Emma Solomon-Moore

Associations between participation in organised physical activity in the school or community outside school hours, and neighbourhood play with child physical activity and sedentary time: a cross-sectional analysis of primary school-aged children from the UK

Objectives To assess the extent to which participation in organised physical activity in the school or community outside school hours and neighbourhood play was associated with children’s physical activity and sedentary time. Design Cross-sectional study. Setting Children were recruited from 47 state-funded primary schools in South West England. Participants 1223 children aged 8–9 years old. Outcome measures Accelerometer-assessed moderate-to-vigorous-intensity physical activity (MVPA) and sedentary time. Methods Children wore an accelerometer, and the mean minutes of MVPA and sedentary time per day were derived. Children reported their attendance at organised physical activity in the school or community outside school hours and neighbourhood play using a piloted questionnaire. Cross-sectional linear and logistic regression were used to examine if attendance frequency at each setting (and all settings combined) was associated with MVPA and sedentary time. Multiple imputation methods were used to account for missing data and increase sample size. Results Children who attended clubs at school 3–4 days per week obtained an average of 7.58 (95% CI 2.7 to 12.4) more minutes of MVPA per day than children who never attended. Participation in the three other non-school-based activities was similarly associated with MVPA. Evidence for associations with sedentary time was generally weaker. Associations were similar in girls and boys. When the four different contexts were combined, each additional one to two activities participated in per week increased participants’ odds (OR: 1.18, 95% CI 1.12 to 1.25) of meeting the government recommendations for 60 min of MVPA per day. Conclusion Participating in organised physical activity at school and in the community is associated with greater physical activity and reduced sedentary time among both boys and girls. All four types of activity contribute to overall physical activity, which provides parents with a range of settings in which to help their child be active.

Are parents’ motivations to exercise and intention to engage in regular family-based activity associated with both adult and child physical activity?

Background/aim To examine the associations between parents’ motivation to exercise and intention to engage in family-based activity with their own and their child’s physical activity. Methods Cross-sectional data from 1067 parent–child pairs (76.1% mother–child); children were aged 5–6 years. Parents reported their exercise motivation (ie, intrinsic motivation, identified regulation, introjected regulation, external regulation and amotivation) as described in self-determination theory and their intention to engage in family-based activity. Parents’ and children’s mean minutes of moderate-to-vigorous-intensity physical activity (MVPA) and mean counts per minute were derived from ActiGraph accelerometers worn for 3 to 5 days (including a mixture of weekdays and weekend days). Multivariable linear regression models, adjusted for parent sex, number of children, indices of multiple deprivation and clustering of children in schools were used to examine associations (total of 24 associations tested). Results In fully adjusted models, each unit increase in identified regulation was associated with a 6.08 (95% CI 3.27 to 8.89, p<0.001) min-per-day increase in parents’ MVPA. Parents’ external regulation was associated with children performing 2.93 (95% CI −5.83 to −0.03, p=0.05) fewer minutes of MVPA per day and a 29.3 (95% CI −53.8 to −4.7, p=0.02) accelerometer count-per-minute reduction. There was no evidence of association for the other 21 associations tested. Conclusions Future family-based physical activity interventions may benefit from helping parents identify personal value in exercise while avoiding the use of external control or coercion to motivate behaviour.

Managing the screen-viewing behaviours of children aged 5–6 years: a qualitative analysis of parental strategies

Objectives The present study used qualitative methods to: (1) examine the strategies that were used by parents of children aged 5–6 years to manage screen viewing; (2) identify key factors that affect the implementation of the strategies and (3) develop suggestions for future intervention content. Design Telephone interviews were conducted with parents of children aged 5–6 years participating in a larger study. Interviews were transcribed verbatim and analysed using an inductive and deductive content analysis. Coding and theme generation was iterative and refined throughout. Setting Parents were recruited through 57 primary schools located in the greater Bristol area (UK). Participants 53 parents of children aged 5–6 years. Results Parents reported that for many children, screen viewing was a highly desirable behaviour that was difficult to manage, and that parents used the provision of screen viewing as a tool for reward and/or punishment. Parents managed screen viewing by setting limits in relation to daily events such as meals, before and after school, and bedtime. Screen-viewing rules were often altered depending on parental preferences and tasks. Inconsistent messaging within and between parents represented a source of conflict at times. Potential strategies to facilitate reducing screen viewing were identified, including setting screen-viewing limits in relation to specific events, collaborative rule setting, monitoring that involves mothers, fathers and the child, developing a family-specific set of alternative activities to screen viewing and developing a childs ability to self-monitor their own screen viewing. Conclusions Managing screen viewing is a challenge for many parents and can often cause tension in the home. The data presented in this paper provide key suggestions of new approaches that could be incorporated into behaviour change programmes to reduce child screen viewing.

How parents perceive screen viewing in their 5–6 year old child within the context of their own screen viewing time: a mixed-methods study

BackgroundFew studies have examined parental perceptions of their child’s screen-viewing (SV) within the context of parental SV time. This study qualitatively examined parents’ perceptions of their 5–6-year-old child’s SV within the context of their own quantitatively measured SV.MethodsA mixed-methods design employed semi-structured telephone interviews, demographic and SV questionnaires, objectively-measured physical activity and sedentary time. Deductive content analysis was used to explore parents’ perceptions of, and concerns about, their child’s SV, and management of their child’s SV. Comparisons were made between parent-child dyads reporting low (<2-h per day) versus high SV time.ResultsFifty-three parents were interviewed (94.3% mothers), with 52 interviews analysed. Fifteen parent-child dyads (28.8%) exceeded the 2-h SV threshold on both weekdays and weekend days; 5 parent-child dyads (9.6%) did not exceed this threshold. The remaining 32 dyads reported a combination of parent or child exceeding/not exceeding the SV threshold on either weekdays or weekend days. Three main themes distinguished the 15 parent-child dyads exceeding the SV threshold from the 5 dyads that did not: 1) parents’ personal SV-related views and behaviours; 2) the family SV environment; and 3) setting SV rules and limits. Parents in the dyads not exceeding the SV threshold prioritized and engaged with their children in non-SV behaviours for relaxation, set limits around their own and their child’s SV-related behaviours, and described an environment supportive of physical activity. Parents in the dyads exceeding the SV threshold were more likely to prioritise SV as a shared family activity, and described a less structured SV environment with minimal rule setting, influenced their child’s need for relaxation time.ConclusionsThe majority of parents in this study who exceeded the SV threshold expressed minimal concern and a relaxed approach to managing SV for themselves and their child(ren), suggesting a need to raise awareness amongst these parents about the time they spend engaging in SV. Parents may understand their SV-related parenting practices more clearly if they are encouraged to examine their own SV behaviours. Designing interventions aimed to create environments that are less supportive of SV, with more structured approaches to SV parenting strategies are warranted.

Examining the challenges posed to parents by the contemporary screen environments of children: a qualitative investigation

BackgroundThe ubiquity of technology in modern society has led to the American Academy of Pediatrics adapting their screen-viewing (SV) recommendations for children. The revised guidelines encourage families to identify an appropriate balance between SV and other activities. The aims of this study were to explore parents’ views of their child’s SV time and how important it is for families to achieve a ‘digital balance’.MethodsSemi-structured telephone interviews were conducted with 51 parents of 8–9-year-old children, between July and October 2016. Inductive and deductive content analyses were used to explore parents’ perceptions of their child’s level of SV (low, medium, high), how parents feel about child SV, and the importance placed on achieving a digital balance. Parent report of child SV behaviours on weekdays and weekend days were assessed via questionnaire.ResultsInterview data revealed that because SV is considered the ‘norm’, parents struggle to limit it, partly because they want their children to be equipped for the modern technological world. While most parents believe SV to have negative effects on children, parents also report advantages to SV. Many parents feel that not all SV is equal, with tablets considered worse than television because of the isolated nature of activities, and educational SV considered more beneficial than non-educational SV. Most parents feel it is important for their family to achieve a digital balance, primarily to spend more quality family time together. Large variation was observed in parents’ descriptions of child SV time on weekdays and weekend days.ConclusionsParents recognise the importance of digital balance but want their children to fit into the ever-advancing digital world. Parents do not treat all SV equally. Watching television and engaging in educational SV may be encouraged, while ‘playing’ on tablets is discouraged. These findings highlight the challenge faced by researchers and policy makers to help families achieve a digital balance, and strategies are needed to support parents to plan child SV time.

The roles of mothers and fathers in supporting child physical activity:: a cross-sectional mixed-methods study

Objectives Examine the extent that parent gender is associated with supporting children’s physical activity. Design Cross-sectional mixed-methods study. Setting 47 primary schools located in Bristol (UK). Participants 944 children aged 8–9 years and one of their parents provided quantitative data; 51 parents (20 fathers) were interviewed. Methods Children wore an accelerometer, and mean minutes of moderate-to-vigorous physical activity (MVPA) per day, counts per minute (CPM) and achievement of national MVPA guidelines were derived. Parents reported who leads in supporting child activity during the week and weekend. Linear and logistic regression examined the association between gender of parent who supports child activity and child physical activity. For the semistructured telephone interviews, inductive and deductive content analyses were used to explore the role of gender in how parents support child activity. Results Parents appeared to have a stronger role in supporting boys to be more active, than girls, and the strongest associations were when they reported that both parents had equal roles in supporting their child. For example, compared with the reference of female/mother support, equal contribution from both parents during the week was associated with boys doing 5.9 (95% CI 1.2 to 10.6) more minutes of MVPA per day and more CPM when both parents support on weekday and weekends (55.1 (14.3 to 95.9) and 52.8 (1.8 to 103.7), respectively). Associations in girls were weaker and sometimes in the opposite direction, but there was no strong statistical evidence for gender interactions. Themes emerged from the qualitative data, specifically; parents proactively supporting physical activity equally, mothers supporting during the week, families getting together at weekends, families doing activities separately due to preferences and parents using activities to bond one-to-one with children. Conclusions Mothers primarily support child activity during the week. Children, possibly more so boys, are more active if both parents share the supporting role.

A longitudinal study of the associations of children's body mass index and physical activity with blood pressure

Childhood blood pressure is a marker of cardiovascular disease risk in later life. We examined how body mass index (BMI) and physical activity, and changes in these, are associated with blood pressure in primary school-aged children. Data are from 1223 children aged 9 years (Year 4) in Bristol, UK, 685 of whom had been assessed at 6 years (Year 1). Child height and weight were measured, and children wore accelerometers for five days, from which average counts per minute, and moderate-to-vigorous-intensity physical activity and sedentary minutes per day were derived. At age 9 years, blood pressure was measured. Multiple imputation of missing data and adjusted linear regression models were used to examine associations. Child BMI at 9 years was cross-sectionally associated with higher systolic (SBP) and diastolic (DBP) blood pressure (mean difference [95% CI]: 1.10 [0.34, 1.87] mmHg and 0.86 [0.13, 1.60] mmHg, respectively, per SD of BMI). Prospective associations of BMI at age 6 with blood pressure at age 9 were consistent with these cross-sectional associations. However, change in BMI between 6 and 9 years was not strongly associated with subsequent SBP or DBP (0.68 [-0.61, 1.98] mmHg and 1.23 [-0.09, 2.54] mmHg, respectively). There was little evidence that physical activity or sedentary time were associated with blood pressure in either cross-sectional or prospective analyses. Greater childhood BMI is associated with higher blood pressure, and this association persists over several years. Prevention of excessive bodyweight from early childhood may be important in stemming the development of cardiovascular risk.

Managing the screen-viewing behaviours of 5-6 year old children: a qualitative analysis of parental strategies

Objectives The present study used qualitative methods to: (1) examine the strategies that were used by parents of children aged 5–6 years to manage screen viewing; (2) identify key factors that affect the implementation of the strategies and (3) develop suggestions for future intervention content. Design Telephone interviews were conducted with parents of children aged 5–6 years participating in a larger study. Interviews were transcribed verbatim and analysed using an inductive and deductive content analysis. Coding and theme generation was iterative and refined throughout. Setting Parents were recruited through 57 primary schools located in the greater Bristol area (UK). Participants 53 parents of children aged 5–6 years. Results Parents reported that for many children, screen viewing was a highly desirable behaviour that was difficult to manage, and that parents used the provision of screen viewing as a tool for reward and/or punishment. Parents managed screen viewing by setting limits in relation to daily events such as meals, before and after school, and bedtime. Screen-viewing rules were often altered depending on parental preferences and tasks. Inconsistent messaging within and between parents represented a source of conflict at times. Potential strategies to facilitate reducing screen viewing were identified, including setting screen-viewing limits in relation to specific events, collaborative rule setting, monitoring that involves mothers, fathers and the child, developing a family-specific set of alternative activities to screen viewing and developing a childs ability to self-monitor their own screen viewing. Conclusions Managing screen viewing is a challenge for many parents and can often cause tension in the home. The data presented in this paper provide key suggestions of new approaches that could be incorporated into behaviour change programmes to reduce child screen viewing.

Child- and Parent-Related Correlates of Total and Prolonged Sedentary Time in 5- to 6-Year-Old Children

The primary aim was to examine child- and parent-related correlates of accelerometer-assessed overall total and prolonged (i.e., accumulated in bouts of ≥10 consecutive minutes) sedentary time (SED) in 5- to 6-year-old children. Second, child- and parent-related correlates of total and prolonged SED during weekend days and the after school period were examined, as associations with parent-related correlates may be stronger during these periods. SED and moderate-to-vigorous-intensity physical activity (MVPA) were assessed by ActiGraph accelerometers in children (n = 836) and one of their parents/carers. Parents completed a questionnaire examining potential parent-related correlates. Multilevel models examined associations between potential correlates and children’s total and prolonged SED. Children’s MVPA was the only correlate that was consistently negatively associated with both total and prolonged SED across the different time periods (overall, after school, and weekend days). Higher total SED in parents was associated with higher overall total SED and weekend total SED in children. Higher body mass index z-scores of children were associated with lower overall total and prolonged SED. Girls had lower prolonged SED after school than boys. Older children had lower total SED during the weekend. In conclusion, few potential correlates were associated with young children’s total or prolonged SED and most associations differed by time period.

Implementation Fidelity of a Voluntary Sector-Led Diabetes Education Programme.

Purpose The quality of voluntary sector-led community health programmes is an important concern for service users, providers and commissioners. Research on the fidelity of programme implementation offers a basis for assessing and further enhancing practice. The purpose of this paper is to report on the fidelity assessment of Living Well Taking Control (LWTC) – a voluntary sector-led, community-based education programme in England focussing on the prevention and management of type 2 diabetes. Design/methodology/approach This fidelity of implementation (FoI) study was conducted with the Devon-based LWTC programme. A fidelity checklist was developed to analyse audio records of group-based lifestyle education sessions – implementation was rated in terms of adherence to protocol and competence in delivery; the influence of wider contextual factors was also assessed. Kappa statistics (κ) were used to test for inter-rater agreement. Course satisfaction data were used as a supplementary indicator of facilitator competence. Findings Analysis of 28 sessions, from five diabetes prevention and two diabetes management groups (total participants, n=49), yielded an overall implementation fidelity score of 77.3 per cent for adherence (moderate inter-rater agreement, κ=0.60) and 95.1 per cent for competence (good inter-rater agreement, κ=0.71). The diabetes prevention groups consistently achieved higher adherence scores than the diabetes management groups. Facilitator competence was supported by high participant satisfaction ratings. Originality/value An appropriate level of implementation fidelity was delivered for the LWTC group-based education programme, which provides some confidence that outcomes from the programme reflected intervention effectiveness. This study demonstrates the viability of assessing the FoI in a voluntary sector-led public health initiative and the potential of this method for assuring quality and informing service development.