Kathryn R. Hesketh

Activity levels in mothers and their preschool children.

OBJECTIVES: To investigate the association between objectively measured maternal and preschool-aged children’s physical activity, determine how this association differs by demographic and temporal factors, and identify factors associated with maternal activity levels. METHODS: In the UK Southampton Women’s Survey, physical activity levels of 554 4-year-olds and their mothers were measured concurrently by using accelerometry for ≤7 days. Two-level mixed-effects linear regression was used to model the association between maternal and children’s minutes spent sedentary, in light (LPA) and moderate-to-vigorous physical activity (MVPA). Linear regression was used to investigate correlates of maternal activity. RESULTS: Mother-child daily activity levels were positively associated at all activity intensities (sedentary, LPA, and MVPA; all P < .001). The association for sedentary time was stronger for normal-weight children (versus those who were overweight/obese), and those attending preschool part-time (versus full-time). The mother-child association for LPA differed by maternal education and was stronger at the weekend (versus weekdays). The opposite was true for MVPA. Sedentary time and MVPA were most strongly associated in mornings, with LPA most strongly associated in the evenings. Maternal BMI, age leaving school, number and age of children at home, and working hours were independently associated with maternal daily sedentary time and LPA. CONCLUSIONS: Physical activity levels in mothers and their 4-year-old children are directly associated, with associations at different activity intensities influenced by temporal and demographic factors. Influences on maternal physical activity levels also differ by activity intensity. Providing targeted interventions for mothers of young children may increase both groups’ activity.

Protocol for systematic reviews of determinants/correlates of obesity-related dietary and physical activity behaviors in young children (preschool 0 to 6 years): evidence mapping and syntheses

BackgroundThe aim of these reviews is to inform the design and content of interventions to reduce obesity in young children. The behaviors that are associated with obesity/overweight have been studied extensively; however, the factors associated with these behaviors in young children (0 to 6 years) have not been systematically reviewed. Over the past few years the focus of obesity prevention has shifted to preschool children because of the high prevalence of obesity at school entry and recognition that habits formed in early life could track into adulthood. In order to develop effective interventions and change behavior, it is important to understand the factors that are associated with those behaviors. For example, we need to understand whether it would be more important to target the family, childcare settings or the wider environment and identify the most effective way of changing these energy balance related behaviors.Methods/DesignQuantitative (intervention and observational) and qualitative literature on determinants/correlates of fruit and vegetable intake, sugar sweetened beverage and other unhealthy diet intake, and physical activity and sedentary behaviors in young children will be systematically identified, mapped and reviewed. A common search strategy (no language or period restrictions) will be used to identify papers from eight electronic databases and this will be supplemented by hand-searching. Next, studies in developed countries that examine the factors associated with these behaviors in children aged 0 to 6 years (at baseline) will be screened and mapped descriptively followed by in-depth data extraction, quality assessment and synthesis. Data from quantitative studies will be summarized using either forest plots or harvest plots and narrative synthesis, and qualitative studies using thematic analysis. Qualitative evidence will be integrated with the quantitative evidence, using a parallel synthesis approach, to provide a deeper understanding of effective strategies to influence these energy balance related behaviors.DiscussionIn addition to updating and mapping current research, these reviews will be the first to comprehensively synthesize and integrate both the quantitative and qualitative evidence pertaining to determinants/correlates/barriers/facilitators of obesity related behaviors in this young age group (0 to 6 years) with the aim of informing future interventions.Systematic review registrationInternational Prospective Register for Systematic Reviews (PROSPERO) Registration number: CRD42012002881

Barriers and facilitators to young children’s physical activity and sedentary behaviour: a systematic review and synthesis of qualitative literature

Positive activity behaviours (i.e. higher physical activity [PA]/lower sedentary behaviour [SB]) are beneficial from infancy, yet evidence suggests that young children (0‐ to 6‐year‐olds) are relatively inactive. To better understand the perceived influences on these behaviours and to aid intervention development, this paper systematically synthesizes the extensive qualitative literature regarding perceived barriers and facilitators to PA and SB in young children (0–6 years old). A search of eight electronic databases (July 2016) identified 43 papers for inclusion. Data extraction and evidence synthesis were conducted using thematic content analysis, underpinned by the socio‐ecological model (i.e. individual, interpersonal, community, organizational and policy levels). Parents, childcare providers and children perceived seven broad themes to be important for PA and SB, including the child; the home; out‐of‐home childcare; parent–childcare provider interactions; environmental factors; safety; and weather. Each theme mapped onto between one and five levels of the socio‐ecological model; barriers and facilitators at the interpersonal level (e.g. parents, care providers and family) were most frequently cited, reflecting the important (perceived) role adults/peers play in shaping young childrens behaviours. We provide an overarching framework to explain PA and SB in early childhood. We also highlight where gaps in the current literature exist (e.g. from male carers; in developing countries; and barriers and facilitators in the environmental and policy domains) and where future quantitative work may focus to provide novel insights about childrens activity behaviours (e.g. safety and weather).

Child Care Provider Adherence to Infant and Toddler Feeding Recommendations: Findings from the Baby Nutrition and Physical Activity Self-Assessment for Child Care (Baby NAP SACC) Study

BACKGROUND Identifying characteristics associated with the Institute of Medicines (IOM) recommended feeding practices among infant and toddler care providers in child care centers could help in preventing childhood obesity. METHODS In 2009, at baseline in a pilot intervention study of 29 licensed Massachusetts child care centers with at least 50% of enrolled children identified as racial minorities, 57 infant and 109 toddler providers completed feeding questionnaires. To assess provider adherence to six IOM-recommended behaviors, we used cluster-adjusted multivariable logistic regression models including provider type (infant or toddler), race, education, and center Child and Adult Care Food Program (CACFP) participation. RESULTS In multivariable analysis, CACFP participation was associated with providers sitting with children at meals (odds ratio [OR], 5.2; 95% confidence interval [CI], 1.2-21.7), offering fruits and vegetables (OR, 3.3; 95% CI 1.7-6.2), and limiting fast food (OR, 3.5; 95% CI, 1.8-6.7). Providers at centers serving meals family style were less likely to allow children to leave food unfinished (OR, 0.27; 95% CI, 0.09-0.77). Infant providers were more likely than toddler providers to sit with children at meals (OR, 6.98; 95% CI, 1.51-32.09), allow children to eat when hungry (OR, 3.50; 95% CI, 1.34-9.16), and avoid serving sugary (OR, 8.74; 95% CI, 3.05-25.06) or fast foods (OR, 11.56; 95% CI, 3.20-41.80). CONCLUSIONS CACFP participation may encourage IOM-recommended feeding practices among infant and toddler providers. Child care providers may benefit from education about how to feed infants and toddlers responsively, especially when offering foods family style. Future research should explore ways to promote child-centered feeding practices, while addressing barriers to providing children with nutrient-rich foods.

Nutrition practices of nurseries in England. Comparison with national guidelines

Highlights • Recent national guidelines call for improved nutrition in child care in England.• Many nurseries were not meeting national guidelines for foods and beverages served.• Comparisons were made between nurseries in deprived areas and high resource areas.• Nurseries in more deprived areas reported serving more healthy and unhealthy foods.• Just over half of providers sought nutrition guidance from national reports.

Determinants of Change in Physical Activity in Children 0–6 years of Age: A Systematic Review of Quantitative Literature

BackgroundUnderstanding the determinants of children’s health behaviours is important to develop successful behaviour-change interventions.ObjectiveWe aimed to synthesise the evidence around determinants (‘preceding predictors’) of change in physical activity (PA) in young children (0–6 years of age).MethodsAs part of a suite of reviews, prospective quantitative studies investigating change in physical activity in children aged 0–6 years were identified from eight databases (to October 2015): MEDLINE, Embase, CINAHL, PsycINFO, Web of Knowledge, British Nursing Index, Applied Social Sciences Index and Abstracts, and Sociological Abstracts. Determinants and direction of association were extracted, described and synthesised according to the socio-ecological model (individual, interpersonal, organisational, community, policy).ResultsForty-four determinants, predominantly in the interpersonal and organisational domains, were reported across 44 papers (six prospective cohort, 38 interventional); 14 determinants were assessed in four or more papers. Parental monitoring showed a consistent positive association with change in PA; provider training was positively associated with change in children’s moderate-to-vigorous PA only. Five (sex, parental goal setting, social support, motor skill training and increased time for PA) showed no clear association. A further seven (child knowledge, parental knowledge, parental motivation, parenting skills, parental self-efficacy, curriculum materials and portable equipment) were consistently not associated with change in children’s PA. Maternal role-modelling was positively associated with change in PA in all three studies in which it was examined.ConclusionsA range of studied determinants of change in young children’s PA were identified, but only parental monitoring was found to be consistently positively associated. More evidence dealing with community and policy domains from low-/middle-income countries and about lesser-explored modifiable family- and childcare-related determinants is required.International Prospective Register for Systematic Reviews (PROSPERO) Registration NumberCRD42012002881.

Maternal awareness of young children’s physical activity: levels and cross-sectional correlates of overestimation

BackgroundFactors associated with parental awareness of children’s physical activity (PA) levels have not been explored in preschool-aged children. This paper investigates maternal awareness of preschool-aged children’s PA levels and determined correlates associated with maternal overestimation of PA.MethodsData from the Southampton Women’s Survey, a UK population-based study, were collected March 2006 through June 2009. Daily minutes of moderate-to-vigorous PA (MVPA) were derived using accelerometry in 478 4-year-old children. Mothers who were realistic or overestimated their child’s PA were identified. Log-binomial regression was used to analyse correlates of maternal overestimation of PA levels in children whose mothers perceived them to be active (n = 438).Results40.8% of children were classified as inactive: 89.7% of these were perceived to be active by their mothers (over-estimators). These mothers were more likely to think their child sometimes lacked skills required to be physically active (RR (95% CI) = 1.29(1.03-1.63)) and their child was more likely to attend nursery full-time (RR = 1.53(1.14-2.04)). They were less likely to have older children at home (RR = 0.71(0.56-0.90)).ConclusionsAlmost 90% of mothers of inactive preschool-aged children perceive their child to be active. Nursery-school attendance and having older siblings at home may be important to consider when designing behavioural interventions to increase PA in preschool children.

Correlates of home and neighbourhood-based physical activity in UK 3-4-year-old children.

Background: Identifying context-specific correlates of home- and neighbourhood-based physical activity in preschool-aged children may help improve intervention program development for these settings. Methods: A total of 153 3–4-year-old children were recruited through preschool settings in Cambridgeshire (January–July 2013). Children wore Actiheart accelerometers for ≤7 days to assess their sedentary time (ST), light-(LPA) and moderate- to vigorous-intensity physical activity (MVPA). A parent-completed questionnaire assessed correlates across the ecological model and the child’s preschool attendance during the measurement week. Only accelerometer data for times when children were at home were used. Multilevel models (Level 1: days; Level 2: child) examined associations between maternal-reported exposure variables and each outcome (children’s home- and neighbourhood-based ST, LPA and MVPA) (main analysis). Further analyses included the subsample of children with complete paternal correlates data (father analysis). Results: In the main analyses, children with older siblings engaged in less ST. Children whose mothers reported being ‘moderately inactive’ or ‘active’ (vs. inactive) engaged in less LPA, while children whose mothers worked >35 h week−1 engaged in less MVPA. More equipment at home was associated with lower LPA but greater MVPA. In the father analysis, father’s television viewing before 6 pm was associated with greater ST and less MVPA in children; the negative association between mother’s activity and children’s LPA was retained. Conclusion: Family demographics and parental behaviours appear to have the strongest association with children’s home- and neighbourhood-based ST, LPA and MVPA. This study further highlights the importance of examining both maternal and paternal behaviours.

Will Physically Active Lessons Improve Academic Achievement for All or Widen the Achievement Gap

In this issue of Pediatrics, Mullender-Wijnsma et al1 report findings from an intervention to evaluate the effects of physically active lessons on enhancing children’s academic achievement. Conducted in primary schools in the Netherlands, results of the study are promising. After 2 years, intervention children showed greater gains in standardized mathematics and spelling test scores compared with control children. To what extent overall activity levels and health of the children have been affected is unknown, and we look forward to results from the children’s fitness tests, which are likely forthcoming. Globally, rates of physical activity in children are low,2,3 and schools are 1 potential setting for health promotion efforts. Indeed, physical activity interventions in primary schools have been implemented with some success.4 Although physically active lessons are 1 example of how children’s physical activity might be increased,5 it is imperative that these lessons do not detract from children’s learning and overall educational attainment. The article by Mullender-Wijnsma et al1 adds to a growing body of evidence showing that physically active lessons in schools may actually … Address correspondence to Sara E. Benjamin Neelon, PhD, MPH, RD, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD 21205. E-mail: sara.neelon{at}jhu.edu

Psycho-educational interventions for children and young people with Type 1 Diabetes in the UK: How effective are they? A systematic review and meta-analysis.

Aims To synthesise evidence from UK-based randomised trials of psycho-educational interventions in children and young people (CYP) with Type 1 Diabetes (T1D) to inform the evidence-base for adoption of such interventions into the NHS. Methods We searched Medline, Embase, Cochrane, PsycINFO, CINAHL, and Web of Science up to March 2016. Two reviewers independently selected UK-based randomised trials comparing psycho-educational interventions for improving management of T1D for CYP with a control group of usual care or attention control. The main outcome was glycaemic control measured by percentage of glycated haemoglobin (HbA1c); secondary outcomes included psychosocial functioning, diabetes knowledge, adverse and other clinical outcomes. A narrative synthesis and meta-analysis were conducted. Pooled effect sizes of standardised mean difference (SMD) were calculated. Results Ten eligible trials of three educational and seven psycho-educational interventions were identified. Most interventions were delivered by non-psychologists and targeted adolescents with more than one year duration of diabetes. Meta-analysis of nine of these trials (N = 1,838 participants) showed a non-significant reduction in HbA1c attributable to the intervention (pooled SMD = -0.06, 95% CI: -0.21 to 0.09). Psycho-educational interventions aiming to increase children’s self-efficacy had a moderate, beneficial effect (SMD = 0.50, 95% CI: 0.13 to 0.87). No benefits on diabetes knowledge and other indicators of psychosocial functioning were identified. Conclusions There is insufficient evidence to recommend the use of particular psycho-educational programme for CYP with T1D in the UK. Further trials with sufficient power and reporting standards are needed. Future trials could consider active involvement of psychological specialists in the delivery of psychologically informed interventions and implementation of psycho-educational interventions earlier in the course of the disease. Systematic review registration PROSPERO CRD42015010701