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Early childhood nutrition, active outdoor play and sources of information for families living in highly socially disadvantaged locations
Abstract
AimsTo compare nutrition and active play of children aged 0–4 years attending Supported Playgroups and mainstream services and to compare access, understanding and application of health information within these families.MethodsA cross-sectional study of children aged 0–4 years attending early childhood services. Following stratified random sampling, 81 parents of children attending Supported Playgroups in two highly disadvantaged municipalities of Victoria, Australia were surveyed about children's nutrition, active outdoor play/screen time and access to health information. Responses were dichotomised based on national recommendations and compared with 331 children attending maternal and child health and childcare centres (mainstream services). All outcomes except age were dichotomous and analysed using chi-square, relative risk and 95% confidence intervals.ResultsMore children from Supported Playgroups consumed sweet drinks (P = 0.005), ‘packaged’ foods (P = 0.012) and tea/coffee (P = 0.038) than mainstream children. Supported Playgroup families reported more food insecurity (P = 0.016) and excessive ‘screen time’ for children under 2 years (P = 0.03). Fewer Supported Playgroups parents sought advice from family members (P < 0.001) and the Internet (P = 0.014) and more experienced difficulties accessing (P < 0.001), understanding (P = 0.002) and applying health information (P < 0.001).Conclusion
Despite comparable availability of child health information, Supported Playgroups children demonstrated more concerning child health practices, and families experienced greater difficulties accessing, understanding and applying advice than families from mainstream services despite living in the same highly disadvantaged locations.
... Supported playgroups may provide a platform or a setting for professionals to access highly disadvantaged and vulnerable families to promote health messages (Myers et al., 2015;Weber et al., 2014). Research investigating families living in highly disadvantaged areas attending supported Box 6. Intensive Supported Playgroups: Save the Children's Playscheme model ...
... playgroups differ from those attending mainstream services. Supported playgroup families experienced more difficulties accessing, understanding and applying child health information, and children showed more concerning health practices (Myers et al., 2015). Similarly, parents' knowledge of children's physical activity requirements was low (Weber et al., 2014). ...
... Similarly, parents' knowledge of children's physical activity requirements was low (Weber et al., 2014). Such findings indicate that families who have the greatest need for information may not be able to access it (Myers et al., 2015), and that supported playgroups may be a potential platform to deliver key messages promoting child health outcomes. ...
Supported playgroups have been operating for many years in Australia, despite the absence of strong empirical evidence for their effectiveness in supporting vulnerable families. This article assesses the evidence on the benefits of supported playgroups for parents and children and the factors important to their operation. It also considers their role as a 'soft entry point' to other services, and whether - and how - they assist families to transition out of the playgroup.
... Research investigating families living in highly disadvantaged areas attending supported playgroups found they differ from those attending mainstream community playgroups. Families attending supported playgroups experienced greater difficulties accessing, understanding and applying child health information, and children showed higher levels of concerning health practices (Myers et al., 2015). Similarly, parents' knowledge of children's physical activity requirements was low (Weber, Rissel, Hector, & Wen, 2014). ...
... Similarly, parents' knowledge of children's physical activity requirements was low (Weber, Rissel, Hector, & Wen, 2014). Such findings indicate that families who have the greatest need for information may not be able to access it (Myers et al., 2015), and highlight the need for skilled facilitation. 4 Research has demonstrated that families receive more benefits from supported playgroup if they are engaged and attending regularly (Berthelsen, Williams, Abad, Vogel, & Nichol, 2012). ...
This resource is intended to provide information on a set of principles that capture the essential core components of a high-quality playgroup. It is intended to be a starting point from which policy makers and those planning, delivering and coordinating playgroups can further develop and tailor their playgroups based on the local needs of the families attending and the communities they live in.
This suite of resources is intended to assist in the development of high-quality and consistent playgroups, and further build and strengthen the evidence base for the effectiveness of playgroups in meeting outcomes for families and children. https://aifs.gov.au/cfca/playgroups
... Crawford et al. [57] reported on structural barriers to achieving food security by homeless young people in Australia; however, there was no mention of the measurement of food insecurity or reporting of food insecurity status for this group within the article. Myers et al. [96] reported that 13% of supported playgroup families were food insecure compared to only 5% of mainstream playgroup families; however, there was no mention of how this information was collected in the article. ...
The number of Australians seeking food aid has increased in recent years; however, the current variability in the measurement of food insecurity means that the prevalence and severity of food insecurity in Australia is likely underreported. This is compounded by infrequent national health surveys that measure food insecurity, resulting in outdated population-level food insecurity data. This review sought to investigate the breadth of food insecurity research conducted in Australia to evaluate how this construct is being measured. A systematic review was conducted to collate the available Australian research. Fifty-seven publications were reviewed. Twenty-two used a single-item measure to examine food security status; 11 used the United States Department of Agriculture (USDA) Household Food Security Survey Module (HFSSM); two used the Radimer/Cornell instrument; one used the Household Food and Nutrition Security Survey (HFNSS); while the remainder used a less rigorous or unidentified method. A wide range in prevalence and severity of food insecurity in the community was reported; food insecurity ranged from 2% to 90%, depending on the measurement tool and population under investigation. Based on the findings of this review, the authors suggest that there needs to be greater consistency in measuring food insecurity, and that work is needed to create a measure of food insecurity tailored for the Australian context. Such a tool will allow researchers to gain a clear understanding of the prevalence of food insecurity in Australia to create better policy and practice responses.
... 14 Previous research demonstrates that children attending SPs consume more packaged foods and sweet drinks, experience greater food insecurity and have greater exposure to television and electronic screens than children of the same age attending MCH services or childcare services in the same location. 15 Therefore, SPs provide an ideal setting for reaching vulnerable families to deliver nutrition and active play information and support. 16 Despite this, there is limited evidence of nutrition and active play interventions using SPs as a setting to promote child nutrition. ...
Issue addressed
Health and nutrition inequalities are prevalent among families from socio‐economically disadvantaged backgrounds. However, there is limited evidence of targeted early childhood nutrition and active play approaches due to the methodological challenges in engaging vulnerable families in research.
Methods
The aim of this paper is to report findings from a pilot intervention called Confident and Understanding Parents (CUPs). CUPs aims to improve child nutrition and active play‐related outcomes for children in vulnerable families. The intervention was delivered in six Supported Playgroups (SPs) in two disadvantaged locations in Victoria. Surveys incorporated knowledge and confidence measures and were administered pre‐ and post‐training of SP facilitators along with pre‐, immediately post‐ and 3 months post‐intervention to SP facilitators and parents. Qualitative data were collected via debriefing discussions with SP facilitators and ethnographic observations during SP sessions. Thematic analyses of qualitative data and statistical quantitative analyses were conducted.
Results
Nine SP facilitators completed training, of whom six delivered CUPs in SPs with 64 parents of children aged 0 to 4 years from socially‐disadvantaged backgrounds. Forty‐three parents (66%) attended a minimum of 50% of SP sessions with CUPs delivery. SP facilitators and parents demonstrated improved knowledge and confidence following the pilot. Learnings for implementation were identified.
Conclusion
Overall, the CUPs intervention reached and engaged vulnerable families. A strength of the intervention is the flexibility offered to SP facilitators in selecting key messages and the strong focus on “local” translation of key child nutrition and active play messages within existing early childhood settings. A further strength was the adaptation of evaluation methodology to optimise the engagement of vulnerable families.
So what?
This pilot study provides insights about engaging vulnerable families in a nutrition and active play intervention to promote child health. These promising findings warrant further implementation and rigorous evaluation of CUPs.
This article is protected by copyright. All rights reserved.
... There is a debate in the general parenting literature about the existence of a digital divide in the use of the internet and Web-based sources of health information according to parents' sociodemographic characteristics. Although internet access is near universal, some research suggests that parents of lower socioeconomic position (as indicated by education, income, or the use of services for vulnerable parents) are less likely to use the internet for health information seeking [22,28,29] but equally likely to use social media for these purposes [28]. In line with this, Guerra-Reyes and colleagues [30] reported that in postpartum women, college graduates searched authoritative Web-based sources, while nongraduates preferred forums. ...
Background
In early life, both mothers and fathers are important influences on their children’s diet, active play, and obesity risk. Parents are increasingly relying on the internet and social media as a source of information on all aspects of parenting. However, little is known about the use of Web-based sources of information relevant to family lifestyle behaviors and, in particular, differences between mothers’ and fathers’ use and sociodemographic predictors.
Objective
The objective of this study was to examine if mothers and fathers differ in their use of the internet for information on their own health and their child’s health, feeding, and playing and to examine sociodemographic predictors of the use of the internet for information on these topics.
Methods
We conducted a secondary analysis on data collected from mothers (n=297) and fathers (n=207) participating in the extended Infant Feeding, Activity and Nutrition Trial (InFANT Extend) when their children were 36 months of age. The main outcome variables were the use of the internet for information gathering for parents’ own health and child health, feeding, and playing. Binary logistic regression was used to examine the sociodemographic predictors of outcomes.
Results
Compared with fathers (n=296), a higher proportion of mothers (n=198) used the internet for information on their own health (230, 78.5% vs 93, 46.5%), child health (226, 77.1% vs 84, 42.4%), child feeding (136, 46.3% vs 35, 17.5%), and child play (123, 42.1% vs 28, 14.0%) and intended to use Facebook to connect with other parents (200, 74.9% vs 43, 30.5%). Despite the high use of the internet to support family health behaviors, only 15.9% (47/296) of mothers reported consulting health practitioners for advice and help for their own or their child’s weight, diet, or physical activity. Sociodemographic predictors of internet use differed between mothers and fathers and explained only a small proportion of the variance in internet use to support healthy family lifestyle behaviors.
Conclusions
Our findings support the use of the internet and Facebook as an important potential avenue for reaching mothers with information relevant to their own health, child health, child diet, and active play. However, further research is required to understand the best avenues for engaging fathers with information on healthy family lifestyle behaviors to support this important role in their child’s life.
Trial Registration
ISRCTN Registry ISRCTN81847050; http://www.isrctn.com/ISRCTN81847050
... These findings are supported by other studies, where the preference to access formal sources of information was found to increase when parents developed a good relationship with the source [16,20,21,34,56]. It is suggested that while the use of technology (internet websites, forums and apps) to access health information by parents is ubiquitous, mothers with higher levels of education are still likely to use 'authoritative online sources', and mothers with lower levels of education are more likely to use discussion forums and social media [57][58][59]. Being comfortable using technology is an important factor in determining the use of online resources by parents [59], and given the multitasking nature of parenthood, online resources must be easily accessible and readily understood [58]. ...
The ‘early years’ is a crucial period for the prevention of childhood obesity. Health services are well placed to deliver preventive programs to families, however, they usually rely on voluntary attendance, which is challenging given low parental engagement. This study explored factors influencing engagement in the Infant Program: a group-based obesity prevention program facilitated by maternal and child health nurses within first-time parent groups. Six 1.5 h sessions were delivered at three-month intervals when the infants were 3⁻18 months. A multi-site qualitative exploratory approach was used, and program service providers and parents were interviewed. Numerous interrelated factors were identified, linked to two themes: the transition to parenthood, and program processes. Personal factors enabling engagement included parents’ heightened need for knowledge, affirmation and social connections. Adjusting to the baby’s routine and increased parental self-efficacy were associated with diminished engagement. Organisational factors that challenged embedding program delivery into routine practice included aspects of program promotion, referral and scheduling and workforce resources. Program factors encompassed program content, format, resources and facilitators, with the program being described as meeting parental expectations, although some messages were perceived as difficult to implement. The study findings provide insight into potential strategies to address modifiable barriers to parental engagement in early-year interventions.
... Sixteen studies used questionnaires to assess active play among preschoolers. 31,32,[35][36][37][38][39][40][41][42][43][44][45][46][47][48] Of these, 12 studies administered a questionnaire developed for the purpose of the study, 20,23,[25][26][27][28][31][32][33][34]36 two used the Physical Activity and Exercise Questionnaire, 19,30 one used the Children's Leisure Activities Study Survey, 24 and one adopted the Teacher Behavior Rating Scale. 35 Additionally, researchers from two studies conducted focus groups with parents, teachers, and community informants to explore this construct. ...
Background:
Many young children are not meeting the Canadian physical activity guidelines. In an effort to change this, the term "active play" has been used to promote increased physical activity levels. Within this young cohort, physical activity is typically achieved in the form of active play behaviour. The current study aimed to review and synthesize the literature to identify key concepts used to define and describe active play among young children. A secondary objective was to explore the various methods adopted for measuring active play.
Methods:
A systematic review was conducted by searching seven online databases for English-language, original research or reports, and were eligible for inclusion if they defined or measured active play among young children (i.e., 2-6 years).
Results:
Nine studies provided a definition or description of active play, six measured active play, and 13 included both outcomes. While variability in active play definitions did exist, common themes included: increased energy exerted, rough and tumble, gross motor movement, unstructured, freely chosen, and fun. Alternatively, many researchers described active play as physical activity (n = 13) and the majority of studies used a questionnaire (n = 16) to assess active play among young children.
Conclusions:
Much variability in the types of active play, methods of assessing active play, and locations where active play can transpire were noted in this review. As such, an accepted and consistent definition is necessary, which we provide herein.
... This measure is highly correlated with total physical activity as measured by accelerometer [25,103]. Six studies used time spent playing outside as a proxy for total moderate to vigorous physical activity (MVPA) [103][104][105][106][107][108]. Two studies also included questions on total TV-watching as proxies for total sedentary time [107,108]. ...
Objective:
The incidence of childhood obesity is highest among children entering kindergarten. Overweight and obesity in early childhood track through adulthood. Programs increasingly target children in early life for obesity prevention. However, the published literature lacks a review on tools available for measuring behaviour and environmental level change in child care. The objective is to describe measurement tools currently in use in evaluating obesity-prevention in preschool-aged children.
Methods:
Literature searches were conducted in PubMed using the keywords "early childhood obesity," "early childhood measurement," "early childhood nutrition" and "early childhood physical activity." Inclusion criteria included a discussion of: (1) obesity prevention, risk assessment or treatment in children ages 1-5 years; and (2) measurement of nutrition or physical activity.
Results:
One hundred thirty-four publications were selected for analysis. Data on measurement tools, population and outcomes were abstracted into tables. Tables are divided by individual and environmental level measures and further divided into physical activity, diet and physical health outcomes. Recommendations are made for weighing advantages and disadvantages of tools.
Conclusion:
Despite rising numbers of interventions targeting obesity-prevention and treatment in preschool-aged children, there is no consensus for which tools represent a gold standard or threshold of accuracy.
Importance:
Pediatric guidelines suggest that infants younger than 2 years avoid screen time altogether, while children aged 2 to 5 years receive no more than 1 hour per day. Although these guidelines have been adopted around the world, substantial variability exists in adherence to the guidelines, and precise estimates are needed to inform public health and policy initiatives.
Objective:
To derive the pooled prevalence via meta-analytic methods of children younger than 2 years and children aged 2 to 5 years who are meeting guidelines about screen time.
Data sources:
Searches were conducted in MEDLINE, PsycINFO, and Embase up to March 2020.
Study selection:
Studies were included if participants were 5 years and younger and the prevalence of meeting (or exceeding) screen time guidelines was reported.
Data extraction and synthesis:
Data extraction followed Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Two independent reviewers extracted all relevant data. Random-effects meta-analyses were used to derive the mean prevalence rates.
Main outcomes and measures:
Prevalence of meeting screen time guidelines.
Results:
From 63 studies, 95 nonoverlapping samples with a total of 89 163 participants were included. For children younger than 2 years, the pooled prevalence of meeting the screen time guideline (0 h/d) was 24.7% (95% CI, 19.0%-31.5%). Moderator analyses revealed that prevalence of meeting screen time guidelines varied as a function of year of data collection (increased over time), measurement method (higher when questionnaires compared with interview), and type of device use (higher when a combination of screen use activities compared with television/movies only). For children aged 2 to 5 years, the mean prevalence of meeting the screen time guideline (1 h/d) was 35.6% (95% CI, 30.6%-40.9%). Moderator analyses revealed that the prevalence of meeting screen time guidelines varied as a function of type of device use (higher when screen time was television/movies only compared with a combination of screen use activities).
Conclusions and relevance:
The findings of this meta-analysis indicate that only a minority of children 5 years and younger are meeting screen time guidelines. This highlights the need to provide support and resources to families to best fit evidence-based recommendations into their lives.
The impact of screen-based devices on children's health and development cannot be properly understood without valid and reliable tools that measure screen time within the evolving digital landscape. This review aimed to summarize characteristics of measurement tools used to assess screen time in young children; evaluate reporting of psychometric properties; and examine time trends related to measurement and reporting of screen time. A systematic review of articles published in English across three databases from January 2009 to April 2020 was undertaken using PROSPERO protocol (registration: CRD42019132599) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included articles measured screen time as outcome, exposure, or confounder in children 0-6 years. The search identified 35,868 records, 1035 full-text articles were screened for eligibility, and 622 met inclusion criteria. Most measures (60%) consisted of one to three items and assessed duration of screen time on a usual day. Few measures assessed content (11%) or coviewing (7%). Only 40% of articles provided a citation for the measure, and only 69 (11%) reported psychometric properties-reliability n = 58, validity n = 19, reliability and validity n = 8. Between 2009 and 2019, the number of published articles increased from 28 to 71. From 2015, there was a notable increase in the proportion of articles published each year that assessed exposure to mobile devices in addition to television. The increasing number of published articles reflects increasing interest in screen time exposure among young children. Measures of screen time have generally evolved to reflect children's contemporary digital landscape; however, the psychometric properties of measurement tools are rarely reported. There is a need for improved measures and reporting to capture the complexity of children's screen time exposures.
This resource is a summary of current publications related to child development. Approximately 10 themes are searched monthly (e.g., early experiences, child care, children's environmental health, gobal early child development, indigenous early childhood development, low income, health inequity, hubs, policy, screening, school readiness). This is a useful resource for those working in the field of child development. Produced through the Human Early Learning Partnership (earlylearning.ubc.ca).
Although introduction of inappropriate foods and liquids in early childhood and their association with breastfeeding is commonly reported in US children, coffee use in very young US children and its association with breastfeeding is not.
This study aimed to determine the proportion of 1- and 2-year-olds in an urban population consuming coffee, their rate of consumption, and predictors of consumption, including breastfeeding status.
We used data from a prospective cohort study on infant weight gain and diet, and body mass index at age 2. We used bivariate analyses to examine variables associated with coffee consumption at 1 and 2 years and multivariate logistic regression to control for variables of interest.
This study included 315 mother-infant dyads. At 1 year, the rate of coffee consumption reported was 2.5%; at 2 years, it was 15.2% and average daily consumption was 1.09 oz (range, 0.01- 4.00 oz). The only characteristic associated with coffee consumption at 1 year was breastfeeding at 1 year (P = .0275), which did not remain significant after controlling for confounding variables. Variables significantly associated with coffee consumption at year 2 were lower maternal education (P = .0016), non-US maternal place of birth (P = .0015), maternal Hispanic ethnicity (P < .0001), infant female sex (P = .0495), and receiving any breast milk at 1 year of age (P = .0189). After multivariate logistic regression, maternal Hispanic ethnicity (P = .0139) and infant female sex (P = .0371) remained significant.
Coffee consumption is not uncommon among toddlers in Boston, Massachusetts, USA. After controlling for possible confounding factors, maternal ethnicity and infant sex were significantly associated with this practice.
© The Author(s) 2015.
Presents an integrative theoretical framework to explain and to predict psychological changes achieved by different modes of treatment. This theory states that psychological procedures, whatever their form, alter the level and strength of self-efficacy. It is hypothesized that expectations of personal efficacy determine whether coping behavior will be initiated, how much effort will be expended, and how long it will be sustained in the face of obstacles and aversive experiences. Persistence in activities that are subjectively threatening but in fact relatively safe produces, through experiences of mastery, further enhancement of self-efficacy and corresponding reductions in defensive behavior. In the proposed model, expectations of personal efficacy are derived from 4 principal sources of information: performance accomplishments, vicarious experience, verbal persuasion, and physiological states. Factors influencing the cognitive processing of efficacy information arise from enactive, vicarious, exhortative, and emotive sources. The differential power of diverse therapeutic procedures is analyzed in terms of the postulated cognitive mechanism of operation. Findings are reported from microanalyses of enactive, vicarious, and emotive modes of treatment that support the hypothesized relationship between perceived self-efficacy and behavioral changes. (21/2 p ref)
Early television exposure and subsequent attentional problems in children . Christakis DA, Zimmerman FJ, Di Giuseppe DL & McCarty CA. ( 2004 ) Pediatrics , 113 , 708 – 713 .
Cross-sectional research has suggested that television viewing may be associated with decreased attention spans in children. However, longitudinal data of early television exposure and subsequent attentional problems have been lacking. The objective of this study was to test the hypothesis that early television exposure (at ages 1 and 3) is associated with attentional problems at age 7.
We used the National Longitudinal Survey of Youth, a representative longitudinal data set. Our main outcome was the hyperactivity subscale of the Behavioural Problems Index determined on all participants at age 7. Children who were > 1.2 standard deviations above the mean were classified as having attentional problems. Our main predictor was hours of television watched daily at ages 1 and 3 years.
Data were available for 1278 children at age 1 and 1345 children at age 3. Ten percent of children had attentional problems at age 7. In a logistic regression model, hours of television viewing per day at both ages 1 and 3 were associated with attentional problems at age 7 [1.09 (1.03–1.15) and 1.09 (1.02–1.16), respectively].
Early television exposure is associated with attentional problems at age 7. Efforts to limit television viewing in early childhood may be warranted, and additional research is needed.
Socioeconomic inequalities in longitudinal patterning of childhood overweight could cause marked differentials in total burden by adulthood. This study aims to determine timing and strength of the association between socioeconomic status (SES) and children's body mass index (BMI) in the pre- and primary school years, and to examine socioeconomic differences in overweight trajectories across childhood.
Participants were 4949 children from the Longitudinal Study of Australian Children. BMI was measured at four biennial waves starting at age 4-5 years in 2004. Developmental trajectories of childhood overweight were identified with latent class analyses. Composite variables of family and neighbourhood SES were used.
Socioeconomic differences in mean BMI z-scores already present at age 4-5 more than doubled by age 10-11 years, reflecting decreasing mean BMI among advantaged rather than increasing means among disadvantaged children. Latent class analysis identified children with 'stable normal weight' (68%), and with 'persistent' (15%), 'late-onset' (14%), and 'resolving' overweight (3%). Risks of persistent and late-onset childhood overweight were highest among low SES families (e.g. most disadvantaged quintile: ORpersistent = 2.51, 95%CI: 1.83-3.43), and only partly explained by birth weight and parental overweight. Relationships with neighbourhood SES were weaker and attenuated fully on adjustment for family SES. No socioeconomic gradient was observed for resolving overweight.
Childhood has become the critical period when socioeconomic inequalities in overweight emerge and strengthen. Although targeting disadvantaged children with early overweight must be a top priority, the presence of childhood overweight even among less-disadvantaged families suggests only whole-society approaches will eliminate overweight-associated morbidity.
OBJECTIVE:
To assess the effectiveness of a home based early intervention on children's body mass index (BMI) at age 2.
DESIGN:
Randomised controlled trial.
SETTING:
The Healthy Beginnings Trial was conducted in socially and economically disadvantaged areas of Sydney, Australia, during 2007-10.
PARTICIPANTS:
667 first time mothers and their infants.
INTERVENTION:
Eight home visits from specially trained community nurses delivering a staged home based intervention, one in the antenatal period, and seven at 1, 3, 5, 9, 12, 18 and 24 months after birth. Timing of the visits was designed to coincide with early childhood developmental milestones.
MAIN OUTCOME MEASURES:
The primary outcome was children's BMI (the healthy BMI ranges for children aged 2 are 14.12-18.41 for boys and 13.90-18.02 for girls). Secondary outcomes included infant feeding practices and TV viewing time when children were aged 2, according to a modified research protocol. The data collectors and data entry staff were blinded to treatment allocation, but the participating mothers were not blinded.
RESULTS:
497 mothers and their children (75%) completed the trial. An intention to treat analysis in all 667 participants recruited, and multiple imputation of BMI for the 170 lost to follow-up and the 14 missing, showed that mean BMI was significantly lower in the intervention group (16.53) than in the control group (16.82), with a difference of 0.29 (95% confidence interval -0.55 to -0.02; P=0.04).
CONCLUSIONS:
The home based early intervention delivered by trained community nurses was effective in reducing mean BMI for children at age 2.
TRIAL REGISTRATION:
Australian Clinical Trial Registry No 12607000168459.
Comment in
The following popper user interface control may not be accessible. Tab to the next button to revert the control to an accessible version.
Destroy user interface controlPrevention of obesity through home visiting up to the age of 2 years. [BMJ. 2012]
Discusses the need to promote health literacy. Such efforts can be achieved through more personal forms of communication and through community-based educational outreach. (Adjunct ERIC Clearinghouse for ESL Literacy Education) (Author/VWL)
Proposes a broader approach to research in human development that focuses on the progressive accommodation, throughout the life span, between the growing human organism and the changing environments in which it actually lives and grows. The latter include not only the immediate settings containing the developing person but also the larger social contexts, both formal and informal, in which these settings are embedded. In terms of method, the approach emphasizes the use of rigorously designed experiments, both naturalistic and contrived, beginning in the early stages of the research process. The changing relation between person and environment is conceived in systems terms. These systems properties are set forth in a series of propositions, each illustrated by concrete research examples. (1¼ p ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
To assess the effectiveness of a home based early intervention on children's body mass index (BMI) at age 2.
Randomised controlled trial.
The Healthy Beginnings Trial was conducted in socially and economically disadvantaged areas of Sydney, Australia, during 2007-10.
667 first time mothers and their infants.
Eight home visits from specially trained community nurses delivering a staged home based intervention, one in the antenatal period, and seven at 1, 3, 5, 9, 12, 18 and 24 months after birth. Timing of the visits was designed to coincide with early childhood developmental milestones.
The primary outcome was children's BMI (the healthy BMI ranges for children aged 2 are 14.12-18.41 for boys and 13.90-18.02 for girls). Secondary outcomes included infant feeding practices and TV viewing time when children were aged 2, according to a modified research protocol. The data collectors and data entry staff were blinded to treatment allocation, but the participating mothers were not blinded.
497 mothers and their children (75%) completed the trial. An intention to treat analysis in all 667 participants recruited, and multiple imputation of BMI for the 170 lost to follow-up and the 14 missing, showed that mean BMI was significantly lower in the intervention group (16.53) than in the control group (16.82), with a difference of 0.29 (95% confidence interval -0.55 to -0.02; P=0.04).
The home based early intervention delivered by trained community nurses was effective in reducing mean BMI for children at age 2.
Australian Clinical Trial Registry No 12607000168459.
Often new arrivals from refugee backgrounds have experienced poor health and limited access to healthcare services. The maternal and child health (MCH) service in Victoria, Australia, is a joint local and state government operated, cost-free service available to all mothers of children aged 0-6 years. Although well-child healthcare visits are useful in identifying health issues early, there has been limited investigation in the use of these services for families from refugee backgrounds. This study aims to explore experiences of using MCH services, from the perspective of families from refugee backgrounds and service providers.
We used a qualitative study design informed by the socioecological model of health and a cultural competence approach. Two geographical areas of Melbourne were selected to invite participants. Seven focus groups were conducted with 87 mothers from Karen, Iraqi, Assyrian Chaldean, Lebanese, South Sudanese and Bhutanese backgrounds, who had lived an average of 4.7 years in Australia (range one month-18 years). Participants had a total of 249 children, of these 150 were born in Australia. Four focus groups and five interviews were conducted with MCH nurses, other healthcare providers and bicultural workers.
Four themes were identified: facilitating access to MCH services; promoting continued engagement with the MCH service; language challenges; and what is working well and could be done better. Several processes were identified that facilitated initial access to the MCH service but there were implications for continued use of the service. The MCH service was not formally notified of new parents arriving with young children. Pre-arranged group appointments by MCH nurses for parents who attended playgroups worked well to increase ongoing service engagement. Barriers for parents in using MCH services included access to transportation, lack of confidence in speaking English and making phone bookings. Service users and providers reported that continuity of nurse and interpreter is preferred for increasing client-provider trust and ongoing engagement.
Although participants who had children born in Melbourne had good initial access to, and experience of, using MCH services, significant barriers remain. A systems-oriented, culturally competent approach to service provision would improve the service utilisation experience for parents and providers, including formalising links and notifications between settlement services and MCH services.
Childhood obesity can cause social, psychological and health problems, and is linked to obesity later in life and poor health outcomes as an adult. Obesity development is related to physical activity and nutrition. To prevent obesity, 55 studies conducted internationally have looked at programmes aiming to improve either or both of these behaviours. Although many studies were able to improve children’s nutrition or physical activity to some extent, only some studies were able to see an effect of the programme on children’s levels of fatness. When we combined the studies, we were able to see that these programmes made a positive difference, but there was much variation between the study findings which we could not explain. Also, it appeared that the findings may be biased by missing small studies with negative findings. We also tried to work out why some programmes work better than others, and whether there was potential harm associated with children being involved in the programmes. Although only a few studies looked at whether programmes were harmful, the results suggest that those obesity prevention strategies do not increase body image concerns, unhealthy dieting practices, level of underweight, or unhealthy attitudes to weight, and that all children can benefit. It is important that more studies in very young children and adolescents are conducted to find out more about obesity prevention in these age groups, and also that we assess how long the intervention effects last. Also, we need to develop ways of ensuring that research findings benefit all children by embedding the successful programme activities into everyday practices in homes, schools, child care settings, the health system and the wider community.
Background Increasing children's participation in physical activity and decreasing time spent in sedentary behaviours is of great importance to public health. Despite living in disadvantaged neighbourhoods, some children manage to engage in health-promoting physical activity and avoid high levels of screen-based activities (i.e. watching TV, computer use and playing electronic games). Understanding how these children manage to do well and whether there are unique features of their home or neighbourhood that explain their success is important for informing strategies targeting less active and more sedentary children. The aim of this qualitative study was to gain in-depth insights from mothers regarding their child's resilience to low physical activity and high screen-time.
Methods Semi-structured face-to-face interviews were conducted with 38 mothers of children who lived in disadvantaged neighbourhoods in urban and rural areas of Victoria, Australia. The interviews were designed to gain in-depth insights about perceived individual, social and physical environmental factors influencing resilience to low physical activity and high screen-time.
Results Themes relating to physical activity that emerged from the interviews included: parental encouragement, support and modelling; sports culture in a rural town; the physical home and neighbourhood environment; child's individual personality; and dog ownership. Themes relating to screen-time behaviours encompassed: parental control; and child's individual preferences.
Conclusions The results offer important insights into potential avenues for developing ‘resilience’ and increasing physical activity and reducing screen-time among children living in disadvantaged neighbourhoods. In light of the negative effects of low physical activity and high levels of screen-time on children's health, this evidence is urgently needed.
A detailed understanding of the underlying drivers of obesity-risk behaviours is needed to inform prevention initiatives, particularly for individuals of low socioeconomic position who are at increased risk of unhealthy weight gain. However, few studies have concurrently considered factors in the home and local neighbourhood environments, and little research has examined determinants among children from low socioeconomic backgrounds. The present study examined home, social and neighbourhood correlates of BMI (kg/m2) in children living in disadvantaged neighbourhoods. Cross-sectional data were collected from 491 women with children aged 5-12 years living in forty urban and forty rural socioeconomically disadvantaged areas (suburbs) of Victoria, Australia in 2007 and 2008. Mothers completed questionnaires about the home environment (maternal efficacy, perceived importance/beliefs, rewards, rules and access to equipment), social norms and perceived neighbourhood environment in relation to physical activity, healthy eating and sedentary behaviour. Children's height and weight were measured at school or home. Linear regression analyses controlled for child sex and age. In multivariable analyses, children whose mothers had higher efficacy for them doing physical activity tended to have lower BMI z scores (B = - 0·04, 95 % CI - 0·06, - 0·02), and children who had a television (TV) in their bedroom (B = 0·24, 95 % CI 0·04, 0·44) and whose mothers made greater use of food as a reward for good behaviour (B = 0·05, 95 % CI 0·01, 0·09) tended to have higher BMI z scores. Increasing efficacy among mothers to promote physical activity, limiting use of food as a reward and not placing TV in children's bedrooms may be important targets for future obesity prevention initiatives in disadvantaged communities.
To assess the effectiveness of a home-based early intervention on infant feeding practices and "tummy time" for infants in the first year of life.
Randomized controlled trial with follow-up measures scheduled at 6 and 12 months.
Socially and economically disadvantaged areas of Sydney, Australia.
We recruited 667 first-time mothers and their infants in 2007 and 2008.
The intervention consisted of 5 or 6 home visits from a specially trained research nurse delivering a staged home-based intervention in the antenatal period and at 1, 3, 5, 9, and 12 months.
Changes in infant feeding practices and "tummy time."
The intervention group had a significantly higher median duration of breastfeeding at 12 months than the control group (17 weeks [95% confidence interval, 13.9-20.4 weeks] vs 13 weeks [95% confidence interval, 10.1-15.0 weeks]; P = .03). Compared with the control group, the hazard ratio for stopping breastfeeding in the intervention group was 0.82 (95% confidence interval, 0.68-0.99). The intervention also resulted in a significantly later introduction of solid foods (P < .001 for trend), reducing the proportion of mothers who introduced solids before 6 months by 12% (95% confidence interval, 4%-20%) from 74% to 62%. The intervention also decreased the age at which infants started tummy time (P = .03 for trend) and increased the daily practice of tummy time by 7% from 76% to 83% (P = .05).
The home-based early intervention delivered by trained community nurses significantly improved some infant feeding practices and resulted in earlier daily practice of tummy time.
anzctr.org.au Identifier: ACTRN012607000168459.
With an increasing focus on obesity prevention there is a need for simple, valid tools to assess dietary indicators that may be the targets of intervention programs. The objective of this study was to determine the relative validity of previous day dietary intake using a newly developed parent-proxy questionnaire (EPAQ) for two to five year old children.
A convenience sample of participants (n = 90) recruited through preschools and the community in Geelong, Australia provided dietary data for their child via EPAQ and interviewer-administered 24-hour dietary recall (24 hr-recall). Comparison of mean food and beverage group servings between the EPAQ and 24 hr-recall was conducted and Spearman rank correlations were computed to examine the association between the two methods.
Mean servings of food/beverage groups were comparable between methods for all groups except water, and significant correlations were found between the servings of food and beverages using the EPAQ and 24-hr recall methods (ranging from 0.57 to 0.88).
The EPAQ is a simple and useful population-level tool for estimating the intake of obesity-related foods and beverages in children aged two to five years. When compared with 24-hour recall data, the EPAQ produced an acceptable level of relative validity and this short survey has application for population monitoring and the evaluation of population-based obesity prevention interventions for young children.
Health literacy is a relatively new concept in health promotion. It is a composite term to describe a range of outcomes to health education and communication activities. From this perspective, health education is directed towards improving health literacy. This paper identifies the failings of past educational programs to address social and economic determinants of health, and traces the subsequent reduction in the role of health education in contemporary health promotion. These perceived failings may have led to significant underestimation of the potential role of health education in addressing the social determinants of health. A ‘health outcome model’ is presented. This model highlights health literacy as a key outcome from health education. Examination of the concept of health literacy identifies distinctions between functional health literacy, interactive health literacy and critical health literacy. Through this analysis, improving health literacy meant more than transmitting information, and developing skills to be able to read pamphlets and successfully make appointments. By improving people's access to health information and their capacity to use it effectively, it is argued that improved health literacy is critical to empowerment. The implications for the content and method of contemporary health education and communication are then considered. Emphasis is given to more personal forms of communication, and community-based educational outreach, as well as the political content of health education, focussed on better equipping people to overcome structural barriers to health.
Primary prevention of childhood overweight is an international priority. In Australia 20-25% of 2-8 year olds are already overweight. These children are at substantially increased the risk of becoming overweight adults, with attendant increased risk of morbidity and mortality. Early feeding practices determine infant exposure to food (type, amount, frequency) and include responses (eg coercion) to infant feeding behaviour (eg. food refusal). There is correlational evidence linking parenting style and early feeding practices to child eating behaviour and weight status. A focus on early feeding is consistent with the national focus on early childhood as the foundation for life-long health and well being. The NOURISH trial aims to implement and evaluate a community-based intervention to promote early feeding practices that will foster healthy food preferences and intake and preserve the innate capacity to self-regulate food intake in young children.
This randomised controlled trial (RCT) aims to recruit 820 first-time mothers and their healthy term infants. A consecutive sample of eligible mothers will be approached postnatally at major maternity hospitals in Brisbane and Adelaide. Initial consent will be for re-contact for full enrolment when the infants are 4-7 months old. Individual mother- infant dyads will be randomised to usual care or the intervention. The intervention will provide anticipatory guidance via two modules of six fortnightly parent education and peer support group sessions, each followed by six months of regular maintenance contact. The modules will commence when the infants are aged 4-7 and 13-16 months to coincide with establishment of solid feeding, and autonomy and independence, respectively. Outcome measures will be assessed at baseline, with follow up at nine and 18 months. These will include infant intake (type and amount of foods), food preferences, feeding behaviour and growth and self-reported maternal feeding practices and parenting practices and efficacy. Covariates will include sociodemographics, infant feeding mode and temperament, maternal weight status and weight concern and child care exposure.
Despite the strong rationale to focus on parents' early feeding practices as a key determinant of child food preferences, intake and self-regulatory capacity, prospective longitudinal and intervention studies are rare. This trial will be amongst to provide Level II evidence regarding the impact of an intervention (commencing prior to age 12 months) on children's eating patterns and behaviours.
ACTRN12608000056392.
To investigate whether the relationship between socioeconomic status and breastfeeding initiation and duration changed in Australia between 1995 and 2004.
Secondary analysis of data from national health surveys (NHSs) conducted by the Australian Bureau of Statistics in 1995, 2001 and 2004-05. The Socio-Economic Indexes for Areas (SEIFA) classification was used as a measure of socioeconomic status.
Rates of initiation of breastfeeding; rates of breastfeeding at 3, 6 and 12 months.
Between the 1995 and 2004-05 NHSs, there was little change in overall rates of breastfeeding initiation and duration. In 2004-05, breastfeeding initiation was 87.8%, and the proportions of infants breastfeeding at 3, 6 and 12 months were 64.4%, 50.4% and 23.3%, respectively. In 1995, the odds ratio (OR) of breastfeeding at 6 months increased by an average of 13% (OR, 1.13 [95% CI, 1.07-1.19]) for each increase in SEIFA quintile; in 2001, the comparative increase was 21% (OR, 1.21 [95% CI, 1.12-1.30]); while in 2004-05, the comparative increase was 26% (OR, 1.26 [95% CI, 1.17-1.36]). Breastfeeding at 3 months and 1 year showed similar changes in ORs. There was little change in the ORs for breastfeeding initiation.
Although overall duration of breastfeeding remained fairly constant in Australia between 1995 and 2004-05, the gap between the most disadvantaged and least disadvantaged families has widened considerably over this period.
Cross-sectional research has suggested that television viewing may be associated with decreased attention spans in children. However, longitudinal data of early television exposure and subsequent attentional problems have been lacking. The objective of this study was to test the hypothesis that early television exposure (at ages 1 and 3) is associated with attentional problems at age 7.
We used the National Longitudinal Survey of Youth, a representative longitudinal data set. Our main outcome was the hyperactivity subscale of the Behavioral Problems Index determined on all participants at age 7. Children who were > or = 1.2 standard deviations above the mean were classified as having attentional problems. Our main predictor was hours of television watched daily at ages 1 and 3 years.
Data were available for 1278 children at age 1 and 1345 children at age 3. Ten percent of children had attentional problems at age 7. In a logistic regression model, hours of television viewed per day at both ages 1 and 3 was associated with attentional problems at age 7 (1.09 [1.03-1.15] and 1.09 [1.02-1.16]), respectively.
Early television exposure is associated with attentional problems at age 7. Efforts to limit television viewing in early childhood may be warranted, and additional research is needed.
This paper reviews the literature on how empowerment can lead to an improvement in the health status of an individual, group, or community. There is a broad body of literature on empowerment, and this review has been designed to identify material, particularly case studies, that can be included within the following 'empowerment domains': Participation; Community-based organizations; Local leadership; Resource mobilization; Asking 'why'; Assessment of problems; Links with other people and organizations; Role of outside agents; and Programme management. The paper discusses the results of the literature review and provides examples, from both developed and developing countries, of how each of the 'empowerment domains' has led to an improvement in health outcomes. The results of the review should be of interest to the planners and practitioners of health, population and nutrition programmes that have a particular focus on empowerment.
This study evaluates the contribution of energy-dense, nutrient-poor 'extra' foods to the diets of 16-24-month-old children from western Sydney, Australia.
An analysis of cross-sectional data collected on participants in the Childhood Asthma Prevention Study (CAPS), a randomised trial investigating the primary prevention of asthma from birth to 5 years. We collected 3-day weighed food records, calculated nutrient intakes, classified recorded foods into major food groups, and further classified foods as either 'core' or 'extras' according to the Australian Guide to Healthy Eating.
Pregnant women, whose unborn child was at risk of developing asthma because of a family history, were recruited from all six hospitals in western Sydney, Australia. Data for this study were collected in clinic visits and at participants' homes at the 18-month assessment.
Four hundred and twenty-nine children participating in the CAPS study; 80% of the total cohort.
The mean consumption of 'extra' foods was approximately 150 g day(-1) and contributed 25-30% of the total energy, fat, carbohydrate and sodium to the diets of the study children. 'Extra' foods also contributed around 20% of fibre, 10% of protein and zinc, and about 5% of calcium. Children in the highest quintile of 'extra' foods intake had a slightly higher but not significantly different intake of energy from those in the lowest quintile. However, significant differences were evident for the percentage of energy provided by carbohydrate and sugars (higher) and protein and saturated fat (lower). The intake of most micronutrients was also significantly lower among children in the highest quintile of consumption. The intake of 'extra' foods was inversely associated with the intake of core foods.
The high percentage of energy contributed by 'extra' foods and their negative association with nutrient density emphasise the need for dietary guidance for parents of children aged 1-2 years. These preliminary data on commonly consumed 'extra' foods and portion sizes may inform age-specific dietary assessment methods.
b>Background : Multiple factors combine to support a compelling case for interventions that target the development of obesity-promoting behaviours (poor diet, low physical activity and high sedentary behaviour) from their inception. These factors include the rapidly increasing prevalence of fatness throughout childhood, the instigation of obesity-promoting behaviours in infancy, and the tracking of these behaviours from childhood through to adolescence and adulthood. The Infant Feeding Activity and Nutrition Trial (INFANT) aims to determine the effectiveness of an early childhood obesity prevention intervention delivered to first-time parents. The intervention, conducted with parents over the infant's first 18 months of life, will use existing social networks (first-time parent's groups) and an anticipatory guidance framework focusing on parenting skills which support the development of positive diet and physical activity behaviours, and reduced sedentary behaviours in infancy.
Methods/Design : This cluster-randomised controlled trial, with first-time parent groups as the unit of randomisation, will be conducted with a sample of 600 first-time parents and their newborn children who attend the first-time parents' group at Maternal and Child Health Centres. Using a two-stage sampling process, local government areas in Victoria, Australia will be randomly selected at the first stage. At the second stage, a proportional sample of first-time parent groups within selected local government areas will be randomly selected and invited to participate. Informed consent will be obtained and groups will then be randomly allocated to the intervention or control group.
Discussion : The early years hold promise as a time in which obesity prevention may be most effective. To our knowledge this will be the first randomised trial internationally to demonstrate whether an early health promotion program delivered to first-time parents in their existing social groups promotes healthy eating, physical activity and reduced sedentary behaviours. If proven to be effective, INFANT may protect children from the development of obesity and its associated social and economic costs.<br /
The influence of home and community factors in predicting ethnic or heritage language vocabulary were examined among 282 Singaporean children whose ethnic languages (or mother tongues) were Chinese, Malay, or Tamil, and who were also learning English. The results indicated that (1) parents speaking ethnic language to children had a strong positive effect on children's ethnic language vocabulary, whereas parents speaking only English had a negative effect; (2) language community had an effect on children's ethnic language vocabulary, which may reflect community support for the language among the broader community; (3) family income worked differently depending on the language community; and (4) watching television in English mostly/only had a negative effect on children's ethnic language vocabulary. These findings lend support to other studies among language-minority children indicating that maintaining an ethnic or heritage language requires home support when schooling is through a societally dominant language.
Cultural competence strategies aim to make health services more accessible for patients from diverse cultural backgrounds. Recently, such strategies have focused on specific groups, and particularly Indigenous Australians, where services have failed to address large disparities in health outcomes. Limitations of cultural competence largely fall into three categories: lack of clarity around how the concept of culture is used in medicine, inadequate recognition of the "culture of medicine" and the scarcity of outcomes-based research that provides evidence of efficacy of cultural competence strategies. Narrow concepts of culture often conflate culture with race and ethnicity, failing to capture diversity within groups and thus reducing the effectiveness of cultural competence strategies. This also hampers the search for evidence linking cultural competence to a reduction in health disparities. Attention to cultural complexity, structural determinants of inequality and power differentials within health care settings not only provide a more expansive notion of cultural competence and a nuanced understanding of the role of culture in the clinic, but may assist in determining the contribution that cultural competence strategies can make to a reduction in health disparities.
Objective:
To explore the effects of an innovative school-based intervention for increasing physical activity.
Methods:
226 children (5-7 years old) randomly selected from 12 Australian primary schools were recruited to a cluster randomised trial with schools randomly allocated to intervention or control conditions. The 13-week intervention comprised: (1) altering the school playground by introducing loose materials and (2) a teacher-parent intervention exploring perceptions of risk associated with children's free play. The primary outcomes were total accelerometer counts and moderate-vigorous physical activity during break times. Testing took place in Sydney, 2009-2010.
Results:
221 participants were tested at baseline. Mixed-effect multilevel regression revealed a small but significant increase from the intervention on total counts (9400 counts, 95% CI 3.5-15.2, p=0.002) and minutes of MVPA (1.8 min, 95% CI 0.5-3.1, p=0.006); and a decrease in sedentary activity (2.1 min, 95% CI 0.5-3.8, p=0.01) during break times. We retested children in one intervention school after 2 years; they maintained the gains.
Conclusions:
Capturing children's intrinsic motivations to play while simultaneously helping adults reconsider views of free play as risky provided increases in physical activity during break times. Using accelerometry as the sole measure of physical activity may underestimate the effect.
Trial registration:
ACTRN12611000089932.
Objective:
To examine the relationship between overweight/obesity in children, socioeconomic status and ethnicity/cultural background.
Design:
Cross-sectional survey of children aged 4-13 years.
Setting:
A total of 23 primary (elementary) schools in an inner urban municipality of Melbourne, Australia. Participants. A total of 2685 children aged 4-13 years and their parents.
Main exposure measures:
Ethnicity/cultural background - maternal region of birth; socioeconomic position (SEP) indicators - maternal and paternal educational attainment, family employment status, possession of a healthcare card, ability to buy food, indicator of disadvantage (Socioeconomic Index for Areas, SEIFA) score for school; parental weight status. Main outcome measure. Prevalence of overweight/obesity.
Results:
Prevalence of overweight/obesity approached 1 in 3 (31%) in this sample. Prevalence of overweight/obesity was greater for children of both North Africa and Middle Eastern background and children of Southern, South Eastern and Eastern European background compared with children of Australian background. This difference remained after adjusting for age, sex, height, clustering by school, SEP indicators and parental weight status; odds ratio, OR=1.57 (95% confidence interval, CI 1.12-2.19) and 1.88 (95%CI 1.24-2.85), respectively.
Conclusions:
There is a clear independent effect of ethnicity above and beyond the effect of socioeconomic status on overweight and obesity in children. Further research is required to explore the mediators of this gradient.
Aim: To describe the diet of a sample of Australian children aged 16–24 months with regard to the amounts of foods and nutrients consumed.
Methods: Cross-sectional data collected from participants in a five-year randomised trial of the primary prevention of asthma. Pregnant women with a family history of atopy were recruited from six hospital antenatal clinics in western Sydney. At the 18-month assessment, carers of 429 of children completed three-day weighed food records. Three-day average intakes of foods and nutrients and average portions per eating occasion for commonly consumed foods. T-tests for comparing gender differences.
Results: Diets were characterised by large amounts of milk and non-milk drinks with smaller amounts of cereals, fruits, vegetables and meats. Total energy intake was significantly higher for boys than girls and exceeded estimated energy requirements in both boys and girls. Food groups contributing most to energy included milk and milk products (35%), cereals (15%), cereal-based products (9%) and non-milk drinks (8%). Micronutrient intakes were below the Estimated Average Requirement in more than 5% of the children for vitamin A, calcium, vitamin C and iron. Sodium intakes exceeded the upper level of 1000 mg for 62% of children, while dietary fibre intake was only half the Adequate Intake of 14 g. Relatively few foods were widely consumed and median portion sizes were typically small in relation to commonly used reference portion sizes.
Conclusion: These data may be useful as a preliminary basis for developing age-specific dietary surveillance tools and dietary guidance for children aged one to two years.
Little evidence exists about the prevalence of adequate levels of physical activity and of appropriate screen-based entertainment in preschool children. Previous studies have generally relied on small samples. This study investigates how much time preschool children spend being physically active and engaged in screen-based entertainment. The study also reports compliance with the recently released Australian recommendations for physical activity (≥3 h·d(-1)) and screen entertainment (≤1 h·d(-1)) and the National Association for Sport and Physical Education physical activity guidelines (≥2 h·d(-1)) and American Academy of Pediatrics screen-based entertainment recommendations (≤2 h·d(-1)) in a large sample of preschool children.
Participants were 1004 Melbourne preschool children (mean age = 4.5 yr, range = 3-5 yr) and their families in the Healthy Active Preschool Years study. Physical activity data were collected by accelerometry during an 8-d period. Parents reported their child's television/video/DVD viewing, computer/Internet, and electronic game use during a typical week. A total of 703 (70%) had sufficient accelerometry data, and 935 children (93%) had useable data on time spent in screen-based entertainment.
Children spent 16% (approximately 127 min·d(-1)) of their time being physically active. Boys and younger children were more active than were girls and older children, respectively. Children spent an average of 113 min·d(-1) in screen-based entertainment. Virtually no children (<1%) met both the Australian recommendations and 32% met both the National Association for Sport and Physical Education and American Academy of Pediatrics recommendations.
The majority of young children are not participating in adequate amounts of physical activity and in excessive amounts of screen-based entertainment. It is likely that physical activity may decline and that screen-based entertainment may increase with age. Compliance with recommendations may be further reduced. Strategies to promote physical activity and reduce screen-based entertainment in young children are required.
It is well known that persons of low socioeconomic position consume generally a less healthy diet. Key determinants of unhealthy eating among disadvantaged individuals include aspects of the family and external environment. Much less is known about family and environmental determinants of healthy eating among social disadvantaged children. The aim of this study was to gain insight into the family and environmental factors underlying resilience to poor nutrition among children and their mothers living in disadvantaged neighbourhoods. Semi-structured interviews were conducted with 38 mother-child pairs (N = 76) from disadvantaged neighbourhoods. Children were selected if they were a healthy weight, consumed adequate intakes of fruit and vegetables and were physically active. Two main themes emerged from the interviews: active strategies from parents to promote healthy eating and external barriers and supports to healthy eating. Mothers believed that exercising control over access to unhealthy food, providing education and encouragement for consumption of healthy food and enabling healthy food options aided their child to eat well. Children did not perceive food advertisements to be major influences on their eating preferences or behaviour. The results of the current study offer insight into potential avenues for nutrition promotion among disadvantaged children.
To examine the extent of nutritional vulnerability seen in a cohort of asylum seekers in Australia. Twenty-one asylum seekers (15 males, 6 females) that used a food bank were interviewed over a 6 week period at the Melbourne based Asylum Seeker Resource Centre about foods consumed in the previous 24-h and any non food bank foods obtained. A basket audit was conducted after participants accessed the food bank on the day of interview, Participants obtained significantly less than the minimum requirements for the Australian Guide to Healthy Eating in the vegetables and legumes (P < .001, 95% CI -3.5, -1.7) fruits (P < .001, 95% CI -1.7, -.1.2), dairy (P < .001, 95% CI -1.8, -1.5) and meat and meat alternatives core food groups (P = .001, 95% CI -0.8, -0.3) using foods accessed from the food bank, their primary or sole food source. A high level of nutritional vulnerability was seen in this cohort due to their inability to meet minimum nutritional requirements from their primary food access point. Health professionals working with asylum seeker populations need to be aware of this issue and the resulting potential for longer term ill health as a consequence.
Information is limited on persistence of early beverage patterns throughout childhood and adolescence and their influence on long-term dietary intake.
To describe changes in beverage intake during childhood and assess beverage and nutrient intake from ages 5 to 15 years among girls who were consuming or not consuming sweetened carbonated beverages (soda) at age 5 years.
Participants were part of a longitudinal study of non-Hispanic white girls and their parents (n=170) assessed biennially from age 5 to 15 years starting fall 1996.
At each assessment, intakes of beverages (milk, fruit juice, fruit drinks, soda, and tea/coffee), energy, macronutrients, and micronutrients were assessed using three 24-hour recalls. Analyses of longitudinal changes and the interaction between beverage type and age were conducted using a mixed modeling approach. Girls were categorized as either soda consumers or nonconsumers at age 5 years. A mixed modeling approach was used to assess longitudinal differences and patterns of change in beverage and nutrient intake between soda consumption groups.
Early differences in soda intake were predictive of later soda and milk intake and of differences in selected nutrients. Relative to girls who were not consuming soda beverages at age 5 years, soda consumers at age 5 years had higher subsequent soda intake, lower milk intake, higher intake of added sugars, lower protein, fiber, vitamin D, calcium, magnesium, phosphorous, and potassium from ages 5 to 15 years.
Soda consumption at age 5 years predicted patterns of nutrient intake that persisted during childhood and into adolescence. Diets of soda consumers were higher in added sugars and lower in protein, fiber, calcium, vitamin D, magnesium, phosphorous, and potassium. Findings provide a more complex picture regarding the emergence of early beverage patterns and their predictive effects on nutrient intake across childhood and adolescence.
Unlabelled:
The small number and recency of the early childhood obesity-prevention literature identified in a previous review of interventions to prevent obesity, promote healthy eating, physical activity, and/or reduce sedentary behaviors in 0-5 year olds suggests this is a new and developing research area. The current review was conducted to provide an update of the rapidly emerging evidence in this area and to assess the quality of studies reported. Ten electronic databases were searched to identify literature published from January 1995 to August 2008.
Inclusion criteria:
interventions reporting child anthropometric, diet, physical activity, or sedentary behavior outcomes and focusing on children aged 0-5 years of age.
Exclusion criteria:
focusing on breastfeeding, eating disorders, obesity treatment, malnutrition, or school-based interventions. Two reviewers independently extracted data and assessed study quality. Twenty-three studies met all criteria. Most were conducted in preschool/childcare (n = 9) or home settings (n = 8). Approximately half targeted socioeconomically disadvantaged children (n = 12) and three quarters were published from 2003 onward (n = 17). The interventions varied widely although most were multifaceted in their approach. While study design and quality varied most studies reported their interventions were feasible and acceptable, although impact on behaviors that contribute to obesity were not achieved by all. Early childhood obesity-prevention interventions represent a rapidly growing research area. Current evidence suggests that behaviors that contribute to obesity can be positively impacted in a range of settings and provides important insights into the most effective strategies for promoting healthy weight from early childhood.
To provide an overview of the science and practice of knowledge translation.
Narrative review outlining what knowledge translation is and a framework for its use.
Knowledge translation is defined as the use of knowledge in practice and decision making by the public, patients, health care professionals, managers, and policy makers. Failures to use research evidence to inform decision making are apparent across all these key decision maker groups. There are several proposed theories and frameworks for achieving knowledge translation. A conceptual framework developed by Graham et al., termed the knowledge-to-action cycle, provides an approach that builds on the commonalities found in an assessment of planned action theories.
Review of the evidence base for the science and practice of knowledge translation has identified several gaps including the need to develop valid strategies for assessing the determinants of knowledge use and for evaluating sustainability of knowledge translation interventions.
This book covers the lifelong importance to health of determinants such as poverty, drugs, working conditions, unemployment, social support, good food and transport policy. It provides a discussion of the social gradient in health, and an explanation of how psychological and social influences affect physical health and longevity. The focus is on the role that public policy can play in shaping the social environment and on structural issues such as unemployment, poverty and the experience of work. Each of the chapters contains a brief summary of what has been established by research, followed by some implications for public policy. [Country: Europe]
Aim: To identify food insecurity and examine its association with socio-demographic factors in a group of newly arrived refugees.
Methods: Structured questionnaire based around the same question asked during the National Nutrition Survey (1995). The questionnaire was administered to a service-based sample of clients accessing early intervention services. Fifty-one individuals who were newly arrived refugees, resident in Australia for less than 12 months and who were receiving torture and trauma counselling.
Results: Thirty-six individuals (71% of sample) reported running out of food. This percentage was much greater than the 5.2% recorded across all social and economic groups in the 1995 National Nutrition Survey. The most common reasons for running out of food were related to large household bills, late welfare payments, poor household skills, sending money ‘home’, transport issues and poor budgeting skills.
Conclusion: Food insecurity in refugees in Perth, Western Australia is comparable to the rates of food insecurity found in this population in other parts of the developed world. There are, however, significant ramifications for the development of intervention strategies as well as policy implications. For refugees, focusing on community food security strategies will assist in building community capacity, facilitate the retention of cultural integrity, restore and maintain dignity, and will be instrumental in ensuring both short- and long-term health.
Evidence is increasingly pointing towards the importance of early life strategies to prevent childhood overweight and obesity. This systematic review synthesizes qualitative research concerning parental perceptions regarding behaviours for preventing overweight and obesity in young children. During May and June 2008, a range of electronic databases were searched and together with lateral searching techniques 21 studies were identified for review. Data extraction and synthesis using thematic content analysis revealed six organizing and 32 finer level themes. These related to child factors, family dynamics, parenting, knowledge and beliefs, extra-familial influences and resources and environment. Themes were mapped to a socioecological model which illustrated how factors at individual, interpersonal, community, organizational and societal levels interact in complex ways to impact on parental perceptions about healthy behaviours for preventing child overweight. Although parents suggested several ideas to promote healthy child weight-related behaviours, many of their views concerned perceived barriers, some of which may be amenable to practical intervention. Furthermore, intergenerational influences on parental health beliefs and knowledge suggest that health promotion strategies may be more effective if directed at the wider family, rather than parents alone. Significantly, many parents believed strategies to promote healthy weight should start early in a child's life.
Maternal feeding styles may be influenced by maternal education, with implications for children's dietary quality and adiposity. One-hundred and eighty mothers completed the Parental Feeding Style Questionnaire, which includes scales assessing four aspects of feeding style, ie, control over feeding, emotional feeding, instrumental feeding, and encouragement/prompting to eat. Mothers with higher education had significantly higher scores on control over feeding [F(1,177)=8.79; P=0.003] and significantly lower emotional feeding scores [F(1,177)=7.26; P=0.008] than those with lower education. There were no differences for instrumental feeding or encouragement/prompting to eat (P>0.05). These findings suggest modest but potentially important differences in maternal control and emotional feeding styles by maternal education. Should these feeding characteristics prove salient to childhood diet and weight, this could inform appropriately targeted parental feeding advice.
The purpose of this study is to identify sources and acceptability of infant-feeding advice among participants in the US-based Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Focus groups are used to identify sources of infant-feeding advice and factors that contribute to acceptance of or resistance to that advice among 65 WICeligible mothers (34 English speaking and 31 Spanish speaking). The mothers primarily rely on experienced family and friends for advice and frequently use their own intuition to find solutions that work to solve real or perceived infant-feeding problems. Professional advice is perceived as credible when caregivers exhibit characteristics similar to those of experienced family and friends: confidence, empathy, respect, and calm. Using this information, it may be possible for WIC staff to make programmatic modifications to increase their ability to promote optimal infant-feeding behaviors in this population, thereby contributing to the reduction in the prevalence of childhood overweight.
To examine the relation between baseline fat mass and gain in bone area and bone mass in preschoolers studied prospectively for 4 years, with a focus on the role of physical activity and TV viewing.
Children were part of a longitudinal study in which measures of fat, lean and bone mass, height, weight, activity, and diet were taken every 4 months from ages 3 to 7 years. Activity was measured by accelerometer and TV viewing by parent checklist. We included 214 children with total body dual energy x-ray absorptiometry (Hologic 4500A) scans at ages 3.5 and 7 years.
Higher baseline fat mass was associated with smaller increases in bone area and bone mass over the next 3.5 years (P < .001). More TV viewing was related to smaller gains in bone area and bone mass accounting for race, sex, and height. Activity by accelerometer was not associated with bone gains.
Adiposity and TV viewing are related to less bone accrual in preschoolers.
The present article presents an integrative theoretical framework to explain and to predict psychological changes achieved by different modes of treatment. This theory states that psychological procedures, whatever their form, alter the level and strength of self-efficacy. It is hypothesized that expectations of per- sonal efficacy determine whether coping behavior will be initiated, how much effort will be expended, and how long it will be sustained in the face of ob- stacles and aversive experiences. Persistence in activities that are subjectively threatening but in fact relatively safe produces, through experiences of mastery, further enhancement of self-efficacy and corresponding reductions in defensive behavior. In the proposed model, expectations of personal efficacy are derived from four principal sources of information: performance accomplishments, vicarious experience, verbal persuasion, and physiological states. The more de- pendable the experiential sources, the greater are the changes in perceived self- efficacy. A number of factors are identified as influencing the cognitive processing of efficacy information arising from enactive, vicarious, exhortative, and emotive sources. The differential power of diverse therapeutic procedures is analyzed in terms of the postulated cognitive mechanism of operation. Findings are reported from microanalyses of enactive, vicarious, and emotive modes of treatment that support the hypothesized relationship between perceived self-efficacy and be- havioral changes. Possible directions for further research are discussed.
The prevalence of obesity among children is high and is increasing. We know that obesity runs in families, with children of obese parents at greater risk of developing obesity than children of thin parents. Research on genetic factors in obesity has provided us with estimates of the proportion of the variance in a population accounted for by genetic factors. However, this research does not provide information regarding individual development. To design effective preventive interventions, research is needed to delineate how genetics and environmental factors interact in the etiology of childhood obesity. Addressing this question is especially challenging because parents provide both genes and environment for children. An enormous amount of learning about food and eating occurs during the transition from the exclusive milk diet of infancy to the omnivore's diet consumed by early childhood. This early learning is constrained by children's genetic predispositions, which include the unlearned preference for sweet tastes, salty tastes, and the rejection of sour and bitter tastes. Children also are predisposed to reject new foods and to learn associations between foods' flavors and the postingestive consequences of eating. Evidence suggests that children can respond to the energy density of the diet and that although intake at individual meals is erratic, 24-hour energy intake is relatively well regulated. There are individual differences in the regulation of energy intake as early as the preschool period. These individual differences in self-regulation are associated with differences in child-feeding practices and with children's adiposity. This suggests that child-feeding practices have the potential to affect children's energy balance via altering patterns of intake. Initial evidence indicates that imposition of stringent parental controls can potentiate preferences for high-fat, energy-dense foods, limit children's acceptance of a variety of foods, and disrupt children's regulation of energy intake by altering children's responsiveness to internal cues of hunger and satiety. This can occur when well-intended but concerned parents assume that children need help in determining what, when, and how much to eat and when parents impose child-feeding practices that provide children with few opportunities for self-control. Implications of these findings for preventive interventions are discussed.
Culturally competent healthcare systems-those that provide culturally and linguistically appropriate services-have the potential to reduce racial and ethnic health disparities. When clients do not understand what their healthcare providers are telling them, and providers either do not speak the client's language or are insensitive to cultural differences, the quality of health care can be compromised. We reviewed five interventions to improve cultural competence in healthcare systems-programs to recruit and retain staff members who reflect the cultural diversity of the community served, use of interpreter services or bilingual providers for clients with limited English proficiency, cultural competency training for healthcare providers, use of linguistically and culturally appropriate health education materials, and culturally specific healthcare settings. We could not determine the effectiveness of any of these interventions, because there were either too few comparative studies, or studies did not examine the outcome measures evaluated in this review: client satisfaction with care, improvements in health status, and inappropriate racial or ethnic differences in use of health services or in received and recommended treatment.
Notes that pediatricians lack information on proven practices for preventing childhood obesity but can address the growing dilemma by talking with families about four behaviors: (1) limiting television viewing, (2) encouraging outdoor play, (3) encouraging breastfeeding, and (4) limiting consumption of sugar-sweetened soft drinks.
We have observed that the nature and amount of free play in young children has changed. Our purpose in this article is to demonstrate why play, and particularly active, unstructured, outdoor play, needs to be restored in children's lives. We propose that efforts to increase physical activity in young children might be more successful if physical activity is promoted using different language-encouraging play-and if a different set of outcomes are emphasized-aspects of child well-being other than physical health. Because most physical activity in preschoolers is equivalent to gross motor play, we suggest that the term "play" be used to encourage movement in preschoolers. The benefits of play on children's social, emotional, and cognitive development are explored.
To test the hypothesis that preschool children have a higher prevalence of obesity, spend less time playing outdoors, and spend more time watching television (TV) when they live in neighborhoods that their mothers perceive as unsafe.
In a cross-sectional survey in 20 large US cities, mothers reported the average daily time of outdoor play and TV viewing for their 3-year-old children, and the children's BMI was measured. Maternal perception of neighborhood safety was assessed with the Neighborhood Environment for Children Rating Scales; the scale score was used to divide children into tertiles of neighborhood safety.
Of the 3141 children studied, 35% lived in households with incomes below the US poverty threshold. After adjustment for sociodemographic factors (household income and mothers' education, race/ethnicity, age, and marital status), obesity prevalence (BMI > or =95th percentile) did not differ in children from the least safe to the safest neighborhood safety tertile (18% vs 17% vs 20%) or in weekday (160 vs 151 vs 156 minutes/day) or weekend (233 vs 222 vs 222 minutes/day) outdoor play time. Children who lived in neighborhoods that were perceived by their mothers as the least safe watched more TV (201 vs 182 vs 185 minutes/day) and were more likely to watch >2 hours/day (66% vs 60% vs 62%). TV viewing and outdoor play minutes were not significantly correlated to each other or to BMI.
In a national sample of preschool children, mothers' perception of neighborhood safety was related to their children's TV viewing time but not to their outdoor play time or risk for obesity.
Despite the fact that it is largely preventable, dental caries (decay) remains one of the most common chronic diseases of early childhood. Dental decay in young children frequently leads to pain and infection necessitating hospitalization for dental extractions under general anaesthesia. Dental problems in early childhood have been shown to be predictive of not only future dental problems but also on growth and cognitive development by interfering with comfort nutrition, concentration and school participation.
To review the current evidence base in relation to the aetiology and prevention of dental caries in preschool-aged children.
A search of MEDLINE, CINALH and Cochrane electronic databases was conducted using a search strategy which restricted the search to randomized controlled trials, meta-analyses, clinical trials, systematic reviews and other quasi-experimental designs. The retrieved studies were then limited to articles including children aged 5 years and under and published in English. The evidence of effectiveness was then summarized by the authors.
The review highlighted the complex aetiology of early childhood caries (ECC). Contemporary evidence suggests that potentially effective interventions should occur in the first 2 years of a child's life. Dental attendance before the age of 2 years is uncommon; however, contact with other health professionals is high. Primary care providers who have contact with children well before the age of the first dental visit may be well placed to offer anticipatory advice to reduce the incidence of ECC.
To analyse the association between socio-economic indicators and diet among 2-year-old children, by assessing the independent contribution of parental education and equivalent income to food intake.
The analysis was based on data from a prospective birth cohort study. Information on diet was obtained using a semi-quantitative food-frequency questionnaire. Low and high intake of food was defined according to the lowest and the highest quintile of food consumption frequency, respectively.
Four German cities (Munich, Leipzig, Wesel, Bad Honnef), 1999-2001. Subjects Subjects were 2637 children at the age of 2 years, whose parents completed questionnaires gathering information on lifestyle factors, including parental socio-economic status, household consumption frequencies and children's diet.
Both low parental education and low equivalent income were associated with a low intake of fresh fruit, cooked vegetables and olive oil, and a high intake of canned vegetables or fruit, margarine, mayonnaise and processed salad dressing in children. Children with a low intake of milk and cream, and a high intake of hardened vegetable fat, more likely had parents with lower education. Low butter intake was associated with low equivalent income only.
These findings may be helpful for future intervention programmes with more targeted policies aiming at an improvement of children's diets.
We aimed to develop policy in relation to three areas: (i) the diagnosis of iron deficiency; (ii) maternal-infant issues and the prevention of iron deficiency; and (iii) the treatment of iron deficiency.
Within each of these topic areas we completed a literature review and developed recommendations to help direct activities of the Royal Australasian College of Physicians, update paediatricians and guide clinical practice.
Iron deficiency can be defined using cut-off values for laboratory measures of iron status or, if an intercurrent infection is not present, by demonstrating a response to a therapeutic trial of iron. The appropriate measures of iron status vary depending upon the presence of intercurrent infection. Full-term babies are born with iron stores sufficient to meet their needs to age 4-6 months but premature infants are not. After age 6 months infants are dependent upon dietary iron from complementary foods even with continued breastfeeding. Infants <33 weeks gestation or <1800 g birthweight should receive iron from 4 weeks of age. In most settings recommended treatment of iron deficiency is with oral ferrous sulphate as a single or twice daily dose of between 3 and 6 mg/kg/day.
Iron deficiency is prevalent and an important determinant of child health. Precise and accurate diagnosis remains challenging. Iron supplementation is required for premature and low-birthweight infants. Oral iron salts remain the recommended treatment of choice in most instances.