Rowan Brockman

The contribution of active play to the physical activity of primary school children

Objective To examine associations between active play and the physical activity of 10- to 11-year-old children. Method Cross-sectional study of 747, 10- tot11-year-olds, conducted between February 2008 and March 2009 in Bristol, UK. Mean minutes of moderate to vigorous physical activity (MVPA) and mean activity levels (counts per minute, CPM) were assessed by accelerometer. Frequency of active play was self-reported. Results Regression models indicated that frequent active play (5 or more days per week) was associated with mean daily activity levels (CPM) (girls: p = < 0.01; boys: p = <0.01), but was only associated with mean daily MVPA for girls (p = < 0.01). For leisure-time physical activity, active play was associated with childrens CPM (girls: p = 0.02; boys: p = < 0.01) and MVPA (girls: p = < 0.01; boys: p = 0.03) on weekdays after school, but was only associated with weekend day CPM for boys (p =<0.01). Conclusion Active play is associated with childrens physical activity with after-school potentially being a critical period. Strategies to promote active play may prove to be a successful means of increasing childrens physical activity.

Licence to be active: parental concerns and 10–11-year-old children's ability to be independently physically active

Background Physical activity independent of adult supervision is an important component of youth physical activity. This study examined parental attitudes to independent activity, factors that limit licence to be independently active and parental strategies to facilitate independent activity. Methods In-depth phone interviews were conducted with 24 parents (4 males) of 10–11-year-old children recruited from six primary schools in Bristol. Results Parents perceived that a lack of appropriate spaces in which to be active, safety, traffic, the proximity of friends and older children affected childrens ability to be independently physically active. The final year of primary school was perceived as a period when children should be afforded increased licence. Parents managed physical activity licence by placing time limits on activity, restricting activity to close to home, only allowing activity in groups or under adult supervision. Conclusions Strategies are needed to build childrens licence to be independently active; this could be achieved by developing parental self-efficacy to allow children to be active and developing structures such as safe routes to parks and safer play areas. Future programmes could make use of traffic-calming programmes as catalysts for safe independent physical activity.

Parental Sedentary Restriction, Maternal Parenting Style, and Television Viewing Among 10- to 11-Year-Olds

OBJECTIVE: To examine whether parenting styles or practices were associated with childrens television (TV) viewing. METHODS: A total of 431 parent-child dyads (10- to 11-year-old children) from Bristol, United Kingdom, were included. Child and parent TV viewing were self-reported and categorized as <2, 2 to 4, or >4 hours/day. Children reported maternal parenting style (authoritarian, authoritative, or permissive). Child-reported maternal and paternal sedentary restriction scores were combined to create a family-level restriction score. Multinomial logistic regression was used to examine whether child TV viewing was predicted by parenting style or family restriction. RESULTS: A greater proportion of children with permissive mothers watched >4 hours of TV per day, compared with children with authoritarian or authoritative mothers (P = .033). A greater proportion of children for whom both parents demonstrated high restriction watched <2 hours of TV per day (P < .001). The risk of watching 2 to 4 hours (vs <2 hours) of TV per day was 2.2 times higher for children from low-restriction families (P = .010). The risk of watching >4 hours (vs <2 hours) of TV per day was 3.3 times higher for children from low-restriction families (P = .013). The risk of watching >4 hours of TV per day was 5.2 times higher for children with permissive (versus authoritative) mothers (P = .010). CONCLUSIONS: Clinicians need to talk directly with parents about the need to place limitations on childrens screen time and to encourage both parents to reinforce restriction messages.

Physical activity and sedentary behaviour typologies of 10-11 year olds

BackgroundTargeted interventions may be more effective at increasing childrens physical activity. The aim of this study was to identify clusters of children based on physical activity and sedentary patterns across the week.MethodsParticipants were 761, 10-11 year old children. Participants self-reported time spent in eight physical activity and sedentary contexts and wore an accelerometer. Cluster analysis was conducted on the time spent in the self-reported physical activity and sedentary contexts. Mean minutes of accelerometer derived of moderate to vigorous physical activity (MVPA) and sedentary time were derived for the entire week, weekdays only, weekend days and four different time periods across each type (weekend or weekday) of days. Differences in the physical activity patterns of the groups derived from the cluster analysis were assessed for overall physical activity as well as for the four time periods on weekdays and weekend days.ResultsThree clusters emerged: 1) High active/Low sedentary; 2) Low active/Moderate sedentary; and 3) High Active/High sedentary. Patterns of activity differed across the week for each group and the High Active/High sedentary obtained the most minutes of MVPA.ConclusionsPatterns of physical activity and sedentary time differed across the week for each cluster. Interventions could be targeted to the key periods when each group is inactive.

Physical activity by stealth? The potential health benefits of a workplace transport plan

OBJECTIVES There are few published evaluations of the effects of travel policy on health-enhancing physical activity. The purpose of this study was to investigate the effect of a workplace travel plan, which mainly focused on restricting parking opportunities, on levels of active commuting and its potential to contribute to public health. STUDY DESIGN Analysis of a repeated bi-annual travel survey in a workplace setting. METHODS Usual mode of commuting, gender, age, worksite location and distance commuted to and from work were obtained from the University of Bristol Staff Travel Surveys conducted in 1998 (n = 2292), 2001 (n = 2332), 2003 (n = 1950), 2005 (n = 2647) and 2007 (n = 2829). Z-tests were used to examine the significance of trends in active commuting between 1998 and 2007. The largest and most recent survey (2007) was used to calculate the effects of gender, age and salary band on mode of transport, length of commuter journey, and the extent to which active commuting contributed to meeting national recommendations for physical activity. RESULTS Results showed that between 1998 and 2007, in contrast to national trends, the percentage of respondents who reported that they usually walked to work increased from 19.0% to 30.0% (Z = 4.24, P < 0.001). The percentage of regular cyclists increased from 7.0% to 11.8%, but this was not statistically significant. In 2007, regular walkers were more likely to be female, under 35 years of age and earning a middle-band salary. Regular cyclists were more likely to be male, aged 36-45 years and earning a higher-band salary. Approximately 70% of respondents who usually walked or cycled to work achieved greater than 80% of the recommended guidelines for physical activity through their active commuting. CONCLUSIONS This study suggests that transport plans aimed at reducing car usage should be considered as a feasible and effective strategy for increasing health-enhancing physical activity among the workforce.

School-based friendship networks and children's physical activity: a spatial analytical approach

Despite the known health benefits, the majority of children do not meet physical activity guidelines, with past interventions to increase physical activity yielding little success. Social and friendship networks have been shown to influence obesity, smoking and academic achievement, and peer-led interventions have successfully reduced the uptake of adolescent smoking. However, the role of social networks on physical activity is not clear. This paper investigates the extent to which friendship networks influence children’s physical activity, and attempts to quantify the association using spatial analytical techniques to account for the social influence. Physical activity data were collected for 986 children, aged 10–11 years old, from 40 schools in Bristol, UK. Data from 559 children were used for analysis. Mean accelerometer counts per minute (CPM) and mean minutes of moderate to vigorous physical activity per day (MVPA) were calculated as objective measures of physical activity. Children nominated up to 4 school-friends, and school-based friendship networks were constructed from these nominations. Networks were tested to assess whether physical activity showed spatial dependence (in terms of social proximity in social space) using Moran’s I statistic. Spatial autoregressive modelling was then used to assess the extent of spatial dependence, whilst controlling for other known predictors of physical activity. This model was compared with linear regression models for improvement in goodness-of-fit. Results indicated spatial autocorrelation of both mean MVPA (I = .346) and mean CPM (I = .284) in the data, indicating that children clustered in friendship groups with similar activity levels. Spatial autoregressive modelling of mean MVPA concurred that spatial dependence was present (ρ = .26, p < .001), and improved model fit by 31% on the linear regression model. These results demonstrate an association between physical activity levels of children and their school-friends, and indicate that spatial modelling is an informative method for incorporating the influence of school social structure into physical activity analysis.

Development of scales to assess children's perceptions of friend and parental influences on physical activity.

BackgroundMany children do not meet physical activity guidelines. Parents and friends are likely to influence childrens physical activity but there is a shortage of measures that are able to capture these influences.MethodsA new questionnaire with the following three scales was developed: 1) Parental influence on physical activity; 2) Motives for activity with friends scale; and 3) Physical activity and sedentary group normative values. Content for each scale was informed by qualitative work. One hundred and seventy three, 10-11 year old children completed the new questionnaire twice, one week apart. Participants also wore an accelerometer for 5 days and mean minutes of moderate to vigorous physical activity, light physical activity and sedentary time per day were obtained. Test-retest reliability of the items was calculated and Principal Component analysis of the scales performed and sub-scales produced. Alphas were calculated for main scales and sub-scales. Correlations were calculated among sub-scales. Correlations between each sub-scale and accelerometer physical activity variables were calculated for all participants and stratified by sex.ResultsThe Parental influence scale yielded four factors which accounted for 67.5% of the variance in the items and had good (α > 0.7) internal consistency. The Motives for physical activity scale yielded four factors that accounted for 66.1% and had good internal consistency. The Physical activity norms scale yielded 4 factors that accounted for 67.4% of the variance, with good internal consistency for the sub-scales and alpha of .642 for the overall scale. Associations between the sub-scales and physical activity differed by sex. Although only 6 of the 11 sub-scales were significantly correlated with physical activity there were a number of associations that were positively correlated >0.15 indicating that these factors may contribute to the explanation of childrens physical activity.ConclusionThree scales that assess how parents, friends and group normative values may be associated with childrens physical activity have been shown to be reliable and internally consistent. Examination of the extent to which these new scales improve our understanding of childrens physical activity in datasets with a range of participant and family characteristics is needed.

Teachers' wellbeing and depressive symptoms, and associated risk factors: A large cross sectional study in English secondary schools

BACKGROUND Teachers have been shown to have high levels of stress and common mental disorder, but few studies have examined which factors within the school environment are associated with poor teacher mental health. METHODS Teachers (n=555) in 8 schools completed self-report questionnaires. Levels of teacher wellbeing (Warwick Edinburgh Mental Wellbeing Scale-WEMWBS) and depressive symptoms (Patient Health Questionnaire-PHQ-9) were measured and associations between these measures and school-related factors were examined using multilevel multivariable regression models. RESULTS The mean (SD) teacher wellbeing score (47.2 (8.8)) was lower than reported in working population samples, and 19.4% had evidence of moderate to severe depressive symptoms (PHQ-9 scores >10). Feeling unable to talk to a colleague when feeling stressed or down, dissatisfaction with work and high presenteeism were all strongly associated with both poor wellbeing (beta coefficients ranged from -4.65 [-6.04, -3.28] to -3.39 [-5.48, -1.31]) and depressive symptoms (ORs ranged from 2.44 [1.41, 4.19] to 3.31 [1.70, 6.45]). Stress at work and recent change in school governance were also associated with poor wellbeing (beta coefficients=-4.22 [-5.95, -2.48] and -2.17 [-3.58, -0.77] respectively), while sickness absence and low student attendance were associated with depressive symptoms (ORs=2.14 [1.24, 3.67] and 1.93 [1.06, 6.45] respectively). LIMITATIONS i) This was a cross-sectional study; causal associations cannot be identified ii) several of the measures were self-report iii) the small number of schools reduced study power for the school-level variables CONCLUSIONS Wellbeing is low and depressive symptoms high amongst teachers. Interventions aimed at improving their mental health might focus on reducing work related stress, and increasing the support available to them.

Protocol for a cluster randomised controlled trial of an intervention to improve the mental health support and training available to secondary school teachers – the WISE (Wellbeing in Secondary Education) study

BackgroundTeachers are reported to be at increased risk of common mental health disorders compared to other occupations. Failure to support teachers adequately may lead to serious long-term mental disorders, poor performance at work (presenteeism), sickness absence and health-related exit from the profession. It also jeopardises student mental health, as distressed staff struggle to develop supportive relationships with students, and such relationships are protective against student depression. A number of school-based trials have attempted to improve student mental health, but these have mostly focused on classroom based approaches and have failed to establish effectiveness. Only a few studies have introduced training for teachers in supporting students, and none to date have included a focus on improving teacher mental health. This paper sets out the protocol (version 4.4 20/07/16) for a study aiming to address this gap.MethodsCluster randomised controlled trial with secondary schools as the unit of randomisation. Intervention schools will receive: i) Mental Health First Aid (MHFA) training for a group of staff nominated by their colleagues, after which they will set up a confidential peer support service for colleagues ii) training in MHFA for schools and colleges for a further group of teachers, which will equip them to more effectively support student mental health iii) a short mental health awareness raising session and promotion of the peer support service for all teachers. Comparison schools will continue with usual practice. The primary outcome is teacher wellbeing measured using the Warwick Edinburgh Mental Wellbeing Scale (WEMWBS). Secondary outcomes are teacher depression, absence and presenteeism, and student wellbeing, mental health difficulties, attendance and attainment. Measures will be taken at baseline, one year follow up (teachers only) and two year follow up. Economic and process evaluations will be embedded within the study.DiscussionThis study will establish the effectiveness and cost-effectiveness of an intervention that supports secondary school teachers’ wellbeing and mental health, and improves their skills in supporting students. It will also provide information regarding intervention implementation and sustainability.Trial registrationInternational Standard Randomised Controlled Trial Number: ISRCTN95909211 registered 24/03/16

NAP SACC UK: protocol for a feasibility cluster randomised controlled trial in nurseries and at home to increase physical activity and healthy eating in children aged 2-4 years.

Introduction Systematic reviews have identified the lack of intervention studies with young children to prevent obesity. This feasibility study examines the feasibility and acceptability of adapting the Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) intervention in the UK to inform a full-scale trial. Methods and analysis A feasibility cluster randomised controlled trial in 12 nurseries in England, with 6 randomly assigned to the adapted NAP SACC UK intervention: nursery staff will receive training and support from an NAP SACC UK Partner to review the nursery environment (nutrition, physical activity, sedentary behaviours and oral health) and set goals for making changes. Parents will be invited to participate in a digital media-based home component to set goals for making changes in the home. As this is a feasibility study, the sample size was not based on a power calculation but will indicate the likely response rates and intracluster correlations. Measures will be assessed at baseline and 8–10 months later. We will estimate the recruitment rate of nurseries and children and adherence to the intervention and data. Nursery measurements will include the Environmental Policy Assessment and Observation score and the nursery staffs review of the nursery environment. Child measurements will include height and weight to calculate z-score body mass index (zBMI), accelerometer-determined minutes of moderate-to-vigorous physical activity per day and sedentary time, and diet using the Child and Diet Evaluation Tool. Questionnaires with nursery staff and parents will measure mediators. A process evaluation will assess fidelity of intervention delivery and views of participants. Ethics and dissemination Ethical approval for this study was given by Wales 3 NHS Research Ethics Committee. Findings will be made available through publication in peer-reviewed journals, at conferences and to participants via the University of Bristol website. Data will be available from the University of Bristol Research Data Repository. Trial registration number ISRCTN16287377.