Alison M. McMinn

The effect of community and family interventions on young people's physical activity levels: a review of reviews and updated systematic review

Background Next to the school environment, the family and community environment are key for young peoples behaviour and for promoting physical activity (PA). Methods A review of reviews was conducted, after which a literature search was conducted (in PubMed, Scopus and PsychInfo) from August 2007 (search date of the most recent review) to October 2010. Inclusion criteria were study population aged 18 years or younger, controlled trial, no PA control condition, PA promotion intervention and reported analyses of a PA-related outcome. Methodological quality was assessed, and data on intervention details, methods and effects on primary and secondary outcomes (PA, body composition and fitness) were extracted. Results Three previous reviews were reviewed, including 13 family-based and three community-based interventions. Study inclusion differed for each review, but all concluded that the evidence was limited, although the potential of family-based interventions delivered in the home and including self-monitoring was highlighted. A further six family-based and four community-based interventions were included in the updated review, with a methodological quality score ranging from 2 to 10 and five studies scoring 6 or higher. Significant positive effects on PA were observed for one community-based and three family-based studies. No distinctive characteristics of the effective interventions compared with those that were ineffective were identified. Conclusions The effect of family- and community-based interventions remains uncertain despite improvements in study quality. Of the little evidence of effectiveness, most comes from those targeted at families and set in the home. Further detailed research is needed to identify key approaches for increasing young peoples PA levels in family and community settings.

Perception versus reality: awareness of physical activity levels of British children.

BACKGROUND Interventions to increase childrens physical activity have had limited success. One reason may be that children and their parents overestimate childrens levels of physical activity, although there is a small amount of data on this topic. PURPOSE This study aims to assess awareness of physical activity levels among British school children aged 9-10 years and their parents. METHODS Physical activity was measured using an accelerometer in a cross-sectional study of 1892 children (44% male; M age=10.3 years, SD=0.3) from 92 Norfolk schools (Sport, Physical Activity and Eating Behavior: Environmental Determinants in Young People [SPEEDY] study). Data were collected between April and July 2007 and analyzed in 2008. Inactive was defined as <60 minutes/day of moderate and vigorous physical activity. Agreement between physical activity perception (child- and parent-rated) and objective physical activity was assessed. Associations between biological (height, weight, fat mass index); parental (support, BMI, physical activity); and peer factors (support, objective physical activity) and child and parental physical activity awareness were studied using multinomial logistic regression. RESULTS In all, 39% of girls and 18% of boys were inactive. A total of 80% of parents of inactive children wrongly thought that their child was sufficiently active. In all, 40% of inactive children overestimated their physical activity level. Compared to parents who accurately described their children as inactive, parents who overestimated were more likely to have girls (p=0.005), to have a child with a lower fat mass index (p<0.001), or to report more parental and peer support (p=0.014 and p<0.001, respectively). CONCLUSIONS Most parents of inactive children wrongly consider their children to be sufficiently active; parents of children with a lower fat mass index appear to assume that their children are adequately active. Increasing awareness regarding health benefits of physical activity beyond weight control might help reverse misperceptions of physical activity levels and encourage behavior change.

Family and home influences on children’s after-school and weekend physical activity

Background: Family- and home-related factors have been shown to be associated with children’s physical activity (PA), but may be time-dependent. Here we investigate whether family- and home-related correlates of children’s PA are different for the after-school period on weekdays than for the weekend. Methods: Data on 21 family- and home-related variables and objectively measured PA (Actigraph GT1M) were available from 1608 Year 5 children (9–10 years old) from 92 schools in Norfolk participating in the SPEEDY (Sport, Physical activity and Eating behaviour: Environmental Determinants in Young people) study. Multi-level multiple linear regression was used to quantify cross-sectional associations between the family/home variables and average min per day of moderate-to-vigorous PA (MVPA, ≥2000 counts/min) after school on weekdays and at the weekend. Models were additionally adjusted for age, sex, BMI z-score and registered accelerometer wear time. Results: After-school MVPA was associated with parent education (ß: −1.1; 95% CI −2.0 to −0.2), being allowed to play out in the neighbourhood (ß: 1.3; 0.7–1.8), restrictions on walking/cycling to friends’ houses (ß: −1.1; −1.6 to −0.7), restrictions on sedentary behaviour (ß: −0.3; −0.5 to −0.02) and family social support (ß: 1.0; 0.7–1.3). Weekend MVPA was associated with number of siblings (ß: 2.6; 0.5–4.8), family encouragement (ß: 1.1; 0.2–2.0) and family social support (ß: 1.5; 0.5–2.5). Conclusion: Family social support is positively associated with children’s out-of-school PA both at weekdays and in weekends. However, rules and restrictions appear to be important only on weekdays. The results of this study merit consideration when identifying appropriate timing of PA-promotion strategies.

Activity levels in mothers and their preschool children.

OBJECTIVES: To investigate the association between objectively measured maternal and preschool-aged children’s physical activity, determine how this association differs by demographic and temporal factors, and identify factors associated with maternal activity levels. METHODS: In the UK Southampton Women’s Survey, physical activity levels of 554 4-year-olds and their mothers were measured concurrently by using accelerometry for ≤7 days. Two-level mixed-effects linear regression was used to model the association between maternal and children’s minutes spent sedentary, in light (LPA) and moderate-to-vigorous physical activity (MVPA). Linear regression was used to investigate correlates of maternal activity. RESULTS: Mother-child daily activity levels were positively associated at all activity intensities (sedentary, LPA, and MVPA; all P < .001). The association for sedentary time was stronger for normal-weight children (versus those who were overweight/obese), and those attending preschool part-time (versus full-time). The mother-child association for LPA differed by maternal education and was stronger at the weekend (versus weekdays). The opposite was true for MVPA. Sedentary time and MVPA were most strongly associated in mornings, with LPA most strongly associated in the evenings. Maternal BMI, age leaving school, number and age of children at home, and working hours were independently associated with maternal daily sedentary time and LPA. CONCLUSIONS: Physical activity levels in mothers and their 4-year-old children are directly associated, with associations at different activity intensities influenced by temporal and demographic factors. Influences on maternal physical activity levels also differ by activity intensity. Providing targeted interventions for mothers of young children may increase both groups’ activity.

Family Dog Ownership and Levels of Physical Activity in Childhood: Findings From the Child Heart and Health Study in England

Dog ownership is associated with higher physical activity levels in adults; whether this association occurs in children is unknown. We used accelerometry to examine physical activity levels in 2065 children aged 9 to 10 years. Children from dog-owning families spent more time in light or moderate to vigorous physical activity and recorded higher levels of activity counts per minute (25; 95% confidence interval [CI]=6, 44) and steps per day (357; 95% CI=14, 701) than did children without dogs.

Validation of a maternal questionnaire on correlates of physical activity in preschool children

BackgroundValid measures of physical activity correlates in preschool children are lacking. This study aimed to assess the validity, factor structure and internal consistency of a maternal questionnaire on potential correlates of four-year-old childrens physical activity.MethodsThe questionnaire was designed to measure the following constructs: child personal factors; parental support and self-efficacy for providing support; parental rules and restrictions; maternal attitudes and perceptions; maternal behaviour; barriers to physical activity; and the home and local environments. Two separate studies were conducted. Study I included 24 mothers of four-year-old children who completed the questionnaire then participated in a telephone interview covering similar items to the questionnaire. To assess validity, the agreement between interview and questionnaire responses was assessed using Cohens kappa and percentage agreement. Study II involved 398 mothers of four-year-old children participating in the Southampton Womens Survey. In this study, principal components analysis was used to explore the factor structure of the questionnaire to aid future analyses with these data. The internal consistency of the factors identified was assessed using Cronbachs alpha.ResultsKappa scores showed 30% of items to have moderate agreement or above, 23% to have fair agreement and 47% to have slight or poor agreement. However, 89% of items had fair agreement as assessed by percentage agreement (≥ 66%). Limited variation in responses to variables is likely to have contributed to some of the low kappa values. Six questions had a low kappa and low percentage agreement (defined as poor validity); these included questions from the child personal factors, maternal self-efficacy, rules and restrictions, and local environment domains. The principal components analysis identified eleven factors and found several variables to stand alone. Eight of the composite factors identified had acceptable internal consistency (α ≥ 0.60) and three fell just short of achieving this (0.60 > α > 0.50).ConclusionOverall, this maternal questionnaire had reasonable validity and internal consistency for assessing potential correlates of physical activity in young children. With minor revision, this could be a useful tool for future research in this area. This, in turn, will aid the development of interventions to promote physical activity in this age group.

Factors predicting drop out from, and retention in, specialist drug treatment services: A case control study in the North West of England

Background:In the United Kingdom (UK), the National Treatment Agency for Substance Misuse (NTA) considers retention to be the best available measure of drug treatment effectiveness. Accordingly, the NTA has set local treatment systems the annual target of retaining 75% of clients for 12 weeks or more, yet little assessment of this target or factors that improve retention has occurred. This study aims to quantify the proportion of people retained in treatment for 12 weeks in the North West of England and to identify factors associated with premature drop out.Methods:The North West National Drug Treatment Monitoring System (NDTMS) was used to identify treatment durations for everyone beginning a treatment episode between 1st April 2005 and 31st March 2006 (N = 16626). Odds ratios, chi-square and logistic regression analyses compared clients retained for 12 weeks to clients whose discharge record showed they had prematurely dropped out before 12 weeks. Individuals with other outcomes were excluded from analyses.Results:75% of clients (N = 12230) were retained for 12 weeks and 10% (N = 1649) dropped out prematurely. Multivariate analysis showed drop out was more likely among Asian drug users (adjusted odds ratio 1.52, 95% CI 1.12 to 2.08) than their white equivalents. Drop out was more likely among residents of Cumbria and Lancashire (adjusted odds ratio 1.80, 95% CI 1.51 to 2.15) and Greater Manchester (adjusted odds ratio 2.00, 95% CI 1.74 to 2.29) than Cheshire and Merseyside and less likely among alcohol users (adjusted odds ratio 0.73, 95% CI 0.59 to 0.91). A significant interaction between age and deprivation was observed. For those aged 18 to 24 years and 25 to 34 years, drop out was significantly more likely among those living in affluent areas. For those in the older age groups the converse effect was observed.Conclusion:In combination, the drug treatment systems of the North West achieved the Governments retention target in 2005/06. A number of factors associated with drop out were identified; these should be considered in strategies that aim to improve retention. Drop out and retention are measures that capture the joint effect of many factors. Further work is required to evaluate the effect of deprivation.

Family and home correlates of children's physical activity in a multi-ethnic population: the cross-sectional child heart and health study in england (CHASE)

BackgroundThe influence of the family and home environment on childhood physical activity (PA) and whether this differs between ethnic groups remains uncertain. This paper investigates associations between family and home factors and childhood PA in a multi-ethnic population and explores whether associations differ between ethnic groups.MethodsCross-sectional study of 9-10 year-old schoolchildren, in which PA was objectively measured by Actigraph GT1 M accelerometers for ≤7 days to estimate average activity counts per minute (CPM). Information on 11 family and home environmental factors were collected from questionnaires. Associations between these factors and CPM were quantified using multi-level linear regression. Interactions with ethnicity were explored using likelihood ratio tests.Results2071 children (mean ± SD age: 9.95 ± 0.38 years; 47.8% male) participated, including 25% white European, 28% black African-Caribbean, 24% South Asian, and 24% other ethnic origin. Family PA support and having a pet were associated with higher average CPM (adjusted mean difference: 6 (95%CI:1,10) and 13 (95%CI:3,23), respectively) while car ownership and having internet access at home were associated with lower average CPM (adjusted mean difference: -19 (95%CI:-30,-8) and -10 (95%CI:-19,0), respectively). These associations did not differ by ethnicity. Although the number of siblings showed no overall association with PA, there was some evidence of interaction with ethnicity (p for ethnicity interaction = 0.04, 0.05 in a fully-adjusted model); a positive significant association with number of siblings was observed in white Europeans (per sibling CPM difference 10.3 (95% CI 1.7, 18.9)) and a positive non-significant association was observed in black African-Caribbeans (per sibling CPM difference: 3.5 (-4.2, 11.2)) while a negative, non-significant association was observed in South Asians (per sibling CPM difference -6.0 (-15.5, 3.4)).ConclusionsSome family and home environmental factors have modest associations with childhood PA and these are mostly similar across different ethnic groups. This suggests that targeting these factors in an intervention to promote PA would be relevant for children in different ethnic groups.

Correlates of light and moderate-to-vigorous objectively measured physical activity in four-year old children

Background Correlates of physical activity (PA) are hypothesized to be context and behaviour specific, but there is limited evidence of this in young children. The aim of the current study is to investigate associations between personal, social and environmental factors and objectively measured light and moderate-to-vigorous PA (LPA and MVPA, respectively) in four-year-old children. Methods Cross-sectional data were used from the Southampton Women’s Survey, a UK population-based longitudinal study. Four-year old children (n = 487, 47.0% male) had valid PA data assessed using accelerometry (Actiheart) and exposure data collected with a validated maternal questionnaire (including data on child personality, family demographics, maternal behaviour, rules and restrictions, and perceived local environment). Linear regression modelling was used to analyse associations with LPA and MVPA separately, interactions with sex were explored. Results LPA minutes were greater in children whose mothers reported more PA (vs. inactive: regression coefficient±standard error: 6.70±2.94 minutes), and without other children in the neighbourhood to play with (−6.33±2.44). MVPA minutes were greater in children with older siblings (vs. none: 5.81±2.80) and those whose mothers used active transport for short trips (vs. inactive: 6.24±2.95). Children accumulated more MVPA in spring (vs. winter: 9.50±4.03) and, in boys only, less MVPA with availability of other children in the neighbourhood (−3.98±1.70). Discussion Young children’s LPA and MVPA have differing associations with a number of social and environmental variables. Interventions targeting PA promotion in young children outside of formal care settings should consider including intensity specific factors.

Maternal awareness of young children’s physical activity: levels and cross-sectional correlates of overestimation

BackgroundFactors associated with parental awareness of children’s physical activity (PA) levels have not been explored in preschool-aged children. This paper investigates maternal awareness of preschool-aged children’s PA levels and determined correlates associated with maternal overestimation of PA.MethodsData from the Southampton Women’s Survey, a UK population-based study, were collected March 2006 through June 2009. Daily minutes of moderate-to-vigorous PA (MVPA) were derived using accelerometry in 478 4-year-old children. Mothers who were realistic or overestimated their child’s PA were identified. Log-binomial regression was used to analyse correlates of maternal overestimation of PA levels in children whose mothers perceived them to be active (n = 438).Results40.8% of children were classified as inactive: 89.7% of these were perceived to be active by their mothers (over-estimators). These mothers were more likely to think their child sometimes lacked skills required to be physically active (RR (95% CI) = 1.29(1.03-1.63)) and their child was more likely to attend nursery full-time (RR = 1.53(1.14-2.04)). They were less likely to have older children at home (RR = 0.71(0.56-0.90)).ConclusionsAlmost 90% of mothers of inactive preschool-aged children perceive their child to be active. Nursery-school attendance and having older siblings at home may be important to consider when designing behavioural interventions to increase PA in preschool children.