Louise Canterford

Overweight, obesity and girth of Australian preschoolers: prevalence and socio-economic correlates

Objective:(1) To determine the prevalence of overweight and obesity in Australian 4–5-year-old children. (2) To investigate associations between socio-economic characteristics and (a) overweight/obesity and (b) waist circumference.Design:Cross-sectional population survey.Setting:Wave 1 (2004) of the Longitudinal Study of Australian Children.Participants:Nationally representative sample of 4983 4–5-year-old children (2537 boys and 2446 girls; mean age 56.9 months (s.d. 2.64 months; range 51–67 months)).Main outcome measures:Prevalence of overweight and obesity (International Obesity TaskForce definitions) and waist circumference (cm).Analysis:Prevalence estimates were obtained as weighted percentages. Uni- and multivariable ordinal logistic regression (using the proportional odds model) were used to assess associations between potential predictors and the risk of higher child body mass index status and a multivariable linear regression model to assess relationships between the same potential predictors and waist circumference.Results:15.2% of Australian preschoolers are estimated to be overweight and 5.5% obese. In univariate analyses, seven of the 12 variables were associated with higher odds of being in a heavier body mass index category. In a multivariable regression model, speaking a language other than English (particularly for boys), indigenous status and lower disadvantage quintile were the clearest independent predictors of higher body mass index status, with children in the lowest quintile of social disadvantage having 47% higher odds (95% CI 14, 92%) of being in a heavier body mass index category compared to those in the highest quintile. Waist circumference was not related to any socio-economic variable.Conclusions:This nationally representative survey confirms high rates of overweight and obesity in preschoolers throughout Australia. The recent emergence of a substantial socio-economic gradient should bring new urgency to public health measures to combat the obesity epidemic.

Adverse associations of sleep problems in Australian preschoolers: national population study

OBJECTIVE. In contrast to school-aged children, the impact of sleep problems in preschool-aged children is not well documented. We aimed to determine relationships between preschool-aged child sleep problems and child behavior; health-related quality of life; verbal, preliteracy, and early numeracy skills; diagnosis of attention-deficit/hyperactivity disorder; and injury. PARTICIPANTS AND METHODS. Participants included families (n = 4983) participating in the first wave of the Longitudinal Study of Australian Children, a nationally representative study of Australian children aged 4 to 5 years surveyed from March to November 2004. Measures consisted of a primary caregivers report of whether their child had a sleep problem (none versus mild versus moderate/severe); specific sleep patterns occurring ≥4 nights per week; health-related quality of life (by using the Pediatric Quality of Life Inventory 4.0); behavior (by using the Strengths and Difficulties Questionnaire) and parent-reported diagnosis of attention-deficit/hyperactivity disorder; and injury requiring medical attention in the past 12 months. Tests of receptive vocabulary and preliteracy/numeracy skills (by using the Who Am I? developmental assessment and the adapted Peabody Picture Vocabulary Test, 3rd Edition) were directly administered to each child. RESULTS. Sleep problems were common, and compared with children without sleep problems, children with sleep problems had poorer child health-related quality of life, more behavior problems, and higher rates of attention-deficit/hyperactivity disorder. Difficulty going to sleep and morning tiredness had greater adverse associations than snoring or night waking. CONCLUSIONS. Given that sleep problems are very common, the adverse outcomes shown here could affect the transition to school for a very large number of preschoolers.

Electronic Media Use and Adolescent Health and Well-Being: Cross-Sectional Community Study

OBJECTIVE To describe time adolescents spend using electronic media (television, computer, video games, and telephone); and to examine associations between self-reported health/well-being and daily time spent using electronic media overall and each type of electronic media. METHODS Design-Cross-sectional data from the third (2005) wave of the Health of Young Victorians Study, an Australian school-based population study. Outcome Measures-Global health, health-related quality of life (HRQoL; KIDSCREEN), health status (Pediatric Quality of Life Inventory 4.0; PedsQL), depression/anxiety (Kessler-10), and behavior problems (Strengths and Difficulties Questionnaire). Exposure Measures-Duration of electronic media use averaged over 1 to 4 days recalled with the Multimedia Activity Recall for Children and Adolescents (MARCA) computerized time-use diary. Analysis-Linear and logistic regression; adjusted for demographic variables and body mass index z score. RESULTS A total of 925 adolescents (mean +/- standard deviation age, 16.1+/-1.2 years) spent, on average, 3 hours 16 minutes per day using electronic media (television, 128 minutes per day; video games, 35; computers, 19; telephone, 13). High overall electronic media use was associated with poorer behavior, health status, and HRQoL. Associations with duration of specific media exposures were mixed; there was a favorable association between computer use (typing/Internet) and psychological distress, whereas high video game use was associated with poorer health status, HRQoL, global health, and depression/anxiety. Television and telephone durations were not associated with any outcome measure. CONCLUSIONS Despite televisions associations with obesity, time spent in other forms of media use appear more strongly related to adolescent health and well-being. This study supports efforts to reduce high video game use and further exploration of the role of computers in health enhancement.

Outcomes of Child Sleep Problems Over the School-Transition Period: Australian Population Longitudinal Study

BACKGROUND. Adequate sleep optimizes childrens learning and behavior. However, the natural history and impact of sleep problems during school transition is unknown. OBJECTIVES. To determine (1) the natural history of sleep problems over the 2-year period spanning school entry and (2) associations of childrens health-related quality of life, language, behavior, learning, and cognition at ages 6.5 to 7.5 years with (a) timing and (b) severity of sleep problems. METHODS. Data were drawn from the Longitudinal Study of Australian Children. Children were aged 4 to 5 years at wave 1 and 6 to 7 years at wave 2. Parent-reported predictors included (1) timing (none, persistent, resolved, incident) of moderate/severe sleep problems over the 2 waves and (2) severity (none, mild, moderate/severe) of sleep problems at wave 2. Outcomes included parent-reported health-related quality of life and language, parent- and teacher-reported behavior, teacher-reported learning, and directly assessed nonverbal (matrix reasoning) and verbal (receptive vocabulary) cognition. Linear regression, adjusted for child age, gender, and social demographic variables, was used to quantify associations of outcomes with sleep-problem timing and severity. RESULTS. Sleep data were available at both waves for 4460 (89.5%) children, of whom 22.6% (17.0% mild, 5.7% moderate/severe) had sleep problems at wave 2. From wave 1, 2.9% persisted and 2.8% developed a moderate/severe problem, whereas 10.1% resolved. Compared with no sleep problems, persistent and incident sleep problems predicted poorest health-related quality of life, behavior, language, and learning scores, whereas resolving problems showed intermediate outcomes. These outcomes also showed a dose-response relationship with severity at wave 2, with effect sizes for moderate/severe sleep problems ranging from −0.25 to −1.04 SDs. Cognitive outcomes were unaffected. CONCLUSIONS. Sleep problems during school transition are common and associated with poorer child outcomes. Randomized, controlled trials could determine if population-based sleep interventions can reduce the prevalence and impact of sleep problems.

Sleep duration and body mass index in 0–7-year olds

Objectives To determine in children aged 0–7 years (1) cross-sectional relationships between body mass index (BMI) and sleep duration, and whether (2) sleep duration predicts later BMI and/or (3) BMI predicts later sleep duration. Design Longitudinal Study of Australian Children, Waves 1 and 2. Participants Infants aged 0–1 years (Wave 1), followed at age 2–3 years (Wave 2); children aged 4–5 years (Wave 1), followed at age 6–7 years (Wave 2). Main outcome measures BMI, sleep duration by time-use diary, parent-reported sleep problems (none/mild vs moderate/severe). Analyses: Cross-sectional, ANOVA (sleep duration) and χ2 (sleep problems); longitudinal, linear regression. Results 3857 (76%) infants and 3844 (77%) children had BMI and sleep data. At every wave, approximately 15% and 5% of children were overweight and obese, respectively. Obesity was not associated with sleep duration at 0–1, 2–3 or 4–5 years, though obese 6–7-year olds slept approximately 30 min less (p<0.001). Sleep problems were similar across BMI categories at all ages. Wave 1 sleep duration did not predict Wave 2 BMI, nor did Wave 1 BMI predict Wave 2 sleep duration. Conclusions In these large child population cohorts, sleep duration did not predict obesity up to age 6–7 years. Current trials of sleep interventions to prevent or manage obesity in young children may be premature.

Problem behaviours and parenting in preschool children with cystic fibrosis

Background: Problems with sleep, eating and adherence to therapy may adversely affect health outcomes in children with cystic fibrosis (CF). Data on the prevalence of such problems, associated parenting styles and caregiver mental health are limited. Aims: To determine: (a) the prevalence of sleep, mealtime, therapy adherence and externalising and internalising behavioural problems in preschool children with CF; (b) the prevalence of caregiver mental health problems and poor sleep quality; and (c) associations between child behavioural problems and parenting styles. Methods: This was a cross sectional survey of caregivers of children aged 6 months to 5 years attending CF outpatient clinics at Royal Children’s Hospital (Melbourne), Monash Medical Centre (Melbourne) and Sydney Children’s Hospital. Main outcome measures were child externalising and internalising behaviours, sleep, eating and adherence with therapy; the predictor was parenting styles (harsh, inconsistent, overprotective). Results: 117 of 139 families participated. Problems were common with child sleep (small problem: 31.6%; moderate/large problem: 21.9%), eating (32.4%) and adherence with physiotherapy (50.4%). Compared to normative data, sleep and mealtime problems were more prevalent. Caregivers reported high rates of symptoms indicating depression (33.3%), anxiety (16.4%) and stress (34.2%). Harsh parenting was associated with internalising behaviours (adjusted OR 3.9, 95% CI 1.16 to 13.17, p = 0.03). Conclusions: Problems with sleeping, eating and physiotherapy adherence were common in preschool children with CF. Caregivers reported high rates of symptoms indicative of mental health problems. Harsh parenting was associated with internalising problems. An intervention targeting child problem behaviours and parental mental health would be appropriate for CF families.

Changes in body mass index and health related quality of life from childhood to adolescence

OBJECTIVE To determine longitudinal relationships between body mass index (BMI) and health-related quality of life (HRQoL) in an adolescent population sample. Design. Data collected in 2000 and 2005 within the Health of Young Victorians longitudinal cohort study. SETTING Originally a community sample of elementary school students in Victoria, Australia. Follow-up occurred in either secondary schools or individuals homes. PARTICIPANTS Cohort recruited in 1997 via a random sampling design from Victorian elementary schools. Originally comprising 1 943 children, 1 569 (80.8%) participated in 2000 (wave 2, 8-13 years) and 851 (54%) in 2005 (wave 3, 13-19 years). Main outcome measures. In both waves participants and their parents completed the PedsQL, a 23-item child HRQoL measure, and BMI z-scores and status (non-overweight, overweight or obese) were calculated from measured height and weight. Associations were tested cross-sectionally and longitudinally (linear regression, adjusted for baseline values) RESULTS A total of 81.6% remained in the same BMI category, while 11.4% and 7.0% moved to higher and lower categories, respectively. Cross-sectional inverse associations between lower PedsQL and higher BMI categories were similar to those for elementary school children. Wave 2 BMI strongly predicted wave 3 BMI and wave 2 PedsQL strongly predicted wave 3 PedsQL. Only parent-reported Total PedsQL score predicted higher subsequent BMI, though this effect was small. Wave 2 BMI did not predict wave 3 PedsQL. CONCLUSIONS This novel study confirmed previous cross-sectional associations, but did not provide convincing evidence that BMI is causally associated with falling HRQoL or vice versa across the transition from childhood to adolescence.

Pet ownership and adolescent health: Cross‐sectional population study

Objective:  To determine whether adolescent health and well‐being are associated with having a pet in the household (any pet, or specifically dogs, cats or horses/ponies) or average daily time spent caring for/playing with pet(s).

Does maternal concern about children's weight affect children's body size perception at the age of 6.5?—A community-based study

ObjectiveThough overweight is often established by school entry, not all mothers of such children report weight concerns. Enhancing concern might assist lifestyle change, but could lead to child body dissatisfaction. We investigated (i) perceived/desired body size and body dissatisfaction in mothers and their 6.5-year-old children, and (ii) the impact of earlier maternal concern about overweight on childrens body mass index (BMI) status and body dissatisfaction.DesignProspective community study.SettingMelbourne, Australia.Subjects317 mother–child dyads.Main exposuresChild and maternal BMI (kg m−2) at 4.0 and 6.5 years; maternal concern about child overweight at 4.0 years.Outcome measuresPaired perceived and desired body size on 7-point figural rating scales self-reported by mothers and children, and reported by mothers regarding children; dissatisfaction (‘desired’ minus ‘perceived’) score.ResultsFor all three actual BMI perceived size pairings (mother self-report, mothers report on child and child self-report), BMI correlated with perceived body size (r=0.82 (mother self-report); r=0.65 (mother reporting on child); r=0.22 (child self-report); all P<0.001). Similarly, all three dissatisfaction scores were greater with increasing BMI status. Childrens own dissatisfaction scores correlated with their actual BMI, but were not related to mothers’ own body dissatisfaction scores or with mothers’ dissatisfaction with childrens body size. Maternal concern about overweight at the age of 4 years was not associated with BMI change, or child body dissatisfaction by the age of 6.5. Most mothers of overweight and obese children (88 and 90%, respectively) regarded their child as the middle figure (that is, 4) or thinner.ConclusionsDespite low rates of recognition of child overweight, maternal perceptions of the childs body correlated strongly with the childs actual BMI. Maternal concerns about child BMI did not appear to impact on child BMI change or child body dissatisfaction.

Adrenarche and the Emotional and Behavioral Problems of Late Childhood

PURPOSE Mental and behavioral disorders increase in prevalence with the passage through puberty. Yet the first symptoms for many children emerge between seven and 11 years, before the pubertal rise in gonadal hormones. A possibility that symptom onset may be linked to the adrenarchal rise in androgens has been little explored. METHODS The Childhood to Adolescence Transition Study recruited a stratified random sample of 1,239 eight-nine year olds from primary schools in Melbourne, Australia. Saliva samples were assayed for dehydroepiandrosterone, dehydroepiandrosterone-sulphate (DHEA-S), and testosterone. Emotional and behavioral problems were assessed through parental report on the Strengths and Difficulties Questionnaire. RESULTS In males, high levels of all androgens were associated with greater total difficulties and peer problems. Higher dehydroepiandrosterone and testosterone were associated with emotional symptoms and DHEA-S with conduct problems. In females, DHEA-S was associated with peer problems. CONCLUSIONS In late childhood, androgens are associated with emotional and behavioral problems in males, raising a possibility that the adrenarchal transition plays a contributing role. If so, the late primary school years may prove to be an important phase for preventing the onset of mental health and behavioral problems in boys.