Introduction to the Active Living Research Reference List 2007



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J. R. Cornelisse-Vermaat and H. M. van den Brink. (2007). Ethnic differences in lifestyle and overweight in the Netherlands. Obesity (Silver Spring).

OBJECTIVE: To study the effects of lifestyle variables and socioeconomic status on overweight among native Dutch and immigrants in The Netherlands. RESEARCH METHODS AND PROCEDURES: Data were used from a survey sample (N = 2551) of native Dutch and immigrant respondents (Surinamese/Antilleans, Turks, and Moroccans). BMI was calculated using self-reported weight and height. Lifestyle variables such as modern food habits (take-out food and eating out) and participating in sports were included, as well as socioeconomic and demographic background variables. Bivariate and ordinary least squares analyses were performed to study BMI and the determinants of overweight among the different groups. RESULTS: All immigrant groups had a higher prevalence of overweight than the Dutch, except Moroccans. Men were overweight more frequently than women. Take-out food, eating out, and fresh vegetables were related to a decrease in BMI, whereas convenience foods were related to an increase in BMI. For ready-to-eat meals, the results were mixed. In all groups, age was associated with a higher BMI, and a higher level of education was associated with a lower BMI. Immigrants participated in sports less frequently than native Dutch people. DISCUSSION: One percent to 5% of the total public health costs can be attributed to costs for overweight-related diseases. Public health policies should aim at stimulating healthy lifestyles and discouraging bad food habits through higher taxes on high-calorie foods. In particular, Dutch immigrants should be encouraged to lose weight, because they have a higher risk for overweight-related diseases.

V. A. Diaz, A. G. Mainous and C. Pope. (2007). Cultural conflicts in the weight loss experience of overweight Latinos. International Journal Of Obesity.

Objective: In spite of the high prevalence of obesity in the Latino population, there is limited recent information that can be used by health-care providers to develop culturally appropriate weight loss strategies for this population. Therefore, we describe weight loss experiences, attitudes and barriers in overweight Latino adults. Design: Qualitative study using focus group methodology Subjects: Twenty-one overweight adults (body mass index >= 25, age >= 20 years) self-identified as Latinos. Methods: Subjects participated in one of three focus groups. Reccurring themes within group discussions were identified by three independent investigators, one who was ethnicity concordant. Results: Themes included the presence of mixed messages when determining one's appropriate weight, with participants' desire to lose weight to be healthy (based on professional advice and personal experience) conflicting with the cultural idea that being overweight is healthy. Participants described discordance when adapting to the mainstream, leading to the loss of healthy traditional habits. Participants expressed interest in weight loss and familiarity with dieting and weight loss interventions. They desired culturally appropriate nutrition education and reassurance regarding healthy dieting from health-care providers. The importance of interactions with peers during education was another relevant theme, and participants were overwhelmingly positive about group education. Conclusions: To improve health promotion for Latinos, cultural factors distinctive to this underserved population, and barriers they articulate, should be considered when developing weight loss interventions.

J. Dollman, K. Ridley, A. Magarey, M. Martin and E. Hemphill. (2007). Dietary intake, physical activity and TV viewing as mediators of the association of socioeconomic status with body composition: a cross-sectional analysis of Australian youth. International Journal of Obesity (London).

BACKGROUND: There is emerging evidence of socioeconomic gradients in adiposity among Australian youth. Behavioral mechanisms for these trends are unexplained. METHODS: In total, 194 South Australian children (97 boys, 11.48+/-0.43 years; 97 girls, 11.60+/-0.38 years) were assessed for pubertal status, stature, weight, skinfolds and waist girth. Socioeconomic status (SES) was represented by postcode of residence (Socioeconomic Index for Areas) and parent education. Children reported moderate-to-vigorous physical activity (MVPA), TV viewing (TV) and dietary intake (daily energy intake as a ratio of predicted basal metabolic rate (DEI/BMR); and fat intake), using three x 24 h recall. Path analysis (partial least-squared method) was used to analyze the independence and interdependence of pathways linking SES, anthropometric variables and measured behaviors. RESULTS: SES was negatively associated with waist girth and skinfolds in girls, and waist girth in boys. In models including behavioral variables, these SES gradients in girls were largely unattenuated; accordingly, physical activity and dietary intake were not confirmed as mediators of the association of SES and girls' adiposity. In boys there was evidence that the negative relationship between SES and waist girth was mediated by fat intake. CONCLUSIONS: The inverse relationships between SES and girls' adiposity were unexplained by the behavioral attributes measured in this study. Mediators of SES gradients in youth adiposity remain elusive, and may require intensive methodologies to explicate.

T. Dubowitz, D. Acevedo-Garcia, J. Salkeld, A. C. Lindsay, S. V. Subramanian and K. E. Peterson. (2007). Lifecourse, immigrant status and acculturation in food purchasing and preparation among low-income mothers. Public Health Nutrition.

OBJECTIVES: This study investigates how lifecourse, immigrant status and acculturation, and neighbourhood of residence influence food purchasing and preparation among low-income women with children, living in the USA. This research sought to understand physical and economic access to food, from both 'individual' and 'community' perspectives. DESIGN: This study used qualitative methodology (focus groups) to examine the mechanisms and pathways of food preparation and purchasing within the context of daily life activity for US- and foreign-born women, living in the USA. The study methodology analysed notes and verbatim transcripts, summarised recurring responses and identified new themes in the discussions. SETTING AND SUBJECTS: A total of 44 women were purposively sampled from two metropolitan areas in Massachusetts, USA, based on (1) neighbourhood of residence and (2) primary language spoken. All focus groups were conducted in community health centres and community centres co-located with offices of the special supplemental nutritional programme for Women, Infants, and Children. RESULTS: Analysis of key response themes suggested that scarcity of food and physical access to food purchasing points did not influence food purchasing and preparation as much as (1) limited time for food shopping, cooking and family activities; and (2) challenges in transportation to stores and childcare. The study results demonstrated differing attitudes toward food acquisition and preparation between immigrant and US-born women and between women who lived in two metropolitan areas in the western and eastern regions of the state of Massachusetts, USA. CONCLUSIONS: The findings illustrate 'hidden' constraints that need to be captured in measures of physical and economic access and availability of food. US policies and programmes that aim to improve access, availability and diet quality would benefit from considering the social context of food preparation and purchasing, and the residential environments of low-income women and families.

G. F. Dunton, M. Schneider and D. M. Cooper. (2007). Factors predicting behavioral response to a physical activity intervention among adolescent females. American Journal of Health Behavior.

OBJECTIVE: To determine whether individual factors influenced rates of physical activity change in response to a school-based intervention. METHODS: Sedentary adolescent females (N = 63) participated in a 9-month physical activity program. Weekly levels of leisure-time physical activity were reported using an interactive website. RESULTS: Change in vigorous activity was more positive among participants who had higher fitness and lower friend support at baseline. Change in moderate activity was more positive among participants who had lower fitness and external barriers, and higher internal barriers at baseline. CONCLUSIONS: Adolescent females responded differentially to a physical activity intervention depending on individual characteristics.

I. U. Eneli, I. D. Kalogiros, K. A. McDonald and D. Todem. (2007). Parental preferences on addressing weight-related issues in children. Clinical Pediatrics (Phila).

Little is known about parental preferences on how providers should approach or manage weight-related concerns. A cross-sectional survey was conducted of 292 parents in a pediatric primary care faculty group practice. Of the 292 respondents, 90% were women, 45% had a child on Medicaid, and 53% had a body mass index of 25 or more. Only 12.1% of parents reported they had an overweight child. The term "gaining too much weight" was preferred 2:1 to "overweight" (51.1% versus 25.9%, P <.001). Most respondents (62.3%) thought the physician's office was the best place to manage an overweight child. Parents who reported they had an overweight child were more likely to prefer individual than group sessions compared with those without an overweight child (odds ratio, 2.1; 95% confidence interval, 1.2-3.7). Further research is needed to investigate the reasons underlying these preferences and how they positively or negatively impact program satisfaction, attrition rates, and behavior change outcomes.


S. Evers, R. Arnold, T. Hamilton and C. Midgett. (2007). Persistence of overweight among young children living in low income communities in Ontario. Journal Of The American College Of Nutrition.

Objective: the rise in the prevalence of overweight in pediatric populations is a major health concern. Little is known however, about the prevalence of overweight in younger children. Our objectives were to determine the annual prevalence of overweight in children from junior kindergarten (JK) to grade 3; to assess the persistence of overweight over this time period; and, to identify factors associated with overweight in this group. Methods: annual inter-views were completed with parents (primarily the mother) living in economically disadvantaged communities in Ontario who are participating in the Better Beginnings, Better Futures project. Weight and height were measured annually for the children (n=760) beginning in JK. Risk of overweight was defined as body mass index (BMI) >= 85(th) to < 95(th) percentile; overweight was BMI >= 95 th percentile. Parents' height and weight were self-reported; BMI >= 25 was considered overweight. Results: the risk of overweight among children ranged from 14.1% to 17.5%; the prevalence of overweight increased from 9.9% to 15.2%; 68.2% (15/22) of the children who were overweight in JK were >95(th) percentile in grade 3. BMI >= 85(th) to < 95(th) percentile or >= 95(th) th percentile in JK were strongly predictive of overweight in grade 3. Almost 50% of the mothers were overweight. Conclusions: A high prevalence of overweight was found in young children; and, for a large proportion, their early weight status persisted. Strategies promoting healthy eating and physical activity for both children and parents are essential.

S. Feldman, M. E. Eisenberg, D. Neumark-Sztainer and M. Story. (2007). Associations between watching TV during family meals and dietary intake among adolescents. Journal of Nutrition Education and Behavior.

OBJECTIVE: To examine associations between watching television during family meals and dietary intake among adolescents. DESIGN: Cross-sectional study using survey data from a diverse sample of adolescents. SETTING: Data were collected from a school-based survey during the 1998-1999 school year. PARTICIPANTS: Middle and high school students (N = 4746) from 31 public schools in the Minneapolis-St. Paul area. Response rate was 81.5%. VARIABLES MEASURED: Intake of fruits, total vegetables, dark green/yellow vegetables, calcium-rich food, grains, soft drinks, fried food, snack food, calories, family meal frequency, and watching television during meals. ANALYSIS: General linear modeling comparing dietary intake across 3 groups. RESULTS: 33.5% of boys and 30.9% of girls reported watching television during family meals. Adolescents watching television were found to have lower intakes of vegetables, dark green/yellow vegetables, calcium-rich food, and grains and higher intakes of soft drinks compared to adolescents not watching television during meals. However, watching television during family meals was associated with a more healthful diet than not eating regular family meals. CONCLUSIONS AND IMPLICATIONS: Watching television during family meals was associated with poorer dietary quality among adolescents. Health care providers should work with families and adolescents to promote family meals, emphasizing turning the TV off at meals.

L. C. Fernald. (2007). Socio-economic status and body mass index in low-income Mexican adults. Social Science & Medicine.

The study reported here explored the associations of body mass index (BMI), socio-economic status (SES), and beverage consumption in a very low-income population. A house-to-house survey was conducted in 2003 of 12,873 Mexican adults. The sample was designed to be representative of the poorest communities in seven of Mexico's 31 states. Greater educational attainment was significantly associated with higher BMI and a greater prevalence of overweight (25 < or = BMI<30) and obesity (30 < or = BMI) in men and women. The combined prevalence of overweight and obesity was over 70% in women greater than the median age of 35.4 years with at least some primary education compared with a prevalence of 45% in women below the median age with no education. In both sexes, BMI was positively correlated with education, occupation, quality of housing conditions, household assets, and subjective social status. BMI and household income were significantly correlated in women but not in men. In the models including all SES variables, education, occupation, housing conditions and household assets all contributed independently and significantly to BMI, and household income and subjective social status did not. Increased consumption of alcoholic and carbonated sugar beverages was associated with higher SES and higher BMI. Thus, in spite of the narrow range of socio-economic variability in this population, the increased consumption of high calorie beverages may explain the positive relationship between SES and BMI. The positive associations between SES and BMI in this low-income, rural population are likely to be related to the changing patterns of food availability, food composition, consumption patterns and cultural factors. Contextually sensitive population-level interventions are critically needed to address obesity and overweight in poor populations, particularly in older women.

E. Fitzpatrick, L. S. Edmunds and B. A. Dennison. (2007). Positive effects of family dinner are undone by television viewing. Journal of the American Dietetic Association.

The purpose of this cross-sectional study was to test the independent associations of eating dinner as a family and having the television on during dinner with child feeding behaviors. Parents/guardians of children participating in the Special Supplemental Nutrition Program for Women, Infants, and Children in New York state were surveyed (n=1,336). Main outcome variables were frequencies of serving fruits, vegetables, and milk. Main exposure variables were the number of days per week the family ate dinner together and the number of days per week the television was on during dinner. Multiple logistic regressions assessed the association between the exposure variables and each of the main outcome measures controlling for race/ethnicity and parental educational attainment. Each night the family ate dinner together was positively associated with serving fruits (odds ratio [OR]=1.14, 95% confidence interval [CI] 1.07 to 1.21) or vegetables (OR=1.15, 95% CI 1.08 to 1.23). Serving fruits (OR= 0.95, 95% CI 0.91 to 0.99) or vegetables (OR=0.94, 95% CI 0.90 to 0.98) decreased with each night the television was on during dinner. Neither family dinner nor television on during dinner was significantly associated with serving milk. Family dinners and dinners without television on are independent predictors of servings of fruits or vegetables offered to preschool children. BecauSEietary habits and preferences are established early in life, parents should be counseled to promote family meal environments that support healthful eating.

S. Gable, Y. Chang and J. L. Krull. (2007). Television watching and frequency of family meals are predictive of overweight onset and persistence in a national sample of school-aged children. Journal of the American Dietetic Association.

OBJECTIVE: To identify eating and activity factors associated with school-aged children's onset of overweight and persistent overweight. DESIGN: Data were gathered at four time points between kindergarten entry and spring of third grade. Children were directly weighed and measured and categorized as not overweight (<95th percentile of body mass index) or overweight (> or =95th percentile body mass index); parents were interviewed by telephone or in person. SUBJECTS/SETTING: Subjects were participants in the Early Childhood Longitudinal Study-Kindergarten Cohort, a nationally representative sample of children who entered kindergarten during 1998-1999. Children who weighed <2,000 g at birth, received therapeutic services before kindergarten, skipped or repeated a grade, or without complete height and weight data were excluded, resulting in 8,459 participants. Children with intermittent overweight were not examined (n=459); analyses addressed 8,000 children. MAIN OUTCOME MEASURES: Three mutually exclusive groups of children were identified: never overweight, overweight onset, and persistent overweight. STATISTICAL ANALYSES PERFORMED: Multilevel, multivariate logistic regression analyses estimated the effects of eating and activity factors on the odds of overweight onset and persistent overweight above child sex, race, and family socioeconomic status. RESULTS: Children who watched more television (odds ratio [OR] 1.02) and ate fewer family meals (OR 1.08) were more likely to be overweight for the first time at spring semester of third grade. Children who watched more television (OR 1.03), ate fewer family meals (OR 1.08), and lived in neighborhoods perceived by parents as less safe for outdoor play (OR 1.32) were more likely to be persistently overweight. Child aerobic exercise and opportunities for activity were not associated with a greater likelihood of weight problems. CONCLUSIONS: This study supports theories regarding the contributions of television watching, family meals, and neighborhood safety to childhood weight status. When working with families to prevent and treat childhood weight problems, food and nutrition professionals should attend to children's time spent with screen media, the frequency of family mealtimes, and parents' perceptions of neighborhood safety for children's outdoor play.

L. Y. Gibson, S. M. Byrne, E. A. Davis, E. Blair, P. Jacoby and S. R. Zubrick. (2007). The role of family and maternal factors in childhood obesity. The Medical Journal of Australia.

OBJECTIVE: To investigate the relationship between a child's weight and a broad range of family and maternal factors. DESIGN, SETTING AND PARTICIPANTS: Cross-sectional data from a population-based prospective study, collected between January 2004 and December 2005, for 329 children aged 6-13 years (192 healthy weight, 97 overweight and 40 obese) and their mothers (n=265) recruited from a paediatric hospital endocrinology department and eight randomly selected primary schools in Perth, Western Australia. MAIN OUTCOME MEASURES: Height, weight and body mass index (BMI) of children and mothers; demographic information; maternal depression, anxiety, stress and self-esteem; general family functioning; parenting style; and negative life events. RESULTS: In a multilevel model, maternal BMI and family structure (single-parent v two-parent families) were the only significant predictors of child BMI z scores. CONCLUSION: Childhood obesity is not associated with adverse maternal or family characteristics such as maternal depression, negative life events, poor general family functioning or ineffective parenting style. However, having an overweight mother and a single-parent (single-mother) family increases the likelihood of a child being overweight or obese.

H. Goncalves, P. C. Hallal, T. C. Amorim, C. L. Araujo and A. M. Menezes. (2007). [Sociocultural factors and physical activity level in early adolescence]. Rev Panam Salud Publica.

OBJECTIVE: To describe the level of physical activity in adolescents born in 1993 in the city of Pelotas, Brazil, and to evaluate the effect of sociocultural variables on those levels. METHODS: A combined ethno-epidemiological methodology was employed. In the epidemiological study, 4 452 adolescents born in 1993 were interviewed. Physical activity level was evaluated by means of a questionnaire. Adolescents with fewer than 300 minutes of physical activity per week were classified as sedentary. The ethnographic study included 69 adolescents randomly selected from among all cohort participants. On average, three in-depth interviews were carried out (about one every 6 months), with mothers and adolescents being interviewed separately. RESULTS: The prevalence of a sedentary lifestyle was 48.7% (95%CI: 46.5 to 50.8) in boys and 67.5% (95%CI: 65.6 to 69.5) in girls (P < 0.001). The independent variable presenting the strongest association with physical activity level was the weekly frequency with which the adolescent met friends outside of school. The ethnographic study showed that boys have more social and family support to engage in physical activities in adolescence, but that many parents associate poor school performance with the amount of time spent outside the home. CONCLUSIONS: This study suggests that physical activity is often viewed as competing with family values in adolescence. This perspective should be explored in future studies and discussed with families so that physical activity may be adopted as a cultural norm.


C. Grace, R. Begum, S. Subhani, G. Frost, T. Greenhalgh and P. Kopelman. (2007). Understanding roadblocks to physical activity participation in a UK South Asian community: cultural and religious perspectives. International Journal Of Obesity.
H. M. Greves, P. Lozano, L. Liu, K. Busby, J. Cole and B. Johnston. (2007). Immigrant families' perceptions on walking to school and school breakfast: a focus group study. International Journal of Behavioral Nutrition and Physical Activity.

ABSTRACT: BACKGROUND: Immigrant children face an increased risk of being overweight. Little is known about how immigrant families perceive school programs that may help prevent obesity, such as walking to school and school breakfast. METHODS: Six focus groups (n = 53) were conducted with immigrant parents of school-aged children, two each in three languages: Vietnamese, Spanish, and Somali. A facilitator and translator conducted the focus groups using a script and question guide. Written notes and audio transcripts were recorded in each group. Transcripts were coded for themes by two researchers and findings classified according to an ecological model. RESULTS: Participants in each ethnic group held positive beliefs about the benefits of walking and eating breakfast. Barriers to walking to school included fear of children's safety due to stranger abductions, distrust of neighbors, and traffic, and feasibility barriers due to distance to schools, parent work constraints, and large families with multiple children. Barriers to school breakfast participation included concerns children would not eat due to lack of appealing/appropriate foods and missing breakfast due to late bus arrival or lack of reminders. Although some parents acknowledged concerns about child and adult obesity overall, obesity concerns did not seem personally relevant. CONCLUSION: Immigrant parents supported the ideals of walking to school and eating breakfast, but identified barriers to participation in school programs across domains of the ecological model, including community, institution, and built environment factors. Schools and communities serving immigrant families may need to address these barriers in order to engage parents and children in walking and breakfast programs.




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