Preventing childhood obesity : the sentinel site for obesity prevention in Victoria, Australia

In spite of greater awareness of the need for action to reduce obesity, the evidence on sustainable community approaches to prevent childhood and adolescent obesity is surprisingly sparse. This paper describes the design and methodological components of the Sentinel Site for Obesity Prevention, a demonstration site in the Barwon-South West region of Victoria, Australia, that aims to build the programs, skills and evidence necessary to attenuate and eventually reverse the obesity epidemic in children and adolescents.

The Sentinel Site for Obesity Prevention is based on a partnership between the region's university (Deakin University) and its health, education and local government agencies. The three basic foundations of the Sentinel Site are: multi-strategy, multi-setting interventions; building community capacity; and undertaking program evaluations and population monitoring. Three intervention projects have been supported that cover different age groups (preschool: 2–5 years, primary school: 5–12 years, secondary school: 13–17 years), but that have many characteristics in common including: community participation and ownership of the project; an intervention duration of at least 3 years; and full evaluations with impact (behaviours) and outcome measures (anthropometry) compared with regionally representative comparison populations.

We recommend the Sentinel Site approach to others for successfully building evidence for childhood obesity prevention and stimulating action on reducing the epidemic.

Perceived sports competence mediates the relationship between childhood motor skill proficiency and adolescent physical activity and fitness : a longitudinal assessment

Background: The purpose of this paper was to investigate whether perceived sports competence mediates the relationship between childhood motor skill proficiency and subsequent adolescent physical activity and fitness.

Methods: In 2000, children's motor skill proficiency was assessed as part of a school-based physical activity intervention. In 2006/07, participants were followed up as part of the Physical Activity and Skills Study and completed assessments for perceived sports competence (Physical Self-Perception Profile), physical activity (Adolescent Physical Activity Recall Questionnaire) and cardiorespiratory fitness (Multistage Fitness Test). Structural equation modelling techniques were used to determine whether perceived sports competence mediated between childhood object control skill proficiency (composite score of kick, catch and overhand throw), and subsequent adolescent self-reported time in moderate-to-vigorous physical activity and cardiorespiratory fitness.

Results: Of 928 original intervention participants, 481 were located in 28 schools and 276 (57%) were assessed with at least one follow-up measure. Slightly more than half were female (52.4%) with a mean age of 16.4 years (range 14.2 to 18.3 yrs). Relevant assessments were completed by 250 (90.6%) students for the Physical Activity Model and 227 (82.3%) for the Fitness Model. Both hypothesised mediation models had a good fit to the observed data, with the Physical Activity Model accounting for 18% (R2 = 0.18) of physical activity variance and the Fitness Model accounting for 30% (R2 = 0.30) of fitness variance. Sex did not act as a moderator in either model.

Conclusion: Developing a high perceived sports competence through object control skill development in childhood is important for both boys and girls in determining adolescent physical activity participation and fitness. Our findings highlight the need for interventions to target and improve the perceived sports competence of youth.

Does childhood motor skill proficiency predict adolescent fitness?

Purpose: To determine whether childhood fundamental motor skill proficiency predicts subsequent adolescent cardiorespiratory fitness.

Methods: In 2000, children's proficiency in a battery of skills was assessed as part of an elementary school-based intervention. Participants were followed up during 2006/2007 as part of the Physical Activity and Skills Study, and cardiorespiratory fitness was measured using the Multistage Fitness Test. Linear regression was used to examine the relationship between childhood fundamental motor skill proficiency and adolescent cardiorespiratory fitness controlling for gender. Composite object control (kick, catch, throw) and locomotor skill (hop, side gallop, vertical jump) were constructed for analysis. A separate linear regression examined the ability of the sprint run to predict cardiorespiratory fitness.

Results: Of the 928 original intervention participants, 481 were in 28 schools, 276 (57%) of whom were assessed. Two hundred and forty-four students (88.4%) completed the fitness test. One hundred and twenty-seven were females (52.1%), 60.1% of whom were in grade 10 and 39.0% were in grade 11. As children, almost all 244 completed each motor assessments, except for the sprint run (n = 154, 55.8%). The mean composite skill score in 2000 was 17.7 (SD 5.1). In 2006/2007, the mean number of laps on the Multistage Fitness Test was 50.5 (SD 24.4). Object control proficiency in childhood, adjusting for gender (P = 0.000), was associated with adolescent cardiorespiratory fitness (P = 0.012), accounting for 26% of fitness variation.

Conclusion: Children with good object control skills are more likely to become fit adolescents. Fundamental motor skill development in childhood may be an important component of interventions aiming to promote long-term fitness.

The relationship between childhood cruelty to animals and psychological adjustment : a Malaysian study

In Western research, cruelty to animals in childhood has been associated with comorbid conduct problems and with interpersonal violence in later life. However, there is little understanding of the etiology of cruelty to animals, and what in the child's life may require attention if the chain linking animal cruelty and later violence is to be broken. The study reported in this paper investigated the association between parent-reported cruelty to animals, and parent- and self-reported psychological strengths and weaknesses in a sample of 379 elementary school children in an Eastern context, Malaysia. No gender differences were found in relation to cruelty to animals or psychological problems, as assessed with the Strengths and Difficulties Questionnaire (SDQ). However, there were different predictors of cruelty to animals for boys and girls. Regression analyses found that for boys, parent-reported hyperactivity was a unique predictor of Malicious and Total Cruelty to animals. For girls, self-reported conduct problems was a unique predictor of Typical Cruelty to animals. Parent-reported total difficulties were associated with Typical, Malicious, and Total Cruelty to animals. We suggest that routine screening of children with an instrument such as the SDQ may help to detect those children who may need to undergo further assessment and perhaps intervention to break the chain linking childhood cruelty to animals and later conduct problems.

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.

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.

The provision of compulsory school physical activity : associations with physical activity, fitness and overweight in childhood and twenty years later

Background
To determine whether the provision of higher levels of compulsory school physical activity is associated with higher physical activity and fitness levels and less overweight in childhood and 20 years later.

Methods
As part of the 1985 Australian Schools Health and Fitness Survey, 109 schools reported how much compulsory physical education (PE) and school sport they provided and were classified as low (<110 and <150 minutes/week for primary and secondary schools, respectively), medium (110–149 and 150–189 minutes/week for primary and secondary schools, respectively) or high (≥150 and ≥190 minutes/week for primary and secondary schools, respectively) compulsory physical activity schools by tertile cutpoints. 6,412 children reported frequency and duration of school (PE and sport) and non-school (commuting and non-organised exercise) physical activity and had height and weight measured; overweight was defined using body mass index (BMI) (m/kg²) cutpoints. 9, 12 and 15 year-olds (n = 2,595) completed a cycle ergometer fitness test (physical working capacity at heart rate 170, PWC₁₇₀). At follow-up in 2004–5, 2,346 participants kept a pedometer record, completed the International Physical Activity Questionnaire and/or a PWC₁₇₀ fitness test; and had height and weight measured (overweight = BMI≥25 m/kg²).

Results
At baseline and follow-up, median total physical activity, fitness and BMI were similar in participants who attended low, medium and high physical activity schools, and those attending high physical activity schools reported only modestly higher school physical activity. There was no difference in the prevalence of high total physical activity and fitness levels in childhood or adulthood across compulsory school physical activity categories. The prevalence of overweight in childhood and adulthood was similar across low, medium and high compulsory physical activity schools.

Conclusion
The amount of compulsory physical activity reported by schools was not associated with total physical activity, fitness or overweight in childhood or in adulthood. Policies promoting amounts of compulsory school physical activity in this range may not be sufficient to increase physical activity and fitness or reduce the prevalence of obesity in children.

Physical activity and healthy weight maintenance from childhood to adulthood

The objective of this study was to determine whether change in physical activity was associated with maintaining a healthy weight from childhood to adulthood. This prospective cohort study examined 1,594 young Australian adults (48.9% female) aged 27–36 years who were first examined at age 9–15 years as part of a national health and fitness survey. BMI was calculated from measured height and weight, and physical activity was self-reported at both time points; pedometers were also used at follow-up. Change in physical activity was characterized by calculating the difference between baseline and follow-up z-scores. Change scores were categorized as decreasing (large, moderate), stable, or increasing (large, moderate). Healthy weight was defined in childhood as a BMI less than international overweight cutoff points, and in adulthood as BMI<25 kg/m2. Healthy weight maintainers were healthy weight at both time points. Compared with those who demonstrated large relative decreases in physical activity, females in all other groups were 25–37% more likely to be healthy weight maintainers, although associations differed according to the physical activity measure used at follow-up and few reached statistical significance. Although younger males whose relative physical activity moderately or largely increased were 27–34% more likely to be healthy weight maintainers than those whose relative physical activity largely decreased, differences were not statistically significant. In conclusion, relatively increasing and stable physical activity from childhood to adulthood was only weakly associated with healthy weight maintenance. Examining personal, social, and environmental factors associated with healthy weight maintenance will be an important next step in understanding why some groups avoid becoming overweight.

The impact of childhood conditions and concurrent morbidities on child health and well-being

Background. Understanding the impact of illnesses and morbidities experienced by children and adolescents is essential to clinical and population health programme decision making and intervention research. This study sought to: (1) examine the population prevalence of physical and mental health conditions for children and quantify their impact on multiple dimensions of children's health and well-being; and (2) examine the cumulative effect of concurrent conditions.

Methods. We conducted a cross-sectional school-based epidemiological study of 5414 children and adolescents aged 5–18 years, and examined parental reports of child health and well-being using the parent-report Child Health Questionnaire (CHQ) PF50 13 scales are scored on a 0–100 pt scale with clinically meaningful differences of five points and the presence of childhood conditions (illnesses and health problems).

Results. Asthma, dental, vision and allergies are the most commonly identified health problems for children and adolescents, followed by attention- and behaviour-related problems (asthma 17.9–23.2%, dental 11.9–22.7%, vision 7.2–14.7%, chronic allergies 8.8–13.9%, attention problems 5.1–13.8% and behaviour problems 5.7–12.0%). As the number of concurrent health problems increase, overall health and well-being decreases substantively with mean differences in CHQ scale scores of 14 points (−7.69 to −21.51) for physical health conditions, and 28 points (−5.15 to −33.81) for mental health conditions.

Conclusions. Children's health and well-being decreases linearly with increasing presence and frequency of health problems. Having three or more conditions concurrently significantly burdens children's health and well-being, particularly for family-related CHQ domains, with a greater burden experienced for mental health conditions than physical health conditions.

Technology education in early childhood setting

Across Victoria, Early Childhood educators are incorporating technology experiences into the daily activities for their children. A small research project, which asked teachers to describe what they did and how they did it, has highlighted some interesting findings. This paper will describe case studies of four pre-school settings and some of the activities undertaken by the children - both as part of the formal program and through incidental play. It will consider these through a socia-cultural framework, noting how teachers used their understandings of play and children's cognitive development, to enhance children's understandings.

Associations between early childhood temperament clusters and later pychosocial adjustment

The study adopted a person-centered approach to examine whether clusters of children could be identified on the basis of temperament profiles assessed on four occasions from infancy to early childhood, and if so whether differing temperament clusters were associated with subsequent differences in behavior problems, social skills, and school adjustment in middle and late childhood. Parent, teacher, and self-report data were obtained from a large community-based cohort sample of Australian children, followed prospectively from infancy to late childhood. Four temperament clusters were identified. Children in the clusters labeled as reactive/inhibited and poor attention regulation tended to have higher levels of later behavior problems than children in clusters labeled nonreactive/outgoing and high attention regulation. Results suggested that a person-oriented clustering approach can identify children on the basis of early temperament who are at greater risk for behavioral, academic, and social difficulties four to eight years later.