in a rural town; the physical home and neighbourhood environment; child's individual personality; and dog ownership. Themes relating to screen-time behaviours encompassed: parental control; and child's individual preferences.

CONCLUSIONS

  The results offer important insights into potential avenues for developing 'resilience' and increasing physical activity and reducing screen-time among children living in disadvantaged neighbourhoods. In light of the negative effects of low physical activity and high levels of screen-time on children's health, this evidence is urgently needed.

The Children's Health and Activity Modification Program (C.H.A.M.P.): participants' perspectives of a four-week lifestyle intervention for children with obesity

To date, there is a paucity of qualitative research examining the influence of community-based interventions for childhood obesity on the participants themselves. This study explored the experiences of children who participated in the Children's Health and Activity Modification Program (C.H.A.M.P.), a four-week day camp for children with obesity aged 8-14, in order to uncover key program elements for positive behavior change. Following the intervention, children (n = 36) participated in focus groups where they were asked about their experiences pertaining to physical activity and nutrition, what it was like to be part of a team, and how they felt about themselves. Findings revealed that participants perceived C.H.A.M.P. as helpful (e.g. in making healthier food choices, being more active, and feeling more confident and self-aware). This pilot study offers unique insights into the perspectives of children with obesity. Results are discussed with respect to future program development and research for childhood obesity treatment.

Identification of facilitators and barriers to physical activity in children and adolescents with cerebral palsy

OBJECTIVE

To explore facilitators and barriers to participation in physical activity and sport in youth with cerebral palsy (CP).

STUDY DESIGN

This was a qualitative study involving in-depth focus group interviews with 33 ambulatory youth with CP and their parents. The interviews were conducted until informational redundancy was achieved.

RESULTS

Youth with CP and their parents reported personal and environmental facilitators and barriers to participation in physical activity. Seven major themes related to personal and environmental factors were identified.

CONCLUSIONS

This study suggests that various personal and environmental factors play a key role in determining the extent to which youth with CP participate in physical activity. The facilitators and barriers identified provide important theoretical insights into how and why youth with CP and their parents might change their physical activity behavior.

Rationale, design, methodology and sample characteristics for the family partners for health study: a cluster randomized controlled study

BACKGROUND

Young children who are overweight are at increased risk of becoming obese and developing type 2 diabetes and cardiovascular disease later in life. Therefore, early intervention is critical. This paper describes the rationale, design, methodology, and sample characteristics of a 5-year cluster randomized controlled trial being conducted in eight elementary schools in rural North Carolina, United States.

METHODS/DESIGN

The first aim of the trial is to examine the effects of a two-phased intervention on weight status, adiposity, nutrition and exercise health behaviors, and self-efficacy in overweight or obese 2nd, 3 rd, and 4th grade children and their overweight or obese parents. The primary outcome in children is stabilization of BMI percentile trajectory from baseline to 18 months. The primary outcome in parents is a decrease in BMI from baseline to 18 months. Secondary outcomes for both children and parents include adiposity, nutrition and exercise health behaviors, and self-efficacy from baseline to 18 months. A secondary aim of the trial is to examine in the experimental group, the relationships between parents and children's changes in weight status, adiposity, nutrition and exercise health behaviors, and self-efficacy. An exploratory aim is to determine whether African American, Hispanic, and non-Hispanic white children and parents in the experimental group benefit differently from the intervention in weight status, adiposity, health behaviors, and self-efficacy.A total of 358 African American, non-Hispanic white, and bilingual Hispanic children with a BMI ≥ 85th percentile and 358 parents with a BMI ≥ 25 kg/m² have been inducted over 3 1/2 years and randomized by cohort to either an experimental or a wait-listed control group. The experimental group receives a 12-week intensive intervention of nutrition and exercise education, coping skills training and exercise (Phase I), 9 months of continued monthly contact (Phase II) and then 6 months (follow-up) on their own. Safety endpoints include adverse event reporting. Intention-to-treat analysis will be applied to all data.

DISCUSSION

Findings from this trial may lead to an effective intervention to assist children and parents to work together to improve nutrition and exercise patterns by making small lifestyle pattern changes.

TRIAL REGISTRATION

NCT01378806.

Intervention fidelity: ensuring application to practice for youth and families

PURPOSE

Limited information on intervention fidelity is available in published studies with youth and families. The components of intervention fidelity, the complexity of measurement in these studies, and strategies for measuring intervention fidelity are described.

CONCLUSIONS

Strategies for ensuring intervention fidelity according to the Treatment Fidelity Workgroup of the Behavior Change Consortium in the areas of study design, provider training, treatment delivery, treatment receipt, and treatment enactment provide guidance for evaluating or developing intervention fidelity plans.

PRACTICE IMPLICATIONS

Ensuring the quality of intervention fidelity in evidence-based reviews or when developing new interventions is essential for translating findings into practice.

A personalized approach to exercise promotion in adolescents with type 1 diabetes

PURPOSE

This exploratory study tested the feasibility of conducting a novel, personalized exercise intervention based upon the current fitness levels of adolescents with type 1 diabetes (T1DM). The relationships of perceptions of benefits and barriers to exercise, exercise self-efficacy and family support to exercise adherence and changes in cardiovascular (CV) fitness, quality of life (QOL), and glycemic control were studied.

METHODS

Adolescents who were sedentary received a graded exercise test to determine their current fitness level (VO(2peak)). A 16-wk personalized exercise program was developed for each adolescent based upon individual fitness level and exercise preferences. Pretest and posttest measures of exercise self-efficacy, benefits and barriers to exercise, family support, and diabetes QOL were completed. A1c levels were obtained using the DCA2000. Adherence to exercise was measured using the Actigraph Accelerometer.

RESULTS

Twelve adolescents completed the study. Accelerometry data revealed adherence to 60 min of moderate-to-vigorous physical activity (MVPA) per day for a mean of 45.5 (SD = 23.9)% of the days the accelerometer was worn. Adolescents' perceptions of family support for exercise improved following the intervention (p = 0.03). Adolescents who had more daily bouts of exercise lasting 60 min increased their CV fitness (r = 0.59, p = 0.04). A1c remained unchanged.

CONCLUSIONS

Encouraging 60 min of accumulated exercise bouts/d can improve fitness levels in adolescents with T1DM, minimizing future CV risks. Although physical activity increased in adolescents, family based strategies are required to promote current physical activity recommendations.

Understanding children's sedentary behaviour: a qualitative study of the family home environment

Electronic media (EM) (television, electronic games and computer) use has been associated with overweight and obesity among children. Little is known about the time spent in sedentary behaviour (SB) among children within the family context. The aim of this study was to explore how the family home environment may influence children's electronic-based SB. Focus groups and family interviews were conducted with 11- to 12-year old children (n = 54) and their parents (n = 38) using a semi-structured discussion guide. Transcripts were analysed using a thematic content approach. A brief self-completed questionnaire was also used to measure leisure behaviour and electronic devices at home. Children incorporated both sedentary and physical activities into their weekly routine. Factors influencing children's EM use included parent and sibling modelling and reinforcement, personal cognitions, the physical home environment and household EM use rules and restrictions. Participants were not concerned about the excessive time children spent with EM. This under-recognition emerged as a personal influencing factor and was viewed as a major barrier to modifying children's electronic-based SB. Efforts to reduce SB in children should focus on the influencing factors that reciprocally interact within the family home. An emphasis on increasing awareness about the risks associated with spending excessive time in screen-based activities should be a priority when developing intervention strategies aimed at modifying the time children spend in SB.

Physically active families - de-bunking the myth? A qualitative study of family participation in physical activity

BACKGROUND

The benefits of physical activity for reducing obesity and related chronic diseases are well known. The need for more family-based interventions to increase physical activity is frequently cited in the literature; however, little is known about if and how families are physically active together, and what factors might influence family-based participation in regular physical activity. This study examined the types of activities (physical and sedentary) engaged in as a family and explored parents' perceptions of the importance, frequency, nature and barriers to family physical activity.

METHODS

Semi-structured telephone interviews were conducted with 30 parents (26 female, four male) of 10- to 11-year-old schoolchildren who attended either low, middle or high socio-economic status schools in Bristol, UK. Interviews were transcribed verbatim, anonymized and analysed using conventional content analysis.

RESULTS

The majority of parents rated family engagement in physical activity as important, and identified benefits such as increased parent-child communication, spending time together, enjoyment, enhanced mental health, weight control and physical fitness. Despite these benefits most parents reported their families did little or no physical activity together as a family unit during the week, and any activities performed together were usually sedentary in nature. They reported increased family physical activity on the weekends but rarely including the full family unit simultaneously. Parents in two-parent households commonly paired off with one or more children because of complexities of schedules. Commonly reported barriers were busy lifestyles, diverse ages and interests of children and adults, bad weather, and lack of access to facilities, transportation and money to support activities.

CONCLUSIONS

Family-based interventions might be more effective if they are designed to accommodate the complex demands and needs of two-parent and single-parent families and provide affordable, diverse activities appealing to a wide range of interests.

Engaging parents to increase youth physical activity a systematic review

BACKGROUND

Parents are often involved in interventions to engage youth in physical activity, but it is not clear which methods for involving parents are effective.

PURPOSE

A systematic review was conducted of interventions with physical activity and parental components among healthy youth to identify how best to involve parents in physical activity interventions for children.

EVIDENCE ACQUISITION

Identified intervention studies were reviewed in 2008 for study design, description of family components, and physical activity outcomes. The quality of reporting was assessed using the CONSORT checklist for reporting on trials of nonpharmacologic treatments.

EVIDENCE SYNTHESIS

The literature search identified 1227 articles, 35 of which met review criteria. Five of the 14 RCTs met > or =70% of CONSORT checklist items. Five general procedures for involving parents were identified: (1) face-to-face educational programs or parent training, (2) family participatory exercise programs, (3) telephone communication, (4) organized activities, and (5) educational materials sent home. Lack of uniformity in reporting trials, multiple pilot studies, and varied measurements of physical activity outcomes prohibited systematic conclusions. Interventions with educational or training programs during family visits or via telephone communication with parents appear to offer some promise.

CONCLUSIONS

There is little evidence for effectiveness of family involvement methods in programs for promoting physical activity in children, because of the heterogeneity of study design, study quality, and outcome measures used. There is a need to build an evidence base of more-predictive models of child physical activity that include parent and child mediating variables and procedures that can effect changes in these variables for future family-based physical activity interventions.

Mothers' involvement in a school-based fruit and vegetable promotion intervention is associated with increased fruit and vegetable intakes--the Pro Children study

Background

Several school-based fruit and vegetable interventions include activities to involve parents, but not much is know about the effectiveness of such a family component on child and parent intake levels. The current study evaluated the effects of the multi-component school-based intervention, 'the Pro Children Study', on mothers' intake levels. Furthermore, associations between level of involvement in the project and improvement in the mothers' intake levels were assessed.

Methods

Effect was evaluated in a cluster randomized controlled trial in Spain, Norway and the Netherlands among mothers of 11-year-olds. Of the 1253 mothers with complete data at baseline, 754 and 476 had complete data at first and second follow-up respectively. Fruit and vegetable intake, level of involvement and demographic variables were assessed by a parental questionnaire. Data was analyzed using multilevel regression analyses.

Results

Results showed no effect of the intervention on mothers' fruit and vegetable intake after one year and two year follow-up. Participation rate for the different activities varied by activity and by country, e.g. 3.7–9.4% visited the website, while 26.4–72.6% of the mothers participated in the home work assignments. Results further showed that higher involvement levels were associated with higher intake at follow-up.

Conclusion

The Pro Children Intervention could not increase the fruit and vegetable consumption of the mothers of participating pupils, which might be explained by the low involvement in the project. More research is needed to increase mothers' involvement in school-based interventions.

Parents matter: intergenerational influences of diabetes mellitus on glycemic control and morbidity in older type 2 diabetic males

In a cross-sectional study, the effects of disease duration of type 2 diabetes mellitus (DM) were examined along with parent history of DM on disease-related outcome variables. Specifically, the moderating role of parent history of DM on outcome variables was examined. Participants were 53 male veterans with DM. Chart reviews and self-reports were examined. Results showed that in those with a positive parent history of DM, hopelessness increased with diabetes duration. In the negative parent history group, glycemic control worsened with disease duration. These findings suggest parent history of DM should be considered in designing interventions to facilitate coping with type 2 diabetes.

Gendered dimensions of obesity in childhood and adolescence

BACKGROUND

The literature on childhood and adolescent obesity is vast. In addition to producing a general overview, this paper aims to highlight gender differences or similarities, an area which has tended not to be the principal focus of this literature.

METHODS

Databases were searched using the terms 'obesity' and 'child', 'adolescent', 'teenager', 'youth', 'young people', 'sex', 'gender', 'masculine', 'feminine', 'male', 'female', 'boy' and 'girl' (or variations on these terms). In order to limit the potential literature, the main focus is on other reviews, both general and relating to specific aspects of obesity.

RESULTS

The findings of genetic studies are similar for males and females, and differences in obesity rates as defined by body mass index are generally small and inconsistent. However, differences between males and females due to biology are evident in the patterning of body fat, the fat levels at which health risks become apparent, levels of resting energy expenditure and energy requirements, ability to engage in certain physical activities and the consequences of obesity for the female reproductive system. Differences due to society or culture include food choices and dietary concerns, overall physical activity levels, body satisfaction and the long-term psychosocial consequences of childhood and adolescent obesity.

CONCLUSION

This review suggests differences between males and females in exposure and vulnerability to obesogenic environments, the consequences of child and adolescent obesity, and responses to interventions for the condition. A clearer focus on gender differences is required among both researchers and policy makers within this field.

A Brief Review on Correlates of Physical Activity and Sedentariness in Youth

INTRODUCTION

Better understanding of the correlates of physical activity and sedentary behaviors in youth will support the development of effective interventions that promote a physically active lifestyle and prevent a sedentary lifestyle. The main goal of this systematic review is to summarize and update the existing literature on correlates of young people's physical activity, insufficient physical activity, and sedentary behavior.

METHODS

A systematic review was conducted and included studies published between January 1999 and January 2005.

RESULTS

The 60 reviewed studies showed that for children (age range 4-12), gender (male), self-efficacy, parental physical activity (for boys), and parent support were positively associated with physical activity. For adolescents (age range 13-18), positive associations with physical activity were found for gender (male), parental education, attitude, self-efficacy, goal orientation/motivation, physical education/school sports, family influences, and friend support. For adolescents, a positive association was found between gender (male) and sedentary behavior, whereas an inverse association was found between gender and insufficient physical activity. Ethnicity (Caucasian), socioeconomic status, and parent education were found to be inversely associated with adolescents' sedentary behaviors. For children, the evidence was insufficient to draw conclusions about correlates of insufficient physical activity and sedentary behavior.

CONCLUSION

To gain more insight in the correlates of change in physical activity levels, more prospective studies are needed. Moreover, further research is needed examining the correlates of insufficient physical activity and sedentary behaviors, to develop effective interventions that may help children and adolescents diminish the time they spend on inactive behaviors.

Environmental correlates of physical activity in youth - a review and update

Obesogenic environments are thought to underlie the increased obesity prevalence observed in youth during the past decades. Understanding the environmental factors that are associated with physical activity (PA) in youth is needed to better inform the development of effective intervention strategies attempting to halt the obesity epidemic. We conducted a systematic semi-quantitative review of 150 studies on environmental correlates of youth PA published in the past 25 years. The ANalysis Grid for Environments Linked to Obesity (ANGELO) framework was used to classify the environmental correlates studied. Most studies retrieved used cross-sectional designs and subjective measures of environmental factors and PA. Variables of the home and school environments were especially associated with children's PA. Most consistent positive correlates of PA were father's PA, time spent outdoors and school PA-related policies (in children), and support from significant others, mother's education level, family income, and non-vocational school attendance (in adolescents). Low crime incidence (in adolescents) was characteristic of the neighbourhood environment associated with higher PA. Convincing evidence of an important role for many other environmental factors was, however, not found. Further research should aim at longitudinal and intervention studies, and use more objective measures of PA and its potential (environmental) determinants.

Moderators of environmental intervention effects on diet and activity in youth

BACKGROUND

The complexity of the relationship between environmental factors on the one hand and dietary behavior and physical activity on the other necessitates the search for moderators of environmental influences. The current evidence base is reviewed regarding potential moderating factors in the effectiveness of environmental interventions aimed at diet and/or physical activity of children and adolescents.

METHODS

The following databases were used: (1) Medline, (2) PubMed, (3) PsychInfo, (4) Web of Science, and (5) ERIC. Additionally, all potentially relevant references in recent reviews were checked.

RESULTS

Of the 41 studies included in the review, only seven studies (17%) were identified that reported tests of potential moderators of intervention effects. Gender proved to be the most frequently studied potential moderator. Additionally, race, age, and site have been studied regarding their potential role in modifying the effect of environmental interventions.

DISCUSSION

The small number of studies identified in this review prohibited us from attempting to formulate a conclusion on differential environment-behavior relationships in distinct subgroups. Rather than being an exception, it is argued that tests of effect modifiers should become common practice in behavioral nutrition and physical activity research to increase our understanding of mechanisms of behavior change and to optimize interventions.

Parental influence on children's oral health-related behavior

OBJECTIVE

The aim of this study was to determine whether there are differences between oral health-related knowledge, attitudes, beliefs and behaviors of children and their parents, and to identify the family-related factors associated with children's poor or good oral health-related behavior.

MATERIAL AND METHODS

The data were gathered by means of questionnaires from 11-12-year-old schoolchildren and their parents who replied without having knowledge of the answers of the others. Differences between subgroups of children were analyzed by cross-tabulation, and the factors related to children's good or poor oral health-related behavior by logistic regression analyses.

RESULTS

Parents of children who reported good oral health-related behavior had better knowledge and more favorable behaviors than those of other parents. Predictors for a child's poor oral health-related behavior were the child's poor knowledge, male gender, the parent's frequent consumption of sweets, and the parent's infrequent use of xylitol gum. When a less strict threshold for the child's poor oral health-related behavior was used, more predictors entered the model: the parent's unfavorable use of fluoride toothpaste; among girls, the parent's lack of knowledge; and among children whose mother's occupation level was high, the parent's infrequent use of xylitol gum. The parents of children whose oral health behavior was favorable were more likely to have a high level occupation and favorable oral health-related behaviors.

CONCLUSIONS

Oral health-related knowledge of children and their parents seems to be associated with children's oral health-related behavior. Parents' behaviors, but not attitudes, were associated with children's oral health behavior.

Leisure-time physical activity of 13-year-old adolescents

The leisure-time physical activity of 13-year-old Finnish adolescents was assessed in the prospective STRIP study. A self-administered questionnaire (N=565) was used. The leisure-time physical activity index (PAI; MET h/week) was calculated on the basis of reported exercise intensity, duration and frequency (N=558; 53% boys). The participants were divided into Sedentary, Moderately Active and Active groups by PAI tertiles. A subpopulation (N=197) also used a heart rate monitor (3 days, >/=8 h/day) to assess the time spent on different activity intensities. The median male PAI was 31.3 (inter-quartile range (IQR) 44.2) MET h/week and female 19.5 (IQR 26.3) MET h/week (P=0.0002). The cutoff points of the PAI tertiles were similar for the Active girls (31.3 MET h/week) and boys (32.6 MET h/week), but for the Sedentary boys it was 19.5 MET h/week and only 5.0 MET h/week for the Sedentary girls. High self-reported leisure-time physical activity associated poorly with time spent on moderate or vigorous exercise measured by heart rate monitoring. Active mothers had more often Active daughters or sons. In conclusion, the amount of leisure-time physical activity of one-third of 13-year-old girls is extremely low. Sedentary adolescents, especially girls, should therefore be put into focus for active efforts to increase their leisure-time physical activity. Parental models may be important.

Tracking and prevalence of cardiovascular disease risk factors across socio-economic classes: a longitudinal substudy of the European Youth Heart Study

BACKGROUND

The highest prevalence of several cardiovascular disease risk factors including obesity, smoking and low physical activity level is observed in adults of low socioeconomic status. This study investigates whether tracking of body mass index and physical fitness from childhood to adolescence differs between groups of socioeconomic status. Furthermore the study investigates whether social class differences in the prevalence of overweight and low physical fitness exist or develop within the age range from childhood to adolescence.

METHODS

In all, 384 school children were followed for a period of six years (from third to ninth grade). Physical fitness was determined by a progressive maximal cycle ergometer test and the classification of overweight was based on body mass index cut-points proposed by the International Obesity Task Force. Socioeconomic status was defined according to The International Standard Classification of Occupation scheme.

RESULTS

Moderate and moderately high tracking was observed for physical fitness and body mass index, respectively. No significant difference in tracking was observed between groups of socioeconomic status. A significant social gradient was observed in both the prevalence of overweight and low physical fitness in the 14-16-year-old adolescents, whereas at the age of 8-10 years, only the prevalence of low physical fitness showed a significant inverse relation to socioeconomic status. The odds of both developing and maintaining risk during the measurement period were estimated as bigger in the group of low socioeconomic status than in the group of high socioeconomic status, although differences were significant only with respect to the odds of developing overweight.

CONCLUSION

The results indicate that the fundamental possibilities of predicting overweight and low physical fitness at an early point in time are the same for different groups of socio-economic status. Furthermore, the observed development of social inequalities in the absolute prevalence of overweight and low physical fitness underline the need for broad preventive efforts targeting children of low socioeconomic status in early childhood.

Promoting healthful diets and exercise: efficacy of a 12-week after-school program in urban African Americans

This study examined the effectiveness of a unique extracurricular after-school initiative designed to promote healthy diets and exercise in urban African Americans. The Students and Parents Actively Involved in Being Fit after-school program was offered for 12 weeks to students and their parents/guardians at an urban middle school. Specific aims of the intervention were to increase participants' vegetable and fruit intake by using established 5 A Day for Better Health educational resource materials/activities and to affect their health-related fitness through dance, games, and fitness activities. Fifty-six children and 25 parents/guardians completed a standard battery of evaluations before and after the program. Pre-post pairwise t test revealed that both children and their parents/guardians showed an increase in fruit consumption and a reduction in diastolic blood pressure (P <.05). Moreover, children showed improvements in systolic blood pressure and fruit juice, salad, and nonfried potato consumption while parents/guardians showed a decrease in body fat, body mass index, and endurance walk/run time (P <.05). Overall, findings indicate that children tended to gain more diet-related benefits while parents/guardians tended to derive more fitness-related benefits. After-school programs like the Students and Parents Actively Involved in Being Fit initiative can potentially contribute to improved health levels in urban African Americans.

Educational and behavioral issues in transitioning from pediatric cardiology to adult-centered health care

It is assumed that when they begin growing up, a child with congenital heart disease will take personal responsibility for his or her care. For this purpose, patients need sufficient knowledge on the heart defect, treatment,and measures to prevent complications. However, empirical studies indicated that the levels of knowledge and understanding of both parents and children with congenital heart disease are poor. Therefore, sound patient education is imperative, particularly when patients are transitioned from pediatric cardiology to adult congenital cardiology. In this respect, the focus of communication shifts from the parent to the young patient; moreover, education should be tailored according to the developmental level of the patient. Issues that should typically be covered by educational programs for adolescents with congenital heart disease are information on the heart defect, treatment, endocarditis, sexuality and reproduction, sports, employability and insurability, and cardiovascular risk factor. International guidelines indicate that advanced practice nurses are key in developing and implementing patient education programs during the transition from pediatric cardiology to adult-centered health care.