The lifestyle of our kids (LOOK) project : outline of methods

This methods paper outlines the overall design of a community-based multidisciplinary longitudinal study with the intent to stimulate interest and communication from scientists and practitioners studying the role of physical activity in preventive medicine. In adults, lack of regular exercise is a major risk factor in the development of chronic degenerative diseases and is a major contributor to obesity, and now we have evidence that many of our children are not sufficiently active to prevent early symptoms of chronic disease. The lifestyle of our kids (LOOK) study investigates how early physical activity contributes to health and development, utilizing a longitudinal design and a cohort of eight hundred and thirty 7–8-year-old (grade 2) school children followed to age 11–12 years (grade 6), their average family income being very close to that of Australia. We will test two hypotheses, that (a) the quantity and quality of physical activity undertaken by primary school children will influence their psychological and physical health and development; (b) compared with existing practices in primary schools, a physical education program administered by visiting specialists will enhance health and development, and lead to a more positive perception of physical activity. To test the first hypothesis we will monitor all children longitudinally over the 4 years. To test the second we will involve an intervention group of 430 children who receive two 50 min physical education classes every week from visiting specialists and a control group of 400 who continue with their usual primary school physical education with their class-room teachers. At the end of grades 2, 4, and 6 we will measure several areas of health and development including blood risk factors for chronic disease, cardiovascular structure and function, physical fitness, psychological characteristics and perceptions of physical activity, bone structure and strength, motor control, body composition, nutritional intake, influence of teachers and family, and academic performance.

Australian dental policy reform and the use of dental therapists and hygienists

Oral diseases including dental caries and periodontal disease are among the most prevalent and costly diseases in Australia today. Around 5.4% of Australia’s health dollar is spent on dental services totalling around $2.6 billion, 84% of which are delivered through the private sector (AIHW 2001). The other 16% is spent providing public sector services in varied and inadequate ways. While disease rates among school children have declined significantly in the past 20 years the gains made among children are not flowing on to adult dentitions and our aging population will place increasing demands on an inadequate system into the future (AHMAC 2001). Around 50% of adults do not received regular care and this has implications for widening health inequalities as the greatest burden falls on lower income groups (AIHW DSRU 2001). The National Competition Policy agenda has initiated, Australia-wide, reviews of dental legislation applying to delivery of services by dentists, dental specialists, dental therapists and hygienists and dental technicians and prosthetists. The review of the Victorian Dentists Act 1972, was completed first in 1999, followed by the other Australian states with Queensland, the ACT and the Northern Territory still developing legislation. One of the objectives of the new Victorian Act is to ‘…promote access to dental care’. This study has grown out of the need to know more about how dental therapists and hygienists might be utilised to achieve this and the legislative frameworks that could enable such roles. This study used qualitative methods to explore dental health policy making associated with strategies that may increase access to dental care using dental therapists and hygienists. The study used a multiple case study design to critically examine the dental policy development process around the Review of the Dentists Act 1972 in Victoria; to assess legislative and regulatory dental policy reforms in other states in Australia and to conduct a comparative analysis of dental health policy as it relates to dental auxiliary practice internationally. Data collection has involved (I) semi-structured interviews with key participants and stakeholders in the policy development processes in Victoria, interstate and overseas, and (ii) analysis of documentary data sources. The study has taken a grounded theory approach whereby theoretical issues that emerged from the Victorian case study were further developed and challenged in the subsequent interstate and international case studies. A component of this study has required the development of indicators in regulatory models for dental hygienists and therapists that will increase access to dental care for the community. These indicators have been used to analyse regulation reform and the likely impacts in each setting. Despite evidence of need, evidence of the effectiveness and efficiency of dental therapists and hygienists, and the National Competition Policy agenda of increasing efficiency, the legislation reviews have mostly produces only minor changes. Results show that almost all Australian states have regulated dental therapists and hygienists in more prescriptive ways than they do dentists. The study has found that dental policy making is still dominated by the views of private practice dentists under elitist models that largely protect dentist authority, autonomy and sovereignty. The influence of dentist professional dominance has meant that governments have been reluctant to make sweeping changes. The study has demonstrated alternative models of regulation for dental therapists and hygienists, which would allow wider utilisation of their skills, more effective use of public sector funding, increased access to services and a grater focus on preventive care. In the light of theses outcomes, there is a need to continue to advocate for changes that will increase the public health focus of oral health care.

Little boys : the potency of peer culture in shaping masculinities

This study explores the peer group understandings of five male friends between the ages of six and eight years and seeks to examine the ways in which the group’s social dynamics interact to define, regulate and maintain dominant and collective understandings of masculinities. Within a self-selected affinity context, and drawing on their lived and imagined experiences, the boys’ enact and interpret their social worlds. Adopting the principles of ethnography within a framework of feminist poststructuralism and drawing on theories of ‘groupness’ and gender(ed) embodiment, the boys’ understandings of masculinities are captured and interpreted. The key analytic foci are directed towards examining the role of power in the social production of collective schoolboy knowledges, and understanding the processes through which boys subjectify and are subjectified, through social but also bodily discourses. The boys’ constructions of peer group masculinities are (re)presented through a narrative methodology which foregrounds my interpretation of the group’s personal and social relevances and seeks to be inductive in ways that ‘bring to life’ the boys’ stories. The study illuminates the potency of peer culture in shaping and regulating the boys’ dominant understandings of masculinity. Within this culture strong essentialist and hierarchical values are imported to support a range of gender(ed) and sexual dualisms. Here patriarchal adult culture is regularly mimicked and distorted. Underpinned by constructions of ‘femininity’ as the negative ‘other’, dominant masculinities are embodied, cultivated and championed through physical dominance, physical risk, aggression and violence. Through feminist poststructural analysis which enables a theorising of the boys’ subjectivities as fluid, tenuous and often characterised by contradiction and resistance, there exists a potential for interrupting and re-working particular masculinities. Within this framework, more affirmative but equally legitimate understandings and embodiments can be explored. The study presents a warrant for working with early childhood affinity groups to disrupt and contest the dominance and hierarchy of peer culture in an effort to counter-act broader gendered and heterosexist global, state and institutional structures. Framing these assertions is an understanding of the peer context as not only self-limiting and productive of hierarchies, but enabling and generative of affirmative subjectivities.

Technology and music in the early years of schooling

An investigation of junior primary school children's use of computer-based music technology found that, with active support from teachers, young children were able to participate effectively in relatively complex musical processes, with particular regard to listening, performing and composing, thus extending the traditional scope of young children's music education.

Evaluation of the Asthma Friendly Schools program

This thesis examined what makes schools want to embrace the Asthma Friendly Schools program. It also investigated the limitations and barriers of the Asthma Friendly Schools program and explored it's uptake by schools and the implications of the findings for the redesign of the program.

Subjective Wellbeing as an affective construct

This thesis quantifies the normative characteristics of Subjective Wellbeing amongst Australian high-school age students using the Personal Wellbeing Index adapted for school children. No previous study has undertaken this task. The results confirm the homeostatic model and corroborate previous research suggesting that Subjective Wellbeing is a construct driven primarily by Core Affect.

Catching gender-Identity production in flight : making the commonplace visible

The purpose of this article is to develop and illustrate an approach for making the commonplace visible in a natural, as opposed to manipulated, social setting. The key research task was to find a way of capturing the ongoing production or enactment of the self that provides some insight into the way in which it is produced in a routine, matter of fact way. The article takes a number of steps to develop a research approach to the task. First, gender-identity was selected as a more specific aspect of self-production. Second, the concept of “flashpoints” was used to refer to a particular moment in the routine which achieves some significance or salience as a result of the participants seizing upon some otherwise unremarkable action or statement and twisting it to their purpose. In this study, the purpose was gender-identity creation. Primary school children in the classroom and their teachers were the participants of the study. Through the use of flashpoints, the article demonstrates how gender-identity production of these children can be caught in flight. The article concludes that this approach can be added to the researcher’s toolkit.

A framework for re-thinking learning in science from recent cognitive science perspectives

Recent accounts by cognitive scientists of factors affecting cognition imply the need to reconsider current dominant conceptual theories about science learning. These new accounts emphasize the role of context, embodied practices and narrative-based representation rather than learners’ cognitive constructs. In this paper we analyze data from a longitudinal study of primary school children’s learning to outline a framework based on these contemporary accounts, and to delineate key points of difference from conceptual change perspectives. The findings suggest this framework provides strong theoretical and practical insights into how children learn and the key role of representational negotiation in this learning. We argue that the nature and process of conceptual change can be re-interpreted in terms of the development of students’ representational resources.

Parental influence and obesity prevention in pre-schoolers : a systematic review of interventions

Obesity is difficult to reverse in older children and adults and calls have been made to implement obesity prevention strategies during the formative pre-school years. Childhood obesity experts suggest that prevention of overweight in the pre-school years should focus on parents, because parental beliefs, attitudes, perceptions and behaviours appear to contribute to children’s development of excessive weight gain. While evidence suggests that parental variables may be instrumental in the development of obesity, there has been no systematic evaluation of whether intervening to change such variables will positively influence the development of excess adiposity during the pre-school years. This paper is a conceptual and methodological review of the literature on the parental variables targeted in interventions designed to modify risk factors for obesity by promoting healthy eating and/or physical activity and/or reducing sedentary behaviours in families of children aged 2–6 years. There were significant methodological limitations of existing studies and the scientific study of this area is in its infancy. However, the results suggest that the modification of parental variables known to be associated with obesity-promoting behaviours in pre-school children may show promise as an obesity prevention strategy; further research is needed.

Changes in body mass index and health related quality of life from childhood to adolescence

Objective . To determine longitudinal relationships between body mass index (BMI) and health-related quality of life (HRQoL) in an adolescent population sample.
Design. Data collected in 2000 and 2005 within the Health of Young Victorians longitudinal cohort study.
Setting. Originally a community sample of elementary school students in Victoria, Australia. Follow-up occurred in either secondary schools or individuals homes.
Participants. Cohort recruited in 1997 via a random sampling design from Victorian elementary schools. Originally comprising 1 943 children, 1 569 (80.8%) participated in 2000 (wave 2, 8 – 13 years) and 851 (54%) in 2005 (wave 3, 13 – 19 years).
Main outcome measures. In both waves participants and their parents completed the PedsQL, a 23-item child HRQoL measure, and BMI z-scores and status (non-overweight, overweight or obese) were calculated from measured height and weight. Associations were tested cross-sectionally and longitudinally (linear regression, adjusted for baseline values)
Results. A total of 81.6% remained in the same BMI category, while 11.4% and 7.0% moved to higher and lower categories, respectively. Cross-sectional inverse associations between lower PedsQL and higher BMI categories were similar to those for elementary school children. Wave 2 BMI strongly predicted wave 3 BMI and wave 2 PedsQL strongly predicted wave 3 PedsQL. Only parent-reported Total PedsQL score predicted higher subsequent BMI, though this effect was small. Wave 2 BMI did not predict wave 3 PedsQL.
Conclusions. This novel study confi rmed previous cross-sectional associations, but did not provide convincing evidence that
BMI is causally associated with falling HRQoL or vice versa across the transition from childhood to adolescence.

Asthma among schoolchildren in the Barwon region of Victoria

Objectives: To determine (i) the relationship between asthma management and socioeconomic status; (ii) whether recent estimates from the International Study of Asthma and Allergies in Childhood (ISAAC) conducted in Melbourne apply to a broader cross-section of Victorian children; and (iii) age-related trends in asthma prevalence.

Design: A questionnaire survey, based on the ISAAC protocol.

Participants and setting: Subjects were children aged 4–13 years from a random sample of primary schools in the Barwon region of Victoria. The survey was conducted between March and September 2005.

Main outcome measures: Parent-reported wheeze and wheeze-related use of health resources during the preceding 12 months.

Results: Questionnaires were returned by 7813/9258 students (84%). Lower socioeconomic status was associated with increased frequency of regular asthma reviews (P < 0.01 for trend), but not of emergency department visits (P = 0.19). The prevalence of wheeze among 6- and 7-year-old children in the Barwon region was similar to that in Melbourne children (20.2% v 20.0%, respectively).There was an age-related increase in the proportion of children with ≥ 12 episodes of wheeze (P = 0.01); but an age-related decrease in emergency department visits (P = 0.02).

Conclusions: Disadvantaged children have good access to regular asthma reviews and are no more likely to attend an emergency department with an episode of acute wheeze. Asthma prevalence in 6- and 7-year-old children in the Barwon region is similar to that in Melbourne. The prevalence of children with very frequent wheeze increases with age, but their use of health resources decreases.

The factor structure of the Chinese family assessment instrument adapted for parent report

This article reports on a confirmatory factor analytic study of an adapted version of an instrument designed to assess family functioning of Chinese families. The Chinese Family Assessment Instrument, originally designed for completion by adolescents, was adapted for completion by parents. A sample of 700 parent dyads of elementary school children (382 girls and 318 boys) completed the adapted questionnaire. Initial factor analyses showed that the existing five-factor structure used for adolescents’ responses was not a good fit for these data. Instead, a four-factor solution emerged where the factors were positive family functioning, negative family functioning, tolerance for family members, and parental understanding. This structure was the same for both mothers and fathers. Further studies of the Chinese Family Assessment Instrument parent adaptation are required to test the factor structure that emerged. Following such studies, validation studies will be required.

Multilevel analysis of the Be Active Eat Well intervention : environmental and behavioural influences on reductions in child obesity risk

Background: The Be Active Eat Well (BAEW) community-based child obesity prevention intervention was successful in modestly reducing unhealthy weight gain in primary school children using a multi-strategy and multi-setting approach.

Objective: To (1) examine the relationship between changes in obesity-related individual, household and school factors and changes in standardised child body mass index (zBMI), and (2) determine if the BAEW intervention moderated these effects.

Methods: The longitudinal relationships between changes in individual, household and school variables and changes in zBMI were explored using multilevel modelling, with measurement time (baseline and follow-up) at level 1, individual (behaviours, n=1812) at level 2 and households (n=1318) and schools (n=18) as higher levels (environments). The effect of the intervention was tested while controlling for child age, gender and maternal education level.

Results: This study confirmed that the BAEW intervention lowered child zBMI compared with the comparison group (−0.085 units, P=0.03). The variation between household environments was found to be a large contributor to the percentage of unexplained change in child zBMI (59%), compared with contributions from the individual (23%) and school levels (1%). Across both groups, screen time (P=0.03), sweet drink consumption (P=0.03) and lack of household rules for television (TV) viewing (P=0.05) were associated with increased zBMI, whereas there was a non-significant association with the frequency the TV was on during evening meals (P=0.07). The moderating effect of the intervention was only evident for the relationship between the frequency of TV on during meals and zBMI, however, this effect was modest (P=0.04).

Conclusions: The development of childhood obesity involves multi-factorial and multi-level influences, some of which are amenable to change. Obesity prevention strategies should not only target individual behaviours but also the household environment and family practices. Although zBMI changes were modest, these findings are encouraging as small reductions can have population level impacts on childhood obesity levels.

TV viewing behaviour among preschoolers : implications for public health recommendations

Excessive television (TV) viewing in early childhood has been associated with adverse cognitive and behavioural outcomes.[1-3] A recent review of the literature revealed that TV viewing in the formative pre-school years has also been linked with other health concerns including sleep difficulties, increased aggression, anxiety and obesity.[4] Given that early childhood is the time in which the foundations for future behaviours and habits are established and evidence shows that TV behaviours track from early childhood to adolescence,[5] it is not surprising that there has been much interest in determining an ‘appropriate’ amount of screen time for pre-schoolers. The aim of this paper is to review current recommendations around Australian pre-school children's TV use and the implications of these guidelines when we consider current data pertaining to young children's TV viewing behaviour.

Physical Education can improve insulin resistance: The LOOK randomized cluster trial

Purpose
As impaired glucose metabolism may arise progressively during childhood, we sought to determine whether the introduction of specialist-taught school physical education (PE) based on sound educational principles could improve insulin resistance (IR) in elementary school children.

Methods
In this 4-yr cluster-randomized intervention study, participants were 367 boys and 341 girls (mean age = 8.1 yr, SD = 0.35) initially in grade 2 in 29 elementary schools situated in suburbs of similar socioeconomic status. In 13 schools, 100 min·wk−1 of PE, usually conducted by general classroom teachers, was replaced with two classes per week taught by visiting specialist PE teachers; the remaining schools formed the control group. Teacher and pupil behavior were recorded, and measurements in grades 2, 4, and 6 included fasting blood glucose and insulin to calculate the homeostatic model of IR, percent body fat, physical activity, fitness, and pubertal development.

Results
On average, the intervention PE classes included more fitness work than the control PE classes (7 vs 1 min, P < 0.001) and more moderate physical activity (17 vs 10 min, P < 0.001). With no differences at baseline, by grade 6, the intervention had lowered IR by 14% (95% confidence interval = 1%–31%) in the boys and by 9% (95% confidence interval = 5%–26%) in the girls, and the percentage of children with IR greater than 3, a cutoff point for metabolic risk, was lower in the intervention than the control group (combined, 22% vs 31%, P = 0.03; boys, 12% vs 21%, P = 0.06; girls, 32% vs 40%, P = 0.05).

Conclusions
Specialist-taught primary school PE improved IR in community-based children, thereby offering a primordial preventative strategy that could be coordinated widely although a school-based approach.