Introduction to the Active Living Research Reference List 2007

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I. R. Contento, P. A. Koch, H. Lee, W. Sauberli and A. Calabrese-Barton. (2007). Enhancing personal agency and competence in eating and moving: formative evaluation of a middle school curriculum--Choice, Control, and Change. Journal of Nutrition Education and Behavior.

The purpose of this formative evaluation was to examine the impact of an innovative inquiry-based science education curriculum for middle school students, called Choice, Control, and Change, that is designed to foster healthful eating and physical activity and a healthy weight through enhancing agency and competence. The 24-session curriculum helps students develop understandings about the interactions between biology, personal behavior, and the environment and personal agency through cognitive self-regulation skills in navigating today's complex food system and sedentary environment. An extended theory of planned behavior served as the design framework. The study used a pretest-posttest evaluation design involving 278 middle school students in 19 science classes within 5 schools. Based on paired t tests, students significantly improved on several curriculum-specific eating and physical activity behaviors: they decreased several sedentary activities and increased their frequencies of fruit and vegetable intake. They decreased the frequency of sweetened beverages, packaged snacks, and eating at a fast-food restaurant, and ate and drank smaller portions of some items. Their outcome beliefs and overall self-efficacy, but not their attitudes, became more positive. A strategy based on fostering personal agency, cognitive self-regulation, and competence can be effective in increasing healthful eating and physical activity behaviors in middle school children and should be explored further.

T. Covic, L. Roufeil and S. Dziurawiec. (2007). Community beliefs about childhood obesity: its causes, consequences and potential solutions. Journal Of Public Health.

Background The objective of this study was to explore community beliefs about the causes, consequences and potential solutions of childhood obesity. Methods A convenience sample of 434 adults (41.2 +/- 13.3 years; 61% parents) in New South Wales, Australia, was surveyed using a newly developed childhood obesity scale. Results Five causal (emotional eating; eating habits and food knowledge; environmental dysfunction; abundance of contemporary lifestyle; cost of contemporary lifestyle), four consequences (known consequences of obesity; behavioural consequences; social consequences; less-known physical consequences) and three potential solutions factors (parental actions; professional assistance; limiting behaviours) were identified. Parents did not differ from non-parents across the 12 factors nor were there any differences based on the level of education. There were, however, gender differences across two causal factors (emotional eating and abundance of contemporary lifestyle) and two consequences factors (behavioural consequences and social consequences), with females endorsing all four factors more strongly than males. Conclusions The results of this study suggest that this sample was aware of the complex nature of childhood obesity in terms of its causes, consequences and a range of potential solutions, but they endorsed more family rather than community-based interventions.

D. Culpepper, S. Tarr and L. Killion. (2007). The role of a specific curriculum model an overall physical activity in elementary, middle, and high school students. Research Quarterly For Exercise And Sport.

B. De Marchi, S. Casati and G. Tarlao. (2007). Stakeholder appraisal of policy options for responding to obesity in Italy. Obesity Reviews.

This article deals with the phenomenon of obesity in contemporary Italian society. It is based on the fieldwork carried out during the year 2005 within the European Union-funded project 'PorGrow: policy options for responding to obesity' (see: The most recent statistical data on the spread of overweight and obesity in Italian society reveal that the phenomenon has reached a dimension that, albeit not as serious as in other Western countries, constitutes a serious threat to public health and to the national budget. The panel of stakeholders interviewed for this research showed awareness of this issue and generally agreed on the necessity to adopt a very multifaceted portfolio of policy measures to address the problem. Participants frequently regarded educational policies as the highest priority, followed by informational measures and infrastructural actions. Fiscal policy options were widely considered ineffective and unacceptable, and little enthusiasm was shown for technological innovations. In sum, while interviewees saw a real need for improved food habits on the part of Italian citizens, nonetheless in a country affected by many criticalities, the weakness of political will and the pressure of fast food culture remain severe obstacles in the fight against overweight and obesity.

W. Dietz, J. Lee, H. Wechsler, S. Malepati and B. Sherry. (2007). Health plans' role in preventing overweight in children and adolescents. Health Affairs (Millwood).

The increasing prevalence of overweight children and adolescents in the United States threatens the well-being of a vast segment of this population. This paper examines how U.S. health plans can promote evidence-based behavioral-change strategies by directly intervening in medical settings and by supporting efforts to modify the environments in which young people live, study, and play. We describe a variety of innovative initiatives launched in recent years by health plans to address overweight among children and adolescents. Despite gaps in the evidence base, enough is now known to support aggressive steps to control this important public health problem.

H. G. Dixon, M. L. Scully, M. A. Wakefield, V. M. White and D. A. Crawford. (2007). The effects of television advertisements for junk food versus nutritious food on children's food attitudes and preferences. Social Science & Medicine.

Television (TV) food advertising has attracted criticism for its potential role in promoting unhealthy dietary practices among children. Content analyses indicate junk food advertising is prevalent on Australian children's TV; healthy eating is rarely promoted. This paper presents (a) a cross-sectional survey examining associations between children's regular TV viewing habits and their food-related attitudes and behaviour; and (b) an experiment assessing the impact of varying combinations of TV advertisements (ads) for unhealthy and healthy foods on children's dietary knowledge, attitudes and intentions. The experimental conditions simulated possible models for regulating food ads on children's TV. Participants were 919 grade five and six students from schools in Melbourne, Australia. The survey showed that heavier TV use and more frequent commercial TV viewing were independently associated with more positive attitudes toward junk food; heavier TV use was also independently associated with higher reported junk food consumption. The experiment found that ads for nutritious foods promote selected positive attitudes and beliefs concerning these foods. Findings are discussed in light of methodological issues in media effects research and their implications for policy and practice. It is concluded that changing the food advertising environment on children's TV to one where nutritious foods are promoted and junk foods are relatively unrepresented would help to normalize and reinforce healthy eating.

D. P. Do, T. Dubowitz, C. E. Bird, N. Lurie, J. J. Escarce and B. K. Finch. (2007). Neighborhood context and ethnicity differences in body mass index: A multilevel analysis using the NHANES III survey (1988-1994). Economics & Human Biology.

A growing body of literature has documented a link between neighborhood context and health outcomes. However, little is known about the relationship between neighborhood context and body mass index (BMI) or whether the association between neighborhood context and BMI differs by ethnicity. This paper investigates several neighborhood characteristics as potential explanatory factors for the variation of BMI across the United States; further, this paper explores to what extent segregation and the concentration of disadvantage across neighborhoods help explain ethnic disparities in BMI. Using data geo-coded at the census tract-level and linked with individual-level data from the Third National Health and Examination Survey in the United States (U.S.), we find significant variation in BMI across U.S. neighborhoods. In addition, neighborhood characteristics have a significant association with body mass and partially explain ethnic disparities in BMI, net of individual-level adjustments. TheSEata also reveal evidence that ethnic enclaves are not in fact advantageous for the body mass index of Hispanics-a relationship counter to what has been documented for other health outcomes. (c) 2007 Elsevier B.V. All rights reserved.

L. Dorfman and L. Wallack. (2007). Moving nutrition upstream: The case for reframing obesity. Journal Of Nutrition Education And Behavior.

Currently, nutrition is described primarily as a matter of individual responsibility, which results in a focus on limited strategies that are unlikely to be successful, Public health advocates need to change the terms of debate or "reframe" the issue so that the context around individuals-the social, economic, and political context-comes into view. This paper uses obesity as an example of the need for refraining in nutrition. The authors also offer some suggestions on reframing based on lessons learned from other public health issues.

A. Drewnowski, C. D. Rehm and D. Solet. (2007). Disparities in obesity rates: analysis by ZIP code area. Social Science & Medicine.

Obesity in the United States has been linked to individual income and education. Less is known about its geographic distribution. The goal of this study was to determine whether obesity rates in King County, Washington State, at the ZIP code scale were associated with area-based measures of socioeconomic status and wealth. Data from the Behavioral Risk Factor Surveillance System were analyzed. At the ZIP code scale, crude obesity rates varied six-fold. In a model adjusting for covariates and spatial dependence, property values were the strongest predictor of the area-based smoothed obesity prevalence. Geocoding of health data provides new insights into the nature of social determinants of health. Disparities in obesity rates by ZIP code area were greater than disparities associated with individual income or race/ethnicity.

R. D. Edwards. (2008). Public transit, obesity, and medical costs: Assessing the magnitudes. Preventive Medicine.

OBJECTIVE.: This paper assesses the potential benefits of increased walking and reduced obesity associated with taking public transit in terms of dollars of medical costs saved and disability avoided. METHODS.: I conduct a new analysis of a nationally representative U.S. transportation survey to gauge the net increase in walking associated with public transit usage. I translate minutes spent walking into energy expenditures and reductions in obesity prevalence, estimating the present value of costs and disability that may be avoided. RESULTS.: Taking public transit is associated with walking 8.3 more minutes per day on average, or an additional 25.7-39.0 kcal. Hill et al. [Hill, J.O., Wyatt, H.R., Reed, G.W., Peters, J.C., 2003. Obesity and the environment: Where do we go from here? Science 299 (5608), 853-855] estimate that an increase in net expenditure of 100 kcal/day can stop the increase in obesity in 90% of the population. Additional walking associated with public transit could save $5500 per person in present value by reducing obesity-related medical costs. Savings in quality-adjusted life years could be even higher. CONCLUSIONS.: While no silver bullet, walking associated with public transit can have a substantial impact on obesity, costs, and well-being. Further research is warranted on the net impact of transit usage on all behaviors, including caloric intake and other types of exercise, and on whether policies can promote transit usage at acceptable cost.

M. S. Faith, K. R. Fontaine, M. L. Baskin and D. B. Allison. (2007). Toward the reduction of population obesity: macrolevel environmental approaches to the problems of food, eating, and obesity. Psychol Bulletin.

The authors reviewed the evidential basis of three environmental approaches to reducing population obesity: What are the effects of (a) taxing or subsidizing foods, (b) manipulating the ease of food access, and (c) restricting access to certain foods? A narrative review evaluated evidence using National Heart, Lung, and Blood Institute criteria. There was strong evidence that subsidization influences food purchases, but not necessarily food consumption or body weight. Ease of food access may influence food purchases, and possibly food intake and body weight. Data on restriction were lacking. More studies are needed to justify that altering these macro-environmental variables will necessarily reduce population obesity. A proposed conceptual model posits that the steps through environmental interventions may exert intended and unintended influences on body weight and obesity prevalence. Contemplated policy changes should weigh scientific evidence with social judgments and values concerning changes to the environment.

D. Fussenegger, A. Pietrobelli and K. Widhalm. (2008). Childhood obesity: political developments in Europe and related perspectives for future action on prevention. Obesity Review.

The dramatically increasing prevalence of obesity, especially among children, has become a major public health problem in Europe. In reaction to this alarming trend, a series of initiatives and actions has been launched in recent years. As the potential impact of these activities is widely unknown so far, we underline the need for adequate evaluation of these measures. The aim of this paper is to report the latest developments in the fight against obesity at different political levels across Europe, with special attention to the major results of the recent World Health Organization European Ministerial Conference on Counteracting Obesity. In accordance with the main principles of the European Charter on Counteracting Obesity adopted at the meeting, immediate action should be taken now by implementing the few available schemes with proven effectiveness. Finally, given the lack of appropriate evaluation, we consider it particularly important to establish national research centres to collect country-specific data that are to be evaluated together by a central European administration department. Based on the results of such a comprehensive data pool, concrete strategies could be developed for future policy building.

T. L. Gary, M. M. Safford, R. B. Gerzoff, S. L. Ettner, A. J. Karter, G. L. Beckles and A. F. Brown. (2008). Perception of neighborhood problems, health behaviors, and diabetes outcomes among adults with diabetes in managed care: the Translating Research Into Action for Diabetes (TRIAD) study. Diabetes Care.

OBJECTIVE: Recent data suggest that residential environment may influence health behaviors and outcomes. We assessed whether perception of neighborhood problems was associated with diabetes behaviors and outcomes. RESEARCH DESIGN AND METHODS: This cross-sectional analysis included 7,830 diabetic adults enrolled in Translating Research Into Action for Diabetes, a study of diabetes care and outcomes in managed care settings. Perception of neighborhood problems was measured using a summary score of participants' ratings of crime, trash, litter, lighting at night, and access to exercise facilities, transportation, and supermarkets. Outcomes included health behaviors and clinical outcomes. Hierarchical regression models were used to account for clustering of patients within neighborhoods and to adjust for objective neighborhood socioeconomic status (percentage living in poverty) and potential individual-level confounders (age, sex, race/ethnicity, education, income, comorbidity index, and duration of diabetes). RESULTS: After adjustment, residents of neighborhoods in the lowest tertile (most perceived problems) reported higher rates of current smoking (15 vs. 11%) than those in the highest tertile and had slightly lower participation in any weekly physical activity (95 vs. 96%). In addition, their blood pressure control was worse (25 vs. 31% <130/80 mmHg), and their Short Form 12 scores were slightly lower (44 vs. 46 units for emotional well-being and 43 vs. 44 units for physical well-being); all P < 0.01. CONCLUSIONS: Neighborhood problems were most strongly associated with more smoking and higher blood pressure, both of which have significant implications for cardiovascular risk. Potential mechanisms that explain these associations should be further explored in longitudinal studies.

K. Giskes, C. B. Kamphuis, F. J. van Lenthe, S. Kremers, M. Droomers and J. Brug. (2007). A systematic review of associations between environmental factors, energy and fat intakes among adults: is there evidence for environments that encourage obesogenic dietary intakes? Public Health Nutrition.

OBJECTIVE: To review the literature examining associations between environmental factors, energy and fat intakes among adults, and to identify issues for future research. METHODS: Literature searches of studies published between 1980 and 2004 were conducted in major databases (i.e. PubMed, Human Nutrition, Web of Science, PsychInfo, Sociofile). Additional articles were located by citation tracking. RESULTS: Twenty-one articles met the inclusion criteria. No study provided a clear conceptualisation of how environmental factors may influence theSEietary intakes. Availability, social, cultural and material aspects of the environment were relatively understudied compared with other factors such as seasonal/day of the week variation and work-related factors. Few studies examined the specific environmental factors implicated in the obesity epidemic, and there was little study replication. All studies were observational and cross-sectional. CONCLUSIONS: It is too premature to conclude whether or not environmental factors play a role in obesogenic and unhealthy dietary intakes. More studies need to examine associations with those environmental factors thought to contribute to obesogenic environments. There needs to be more development in theories that conceptualise the relationship between environmental factors and dietary intakes.

L. I. Gonzalez-Zapata, R. Ortiz-Moncada and C. Alvarez-Dardet. (2007). Mapping public policy options responding to obesity: the case of Spain. Obesity Reviews.

This study assesses the opinions of the main Spanish stakeholders from food and physical exercise policy networks on public policy options for responding to obesity. We followed the multi-criteria mapping methodology in the framework of the European project 'Policy options in responding to obesity' (PorGrow), through a structured interview to 21 stakeholders. A four-step approach was taken: options, criteria, scoring and weighting, obtaining in this way a measure of the performance of each option which integrates qualitative and quantitative information. In an overall analysis, the more popular policy options where those grouped as educational initiatives: include food and health in the school curriculum, improve health education to the general public, improve the training of health professionals in obesity care and prevention, incentives to caterers to provide healthier menus and improve community sports facilities. Fiscal measures as subsidies and taxes had the lowest support. The criteria assessed as priorities were grouped as efficacy and societal benefits. Obesity in Spain can be approached through public policies, although the process will not be easy or immediate. The feasibility of changes requires concerned public policymakers developing long-term actions taking into account the map of prioritized options by the stakeholders.

A. A. Gorin, H. A. Raynor, H. M. Niemeier and R. R. Wing. (2007). Home grocery delivery improves the household food environments of behavioral weight loss participants: Results of an 8-week pilot study. International Journal of Behavioral Nutrition and Physical Activity.

ABSTRACT: BACKGROUND: Household food availability is consistently linked to dietary intake; yet behavioral weight control treatment includes only minimal instruction on how to change the home environment to support dietary goals. This pilot study examined whether it is feasible to change the household food environments of behavioral weight loss participants through the use of a commercially available grocery home delivery service. METHODS: Overweight participants (N = 28; BMI = 31.7 +/- 3.6 kg/m2; 89.3% women, 47.9 +/- 9.5 years) were randomly assigned to 8-weeks of standard behavioral weight loss (SBT) or to SBT plus home food delivery (SBT+Home). SBT+Home participants were instructed to do their household grocery shopping via an online service affiliated with a regional supermarket chain and were reimbursed for delivery charges. RESULTS: Compared to SBT, SBT+Home produced significantly greater reductions in the total number of foods in the home (p =.01) and number of foods that were high in fat (p =.002). While the groups did not differ in 8-week weight losses, within SBT+Home there was a trend for the number of home deliveries to be associated with weight loss (p =.08). Participants reported that the home delivery service was easy to use and that it helped decrease impulse purchases and lead to healthier choices; however, few planned to continue using the service after the study. CONCLUSION: Encouraging weight loss participants to use a commercially available online grocery ordering and home delivery service reduces the overall number of food items in the home and decreases access to high-fat food choices. More research is needed to determine whether this is a viable strategy to strengthen stimulus control and improve weight loss outcomes.

N. Gorman, J. A. Lackney, K. Rollings and T. T. Huang. (2007). Designer schools: the role of school space and architecture in obesity prevention. Obesity (Silver Spring).

Spatial features of obesogenic environments studied on a broad community level have been associated with childhood overweight and obesity, but little research has focused on the effects of the design of micro spaces, such as schools, on individual health behaviors. This article aims to generate thinking and research on the link between school space and architecture and obesity prevention by reviewing and synthesizing available literature in architecture, environmental psychology, and obesity research, in an effort to propose promising ideas for school space design and redesign. The school environment is defined through 5 dimensions: physical, legal, policy, social, and cultural domains. Theories underlying environmental interventions and documented associations between the environment and health behaviors and outcomes are reviewed to illustrate how existing environmental research could translate to obesity prevention. Design strategies aimed at promoting physical activity and healthful eating are proposed, with particular emphasis on the design of cafeterias, activity spaces, connectivity with the larger community, and student health centers.

R. Guerrieri, C. Nederkoorn and A. Jansen. (2007). The interaction between impulsivity and a varied food environment: its influence on food intake and overweight. International Journal of Obesity (London).

Objective:The current study tests the influence of two factors, the obesogenic environment and impulsivity, on food intake in primary school children. Our current food environment offers a large variety of cheap and easily available sweet and fatty foods. This obesogenic environment is believed to be a cause of the recent obesity epidemic. Impulsive people are generally less successful at inhibiting prepotent responses and they are reward sensitive. We investigate whether the interaction between an obesogenic environment and an impulsive person leads to overeating.Design:A quasi-experimental 2 (reward sensitive versus not reward sensitive) by 2 (successful response inhibitors versus unsuccessful response inhibitors) by 2 (monotonous versus varied food environment) between-subjects design with caloric intake during a taste test as the main dependent variable. The link between impulsivity and overweight was also examined.Subjects:78 healthy primary school children (age: 8-10 years).Measurements:We measured two aspects of impulsivity: reward sensitivity and deficient response inhibition. Subsequently, one aspect of the obesogenic environment was manipulated; half of the participants received monotonous food during a bogus taste test whereas the other half tasted food that was varied in colour, form, taste and texture.Results:As expected, reward sensitivity interacted with variety. In the monotony group there was no difference in food intake between the less and more reward-sensitive children (183 kcal+/-23 s.d. versus 180 kcal+/-21 s.d.). However, in the variety group the more reward-sensitive children ingested significantly more calories than the less reward-sensitive children (237 kcal+/-30 s.d. versus 141 kcal+/-19 s.d.). Reward sensitivity was not linked to overweight. Deficient response inhibition did not interact with variety, but it was linked to overweight.Conclusion:It is suggested that reward sensitivity could be a causal mechanism for overeating in an obesogenic environment whereas prepotent response inhibition may be a maintaining factor of the problem of overeating.International Journal of Obesity advance online publication, 4 December 2007; doi:10.1038/sj.ijo.0803770.

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