Cluster Randomized Trial of the Impact of an Obesity Prevention Intervention on Child Care Center Nutrition and Physical Activity Environment Over Two Years

Objective: The prevalence of obesity among preschool-aged children in the United States remains unacceptably high. Here we examine the impact of Healthy Caregivers-Healthy Children (HC2) Phase 2, a child care center (CCC)-based obesity prevention intervention on changes in the CCC nutrition and physical activity environment over two school years. Design: This was a cluster randomized trial with 12 CCC receiving the HC2 intervention arm and 12 in the control arm. The primary outcome was change in the Environment and Policy Assessment and Observation (EPAO) tool over two school years (Fall-2015, Spring-2016 and Spring-2017). Changes in EPAO physical activity and nutrition score were analyzed via a (1) random effects mixed models and (2) mixed models to determine the effect of HC2 versus control. Setting: The study was conducted in 24 CCCs serving low-income, ethnically diverse families in Miami-Dade County. Participants: Intervention CCCs received (1) teachers/parents/children curriculum; (2) snack, beverage, physical activity, and screen time policies; and (3) menu modifications. Results: Two-year EPAO nutrition score changes in intervention CCCs were almost twice that of control CCCs. The EPAO physical activity environment scores only slightly improved in intervention CCCs versus control CCCs. Intervention CCCs showed higher combined EPAO physical activity and nutrition scores compared to control CCCs over the 2-year study period (β=0.09, P=0.05). Conclusions: Obesity prevention programs can have a positive impact on the CCC nutrition environment and can promote healthy weight in early childhood. CCCs may need consistent support to improve the physical activity environment to ensure the policies remain intact.

Association between the school physical activity environment, measured and self-reported student physical activity and active transport behaviours in Victoria, Australia

Background Environments within schools including the physical, social-cultural and policy/practice environments have the potential to influence children’s physical activity (PA) behaviours and weight status. This Australian first study comprehensively examined the association(s) of physical, social-cultural and policy/practice environments with PA, active transport (AT) and weight status among regional primary school children. Methods Data were from two childhood obesity monitoring systems in regional Victoria, Australia. Measured height and weight were collected from students in Year 2 (aged approx. 7–8 years), Year 4 (9–10 years), and Year 6 (11–12 years). Self–reported PA behaviour, including AT were collected from students in Year 4 and 6 and a sub-sample wore an ActiGraph (wGT3X-BT) accelerometer for 7-days. A school physical activity environment audit was completed by the school principal and responses were used to calculate school physical activity environment scores (PAES) and active transport environment scores (ATES). Mixed effects logistic regression was used to assess the relationship between the proportion of students meeting the PA guidelines (≥60mins/day of moderate-to-vigorous PA) and PAES tertiles (low, medium, high) and those using AT and school ATES tertiles, controlling for gender, school size/type and socioeconomic composition. Results The analysed sample included 54/146 (37%) schools and 3360/5376 (64%) students. In stratified analysis, girls in schools with a medium PAES score were more likely to meet the objectively measured PA guideline compared to low PAES score (OR 2.3, 95%CI 1.27, 4.16). Similarly, students in schools with a medium or high ATES score had higher odds of self-reported AT (medium OR 3.15, 95%CI 1.67, 5.94; high OR 3.71, 95%CI: 1.80, 7.64). No association between PAES or ATES and weight status were observed. Self-reported AT among boys (OR 1.59, 95%CI 1.19, 2.13) and girls (OR 1.56, 95%CI 1.08, 2.27) was associated with higher odds of meeting self-reported PA guidelines on all 7-days than those who did not report using AT. Conclusions In this study of regional Victorian primary schools, PA environments were only associated with girls’ adherence to PA guidelines. School AT environments were strongly associated with students’ AT behaviours and with increased likelihood of students being physically active.

Effects of Healthy Change Intervention on Childhood Obesity Prevention in Mexico

Objectives To evaluate the effects of the Healthy Change intervention on maternal perceptions of their child's body weight (MPCW), weight status as overweight-obese (OW-OB), and associated variables (child’ BMI, maternal feeding style, and obesogenic home environment) in Mexico. Methods Randomized control trial consisted of two arms: the intervention group received Healthy Change, and control group received Hygiene and Accident Prevention. Data were collected at baseline and at the end of the program via self-administered questionnaires by mothers and anthropometric measurement in children. Results The proportion of mothers who accurately identified their children's weight status increased at study endpoint in both groups. The intervention group also showed a shift of mothers feeding style towards an authoritative style (17.4 vs 26.2, P < 0.001) and favorable changes family nutrition and physical activity environment scores on family eating practices, healthy home environment, family and child's physical activity. Conclusions The Healthy Change Intervention contributed to an increased recognition of children's overweight status, a shift toward a maternal authoritative feeding style, and favorable changes in family nutrition and physical activity environment. Funding Sources The National Council for Science and Technology (CONACYT)

Association of Neighborhood Food Environment and Physical Activity Environment With Obesity: A Large-Scale Cross-Sectional Study of Fifth- to Ninth-Grade Children in Japan

Objective: This study examined the relationship between neighborhood food and physical activity environment, and obesity among elementary and junior high school students in Japan. Methods: The participants were fifth- to ninth-grade children (n=7277), who were attending municipal schools in Japan. Percent overweight (POW) was calculated using their age, gender, height, and weight, which were collected through a questionnaire. A POW of < 20% was considered non-obese, while ≥ 20% was considered obese. Furthermore, using a geographic information system, we investigated the density of convenience stores, fast-food stores, casual restaurants, supermarkets and department stores, parks, sports facilities, stations, and intersections in the school district. Additionally, from the census, we obtained information regarding the population density of the municipality where the participants’ schools were located. Multiple logistic regression analysis was used to examine the relationship between obesity and food environment (the food environment model), between obesity and physical activity environment (the physical activity environment model), and among obesity, food, and physical activity environment (the food and physical activity environment model). Results: In the food environment model and the food and physical activity environment model, the density of convenience stores showed a significant positive association. In the physical activity environment model, the density of stations showed a significant negative association. Conclusion: This study’s findings can contribute to the development of appropriate community interventions for improving children’s health in Japan and similar areas.

Assessment of the Food and Physical Activity Environment on a University Campus

Large percentages of college students are reported to be overweight and sedentary and do not consume the recommended amounts of fruits and vegetables. These outcomes can be influenced by the students’ environment. The purpose of this study was to determine the level of healthfulness and environmental supports on Rutgers University’s Cook Campus (RU)—one of the five Rutgers campuses—by examining campus food and physical activity environment, and related policies. As a part of the nationwide Get Fruved study on over 90 college/university campuses, the Healthy Campus Environmental Audit (HCEA) instrument was used to assess dining establishments, vending machines, recreational environment, and policies at RU. RU scores were compared to the original scales and to the average of the other Get Fruved universities/colleges. RU’s healthfulness scores for dining halls/cafeterias, recreational environment, vending machine supports, and stimulants policy were on the higher end of the scales and above the averages of other Get Fruved schools. However, RU’s scores indicated limited healthfulness in fast-food/sit-down restaurants; walking/biking supports; availability of healthy snacks and beverages in vending machines; healthy eating policies; and policies encouraging physical activity and chronic disease prevention. This study identified the strengths and weaknesses in RU’s campus environment and in RU’s policies for healthy eating and active living. These results can be used to support a healthier campus environment.

Reflections on Developing a Career in Kinesiology and Public Health

This paper provides reflections on my academic career in kinesiology and public health from an autobiographical perspective. Themes include the importance of movement and physical activity in my development and career choices, a recognition of the importance of physical activity for health outcomes, experiences in studying physical activity in a public health framework, and observations on kinesiology in higher education. I also reflect on the importance of the physical education and physical activity environment that brought me a sense of belonging, enjoyment, and accomplishment that has lasted throughout my career. As in sports and professional activities, I have tried my best and never given up until I felt the task was done.