Nick Andrianopoulos

Children's fruit and vegetable intake : Associations with the neighbourhood food environment

OBJECTIVEnTo examine associations between availability of different types of food outlets and childrens fruit and vegetable intake.nnnMETHODnParents of 340 5-6 and 461 10-12 year-old Australian children reported how frequently their child ate 14 fruits and 13 vegetables in the last week in 2002/3. A geographic information system (GIS) was used to determine the availability of the following types of food outlets near home: greengrocers; supermarkets; convenience stores; fast food outlets; restaurants, cafés and takeaway outlets. Logistic regression analyses examined the likelihood of consuming fruit >or=2 times/day and vegetables >or=3 times/day, according to access to food outlets.nnnRESULTSnOverall, 62.5% of children ate fruit >or=2 times/day and 46.4% ate vegetables >or=3 times/day. The more fast food outlets (OR=0.82, 95%CI=0.67-0.99) and convenience stores (OR=0.84, 95%CI=0.73-0.98) close to home, the lower the likelihood of consuming fruit >or=2 times/day. There was also an inverse association between density of convenience stores and the likelihood of consuming vegetables >or=3 times/day (OR=0.84, 95%CI=0.74-0.95). The likelihood of consuming vegetables >or=3 times/day was greater the farther children lived from a supermarket (OR=1.27, 95%CI=1.07-1.51) or a fast food outlet (OR=1.19, 95%CI=1.06-1.35).nnnCONCLUSIONnAvailability of fast food outlets and convenience stores close to home may have a negative effect on childrens fruit and vegetable intake.

The longitudinal influence of home and neighbourhood environments on children's body mass index and physical activity over 5 years: the CLAN study

Objective:To determine the independent contributions of family and neighbourhood environments to changes in youth physical activity and body mass index (BMI) z-score over 5 years.Methods:In 2001, 2004 and 2006, 301 children (10–12 years at baseline) had their height and weight measured (BMI was converted to z-scores using Centers for Disease Control and Prevention reference charts; see http://www.cdc.gov/growthcharts) and moderate-to-vigorous physical activity (MVPA) assessed using accelerometers. In 2001, parents reported on the home environment (social support, role modelling, rules and restrictions, physical environment) and perceived neighbourhood environment (local traffic, road safety, sporting venues, public transport), and Geographic Information Systems were used to map features of the neighbourhood environment (destinations, road connectivity, traffic exposure). Generalized estimating equations were used to predict average BMI z-score and MVPA over time from baseline home and perceived and objective neighbourhood environment factors.Results:Among boys, maternal education and heavy traffic were inversely associated, and sibling physical activity, maternal role modelling of MVPA and the presence of dead-end roads were positively associated with MVPA. Having unmarried parents, maternal MVPA role modelling and number of home sedentary items were positively associated with BMI z-score among boys. Among girls, having siblings, paternal MVPA role modelling, physical activity rules and parental physical activity co-participation were positively associated with MVPA. Having unmarried parents and maternal sedentary behaviour role modelling were positively associated, and number of sedentary behaviour rules and physical activity items were inversely associated with BMI z-score among girls.Conclusion:The home environment seems more important than the neighbourhood environment in influencing childrens physical activity and BMI z-score over 5 years. Physical activity and weight gain programmes among youth should focus on parental role modelling, rules around sedentary and active pursuits, and parental support for physical activity. Intervention studies to investigate these strategies are warranted.

Parental use of restrictive feeding practices and child BMI z-score. A 3-year prospective cohort study

This study examines associations between parental feeding restriction at baseline and child body mass index (BMI) z-score at 3-year follow-up. Parents of 204 5-6-year-old and 188 10-12-year-old children completed the Child Feeding Questionnaire at baseline (2002/3). In 2002/3 and 2005/6, childrens BMI z-score was calculated from measured height and weight. Analyses were stratified by age-group. The association of follow-up zBMI and baseline feeding restriction score was explored using (i) linear regression with adjustment for baseline zBMI and (ii) with further adjustments for baseline maternal BMI, maternal education level and child sex. Baseline restriction was associated with follow-up zBMI at 3 years in 5-6-year-old children and was largely unchanged when adjusting for child sex, maternal BMI and education. Restriction was not associated with follow-up zBMI in 10-12-year-old children. This longitudinal study adds important depth to our understanding of associations between restrictive feeding and change in zBMI, suggesting that restriction of energy-dense foods and drinks may be protective of unhealthy weight gain in younger children but may have no effect among older children. These findings support a reconsideration of the notion that restriction is likely to result in increased child weight.

Features of public open spaces and physical activity among children: findings from the CLAN study

OBJECTIVEnTo examine associations between features of public open spaces, and childrens physical activity.nnnPARTICIPANTSn163 children aged 8-9 years and 334 adolescents aged 13-15 years from Melbourne, Australia participated in 2004.nnnMETHODSnA Geographic Information System was used to identify all public open spaces (POS) within 800 m of participants homes and their closest POS. The features of all POS identified were audited in 2004/5. Accelerometers measured moderate-to-vigorous physical activity (MVPA) after school and on weekends. Linear regression analyses examined associations between features of the closest POS and participants MVPA.nnnRESULTSnMost participants had a POS within 800 m of their home. The presence of playgrounds was positively associated with younger boys weekend MVPA (B=24.9 min/day; p< or =0.05), and lighting along paths was inversely associated with weekend MVPA (B=-54.9 min/day; p< or =0.05). The number of recreational facilities was inversely associated with younger girls MVPA after school (B=-2.6 min/day; p< or =0.05) and on the weekend (B=-8.7 min/day; p< or =0.05). The presence of trees providing shade (5.8 min/day, p< or =0.01) and signage regarding dogs (B=6.8 min/day, p< or =0.05) were positively associated with adolescent girls MVPA after school.nnnCONCLUSIONnCertain features of POS were associated with participants MVPA, although mixed associations were evident. Further research is required to clarify these complex relationships.

Neighbourhood fast food outlets and obesity in children and adults: the CLAN Study

OBJECTIVEnWe examined associations between density of and proximity to fast food outlets and body weight in a sample of children (137 aged 8-9 years and 243 aged 13-15 years) and their parents (322 fathers and 362 mothers).nnnMETHODSnChildrens measured and parents self-reported heights and weights were used to calculate body mass index (BMI). Locations of major fast food outlets were geocoded. Bivariate linear regression analyses examined associations between the presence of any fast food outlet within a 2 km buffer around participants homes, fast food outlet density within the 2 km buffer, and distance to the nearest outlet and BMI. Each independent variable was also entered into separate bivariate logistic regression analyses to predict the odds of being overweight or obese.nnnRESULTSnAmong older children, those with at least one outlet within 2 km had lower BMI z-scores. The further that fathers lived from an outlet, the higher their BMI. Among 13-15-year-old girls and their fathers, the likelihood of overweight/obesity was reduced by 80% and 50%, respectively, if they had at least one fast food outlet within 2 km of their home. Among older girls, the likelihood of being overweight/obese was reduced by 14% with each additional outlet within 2 km. Fathers odds of being overweight/obese increased by 13% for each additional kilometre to the nearest outlet.nnnCONCLUSIONSnWhile consumption of fast food has been shown to be associated with obesity, this study provides little support for the concept that exposure to fast food outlets in the local neighbourhood increases risk of obesity.

Can social cognitive theory constructs explain socio-economic variations in adolescent eating behaviours? A mediation analysis

Adolescents of low socio-economic position (SEP) are less likely than those of higher SEP to consume diets in line with current dietary recommendations. The reasons for these SEP variations remain poorly understood. We investigated the mechanisms underlying socio-economic variations in adolescents eating behaviours using a theoretically derived explanatory model. Data were obtained from a community-based sample of 2529 adolescents aged 12-15 years, from 37 secondary schools in Victoria, Australia. Adolescents completed a web-based survey assessing their eating behaviours, self-efficacy for healthy eating, perceived importance of nutrition and health, social modelling and support and the availability of foods in the home. Parents provided details of maternal education level, which was used as an indicator of SEP. All social cognitive constructs assessed mediated socio-economic variations in at least one indicator of adolescents diet. Cognitive factors were the strongest mediator of socio-economic variations in fruit intakes, while for energy-dense snack foods and fast foods, availability of energy-dense snacks at home tended to be strong mediators. Social cognitive theory provides a useful framework for understanding socio-economic variations in adolescents diet and might guide public health programmes and policies focusing on improving adolescent nutrition among those experiencing socio-economic disadvantage.

Children's takeaway and fast-food intakes: associations with the neighbourhood food environment

OBJECTIVEnThe present study aimed to examine associations between availability of outlets where takeaway or fast food could be purchased and consumption of takeaway or fast food among children.nnnDESIGNnCross-sectional. Parents completed a questionnaire regarding the frequency per week their child usually ate takeaway or fast foods. The availability of outlets where these foods could be purchased close to home and en route to school was determined with a Geographic Information System (presence of any outlets and density of outlets within 800 m from home and along the route to school, and distance from home to closest outlet).nnnSETTINGnGreater Melbourne and Geelong, Australia.nnnSUBJECTSnThree hundred and fifty-three children aged 5-6 years and 463 children aged 10-12 years.nnnRESULTSnOverall, 69.4% of children consumed takeaway or fast foods once weekly or more often. Only one measure of availability of outlets close to home was associated with consumption; each additional outlet within 800 m was associated with 3% lower odds of consuming takeaway or fast foods at least once weekly (OR = 0.97, 95% CI 0.95, 1.00). There were no associations between availability en route to school and the likelihood of consuming takeaway or fast food at least once weekly.nnnCONCLUSIONSnAccess to outlets where takeaway or fast food could be purchased did not predict frequency of consumption of takeaway or fast food in the expected direction. Such relationships appear to be complex and may not be adequately captured by the measures of access included in the current study.

The Melbourne Infant Feeding, Activity and Nutrition Trial (InFANT) Program follow-up

BACKGROUNDnThe Melbourne Infant Feeding, Activity and Nutrition Trial (InFANT) Program, is a community-based, cluster-randomised controlled trial of an obesity prevention intervention delivered to first-time parents of infants from age 4-20 months. Conducted from 2008 to 2010, the program had high uptake and retention and showed positive impacts on some dietary outcomes and television viewing. Funding was secured for a follow-up study of participants two and 3.5 years post intervention (at child ages ~3.5 and 5 years). The follow-up study aims to assess intervention effects, mediators and moderators of effects, and program cost-effectiveness over the longer term.nnnMETHODS/DESIGNnThe 492 families still enrolled in the Melbourne InFANT Program at intervention conclusion will be recontacted and renewed consent sought to participate in this follow-up study. No further intervention will occur. Home visit data collections will occur approximately two and 3.5 years post intervention. Main outcomes to be assessed include child body mass index, waist circumference, diet (3 × 24-hour recalls; food frequency questionnaire), physical activity (8 days ActiGraph accelerometer data; parent reported active play) and sedentary time (8days ActiGraph accelerometer and ActivPAL inclinometer data; parent reported screen time).nnnDISCUSSIONnFollow-up of participants of the Melbourne InFANT Program at two and 3.5 years post intervention will allow assessment of longer term intervention effects, investigation of potential mediators and moderators of such effects, and economic evaluation of the longer term outcomes. This information will be valuable to researchers and policy makers in progressing the field of early childhood obesity prevention.

ShopSmart 4 Health – Protocol of a skills-based randomised controlled trial promoting fruit and vegetable consumption among socioeconomically disadvantaged women

BackgroundThere is a need for evidence on the most effective and cost-effective approaches for promoting healthy eating among groups that do not meet dietary recommendations for good health, such as those with low incomes or experiencing socioeconomic disadvantage. This paper describes the ShopSmart 4 Health study, a randomised controlled trial conducted by Deakin University, Coles Supermarkets and the Heart Foundation, to investigate the effectiveness and cost-effectiveness of a skill-building intervention for promoting increased purchasing and consumption of fruits and vegetables amongst women of low socioeconomic position (SEP).Methods/designShopSmart 4 Health employed a randomised controlled trial design. Women aged 18–60 years, holding a Coles store loyalty card, who shopped at Coles stores within socioeconomically disadvantaged neighbourhoods and met low-income eligibility criteria were invited to participate. Consenting women completed a baseline survey assessing food shopping and eating habits and food-related behaviours and attitudes. On receipt of their completed survey, women were randomised to either a skill-building intervention or a wait-list control condition. Intervention effects will be evaluated via self-completion surveys and using supermarket transaction sales data, collected at pre- and post-intervention and 6-month follow-up. An economic evaluation from a societal perspective using a cost-consequences approach will compare the costs and outcomes between intervention and control groups. Process evaluation will be undertaken to identify perceived value and effects of intervention components.DiscussionThis study will provide data to address the currently limited evidence base regarding the effectiveness and cost-effectiveness of skill-building intervention strategies aimed at increasing fruit and vegetable consumption among socioeconomically disadvantaged women, a target group at high risk of poor diets.Trial registrationCurrent Controlled Trials ISRCTN48771770