Showing papers in "International Journal of Behavioral Nutrition and Physical Activity in 2009"

The International Prevalence Study on Physical Activity: results from 20 countries

Abstract: Physical activity (PA) is one of the most important factors for improving population health, but no standardised systems exist for international surveillance. The International Physical Activity Questionnaire (IPAQ) was developed for international surveillance. The purpose of this study was a comparative international study of population physical activity prevalence across 20 countries. Between 2002–2004, a standardised protocol using IPAQ was used to assess PA participation in 20 countries [total N = 52,746, aged 18–65 years]. The median survey response rate was 61%. Physical activity levels were categorised as "low", "moderate" and "high". Age-adjusted prevalence estimates are presented by sex. The prevalence of "high PA" varied from 21–63%; in eight countries high PA was reported for over half of the adult population. The prevalence of "low PA" varied from 9% to 43%. Males more frequently reported high PA than females in 17 of 20 countries. The prevalence of low PA ranged from 7–41% among males, and 6–49% among females. Gender differences were noted, especially for younger adults, with males more active than females in most countries. Markedly lower physical activity prevalence (10% difference) with increasing age was noted in 11 of 19 countries for males, but only in three countries for women. The ways populations accumulated PA differed, with some reporting mostly vigorous intensity activities and others mostly walking. This study demonstrated the feasibility of international PA surveillance, and showed that IPAQ is an acceptable surveillance instrument, at least within countries. If assessment methods are used consistently over time, trend data will inform countries about the success of their efforts to promote physical activity.

Determinants of participation in worksite health promotion programmes: a systematic review

Abstract: The workplace has been identified as a promising setting for health promotion, and many worksite health promotion programmes have been implemented in the past years. Research has mainly focused on the effectiveness of these interventions. For implementation of interventions at a large scale however, information about (determinants of) participation in these programmes is essential. This systematic review investigates initial participation in worksite health promotion programmes, the underlying determinants of participation, and programme characteristics influencing participation levels. Studies on characteristics of participants and non-participants in worksite health promotion programmes aimed at physical activity and/or nutrition published from 1988 to 2007 were identified through a structured search in PubMed and Web of Science. Studies were included if a primary preventive worksite health promotion programme on PA and/or nutrition was described, and if quantitative information was present on determinants of participation. In total, 23 studies were included with 10 studies on educational or counselling programmes, 6 fitness centre interventions, and 7 studies examining determinants of participation in multi-component programmes. Participation levels varied from 10% to 64%, with a median of 33% (95% CI 25–42%). In general, female workers had a higher participation than men (OR = 1.67; 95% CI 1.25–2.27]), but this difference was not observed for interventions consisting of access to fitness centre programmes. For the other demographic, health- and work-related characteristics no consistent effect on participation was found. Pooling of studies showed a higher participation level when an incentive was offered, when the programme consisted of multiple components, or when the programme was aimed at multiple behaviours. In this systematic review, participation levels in health promotion interventions at the workplace were typically below 50%. Few studies evaluated the influence of health, lifestyle and work-related factors on participation, which hampers the insight in the underlying determinants of initial participation in worksite health promotion. Nevertheless, the present review does provide some strategies that can be adopted in order to increase participation levels. In addition, the review highlights that further insight is essential to develop intervention programmes with the ability to reach many employees, including those who need it most and to increase the generalizability across all workers.

Socioeconomic differences in lack of recreational walking among older adults: the role of neighbourhood and individual factors

Abstract: People with a low socioeconomic status (SES) are more likely to be physically inactive than their higher status counterparts, however, the mechanisms underlying this socioeconomic gradient in physical inactivity remain largely unknown. Our aims were (1) to investigate socioeconomic differences in recreational walking among older adults and (2) to examine to what extent neighbourhood perceptions and individual cognitions regarding regular physical activity can explain these differences. Data were obtained by a large-scale postal survey among a stratified sample of older adults (age 55–75 years) (N = 1994), residing in 147 neighbourhoods of Eindhoven and surrounding areas, in the Netherlands. Multilevel logistic regression analyses assessed associations between SES (i.e. education and income), perceptions of the social and physical neighbourhood environment, measures of individual cognitions derived from the Theory of Planned Behaviour (e.g. attitude, perceived behaviour control), and recreational walking for ≥10 minutes/week (no vs. yes). Participants in the lowest educational group (OR 1.67 (95% CI, 1.18–2.35)) and lowest income group (OR 1.40 (95% CI, 0.98–2.01)) were more likely to report no recreational walking than their higher status counterparts. The association between SES and recreational walking attenuated when neighbourhood aesthetics was included in the model, and largely reduced when individual cognitions were added to the model (with largest effects of attitude, and intention regarding regular physical activity). The assiation between poor neighbourhood aesthetics and no recreational walking attenuated to (borderline) insignificance when individual cognitions were taken into account. Both neighbourhood aesthetics and individual cognitions regarding physical activity contributed to the explanation of socioeconomic differences in no recreational walking. Neighbourhood aesthetics may explain the association between SES and recreational walking largely via individual cognitions towards physical activity. Intervention and policy strategies to reduce socioeconomic differences in lack of recreational walking among older adults would be most effective if they intervene on both neighbourhood perceptions as well as individual cognitions.

Disagreement in physical activity assessed by accelerometer and self-report in subgroups of age, gender, education and weight status

Abstract: The purpose of this study is to compare self-reported time (by questionnaire) and objectively measured time (by accelerometer) spent on physical activity at moderate (MPA) and vigorous intensity (VPA) in subgroups of age, gender, education and weight status. In total, 236 adolescents (aged 12–18) and 301 adults (aged 22–40), completed the questionnaire and wore an accelerometer for two weeks. Adolescents reported exceptionally more time spent on MPA (mean difference 596 ± 704 min/wk) and VPA (mean difference 178 ± 315 min/wk) than was assessed objectively by the accelerometer. Based on the questionnaire, high educated adolescents spent more time on MPA (205 min/wk, p = 0.002) and VPA (120 min/wk, p = 0.01) than low educated adolescents, but according to the accelerometer they spent less time on MPA (149 min/wk, p = 0.001) and VPA (47 min/wk, p = 0.001). Among adults there was moderate agreement between self-reported time and objectively measured time spent on MPA, but in general the reported time spent on MPA (mean difference 107 ± 334 min/wk) and VPA (mean difference 169 ± 250 min/wk) exceeded the time measured with the accelerometer. Overweight adults reported significantly more VPA (57 min/wk, p = 0.04) than normal weight adults, but this was not confirmed by the accelerometer data. We observed large differences in time spent on MPA and VPA measured by questionnaire and accelerometer in adolescents but reasonably good agreement in adults. Differences between methods varied by gender, education and weight status. This finding raises serious questions about the use of questionnaires to quantify MPA and VPA in adolescents. There is a clear need in advanced valid assessments of PA in adolescents. ISRCTN93896459

Portion size: review and framework for interventions

Abstract: The prevalence of overweight and obesity has increased. A strong environmental factor contributing to the obesity epidemic is food portion size. This review of studies into the effects of portion size on energy intake shows that increased food portion sizes lead to increased energy intake levels. Important mechanisms explaining why larger portions are attractive and lead to higher intake levels are value for money and portion distortion. This review also shows that few intervention studies aiming to reverse the negative influence of portion size have been conducted thus far, and the ones that have been conducted show mixed effects. More intervention studies targeted at portion size are urgently needed. Opportunities for further interventions are identified and a framework for portion size interventions is proposed. Opportunities for intervention include those targeted at the individual as well as those targeted at the physical, economic, political and socio-cultural environment.

Three factor eating questionnaire-R18 as a measure of cognitive restraint, uncontrolled eating and emotional eating in a sample of young Finnish females

Abstract: The aim of the study was to examine the construct validity of the Three-Factor Eating Questionnaire -R18 (TFEQ-R18), a measure of eating behaviour, and to evaluate cognitive restraint, uncontrolled eating and emotional eating in a sample of adolescent and young adult females of different weights. Subjects were 2 997 females, aged 17 to 20 years, who participated in a phase III human papillomavirus vaccination trial in Finland in 2004 – 2009. Self-administered questionnaires and weight and height measurements were used. The factor structure of the TFEQ-R18 was verified by factor analysis. Connections between measured eating behaviour and Body Mass Index (BMI) were tested using analysis of variance. The original factor structure of the TFEQ-R18 was replicated: six of the eighteen items measured cognitive restraint, nine measured uncontrolled eating, and three measured emotional eating. On average, higher BMI was associated with higher levels of cognitive restraint (p < 0.001) and emotional eating (p < 0.001), but not with uncontrolled eating. Structural validity of the TFEQ-R18 was good in this sample of young Finnish females with a varying range of body weights. Use of the instrument as a measure of eating behaviour was thus corroborated. Connections of restrained and emotional eating with BMI were in accordance with previous findings from young females.

Global positioning system: a new opportunity in physical activity measurement.

Abstract: Accurate measurement of physical activity is a pre-requisite to monitor population physical activity levels and design effective interventions. Global Positioning System (GPS) technology offers potential to improve the measurement of physical activity. This paper 1) reviews the extant literature on the application of GPS to monitor human movement, with a particular emphasis on free-living physical activity, 2) discusses issues associated with GPS use, and 3) provides recommendations for future research. Overall findings show that GPS is a useful tool to augment our understanding of physical activity by providing the context (location) of the activity and used together with Geographical Information Systems can provide some insight into how people interact with the environment. However, no studies have shown that GPS alone is a reliable and valid measure of physical activity.

Reproducibility and comparative validity of a food frequency questionnaire for Australian children and adolescents

Abstract: Dietary intake during childhood and adolescence is of increasing interest due to its influence on adult health, particularly obesity, cardiovascular disease and diabetes. There is a need to develop and validate dietary assessment methods suitable for large epidemiologic studies of children and adolescents. Limited large scale dietary studies of youth have been undertaken in Australia, due partly to the lack of a suitable dietary intake tool. A self-administered, semi-quantitative food-frequency questionnaire (FFQ), the 'Australian Child and Adolescent Eating Survey' (ACAES), was developed for youth aged 9-16 years. This study evaluated reproducibility and comparative validity of the ACAES FFQ using assisted food records (FRs) as the reference method. The ACAES FFQ was completed twice (FFQ1 and FFQ2) at an interval of 5 months, along with four one-day assisted FRs. Validity was evaluated by comparing the average of the FRs with FFQ2 (n = 113) as well as with the average of FFQ1 and FFQ2 (n = 101). Reproducibility was evaluated by comparing FFQ1 and FFQ2 (n = 101). The two methods were compared using correlations, Kappa statistics and Bland-Altman plots. Correlation coefficients for comparative validity ranged from 0.03 for retinol to 0.56 for magnesium for transformed, energy-adjusted, deattenuated nutrient data, with correlation coefficients greater than 0.40 for total fat, saturated fat, monounsaturated fat, carbohydrate, sugars, riboflavin, vitamin C, folate, beta-carotene, magnesium, calcium and iron. Correlation coefficients for reproducibility ranged from 0.18 for vitamin A to 0.50 for calcium for transformed, energy-adjusted, deattenuated nutrient data. The ACAES FFQ ranked individuals reasonably accurately, with the comparative validity analysis showing that over 50% of participants were classified within one quintile for all nutrients, with only a small percentage grossly misclassified (0-7%). The ACAES FFQ is the first child and adolescent specific FFQ available for ranking the dietary intakes of Australian children and adolescents for a range of nutrients in epidemiologic research and public health interventions.

Cross-validation of the factorial structure of the Neighborhood Environment Walkability Scale (NEWS) and its abbreviated form (NEWS-A)

Abstract: The Neighborhood Environment Walkability Scale (NEWS) and its abbreviated form (NEWS-A) assess perceived environmental attributes believed to influence physical activity. A multilevel confirmatory factor analysis (MCFA) conducted on a sample from Seattle, WA showed that, at the respondent level, the factor-analyzable items of the NEWS and NEWS-A measured 11 and 10 constructs of perceived neighborhood environment, respectively. At the census blockgroup (used by the US Census Bureau as a subunit of census tracts) level, the MCFA yielded five factors for both NEWS and NEWS-A. The aim of this study was to cross-validate the individual- and blockgroup-level measurement models of the NEWS and NEWS-A in a geographical location and population different from those used in the original validation study. A sample of 912 adults was recruited from 16 selected neighborhoods (116 census blockgroups) in the Baltimore, MD region. Neighborhoods were stratified according to their socio-economic status and transport-related walkability level measured using Geographic Information Systems. Participants self-completed the NEWS. MCFA was used to cross-validate the individual- and blockgroup-level measurement models of the NEWS and NEWS-A. The data provided sufficient support for the factorial validity of the original individual-level measurement models, which consisted of 11 (NEWS) and 10 (NEWS-A) correlated factors. The original blockgroup-level measurement model of the NEWS and NEWS-A showed poor fit to the data and required substantial modifications. These included the combining of aspects of building aesthetics with safety from crime into one factor; the separation of natural aesthetics and building aesthetics into two factors; and for the NEWS-A, the separation of presence of sidewalks/walking routes from other infrastructure for walking. This study provided support for the generalizability of the individual-level measurement models of the NEWS and NEWS-A to different urban geographical locations in the USA. It is recommended that the NEWS and NEWS-A be scored according to their individual-level measurement models, which are relatively stable and correspond to constructs commonly used in the urban planning and transportation fields. However, prior to using these instruments in international and multi-cultural studies, further validation work across diverse non-English speaking countries and populations is needed.

Psychosocial correlates of eating behavior in children and adolescents: a review.

Abstract: Understanding the correlates of dietary intake is necessary in order to effectively promote healthy dietary behavior among children and adolescents. A literature review was conducted on the correlates of the following categories of dietary intake in children and adolescents: Fruit, Juice and Vegetable Consumption, Fat in Diet, Total Energy Intake, Sugar Snacking, Sweetened Beverage Consumption, Dietary Fiber, Other Healthy Dietary Consumption, and Other Less Healthy Dietary Consumption in children and adolescents. Cross-sectional and prospective studies were identified from PubMed, PsycINFO and PsycArticles by using a combination of search terms. Quantitative research examining determinants of dietary intake among children and adolescents aged 3–18 years were included. The selection and review process yielded information on country, study design, population, instrument used for measuring intake, and quality of research study. Seventy-seven articles were included. Many potential correlates have been studied among children and adolescents. However, for many hypothesized correlates substantial evidence is lacking due to a dearth of research. The correlates best supported by the literature are: perceived modeling, dietary intentions, norms, liking and preferences. Perceived modeling and dietary intentions have the most consistent and positive associations with eating behavior. Norms, liking, and preferences were also consistently and positively related to eating behavior in children and adolescents. Availability, knowledge, outcome expectations, self-efficacy and social support did not show consistent relationships across dietary outcomes. This review examined the correlates of various dietary intake; Fruit, Juice and Vegetable Consumption, Fat in Diet, Total Energy Intake, Sugar Snacking, Sweetened Beverage Consumption, Dietary Fiber, Other Healthy Dietary Consumption, and Other Less Healthy Dietary Consumption in cross-sectional and prospective studies for children and adolescents. The correlates most consistently supported by evidence were perceived modeling, dietary intentions, norms, liking and preferences. More prospective studies on the psychosocial determinants of eating behavior using broader theoretical perspectives should be examined in future research.

Associations among parental feeding styles and children's food intake in families with limited incomes.

Abstract: Background Although general parenting styles and restrictive parental feeding practices have been associated with children's weight status, few studies have examined the association between feeding styles and proximal outcomes such as children's food intake, especially in multi-ethnic families with limited incomes. The purpose of this study was to evaluate the association of parental feeding styles and young children's evening food intake in a multiethnic sample of families in Head Start.

Objectively measured physical activity of USA adults by sex, age, and racial/ethnic groups: a cross-sectional study

Abstract: Accelerometers were incorporated in the 2003–2004 National Health and Nutritional Examination Survey (NHANES) study cycle for objective assessment of physical activity. This is the first time that objective physical activity data are available on a nationally representative sample of U.S. residents. The use of accelerometers allows researchers to measure total physical activity, including light intensity and unstructured activities, which may be a better predictor of health outcomes than structured activity alone. The aim of this study was to examine objectively determined physical activity levels by sex, age and racial/ethnic groups in a national sample of U.S. adults. Data were obtained from the 2003–2004 NHANES, a cross-sectional study of a complex, multistage probability sample of the U.S. population. Physical activity was assessed with the Actigraph AM-7164 accelerometer for seven days following an examination. 2,688 U.S. adults with valid accelerometer data (i.e. at least four days with at least 10 hours of wear-time) were included in the analysis. Mean daily total physical activity counts, as well as counts accumulated in minutes of light, and moderate-vigorous intensity physical activity are presented by sex across age and racial/ethnic groups. Generalized linear modeling using the log link function was performed to compare physical activity in sex and racial/ethnic groups adjusting for age. Physical activity decreases with age for both men and women across all racial/ethnic groups with men being more active than women, with the exception of Hispanic women. Hispanic women are more active at middle age (40–59 years) compared to younger or older age and not significantly less active than men in middle or older age groups (i.e. age 40–59 or age 60 and older). Hispanic men accumulate more total and light intensity physical activity counts than their white and black counterparts for all age groups. Physical activity levels measured objectively by accelerometer demonstrated that Hispanic men are, in general, more active than their white and black counterparts. This appears to be in contrast to self-reported physical activity previously reported in the literature and identifies the need to use objective measures in situations where the contribution of light intensity and/or unstructured physical activity cannot be assumed homogenous across the populations of interest.

Independent mobility in relation to weekday and weekend physical activity in children aged 10-11 years: The PEACH Project.

Abstract: Children's independent mobility has fallen in recent years and may in part explain reported declines in physical activity in young people. This cross-sectional study investigated whether independent mobility in boys and girls was related to objectively measured physical activity. Thirteen hundred and seven 10–11 year old boys and girls from 23 schools in a large UK city took part. Measures included objectively recorded physical activity (accelerometer (Actigraph GT1M)), height (m) and weight (kg), a newly developed scale for local (Local-IM) and area independent mobility (Area-IM), minutes of daylight after school, level of neighbourhood deprivation and pubertal status. Boys had greater Local-IM, Area-IM and physical activity (average weekday and weekend counts per minute) compared to girls. In linear regression analyses (adjusting for minutes of daylight after school, neighbourhood deprivation, pubertal status and body mass index) higher scores for Local-IM and Area-IM were significantly (p < 0.01) related to higher levels of physical activity on weekdays for boys and girls. For weekend physical activity, only Local-IM in girls remained significant (p < 0.05) in the model. Independent mobility appears to be an important independent correlate of weekday physical activity for both boys and girls.

Environmental supportiveness for physical activity in English schoolchildren: a study using Global Positioning Systems

Abstract: There is increasing evidence that the environment plays a role in influencing physical activity in children and adults. As children have less autonomy in their behavioural choices, neighbourhood environment supportiveness may be an important determinant of their ability to be active. Yet we know rather little about the types of environment that children use for bouts of physical activity. This study uses accelerometery and global positioning system technologies to identify the charactieristics of environments being used for bouts of continuous moderate to vigorous physical activity (MVPA) in a sample of English schoolchildren. The study used a convenience sample of 100 children from SPEEDY (Sport, Physical activity and Eating behaviour: Environmental Determinants in Young people), a cohort of 2064 9–10 year-olds from Norfolk, England, recruited in 2007. Children wore an ActiGraph GT1M accelerometer and a Garmin Forerunner 205 GPS unit over four consecutive days. Accelerometery data points were matched to GPS locations and bouts (5 minutes or more) of MVPA were identified. Bout locations were overlaid with a detailed landcover dataset developed in a GIS to identify the types of environment supporting MVPA. Findings are presented using descriptive statistics. Boys were also more active than girls, spending an average of 20 (SD 23) versus 11 (SD 15) minutes per day in MVPA bouts. Children who spent more time outside the home were more active (p = 0.002), especially girls and children living in rural locations (both p < 0.05). Children tended to be active close to home, with 63% of all bout time occurring inside neighbourhoods, although boys (p = 0.05) and rural children (p = 0.01) were more likely to roam outside their neighbourhood. Amongst urban children, gardens (28% of bout time) and the street environment (20%) were the most commonly used environments for MVPA bouts. Amongst rural children farmland (22%) and grassland (18%) were most frequently used. The study has developed a new methodology for the identification of environments in which bouts of continuous physical activity are undertaken. The results highlight the importance of the provision of urban gardens and greenspaces, and the maintenance of safe street environments as places for children to be active.

Steps in the design, development and formative evaluation of obesity prevention-related behavior change trials

Abstract: Obesity prevention interventions through dietary and physical activity change have generally not been effective. Limitations on possible program effectiveness are herein identified at every step in the mediating variable model, a generic conceptual framework for understanding how interventions may promote behavior change. To minimize these problems, and thereby enhance likely intervention effectiveness, four sequential types of formative studies are proposed: targeted behavior validation, targeted mediator validation, intervention procedure validation, and pilot feasibility intervention. Implementing these studies would establish the relationships at each step in the mediating variable model, thereby maximizing the likelihood that an intervention would work and its effects would be detected. Building consensus among researchers, funding agencies, and journal editors on distinct intervention development studies should avoid identified limitations and move the field forward.

Takeaway food consumption and its associations with diet quality and abdominal obesity : a cross-sectional study of young adults

Abstract: Few studies have investigated the associations of takeaway food consumption with overall diet quality and abdominal obesity. Young adults are high consumers of takeaway food so we aimed to examine these associations in a national study of young Australian adults. A national sample of 1,277 men and 1,585 women aged 26–36 completed a self-administered questionnaire on demographic and lifestyle factors, a 127 item food frequency questionnaire, usual daily frequency of fruit and vegetable consumption and usual weekly frequency of takeaway food consumption. Dietary intake was compared with the dietary recommendations from the Australian Guide to Healthy Eating. Waist circumference was measured for 1,065 men and 1,129 women. Moderate abdominal obesity was defined as ≥ 94 cm for men and ≥ 80 cm for women. Prevalence ratios (PR) were calculated using log binomial regression. Takeaway food consumption was dichotomised, with once a week or less as the reference group. Consumption of takeaway food twice a week or more was reported by more men (37.9%) than women (17.7%, P < 0.001). Compared with those eating takeaway once a week or less, men eating takeaway twice a week or more were significantly more likely to be single, younger, current smokers and spend more time watching TV and sitting, whereas women were more likely to be in the workforce and spend more time watching TV and sitting. Participants eating takeaway food at least twice a week were less likely (P < 0.05) to meet the dietary recommendation for vegetables, fruit, dairy, extra foods, breads and cereals (men only), lean meat and alternatives (women only) and overall met significantly fewer dietary recommendations (P < 0.001). After adjusting for confounding variables (age, leisure time physical activity, TV viewing and employment status), consuming takeaway food twice a week or more was associated with a 31% higher prevalence of moderate abdominal obesity in men (PR: 1.31; 95% CI: 1.07, 1.61) and a 25% higher prevalence in women (PR: 1.25; 95% CI: 1.04, 1.50). Eating takeaway food twice a week or more was associated with poorer diet quality and a higher prevalence of moderate abdominal obesity in young men and women.

Computer-tailored physical activity behavior change interventions targeting adults: a systematic review

Abstract: Background Increasing physical activity is important in the promotion of better health. Computer-tailored behavior change programs have shown promise in changing lifestyle risk factors.

Development and preliminary validation of a Family Nutrition and Physical Activity (FNPA) screening tool

Abstract: Parents directly influence children's physical activity and nutrition behaviors and also dictate the physical and social environments that are available to their children. This paper summarizes the development of an easy to use screening tool (The Family Nutrition and Physical Activity (FNPA) Screening Tool) designed to assess family environmental and behavioral factors that may predispose a child to becoming overweight. The FNPA instrument was developed using constructs identified in a comprehensive evidence analysis conducted in collaboration with the American Dietetics Association. Two or three items were created for each of the ten constructs with evidence grades of II or higher. Parents of first grade students from a large urban school district (39 schools) were recruited to complete the FNPA screening tool and provide permission to link results to BMI data obtained from trained nurses in each school. A total of 1085 surveys were completed out of the available sample of 2189 children in the district. Factor analysis was conducted to examine the factor structure of the scale. Mixed model analyses were conducted on the composite FNPA score to determine if patterns in home environments and behaviors matched some of the expected socio-economic (SES) and ethnic patterns in BMI. Correlations among FNPA constructs and other main variables were computed to examine possible associations among the various factors. Finally, logistic regression was used to evaluate the construct validity of the FNPA scale. Factor analyses revealed the presence of a single factor and this unidimensional structure was supported by the correlation analyses. The correlations among constructs were consistently positive but the total score had higher correlations with child BMI than the other individual constructs. The FNPA scores followed expected demographic patterns with low income families reporting lower (less favorable) scores than moderate or high income families. Children with a total score in the lowest tertile (high risk family environment and behaviors) had an odds ratio (OR) of 1.7 (95% CI = 1.07 – 2.80) compared to children with a total score in the highest tertile (more favorable family environment and behaviors) but this effect was reduced when parent BMI was included as a covariate. The results support the contention that the FNPA tool captures important elements of the family environment and behaviors that relate to risk for child overweight.

Friendship groups and physical activity: qualitative findings on how physical activity is initiated and maintained among 10–11 year old children

Abstract: Many youth physical activity interventions have minimal effect. To design better interventions we need to understand more about the factors that influence youth activity. Application of self-determination theory to youth physical activity, particularly the relatedness and competence, might suggest that friends and friendship groups influence the initiation and maintenance of youth physical activity. In this study we examined this issue. Seventeen focus groups were conducted with 113, 10–11 year old children, from 11 primary schools in Bristol, UK. Focus groups examined: 1) the nature of children's friendship groups; 2) associations between physical activity and social group status; and 3) how friendship groups affect the initiation and maintenance of physical activity. All focus groups were audio-taped and transcribed verbatim. Data were analyzed using content analysis. Participants reported that there were three different types of friendship groups; School friends; Neighborhood friends; and Other Friends who were friends from organized activities or children of their parents' friends. Participants had multiple groups of friends and engaged in different activities with the different groups. Possessing several groups of friends was desirable as it kept the friendships fresh and interesting. Physical activity was perceived as a positive attribute and linked to social status among boys. Among girls the association between physical activity ability and social status was more complex, appearing to differ by the norms of the group to which participants belonged. Some participants reported that low activity ability could be perceived as desirable in some social groups. Participants reported that friends provide support to initiate physical activity via co-participation (i.e. engaging in activity together); modeling of being active; and providing verbal support to engage in activity. Enjoyment was the most important factor in maintaining activity participation with participating in activity with friends a key factor influencing enjoyment. Friendship groups affect both the initiation and maintenance of youth physical activity. Children belong to several groups and engage in different activities with different groups. Simple strategies that aim to promote physical activity via the different friendship groups could be an effective means of promoting increased physical activity in young people.

Patterns of adolescent physical activity and dietary behaviours

Abstract: The potential synergistic effects of multiple dietary and physical activity behaviours on the risk of chronic conditions and health outcomes is a key issue for public health. This study examined the prevalence and clustering patterns of multiple health behaviours among a sample of adolescents in the UK. Cross-sectional survey of 176 adolescents aged 12–16 years (49% boys). Adolescents wore accelerometers for seven days and completed a questionnaire assessing fruit, vegetable, and breakfast consumption. The prevalence of adolescents meeting the physical activity (≥ 60 minutes moderate-to-vigorous physical activity/day), fruit and vegetable (≥ 5 portions of FV per day) and breakfast recommendations (eating breakfast on ≥ 5 days per week), and clustering patterns of these health behaviours are described. Boys were more active than girls (p < 0.001) and younger adolescents were more active than older adolescents (p < 0.01). Boys ate breakfast on more days per week than girls (p < 0.01) and older adolescents ate more fruit and vegetables than younger adolescents (p < 0.01). Almost 54% of adolescents had multiple risk behaviours and only 6% achieved all three of the recommendations. Girls had significantly more risk factors than boys (p < 0.01). For adolescents with two risk behaviours, the most prevalent cluster was formed by not meeting the physical activity and fruit and vegetable recommendations. Many adolescents fail to meet multiple diet and physical activity recommendations, highlighting that physical activity and dietary behaviours do not occur in isolation. Future research should investigate how best to achieve multiple health behaviour change in adolescent boys and girls.

Time spent playing outdoors after school and its relationship with independent mobility: a cross-sectional survey of children aged 10-12 years in Sydney, Australia.

Abstract: Time spent outdoors is positively associated with physical activity and has been suggested as a proxy for physical activity of children. The role of children's independence in physical activity and time spent outdoors is less understood. This study aimed to assess how much time children spent playing outdoors after school, and to explore the relationship between outdoor play and independence among children aged 10–12 years. Children recorded how much time they spent playing outdoors or watching TV/videos or playing computer games after school using a five-day diary, and also reported whether they were allowed to walk on their own in their neighbourhood as an indicator of their independent mobility. Parents were surveyed on family demographics and perception of neighbourhood safety. The surveys were conducted in late 2006 as part of the Central Sydney Walk to School program which involved 1975 children and their parents from 24 primary schools. Factors associated with time spent playing outdoors were determined by logistic regression modelling. Thirty-seven per cent of children spent less than half an hour a day playing outdoors after school, and 43% spent more than 2 hours a day watching TV, videos or playing computer games. Forty-eight per cent of children were allowed to walk on their own near where they lived. Children's independent mobility was significantly associated with outdoor play after adjusting for other confounders. Compared with those who were never allowed to walk on their own near where they lived, students who were allowed to walk on their own were significantly more likely to spend more than half an hour a day playing outdoors after school with an adjusted odds ratio of 2.6, 95% CI 1.84–3.58, P < 0.001. The findings that a significant proportion of children spend less than half an hour a day playing outdoors after school and have excessive screen time have important implications for physical activity promotion and obesity prevention. The study also suggests that children's independent mobility should be considered in research and evaluation into children's play and physical activity. Environments that promote greater independent mobility in children may increase their physical activity levels and hence reduce their risk of overweight/obesity.

Effect of a school-based intervention to promote healthy lifestyles in 7-11 year old children.

Abstract: Physical inactivity is recognised as a public health concern within children and interventions to increase physical activity are needed. The purpose of this research was to evaluate the effect of a school-based healthy lifestyles intervention on physical activity, fruit and vegetable consumption, body composition, knowledge, and psychological variables. A non-randomised controlled study involving 8 primary schools (4 intervention, 4 control). Participants were 589 children aged 7–11 years. The intervention lasted 10 months and comprised a CD-rom learning and teaching resource for teachers; an interactive website for pupils, teachers and parents; two highlight physical activity events (1 mile school runs/walks); a local media campaign; and a summer activity wall planner and record. Primary outcome measures were objectively measured physical activity (pedometers and accelerometers) and fruit and vegetable consumption. Secondary outcomes included body mass index, waist circumference, estimated percent body fat, knowledge, psychological variables. Multi-level modelling was employed for the data analysis. Relative to children in control schools, those in intervention schools significantly increased their total time in moderate-to-vigorous physical activity (MVPA) (by 9 minutes/day vs a decrease of 10 minutes/day), their time in MVPA bouts lasting at least one minute (10 minutes/day increase vs no change) and increased daily steps (3059 steps per day increase vs 1527 steps per day increase). A similar pattern of results was seen in a subset of the least active participants at baseline. Older participants in intervention schools showed a significant slowing in the rate of increase in estimated percent body fat, BMI, and waist circumference. There were no differences between groups in fruit and vegetable intake. Extrinsic motivation decreased more in the intervention group. The intervention produced positive changes in physical activity levels and body composition. It appeared to have little or no effect on consumption of fruit and vegetables. Schools are a suitable setting for the promotion of healthy lifestyles although more work, particularly focussed on dietary change, is needed in a variety of schools and social settings.

Do walking strategies to increase physical activity reduce reported sitting in workplaces: a randomized control trial

Abstract: Background Interventions designed to increase workplace physical activity may not automatically reduce high volumes of sitting, a behaviour independently linked to chronic diseases such as obesity and type II diabetes. This study compared the impact two different walking strategies had on step counts and reported sitting times.

The environment and physical activity: The influence of psychosocial, perceived and built environmental factors

Abstract: This study sought to integrate perceived and built environmental and individual factors into the Theory of Planned Behavior (TPB) model to better understand adolescents' physical activity Participants (n = 110) aged 12 to 17 years (M = 146 ± 155) were recruited from two large metropolitan high schools in Auckland, New Zealand, were included in the analysis Participants completed measures of the revised TPB and the perceived environment Individual factors such as ethnicity and level of deprivation were also collected Geographical Information Systems (GIS) software was used to measure the physical environment (walkability, access to physical activity facilities) Physical activity was assessed using the ActiGraph accelerometer and the Physical Activity Questionnaire for Adolescents (PAQ-A) Data from the various sources were combined to develop an integrated model integrated for statistical analysis using structural equation modeling The TPB model variables (intention and perceived behavioral control) explained 43% of the variance of PAQ-A Unique and individual contributions were made by intention and PBC and home ownership of home equipment The model explained 13% of time spent in moderate and vigorous physical activity (Actigraph) Unique and individual contribution was made by intention Social cognitive variables were better predictors of both subjective and objective physical activity compared to perceived environmental and built environment factors Implications of these findings are discussed

Objective and perceived availability of physical activity opportunities: differences in associations with physical activity behavior among urban adolescents

Abstract: Background: This study examined the associations of the perceived and objective environment with adolescent engagement in sports activities and walking and cycling in leisure time. It also explored the degree of agreement between objective and perceived availability of physical activity (PA) facilities in neighborhoods. Methods: Cross-sectional data on physical activity, the perceived availability of physical activity opportunities (perceived physical environment) was assessed through a questionnaire and the objective availability of PA opportunities (objective physical environment) was obtained through GIS data. The final sample included 654 adolescents with a mean age of 14.1 (SD = 1.2) years. Results: Perceived availability of sports facilities and parks was significantly associated with engaging in sports (OR: 1.73; 95% CI: 1.16-2.56) and with walking and cycling in leisure time (OR: 1.66; 95% CI: 1.07-2.57) respectively. Agreement between objective and perceived environment was low to moderate with Kappa values ranging from -0.005 to 0.053. Conclusion: The perceived environment was the stronger correlate of PA behavior among adolescents. There were substantial differences between assessments of objective and perceived physical environment.

Correspondence of perceived vs. objective proximity to parks and their relationship to park-based physical activity.

Abstract: Parks are key environmental resources for encouraging population-level physical activity (PA). In measuring availability of parks, studies have employed both self-reported and objective indicators of proximity, with little correspondence observed between these two types of measures. However, little research has examined how the degree of correspondence between self-reported and objectively-measured distance to parks is influenced by individual, neighborhood, and park-related variables, or which type of measure is more strongly related to physical activity outcomes. We used data from 574 respondents who reported the distance to their closest park and compared this with objective measurements of proximity to the closest park. Both indicators were dichotomized as having or not having a park within 750 m. Audits of all park features within this distance were also conducted and other personal characteristics and neighborhood context variables (safety, connectedness, aesthetics) were gleaned from participants' survey responses. Participants also completed detailed seven-day PA log booklets from which measures of neighborhood-based and park-based PA were derived. Agreement was poor in that only 18% of respondents achieved a match between perceived and objective proximity to the closest park (kappa = 0.01). Agreement was higher among certain subgroups, especially those who reported engaging in at least some park-based PA. As well, respondents with a greater number of parks nearby, whose closest park had more features, and whose closest park contained a playground or wooded area were more likely to achieve a match. Having a ball diamond or soccer field in the closest park was negatively related to achieving a match between perceived and objective proximity. Finally, engaging in at least some park-based PA was not related to either perceived or objective proximity to a park, but was more likely when a match between and perceived and objective proximity occurred. Poor levels of correspondence were observed between self-reported and objective proximity to parks, but certain individual, neighborhood, and park variables increased the likelihood of a participant being aware of local parks. Future research should examine how people conceptualize parks and what urban and park planners can do to increase awareness and use of these community assets.

Family influences on children's physical activity and fruit and vegetable consumption

Abstract: Background There is evidence of a clustering of healthy dietary patterns and physical activity among young people and also of unhealthy behaviours. The identification of influences on children's health behaviors, particularly clustered health behaviors, at the time at which they develop is imperative for the design of interventions. This study examines associations between parental modelling and support and children's physical activity (PA) and consumption of fruit and vegetables (FV), and combinations of these behaviours.

Does television viewing predict dietary intake five years later in high school students and young adults

Abstract: Prior research has found that television viewing is associated with poor diet quality, though little is known about its long-term impact on diet, particularly during adolescence. This study examined the associations between television viewing behavior with dietary intake five years later. Survey data, which included television viewing time and food frequency questionnaires, were analyzed for 564 middle school students (younger cohort) and 1366 high school students (older cohort) who had complete data available at Time 1 (1998–1999) and five years later at Time 2 (mean age at Time 2, 17.2 ± 0.6 and 20.5 ± 0.8 years, respectively). Regression models examined longitudinal associations between Time 1 television viewing behavior and Time 2 dietary intake adjusting for sociodemographic characteristics, Time 1 dietary intake, and Time 2 total daily energy intake. Respondents were categorized as limited television users (<2 hours/daily), moderately high television viewers (2–5 hours/daily), and heavy television viewers (≥5 hours/daily). Among the younger cohort, Time 1 heavy television viewers reported lower fruit intake and higher sugar-sweetened beverage consumption than the other two groups. Among the older cohort, watching five or more hours of television per day at Time 1, predicted lower intakes of fruits, vegetables, whole grain and calcium-rich foods, and higher intakes of trans fat, fried foods, fast food menu items, snack products, and sugar-sweetened beverages (products commonly advertised on television) five years later. Television viewing in middle and high school predicted poorer dietary intake five years later. Adolescents are primary targets of advertising for fast food restaurants, snack foods, and sugar-sweetened beverages, which may influence their food choices. Television viewing, especially during high school, may have long-term effects on eating choices and contribute to poor eating habits in young adulthood.

Assessment of environmental correlates of physical activity: development of a European questionnaire

Abstract: Background Research on the influence of the physical environment on physical activity is rapidly expanding and different measures of environmental perceptions have been developed, mostly in the US and Australia. The purpose of this paper is to (i) provide a literature review of measures of environmental perceptions recently used in European studies and (ii) develop a questionnaire for population monitoring purposes in the European countries.

Behavioral self-regulation for weight loss in young adults: a randomized controlled trial.

Abstract: To determine the feasibility of recruiting and retaining young adults in a brief behavioral weight loss intervention tailored for this age group, and to assess the preliminary efficacy of an intervention that emphasizes daily self-weighing within the context of a self-regulation model. Forty young adults (29.1 ± 3.9 years, range 21–35, average BMI of 33.36 ± 3.4) were randomized to one of two brief behavioral weight loss interventions: behavioral self-regulation (BSR) or adapted standard behavioral treatment (SBT). Assessments were conducted at baseline, post-treatment (10 weeks), and follow-up (20 weeks). Intent to treat analyses were conducted using general linear modeling in SPSS version 14.0. Participants in both groups attended an average of 8.7 out of 10 group meetings, and retention rates were 93% and 88% for post-treatment and follow-up assessments, respectively. Both groups achieved significant weight losses at post-treatment (BSR = -6.4 kg (4.0); SBT = -6.2 kg (4.5) and follow-up (BSR = -6.6 kg (5.5); SBT = -5.8 kg (5.2), p < .001; but the interaction of group × time was not statistically significant, p = .84. Across groups, there was a positive association between frequency of weighing at follow-up and overall weight change at follow-up (p = .01). Daily weighing was not associated with any adverse changes in psychological symptoms. Young adults can be recruited and retained in a behavioral weight loss program tailored to their needs, and significant weight losses can be achieved and maintained through this brief intervention. Future research on the longer-term efficacy of a self-regulation approach using daily self-weighing for weight loss in this age group is warranted. # NCT00488228