Physical activity and healthy eating environmental audit tools in youth care settings: A systematic review

BackgroundThere is a growing interest in evaluating the physical activity (PA) and healthy eating (HE) policy and practice environment characteristics in settings frequented by youth (≤ 18 years).ObjectiveThis review evaluates the measurement properties of audit tools designed to assess PA and HE policy and practice environment characteristics in settings that care for youth (e.g., childcare, school, afterschool, summer camp).MethodThree electronic databases, reference lists, educational department and national health organizations' web pages were searched between January 1980 and February 2014 to identify tools assessing PA and/or HE policy and practice environments in settings that care for youth (≤ 18 years).ResultsSixty-five audit tools were identified of which 53 individual tools met the inclusion criteria. Thirty-three tools assessed both the PA and HE domains, 6 assessed the PA domain and 14 assessed the HE domain solely. The majority of the tools were self-assessment tools (n = 40), and were developed to assess the PA and/or HE environment in school settings (n = 33), childcare (n = 12), and after school programs (n = 4). Four tools assessed the community at-large and had sections for assessing preschool, school and/or afterschool settings within the tool. The majority of audit tools lacked validity and/or reliability data (n = 42). Inter-rater reliability and construct validity were the most frequently reported reliability (n = 7) and validity types (n = 5).ConclusionsLimited attention has been given to establishing the reliability and validity of audit tools for settings that care for youth. Future efforts should be directed towards establishing a strong measurement foundation for these important environmental audit tools.     

Evaluation of a 2-year physical activity and healthy eating intervention in middle school children

The aim of the present study was to evaluate the effects of a middle school physical activity and healthy eating intervention, including an environmental and computer-tailored component, and to investigate the effects of parental involvement. A random sample of 15 schools with seventh and eight graders was randomly assigned to one of three conditions: (i) intervention with parental involvement, (ii) intervention alone and (iii) control group. In 10 schools, an intervention, combining environmental changes with computer-tailored feedback, was implemented over 2 school years. In five intervention schools, increased parental support was added. Physical activity was measured with questionnaires in the total sample and with accelerometers in a sub-sample of children. Fat intake, fruit, water and soft drink consumption were measured using food-frequency questionnaires. Results showed significant positive intervention effects on physical activity in both genders and on fat intake in girls. Parental involvement did not increase intervention effects. It can be concluded that physical activity and eating behaviours of middle school children can be improved by school-based strategies combining environmental and personal interventions. The use of personalized computer-tailored interventions seems to be a promising tool for targeting adolescents but needs to be further explored.     

Effects of a physical activity and healthy eating intervention to reduce stroke risk factors in older adults

Objective

To evaluate the effects of a theory-based physical activity and healthy eating intervention aimed at reducing stroke risk factors among overweight/obese and sedentary older adults.

Methods

Between 12/2009–1/2011, participants (n = 69) were randomly assigned to an 8-week group motivational intervention or biweekly newsletters by mail. Physical activity (blinded pedometer, 7-day recall) body composition, theoretical mediator, and dietary (24-hour recall) variables were measured at pre-test and post-test. The physical activity and dietary outcomes are reported.

Results

For outcome measures, the follow-up was 90% for the intervention group (n = 29) and 91% for the control group (n = 34) for this sample. Statistically significant differences in the 7-day physical activity self-report were noted at post-test in the intervention group. The dietary measures were not statistically significant at post-test; however, the intervention group increased the quantity of vegetable servings.

Conclusion

Limited efficacy testing was supported for a combined physical activity-dietary intervention, framed by a wellness-motivation theory, and designed to reduce stroke risk factors in older adults who are sedentary and overweight/obese. Limitations were identified and recommendations for additional research provided.     

“52110”干预模式对中小学生健康饮食运动行为效果分析

分析“52110”干预模式对中小学生健康知识、行为干预效果,为中小学生肥胖控制提供合理干预措施.方法 采用分层整群随机抽样方法,于2013年9月在宁夏银川和吴忠市抽取学生2 148名,采用问卷调查和体格检查方法,评价“52110”模式对中小学生饮食运动干预效果.结果 宁夏银川、吴忠2地区中小学生对于健康饮食知晓率较高.干预前12项问题均答对者,干预组比例(52.7%)高于对照组(42.5%),差异有统计学意义(x2=14.036,P<0.01);干预后干预组(69.8%)高于对照组(64.1%),差异有统计学意义(x2=4.965,P=0.026).干预后健康饮食行为中,干预组每天食用水果、蔬菜、肉类的份数均多于对照组,差异均有统计学意义(P值均<0.05);干预后健康运动行为中,与对照组相比,干预组高强度运动时间和看电视时间较少,中强度运动时间较高,差异均有统计学意义(P值均<0.05).干预组干预后,身高、体重高于干预前,收缩压(SBP)低于干预前,差异均有统计学意义(P值均<0.01),干预前后体质量指数(BMI),舒张压(DBP)差异无统计学意义;对照组干预后BMI、身高、体重均高于干预前(P值均<0.01),SBP干预后低于干预前(P<0.05),DBP干预前后差异无统计学意义(P>0.05).结论 “52110”干预模式对中小学生健康饮食知识知晓率和行为干预有一定的促进作用,能有效缓解中小学生超重、肥胖的发生.     

The importance of exposure for healthy eating in childhood: a review

Children's food preferences are strongly associated with their consumption patterns. Identifying the factors that influence preferences is therefore crucial to the development of effective interventions to improve children's diets. Perhaps the most important determinant of a child's liking for a particular food is the extent to which it is familiar. Put simply, children like what they know and they eat what they like. From the very earliest age, children's experiences with food influence both preferences and intake, and research suggests that the earlier and broader that experience, the healthier the child's diet. Laboratory studies of children's food acceptance have indicated that repeated opportunities to taste unfamiliar foods results in increased liking and consumption. In order to investigate whether these results can be replicated in real-world situations, a series of naturalistic studies testing the efficacy of exposure-based interventions have been carried out. In a school-based study large increases in liking and intake of raw red pepper were seen in 5- to 7-year olds and two further studies, in which mothers used exposure techniques to increase children's acceptance of vegetables, achieved similar results. If future large-scale interventions prove to be successful, training could be offered to health professionals or directly to parents themselves.     

RCT of a theory-based intervention promoting healthy eating and physical activity amongst out-patients older than 65 years

A randomised controlled trial was used to evaluate a theory-based health promotion intervention. The intervention, a healthy living booklet, was designed to promote healthy eating and physical activity amongst people aged over 65 years attending hospital out-patient clinics. The booklet employed persuasive arguments targeting the most proximal cognitive antecedents of behaviour specified by the theory of planned behaviour, as well as goal setting prompts. Participants (N = 252, average age=82) were randomly allocated to a control (patient satisfaction questionnaire) or intervention (healthy living booklet) group. Cognitions and behaviour were measured pre-intervention and at a two week follow up. The intervention group made significantly higher gains in perceived behavioural control, intention and behaviour for both target behaviours, suggesting that the intervention was successful. Sixty three of those invited to set goals to eat more healthily (e.g., "to eat five portions of fruit and vegetables a day") did so, and 67% of those who set such goals reported 100% success in acting on them. By contrast, only 34% of intervention participants set an activity goal (e.g., "a five minute walk everyday"), and only 51% reported 100% success in enacting these goals. Results suggest that the observed behavioural effects of the healthy eating booklet could be attributed to goal setting as well as changes in perceived behavioural control and intention.     

Day hospitalization programs for eating disorders: a systematic review of the literature

OBJECTIVE: Partial day hospitalization programs for the treatment of eating disorders are increasingly being developed worldwide. METHOD: First, a systematic database search of day hospitalization programs for eating disorders, published in either English or German, was conducted. Programs that provided sufficient information on their program structure were summarized and compared across various dimensions. Second, the responsible program directors were contacted to provide additional information regarding outcome data, current trends, challenges, and future directions of their programs. Third, outcome data from day programs presented at international conferences were included to expand the base of the review. DISCUSSION: Although the programs from different countries and health care environments varied in terms of their purpose and operated within very different health care systems, many similarities were found to exist, including the use of a multidisciplinary staff and reliance on group treatment as the primary means of therapy. Marked differences were noted in terms of inclusion criteria and intensity of care.     

Case study of a healthy eating intervention for Swedish lorry drivers

Professional drivers, i.e. lorry, truck, bus and taxi drivers, have been identified as a particular health risk group. An intervention to study the efficacy of a series of educational programmes, involving improved nutritional balance in meals served, food preparation routines and carrying out personal health profiles on staff, was implemented at a Swedish truck stop in order to target this specific hard-to-reach risk group. Professional drivers were targeted through an information campaign, healthier 'Today's Special' choices and by using staff as proxy health promoters. A campaign emblem on the menu notice board indicated healthier food choice menu items. Drivers choosing healthier alternatives were given lottery tokens. The intervention was evaluated through nutritional analyses, field observations, questionnaires and interviews. Positive staff-level outcomes included increased nutritional awareness, personal health empowerment and, most crucially, overwhelming staff support for a health-promoting role. Nutritional analysis of pre- and post-intervention 'Today's Specials' showed a better balance of fat, calories, carbohydrates and protein (per 100 g) content in the dishes tested. At management level there were economic benefits in terms of time savings and reduced use of cooking fat in food preparation. Drivers tended to choose healthier alternatives and there was increased awareness of the healthier alternatives on offer. The case study showed that using truck stop staff as proxy health promoters offers a viable intervention strategy.     

Promoting healthy eating and physical activity in adolescents

The purpose of this article is to provide an update on promoting healthy dietary and physical activity behaviors in adolescents. In the first part of the article the authors discuss the importance of healthy eating and physical activity during adolescence, present national recommendations and guidelines for diet and activity, and briefly review major nutrition and physical activity concerns of adolescents today. The second part presents a review of diet- and activity-related health promotion and risk reduction factors in a variety of settings and provides recommendations for practitioners. Future research needs are also addressed.     

Physical activity and Native Americans: a review

The physical activity behaviors of Native-American populations in the United States and Canada have received little attention in the health literature. The purpose of this review was to unite the literature regarding the physical activity behaviors of Native Americans. A majority of the literature was obtained using online databases. Reference lists were also reviewed to gain further access to the literature. Key-word searches included various combinations of Aboriginal, Native Indian, American Indian, Native American, First Nation, Métis, or Alaska Native with physical activity, exercise, and health behavior. Articles included were those published in English-language, peer-reviewed journals from 1990 until November 2005 that focused on participants aged 18 years and older. This review is organized according to ecologic models of health behavior, which take into account several correlates to explain human behavior, including demographic, personal health, environmental, and psychosocial. Correlates were included if they appeared at least three times in the literature. As a result of these inclusion criteria, the number of reviewed articles includes 28 quantitative, 4 qualitative, and 3 intervention studies. Results indicate that age, gender, and social support are important factors associated with physical activity. The remaining correlates show inconsistent or indeterminate results due in part to the paucity of research. It is suggested that an increase in the number of studies, especially those using longitudinal designs, is needed. Further, the application of psychosocial models to understand physical activity motivations as well as culturally appropriate and validated measurement tools are largely absent in the Native-American physical activity literature.     

Dissonance thin-ideal and didactic healthy behavior eating disorder prevention programs: results from a controlled trial

OBJECTIVE: Negative body image, a common problem among college-age women in the United States, strongly correlates with low self-esteem, disturbed eating behavior, and eating disorders. Psychoeducational programs have inconsistently shown improvement in body image, thin-ideal internalization, eating behaviors, psychosocial functioning, and self-esteem. METHOD: In the current study, college women with body image concerns (N = 84) were randomly assigned to a cognitive dissonance-based, thin-ideal internalization, single-session workshop (DTI; n = 26); a psychoeducational, healthy behavior, single-session workshop (HB; n = 24); or a wait-list control (WL; n = 34). RESULTS: Comparing baseline data with 4-week follow-up data, results indicated that both DTI and HB participants reported improvement in body image, thin-ideal internalization, and eating behaviors. DISCUSSION: Results provide evidence that both interventions effectively reduce risk factors for eating pathology.     

Physical activity and breast cancer: a systematic review

BACKGROUND: Many epidemiologic studies have found an association between physical activity and breast cancer risk, although this has not been a consistent finding. METHODS: Studies were identified through a systematic review of literature available on PubMed through February 2006. We included all cohort and case-control studies that assessed total or leisure time activities in relation to occurrence or mortality of breast cancer. The fully adjusted risk estimates and 95% confidence intervals for the highest versus lowest level of activity were documented for each study as well as evidence for a dose-response relationship. Methodologic quality was also assessed. Due to statistical and methodologic heterogeneity among studies, we did not carry out statistical pooling. To draw conclusions, we performed a best-evidence synthesis taking study quality into account. RESULTS: Nineteen cohort studies and 29 case-control studies were evaluated. There was strong evidence for an inverse association between physical activity and postmenopausal breast cancer with risk reductions ranging from 20% to 80%. For premenopausal breast cancer, however, the evidence was much weaker. For pre- and postmenopausal breast cancer combined, physical activity was associated with a modest (15-20%) decreased risk. Evidence for a dose-response relationship was observed in approximately half of the higher-quality studies that reported a decreased risk. A trend analysis indicated a 6% (95% confidence interval = 3% to 8%) decrease in breast cancer risk for each additional hour of physical activity per week assuming that the level of activity would be sustained. CONCLUSIONS: There is evidence for an inverse association between physical activity and breast cancer risk. The evidence is stronger for postmenopausal breast cancer than for premenopausal breast cancer.     

Physical activity and nutrition programs for couples: a randomized controlled trial

Diet and physical activity habits may deteriorate after cohabitation, leading to weight gain and increased risk of lifestyle diseases. We carried out a 4-month, randomized controlled trial of a diet and physical activity program for couples with a 1-year follow-up, comparing two methods of delivery. The program used six modules, which, after an initial group session, were mailed to the low-level intervention group. In the high-level intervention group, half of the modules were mailed, and the others were delivered at interactive group sessions. A control group received no intervention. Postintervention and at follow-up, physical fitness improved in the high-level group, saturated fat intake decreased in both intervention groups, and low-density lipoprotein cholesterol fell in the high-level group. Fewer participants in the high-level group became overweight or obese. Health promotion for couples can improve health behaviors and potentially lower the risk of lifestyle diseases in participants and their future families.