Richard R. Rosenkranz

Model of the home food environment pertaining to childhood obesity

The home food environment can be conceptualized as overlapping interactive domains composed of built and natural, sociocultural, political and economic, micro-level and macro-level environments. Each type and level of environment uniquely contributes influence through a mosaic of determinants depicting the home food environment as a major setting for shaping child dietary behavior and the development of obesity. Obesity is a multifactorial problem, and the home food environmental aspects described here represent a substantial part of the full environmental context in which a child grows, develops, eats, and behaves. The present review includes selected literature relevant to the home food environments influence on obesity with the aim of presenting an ecologically informed model for future research and intervention in the home food environment.

Physical activity levels among children attending after-school programs.

PURPOSE To describe the physical activity (PA) levels of children attending after-school programs, 2) examine PA levels in specific after-school sessions and activity contexts, and 3) evaluate after-school PA differences in groups defined by sex and weight status. METHODS One hundred forty-seven students in grades 3-6 (mean age: 10.1 +/- 0.7, 54.4% male, 16.5 % overweight (OW), 22.8% at-risk for OW) from seven after-school programs in the midwestern United States wore Actigraph GT1M accelerometers for the duration of their attendance to the program. PA was objectively assessed on six occasions during an academic year (three fall and three spring). Stored activity counts were uploaded to a customized data-reduction program to determine minutes of sedentary (SED), light (LPA), moderate (MPA), vigorous (VPA), and moderate-to-vigorous (MVPA) physical activity. Time spent in each intensity category was calculated for the duration of program attendance, as well as specific after-school sessions (e.g., free play, snack time). RESULTS On average, participants exhibited 42.6 min of SED, 40.8 min of LPA, 13.4 min of MPA, and 5.3 min of VPA. The average accumulation of MVPA was 20.3 min. Boys exhibited higher levels of MPA, VPA, and MVPA, and lower levels of SED and LPA, than girls. OW and at-risk-for-OW students exhibited significantly less VPA than nonoverweight students, but similar levels of LPA, MPA, and MVPA. MVPA levels were significantly higher during free-play activity sessions than during organized or structured activity sessions. CONCLUSION After-school programs seem to be an important contributor to the PA of attending children. Nevertheless, ample room for improvement exists by making better use of existing time devoted to physical activity.

Physical Activity and Healthy Eating in the After-School Environment.

BACKGROUND No research to date has extensively described moderate and vigorous physical activity (MVPA) and healthful eating (HE) opportunities in the after-school environment. The current study described the quality of the after-school environment for its impact on childrens MVPA and HE. METHODS An alliance of 7 elementary schools and Boys and Girls Clubs who worked with the Cooperative Extension Service in Lawrence, KS, was selected to participate in a larger intervention study. After-school settings were observed for information regarding session type, session context, leader behavior, physical activity, and snack quality using validated instruments such as the System for Observing Fitness Instruction Time. Data presented are baseline measures for all sites. RESULTS Participating children (n = 144) were primarily non-Hispanic white (60%) and in fourth grade (69%). After-school sites offered 4 different sessions per day (active recreation, academic time, nonactive recreation, and enrichment activities). Children were provided with a daily snack. On 36% of the days observed, this snack included fruit, fruit juice, or vegetables. There was significantly more time spent in MVPA during free play sessions (69%) compared to organized adult-led sessions (51%). There was also significantly more discouragement of physical activity during organized adult-led sessions (29%) as compared to the free play sessions (6%). CONCLUSIONS The quality of after-school programs can be improved by providing fruits and vegetables as snacks; offering more free play activities; training the after-school staff in simple, structured games for use in a variety of indoor and outdoor settings; and training after-school staff to promote and model MVPA and HE in and out of the after-school setting.

Effectiveness of a web- and mobile phone-based intervention to promote physical activity and healthy eating in middle-aged males: randomized controlled trial of the ManUp study.

Background The high number of adult males engaging in low levels of physical activity and poor dietary practices, and the health risks posed by these behaviors, necessitate broad-reaching intervention strategies. Information technology (IT)-based (Web and mobile phone) interventions can be accessed by large numbers of people, yet there are few reported IT-based interventions targeting males’ physical activity and dietary practices. Objective This study examines the effectiveness of a 9-month IT-based intervention (ManUp) to improve the physical activity, dietary behaviors, and health literacy in middle-aged males compared to a print-based intervention. Methods Participants, recruited offline (eg, newspaper ads), were randomized into either an IT-based or print-based intervention arm on a 2:1 basis in favor of the fully automated IT-based arm. Participants were adult males aged 35-54 years living in 2 regional cities in Queensland, Australia, who could access the Internet, owned a mobile phone, and were able to increase their activity level. The intervention, ManUp, was based on social cognitive and self-regulation theories and specifically designed to target males. Educational materials were provided and self-monitoring of physical activity and nutrition behaviors was promoted. Intervention content was the same in both intervention arms; only the delivery mode differed. Content could be accessed throughout the 9-month study period. Participants’ physical activity, dietary behaviors, and health literacy were measured using online surveys at baseline, 3 months, and 9 months. Results A total of 301 participants completed baseline assessments, 205 in the IT-based arm and 96 in the print-based arm. A total of 124 participants completed all 3 assessments. There were no significant between-group differences in physical activity and dietary behaviors (P≥.05). Participants reported an increased number of minutes and sessions of physical activity at 3 months (exp(β)=1.45, 95% CI 1.09-1.95; exp(β)=1.61, 95% CI 1.17-2.22) and 9 months (exp(β)=1.55, 95% CI 1.14-2.10; exp(β)=1.51, 95% CI 1.15-2.00). Overall dietary behaviors improved at 3 months (exp(β)=1.07, 95% CI 1.03-1.11) and 9 months (exp(β)=1.10, 95% CI 1.05-1.13). The proportion of participants in both groups eating higher-fiber bread and low-fat milk increased at 3 months (exp(β)=2.25, 95% CI 1.29-3.92; exp(β)=1.65, 95% CI 1.07-2.55). Participants in the IT-based arm were less likely to report that 30 minutes of physical activity per day improves health (exp(β)=0.48, 95% CI 0.26-0.90) and more likely to report that vigorous intensity physical activity 3 times per week is essential (exp(β)=1.70, 95% CI 1.02-2.82). The average number of log-ins to the IT platform at 3 and 9 months was 6.99 (SE 0.86) and 9.22 (SE 1.47), respectively. The average number of self-monitoring entries at 3 and 9 months was 16.69 (SE 2.38) and 22.51 (SE 3.79), respectively. Conclusions The ManUp intervention was effective in improving physical activity and dietary behaviors in middle-aged males with no significant differences between IT- and print-based delivery modes. Trial Registration Australian New Zealand Clinical Trials Registry: ACTRN12611000081910; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12611000081910 (Archived by WebCite at http://www.webcitation.org/6QHIWad63).

Girls’ physical activity levels during organized sports in Australia

PURPOSE The primary aim of this study was to objectively examine the physical activity (PA) levels of girls during organized sports (OS) and to compare the levels between games and practices for the same participants. The secondary aims of this study were to document lesson context and coach behavior during practices and games. METHODS Participants were 94 girls recruited from 10 teams in three OS (netball, basketball, and soccer) from the western suburbs of Sydney. Each participant wore an ActiGraph GT3X monitor for the duration of one practice and one game. The System for Observing Fitness Instruction Time was concurrently used to document lesson context and coach behavior. RESULTS Girls spent a significantly higher percentage of time in moderate-to-vigorous PA (MVPA) during practices compared with games (33.8% vs 30.6%; t = 2.94, P < 0.05). Girls spent approximately 20 min·h(-1) in MVPA during practices and approximately 18 min·h(-1) in MVPA during games. An average of 2957 and 2702 steps per hour were accumulated during practices and games, respectively. However, girls spent roughly two-thirds of their OS time in light PA or sedentary. On the basis of the System for Observing Fitness Instruction Time findings, coaches spent a large proportion of practice time in management (15.0%) and knowledge delivery (18.5%). An average of 13.0 and 15.8 occurrences per hour were observed during games and practices where coaches promoted PA. CONCLUSIONS For every hour of game play or practice time, girls accumulated approximately one third of the recommended 60 min of MVPA time and approximately one quarter of the 12,000 steps that girls are recommended to accumulate daily. For this population, OS seems to make a substantial contribution to the recommended amounts of MVPA and steps for participating girls. OS alone, however, does not provide amounts of PA sufficient to meet daily recommendations for adolescent girls.

A group-randomized controlled trial for health promotion in Girl Scouts: Healthier Troops in a SNAP (Scouting Nutrition & Activity Program)

BackgroundGirl Scouting may offer a viable channel for health promotion and obesity prevention programs. This study evaluated the effectiveness of an intervention program delivered through Girl Scout Junior troops that was designed to foster healthful troop meeting environments and increase obesity prevention behaviors at home.MethodsSeven Girl Scout troops were randomized to intervention (n = 3, with 34 girls) or standard-care control (n = 4, with 42 girls) conditions. Girls ranged in age from 9 to 13 years (mean 10.5 years). Intervention troop leaders were trained to implement policies promoting physical activity (PA) and healthful eating opportunities at troop meetings, and to implement a curriculum promoting obesity-prevention behaviors at home. The primary outcome variable was child body mass index (BMI) z-score. Secondary outcomes included accelerometer-assessed PA levels in troop meetings, direct observations of snack offerings, time spent in physically active meeting content, and leader encouragement of PA and healthful eating.ResultsThe intervention was delivered with good fidelity, and intervention troops provided greater opportunities for healthful eating and PA (x2 = 210.8, p < .001), relative to control troops. In troop meetings, intervention troop leaders promoted PA (x2 = 23.46, p < .001) and healthful eating (x2 = 18.14, p < .001) more frequently, and discouraged healthful eating and PA less frequently (x2 = 9.63, p = .002) compared to control troop leaders. Most effects of the intervention on individual-level variables of girls and parents were not significantly different from the control condition, including the primary outcome of child BMI z-score (F1, 5 = 0.42, p = .544), parent BMI (F1, 5 = 1.58, p = .264), and related behavioral variables. The notable exception was for objectively assessed troop PA, wherein girls in intervention troops accumulated significantly less sedentary (x2 = 6.3, p = .011), significantly more moderate (x2 = 8.2, p = .004), and more moderate-to-vigorous physical activity, (x2 = 18.4, p < .001), than girls in control troops.ConclusionsImplementing a health promotion curriculum and supporting policies to provide more healthful environments in Girl Scout troop meetings appears feasible on a broader scale. Additional work is needed to bridge health promotion from such settings to other environments if lasting individual-level behavior change and obesity prevention remain targeted outcomes. Trial registration number: NCT00949637

Examining participant engagement in an information technology-based physical activity and nutrition intervention for men: the manup randomized controlled trial.

Background Males experience a shorter life expectancy and higher rates of chronic diseases compared to their female counterparts. To improve health outcomes among males, interventions specifically developed for males that target their health behaviors are needed. Information technology (IT)-based interventions may be a promising intervention approach in this population group, however, little is known about how to maximize engagement and retention in Web-based programs. Objective The current study sought to explore attributes hypothesized to influence user engagement among a subsample of participants from the ManUp study, a randomized controlled trial testing the efficacy of an interactive Web-based intervention for promoting physical activity and nutrition among middle-aged males. Methods Semistructured interviews were conducted and audiotaped with 20 of the ManUp participants. Interview questions were based on a conceptual model of engagement and centered on why participants took part in the study, what they liked and did not like about the intervention they received, and how they think the intervention could be improved. Interview recordings were transcribed and coded into themes. Results There were five themes that were identified in the study. These themes were: (1) users’ motives, (2) users’ desired outcomes, (3) users’ positive experiences, (4) users’ negative emotions, and (5) attributes desired by user. Conclusions There is little research in the field that has explored user experiences in human-computer interactions and how such experiences may relate to engagement, especially among males. Although not conclusive, the current study provides some insight into what personal attributes of middle-aged males (such as their key motives and goals for participating) and attributes of the intervention materials (such as usability, control, and interactivity) may impact on user engagement in this group. These findings will be helpful for informing the design and implementation of future health behavior interventions for males. Trial Registration Australian New Zealand Clinical Trials Registry: ACTRN12611000081910; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12611000081910 (Archived by WebCite at http://www.webcitation.org/6M4lBlvCA).

WALK 2.0 - using Web 2.0 applications to promote health-related physical activity : a randomised controlled trial protocol

BackgroundPhysical inactivity is one of the leading modifiable causes of death and disease in Australia. National surveys indicate less than half of the Australian adult population are sufficiently active to obtain health benefits. The Internet is a potentially important medium for successfully communicating health messages to the general population and enabling individual behaviour change. Internet-based interventions have proven efficacy; however, intervention studies describing website usage objectively have reported a strong decline in usage, and high attrition rate, over the course of the interventions. Web 2.0 applications give users control over web content generated and present innovative possibilities to improve user engagement. There is, however, a need to assess the effectiveness of these applications in the general population. The Walk 2.0 project is a 3-arm randomised controlled trial investigating the effects of “next generation” web-based applications on engagement, retention, and subsequent physical activity behaviour change.Methods/design504 individuals will be recruited from two sites in Australia, randomly allocated to one of two web-based interventions (Web 1.0 or Web 2.0) or a control group, and provided with a pedometer to monitor physical activity. The Web 1.0 intervention will provide participants with access to an existing physical activity website with limited interactivity. The Web 2.0 intervention will provide access to a website featuring Web 2.0 content, including social networking, blogs, and virtual walking groups. Control participants will receive a logbook to record their steps. All groups will receive similar educational material on setting goals and increasing physical activity. The primary outcomes are objectively measured physical activity and website engagement and retention. Other outcomes measured include quality of life, psychosocial correlates, and anthropometric measurements. Outcomes will be measured at baseline, 3, 12 and 18 months.DiscussionThe findings of this study will provide increased understanding of the benefit of new web-based technologies and applications in engaging and retaining participants on web-based intervention sites, with the aim of improved health behaviour change outcomes.Trial registrationAustralian New Zealand Clinical Trials Registry, ACTRN12611000157976

The quality of dietary intake methodology and reporting in child and adolescent obesity intervention trials: a systematic review

Assessing dietary intake is important in evaluating childhood obesity intervention effectiveness. The purpose of this review was to evaluate the dietary intake methods and reporting in intervention studies that included a dietary component to treat overweight or obese children. A systematic review of studies published in the English language, between 1985 and August 2010 in health databases. The search identified 2,295 papers, of which 335 were retrieved and 31 met the inclusion criteria. Twenty‐three studies reported energy intake as an outcome measure, 20 reported macronutrient intakes and 10 studies reported food intake outcomes. The most common dietary method employed was the food diary (n = 13), followed by 24‐h recall (n = 5), food frequency questionnaire (FFQ) (n = 4) and dietary questionnaire (n = 4). The quality of the dietary intake methods reporting was rated as ‘poor’ in 15 studies (52%) and only 3 were rated as ‘excellent’. The reporting quality of FFQs tended to be higher than food diaries/recalls. Deficiencies in the quality of dietary intake methods reporting in child obesity studies were identified. Use of a dietary intake methods reporting checklist is recommended. This will enable the quality of dietary intake results to be evaluated, and an increased ability to replicate study methodology by other researchers.

Factors influencing the implementation of organized physical activity and fruit and vegetable snacks in the HOP’N After-School Obesity Prevention Program

OBJECTIVE To identify barriers and facilitators for improving the after-school organized physical activity (PA) and snack quality. METHODS After-school staff (Year 1, n = 20; Year 2, n = 17) participated in qualitative, semistructured interviews about the implementation of an after-school obesity prevention intervention. Interviews were recorded, transcribed, coded for common themes, and analyzed using NVivo software. RESULTS Several factors influencing implementation of PA and fruit and vegetable (FV) consumption were revealed. Facilitators for PA included: staff training, equipment/gym space, and scheduling organized PA. Physical activity barriers included prioritizing PA and lack of school administration support. Fruit and vegetable facilitators included requesting healthier snacks. Fruit and vegetable barriers included cost and low priority of snack. CONCLUSIONS AND IMPLICATIONS The success of improving after-school PA and FV snack quality is dependent on many factors, including several organizational system and staff variables. Future research should focus on systemic changes in the after-school environment to increase the priority of daily PA and a healthy snack.