Claudia Strugnell

Changing from primary to secondary school highlights opportunities for school environment interventions aiming to increase physical activity and reduce sedentary behaviour: a longitudinal cohort study

BackgroundThere is little empirical evidence of the impact of transition from primary to secondary school on obesity-related risk behaviour. The purpose of this study was to examine the effect of a change of school system on physical activity (PA) and sedentary behaviour in pre-early adolescents.MethodsFifteen schools in Victoria, Australia were recruited at random from the bottom two strata of a five level socio-economic scale. In nine schools, students in year 6 primary school transitioned to a different school for year 7 secondary school, while in six schools (combined primary-secondary), students remained in the same school environment from year 6 to year 7. Time 1 (T1) measures were collected from students (N=245) in year 6 (age 11-13). Time 2 (T2) data were collected from 243 (99%) of the original student cohort when in year 7.PA and sedentary behaviour data were collected objectively (via ActiGraph accelerometer) and subjectively (via child self-report recall questionnaire). School environment data were collected via school staff survey. Change of behaviour analyses were conducted longitudinally i) for all students and ii) by change/no change of school. Mixed model regression analysis tested for behavioural interaction effects of changing/not changing school.ResultsSixty-three percent (N=152) changed schools from T1 to T2. Across all students we observed declines in average daily moderate to vigorous physical activity (MVPA) (−4 min) and light PA (−23 min), and increases in average daily sedentary behaviour (16 min), weekday leisure screen time (17 min) and weekday homework screen time (25 min), all P<0.05. Compared to students who remained in the same school environment, students who changed school reported a greater reduction in PA intensity at recess and lunch, less likelihood to cycle to/from school, greater increase in weekday (41 mins) and weekend (45 mins) leisure screen time (P<0.05) and greater encouragement to participate in sport. School staff surveys identified that sport participation encouragement was greater in primary and combined primary-secondary than secondary schools (P<0.05).ConclusionTransitioning from primary to secondary school negatively impacts on children’s PA and sedentary behaviour, and has further compounding effects on behaviour type by changing school environments.

Influence of age and gender on fat mass, fat-free mass and skeletal muscle mass among Australian adults: The Australian Diabetes, Obesity and Lifestyle study (AusDiab)

BackgroundBioelectrical impedance (BIA) represents a simple, inexpensive and non-invasive method that is often used to assess fat-mass (FM) and fat-free mass (FFM) in large population-based cohorts.ObjectiveThe aim of this study was to describe the reference ranges and examine the influence of age and gender on FM, FFM and skeletal muscle mass (SMM) as well as height-adjusted estimates of FM [fat mass index (FMI)], FFM [fat-free mass index (FFMI)] and SMM [SMM index (SMI)] in a national, population-based cohort of Australian adults.Design and ParticipantsThe analytical sample included a total of 8,582 adults aged 25–91 years of Europid origin with complete data involved in the cross-sectional 1999–2000 Australian, Diabetes, Obesity and Lifestyle (AusDiab) Study.MeasurementsBioelectrical impedance analysis was used to examine components of body composition. Demographic information was derived from a household interview.ResultsFor both genders, FFM, SMM and SMI decreased linearly from the age of 25 years, with the exception that in men SMI was not related to age and FFM peaked at age 38 years before declining thereafter. The relative loss from peak values to ≥75 years in FFM (6–8%) and SMM (11–15%) was similar between men and women. For FM and FMI, there was a curvilinear relationship with age in both genders, but peak values were detected 6–7 years later in women with a similar relative loss thereafter. For FFMI there was no change with age in men and a modest increase in women.ConclusionIn Australian adults there is heterogeneity in the age of onset, pattern and magnitude of changes in the different measures of muscle and fat mass derived from BIA, but overall the age-related losses were similar between men and women.

Reliability of the modified child and adolescent physical activity and nutrition survey, physical activity (CAPANS-PA) questionnaire among chinese-australian youth

BackgroundEvidence suggests that differences exist in physical activity (PA) participation among Culturally and Linguistically Diverse (CALD) children and adolescents. It is possible that these differences could be influenced by variations in measurement technique and instrument reliability. However, culturally sensitive instruments for examining PA behaviour among CALD populations are lacking. This study tested the reliability of the Child and Adolescent Physical Activity and Nutrition Survey (CAPANS-PA) recall questionnaire among a sample of Chinese-Australian youth.MethodsThe psychometric property of the CAPANS-PA questionnaire was examined among a sample of 77 Chinese-Australian youth (aged 11 - 14 y) who completed the questionnaire twice within 7 days. Test-retest reliability of individual items and scales within the CAPANS-PA questionnaire was determined using Kappa statistics for categorical variables and intraclass correlation coefficients (ICC) for continuous variables.ResultsThe CAPANS-PA questionnaire demonstrated acceptable test-retest reliability for frequency and duration of time spent in weekly Moderate to Vigorous Physical Activity (MVPA) (ICC ≥ 0.70) for all participants. Test-retest reliability for time spent in weekly sedentary activities was acceptable for females (ICC = 0.82) and males (ICC = 0.72).ConclusionsThe results suggest the CAPANS-PA questionnaire provides reliable estimates for type, frequency and duration of MVPA participation among Chinese-Australian youth. Further investigation into the reliability of the sedentary items within the CAPANS-PA is required before these items can be used with confidence. This study is novel in that the reliability of instruments among CALD groups nationally and internationally remains sparse and this study contributes to the wider body of available psychometrically tested instruments. In addition, this study is the first to our knowledge to successfully engage and investigate the basic health enhancing behaviours of Chinese-Australian adolescents.

Whole of Systems Trial of Prevention Strategies for Childhood Obesity: WHO STOPS Childhood Obesity

Background: Community-based initiatives show promise for preventing childhood obesity. They are characterized by community leaders and members working together to address complex local drivers of energy balance. Objectives: To present a protocol for a stepped wedge cluster randomized trial in ten communities in the Great South Coast Region of Victoria, Australia to test whether it is possible to: (1) strengthen community action for childhood obesity prevention, and (2) measure the impact of increased action on risk factors for childhood obesity. Methods: The WHO STOPS intervention involves a facilitated community engagement process that: creates an agreed systems map of childhood obesity causes for a community; identifies intervention opportunities through leveraging the dynamic aspects of the system; and, converts these understandings into community-built, systems-oriented action plans. Ten communities will be randomized (1:1) to intervention or control in year one and all communities will be included by year three. The primary outcome is childhood obesity prevalence among grade two (ages 7–8 y), grade four (9–10 y) and grade six (11–12 y) students measured using our established community-led monitoring system (69% school and 93% student participation rate in government and independent schools). An additional group of 13 external communities from other regions of Victoria with no specific interventions will provide an external comparison. These communities will also allow us to assess diffusion of the intervention to control communities during the first three years of the trial. Conclusion: This trial will test effectiveness, over a five-year period, of community-owned, -supported and -led strategies designed to address complex and dynamic causes of childhood obesity.

Healthy together Victoria and childhood obesity—a methodology for measuring changes in childhood obesity in response to a community-based, whole of system cluster randomized control trial

BackgroundHealthy Together Victoria (HTV) - a complex ‘whole of system’ intervention, including an embedded cluster randomized control trial, to reduce chronic disease by addressing risk factors (physical inactivity, poor diet quality, smoking and harmful alcohol use) among children and adults in selected communities in Victoria, Australia (Healthy Together Communities).ObjectivesTo describe the methodology for: 1) assessing changes in the prevalence of measured childhood obesity and associated risks between primary and secondary school students in HTV communities, compared with comparison communities; and 2) assessing community-level system changes that influence childhood obesity in HTC and comparison communities.MethodsTwenty-four geographically bounded areas were randomized to either prevention or comparison (2012). A repeat cross-sectional study utilising opt-out consent will collect objectively measured height, weight, waist and self-reported behavioral data among primary [Grade 4 (aged 9-10y) and Grade 6 (aged 11-12y)] and secondary [Grade 8 (aged 13-14y) and Grade 10 (aged 15-16y)] school students (2014 to 2018). Relationships between measured childhood obesity and system causes, as defined in the Foresight obesity systems map, will be assessed using a range of routine and customised data.ConclusionThis research methodology describes the beginnings of a state-wide childhood obesity monitoring system that can evolve to regularly inform progress on reducing obesity, and situate these changes in the context of broader community-level system change.

Lifestyle factors and adolescent depressive symptomatology: Associations and effect sizes of diet, physical activity and sedentary behaviour

Objective: Depression affects many Australian adolescents. Research points to the potential of lifestyle improvement for the population-level prevention of mental disorders. However, most studies examine single relationships without considering the combined contribution of lifestyle factors to variance in depression. This study examined associations between adolescent diet, physical activity and screen time behaviours and depressive symptomatology. Methods: A cross-sectional sample of year 8 and 10 students was recruited from 23 participating schools in 18 Victorian communities. Students were recruited using opt-out consent, resulting in 3295 participants from 4680 registered school enrolments (Participation Rate: 70.4%). Participants completed a supervised self-report questionnaire comprising Moods and Feelings Questionnaire–Short Form, an assessment of physical activity and sedentary behaviours during and outside school, and weekly food intake. Surveyed covariates included hours of sleep per night, age, socio-economic status and measured anthropometry. A hierarchical regression stratified by gender was conducted, with dichotomised Moods and Feelings Questionnaire–Short Form score as the outcome, and screen time, physical activity and dietary patterns as predictors. Nested regression analyses were then conducted to ascertain the variance in Moods and Feelings Questionnaire–Short Form score attributable to each significant predictor from the initial regression. Results: Increased scores on an unhealthy dietary pattern (odds ratio = 1.18; 95% confidence interval = [1.07, 1.32]) and physical activity guideline attainment (0.91; [0.85, 0.97]) were associated with depressive symptomatology in males, while screen time guideline attainment (0.95; [0.91, 0.98]) was associated with depression in females. No association was observed between healthy diet pattern and Moods and Feelings Questionnaire–Short Form. Overall, effect sizes were generally small, and the regression model accounted for 5.22% of Moods and Feelings Questionnaire–Short Form variance. Conclusion: Gender-specific associations were observed between physical activity and both sedentary and dietary behaviours and depressive symptomatology among adolescents, although reverse causality cannot be refuted at this stage. Lifestyle behaviours may represent a modifiable target for the prevention of depressive symptomatology in adolescents.

Establishing a sustainable childhood obesity monitoring system in regional Victoria

Issue addressed Childhood obesity poses a significant immediate and long-term burden to individuals, societies and health systems. Infrequent and inadequate monitoring has led to uncertainty about trends in childhood obesity prevalence in many countries. High-quality data, collected at regular intervals, over extended timeframes, with high response rates and timely feedback are essential to support prevention efforts. Our aim was to establish a sustainable childhood obesity monitoring system in regional Australia to collect accurate anthropometric and behavioural data, provide timely feedback to communities and build community engagement and capacity. Methods All schools from six government regions of South-West Victoria were invited to participate. Passive (opt-out) consent was used to collect measured anthropometric and self-reported behavioural data from children in years 2, 4, and 6, aged 7-12 years. Results We achieved a 70% school participation rate (n=46) and a 93% student response rate (n=2198) among government and independent schools. Results were reported within 10 weeks post data collection. Harnessing high levels of community engagement throughout the planning, data collection and reporting phases increased community capacity and data utility. Conclusions The monitoring system achieved high response rates, community engagement and community capacity building, and delivered results back to the community in a timely manner. So what? This system has the potential to provide sustainable monitoring of childhood obesity that is not dependent on external funding. The results of this monitoring will likely inform health promotion efforts in communities across the region.

Composition of objectively measured physical activity and sedentary behaviour participation across the school-day, influence of gender and weight status: cross-sectional analyses among disadvantaged Victorian school children

Background The after-school period has been described as the ‘critical window’ for physical activity (PA) participation. However, little is known about the importance of this window compared with the before and during-school period among socioeconomically disadvantaged children, and influence of gender and weight status. Methods 39 out of 156 (RR=25%) invited primary schools across 26 local government areas in Victoria, Australia, consented to participate with 856 children (RR=36%) participating in the wider study. The analysis sample included 298 Grade 4 and Grade 6 children (mean age: 11.2±1.1; 44% male) whom met minimum accelerometry wear-time criteria and had complete height, weight and health-behaviours questionnaire data. Accelerometry measured duration in daily light-intensity PA (LPA), moderate-to-vigorous PA (MVPA) and sedentary time (ST) was calculated for before-school=8–8:59, during-school=9:00–15:29 and after-school=15:30–18:00. Bivariate and multivariable linear regression analyses were conducted. Results During-school represented the greatest accumulation of LPA and MVPA compared with the before and after-school periods. Boys engaged in 102 min/day of LPA (95% CI 98.5 to 104.9) and 62 min/day of MVPA (95% CI 58.9 to 64.7) during-school; girls engaged in 103 min/day of LPA (95% CI 99.7 to 106.5) and 45 min/day of MVPA (95% CI 42.9 to 47.4). Linear regression models indicated that girls with overweight or obesity engaged in significantly less LPA, MVPA and more time in ST during-school. Conclusions This study highlights the importance of in-school PA compared with after-school PA among socioeconomically disadvantage children whom may have fewer resources to participate in after-school PA.

Networks for prevention in 19 communities at the start of a large-scale community-based obesity prevention initiative

Community-based obesity prevention efforts are dependent on the strength and function of collaborative networks across multiple community members and organizations. There is little empirical work on understanding how community network structure influences obesity prevention capacity. We describe network structures within 19 local government communities prior to a large-scale community-based obesity prevention intervention, Healthy Together Victoria, Australia (2012-2015). Participants were from a large, multi-site, cluster randomized trial (cRCT) of a whole-of-systems chronic disease prevention initiative. Community leaders from 12 intervention and seven comparison (non-intervention) regions identified and described their professional networks in relation to dietary, physical activity, and weight status among young children (<5 years of age). Social network measures of density, modularity, clustering, and centrality were calculated for each community. Comparison of means and tests of association were conducted for each network relationship. One-hundred and seven respondents (78 intervention; 29 comparison) reported on 996 professional network relationships (respondent average per region: 10 intervention; 8 comparison). Networks were typically sparse and highly modular. Networks were heterogeneous in size and relationship composition. Frequency of interaction, close and influential relationships were inversely associated with network density. At baseline in this cRCT there were no significant differences between community network structures of key actors with influence over environments affecting childrens diet and physical activity. Tracking heterogeneity in both networks and measured outcomes over time may help explain the interaction between professional networks and intervention effectiveness of community-based obesity prevention.

Impact of cultural background on fundamental movement skill and its correlates

ABSTRACT Children’s fundamental movement skill levels (FMS) predict moderate-to-vigorous physical activity (MVPA). Asian children have been reported as less active than English-Europeans, possibly due to poorer skills. This study compared the FMS of children from Culturally and Linguistically Diverse (CALD) backgrounds and examined FMS correlates. A total of 261 children (122 males) aged 9-to-11 years were divided based on language spoken at home: English-European (n = 105) and Asian (n = 156). Height, mass, FMS (Test of Gross Motor Development-2), MVPA (accelerometer) and cardio-respiratory fitness (20m multistage shuttle run) were directly measured. Sex, age, language and perceived sport competence (CY-PSPP) were self-reported. Independent sample t-tests assessed age, BMI, FMS and perception by CALD group. Linear mixed models examined FMS correlates. Asian-speaking children had lower object control skill (35.5 v 37.2; CI [0.17, 3.18]; p < 0.03) compared to English-European- children, but no between-group differences in locomotor skills were observed. Fitness, physical activity and sport competence perception were positively associated with object control, yet adjusting for these variables (and age and BMI) did not remove the CALD effect (B = −2.02, SE = 0.69, p = 0.004). Cultural factors may affect object control competence in Asian-Australian children.