The Wellness Child Care Assessment Tool: a measure to assess the quality of written nutrition and physical activity policies

BackgroundThere is a growing interest in studying the influence of child-care center policies on the health of preschool-aged children.ObjectiveTo develop a reliable and valid instrument to quantitatively evaluate the quality of written nutrition and physical activity policies at child-care centers.DesignReliability and validation study. A 65-item measure was created to evaluate five areas of child-care center policies: nutrition education, nutrition standards for foods and beverages, promoting healthy eating in the child-care setting, physical activity, and communication and evaluation. The total scale and each subscale were scored on comprehensiveness and strength.SettingAnalyses were conducted on 94 independent policies from Connecticut child-care centers participating in the Child and Adult Care Food Program.Statistical analyses performedIntraclass correlation coefficient was calculated to measure inter-rater reliability, and Cronbach's α was used to estimate internal consistency. To test construct validity, t tests were used to assess differences in scores between Head Start and non–Head Start centers and between National Association for the Education of Young Children–accredited and nonaccredited centers.ResultsInter-rater reliability was high for total comprehensiveness and strength scores (intraclass correlation coefficient=0.98 and 0.94, respectively) and subscale scores (intraclass correlation coefficient=0.84 to 0.99). Subscales were adequately internally reliable (Cronbach's α=.53 to .83). Comprehensiveness and strength scores were higher for Head Start centers than non–Head Start centers across most domains and higher for National Association for the Education of Young Children–accredited centers than nonaccredited centers across some but not all domains, providing evidence of construct validity.ConclusionsThis instrument provides a standardized method to analyze and compare the comprehensiveness and strength of written nutrition and physical activity policies in child-care centers.     

Developing a reliable audit instrument to measure the physical environment for physical activity

BACKGROUND: The physical environment plays an important role in influencing participation in physical activity, although which factors of the physical environment have the greatest effect on patterns of activity remain to be determined. We describe the development of a comprehensive instrument to measure the physical environmental factors that may influence walking and cycling in local neighborhoods and report on its reliability. METHODS: Following consultation with experts from a variety of fields and a literature search, we developed a Systematic Pedestrian and Cycling Environmental Scan (SPACES) instrument and used it to collect data over a total of 1987 kilometers of roads in metropolitan Perth, Western Australia. The audit instrument is available from the first author on request. Additional environmental information was collected using desktop methods and geographic information systems (GIS) technology. We assessed inter- and intra-rater reliability of the instrument among the 16 observers who collected the data. RESULTS: The observers reported that the audit instrument was easy to use. Both inter- and intra-rater reliability of the environmental scan instrument were generally high. CONCLUSIONS: Our instrument provides a reliable, practical, and easy-to-use method for collecting detailed "street-level" data on physical environmental factors that are potential influences on walking in local neighborhoods.     

Validity of a short questionnaire to assess physical activity in 10 European countries

To accurately examine associations of physical activity (PA) with disease outcomes, a valid method of assessing free-living activity is required. We examined the validity of a brief PA questionnaire (PAQ) used in the European Prospective Investigation into Cancer and Nutrition (EPIC). PA energy expenditure (PAEE) and time spent in moderate and vigorous physical activity (MVPA) was measured in 1,941 healthy individuals from 10 European countries using individually-calibrated combined heart-rate and movement sensing. Participants also completed the short EPIC-PAQ, which refers to past year’s activity. Pearson (r) and Spearman (σ) correlation coefficients were calculated for each country, and random effects meta-analysis was used to calculate the combined correlation across countries to estimate the validity of two previously- and one newly-derived ordered, categorical PA indices (“Cambridge index”, “total PA index”, and “recreational index”) that categorized individuals as inactive, moderately inactive, moderately active, or active. The strongest associations with PAEE and MVPA were observed for the Cambridge index (r = 0.33 and r = 0.25, respectively). No significant heterogeneity by country was observed for this index (I² = 36.3%, P = 0.12; I² = 0.0%, P = 0.85), whereas heterogeneity was suggested for other indices (I² > 48%, P < 0.05, I² > 47%, P < 0.05). PAEE increased linearly across self-reported PA categories (P for trend <0.001), with an average difference of approximately 460 kJ/d for men and 365 kJ/d for women, between categories of the Cambridge index. The EPIC-PAQ is suitable for categorizing European men and women into four distinct categories of overall physical activity. The difference in PAEE between categories may be useful when estimating effect sizes from observational research.     

Assessment of food, nutrition, and physical activity practices in Oklahoma child-care centers

The purpose of the current study was to determine the obesogenic practices in all-day child-care centers caring for preschool-aged children. This study used a cross-sectional, self-reported survey mailed to centers across Oklahoma (n=314). Frequency of responses and χ(2) were calculated comparing region and star rating. Items where the majority of centers frequently report best practices include: daily fruits served (76%), daily nonfried vegetables served (71%), rarely/never served sugary drinks (92%), rarely/never used food to encourage good behaviors (88%), staff join children at table most of the time (81%), staff rarely eat different foods in view of children (69%), visible self-serve or request availability of water (93%), regular informal communication about healthy eating (86%), opportunities for outdoor play (95%), not withholding activity for punishment (91%), accessible play equipment (59% to 80% for different types of equipment), and minimization of extended sitting time (78%). Practices where centers can improve include increasing variety of vegetables (18%), reducing frequency of high-fat meats served (74% serve more than once per week), increasing high-fiber and whole-grain foods (35% offer daily), serving style of "seconds" (28% help kids determine whether they are still hungry), nonfood holiday celebrations (44% use nonfood treats), having toys and books that encourage healthy eating (27%) and physical activity (25%) in all rooms in the center, a standard nutrition (21%) and physical education (50%) curriculum, and following a written physical activity policy (43%). Practitioners can use these data to develop benchmarks and interventions, as this was the first study to assess statewide obesogenic practices in child care.     

Validity and reliability of a self-report instrument to assess social support and physical environmental correlates of physical activity in adolescents

ABSTRACT: BACKGROUND: The purpose of this study was to examine the internal consistency, test-retest reliability, construct validity and predictive validity of a new German self-report instrument to assess the influence of social support and the physical environment on physical activity in adolescents. METHODS: Based on theoretical consideration, the short scales on social support and physical environment were developed and cross-validated in two independent study samples of 9 to 17 year-old girls and boys. The longitudinal sample of Study I (n = 196) was recruited from a German comprehensive school, and subjects in this study completed the questionnaire twice with a between-test interval of seven days. Cronbach's alphas were computed to determine the internal consistency of the factors. Test-retest reliability of the latent factors was assessed using intra-class coefficients. Factorial validity of the scales was assessed using principle components analysis. Construct validity was determined using a cross-validation technique by performing confirmatory factor analysis with the independent nationwide cross-sectional sample of Study II (n = 430). Correlations between factors and three measures of physical activity (objectively measured moderate-to-vigorous physical activity (MVPA), self-reported habitual MVPA and self-reported recent MVPA) were calculated to determine the predictive validity of the instrument. RESULTS: Construct validity of the social support scale (two factors: parental support and peer support) and the physical environment scale (four factors: convenience, public recreation facilities, safety and private sport providers) was shown. Both scales had moderate test-retest reliability. The factors of the social support scale also had good internal consistency and predictive validity. Internal consistency and predictive validity of the physical environment scale were low to acceptable. CONCLUSIONS: The results of this study indicate moderate to good reliability and construct validity of the social support scale and physical environment scale. Predictive validity was only confirmed for the social support scale but not for the physical environment scale. Hence, it remains unclear if a person's physical environment has a direct or an indirect effect on PA behavior or a moderation function.     

Seven-day activity and self-report compared to a direct measure of physical activity

To determine how well a seven-day interview-administered activity recall used in a large epidemiologic study at Stanford University reflected seven days of self-reported activity and directly measured physical activity, 30 white males, mean age 52 years, recorded daily physical activity for a week, and half of these wore an ambulatory solid-state minicomputer (Vitalog) which measures continuous heart rate and motion. Total hours of moderate, hard, and hard plus very hard activity were not significantly different for weekdays and weekends for self-report and recall and were significantly correlated. Total energy expenditure for subjects wearing the Vitalog averaged 38.5 +/- 6.7 kcal/kg/day compared to an average of 37.7 +/- 4.5 kcal/kg/day for recall or 39.6 +/- 7.2 kcal/kg/day for self-report. Conditioning activities are best remembered followed by home or leisure and job activities. Mean hours of sleep per week night were significantly greater reported by self-report than reported by recall, but the two were significantly correlated. It is concluded that a seven-day activity recall accurately reflects mean kcal/day expenditure, with conditioning activities being the best recalled. A self-report log used in conjunction with an interview-based seven-day recall might maximize accuracy of recall.     

Test-retest reliability of a questionnaire to assess physical environmental factors pertaining to physical activity

Background  

Despite the documented benefits of physical activity, many adults do not obtain the recommended amounts. Barriers to physical activity occur at multiple levels, including at the individual, interpersonal, and environmental levels. Only until more recently has there been a concerted focus on how the physical environment might affect physical activity behavior. With this new area of study, self-report measures should be psychometrically tested before use in research studies. Therefore the objective of this study was to document the test-retest reliability of a questionnaire designed to assess physical environmental factors that might be associated with physical activity in a diverse adult population.     

A systematic review of existing observational tools to measure the food and physical activity environment in schools

Objective measures of schools' wellness-promoting environments are commonly used in obesity prevention studies; however, the extent to which findings from these measures translate to policy and practice is unknown. This systematic review describes the comprehensiveness and usability (practicality, quality, and applicability) of existing objective measures to assess schools’ food and physical activity environments. A structured keyword search and standard protocol in electronic databases yielded 30 publications reporting on 23 measures that were deemed eligible to include in this review. Findings provide details to guide researchers and practitioners in selecting the best tool for use in policy and program evaluations.     

Validity and repeatability of the EPIC physical activity questionnaire: a validation study using accelerometers as an objective measure

Background

Few measures exist to measure the overall home environment for its ability to support physical activity (PA) and healthy eating in overweight children. The purpose of this study was to develop and test the reliability and validity of such a measure.

Methods

The Home Environment Survey (HES) was developed to reflect availability, accessibility, parental role modelling, and parental policies related to PA resources, fruits and vegetables (F&V), and sugar sweetened drinks and snacks (SS). Parents of overweight children (n = 219) completed the HES and concurrent behavioural assessments. Children completed the Block Kids survey and wore an accelerometer for one week. A subset of parents (n = 156) completed the HES a second time to determine test-retest reliability. Finally, 41 parent dyads living in the same home (n = 41) completed the survey to determine inter-rater reliability. Initial psychometric analyses were completed to trim items from the measure based on lack of variability in responses, moderate or higher item to scale correlation, or contribution to strong internal consistency. Inter-rater and test-retest reliability were completed using intraclass correlation coefficients. Validity was assessed using Pearson correlations between the HES scores and child and parent nutrition and PA.

Results

Eight items were removed and acceptable internal consistency was documented for all scales (α = .66–84) with the exception of the F&V accessibility. The F&V accessibility was reduced to a single item because the other two items did not meet reliability standards. Test-retest reliability was high (r > .75) for all scales. Inter-rater reliability varied across scales (r = .22–.89). PA accessibility, parent role modelling, and parental policies were all related significantly to child (r = .14–.21) and parent (r = .15–.31) PA. Similarly, availability of F&V and SS, parental role modelling, and parental policies were related to child (r = .14–36) and parent (r = .15–26) eating habits.

Conclusion

The HES shows promise as a potentially valid and reliable assessment of the physical and social home environment related to a child's physical activity and eating habits.     

Comparison of surveys used to measure physical activity

OBJECTIVE: To compare the level of agreement in results obtained from four physical activity (PA) measurement instruments that are in use in Australia and around the world. METHODS: 1,280 randomly selected participants answered two sets of PA questions by telephone. 428 answered the Active Australia (AA) and National Health Surveys, 427 answered the AA and CDC Behavioural Risk Factor Surveillance System surveys (BRFSS), and 425 answered the AA survey and the short International Physical Activity Questionnaire (IPAQ). RESULTS: Among the three pairs of survey items, the difference in mean total PA time was lowest when the AA and NHS items were asked (difference=24) (SE:17) minutes, compared with 144 (SE:21) mins for AA/BRFSS and 406 (SE:27) mins for AA/IPAQ). Correspondingly, prevalence estimates for 'sufficiently active' were similar for AA and NHS (56% and 55% respectively), but about 10% higher when BRFSS data were used, and about 26% higher when the IPAQ items were used, compared with estimates from the AA survey. CONCLUSIONS: The findings clearly demonstrate that there are large differences in reported PA times and hence in prevalence estimates of 'sufficient activity' from these four measures. IMPLICATIONS: It is important to consistently use the same survey for population monitoring purposes. As the AA survey has now been used three times in national surveys, its continued use for population surveys is recommended so that trend data over a longer period of time can be established.     

Grandparents raising grandchildren: a response to a nutrition and physical activity intervention

This pilot study explored the impact of an educational program on nutrition and physical activity knowledge of urban African-American grandparents raising their grandchildren. The program was integrated into a community-based intervention, Project Healthy Grandparents, and was implemented during the first 15 minutes of 10 grandparent support groups and parenting classes. Subjects included 22 grandparents who attended at least six sessions and completed pre- and posttests of nutrition and physical activity knowledge. Participants' posttest scores were significantly higher than their pretest scores (P<0.05), indicating an increase in knowledge. Eighteen grandparents provided insights about diet and physical activity and barriers to lifestyle changes during an audiotaped focus group. Based on analysis of the focus group's discussion, three major influences on healthful eating and physical activity emerged, including financial considerations, presence of grandchildren in the home, and preference for traditional cultural foods. Themes from the focus group were consistent with responses on the nutrition and physical activity knowledge test. Satisfaction with the program was very high and no specific recommendations for improvements were made. Results can guide future nutrition interventions for this target group and potentially contribute to grandparents' improved health and ability to care for their grandchildren.     

Brief scales to assess physical activity and sedentary equipment in the home

Background  

Sedentary behaviors such as TV viewing are associated with childhood obesity, while physical activity promotes healthy weight. The role of the home environment in shaping these behaviors among youth is poorly understood. The study purpose was to examine the reliability of brief parental proxy-report and adolescent self-report measures of electronic equipment and physical activity equipment in the home and to assess the construct validity of these scales by examining their relationship to physical activity, sedentary behavior, and weight status of children and adolescents.     

Sustainability of a physical activity and nutrition program for seniors

Objective

This prospective cohort study aimed to determine the impact of a low cost, home-based physical activity and nutrition program for older adults at 6 months follow-up.

Design

A follow-up survey was conducted 6 months after program completion via computer-assisted telephone interviewing. The International Physical Activity Questionnaire and the Fat and Fibre Barometer were used to measure physical activity levels and dietary behaviours, respectively. Self-reported height, weight, waist and hip circumferences were obtained. Changes over three time points of data collection (baseline, post-program, follow-up) and differences between the intervention and control groups were assessed. The use of program materials was also evaluated.

Setting

Community and home-based.

Participants

Insufficiently active 60 to 70 year olds (n = 176, intervention and n = 198, control) residing in suburbs within the Perth metropolitan area.

Results

A sustained improvement was observed for the intervention group in terms of fat avoidance behaviours (p interaction =.007). Significant improvements were found for strength exercises, fibre intake, body mass index and waist-to-hip ratio at either post-program or follow-up, however the overall effect was not significant. At post-program, the intervention group increased time spent participating in moderate activity by 50 minutes (p >.05), which was followed by a significant decline at follow-up (p <.05). Among intervention group participants, males and females differed with respect to strength exercises and moderate physical activity.

Conclusion

This low-cost physical activity and nutrition intervention resulted in a sustained improvement in fat avoidance behaviours and overall short-term gains in physical activity. Future studies for older adults are recommended to investigate gender-specific behavioural barriers as well as booster interventions which focus on physical activity.     

Cross-cultural adaptation,content validity,and feasibility of the school physical activity and nutrition environment tool

ObjectiveTo perform a cross-cultural adaptation, content validity and feasibility of The School Physical Activity and Nutrition Environment Tool (SPAN-ET) for the Spanish context. It is a valuable tool for making comprehensive assessments of school environments in three environmental categories: policy, situation/social, and physical.MethodWe followed the cross-cultural adaptation guidelines which consist of a five-stage methodological approach: 1) forward translation, 2) synthesis, 3) back translation, 4) adaptation to the Spanish context, and 5) pilot testing. In addition, an expert panel performed a content validity analysis to assess the level of comprehensibility, applicability, and cultural appropriateness of the SPAN-ET for its use in Spain. The pilot test was carried out in five schools to assess the feasibility of the tool in the Spanish context.ResultsAfter applying the guidelines for the translation and cultural adaptation of the SPAN-ET into the Spanish context, the new tool (SPAN-ET-ES) preserves the main dimensions of the original document to evaluate school environments in Spain. The evaluation of the SPAN-ET-ES, done by an expert panel, concluded that items included in the revised version of the SPAN-ET-ES were relevant (S-CVI/Ave = 0.96), clear (S-CVI/Ave = 0.96), simple (S-CVI/Ave = 0.98), and non-ambiguous (S-CVI/Ave = 0.98) for the Spanish context. Finally, the pilot test offered empirical evidence for the feasibility and content validity of the SPAN-ET-ES at assessing school environments in Spain.ConclusionsSPAN-ET-ES is a feasible tool for assessing nutrition and physical activity environments at schools in Spain.     

Reproducibility and relative validity of the short questionnaire to assess health-enhancing physical activity

BACKGROUND/OBJECTIVES: The purpose of this study is to determine reproducibility and relative validity of the Short QUestionnaire to ASsess Health-enhancing physical activity (SQUASH). METHODS: Participants (36 men and 14 women, aged 27-58) were asked to complete the SQUASH twice with an inbetween period of approximately 5 weeks. In addition, participants wore the Computer Science and Applications (CSA) Activity Monitor for a 2-week period following the first questionnaire. RESULTS: The Spearman correlation for overall reproducibility of the SQUASH was 0.58 (95%-CI 0.36-0.74). Correlations for the reproducibility of the separate questions varied between 0.44 and 0.96. Spearman's correlation coefficient between CSA readings and the total activity score was 0.45 (95%-CI 0.17-0.66). CONCLUSIONS: In conclusion, the SQUASH is a fairly reliable and reasonably valid questionnaire and may be used to order subjects according to their level of physical activity in an adult population. Because the SQUASH is a short and simple questionnaire, it may proof to be a very useful tool for the evaluation of health enhancing physical activity in large populations.