Effects of the Active Kids voucher program on children and adolescents' physical activity: a natural experiment evaluating a state-wide intervention

Higher Family Affluence is Associated With Multi-Sport Participation Among Irish Youth

The impact of early single sport participation among young people has received much attention, with both sport leaders and pediatricians advocating multi-sport participation at least until early adolescence. In this study we explored the association between family socioeconomic status and level of Irish youth specialization in sport. We relied on data from the Children's Sport Participation and Physical Activity (CSPPA) study, involving a representative sample of 3499 Irish children and adolescents aged 10-15 years. We analyzed data from questions related to the number of sports played, the number of days per week the youth were engaged in sport, and family affluence (as a proxy measure for socioeconomic status). Youth sport specialization before 12 years of age (males 5.7%; females 4.2%) and even between 13-15 years of age (males, 7.8%; females, 5.8%) was uncommon. However, lower levels of specialization were associated with higher socioeconomic status in that more children with high family affluence participated in multiple sports. Careful consideration should be given to whether low socioeconomic status may act as a barrier to participation in multiple sports.

Impact and recovery of the COVID-19 pandemic on weight status of children and adolescents

Recent evidence suggests the immediate effects of the COVID-19 lockdowns and restrictions have resulted in increased weight in children and adolescents. However, the longer-term effects have not been assessed. The aim of this study was to examine the impact and longer-term effects of the COVID-19 pandemic on BMI and weight status of children and adolescents. This study used routinely collected clinical data from the Sydney Children's Hospitals Network, comprising two socio-demographically diverse children's hospitals in New South Wales, Australia from 2018 to 2021. Of 245 836 individuals ≤18-years assessed, mean BMI percentile increased from 58.7 (SD 31.6) pre-COVID-19 to 59.8 (SD 31.7) (p < .05) post-restrictions and overweight/obesity increased by 5.5% (obesity alone 6.3%), predominantly in children <12-years and from lower socioeconomic backgrounds. The trend in BMI percentile was steady pre-COVID-19 (β = -0.03 [95% CI -0.07, 0.01]), peaked immediately following COVID-19 restrictions (β = 1.28 [95% CI 0.24, 2.32]) and returned to pre-pandemic levels over ensuing 21 months (β = -0.04 [95% CI -0.13, 0.04]). Routine anthropometric measurement facilitates ongoing monitoring and evaluation of the weight status of children and adolescents, helping to identify those at-risk. Despite initial BMI and weight increases among children and adolescents, longer-term follow-up highlighted a return to pre-pandemic rates, possibly attributed to state-wide policies aimed at reducing childhood obesity.

Evaluation of the First Lap learn to swim voucher programme: protocol

INTRODUCTION

Swimming skills are an evidence-based component of drowning prevention. However, in Australia, many children miss out on learn to swim education. Voucher programmes may reduce swimming lesson cost and increase participation, especially among priority populations. The First Lap voucher programme provides two New South Wales state government-funded $100 vouchers for parents/carers of preschool children to contribute to swimming lesson costs. This evaluation aims to determine the effectiveness of the programme in meeting objectives of increasing preschool-aged children participating in learn to swim programmes and building parent/carer knowledge and awareness of the importance of preschool-aged children learning to swim.

METHODS AND ANALYSIS

A programme logic model was developed to explain the inputs, activities and intended outputs, and outcomes, which guided this mixed-methods evaluation design of quantitative and qualitative analysis within an impact/outcome evaluation. Baseline sociodemographic registration data will be provided by the parent/carer of each child participant and linked to swim school provider data on voucher redemption. Data will be collected on voucher use, knowledge, and attitudes to swimming lessons at registration and across two surveys. An economic evaluation will assess programme cost-effectiveness.

CONCLUSION

This evaluation will determine impacts on participation rates in learn to swim programmes, particularly within priority populations. It will examine whether the programme has influenced attitudes and motivations of parents and carers toward learn to swim programmes and water safety, whether the programme has impacted or enhanced the ability of the aquatics sector to deliver learn to swim programmes and assess its cost-effectiveness.

"It Goes Hand in Hand with Us Trying to Get More Kids to Play" Stakeholder Experiences in a Sport and Active Recreation Voucher Program

Vouchers that reduce the cost of sport and active recreation participation have been shown to increase children's and adolescent's physical activity levels. Yet, the influence of government-led voucher programs on the capacity of sport and active recreation organisations is unclear. This qualitative study explored the experiences of stakeholders in the sport and recreation sector that were engaged in implementing the New South Wales (NSW) Government's Active Kids voucher program in Australia. Semi-structured interviews were conducted with 29 sport and active recreation providers. Interview transcriptions were analysed by a multidisciplinary team using the Framework method. Overall, participants reported that the Active Kids voucher program was an acceptable intervention to address the cost barrier to participation for children and adolescents. Three main steps influenced the capacity of organisations to deliver their sport and recreation programs and the voucher program: (1) Implementation priming-alignment of the intervention aims with stakeholder priorities and early information sharing, (2) Administrative ease-enhanced technology use and establishment of simple procedures, and (3) Innovation impacts-enablement of staff and volunteers to address barriers to participation for their participants. Future voucher programs should include strategies to enhance the capacity of sport and active recreation organisations to meet program guidelines and increase innovation.

Fair play? Participation equity in organised sport and physical activity among children and adolescents in high income countries: a systematic review and meta-analysis

BACKGROUND

Physical activity and sport have numerous health benefits and participation is thought to be lower in disadvantaged children and adolescents. However, evidence for the disparity in physical activity is inconsistent, has not been reviewed recently, and for sport has never been synthesised. Our aim was to systematically review, and combine via meta-analyses, evidence of the socioeconomic disparities in physical activity and sport participation in children and adolescents in high income countries.

METHODS

We conducted searches of five electronic databases using physical activity, sport, and socioeconomic disparity related terms. Two independent reviewers assessed 21,342 articles for peer-reviewed original research, published in English that assessed socioeconomic disparities in physical activity and sport participation in children and adolescents. We combined evidence from eligible studies using a structural equation modelling approach to multilevel meta-analysis.

RESULTS

From the 104 eligible studies, we meta-analysed 163 effect sizes. Overall, children and adolescents living in higher socioeconomic status households were more likely to participate in sport (OR: 1.87, 95% CIs 1.38, 2.36) and participated for a longer duration (d = 0.24, 95% CIs 0.12, 0.35). The socioeconomic disparity in the duration of sport participation was greater in children (d = 0.28, 95% CIs 0.15, 0.41) compared with adolescents (d = 0.13, 95% CIs - 0.03, 0.30). Overall, children and adolescents living in higher socioeconomic status households were more likely to meet physical activity guidelines (OR: 1.21, 95% CIs 1.09, 1.33) and participated for a longer duration (d = 0.08, 95% CIs 0.02, 0.14). The socioeconomic disparity in the duration of total physical activity between low and high socioeconomic status households was greater in children (d = 0.13, 95% CIs 0.04, 0.21) compared with adolescents (d = 0.05, 95% CIs - 0.05, 0.15). There was no significant disparity in leisure time physical activity (d = 0.13, 95% CIs - 0.06, 0.32).

CONCLUSIONS

There was evidence of socioeconomic disparities in sport participation and total physical activity participation among children and adolescents. Socioeconomic differences were greater in sport compared to total physical activity and greater in children compared with adolescents. These findings highlight the need importance of targeting sport programs according to socio-economic gradients, to reduce inequities in access and opportunity to organised sport.

Physical Activity Knowledge, Attitude, and Behaviours Among Adolescents in the Kingdom of Saudi Arabia Prior to and during COVID-19 Restrictions

BACKGROUND

The prevalence of childhood and adolescent obesity has increased dramatically and poses a major public health threat globally. In the Kingdom of Saudi Arabia (KSA), the main cause of adolescent obesity is an increase in physical inactivity and unhealthy eating habits due to lifestyle changes. This study reports on factors associated with physical activity (PA) prior to and during the coronavirus disease of 2019 (COVID-19) among middle school students in Jeddah, KSA.

METHOD

A cross-sectional online survey was conducted in Jeddah, KSA among 1500 middle school students aged 11 to 15 years. Sociodemographic characteristics; PA knowledge, attitude, and behaviours; and information about the impact of COVID-19 on PA were collected. Knowledge, attitude, and behaviours of PA before and during COVID-19 restrictions and between gender were compared. Regression analyses were conducted to assess the determinants of PA.

RESULTS

Female students were significantly more likely to report better knowledge of PA compared to males (p < 0.001). However, males were significantly more likely to participate in PA compared to females (p < 0.001). Approximately 60% of students reported their PA decreased during COVID-19 isolations. Most students did not participate in the recommended levels of daily PA during COVID-19 lockdowns and school closures. After adjusting for demographics, knowledge, and attitude, students who did not usually participate in school sports (p=0.017) and as members of clubs (p=0.002) were less likely to be active during COVID-19 lockdown.

CONCLUSIONS

Efforts to enhance PA should be implemented through coordinated school and community-based programs to achieve the recommended PA among adolescents at home and in schools. Policy to ensure students receive PA opportunities at school is recommended.

Community support for policy interventions targeting unhealthy food environments in public institutions

ISSUE ADDRESSED

Understanding community support for obesity prevention policy is important for developing effective preventive health action. This study assessed support for a range of obesity prevention interventions, including food environment policies designed to improve healthy food and drink availability and promotion within public institutions.

METHODS

An online cross-sectional survey was completed by 2,006 NSW adults. Questions explored attitudes and beliefs about obesity, the importance of government-led prevention and support for eight obesity prevention interventions. Regression analyses examined associations between intervention support and sociodemographic, attitudinal, and behavioral characteristics.

RESULTS

Most respondents (80%) believed obesity was a large problem and that poor individual choices (86%) and the widespread availability of unhealthy food and drink (78%) contributed to the issue. There was moderate to high support for most (n=7) initiatives. Support for food environment policies was highest for schools (76-82%) and hospitals (67-79%). Supporters and opponents rationalised opinions based on perceived effectiveness, the government's role and cost benefits. Opponents were a minority, but principles of autonomy were predominant. Attributing obesity to environment-related factors, and personal lower SSB consumption strongly predicted support.

CONCLUSION

There is significant recognition of the obesity issue and strong support for policies designed to improve the availability and promotion of healthy food and drink in public institutions, particularly in schools and hospitals. SO WHAT?: Substantial community support for healthy food environment policies in schools and hospitals warrants continued implementation in NSW. This may foster further acceptance for wider implementation. Our findings could inform the framing of policy advocacy messages.

Enabling Better Physical Activity and Screen Time Behaviours for Adolescents from Middle Eastern Backgrounds: Semi-Structured Interviews with Parents

The unrelenting obesity pandemic in Middle Eastern (ME) adolescents living in Australia warrants culturally responsive and locally engineered interventions. Given the influence of parents on the lifestyle behaviours of adolescents, this qualitative study aimed to capture the opinions of ME parents on the barriers and enablers to sufficient physical activity and limiting screen time behaviours in adolescents. Semi-structured interviews were conducted with 26 ME parents (female) aged 35–59 years old, most of whom resided in lower socioeconomic areas (n = 19). A reflexive thematic analysis using the Theoretical Domains Framework and the Capability, Opportunity, Motivation-Behaviour model was performed for coding. Parents voiced confidence in their knowledge of the importance of physical activity and limiting screen time but were less optimistic in their ability to enable change in behaviours, especially for older adolescents without outside support. Despite adolescents having the necessary skills to engage in a wide array of sports, the parents admitted deep fears regarding the safety of the social environment and restricted their children’s independent mobility. Gender differences were noted, with parents reporting older girls expressing disinterest in sports and having limited physical opportunities to participate in sports at school. It may be that a community-based participatory framework is needed to improve physical activity opportunities and to address specific physical, social, and cultural barriers.