Parent-reported health status of overweight and obese Australian primary school children: a cross-sectional population survey

Introduction: Childhood overweight/obesity is associated with poor physical and psychosocial health in clinical samples. However, there is little information on the health status of overweight and obese children in the community, who now represent a large proportion of the child population. We examined parent-reported child health and well-being and parent concern about child weight by body mass index (BMI) category in a population sample of primary school children.

Design: A stratified two-stage random cluster sample of 24 primary schools representative of the state of Victoria, Australia.

Measures: BMI (weight/height2) transformed to normalised Z-scores using the 1990 UK Growth Reference; the Child Health Questionnaire (CHQ), a 13-scale 50-item parent-completed measure of health and well-being; parent self-reported height and weight; parent concern about child's weight.

Results: Data were available for 2863 children aged 5-13 y (50.5% male), of whom 17% were overweight and 5.7% obese. Using logistic regression analyses with 'normal weight' as the referent category, obese boys were at greater risk of poor health (ie <15th centile) on seven of the 12 CHQ scales: Physical Functioning (odds ratio (OR) 2.8), Bodily Pain (OR 1.8), General Health (OR 3.5), Mental Health (OR 2.8), Self Esteem (OR 1.8), Parent Impact¾Emotional (OR 1.7) and Parent Impact¾Time (OR 1.9). Obese girls were at greater risk of poor health on only two scales: General Health (OR 2.1) and Self Esteem (OR 1.8). Forty-two percent of parents with obese children and 81% with overweight children did not report concern about their child's weight. Parents were more likely to report concern if the child was obese (OR 21.3), overweight (OR 3.5) or underweight (OR 5.4) than normal weight (P<0.05). Concern was not related to child gender, parental BMI or parental education after controlling for child BMI. Perceived health and well-being of overweight/obese children varied little by weight category of the reporting parent (overweight vs non-overweight).

Conclusions: Parents were more likely to report poorer health and well-being for overweight and obese children (particularly obese boys). Parental concern about their child's weight was strongly associated with their child's actual BMI. Despite this, most parents of overweight and obese children did not report poor health or well-being, and a high proportion did not report concern. This has implications for the early identification of such children and the success of prevention and intervention efforts.

Television, computer use and body mass index in Australian primary school children

Objective: To investigate relationships between children's body mass index (BMI) and parent reports of children's television and video game/computer habits, controlling for other potential risk factors for paediatric obesity.

Methods: Child BMI was calculated from measured height and weight collected in 1997 as part of a large, representative, cross-sectional study of children in Victoria, Australia. Parents reported the amount of time children watched television and used video games/computers, children's eating and activity habits, parental BMI and sociodemographic details.

Results: A total of 2862 children aged 5−13 years participated. Child mean BMI z-score was significantly related to television (F = 10.2₃, P < 0.001) but not video game/computer time (F = 2.2₃, P = 0.09), but accounted for only 1 and 0.2% of total BMI variance, respectively. When parental BMI, parental education, number of siblings, food intake, organized exercise and general activity level were included, television ceased to be independently significantly related to child BMI. Using adjusted logistic regression, the odds of being overweight and obese generally increased with increasing television viewing. No relationship was found for video game/computer use.
Conclusions: A small proportion of variance in child BMI was related to television, but not video game/computer time. This was far outweighed by the influence of other variables. Causal pathways are likely to be complex and interrelated.

Weight concerns among elementary school children : a review of prevention programs

There is increasing evidence that children display high levels of weight and muscle concerns, which include body dissatisfaction and problem eating. In order to address these issues, researchers have designed and implemented prevention programs for this age group. Thirteen published studies were located and reviewed, with children aged 8–12 years from elementary schools, or equivalent. Overall, the programs were shown to be effective in improving children's knowledge at post-test and at follow-up assessments. However, there is limited evidence to show that the programs reduced or prevented body image concerns and/or problem eating. Too few studies have examined muscle concerns so no conclusions can yet be drawn about this domain. Limitations of the studies and suggestions for future prevention efforts are discussed.

Double disadvantage : the influence of ethnicity over socioeconomic position on childhood overweight and obesity: findings from an inner urban population of primary school children

Objective: To examine the relationship between overweight/obesity in children, socioeconomic status and ethnicity/cultural background.

Design: Cross-sectional survey of children aged 4–13 years.

Setting: A total of 23 primary (elementary) schools in an inner urban municipality of Melbourne, Australia.

Participants: A total of 2685 children aged 4–13 years and their parents.

Main exposure measures: Ethnicity/cultural background – maternal region of birth; socioeconomic position (SEP) indicators – maternal and paternal educational attainment, family employment status, possession of a healthcare card, ability to buy food, indicator of disadvantage (Socioeconomic Index for Areas, SEIFA) score for school; parental weight status.

Main outcome measure: Prevalence of overweight/obesity.

Results: Prevalence of overweight/obesity approached 1 in 3 (31%) in this sample. Prevalence of overweight/obesity was greater for children of both North Africa and Middle Eastern background and children of Southern, South Eastern and Eastern European background compared with children of Australian background. This difference remained after adjusting for age, sex, height, clustering by school, SEP indicators and parental weight status; odds ratio, OR=1.57 (95% confidence interval, CI 1.12–2.19) and 1.88 (95%CI 1.24–2.85), respectively.

Conclusions: There is a clear independent effect of ethnicity above and beyond the effect of socioeconomic status on overweight and obesity in children. Further research is required to explore the mediators of this gradient.

Cost-effectiveness of active transport for primary school children - Walking School Bus Program

Background : To assess from a societal perspective the incremental cost-effectiveness of the Walking School Bus (WSB) program for Australian primary school children as an obesity prevention measure. The intervention was modelled as part of the ACE-Obesity study, which evaluated, using consistent methods, thirteen interventions targeting unhealthy weight gain in Australian children and adolescents.

Methods : A logic pathway was used to model the effects on body mass index [BMI] and disability-adjusted life years [DALYs] of the Victorian WSB program if applied throughout Australia. Cost offsets and DALY benefits were modelled until the eligible cohort reached 100 years of age or death. The reference year was 2001. Second stage filter criteria ('equity', 'strength of evidence', 'acceptability', feasibility', sustainability' and 'side-effects') were assessed to incorporate additional factors that impact on resource allocation decisions.

Results : The modelled intervention reached 7,840 children aged 5 to 7 years and cost $AUD22.8M ($16.6M;$30.9M). This resulted in an incremental saving of 30 DALYs (7:104) and a net cost per DALY saved of $AUD0.76M ($0.23M; $3.32M). The evidence base was judged as 'weak' as there are no data available documenting the increase in the number of children walking due to the intervention. The high costs of the current approach may limit sustainability.

Conclusions : Under current modelling assumptions, the WSB program is not an effective or cost-effective measure to reduce childhood obesity. The attribution of some costs to non-obesity objectives (reduced traffic congestion and air pollution etc.) is justified to emphasise the other possible benefits. The program's cost-effectiveness would be improved by more comprehensive implementation within current infrastructure arrangements. The importance of active transport to school suggests that improvements in WSB or its variants need to be developed and fully evaluated.

Predictors of body mass index change in Australian primary school children

Objective. To assess associations between multiple potential predictors and change in child body mass index (BMI). Methods.In the 1997 Health of Young Victorians Study, children in Grades preparatory to three (aged 510 years) had their height and weight measured. Parents provided information on potential predictors of childhood overweight across six domains (children’s diet, children’s activity level, family composition, sociodemographic factors, prenatal factors and parental adiposity). Measures were repeated three years later in 2000/1. BMI was transformed to standardised (z) scores using the US 2000 Growth Chart data and children were classified as non-overweight or overweight according to international cutpoints.Regression analyses, including baseline BMI z-score as a covariate, assessed the contribution of each potential predictor to change in BMI z-score, development of overweight and spontaneous resolution of overweight in 1 373 children.Results. BMI z-score change was positively associated with frequency of take-away food, food quantity, total weekly screen time, non-Australian paternal country of birth, maternal smoking during pregnancy, and maternal and paternal BMI.Inverse associations were noted for the presence of siblings and rural residence (all pB0.05). Predictors of categorical change (development and resolution of overweight) were less clearly identified, apart from an association between maternal BMI and overweight development (p0.02). Multivariable models suggested individual determinants have a cumulative effect on BMI change. Conclusions. Strong short-term tracking of BMI makes it difficult to identify predictors of change. Nonetheless, putative determinants across all domains assessed were independently associated with adiposity change. Multi-faceted solutions are likely to be required to successfully deal with the complexities of childhood overweight.

Fundamental movement skills - How do primary school children perform? The 'Move it Groove it' program in rural Australia

Child Fundamental Movement Skills (FMS) underpin active lifestyles yet little is known of their distribution and mastery.

‘Move it Groove it’ project rated proficiency of primary school children (n=1045, 18 schools) in skills of balance, throw, catch, sprint, hop, kick, side gallop and jump. Rating categories were ‘mastery’, ‘near mastery’ or ‘poor’ (ie mastered all, all but one, or less of the five to six components of an FMS).

Less than half of all child tests were rated at mastery (21.3%) or near mastery (25.7%) level. In grade three, 75.4% of children achieved mastery or near mastery (MNM) in static balance but less than half did so for any other FMS. In grade four, 59.0% achieved MNM in the side gallop and 56.0% in the catch but less than half did so for any other FMS.

Although the highest percent mastery for both genders was for the balance, the skills best performed thereafter by boys (throw and kick) rated poorest for girls. Conversely the hop and side gallop which rated, after balance, as the skills best mastered by girls, were among the more poorly performed skills for boys.

The low prevalence of FMS mastery found in this survey suggests that there may be great potential to improve fundamental movement skills of primary aged children in many parts of rural Australia. Even if the aim were for children to achieve near mastery levels, the improvement could be substantial in every skill category. Where appropriate, gender differences in mastery might easily be addressed by tailored physical education programs and modification of social and physical environments.

Separate spheres and public policy : the role of women in the development of children's services in Victorian local government, 1840-1992

The thesis is an explanation of the development of pre-school children's services (infant welfare, kindergartens and child care) at local government level in Victoria. The critical framework of analysis focuses on three dimensions of public policy: 1) the socio-historical environment; 2) the political processes involved in the development of the specific children's service; and 3) the major individuals and groups that exerted pressure for children's service, The argument is threefold. Firstly it is argued that the political environment of children's services has been dominated by the practice of separate spheres of public and private, in which the care of children is primarily the role of women. Secondly, it is argued that the political processes surrounding the development of local children's services have involved all levels of government in what is termed a local state. Thirdly, it is argued that the development of these children's services in local government has resulted mainly from the work of women both individually and collectively. Since the three services of infant welfare, kindergartens and child care all became a normal function of children's services at different times, the circumstances that surrounded each development exhibited different aspects of the three major arguments. The periodisation is broken into four phases: 1) the establishment of local government with no children's services in the nineteenth century; 2) the establishment of infant welfare services in local government in the early part of the twentieth century; 3) the incorporation of kindergartens into local government after the second world war; and 4) the incorporation of child care into local government in the 1970s and 1980s. The thesis concludes by arguing that the existence of children's services in local government in Victoria is testimony to the remarkable work of those women who have pursued the issue both individually and collectively. It has been the identification of children's services as a women's issue in Australian politics that has enabled women's groups at different times to influence the policy makers in diverse ways. However, while the establishment of children's services as a legitimate political concern brings the matter onto the public agenda, the separate spheres still remains a contested issue in the public policies of children's services.

Do young children get the message? The effects of repeated video viewing on explicit and implicit information

The aim of this study was to explore the effects of repeat viewing on comprehension of explicitly and implicitly presented information in an animated movie. Seventy-three pre-school children watched an animated film and were tested for comprehension after either their single or fifth viewing. Only children’s comprehension of explicitly presented information was facilitated by repeat viewing. However, post hoc analyses revealed that children’s explicit and implicit comprehension of a central character Thunderbolt significantly increased across viewing conditions, whereas, repeat viewing only facilitated children’s explicit comprehension of the central character Patch. The theoretical and practical implications of these findings are discussed.