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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]

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]

Background: Cognitive development in pre-schoolers through healthy eating and socio-demographic support is crucial for their later lives. We investigated healthy eating encouragement, socio-demographic factors and their association with cognitive development in pre-schoolers. Methods: Quantitative data were collected using a multi-stage random sampling between February and April 2021. Pre-schoolers 36 and 71 months and their primary caregivers were recruited from three local government units of Rupandehi district. We compared healthy eating encouragement, socioeconomic and demographic factors with cognitive development using t-test, one-way analysis of variance and multiple linear regression analysis to identify the predictors of the cognitive development among pre-schoolers. Results: Cognitive development in pre-schoolers is significantly positively associated with age 36-48 months (β = 0.153; 95% CI: 0.12, 13.96), living in a nuclear family (β = 0.121; 95% CI: 0.59, 6.88) and following Buddhism (β = 0.148; 95% CI: 0.88, 14.32). Conversely, children from specific caste/ethnic backgrounds, such as Dalit (β = -0.126; 95% CI: -10.79, -0.68), Janajati (β = -0.237; 95% CI: -6.14, -2.09) and non-Dalit Tarai caste or ethnicity (β = -0.133; 95% CI: -3.46, -0.25) and mothers employed (β = -0.134; 95% CI: -10.62, -1.44) show significantly lower levels of cognitive development. Conclusions: The finding shows that socioeconomic factors have an influence on cognitive development and also stimulate the adoption of healthy eating encouragement practices. [ABSTRACT FROM AUTHOR]

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. Adolescence is a critical phase of development characterized by numerous physical, psychological and social changes. During this stage, individuals may engage in experimentation and risky behavior, leading to increased vulnerability to addiction. This article aims to present the results of a survey based on the HBSC (Health Behavior in School-aged Children) surveillance model in a province of Southern Italy for primary and secondary school students. Methods. We conducted a prospective study from March 2020 to April 2023 through the administration of a questionnaire to students of the healthcare faculties of the University of Messina and primary and secondary school students, composed of 19 items and based on HBSC surveillance. Results. We collected a total of 664 questionnaires. We found that smoking habits increase with age: approximately 31% of secondary school students declare they are real smokers compared to 40% of HCP students. At least once, in the three study groups, students experienced alcohol consumption at different rates, with younger students having a greater propensity to drink than older students. Fortunately, in our sample, no middle school students had tried cannabis. At the same time there is a surprising decrease in gambling in all categories compared to national data. Conclusions. The presence of addictive behaviors in our sample was found to be widespread despite being in line with the national trend. Furthermore, we have observed a reduction in recent years which needs to be investigated to assess the reasons. Primary prevention is probably the main weapon in the hands of politicians and must be applied early in school and community settings to reduce prevalence. [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]

In the current study, experimenters implemented synchronous schedules of reinforcement to increase mask wearing for up to 30 min for six children under the age of 5 years. Additionally, for a subset of children, we evaluated whether mask wearing would continue under baseline conditions in their classroom with staff during 30 min sessions (treatment extension), and later throughout the day (all‐day probes). Results showed the intervention increased mask wearing for all children for up to 30 min. Additionally, treatment‐extension sessions and all‐day probes, conducted with some children, showed mask wearing maintained in their classroom with staff. [ABSTRACT FROM AUTHOR]

School bullying and cyberbullying are serious public health problems that negatively affect the lives of school-aged children. We examined the correlation between risk behaviors and lack of resiliency factors with bullying and cyberbullying across seven Mediterranean countries. The sample consisted of 33,399 adolescents (51.1% girls) aged 11, 13, and 15 years who participated in the Health Behavior in School-aged Children (HBSC) survey in 2018 in Greece, Israel, Italy, Macedonia, Malta, Portugal, and Spain. Bivariate logistic regressions were conducted to test the relationship between risk behaviors, resilience, and bullying. All risk behaviors and lack of resiliency factors examined were related to involvement in bullying as a victim, perpetrator, or bully-victim, both in school and cyberbullying. Moreover, the odds of involvement in school bullying and cyberbullying increased as the number of risk behaviors and the lack of resiliency factors grew. Our results may contribute to the development and implementation of anti-bullying programs. [ABSTRACT FROM AUTHOR]

Background: Although many negative consequences of the COVID-19 pandemic are reported for adults, little is known about its impacts on children, especially in terms of the relative roles of joint and nuclear families. Using a qualitative design, we explored the protective roles of joint and nuclear families in shaping the children's life outcomes during COVID-19. Methods: In a qualitative study, 16 full-time mothers of children aged 9-12 years (8 each from joint and nuclear families) from Sagar City, India were interviewed during June and July 2020. Interview contents were audiotaped, transcribed verbatim, and analyzed using the thematic analysis method. Results: Five major themes were identified, negative impacts of the COVID-19 pandemic, differences in positive engagements, emotional protective benefits, promotion of positive health habits, and routine activity management strategies. The results showed that the joint families availed and utilized more resources to positively engage their children in creativity, studies, exercise, and entertainment during the restrictions of the lockdown compared to the nuclear families. Contrary to the nuclear families, the joint families emphasized resolving emotional grievances, promoting positive emotional engagement, and extending more emotional support to their children. The joint and nuclear families also differed in their children's food habits, health grievances, and physical exercise. Also, the joint families played more positive roles in managing children's play behaviors, sleep habits, television watching, and other children's activities compared to the nuclear families. Conclusion: The distinctive availability of experiential, emotional, relational, and positive value resources and knowledge repertoires of the two family systems may have extended differential protective benefits to their children during the COVID-19 lockdown. [ABSTRACT FROM AUTHOR]

Twice daily parental supervised brushing (PSB) is recommended for the effective oral hygiene of children with toothpaste including fluoride. This cross-sectional study aimed to identify dentist mothers' attitudes, challenges, and facilitators in the oral health promotion of their young children. An online questionnaire was prepared and distributed to dentists via e-mail with a link to the form. Of all the mothers, 46.50% started brushing their children's teeth after the eruption of the first primary teeth. Nearly 50% of the mothers thought that they should brush their children's teeth until at least the age of 7–8 years old. In terms of the main barriers to toothbrushing, 52.9% said children could fall asleep at home or in the car, while 27.5% of all mothers reported being tired as the main barrier to toothbrushing. Although dentist mothers have sufficient knowledge to promote oral and dental health, they do not always have ideal attitudes and behaviors and they may encounter various barriers regarding themselves and their children in practical applications. Providing oral care for young children goes beyond 'knowledge' and is sometimes 'challenging'; however, it could be 'possible' by developing and implementing the most appropriate solution strategies suitable for each unique family and child. [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: Understanding oral health behaviour s and their impact on Oral Health-Related Quality of Life (OHRQoL) may serve as an instrument to articulate the conventional oral health policy framework, thereby ameliorating the overall health of young individuals in the long term. Objective: The aim of this study was to investigate the relationship between children's oral health behaviour s and Oral Health-Related Quality of Life in the capital governorate, Kuwait. Methods: A cross-sectional study involving 607 children aged 12–14 years, randomly selected from schools in Kuwait Capital Region. A validated Oral Health Behaviour s and OHRQoL Child Perception Questionnaires (CPQ12-14) was used to collect the data. Chi-square, t-tests, and ANOVA were used to examine the association between oral behaviour s and children's OHRQoL. Results: About 52.2% of participants were males and the overall response rate was 93.8%. The mean ± SD for total OHRQoL impact was 3.1 ± 0.58, while the total mean for individual domains- for oral symptoms, functional limitations, emotional well-being and social well-being were 2.89 ± 0.63, 2.89 ± 0.72, 3.1 ± 0.91 and 3.4 ± 0.61, respectively. There was no significant difference in total OHRQoL impact score by frequency of last dental visit, flossing, use of mouth rinse or chewing gum (p > 0.05) but for the overall OHRQoL, frequency of soft drink intake was the only significant predictor associated with 0.2-unit decrease (B = -0.207, 95% CI, p = 0.002) in total OHRQoL scores. Conclusions: High frequency of soft drink consumption was related to poorer OHRQoL. Behaviour changing interventions based on OHRQoL inferences coupled with clinical intervention are needed. [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, excessive sedentary time, and lack of sleep time have been independently associated with lower health‐related physical fitness. However, little is known about the combined association between 24‐h movement guidelines (i.e., physical activity, recreational screen time, and sleep duration) and components of physical fitness. Objective: The main aim was to examine the likelihood of having high/very high levels on different components of physical fitness based on meeting with 24‐h movement guidelines. Methods: In this cross‐sectional study, 1276 Spanish youths (13.07 ± 0.86; 55.88% boys), aged 11–16 years, completed self‐reported questionnaires on physical activity, recreational screen time, and sleep duration. Physical fitness components were assessed by 20‐m shuttle‐run test, standing long jump test, handgrip strength test, and 4 × 10‐m shuttle‐run test. Meeting 24‐h movement guidelines was defined as: 9–11 h/day (children aged 5–13) or 8–10 h/day (adolescents aged 14–17) of sleep, ≤2 h/day of recreational screen time and at least 60 min/day of moderate‐to‐vigorous physical activity. The probability of having a high/very high score for each physical fitness components (i.e., ≥60th centile according to the normative cut‐off points for European adolescents) in relation to adherence to 24‐h movement guidelines was analyzed using a series of binary logistic regressions. Results: Participants who met the three 24‐h movement guidelines were more likely to have high/very high for cardiorespiratory fitness (OR = 3.31; 95% CI: 1.79, 6.14; p < 0.001), standing long jump (OR = 1.91; 95% CI: 1.06, 3.45; p = 0.031), muscular fitness (OR = 2.05; 95% CI: 1.09, 3.86; p = 0.048) and physical fitness (OR = 1.99; 95% CI: 1.08, 3.66; p = 0.012), but not for handgrip strength (OR = 1.15; 95% CI: 0.64, 2.01; p = 0.636) and speed/agility (OR = 1.65; 95% CI: 0.92, 2.96; p = 0.093), compared to those who did not meet all three recommendations. Conclusion: Since meeting the three 24‐h movement guidelines increased the likelihood of having higher levels in most physical fitness components, it seems necessary to promote these movement behaviors early in life, as they could serve as a gateway for improving health‐related fitness in future generations. [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]

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]

This research assessed oral health behaviors changes in urban families with young children during the stay-at-home period of the COVID-19 pandemic (Nov 2020–August 2021). Survey data on oral health behaviors were collected in homes at three points before COVID-19, and via phone during COVID-19. A subset of parents and key informants from clinics and social service agencies completed in-depth interviews via video/phone. Of the 387 parents invited, 254 completed surveys in English or Spanish (65.6%) during COVID-19. Fifteen key informant interviews (25 participants) and 21 family interviews were conducted. The mean child age was 4.3 years. Children identified as mainly Hispanic (57%) and Black race (38%). Parents reported increased child tooth brushing frequency during the pandemic. Family interviews highlighted changes in family routines that impacted oral health behaviors and eating patterns, suggesting less optimal brushing and nutrition. This was linked to changed home routines and social presentability. Key informants described major disruptions in oral health services, family fear, and stress. In conclusion, the stay-at-home period of the COVID-19 pandemic was a time of extreme routine change and stress for families. Oral health interventions that target family routines and social presentability are important for families during times of extreme crisis. [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]

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]

Purpose:To examine (1) associations between body fat percent (BF) and lifestyle behaviors in children aged 9–11 years and (2) the consistency of these associations over a 10-year period. Methods: In this repeat, cross-sectional study, 15,977 children aged 9–11 years completed an anthropometric assessment and the SportsLinx Lifestyle survey between 2004 and 2013. Body fat was estimated according to the sum of the triceps and subscapular skinfold measurements. Multilevel models were utilized to examine associations between BF and responses to the lifestyle survey while controlling for known covariates. Results: Lifestyle behaviors explained 8.6% of the total variance in body fat. Specifically, negative associations were found between BF and active transport to school (β = −0.99 [0.19], P <.001), full-fat milk (−0.07 [0.15], P <.001), and sweetened beverage consumption (−0.40 [0.15], P =.007). Relative to the reference group of ≤8:00 PM, later bedtime was positively associated with BF: 8:00 to 8:59 PM (β = 1.60 [0.26], P <.001); 9:00 to 10:00 PM (β = 1.04 [0.24], P <.001); ≥10:00 PM (β = 1.18 [0.30], P <.001). Two-way interactions revealed opposing associations between BF and the consumption of low-calorie beverages for boys (β = 0.95 [0.25], P <.001) and girls (β = −0.85 [0.37], P =.021). There was no significant change in these associations over a 10-year period. Conclusions: In this population-level study covering a decade of data collection, lifestyle behaviors were associated with BF. Policies and interventions targeting population-level behavior change, such as active transport to school, sleep time, and consumption of full-fat milk, may offer an opportunity for improvements in BF. [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]

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]

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]

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 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.

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]

Understanding parental practices and attitudes regarding child sexual abuse (CSA) prevention could be used to improve CSA prevention, but little information is available. In this study, we summarise survey data collected from 248 Australian and UK parents (87% female) with at least one child aged 6-11 years (M = 8.6, SD = 1.8). This is the first study to quantify parental use of protective practices, other than prevention education, which may guard against CSA. Parental media mediation, which may safeguard against online dangers, was another unique focus of this study. Participants reported their discussion of sensitive topics with their children including CSA; behaviors that may reduce the incidence of CSA (e.g., monitoring, supervision, delegation of care and checking-in with the child); mediation of their child's media use; and attitudes towards CSA prevention education. Parents reported discussing sexual abuse less than other sensitive topics such as abduction dangers, drugs, and death but more than issues surrounding puberty, sex and pornography. Parents reported using high levels of protective behaviours, however some areas of concern were revealed. Of concern was the low-moderate level of parental media mediation, with substantial numbers of children potentially exposed to online risks such as using devices unsupervised in bedrooms or chatting to individuals unknown to their parents and not having their devices checked for concerning content. Almost all parents were supportive of CSA prevention education and felt they should provide this education. However, two-thirds of parents thought CSA education may be associated with harms for the child and two-thirds of parents believed children could prevent their own abuse. Reported results will aid in our understanding of which areas of parenting could be strengthened to create safer environments for children. This research has particularly highlighted the need for parents to be more protective around their children's access to online devices. [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]

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]

Background: The focus on school health has moved from the classroom to a more comprehensive approach focusing on students' health behaviours and a supportive school environment in health promotion. As school health policy helps to reduce health risk behaviours, knowledge and perspectives of Teachers in school health are key. Method: An institutional school-based cross-sectional study involving 220 teachers in second-cycle institutions in the Kwadaso Municipal-Ghana from June to August 2022. Data was collected using a structured questionnaire and analysed using STATA version 16, Microsoft Excel, and Jamovi 2.3.12. Descriptive statistics and Chi-square association tests were conducted between the outcome and independent variables. Results: The age range was 24-56 years. Most respondents were first-degree graduates (52.5%). The study found that the school's health program covers all aspects of the health needs of the students (Mean=2.98, SD= 1.34). Also, the school health programs focused on preventive measures (Mean=2.46, SD= 1.081). Again, about 41.63% perceived that they passionately share the view that effective implementation of the health policy in their school is associated with their classroom responsibility (Mean=2.34, SD=0.918). Items such as 'My school has adequate classrooms' (110 [50.2%], Mean=2.33, SD 1.169, 'My school has friendly facilities for People Living with Disability (84[38.0%], mean=2.70 and SD of 1.315) have seen a high agreement. About 44.3% of the respondents believe that the school health program has improved their knowledge. Conclusion: Most teachers had adequate perspective in the school health program due to their high knowledge of school health issues. [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]

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]

Given the importance of adaptive behaviour (AB) for the identification of intellectual disability and the design of intervention plans for people with Down syndrome (DS), this cross-sectional study explored AB in infants with DS, compared to infants with typical development (TD). Method: we evaluated 60 infants (10–36 months) with ABAS-II (32 with DS, 28 with TD). Using the developmental trajectories method for data analysis, we compared AB between the two groups. We found significant differences between groups in most of the skills assessed, in favour of infants with TD. Three different patterns of trajectories were found for the AB and the relation between the groups: (1) no differences (Leisure and Self-Care Skills); (2) differences at the beginning of the trajectory and then a similar slope (Home Living, Self-Direction, Social and Motor Skills); and (3) a similar starting-point with differences in the trajectories (Communication, Community Use, Pre-Academic, and Health and Safety). This empirical cross-sectional study contributes to the understanding of the development of AB in children with DS, showing both weak areas and skills that continue improving over time in these early years. Contributions and limitations of the study are discussed. [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]

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]

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]

Schools play an important role in promoting physical activity (PA) through school day schedules and policies. To investigate different intensities of children's movement behavior during instructional time, recess, and in relation to the Ontario Daily Physical Activity (DPA) policy. Movement behavior intensities were assessed using accelerometers during 5 school days. Behaviors were calculated for learning blocks, recesses, and physical education classes. Participants with ≥20 min of moderate-vigorous physical activity (MVPA)/day were considered compliant with the DPA policy. The sample included 159 children (52% female, 9.03 ± 1.66 years old). In all school day segments, sedentary behavior was higher than light PA and MVPA combined, and 21% met the DPA requirement. Females spent more time sedentary and less time in light PA and MVPA than males in all school day segments. Age was inversely associated with light PA and positively related to sedentary behavior. Participants who met the DPA requirement spent less time in sedentary behavior and more time in light PA and MVPA during school segments. Most of the time spent at school is sedentary behavior. There is room to potentialize the promotion of physical activity in physical and health education classes and enhance DPA. Our findings suggest that there is a need to strengthen DPA and improve the physical activity levels of children in school. [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]

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]

To evaluate the association between individual and environmental determinants of diet quality with diet quality of children exposed to gestational diabetes mellitus (GDM+) and unexposed (GDM−); to study the association between mother and child vegetables and fruit (VF) intakes. Cross-sectional study. One hundred forty-two children (104 GDM+; 38 GDM−) aged 6.2 ± 2.5 years. Canadian Healthy Eating Index 2007 (HEI-C) and VF were obtained with 2 24-hour dietary recall questionnaires in children. Maternal VF was obtained by a validated food frequency questionnaire, and weight and height were measured. Sociodemographic determinants were obtained by questionnaires. Linear regression models were used to evaluate the association between individual and environmental determinants and the HEI-C score with interaction for GDM status. Family meals were associated with HEI-C among GDM− but not GDM+ children (β = 9.97, P = 0.01 and β = −0.41, P = 0.84, respectively; P for interaction = 0.02). Children's age (β = −1.45; 95% confidence interval, −2.19 to −0.72; P < 0.001) was a determinant of HEI-C among all children. Maternal VF intakes were positively associated with children's VF intake (r = 0.30, P < 0.001, r 2 = 0.09), with association of larger variance among GDM− children (r = 0.38, r 2 = 0.14, P = 0.02) than GDM+ children (r = 0.23, r 2 = 0.05, P = 0.02). The food environment at home was associated differently with the diet quality of GDM+ and GDM− children. Whether targeting family meals and maternal diet quality is a good strategy to improve children's diet quality among GDM+ children needs to be further investigated. [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]

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: 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: 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: 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: 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]