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Objective To examine the cost-effectiveness of Be Active Eat Well (BAEW), a large, multifaceted, community-based capacity-building demonstration program that promoted healthy eating and physical activity for Australian children aged 4-12 years between 2003 and 2006. Design and Methods A quasi-experimental, longitudinal design was used with anthropometric data collected at baseline (1001 children—intervention; 1183—comparator) and follow-up. A societal perspective was employed, with intervention resource use measured retrospectively based on process evaluation reports, school newsletters, reports, and key stakeholder interviews, and valued in 2006 Australian dollars (AUD). Outcomes were measured as Body Mass Index (BMI) units saved and Disability Adjusted Life Years (DALYs) averted over the predicted cohort lifetime, and reported as incremental cost-effectiveness ratios (with 95% uncertainty intervals). Results The intervention cost AUD0.34M ($0.31M; $0.38M) annually, and resulted in savings of 547 (−104; 1209) BMI units and 10.2 (−0.19; 21.6) DALYs. This translated to modest cost offsets of AUD27 311 (−$1803; $58 242) and a net cost per DALY saved of AUD29 798 (dominated; $0.26M). Conclusions BAEW was affordable and cost-effective, and generated substantial spin-offs in terms of activity beyond funding levels. Elements fundamental to its success and any potential cost efficiencies associated with scaling-up now require identification.

Summary What is already known about this subject Sugar-sweetened beverages have been suggested as a possible contributor to the development of obesity. However, longitudinal evidence is limited, and most previous studies were conducted in the United States. It is unclear if the results are applicable to other parts of the world. What this study adds We assessed the longitudinal association between sweet drink intake and body mass index in a large sample of children and adolescents in the Australian state of Victoria. We generally found limited evidence for a longitudinal association between various indicators of sweet drink consumption and body mass index. Objective The aim of this study was to examine whether baseline (T1) or 2-year change in sweet drink intake in children and adolescents was associated with age- and gender-standardized body mass index (BMIz) at time two (T2), 2 years later. Methods Data on 1465 children and adolescents from the comparison groups of two quasi-experimental intervention studies from Victoria, Australia were analysed. At two time points between 2003 and 2008 (mean interval: 2.2 years) height and weight were measured and sweet drink consumption (soft drink and fruit juice/cordial) was assessed. Results No association was observed between T1 sweet drink intake and BMIz at T2 among children or adolescents. Children from higher socioeconomic status families who reported an increased intake of sweet drinks at T2 compared with T1 had higher mean BMIz at T2 (β: 0.13, P = 0.05). There was no evidence of a dose–response relationship between sweet drink intake and BMIz. In supplementary analyses, we observed that more frequent usual consumption of fruit juice/cordial was associated with a higher BMIz at T2 among children. Conclusion This study showed limited evidence of an association between sweet drink intake and BMIz. However, the association is complex and may be confounded by both dietary and activity behaviours.

Objective To examine the strength of associations between child oral health and aspects of the home environment (child behaviour, parental psychological distress and family functioning) in a large sample of 1- to 12-year-old Australian children. Methods The current study used data from the 2006 Victorian Child Health and Wellbeing Study. Data were obtained on 4590 primary carers. Measures of the family environment included the level of family functioning, parental psychological distress, child's emotion and behavioural problems and the family structure. Results The odds of children having good oral health status were lower with increasing parental psychological distress and poor family functioning across all age groups, and lower with increasing child mental health or conduct problems among children aged 4 years or older. Socioeconomic factors were also related to child oral health status, but this was significant only among children aged 4–7 years, with the odds of children having good oral health status 68% higher in households with a yearly income ≥AUD$ 60 000 compared with households with income

de Silva-Sanigorski A, Ashbolt R, Green J, Calache H, Keith B, Riggs E, Waters E. Parental self-efficacy and oral health-related knowledge are associated with parent and child oral health behaviors and self-reported oral health status. Community Dent Oral Epidemiol 2012. © 2012 John Wiley & Sons A/S. Published by Blackwell Publishing Ltd Abstract - Objectives: This study sought to advance understanding of the influence of psychosocial factors on oral health by examining how parental self- efficacy (with regard to acting on their child's oral health needs) and oral health knowledge relate to parental and child oral health behaviors and self-rated oral health. Methods: Parents of children in grades 0/1 and 5/6 (n = 804) and children in grades 5/6 (n = 377, mean age 11.5 ± 1.0, 53.9% female) were recruited from a stratified random sample of 11 primary (elementary) schools. Participants completed surveys capturing psychosocial factors, oral health- related knowledge, and parental attitudes about oral health. Parents also rated their own oral health status and the oral health of their child. Correlations and logistic regression analysis (adjusted for socioeconomic status, child age, and gender) examined associations between psychosocial factors and the outcomes of interest (parent and child behaviors and self-rated oral health status). Results: Higher parental self-efficacy was associated with more frequent toothbrushing (by parent and child), and more frequent visits to a dental professional. These associations were particularly strong with regard to dental visits for children, with parents with the highest tertile for self-efficacy 4.3 times more likely to report that their child attended a dentist for a checkup at least once a year (95% CI 2.52-7.43); and 3 times more likely to report their child brushing their teeth at least twice a day (Adjusted Odds Ratio 3.04, 95%CI 1.64-5.64) compared with those parents in the lowest tertile for self-efficacy. No associations with oral health knowledge were found when examined by tertile of increasing knowledge. Conclusions: Oral health self-efficacy and knowledge are potentially modifiable risk factors of oral health outcomes, and these findings suggest that intervening on these factors could help foster positive dental health habits in families.

Background Early childhood caries (ECC) describes dental caries affecting children aged 0–71 months. Current research suggests ECC has important aetiological bases during the first year of life. Gaps in knowledge about disease progression prevent the effective and early identification of ‘at risk’ children. Aim To conduct a systematic review of research studies focusing on (a) acquisition and colonization of oral bacteria and ECC and (b) risk and/or protective factors in infants aged 0–12 months. Design Ovid Medline and Embase databases (1996–2011) were searched for RCT, longitudinal, cross‐sectional and qualitative studies. Two investigators undertook a quality assessment for risk of bias. Results Inclusion criteria were met for (a) by four papers and for (b) by 13 papers; five papers were rated medium or high quality. Bacterial acquisition/colonization and modifying factor interrelationships were identified, but their role in the caries process was not clarified. Key risk indicators were infant feeding practices (nine papers), maternal circumstances and oral health (6) and infant‐related oral health behaviours (4). Conclusion This review confirmed that factors occurring during the first year of life affect ECC experience. Despite heterogeneity, findings indicated maternal factors influence bacterial acquisition, whereas colonization was mediated by oral health behaviours and practices and feeding habits.

Childhood obesity monitoring is a fundamental component of obesity prevention but is poorly done in Australia. Monitoring obesity prevalence in children provides important population health data that can be used to track trends over time, identify areas at greatest risk of obesity, determine the effectiveness of interventions and policies, raise awareness and stimulate action. High participation rates are essential for effective monitoring because these provide more representative data. Passive ('opt-out') consent has been shown to provide high participation rates in international childhood obesity monitoring programs and in a recent Australian federal initiative monitoring early child development. A federal initiative structured like existing child development monitoring programs, but with the authority to collect height and weight measurements using opt-out consent, is recommended to monitor rates of childhood obesity in Australia.

Summary ‘It’s Your Move!’ was a 3-year intervention study implemented in secondary schools in Australia as part of the Pacific Obesity Prevention In Communities Project. This paper reports the outcome results of anthropometric indices and relevant obesity-related behaviours. The interventions focused on building the capacity of families, schools and communities to promote healthy eating and physical activity. Baseline response rates and follow-up rates were 53% and 69% respectively for the intervention group (n = 5 schools) and 47% and 66% respectively for the comparison group (n = 7 schools). Statistically significant relative reductions in the intervention versus comparison group were observed: weight (-0.74 kg, P < 0.04), and standardized body mass index (-0.07, P < 0.03), and non-significant reductions in prevalence of overweight and obesity (0.75 odds ratio, P = 0.12) and body mass index (-0.22, P = 0.06). Obesity-related behavioural variables showed mixed results with no pattern of positive intervention outcomes. In conclusion, this is the first study to show that long-term, community-based interventions using a capacity-building approach can prevent unhealthy weight gain in adolescents. Obesity prevention efforts in this important transitional stage of life can be successful and these findings need to be translated to scale for a national effort to reverse the epidemic in children and adolescents.

Background The Romp & Chomp intervention reduced the prevalence of overweight/obesity in pre-school children in Geelong, Victoria, Australia through an intervention promoting healthy eating and active play in early childhood settings. This study aims to determine if the intervention successfully created more health promoting family day care (FDC) environments. Methods The evaluation had a cross-sectional, quasi-experimental design with the intervention FDC service in Geelong and a comparison sample from 17 FDC services across Victoria. A 45-item questionnaire capturing nutrition- and physical activity-related aspects of the policy, socio-cultural and physical environments of the FDC service was completed by FDC care providers (in 2008) in the intervention (n= 28) and comparison (n= 223) samples. Results Select results showed intervention children spent less time in screen-based activities (P= 0.03), organized active play (P < 0.001) and free inside play (P= 0.03) than comparison children. There were more rules related to healthy eating (P < 0.001), more care provider practices that supported children's positive meal experiences (P < 0.001), fewer unhealthy food items allowed (P= 0.05), higher odds of staff being trained in nutrition (P= 0.04) and physical activity (P < 0.001), lower odds of having set minimum times for outside (P < 0.001) and organized (P= 0.01) active play, and of rewarding children with food (P < 0.001). Conclusions Romp & Chomp improved the FDC service to one that discourages sedentary behaviours and promotes opportunities for children to eat nutritious foods. Ongoing investment to increase children's physical activity within the setting and improving the capacity and health literacy of care providers is required to extend and sustain the improvements.

Over a quarter of a century ago, the childhood obesity epidemic started its upswing in high-income countries (1) but it was not until the early 2000s that the issue hit the headlines and really forced the public and politicians to take note (2). That awareness has sparked a surge in research, policies, and programs, but what is the current state of action and, more importantly, where to from here for the prevention of childhood obesity?