An index of diet and eating patterns is a valid measure of diet quality in an Australian population

Diet indices represent an integrated approach to assessing eating patterns and behaviors. The aim of this study was to develop a comprehensive food-based dietary index to reflect adherence to healthy eating recommendations, evaluate the construct validity of the index using nutrient intakes, and evaluate this index in relation to sociodemographic factors, health behaviors, risk factors, and self-assessed health status. Data were analyzed from adult participants of the Australian National Nutrition Survey who completed a 108-item FFQ and a food habits questionnaire (n = 8220). The dietary guideline index (DGI) consisted of 15 items reflecting the dietary guidelines, including dietary indicators of vegetables and legumes, fruit, total cereals, meat and alternatives, total dairy, beverages, sodium, saturated fat, alcoholic beverages, and added sugars. Diet quality was incorporated using indicators relating to whole-grain cereals, lean meat, reduced/low fat dairy, and dietary variety. We investigated associations between the DGI score, sociodemographic factors, health behaviors, chronic disease risk factors, and nutrient intakes. We found associations between the DGI scores and sex, age, income, area-level socioeconomic disadvantage, smoking, physical activity, waist:hip ratio, systolic blood pressure (males only), and self-assessed health status (females only) (all P < 0.05). Higher DGI scores were associated with lower intakes of energy, total fat, and saturated fat and higher intakes of fiber, β-carotene, vitamin C, folate, calcium, and iron (P < 0.05). This food-based dietary index is able to discriminate across a variety of sociodemographic factors, health behaviors, and self-assessed health and reflects intakes of key nutrients.

Dietary patterns of adolescents and risk of obesity and hypertension

Increasingly, measures of dietary patterns have been used to capture the complex nature of dietary intake and investigate its association with health. Certain dietary patterns may be important in the prevention of chronic disease; however, there are few investigations in adolescents. The aim of this study was to describe the dietary patterns of adolescents and their associations with sociodemographic factors, nutrient intakes, and behavioral and health outcomes. Analysis was conducted using data collected in the 1995 Australian National Nutrition Survey of participants aged 12–18 y who completed a 108-item FFQ (n = 764). Dietary patterns were identified using factor analysis and associations with sociodemographic factors and behavioral and health outcomes investigated. Factor analysis revealed 3 dietary patterns labeled a fruit, salad, cereals, and fish pattern; a high fat and sugar pattern; and a vegetables pattern, which explained 11.9, 5.9, and 3.9% of the variation in food intakes, respectively. The high fat and sugar pattern was positively associated with being male (P < 0.001), the vegetables pattern was positively associated with rural region of residence (P = 0.004), and the fruit, salad, cereals, and fish pattern was inversely associated with age (P = 0.03). Dietary patterns were not associated with socioeconomic indicators. The fruit, salad, cereals, and fish pattern was inversely associated with diastolic blood pressure (P = 0.0025) after adjustment for age, sex, and physical activity in adolescents ≥16 y. This study suggests that specific dietary patterns are already evident in adolescence and a dietary pattern rich in fruit, salad, cereals, and fish pattern may be associated with diastolic blood pressure in older adolescents.

Is the perception of time pressure a barrier to healthy eating and physical activity among women?

Objectives To describe the proportion of women reporting time is a barrier to healthy eating and physical activity, the characteristics of these women and the perceived causes of time pressure, and to examine associations between perceptions of time as a barrier and consumption of fruit, vegetables and fast food, and physical activity.
Design A cross-sectional survey of food intake, physical activity and perceived causes of time pressure.
Setting A randomly selected community sample.
Subjects A sample of 1580 women self-reported their food intake and their perceptions of the causes of time pressure in relation to healthy eating. An additional 1521 women self-reported their leisure-time physical activity and their perceptions of the causes of time pressure in relation to physical activity.
Results Time pressure was reported as a barrier to healthy eating by 41 % of the women and as a barrier to physical activity by 73 %. Those who reported time pressure as a barrier to healthy eating were significantly less likely to meet fruit, vegetable and physical activity recommendations, and more likely to eat fast food more frequently.
Conclusions Women reporting time pressure as a barrier to healthy eating and physical activity are less likely to meet recommendations than are women who do not see time pressure as a barrier. Further research is required to understand the perception of time pressure issues among women and devise strategies to improve women’s food and physical activity behaviours.

Perceptions of neighborhood safety and physical activity among youth : the CLAN study

Background: The purpose of this study was to examine associations between perceptions of neighborhood safety and physical activity among youth. Methods: We completed a cross-sectional study of children age 8 to 9 years (n = 188) and adolescents age 13 to 15 years (n = 346) in areas of varying socioeconomic status in Melbourne, Australia. Parents and adolescents completed questionnaires on perceptions of neighborhood safety. Scores were computed for perceptions of road safety, incivilities, and personal safety of the child or adolescent. Moderate-to-vigorous physical activity (MVPA) before or after school, on evenings, and on weekends was recorded using accelerometers. Results: There were no associations between parental perceptions of neighborhood safety and children’s MVPA outside school hours. Parental perception of personal safety was positively associated with adolescent boys’ MVPA after school. Adolescent girls’ concern about road safety was negatively associated with their MVPA during evenings and outside school hours. Conclusion: Perceptions of neighborhood safety might influence physical activity among youth in different ways according to age group and sex.

Playing it safe : the influence of neighbourhood safety on children's physical activity − A review

Compared with previous generations, children spend less time playing outdoors and have lower participation rates in active transport. Many studies have identified lack of neighbourhood safety as a potential barrier to children's physical activity. This review describes concerns regarding ‘stranger danger’ and road safety, and discusses empirical studies that examine associations between neighbourhood safety and physical activity among youth. Variability of perceptions of safety between parents and youth are examined; ‘social traps’ are identified; and physical/social environmental interventions aimed at improving neighbourhood safety are discussed. A research agenda is suggested for further study of perceived and objective measures of neighbourhood safety and their associations with children's physical activity.

Neighborhood road environments and physical activity among youth : the CLAN Study

We examined associations between objective measures of the local road environment and physical activity (including active transport) among youth. There is little empirical evidence of the impact of the road environment on physical activity among children/adolescents in their neighborhoods. Most recent studies have examined perceptions rather than objective measures of the road environment. This was a cross-sectional study of children aged 8–9 years (n = 188) and adolescents aged 13–15 years (n  = 346) who were participants in the 3-year follow-up of the Children Living in Active Neighborhoods (CLAN) longitudinal study in Melbourne, Australia. At baseline (2001), they were recruited from 19 state primary schools in areas of varying socioeconomic status across Melbourne. Habitual walking/cycling to local destinations was parent-reported for children and self-reported for adolescents, while moderate-to-vigorous physical activity (MVPA) outside school hours was recorded using accelerometers. Road environment features in each participant’s neighborhood (area of radius 800 m around the home) were measured objectively using a geographical information system. Regression analyses found no associations between road environment variables and children’s likelihood of making at least seven walking/cycling trips per week to neighborhood destinations. Adolescent girls residing in neighborhoods with two to three traffic/pedestrian lights were more likely to make seven or more walking/cycling trips per week as those whose neighborhoods had fewer traffic lights (OR: 2.7; 95% CI: 1.2–6.2). For adolescent boys, residing on a cul-de-sac, compared with a through road, was associated with increases in MVPA of 9 min after school, 5 min in the evenings, and 22 min on weekend days. Speed humps were positively associated with adolescent boys’ MVPA during evenings. The road environment influences physical activity among youth in different ways, according to age group, sex and type of physical activity.

Are perceptions of the physical and social environment associated with mothers' walking for leisure and for transport? A longitudinal study

Objective
The role local neighbourhood environments play in influencing purpose-specific walking behaviors has not been well-explored in prospective studies. This study aimed to cross-sectionally and prospectively examine whether local physical and social environments were associated with mothers' walking for leisure and for transport.

Methods
In 2004, 357 mothers from Melbourne, Australia, provided information on their local physical and social neighbourhood environments, and in 2004 and 2006 reported weekly time spent walking for leisure and for transport. Environmental predictors of high levels of walking and increases in walking were examined using log binomial regression.

Results
Public transport accessibility and trusting many people in the neighbourhood were predictive of increases in walking for leisure, while connectivity, pedestrian crossings, a local traffic speed were predictive of increases in transport-related walking. Satisfaction with local facilities was associated with increasing both types of walking, and the social environment was important for maintaining high levels of both leisure- and transport-related walking.

Conclusion
The findings provide evidence of a longitudinal relationship between physical and social environments and walking behaviors amongst mothers. Enhancing satisfaction with local facilities and giving consideration to ‘walkability’, safety and public transport accessibility during environment planning processes may help mothers to increase walking.

A prospective examination of children's time spent outdoors, objectively measured physical activity and overweight

Objective: This study aimed to determine whether time spent outdoors was associated with objectively measured physical activity, body mass index (BMI) z-score and overweight in elementary-school aged children, cross-sectionally and prospectively over 3 years.
Methods: Three-year cohort study with data collected during 2001 and 2004. Nineteen randomly selected state elementary schools across Melbourne, Australia. One hundred and eighty eight 5–6-year-old and 360 10–12-year-old children. Baseline parent reports of children’s time spent outdoors during warmer and cooler months, on weekdays and weekends. At baseline and follow-up, children’s moderate and vigorous physical activity (MVPA) was objectively assessed by accelerometry, and BMI zscore and overweight was calculated from measured height and weight.
Results: Cross-sectionally, each additional hour outdoors on weekdays and weekend days during the cooler months was associated with an extra 27 min week^-1 MVPA among older girls, and with an extra 20 min week^-1 MVPA among older boys. Longitudinally, more time outdoors on weekends predicted higher MVPA on weekends among older girls and boys (5 min week^-1). The prevalence of overweight among older children at follow-up was 27–41% lower among those spending more time outdoors at baseline.
Conclusion: Encouraging 10–12-year-old children to spend more time outdoors may be an effective strategy for increasing physical activity and preventing increases in overweight and obesity. Intervention research investigating the effect of increasing time outdoors on children’s physical activity and overweight is warranted.

Does weight status influence associations between children's fundamental movement skills and physical activity?

This study sought to determine whether weight status influences the association among children's fundamental movement skills (FMS) and physical activity (PA). Two hundred forty-eight children ages 9-12 years participated. Proficiency in three object-control skills and two locomotor skills was examined. Accelerometers objectively assessed physical activity. Body mass index was calculated to determine weight status. Correlations between physical activity and FMS proficiency were evident among boys and girls. No significant interaction was apparent when examining FMS proficiency scores, PA variables, and weight status. Future studies should examine a broader range of skills and types of activities to better characterize this relationship and to inform the promotion of movement skill proficiency and PA.

Outcomes of a group-randomized trial to prevent excess weight gain, reduce screen behaviours and promote physical activity in 10-year-old children : switch-play

Objectives : To evaluate the effectiveness of an intervention to prevent excess weight gain, reduce time spent in screen behaviours, promote participation in and enjoyment of physical activity (PA), and improve fundamental movement skills among children.

Participants : In 2002, 311 children (78% response; 49% boys), average age 10 years 8 months, were recruited from three government schools in low socioeconomic areas of Melbourne, Australia.

Design : Group-randomized controlled trial. Children were randomized by class to one of the four conditions: a behavioural modification group (BM; n=66); a fundamental movement skills group (FMS; n=74); a combined BM/FMS group (BM/FMS; n=93); and a control (usual curriculum) group (n=62). Data were collected at baseline, post intervention, 6- and 12-month follow-up periods.

Results : BMI data were available for 295 children at baseline and 268 at 12-month follow-up. After adjusting for food intake and PA, there was a significant intervention effect from baseline to post intervention on age- and sex-adjusted BMI in the BM/FMS group compared with controls (-1.88 kg m-2, P<0.01), which was maintained at 6- and 12-month follow-up periods (-1.53 kg m-2, P<0.05). Children in the BM/FMS group were less likely than controls to be overweight/obese between baseline and post intervention (adjusted odds ratio (AOR)=0.36, P<0.05); also maintained at 12-month follow-up (AOR=0.38, P<0.05). Compared with controls, FMS group children recorded higher levels and greater enjoyment of PA; and BM children recorded higher levels of PA and TV viewing across all four time points. Gender moderated the intervention effects for participation in and enjoyment of PA, and fundamental movement skills.

Conclusion : This programme represents a promising approach to preventing excess weight gain and promoting participation in and enjoyment of PA. Examination of the mediators of this intervention and further tailoring of the programme to suit both genders is required.

The infant feeding activity and nutrition trial (INFANT) an early intervention to prevent childhood obesity : cluster-randomised controlled trial

Background : Multiple factors combine to support a compelling case for interventions that target the development of obesity-promoting behaviours (poor diet, low physical activity and high sedentary behaviour) from their inception. These factors include the rapidly increasing prevalence of fatness throughout childhood, the instigation of obesity-promoting behaviours in infancy, and the tracking of these behaviours from childhood through to adolescence and adulthood. The Infant Feeding Activity and Nutrition Trial (INFANT) aims to determine the effectiveness of an early childhood obesity prevention intervention delivered to first-time parents. The intervention, conducted with parents over the infant's first 18 months of life, will use existing social networks (first-time parent's groups) and an anticipatory guidance framework focusing on parenting skills which support the development of positive diet and physical activity behaviours, and reduced sedentary behaviours in infancy.

Methods/Design : This cluster-randomised controlled trial, with first-time parent groups as the unit of randomisation, will be conducted with a sample of 600 first-time parents and their newborn children who attend the first-time parents' group at Maternal and Child Health Centres. Using a two-stage sampling process, local government areas in Victoria, Australia will be randomly selected at the first stage. At the second stage, a proportional sample of first-time parent groups within selected local government areas will be randomly selected and invited to participate. Informed consent will be obtained and groups will then be randomly allocated to the intervention or control group.

Discussion : The early years hold promise as a time in which obesity prevention may be most effective. To our knowledge this will be the first randomised trial internationally to demonstrate whether an early health promotion program delivered to first-time parents in their existing social groups promotes healthy eating, physical activity and reduced sedentary behaviours. If proven to be effective, INFANT may protect children from the development of obesity and its associated social and economic costs.

Are parental concerns about children's inactivity warranted, and are they associated with a supportive home environment?

This paper explores parental concern about children's activity levels and whether parents who are concerned about their child's activity provide a supportive environment, a sample of 615 parents of 5-6-year-old children and 947 parents of 10-12-year-old children completed a questionnaire. Just over 50% of parents reported they were concerned their child was not getting enough activity. Children of concerned parents were less active than those whose parents were not concerned. These findings suggest that parents who are concerned about their child's physical activity levels provided a less supportive environment for physical activity than parents who are not concerned. The challenge for public health will be to harness parental concerns and translate them into action.

Preschool children and physical activity : a review of correlates

Background
Several reviews have summarized the research on correlates of older children's and adolescents' physical activity behaviors, but none have been published on preschool children. Over the past 27 years, a number of studies have investigated the correlates of preschool children's physical activity behaviors. It is timely and necessary to review the extant literature in this area. This paper reviews articles investigating correlates of preschool children's physical activity behaviors published in peer-reviewed journals between 1980 and March 2007.

Methods
A literature search was conducted to identify studies that investigated correlates of preschool children's physical activity. Data were collected and analyzed in 2007.

Results
Twenty-four articles were identified that met the inclusion criteria. From those articles, 39 variables were identified across five domains. Results showed that boys were more active than girls, that children with active parents tended to be more active, and that children who spent more time outdoors were more active than children who spent less time outdoors. Age and BMI were consistently shown to have no association with preschool children's physical activity. Other variables produced largely inconclusive results.

Conclusions
The influences on the physical activity behaviors of preschool children are multidimensional. Further research is required to enhance an understanding of these influences.

Children's fruit and vegetable intake : Associations with the neighbourhood food environment

Objective : To examine associations between availability of different types of food outlets and children's fruit and vegetable intake.
Method : Parents of 340 5–6 and 461 10–12 year-old Australian children reported how frequently their child ate 14 fruits and 13 vegetables in the last week in 2002/3. A geographic information system (GIS) was used to determine the availability of the following types of food outlets near home: greengrocers; supermarkets; convenience stores; fast food outlets; restaurants, cafés and takeaway outlets. Logistic regression analyses examined the likelihood of consuming fruit ≥ 2 times/day and vegetables ≥ 3 times/day, according to access to food outlets.
Results : Overall, 62.5% of children ate fruit ≥ 2 times/day and 46.4% ate vegetables ≥ 3 times/day. The more fast food outlets (OR = 0.82, 95%CI = 0.67–0.99) and convenience stores (OR = 0.84, 95%CI = 0.73–0.98) close to home, the lower the likelihood of consuming fruit ≥ 2 times/day. There was also an inverse association between density of convenience stores and the likelihood of consuming vegetables ≥ 3 times/day (OR = 0.84, 95%CI = 0.74–0.95). The likelihood of consuming vegetables ≥ 3 times/day was greater the farther children lived from a supermarket (OR = 1.27, 95%CI = 1.07–1.51) or a fast food outlet (OR = 1.19, 95%CI = 1.06–1.35).
Conclusion : Availability of fast food outlets and convenience stores close to home may have a negative effect on children's fruit and vegetable intake.

Features of public open spaces and physical activity among children : findings from the CLAN study

Objective : To examine associations between features of public open spaces, and children's physical activity.
Participants : 163 children aged 8–9 years and 334 adolescents aged 13–15 years from Melbourne, Australia participated in 2004.
Methods : A Geographic Information System was used to identify all public open spaces (POS) within 800 m of participants' homes and their closest POS. The features of all POS identified were audited in 2004/5. Accelerometers measured moderate-to-vigorous physical activity (MVPA) after school and on weekends. Linear regression analyses examined associations between features of the closest POS and participants' MVPA.
Results : Most participants had a POS within 800 m of their home. The presence of playgrounds was positively associated with younger boys' weekend MVPA (B = 24.9 min/day; p ≤ 0.05), and lighting along paths was inversely associated with weekend MVPA (B = − 54.9 min/day; p ≤ 0.05). The number of recreational facilities was inversely associated with younger girls' MVPA after school (B = − 2.6 min/day; p ≤ 0.05) and on the weekend (B = − 8.7 min/day; p ≤ 0.05). The presence of trees providing shade (5.8 min/day, p ≤ 0.01) and signage regarding dogs (B = 6.8 min/day, p ≤ 0.05) were positively associated with adolescent girls' MVPA after school.
Conclusion : Certain features of POS were associated with participants' MVPA, although mixed associations were evident. Further research is required to clarify these complex relationships.