Huilan Xu

Sustainability of Effects of an Early Childhood Obesity Prevention Trial Over Time: A Further 3-Year Follow-up of the Healthy Beginnings Trial

IMPORTANCE Little evidence exists on whether effects of an early obesity intervention are sustainable. OBJECTIVE To assess the sustainability of effects of a home-based early intervention on childrens body mass index (BMI) and BMI z score at 3 years after intervention. DESIGN, SETTING, AND PARTICIPANTS A longitudinal follow-up study of the randomized clinical Healthy Beginnings Trial was conducted with 465 participating mothers consenting to be followed up at 3 years after intervention until their children were age 5 years. This study was conducted in socially and economically disadvantaged areas of Sydney, Australia, from March 2011 to June 2014. INTERVENTIONS No further intervention was carried out in this Healthy Beginnings Trial phase 2 follow-up study. The original intervention in phase 1 comprised 8 home visits from community nurses delivering a staged home-based intervention, with one visit in the antenatal period and 7 visits at 1, 3, 5, 9, 12, 18, and 24 months after birth. MAIN OUTCOMES AND MEASURES Primary outcomes were childrens BMI and BMI z score. Secondary outcomes included dietary behaviors, quality of life, physical activity, and TV viewing time of children and their mothers. RESULTS In total, 369 mothers and their children completed the follow-up study, a phase 2 completion rate of 79.4% (80.9% for the intervention group and 77.7% for the control group). The differences between the intervention and control groups at age 2 years in childrens BMI and BMI z score disappeared over time. At age 2 years, the difference (intervention minus control) in BMI (calculated as weight in kilograms divided by height in meters squared) was -0.41 (95% CI, -0.71 to -0.10; P = .009), but by age 5 years it was 0.03 (95% CI, -0.30 to 0.37). No effects of the early intervention on dietary behaviors, quality of life, physical activity, and TV viewing time were detected at age 5 years. CONCLUSIONS AND RELEVANCE The significant effect of this early life home-visiting intervention on child BMI and BMI z score at age 2 years was not sustained at age 5 years without further intervention. Obesity prevention programs need to be continued or maintained during the early childhood years.

The Relationships Between Active Transport to Work or School and Cardiovascular Health or Body Weight A Systematic Review

To systematically examine the relationships between active transport to work or school and cardiovascular health, body weight, or other health outcomes, a systematic review of the literature was conducted in September 2012 using 3 electronic databases. A total of 3887 articles were screened, 30 full text articles were retrieved, and 19 articles were identified. Two reviewers independently assessed the quality of each article. The review found that active transport to work or school was significantly associated with improved cardiovascular health and lower body weight. However, the strength of the evidence varied from weak (mental health and cancer), moderate (body weight), to strong (cardiovascular health). The evidence was limited by lack of comparability of study outcomes, weak study designs, small sample sizes, and lack of experimental studies. Further research is needed to examine the effect of active transport on health using stronger research designs, including randomized controlled trials or longitudinal studies.

Measuring workplace travel behaviour: validity and reliability of survey questions.

Background. The purpose of this study was to assess the (previously untested) reliability and validity of survey questions commonly used to assess travel mode and travel time. Methods. Sixty-five respondents from a staff survey of travel behaviour conducted in a south-western Sydney hospital agreed to complete a travel diary for a week, wear an accelerometer over the same period, and twice complete an online travel survey an average of 21 days apart. The agreement in travel modes between the self-reported online survey and travel diary was examined with the kappa statistic. Spearmans correlation coefficient was used to examine agreement of travel time from home to workplace measured between the self-reported online survey and four-day travel diary. Moderate-to-vigorous physical activity (MVPA) time of active and nonactive travellers was compared by t-test. Results. There was substantial agreement between travel modes (K = 0.62, P < 0.0001) and a moderate correlation for travel time (ρ = 0.75, P < 0.0001) reported in the travel diary and online survey. There was a high level of agreement for travel mode (K = 0.82, P < 0.0001) and travel time (ρ = 0.83, P < 0.0001) between the two travel surveys. Accelerometer data indicated that for active travellers, 16% of the journey-to-work time is MVPA, compared with 6% for car drivers. Active travellers were significantly more active across the whole workday. Conclusions. The survey question “How did you travel to work this week? If you used more than one transport mode specify the one you used for the longest (distance) portion of your journey” is reliable over 21 days and agrees well with a travel diary.

Correlates of body mass index and overweight and obesity of children aged 2 years: Findings from the healthy beginnings trial

We sought to determine early life factors that predict body mass index (BMI) and overweight/obesity of children aged 2 years.

Developing a hospital travel plan: Process and baseline findings from a western Sydney hospital

OBJECTIVE To describe the development of a hospital travel plan and report baseline findings. METHODS The development of a travel plan involved an assessment of organisational barriers and enablers to travel planning, auditing of the transport to and physical environment of the hospital, a staff survey, analysis of distances staff travel to work and interviews with hospital managers. RESULTS There were no significant organisational impediments to, and consistent managerial support for a travel plan. The staff survey response rate was similar to response rates in workplace surveys delivered mostly online via all staff emails (n = 804, 25%). The majority (83%) of respondents drove to work on most days during the week of the survey, and the majority of drivers (58%) said they were not trying to reduce their car use and not thinking of doing so. Half (47%) of all hospital staff (n = 3222) lived within 10 km and 25% lived within 5 km. People living 5-10 km from the hospital were more likely to be active travellers than were those living less than 5 km from the hospital (AOR 2.7, 95% (CI): 1.6-4.5), as were male than female staff (AOR 1.7, 95% CI: 1.1-2.9). CONCLUSIONS The process and baseline findings described in this paper are a useful reference for Australian hospitals developing travel plans.

Parenting style and dietary behaviour of young children. Findings from the Healthy Beginnings Trial.

Parenting style may have a role in the development of young childrens dietary behaviour, and a better understanding of parenting style may lead to better-targeted childhood obesity prevention interventions. This study aimed to investigate the association of parental self-efficacy, parenting style and dietary behaviour of young children. A cross-sectional study with 242 first-time mothers and their children was conducted using the data from the Healthy Beginnings Trial undertaken in one of the most socially and economically disadvantaged areas of south-western Sydney, in 2007-2010. Parental self-efficacy, parenting style (warmth and hostility) and childrens dietary behaviours (consumption of vegetables, fruit, soft-drink and snacks) were assessed by face-to-face interviews with participating mothers in the control group when their children were 2 years old. Logistic regression analysis was conducted to examine the association between parenting style and the childs dietary behaviour. Mothers with higher levels of global parental self-efficacy and self-efficacy for an infant were more likely to report their children had 2 serves of vegetables per day, with odds ratio (OR) 2.40 (95%CI 1.35-4.27, P=0.003) and OR 1.88 (95%CI 1.06-3.36, P=0.03), respectively. A higher level of global parental self-efficacy or self-efficacy for an infant was significantly associated with having 2 serves of fruit per day with adjusted odds ratio (AOR) 2.46 (95%CI 1.35-4.48, P=0.003) and AOR 1.85 (95%CI 1.00-3.41, P=0.048), respectively, after adjusting for annual household income. Mothers with a higher level of parental warmth were more likely to report their children had 2 serves of vegetable per day with OR 1.85 (95%CI 1.06-3.25, P=0.03). Parental self-efficacy and parenting style were associated, cross-sectionally, with important childrens dietary behaviours. Interventions which target parental self-efficacy and parenting style may improve eating habits of young children, and contribute to childhood obesity prevention.

Associations of maternal influences with outdoor play and screen time of two-year-olds: Findings from the Healthy Beginnings Trial

This study aims to investigate if maternal influences are associated with childrens outdoor playtime and screen time at the age of 2 years.

Associations of outdoor play and screen time with nocturnal sleep duration and pattern among young children

Sleep duration and pattern have important implications for childrens health. This study aims to investigate nocturnal sleep duration, sleep pattern and their relationships with outdoor play and screen time among children aged 2 to five years.

Formative research to promote the Get Healthy Information and Coaching Service (GHS) in the Australian-Chinese community

The free, telephone-based Get Healthy Information and Coaching Service (GHS) has made sustained improvements in healthy behaviours and weight change in the Australian population, but there is poor uptake of the GHS by culturally and linguistically diverse communities. This formative research study explored the Australian-Chinese communitys awareness, perceptions and experiences of the GHS and their knowledge and cultural beliefs about healthy lifestyles. Conducted in Sydney, Australia, the research included 16 Chinese community-stakeholder interviews, a cross-sectional survey of 253 Chinese community members; and a review of Chinese participant GHS data. The study revealed poor uptake (<1%) and awareness (16%) of the GHS, but good intent (86%) to use it. The need for culturally appropriate and relevant information on healthy eating and physical activity was identified. Employment of a bilingual, bicultural coach, redesign and translation of written resources and targeted promotion in partnership with community organisations were recommended.

Mothers’ Perceived Neighbourhood Environment and Outdoor Play of 2- to 3.5-Year-Old Children: Findings from the Healthy Beginnings Trial

Background: This study aims to investigate whether mothers’ perceived neighbourhood environment is associated with outdoor playtime of 2- to 3.5-year-old children. Methods: Cross-sectional analyses were conducted using data from the Healthy Beginnings Trial (HBT). Data on children’s outdoor playtime and mothers’ perceived neighbourhood environment were collected through face-to-face interviews with mothers when their children were 2 and 3.5 years old. Walk score was obtained from a publicly available website and population density data were obtained from Australian Census data. Multiple logistic regression models were built to investigate these associations. Results: A total of 497 and 415 mother-child dyads were retained at 2 years and 3.5 years. After adjusting for intervention group allocation and other confounding factors, at 2 years, mothers’ perceptions that ‘the neighbourhood is a good place to bring up children’, ‘it is safe to play outside during the day’, and ‘there are good parks or playgrounds in neighbourhood’ were positively associated with children’s outdoor playtime. At 3.5 years, living in a free-standing house was associated with more children’s outdoor playtime. Conclusions: Children may benefit from living in a neighbourhood that supports active lifestyle. Improving social and physical environments in neighbourhoods could be an important strategy for improving young children’s physical activity.