Julia McPhee

Understanding the Relationship between Activity and Neighbourhoods (URBAN) Study: research design and methodology

BackgroundBuilt environment attributes are recognized as being important contributors to physical activity (PA) engagement and body size in adults and children. However, much of the existing research in this emergent public health field is hindered by methodological limitations, including: population and site homogeneity, reliance on self-report measures, aggregated measures of PA, and inadequate statistical modeling. As an integral component of multi-country collaborative research, the Understanding the Relationship between Activity and Neighbourhoods (URBAN) Study seeks to overcome these limitations by determining the strengths of association between detailed measures of the neighborhood built environment with PA levels across multiple domains and body size measures in adults and children. This article outlines the research protocol developed for the URBAN Study.Methods and designThe URBAN Study is a multi-centered, stratified, cross-sectional research design, collecting data across four New Zealand cities. Within each city, 12 neighborhoods were identified and selected for investigation based on higher or lower walkability and Māori demographic attributes. Neighborhoods were selected to ensure equal representation of these characteristics. Within each selected neighborhood, 42 households are being randomly selected and an adult and child (where possible) recruited into the study. Data collection includes: objective and self-reported PA engagement, neighborhood perceptions, demographics, and body size measures. The study was designed to recruit approximately 2,000 adults and 250 children into the project. Other aspects of the study include photovoice, which is a qualitative assessment of built environment features associated with PA engagement, an audit of the neighborhood streetscape environment, and an individualized neighborhood walkability profile centered on each participants residential address. Multilevel modeling will be used to examine the individual-level and neighborhood-level relationships with PA engagement and body size.DiscussionThe URBAN Study is applying a novel scientifically robust research design to provide urgently needed epidemiological information regarding the associations between the built environment and health outcomes. The findings will contribute to a larger, international initiative in which similar neighborhood selection and PA measurement procedures are utilized across eight countries. Accordingly, this study directly addresses the international priority issues of increasing PA engagement and decreasing obesity levels.

Built environment and physical activity in New Zealand adolescents: a protocol for a cross-sectional study

Introduction Built-environment interventions have the potential to provide population-wide effects and the means for a sustained effect on behaviour change. Population-wide effects for adult physical activity have been shown with selected built environment attributes; however, the association between the built environment and adolescent health behaviours is less clear. This New Zealand study is part of an international project across 10 countries (International Physical Activity and the Environment Network–adolescents) that aims to characterise the links between built environment and adolescent health outcomes. Methods and analyses An observational, cross-sectional study of the associations between measures of the built environment with physical activity, sedentary behaviour, body size and social connectedness in 1600 New Zealand adolescents aged 12–18 years will be conducted in 2013–2014. Walkability and neighbourhood destination accessibility indices will be objectively measured using Geographic Information Systems (GIS). Physical activity and sedentary behaviours will be objectively measured using accelerometers over seven consecutive days. Body mass index will be calculated as weight divided by squared height. Demographics, socioeconomic status, active commuting behaviours and perceived neighbourhood walkability will be assessed using the Neighbourhood Environment Walkability Scale for Youth and psychosocial indicators. A web-based computer-assisted personal interview tool Visualisation and Evaluation of Route Itineraries, Travel Destinations, and Activity Spaces (VERITAS) and Global Positioning System (GPS) receivers will be used in a subsample of 300 participants. A qualitative research component will explore barriers and facilitators for physical activity in adolescents with respect to the built and social environment in a subsample of 80 participants. Ethics and dissemination The study received ethical approval from the Auckland University of Technology Ethics Committee (12/161). Data will be entered and stored into a secure (password protected) database. Only the named researchers will have access to the data. Data will be stored for 10 years and permanently destroyed thereafter. The results papers will be submitted for publication in peer-reviewed journals.

Neighbourhoods for Active Kids: study protocol for a cross-sectional examination of neighbourhood features and children's physical activity, active travel, independent mobility and body size.

Introduction New Zealand childrens physical activity, including independent mobility and active travel, has declined markedly over recent decades. The Neighbourhoods for Active Kids (NfAK) study examines how neighbourhood built environments are associated with the independent mobility, active travel, physical activity and neighbourhood experiences of children aged 9–12 years in primary and intermediate schools across Auckland, New Zealands largest city. Methods and analysis Child-specific indices of walkability, destination accessibility and traffic exposure will be constructed to measure the built environment in 8 neighbourhoods in Auckland. Interactive online-mapping software will be used to measure childrens independent mobility and transport mode to destinations and to derive measures of neighbourhood use and perceptions. Physical activity will be measured using 7-day accelerometry. Height, weight and waist circumference will be objectively measured. Parent telephone interviews will collect sociodemographic information and parent neighbourhood perceptions. Interviews with school representative will capture supports and barriers for healthy activity and nutrition behaviours at the school level. Multilevel modelling approaches will be used to understand how differing built environment variables are associated with activity, neighbourhood experiences and health outcomes. Discussion We anticipate that children who reside in neighbourhoods considered highly walkable will be more physically active, accumulate more independent mobility and active travel, and be more likely to have a healthy body size. This research is timely as cities throughout New Zealand develop and implement plans to improve the liveability of intensifying urban neighbourhoods. Results will be disseminated to participants, local government agencies and through conventional academic avenues.

Change of School Playground Environment on Bullying: A Randomized Controlled Trial

This randomized controlled trial investigated how introducing greater risk and challenge into the school playground influenced how children interacted with one another. OBJECTIVE: To investigate whether increasing risk and challenge in primary school playgrounds influences interactions between children. METHODS: In a 2-year cluster-randomized controlled trial, 8 control schools were asked to not change their play environment, whereas 8 intervention schools increased opportunities for risk and challenge (eg, rough-and-tumble play), reduced rules, and added loose parts (eg, tires). Children (n = 840), parents (n = 635), and teachers (n = 90) completed bullying questionnaires at baseline, 1 (postintervention), and 2 (follow-up) years. RESULTS: Intervention children reported higher odds of being happy at school (at 2 years, odds ratio [OR]: 1.64; 95% confidence interval [CI]: 1.20–2.25) and playing with more children (at 1 year, OR: 1.66; 95% CI: 1.29–2.15) than control children. Although intervention children indicated they were pushed/shoved more (OR: 1.33; 95% CI: 1.03–1.71), they were less likely to tell a teacher (OR: 0.69; 95% CI: 0.52–0.92) at 2 years. No significant group differences were observed in parents reporting whether children had “ever” been bullied at school (1 year: P = .23; 2 years: P = .07). Intervention school teachers noticed more bullying in break time at 1 year (difference in scores: 0.20; 95% CI: 0.06–0.34; P = .009), with no corresponding increase in children reporting bullying to teachers (both time points, P ≥ .26). CONCLUSIONS: Few negative outcomes were reported by children or parents, except for greater pushing/shoving in intervention schools. Whether this indicates increased resilience as indicated by lower reporting of bullying to teachers may be an unanticipated benefit.

The effect of increasing risk and challenge in the school playground on physical activity and weight in children: a cluster randomised controlled trial (PLAY)

Background:To investigate whether changing the play environment in primary schools to one that includes greater risk and challenge increases physical activity and reduces body mass index (BMI).Subjects/Methods:A 2-year cluster randomised controlled trial was undertaken in 16 New Zealand schools (years 1–8). Intervention schools (n=8) redesigned their play environments to encourage imaginative and independent free play by increasing opportunities for risk and challenge (for example, rough-and-tumble play), reducing rules and adding new playground components (for example, loose parts). Control schools (n=8) were asked to not change their play environment. A qualified playworker rated all school play environments at baseline and 1 year. Primary outcomes were moderate-to-vigorous physical activity (7-day accelerometry) and BMI z-score, collected in 840 children at baseline, 1 and 2 years. Data were analysed using generalised estimating equations.Results:Multiple changes were made to the school play environments resulting in a significant difference in overall play evaluation score between intervention and control schools of 4.50 (95% confidence interval: 1.82 to 7.18, P=0.005), which represents a substantial improvement from baseline values of 19.0 (s.d. 3.2). Overall, schools liked the intervention and reported many benefits, including increased physical activity. However, these beliefs did not translate into significant differences in objectively measured physical activity, either as counts per minute (for example, 35 (−51 to 120) during lunch break) or as minutes of moderate-to-vigorous physical activity (0.4, −1.1 to 2.0). Similarly, no significant differences were observed for BMI, BMI z-score or waist circumference at 1 or 2 years (all P>0.321).Conclusions:Altering the school play environment to one that promoted greater risk and challenge for children did not increase physical activity, nor subsequently alter body weight. Although schools embraced the concept of adding risk and challenge in the playground, our findings suggest that children may have been involved in different, rather than additional activities.

What did schools experience from participating in a randomised controlled study (PLAY) that prioritised risk and challenge in active play for children while at school

ABSTRACT ‘Risky’ play is an important component of play, which positively affects the cognitive, social and emotional development of children. However, a growing culture of ‘risk aversion’ may be limiting the degree of risk that children are allowed to encounter. We undertook qualitative interviews with eight schools to examine the acceptability of an intervention designed to increase risk and challenge in the school playground (e.g. more rough-and-tumble play and tree climbing). Schools were overwhelmingly positive about the approach and all enjoyed participating. Each school believed many benefits occurred from increasing risk and challenge within play, including better behaviour, improved cooperation between children and increases in physical activity. There were some challenges for schools, but these were generally research related, and all were viewed as acceptable. Indeed, schools found the process enlightening, and upon completion of the two-year intervention often viewed play in quite a different light.

A 12-week low-carbohydrate, high-fat diet improves metabolic health outcomes over a control diet in a randomised controlled trial with overweight defence force personnel

Overweight, obesity, and poor health is becoming a global concern for defence force personnel. Conventional nutrition guidelines are being questioned for their efficacy in achieving optimal body composition and long-term health. This study compared the effects of a 12-week low-carbohydrate, high-fat diet with a conventional, high-carbohydrate, low-fat diet on weight reduction and metabolic health outcomes in at-risk New Zealand Defence Force personnel. In this randomised controlled trial, 41 overweight personnel were assigned to intervention and control groups. Weight, waist circumference, fasting lipids, and glycaemic control were assessed at baseline and at 12 weeks. Within-group change scores were analysed using the t statistic and interpreted using a p < 0.05 level of statistical significance. Between-group mean differences and confidence intervals were analysed using effect sizes and magnitude-based inferences. Twenty-six participants completed the trial (14 intervention, 12 control). Both groups showed statistically significant weight and waist circumference reductions; the intervention group significantly reduced triglycerides and serum glucose and significantly increased high-density lipoprotein cholesterol (HDLc). Relative to control, the intervention group showed small, possibly to likely beneficial effects for weight, triglycerides, glucose, insulin, and homeostasis model assessment of insulin resistance; moderate, likely beneficial effects for HDL cholesterol, triglyceride:HDLc ratio and HbA1c; and a small, likely harmful effect for low-density lipoprotein cholesterol. This dietary approach shows promise for short-term weight loss and improved metabolic health outcomes conditions compared with mainstream recommendations. It should be offered to defence force personnel at least as a viable alternative means to manage their weight and health.

Family‐centered brief intervention for reducing obesity and cardiovascular disease risk: A randomized controlled trial

To assess the effects of a family‐centered, physical activity and nutrition “brief” intervention (time‐limited contact) on body weight and related health outcomes in primary health care patients with an elevated 5‐year cardiovascular disease (CVD) risk.

‘Real Play Families’: a New Zealand case study

ABSTRACT This case study examined the experiences of three New Zealand families selected to participate in a four-week ‘Real Play Families’ project. The overall aim of the project was to explore the issues faced when embedding traditional, unstructured, and largely unsupervised play practices in the modern family environment. The project commenced with an initial workshop day, including a two-hour information seminar for parents, real play activities for the children, and a combined debriefing session. Data from parent and child focus group interviews and social media postings were reviewed to generate a comprehensive, triangulated picture of the experiences of each family. The analysis focused on how the families derived meaning and value out of real play, drawing upon their initial perspectives, experiences, challenges, and post-project reflections. Our findings suggest that providing families with appropriate advice and social support around real play can prompt positive and rewarding outcomes for children and parents.