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Aim: Dental caries is one of the most common chronic diseases which affects oral health. Tooth brushing is considered the most effective method of preventing dental caries. Providing this motivation and ensuring this habit can be difficult, especially in children. Novel methods for improving tooth brushing habits are desired. This study aimed to investigate a mobile application’s effectiveness in improving oral health in children. Materials and Methods: Two hundred children between 5-12 years old who applied to the Department of Pedodontics, Ege University Faculty of Dentistry, for routine dental examination were included in this study. Children who had any systemic, physical, and/or mental disorders or those who had emergency dental complaints were not included in this study. A structured questionnaire including the child's oral hygiene habits was completed by the parents. In the clinical examination, the caries indices (DMFT/dmft and DMFS/dmfs), dental plaque, and gingival index scores of the children were recorded. Following this clinical examination, the “Brush DJ” mobile application was introduced to the children and their parents. After the first examination, the children were referred for their dental treatment and all were recalled after three months. At the recall examination, a second questionnaire was completed by the parents. The dental caries index (DMFT/dmft and DMFS/dmfs) scores, dental plaque, and gingival index scores were recorded again. A parental satisfaction questionnaire was administered to the parents. Statistical analysis was carried out using the SPSS 25.0 software program. The compliance of the parameters to the normal distribution was evaluated via the Shapiro-Wilk test. The Mann-Whitney U and Kruskal-Wallis tests were used for comparisons between the groups. For intra-group comparisons, the Wilcoxon test, chi-square test, Fisher’s Exact test, and t-test were used. The results were evaluated at a 95% confidence interval and a statistical significance level of p<0.05. Results: It was determined that 56.5% (n=113) of the children participating in this study were girls and 43.5% (n=87) were boys. One hundred and seventy-one of the 200 children were reported to be using the mobile application. It was observed that the tooth brushing frequency increased in 97 children due to their use of the mobile application. It was also observed that the tooth brushing duration increased in 143 of 171 children as a result of their use of the application. Initial plaque and gingival index scores (1.59±0.40; 1.18±0.40, respectively) were statistically higher than the recall examination scores (1.29±0.46; 1.09±0.49 respectively) (p<0.05). Based on the parental satisfaction survey data, it was observed that the use of the mobile app was effective in improving tooth brushing habits, and brushing became more regular and enjoyable in all children. Conclusion: It was concluded that using the “Brush DJ” mobile tooth brushing app is effective in improving oral hygiene habits and making it a regular behavior in children. Long-term follow-up studies with a larger number of subjects comparing different oral hygiene education methods should be planned. [ABSTRACT FROM AUTHOR]

Background: The first 2000 days of life are a crucial and opportunistic time to promote positive dietary and physical activity behaviours that can continue throughout life. The bulk of research on the impact of parents promoting positive dietary and physical activity behaviours has been on mothers, with the impact of fathers rarely investigated. The aim of this study is to investigate fathers' perceived role, self-efficacy and support needs in promoting positive dietary and physical activity behaviours in early childhood. Methods: A sequential explanatory mixed methods study design consisted of a cross sectional survey of Australian fathers (n = 200) from a convenience sample, followed by semi-structured qualitative interviews (n = 21) with a purposeful sample of Australian fathers. Results: Quantitative survey data revealed that more than 90.0% of fathers agreed that it is important to role model healthy eating and participating in physical activity with their babies, toddlers and children. A majority of fathers were confident in getting their child to eat fruit/ vegetables (90%) and playing with their child (80%). When searching for information about nutrition and physical activity, the highest proportion of fathers nominated online sources (52%) as their preferred source in survey data. Qualitative interview data revealed that while fathers exhibited high self-efficacy in their abilities, this was susceptible to deterioration due to feelings of isolation, pressures of fatherhood, a lack of information and resources that are father specific, and difficulties navigating the different types of information/resources to find what is right for them. Conclusions: Although possessing self-efficacy, being committed and seeking knowledge, many fathers found that useful information was hard to find and understand. Appropriate resources are therefore required to support the specific needs of fathers to promote positive dietary and physical activity behaviours in their infants and young children. [ABSTRACT FROM AUTHOR]

Aim: The programme "Join the Healthy Boat" promotes amongst other things a healthy diet in primary school children. In order to evaluate the programme's effectiveness, this study longitudinally investigated children's nutrition behaviour. Subject and methods: A total of 1564 children (7.1 ± 0.6 years) participated in a cluster-randomised study. Teachers delivered lessons including behavioural contracting and budgeting. Nutritional behaviours of parents and child were assessed via parental report. Anthropometrics were measured on site. Results: After one year, children in the intervention group (IG) showed a significant reduction in the consumption of pure juices (p ≤ 0.001). Soft drink consumption reduced in both groups, although with a trend towards a slightly greater reduction in the IG. Children with fathers of normal weight as well as first graders showed a significant reduction of soft drink consumption in the IG (p = 0.025 and p = 0.022 respectively). Fruit and vegetable intake increased significantly for first graders (p = 0.050), children from families with a high parental education level (p = 0.023), and for children with an overweight father (p = 0.034). Significant group differences were found for fruit and vegetable intake of children with migration background (p = 0.01) and children of parents with a high school degree could be observed (p = 0.019). Conclusion: This shows that the programme appeals to a wider range of children, and is therefore more likely to compensate for differences due to origin or other social inequalities, which also shows that active parental involvement is vital for successful interventions. [ABSTRACT FROM AUTHOR]

Background: Physical inactivity is often reported in youth and differs among boys and girls. The aim of this study is to assess sex/gender considerations in intervention studies promoting physical activity and reducing sedentary behavior in youth using a sex/gender checklist. Methods: A systematic search was conducted in August 2018 to identify all relevant controlled trials. Studies screened must have reported a quantified measure of physical activity and/or sedentary behavior, and identified participants by sex/gender at baseline. For evaluation of the sex/gender consideration, the authors used a sex/gender checklist developed by expert consensus. Results: The authors reviewed sex/gender considerations in all aspects of intervention development, implementation, and evaluation in 217 studies. Sex/gender aspects were only rudimentarily taken into account, most frequently during statistical analyses, such as stratification or interaction analysis. Conclusions: Sex/gender effects are not sufficiently reported. To develop guidelines that are more inclusive of all girls and boys, future interventions need to document sex/gender differences and similarities, and explore whether sex/gender influences different phases of intervention programs. The newly developed sex/gender checklist can hereby be used as a tool and guidance to adequately consider sex/gender in the several steps of intervention planning, implementation, and evaluation. [ABSTRACT FROM AUTHOR]

Background: Global estimates have shown that a small proportion of children and adolescents are physically active. However, the evidence on physical activity (PA) among Colombian children and adolescents is limited. The objective of this study was to describe the prevalence and correlates of meeting PA guidelines among Colombian children and adolescents. Methods: Data were collected as part of the National Survey of Nutrition 2015. A national sample of 16,612 children and adolescents (3–17 y) was included. Prevalence estimates of meeting PA and active play guidelines were calculated, and Poisson regression models were conducted to identify correlates of PA. Results: Low proportion of Colombian children and adolescents met the PA guidelines. Low engagement in active play was observed among preschoolers. Correlates varied by age group. Female sex was a consistent negative correlate of meeting PA guidelines across all age groups. Conclusions: Urgent actions are needed to promote active play and PA among Colombian children and adolescents. The correlates identified in our study can help inform the development of actions to overcome the disparities and provide opportunities for children to achieve their full potential for healthy growth and development. [ABSTRACT FROM AUTHOR]

To develop and test the feasibility of a mobile health (mHealth) intervention with parents to improve preschooler's eating and physical activity behaviors. Previously tested content from an in-person parent intervention, HEROs (HEalthy EnviROnments), is being developed and assessed in digital formats utilizing a user-centered design (UCD) approach. The intervention addresses healthy eating (picky eating), physical activity (active play), and optimizing the home environment. Year 3 focused on Mobile app development and testing. Testing consisted of a multi-phase, iterative approach to assess mobile app wireframes (ie, schematics) and UCD constructs with parents of preschoolers. Ten sessions were conducted in 2 phases (n=5/phase) with 8 participants (2 completed both phases). Participants reported positive experiences with functionality: interactions with various features (eg, audio/video buttons, checklists, text boxes, photo uploads, and dashboards) were intuitive and acceptable; and ease of use in moving through the app was high and "almost common sense". Usability items showcased that more complex features, including behavior change activities (ie, goal setting), were not as intuitive and more attention was needed to contextualize these activities. Phase 2 added complexity to the wireframe and tested the user experience construct, revealing that for positive sensory and cognitive experiences, participants desired color and graphics, simplicity in design and function, text in small chunks, and content delivered in multiple formats (ie, text, audio, video). A positive emotional experience was tied to an acknowledgment of participants' progress (ie, progress bar, affirmations, and congratulatory phrases). Insights from wireframe testing are driving the build-out of the mobile app prototype. Assessment of the app prototype and usability testing will occur in Year 4. Application of a user centered design approach, namely wireframe testing, assists in establishing a cohesive and well-designed digital product (ie, mobile app) to provide a positive user experience. [ABSTRACT FROM AUTHOR]

The article presents a follow-up study of a multi-component community-driven health promotion intervention in Denmark. The study examines the perceptions and actions of professional stakeholders 3 years after completion of a 19 months intervention period addressing healthy living, well-being and social engagement among families with young children living in three rural communities on the Danish island of Bornholm. The intervention was implemented within the framework of Project Health and Local Community, also referred to as Project SoL. Qualitative in-depth interviews were conducted with diverse professional stakeholders of the project. They represented local government, public institutions, private enterprises, civil society organizations and local mass media. The interviews addressed the extent to which the project had sustained its influence on professional stakeholders' perceptions and actions following project completion. Efforts were made to understand if persisting influences were value-based and/or manifested as concrete community-driven actions. The study showed that the project had succeeded in sustaining a positive long-term post-intervention influence among informants regarding the values and principles of the project. Despite their sustained motivation and preparedness to continue implementing coordinated community-driven actions this was severely hampered by lack of coordination after project completion. Instead, some of the stakeholders continued developing and implementing actions based on the values and principles of the project within the framework of their own professional networks. The article discusses the structural factors that are required to sustain complex community-driven interventions and the need to reconsider the nature of external support to community development from being project-based to integrated, strategic and long term. [ABSTRACT FROM AUTHOR]

Background: Low back pain (LBP) is the leading cause of disability in the world that affects the population of all ages globally. The main aim of the present study was to analyze the cross-sectional association of postural education and postural hygiene habits with LBP, differentiating between frequency and intensity of pain. Methods: This cross-sectional study assessed 849 students aged 10-12 years from primary schools. The study was based on four different structured and self-administered questionnaires: back pain questionnaire, Back Pain and Body Posture Evaluation Instrument (BackPEI), Frequency of Commuting to and from School Questionnaire, and the Hebacaknow questionnaire. In addition, height and weight were included to determine the body mass index (BMI). Results: Participants with prevalence of LBP were significantly older (P =0.038), girls (P <0.001),>P=0.018), and practice active travelled back from school (P =0.016). Otherwise, participants with no prevalence of LBP sat correctly at the desk (P <0.001).> P =0.004). Conclusion: The knowledge related to postural education it is associated with less LBP. School interventions improving knowledge about postural education, ergonomics and postural hygiene are needed to address this important matter. [ABSTRACT FROM AUTHOR]

The article reports that the ubiquity of mobile devices and their use in daily life create new paths for health promotion interventions such as promoting healthy behaviors among families. Topics include examines the preschool years are an important stage of development when children begin displaying independence while still requiring guidance to help them develop healthy eating and physical activity (PA) behaviors.

Summary: Background: Few randomized controlled trial (RCT) interventions targeted children's early risk behaviours using telephone or short message service (SMS) support. Objective: To evaluate the effectiveness of telephone or SMS early intervention focusing on mothers' behaviours starting from late pregnancy to improve BMI, and eating and screen time behaviours of children aged 2 years in comparison with the control group. Methods: A 3‐arm RCT was conducted in Australia, 2017–2019. Two arms involved the interventions using nurse‐led telephone or SMS support, delivered in nine stages from late pregnancy to age 2 years. The third arm was control. The primary outcome was children's objectively measured BMI and BMI z‐score at 2 years. Secondary outcomes included child eating and screen time behaviours as reported by parents at 2 years. Results: At 2 years, 797 mother–child dyads (69%) completed the telephone survey with 666 (58%) completing weight and height measurements. The study found no statistically significant difference in BMI between the groups. The mean BMI for telephone support was 16.93 (95% CI: 16.73 to 17.13), for SMS 16.92 (95% CI: 16.73 to 17.11) or for control 16.95 (95% CI: 16.73 to 17.16) with a difference of −0.02 (95% CI: −0.31 to 0.27, p = 0.907) in telephone versus control, and a difference of −0.03 (95% CI: −0.30 to 0.24, p = 0.816) in SMS versus control. Telephone support was associated with higher odds of no bottle at bedtime (adjusted odds ratio [AOR]: 2.99; 95% CI: 2.01 to 4.47), family meals (AOR: 2.05; 95% CI: 1.26 to 3.33), drinking from a cup (AOR: 1.89; 95% CI: 1.24 to 2.88), less screen time (<1 h/day) (AOR: 1.56; 95% CI: 1.10 to 2.23) and not eating dinner in front of the TV (AOR: 1.50; 95% CI: 1.09 to 2.06). SMS support was also associated with higher odds of no bottle at bedtime (AOR 2.30, 95% CI: 1.58 to 3.33) than the control. Conclusion: The telephone or SMS support intervention had no significant effects on BMI, but was effective in increasing no bottle use at bedtime. Telephone support showed more effects than SMS on reducing screen time and eating behaviours. [ABSTRACT FROM AUTHOR]

Introduction. The success of family-based community programs for childhood obesity may be increased by promoting social-cognitive factors that influence motivation and participant engagement. Incentivizing behavior can potentially enhance engagement and encourage behavior change. This research investigated motivators to engagement with a multicomponent incentive-based strategy to improve attendance and health-related behavior change in a family community-based weight management program for overweight and obese children. Method. Qualitative analysis combining; demographic data (n = 512), survey of parents (n = 273), and stakeholder (n = 10) and family interviews (n = 24). Participants were selected from program providers and families participating in an Australian community weight management program during a randomized controlled trial (n = 512 children). Maximum variation sampling (demographics and group characteristics) and inductive thematic analysis were used. Results/Conclusion. Four factors influencing engagement were (1) personal value, (2) achievement, (3) support, and (4) overwhelm. These themes corroborated with social-cognitive factors, fostered by a combination of behavior change components in the program that increased participant accountability and intrinsic motivation. Focusing on autonomous goal planning with parental involvement, tracking of goals, and reviewing of goals may complement existing strategies in child-focused treatment programs. Low-value noncash incentives linked to goal setting for encouraging healthy eating and physical activity were well accepted and may enhance family engagement and attendance. [ABSTRACT FROM AUTHOR]

Background: Parents and childcare providers play a substantial role in the development of health behaviours among the children they care for. In order to ensure the optimal growth and development of children, communication and family engagement in childcare is critical. Previous studies examining parent or provider perceptions about healthy eating or physical activity have explored these concepts individually and/or have only included only parents or providers. Therefore, the purpose of this study was to compare childcare provider and parent perceptions of communication regarding healthy eating and physical activity as well as use of best practice strategies on family engagement for these topics. Methods: Childcare providers (n = 12) in childcare centres or a family childcare home and a parent (n = 12) of a child they provide care for participated in a semi‐structured interview guided by the Social Ecological Model. Interviews were transcribed verbatim and uploaded to NVivo for data analysis. Data were analysed using a directed content analysis. Three trained qualitative researchers developed a codebook and then compared responses between parents and providers. Results: Similarities in provider and parent responses included agreement on healthy eating; influences on child development; parents being the most influential on children's healthy eating; how they identified physical activity opportunities; and the use of family engagement principles. Differences that arose included parents' roles in promoting children's physical activity; challenges for parents in promoting healthy eating and physical activity; and providers' encouragement of physical activity. Importantly, few parents mentioned providers were top influences on their child's healthy eating or physical activity. Providers also mentioned having difficult conversations with parents was challenging. Conclusions: Future efforts are needed to (1) help parents understand the providers' role in the development of their child's health behaviours and (2) strengthen efforts to engage families in healthy behaviours outside of childcare facilities. [ABSTRACT FROM AUTHOR]

Background: Outside-of-school-hours-care (OSHC) services are well positioned to influence the health behaviours of 489, 800 Australian children, and are an important setting for health promotion given the current rates of childhood overweight and obesity and associated health risks. OSHC Professionals are ideally placed to become positive influencers in this setting, although they may require training and support to confidently perform this role. This study piloted a multifaceted intervention strategy to increase OSHC Professional's confidence and competencies, to support a health promoting OSHC environment with a nutrition and physical activity focus.Methods: A mixed methods approach was used. Nineteen OSHC Professionals participated in the study, including a face-to-face workshop, supported by a closed Facebook group and website. Role adequacy (self-confidence) and legitimacy (professional responsibility) were measured pre and post workshop and evaluated using non-parametric statistics. Facebook interactions were monitored, and four participants undertook qualitative exit interviews to discuss their experiences with the intervention.Results: Pre-workshop 68% of participants had not received any OSHC-specific health promotion training. Post-workshop significant improvements in confidence about menu planning, accessing nutrition information, activities and recipes was observed (P < 0.05 for all). A significant improvement was observed in role support and role related training (P < 0.05). A high level of support and interaction was observed between participants on Facebook and the website was reported a useful repository of information.Conclusions: Health promotion training, combined with positive social connections, shared learning experiences, and a website improved OSHC Professionals confidence and capacity to provide a health promoting OSHC environment. Health promotion professional development for OSHC professionals should be mandated as a minimum requirement, and such learning opportunities should be scaffolded with support available through social media interactions and website access. [ABSTRACT FROM AUTHOR]

Objectives Obesity is the most prevalent risk factor for cardiovascular disease (CVD) in children. We developed a 2-year lifestyle intervention for youth at risk of CVD. We assessed changes in body mass index z-scores (zBMI) and key cardiometabolic risk factors, physical fitness, and capacity among those who completed the program. Methods The CIRCUIT program is a multidisciplinary lifestyle intervention for children aged 4 to 18 years at risk of CVD, based on a personalized plan to improve cardiometabolic outcomes by increasing physical activity and reducing sedentary behaviours. Both at baseline and 2-year follow-up, we measured zBMI, blood pressure z-scores (zBP), adiposity (%body and %trunk fat), fasting blood glucose and lipid profile, aerobic (VO2max) and anaerobic (5×5 m shuttle run test) fitness, and physical capacity indicators. Differences between baseline and follow-up were examined using paired t-tests (for age-sex standardized outcomes) and multivariable mixed effect models, adjusted for age and sex (for other outcomes). Results Among the 106 participants (53 males) who completed the 2-year program, mean age at baseline was 10.9 years (SD=3.2). After 2 years, zBMI and diastolic zBP decreased by 0.30SD (95% CI: −0.44; −0.16) and 0.43SD (95% CI: −0.65; −0.23), respectively. Participants improved %body and %trunk fat, lipid profile, aerobic and anaerobic fitness levels, and physical capacity (p<0.02). No changes in systolic zBP nor in fasting plasma glucose were observed. Conclusion Our findings showed improved zBMI, cardiometabolic outcomes, physical fitness, and capacity among children at risk of CVD, suggesting that CIRCUIT is a promising intervention. [ABSTRACT FROM AUTHOR]

Identifying correlates of behavioural patterns are important to target population sub-groups at increased health risk. The aim was to investigate correlates of behavioural patterns comprising four behavioural domains in children. Data were from the HAPPY study when children were 6–8 years (n = 335) and 9–11 years (n = 339). Parents reported correlate and behavioural data (dietary intake, physical activity, sedentary behaviour, and sleep). Behavioural data were additionally captured using accelerometers. Latent profile analysis was used to derive patterns. Patterns were identified as healthy, unhealthy, and mixed at both time points. Multinomial logistic regression tested for associations. Girls were more likely to display healthy patterns at 6–8 years and display unhealthy and mixed patterns at 9–11 years than boys, compared to other patterns at the corresponding ages. Increased risk of displaying the unhealthy pattern with higher age was observed at both timepoints. At 9–11 years, higher parental working hours were associated with lower risk of displaying mixed patterns compared to the healthy pattern. Associations observed revealed girls and older children to be at risk for unhealthy patterns, warranting customisation of health efforts to these groups. The number of behaviours included when deriving patterns and the individual behaviours that dominate each pattern appear to be drivers of the associations for child level, but not for family level, correlates. [ABSTRACT FROM AUTHOR]

Background: Brief scales to measure parental self-efficacy (PSE) in relation to children's obesogenic behaviours have not been developed and validated using more rigorous methodology such as invariance testing, limiting their generalisability to sub-groups. This study aimed to assess the construct validity and measurement invariance of brief PSE scales for children's intake of vegetables, soft drinks, and sweets, and physical activity.Methods: Parents (n = 242) of five-to-seven-year-old children in disadvantaged and culturally diverse settings in Sweden responded to a questionnaire in Swedish with 12 items assessing PSE in relation to healthy and unhealthy behaviours. Construct validity was assessed with confirmatory factor analysis, invariance testing compared the scales by groups of parental sex, education, and child weight status. Criterion validity was evaluated using objective measures of children's physical activity and semi-objective measures of diet.Results: Two-factor models showed moderate to excellent fit to the data. Invariance was supported across all groups for healthy behaviour scales. Unhealthy behaviour scales were invariant for all groups except parental education where partial metric invariance was supported. Scales were significantly correlated with physical activity and diet.Conclusion: This study provides preliminary evidence for the validity of brief PSE scales and invariance across groups suggesting their utility for research and clinical management of weight-related behaviours. [ABSTRACT FROM AUTHOR]

Mental health (MH) and behavioral health are fundamental to a good quality of life. Only a few studies have investigated the association between behavioral health (e.g. physical activity (PA), screen time (ST)) and MH from childhood to adolescence. Therefore, we investigated the relationships of PA and ST with MH by sex in an 11-year longitudinal cohort study of German schoolchildren during 2003–2017. A subsample (n  = 686; 55.2% female) of participants from the German Motorik-Modul (MoMo) Longitudinal Study who participated in all 3 measurement phases (mean ages: time 1 (baseline; 2003–2006), 5.57 (standard deviation (SD), 1.00) years; time 2 (wave 1; 2009–2012), 11.85 (SD, 1.03) years; time 3 (wave 2; 2014–2017), 16.86 (SD, 1.04) years) were analyzed with regard to PA, ST, and MH (emotional symptoms, conduct problems, hyperactivity/inattention, peer relationship problems, prosocial behavior, and overall strengths and difficulties). Path panel prediction models were fitted with time 1, time 2, and time 3 PA, ST, and MH indicators. PA predicted less television (TV)/video watching in females, and TV/video watching predicted personal computer (PC)/Internet use in both sexes. Behavior and MH results suggested that, for females, higher TV/video watching and PC/Internet use was related to higher MH challenges over the course of maturation. Some preadolescent males' MH challenges increased ST (TV/video watching and PC/Internet use) in adolescence. Researchers should explore innovative and effective methods for reducing childhood ST, especially among females with early signs of MH issues, and addressing preadolescent males' MH challenges. [ABSTRACT FROM AUTHOR]

Background: Identifying periods of the day which are susceptible to varying levels of physical activity (PA) may help identify key times to intervene and potentially change preschool children's PA behaviors. This study assessed variability of objectively measured moderate-to-vigorous physical activity (MVPA) during weekdays and weekend days among preschool children. Methods: One hundred and eighty-eight children (aged 3 to 5 years; 53.2% boys) from a northwest English city wore uni-axial accelerometers for 7 consecutive days. Results: Higher levels of MVPA were recorded in boys, particularly those who attended preschool for a half day. Children who attended preschool for a full day engaged in 11.1 minutes less MVPA than children who attended for a half day. After-school hours were characterized by a decrease in activity for all groups. Patterns of activity during the weekend were smoother with less variability. Conclusion: This study identified discrete segments of the week, specifically afterschool and during the weekend, when preschoolers engage in low levels of PA. Higher levels of MVPA among children who attended preschool for less time each day suggests that the structured preschool environment is related to decreased activity. Consequently, there is a need for interventions in young children to focus on school and home environments. [ABSTRACT FROM AUTHOR]

Background: The YMCA of USA recently adopted Healthy Eating and Physical Activity (HEPA) Standards for their summer-day-camps (SDCs). Standards call for staff to exhibit HEPA promoting behaviors while eliminating HEPA discouraging behaviors. No studies have evaluated training programs to influence policy specified staff behaviors and related changes in child activity in SDCs. Method: Four YMCA SDCs serving approximately 800 children/week participated in this no control group pre/post pilot study. Professional development training founded in the 5 Ms (Mission, Model, Manage, Monitor, Maximize) and LET US Play principles (lines; elimination; team size; uninvolved staff/kids; and space, equipment, and rules) was delivered to staff. Outcomes were staff promotion behaviors and child activity assessed via systematic observation instruments. Results: Twelve of 17 HEPA staff behaviors changed in the appropriate direction from baseline to postassessment with 5 behaviors reaching statistically significant changes. The percentage of girls and boys observed in moderate-to-vigorous physical activity increased from 15.3% to 18.3% (P > .05) and 17.9% to 21.2%, whereas sedentary behavior decreased from 66.8% to 59.8% and 62.3% to 53.6%, respectively. Conclusion: Evidence suggests that the professional development training designed to assist SDCs to meet the HEPA Standards can lead to important changes in staff behaviors and children's physical activity. [ABSTRACT FROM AUTHOR]

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Objective: Parental factors have been linked to weight‐related outcomes in children, though less is known regarding the role of parental self‐efficacy (PSE) for promoting healthy dietary behaviors (HDBs). This study examined associations between PSE for promoting HDBs and child reports of craving, overeating, and loss of control eating in daily life. The interactive effects of PSE and child eating style (emotional eating, external eating, and restraint) were also explored. Method: Thirty‐eight youth (ages 8–14; 55.3% female) with overweight/obesity and their parents completed the Dutch Eating Behavior Questionnaire for Children (DEBQ‐C) and Parental Self‐Efficacy for Healthy Dietary and Physical Activity Behaviors Scale, respectively. Youth completed ecological momentary assessment (EMA) to report craving, overeating, and loss of control eating. Results: Generalized estimating equations indicated no consistent main effects of PSE on EMA outcomes, but PSE interacted with DEBQ‐C child eating styles to predict each EMA outcome. Among children of parents with lower PSE, (a) higher emotional eating was associated with greater overeating and loss of control eating; (b) higher external eating was associated with greater craving; and (c) higher restraint was associated with greater loss of control eating and craving. Conversely, these associations were attenuated among children of parents with higher PSE. Discussion: Together findings suggest the interplay of child characteristics and PSE regarding children's eating behaviors warrants future investigation in the context of eating and weight disorders. In particular, further research is needed to examine the directionality of effects and mechanisms underlying these associations. [ABSTRACT FROM AUTHOR]

Purpose: To describe toothbrushing frequency/duration and toothpaste use among young children in an urban, vulnerable population in Chicago, Ill., USA. Methods: Caregivers of children younger than three years old were recruited from university and community pediatric dental clinics. Caregivers completed a 37-item questionnaire in English or Spanish about predictors/covariates (demographics, child/ caregiver oral health, access to dental care) and primary outcomes (child toothbrush-ing behaviors, toothpaste use). Models employed generalized logit and ordinal logistic regression. Results: A total of 148 caregivers completed the survey. The average child age was 18.8 months (±7.4 SD). Approximately 41 percent of children brushed once a day or less, and 19 percent of caregivers did not regularly assist. Almost all children used toothpaste (96 percent), but 36 percent of caregivers did not know if it contained fluoride. Increased child brushing frequency was associated with older child age, higher caregiver brushing frequency, history of a child dental visit, and caregiver assistance (P<0.05). Children with a history of dental visits were seven times more likely to brush for 30 seconds or more, and receiving caregiver assistance was associated with brushing longer than two minutes (P<0.05). Conclusion: Most children brushed at least once daily and nearly all of them used toothpaste. Access to dental care, parental involvement, and parental oral health were associated with favorable child toothbrushing behaviors. Toothbrushing duration, frequency, and encouraging family assistance are modifiable protective factors and opportunities for intervention. [ABSTRACT FROM AUTHOR]

A link between higher rates of childhood obesity and deprivation has been noted in the UK, as well as several other European countries and the US. The drivers of obesity are complex and multi‐factorial, but socially and economically disadvantaged groups may be more vulnerable to many of these. Evidence that rates of obesity are rising faster in low‐income population groups, resulting in widening inequalities indicates that prevention policies must take account of socio‐economic factors. It has been suggested that community‐wide approaches placing less emphasis on individual responsibility or 'agency' (i.e. have less emphasis on aspects that require cognitive, psychological and material resources and time) can be more effective and equitable. This paper outlines examples of community approaches that may have contributed to the reported reductions in childhood obesity in some areas, particularly amongst deprived groups including Health, Exercise and Nutrition in the Really Young in Leeds, UK; Ensemble Prévenons l'Obésité Des Enfants and Amsterdam's citywide Healthy Weight Programme. The policies enacted that improved the nutrition environment and increased opportunities for physical activity in four US sites (the Childhood Obesity Declines project) are also considered. It is clear that there is no silver bullet for tackling childhood obesity. A whole systems approach that takes into account more holistically the reasons why healthy diet and lifestyles may be less available to families on low incomes is needed. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to assess the feasibility and acceptability of a home‐based intervention—Amagugu Asakhula—to promote nurturing interactions and healthy behaviours with the caregivers of preschool children. Amagugu Asakhula means "treasures that are still growing" and focuses on children's cognitive development, physical activity, screen time, diet and sleep while also promoting the caregiver–child relationship. Methods: This study took place in a low‐income setting in Cape Town, South Africa. The 6‐week intervention was implemented by community health workers (CHWs) with 20 caregivers of preschool children. CHWs provided written feedback on intervention sessions, and two focus groups were conducted, one with the CHWs involved (n = 4) and another with caregivers (n = 6), to obtain their feedback on the intervention and its implementation. Data were collated according to themes relating to implementation. In this pilot study, training and recruitment proved feasible and were facilitated by partnership with a community‐based organization. Results: The intervention was generally implemented as intended, in terms of dose and delivery. Family support and active engagement of caregivers' preschool children in intervention activities were reported by CHWs and caregivers, and CHWs also reported mostly positive interactions with caregivers. CHWs and caregivers perceived the intervention to have benefits relating to the following: caregivers' awareness and knowledge of health behaviours, awareness of their role, changes in behaviours, and connection between the caregiver and child. The only change to the intervention suggested was the inclusion of some group sessions to promote support amongst intervention participants and sustain engagement in the intervention. Conclusions: The findings of this pilot study indicate that Amagugu Asakhula was both feasible and acceptable with caregivers of preschool children in a low‐income urban setting. Further research is needed to assess the extent to which this intervention has an objective and measurable effect on intended outcomes. [ABSTRACT FROM AUTHOR]

Background: We know very little about physical activity in children with long-term illness or disability compared with those children without disabilities. Previous studies indicate low physical activity levels among all adolescents. Methods: The sample consisted of Canadian (n = 2720) and Finnish pupils (n = 3459) approximately 13.5 and 15.5 years of age in general (mainstreamed) education. The study is a part of the Health Behavior in School-aged Children (HBSC) study. Nationally representative data were collected in 2002 using a standardized questionnaire. The moderate-to-vigorous intensity physical activity screening measure was used. Results: Approximately one-fifth of the pupils in both countries had a long-term disability, illness or medical condition. In both countries boys and girls with a long-term illness or disability were equally physically inactive, and adolescents with a long-term illness or disability were as physically active as those without disabilities. Conclusions: There is no difference between young people with and without long-term illness/disability, and between boys and girls, in relation to their physical activity. However, all of them fall short of recommended guidelines. This indicates that promoting a physically active lifestyle should be of high priority in the lives of young people. [ABSTRACT FROM AUTHOR]

Background: Inner-city schools experience substantial difficulties in providing sufficient physical activity opportunities for their pupils. This study evaluated the Y-Active, an outreach physical activity and well-being program delivered in an inner-city primary school in London, UK by a third-sector partner. Methods: A process evaluation focusing on perceived effectiveness and implementation issues was conducted using qualitative case-study methodology. Semistructured interviews and focus groups were conducted with Year 5 and Year 6 pupils (N = 17, age range = 9 to 11 years), Y-Active sports leaders (N = 4), the school head teacher, class teachers (N = 2), and the Y-Active administrator. Transcripts were thematically analyzed and multiple informant and analyst triangulation performed. Results: The Y-Active leaders created a positive learning environment supporting autonomy, balancing discipline and structure and providing self-referenced feedback, excellence in tuition and a strong focus on fun and praise. Pupils reported improvements in self-confidence and competence, self-discipline and interpersonal relationships. School staff and Y-Active leaders highlighted that their partnership was built on trust, top-down leadership support and open lines of communication between the provider and the school. Conclusions: Collaboration between third sector service providers and inner-city schools represents a promising means of increasing children's physical activity and well-being. [ABSTRACT FROM AUTHOR]

Background: Evidence supporting the effectiveness of a developmental-focused youth sport (DYS) program designed exclusively for elementary school aged girls is mounting. The purpose of this study was to evaluate the impact of on the Girls on the Run program on psychological and physical assets among 3rd- to 5th-grade girls. Methods: A longitudinal quasi-experimental study was conducted to evaluate intervention effects among 877 participants categorized into 1 of 3 groups (never, newly, and previously exposed). A 64-item self-report survey measured developmental assets at 3 time-points. Nested random effects ANOVA models were used to compare demographic factors and psychological and physical assets between exposure groups and to compare longitudinal differences in these assets. Results: After adjustment for multiple comparisons, previous program participants had significantly higher physical activity commitment (P = .006) and physical activity levels (P = .047) at preintervention than never exposed. From pre- to postintervention body image improved in newly exposed participants (P = .03). Physical activity increased from preintervention to follow-up among never and newly exposed participants (all P < .05). Conclusions: Although we were unable to fully confirm the study hypotheses, the results of the current study provide new evidence to support future long-term studies examining the effectiveness of an innovative DYS program for 3rd- to 5th-grade girls. [ABSTRACT FROM AUTHOR]

Background: Pedometer step-frequency thresholds (120 steps·min-1, SPM) corresponding to moderate-tovigorous intensity physical activity (MVPA) have been proposed for youth. Pedometers now have internal mechanisms to record time spent at or above a user-specified SPM. If pedometers provide comparable MVPA (P-MVPA) estimates to those from accelerometry, this would have broad application for research and the general public. The purpose of this study was to examine the convergent validity of P-MVPA to accelerometer-MVPA for youth. Methods: Youth (N = 149, average 8.6 years, range 5 to 14 years, 60 girls) wore an accelerometer (5-sec epochs) and a pedometer for an average of 5.7 ± 0.8 hours·day-1. The following accelerometer cutpoints were used to compare P-MVPA: Treuth (TR), Mattocks (MT), Evenson (EV), Puyau (PU), and Freedson (FR) child equation. Comparisons between MVPA estimates were performed using Bland-Altman plots and paired t tests. Results: Overall, P-MVPA was 24.6 min ± 16.7 vs. TR 25.2 min ± 16.2, MT 18.8 min ± 13.3, EV 36.9 min ± 21.0, PU 22.7 min ± 15.1, and FR 50.4 min ± 25.5. Age-specific comparisons indicated for 10 to 14 year-olds MT, PU, and TR were not significantly different from P-MVPA; for the younger children (5-8 year- olds) P-MVPA consistently underestimated MVPA. Conclusions: Pedometer-determined MVPA provided comparable estimates of MVPA for older children (10-14 year-olds). Additional work is required to establish age appropriate SPM thresholds for younger children. [ABSTRACT FROM AUTHOR]

Background: Active recreation sessions taking place within after-school programs (ASP) present an opportunity for attending children to attain part of the recommended 60 minutes of daily moderate-to-vigorous physical activity (MVPA). This cross-sectional study's purpose was to assess relationships between microlevel ASP environmental characteristics and physical activity and sedentary behavior (SED). Methods: During 161 ASP active recreation sessions, 240 children from 7 schools wore Actigraph GT1M accelerometers and were observed up to 6 times per year, over 3 years. To provide microlevel environmental data, trained observers recorded session times, location, duration, organization, equipment, and number of children and staff. Unadjusted bivariate correlations and multivariable regression analyses were used to assess the influence of microlevel environmental variables on MVPA and SED, with regression models controlling for relevant covariates. Results: Across all ASP active recreation sessions, children spent 39 ± 15% in MVPA and 16 ± 11% in SED. Session location, boy-to-girl ratio, and duration were significantly related to MVPA in the regression model. For SED, location and duration were significant influences in the model. Conclusions: Both location and duration appear to be modifiable correlates of group physical activity level, which may serve to inform intervention efforts to promote physical activity in ASP. [ABSTRACT FROM AUTHOR]

Background: Children in residential children's homes (RCH) may be at increased risk for physical inactivity due to decreased access to opportunities for activity. Little is known about environmental determinants of physical activity for children in RCH. Methods: Thirty-minute blocks of MVPA and Total METs were measured using the 3-Day Physical Activity Recall (3DPAR). A staff interview, based on the Structural Ecologic Model of Health Behavior, assessed physical activity opportunities, structures, characteristics, policies, and social environment. Wilcoxon 2-sample tests were used to examine differences in environment by location and presence of a recreation director. Mixed model ANOVAs assessed the differences in child level activity by environmental variables. Results: There were significant correlations between opportunities and characteristics of physical activity, facilities, and equipment with total METS for children. Children in homes with a recreation director and homes in rural locations reported more physical activity. Only rural location had a significant effect on physical activity. Presence of a recreation director was significant in several models. Conclusions: Rural location may be conducive for increased physical activity in children at RCH. Employing a recreation director or other trained personnel may be an important policy determinant of physical activity for children. [ABSTRACT FROM AUTHOR]

Background: To assess from a societal perspective the cost-effectiveness of a school program to increase active transport in 10- to 11-year-old Australian children as an obesity prevention measure. Methods: The TravelSMART Schools Curriculum program was modeled nationally for 2001 in terms of its impact on Body Mass Index (BMI) and Disability-Adjusted Life Years (DALYs) measured against current practice. Cost offsets and DALY benefits were modeled until the eligible cohort reached age 100 or died. The intervention was qualitatively assessed against second stage filter criteria ('equity,' 'strength of evidence,' 'acceptability to stakeholders,' 'feasibility of implementation,' 'sustainability,' and 'side-effects') given their potential impact on funding decisions. Results: The modeled intervention reached 267,700 children and cost $AUD13.3M (95% uncertainty interval [UI] $6.9M; $22.8M) per year. It resulted in an incremental saving of 890 (95%UI -540; 2,900) BMI units, which translated to 95 (95% UI -40; 230) DALYs and a net cost per DALY saved of $AUD117,000 (95% UI dominated; $1.06M). Conclusions: The intervention was not cost-effective as an obesity prevention measure under base-run modeling assumptions. The attribution of some costs to nonobesity objectives would be justified given the program's multiple benefits. Cost-effectiveness would be further improved by considering the wider school community impacts. [ABSTRACT FROM AUTHOR]

Background: Most youth are not meeting physical activity guidelines, and schools are a key venue for providing physical activity. School districts can provide physical activity opportunities through the adoption, implementation, monitoring, and evaluation of policies. This paper reports results of a 2009 survey of California school governance leaders on the barriers and opportunities to providing school-based physical activity and strategies to promote adoption of evidence-based policies. Methods: California school board members (n = 339) completed an 83 item online survey about policy options, perceptions, and barriers to improving physical activity in schools. Results: Board members' highest rated barriers to providing physical activity were budget concerns, limited time in a school day, and competing priorities. The key policy opportunities to increase physical activity were improving the quantity and quality of physical education, integrating physical activity throughout the school day, supporting active transportation to/from school, providing access to physical activity facilities during nonschool hours, and integrating physical activity into before/after school programs. Conclusions: Survey findings were used to develop policy resources and trainings for school governance leaders that provide a comprehensive approach to improving physical activity in schools. [ABSTRACT FROM AUTHOR]

Background: This paper evaluates the impact of a large-scale, community agency-driven initiative to increase physical activity (PA) in after-school programs in Ontario. In 2008, the YMCA and Boys and Girls Club (BGC) introduced CATCH Kids Club (CKC) into 330 after-school program sites. Methods: This study assessed the impact of the intervention on the quality and quantity of PA using a pretest/posttest quasi-experimental research design with a comparison non-CKC group. Data were collected at baseline (September 2008) and postintervention (May/June 2009) using the System for Observing Fitness Instruction Time (SOFIT). Results: Nearly all sites, with the exception of the BGC baseline program (a sports program) achieved greater than 50% of time spent in MVPA. Significant differences were not found between levels of MVPA at CKC and comparison sites (59.3% vs. 64.2%), or at CKC sites at baseline versus postintervention (59.3% vs. 52.1%). BGC sites had significantly higher levels MVPA in CKC programs than in sports programs (70.8% vs. 35.2%). In postimplementation interviews, leaders reported general support but some mixed reactions related to how the program was received by participants. Conclusions: This paper offers support for PA programs that focus on inclusivity and enjoyment and emphasize the important role of staff competency. [ABSTRACT FROM AUTHOR]

Background: Evidence-based physical education (EBPE) programs have increased physical activity (PA) by as much as 18%, yet widespread adoption has not occurred. Understanding school facilitators and barriers to PE should prove useful to EBPE dissemination efforts. Methods: Pairs of principals and PE teachers from 154 schools (75 Adopters and 79 Non-Adopters) from 34 states completed questionnaires. Differences between Adopter and Non-Adopter schools were tested using t tests or Wilcoxon Signed Rank Tests and chi-square analyses. Results: Principals and teachers reported distinct PE curriculum adoption decision making roles, but few viewed themselves as very involved in program evaluation. Teachers in Adopter schools were more satisfied with PE program outcomes and had greater involvement in teacher evaluation and program decision making. Compared with teachers, principals were generally more satisfied with their school's PE program outcomes and did not share the same perceptions of PE barriers. However, principals also demonstrated a general lack of PE program familiarity. Conclusions: To facilitate EBPE adoption, dissemination efforts should target both principals and PE teachers. Increasing principal's knowledge may be instrumental in addressing some teacher perceptions of barriers to PE. Strategic advocacy efforts, including targeting policies that require PE program evaluation, are needed. [ABSTRACT FROM AUTHOR]

The study aim was to evaluate the effectiveness of a 2-year health-related physical education intervention in a pretest-posttest design. Sixteen elementary schools (764 pupils, mean age: 11.2 ± 0.7) participated in the study. Schools were randomly assigned to the intervention condition (n = 8) and the control condition (n = 8). Making use of direct observation data gathered according to SOFIT (System for Observing Fitness Instruction Time), the moderate-to-vigorous physical activity engagement during physical education classes was significantly higher in the intervention condition than in the control condition. Children's moderate-to-vigorous physical activity engagement during physical education lessons increased with 14% in the intervention condition (from 42 to 56%). No significant effects were found on the accelerometer data. The health-related physical education intervention was found to be promising in promoting physical activity during physical education classes. [ABSTRACT FROM AUTHOR]

In the context of rising screen time, only a third of Canadian children are achieving adequate amounts of active play, an important source of physical activity. ParticipACTION, a national not-for-profit organization, created the "Make Room for Play" campaign targeting parents with television advertisements depicting how screen time takes away from active play. The advertisements featured children engaging in active play (e.g., jump rope) while a black screen progressively sequesters the room for them to play. This study's purpose was to evaluate the campaign using the hierarchy of effects model, a framework for conceptualizing the impact of mass media campaigns. It was hypothesized that recall would relate to intermediate (e.g., cognitions, self-efficacy) and distal (e.g., parental support) factors. Twenty-six percent of the general population and caregiver samples surveyed (N = 1576) recalled (unaided) the advertisement and 45.9% recalled when prompted. Parental support was significantly higher in those recalling the campaign, p = .009. Twenty-four percent of parents reporting unaided recall (versus 14.0% of those not) tried to engage in active play with their children and 21.2% (versus 12.0%) tried to create opportunities for children to engage in play. Strengths and limitations of mass media approaches targeting active play and screen time are discussed. [ABSTRACT FROM AUTHOR]

Abstract Objective Evaluate whether participation in Choose Health: Food, Fun, and Fitness (CHFFF), a hands-on, experiential curriculum aimed at third- to sixth-graders, resulted in improvements in the targeted obesity and chronic disease prevention behaviors. Methods The researchers evaluated CHFFF in low-income youth participating in 2 federal programs in New York State during 2013–2015. Food and activity behaviors were assessed using the Expanded Food and Nutrition Education Program third- through fifth- and sixth- through eighth-grade pre-post surveys, along with 2 sets of added CHFFF-specific items completed by subsamples. Educators trained in CHFFF had youth complete the surveys as they delivered the curriculum, primarily in schools and after-school programs. Results Paired t tests showed significant (P <.01) positive changes before to after CHFFF education for consumption of vegetables, fruits, sweetened drinks, nutrition label reading, and other food and activity behaviors. Conclusions and Implications Results provide practice-based evidence that CHFFF promotes positive behavior change in participating youth. [ABSTRACT FROM AUTHOR]

To develop and test the feasibility of a mobile health (mHealth) intervention with parents to improve preschooler's eating and physical activity behaviors. Previously tested content from an in-person parent intervention, HEROs (HEalthy EnviROnments), is being developed and assessed in digital formats utilizing a user-centered design process. The intervention focuses on healthy eating (picky eating), physical activity (active play), and optimizing the home environment. Each topic includes theory-based modules and strategies for parents to engage with their child(ren). An explanatory, sequential mixed methods approach was implemented to examine mobile device use, appeal for a digital program, and digital literacy of parents of preschoolers. Participants were recruited from rural Head Start centers in NY (n = 5) and CO (n = 5) via electronic flyers. A Qualtrics survey (33 items) was completed by 116 respondents with 16 of those completing a semi-structed, virtual (Zoom) interview (12 questions with probes). Respondents primarily use smartphones (63%) to access the internet, have a moderately high level of digital literacy (χ=29.8 + 5.9; possible score 8-40); and half (49%) preferred a digital program compared to in-person (16%) or a hybrid delivery (34%). Parents expressed varied preference and reasoning for information delivery modalities (eg, video, audio, text). The most feasible time for digital program engagement was described as when they had uninterrupted time (eg, child at school or after bedtime). Features that provided choice, opportunities to connect with other parents, and were interactive were favored. Findings informed the development of interactive wireframe illustrations. Multiple phases of wireframe testing will occur using user-centered methods to test functionality and usability (technical aspects), content (information delivery), and user experience (sensory, cognitive and emotional experiences) with potential users. Collectively, these findings will inform the development of the HEROs mHealth intervention, including mobile app prototype development and testing. 2021-68015-34557 This work is supported by the USDA National Institute of Food and Agriculture. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effectiveness of a pilot study of a parental school-based intervention to promote healthy eating behaviours in young children.Design: A quasi-experimental longitudinal design with three conditions (complete intervention (CIG), minimal intervention (MIG), control (CG)), with repeated measures at baseline, immediately after the intervention, 6 months and 1 year after intervention.Setting: Fourteen public and state-funded kindergartens near Lisbon, Portugal.Subjects: Parents (n 349) of 3- to 6-year-old children assigned to the three conditions completed the baseline protocol. The 'Red Apple' intervention included four parental group sessions about young children's growth, nutritional guidelines and positive parental feeding strategies, which was combined with adult-child activities at home and in the classroom, and newsletters (CIG). MIG included only a single nutritional counselling session, whereas the CG had no intervention. At the end, thirty-eight, twenty-six and fifty-four parents in the CIG, MIG and CG, respectively, had completed all evaluation components. Data regarding parental perception of children's weight, self-efficacy, nutritional knowledge, feeding strategies, eating behaviours and BMI were collected at the four assessment moments.Results: The CIG showed improvements in children's healthy food intake, compared with the MIG and CG. Parental self-efficacy regarding the regulation of children's eating behaviours decreased in the CG but not in both intervention groups.Conclusions: Considering the low dosage of the intervention, the results obtained were positive. Future studies should offer additional solutions to overcome barriers to parents' participation. [ABSTRACT FROM AUTHOR]

Background: Children's overweight and obesity have increased in Western societies, including Israel. Childhood is an important time for shaping healthy habits. Purpose: The purpose of this study was to evaluate the effectiveness of a healthy lifestyle intervention on health knowledge, behavior, and anthropometric measurements. Methods: A total of 396 fifth- and sixth-grade children, from 2 religious and 2 secular schools, participated in a nonrandomized controlled trial during the 2011-2012 school year. Intervention group were given an extensive educational program focusing on eating habits and physical activity. Results: Overweight and obesity decreased significantly within the intervention group (from 25% to 17.9%, P = .04), without a significant change in the control group (from 20.5% to 17.6%, P = .12). Religious children had double the risk of being overweight or obese (odds ratio [OR] = 2.10; 95% confidence interval [CI], 1.15-3.73; P = .02). Knowledge was improved in both study groups (P < .01), with no difference in health behavior scores at the beginning (P = .59) or end (P = .36) of the year. Discussion: Health Education during fifth and sixth grades improved children's weight and health knowledge but not healthy behavior. Translation to Health Education Practice: School-based healthy lifestyle educational programs are important for primary prevention and weight management. [ABSTRACT FROM AUTHOR]

Purpose Parent-focused interventions (PFIs) are a promising method for supporting parents and promoting children’s well-being. Few PFIs in the USA, however, include physical health promotion content and are universal programs. The purpose of this paper is to describe a universal health-promoting PFI for parents of elementary school-aged children and demonstrate proof of concept.Design/methodology/approach The program emphasizes positive parenting practices, stress management skills and physical health promotion strategies and recommendations, and is part of a larger initiative that includes a continuum of universal, developmentally appropriate, health-promoting PFIs for civilian and military parents. The program was implemented at two community sites in rural Pennsylvania with 20 civilian parents completing pretests and posttests. Study measures assessed parenting, stress and stress management and physical health promotion related outcomes.Findings Parents reported decreases in suboptimal discipline and feeding practices, stress and child internalizing behavior. They also reported increases in their sense of control in managing child behavior, coping socialization, child’s outdoor playtime and health recommendations met.Research limitations/implications While these preliminary findings may not be generalizable, they serve as proof of concept, which suggests that more rigorous research on the program is warranted.Practical implications Implementing a universal, health-promoting PFI within the USA is viable and has the potential to impact multiple short-term outcomes.Originality/value Parents are among their child’s earliest and most influential educators, and this study lends further support to their role as health educators. Given the significant public health benefits of holistically promoting child health, the time has come for universal PFIs to begin including physical health promotion content. [ABSTRACT FROM AUTHOR]

Childhood obesity is an epidemic, resulting in physiological and psychological infirmities. Primary care providers (PCPs) can engage in preventing obesity by instilling positive healthy behaviors early in children's lives. Providing support and evidencebased interventions can enable children to avoid co-morbidities of obesity, such as diabetes, cardiovascular disease, and depression. Relevant literature was retrieved from The Cochrane Library, CINAHL, PubMed, Medline, Sport Discus, and Health Source Nursing Academic Edition from January 2012 through February 2017 by using key words "child obesity," "physical activity," "diet," and "body mass index." Four studies are reviewed: 1) a randomized control trial on the effects of a 10-week FATmax exercise training of obese 8- to 10-year-old boys, 2) a cross-sectional study on the correlation of physical activities and sedentary behavior to body mass index (BMI) and obesity rates among 6,539 children 9 to 11 years of age, 3) a randomized study on the effects of a walking program on the BMI of children ages 6 to 11 years, and 4) a systematic review on the efficacy of school-based dietary behavior and physical activity in children and adolescents ages 6 to 18 years. Outcomes from all four studies revealed a reduction in obesity when adequate physical activity and balanced meals were incorporated during childhood. Integrating evidence-based findings into practice can foster health and wellness of children, and reduce unnecessary healthcare costs attributed to obesity. [ABSTRACT FROM AUTHOR]

The emphasis on childhood obesity reduction has been attributed to the dominant obesity discourse. However, some researchers argue that this discourse may be ineffective and even harmful for children. From a post-structuralist perspective, the dominant obesity discourse has the power to shape children's subjectivities, though subjectivities may also be influenced by personal experiences and other knowledge about bodies and health. There is limited research which explores how children's conceptualizations of health are informed by the dominant obesity discourse. To address this knowledge gap, qualitative data were collected from 8- to 11-year- old children (n = 29) regarding their conceptualizations of health, healthy bodies, and health practices. Results suggest that children's conceptualizations reflected arguments embedded within the dominant obesity discourse, but at times, also contradicted or deviated from it. Study findings can be applied toward children's health promotion programming to offer a more holistic and inclusive perspective on health and well-being. [ABSTRACT FROM AUTHOR]

Objective This study explored whether a cartoon show with healthy eating messages positively affected children's food choices and food preferences. Design Experimental between-subjects design. Setting Four elementary schools in Portugal were investigated. Participants Children (aged 4–8 years; n = 142) were randomly assigned to 1 of 2 groups: a comparison group (n = 73) was exposed to cartoons with no reference to food and an intervention group (n = 69) was exposed to cartoons with healthy eating messages. After viewing, each child was given the opportunity to eat ad libitum for 10 minutes from a small selection of snack foods. Main Outcome Measure Number of healthy and unhealthy food items chosen. Food preferences were measured using an adapted version of the Leeds Food Preference Checklist. Analysis Generalized linear models were used to test for differences between groups. Results were considered significant at P  ≤ .05. Results Children in the experimental group chose significantly more healthy food items than did those in the comparison group (B = –.600; SE = .19; P  < .05). Conclusions and Implications Future studies may address the effect of prolonged exposure to healthy eating cartoons. Cartoons can be used to promote healthy food choices and can be a part of health promotion campaigns. [ABSTRACT FROM AUTHOR]

Obesity prevention in youth is a health priority, and teaching healthy habits toward this end is one of a school nurse’s many responsibilities. A school nurse developed and implemented a school-wide, 2-week-long Activity and Nutrition Challenge (ANC) using the evidence-based 5-2-1-0 initiative to prevent and fight childhood obesity. Despite minimal promotion, nearly half of the students at two elementary schools participated and earned points by following the guidelines in the ANC. The amount of chocolate milk consumed by students dropped significantly during the ANC, showing that the healthy behavior of choosing beverages without added sugar had been positively impacted. Anecdotal evidence suggested positive changes in other healthy behaviors as well. This ANC was a new way for a school nurse to teach healthy habits to a large group of children in a short period of time, with limited extra work, and with promising results. [ABSTRACT FROM AUTHOR]

Analyzing children's conceptualizations of health and body and health literacy will significantly add understanding to how problematic health attitudes and behaviors may take root (Driessnack, Chung, Perkhounkova, & Hein, 2014). The knowledge gained from such an assessment can be applied towards communication contexts that aim to promote children's health literacy and their well-being. With increased health literacy, children can actively participate in decision-making regarding their own health and can understand why healthy behaviors are important to adult health (Borzekowski, 2009). The purpose of this exploratory study was to examine the understudied intersection between health literacy and health conceptualizations in children in order to elaborate on health literacy theory. Specifically, the findings contribute to health communication between children and their caregivers, and between children and health care providers. Qualitative, in depth interviews were conducted with elementary school children. The significance of the study is its contribution to health communication for children, where interventions can consider health literacy types and levels before addressing children's health outcomes. Findings show how we can understand children's conceptualizations and can address health literacy skills inside and out of the classroom in ways that resonate with children. [ABSTRACT FROM AUTHOR]

Abstract: In this study, we investigated the ecological factors that influence health‐promoting behaviors in children from low‐income families in South Korea using a descriptive correlational design. The participants included 297 elementary school students who used community childcare centers, 297 caregivers, and 68 teachers at the centers. Data were collected using a structured self‐report survey, and were subjected to a multi‐level regression analysis. The factors influencing the health‐promoting behaviors of children were as follows: self‐efficacy and self‐regulation as intrapersonal factors; caregivers’ parenting behavior and peer relationships as interpersonal factors; and the number of months since the centers’ establishment, teachers workloads, and centers’ perceived environments as institutional factors. The findings emphasize the need to create a healthy environment to promote the health of children from vulnerable groups, and that community‐based participatory research might be an effective strategy to address these environmental problems, and ultimately help reduce health disparities between children. [ABSTRACT FROM AUTHOR]

Context: Consumption of sugar-sweetened beverages (SSBs) among children has been associated with adverse health outcomes. Numerous behavioral interventions aimed at reducing the intake of SSBs among children have been reported, yet evidence of their effectiveness is lacking. Objective: This systematic review explored the effectiveness of educational and behavioral interventions to reduce SSB intake and to influence health outcomes among children aged 4 to 16 years. Data Sources: Seven databases were searched for randomized controlled trials published prior to September 2016. Studies identified were screened for eligibility. Study Selection: Trials were included in the review if they met the PICOS (Population, Intervention, Comparison, Outcome, and Study design) criteria for inclusion of studies. Data Extraction: Data were extracted by 2 reviewers following Cochrane guidelines and using Review Manager software. Results: Of the 16 trials included, 12 were school based and 4 were community or home based. Only 3 trials provided data that could be pooled into a meta-analysis for evaluating change in SSB intake. Subgroup analyses showed a trend toward a significant reduction in SSB intake in participants in school-based interventions compared with control groups. Change in body mass index z scores was not statistically significant between groups. Conclusions: The quality of evidence from included trials was considered moderate, and the effectiveness of educational and behavioral interventions in reducing SSB intake was modest. [ABSTRACT FROM AUTHOR]

Introduction: Enteroparasitosis has been causing serious problems of public health globally, especially in developing countries. Even with the general population reportedly having knowledge about intestinal parasites, studies indicate that they do not know how to identify the verminoses. Objective: To elaborate, implement, and evaluate an educational program on intestinal parasites in a public school in Ribeirão Preto - SP. Materials and Methods: Quase-experimental, non-randomized study conducted with 56 students from the first to the fourth grades of elementary education. In order to evaluate the students' knowledge before and after the educational intervention, a semi-structured questionnaire was applied (pre- and post-test). Results: Changes were evidenced in the students' responses to hygiene habits, especially in questions about how worms feed (p = 0.008); or what not to do to avoid contamination with worms (p = 0.05); what is the form of the worms when ingested (p = 0.001); which organs the worms enter (p = 0.001). Thus, it was evident that this type of educational activity was efficient to help in the learning by elementary school students. Discussion: After the educational activity, growth was noted in the correct answers for most of the questions, however, difficulties persisted in understanding about the symptoms, the cycle, and which organisms are worms. Conclusions: It is hoped that this work will encourage health and education professionals to include health educational practices in the school context. [ABSTRACT FROM AUTHOR]