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Purpose: The purposes of the current study were to identify risk profiles for nonadherence among children and youth (5–17 y) at the 6-month mark of the COVID-19 pandemic and to discuss similarities and differences between risk profiles identified in the current study and those identified at the 1-month mark of the pandemic. Methods: Data were part of a nationally representative sample of 1143 parents (Mage = 43.07 y, SD = 8.16) of children and youth (5–17 y) living in Canada. Survey data were collected in October 2020. Results: Results showed that 3.8% met all movement behavior recommendations, 16.2% met the physical activity recommendation, 27% met the screen time recommendation, and 63.8% met the sleep recommendation. Characteristics associated with nonadherence to all movement behaviors included low parental perceived capability to restrict screen time and decreased overall time spent outdoors. Characteristics associated with nonadherence to the physical activity and screen time recommendations included youth (12–17 y), low parental perceived capability to restrict screen time, decreased time spent outdoors, and increased screen time. Conclusion: Results emphasized the importance of parental perceived capability to restrict screen time and children's and youth's outdoor time and showed that pandemic-related factors have impacted children and youth differently. [ABSTRACT FROM AUTHOR]

For the first time, data on children and adolescents with disabilities in Ireland are reported based on the Active Healthy Kids Global Alliance Para Report Card methodology. The most recent data from the last 10 years were used in the grading process (A+ to F), and indicators with insufficient data were graded as incomplete. Of the 10 indicators from the Global Matrix Para Report Cards, grades were assigned to Overall Physical Activity (F), Organized Sport (D), Active Transport (D−), Sedentary Behaviors (D−), Family & Peers (C), School (C−), Community & Environment (B−), and Government (B). Irish disability sport organizations were invited to assess the research-led audit and provided commentary around the final grading. The contextual discussion of the grades is presented through the lens of strengths, weaknesses, opportunities, and threats with the purpose being to provide direction for the reduction of physical activity disparities among children with disabilities. [ABSTRACT FROM AUTHOR]

Introduction: Effective public health interventions targeting factors that influence physical activity are urgently needed to reduce the age-related decline in physical activity in youth. The purpose of this study was to identify associations between physical activity and a set of potential influences on physical activity in children as they transition from elementary to high school. Methods: Participants were 951 children from South Carolina school districts who completed outcome and independent variable measures on at least two time points from the 5th to 11th grades in 2010-2017. The primary outcome variable was physical activity, measured by accelerometry. Independent variables included a comprehensive set of variables in the child, parent/home, school, and community domains. Children, parents and school administrators, and staff completed questionnaires to assess psychosocial and home, school, and neighborhood environmental influences. Growth curve analyses identified independent variables associated with physical activity over time, either as a main effect or as an interaction with age. Results: As main effects, self-efficacy, self-schema, sport participation, weekday outdoor hours, importance of child participating in sports and physical activity, safe to play outside, and Physical Activity Resource Assessment weighted score were positively associated with physical activity. The associations between physical activity and enjoyment motivation, appearance motivation, weekend outdoor time, and home equipment exhibited significant interactions with age. Enjoyment motivation influenced physical activity during the earlier years, whereas the remaining three variables influenced physical activity in the later years. Conclusions: Interventions should target multiple domains of influences that may vary by age. [ABSTRACT FROM AUTHOR]

The primary objective of this study was to develop and validate a Social Cognitive Theory-based instrument to identify psychosocial factors that influence diet and physical activity among Chinese children aged 10–12 years. This is a cross-sectional study, with data collected from questionnaires. Two elementary schools in Beijing, China. Fourth to sixth-grade students (N = 1,486) aged 10–12 years were recruited. Gender, height, weight, nation, and grade were collected. Energy-balanced eating behaviors and their related sociopsychological factors were surveyed. Confirmatory factor analysis, Pearson correlations, Cronbach α index, and mediation analysis were used. (1) Confirmatory factor analysis revealed a 6-factor solution (51 items) and all factor loadings > 0.32, indicating that the model fitness was acceptable. (2) All correlation coefficients are statistically significant. All of the Cronbach α indexes were > 0.65, indicating acceptable reliability. (3) The mediating effect of goal intention and outcome expectations between self-efficacy and habit strength was statistically significant (P < 0.01), verifying the theory structure. This questionnaire exhibits good internal consistency, reliability, and structural validity. It can be effectively employed to investigate energy-balanced eating behaviors related to the Social Cognitive Theory in Chinese children. [ABSTRACT FROM AUTHOR]

Objective: To analyze the co‐existing patterns of health‐related behaviors among children and adolescents at different education stages and the association with obesity. Design: Cross‐sectional study. Sample: A total of 5651 primary and secondary school students were drawn from the National Student Physical Health Survey in 2014 with an average age of 13.53 ± 2.87 years. Measurements: Physical measurements and questionnaires were completed, which concluded height, weight, and health‐related behaviors (sleep, physical activity, dietary, and screen behavior et al.). Latent profile analysis (LPA) was conducted using Mplus 8.3 and SPSS 26.0 was used for other statistical analysis. Results: Three latent classes of health‐related behaviors were fitted for each of the education stages. After adjustment for age, gender, and region, the high‐screen behavior group were 2.217 (95%CI = 1.030–4.772, p =.042) times more likely to be obesity than the health‐behavior group in primary school, and the poor‐diet group and poor‐diet and high‐screen behavior group were 2.101 (95%CI = 1.396–3.396, p <.001) and 1.788 (95%CI = 1.003–3.190, p =.049) times more likely to be overweight than the health‐behavior group in junior middle school respectively. Conclusion: Obesity is mainly influenced by screen behavior and dietary patterns among children and adolescents. Health‐related behavior patterns should be accurately identified and comprehensive joint interventions should be carried out to prevent obesity. [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]

Background: Children with visual impairment (VI) tend to maintain the insufficient physical activity (PA) engagement and excessive sedentary behavior (SB) that could elevate health risks of various domains. Anxiety have been shown to correlate with PA and SB in general population, whereas the longitudinal or temporal relationships between PA, SB, and anxiety have yet to be examined in children with VI. Therefore, the primary purpose of this study is to investigate the bidirectional relationships between these variables over time. Methods: 72 Chinese children with VI (mean age = 14.65 ± 3.34 years) recruited from a special school for individuals with VI participated in this study. Moderate-to-vigorous physical activity (MVPA) and SB were assessed using ActiGraph GT3x + accelerometers across seven consecutive days. Anxiety was assessed by a self-reported questionnaire. Cross-lagged panel models were employed to examine the potential bidirectional relationships between PA, SB, and anxiety at baseline (T1) and 12-week follow-up (T2). Results: T1 anxiety significantly predicted T2 MVPA only in children with low vision (β= -0.30, p = 0.01). In additional, children with blindness showed a cross-lagged effect of T1 MVPA on T2 anxiety (β=-0.29, p = 0.02). Lastly, anxiety significantly predicted T2 SB in the total sample (β = 0.21, p = 0.04) and children with low vision (β = 0.42, p < 0.01). Conclusion: The relationships between PA, SB and anxiety were not bidirectional in children with VI. It is suggested that higher anxiety predicted less PA and more SB in children with low vision. [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]

Introduction: Children aged two to five years old are influenced by the behaviors of their guardians and Early Care Education (ECE) teachers. This study aims to determine the relationship between adults' and children's health behaviors in home and ECE settings. This study is novel in examining this correlation between multiple environments. Method: Surveys were conducted across 32 ECE centers. Guardians and teachers reported on their and their children's health behaviors within the home and ECE. Matched child-adult responses (n = 1,140) were analyzed from a representative sample of 32 ECE centers throughout Georgia. Frequency of consumption of fruits, vegetables, and water, as well as frequency of physical activity were measured. Spearman rho correlations were analyzed using SPSS software, with p < 0.05 indicating significance. Results: Spearman rho correlations indicated significant positive correlations between guardian and child behavior (rho = 0.49 to 0.70, p < 0.001) for all data. Teacher and child correlations were inconsistently significant across categories (rho = -0.11 to 0.17, p < 0.001). Discussion: The influence of guardian behavior modeling on child health outcomes is critical for improving ECE programming and child obesity outcomes. This research can be used to inform future health interventions for young children. Significance: Children's behaviors are influenced by the behaviors of guardians in their life. Childhood obesity rates are increasing in the United States, and increased physical activity and improved dietary practices are key methods to prevent obesity. This study assessed the degree to which children's health behaviors model those of their guardians and teachers. Children's health behavior practices were significantly correlated with the practices of their guardians but not with teachers, indicating home-based health promotions can have positive impacts on both adults and children. [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]

Background: Effective physical activity interventions are needed for children because health behaviors track into adulthood, and risk factors for diseases begin early in life. No study has determined whether an intervention designed using a Community-Based Participatory Research approach can improve moderate to vigorous physical activity (MVPA) and the related psychosocial constructs in underserved children. This study determined whether improvements in MVPA and related psychosocial constructs (self-efficacy, knowledge, beliefs, attitudes, and skills) occurred following a Community-Based Participatory Research intervention in underserved, rural children. It was then determined if these constructs were mediators of MVPA. Methods: Two fifth-grade classes at a school (n = 19 and n = 20) were randomly assigned to an intervention or comparison group. The intervention group participated in a 4-week intervention designed to improve MVPA (wGT3X-BT accelerometer; ActiGraph, Pensacola, FL) and the related psychosocial constructs (written survey). Groups were assessed prior to and immediately following the intervention. Results: There were no differences at baseline between groups. MVPA (30.0 [4.4] min), knowledge, and skill scores were significantly higher in the intervention group compared with the comparison group at follow-up (P <.05). Knowledge and skills were mediating variables of MVPA. Conclusions: Priority should be placed on research that determines the sustained impact of similar Community-Based Participatory Research interventions. [ABSTRACT FROM AUTHOR]

Background: The objective was to examine changes of children's time spent in sedentary, light physical activity, moderate to vigorous physical activity (MVPA), and estimated energy expenditure (EE) rates during weekdays and weekends across 3 years. Methods: An initial sample of 261 children's (mean age = 7.81 y) 5-day physical activity and EE were assessed annually via accelerometry across 3 years using repeated-measures multivariate analysis of variance. The outcome variables were time spent in sedentary, light physical activity, MVPA, and kilocalories per day for weekdays and weekends. Results: A significant decrease in MVPA and EE occurred during weekdays across the 3 years (P = .01). Only the second-year data demonstrated an increase (+2.49 min) in weekend MVPA (P = .04). Children's sedentary time during weekdays increased significantly in years 1 and 2 (P = .01), yet significantly decreased in the third year (-44.31 min). Children's sedentary time during weekends significantly decreased in the first year (-27.31 min), but increased in the following 2 years (P = .01). Children's light physical activity demonstrated a statistically significant increase in year 2 (+3.75 min) during weekdays (P = .05). Conclusions: Children's MVPA and EE generally declined during weekdays but were maintained during weekends across a 3-year time span. Children may benefit most from weekday intervention strategies. [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]

One-third of American children are obese (13.7 million children). Although there are programs and strategies to address this issue, there is limited evidence regarding the role teachers and parents play as role models for healthy behaviors among preschool- aged children. This interventional study examined the impact educating parents and teachers as role models had on preschool-aged children's healthy behaviors (eating and physical activity). Parents and teachers in a public preschool in Newark, New Jersey, were invited to attend. Thirty-seven parents, teachers, and teacher aides representing 37 unduplicated children ages 3 to 5 years participated in the study. More than three-quarters of participants (83.8%, n = 31) were parents, and the remainder were teachers or teacher aides (16.2%, n = 6). The program was structured as a weekly 45-minute session over four weeks. Statistically significant results indicated that children's fruit and vegetable consumption increased by three servings from an average of one to five servings a day. Furthermore, the number of days children shared dinner and breakfast with the family increased from an average of two to five days a week, and children reduced eating takeout food by an average two days a week. There was also a 2-hour decline in the time children spent watching TV or playing video games, from slightly above 3.5 hours on average to 1.5 hours after the intervention. This family-centered/school-focused obesity intervention produced significant improvements in healthy behaviors for both adults and children. Educating parents and teachers to serve as role models for preschool children may contribute to decreasing the childhood obesity epidemic in the United States. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to identify clusters of lifestyle behaviours in toddlers and assess associations with socio-demographic characteristics. Methods: We used data from the Dutch National Food Consumption Survey 2012–2016 and included 646 children aged 1–3 years. Based on 24-h dietary recalls and a questionnaire, a two-step cluster analysis was conducted to identify clusters in the intake of fruit, vegetables, sugar-sweetened beverages and unhealthy snacks, physical activity and screen time. Logistic regression models assessed associations between socio-demographic characteristics and cluster allocation. Results: Three clusters emerged from the data. The 'relatively healthy cluster' demonstrated a high intake of fruit and vegetables, low sugar-sweetened beverage and unhealthy snack intake and low screen time. The 'active snacking cluster' was characterised by high unhealthy snack intake and high physical activity, and the 'sedentary sweet beverage cluster' by high intake of sugar-sweetened beverages and high screen time. Children aged 1 year were most likely to be allocated to the 'relatively healthy cluster'. Compared to children of parents with a high education level, children of parents with a low or middle education level were less likely to be in the 'relatively healthy cluster', but more likely to be in the 'sedentary sweet beverage cluster'. Conclusion: Clusters of lifestyle behaviours can be distinguished already in children aged 1–3 years. To promote healthy lifestyle behaviour, efforts may focus on maintaining healthy behaviour in 1-year-olds and more on switching towards healthy behaviour in 2- and 3-year-olds. [ABSTRACT FROM AUTHOR]

Background: Cardiometabolic disease (CMD) risk often begins early in life. Healthy lifestyle behaviors can mitigate risk, but the optimal combination of behaviors has not been determined. This cross-sectional study simultaneously examined the associations between lifestyle factors (fitness, activity behaviors, and dietary patterns) and CMD risk in preadolescent children. Methods: 1480 New Zealand children aged 8–10 years were recruited. Participants included 316 preadolescents (50% female, age: 9.5 ± 1.1 years, BMI: 17.9 ± 3.3 kg/m2). Fitness (cardiorespiratory fitness [CRF], muscular fitness), activity behaviors (physical activity, sedentary, sleep), and dietary patterns were measured. Factor analysis was used to derive a CMD risk score from 13 variables (adiposity, peripheral and central hemodynamics, glycemic control, and blood lipids). Results: Only CRF (β = −0.45, p < 0.001) and sedentary time (β = 0.12, p = 0.019) were associated with the CMD risk score in the adjusted multivariable analysis. CRF was found to be nonlinear (VO2 max ≤ ≈42 mL/kg/min associated with higher CMD risk score), and thus a CRF polynomial term was added, which was also associated (β = 0.19, p < 0.001) with the CMD risk score. Significant associations were not found with sleep or dietary variables. Conclusion: The findings indicate that increasing CRF and decreasing sedentary behavior may be important public health targets in preadolescent children. [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.

The purpose of this study was to compare the degree to which children and adolescents with and without visual impairments (VIs) met national physical activity, screen-time, and sleep guidelines. This observational, cross-sectional analysis of the 2016 National Survey of Children's Health focused on children (age 6–12 yr) and adolescents (age 13–17 yr) with and without VIs. The sample included 241 (weighted n = 472,127) and 17,610 (weighted n = 28,249,833) children, and 255 (weighted n = 505,401) and 17,417 (weighted n = 20,071,557) adolescents with and without VIs, respectively. Chi-square statistics were computed to examine the degree to which participants with and without VIs met health-behavior guidelines. Children (p =.02) with VIs were less likely to meet screen-time guidelines, but adolescents with VIs were not (p =.87). VI status was not associated with the likelihood of meeting physical activity or sleep guidelines (p <.05). Low numbers of children and adolescents with and without VIs meeting health-behavior guidelines warrant targeted interventions aimed at enhancing engagement. [ABSTRACT FROM AUTHOR]

The present study aimed to explore the association between healthy lifestyle pattern and childhood early onset of puberty. Based on a cohort study in Xiamen of China, a total of 1294 children was followed for three and a half years. Children's lifestyles, including dietary behaviour, physical activity, sleep duration, smoking and drinking behaviour and sedentary behaviour, were collected by questionnaires. Healthy lifestyle pattern was determined mainly according to the recommendations by the Dietary Guidelines for Chinese school-age children and Canadian Guidelines for children and youth. The pubertal development was assessed by clinical examination according to Tanner stages. The association between pre-pubertal lifestyle and early onset of puberty was estimated using linear regression and log-binomial regression. We found that children who adhered to a healthy lifestyle had a 0·36-year delay of the age of puberty onset (coef = 0·36, 95 % CI (0·08, 0·65)) and 53 % lower risk of early onset of puberty (risk ratio = 0·47, 95 % CI (0·27, 0·80)), compared with those who had a poor lifestyle. However, the beneficial effect of favourable lifestyles on the early onset of puberty was found only in boys with normal weight. Boys who adhered to active physical activity and low sedentary behaviour had a relatively delayed age of puberty onset (coef = 0·49, 95 % CI (0·26, 0·72)). This is the first time to find that healthy lifestyle pattern was associated with a substantially lower risk of early onset of puberty, especially in boys with normal weight. Advocating an integrated healthy lifestyle is essential for the development of children. [ABSTRACT FROM AUTHOR]

Summary: Background: The complex multifactorial nature of childhood obesity makes community interventions difficult to evaluate using traditional approaches; innovative methods are needed. Objective: To evaluate the impact of various interventions targeting childhood obesity‐related behaviours, and classified as using a micro‐level (e.g., home visitation programs) or macro‐level (e.g., business practices) strategy, on obesity among children enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Methods: We simulated a population of 1500 children enrolled in WIC, with specific diet, physical activity, breastfeeding behaviours and body mass index z‐scores (BMIz), following them from age 2 to 5 years. Results: Combined interventions targeting breastfeeding appeared to be moderately effective, reducing BMIz by 0.03 (95% CI −005, −0.01). Two strategy‐specific interventions, home visitation programs and business practices targeting obesity‐related behaviours, appeared to be moderately effective at reducing BMIz by 0.04 (95% CI −0.06, −0.02) and 0.02 (95% CI −0.04, 0.00), respectively. Contrary to expectation, combining all micro and macro interventions appeared to have no impact or moderately increased the proportion of obesity/overweight among children. Conclusion: Interventions targeting breastfeeding behaviour were most effective when both micro and macro strategies were implemented. Interventions targeting obesity‐related behaviours in general were effective for two strategies, home visitation and business practices. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 pandemic has resulted in substantial disruptions to daily functioning and lifestyle behaviours, with negative health consequences for youth. Parents play a large role in their children's health behaviour; yet changes to parenting behaviours during the pandemic related to food and physical activity remain relatively unexplored. The present study is the first to our knowledge to examine specific changes in American parents' parenting behaviours related to food and physical activity during COVID‐19, and potential correlates of such changes, including perceived stress and decision fatigue. Methods: A total of 140 parents (88.57% female; 88.41% White; 87.59% married; with one to five children) from middle to upper income households completed an online survey assessing demographics, perceived stress (Perceived Stress Scale), decision fatigue (Decision Fatigue Scale) and food and activity parenting behaviour changes during COVID‐19. Results: Overall, a greater proportion of parents engaged primarily in positive (57.14%) than negative (22.86%) parenting practices related to food and physical activity during the pandemic. Moderation analyses showed that the negative relation between perceived stress and positive parental behaviour changes was stronger at higher perceived increases in decision fatigue during the pandemic. Conclusions: In the face of a major public health crisis, adaptive parental responses may emerge, but perceived stress may inhibit such behaviour change. Perceived stress and decision fatigue may represent important explanatory factors in parental health promoting behaviours during times of uncertainty and change. [ABSTRACT FROM AUTHOR]

The Mediterranean diet (MD) is a model of a healthy diet and healthy lifestyle. Adherence to the MD has been correlated with a reduction in many metabolic disorders including cancers. The factors associated with adolescents' adherence to the MD in North Lebanon using the KIDMED index have never been explored. Therefore, we thought to examine these factors amongst a sample of them. A cross-sectional survey was conducted in the city of Tripoli, North Lebanon. A total of 798 adolescents aged 11–18 years were randomly selected to participate in this study. All participants completed a questionnaire assessing adherence to the MD (KIDMED index), physical activity (physical activity questionnaires for older children and adolescents), health-related quality of life (KIDSCREEN-27 index) and sociodemographic characteristics (age, sex, grade level and parents' educational status). Anthropometric measurements, including weight, height and waist circumference, were also collected. Adherence to the MD was good amongst only 13·3 % of the adolescents. The prevalence rate of overweight and obesity was elevated, affecting 36·9 % of the students. Lower adherence to the MD was significantly correlated with skipping meals (P = 0·001). Meanwhile, adolescents who were engaged in a high level of physical activity, those who consumed more meals with their families and those who benefited from better physical well-being had a better diet quality (P < 0·001). Nutrition intervention programmes, as well as public health policies, would be of interest in order to improve diet quality amongst Lebanese adolescents. [ABSTRACT FROM AUTHOR]

Purpose: The consensus is that physical activity (PA) and sedentary behavior (SB) are independent behaviors, but past findings suggest that they may be influenced by common underlying factors. To clarify this issue, we examined associations between enjoyment of PA and participation in both PA and SB in a large sample of 4th- to 12th-grade US youth. Methods: A total of 18,930 students from 187 schools completed the youth activity profile, a self-report 15-item survey that assesses time spent in PA and SB in school and home settings. Two additional items captured enjoyment of PA and physical education. Two-way (gender x enjoyment and grade x enjoyment) mixed analysis of variances were conducted. Results: Pearson correlation results revealed a positive relationship between enjoyment and PA (r = .38, P < .05) and an inverse correlation between enjoyment and SB (r = -.23, P < .05). Statistically significant main effects of enjoyment were found in the 2-way analysis of variance for both PA and SB. The simple main effect from analysis of variance indicated students with high enjoyment of PA reported higher levels of PA and lower levels of SB compared with students reporting moderate or low levels of enjoyment. Conclusion: The results provide new insights related to the relevance of enjoyment as a common underlying variable influencing both PA and SB across gender and grade levels. [ABSTRACT FROM AUTHOR]

Background: Active-6 is exploring how the COVID-19 pandemic has impacted physical activity behaviour among Year 6 children (aged 10–11 years) and their parents in Southwest England. Initial findings from the Active-6 project have shown a 7–8 min decrease in moderate-to-vigorous physical activity and an increase in sedentary behaviour among children following the easing of restrictions in the UK in latter half of 2021. This finding suggests that the pandemic has had a persistent impact on child physical activity behaviour. This paper explored the possible mechanisms behind these changes. Methods: Interviews with parents (n = 21), members of school staff (n = 9) and focus groups with children aged 10–11 years (n = 47) were conducted between August and December 2021 to discuss the impact of the pandemic on child physical activity behaviour. The framework method was used for analysis. Results: Five themes spanning two key stages of the pandemic were described. Three themes related to the period of lockdowns and fluctuating restrictions (March 2020 – April 2021). These included: Theme 1) Lockdown: A short-lived adventure; Theme 2) Access to facilities during restrictions; and Theme 3) The importance of the parent. A further two themes were identified related to the period following the gradual easing of restrictions in April 2021. These included: Theme 4) An overwhelming return to normal; and Theme 5) Reopening fatigue. Conclusions: The analysis suggested that feelings of novelty experienced during the initial stages of lockdown waned as restrictions were prolonged, creating an increasingly challenging period for parents and their children. However, during periods of restrictions, the importance of parental encouragement and access to appropriate facilities in the local and home environment helped facilitate physical activity. Following the easing of COVID-19 restrictions, emotional overwhelm and physical fatigue among children, stemming from a sedentary and socially isolated life in lockdown and other restrictions, were key contributors to the decreased moderate to vigorous physical activity and increased sedentary behaviour that was observed in a related quantitative study. [ABSTRACT FROM AUTHOR]

Children with autism spectrum disorder (ASD) engage in reduced levels of physical activity relative to neurotypical children. Researchers conducted 2 studies to 1) evaluate the influence of the number of physical activity options and effort on choice and 2) develop a token‐based intervention to increase physical activity engagement and evaluate whether the opportunity to access the intervention supported responding similar to physical or sedentary activity alone. Four children with ASD participated. Additional physical activity options alone did not increase physical activity selection, but increased effort reduced selection of sedentary activity. Tokens increased physical activity for 2 participants. A combination of physical and sedentary activities maintained as much as or more responding than either activity in isolation for all participants. Limitations and potential areas of future research on choice and physical activity are discussed. [ABSTRACT FROM AUTHOR]

Summary: Background: Identifying environmental factors that influence health in children are necessary to develop preventive strategies. Objective: To determine the association between the lifestyles of children (i.e., Mediterranean diet (MD), physical activity (PA), fitness and screen time (ST) with abdominal obesity (AO) of preschoolers from three Spanish‐speaking countries (Chile, Colombia and Spain) with different socioeconomic levels and Human Development Index (HDI) indicators. Material and Methods: This cross‐sectional study included 982 schoolchildren (aged 4–6 years; 56.8% girls) from Chile (n = 409), Colombia (n = 281), and Spain (n = 292). Body mass index (BMI), waist circumference (WC), waist‐to‐height ratio (WtHR), adherence to the MD, PA, ST and physical fitness were evaluated. Results: Spanish preschoolers reported a lower WtHR (p < 0.001), greater physical fitness (Z‐score) (p < 0.001) and higher adherence to the MD (p < 0.001) than their Chilean and Colombian peers. In addition, Colombian preschoolers had a better lifestyle (PA + ST) than their Chilean and Spanish peers (p < 0.001). Chilean preschoolers reported a higher prevalence of AO than the Spanish preschoolers (65% vs. 51.9%; p = 0.001). Conclusion: Lifestyle had a significant association with AO among Spanish‐speaking preschool children, with physical fitness especially being a relevant factor regardless of the country of origin. The findings of the current study may support the development of public guidelines focusing on healthy lifestyles in children to create effective plans that contribute to the early treatment of AO in preschool children. [ABSTRACT FROM AUTHOR]

Background: A limitation of accelerometer measures of moderate to vigorous physical activity (MVPA) is nonwear time. Nonwear-time data is typically deleted prior to estimating MVPA. In this study, we used an approach that used sociodemographic, health, and time data to guide the imputation of nonwear-time data. We determined whether imputing nonweartime data influences estimates of MVPA and the association between MVPA, body mass index, and blood pressure. Methods: Seven days of accelerometer data were collected on 332 children aged 10-13 years. MVPA was estimated in a "nonimputed dataset," wherein nonwear-time data were deleted prior to estimating MVPA, and in an "imputed dataset," wherein nonwear-time data were imputed using sociodemographic and health characteristics of participants and time characteristics of the nonwear period prior to estimating MVPA. Results: Nonwear time represented 7% of waking hours. Average MVPA estimates did not differ in the nonimputed and imputed datasets (56.8 vs 58.4 min/d). The strength of the relationship between MVPA and the 2 health outcomes did not differ in the nonimputed and imputed datasets. Conclusions: Studies achieving high accelerometer wear-time compliance can obtain MVPA estimates without substantial bias if they use the traditional approach of deleting nonwear-time data. [ABSTRACT FROM AUTHOR]

Background: The aim of the study was to test the 12-month effects of a multicomponent physical activity (PA) intervention at schoolyards on morning recess PA levels of sixth- and seventh-grade children in primary schools, using accelerometry and additional global positioning system data. Methods: A quasi-experimental study design was used with 20 paired intervention and control schools. Global positioning system confirmatory analyses were applied to validate attendance at schoolyards during recess. Accelerometer data from 376 children from 7 pairs of schools were included in the final analyses. Pooled intervention effectiveness was tested by multilevel linear regression analyses, whereas effectiveness of intervention components was tested by multivariate linear regression analyses. Results: Children exposed to the multicomponent intervention increased their time spent in light PA (+5.9%) during recess. No pooled effects on moderate to vigorous PA were found. In-depth analyses of intervention components showed that physical schoolyard interventions particularly predicted a decrease in time spent in sedentary behavior during recess at follow-up. Intervention intensity and the school's commitment to the project strengthened this effect. Conclusions: The multicomponent schoolyard PA intervention was effective in making children spend a larger proportion of recess time in light PA, which was most likely the result of a shift from sedentary behavior to light PA. [ABSTRACT FROM AUTHOR]

Background: Temperament activity level can serve as a proxy for nondeliberate activity and an important part of overall energy expenditure. However, little is known about any association between temperament activity level and children's levels of moderate- to vigorous-intensity physical activity. We examined whether temperament activity level in young children is associated with moderate- to vigorous-intensity physical activity later in childhood and midadolescence. We also assessed if parenting behaviors moderate any association. Methods: Data were obtained from 799 children and their mothers involved in the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development. Growth curve analyses were used to examine the relationships over time, controlling for child and parent characteristics. Results: High temperament activity level at age 4.5 was associated with higher moderate- to vigorous-intensity physical activity at age 9 (β = 5.15; SE =2.47; P < .001). The association became no longer significant after 10.2 years of age. The association was moderated by parental support for physical activity (β = -2.56; SE = 1.01; P = .01). Conclusions: Low temperament activity level in early childhood was a risk factor for low physical activity in later childhood and adolescence. Parental support for physical activity may be beneficial for children whose temperament activity level is low. [ABSTRACT FROM AUTHOR]

Background: Many mothers and young children are not meeting physical activity guidelines. Parent-child coparticipation in physical activity (ie, shared physical activity) provides opportunities for social modeling and might be associated with child physical activity. There is very little information about shared physical activity using objective measures. Methods: Participants (N = 17 mother-young child dyads) completed a demographic survey and height/weight measurements, and wore a Bluetooth® accelerometer for 1 week. Accelerometers were initialized using the proximity function to yield both individual and proximity [a minute-by-minute log of whether the 2 accelerometers were in-or out-of-range (~50 m or less)] data. Shared physical activity was calculated in MATLAB by overlaying individual and proximity accelerometer data. Results: Mother-child dyads spent approximately 2 hours per day in shared time that was mostly shared sedentary activities. Less than 1% of shared minutes per day were spent in shared moderate to vigorous physical activity. Conclusions: Mothers and young children spent a small portion of their day in shared activities. Most mother-child shared time was spent in sedentary or light activities rather than moderate to vigorous physical activity. This method for objectively measuring shared physical activity provides novel information about the context in which physical activity occurs and could be used to understand patterns of physical activity among other dyads. [ABSTRACT FROM AUTHOR]

Background: Active recreation contributes to child and adolescent physical activity, however, factors affecting uptake are poorly understood at the systems level. The aims of this study were: (1) to use systems analysis methods to understand youth active recreation in Victoria, Australia, (ii) identify potential system leverage points to enhance active recreation, and (iii) explore stakeholder views of systems analysis methods for informing practice and policy decision-making. Methods: Phase 1: Umbrella review of systematic reviews (2013–2018), synthesising evidence for correlates, determinants and intervention evidence for promoting active recreation. Phase 2: Development of three systems models (ActorMap and two ActivMaps), depicting active recreation actors/organisations, correlates, determinants and intervention evidence. Phase 3: Development of causal loop diagrams (CLDs) and identification of leverage points based on the Action Scales Model. Phase 4: Model feedback via stakeholder interviews (n = 23; 16 organisations). Results: From the literature, 93 correlates and determinants, and 49 intervention strategies were associated with child and adolescent active recreation; the majority located at a social or individual level. Ten potential system leverage points were identified in the CLDs, which differed for pre-schoolers versus children and adolescents. Only time outdoors (an event leverage point) emerged for all age groups. Changes to the built and natural environment (i.e., land use planning, urban design) as a complete domain was a key structural leverage point for influencing active recreation in children and adolescents. Subject matter experts and stakeholder interviews identified 125 actors operating across seven hierarchical active recreation system levels in Victoria. Stakeholder interviews identified 12 areas for future consideration and recommendations for practice/policy influence. Conclusions: Our findings underscore the need for dynamic models of system behaviour in active recreation, and to capture stakeholder influence as more than a transactional role in evidence generation and use. Effective responses to youth inactivity require a network of interventions that target specific leverage points across the system. Our models illustrate areas that may have the greatest system-level impact, such as changes to the built and natural environment, and they provide a tool for policy, appraisal, advocacy, and decision-making within and outside of government. [ABSTRACT FROM AUTHOR]

Background: Considering the relevant amount of time spent by children at school, it is essential to ensure that suitable levels of physical activity (PA) are guaranteed. This study aimed to assess possible changes induced in the amount and type of PA performed following the 2 schedules in Italian primary schools, namely regular and full time (30-40 h/week respectively). Methods: A sample of 169 children wore a triaxial accelerometer 24h/day for 7 consecutive days. Raw data were processed to calculate the number of steps, amount and intensity of the PA performed in morning, afternoon and evening time slots. Results: During weekday afternoon times (1:30 to 4:30 PM), children attending the full-time schedule spent significantly less time in sedentary behavior with respect to those who attend the regular time (54.7% vs. 60.0%, P < .001) and more time in moderate-to-vigorous activity (18.0% vs. 15.0%, P = .004). No differences between morning and evening times were found. Conclusions: The structure of the full time schedule, which includes a second recess, promotes higher and more intense levels of PA during the afternoon. Such information represent a useful input in planning differential PA activities for children attending the regular time to achieve similar PA levels for the whole school population. [ABSTRACT FROM AUTHOR]

The introduction of the International Classification of Functioning, Disability and Health has placed emphasis on framing health behavior as a multidimensional construct. In relation to childhood physical activity, this encompasses dimensions of functional performance, activity attendance, and subjective perceptions of involvement and enjoyment within activity settings. Current literature, however, primarily investigates physical activity in terms of performance and activity levels. The resulting misalignment of theory and measurement practice challenges the development of a comprehensive understanding of childhood physical activity behavior. For children with disabilities, who may have nuanced experiences in activity, there may be greater necessity to examine additional dimensions of physical activity (e.g., participation). In an effort to support meaningful interpretations of physical activity behavior measures among children with disabilities, the purposes of this article are to (a) conceptualize childhood physical activity within the International Classification of Functioning, Disability and Health, and (b) provide guidance on aligning measurement tools with physical activity dimensions. [ABSTRACT FROM AUTHOR]

The study aimed to investigate the individual and combined association of health-risk behaviors with mental health among Chinese children. A cross-sectional study was conducted in Wuhan, China, from May to June 2018. Participants self-reported the information on physical activity (PA), screen time (ST), fruit and vegetable (FV) intake, and sleep duration. Mental health, including depression, social anxiety and self-esteem, was assessed using standard questionnaires. A total of 1296 children (704 males and 592 females) aged 9.2 ± 0.4 years were included in the present study. The prevalence of low PA, high ST, low FV intake, and inadequate sleep duration was 45.6%, 18.0%, 69.7%, and 64.7%, respectively. Overall, significant associations were found between individual health-risk behavior and increased risks of mental health. Furthermore, children with three or four health-risk behaviors showed significantly increased risks of anxiety (OR: 3.18, 95%CI: 1.63–6.21), depression (OR: 4.55, 95%CI: 2.28–9.09) and low self-esteem (OR: 3.59, 95%CI: 2.20–5.88) compared with those without health-risk behavior. Results of this study revealed a high prevalence of health-risk behaviors among Chinese children. Furthermore, the clustering of health-risk behavior was associated with significantly increased risks of mental health in this population. Considering these findings, it is important to perform early interventions to reduce children's health-risk behavior and prevent mental health problems. [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: The home environment is thought to influence children's weight trajectories. However, few studies utilise composite measures of the home environment to examine associations with energy balance behaviours and weight. The present study aimed to adapt and update a comprehensive measure of the obesogenic home environment previously developed for pre-schoolers, and explore associations with school-aged children's energy balance behaviours and weight. Methods: Families from the Gemini cohort (n = 149) completed the Home Environment Interview (HEI) via telephone when their children were 12 years old. The HEI comprises four composite scores: one for each domain (food, activity and media) of the environment, as well as a score for the overall obesogenic home environment. The primary caregiver also reported each child's height and weight (using standard scales and height charts), diet, physical activity and sedentary screen-based behaviours. A test-retest sample (n = 20) of caregivers completed the HEI a second time, 7–14 days after the initial interview, to establish test-retest reliability. Results: Children (n = 298) living in 'higher-risk' home environments (a 1 unit increase in the HEI obesogenic risk score) were less likely to consume fruits (OR; 95% CI = 0.40; 0.26–0.61, p < 0.001), and vegetables (0.30; 0.18–0.52, p < 0.001), and more likely to consume energy-dense snack foods (1.71; 1.08–2.69, p = 0.022), convenience foods (2.58; 1.64–4.05, p < 0.001), and fast foods (3.09; 1.90–5.04, p < 0.001). Children living in more obesogenic home environments also engaged in more screen-time (β (SE) = 4.55 (0.78), p < 0.001), spent more time playing video games (β (SE) = 1.56 (0.43), p < 0.001), and were less physically active (OR; 95% CI = 0.57; 0.40–0.80, p < 0.01). Additionally, there was a positive association between higher-risk overall home environment composite score and higher BMI-SDS (β (SE) = 0.23 (0.09), p < 0.01). This finding was mirrored for the home media composite (β (SE) = 0.12 (0.03), p < 0.001). The individual home food and activity composite scores were not associated with BMI-SDS. Conclusion: Findings reveal associations between the overall obesogenic home environment and dietary intake, activity levels and screen-based sedentary behaviours, as well as BMI in 12 year olds. These findings suggest that the home environment, and in particular the home media environment, may be an important target for obesity prevention strategies. [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]

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]

Our aim in this study was to investigate the relationships between physical activity (PA), pain, and injury among children. Secondarily, we examined whether these relationships differed between children with normal versus excessive weight or obesity. This was a cross-sectional study of 102 children (57 girls) aged 8–12 years old. We assessed the prevalence of moderate and vigorous PA using accelerometry over a seven-day period. We examined the associations between moderate PA, vigorous PA, pain presence, and injury presence using generalized estimating equations with a logit link and binomial distribution. We adjusted the obtained models for potential confounders and explored the moderating effect of weight status. We found no association between moderate PA and pain, but time spent in vigorous PA was associated with pain. Neither moderate or vigorous PA were associated with injury, and there was no moderating effect of weight status in these relationships. In summary, we found that objectively measured vigorous PA is associated with pain among 8–12 year old children. While these results should be replicated in longitudinal studies, they suggest that an association between vigorous PA and pain should be considered when developing PA interventions for children. [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]

Purpose: To investigate the relations between sedentary behaviors and health-related physical fitness and physical activity in middle school boys and girls. Methods: Students (n = 1515) in grades 6-8 completed the Youth Risk Behavior Survey sedentary behavior questions, the FITNESSGRAM physical fitness items, and FITNESSGRAM physical activity self-report questions. Results: When students reported ≤ 2 hours per day of sedentary behaviors, their odds of achieving the FITNESSGRAM Healthy Fitness Zone for aerobic capacity, muscular strength and endurance, flexibility, and body composition increased. Similarly, the odds of achieving physical activity guidelines for children increased when students reported ≤ 2 hours per day of sedentary behaviors. Conclusions: Results illustrate the importance of keeping sedentary behaviors to ≤ 2 hours per day in middle school children, thus increasing the odds that the student will achieve sufficient health-related fitness benefits and be more likely to achieve the national physical activity guidelines. [ABSTRACT FROM AUTHOR]

Background: The wrist has become a standard location for accelerometry (ACC) data collection, primarily to optimize compliance, yet interpretation of wrist ACC data is limited due to a lack of calibration studies. This study aimed to establish cutpoints for a wrist-mounted Actical accelerometer in 6- to 11-year-old children using 2 methods. Methods: Metabolic and ACC data (15-sec epoch) were collected during 8 activities in 22 children ages 6-11. Linear regression (LR) and Receiver Operator Characteristics (ROC) were used to examine the relationship between METs and ACC counts. Cutpoints were established at < 1.5, 1.5-2.99, 3-5.99, and = 6 METs for sedentary, light, moderate, and vigorous activity, respectively. Cutpoints were applied to a large, multiday sample of children (n = 269) to examine differences in cutpoints on minutes of moderate to vigorous PA (MVPA). Results: LR and ROC yielded moderate cutpoints of 574 and 388, respectively. When applied to the large sample, LR and ROC cutpoints resulted in an estimated 83 and 140 minutes of daily MVPA, respectively. Conclusions: This study established wrist-mounted Actical cutpoints for children using 2 methods. The differences in cutpoints and their effect on estimates of MVPA in an independent sample highlight challenges associated with establishing cutpoints, suggesting that standardized calibration procedures be developed. [ABSTRACT FROM AUTHOR]

Background: Research is lacking regarding the eating habits of cartoon characters in relation to their body weight. The present study explored the context of food consumption and the cartoon characters' traits, according to body weight. Studies show that slim cartoon characters are usually considered as attractive; however, little is known regarding the type of messages projected about their physical appearance. Method: One hundred episodes of ten series with high TV audience rates were reviewed. Characters' body weight status was classified into underweight, normal weight, and overweight, and food consumed as processed and less processed. Characters' traits such as physical activity and attractiveness were classified as positive, negative, or neutral. Comments made by the characters themselves regarding their proper physical appearance or the appearance of partner characters were recorded and classified as positive or negative. Results: Results show that characters' body weight was related to both type and quantity of foods consumed, as 58% of the non-core and 48% of all foods were actually eaten by oversized characters. Positive characters' traits, as defined by attractiveness and physical activity engagement, referred consistently to slim characters, with nine out of ten shown as good-looking and physically active. In addition, the majority (51 out of 58) of the positive comments on physical appearance were recorded for slim and attractive characters, either expressed by fellow actors or the characters themselves. Conclusion: Body weight of cartoon characters seems to follow stereotypic perceptions which value slimness and relate unhealthy food consumption with overweight. [ABSTRACT FROM AUTHOR]

Background To identify the patterns of lifestyle behaviours in children aged 3 years, to investigate the parental and child characteristics associated with the lifestyle patterns, and to examine whether the identified lifestyle patterns are associated with child BMI and weight status. Methods Cross-sectional data of 2090 children 3 years old participating in the Dutch BeeBOFT study were used. Child dietary intakes, screen times and physical activity were assessed by parental questionnaire, and child weight and height were measured by trained professionals according to a standardized protocol. Latent class analysis was applied to identify patterns of lifestyle behaviours among children. Results Three subgroups of children with distinct patterns of lifestyle behaviours were identified: the 'unhealthy lifestyle' pattern (36%), the 'low snacking and low screen time' pattern (48%) and the 'active, high fruit and vegetable, high snacking and high screen time' pattern (16%). Children with low maternal educational level, those raised with permissive parenting style (compared those with authoritative parents), and boys were more likely be allocated to the 'unhealthy lifestyle' pattern and the 'active, high fruit and vegetable, high snacking and high screen time' pattern (P  < 0.05). No association was found between the identified lifestyle patterns and child BMI z-score at age 3 years. Conclusions Three different lifestyle patterns were observed among children aged 3 years. Low maternal educational level, permissive parenting style and male gender of the child were associated with having unhealthy lifestyle patterns for the child. [ABSTRACT FROM AUTHOR]

Background: Children's achievement of recommendations for moderate-to-vigorous physical activity (MVPA) in afterschool programs (ASP) is complex. It is unclear what elements of the ASP environment influence children's physical activity (PA). The purpose of this study was to determine the relationship of staff behaviors and ASP features (eg, organized activity, recreational equipment) to MVPA participation in youth attending ASPs. Methods: Data were collected in 12 ASPs in the Midwest. Staff behavior and child PA was measured using the System for Observing Play and Leisure Activity in Youth. The percentage of children's MVPA was examined in relation to staff behaviors and ASP features. Results: Increases in MVPA were observed when staff were directly engaged in PA, verbally promoted MVPA, and when PA was organized and equipment was present. When 3 or more of these characteristics were present, the proportion of children engaged in MVPA increased by 25%-30%. Conversely, MVPA levels decreased when these characteristics were absent and when staff were attending to other ASP duties or were supervising. Conclusion: This study provides evidence about the specific staff behaviors that may influence higher proportions of youth being active during ASP and implies specific skills that need to be incorporated into ASP staff training. [ABSTRACT FROM AUTHOR]

Background: Children in primary school are more physically active in the spring/summer. Little is known about the relative contributions of day length and weather, however, or about the underlying behavioral mediators. Methods: 325 British children aged 8 to 11 wore accelerometers as an objective measure of physical activity, measured in terms of mean activity counts. Children simultaneously completed diaries in which we identified episodes of out-of-home play, structured sports, and active travel. Our main exposure measures were day length, temperature, rainfall, cloud cover, and wind speed. Results: Overall physical activity was higher on long days (≥ 14 hours daylight), but there was no difference between short (< 9.5 hours) and medium days (10.2-12.6 hours). The effect of long day length was largest between 5 PM and 8 PM, and persisted after adjusting for rainfall, cloud cover, and wind. Up to half this effect was explained by a greater duration and intensity of out-of-home play on long days; structured sports and active travel were less affected by day length. Conclusions: At least above a certain threshold, longer afternoon/evening daylight may have a causal role in increasing child physical activity. This strengthens the public health arguments for daylight saving measures such as those recently under consideration in Britain. [ABSTRACT FROM AUTHOR]