Reliability and validity of a nutrition and physical activity environmental self-assessment for child care

Background  

Few assessment instruments have examined the nutrition and physical activity environments in child care, and none are self-administered. Given the emerging focus on child care settings as a target for intervention, a valid and reliable measure of the nutrition and physical activity environment is needed.     

Joint care: what the parents want

No-one knows better than the parents of mentally handicapped children what facilities should be available for their short-term care, but they are not often asked. The North Tyneside Planning Group for the Mentally Handicapped did ask. Dave Bromley, senior administrative assistant, North Tyneside AHA and Tim Lister, clinical psychologist, Northumberland AHA explain that the results indicate the need for a flexible service.     

Quality child care: what does it mean for individual infants, parents and caregivers?

It is argued that previous research on child care quality fits a “black box” model where individual characteristics and the experiences of children, parents and caregivers are largely ignored as factors influencing outcome. An individual model of quality child care is presented in which infant-caregiver, parent-caregiver and peer relationships are the central features of a model which considers the influence of pre-care differences and the effect of program characteristics and standards on the well-being of children, parents and caregivers.     

Improving nutrition and physical activity in the workplace: a meta-analysis of intervention studies

A comprehensive search of the literature for studies examining physical activity or nutrition interventions in the workplace, published between 1999 and March 2009, was conducted. This search identified 29 relevant studies. Interventions were grouped according to the theoretical framework on which the interventions were based (e.g. education, cognitive-behavioural, motivation enhancement, social influence, exercise). Weighted Cohen's d effect sizes, percentage overlap statistics, confidence intervals and fail safe Ns were calculated. Most theoretical approaches were associated with small effects. However, large effects were found for some measures of interventions using motivation enhancement. Effect sizes were larger for studies focusing on one health behaviour and for randomized controlled trials. The workplace is a suitable environment for making modest changes in the physical activity, nutrition and health of employees. Further research is necessary to determine whether these changes can be maintained in the long term.     

Nutrition and physical activity in child care: results from an environmental intervention

BACKGROUND: With evidence of increased levels of obesity in younger children, the child-care setting is an important intervention target. Few environmental interventions exist, and none target both diet and physical activity. The Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) intervention was developed to fill this research and practice gap. DESIGN: Randomized controlled. SETTING/PARTICIPANTS: Health professionals (child-care health consultants) serving child-care centers in North Carolina were recruited (n=30), randomly assigned into intervention or delayed-intervention control groups, and trained to implement the NAP SACC program. Up to three child-care centers were recruited (n=84) from each consultant's existing caseload. INTERVENTION: Implemented in 2005, the NAP SACC intervention includes an environmental self-assessment, selection of areas for change, continuing education workshops, targeted technical assistance, and re-evaluation. Implementation occurred over a 6-month period. MAIN OUTCOME MEASURES: An observational instrument, Environment and Policy Assessment and Observation (EPAO), provided objective evidence of intervention impact and was completed by trained research staff blinded to study assignment. Data were collected in 2005 and 2006. Statistical analyses were conducted in 2006. RESULTS: Intention-to-treat analysis results were nonsignificant. Exploratory analyses using only centers that completed most of the NAP SACC program suggest an intervention effect. CONCLUSIONS: Factors in the intervention design, the fidelity of implementation, the selection of outcome measure, or a combination of these may have contributed to the lack of intervention effect observed. Because of this study's use of existing public health infrastructure and its potential for implementation, future studies should address strategies for improving effectiveness.     

Helping hospital patients quit: what the evidence supports and what guidelines recommend

OBJECTIVE: The study aimed to critically appraise the extent and strength of systematic review evidence for, and guideline recommendations regarding hospital smoking cessation interventions. METHODS: Systematic reviews of smoking cessation interventions were identified via an electronic search of the Cochrane Library. Meta-analyses from Cochrane reviews were categorised as those that incorporated only studies of hospital based interventions, and those which incorporated interventions which were not hospital based. Smoking cessation guidelines for hospital health professionals were identified via a search of the World Wide Web. RESULTS: The review found that evidence from meta-analyses restricted to hospital studies was insufficient to evaluate a number of specific intervention strategies and at times conflicted with the findings of meta-analyses without such restrictions. The majority of guidelines recommended the provision of brief advice, counseling, nicotine replacement therapy despite the absence of clear supporting evidence. CONCLUSIONS: Further hospital-based research addressing specific cessation strategies is required. Furthermore, smoking cessation guidelines for hospital based health professionals should more specifically reflect evidence from this setting.     

Obesity prevention in children: physical activity and nutrition

The current environmental experience of young children includes few opportunities for physical activity and an overabundance of high calorie foods. Sedentary lifestyles and poor nutrition challenge children who are predisposed to metabolic disorders. Obesity is a logical response to this challenge. To prevent clinically significant obesity and later metabolic disease in predisposed youth, all sectors of society must work together to support strategies to change public opinion and behavior across the life span. Parental education in all medical settings is strongly recommended, especially if the parent(s) are obese, beginning with the first pregnancy visit to the physician. Schools should be primary targets for efforts to educate parents concerning the reduction of TV, computer games, and unhealthy snacks. Schools should be encouraged to adopt vending machine policies that promote healthy drinks and food in appropriate portion sizes and discouraged from providing unhealthy food as rewards for positive behavior or academic accomplishment. Schools should provide daily physical education and frequent periods of unstructured play in young children. Clinical treatment should be both encouraged and financially supported in children who are already overweight. Community wide efforts to increase awareness and promote environments that encourage physical activity and healthy nutrition are needed.     

Participation of disadvantaged parents in child care research

AIM: To assess the level to which parents from deprived and socially dysfunctional families collaborate in complex and time-consuming research. DESIGN: Home-based study, of early physiological development in infants from a severely deprived area. Overnight continuous recordings of deep-body temperature with twice daily urine collection, parental daily diary of life-events and completion of child care social and psychological assessment by interview questionnaire. Measurements taken between age 6-12 weeks, each lasted 8-12 h per night, averaging four nights per baby. Level of parental participation assessed in relation to ongoing lifestyle pressures. Setting Home based. Inner city deprived estate. PARTICIPANTS: Random sample of mothers with newborn healthy infants. MEASUREMENTS: A total of 87 overnight deep body temperature recordings were made on 22 infants each lasting 8-12 h; 174 urine samples were taken; and 22 sets of questionnaires were completed. RESULTS: Of 62 inner city deprived parents, 39 (62%) agreed to participate. 22 (35%) completed the study. Ongoing lifestyle pressures were high including incidents of burglary, fire and family violence. Family and partner pressures and life crises overwhelmed 10 non-participations. CONCLUSIONS: Research partnerships can be developed with underprivileged families facing severe life-events. Parents were highly motivated to complete what they perceived as important infant care research.     

Factors associated with physical activity in children attending family child care homes

Objective

To determine the relationship between family child care home (FCCH) practices and characteristics, and objectively measured physical activity (PA) among children attending FCCHs.

Methods

FCCH practices and characteristics were assessed in 45 FCCHs in Oregon (USA) in 2010-2011 using the Nutrition and Physical Activity Self-Assessment for Child Care Instrument. Within the 45 FCCHs, 136 children between ages 2 and 5 years wore an accelerometer during child care attendance over a one-week period. Time spent in light, moderate, and vigorous PA per hour was calculated using intensity-related cut-points (Pate et al., 2006).

Results

FCCH characteristics and practices associated with higher levels of PA (min/h; p < 0.05) included provision of sufficient outdoor active play [32.2 (1.0) vs. 28.6 (1.3)], active play using portable play equipment [31.7 (1.0) vs. 29.3 (1.4)], the presence of a variety of fixed play equipment [32.2 (1.0) vs. 28.9 (1.3)], and suitable indoor play space [32.2 (1.0) vs. 28.6 (1.3)], engaging in active play with children [32.1 (1.1) vs. 29.6 (1.2)], and receiving activity-related training [33.1 (1.2) vs. 30.3 (1.1)].

Conclusions

This is the first study to identify practices and characteristics of FCCHs that influence children's PA. These data should be considered when developing programs and policies to promote PA in FCCHs.     

人力资本理论的形成、发展及其现实意义

伴随儿童营养干预评价技术的不断发展,儿童营养干预的效果评价已从单纯的健康效果评价发展至更为综合的总体效益评价。儿童营养干预项目的成本核算已细分出不同的核算方法,成本 – 效果分析中效果评价指标的选择不再局限于单一维度指标,成本 – 效用分析在评估儿童营养干预措施时建立起更为完善的分析框架并引入概率方法进行项目的成本效益估计。成本 – 效益分析因工资收入、医疗花费和生命年赋值的处理得以更全面地估计干预效益。为获得儿童营养干预后人力资本的提升程度,社会学和计量经济学方法也开始被引入,并从营养改善后儿童身高、受教育年限和认知能力的变化进行人力资本预测模型的构建。儿童营养干预的经济学评价研究正呈现出多学科深度融合的发展趋势。     

Understanding environmental influences on nutrition and physical activity behaviors: where should we look and what should we count?

Research interest in the influence of environmental factors on nutrition and physical activity behaviors has surged internationally in recent years. This is evident from a rapidly expanding literature and facilitated by advances in methodological and analytical approaches to assessing multiple levels of influence on health behaviors. However, a number of conceptual challenges complicate research endeavours in this field. The purpose of this paper is to provide a 'state of the science' overview of evidence regarding environmental influences on nutrition and physical activity behaviors. We focus particularly on a number of key conceptual and methodological issues, including: a consideration of how the environment is defined; the selection and operationalization of environmental exposures; and the importance of integrating existing understanding of individual influences on behavior with the emerging data on the role of the environment. We draw on examples from the published literature including our own research studies to illustrate these issues. We conclude by proposing a research agenda to progress understanding of the influences of the environment on population nutrition and physical activity behaviors.     

Improving health-enhancing physical activity in girls' physical education

This study examined the effectiveness of an intervention to increase levels of moderate-to-vigorous intensity physical activity (MVPA) during girls' physical education lessons. Two Year 7 classes (age 11-12 years) were randomly appointed to control and experimental groups. Both followed the same six-lesson unit of gymnastics with identical lesson objectives. The experimental class teacher included the additional objective of increasing MVPA during each lesson. MVPA was assessed in all six lessons using heart rate (HR) monitoring and systematic observation. After each lesson, students' intrinsic motivation and perceived competence were assessed, and the teachers evaluated whether they had met planned objectives. The experimental group engaged in more MVPA [F(1, 21) = 8.49, P = 0.008 (HR), t8 = -2.35, P = 0.048 (observation)] than the control group and also had most opportunities for skill practice (t8 = -2.81, P = 0.023). Intrinsic motivation and perceived competence levels were similar between the groups for each lesson, and teachers reported that lesson objectives were satisfactorily achieved. This intervention succeeded in increasing MVPA without compromising intrinsic motivation, perceived competence or planned lesson objectives.     

A child whose parents denied her psychiatric care

A 15-year-old girl was admitted because of an abdominal tumour and inability to eat. History revealed that after an accident at 9 years of age she increasingly developed medically unexplained signs and symptoms (e.g. tunnel vision with blindness, paralysis and loss of sensitivity below the umbilicus, periods of diminished consciousness). No somatic explanation could be found; the parents rejected psychiatric examination. Upon physical examination the patient's weight's was far below the third percentile (32 kg) and the tumour appeared to be the lumbar spine, palpable through the abdominal wall. Following tube feeding and behavioural therapy the girl gained weight and the tumour disappeared. No cause for the underweight was found. Conversion disorder was diagnosed. However, the parents strongly refused to accept this diagnosis; they lodged complaints with various bodies and made further treatment and counseling impossible. Children with psychological problems who were treated as having a somatic disorder by their mothers have been described before. The outcome can be lethal. Children showing unexplained signs and symptoms whose parents strongly refuse psychiatric care will be seriously jeopardised in terms of their somatic and psychological development. Physicians should identify this situation at an early stage.     

Obesity in rural youth: looking beyond nutrition and physical activity

Contributors to excessive obesity in rural youth include well-documented nutrition and physical activity behaviors. However, emerging research suggests that preventing excessive weight gain and smoking during pregnancy, teen pregnancy, and child abuse also could reduce obesity in this vulnerable population. These traditional and emerging, nontraditional factors need to be addressed within the confines of current challenges faced by rural communities. An enhanced ecological model provides a framework for combining traditional and nontraditional factors into a more comprehensive approach that addresses the complexity of the issues contributing to youth obesity.