Cost effectiveness of childhood obesity interventions: Evidence and methods for CHOICES

INTRODUCTION: The childhood obesity epidemic continues in the U.S., and fiscal crises are leading policymakers to ask not only whether an intervention works but also whether it offers value for money. However, cost-effectiveness analyses have been limited. This paper discusses methods and outcomes of four childhood obesity interventions: (1) sugar-sweetened beverage excise tax (SSB); (2) eliminating tax subsidy of TV advertising to children (TV AD); (3) early care and education policy change (ECE); and (4) active physical education (Active PE). METHODS: Cost-effectiveness models of nationwide implementation of interventions were estimated for a simulated cohort representative of the 2015 U.S. population over 10 years (2015-2025). A societal perspective was used; future outcomes were discounted at 3%. Data were analyzed in 2014. Effectiveness, implementation, and equity issues were reviewed. RESULTS: Population reach varied widely, and cost per BMI change ranged from $1.16 (TV AD) to $401 (Active PE). At 10 years, assuming maintenance of the intervention effect, three interventions would save net costs, with SSB and TV AD saving $55 and $38 for every dollar spent. The SSB intervention would avert disability-adjusted life years, and both SSB and TV AD would increase quality-adjusted life years. Both SSB ($12.5 billion) and TV AD ($80 million) would produce yearly tax revenue. CONCLUSIONS: The cost effectiveness of these preventive interventions is greater than that seen for published clinical interventions to treat obesity. Cost-effectiveness evaluations of childhood obesity interventions can provide decision makers with information demonstrating best value for the money.

Cross-cultural comparison of motor competence in children from Australia and Belgium

Motor competence in childhood is an important determinant of physical activity and physical fitness in later life. However, childhood competence levels in many countries are lower than desired. Due to the many different motor skill instruments in use, children's motor competence across countries is rarely compared. The purpose of this study was to evaluate the motor competence of children from Australia and Belgium using the Körperkoordinationstest für Kinder (KTK). The sample consisted of 244 (43.4% boys) Belgian children and 252 (50.0% boys) Australian children, aged 6-8 years. A MANCOVA for the motor scores showed a significant country effect. Belgian children scored higher on jumping sideways, moving sideways and hopping for height but not for balancing backwards. Moreover, a Chi squared test revealed significant differences between the Belgian and Australian score distribution with 21.3% Belgian and 39.3% Australian children scoring "below average." The very low levels reported by Australian children may be the result of cultural differences in physical activity contexts such as physical education and active transport. When compared to normed scores, both samples scored significantly worse than children 40 years ago. The decline in children's motor competence is a global issue, largely influenced by increasing sedentary behavior and a decline in physical activity.

Earth-based spirituality in Australian outdoor & environmental studies

Australian Outdoor & Environmental Studies (OES), under the curriculum framework of Health and Physical Education (HPE), is influenced by dominant discourses of androcentric perspectives of wilderness. As such, inherent adventure hegemonies impact the type and depth of relationship that can emerge with nature. Through an eco-feminist lens, I will draw on the stories of three adolescent students and their encounters with spiritual pedagogy, namely meditation practices within Australian OES. These student stories, collected during a 5-day hiking expedition in a remote coastal environment in southern Victoria, demonstrated that ideas of ‘femininity’ are subjugated and inferiorised to ideas of ‘masculinity’ in the outdoors. Therefore, I call for OES pedagogical approaches to work towards a more robust integration of ‘masculine’ and ‘feminine’ psyches towards values of deep ecology. In this paper I will draw on Merleau - Ponty’s emotional embodiment theories and Jung’s psychological theories, to argue for a reshaping of OES pedagogical approaches that more thoroughly include spiritual and emotional inquiry, in order to create deeper connections to the natural world in the context of contemporary global environmental challenges.

‘I felt like I was watching porn’: the reality of preparing pre-service teachers to teach about sexual pleasure

Overwhelmingly, school-based sexuality education programmes focus on the prevention of infection, pregnancy and abuse, with little if any attention given to positive views of sexuality and rarely the inclusion of sex positive issues such as pleasure, intimacy and desire. This paper explores the experience of teaching about pleasure to pre-service health and physical education teachers as part of compulsory studies in a unit on sexuality education designed to prepare them to teach sexuality education in secondary schools. Drawing on the aims, theoretical framework, content and pedagogical structure of the unit, and data collected from 42, third-year pre-service teachers (PST) in Australia via surveys and student assessment, the paper provides some practical examples of what teaching about pleasure might look like in practice. It argues that with adequate preparation, a framework to celebrate sex and sexuality, a gender lens to examine normative discourses, and the opportunity for reflection, PST can develop the confidence, skill and willingness to include pedagogies of pleasure in their school-based work.

Fundamental movement skills are more than run, throw and catch: the role of stability skills

INTRODUCTION: In motor development literature fundamental movement skills are divided into three constructs: locomotive, object control and stability skills. Most fundamental movement skills research has focused on children's competency in locomotor and object control skills. The first aim of this study was to validate a test battery to assess the construct of stability skills, in children aged 6 to 10 (M age = 8.2, SD = 1.2). Secondly we assessed how the stability skills construct fitted into a model of fundamental movement skill. METHOD: The Delphi method was used to select the stability skill battery. Confirmatory factor analysis (CFA) was used to assess if the skills loaded onto the same construct and a new model of FMS was developed using structural equation modelling. RESULTS: Three postural control tasks were selected (the log roll, rock and back support) because they had good face and content validity. These skills also demonstrated good predictive validity with gymnasts scoring significantly better than children without gymnastic training and children from a high SES school performing better than those from a mid and low SES schools and the mid SES children scored better than the low SES children (all p < .05). Inter rater reliability tests were excellent for all three skills (ICC = 0.81, 0.87, 0.87) as was test re-test reliability (ICC 0.87-0.95). CFA provided good construct validity, and structural equation modelling revealed stability skills to be an independent factor in an overall FMS model which included locomotor (r = .88), object control (r = .76) and stability skills (r = .81). DISCUSSION: This study provides a rationale for the inclusion of stability skills in FMS assessment. The stability skills could be used alongside other FMS assessment tools to provide a holistic assessment of children's fundamental movement skills.