Process and impact evaluation of the romp & chomp obesity prevention intervention in early childhood settings : lessons learned from implementation in preschools and long day care settings

Background: The Romp & Chomp controlled trial, which aimed to prevent obesity in preschool Australian children, was recently found to reduce the prevalence of childhood overweight and obesity and improve children’s dietary patterns. The intervention focused on capacity building and policy implementation within various early childhood settings. This paper reports on the process and impact evaluation of this trial and the lessons learned from this complex community intervention.
Methods: Process data was collected throughout and audits capturing nutrition and physical activity-related environments and practices were completed postintervention by directors of Long Day Care (LDC) centers (n = 10) and preschools (n = 41) in intervention and comparison (n = 161 LDC and n = 347 preschool) groups.
Results: The environmental audits demonstrated positive impacts in both settings on policy, nutrition, physical activity opportunities, and staff capacity and practices, although results varied across settings and were more substantial in the preschool settings. Important lessons were learned in relation to implementation of such community-based interventions, including the significant barriers to implementing health-promotion interventions in early childhood settings, lack of engagement of for-profit LDC centers in the evaluation, and an inability to attribute direct intervention impacts when the intervention components were delivered as part of a health-promotion package integrated with other programs.
Conclusions: These results provide confidence that obesity prevention interventions in children’s settings can be effective; however, significant efforts must be directed toward developing context-specific strategies that invest in policies, capacity building, staff support, and parent engagement. Recognition by funders and reviewers of the difficulties involved in implementing and evaluating such complex interventions is also critical to strengthening the evidence base on the effectiveness of such public health approaches to obesity prevention.

School day segmented physical activity patterns of high and low active children

Background

Variability exists in children's activity patterns due to the association with environmental, social, demographic, and inter-individual factors. This study described accelerometer assessed physical activity patterns of high and low active children during segmented school week days whilst controlling for potential correlates.
Methods

Two hundred and twenty-three children (mean age: 10.7 +/- 0.3 yrs, 55.6% girls, 18.9% overweight/obese) from 8 north-west England primary schools wore ActiGraph GT1M accelerometers for 7 consecutive days during autumn of 2009. ActiGraph counts were converted to minutes of moderate (MPA), vigorous (VPA) and moderate-to-vigorous (MVPA) physical activity. Children were classified as high active (HIGH) or low active (LOW) depending on the percentage of week days they accumulated at least 60 minutes of MVPA. Minutes spent in MPA and VPA were calculated for school time and non-school time and for five discrete school day segments (before-school, class time, recess, lunchtime, and after-school). Data were analysed using multi-level modelling.
Results

The HIGH group spent significantly longer in MPA and/or VPA before-school, during class time, lunchtime, and after-school (P < .05), independent of child and school level factors. The greatest differences occurred after-school (MPA = 5.5 minutes, VPA = 3.8 minutes, P < 0.001). MPA and VPA were also associated with gender, BMI z-score, number of enrolled children, playground area per student, and temperature, depending on the segment analysed. The additive effect of the segment differences was that the HIGH group accumulated 12.5 minutes per day more MVPA than the LOW group.
Conclusions

HIGH active children achieved significantly more MPA and VPA than LOW active during four of the five segments of the school day when analyses were adjusted for potential correlates. Physical activity promotion strategies targeting low active children during discretionary physical activity segments of the day, and particularly via structured after-school physical activity programs may be beneficial.

"I don't eat a hamburger and large chips every day!" A qualitative study of the impact of public health messages about obesity on obese adults

Background
We are a society that is fixated on the health consequences of 'being fat'. Public health agencies play an important role in 'alerting' people about the risks that obesity poses both to individuals and to the broader society. Quantitative studies suggest people comprehend the physical health risks involved but underestimate their own risk because they do not recognise that they are obese.

Methods
This qualitative study seeks to expand on existing research by exploring obese individuals' perceptions of public health messages about risk, how they apply these messages to themselves and how their personal and social contexts and experiences may influence these perceptions. The study uses in depth interviews with a community sample of 142 obese individuals. A constant comparative method was employed to analyse the data.

Results
Personal and contextual factors influenced the ways in which individuals interpreted and applied public health messages, including their own health and wellbeing and perceptions of stigma. Individuals felt that messages were overly focused on the physical rather than emotional health consequences of obesity. Many described feeling stigmatised and blamed by the simplicity of messages and the lack of realistic solutions. Participants described the need for messages that convey the risks associated with obesity while minimising possible stigmatisation of obese individuals. This included ensuring that messages recognise the complexity of obesity and focus on encouraging healthy behaviours for individuals of all sizes.

Conclusion
This study is the first step in exploring the ways in which we understand how public health messages about obesity resonate with obese individuals in Australia. However, much more research - both qualitative and quantitative - is needed to enhance understanding of the impact of obesity messages on individuals.

The content validity of the behaviour support plan quality evaluation tool (BSP-QEII) and its potential application in accommodation and day-support services for adults with intellectual disability

Background The quality of support provided to people with disability who show challenging behaviour could be influenced by the quality of the behaviour support plans (BSPs) on which staff rely for direction. This study investigated the content validity of the Behaviour Support Plan Quality Evaluation tool (BSP-QEII), originally developed to guide the development of BSPs for children in school settings, and evaluated its application for use in accommodation and day-support services for adults with intellectual disability.

Method A three-round Delphi study involving a purposive sample of experienced behaviour support practitioners (n = 30) was conducted over an 8-week period. The analyses included deductive content analysis and descriptive statistics.

Results The 12 quality domains of the BSP-QEII were affirmed as valid for application in adult accommodation and day-support service settings. Two additional quality domains were suggested, relating to the provision of detailed background on the client and the need for plans to reflect contemporary service philosophy. Furthermore, the results suggest that some issues previously identified in the literature as being important for inclusion in BSPs might not currently be a priority for practitioners. These included: the importance of specifying replacement or alternative behaviours to be taught, descriptions of teaching strategies to be used, reinforcers, and the specification of objective goals against which to evaluate the success of the intervention programme.

Conclusions The BSP-QEII provides a potentially useful framework to guide and evaluate the development of BSPs in services for adults with intellectual disability. Further research is warranted to investigate why practitioners are potentially giving greater attention to some areas of intervention practice than others, even where research has demonstrated these others areas of practice could be important to achieving quality outcomes.

Small within-day increases in temperature affects boldness and alters personality in coral reef fish

Consistent individual differences in behaviour, termed personality, are common in animal populations and can constrain their responses to ecological and environmental variation, such as temperature. Here, we show for the first time that normal within-daytime fluctuations in temperature of less than 3°C have large effects on personality for two species of juvenile coral reef fish in both observational and manipulative experiments. On average, individual scores on three personality traits (PTs), activity, boldness and aggressiveness, increased from 2.5- to sixfold as a function of temperature. However, whereas most individuals became more active, aggressive and bold across temperature contexts (were plastic), others did not; this changed the individual rank order across temperatures and thus altered personality. In addition, correlations between PTs were consistent across temperature contexts, e.g. fish that were active at a given temperature also tended to be both bold and aggressive. These results (i) highlight the importance of very carefully controlling for temperature when studying behavioural variation among and within individuals and (ii) suggest that individual differences in energy metabolism may contribute to animal personality, given that temperature has large direct effects on metabolic rates in ectotherms.

Communities of memory? The Jewish holocaust museum and research centre, Melbourne

The Jewish Holocaust Museum and Research Centre (JHC), Melbourne, opened in 1984. Through the support of large numbers of Jewish people, it has become an impmiant part of their lives as they age, a place of solace and memorialisation. It is a second home for some, providing networking support within and between the different Jewish ethnic communities. This paper will draw on the JHC's ever growing videotestimony collection as well as oral interviews on the roles played by Melbourne survivor volunteers and others in developing the Centre. The survivors have experienced many different aspects of the Holocaust, have come from all over Europe and elsewhere, and 1 are sometimes culturally very different. It will discuss the role played by the various social and cultural communities in creating and responding to the JHC and the success they have had in establishing 'communities of memory' or, alternatively, representing and 1 contextualising the various social and cultural communities.

Screening women’s complicity in the holocaust : the problems of judgement and representation

This essay analyses the representation of female perpetrators in Holocaust fiction films, particularly in relation to the persecution of prisoners in the Nazi camps. The screening of women in general, and female perpetrators in particular, is shown to be problematic due to their frequent marginalisation and the gendered, voyeuristic ways in which women's bodies are often objectified in Holocaust films. While the actions of female perpetrators and their depiction in films pose acute problems of judgement and representation that need to be acknowledged, it is argued that films have the potential to effectively explore the issue of women's complicity in the Holocaust.

Racialized urban America and Holocaust film : negotiating the limits of representation

Sidney Lumet’s influential film The Pawnbroker (1964) is one of the earliest films to consider the encounter between Holocaust narratives and low-income, urban American racial minorities. As much concerned with contemporary ‘race relations’ in the United States as it is with the Nazis’ persecution of Europe’s Jews, the film intertwines the story of Holocaust survivor Sol Nazerman with the social tensions of 1960s America, represented in his relationship with the young Puerto Rican shop assistant Jesus Oritz. The film stylistically juxtaposes raw footage of concentration camp existence with dismal images of New York slum life. Against these backdrops, the protagonist’s climactic ‘silent scream’ emblematically merges the repressed trauma of the survivor with the filmmaker’s interest in race relations, a theme that has undergone various transformations in a number of films since. One film that contemporizes this encounter is Richard LaGravenese’s Freedom Writers (2007). As opposed to the tragic outcome of the pawnbroker’s induction into urban America, here the Holocaust is a redemptive tool that permits inner-city Black and Latino youth to contextualize their own suffering. After reading The Diary of Anne Frank, this group of ‘at-risk’ sophomores to inspired to collaborate on an ultimately successful effort to bring Miep Geis, the woman who sheltered Anne Frank, to speak at their high school. Foregrounded by the 1992 Los Angeles riots, gentiles teacher Erin Gruwell and savior Miep Geis transform the Holocaust from an amplified parallel of American slums into an event that permits the children of American postcoloniality to triumph in spite of their socio-economic circumstances. Underlining the tension between the Jewish specificity and unprecedented nature of the Holocaust, and the need to generate Holocaust narratives that intersect with intrinsically racialized American narratives, such films have significant implications for how collective memories of suffering are constructed and contested.