Pooja S. Tandon

Home environment relationships with children’s physical activity, sedentary time, and screen time by socioeconomic status

BackgroundChildren in households of lower socioeconomic status (SES) are more likely to be overweight/obese. We aimed to determine if home physical activity (PA) environments differed by SES and to explore home environment mediators of the relation of family SES to children’s PA and sedentary behavior.MethodsParticipants were 715 children aged 6 to 11 from the Neighborhood Impact on Kids (NIK) Study. Household SES was examined using highest educational attainment and income. Home environment was measured by parent report on a survey. Outcomes were child’s accelerometer-measured PA and parent-reported screen time. Mediation analyses were conducted for home environment factors that varied by SES.ResultsChildren from lower income households had greater media access in their bedrooms (TV 52% vs. 14%, DVD player 39% vs. 14%, video games 21% vs. 9%) but lower access to portable play equipment (bikes 85% vs. 98%, jump ropes 69% vs. 83%) compared to higher income children. Lower SES families had more restrictive rules about PA (2.5 vs. 2.0). Across SES, children watched TV/DVDs with parents/siblings more often than they engaged in PA with them. Parents of lower SES watched TV/DVDs with their children more often (3.1 vs. 2.5 days/week). Neither total daily and home-based MVPA nor sedentary time differed by SES. Children’s daily screen time varied from 1.7 hours/day in high SES to 2.4 in low SES families. Media in the bedroom was related to screen time, and screen time with parents was a mediator of the SES--screen time relationship.ConclusionsLower SES home environments provided more opportunities for sedentary behavior and fewer for PA. Removing electronic media from children’s bedrooms has the potential to reduce disparities in chronic disease risk.

Indoor versus outdoor time in preschoolers at child care.

BACKGROUND Being outdoors may have health benefits including being more physically active. Understanding the relationship between outdoor time and health is hampered by the difficulty of measuring outdoor time. PURPOSE To examine the accuracy and validity of light-sensor and GPS methods for quantifying outdoor time among those aged 3-5 years at child care. METHODS A total of 45 children (mean age 4.5 years, 64% boys) from five child care centers wore portable accelerometers with built-in light sensors and a separate GPS device around their waists during child care, providing 80,648 episodes (15 seconds each) for analysis. Direct observation (gold standard) of children being outdoors versus indoors was conducted for 2 days at each center. GPS signal-to-noise ratios, processed through the Personal Activity and Location Measurement System were used to define indoor versus outdoor locations. Receiver operating characteristic (ROC) analyses were used to determine thresholds for defining being indoors versus outdoors. Data were collected in Fall 2011, analyzed in 2012. RESULTS Mean observed outdoor time was 63 [±44; range: 18-152] minutes/day. Mean light-sensor levels were significantly higher outdoors. The area under the ROC curve for location based on light sensor for all weather conditions was 0.82 (range: 0.70 on partly cloudy days to 0.97 on sunny days); for GPS, it was 0.89. The light sensor had a sensitivity of 74% and specificity of 86%. GPS had a sensitivity of 82% and specificity of 88%. CONCLUSIONS A light sensor and a GPS device both distinguish indoor from outdoor time for preschoolers with moderate to high levels of accuracy. These devices can increase the feasibility and lower the cost of measuring outdoor time in studies of preschool children.

Active Play Opportunities at Child Care

BACKGROUND AND OBJECTIVES: Physical activity (PA) is important for children’s health and development, yet preschoolers are not meeting PA recommendations. The objective of this study was to examine different PA opportunities at child care and how variation in indoor versus outdoor and free versus teacher-led opportunities relate to children’s PA. METHODS: An observational study of 98 children (mean age 4.5 years, 49% girls) from 10 child care centers. Classrooms were observed for at least 4 full days per center (total 50 days) to categorize time into (1) not an active play opportunity (APO); (2) naptime; (3) APO, outdoor free play; (4) APO, outdoor teacher-led; (5) APO, indoor free play; and (6) APO, indoor teacher-led. Children wore accelerometers during observations. Linear regression models examined the influence of APO categories on moderate-vigorous physical activity (MVPA) and sedentary time. RESULTS: Children’s activity was 73% sedentary, 13% light, and 14% MVPA. For 88% of time children did not have APOs, including 26% time as naptime. On average, 48 minutes per day were APOs (41% sedentary, 18% light, and 41% MVPA), 33 minutes per day were outdoors. The most frequent APO was outdoor free play (8% of time); outdoor teacher-led time was <1%. Children were more active and less sedentary outdoors versus indoors and during the child-initiated APOs (indoors and outdoors) versus teacher-led APOs. CONCLUSIONS: Preschoolers were presented with significantly fewer than recommended opportunities for PA at child care. More APOs are needed for children to meet recommendations, particularly those that encourage more outdoor time, more teacher-led and child-initiated active play, and flexibility in naptime for preschoolers.

Physical and social home environment in relation to children's overall and home-based physical activity and sedentary time

BACKGROUND Given the obesity epidemic, it is critical to understand factors associated with youth physical activity and sedentary behavior at home, where youth spend significant time. We examined relationships between these child behaviors and home environment factors. METHODS Data were obtained from 713 children aged 6 to 11 in Washington and California 2007-2009. Multivariate regression analyses controlling for socio-demographics examined associations between parent-reported home environment factors and childs accelerometer-measured moderate-to-vigorous physical activity (MVPA) and sedentary time, overall and at home, and parent-reported child screen time. RESULTS Children averaged 47.2% of time at home, which included 43.6% and 46.4% of overall MVPA and sedentary behavior, respectively. Parental support for physical activity and having a basketball hoop were positively associated with MVPA and negatively associated with sedentary behavior. Combined parental support and a basketball hoop was associated with even higher MVPA. Children with fewer bedroom media devices and more fixed play equipment had lower overall sedentary behavior and screen time than either factor alone. Findings were similar regardless of weight status. CONCLUSIONS Physical and social home environment variables, especially when combined, were related to more child MVPA and less sedentary behavior. Results support addressing multiple home environment factors in childhood obesity prevention.

Physical Activity and Beverages in Home- and Center-based Child Care Programs

OBJECTIVE To describe and compare obesity prevention practices related to physical activity and beverages in home- and center-based child care programs. METHODS A telephone survey of licensed home- and center-based child care programs in Florida, Massachusetts, Michigan, and Washington between October and December 2008. RESULTS Most programs reported almost universal access to outdoor play areas and staff who frequently engage in and lead physical activities. About half of the programs reported ≤ 60 minutes of outdoor play time per day for preschoolers. Fewer home-based programs offered a variety of fixed and portable play equipment. Over a third of the programs did not have adequate indoor space for all physical activities. Over two thirds of programs offered juice 3 or 4 times per week or more. CONCLUSIONS AND IMPLICATIONS Many child care programs could increase active opportunities (by increasing outdoor time and providing better spaces for indoor physical activity) and decrease juice provision.

The relationship between physical activity and diet and young children's cognitive development: A systematic review

Objective Given the high prevalence of suboptimal nutrition and low activity levels in children, we systematically reviewed the literature on the relationship between physical activity and dietary patterns and cognitive development in early childhood (six months to five years). Methods In February 2016, we conducted two different searches of MEDLINE, PsycINFO, and ERIC. Each search included either physical activity (including gross motor skills) or diet terms, and neurocognitive development outcome terms. Included studies were in English, published since 2005, and of any study design in which the physical activity or diet measure occurred prior to age five. Results For physical activity, twelve studies (5 cross-sectional, 3 longitudinal and 4 experimental) were included. Eleven studies reported evidence suggesting that physical activity or gross motor skills are related to cognition or learning. Both acute bouts and longer term exposures showed benefit. For diet, eight studies were included consisting of secondary analyses from longitudinal cohort studies. A healthier dietary pattern was associated with better cognitive outcomes in all studies, although some of the reported associations were weak and the measures used varied across the studies. Conclusions Physical activity and healthy diets in early childhood are associated with better cognitive outcomes in young children. The paucity of literature and the variability in the type and quality of measures used highlight the need for more rigorous research. Given that the early childhood years are critical for both obesity prevention and neurocognitive development, evidence that the same healthy behaviors could promote both should inform future interventions.

The Frequency of Outdoor Play for Preschool Age Children Cared for at Home-Based Child Care Settings

OBJECTIVE Given that more than 34% of U.S. children are cared for in home-based child care settings and outdoor play is associated with physical activity and other health benefits, we sought to characterize the outdoor play frequency of preschoolers cared for at home-based child care settings and factors associated with outdoor play. METHODS Cross-sectional study of 1900 preschoolers (representing approximately 862,800 children) cared for in home-based child care settings (including relative and nonrelative care) using the nationally representative Early Childhood Longitudinal Study, Birth Cohort. RESULTS Only 50% of home-based child care providers reported taking the child outside to walk or play at least once/day. More than one-third of all children did not go outside to play daily with either their parent(s) or home-based child care provider. There were increased odds of going outside daily for children cared for by nonrelatives in the childs home compared with care from a relative. Children with ≥3 regular playmates had greater odds of being taken outdoors by either the parents or child care provider. We did not find statistically significant associations between other child level (age, sex, screen-time), family level (highest education in household, mothers race, employment, exercise frequency), and child care level (hours in care, providers educational attainment, perception of neighborhood safety) factors and frequency of outdoor play. CONCLUSIONS At a national level, the frequency of outdoor play for preschoolers cared for in home-based child care settings is suboptimal. Further study and efforts to increase outdoor playtime for children in home-based child care settings are needed.

Parents’ Perceptions of Preschool Activities: Exploring Outdoor Play

ABSTRACT Research Findings: Outdoor play is important for children’s health and development, yet many preschool-age children in child care settings do not receive the recommended 60 min/day of outdoor play. Child care providers have previously described parent-related barriers to increasing outdoor playtime, including parents not providing appropriate clothing for their children and parents’ preference for academics over active play. This study explored parent perceptions and knowledge of outdoor playtime in child care environments. On average, parents reported wanting their child to spend significantly more time playing outside during a full day of child care than the recommended minimum. However, more than half of parents reported that they did not know how much time their child actually spent playing outside, and 43% reported that they did not know their child care center’s outdoor play policies. Practice or Policy: Child care providers may overperceive parent-related barriers to outdoor play. Parents generally support outdoor play for their preschooler during center-based child care but are not well informed about outdoor playtime and policies. Encouraging communication between parents and early childhood educators about these topics could lead to more universal support and strategies for promoting outdoor and active play opportunities for children, which are important for children’s health and development.

Illnesses and Injuries at Nature Preschools

Nature preschools, where children spend the entire school day outdoors, are increasingly popular, but their health consequences have not been well researched. This study tested the hypothesis that nature preschools and conventional preschools differ in their illness and injury incidence, by comparing observed illness and injury occurrence in the two types of schools. For 14 weeks, teachers at five nature preschools and four conventional preschools in Seattle, Washington logged absences due to illness. Two nature preschools and three conventional preschools also logged injuries that occurred during the school day. There was no difference in illness incidence by preschool type, and no serious injuries were reported in either setting. Overall, the study found that nature preschools are a healthy and safe child-care model.

The relationship of gross motor and physical activity environments in child care settings with early learning outcomes

ABSTRACT Gross motor and physical activity opportunities in early childhood are important for promoting health and development. We conducted two studies with the following aims: (1) to describe the quality of gross motor/physical activity early learning environments in Washington (WA) state, USA and (2) to study the relationship between the quality of gross motor/physical activity environments and various early learning outcomes. We used state-wide classroom quality measures related to gross motor activities from the Early Childhood Environment Rating Scale- Revised (N = 1335 centres). For Aim 2, individual early learning assessments were conducted on 495 children from 72 centres in the fall and spring. We found considerable room for improvement in the space, equipment, schedule and supervision related to gross motor activities in child care centres. The quality of the gross motor environments was found to be related to desirable early learning outcomes including preschoolers’ executive functions and behaviour. Abbreviations: ECERS-R: Early Childhood Environment Rating Scale- Revised; QRIS: Quality Rating and Improvement System; WA: Washington