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Austin EW, Austin BW, Power TG, Parker L, Kaiser CK, Edwards Z. Youth Perspectives on the Effects of a Family-centered Media Literacy Intervention to Encourage Healthier Eating. HEALTH COMMUNICATION 2024; 39:122-135. [PMID: 36571284 DOI: 10.1080/10410236.2022.2160078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
A pretest-posttest field test with control group (N = 189 parent-child dyads) tested a structural model representing youths' (ages 9-14) perspectives to examine the efficacy of a family-centered, media literacy-oriented intervention promoting fruit and vegetable consumption. The intervention facilitated critical discussion about nutrition and media, mentored by the parent. Results showed that youths' increases in fruit and vegetable consumption flowed from parent-child discussion of nutrition labels, which was predicted by child-initiated discussion, critical thinking about media sources, and critical thinking about media content. Multivariate analyses revealed that the intervention was productive for all participating age groups and for all dependent variables. The results suggest that a developmental progression from critical thinking about source to critical thinking about content affects behavior change and can be catalyzed through media literacy education and encouragement to discuss media messages (i.e. practice) with parents.
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Affiliation(s)
- Erica Weintraub Austin
- Edward R. Murrow Center for Media and Health Promotion Research, Department of Strategic Communication, Edward R. Murrow College of Communication, Washington State University
| | - Bruce W Austin
- Department of Kinesiology and Educational Psychology, Washington State University
| | - Thomas G Power
- Department of Human Development, Washington State University
| | - Louise Parker
- Department of Human Development, Washington State University
| | - C Kit Kaiser
- Department of Strategic Communication, The Edward R. Murrow College of Communication, Washington State University
| | - Zena Edwards
- Extension Youth & Families, Washington State University
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Neil-Sztramko SE, Caldwell H, Dobbins M. School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18. Cochrane Database Syst Rev 2021; 9:CD007651. [PMID: 34555181 PMCID: PMC8459921 DOI: 10.1002/14651858.cd007651.pub3] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Physical activity among children and adolescents is associated with lower adiposity, improved cardio-metabolic health, and improved fitness. Worldwide, fewer than 30% of children and adolescents meet global physical activity recommendations of at least 60 minutes of moderate to vigorous physical activity per day. Schools may be ideal sites for interventions given that children and adolescents in most parts of the world spend a substantial amount of time in transit to and from school or attending school. OBJECTIVES The purpose of this review update is to summarise the evidence on effectiveness of school-based interventions in increasing moderate to vigorous physical activity and improving fitness among children and adolescents 6 to 18 years of age. Specific objectives are: • to evaluate the effects of school-based interventions on increasing physical activity and improving fitness among children and adolescents; • to evaluate the effects of school-based interventions on improving body composition; and • to determine whether certain combinations or components (or both) of school-based interventions are more effective than others in promoting physical activity and fitness in this target population. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, BIOSIS, SPORTDiscus, and Sociological Abstracts to 1 June 2020, without language restrictions. We screened reference lists of included articles and relevant systematic reviews. We contacted primary authors of studies to ask for additional information. SELECTION CRITERIA Eligible interventions were relevant to public health practice (i.e. were not delivered by a clinician), were implemented in the school setting, and aimed to increase physical activity among all school-attending children and adolescents (aged 6 to 18) for at least 12 weeks. The review was limited to randomised controlled trials. For this update, we have added two new criteria: the primary aim of the study was to increase physical activity or fitness, and the study used an objective measure of physical activity or fitness. Primary outcomes included proportion of participants meeting physical activity guidelines and duration of moderate to vigorous physical activity and sedentary time (new to this update). Secondary outcomes included measured body mass index (BMI), physical fitness, health-related quality of life (new to this update), and adverse events (new to this update). Television viewing time, blood cholesterol, and blood pressure have been removed from this update. DATA COLLECTION AND ANALYSIS: Two independent review authors used standardised forms to assess each study for relevance, to extract data, and to assess risk of bias. When discrepancies existed, discussion occurred until consensus was reached. Certainty of evidence was assessed according to GRADE. A random-effects meta-analysis based on the inverse variance method was conducted with participants stratified by age (children versus adolescents) when sufficient data were reported. Subgroup analyses explored effects by intervention type. MAIN RESULTS Based on the three new inclusion criteria, we excluded 16 of the 44 studies included in the previous version of this review. We screened an additional 9968 titles (search October 2011 to June 2020), of which 978 unique studies were potentially relevant and 61 met all criteria for this update. We included a total of 89 studies representing complete data for 66,752 study participants. Most studies included children only (n = 56), followed by adolescents only (n = 22), and both (n = 10); one study did not report student age. Multi-component interventions were most common (n = 40), followed by schooltime physical activity (n = 19), enhanced physical education (n = 15), and before and after school programmes (n = 14); one study explored both enhanced physical education and an after school programme. Lack of blinding of participants, personnel, and outcome assessors and loss to follow-up were the most common sources of bias. Results show that school-based physical activity interventions probably result in little to no increase in time engaged in moderate to vigorous physical activity (mean difference (MD) 0.73 minutes/d, 95% confidence interval (CI) 0.16 to 1.30; 33 studies; moderate-certainty evidence) and may lead to little to no decrease in sedentary time (MD -3.78 minutes/d, 95% CI -7.80 to 0.24; 16 studies; low-certainty evidence). School-based physical activity interventions may improve physical fitness reported as maximal oxygen uptake (VO₂max) (MD 1.19 mL/kg/min, 95% CI 0.57 to 1.82; 13 studies; low-certainty evidence). School-based physical activity interventions may result in a very small decrease in BMI z-scores (MD -0.06, 95% CI -0.09 to -0.02; 21 studies; low-certainty evidence) and may not impact BMI expressed as kg/m² (MD -0.07, 95% CI -0.15 to 0.01; 50 studies; low-certainty evidence). We are very uncertain whether school-based physical activity interventions impact health-related quality of life or adverse events. AUTHORS' CONCLUSIONS Given the variability of results and the overall small effects, school staff and public health professionals must give the matter considerable thought before implementing school-based physical activity interventions. Given the heterogeneity of effects, the risk of bias, and findings that the magnitude of effect is generally small, results should be interpreted cautiously.
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Affiliation(s)
| | - Hilary Caldwell
- Department of Kinesiology, Child Health & Exercise Medicine Program, McMaster University, Hamilton, Canada
| | - Maureen Dobbins
- School of Nursing, McMaster University, Hamilton, Canada
- National Collaborating Centre for Methods and Tools, Hamilton, Canada
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Austin EW, Austin B, Kaiser CK, Edwards Z, Parker L, Power TG. A Media Literacy-Based Nutrition Program Fosters Parent-Child Food Marketing Discussions, Improves Home Food Environment, and Youth Consumption of Fruits and Vegetables. Child Obes 2020; 16:S33-S43. [PMID: 32311295 DOI: 10.1089/chi.2019.0240] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background: Media use is a known contributor to childhood obesity, but encouraging reductions in screen use only partially eliminates media influence. We tested a family-centered, media literacy-oriented intervention to empower parents and children 9-14 years to skillfully use media to reduce marketing influences, enhance nutrition knowledge, improve the selection of foods in the home environment, and improve fruit and vegetable consumption. Methods: A community-based, 6-U program included separate parent and youth (ages 9-14 years) sessions, each of which was followed by a session together in which skills from the individual sessions were reinforced. A pretest to posttest field test with control groups (N = 189, parent-child dyads) tested the intervention's efficacy. Results: Standardized mean differences from the multiple analysis of covariance tests showed that the intervention group demonstrated improvements on parents' use of nutrition labels (0.29), the ratio of healthy to unhealthy food in the home environment (0.25), youth's fruit (0.30) and vegetable (0.25) consumption, parent and youth media literacy skills, and family communication dynamics about food. The largest effects found were for negative parental mediation (0.48) and parents' report of child-initiated discussion (0.47). Consistent but weaker results were revealed for Latinx families. Conclusions: This family-centered approach helped family members practice using media together to make better nutrition decisions without depending on the ability of parents to limit media use. It successfully addressed the often-negative impact of the media on behaviors that increase obesity risk while also cultivating the potential for media to provide useful information that can lead to behaviors that decrease obesity risk.
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Affiliation(s)
- Erica Weintraub Austin
- Edward R. Murrow Center for Media and Health Promotion Research, Department of Strategic Communication, Edward R. Murrow College of Communication, Washington State University, Pullman, WA, USA
| | - Bruce Austin
- Department of Kinesiology and Educational Psychology, Washington State University, Pullman, WA, USA
| | - Christopher Kit Kaiser
- Department of Strategic Communication, The Edward R. Murrow College of Communication, Washington State University, Pullman, WA, USA
| | - Zena Edwards
- Food Safety and Nutrition, Washington State University Extension, Clark County, Vancouver, WA, USA
| | - Louise Parker
- Department of Human Development, Washington State University, Pullman, WA, USA
| | - Thomas G Power
- Department of Human Development, Washington State University, Pullman, WA, USA
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Briançon S, Legrand K, Muller L, Langlois J, Saez L, Spitz E, Quinet MH, Böhme P, Lecomte E, Omorou AY. Effectiveness of a socially adapted intervention in reducing social inequalities in adolescence weight. The PRALIMAP-INÈS school-based mixed trial. Int J Obes (Lond) 2020; 44:895-907. [PMID: 31969652 DOI: 10.1038/s41366-020-0520-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 11/19/2019] [Accepted: 01/03/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND A high prevalence of overweight/obesity among low socioeconomic status adolescents contributes to health inequalities. However, evidence-based interventions for reducing social inequalities in adolescent weight are lacking. We aimed to investigate whether strengthened care management for adolescents with low socioeconomic status has an equivalent effect in reducing overweight as standard care management in adolescents with high status. METHODS PRALIMAP-INÈS was a multicentre trial including 35 state-run high and middle schools in the north-eastern France. A population-based sample of 1639 adolescents aged 13-18 years with screened and clinically confirmed overweight/obesity were proposed for inclusion and divided into two groups by the Family Affluence Scale score: advantaged (score > 5), receiving standard care management (A.S) and less-advantaged randomly assigned to two groups (1:2 ratio): standard care management (LA.S) and standard and strengthened care management (LA.S.S). Interventions were based on the proportionate universalism principle: universal standard care for all groups and proportionate care for the LA.S.S group. Main outcome was body mass index z-score (BMIz) assessed before and 1 year after inclusion. RESULTS A total of 1419 adolescents were included and 1143 followed up at 1 year: 649 in A.S, 158 in LA.S and 336 in LA.S.S groups. BMIz decreased significantly for boys (-0.11 [95% CI, -0.13 to -0.08]; p < 0.0001) and girls (-0.05 [-0.08 to -0.03]; p < 0.0001). No equivalence between LA.S.S and A.S groups was evidenced. For girls, the trend to superiority for LA.S.S was confirmed by the more favourable change (-0.06 [-0.11 to -0.01]; p = 0.01) observed on superiority analysis, with no differential change for boys (0.02 [-0.03 to 0.08]; p = 0.41). CONCLUSIONS A public health school-based intervention using the proportionate universalism principle may be effective in not worsening or even reducing overweight social inequalities in adolescents, especially for girls. Overcoming social barriers may help health professionals dealing with the burden and inequalities of overweight in adolescents.
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Affiliation(s)
- Serge Briançon
- University of Lorraine, EA 4360 APEMAC, Nancy Metz, France.
| | - Karine Legrand
- University of Lorraine, EA 4360 APEMAC, Nancy Metz, France.,CHRU-Nancy, INSERM, University of Lorraine, CIC-1433 Clinical Epidemiology, Nancy, France
| | - Laurent Muller
- University of Lorraine, EA 4360 APEMAC, Nancy Metz, France
| | | | - Laura Saez
- University of Lorraine, EA 4360 APEMAC, Nancy Metz, France
| | | | | | - Philip Böhme
- Department of endocrinology, diabetology and nutrition, Nancy University Hospital, Nancy, France
| | - Edith Lecomte
- National Conservatory of Arts and Crafts, Nancy, France
| | - Abdou Y Omorou
- University of Lorraine, EA 4360 APEMAC, Nancy Metz, France.,CHRU-Nancy, INSERM, University of Lorraine, CIC-1433 Clinical Epidemiology, Nancy, France
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Removing competitive foods v. nudging and marketing school meals: a pilot study in high-school cafeterias. Public Health Nutr 2019; 23:366-373. [DOI: 10.1017/s136898001900329x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjective:To compare federally reimbursable school meals served when competitive foods are removed and when marketing and nudging strategies are used in school cafeterias operating the National School Lunch Program (NSLP). The second objective was to determine how marketing and nudging strategies influence competitive food sales.Design:In the Healthy Choices School, all competitive foods were removed; the Healthy Nudging School retained competitive foods and promoted the school meal programme using marketing and nudging strategies; a third school made no changes. Cafeteria register data were collected from the beginning of the 2013–2014 school year through the four-week intervention. Outcome measures included daily entrées served; share of entrées served with vegetables, fruit and milk; and total competitive food sales. Difference-in-difference models were used to examine outcome measure changes.Setting:Three high schools in a diverse, Northeast US urban district with universally free meals.Participants:High-school students participating in the NSLP.Results:During the intervention weeks, the average number of entrées served daily was significantly higher in the Healthy Choices School (82·1 (se 33·9)) and the Healthy Nudging School (107·4 (se 28·2)) compared with the control school. The only significant change in meal component selection was a 6 % (se 0·02) higher rate of vegetable servings in the Healthy Choices School compared with the control school. Healthy Nudging School competitive food sales did not change.Conclusions:Both strategies – removing competitive foods and marketing and nudging – may increase school meal participation. There was no evidence that promoting school meals decreased competitive food sales.
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Green B, Ralston PA, Young-Clark I, Waryoba C, Smith S, Harris CM, Finch S, Mitchell M, Coccia C. A Youth Health Leadership Program: Feasibility and Initial Outcomes. J Community Health 2019; 45:228-238. [PMID: 31494798 DOI: 10.1007/s10900-019-00707-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study determined the feasibility (attendance, participation and completion) and initial outcomes (food consumption, food acquisition, physical activity and leadership) of a community-based youth health leadership (YHL) program. YHL was developed as a part of a larger childhood obesity prevention coalition in a medium-sized community in North Florida using community-based participatory research approaches. The theory-driven 6-week program included content sessions, application rotation, and health campaign. Data were collected from youth participants (n = 36) and a purposive comparison group (n = 29) via self-administered questionnaire and project records in the first three years of YHL. Feasibility outcomes show that the majority of program participants attended and participated. Completion rates ranged from 61.5% in year one to 100% in years two and three. Significant differences in treatment and comparison groups were noted in frequency of fruit consumption (p < 0.001) and physical activity (p < 0.002). However, there were no clear patterns of improvements for the treatment group. Trends in the data showed that the consumption of foods high in fat, sugar and sodium decreased slightly for the treatment group but increased or remained the same for the comparison group. The leadership outcomes for youth participants show that those reached are furthering their education, participating in activities such as internships, receiving honors, and garnering leadership achievements. This study suggests that a community-based youth health leadership model is feasible, but more work is needed to impact health behaviors. Future research directions are provided.
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Affiliation(s)
- Brandon Green
- Department of Surgery, Howard University Hospital, Washington, DC, USA
| | - Penny A Ralston
- Center on Better Health and Life for Underserved Populations, Florida State University, Tallahassee, FL, 32306-1491, USA.
| | - Iris Young-Clark
- School of Business and Industry, Florida A&M University, Tallahassee, FL, USA
| | - Caroline Waryoba
- College of Medicine, Florida State University, Tallahassee, FL, USA
| | - SchMiyah Smith
- College of Medicine, Florida State University, Tallahassee, FL, USA
| | - Cynthia M Harris
- Institute of Public Health, Florida A&M University, Tallahassee, FL, USA
| | - Sokoya Finch
- Florida Family Network, Inc, Tallahassee, FL, USA
| | | | - Catherine Coccia
- Department of Dietetics & Nutrition, Florida International University, Miami, FL, USA
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Brown T, Moore TH, Hooper L, Gao Y, Zayegh A, Ijaz S, Elwenspoek M, Foxen SC, Magee L, O'Malley C, Waters E, Summerbell CD. Interventions for preventing obesity in children. Cochrane Database Syst Rev 2019; 7:CD001871. [PMID: 31332776 PMCID: PMC6646867 DOI: 10.1002/14651858.cd001871.pub4] [Citation(s) in RCA: 275] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
EDITORIAL NOTE This Cochrane review is now out of date and should not be used for reference. It has been split into four age groups and updated. Please refer to the 5‐11 and 12‐18 age group Cochrane reviews which were published in May 2024: https://doi.org/10.1002/14651858.CD015328.pub2 https://doi.org/10.1002/14651858.CD015330.pub2 The 2‐4 age group Cochrane review is planned for publication in September 2024. BACKGROUND Prevention of childhood obesity is an international public health priority given the significant impact of obesity on acute and chronic diseases, general health, development and well-being. The international evidence base for strategies to prevent obesity is very large and is accumulating rapidly. This is an update of a previous review. OBJECTIVES To determine the effectiveness of a range of interventions that include diet or physical activity components, or both, designed to prevent obesity in children. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsychINFO and CINAHL in June 2015. We re-ran the search from June 2015 to January 2018 and included a search of trial registers. SELECTION CRITERIA Randomised controlled trials (RCTs) of diet or physical activity interventions, or combined diet and physical activity interventions, for preventing overweight or obesity in children (0-17 years) that reported outcomes at a minimum of 12 weeks from baseline. DATA COLLECTION AND ANALYSIS Two authors independently extracted data, assessed risk-of-bias and evaluated overall certainty of the evidence using GRADE. We extracted data on adiposity outcomes, sociodemographic characteristics, adverse events, intervention process and costs. We meta-analysed data as guided by the Cochrane Handbook for Systematic Reviews of Interventions and presented separate meta-analyses by age group for child 0 to 5 years, 6 to 12 years, and 13 to 18 years for zBMI and BMI. MAIN RESULTS We included 153 RCTs, mostly from the USA or Europe. Thirteen studies were based in upper-middle-income countries (UMIC: Brazil, Ecuador, Lebanon, Mexico, Thailand, Turkey, US-Mexico border), and one was based in a lower middle-income country (LMIC: Egypt). The majority (85) targeted children aged 6 to 12 years.Children aged 0-5 years: There is moderate-certainty evidence from 16 RCTs (n = 6261) that diet combined with physical activity interventions, compared with control, reduced BMI (mean difference (MD) -0.07 kg/m2, 95% confidence interval (CI) -0.14 to -0.01), and had a similar effect (11 RCTs, n = 5536) on zBMI (MD -0.11, 95% CI -0.21 to 0.01). Neither diet (moderate-certainty evidence) nor physical activity interventions alone (high-certainty evidence) compared with control reduced BMI (physical activity alone: MD -0.22 kg/m2, 95% CI -0.44 to 0.01) or zBMI (diet alone: MD -0.14, 95% CI -0.32 to 0.04; physical activity alone: MD 0.01, 95% CI -0.10 to 0.13) in children aged 0-5 years.Children aged 6 to 12 years: There is moderate-certainty evidence from 14 RCTs (n = 16,410) that physical activity interventions, compared with control, reduced BMI (MD -0.10 kg/m2, 95% CI -0.14 to -0.05). However, there is moderate-certainty evidence that they had little or no effect on zBMI (MD -0.02, 95% CI -0.06 to 0.02). There is low-certainty evidence from 20 RCTs (n = 24,043) that diet combined with physical activity interventions, compared with control, reduced zBMI (MD -0.05 kg/m2, 95% CI -0.10 to -0.01). There is high-certainty evidence that diet interventions, compared with control, had little impact on zBMI (MD -0.03, 95% CI -0.06 to 0.01) or BMI (-0.02 kg/m2, 95% CI -0.11 to 0.06).Children aged 13 to 18 years: There is very low-certainty evidence that physical activity interventions, compared with control reduced BMI (MD -1.53 kg/m2, 95% CI -2.67 to -0.39; 4 RCTs; n = 720); and low-certainty evidence for a reduction in zBMI (MD -0.2, 95% CI -0.3 to -0.1; 1 RCT; n = 100). There is low-certainty evidence from eight RCTs (n = 16,583) that diet combined with physical activity interventions, compared with control, had no effect on BMI (MD -0.02 kg/m2, 95% CI -0.10 to 0.05); or zBMI (MD 0.01, 95% CI -0.05 to 0.07; 6 RCTs; n = 16,543). Evidence from two RCTs (low-certainty evidence; n = 294) found no effect of diet interventions on BMI.Direct comparisons of interventions: Two RCTs reported data directly comparing diet with either physical activity or diet combined with physical activity interventions for children aged 6 to 12 years and reported no differences.Heterogeneity was apparent in the results from all three age groups, which could not be entirely explained by setting or duration of the interventions. Where reported, interventions did not appear to result in adverse effects (16 RCTs) or increase health inequalities (gender: 30 RCTs; socioeconomic status: 18 RCTs), although relatively few studies examined these factors.Re-running the searches in January 2018 identified 315 records with potential relevance to this review, which will be synthesised in the next update. AUTHORS' CONCLUSIONS Interventions that include diet combined with physical activity interventions can reduce the risk of obesity (zBMI and BMI) in young children aged 0 to 5 years. There is weaker evidence from a single study that dietary interventions may be beneficial.However, interventions that focus only on physical activity do not appear to be effective in children of this age. In contrast, interventions that only focus on physical activity can reduce the risk of obesity (BMI) in children aged 6 to 12 years, and adolescents aged 13 to 18 years. In these age groups, there is no evidence that interventions that only focus on diet are effective, and some evidence that diet combined with physical activity interventions may be effective. Importantly, this updated review also suggests that interventions to prevent childhood obesity do not appear to result in adverse effects or health inequalities.The review will not be updated in its current form. To manage the growth in RCTs of child obesity prevention interventions, in future, this review will be split into three separate reviews based on child age.
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Affiliation(s)
- Tamara Brown
- Department of Sport and Exercise Sciences, Durham University, Durham, UK
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Haidar A, Ranjit N, Archer N, Hoelscher DM. Parental and peer social support is associated with healthier physical activity behaviors in adolescents: a cross-sectional analysis of Texas School Physical Activity and Nutrition (TX SPAN) data. BMC Public Health 2019; 19:640. [PMID: 31132999 PMCID: PMC6537420 DOI: 10.1186/s12889-019-7001-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 05/17/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Parental and peer support can influence children's physical activity; however, these associations have not been fully examined in a multi-ethnic population across early and late adolescence. The objective of this study was to examine associations between perceived parental/peer social support, perceived parental disapproval for not exercising, and physical activity/screen time behaviors among a multi-ethnic sample of adolescents. METHODS The Texas School Physical Activity and Nutrition (TX SPAN) survey is a cross-sectional statewide probability-based survey, used to assess obesity-related behaviors such as diet and physical activity. The SPAN 2009-2011 study measured 8th and 11th grade students using a self-report questionnaire with established psychometric properties, along with objectively measured height and weight. Associations were examined using multiple logistic and linear regression. RESULTS For every 1-point increase in parental physical activity support, adolescents had 1.14 higher odds of engaging in five or more days of moderate physical activity per week (p < 0.001), and 1.12 higher odds of engaging in three or more days of vigorous physical activity per week (p < 0.001). For every 1-point increase in peer physical activity support, adolescents had 1.17 higher odds of engaging in five or more days of moderate physical activity per week (p < 0.001), and 1.15 higher odds of engaging in three or more days of vigorous physical activity per week (p < 0.001). CONCLUSIONS Parental and peer social support is associated with positive physical activity behaviors in adolescents. Strategies to focus on parent and peer support should be integral to intervention programs designed to increase physical activity in adolescents in middle and high schools.
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Affiliation(s)
- Amier Haidar
- Michael & Susan Dell Center for Healthy Living, UTHealth School of Public Health, 1616 Guadalupe St, Suite 6.300, Austin, TX 78701 USA
| | - Nalini Ranjit
- Michael & Susan Dell Center for Healthy Living, UTHealth School of Public Health, 1616 Guadalupe St, Suite 6.300, Austin, TX 78701 USA
| | - Natalie Archer
- Texas Department of State Health Services, 1100 W 49th Street, Austin, TX 78756 USA
| | - Deanna M. Hoelscher
- Michael & Susan Dell Center for Healthy Living, UTHealth School of Public Health, 1616 Guadalupe St, Suite 6.300, Austin, TX 78701 USA
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Wolfenden L, Nathan NK, Sutherland R, Yoong SL, Hodder RK, Wyse RJ, Delaney T, Grady A, Fielding A, Tzelepis F, Clinton‐McHarg T, Parmenter B, Butler P, Wiggers J, Bauman A, Milat A, Booth D, Williams CM. Strategies for enhancing the implementation of school-based policies or practices targeting risk factors for chronic disease. Cochrane Database Syst Rev 2017; 11:CD011677. [PMID: 29185627 PMCID: PMC6486103 DOI: 10.1002/14651858.cd011677.pub2] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND A number of school-based policies or practices have been found to be effective in improving child diet and physical activity, and preventing excessive weight gain, tobacco or harmful alcohol use. Schools, however, frequently fail to implement such evidence-based interventions. OBJECTIVES The primary aims of the review are to examine the effectiveness of strategies aiming to improve the implementation of school-based policies, programs or practices to address child diet, physical activity, obesity, tobacco or alcohol use.Secondary objectives of the review are to: Examine the effectiveness of implementation strategies on health behaviour (e.g. fruit and vegetable consumption) and anthropometric outcomes (e.g. BMI, weight); describe the impact of such strategies on the knowledge, skills or attitudes of school staff involved in implementing health-promoting policies, programs or practices; describe the cost or cost-effectiveness of such strategies; and describe any unintended adverse effects of strategies on schools, school staff or children. SEARCH METHODS All electronic databases were searched on 16 July 2017 for studies published up to 31 August 2016. We searched the following electronic databases: Cochrane Library including the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; MEDLINE In-Process & Other Non-Indexed Citations; Embase Classic and Embase; PsycINFO; Education Resource Information Center (ERIC); Cumulative Index to Nursing and Allied Health Literature (CINAHL); Dissertations and Theses; and SCOPUS. We screened reference lists of all included trials for citations of other potentially relevant trials. We handsearched all publications between 2011 and 2016 in two specialty journals (Implementation Science and Journal of Translational Behavioral Medicine) and conducted searches of the WHO International Clinical Trials Registry Platform (ICTRP) (http://apps.who.int/trialsearch/) as well as the US National Institutes of Health registry (https://clinicaltrials.gov). We consulted with experts in the field to identify other relevant research. SELECTION CRITERIA 'Implementation' was defined as the use of strategies to adopt and integrate evidence-based health interventions and to change practice patterns within specific settings. We included any trial (randomised or non-randomised) conducted at any scale, with a parallel control group that compared a strategy to implement policies or practices to address diet, physical activity, overweight or obesity, tobacco or alcohol use by school staff to 'no intervention', 'usual' practice or a different implementation strategy. DATA COLLECTION AND ANALYSIS Citation screening, data extraction and assessment of risk of bias was performed by review authors in pairs. Disagreements between review authors were resolved via consensus, or if required, by a third author. Considerable trial heterogeneity precluded meta-analysis. We narratively synthesised trial findings by describing the effect size of the primary outcome measure for policy or practice implementation (or the median of such measures where a single primary outcome was not stated). MAIN RESULTS We included 27 trials, 18 of which were conducted in the USA. Nineteen studies employed randomised controlled trial (RCT) designs. Fifteen trials tested strategies to implement healthy eating policies, practice or programs; six trials tested strategies targeting physical activity policies or practices; and three trials targeted tobacco policies or practices. Three trials targeted a combination of risk factors. None of the included trials sought to increase the implementation of interventions to delay initiation or reduce the consumption of alcohol. All trials examined multi-strategic implementation strategies and no two trials examined the same combinations of implementation strategies. The most common implementation strategies included educational materials, educational outreach and educational meetings. For all outcomes, the overall quality of evidence was very low and the risk of bias was high for the majority of trials for detection and performance bias.Among 13 trials reporting dichotomous implementation outcomes-the proportion of schools or school staff (e.g. classes) implementing a targeted policy or practice-the median unadjusted (improvement) effect sizes ranged from 8.5% to 66.6%. Of seven trials reporting the percentage of a practice, program or policy that had been implemented, the median unadjusted effect (improvement), relative to the control ranged from -8% to 43%. The effect, relative to control, reported in two trials assessing the impact of implementation strategies on the time per week teachers spent delivering targeted policies or practices ranged from 26.6 to 54.9 minutes per week. Among trials reporting other continuous implementation outcomes, findings were mixed. Four trials were conducted of strategies that sought to achieve implementation 'at scale', that is, across samples of at least 50 schools, of which improvements in implementation were reported in three trials.The impact of interventions on student health behaviour or weight status were mixed. Three of the eight trials with physical activity outcomes reported no significant improvements. Two trials reported reductions in tobacco use among intervention relative to control. Seven of nine trials reported no between-group differences on student overweight, obesity or adiposity. Positive improvements in child dietary intake were generally reported among trials reporting these outcomes. Three trials assessed the impact of implementation strategies on the attitudes of school staff and found mixed effects. Two trials specified in the study methods an assessment of potential unintended adverse effects, of which, they reported none. One trial reported implementation support did not significantly increase school revenue or expenses and another, conducted a formal economic evaluation, reporting the intervention to be cost-effective. Trial heterogeneity, and the lack of consistent terminology describing implementation strategies, were important limitations of the review. AUTHORS' CONCLUSIONS Given the very low quality of the available evidence, it is uncertain whether the strategies tested improve implementation of the targeted school-based policies or practices, student health behaviours, or the knowledge or attitudes of school staff. It is also uncertain if strategies to improve implementation are cost-effective or if they result in unintended adverse consequences. Further research is required to guide efforts to facilitate the translation of evidence into practice in this setting.
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Delk J, Harrell MB, Fakhouri TH, Muir KA, Perry CL. Implementation of a Computerized Tablet-Survey in an Adolescent Large-Scale, School-Based Study. THE JOURNAL OF SCHOOL HEALTH 2017; 87:506-512. [PMID: 28580672 PMCID: PMC5485855 DOI: 10.1111/josh.12521] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 10/03/2016] [Accepted: 11/23/2016] [Indexed: 06/07/2023]
Abstract
BACKGROUND Computerized surveys present many advantages over paper surveys. However, school-based adolescent research questionnaires still mainly rely on paper-and-pencil surveys as access to computers in schools is often not practical. Tablet-assisted self-interviews (TASI) present a possible solution, but their use is largely untested. This paper presents a method for and our experiences with implementing a TASI in a school setting. METHODS A TASI was administered to 3907 middle and high school students from 79 schools. The survey assessed use of tobacco products and exposure to tobacco marketing. To assess in-depth tobacco use behaviors, the TASI employed extensive skip patterns to reduce the number of not-applicable questions that nontobacco users received. Pictures were added to help respondents identify the tobacco products they were being queried about. RESULTS Students were receptive to the tablets and required no instructions in their use. None were lost, stolen, or broken. Item nonresponse, unanswered questions, was a pre-administration concern; however, 92% of participants answered 96% or more of the questions. CONCLUSIONS This method was feasible and successful among a diverse population of students and schools. It generated a unique dataset of in-depth tobacco use behaviors that would not have been possible through a paper-and-pencil survey.
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Affiliation(s)
- Joanne Delk
- Michael & Susan Dell Center for Healthy Living, The University of Texas Health Science Center at Houston-UTHealth, School of Public Health, Austin Campus, Austin, TX 78701,
| | - Melissa Blythe Harrell
- Human Genetics and Environmental Sciences at The University of Texas Health Science Center at Houston-UTHealth, School of Public Health, Austin Campus, Austin, TX 78701,
| | - Tala H.I. Fakhouri
- ICF International, Division of Public Health and Survey Research, Rockville, MD,
| | - Katelyn A. Muir
- ICF International, Division of Public Health and Survey Research, Burlington, VT,
| | - Cheryl L. Perry
- Health Promotion and Behavioral Sciences at The University of Texas School of Public Health-UTHealth, School of Public Health, Austin Campus, Austin, TX 78701,
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11
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Legrand K, Lecomte E, Langlois J, Muller L, Saez L, Quinet MH, Böhme P, Spitz E, Omorou AY, Briançon S. Reducing social inequalities in access to overweight and obesity care management for adolescents: The PRALIMAP-INÈS trial protocol and inclusion data analysis. Contemp Clin Trials Commun 2017; 7:141-157. [PMID: 29696179 PMCID: PMC5898577 DOI: 10.1016/j.conctc.2017.05.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 05/23/2017] [Accepted: 05/29/2017] [Indexed: 01/25/2023] Open
Abstract
Background Despite social inequalities in overweight/obesity prevalence, evidence-based public health interventions to reduce them are scarce. The PRALIMAP-INÈS trial aimed to investigate whether a strengthened-care management for adolescents with low socioeconomic status has an equivalent effect in preventing and reducing overweight as a standard-care management for high socioeconomic status adolescents. Methods PRALIMAP-INÈS was a mixed, prospective and multicenter trial including 35 state-run schools. It admitted overweight or obese adolescents, age 13–18 years old, for 3 consecutive academic years. One-year interventions were implemented. Data were collected before (T0), after (T1) and post (T2) intervention. Among 2113 eligible adolescents who completed questionnaires, 1639 were proposed for inclusion and 1419 were included (220 parental refusals). Two groups were constituted according to the Family Affluence Scale (FAS) score: the less advantaged (FAS≤5) were randomly assigned to 2 groups in a 2/1 ratio. The 3 intervention groups were: advantaged with standard-care management (A.S, n = 808), less advantaged with standard-care management (LA.S, n = 196), and less advantaged with standard and strengthened-care management (LA.S.S, n = 415). The standard-care management was based on the patient education principle and consisted of 5 collective sessions. The strengthened-care management was based on the proportionate universalism principle and consisted of activities adapted to needs. Inclusion results The written parental refusal was less frequent among less advantaged and more overweight adolescents. A dramatic linear social gradient in overweight was evidenced. Discussion The PRALIMAP-INÈS outcomes should inform how effectively a socially adapted public health program can avoid worsening social inequalities in overweight adolescents attending school. Trial registration ClinicalTrials.gov (NCT01688453).
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Affiliation(s)
- Karine Legrand
- Lorraine University, Paris Descartes University, EA 4360 APEMAC, Nancy, France.,Inserm, CIC-1433 Clinical Epidemiology, Nancy University Hospital, Nancy, France
| | - Edith Lecomte
- National Conservatory of Arts and Crafts, Nancy, France
| | - Johanne Langlois
- Lorraine University, Paris Descartes University, EA 4360 APEMAC, Nancy, France.,National Conservatory of Arts and Crafts, Nancy, France
| | - Laurent Muller
- Lorraine University, Paris Descartes University, EA 4360 APEMAC, Nancy, France
| | - Laura Saez
- Lorraine University, Paris Descartes University, EA 4360 APEMAC, Nancy, France
| | | | - Philip Böhme
- Lorraine University, Paris Descartes University, EA 4360 APEMAC, Nancy, France.,Department of Diabetology, Metabolic Diseases and Nutrition, Nancy University Hospital, Nancy, France
| | - Elisabeth Spitz
- Lorraine University, Paris Descartes University, EA 4360 APEMAC, Nancy, France
| | - Abdou Y Omorou
- Lorraine University, Paris Descartes University, EA 4360 APEMAC, Nancy, France.,Inserm, CIC-1433 Clinical Epidemiology, Nancy University Hospital, Nancy, France
| | - Serge Briançon
- Lorraine University, Paris Descartes University, EA 4360 APEMAC, Nancy, France.,Inserm, CIC-1433 Clinical Epidemiology, Nancy University Hospital, Nancy, France
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12
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Hollis JL, Sutherland R, Williams AJ, Campbell E, Nathan N, Wolfenden L, Morgan PJ, Lubans DR, Gillham K, Wiggers J. A systematic review and meta-analysis of moderate-to-vigorous physical activity levels in secondary school physical education lessons. Int J Behav Nutr Phys Act 2017; 14:52. [PMID: 28438171 PMCID: PMC5402678 DOI: 10.1186/s12966-017-0504-0] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 04/05/2017] [Indexed: 11/24/2022] Open
Abstract
Background Schools play an important role in physical activity promotion for adolescents. The systematic review aimed to determine the proportion of secondary (middle and high) school physical education (PE) lesson time that students spend in moderate to vigorous physical activity (MVPA), and to assess if MVPA was moderated by school level (middle and high school), type of physical activity measurement and type of PE activities. Methods A systematic search of nine electronic databases was conducted (PROSPERO2014:CRD42014009649). Studies were eligible if they were published between 2005 and 2014; written in English; assessed MVPA in PE lessons of secondary (middle and high) school students; and used a quantitative MVPA measure (i.e., accelerometry, heart rate monitoring, pedometers or observational measures). Two reviewers examined the retrieved articles, assessed risk of bias, and performed data extraction. Random effects meta-analysis was used to calculate a pooled estimate of the percent of PE lesson time spent in MVPA and to assess moderator effects where data allowed. Results The search yielded 5,132 potentially relevant articles; 28 articles representing 25 studies (7 middle and 18 high school) from seven countries were included. Twelve studies measured MVPA through observational measures, seven used accelerometers, five used heart rate monitors and four used pedometers (including three studies using a mix of measures). Meta-analysis of 15 studies found that overall, students spent a mean (95% CI) of 40.5% (34.8–46.2%) of PE in MVPA. Middle school students spent 48.6% (41.3–55.9%) of the lesson in MVPA (n = 5 studies) and high school students 35.9% (28.3–43.6%) (n = 10 studies). Studies measuring MVPA using accelerometers (n = 5) showed that students spent 34.7% (25.1–44.4%) of the lesson in MVPA, while 44.4% (38.3–50.5%) was found for lessons assessed via observation (n = 9), 43.1% (24.3–61.9%) of the lesson for a heart rate based study, and 35.9% (31.0–40.8%) for a pedometer-measured study. Conclusions The proportion of PE spent in MVPA (40.5%) is below the US Centre for Disease Control and Prevention and the UK Associations for Physical Education recommendation of 50%. Findings differed according to the method of MVPA assessment. Additional strategies and intervention research are needed to build more active lesson time in PE. Electronic supplementary material The online version of this article (doi:10.1186/s12966-017-0504-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jenna L Hollis
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia. .,School of Medicine and Public Health, University of Newcastle, Callaghan, 2308, Australia.
| | - Rachel Sutherland
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, 2308, Australia.,Hunter Medical Research Institute, Lambton, NSW, 2305, Australia
| | - Amanda J Williams
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, 2308, Australia.,Hunter Medical Research Institute, Lambton, NSW, 2305, Australia
| | - Elizabeth Campbell
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, 2308, Australia.,Hunter Medical Research Institute, Lambton, NSW, 2305, Australia
| | - Nicole Nathan
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, 2308, Australia.,Hunter Medical Research Institute, Lambton, NSW, 2305, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, 2308, Australia.,Hunter Medical Research Institute, Lambton, NSW, 2305, Australia
| | - Philip J Morgan
- Priority Research Centre in Physical Activity and Nutrition, School of Education, University of Newcastle, Callaghan, 2308, Australia
| | - David R Lubans
- Priority Research Centre in Physical Activity and Nutrition, School of Education, University of Newcastle, Callaghan, 2308, Australia
| | - Karen Gillham
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, 2308, Australia
| | - John Wiggers
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, 2308, Australia.,Hunter Medical Research Institute, Lambton, NSW, 2305, Australia
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13
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Springer AE, Evans AE. Assessing environmental assets for health promotion program planning: a practical framework for health promotion practitioners. Health Promot Perspect 2016; 6:111-8. [PMID: 27579254 PMCID: PMC5002877 DOI: 10.15171/hpp.2016.19] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 07/24/2016] [Indexed: 11/25/2022] Open
Abstract
Conducting a health needs assessment is an important if not essential first step for health promotion planning. This paper explores how health needs assessments may be further strengthened for health promotion planning via an assessment of environmental assets rooted in the multiple environments (policy, information, social and physical environments) that shape health and behavior. Guided by a behavioral-ecological perspective- one that seeks to identify environmental assets that can influence health behavior, and an implementation science perspective- one that seeks to interweave health promotion strategies into existing environmental assets, we present a basic framework for assessing environmental assets and review examples from the literature to illustrate the incorporation of environmental assets into health program design. Health promotion practitioners and researchers implicitly identify and apply environmental assets in the design and implementation of health promotion interventions;this paper provides foundation for greater intentionality in assessing environmental assets for health promotion planning.
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Affiliation(s)
- Andrew E Springer
- Assistant Professor of Health Promotion and Behavioral Sciences, Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston School of Public Health, Austin, TX, USA
| | - Alexandra E Evans
- Associate Professor of Health Promotion and Behavioral Sciences, Michael & Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston School of Public Health, Austin, TX, USA
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14
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Gray HL, Koch PA, Contento IR, Bandelli LN, Ang IYH, Di Noia J. Validity and Reliability of Behavior and Theory-Based Psychosocial Determinants Measures, Using Audience Response System Technology in Urban Upper-Elementary Schoolchildren. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2016; 48:437-452.e1. [PMID: 27142929 DOI: 10.1016/j.jneb.2016.03.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 03/24/2016] [Accepted: 03/29/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To examine the validity and reliability of a questionnaire administered with an audience response system (ARS). DESIGN Cross-sectional study. SETTING Two New York City public elementary schools. PARTICIPANTS Fourth- and fifth-grade students. MAIN OUTCOME MEASURES A Food, Health, and Choices questionnaire (FHC-Q) assessed energy balance-related behaviors (EBRBs) including intake of fruits and vegetables, sugar-sweetened beverages, processed packaged snacks, and fast food; physical activity; recreational screen time; and associated psychosocial determinants (≥ 3 questions/outcome scale). Previously validated reference instruments were used for relative validation. The ARS format was compared with a paper-and-pencil format. All measures were administered in a classroom setting. ANALYSIS Pearson correlation coefficients between the reference instruments and the FHC-Q were calculated. Internal consistency reliabilities were evaluated with Cronbach α. Spearman rank correlation, intra-class correlation, and percent agreement were used for test-retest reliability between paper-and-pencil and ARS, and between 2 ARS FHC-Q administrations. RESULTS Correlations for EBRBs with reference instruments ranged from 0.38 to 0.61 (P < .01). Cronbach α ranged from .77 to .92 for EBRBs and .74 to .90 for psychosocial determinants. Test-retest reliability correlations ranged from 0.36 to 0.87 (P < .001). Agreement for knowledge questions ranged from 69.8% to 84.8%. CONCLUSIONS AND IMPLICATIONS The ARS FHC-Q has acceptable validity and reliability for collecting data on EBRBs and associated psychosocial determinants for upper-elementary students.
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Affiliation(s)
- Heewon Lee Gray
- Department of Health and Behavior Studies, Teachers College Columbia University, New York, NY.
| | - Pamela A Koch
- Department of Health and Behavior Studies, Teachers College Columbia University, New York, NY
| | - Isobel R Contento
- Department of Health and Behavior Studies, Teachers College Columbia University, New York, NY
| | | | - Ian Yi Han Ang
- Department of Health and Behavior Studies, Teachers College Columbia University, New York, NY
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15
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Springer AE, Li L, Ranjit N, Delk J, Mehta K, Kelder SH. School-level economic disadvantage and obesity in middle school children in central Texas, USA: a cross-sectional study. Int J Behav Nutr Phys Act 2015; 12 Suppl 1:S8. [PMID: 26222099 PMCID: PMC4518903 DOI: 10.1186/1479-5868-12-s1-s8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Although children of lower socio-economic status (SES) in the United States have generally been found to be at greater risk for obesity, the SES-obesity association varies when stratified by racial/ethnic groups-with no consistent association found for African American and Hispanic children. Research on contextual and setting-related factors may provide further insights into ethnic and SES disparities in obesity. We examined whether obesity levels among central Texas 8th grade students (n=2682) vary by school-level economic disadvantage across individual-level family SES and racial/ethnicity groups. As a secondary aim, we compared the association of school-level economic disadvantage and obesity by language spoken with parents (English or Spanish) among Hispanic students. METHODS Multilevel regression models stratified by family SES and ethnicity were run using cross-sectional baseline data from five school districts participating in the Central Texas CATCH Middle School project. For family SES, independent multi-level logistic regression models were run for total sample and by gender for each family SES stratum (poor/near poor/just getting by, living comfortably, and very well off), adjusting for age, ethnicity, and gender. Similarly, multi-level regression models were run by race/ethnic group (African American, Hispanic, and White), adjusting for age, family SES, and gender. RESULTS Students attending highly economically disadvantaged (ED) schools were between 1.7 (95% CI: 1.1-2.6) and 2.4 (95% CI: 1.2-4.8) times more likely to be obese as students attending low ED schools across family SES groups (p<.05). African American (OR(Adj) =3.4, 95% CI: 1.1-11.4), Hispanic (OR(Adj)=1.8, 95% CI 1.1-3.0) and White (OR(Adj)=3.8, 95% CI: 1.6-8.9) students attending high ED schools were more likely to be obese as counterparts at low ED schools (p<.05). Gender-stratified findings were similar to findings for total sample, although fewer results reached significance. While no obesity differences across school ED categories were found for Hispanic Spanish-speaking students, Hispanic English-speaking students (HES) attending high ED schools were 2.4 times more likely to be obese as HES students at low ED schools (p=.003). CONCLUSION Findings support the need to prioritize economically disadvantaged schools for obesity prevention efforts and support further exploration of school SES context in shaping children’s physical activity and dietary behaviors.
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Affiliation(s)
- Andrew E Springer
- Michael & Susan Dell Center for Advancement of Healthy Living, University of Texas School of Public Health-Austin Regional Campus, TX, USA
| | - Linlin Li
- Michael & Susan Dell Center for Advancement of Healthy Living, University of Texas School of Public Health-Austin Regional Campus, TX, USA
| | - Nalini Ranjit
- Michael & Susan Dell Center for Advancement of Healthy Living, University of Texas School of Public Health-Austin Regional Campus, TX, USA
| | - Joanne Delk
- Texas Department of State Health Services, Austin, TX, 78756, USA
| | - Kajal Mehta
- UT Southwestern Medical Center, Dallas, TX, USA
| | - Steven H Kelder
- Michael & Susan Dell Center for Advancement of Healthy Living, University of Texas School of Public Health-Austin Regional Campus, TX, USA
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16
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Ranjit N, Evans AE, Springer AE, Hoelscher DM, Kelder SH. Racial and ethnic differences in the home food environment explain disparities in dietary practices of middle school children in Texas. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2015; 47:53-60. [PMID: 25439762 DOI: 10.1016/j.jneb.2014.09.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 09/03/2014] [Accepted: 09/07/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To examine racial and ethnic differences among middle school children in the home food environment (HFE) and the extent to which associations of healthy and unhealthy eating with the HFE differ by race and ethnicity. DESIGN Cross-sectional secondary analyses of baseline data from Coordinated Approach to Child Health Middle School, a school-based intervention targeting obesity and obesogenic behaviors among middle school children in Austin, TX. PARTICIPANTS A total of 2,502 children (mean age, 13.9 years; 58% Hispanic, 28% white, and 14% black). VARIABLES MEASURED Availability and accessibility of healthy foods, and parental support of healthy eating, and family meals. Consumption of both healthy and unhealthy foods was examined. ANALYSIS Differences across racial and ethnic groups in aspects of HFE were estimated using linear regression. Models also examined racial and ethnic differences in consumption of healthy and unhealthy foods. If adjusting for HFE, such differences were accounted for. RESULTS White children had significantly better HFEs than Hispanic and black children with greater availability and accessibility of healthy foods (P < .001). Adjusting for a healthy HFE reduced disparities in consumption of healthy foods but not in consumption of unhealthy foods. CONCLUSIONS AND IMPLICATIONS Improved HFE may increase healthy eating among ethnic minorities but is unlikely to reduce unhealthy eating.
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Affiliation(s)
- Nalini Ranjit
- Michael and Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston School of Public Health, Austin Regional Campus, Austin, TX.
| | - Alexandra E Evans
- Michael and Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston School of Public Health, Austin Regional Campus, Austin, TX
| | - Andrew E Springer
- Michael and Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston School of Public Health, Austin Regional Campus, Austin, TX
| | - Deanna M Hoelscher
- Michael and Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston School of Public Health, Austin Regional Campus, Austin, TX
| | - Steve H Kelder
- Michael and Susan Dell Center for Healthy Living, University of Texas Health Science Center at Houston School of Public Health, Austin Regional Campus, Austin, TX
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Sutherland R, Campbell E, Lubans DR, Morgan PJ, Okely AD, Nathan N, Gillham K, Lecathelinais C, Wiggers J. Physical education in secondary schools located in low-income communities: Physical activity levels, lesson context and teacher interaction. J Sci Med Sport 2014; 19:135-41. [PMID: 25559053 DOI: 10.1016/j.jsams.2014.12.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 11/03/2014] [Accepted: 12/06/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Physical education (PE) plays an important role in contributing to students' physical activity (PA); however, moderate-to-vigorous PA (MVPA) within PE is lower than recommended. Little is known about the PA levels of students from disadvantaged schools within PE. This study aimed to describe: (i) the PA levels of students from disadvantaged secondary schools during PE lessons, (ii) the lesson context and teacher interactions occurring during PE, and (iii) the associations between teacher, school or PE lesson characteristics with student physical activity levels in PE. DESIGN Cross-sectional study of 100 Grade 7 PE lessons across 10 secondary schools. METHODS System for observing fitness instruction time (SOFIT) was used to assess student PA, lesson context, and teacher interaction. Teacher and school characteristics were collected via survey. Mean proportion of lesson time was used to describe PA, lesson context and teacher interaction. Associations between each outcome variable and each characteristic were examined using 2-sample t-tests, ANOVAs and linear regression. RESULTS Thirty-nine percent of PE lesson was spent in MVPA, and less than 10% spent in VA. Lessons in schools in urban areas included significantly more MVPA than rural areas (P=0.04). Male teachers and more experienced teachers conducted lessons with significantly more VA than female and less experienced teachers (P=0.04 and 0.02). MVPA was also higher in lessons conducted by more experienced teachers. CONCLUSIONS PA during PE lessons within disadvantaged secondary schools is below international recommendations. Male teachers, more experienced teachers and schools in urban regions teach more active lessons.
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Affiliation(s)
- Rachel Sutherland
- Hunter New England Population Health, Wallsend, Australia; School of Medicine and Public Health, University of Newcastle, Newcastle, Australia; Hunter Medical Research Institute, Newcastle, Australia.
| | - Elizabeth Campbell
- Hunter New England Population Health, Wallsend, Australia; School of Medicine and Public Health, University of Newcastle, Newcastle, Australia; Hunter Medical Research Institute, Newcastle, Australia
| | - David R Lubans
- Priority Research Centre in Physical Activity and Nutrition, School of Education, University of Newcastle, Newcastle, Australia
| | - Philip J Morgan
- Priority Research Centre in Physical Activity and Nutrition, School of Education, University of Newcastle, Newcastle, Australia
| | - Anthony D Okely
- Early Start Research Institute and School of Education, University of Wollongong, Wollongong, Australia
| | - Nicole Nathan
- Hunter New England Population Health, Wallsend, Australia; School of Medicine and Public Health, University of Newcastle, Newcastle, Australia; Hunter Medical Research Institute, Newcastle, Australia
| | - Karen Gillham
- Hunter New England Population Health, Wallsend, Australia; Hunter Medical Research Institute, Newcastle, Australia
| | - Christophe Lecathelinais
- Hunter New England Population Health, Wallsend, Australia; Hunter Medical Research Institute, Newcastle, Australia
| | - John Wiggers
- Hunter New England Population Health, Wallsend, Australia; School of Medicine and Public Health, University of Newcastle, Newcastle, Australia; Hunter Medical Research Institute, Newcastle, Australia
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18
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Delk J, Springer AE, Kelder SH, Grayless M. Promoting teacher adoption of physical activity breaks in the classroom: findings of the Central Texas CATCH Middle School Project. THE JOURNAL OF SCHOOL HEALTH 2014; 84:722-730. [PMID: 25274172 DOI: 10.1111/josh.12203] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 03/03/2014] [Accepted: 05/11/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND Research suggests that physical activity breaks (ABs) during class increase students' physical activity levels and provide an academic benefit. This study evaluates a 3-year intervention aimed at encouraging teacher AB use. METHODS Thirty central Texas middle schools were assigned to 1 of 3 conditions: training-only (Basic), training plus facilitator support (Basic Plus), and training/facilitator support and a social marketing campaign (Basic Plus SM). Teachers completed surveys at end of years 2 (N = 1039) and 3 (N = 831) to assess exposure to program, self-efficacy, and frequency of AB use. RESULTS At end of year 3, teachers in facilitator-supported conditions reported increased exposure, self-efficacy, and use compared to Basic condition. Only 43.2% of teachers in the Basic condition reported receiving training in ABs compared to 84.2% and 90.6% in the Basic Plus and Basic Plus SM conditions, respectively. Additionally, a greater percentage of teachers in the facilitator-support conditions reported conducting ABs weekly (Basic = 23.3%, Basic Plus = 34.4%, Basic Plus SM = 38.7%, at year 3; p < .001). CONCLUSIONS Despite perceived barriers, including fear that ABs will detract from instructional time, the intervention was successful in having a core group of teachers implement them weekly. More research is needed to increase the percentage of teachers implementing ABs regularly.
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Affiliation(s)
- Joanne Delk
- University of Texas School of Public Health, Austin Regional Campus, Michael & Susan Dell Center for Healthy Living, 1616 Guadalupe St. Suite 6.300, Austin, TX 78701.
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Zimmerman MA. Resiliency theory: a strengths-based approach to research and practice for adolescent health. HEALTH EDUCATION & BEHAVIOR 2014; 40:381-3. [PMID: 23863911 DOI: 10.1177/1090198113493782] [Citation(s) in RCA: 173] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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