Personal, social and environmental correlates of healthy weight status amongst mothers from socioeconomically disadvantaged neighborhoods : findings from the READI study

Background

Socioeconomically disadvantaged mothers are at high risk of obesity, yet the aetiology of obesity in this group remains poorly understood. The aim of this study was to examine the perceived personal, social and physical environmental factors associated with resilience to obesity among mothers from socioeconomically disadvantaged neighbourhoods.
Methods

Survey data were provided by a cohort of 1840 women aged 18-46 years with dependent children (aged 0-18 years) from 40 urban and 40 rural socioeconomically disadvantaged neighbourhoods across Victoria, Australia. Mothers responded to a number of questions relating to personal, social and environmental influences on their physical activity and eating habits. Mothers' weight status was classified as healthy weight (BMI: 18.5-24.99), overweight (BMI: 25-29.99) or obese (BMI: 30+).
Results

Mothers' weight status was bivariably associated with factors from all three domains (personal, social and physical environmental). In a multivariable model, mothers' perceived ability to make time for healthy eating (OR = 1.34) and physical activity (OR = 1.11) despite family commitments, and the frequency with which families ate healthy low-fat foods with mothers (OR = 1.28) remained significantly positively associated with healthy weight status. The frequency with which families encouraged eating healthy low-fat foods remained negatively associated (OR = 0.81) with weight status; ie greater encouragement was associated with less healthy weight status.
Conclusions

Drawing on the characteristics of mothers resilient to obesity might assist in developing intervention strategies to help other mothers in socioeconomically disadvantaged neighbourhoods to manage their weight. Such strategies might focus on planning for and prioritising time for healthy eating and physical activity behaviours, and including family members in and encouraging family mealtimes.

Can social cognitive theory constructs explain socio-economic variations in adolescent eating behaviours? A mediation analysis

Adolescents of low socio-economic position (SEP) are less likely than those of higher SEP to consume diets in line with current dietary recommendations. The reasons for these SEP variations remain poorly understood. We investigated the mechanisms underlying socio-economic variations in adolescents’ eating behaviours using a theoretically derived explanatory model. Data were obtained from a community-based sample of 2529 adolescents aged 12–15 years, from 37 secondary schools in Victoria, Australia. Adolescents completed a web-based survey assessing their eating behaviours, self-efficacy for healthy eating, perceived importance of nutrition and health, social modelling and support and the availability of foods in the home. Parents provided details of maternal education level, which was used as an indicator of SEP. All social cognitive constructs assessed mediated socio-economic variations in at least one indicator of adolescents’ diet. Cognitive factors were the strongest mediator of socio-economic variations in fruit intakes, while for energy-dense snack foods and fast foods, availability of energy-dense snacks at home tended to be strong mediators. Social cognitive theory provides a useful framework for understanding socio-economic variations in adolescent's diet and might guide public health programmes and policies focusing on improving adolescent nutrition among those experiencing socio-economic disadvantage.

Scaling up community-based obesity prevention in Australia : background and evaluation design of the health promoting communities : being active eating well initiative

Background : There is only limited evidence available on how best to prevent childhood obesity and community-based interventions hold promise, as several successful interventions have now been published. The Victorian Government has recently funded six disadvantaged communities across Victoria, Australia for three years to promote healthy eating and physical activity for children, families, and adults in a community-based participatory manner. Five of these intervention communities are situated in Primary Care Partnerships and are the subject of this paper. The interventions will comprise a mixture of capacity-building, environmental, and whole-of-community approaches with targeted and population-level interventions. The specific intervention activities will be determined locally within each community through stakeholder and community consultation. Implementation of the interventions will occur through funded positions in primary care and local government. This paper describes the design of the evaluation of the five primary care partnership-based initiatives in the 'Go for your life' Health Promoting Communities: Being Active Eating Well (HPC:BAEW) initiative.

Methods/Design : A mixed method and multi-level evaluation of the HPC:BAEW initiative will capture process, impact and outcome data and involve both local and state-wide evaluators. There will be a combined analysis across the five community intervention projects with outcomes compared to a comparison group using a cross-sectional, quasi-experimental design. The evaluation will capture process, weight status, socio-demographic, obesity-related behavioral and environmental data in intervention and comparison areas. This will be achieved using document analysis, paper-based questionnaires, interviews and direct measures of weight, height and waist circumference from participants (children, adolescents and adults).

Discussion : This study will add significant evidence on how to prevent obesity at a population level in disadvantaged and ethnically diverse communities. The outcomes will have direct influence on policy and practice and guide the development and implementation of future obesity prevention efforts in Australia and internationally.

Mediators of longitudinal associations between television viewing and eating behaviours in adolescents

Background: Television viewing has been associated with poor eating behaviours in adolescents. Changing unhealthy eating behaviours is most likely to be achieved by identifying and targeting factors shown to mediate the association between these behaviours. However, little is known about the mediators of the associations between television viewing and eating behaviours. The aim of this study was to examine mediators of the longitudinal associations between television viewing (TV) and eating behaviours among Australian adolescents.
Method: Eating behaviours were assessed using a web-based survey completed by a community-based sample of 1729 adolescents from years 7 and 9 of secondary schools in Victoria, Australia, at baseline (2004-2005) and two years later. TV viewing and the potential mediators (snacking while watching TV and perceived value of TV viewing) were assessed via the web-based survey at baseline.
Results: Adolescents who watched more than two hours of TV/day had higher intakes of energy-dense snacks and beverages, and lower intakes of fruit two years later. Furthermore, the associations between TV viewing and consumption of energy-dense snacks, energy-dense drinks and fruit were mediated by snacking while watching TV. Perceived value of TV viewing mediated the association between TV viewing and consumption of energy-dense snacks, beverages and fruit.
Conclusion: Snacking while watching TV and perceived value of TV viewing mediated the longitudinal association between TV viewing and eating behaviours among adolescents. The efficacy of methods to reduce TV viewing, change snacking habits while watching TV, and address the values that adolescents place on TV viewing should be examined in an effort to promote healthy eating among adolescents.

Home and neighbourhood correlates of BMI among children living in socioeconomically disadvantaged neighbourhoods

A detailed understanding of the underlying drivers of obesity-risk behaviours is needed to inform prevention initiatives, particularly for individuals of low socioeconomic position who are at increased risk of unhealthy weight gain. However, few studies have concurrently considered factors in the home and local neighbourhood environments, and little research has examined determinants among children from low socioeconomic backgrounds. The present study examined home, social and neighbourhood correlates of BMI (kg/m2) in children living in disadvantaged neighbourhoods. Cross-sectional data were collected from 491 women with children aged 5–12 years living in forty urban and forty rural socioeconomically disadvantaged areas (suburbs) of Victoria, Australia in 2007 and 2008. Mothers completed questionnaires about the home environment (maternal efficacy, perceived importance/beliefs, rewards, rules and access to equipment), social norms and perceived neighbourhood environment in relation to physical activity, healthy eating and sedentary behaviour. Children's height and weight were measured at school or home. Linear regression analyses controlled for child sex and age. In multivariable analyses, children whose mothers had higher efficacy for them doing physical activity tended to have lower BMI z scores (B = − 0·04, 95 % CI − 0·06, − 0·02), and children who had a television (TV) in their bedroom (B = 0·24, 95 % CI 0·04, 0·44) and whose mothers made greater use of food as a reward for good behaviour (B = 0·05, 95 % CI 0·01, 0·09) tended to have higher BMI z scores. Increasing efficacy among mothers to promote physical activity, limiting use of food as a reward and not placing TV in children's bedrooms may be important targets for future obesity prevention initiatives in disadvantaged communities.

Understanding determinants of nutrition, physical activity and quality of life among older adults : the Wellbeing, Eating and Exercise for a Long Life (WELL) study

Background : Nutrition and physical activity are major determinants of health and quality of life; however, there exists little research focusing on determinants of these behaviours in older adults. This is important, since just as these behaviours vary according to subpopulation, it is likely that the determinants also vary. An understanding of the modifiable determinants of nutrition and physical activity behaviours among older adults to take into account the specific life-stage context is required in order to develop effective interventions to promote health and well-being and prevent chronic disease and improve quality of life.

Methods : The aim of this work is to identify how intrapersonal, social and environmental factors influence nutrition and physical activity behaviours among older adults living in urban and rural areas. This study is a cohort study of adults aged 55-65 years across urban and rural Victoria, Australia. Participants completed questionnaires at baseline in 2010 and will complete follow-up questionnaires in 2012 and 2014. Self-report questionnaires will be used to assess outcomes such as food intake, physical activity and sedentary behaviours, anthropometry and quality of life. Explanatory variables include socioeconomic position, and measures of the three levels of influence on older adults' nutrition and physical activity behaviours (intrapersonal, social and perceived environmental influences).

Discussion : Obesity and its determinant behaviours, physical inactivity and poor diet are major public health concerns and are significant determinants of the quality of life among the ageing population. There is a critical need for a better understanding of the determinants of nutrition and physical activity in this important target group. This research will provide evidence for the development of effective policies and programs to promote and support increased physical activity and healthy eating behaviours among older adults.

Daily eating frequency and cardiometabolic risk factors in young Australian adults : cross-sectional analyses

Eating frequency may be important in the development of overweight and obesity and other cardiometabolic risk factors; however, the evidence is inconsistent. The aim of the present study was to examine the associations between the number of eating occasions and cardiometabolic risk factors in a national population-based sample of young adults. A cohort of 1273 men and 1502 women, aged 26–36 years, completed a meal pattern chart to record when they had eaten during the previous day (in hourly intervals). The total number of eating occasions was calculated. Diet quality was assessed, waist circumference was measured and a fasting blood sample was taken. Dietary intake was compared with the Australian Guide to Healthy Eating. The associations between the number of eating occasions and cardiometabolic risk factors were calculated using linear regression. Analyses were adjusted for age, education and physical activity. Most men ate three to five times per d and most women ate four to six times. The proportion of participants meeting dietary recommendations increased with the number of eating occasions. For men, an additional eating occasion was associated with reductions in mean values for waist circumference ( − 0·75 cm), fasting glucose ( − 0·02 mmol/l), fasting insulin ( − 0·34 mU/l; 2·04 pmol/l), TAG ( − 0·03 mmol/l), total cholesterol ( − 0·08 mmol/l) and LDL-cholesterol ( − 0·06 mmol/l). Adjustment for waist circumference attenuated the results. Significant trends were not observed for women. In conclusion, a higher number of eating occasions were associated with reduced cardiometabolic risk factors in men. Many associations were mediated by waist circumference.

Barriers to avoiding fast-food consumption in an environment supportive of unhealthy eating

Objective
To investigate factors (ability, motivation and the environment) that act as barriers to limiting fast-food consumption in women who live in an environment that is supportive of poor eating habits.

Design
Cross-sectional study using self-reports of individual-level data and objectively measured environmental data. Multilevel logistic regression was used to assess factors associated with frequency of fast-food consumption.

Setting
Socio-economically disadvantaged areas in metropolitan Melbourne, Australia.

Subjects
Women (n 932) from thirty-two socio-economically disadvantaged neighbourhoods living within 3 km of six or more fast-food restaurants. Women were randomly sampled in 2007–2008 as part of baseline data collection for the Resilience for Eating and Activity Despite Inequality (READI) study.

Results
Consuming low amounts of fast food was less likely in women with lower perceived ability to shop for and cook healthy foods, lower frequency of family dining, lower family support for healthy eating, more women acquaintances who eat fast food regularly and who lived further from the nearest supermarket. When modelled with the other significant factors, a lower perceived shopping ability, mid levels of family support and living further from the nearest supermarket remained significant. Among those who did not perceive fruits and vegetables to be of high quality, less frequent fast-food consumption was further reduced for those with the lowest confidence in their shopping ability.

Conclusions
Interventions designed to improve women's ability and opportunities to shop for healthy foods may be of value in making those who live in high-risk environments better able to eat healthily.

Exploring influences on eating behaviours of adolescents experiencing socioeconomic disadvantage

Dr Stephens' thesis utilised a novel approach to examine eating habits of socioeconomically disadvantaged adolescents and to identify factors supportive of healthy eating. Several potential targets and strategies were identified that could be considered when designing interventions, particularly the role of parents and the home food environment.

Process evaluation of a community-based intervention program: Healthy Youth Healthy Communities, an adolescent obesity prevention project in Fiji

Nearly one-half of the adult population in Fiji between the ages of 15–64 years is either overweight or obese; and rates amongst school children have, on average, doubled during the last decade. There is an urgent need to scale up the promotion of healthy behaviors and environments using a multi-sectoral approach. The Healthy Youth Healthy Community (HYHC) project in Fiji used a settings approach in secondary schools and faith-based organizations to increase the capacity of the whole community, including churches, mosques and temples, to promote healthy eating and regular physical activity, and to prevent unhealthy weight gain in adolescents aged 13–18 years. The team consisted of a study manager, project coordinator and four research assistants (RAs) committed to planning, designing and facilitating the implementation of intervention programs in collaboration with other stakeholders, such as the wider school communities, government and non-governmental organizations and business partners. Process data were collected on all intervention activities and analyzed by dose, frequency and reach for each specific strategy. The Fiji Action Plan included nine objectives for the school settings; four were based on nutrition and two on physical activity in schools, plus three general objectives, namely capacity building, social marketing and evaluation. Long-term change in nutritional behavior was difficult to achieve; a key contributor to this was the unhealthy food served in the school canteens. Whilst capacity-building proved to be one of the best mechanisms for intervening, it is important to consider the cultural and social factors influencing health behaviors and affecting specific groups.

Effect of changes to the school food environment on eating behaviours and/or body weight in children: a systematic review

Previous school obesity-prevention reviews have included multi-component interventions. Here, we aimed to review the evidence for the effect of isolated food environment interventions on both eating behaviours (including food purchasing) and/or body weight. Five electronic databases were searched (last updated 30 November 2013). Of the 1,002 unique papers identified, 55 reported on school food environment changes, based on a review of titles and abstracts. Thirty-seven further papers were excluded, for not meeting the inclusion criteria. The final selection consisted of 18 papers (14 United States, 4 United Kingdom). Two studies had a body mass index (BMI) outcome, 14 assessed purchasing or eating behaviours and two studies assessed both weight and behaviour. Seventeen of 18 papers reported a positive outcome on either BMI (or change in BMI) or the healthfulness of food sold or consumed. Two studies were rated as strong quality and 11 as weak. Only three studies included a control group. A school environment supportive of healthy eating is essential to combat heavy marketing of unhealthy food. Modification of the school food environment (including high-level policy changes at state or national level) can have a positive impact on eating behaviours. A need exists, however, for further high-quality studies.

A randomised controlled trial of an intervention to increase the implementation of a healthy canteen policy in Australian primary schools: study protocol

Background: The implementation of healthy school canteen policies has been recommended as a strategy to help prevent unhealthy eating and excessive weight gain. Internationally, research suggests that schools often fail to implement practices consistent with healthy school canteen policies. Without a population wide implementation, the potential benefits of these policies will not be realised. The aim of this trial is to assess the effectiveness of an implementation intervention in increasing school canteen practices consistent with a healthy canteen policy of the New South Wales (NSW), Australia, government known as the 'Fresh Tastes @ School NSW Healthy School Canteen Strategy'.Methods/design: The parallel randomised trial will be conducted in 70 primary schools located in the Hunter region of New South Wales, Australia. Schools will be eligible to participate if they are not currently meeting key components of the healthy canteen policy. Schools will be randomly allocated after baseline data collection in a 1:1 ratio to either an intervention or control group using a computerised random number function in Microsoft Excel. Thirty-five schools will be selected to receive a multi-component intervention including implementation support from research staff, staff training, resources, recognition and incentives, consensus and leadership strategies, follow-up support and implementation feedback. The 35 schools allocated to the control group will not receive any intervention support as part of the research trial. The primary outcome measures will be i) the proportion of schools with a canteen menu that does not contain foods or beverages restricted from regular sale ('red' and 'banned' items) and ii) the proportion of schools where healthy canteen items ('green' items) represent the majority (>50%) of products listed on the menu. Outcome data will be collected via a comprehensive menu audit, conducted by dietitians blind to group allocation. Intervention effectiveness will be assessed using logistic regression models adjusting for baseline values.Discussion: The proposed trial will represent a novel contribution to the literature, being the first randomised trial internationally to examine the effectiveness of an intervention to facilitate implementation of a healthy canteen policy.

The Healthy Migrant Families Initiative: Development of a culturally competent obesity prevention intervention for African migrants Disease epidemiology - Chronic

Background: Although obesity among immigrants remains an important area of study given the increasing migrant population in Australia and other developed countries, research on factors amenable to intervention is sparse. The aim of the study was to develop a culturally-competent obesity prevention program for sub-Saharan African (SSA) families with children aged 12-17 years using a community-partnered participatory approach. Methods: A community-partnered participatory approach that allowed the intervention to be developed in collaborative partnership with communities was used. Three pilot studies were carried out in 2008 and 2009 which included focus groups, interviews, and workshops with SSA parents, teenagers and health professionals, and emerging themes were used to inform the intervention content. A cultural competence framework containing 10 strategies was developed to inform the development of the program. Using findings from our scoping research, together with community consultations through the African Review Panel, a draft program outline (skeleton) was developed and presented in two separate community forums with SSA community members and health professionals working with SSA communities in Melbourne. Results: The 'Healthy Migrant Families Initiative (HMFI): Challenges and Choices' program was developed and designed to assist African families in their transition to life in a new country. The program consists of nine sessions, each approximately 1 1/2 hours in length, which are divided into two modules based on the topic. The first module 'Healthy lifestyles in a new culture' (5 sessions) focuses on healthy eating, active living and healthy body weight. The second module 'Healthy families in a new culture' (4 sessions) focuses on parenting, communication and problem solving. The sessions are designed for a group setting (6-12 people per group), as many of the program activities are discussion-based, supported by session materials and program resources. Conclusion: Strong partnerships and participation by SSA migrant communities enabled the design of a culturally competent and evidence-based intervention that addresses obesity prevention through a focus on healthy lifestyles and healthy families. Program implementation and evaluation will further inform obesity prevention interventions for ethnic minorities and disadvantaged communities.

Psychosocial influences on fruit, vegetable and milk consumption among a cohort of Houston-area 5th graders

Epidemiological evidence suggests that fruit and vegetable intake is negatively associated with the development of several chronic diseases, including heart disease, some cancers and diabetes mellitus. Inadequate consumption of milk during developmental years is associated with osteoporosis. Consumption of fruit, vegetable and milk (FVM) declines from childhood to adolescence. Adolescent eating habits persist into adulthood; thus, understanding psychosocial factors such as self-efficacy, norms and preferences, is important for developing effective interventions. Preferences, one of the most consistent correlates of fruit and vegetable consumption in children and adolescents, may mediate the relationships between self-efficacy and norms and fruit and vegetable consumption. ^ Fifth grade students from one middle school in South Texas were followed for two years. Students completed lunch food records and questionnaires assessing fruit, vegetable and milk self-efficacy and norms and fruit and vegetable preferences. Principal component analyses identified four scales: Fruit Self-Efficacy, Vegetable Self-Efficacy, Fruit and Vegetable Norms, and Milk Influences. Reliability and validity of the four scales and emerging subscales were assessed using Cronbach's alpha and consumption data, respectively. Associations between longitudinal FVM consumption and self-efficacy and norms were tested. Additionally, the influence of preferences on the relationship of self-efficacy, norms and fruit and vegetable consumption was examined. ^ Confirmatory factor analyses confirmed four scales and subscales. Internal consistency and test-retest reliabilities were acceptable. Self-efficacy and norms were related to FVM consumption and changes in fruit and high fat vegetable consumption over the two-year period. While intake over the two-year period differed statistically, eating patterns were stable. Preferences mediated the relation between fruit self-efficacy and FV norms and fruit consumption. ^ In conclusion, self-efficacy and norms about consuming FVM at school appear to influence FVM consumption. Because eating patterns were similar over the two-year period, establishing healthy eating habits in elementary school is important. While FVM self-efficacy and norms influenced FVM consumption in children, only fruit preferences mediated the relationship of fruit consumption, self-efficacy and norms. Since the influences of FVM consumption appear to differ, interventions designed to increase consumption should target these differences and consider the specificity of self-efficacy and norms. ^

Evaluation of the effectiveness of the Fresh and Healthy Program

Background. Diets high in fat and calories are promoted by the toxic food environment in which high fat, high calorie foods are readily accessible, thus contributing to high rates of overweight and obesity.^ Hypothesis. Changing the food environment to make low-fat, low-calorie foods readily identifiable and accessible while simultaneously offering incentives for choosing those foods will result in increased consumption of targeted foods, thus decreasing caloric and fat intake and ultimately decreasing obesity rates.^ Objective. To conduct an outcome evaluation study on the effectiveness of The Fresh & Healthy Program, a health promotion project designed to promote healthy eating among The Methodist Hospital employees by labeling and promoting low calorie, low fat items in the hospital cafeteria. ^ Program. By promoting healthy eating, this program seeks to address unhealthy dietary behaviors, one of the most widely known and influential behavioral causes of obesity. Food items that are included in the program meet nutritional criteria for calories and fat and are labeled with a special logo. Program participants receive incentives for purchasing Fresh & Healthy items. The program was designed and implemented by a team of registered dietitians, two health education specialists, and retail foodservice managers at The Methodist Hospital in the Texas Medical Center in Houston and has been in existence since April 2006.^ Methods. The evaluation uses a non-randomized, one-group, time series design to evaluate the effect of the program on sales of targeted food items.^ Key words. point-of-purchase, menu labeling, environmental obesity interventions, food pricing interventions ^