Kate Storey

Diet quality, nutrition and physical activity among adolescents: the Web-SPAN (Web-Survey of Physical Activity and Nutrition) project.

OBJECTIVE To assess the overall diet quality of a sample of adolescents living in Alberta, Canada, and evaluate whether diet quality, nutrient intakes, meal behaviours (i.e. meal skipping and consuming meals away from home) and physical activity are related. DESIGN A cross-sectional study design. Students completed the self-administered Web-Survey of Physical Activity and Nutrition (Web-SPAN). Students were classified as having poor, average or superior diet quality based on Canadas Food Guide to Healthy Eating (CFGHE). SETTING One hundred and thirty-six schools (37 %) within forty-four public and private school boards (75 %) in Alberta, Canada. SUBJECTS Grade 7 to 10 Alberta students (n 4936) participated in the school-based research. RESULTS On average, students met macronutrient requirements; however, micronutrient and fibre intakes were suboptimal. Median CFGHE food group intakes were below recommendations. Those with poor diet quality (42 %) had lower intakes of protein, fibre and low-calorie beverages; higher intakes of carbohydrates, fat and Other Foods (e.g. foods containing mostly sugar, high-salt/fat foods, high-calorie beverages, low-calorie beverages and high-sugar/fat foods); a lower frequency of consuming breakfast and a higher frequency of consuming meals away from home; and a lower level of physical activity when compared with students with either average or superior diet quality. CONCLUSIONS Alberta adolescents were not meeting minimum CFGHE recommendations, and thus had suboptimal intakes and poor diet quality. Suboptimal nutritional intakes, meal behaviours and physical inactivity were all related to poor diet quality and reflect the need to target these health behaviours in order to improve diet quality and overall health and wellness.

Healthy Eating Index-C is compromised among adolescents with body weight concerns, weight loss dieting, and meal skipping.

The objective was to describe weight concerns, dieting, and meal skipping of adolescents and to determine associations with the Healthy Eating Index-C (HEI-C). Data, that were collected using the Food Behaviour Questionnaire, revealed that participants (male=810, female=1016) in grades 9/10 reported weight concerns (n=518), dieting (n=364), and skipping breakfast (n=498), lunch (n=252), and/or dinner (n=129). Of those dieting or weight concerned (n=602), 61% were healthy weight and of those not dieting or weight concerned (n=1224), 13% were overweight/obese. The ordinal logistic regression analysis revealed that HEI-C was likely to be rated lower among those weight concerned and dieting (p<.001), and among those that skipped the breakfast meal (p<.001). The current study identified inappropriate weight concerns and dieting that compromised diet quality and has implications for future intervention and policy development.

Involvement in home meal preparation is associated with food preference and self-efficacy among Canadian children

OBJECTIVE To examine the association between frequency of assisting with home meal preparation and fruit and vegetable preference and self-efficacy for making healthier food choices among grade 5 children in Alberta, Canada. DESIGN A cross-sectional survey design was used. Children were asked how often they helped prepare food at home and rated their preference for twelve fruits and vegetables on a 3-point Likert-type scale. Self-efficacy was measured with six items on a 4-point Likert-type scale asking children their level of confidence in selecting and eating healthy foods at home and at school. SETTING Schools (n =151) located in Alberta, Canada. SUBJECTS Grade 5 students (n = 3398). RESULTS A large majority (83-93 %) of the study children reported helping in home meal preparation at least once monthly. Higher frequency of helping prepare and cook food at home was associated with higher fruit and vegetable preference and with higher self-efficacy for selecting and eating healthy foods. CONCLUSIONS Encouraging children to be more involved in home meal preparation could be an effective health promotion strategy. These findings suggest that the incorporation of activities teaching children how to prepare simple and healthy meals in health promotion programmes could potentially lead to improvement in dietary habits.

Chronic Disease–Related Lifestyle Risk Factors in a Sample of Canadian Adolescents

This study examined the prevalence, clustering, age trends, and gender differences of chronic-disease related risk factors among a large sample of adolescents (N = 4932) in Alberta, Canada. Approximately 43% of boys and 53% of girls displayed two or more risk factors. Age trends and gender differences were also observed.

Sociodemographic, behavioural and environmental correlates of sweetened beverage consumption among pre-school children

OBJECTIVE To identify sociodemographic and environmental correlates of sweetened beverages (regular soft drinks, fruit juice) among children of pre-school age. DESIGN Childrens dietary intake, food behaviours and screen time were measured by parental report. A Geographic Informational System was used to assess the number of grocery stores and fast-food restaurants available within 1 km of the childrens residence. Multivariate log-binomial regression models were constructed to determine correlates of drinking soft drinks during the previous week. SETTING Edmonton region, Canada. SUBJECTS Children aged 4 and 5 years (n 2114) attending a public health unit for immunization were recruited for a cohort study on determinants of childhood obesity, between 2005 and 2007. RESULTS Children from neighbourhoods with low socio-economic status (relative risk (RR) = 1·17, 95 % CI 0·98, 1·40) or who participated in >2 h of screen time daily (RR = 1·28, 95 % CI 1·13, 1·45) were significantly more likely to have consumed regular soft drinks within the last week. Those who lived within 1 km of a grocery store were significantly less likely to consume regular soft drinks (RR = 0·84, 95 % CI 0·73, 0·96). Children who participated in >2 h of screen time daily (RR = 1·16, 95 % CI 1·06, 1·27) were more likely to exceed the recommended weekly number of servings of fruit juice. CONCLUSIONS Socio-economic and built environment factors are associated with soft drink consumption in children of pre-school age. These findings may help health professionals to advocate for policies that reduce soft drink consumption among children.

Involvement in Meal Preparation at Home Is Associated With Better Diet Quality Among Canadian Children

OBJECTIVE To examine the associations between home meal preparation involvement with diet quality and food group intake among children. METHODS Grade 5 children aged 10-11 years (n = 3,398) were surveyed. Food intake was measured using the Harvard Youth/Adolescent Food Frequency Questionnaire, and diet quality was measured using the Diet Quality Index-International. Random effects regression models with children nested within schools were used to test for associations. RESULTS Higher frequency of involvement in home meal preparation was associated with higher Diet Quality Index-International scores. Children who were involved in meal preparation daily ate 1 more serving/d of vegetables and fruit compared with children who never helped (P < .001). Similar significant differences, although small, were observed for intake of the other food groups. CONCLUSIONS AND IMPLICATIONS Children who were more involved in home meal preparation also consumed healthier diets. Encouraging parents to involve their children in meal preparation could be a viable health promotion strategy.

Reflections on community-based population health intervention and evaluation for obesity and chronic disease prevention: the Healthy Alberta Communities project

ObjectivesTo reflect upon a population health intervention for obesity and chronic disease prevention, with specific attention to the processes of change and developing, implementing and evaluating an intervention in a community–university–government partnership context.MethodsTo capture the value, process and context of our interventions, we employed a multi-layered, mixed methods research and evaluation design. Guided by assumptions of community-based participatory research, and using a validated capacity-building tool, the investigators described and reflected critically upon the level and nature of capacity built (for both research and intervention) as indicators of the process and contextual influences on intervention success.ResultsCapacity was built in communities through collaborative approaches. We captured complexity of change in social context to advance understanding of how to intervene to transform environments. Developing novel community evaluation strategies can help to advance understanding of how environmental interventions affect health before health outcomes data demonstrate change.ConclusionsOur experience provides an example of operationalizing an ecological framework. As a community–university–government partnership, Healthy Alberta Communities provides an opportunity for developing promising practices for the health of communities, as well as a unique research platform for evaluating the process and establishing effectiveness of population health interventions.

Dietary patterns associated with glycemic index and glycemic load among Alberta adolescents

The purpose of this study was to assess the dietary glycemic index (GI) and glycemic load (GL) of adolescents, based on a Web-based 24-h recall, and to investigate dietary predictors of GI and GL. In addition, the relationship between GI and GL and weight status was examined. A Web-based 24-h recall was completed by 4936 adolescents, aged 9-17 years; macronutrient and food group intakes were assessed using the ESHA Food Processor, the Canadian Nutrient File, and Canadas Food Guide. Dietary GI and GL were calculated based on published GI values for foods. Students provided self-reported height and mass. Multiple regression models assessed the ability of food group choices and food behaviours to predict GI and GL. Mean GI was 55 for girls and 56 for boys. Mean GL was 128 for girls and 168 for boys. Food group choices explained 26% of the variation in GI (p < 0.01) and 84% of the variation in GL (p < 0.01). The number of meals per day explained 10% (p < 0.01), and eating meals outside of the home accounted for 2.5% (p < 0.01) of the variation in GL; however, these results disappeared when adjusted for total energy intake. The GI was positively correlated with body mass index in girls (r = 0.05, p = 0.02), and GL was significantly higher among nonoverweight boys than overweight boys. This study identified eating patterns related to daily GI and GL, and suggests certain dietary patterns that could have beneficial effects on health. It also showed that GI and GL were weakly related to weight status.

Adolescent weight status and related behavioural factors: web survey of physical activity and nutrition

Purpose. To identify whether non-overweight students were different from their overweight or obese peers with respect to diet, suboptimal meal behaviours, and physical activity using a self-administered web-based survey. Methods. 4097 adolescents living in Alberta, Canada completed Web-SPAN (Web Survey of Physical Activity and Nutrition). Students were classified as overweight or obese, and differences were described in terms of nutrient intakes, physical activity, and meal behaviours. Results. Non-overweight students consumed significantly more carbohydrate and fibre, and significantly less fat and high calorie beverages, and had a higher frequency of consuming breakfast and snacks compared to overweight or obese students. Both non-overweight and overweight students were significantly more active than obese students. Conclusions. This research supports the need to target suboptimal behaviours such as high calorie beverage consumption, fat intake, breakfast skipping, and physical inactivity. School nutrition policies and mandatory physical education for all students may help to improve weight status in adolescents.

Essential conditions for the implementation of comprehensive school health to achieve changes in school culture and improvements in health behaviours of students

BackgroundComprehensive School Health (CSH) is an internationally recognized framework that holistically addresses school health by transforming the school culture. It has been shown to be effective in enhancing health behaviours among students while also improving educational outcomes. Despite this effectiveness, there is a need to focus on how CSH is implemented. Previous studies have attempted to uncover the conditions necessary for successful operationalization, but none have described them in relation to a proven best practice model of implementation that has demonstrated positive changes to school culture and improvements in health behaviours.MethodsThe purpose of this research was to identify the essential conditions of CSH implementation utilizing secondary analysis of qualitative interview data, incorporating a multitude of stakeholder perspectives. This included inductive content analysis of teacher (n = 45), principal (n = 46), and school health facilitator (n = 34) viewpoints, all of whom were employed within successful CSH project schools in Alberta, Canada between 2008 and 2013.ResultsMany themes were identified, here called conditions, that were divided into two categories: ‘core conditions’ (students as change agents, school-specific autonomy, demonstrated administrative leadership, dedicated champion to engage school staff, community support, evidence, professional development) and ‘contextual conditions’ (time, funding and project supports, readiness and prior community connectivity). Core conditions were defined as those conditions necessary for CSH to be successfully implemented, whereas contextual conditions had a great degree of influence on the ability for the core conditions to be obtained. Together, and in consideration of already established ‘process conditions’ developed by APPLE Schools (assess, vision, prioritize; develop and implement an action plan; monitor, evaluate, celebrate), these represent the essential conditions of successful CSH implementation.ConclusionsOverall, the present research contributes to the evidence-base of CSH implementation, ultimately helping to shape its optimization by providing school communities with a set of understandable essential conditions for CSH implementation. Such research is important as it helps to support and bolster the CSH framework that has been shown to improve the education, health, and well-being of school-aged children.