[Show abstract][Hide abstract] ABSTRACT: Television viewing is highly prevalent in preschoolers (3-5 years). Because of the adverse health outcomes related to this behavior, it is important to investigate associations and mediators of young children's television viewing time. This study investigated whether parental rules regarding television viewing time and parental concerns about screen viewing activities mediated the association between parents' and preschoolers' television viewing time.
Mediation analyses were performed with the product-of-coefficient test on data derived from the Australian HAPPY study (n=947) and the Belgian sample of the ToyBox-study (n=1527). Parents reported their own and their child's television viewing time, their rules regarding television viewing and concerns about their child's screen viewing activities.
Parents' television viewing time was directly associated with preschoolers' television viewing time and parental rule for television viewing time mediated this association in both samples (14.4% and 8.1% in the Australian and Belgian samples, respectively).
This study is unique in examining the mediating pathway of parental television viewing and a rule limiting TV viewing time and whether this is consistent in different samples. Due to the consistent importance, both parents' television viewing time and rules should be targeted in interventions to decrease preschoolers' television viewing time.
[Show abstract][Hide abstract] ABSTRACT: Abstract This study aimed at translating the physical activity (PA) guideline (180 min of total PA per day) into a step count target in preschoolers. 535 Flemish preschoolers (mean age: 4.41 ± 0.58) wore an ActiGraph accelerometer (GT1M, GT3X and GT3X+) - with activated step count function - for four consecutive days. The step count target was calculated from the accelerometer output using a regression equation, applying four different cut-points for light-to-vigorous PA: Pate, Evenson, Reilly, and Van Cauwenberghe. The present analysis showed that 180 min of total PA per day is equivalent to the following step count targets: 5,274 steps/day using the Pate cut-point, 4,653 steps/day using the Evenson cut-point, 11,379 steps/day using the Reilly cut-point and 13,326 steps/day using the Van Cauwenberghe cut-point. Future studies should focus on achieving consensus on which cut-points to use in preschoolers before a definite step count target in preschoolers can be proposed. Until then, we propose to use a provisional step count target of 11,500 steps/day as this step count target is attainable, realistic and helpful in promoting preschoolers' PA.
[Show abstract][Hide abstract] ABSTRACT: Background
This systematic literature review describes the potential public health impact of evidence-based multi-level interventions to improve obesity-related behaviours in adults, using the Reach, Efficacy, Adoption, Implementation and Maintenance (RE-AIM) framework.Methods
Electronic databases (PubMed, Embase, and The Cochrane Library) were searched to identify intervention studies published between January 2000 and October 2013. The following inclusion criteria were used: (1) the study included at least one outcome measure assessing obesity-related behaviours (i.e. diet, physical activity or sedentary behaviour), (2) the study collected data over at least one year and (3) the study¿s intervention targeted adults, was conducted in a specified geographical area or worksite, and was multi-level (i.e. targeting both individual and environmental level). Evidence of RE-AIM of the selected interventions was assessed. Potential public health impact of an intervention was evaluated if information was provided on at least four of the five RE-AIM dimensions.ResultsThirty-five multi-level interventions met the inclusion criteria. RE-AIM evaluation revealed that the included interventions generally had the potential to: reach a large number of people (on average 58% of the target population was aware of the intervention); achieve the assumed goals (89% found positive outcomes); be broadly adopted (the proportion of intervention deliverers varied from 9% to 92%) and be sustained (sixteen interventions were maintained). The highest potential public health impact was found in multi-level interventions that: 1) focused on all levels at the beginning of the planning process, 2) guided the implementation process using diffusion theory, and 3) used a website to disseminate the intervention.Conclusions
Although most studies underreported results within the RE-AIM dimensions, the reported Reach, Effectiveness, Adoption, Implementation and Maintenance were positively evaluated. However, more information on external validity and sustainability is needed in order to take informed decisions on the choice of interventions that should be implemented in real-world settings to accomplish long-term changes in obesity-related behaviours.
International Journal of Behavioral Nutrition and Physical Activity 12/2014; 11(1):147. · 3.58 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: There are currently no studies available reporting intervention effects on breaking up children's sedentary time. This study examined the UP4FUN intervention effect on objectively measured number of breaks in sedentary time, number of sedentary bouts (≥10 mins) and total and average amount of time spent in those sedentary bouts among 10- to 12- year-old Belgian children. The total sample included 354 children (mean age: 10.9±0.7 years; 59% girls) with valid ActiGraph accelerometer data at pre- and post-test. Only few and small intervention effects were found, namely on total time spent in sedentary bouts immediately after school hours (4-6PM; ß=-3.51mins) and on average time spent in sedentary bouts before school hours (6-8.30AM; ß=-4.83mins) and immediately after school hours in favour of children from intervention schools (ß=-2.71mins). Unexpectedly, girls from intervention schools decreased the number of breaks during school hours (8.30AM-4PM; ß=-23.45breaks) and increased the number of sedentary bouts on a weekend day (ß=+0.90bouts), whereas girls in control schools showed an increase in number of breaks and a decrease in number of bouts. In conclusion, UP4FUN did not have a consistent or substantial effect on breaking up children's sedentary time and these data suggest that more intensive and longer lasting interventions are needed.
[Show abstract][Hide abstract] ABSTRACT: a b s t r a c t Active transport might be well suited to counteract the decrease in physical activity and the increase in weight gain in students and working young adults (18–25 years). To promote active transport in this neglected age group, knowledge of factors influencing all transport modes is needed. Focus groups were used to explore factors influencing transport choice of studying and working young adults, for short distance travel to various destinations. Nineteen students (mean age of 2171.1 years) and 17 working young adults (mean age of 23 71.5 years) were recruited. Three focus groups were conducted with students and three with working young adults. Content analysis was performed using NVivo 9 software (QSR International). Grounded theory was used to derive categories and subcategories. Young adults talked about several factors that influence transport choice, which could be categorized in three themes: Personal factors, social factors and physical environmental factors. Some factors were reported as very important for choosing between transport modes, such as autonomy, travel time, financial cost and vehicle ownership; some as less important, such as the built environment and perceived safety and some as not important at all, such as ecology and health. Most factors were discussed by both students and working young adults, but some differences were found between the two groups, mainly based on income and living situation. When promoting active transport in young adults, health benefits or ecological benefits should not be emphasized. Focus should be put on cycling instead of walking, on flexibility, speed, good social support and low costs. Also, more bicycle storage and workplace facilities should be provided. It should be avoided that young adults own a private car and the public transport system should be optimized to fit their needs. & 2014 Elsevier Ltd. All rights reserved. 1. Background Young adulthood (18–25 years), also referred to as emerging adulthood, is distinguished from adolescence and adulthood by relative independence from social roles and normative expectations (Arnett, 2000). Young adults who left secondary school have shown to be at risk for decreasing physical activity levels and increasing weight gain (Crombie et al., 2009; Keating et al., 2005; Laska et al., 2009). Active transport (AT) (i.e. walking, cycling) represents an opportunity to incorporate physical activity into young adults' daily routines (Sisson and Tudor-Locke, 2008). AT offers health benefits to adolescents, young people and adults, such as lower odds of being overweight or obese (Gordon-Larsen et al., 2009; Bere et al., 2011), an overall reduction in cardiovascular risk (Hamer and Chida, 2008), higher levels of cardiovascular fitness (Oja et al., 2011; Gordon-Larsen et al., 2009; Hamer and Chida, 2008) and more minutes of total moderate-to-vigorous physical activity (Sisson and Tudor-Locke, 2008). More-over, the public health benefits of AT go beyond individual health and include reduced traffic crashes, reduced pollution emissions (Litman,
Transport Policy 11/2014; 36:151-159. · 1.72 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
Drop-off spots are locations in the proximity of primary schools where parents can drop off or pick up their child. From these drop-off spots children can walk to and from school. This pilot study aimed to investigate the feasibility and effectiveness of drop-off spots and to evaluate how drop-off spots are perceived by school principals, teachers and parents of 6-to-12-year old children.Methods
First, a feasibility questionnaire was completed (n¿=¿216) to obtain parental opinions towards the implementation of drop-off spots. A drop-off spot was organized (500¿800 m distance from school) in two primary schools. A within-subject design was used to compare children¿s (n¿=¿58) step counts and number of walking trips during usual conditions (baseline) and during implementation of a drop-off spot (intervention). Three-level (class-participant-condition) linear regression models were used to determine intervention effects. After the intervention, 2 school principals, 7 teachers and 44 parents filled out a process evaluation questionnaire.ResultsPrior to the intervention, 96% expressed the need for adult supervision during the route to school. Positive significant intervention effects were found for step counts before/after school hours (+732 step counts/day; X2¿=¿12.2; p¿<¿0.001) and number of walking trips to/from school (+2 trips/week; X2¿=¿52.9; p¿<¿0.001). No intervention effect was found for total step counts/day (X2¿=¿2.0; p¿=¿0.16). The intervention was positively perceived by the school principals and parents, but teachers expressed doubts regarding future implementation.Conclusion
This pilot study showed that implementing drop-off spots might be an effective intervention to promote children¿s walking to school. Implementing drop-off spots does not require major efforts from the schools and schools can choose how and when they organize drop-off spots. However, motivating teachers and involving other volunteers (e.g. parents, grandparents) may be needed. Future studies should investigate the feasibility and effectiveness of drop-off spots in a larger sample of schools.
International Journal of Behavioral Nutrition and Physical Activity 10/2014; 11(1):136. · 3.58 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Sedentary behaviour (including sitting) is negatively associated with physical health, independent from physical activity (PA). Knowledge on the associations with mental health is less elaborated. Therefore this study aims to investigate the relationship between sitting and five indices of mental health in adults, and between sitting interactions (sitting*gender, sitting*age, sitting*education, and sitting*PA) and these mental health indices.
[Show abstract][Hide abstract] ABSTRACT: 10,11 , H Pohlabeln 10 , W Ahrens 10,11 and D Molnár 1 on behalf of the IDEFICS consortium BACKGROUND/OBJECTIVES: To address behaviours associated with childhood obesity, certain target values are recommended that should be met to improve children's health. In the IDEFICS (Identification and prevention of Dietary-and lifestyle-induced health Effects in Children and infantS) study such lifestyle recommendations were conveyed as six key messages. Here, we investigate the adherence of European children to these messages. METHODS: The IDEFICS intervention was based on the intervention mapping approach with the following six targets: increase water consumption (to replace sugar-containing beverages), increase fruit/vegetable consumption, reduce daily screen time, increase daily physical activity, improve the quality of family life and ensure adequate sleep duration. Internationally recommended target values were applied to determine the prevalence of children meeting these targets. RESULTS: In a cohort of 18 745 children participating in the IDEFICS baseline survey or newly recruited during follow-up, data on the above lifestyle behaviours were collected for a varying number of 8302 to 17 212 children. Information on all six behaviours was available for 5140 children. Although 52.5% of the cohort was classified in the highest category of water consumption, only 8.8% met the target of an intake of fruits/vegetables five times a day. The prevalence of children adhering to the recommendation regarding total screen time—below 1 h for pre-school children and 2 h for school children—was 51.1%. The recommended amount of at least 60 min of moderate-to-vigorous physical activity per day was fulfilled by 15.2%. Family life of the child measured by various indicators was considered as satisfactory in 22.8%. Nocturnal sleep duration of 11 (10) hours or more in pre-school (school) children was achieved by 37.9%. In general, children in northern countries and younger children showed better adherence to the recommendations. Only 1.1% of the children adhered to at least five of these recommendations. CONCLUSIONS: Current adherence of children to lifestyle recommendations to prevent childhood obesity is low where observed differences with respect to country, age and gender call for targeted intervention.
[Show abstract][Hide abstract] ABSTRACT: This study aimed to investigate how parental and peer variables are associated with moderate- to-vigorous intensity physical activity (MVPA) on week- and weekend days among Australian adolescents (13-15y), and whether perceived internal barriers (e.g. lack of time), external barriers (e.g. lack of others to be physically active with) and self-efficacy mediated these associations.
BMC Public Health 09/2014; 14(1):966. · 2.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Parents and their parenting practices play an important role in shaping their children's environment and energy-balance related behaviours (EBRBs). Measurement of parenting practices can be parent- or child-informed, however not much is known about agreement between parent and child perspectives. This study aimed to assess agreement between parent and child reports on parental practices regarding EBRBs across different countries in Europe and to identify correlates of agreement.
BMC Public Health 09/2014; 14(1):918. · 2.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This observational study aimed to adapt a computer-tailored step advice for the general population into a feasible advice for breast cancer survivors and to test its usability. First, several adaptations were made to the original design (adding cancer-related physical activity (PA) barriers and beliefs, and self-management strategies to improve survivors' personal control). Second, the adapted advice was evaluated in two phases: (1) a usability testing in healthy women (n = 3) and survivors (n = 6); and (2) a process evaluation during 3 weeks in breast cancer survivors (n = 8). Preliminary usability testing revealed no problems during logging-in; however, three survivors misinterpreted some questions. After refining the questionnaire and advice, survivors evaluated the advice as interesting, attractive to read, comprehensible and credible. Inactive survivors found the advice novel, but too long. The process evaluation indicated that the majority of the women (n = 5/8) reported increased steps. Monitoring step counts by using a pedometer was perceived as an important motivator to be more active. To conclude, this study provides initial support for the usability and acceptability of a computer-tailored pedometer-based PA advice for breast cancer survivors. After testing efficacy and effectiveness of this intervention, this tool can broaden the reach of PA promotion in breast cancer survivors.
European Journal of Cancer Care 09/2014; · 1.31 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
Adequate knowledge on environmental correlates of physical activity (PA) in older adults is needed to develop effective health promotion initiatives. However, research in this age group is scarce and most existing studies were conducted in North America. The present study aimed to examine relationships between GIS-based neighborhood walkability and objective and self-reported PA in community-dwelling Belgian older adults. Furthermore, moderating effects of neighborhood income levels were investigated.Methods
The Belgian Environmental Physical Activity Study (BEPAS) for Seniors is a cross-sectional study in older adults (¿65 yrs) and was conducted between October 2010 and September 2012. Data from 438 older adults living in 20 neighborhoods across Ghent (Belgium) were analyzed. Stratification of selected neighborhoods was based upon objective walkability and neighborhood income. Participants wore an accelerometer during seven consecutive days to obtain objective levels of moderate-to-vigorous physical activity (MVPA). Self-reported levels of transportation walking/cycling and recreational walking/cycling were assessed using the International Physical Activity Questionnaire (long, last 7 days version) adapted for the elderly. Multi-level regression analyses were conducted.ResultsFindings showed a positive relationship between neighborhood walkability and weekly minutes of older adults¿ self-reported walking for transportation (B = 4.63 ± 1.05;p < 0.001) and a negative relationship between walkability and accelerometer-derived low-light PA (B = ¿1.38 ± 0.62;p = 0.025). Walkability was not related to any measure of recreational PA. A walkability x income interaction was found for accelerometer-derived MVPA (B = -1.826 ± 1.03;p = 0.075), showing only a positive association between walkability and MVPA in low-income neighborhood residents.Conclusions
This was the first European study to examine walkability-PA relationships in older adults. These Belgian findings suggest that a high neighborhood walkability relates to higher levels of older adults¿ transport-related walking. As transport-related walking is an accessible activity for older adults and easy to integrate in their daily routine, policy makers and health promoters are advised to provide sufficient destinations and pedestrian-friendly facilities in the close vicinity of older adults¿ residences, so short trips can be made by foot. Neighborhood income moderated the relationship between walkability and objectively-measured MVPA. Increasing total MVPA levels in older adults should be a key topic in development of promotion initiatives and special attention should be paid to low-income neighborhood residents.
International Journal of Behavioral Nutrition and Physical Activity 08/2014; 11(1):110. · 3.58 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
Objective walkability is an important correlate of adults¿ physical activity. Studies investigating the relation between walkability and children¿s physical activity are scarce. However, in order to develop effective environmental interventions, a profound investigation of this relation is needed in all age groups. The aim of this study was to investigate the association between objective walkability and different domains of children¿s physical activity, and to investigate the moderating effect of neighborhood socio-economic status in this relation.Methods
Data were collected between December 2011 and May 2013 as part of the Belgian Environmental Physical Activity Study in children. Children (9¿12 years old; n¿=¿606) were recruited from 18 elementary schools in Ghent (Belgium). Children together with one of their parents completed the Flemish Physical Activity Questionnaire and wore an accelerometer for 7 consecutive days. Children¿s neighborhood walkability was calculated using geographical information systems. Multilevel cross-classified modeling was used to determine the relationship between children¿s PA and objectively measured walkability and the moderating effect of neighborhood SES in this relation.ResultsIn low SES neighborhoods walkability was positively related to walking for transportation during leisure time (ß¿=¿0.381¿±¿0.124; 95% CI¿=¿0.138, 0.624) and was negatively related to sports during leisure time (ß¿=¿¿0.245¿±¿0.121; 95% CI¿=¿¿0.482, ¿0.008). In high socio-economic status neighborhoods, walkability was unrelated to children¿s physical activity. No relations of neighborhood walkability and neighborhood socio-economic status with cycling during leisure time, active commuting to school and objectively measured moderate- to vigorous-intensity physical activity were found.Conclusions
No univocal relation between neighborhood walkability and physical activity was found in 9¿12 year old children. Results from international adult studies cannot be generalized to children. There is a need in future research to determine the key environmental correlates of children¿s physical activity.
International Journal of Behavioral Nutrition and Physical Activity 08/2014; 11(1):104. · 3.58 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Previous studies have shown convincing evidence for positive relationships between transportation cycling in adults and macro-scale physical environmental factors. In contrast, relationships are less consistent for more changeable, micro-scale environmental factors. The majority of existing studies used observational study designs, which cannot determine causality. The present mixed-methods study used manipulated photographs to determine causal relationships between micro-scale environmental factors and the environment¿s invitingness for transportation cycling. Further, interactions among environmental factors and moderating effects of gender, age and educational level were investigated. For this study a panoramic photograph of a street was manipulated on eight environmental factors: traffic, speed bump, general upkeep, evenness of the cycle path, vegetation, separation of motorized traffic, separation with sidewalk and cycle path width. Sixty-six middle-aged adults participated in the study and sorted the manipulated panoramic photographs from least to most inviting to cycle for transportation. Participants also provided qualitative data on how they sorted the streets. Multilevel cross-classified modelling was used to analyse the relationships between the environmental manipulations and the invitingness-scores. The qualitative data were deductively categorized according to the environmental factors. All environmental factors, except for separation with sidewalk, proved to have a significant main effect on the invitingness-score for transportation cycling. Cycle path evenness appeared to have the strongest effect on the invitingness. This effect was even stronger in an environment with good compared to poorly overall upkeep. Another significant interaction effect showed that the invitingness decreased when both separations along the cycle path were present compared to only a separation with traffic. No moderating effects of the demographic factors on these relationships were found. Qualitative data confirmed the observed quantitative relationships and added depth and understanding. Current study shows that the use of manipulated photographs can be an effective way to examine environment-physical activity relationships. Our findings indicate that evenness of the cycle path may be a crucial environmental factor when aiming to increase a street¿s invitingness for transportation cycling among middle-aged adults. The findings of our exploratory study could be used to develop an environmental intervention to determine if our findings are applicable to real changes in cycling behavior.
International Journal of Behavioral Nutrition and Physical Activity 08/2014; 11(1):88. · 3.58 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Screen-related behaviours are highly prevalent in schoolchildren. Considering the adverse health effects and the relation of obesity and screen time in childhood, efforts to affect screen use in children are warranted. Parents have been identified as an important influence on children's screen time and therefore should be involved in prevention programmes. The aim was to examine the mediating role of family-related factors on the effects of the school-based family-focused UP4FUN intervention aimed at screen time in 10- to 12-year-old European children (n child-parent dyads = 1940).
BMC Public Health 08/2014; 14(1):857. · 2.08 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Reliable assessments of health-related behaviours are necessary for accurate evaluation on the efficiency of public health interventions. The aim of the current study was to examine the reliability of a self-administered primary caregivers questionnaire (PCQ) used in the ToyBox-intervention. The questionnaire consisted of six sections addressing sociodemographic and perinatal factors, water and beverages consumption, physical activity, snacking and sedentary behaviours. Parents/caregivers from six countries (Belgium, Bulgaria, Germany, Greece, Poland and Spain) were asked to complete the questionnaire twice within a 2-week interval. A total of 93 questionnaires were collected. Test-retest reliability was assessed using intra-class correlation coefficient (ICC). Reliability of the six questionnaire sections was assessed. A stronger agreement was observed in the questions addressing sociodemographic and perinatal factors as opposed to questions addressing behaviours. Findings showed that 92% of the ToyBox PCQ had a moderate-to-excellent test-retest reliability (defined as ICC values from 0.41 to 1) and less than 8% poor test-retest reliability (ICC < 0.40). Out of the total ICC values, 67% showed good-to-excellent reliability (ICC from 0.61 to 1). We conclude that the PCQ is a reliable tool to assess sociodemographic characteristics, perinatal factors and lifestyle behaviours of pre-school children and their families participating in the ToyBox-intervention.
Obesity reviews : an official journal of the International Association for the Study of Obesity. 08/2014; 15 Suppl S3:61-66.
[Show abstract][Hide abstract] ABSTRACT: The ToyBox-study aims to develop and test an innovative and evidence-based obesity prevention programme for preschoolers in six European countries: Belgium, Bulgaria, Germany, Greece, Poland and Spain. In multicentre studies, anthropometric measurements using standardized procedures that minimize errors in the data collection are essential to maximize reliability of measurements. The aim of this paper is to describe the standardization process and reliability (intra- and inter-observer) of height, weight and waist circumference (WC) measurements in preschoolers. All technical procedures and devices were standardized and centralized training was given to the fieldworkers. At least seven children per country participated in the intra- and inter-observer reliability testing. Intra-observer technical error ranged from 0.00 to 0.03 kg for weight and from 0.07 to 0.20 cm for height, with the overall reliability being above 99%. A second training was organized for WC due to low reliability observed in the first training. Intra-observer technical error for WC ranged from 0.12 to 0.71 cm during the first training and from 0.05 to 1.11 cm during the second training, and reliability above 92% was achieved. Epidemiological surveys need standardized procedures and training of researchers to reduce measurement error. In the ToyBox-study, very good intra- and-inter-observer agreement was achieved for all anthropometric measurements performed.
Obesity reviews : an official journal of the International Association for the Study of Obesity. 08/2014; 15 Suppl S3:67-73.
[Show abstract][Hide abstract] ABSTRACT: Process evaluation (PE) is used for the in-depth evaluation of the implementation process of health promotion programmes. The aim of the current paper was to present the PE design and tools used in the ToyBox-intervention. The PE design was based on a three-step approach, including the identification of ToyBox-specific PE elements (step 1), the development of PE tools and harmonization of procedures (step 2), and the implementation of PE using standardized protocol and tools across the intervention countries (step 3). Specifically, to evaluate the implementation of the intervention, teachers' monthly logbooks were recorded (dose delivered, fidelity, dose received); post-intervention questionnaires were completed by parents/caregivers and teachers (dose received); participation and attrition rates were recorded (recruitment, reach); and audit questionnaires and retrospective information on weather conditions were collected (physical and social environment within which the intervention was implemented). Regarding the teachers' training sessions, the researchers who performed the trainings completed evaluation forms and documented teachers' attendance after each training (dose delivered, fidelity, dose received) and teachers completed evaluation forms after each training (dose received). The PE performed in the ToyBox-intervention may contribute in the evaluation of its effectiveness, guide the revision of the intervention material and provide insights for future health promotion programmes and public health policy.
Obesity reviews : an official journal of the International Association for the Study of Obesity. 08/2014; 15 Suppl S3:74-80.