Longitudinal effects of GALM on physical activity, health and fitness of older adults

ISBNPA 2010International Society of

Behavioral Nutrition and Physical Activity

2010 Annual Conference of the ISBNPAInternational Society of Behavioral Nutrition and Physical Activity

Program Committee

Knut-Inge Klepp (Chair) Norwegian Directorate of Health/University of Oslo, Oslo, Norway

David Crawford Deakin University, Burwood, Australia

Simone French University of Minnesota, Minneapolis, United States

Greet Cardon Ghent University, Ghent, Belgium

Deanna Hoelscher University of Texas School of Public Health, Austin, United States

Nanna Lien University of Oslo, Oslo, Norway

Anke Oenema Erasmus MC, University Medical Center, Rotterdam, Netherlands

Carmen Perez-Rodrigo Bilbao Department of Public Health, Bilbao, Spain

Local Organizing Committee

University of Minnesota

Simone French (Chair) Division of Epidemiology & Community Health

Jayne Fulkerson School of Nursing

Robert Jeffery Division of Epidemiology & Community Health

Martha Kubik School of Nursing

Mindy Kurzer Department of Food Science and Nutrition

Melissa Nelson Laska Division of Epidemiology & Community Health

Allen Levine Department of Food Science and Nutrition

Beth Lewis School of Kinesiology

Jennifer Linde Division of Epidemiology & Community Health

Ken Meter Crossroads Resource Center, Minneapolis, Minnesota

Mark Pereira Division of Epidemiology & Community Health

Alexander Rothman Department of Psychology

Sarah Rydell Division of Epidemiology & Community Health

Nancy Sherwood HealthPartners Research Foundation, Bloomington, Minnesota

Scott Shimotsu Division of Epidemiology & Community Health

John Sirard Division of Epidemiology & Community Health

Mary Story Division of Epidemiology & Community Health

Steven Stovitz Department of Family Medicine and Community Health

International Society of Behavioral Nutrition and Physical Activity (ISBNPA) 2010 Annual Conference 5

Keynotes 7

Symposia 15

Oral Sessions 181

Poster Sessions 261

Keynotes

Plenary Session

Food and nutrition policies in Europe – implications for behavioural nutrition

Knut-Inge Klepp

Norwegian Directorate of Health / University of Oslo, Oslo, Norway

The WHO region of Europe consists of 53 member states, representing a huge degree of cultural and socio-economic diversity. At this pan-European level, there is a current WHO European Action Plan for Food and Nutrition Policy (2007-2012) presenting a number of health-related goals and targets, including strategies targeting the growing obesity challenge. Ensuring a safe, healthy and sustainable food supply and providing comprehensive information and education to consumers are among the key action areas. Half of the countries – 27 – are member countries of the European Union which is active in policy formulation in a number of fields, including agriculture, fisheries and foods. In 2007, the Commission adopted the White Paper “A Strategy on Nutrition, Overweight, and Obesity-Related Health Issues” outlining a multi-sectorial strategy to address the issues of overweight and obesity. In addition, most European countries have government-approved policies dealing with food and nutrition, policies clearly demonstrating how food and nutrition span different government sectors and involve both public and private sectors. In this talk, key food and nutrition policies at the European level (WHO) and at the level of the European Union will be presented and discussed along with national level policies. Examples will include policies relating to fortification, labeling, marketing, subsidies and pricing, as well as school food programs. In particular, their implications for behavioural nutrition interventions and research will be explored.

International Society of Behavioral Nutrition and Physical Activity (ISBNPA) 2010 Annual Connference10

Plenary Session

Dual-process theories of behavior: Implications for intervention

Paschal Sheeran

Department of Psychology, University of Sheffield, Sheffield, United Kingdom

Accumulated evidence indicates that dietary behaviors and physical activity may be influenced by both reflective and automatic factors. This session focuses on the implications of this dual-process analysis for behavior change interventions. What new possibilities for intervention might this analysis suggest, and what research is needed to exploit this potential?

Plenary Session

The past, present and future of behavioral treatments for obesity

Robert Jeffery

Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, United States

“Behavioral” or “Lifestyle” interventions for obesity have their origins in the 1970s embrace of behavior theory (BT) as an alternative to psycho-dynamic theory by social scientists interested in behavior change. Behavioral theory recognized the importance of environmental factors in eating and physical activity behaviors. Antecedent cues were seen as triggers for behavior (e.g. food availability), and behavioral consequences were seen as motivators for behavior (e.g. social approval for PA behaviors). Studies of BT treatments for excess body weight were attractive because the problem was a common one and the outcome (weight) was easily tracked and objectively measurable.

This presentation describes the evolution of BT based therapies for obesity treatment over time. It traces the research trail from short term studies in healthy volunteers to multi-center, multi-year RCTs in ill or high risk populations with “hard” health end point (i.e. disease and disability). It is a story with impressive “results”, but one also tempered by persistent obstacles. Recent research on lifestyle interventions for obesity highlight the continuing theoretical challenges of integrating cognitive and environmental models to behavior change, and the practical challenges of achieving durable changes in either set of mediating factors. New development on the cognitive side (e.g. motivational interviewing, and mindfulness) and environmental side (e.g. reinforcement theory and clinical systems approaches) will be described and speculations suggested about the outcomes of the current generation of BT weight control studies.

Plenary Session

Moving on and moving more: Finding ways to use technology to promote energy expenditure and energy balance in 2010

Deborah Tate

University of North Carolina, Chapel Hill, United States

Youth have unprecedented access and familiarity with technology. Though technology use is often associated with energy saving and physical inactivity, evidence suggests that computers and other screen time may not universally be inactive. The thoughtful use of these technologies can be part of a toolbox of intervention strategies to promote energy expenditure. Many challenges exist for next generation programs to be engaging, yet with careful application of behavioral theory. Technology needs to be well-matched to functional goals, and user preferences and use patterns need careful consideration. This paper explores ways we can accept technology’s assets and liabilities for physical activity behavior, and harness its power to extend the reach of clinical care, create engaging behavior change programs, and promote energy expenditure in modern society.

Plenary Session

An integrative, family-based approach to childhood obesity

David Ludwig

Children’s Hospital Boston, Boston, United States

Excessive body weight has become the most common chronic medical condition of childhood, with prevalence rates of 1 in 3 among the general population and an astounding 1 in 2 among some minority groups. Obesity in children increases the risk of many immediate and in some cases life-threatening complications, including type 2 diabetes, fatty liver and sleep apnea. Remarkably, life-expectancy in this country may decline for the first time since the Civil War, as a direct result of childhood obesity, unless this epidemic is reversed.

Despite recent widespread attention to the problem, the treatment of childhood obesity remains largely ineffectual. A likely explanation for this situation is that conventional approaches tend to focus on just one determinant of body weight, whereas the cause of obesity is multi-dimensional in nature. The most powerful behavioral modification methods will likely fail, if they promote a dietary plan that exacerbates hunger and adversely affects metabolism. Conversely, the best possible diet will produce little practical benefit, if people lack the motivation to follow it. Moreover, the effectiveness of all diet and behavioral change programs are undermined by a “toxic environment” that places private profit over public health.

Ultimately, successful long-term treatment of childhood obesity will require an integrative approach, focusing on three key factors: 1) Biology – including a low glycemic load diet and an activity plan that works with, rather than against, the underlying physiological mechanisms governing body weight. 2) Behavior – providing parents with age-appropriate tools to guide their children toward healthful lifestyle habits, without causing conflict. 3) Environment – for now, the family remains the last bastion of protection for children in a world seemingly designed to make them fat. However, families can come together, uniting with health care providers, teachers and others, to create a social environment that truly values the well-being of our children.

Symposia

Symposium

S01 Food parenting practices: Role of parental style and child characteristics in association with dietary behaviour

Food parenting practices: Role of parental style and child characteristics in association with dietary behaviour

Chairperson: Carine Vereecken

Ghent University, Ghent, Belgium

Discussant: Stef Kremers

Maastricht University, Maastricht, Netherlands

Purpose and Rationale: A growing number of studies indicate the importance of food parenting practices in explaining childrens’ and adolescents’ dietary behaviors. However, parenting practices do not occur in isolation, and little is known about the interrelationships between dietary intake, parenting and parent and child characteristics.

Objective: To discuss and gain more insight into the interrelationship of parent and child characteristics with food parenting practices and dietary intake in different countries, in order to guide future research and help to develop more effective interventions.

Format and Summary: The different sessions will use data of different countries (Belgium, Italy, the Netherlands, United States), different methodology (observation, cross-sectional and cohort studies) and different age groups starting from preschoolers to young adults.

Carine Vereecken will examine the associations and interactions between food parenting practices and child characteristics in explaining child dietary behaviour in Flemish preschoolers. Sheryl Hughes will focus on how feeding styles and the emotional climate created by these feeding styles impact on child eating behaviours and weight status in preschoolers, based on observational data on Head Start families during meal time. Ester Sleddens will present data on the interrelationships between general parental style, food parenting practices, child temperament, and dietary behaviour in 6-7 year old children from the Netherlands, using data of the ongoing KOALA birth cohort study. Chiara Verzeletti will investigate if gender and country are moderating the role of parenting practices in Belgian and Italian adolescents participating in the HBSC study. Finally, Sharon Hoerr will present data of a cross-sectional study in college students on parenting behaviour during childhood in general situations and feeding specific situations in relation to current anthropometric measurements and fruit and vegetable consumption.

Presenters: Sheryl Hughes, Ester Sleddens, Chiara Verzeletti, Sharon Hoerr, Carine Vereecken

Associations of parental feeding practices and child characteristics with dietary intake in preschoolersAuthors:

Carine Vereecken - Ghent University, Ghent, Belgium

Lea Maes - Ghent University, Ghent, Belgium

Symposium

Purpose: To examine the relationship of parental feeding practices and child characteristics with the dietary intake in preschoolers and to investigate if child characteristics moderate these associations.

Method: In 2008, 862 parents of preschoolers (mean age 3.5 years) from 56 schools in Belgium-Flanders, completed questionnaires including a parent and child food frequency questionnaire, questions on parental feeding practices (restriction of unhealthy food and pressure to eat derived from the child feeding questionnaire) and children’s temperament (childrens’ shyness, emotionality, activity, sociability, stubbornness/disobedience, and negative reactions to food). A healthy score (fruit and vegetables) and an unhealthy score (snacks and sugared soft drinks) were computed and transformed using the squared root. Multiple linear regression analyses, controlling for parent’s consumption, were used to investigate associations with the outcome variables.

Restrictions were positively associated with the healthy score and negatively with the unhealthy food score. Pressure was positively related with the unhealthy score, but the negative association with the healthy score largely disappeared after controlling for negative reactions to foods. Of the child characteristics only two associations were significant in the multiple regressions: the negative reactions to food scale was negatively associated with the healthy score and shyness was negatively associated with the unhealthy score. No significant two-way interactions between parenting practices and child characteristics (p<0.01) were found.

Conclusions: The present findings suggest favourable associations with the restricting parenting practices and unfavourable with pressuring, findings that need to be confirmed in a longitudinal setting. Parenting practices did not seem to differentially influence children with different characteristics.

Funding Source: Research Foundation - Flanders

Emotional climate and feeding styles: Observational analysis of dinner in low-income familiesAuthors:

Sheryl Hughes - Baylor College of Medicine, Houston, United States

Thomas Power - Washington State University, Pullman, United States

Maria A. Papaioannou - Baylor College of Medicine, Houston, United States

Susan Johnson - University of Colorado Denver, United States

Purpose: Indulgent feeding styles have been associated with a higher risk for childhood overweight. The processes through which feeding styles impact child weight are poorly understood. The aim of this study was to observe differences in the emotional climate created by parents (affect, tone of voice, gestures) among those reporting different feeding styles on the Caregiver’s Feeding Style Questionnaire.

Method: Using observations to measure parent emotional behaviors during dinner, the relationship between the emotional climate of the meal, self-reported feeding styles, and child weight were examined among 159 low-income families. Average age of the children was 4.4±0.7 years equally distributed across gender. Families were observed on 3 separate dinner occasions. MANOVAs were used to evaluate differences across parent-reported feeding style categories on observed measures of parent positive

Symposium

affect, negative affect, intrusion, detachment and cognitive stimulation.

Results: Authoritarian parents were significantly more negative and intrusive with children during dinner compared to authoritative and indulgent parents. Uninvolved parents were significantly more detached with children during dinner compared to authoritative and authoritarian parents. Indulgent and uninvolved parents provided significantly less cognitive stimulation compared to authoritarian parents. Child BMI z scores were as follows: authoritative (n = 32) 0.55; authoritarian (n = 46) 0.59; indulgent (n= 48) 0.91; uninvolved (n = 33) 1.05.

Conclusions: Results suggest that the emotional climate of the dinner meal may play an important part in how parents socialize their children around eating and that self-reported feeding styles may be a proxy for the emotional climate of the dinner meal.

Funding Source: United States Department of Agriculture

Exploring the interrelationships between parenting styles, food-related parenting practices, child temperament and dietary behavior: The KOALA birth cohort studyAuthors:

Ester Sleddens - Maastricht University, Maastricht, Netherlands

Stef Kremers - Maastricht University, Maastricht, Netherlands

Carel Thijs - Maastricht University, Maastricht, Netherlands

Annette Stafleu - TNO Quality of Life, Zeist, Netherlands

Nanne De Vries - Maastricht University, Maastricht, Netherlands

Introduction: This study examined the interrelationship between general parenting style, diet-related parenting practices, child temperament, and dietary behaviors of 6-7 year old children.

Method: Data were gathered from the KOALA Study, a birth cohort study conducted in the Netherlands in which women and their children have been followed from pregnancy onwards. Parents of approximately 1,800 children aged 6-7 completed a follow-up survey consisting of tools measuring general parenting (including nurturing and restrictiveness), parental feeding practices, child temperament and dietary behaviors (e.g., breakfast consumption, fruit consumption, snacking). Hierarchical linear regression analyses were performed to examine interrelations between the study variables.

Results: Parental nurturing was negatively related to both instrumental and emotional feeding, whereas these feeding styles were positively associated with restrictiveness. Furthermore, nurturing was positively related to encouraging and controlling feeding styles. For restrictiveness, these relations were less pronounced.

Conclusion: The preliminary results demonstrate the importance of assessing parenting style in research examining feeding styles, and emphasize the need to address parenting style in interventions to promote healthy eating in children.

Funding Source: Netherlands Heart Foundation, grant number 2008B112

Symposium

Does the family matter? Family structure, parenting practices and food-related lifestyle behaviours related to fruit and vegetable consumption among young Belgian and Italian adolescentsAuthors:

Chiara Verzeletti - University of Padova, Padova, Italy

Massimo Santinello - University of Padova, Padova, Italy

Alessio Vieno - University of Padova, Padova, Italy

Martina Furegato - Regional Centre for Health Promotion, Verona, Italy

Carine Vereecken - Ghent University, Ghent, Belgium

Background: Despite the positive effect on disease prevention and weight management of fruit and vegetable consumption, adolescents are not consuming recommended amounts. In the present study, the relationship of fruit and vegetable consumption with different family background characteristics (family wealth and family structure), food-related lifestyle behaviours (television viewing, fast food consumption and evening meals with parents), and family parenting practices (restriction and obligation rules) are investigated in two large samples of Belgian–Flemish and Italian Veneto Region adolescents.

Methods: The data are part of the Health Behavior in School-aged Children (HBSC) cross-sectional survey. Adolescents between 11 and 16 years of age were included, resulting in a final sample of 14,407 adolescents from Belgium Flanders (N = 7904) and the Veneto Region of Italy (N = 6503). Binary logistic regression was used to test the association between fruit and vegetable consumption, food-related lifestyle variables, family structure, wealth and parenting practices.

Results: Few adolescents reported a daily fruit and vegetable intake. Having more strict family food rules was associated with daily fruit and vegetable intake. Family wealth and several lifestyle variables were differently related with daily fruit and vegetable consumption, while the family structure was not associated with the outcome variables.

Conclusion: These findings underline the importance of food parenting practices in promoting fruit and vegetable consumption among adolescents. Involving parents, improving adolescents’ and families’ food-related lifestyles could increase the effectiveness of the interventions aimed at improving fruit and vegetable consumption in adolescence.

Funding Source: Data from Veneto Region (Italy) are funded by Veneto Region (D.G.R. n. 812 of March, 21, 2006). The Flemish Government, Department of Welfare, Health and Family, funding for the Flemish HBSC-study.

Symposium

Maternal parenting behaviors during childhood relate to weight status and fruit and vegetable intakes of college studentsAuthors:

Sharon Hoerr - Michigan State University, East Lansing, United States

Megumi Murshima - Michigan State University, East Lansing, United States

Sheryl Hughes - Baylor College of Medicine, Houston, United States

Kendra K. Kattelmann - South Dakota State University, Brookings, United States

Purpose: Examine if childhood parenting behaviors, under both general and feeding specific situations, related to college students’ weight status, waist circumference (WC) and fruit and vegetable (FV) intakes.

Methods: U.S. college students (n=424, 66% female, 18-24 yr, Body Mass Index ≥18.5kg/m2, non-nutrition majors) completed anthropometric measurements (weight, height, WC) and questionnaires on current FV intakes and their mother’s parenting behaviors during elementary school. Maternal behaviors included child acceptance, psychological control, behavioral control under general situations, and parent-centered feeding behaviors and child-centered feeding behaviors under feeding specific situations. Regression analysis tested if the maternal parenting behaviors during childhood predicted college students’ BMI, WC, and FV intakes controlling for demographic and family-related variables.

Results: Maternal acceptance had no association with any outcome variables. The greater the maternal psychological control, the higher the students’ BMI and WC. Maternal behavioral control was not associated with any dependent variables except weakly with FV intake in males. Maternal parent-centered feeding behaviors negatively related to female students’ FV intake and negatively to males’ BMI. Maternal child-centered feeding behaviors related to WC in both genders, but the significance weakened when analyzed by gender.

Conclusions: During childhood, parental use of psychological control in general situations (i.e. neglect and guilt induction), and parent-centered behaviors in feeding specific situation (i.e. food restriction and rewarding child to eat) should be minimized. Instead, parental use of child-centered feeding practices (i.e., praising and encouragement at mealtimes) should be advocated to promote long-term healthy weight status and dietary habits.

Funding Source: This was a substudy of a project supported by the National Research Initiative of the USDA CSREES, grant # 2005- 35215-154121541 and part of the multistate regional project NC1028.

Symposium

S02 Digital health promotion: Promoting physical activity using active video games technology

Digital health promotion: Promoting physical activity using active video games technology

Chairperson: Alasdair Thin

School of Life Sciences, Heriot-Watt University, Edinburgh, United Kingdom

Discussant: António Palmeira

Faculty of Physical Education and Sport, Universidade Lusófona de Humanidades e Tecnologias, Lisbon, Portugal

Purpose: Active video games require physical exertion to play them and are a growing cultural phenomenon. This symposium will explore aspects of this technology with a view to its potential use to promote and support a physically active lifestyle.

Rationale: The first decade of the 21st century has seen many high-tech lifestyle products and services become widely adopted in society, including smart-phones, mp3 players, video games and online social networking tools. The resultant effect is that digital technologies and media are now an integral part of many peoples’ daily lives. Active video games offer a novel and potentially enjoyable approach to promote a physically active lifestyle by working with, rather than against these technologies.

Objectives: This symposium will explore psychological, social and behavioral aspects of game-based approaches to promoting physical activity. It will provide a forum to discuss research findings into various health-related aspects of active video games, share experiences and learn from others and will be of interest to researchers concerned with “digital” health promotion. The concluding open discussion will provide insight in challenges and opportunities in using game-based approaches to promoting a physically active lifestyle.

Summary: The symposium will consist of five presentations and time allocated to open discussion on the lessons learned.

Format: António Palmeira will present of review of the recent and emerging digital technologies including active video games which now constitute a significant new “digital” dimension to the ecological perspective of health behavior.

Lisa Hansen will present her work on the socialization and evolution of play during physical education classes incorporating a range of different active video games.

Ralph Madison will present results of the electronic games to aid motivation to exercise (eGAME) RCT study designed to investigate the effects of active video game play on overall levels of physical activity, fitness and body composition in children.

Monique Simons will present results of her studies with children and their parents into the psychological and social correlates of both traditional and active video game purchase and game play time and the implications for using active video games as a tool to promote a physically active lifestyle.

Alasdair Thin will present the results of an investigation into what players experience whilst playing active video games and provide evidence that they offer a high level of engagement that is closer to competitive sport rather than recreational exercise.

Symposium

Active video games as an example of a cyber-ecological approach to health promotionAuthors:

António Palmeira - Universidade Lusófona de Humanidades e Tecnologias, Lisbon, Portugal

Alasdair Thin - Heriot-Watt University, Edinburgh, United Kingdom

Purpose: To place Active Video Games (AVGs) within the context of a new Cyber-Ecological Model which incorporates a hierarchy of “digital” influences on health behavior.

Background: The advent of the networked society means that reality for many people in the 21st century is lived through a bricolage of their physical existence and their activities in one or more digital realms. Mobile phones and video game consoles are key consumer platforms and a range of health and lifestyle applications and games have emerged.

Key Points: A Cyber-Ecological Model is proposed whereby an individual and their digital representation(s) (avatars) sit at the confluence of two hierarchies of influences on health behavior arising from their physical and digital worlds, respectively. Similar to the varying levels of influence in the real world, the digital agents will vary in the influence they exert. In the real world, top-down influences predominate as an accident of birth. In contrast, in the digital realm individuals sign-up by choice and have greater levels of control and higher expectations and levels of interactivity that are often near instantaneous. AVGs are a type of digital agent with influence whereby physical activity is an emergent behavior of game play and it is predicted that AVGs’ popularity is due to the high levels of control and interactivity that they offer users.

Conclusions: The understanding of how agents of the digital realm including AVGs can influence health behavior is a crucial challenge for health promotion in the 21st century.

Socialization and the evolution of play during physical education classes incorporating active video gamesAuthor:

Lisa Hansen - University of South Florida, Tampa, United States

Purpose: Video games are a popular form of entertainment and in an effort to broaden their appeal a new genre of Active Video Games (AVGs) has emerged which requires physical exertion in order to play them. The impact of introducing a program of AVGs play into a physical education class was explored through students’ experiences.

Methods: A class of 5th grade (age 9-11 years) students was observed during their twice weekly physical education class incorporating AVGs (30 minutes duration) over an eight week period. Qualitative case study methods were used including observational field notes, journal entries and interviews and were analyzed using inductive analysis and a descriptive narrative approach.

Symposium

Results: The students demonstrated a consistent desire to be engaged in physical activity in order to play the AVGs. Not only was social interaction (e.g. discussing strategies, assisting classmates, issuing challenges) highly evident, the analysis indicated it was a major factor towards the eagerness for students to continue to play the AVGs. Furthermore, the students were visibly non-compliant when asked by the teacher to stop game play at the end of each class.

Conclusion: Whilst participating in AVGs play the students demonstrated a “Persistence to Game” as characterized by an unremitting interest to engage with the gaming activities and a high level of social interaction centered on game play strategies and challenges. These findings indicate that the AVGs provided a highly engaging physical activity experience and that AVGs could be used to help promote regular physical activity to children.

Funding Source: United States Government Earmark, Center for Disease Control

Electronic games to aid motivation to exercise (eGAME): A randomized controlled trialAuthors:

Ralph Maddison - University of Auckland, Auckland, New Zealand

Louise Foley - University of Auckland, Auckland, New Zealand

Yannan Jiang - University of Auckland, Auckland, New Zealand

Cliona Ni Mhurchu - University of Auckland, Auckland, New Zealand

Andrew Jull - University of Auckland, Auckland, New Zealand

Harry Prapavessis - University of Western Ontario, London, Canada

Maea Hohepa - Sport and Recreation New Zealand, Wellington, New Zealand

Anthony Rodgers - The George Institute, Sydney, Australia

Purpose: This paper presents the results of a randomized controlled trial to determine the effects of active video games over 6 months on: body composition, physical activity, and physical fitness in New Zealand in overweight children. This is the largest trial of its kind to date to investigate these issues.

Methods: Two-arm parallel randomized controlled trial. Children (n=322) aged 10-14 years (M =11.6, SD= 1.08) were randomized to either receive an upgrade (hardware and games) to their existing video game technology to enable them to play active video games (n=160) or to a control group (no change; n=162). Randomization was stratified by sex (Female/Male) and ethnicity. Height, weight, waist circumference, and % body fat at three and six months. Secondary measures collected at the same time points included physical fitness (shuttle run test), physical activity (Actigraph accelerometer and Physical Activity Questionnaire for Children) and self-reported video game play and food snacking.

All outcome variables were analyzed as change from baseline at three and six months using the Repeated Measure analysis, adjusting for baseline outcome measure and important demographics. Intervention effect was evaluated over the whole study period if there was no significant interaction between treatment groups and visits.

Symposium

Results: Significant differences were found for BMI favoring the intervention group (Mean difference between group = -0.33 kg/m2, SE=0.1, p=0.009), and zBMI (-0.08, SE=0.04, p=0.02). A significant difference was also found for % body fat (-1.5%, SE=0.7, p=0.02), but not for waist circumference at six month (-1.2 cm, SE=0.6, p=0.22).

Conclusions: This large pragmatic and innovative trial showed that playing active video games can prevent weight gain and improve body composition in children.

Funding Source: Health Research Council of New Zealand

Correlates of purchasing and playing active and traditional video gamesAuthors:

Monique Simons - VU University, EMGO Institute, Body@Work, Amsterdam, Netherlands

Emely de Vet - VU University, Amsterdam, Netherlands

Mai Chin A Paw - EMGO Institute, Amsterdam, Netherlands

Johannes Brug - EMGO Institute, Amsterdam, Netherlands

Jaap Seidell - VU University, Amsterdam, Netherlands

Purpose: Active video games might be a promising method for reducing sedentary pastime and could therefore be a possible tool for weight gain prevention. In this light, the purpose of the study was to explore correlates of purchasing and playing video games and to evaluate if there is a difference in correlates between active and sedentary gaming.

Methods: Six focus groups were conducted with children (n=46) in the age of 8-12 years and four focus groups with parents (n=19) of 8-12 year old children using a semi-structured discussion guide. Because of the explorative nature, the grounded theory was applied. Content analysis was performed using Atlas.ti 5.2.

Results/Findings:

Children: The participants listed various aspects, like challenge en genre, which determines whether a game is enjoyable or not. Most children preferred active games over traditional games. Social context of gaming was discussed. Furthermore, the way of purchasing and the rules at home for gaming were points of discussion.

Parents: Parents discussed both positive and negative aspects about gaming. Parents mentioned that playing active video games should not be at the expense of participation in outdoor activities. Furthermore, considerations for purchasing a game and rules at home were discussed.

Conclusions: In general, both children and parents seem to have a positive attitude towards active games. No concerning differences between active video gaming and sedentary gaming came to light. This opens up the opportunity of active games to motivate sedentary children to get active.

Funding Source: ZonMw and Nederlandse Hartstichting (JUMP)

Symposium

Sport-like experience from active video game playAuthors:

Alasdair Thin - Heriot-Watt University, Edinburgh, United Kingdom

Purpose: The interactive and engaging nature of active video games (AVGs) are such that they could potentially facilitate such an absorbing and rewarding form of physical exercise to the extent that AVGs players experience the so-called “flow” state. Alternatively, the competitive skill demands and/or bodily sensations of exertion may in fact be a significant obstacle to such an optimal experience.

Methods: In order to investigate the potential for players of AVGs to experience the “flow” state, 14 young adults played six different AVGs for six minutes each and also performed conventional cycling exercise, all in a randomized order. Subjects had two separate familiarization sessions playing the AVGs and on a third occasion after each game rated their enjoyment of the games using a visual analogue scale and completed the Flow State Scale-2 questionnaire.

Results: Four of the six AVGs were rated significantly more enjoyable than the conventional cycling. Two “flow” constructs Challenge-Skill Balance and Merging of Action and Awareness were rated significantly higher than the published norms for dance (ES=+0.53 and +0.77 respectively) and for physical activity (ES=+0.36 and +0.53 respectively). Overall, the reported “flow” profile after AVGs play corresponded more closely to the norm for sporting activity.

Conclusion: Rather than just being a novel form of technology-enhanced exercise, these results suggest that playing AVGs can result in players having a “sport-like” experience and that playing AVGs could potentially act as a gateway for sedentary individuals to become involved in sporting activities.

Funding Source: School of Life Sciences, Heriot-Watt University

Symposium

S03 Healthy eating research: Building evidence for environmental and policy solutions to prevent child obesity

Healthy eating research: Building evidence for environmental and policy solutions to prevent child obesity

Chairperson: Mary Story

Division of Epidemiology & Community Health University of Minnesota, Minneapolis, United States

Discussant: Mary Story

Purpose: To present results of funded studies from the Robert Wood Johnson Foundation’s Healthy Eating Research (HER) program focused on policies and practices to promote healthful food choices and prevent obesity among children and adolescents.

Rationale: HER supports innovative research on environmental and policy strategies with strong potential to improve children’s diets and energy balance to prevent childhood obesity. The aim is to identify effective strategies likely to have population-level impacts and to provide decision-and policy makers with evidence to guide and accelerate effective action to reverse the rise in childhood obesity.

Objectives: 1) To present data from four original studies funded by HER that address policy and environmental factors that influence healthy eating and obesity prevention in children and adolescents; 2) To discuss the implications of data for developing policies and interventions to prevent child obesity; and 3) To discuss future directions for nutrition and diet-related policy and environmental research for child obesity prevention.

Summary: At this point in time we do not know the most effective strategies for preventing childhood obesity. This session will focus on four key priority areas in child obesity prevention: evaluating nutrition polices in US secondary schools in low-income communities; farmers markets and access to improving healthy food in low-income urban communities; the effect of food prices and food advertising on children’s weight; and factors related to eating environments of children outside of school time. The four presentations were funded by the Healthy Eating Research Program of the Robert Wood Johnson Foundation.

Format: Environmental and policy-relevant research related to childhood obesity will be addressed as part of four data-based presentations pertaining to key topic areas in obesity prevention – schools, farmers markets, food advertising and eating environments of children outside of school. Each speaker will present their findings. The discussion will focus on the implications of the findings for obesity prevention and future research directions.

Presenters:

Gary D. Foster – Factors influencing intake before and after school among ethnically diverse, low-income youth

Marilyn S. Nanney – Evaluating the distribution of nutrition policies and practices in U.S. secondary schools serving the most weight-vulnerable children

Symposium

Kathryn M. Neckerman – Can farmers’ markets improve access to healthy foods in low-income urban communities?

Roy Wada – Analyzing the effects of food prices and food advertising on body composition of children

Snacking in children: The role of urban corner stores Authors:

Gary Foster - Temple University, Philadelphia, United States

Kelley Borradaile - Temple University, Philadelphia, United States

Sandy Sherman - The Food Trust, Philadelphia, United States

Stephanie Vander Veur - Temple University, Philadelphia, United States

Tara McCoy - Temple University, Philadelphia, United States

Brianna Sandoval - The Food Trust, Philadelphia, United States

Joan Nachmani - School District of Philadelphia, Philadelphia, United States

Allison Karpyn - The Food Trust, Philadelphia, United States

Purpose: Childhood obesity is higher among ethnic minorities. One reason may be the limited access to affordable, healthy options. The disparate prevalence of urban corner stores in low-income and high-minority communities has been well documented. There are no data, however, on what children purchase in these environments before and after school.

Objective: The purpose of this study was to document the nature of children’s purchases in corner stores proximal to their schools.

Methods: This was an observational study from January to June 2008. Participants were children in grades 4 through 6 from 10 urban K-8 schools with ≥ 50% of students eligible for free or reduced price meals. A total of 817 intercept surveys of children’s purchases were conducted outside of 24 corner stores before and after school. The main outcomes were type and energy content of items purchased.

Results: The most frequently purchased items were energy-dense, low-nutritive foods and beverages, such as chips, candy, and sugar-sweetened beverages. Students spent $1.08 ± 0.93 on 2.1 ± 1.4 items (1.6 ± 1.2 food items and 0.5 ± 0.6 beverage items) per purchase. The total number of calories purchased per trip was 360.0 ± 288.1 kcal. More calories came from foods than from beverages.

Conclusion: Purchases made in corner stores contribute significantly to energy intake among urban school children. Obesity prevention efforts, as well as broader efforts to enhance dietary quality among children in urban settings, should include corner store environments proximal to schools.

Funding Source: Robert Wood Johnson Foundation, Healthy Eating Research

Symposium

Evaluating the distribution of nutrition policies and practices in U.S. secondary schools by race/ethnicity, geography and income Authors:

Marilyn S. Nanney - University of Minnesota, Minneapolis, United States

Cynthia Davey - University of Minnesota, Minneapolis, United States

Susan Lowry - University of Minnesota, Minneapolis, United States

Martha Kubik - University of Minnesota, Minneapolis, United States

Purpose: To evaluate the distribution of nutrition policies and practices from 27 U.S. states representing 6,421 secondary schools.

Methods: Using data from the School Health Profiles Survey (2008), summary scales were created to assess the availability of less healthy snacks/drinks (n=10 items), healthy eating strategies (n=5-items) and food marketing (n=5-items). Cronbach’s alphas ranged from 0.61-0.89. Binary summary variables representing availability of fruit/non-fried vegetables and healthy vending/school stores were also created. For each school, school-level demographics (% free/reduced lunch, minority enrollment, geographic location) were linked using the National Child Education Survey. Disparities were defined as mean differences of Ł 0.10 SD between groups.

Results: Adjusted LS mean scores indicated schools serving mostly whites and higher SES students were more likely to have less healthy snacks/drinks available, while mostly white and lower SES schools were least likely to have fruit/non-fried vegetables in vending/school stores, at celebrations or to have no vending at all. Use of strategies that encourage healthy eating (i.e., pricing, nutrition info, tasting) and policies that prohibit candy, soda and restaurant advertisement or food marketing (i.e., on school grounds, bus) were least likely to occur in town or rurally located schools and those serving mostly whites.

Conclusion: Rural and mostly white and low income schools may need additional support in establishing school policies and practices that promote healthy eating environments.

Funding Source: Robert Wood Johnson Foundation Healthy Eating Research New Connections

Can farmers’ markets improve access to healthy foods in low-income urban communities?Author:

Kathryn Neckerman - University of Chicago, Chicago, United States

Purpose: Farmers’ markets have significant potential for enhancing access to healthy foods in low- and mixed-income urban areas because they can be established more quickly and at lower cost than supermarkets. Little is known about how receptive residents of these neighborhoods are to shopping at farmers’ markets. This study examines whether consumers who live in “food deserts” are more likely to shop at farmers’ markets and more likely to express favorable attitudes about them.

Symposium

Methods: This study reports results of a street intercept survey carried out at farmers’ markets and nearby commercial districts in eight cities and towns. Sampling strategies were designed to include low-income urban residents. The total sample included 876 respondents, of whom 42% were interviewed at farmers’ markets and 58% in commercial districts. The sample was ethnically diverse and included significant numbers of low-income respondents. The survey included questions about farmers’ market use and about respondents’ attitudes and perceptions about the markets. Questions about their local grocery stores included perceptions about quality and price. Data on zip code of residence will be used to construct objective food environment indicators.

Results/Findings: Consistent with expectations, preliminary findings indicate that consumers who rate their usual grocery store poorly are more likely to express favorable attitudes about farmers’ markets. Multivariate analysis (to be conducted over the next two months) is needed to assess the relationship between the local food environment and farmers’ market use.

Conclusions: The study provides insight into conditions under which low-income consumers will shop at farmers’ markets.

Funding Source: RWJF Healthy Eating Research

Analyzing the effects of food prices and food advertising on body composition of childrenAuthors:

Michael Grossman - NBER / City University of New York, New York, United States

Erdal Tekin – NBER / Georgia State University, Atlanta, United States

Roy Wada - UCLA School of Public Health, Los Angeles, United States

Purpose: (1) To develop measures of body composition for children that can serve as an alternative to body mass index (BMI)-based obesity measures, (2) use them to conduct an analysis of the effects of food prices and fast-food restaurant advertising on television on obesity among children ages 12-18, and (3) examine whether the effects of food prices and food advertising on body composition differ between adolescents from low socio-economic backgrounds and other adolescents.

Methods: Data on body composition from the National Health and Nutrition Examination Surveys (NHANES) were used to calculate the body composition for the survey participants in the National Longitudinal Survey of Youth 1997 (NLSY97). The calculated body composition in NLSY97 was then used to estimate the effect of food prices and food advertising on body composition of children ages 12-18 in NLSY97. Adolescent obesity is defined as having greater than 22 percent body fat for boys and 24 percent for girls.

Results/Findings: A ban on food advertising on television would potentially reduce the number of obese adolescents ages 12-18 by about 15-20 percent. Lower fast-food restaurant price is associated with higher

Symposium

incidence of childhood obesity. The effect of ethnicity on childhood obesity becomes stronger when body composition is used to defined obesity.

Conclusions: Body composition for children can serve as a useful alternative for measuring the impact of environment on the incidence of childhood obesity.

Funding Source: Robert Wood Johnson Foundation - Healthy Each Research

Symposium

S04 Physical activity behaviour in older adults: Challenges in measurement and interventions

Physical activity behaviour in older adults: Challenges in measurement and interventions

Chairperson: Marijke Hopman-Rock

TNO Quality of Life / VU University Medical Center, Leiden/Amsterdam, Netherlands

Discussant: Marijke Hopman-Rock

TNO Quality of Life / VU University Medical Center, Leiden/Amsterdam, Netherlands

Regular participation in exercise and physical activity (PA) has been associated with a variety of health benefits, also in populations of older adults. Several physical functions, such as strength and endurance can be improved by an increased amount of PA. Physical Inactivity and sedentary behaviour are independent risk factors which may ameliorate several chronic diseases which occur often in the elderly, like diabetes mellitus type II, osteoporosis, and osteoarthritis.

After the age of 55 years, there is a significant decrease in the compliance to the HEPA guidelines, and this gets worse at older age. It is important to reverse this negative behavioural trend with evidence based interventions and by developing high quality measurements.

This symposium contributes to the knowledge about the topic. Marijke Hopman-Rock will present the latest insights into measurement of physical activity of older adults. Margot Koeneman will present a systematic review in the area of barriers and motivators to PA behaviour in older adults. Erwin Tak will present challenges and opportunities in PA intervention studies for older adults with disabling conditions such as incontinence and osteoarthritis. Johan de Jong will present the results of the Groningen Active Living Model, a community based PA stimulation intervention in people aged 55-65 years.

Discussion will be lead by Marijke Hopman-Rock who is the founding chair of the European Network for Action on Aging and Physical Activity (www.EUNAAPA.org).

Introduction to physical activity behaviour in older adults: Challenges in measurement and interventions

Author:

Marijke Hopman-Rock - TNO Quality of Life / VU University Medical Center, Leiden/Amsterdam, Netherlands

Regular participation in exercise and physical activity (PA) has been associated with a variety of health benefits, also in populations of older adults. Several physical functions, such as strength, and endurance can be improved by an increased amount of PA. Physical Inactivity and sedentary behaviour are independent risk factors which may ameliorate several chronic diseases which occur often in the elderly, like diabetes mellitus type II, osteoporosis, and osteoarthritis.

Symposium

After the age of 55 years there is a significant decrease in the compliance to the HEPA guidelines, and this gets worse at older age. It is important to reverse this negative behavioural trend with evidence based interventions and by developing high quality measurements.

This symposium contributes to the knowledge about the topic. Marijke Hopman-Rock will present the latest insights into measurement of physical activity of older adults. Margot Koeneman will present a systematic review in the area of barriers and motivators to PA behaviour in older adults. Erwin Tak will present challenges and opportunities in PA intervention studies for older adults with disabling conditions such as incontinence and osteoarthritis. Johan de Jong will present the results of the Groningen Active Living Model, a community based PA stimulation intervention in people aged 55-65 years. Discussion will be lead by Marijke Hopman-Rock who is the founding chair of the European Network for Action on Aging and Physical Activity (www.EUNAAPA.org).

Measurement of physical activity in older adults: A challengeAuthors:

Kerstin Frandin - Karolinska Institute, Stockholm, Sweden

Lisa Forsen - Norwegian Institute of Public Health, Oslo, Norway

Purpose: Review of existing knowledge about measurement of physical activity in older adults.

Background: Measurement of physical activity is still a challenge. Many questionnaires and instruments were developed and are used in a whole range of settings (communities, hospitals, nursing homes, etc).

Method: From 2006-2008 the EUNAAPA (European Network for Action on Aging and Physical Activity) project has been carried out with funding by the department of DG Sanco (Public Health) of the EU. One of the goals of this project was to make an inventory of the most frequently used questionnaires/instruments in the area of physical activity and older people, and to rate the quality by asking the opinion of users in the participating 15 countries (expert survey; Frändin et al, 2008). In addition, a review (Forsén et al, submitted) has been carried out to identify the questionnaires with the highest reliability and validity in the field. Besides these results, attention will be paid to other research such as with the IPAQ (International Physical Activity Questionnaire) and Response Conversion.

Conclusions: IPAQ and PASE are the most widely used self-report instruments. Pedometer, METs values and actometers are the most used performance based instruments. PASE is the only questionnaire which is sufficiently valid and reliable. Response Conversion is promising to improve international comparisons.

References:

Frändin et al. Expert Survey regarding Assessment Instruments on Physical Activity and Physical Functioning in Older People (report Work package 4, www.eunaapa.org)

Hopman-Rock M, Dusseldorp E, Chorus A M J, Jacobusse G, Rütten A, Buuren van S. Response conversion for improving comparability of international physical activity data. Under review.

Symposium

Determinants of physical activity and exercise among older adults: A reviewAuthors:

Margot Koeneman - Body@Work, Research Center, VU University Medical Center, Amsterdam, Netherlands

Marieke Verheijden - TNO Quality of Life, Leiden, Netherlands

Mai ChinAPaw - EMGO Institute of Health and Care Research, VU University Medical Center, Amsterdam, Netherlands

Purpose: The aim of this review is to provide an overview of recent literature on determinants of physical activity (PA) and exercise in older adults and to provide the field with a sense of direction in which to conduct further research.

Background: An ever growing number of studies suggests that low to moderate physical activity can prevent a decline in mobility and improve well being in older adults.

Methods: We conducted literature searches in the databases PubMed/Medline and PsycINFO/OVID for studies published in the period from 1990 until May 2009. The search included studies reporting on 1) Community dwelling healthy older adults aged 55 and older and 2) Determinants associated with initiating and maintaining physical activity and exercise. Two researchers independently assessed the studies’ eligibility. The exclusion of papers reporting case studies, qualitative data only, cross-sectional studies, and papers targeting minority groups other than older adults resulted in 36 eligible papers to be included in the review. Physical activity was reported in 3 studies, 24 studies reported exercise and 9 studies reported a combination of the two. Only 3 of the 36 studies quantified exercise/PA in an objective way. 12 studies used a combination of self-report and objective measures.

Conclusions: This review provides a useful overview of work on determinants of physical activity and exercise in older adults. Environmental, unconscious and psychological determinants, like major life events, loneliness and age expectations need to be studied in future research using objective measures for physical activity and exercise.

Funding Source: Body@Work, Research Center on Physical Activity, TNO-VU University Medical Centre, Amsterdam, The Netherlands

Challenges and opportunities in physical activity intervention studies for older adults with chronic conditionsAuthors:

Erwin Tak - TNO Quality of Life, VU University Medical Center, Amsterdam, Netherlands

Astrid Chorus - TNO Quality of Life, Leiden, Netherlands

Purpose: Physical activity (PA) has been shown to be able to reduce the level of disability in populations of older adults. However, there is less research and evidence on older adults with chronic conditions due

Symposium

to exclusion of this group from most research. Our goal was to identify challenges and opportunities in carrying out PA intervention studies.

Methods: Two case studies are presented which describe RCT studies into exercise programs to prevent disability in institutionalized frail older adults with urinary incontinence (UI) and in community dwelling older adults with hip osteoarthritis (OA). Outcome measures in both studies were functional limitations and disability. Encountered challenges are recorded and if possible solutions are mentioned.

Results/Findings: Challenges encountered included intervention (lower intensity of exercises, lack of compliance), design (blinding was not always possible due to use of nursing staff), measurements (had to be limited to reduce burden and cognitive limitation participants), selection biases (less disabled participants enrolled in both studies), selective dropout (dropouts in both studies were less disabled then non-dropouts), missing data in the UI study which resulted in loss of power, responsiveness (participants in both the exercise and control group reduced their frequency of UI episodes (51%-42% respectively)). Adaptations included use of per protocol analysis, imputation of missing data and reduction of measurements.

Conclusions: There were practical and methodological issues which influenced our results. Issues concerning enrolment, outcome measurement and statistics can and need to be addressed in order to study the effectiveness of PA in this population.

Longitudinal effects of GALM on physical activity, health and fitness of older adultsAuthors:

Johan de Jong - School of Sports Studies, Hanze University of Applied Sciences, Groningen, Netherlands

Koen Lemmink - Hanze University of Applied Sciences & Human Movement Sciences, Groningen, Netherlands

Martin Stevens - University Medical Center Groningen, Groningen, Netherlands

Purpose: To determine the longitudinal effects of participation in the Groningen Active Living Model (GALM) on physical activity, health and fitness of sedentary and underactive older adults aged 55-65.

Methods: A group-randomized trial was conducted and older adults were assigned to an intervention (n=79) or waiting-list control group (n=102). The GALM program can be characterized as a versatile recreational sports program (e.g., softball, dance, etc.). Measurements of physical activity (energy expenditure), indicators of health (e.g., BMI, blood pressure, %body fat, etc.) and fitness (e.g., aerobic endurance, strength, etc.) took place at baseline and after 6, 12 and 18 months. Data were analyzed using ANCOVA and multilevel analysis.

Results: The six-month results showed favorable significant time effects for leisure-time physical activity, body fat and many performance-based fitness outcomes in both study groups. Only two significant between-group differences appeared in favor of the intervention group (i.e., fitness score, grip strength). The twelve-month results showed significant main effects for time regarding recreational sports activities and especially performance-based fitness outcomes. No changes for health were found except for BMI

Symposium

that significantly decreased over time. Finally, cardiovascular functioning (i.e., decrease in heart rate during (sub)maximal walking speeds) improved significantly from baseline to 18 months. The relative decreases in heart rate ranged from 5.1% to 7.4% compared with baseline values.

Conclusions: GALM stimulates leisure-time physical activity and health in the short term and recreational sports activities and performance-based fitness in the long term.

Funding Source: ZonMw (grant number 2200.0074)

Symposium

S05 Gathering information beyond effectiveness to enhance dissemination: Using the RE-AIM framework for the evaluation of physical activity interventions

Gathering information beyond effectiveness to enhance dissemination: Using the RE-AIM framework for the evaluation of physical activity interventions

Chairperson: Greet Cardon

Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium

Discussant: Lisa Klesges

School of Public Health, University of Memphis, Memphis, United States

Purpose: The symposium aims to discuss the importance of systematic evaluation as a basis for policymaking and dissemination of physical activity interventions. It introduces the RE-AIM framework as one way of conducting systematic evaluation and gives practical examples of RE-AIM’s use in studies of physical activity interventions implemented in various settings. Finally, the symposium brings out the possibilities and challenges specifically related to the RE-AIM framework from the dissemination point of view.

Rationale: In the recent literature, the need for more thorough evaluation of PA interventions has been clearly articulated. Systematic evaluation is needed to compare the interventions for decision making, to increase successful translation of study results into practice and to disseminate the intervention actions more effectively. The use of RE-AIM framework (www.re-aim.org) has been recommended for more systematic balancing of internal and external validity. While focusing evaluation on both the individual and setting level, the key components of the framework are Reach, Efficacy/Effectiveness, Adoption, Implementation and Maintenance. The dimensions beyond efficacy/effectiveness represent the external validity and thus the translation and dissemination potential of the intervention. To date only a few studies include information on their external validity. For example, in childhood obesity prevention research the median of studies that reported elements crucial for translation and dissemination was 34.5%.

Objectives:

1. To introduce the RE-AIM framework for systematic evaluation of interventions

2. To show the application of RE-AIM in evaluating physical activity interventions in various settings

3. To discuss the possibilities RE-AIM offers in disseminating intervention actions into practice

4. To bring out the challenges related to the use of RE-AIM in dissemination studies

Summary and Format:

Paul Estabrooks, Introduction to the RE-AIM framework

Minna Aittasalo, Evaluating a nationwide physical activity prescription program

Ragnar Van Acker, Evaluating the 10,000 steps whole-community project in Flanders

Genevieve Fridlund Dunton, Using the RE-AIM framework to evaluate the statewide dissemination of a school-based physical activity and nutrition curriculum: exercise your options.

Symposium

Based on these four presentations, Lisa Klesges will lead the discussion on practical issues of applying the RE-AIM framework as an instrument to expand the evidence base on successful dissemination and external validity of PA interventions.

The fundamentals of the RE-AIM frameworkAuthor:

Paul Estabrooks - Virginia Tech, Blacksburg, United States

Background: The RE-AIM framework provides an evaluation structure that balances the focus on internal/external validity as well as individual/organizational areas of impact. Reach (i.e., the number, proportion, and representativeness of participants) and Effectiveness (i.e., magnitude and robustness of change in the primary outcome and quality of life while considering potential negative outcomes) are assessed at the individual level. Adoption (i.e., the number, proportion, & representativeness of delivery sites) and Implementation (i.e., the degree to which the program/policy is delivered as intended) are assessed at the organizational level. Finally, Maintenance is assessed at both the individual (i.e., sustainability of behavior change) and organizational (i.e., sustainability of program/policy delivery) levels. RE-AIM based reviews of physical activity and nutrition intervention research consistently demonstrate a lack of information on representativeness, adoption, and organizational maintenance.

Purpose: To provide a general overview of the RE-AIM framework and highlight methods for collecting, combining, and interpreting RE-AIM indicators.

Key Points: Each RE-AIM dimension will be introduced, defined, and applied to physical activity promotion interventions. Approaches to plan data collection to, for example, determine appropriate denominators for reach and adoption calculations and intervention implementation will be presented. Graphical and numeric methods for presentation of RE-AIM findings will also be discussed. Finally, the creation of composite reach and effectiveness scores, individual level and organizational level impacts, and cost issues will be described.

Conclusions: The RE-AIM framework provides a comprehensive approach for examining broad indicators of public health impact for physical activity programs, policies, and practices.

Funding Source: National Institutes of Health R01DK071664 (Estabrooks PI)

Evaluating national physical activity prescription program (PAPP)

Authors:

Minna Aittasalo - The UKK Institute for Health Promotion Research, Tampere, Finland

Katriina Kukkonen-Harjula - The UKK Institute for Health Promotion Research, Tampere, Finland

Purpose: In 2001-2004 a collaborative Physical Activity Prescription Program (PAPP) was implemented in Finland to increase physical activity (PA) counseling among primary care physicians. A tool for counseling

Symposium

and PA prescription, was developed (www.liikkumisresepti.net) to systematize practices and to enhance co-operation among health care practitioners and between health care and exercise providers. A broad range of actions was taken to disseminate PA prescription into practice. The purpose of this study was to evaluate PAPP within the framework of RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance).

Methods: Reach was evaluated with the extent and coverage of prescription material requested by health care units; Effectiveness with the change at the national level in the frequency of PA counseling among physicians from the year 2002 (N= 16692) to 2004 (N=17170); Adoption with the change at the national level in the frequency of using written material, such as prescription, in counseling; Implementation with the extent the intended actions were accomplished and Maintenance with the extent the prescription was institutionalized.

Findings and Conclusions: A national program with three-year public funding was successful in reaching the target group, implementing the actions and creating local projects for maintenance. However, it did not facilitate the uptake and adoption of PA prescription. Extending the duration of the program and investing more effort at local level may have improved the results.

Reference: Aittasalo M, Miilunpalo S, Ståhl T, Kukkonen-Harjula K. From innovation to practice: initiation, implementation and evaluation of a physician-based physical activity promotion programme in Finland. Health Promotion International 2007;22:19-27.

Dissemination and implementation of the 10,000 steps whole community project in FlandersAuthors:

Ragnar Van Acker - Ghent University, Ghent, Belgium

Ilse De Bourdeaudhuij - Ghent University, Ghent, Belgium

Greet Cardon - Ghent University, Ghent, Belgium

Purpose: To evaluate the dissemination and implementation of interventions based on the whole community project “10,000 steps Ghent.”

Methods: Dissemination efforts were undertaken within a period of 1.5 years and were limited to a mailed report of the pilot study’s results, a website, and informative presentations about the 10,000 steps project. A representative sample of 69 (local) health and sports services were surveyed on project awareness, adoption and implementation of projects based on 10,000 steps. Analyses included descriptive statistics, chi-square and t-tests.

Results: 90% knew the 10,000 steps project (dissemination effectiveness). Projects based on 10,000 steps and targeting the whole-community were adopted by 30% of the settings. Another 6% adapted the project to solely target a specific population group. Health services were better represented among settings that adopted the program than among those who didn’t (81% versus 56%;p=0.05), while setting size did not have any impact. For implementation and project content, the sample achieved a median score of 52% on the nine project components. Lowest component mean scores were found for making personal contact with the community population (17% ± 28), environmental components (street signs

Symposium

and billboards, 19% ± 37), and making community-partnerships (37% ± 46). Of the whole-community adopters, 33% reported plans for a sequel of the project in the future (maintenance).

Conclusions: The RE-AIM analyses showed that modest dissemination efforts of the 10,000 steps project can evoke substantial project awareness and moderate adoption. However, more support (e.g. a regional advisory entity) seems necessary to increase project fidelity.

Using the RE-AIM framework to evaluate the statewide dissemination of a school-based physical activity and nutrition curriculum: “Exercise Your Options”Authors:

Genevieve Dunton - University of Southern California, Alhambra, United States

Renee Lagloire - Hader + Company, Community Research, Los Angeles, United States

Trina Robertson - Dairy Council of California, Irvine, United States

Purpose: Obesity prevention programs delivered in the school setting have demonstrated only modest levels of effectiveness. However, past studies typically do not consider the overall public health impact of the interventions. The current study used the RE-AIM framework to evaluate the reach, efficacy, adoption, implementation, and maintenance of the “Exercise Your Options” (EYO) program, a school-based physical activity and nutrition curriculum.

Methods: California middle schools (N = 683 students, N = 16 teachers) participated in a non-experimental pilot evaluation for a statewide dissemination trial of the curriculum. The intervention consisted of eight nutrition and physical activity lessons delivered by classroom teachers. A teacher guide, video clips, a student activity booklet and ancillary materials were distributed to each teacher. Evaluation measures included program records, classroom observations, teacher surveys, and student pre- and post-surveys. Data were analyzed through descriptive statistics and multi-level random-coefficient modeling.

Results: The EYO program reached 234,442 middle-school students in California. During the program, total physical activity increased (p < .001), whereas watching TV/DVD’s and playing electronic games/computer use decreased (p’s < .05). Intake of milk and dairy products increased (p’s < .05), whereas consumption of sugars/sweets decreased (p <.001). Forty-two percent of eligible middle-school classrooms ordered the program materials. Eighty-six percent of sampled teachers implemented all of the lessons. Over the past five years, 51% of all middle-school students in California were exposed to the program.

Conclusions: Using the RE-AIM evaluation framework, the EYO program showed potential for moderate to high public health impact among California middle-school students.

Funding Source: Dairy Council of California

Symposium

Implications for improved decision makingAuthor:

Lisa Klesges - University of Memphis, Memphis, United States

Purpose: To summarize cross-cutting elements from the presentations and discuss the implications for decision-making regarding the translation of physical activity interventions into practice and policy. Discussion will focus attention on issues needed to improve the reporting of research evidence and to estimate population impact. The presenters will discuss with the audience the strengths and weaknesses of applying the RE-AIM framework within their programs, and will respond to comments and questions from the audience.

Background: Translational research would benefit from a greater accumulation of evidence having external validity to drive program planning and policy decisions. The RE-AIM approach is one practical framework for use in systematic evaluation of health promotion interventions; it supports reporting of evidence that emphasizes high generalizability to time, place and population characteristics, which combines external validity and contextual relevance to support decision making.

Key Points: Major points include: 1. The RE-AIM approach was successfully applied to systematic evaluations of physical activity programs in three unique settings; 2. Applying the evaluation resulted in assessment of key external validity and contextual elements such as estimates of reach in the population, adoption potential of programs and implementation issues; and 3. Conducting and reporting research studies to include key elements of external validity can support future decision-making by allowing comparison between programs, the need for intervention adaptation, and population impact summaries.

Conclusions: Applying systemic evaluation of key external validity elements expanded the program evidence available for future decisions to aid the adaptation, selection and implementation of effective and sustainable physical activity programs.

Symposium

S07 The prevention of socioeconomic inequalities in physical activity and diet in adolescence: Results from the TEENAGE project

The prevention of socioeconomic inequalities in physical activity and diet in adolescence: Results from Project TEENAGE

Chairperson: Frank van Lenthe

Department of Public Health, Rotterdam, Netherlands

Discussant: Frank van Lenthe

Department of Public Health, Rotterdam, Netherlands

Purpose: Adolescence is among the crucial periods in life for the development of socioeconomic inequalities in physical activity and diet, and therefore also for the prevention of these inequalities. Little is known about effective strategies to promote health behaviours among adolescents from lower socioeconomic groups; it is even thought that some effective interventions in the general adolescent population may widen the inequalities. In the EU funded Project Teenage, a systematic inventory of interventions in Europe aimed at the promotion of physical activity and a healthy diet among adolescents has been conducted and selected studies have been re-analysed in high and low socioeconomic groups. It is the purpose of this symposium to evidence on effective approaches for prevention of socioeconomic inequalities in physical activity and diet among adolescents. Moreover, we will discuss how the evidence can be strengthened, and to what extent the findings can be transferred to other countries.

Rationale: Little is known about strategies to promote physical activity and a healthy diet in lower socioeconomic groups. SES-stratified re-analysis of existing interventions can yield important information for the development and improvement of interventions aimed at preventing socioeconomic inequalities in physical activity and a healthy diet.

Objectives: To present the main findings regarding the differential effectiveness of interventions to promote physical activity and a healthy diet in adolescents in higher and lower socioeconomic groups across Europe

To present the main findings regarding the transferability of effective interventions in lower socioeconomic groups from ‘source’ countries to other European countries. To discuss the implication of the findings with regard to the improvement of interventions aimed at promoting physical activity in adolescents in lower socioeconomic groups

Format:

Background and design of TEENAGE (Frank J van Lenthe, PhD)

The prevention of socioeconomic inequalities in physical inactivity (Ilse de Bourdeaudhuij)

The prevention of socioeconomic inequalities in diet (Nanna Lien)

The transferability of effective interventions among lower socioeconomic groups (Carlijn Kamphuis)

Discussion of main findings (Frank J van Lenthe)

Symposium

The prevention of socioeconomic inequalities in physical activity and diet in adolescence: Project TEENAGEAuthors:

Frank van Lenthe - Erasmus Medical Centre Rotterdam, Rotterdam, Netherlands

Ilse de Bourdeaudhuij - Ghent University, Ghent, Belgium

Nanna Lien - University of Oslo, Oslo, Norway

Carlijn Kamphuis - Erasmus Medical Centre Rotterdam, Rotterdam, Netherlands

Background: Higher prevalence rates of unhealthy behaviours among lower socioeconomic groups contribute substantially to socioeconomic inequalities in health in adults. Preventing the development of these inequalities in unhealthy behaviours early in life is an important strategy to tackle socioeconomic inequalities in health. Little is known however, about health promotion strategies particularly effective in lower socioeconomic groups in youth. It is the purpose of project TEENAGE to improve knowledge on the prevention of socioeconomic inequalities in health behaviours among adolescents in Europe. This presentation describes the background, design and methods used in the project.

Methods/Design: Through a systematic literature search, existing interventions aimed at promoting physical activity and a healthy diet, and evaluated in the general adolescent population in Europe are identified. Studies in which indicators of socioeconomic position are included are re-analysed by socioeconomic position. Results of such stratified analyses will be summarised by type of behaviour, across behaviours by type of intervention, and by setting. In addition, the degree to which effective interventions can be transferred to other European countries will be assessed.

Discussion: Although it is sometimes assumed that some health promotion strategies may be particularly effective in higher socioeconomic groups, there is little knowledge about differential effects of health promotion across socioeconomic groups.

Are physical activity interventions equally effective in adolescents from lower and higher socioeconomic groups?Authors:

Chantal Simon - Centre de Recherche en Nutrition Humaine, Lyon, France

Femke De Meester - Ghent University, Ghent, Belgium

Frank van Lenthe - Erasmus Medical Centre, Rotterdam, Netherlands

Nanna Lien - Oslo University, Oslo, Norway

Fabrizio Faggiano - Avogadro University, Novara, Italy

Laurence Moore - Cardiff University, Cardiff, United Kingdom

Leen Haerens - Ghent University, Ghent, Belgium

Symposium

Purpose: The aim was to study whether physical activity (PA) interventions in European teenagers are equally effective in promoting a physically active lifestyle in low versus high SES adolescents.

Methods: Based on a systematic review on effects of interventions targeting PA in European teenagers (De Meester, IJBNPA, 2009), studies for secondary analyses were selected based on the following criteria: (1) high quality intervention, (2) published intervention effects, (3) SES available, and (4) agreement of authors. This resulted in 3 school-based studies in which secondary SES stratified analyses were run: a Belgian (Haerens, 2007a), and a French multi-component intervention (Simon, 2008), and a Belgian computer-tailored education trial (Haerens, 2007b).

Results: All three interventions reached significant effects on PA in low and in high SES adolescents. Results from the first study were a bit in favour of the low SES group, with a 40 minutes increase in objective PA compared to a decrease in all other groups (p=0.015). In the second study, larger effects were found in high SES adolescents (increase of 50 min/week, p<0.001), compared with lower SES adolescents (increase 100 min/week, p=0.02) at the longer term. The third study showed a positive effect on school-related PA in high SES adolescents (p<0.05), and on leisure time transportation in low SES adolescents (p<0.05).

Conclusions: PA interventions in European adolescents are effective in high and in low SES adolescents and seem not to widen nor narrow social inequalities. Future studies should systematically include SES stratified analyses to confirm or to reject these findings.

Funding Source: European Union, Public Health Programme [project number 2006323]

Do effective dietary interventions among European teenagers influence social inequality? Results from Project TEENAGEAuthors:

Leen Haerens - University of Ghent, Ghent, Belgium

Saskia te Velde - VU University Medical Centre, Amsterdam, Netherlands

Lisbeth Mercken - University of Cardiff, Cardiff, United Kingdom

Ilse de Bourdeaudhuij - University of Ghent, Ghent, Belgium

Laurence Moore - University of Cardiff, Cardiff, United Kingdom

Fabrizio Faggiano - Universita degli Studi del Piemonte Orientale, Milano, Italy

Frank van Lenthe - Erasmus Medical Centre, Rotterdam, Netherlands

Aim: The aim was to study whether dietary interventions aimed at European teenagers are equally effective in promoting healthy eating in low versus high socioeconomic status (SES) groups.

Methods: A systematic review on effects of interventions targeting diet in European teenagers was conducted to select effective studies for secondary analyses given that effect by SES was not previously reported and an SES measure was available. The original authors conducted the secondary analyses in accordance with previous analyses for the three school-based studies: a Belgium multi-component

Symposium

intervention on intake of fat, a fruit and vegetable (FV) multi-component intervention in three European countries (the Pro Children study) and a breakfast initiative in Wales, UK.

Results: The decrease in fat intake was higher among low than high SES girls after one year, but the opposite was found after two years. The one year effect was higher in the group with parental support compared to the control group. No SES differences in effect on FV intake were found. There was a higher increase in the number of healthy food items eaten for breakfast among students from the low than high SES schools.

Discussion/Conclusions: Different measures of diet and SES used in the three studies, as well as the studies not being powered for analyses by SES, makes general conclusions difficult. However, the interventions did not appear to widen the social inequalities and there were indications that some of them promoted healthy eating more effectively among low than high SES groups.

Funding Source: EU

TEENAGE interventions: Their potential usefulness and effectiveness for different European countriesAuthors:

Carlijn Kamphuis - Erasmus University Medical Centre, Rotterdam, Netherlands

Carolien van Hooijdonk - Erasmus University Medical Centre, Rotterdam, Netherlands

Frank van Lenthe - Erasmus University Medical Centre, Rotterdam, Netherlands

Background: In TEENAGE, data of European intervention studies to prevent unhealthy behaviours (low physical activity, poor diet, smoking or alcohol consumption) among adolescents were re-analyzed by socioeconomic indicators, to find out whether effective interventions increase or decrease socioeconomic inequalities in health behaviours. Most interventions were applied in the school setting. Workshops with experts in five European countries were held to discuss which activities or policies may be most promising for preventing or reducing socioeconomic inequalities in health-related behaviours among adolescents, taking the specific country context into account.

Methods: Five countries with contrasting welfare regimes were selected (Estonia, United Kingdom, Denmark, Portugal and Switzerland). A country-specific profile was made including information on demography, epidemiology and magnitude of socioeconomic inequalities in health-behaviour among adolescents. Participating experts supplied their country’s leading policy documents concerning socioeconomic health inequalities. Based on a structured outline, workshop participants were asked their view on the most promising interventions for prevention or reduction of socioeconomic inequalities in health-related behaviours among adolescents in their country. The effectiveness of the presented Teenage interventions was evaluated against the country context and possible improvements of the interventions were discussed. Also, the usefulness, effectiveness and possibilities regarding the school as a setting for interventions was discussed.

Symposium

Results and Recommendations: Strength and direction of associations between socioeconomic status and health-behaviours among adolescents vary by country, and consequently, need for, urgency of and types of interventions to prevent/reduce these inequalities depend on the country context. Differences in school systems between countries may offer possibilities for interventions.

Symposium

S08 Measurement of food access in local environments: Innovations and implications

Measurement of food access in local environments: Innovations and implications

Chairperson: Lukar Thornton

School of Exercise and Nutrition Sciences, Deakin University, Burwood Victoria, Australia

Discussant: David Crawford

School of Exercise and Nutrition Sciences, Deakin University, Burwood Victoria, Australia

Purpose: The purpose of this symposium is to present conceptual developments and novel measurement approaches in epidemiologic and evaluation research on neighbourhood food environments. Importantly, it will also incorporate perspectives of community members and policymakers.

Rationale: Methodological and conceptual advances are needed in epidemiologic and evaluation research to understand the impact of the neighbourhood food environment on diet. Existing research on food environments have relied on crude measures of access such as counting the number of certain food stores within administrative units. Further, store types have been defined so that supermarkets are considered a proxy for healthy foods and fast food considered a proxy for unhealthy foods, thus healthy and unhealthy food environments are often defined by the presence of absence of supermarkets and fast food stores within neighbourhood boundaries, respectively. Growing use of Geographic Information Systems (GIS) has allowed more precise measurements of access. However, conceptual progress is required before we can fully leverage this methodological tool to enhance our understanding of the role of the food environment on dietary behaviours.

Objectives: 1. To showcase research on individual-environment interactions and as a result improved definitions of access; 2. To illustrate the use of spatial simulation modeling to create comprehensive local-level population health profiles and consider the potential relationships between food environments and diet/health; 3. To explore the implications of current definitions of food store types and present a novel approach that encapsulates all stores present in the local environment; and 4. To discuss how food environment interventions are conceptualised and operationalised by policymakers and what the implications are for evaluation research

Summary: The session will present recent advances in the conceptualisation and measurement of local food environments and interventions. The proposed contributions will complement each other and provide unique aspects to the measurement of food access both from a research and policy sense.

Format: The symposium will draw together research approaches from across Australia, the United Kingdom (UK), and the United States (US). The proposed speakers are (in order of the objectives):

Shannon Zenk - University of Illinois at Chicago, Chicago, United States

Dianna Smith - Queen Mary, University of London, London, United Kingdom

Lukar Thornton - Deakin University, Burwood, Australia

This symposium will conclude with questions and comments facilitated by Professor David Crawford.

Symposium

Activity-space food environment and diet: Results and methodological opportunities and challenges Authors:

Amy Schulz - University of Michigan, Ann Arbor, United States

JoEllen Wilbur - Rush University, Chicago, United States

Angela Odoms-Young - University of Illinois at Chicago, Chicago, United States

Carol Braunschweig - University of Illinois at Chicago, Chicago, United States

Carmen Stokes - University of Detroit Mercy, Detroit, United States

Purpose: Characterizing the food environment where individuals spend time (activity-space) rather than only where they live (residential neighborhood) may provide a better measure of food access. This study examined effects of activity-space and residential neighborhood supermarket and fast food outlet density on dietary intake and body weight.

Methods: As part of a population-based survey conducted by the Detroit Healthy Environments Partnership with a tri-ethnic sample of urban adults, a subset of respondents (n=131) wore wrist- mounted global positioning systems (GPS) for up to 7 days to track their movement. Based on the GPS data, we derived three alternative activity-space measures (one and two standard-deviation ellipses, path area). We calculated chain supermarket and fast-food outlet density in these activity-spaces and residential neighborhoods (one-mile radial buffer). A 7-day food frequency questionnaire measured dietary intakes. Interviewers measured waist circumference, height, and weight. Ordinary least squares regression models estimated relationships.

Results: Adjusting for individual demographics and residential neighborhood fast food outlet density, activity-space fast food outlet density was positively associated with frequency of fast-food consumption, energy-adjusted saturated fat intake, body mass index, and abdominal obesity and negatively associated with fruit intake. We found no effects of residential neighborhood fast food outlet density. Adjusting for individual demographics, activity-space supermarket density was positively associated with fiber and fruit intake. (Only two participants had a supermarket in their residential neighborhood.) Results varied by measure of activity-space and diet.

Conclusions: Applying the concept of activity-spaces to the food environment may advance understanding of environmental influences on diet. As we will discuss, it also presents methodological opportunities and challenges.

Funding Source: NIH K01NR10540, R01ES014234; Midwest Nursing Research Society; Chicago Center for Excellence in Health Promotion Economics

Symposium

Understanding relationships between local food environments and health: Creating synthetic population datasets for analysisAuthors:

Dianna Smith - Queen Mary, University of London, London, United Kingdom

Steve Cummins - Queen Mary, University of London, London, United Kingdom

Purpose: This paper introduces the application of a synthetic small area population generation technique to create comprehensive local population health profiles with the purpose of evaluating potential relationships between area food environments and population diet/health.

Background: Much of the literature concerning food access is implicitly focused on the effects of physical or economic access to un/healthy food options on the diets and related health of local residents. Recent studies have attempted to correlate the prevalence of diet related health outcomes such as obesity with characteristics of the local food environment, including fast food and supermarkets. However, one challenge that remains is to access detailed health data about the local population.

Methods: A spatial microsimulation model is used to create estimates of health outcomes (such as adult obesity and type 2 diabetes) and other health-related behaviours such as portions of fruit and vegetables, crisps, and soft drinks consumed regularly. This is accomplished by using an iterative technique to link a national-level health dataset with the local population census based on common characteristics which are predictors of the health behaviours or outcomes. This includes individual age, sex, ethnicity and social class. The model is validated against existing small datasets where available or its ability to accurately estimate other characteristics present in both the national survey and local census.

Conclusions: The resulting synthetic population, complete with detailed health profiles can be used in statistical analyses to explore the potential relationships between proximity of residence to different types of food stores and prevalence of health outcomes and behaviours.

Creating an exposure measure to examine the entire local food environment Authors:

Lukar Thornton - Deakin University, Burwood, Australia

Anne Kavanagh - The University of Melbourne, Parkville, Australia

Purpose: Previous studies exploring food environments have mostly used crude exposure measures that include few store types (e.g. only major supermarkets and fast-food chains). A Food Environment Score (FES) was developed to include all food stores. We use the FES to demonstrate an association with a single dietary behaviour (fast-food purchasing).

Methods: A Delphi study was employed to create a weighting score (from +10 to -10) for all food stores (excluding sit-down restaurants) based on their potential to influence healthy and unhealthy dietary behaviours. This allows stores such as large supermarkets to be considered more important to health

Symposium

than smaller independent supermarkets. The total number of stores in an area and the weighting score were used to create a healthy-FES and unhealthy-FES. Multi-level, multi-nomial models were used to test whether the FES was associated with fast-food purchasing frequency for 2547 survey participants from 49 areas in Melbourne, Australia.

Results: Fruit and vegetable stores/markets were considered the most healthy outlets (score 8.8) and chain brand takeaway the least healthy (score -8.3). Purchasing fast-food was less likely when individuals were exposed to a higher healthy-FES independent of the unhealthy-FES (OR 0.52; 95% CI 0.32-0.85), while those exposed to a higher unhealthy-FES than healthy-FES purchased fast-food more frequently (OR 1.35; 95% CI 1.00-1.83).

Conclusion: The FES provides a novel approach to including all food stores in an exposure measure. Results indicate the importance of having healthy food options in the local environment as this may discourage unhealthy dietary behaviours (fast-food purchasing).

Funding Source: LT is supported by a National Health and Medical Research Council Capacity Building Grant, ID 425845

Symposium

S09 Sugar sweetened beverages & obesity: Empirical evidence and the potential role of taxation

Sugar sweetened beverages & obesity: Empirical evidence and the potential role of taxation

Chairperson: Lisa Powell

University of Illinois at Chicago, Institute for Health Research and Policy, Chicago, United States

Discussant: Robert Jeffery

University of Minnesota, Minneapolis, United States

Purpose: The proposed symposium will present evidence on links between sugar sweetened beverage (SSB) consumption and obesity and on the influence of food/beverage pricing on dietary intake and weight outcomes. New evidence will be presented on the impact of food/beverage taxes on consumption and weight outcomes. This symposium addresses policies related to food and physical activity. This symposium will assess the current evidence base and provide new evidence on food/beverage pricing, taxation and behavior, and begin to answer some key understudied policy questions.

Rationale: This symposium centers on issues critical in understanding and intervening on behavioral aspects of nutrition. Attention to the role of SSBs in obesity prevalence has grown, with substantial evidence showing that increased SSB consumption leads to excess weight gain and increased risk of obesity in youth and adults. Studies looking at food/beverage prices have demonstrated that as prices of unhealthy foods increase relative to prices of healthy foods, weight levels decrease, particularly for youth, lower socioeconomic status populations, and those most at risk for obesity. While many states tax SSBs, mostly by disfavoring them under their sales tax systems, limited recent research suggests that these modest taxes have little impact on weight. Emerging studies, however, suggest that significant taxes on SSBs may be one way of reducing obesity. This symposium will present new data that builds on this body of research.

Objectives: The symposium centers on four key issues: 1) What evidence exists to show an association or cal role between SSB consumption and weight outcomes?; 2) How are states currently taxing the different SSBs?; 3) What does the research show regarding the effects of tax and pricing strategies on consumption and weight outcomes, especially in regards to beverages?; and 4) What can we learn from experiences with tobacco taxation about the potential of taxes to generate revenues and influence behavior?

Summary: The session will consist of four presentations. The first presentation reviews the evidence from cross sectional, longitudinal and experimental studies showing linkages between SSB consumption and obesity. The second presentation illustrates current state-level sales and non-sales taxes on soda and other SSBs. The third presentation shares new empirical evidence on the effect of food and beverage taxation on weight outcomes. Finally, the fourth presentation highlights lessons learned from tobacco taxation and the revenue potential of SSB taxes.

Format: Presentation order will be: 1) Gortmaker; 2) Chriqui; 3) Powell; and 4) Chaloupka

Symposium

The intake of sugar sweetened beverages as a cause of childhood and adult obesityAuthors:

Steve Gortmaker - Harvard School of Public Health, Boston, United States

Y Claire Wang - Columbia Mailman School of Public Health, New York, United States

Purpose: To review evidence from cross sectional, longitudinal and experimental studies showing linkages between sugar sweetened beverage intake and relative weight change and obesity, as well as the potential influence of research Funding Source.

Background: Intakes of sugar sweetened beverages (SSB: including soda, fruit drinks, punch, and sports drinks) have increased rapidly among children and adults in the U.S. over the past 30 years, as have rates of childhood and adult obesity. Evidence indicates that intake of calories in liquid form may lead to incomplete caloric compensation.

Methods: We review studies documenting evidence from cross sectional, longitudinal and experimental research linking intake of SSB’s to excess weight gain and obesity. We review evidence linking source of research funding to findings, as well as studies documenting change in SSB intake over past decades. Multiple review studies indicate that SSB consumption is associated with excess caloric intake and weight gain, which in turn leads to higher obesity rates. Both adult and child studies that alter SSB intake, as well as longitudinal studies following change in SSB consumption and weight over time have consistently found direct relationships. Two reviews indicate that studies funded by the beverage industry have shown less consistent associations between SSB intake and weight gain and obesity.

Conclusions: The preponderance of research shows that SSB consumption leads to excess caloric intake and weight gain, as well as increased obesity rates among children and adults. Weaker studies, some of which are funded by the beverage industry, have shown less consistent associations.

Funding Source: Robert Wood Johnson Foundation

State approaches to taxation of sugar sweetened beveragesAuthors:

Jamie Chriqui - University of Illinois at Chicago, Institute for Health Research and Policy, Chicago, United States

Frank Chaloupka - University of Illinois at Chicago, Institute for Health Research and Policy, Chicago, United

Shelby Eidson - The MayaTech Corporation, Silver Spring, United States

Purpose: Taxes on sugar sweetened beverages (SSBs) are being considered nationwide. This presentation will present new data on the scope of state SSB taxes across the 50 states and the District of Columbia.

Methods: State sales and non-sales (e.g., excise) taxes on regular, sugar-sweetened sodas, <50% juice drinks, sweetened teas, and isotonic beverages as of January 1, 2010 are being compiled under the Bridging the Gap Program through primary legal research using statutory and administrative laws available in Westlaw and Lexis-Nexis and through state confirmation.

Symposium

Results: Preliminary data from 2009 indicate that sales taxes are imposed on regular, sugar sweetened soda sold in grocery stores in 33 states, with an average tax of 5.2% in states with taxes and 3.36% across all states; 39 states tax vending machine sales of soda at an average of 5.26%. Seven states impose additional taxes/levies on soda bottles, syrups, powders, and mixes. Grocery sales of <50% juice drinks are taxed in 27 states at 5.08% and at 2.69% across all states; 37 states tax vending sales of <50% juice drinks at 5.25%. Taxation of soda and <50% juice drinks is disfavored compared to lower taxes on food products. None of the SSB tax revenue is dedicated to obesity prevention efforts. Additional data will be presented for 2010 including sweetened teas and isotonic beverages.

Conclusions: SSB taxes vary greatly by product and across the states and are higher than taxes on food products. Revenue from such taxes could be used to fund obesity prevention efforts.

Soda taxes and adolescent weight outcomesAuthors:

Lisa Powell - University of Illinois at Chicago, Chicago, United States

Jamie Chriqui - University of Illinois at Chicago, Chicago, United States

Frank Chaloupka - University of Illinois at Chicago, Chicago, United States

Purpose: Soft drink consumption has been linked with higher energy intake, obesity and poorer health. Fiscal pricing policies such as soda taxes may lower soda consumption and, in turn, reduce weight among U.S. adolescents. This presentation will provide empirical evidence on the associations between state-level grocery store and vending machine soda taxes and adolescent body mass index.

Methods: Multivariate linear regression analyses are undertaken drawing on both cross-sectional and longitudinal data sources, to control for individual-level unobserved heterogeneity. We use repeated cross sections from 1997 through 2006 of individual-level data on adolescents drawn from the Monitoring the Future and longitudinal data from 1997 through 2000 drawn from the 1997 National Longitudinal Survey of Youth combined using geocode identifiers with external state-level soda taxes.

Findings: The results show that current state-level tax rates are very modestly and mostly insignificantly associated with adolescent weight outcomes. Effects were found, in particular, among adolescents at risk for overweight. Ongoing analyses will examine a number of other socioeconomic and demographic adolescent subpopulations.

Conclusions: It is likely that taxes would need to be raised substantially in order to detect significant associations between taxes and adolescent weight.

Funding Source: This research was supported by the Robert Wood Johnson Foundation through the Bridging the Gap the ImpacTeen project and it was supported by Award Number R01HL096664 from the National Heart, Lung, and Blood Institute. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung, And Blood Institute or the National Institutes of Health.

Symposium

Lessons learned from tobacco taxation and SSB tax revenue opportunitiesAuthor:

Frank Chaloupka - University of Illinois at Chicago, Institute for Health Research and Policy, Chicago, United States

Purpose: States are increasingly considering economic strategies for reducing consumption of SSBs and preventing obesity. This presentation highlights successful examples from tobacco taxation and describes the revenue generating potential of SSB taxes.

Methods: Published literature on the effects of tobacco taxation was reviewed. Estimates of the revenue generating potential of SSB taxes were calculated using consumption data from the Beverage World “State of the Industry Report” and population projections from the Census Bureau.

Results: Extensive research demonstrates that higher tobacco taxes are effective in significantly reducing tobacco use by encouraging cessation, preventing initiation, and reducing intensity of use. Studies show that dedicating some new revenue to comprehensive tobacco control programs further reduces use. Given other evidence presented in this session, it is unlikely that the current approaches to SSB taxation will significantly impact weight outcomes or obesity. Larger taxes, however, may have a greater impact while generating considerable new revenues. For example, a national 1-cent/ounce tax on SSBs could raise over $14 billion during 2010. In Mississippi (where the state obesity rate is highest), such a tax could generate over $143 million. In California, the state with the largest population, such a tax could generate over $1.8 billion.

Conclusions. Evidence that tobacco taxes promote public health has stimulated interest in SSB taxes as a tool for reversing the rise in obesity. Significant SSB taxes are likely to affect weight outcomes, while generating new revenues that could fund obesity prevention programs.

Symposium

S10 Combating the obesity pandemic: Preventing undesirable gradual weight gain in adults

Combating the obesity pandemic: Preventing undesirable gradual weight gain in adults

Chairperson: Marieke Verheijden

TNO Quality of Life, Leiden, The Netherlands

Discussant: Nico Pronk

HealthPartners Research Foundation, Minneapolis, United States

The prevalence of overweight and obesity is increasing rapidly throughout most countries in the world.

Unfortunately, treatment of overweight/obesity has had little or no long term effects in the majority of people. This calls for increased efforts to be successful in the prevention of weight gain. Therefore, the currently proposed symposium focuses on research on the prevention of undesirable gradual weight gain, either in adults of normal weight, or in adults being (mildly) overweight. We propose to schedule the following four presentations (each followed by a brief discussion) and an overall discussion with the audience at the end.

David Levitsky will start the symposium by giving his presentation entitled “Preventing weight gain in an expanding universe’”. This presentation will include his successful work on the prevention of weight gain in freshman.

Lenneke van Genugten - Weight gain prevention (WGP) is very important among overweight adults, because they are at high risk to become obese. Lenneke van Genugten will present a description of determinants of weight gain prevention and its related behaviours among overweight adults. Special attention will be paid to self-regulatory processes related to WGP.

Jantine Slinger/Marieke Verheijden will present results from a large-scale cohort study. They will focus on correlates and determinants of frequent self-weighing as a strategy to prevent weight gain, also in relation to self-reported changes in body weight.

Jeff VanWormer will present results from the recently completed HealthWorks trial in the Minneapolis metro area. It was a 2 year worksite-randomized intervention focused on weight gain prevention across the entire workforce environment (versus individual sub-groups such as those who recently lost weight or those that are healthy weight only). Specifically, he will examine the impact that self-weighing had on overall weight change, as well as weight gain prevention.

The symposium will be concluded by a discussion led by Nico Pronk.

Symposium

Preventing weight gain in an expanding universeAuthor:

David Levitsky - Cornell University, Ithaca, United States

Purpose: The purpose of these studies was to examine the effects of daily weight monitoring on the prevention of weight gain in college freshman women.

Methods: On two successive years, freshman women were recruited from Cornell University to engage in a study of freshman weight gain. The first study consisted of 34 women, the second having 41 women. Half were randomly allocated to the experimental group and half to the controls. The experimental group was instructed to weigh themselves everyday as soon as they rose from bed, record their weight, then email it to our staff later in the morning. They would then receive an email containing the slope of their weight across the last seven days.

Both groups were weighed at the beginning and end of the 12 week semester.

Results: In both studies, the control groups gained significant amount of weight (3.1 ± 0.51 kg and 2.1±0.65 kg, respectively). The experimental group, on the other hand, gained no weight over the course of the semester. We observed no incidence where the regular weighing produced any signs of an eating disorder.

Conclusions: The studies demonstrate that consistent weight monitoring is effective as a tool to prevent weight gain among college freshman. We are currently expanding this system into a web-based system of weight monitoring that is designed to help participants lose weight very slowly to enable them not only to lose weight, but to enable them to sustain the loss over time.

Identifying correlates and associations of intentions toward weight gain prevention and weight-related behavioursAuthors:

Lenneke van Genugten - Erasmus MC, University Medical Center, Rotterdam, Netherlands

Pepijn van Empelen - Erasmus MC, University Medical Center, Rotterdam, Netherlands

Anke Oenema - Erasmus MC, University Medical Center, Rotterdam, Netherlands

Purpose: Prevention of weight gain (WGP) is thought to be a promising approach in the prevention of obesity. The present study aimed to identify correlates of intention for WGP and associated weight related behaviours (dietary intake (DI) and physical activity (PA)) and to investigate whether intention toward WGP is related with intentions for changes in DI and PA.

Methods: In a cross-sectional study among 457 overweight adults (mean age 47y, 68% female, mean BMI=28,0), perceived weight status (PWS), attitude, subjective norm (SN), perceived behavioral control (PBC) and intentions toward WGP and toward changes in DI and PA and preferences were assessed using an online questionnaire.

Symposium

Results: Most participants had a positive (22.4%) or highly positive (72.8%) intention toward WGP. Ordinal regression analysis showed that female gender, PWS, attitude, PBC and SN were positively associated with the intention to prevent weight gain. 26.8% had a very positive intention towards increasing PA and 36.4% towards decreasing DI. Linear regression analyses showed that PBC towards increasing PA, preference for PA and intention for WGP were positively associated with the intention to increase PA (Rsq=56%). PBC towards changing DI, preference for DI and intention for WGP were positively associated with intention to make changes to DI (Rsq=42%).

Conclusions: Attitude, PBC, SN, PWS and being a woman are positively related to intention to WGP, which in turn is positively associated with intention for weight related behaviours. The results of this study imply that intention for WGP may be a prerequisite for effective weight-related behaviour.

Funding Source: ZonMw, The Netherlands organization for health research and development

Weight management in a Dutch population of adults: Determinants of regular self-weighingAuthors:

Jantine Slinger - TNO Quality of Life, Leiden, Netherlands

Nicole Van Kesteren - TNO Quality of Life, Leiden, Netherlands

Andrea Werkman - Netherlands Nutrition Centre, Den Haag, Netherlands

Marieke Verheijden - TNO Quality of Life, Leiden, Netherlands

Purpose: Since self-weighing seems to be related to successful weight maintenance, we investigated determinants of regular self-weighing.

Methods: In November 2007, 1030 adults completed a questionnaire about body weight; personality traits; knowledge, use of, and attitude towards energy balance; the frequency of overeating; their response to overeating; and eating behavior. In March 2009, body weight and frequency of self-weighing were measured.

Results: 84% possessed a scale and used it regularly (at least once a year). People with a higher age (18-29y: 71% vs. 65-75y: 95%, p=.001) and being overweight (88% vs. 82% in normal weight group, p=.035) reported regular self-weighing more often. Mean weight gain over the study period was 0.4 (± 5.08) kg in the group who regularly used a scale, whereas it was 1.4 (± 5.42) kg in the non users (p=.062).Determinants of self-weighing were knowledge (p=.057), attitude (p<.001), self efficacy expectations (p=.017), intention (p<.001) and the reported energy balance behavior (p<.001). Scale users had a higher score on these determinants. Scale users also reported more overeating (p=.003) and they compensated more often for a day with overeating with a ‘balance day’ (p=.008). Eating behavior seemed to be more restrained (p<.001) in the scale users.

Conclusions: The majority used a scale regularly. The proportion of users was higher in older and overweight groups. Scale users seemed to be preoccupied with weight management at baseline and

Symposium

gained, although non-significant, less weight in the study period. Our data suggest that self-weighing might support weight management.

Funding Source: The research was funded by The Netherlands Nutrition Centre and the Ministry of Health, Welfare and Sports in The Netherlands

Self-weighing in a 2-year worksite weight maintenance intervention: The HealthWorks trialAuthors:

Jeffrey VanWormer - University of Minnesota, Minneapolis, United States

Robert Jeffery - University of Minnesota, Minneapolis, United States

Jennifer Linde - University of Minnesota, Minneapolis, United States

Purpose: Frequent self-weighing has been indicated as a helpful technique for weight loss, but few studies have examined the association between self-weighing and weight maintenance. Those that tend to have small samples and short follow-up timeframes. As such, we investigated the association between self-weighing frequency and weight maintenance in a large worksite weight maintenance trial over two years.

Methods: Data was examined from 1,747 participants enrolled in the HealthWorks trial. Self-weighing frequency was assessed after two years via self-report and categorized as daily or more, weekly, or monthly or less. Two separate analyses were conducted, one a mixed model examining body weight change as a continuous outcome and the other a logistic regression examining weight maintenance as a categorical outcome (i.e., maintainers versus gainers). Potential covariates included baseline age, sex, education, race, marital status, randomized condition, worksite, self-weighing frequency, body mass index, smoking status, diabetes, high blood pressure, depression status, number of weight loss attempts, and number of scales in the home.

Results/Conclusions: Data was available on 1,407 participants who completed the trial. More frequent self-weighing was associated with greater weight reduction. Frequent self-weighing seems to be a useful strategy in worksite populations, where the ability to promote large scale increases in self-weighing through environmental intervention is arguably strongest. More research is still needed, however, to firmly and experimentally establish the cal effects of frequent self-weighing.

Funding Source: NIH

Symposium

S11 Sedentary behaviour: Definition, measurement and correlates

Sedentary behaviour: Definition, measurement and correlates

Chairperson: Stuart Biddle

School of Sport, Exercise & Health Sciences, Loughborough University, Loughborough, Leicestershire, United Kingdom

The study of sedentary behaviour has expanded greatly in the past few years. Using the behavioural epidemiological framework to organise the field, it is possible to identify studies that have investigated the measurement of sedentary behaviour, the health outcomes of sedentary behaviour, the correlates of sedentary behaviour, and interventions designed to reduced sedentary behaviour. Two key issues are now in need of further consideration before the field can move forward. First, there is diversity in the way we operationalise and assess sedentary behaviours. For example, what are ‘sedentary behaviours’ and which ones might be more problematic from a health point of view? Moreover, what behaviours should be assessed and how, and what is the role of ‘objective’ assessment using accelerometers and inclinometers? This raises the issue of volume of sedentary behaviour vs. specificity of behavioural choice of certain sedentary pursuits. Another issue concerning assessment is when sedentary behaviours should be assessed from a temporal perspective. In other words, are there some times of the day that are more important for avoiding sedentary behaviour than others?

The second key issue to address is that of correlates. It is surprising that this remains an understudied area. Correlates will inform successful interventions, yet the literature has yet to identify many clear correlates beyond those that are socio-demographic and relatively difficult to change.

Sedentary behaviour: What is it and how do we measure it? (Stuart Biddle, UK). This paper will consider how best to operationalise sedentary behaviour and to consider the advantages and disadvantages of using different self-report and objective measures. Correlates of sedentary behaviour in young people (Trish Gorely, UK). This paper will summarise the evidence of sedentary correlates for young children, children, and adolescents for TV viewing and other screen behaviour, as well as general sedentary behaviour. Discussion will centre on moderators, mediators and research directions. Correlates of sedentary behaviour in adults (Jean-Michel Oppert, France). This paper will summarise the evidence of sedentary correlates for adults. Specific issues to be addressed include whether there are different correlates for different sedentary behaviours in adults, and whether correlates of sedentary behaviours differ in adults, older adults, and young people. Future directions will be considered.

Sedentary behaviour: What is it and how do we measure it? Author:

Stuart Biddle - Loughborough University, Loughborough, United Kingdom

Sedentary behaviour research is rapidly expanding and there is a need for consensus on definition and measurement. Sedentary behaviour is where sitting or lying is the dominant mode of posture and energy expenditure is very low. Sedentary behaviours might include behaviours at work or school, at home,

Symposium

during transport, and in leisure-time and can include screen-time (TV viewing, computer use), motorised transport, and sitting to read, listening to music etc. Total time spent can be captured by objective monitoring devices (e.g., accelerometers) and can quantify the amount and temporal patterning across the day. Inclinometers can quantify time spent in different postures (e.g., sitting). Self-reported sedentary behaviour instruments can ask respondents to report frequency and duration of time spent in different behaviours, such as TV viewing and computer game playing, over a specific time frame. Researchers also use time-use diaries and ‘parent proxy’ measures for young children. Advantages and disadvantages will be considered.

Bryant et al. (Obes Rev, 2007, 8, 197-209) reviewed TV viewing measures in children and adolescents and concluded that most studies used self-report rather direct observation and few reported validity or reliable data for the instruments. Clark et al. (Obes Rev, 2009, 10, 7-16) reviewed measures of television viewing time and other non-occupational sedentary behaviour in adults. In 60 papers, TV viewing time was the most commonly measured sedentary behaviour and self-report was the main method used. Only a few studies examined validity and reliability. A wider range of behaviours needs to be assessed.

Correlates of sedentary behaviour in young people Authors:

Trish Gorely - Loughborough University, Loughborough, United Kingdom

Russ Jago - University of Bristol, Bristol, United Kingdom

The mediating variable model suggests that in order to change a behaviour we need to identify the key mediators and moderators of the behaviour. This presentation is based on a review of several systematic reviews of the correlates of sedentary behaviour (Gorely et al, 2004, van der Horst et al 2007, Cillero & Jago, in review). These have largely focused on screen viewing behaviours and there is a paucity of research examining the correlates of other sedentary behaviours. Potential mediators related to screen-viewing in young people (<18 years) include family TV viewing, snacking, body weight, parent viewing, and having a TV in the bedroom. Higher BMI and depression are associated with screen-viewing in adolescents. Potential moderators of screen-viewing include age, gender, and socioeconomic status in young children (<7 years) and age, gender, ethnicity, SES, and parent education in adolescents. No one mediator has been consistently associated with screen-viewing behaviours and therefore it is not yet possible to identify a key mediator of screen-viewing that should be the target of behaviour change strategies. Few longitudinal studies were identified within the reviews so the direction of relationships has not been established. The quality of measurement tools employed may have influenced findings with the majority of papers assessing screen-viewing via self-report instruments of unknown validity and reliability and with a variety of recall units and periods. Much more work is needed particularly to identify modifiable correlates (mediators) of TV viewing and other prominent sedentary behaviours in youth, with stronger measures and longitudinal designs.

Symposium

Correlates of sedentary behaviour in adultsAuthor:

Jean-Michel Oppert - University Pierre et Marie Curie-Paris6, Paris, France

Purpose: The aim of this paper is to summarise the evidence for correlates of sedentary behaviour in adults.

Background: Less is known on the issue of sedentary correlates in adults than in youth. Moreover, a large fraction of working time may be spent in a sedentary state in many professions.

Methods/Key Points: A literature search was performed through existing reviews, the EPPI database on sedentary behaviours and obesity, and Medline. All types of sedentary behaviours were looked for with main categories being screen/television viewing and sitting. We distinguished between studies that used self-report assessment and those that used objective measurements of sedentary behaviour (e.g. accelerometer recordings). Factors associated with sedentary behaviours that were considered included socio-demographic, behavioural, psychological/cognitive, biological and environmental correlates. The evidence collected shows that sedentary behaviours in adults are associated with age (highest over 70 y), gender (higher in women before 60 y), socioeconomic conditions in general (positive association with area deprivation) and occupation in particular (with large differences according to work sectors), weight status (inverse association with indices of obesity) and with some characteristics of the physical environment (inverse association with neighborhood walkability in one study), independent of physical activity.

Conclusions: A number of these correlates appear similar to those reported in younger subjects, however there is less evidence available. Objective measurements of sedentary behaviour in adults from various populations are needed. In addition, the possibility that different sedentary behaviours may have different correlates should be investigated further.

Symposium

S12 Innovative and pragmatic partnerships and programs for promoting healthy eating and physical activity: Discovery vitality in schools, workplaces, supermarkets, fitness centres and the web - the evidence

Innovative and pragmatic partnerships and programs for promoting healthy eating and physical activity: Discovery vitality in schools, workplaces, supermarkets, fitness centres and the web - the evidence

Chairperson: Estelle Lambert

MRC/UCT Research Unit for Exercise Science and Sports Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

Purpose: The purpose of this symposium is to describe the components of an innovative, incentivised program for the promotion of healthy eating and physical activity throughout the life course, offered by a major national private health insurer in South Africa. For each component of the program, we will present the theoretical underpinning, process of development and formative research, program design (logic model), and impact or effectiveness results, as well as barriers to implementation and/or uptake. The settings in which these interventions take place include: health insured in-person and on the web, worksite, retail food outlets, and schools.

Rationale: South Africa has not been spared the emerging burden of chronic, non-communicable diseases, with more than 55% of women and 20% of men either overweight or obese, and nearly half the population reportedly inactive. Moreover, these same trends are shown in children and adolescents. Nearly 40% of deaths may be attributed to these chronic conditions. However, preliminary data suggests that health risk behavior, as determined by data garnered from health risk appraisals at employee wellness days, may actually be worse in the private sector. In response, a major national private health insurer has developed an incentivized wellness program, the components of which may be accessed via the web or through in-person visits, through the worksite, in retail stores, in a national fitness centre chain, and most recently through schools. Incentives vary, but, as an example, the health-insured members may enjoy a subsidized gym membership and advance through tiers via the acquisition of points, which may be rewarded by retail benefits, or receive discounts on selected healthy foods at a major retail chain, as a “cash-back” incentive.

Objectives: The three main aims of this symposium are 1) to present an overview of an innovative, yet pragmatic, set of incentivized wellness programs, offered by an national major health insurer in South Africa, with respect to the theoretical underpinning, the programs and the impact, 2) to share real-world experiences of both successful implementation and barriers encountered, and 3) to reflect on similar initiatives which may be/may have been undertaken in other settings or countries and the potential for research translation of these programs.

Format: The symposium will include a 10 minute overview of the context of the pragmatic partnerships and programs between the health insurer and its beneficiaries, “The logic model for Vitality, an incentivized wellness program” (Jill Borresen), followed by four 15 minute presentations, with 2-3 minutes of questions. The presentations in sequence will be 1. “Vitality Insured Persons: increasing engagement in physical activity behavior, does it work? (Estelle Lambert) 2. Working on wellness: pragmatic trial of motivational interviewing to change nutrition and physical activity behavior in the workplace (Tracy Kolbe-Alexander), 3. HealthyFood™ benefit: impact of financial incentives and rewards on healthy food purchasing behavior (Marieke Loubscher), 4. Vitality Schools: real-world implementation of a widely disseminated school-

Symposium

based intervention, successes and lessons learned (Karen Johnson). Finally, the discussant will provide an independent summary of these models and programs, including lessons learned and suggestions for the way forward with respect to replication, and dissemination. In addition, the discussant will provide some insight as to how these programs may translate in other settings and with different health insurance models (10 minutes).

The logic model for Vitality, an incentivized wellness program Authors:

Jill Borresen - Discovery Health, Johannesburg, South Africa

Deepak Patel - Discovery Health, Johannesburg, South Africa

Craig Nossel - Discovery Health, Johannesburg, South Africa

Adam Noach - Discovery Health, Johannesburg, South Africa

Tracy Kolbe-Alexander - University of Cape Town, Cape Town, South Africa

Wayne Derman - University of Cape Town, Cape Town, South Africa

Timothy Noakes - University of Cape Town, Cape Town, South Africa

Estelle Lambert - University of Cape Town, Cape Town, Netherlands

Purpose: The aim of this presentation is to provide an overview of an innovative, incentivised wellness program, offered by a major national private health insurer in South Africa, for the promotion of healthy eating, physical activity and health screening in over 1.3 million members. The overall wellness program design (logic model) will be described, along with the component interventions, programs and relevant partnerships.

Rationale: Healthcare costs are increasing globally. Many factors may contribute to these rising costs however the increase in chronic disease is playing a significant role. Lifestyle risk factors such as smoking, unhealthy eating, obesity and physical inactivity make a considerable contribution toward this burden. Importantly, these risk factors are modifiable suggesting that the health of members may be improved by impacting on these behavioural factors and can thus create a more sustainable way of reducing long-term healthcare costs. The incentivized health promotion program is structured in progressive tiers according to points accumulated for activities undertaken in one of 4 categories including: ‘assessment and screening’, ‘healthy choices’, ‘health knowledge’ and ‘fitness activities’; designed to empower members to improve their health by providing knowledge, tools and motivation to facilitate health behaviour change.

Objectives: The specific objectives of this presentation are to: describe the general structure and specific components of the Vitality wellness program, describe the evaluation framework, including reach, impact, effectiveness, uptake and adoption of the various program components, and to provide the theoretical bases for each of the program components.

Summary: After an overview of the core purpose and global structure of the Vitality wellness program, and a brief description of specific components of the program with reference to their design, incentive structure, relevant partnerships and scientific foundation, this presentation will serve as an introduction to subsequent presentations detailing the implementation and impact of specific interventions and programs.

Funding Source: Discovery Health

Symposium

Vitality Insured Persons: Increasing engagement in physical activity behavior, does it work? Authors:

Estelle Lambert - University of Cape Town, Cape Town, South Africa

Deepak Patel - Discovery Health, Johannesburg, South Africa

Roseanne da Silva - University of the Witwatersrand, Johannesburg, South Africa

Michael Greyling - University of the Witwatersrand, Johannesburg, South Africa

Thomas Gaziano - Harvard Medical School, Boston, United States

Background: Physical inactivity and sedentary living are major lifestyle factors that contribute to increasing burden of disease. In cross-sectional studies, we have previously shown an association between engagement in fitness-related activities, as part of an incentivised health promotion program offered by a national private health insurer in South Africa (>940,000 members). In this retrospective longitudinal study, we interrogated changes in participation in fitness activities and inpatient health claims over 5 yrs amongst a cohort of these members.

Methods: Adult members who joined the health promotion program (Jan 2001-Dec 2003)(N=192467),along with those not on the program (N= 111587) were enrolled. The program was comprised of 4 categories: assessment/screening, healthy choices, health knowledge and ‘getting active’. Points were awarded in the ”getting active” category for frequency of recorded gym visits. Participation was defined a priority, as not registered, Inactive: 0-4, Low-: 4-24, Medium-: 24-48, or High-Active: >48 gym visits/yr. Trends in participation (over 3 yrs) were compared to probability of admission.

Results: There was a significant increased participation in fitness activities over 5 yrs, evidenced by an increase in gym membership (and visit frequency) over time, a decrease in the prevalence of inactive members (76-68%). Members who remained high-active (in yrs 1-3) had a lower probability (P<0.05) of hospital admission in years 4-5 (19.9%) compared to those who remained inactive (21.8%), or who participated less (21.3%). Persons attending gym twice per week had a reduced odds for probability of admission compared to those who did not attend gym (OR: 0.87, 95%CI: 0.801-0.949) >

Conclusion: An incentive-based health promotion program may increase physical activity behavior over time, and is associated with a significant reduction in health care expenditure. We will discuss the potential impact of behavioral economics and financial incentives as a means to increase uptake and participation.

Symposium

Working on Wellness: A worksite-based intervention incorporating motivational interviewing Authors:

Karin Proper - Vrye University and VU University Medical Center, Amsterdam, Netherlands

Willem van Mechelen - Vrye University Medical Center, Amsterdam, Netherlands

Leegale Adonis - Discovery Health, Johannesburg, South Africa

Robert Mash - University of Stellenbosch, Tygerberg, South Africa

Lizette Jooste - Discovery Health, Johannesburg, South Africa

Purpose: South African employees are at increased risk for cardiovascular disease (CVD) with >50% not meeting physical activity (PA) guidelines. We have shown that insufficient PA clustered with other risk factors such as low fruit and vegetable intake (80%), smoking (61%), overweight or obesity (31%), increased serum cholesterol (19%) and elevated blood pressure. The aim of this pilot study was to determine whether wellness coaching incorporating motivational interviewing (MI), in targeted, high risk employees resulted in improved self-reported levels of physical activity and other health-seeking behaviour, along with decreased risk for CVD.

Methods: Employees voluntarily attended wellness days conducted by the health insurer, and those categorised as ‘increased risk’ were invited to receive health coaching, including face-to face visits and telephone calls (using MI techniques). Self-reported PA, nutritional habits and health status was recorded at baseline and 12 weeks. Clinical measures included: cholesterol and glucose concentrations, blood pressure and body mass index (BMI). Data are currently available for 86 employees.

Results: One in 5 hoped to lose weight; 1 in 10 aimed to improve diet or PA. The proportion not meeting PA guidelines decreased from 79 (92%) at baseline to 67 (88%) at 12 weeks (P <0.0001). Age-adjusted diastolic blood pressure also decreased significantly. There were no changes in BMI, cholesterol or other health behaviours over 12 weeks.

Conclusion: Health coaching as part of wellness day follow-up provided by a private health insurer, targeting high-risk individuals, results in at least short-term changes in self-reported PA, with some changes in health risk status. Low levels of participation and high prevalence of risk factors remain a challenge for this health promotion initiative.

Funding Source: South Africa Netherlands Research Programme on Alternatives in Development (SANPAD), Discovery Health

Symposium

S12 Innovative and pragmatic partnerships and programs for promoting healthy eating and physical activity: discovery vitality in schools, workplaces, supermarkets, fitness centres and the web-the evidence

“HealthyFood” benefit: Impact of financial incentives and rewards on healthy food purchasing behavior Authors:

Marieke Loubser - Discovery Health, Johannesburg, South Africa

Till Anne - Anne Till and Associates, Johannesburg, South Africa

Jill Borresen - Discovery Health, Johannesburg, South Africa

Senekal Marjanne - University of Cape Town, Cape Town, South Africa

Background: One of the main lifestyle risk factors for chronic diseases is a poor diet. More specifically, this includes an increased intake of calorie-dense foods, foods high in saturated fat and trans fat, high in sugar and refined starch, and an inadequate consumption of fruits and vegetables. Therefore, assisting individuals in making healthy food choices may have a significant impact on the risk of developing coronary heart disease, stroke and diabetes.

Aim: We describe the Discovery Vitality HealthyFoodTM Benefit (HF), which is a health promotion initiative offered by a national private health insurer involving cash-back discounting of between 10-25% following purchase of >6000 pre-selected food items at a major national grocery chain. Members qualify for the higher discount after completing an online health risk appraisal. The HF benefit is part of an incentivised, wellness programme, involving health risk screening, health knowledge and awareness activities, and fitness activities, more than 1.3 million members are eligible and pay a nominal monthly fee.

Results: In the first year, >140 000 families signed up for the HF benefit (representing between 20-30% of those eligible), with >1,6 million supermarket trolleys of HF purchased (with a value of over ZAR150 million). This represents approximately 20% of total spend. To date, cash back to members is valued over ZAR35 million. Members who have completed an online health risk appraisal have more than doubled since the launch of the HF benefit.

Summary: This presentation will provide an overview of the HealthyFoodTM Benefit structure, the program components and incentive structure, supporting theoretical and scientific evidence, partnerships and practical implementation, as well as the impact to date on the health and purchasing behaviour amongst Discovery Vitality members. Further to this, it will provide insight into the role of financial incentives in promoting health behaviour change.

Symposium

Vitality Schools programme: Real world implementation of a widely disseminated, school-based intervention, successes and lessons learnedAuthors:

Karen Johnson - Discovery Health, Johannesburg, South Africa

Avi Joseph - Discovery Health, Johannesburg, South Africa

Jared Forbes - University of Cape Town, Cape Town, South Africa

Rationale: Insufficient physical activity (PA), an unhealthy diet and tobacco use has been shown to increase the risk for diseases such as cardiovascular disease (CVD) which accounts for 50% of all deaths globally. The Healthy Active Kids South Africa (2007) Report Card summarised the current health status of South African children: >30% of SA adolescent girls are overweight/obese, 40% of children do not participate in weekly PA, 42% of children eat <4 servings of fruit or vegetables/day, nearly half choose chips, cool drinks and sweets when buying from the tuck shop, and 25% watch >3 hours of TV/day.

Aim: The aim of this presentation is to provide a description of a widely-disseminated, youth program that promotes PA, healthy eating and sports coaching in the school environment in South Africa.

Description of program: The Vitality Schools program, modeled in part on the Active Schools! BC program, commenced in 2008 and has been the vehicle for numerous health promotion interventions, including the provision of lesson plans for teachers, wellness days for teachers, the building of playground circuits at the schools, a healthy tuck shop initiative, conferences and workshops for teachers and the development of a website for teachers. The Vitality schools program currently runs in over 1000 schools and has impacted 17,000 teachers and 500,000 school children in the past 2 years.

Objectives: The specific objectives of this presentation are to share information on the various components of Vitality Schools program, to discuss successes and challenges in implementing the program, and to share strategies to improve uptake and effectiveness of school interventions.

Summary: A discussion will be conducted on the successes and challenges of the program and some ideas on how to improve the effectiveness of the schools program and youth interventions.

Symposium

S13 Addressing nutrition behaviors in preschool children through innovative policy, evaluation, and parent multi-component programs

Addressing nutrition behaviors in preschool children through innovative policy, evaluation, and parent multi-component programs

Chairperson: Deanna M. Hoelscher

Dell Center for Healthy Living, University of Texas School of Public Health, Austin, United States

Moderator: Margaret Briley

University of Texas, Austin, United States

Discussant: Deanna M. Hoelscher

Dell Center for Healthy Living, University of Texas School of Public Health, Austin, United States

Purpose: The aim of this session is to present new and emerging data on addressing the nutritional needs and dietary intakes of preschool children, ages 2-5. This session will include presentations that address nutrition- and food-related policies that are currently in place for preschool children; a newly validated method of evaluating dietary intake in preschool children; and two programs that have shown promising results in addressing psychosocial factors and nutrition-related outcomes associated with the dietary intake of preschool children.

Rationale: To date, there have been few studies that have addressed the dietary intake of preschool children. There are numerous challenges for nutrition- and food-related interventions in this population, including: effective policies that target daycare centers; accurate evaluation tools for determining dietary intake; and behaviorally-based intervention strategies that address parents. Several new studies have recently been funded and initiated, and this session will include initial results from this emerging field.

Objectives: After attending this session, participants will be able to: 1. Describe nutrition- and food-related policies for daycare centers in the U.S., and the impact of these policies on dietary intake of preschool children; 2. Explain the development and validation of a new tool to measure dietary intake in preschool children through parent proxy measures (EPAQ); 3. Discuss new data on parent lunch-packing behaviors and related psychosocial constructs from a 5-week trial in daycare centers in the U.S.; and 4 Describe behaviorally-based strategies for a community-based obesity prevention program for preschool children and their parents in the UK and Australia

Summary: This session will include a group of international researchers who are expert in nutrition-related studies of preschool children. The moderator will introduce the participants (5-10 minutes), and each participant will have a total of 15 minutes (12 minutes for presentation, and 3 minutes transition time). After all the participants have presented, the discussant will review the presentations, and engage the audience in a question-and-answer period for about 20 minutes.

Format: Moderator with four 15-minute presentations, followed by a 20-25 minute question-and-answer period led by a discussant.

Symposium

Best practice guidelines for nutrition-and food-related policies at childcareAuthors:

Dianne Ward - University of North Carolina, Chapel Hill, United States

Sarah Ball - University of North Carolina, Chapel Hill, United States

Christina McWilliams - University of North Carolina, Chapel Hill, United States

Sara Benjamin - Duke University, Durham, United States

Amber Vaughn - University of North Carolina, Chapel Hill, United States

Background: Childcare policy, as a strategy to address the childhood obesity epidemic, is garnering great attention.

Purpose: To present a set of best practice guidelines for nutrition- and food-related policies for the childcare setting.

Methods: Due to the lack of comprehensive recommendations, the Nutrition and Physical Activity Self-Assessment for Child Care (NAPSACC) best practice guidelines for healthy weight development were created based on an extensive review of existing guidelines, research evidence, and expert review. A convenience sample of 96 child care centers from 33 counties across North Carolina was recruited to participate in this study. Centers’ physical activity environments were assessed using the Environmental and Policy Assessment and Observation (EPAO) instrument, designed to evaluate child care policies, practices, and environment.

Results: Thirty-one best practice guidelines for nutrition addressing eight unique components of the childcare environment were assessed, including: Fruits & vegetables; Grains; High fat/high sugar foods; Beverages; Nutrition Environment; Staff Behavior, Staff Training/Education, and Center Food Policies. Our results showed that only seven of these best practice guidelines were achieved by a majority (50% or more) of the 96 North Carolina child care centers participating in this study: offering 2+ fruit/day, limiting fried to potatoes once/wk, limiting fried meats to once/wk, rarely/never offering sugary drinks, encouraging children to try new foods, joining children at table during meals, and avoiding eating unhealthy foods in front of children.

Conclusions: Establishing comprehensive guidelines for food at childcare could result in better child nutrition and healthier children. However, more policy research is needed.

Evaluation of the impact of a community-wide intervention on child behaviors using a parent-proxy method to assess dietary intake of preschool childrenAuthor:

Rachel Boak - Deakin University, Geelong, Australia

Purpose: To determine the effectiveness of the Romp & Chomp intervention to reduce obesity and promote healthy eating and active play in children aged 0-5 years.

Symposium

Methods: Romp & Chomp was a community-wide, multifaceted intervention conducted in Australia (2004-2008) in a large regional city with a target of 12,000 children. The intervention focused on community capacity building and environmental changes to increase healthy eating and active play in early childhood settings. The evaluation was repeated cross-sectional, and quasi-experimental with a comparison sample. Main outcome measures included the prevalence of overweight/obesity and obesity-related behaviours, using the newly validated Eating and Physical Activity Questionnaire (EPAQ) which assesses the child’s previous day dietary intake using parent-proxy.

Results: Post intervention there was a significantly lower prevalence of overweight/obesity in both the 2 and 3.5 year old children (by 2.5 and 3.4 percentage points, respectively), compared to a difference of 0.7 percentage points in the comparison, sample from baseline levels (p<0.05). Intervention child behavioral data showed a significantly lower intake of packaged snacks, fruit juice and cordial compared to the comparison sample (all p<0.05).

Conclusions: The EPAQ is a simple and useful instrument for the evaluation of population-based obesity prevention interventions for young children. Further, the results demonstrate that a community-wide multifaceted intervention in early childhood settings can reduce obesity and improve young children’s diets.

Funding Source: Department of Human Services, Victoria, Australia

Diet-related psychosocial and behavioral outcome results from the Lunch is in the Bag studyAuthors:

Sara Sweitzer - The University of Texas at Austin, Austin, United States

Margaret Briley - The University of Texas at Austin, Austin, United States

Deanna Hoelscher - UT School of Public Health, Austin, United States

Ronald Harrist - UT School of Public Health, Austin, United States

Deanna Staskel - The University of Texas at Austin, Austin, United States

Fawaz Almansour - The University of Texas at Austin, Austin, United States

Cindy Roberts-Gray - Third Coast Research, Galveston, United States

Purpose: To determine the effects of Lunch is in the Bag on selected behavioral constructs and to predict the relationship of lunch packing behaviors of parents of preschool children.

Methods: Using a quasi-experimental design, six childcare centers in Central Texas were paired by size before being randomly assigned into Intervention and Control groups. A total of 131 parent-child dyads, with children aged 3-5 years, participated. Lunch is in the Bag was implemented at the Intervention centers. The variables measured at all centers both pre and post intervention were number of servings of fruits, vegetables and whole grains as well as knowledge, outcome expectations, perceived behavioral control and self-efficacy, subjective norms and intentions. Hierarchical linear regression analyses were performed and p < 0.05 was considered significant.

Symposium

Results: There was a mean increase in number of servings of vegetables (0.24, p = 0.001) and whole grains (0.52, p = 0.001) with no significant change in number of servings of fruits. Significant effects of time and intervention were seen for knowledge of meal pattern, subjective norms for fruit, vegetables and whole grains, and outcome expectations for whole grains. Self-efficacy and perceived behavioral control, outcome expectations and intentions were significant predictors for the behavior of packing vegetables and knowledge of meal pattern significantly predicted the behavior of packing whole grains.

Conclusions: Lunch is in the Bag is an effective behaviorally based multi-component intervention for improving the lunch packing behaviors of parents of preschool aged children and fits easily into the childcare setting.

Funding Source: National Cancer Institute grant number 1 R21 CA123140-01A and the Michael and Dell Center for the Advancement of Healthy Living

Symposium

S14 Strategies for incorporating physical activity breaks into organizational practices

Strategies for incorporating physical activity breaks into organizational practices

Chairperson: Melicia Whitt-Glover

Gramercy Research Group, Winston Salem, United States

Discussant: Melicia Whitt-Glover

Gramercy Research Group, Winston Salem, United States

Purpose: The purpose of this symposium is to discuss effective strategies for promoting large scale community-level increases in physical activity by impacting policies in organizations. We will describe a thetheoretical model that guides this work and then present three case studies to highlight the implementation and impact of activity breaks in three different organizational settings.

Rationale: Regular physical activity (PA) is recommended for improvement of overall health and to facilitate weight control. Despite the known benefits of physical activity (PA) many Americans do not get adequate amounts on a regular basis. Organization-level strategies for increasing physical activity have been limited. One strategy that has shown promising results is the implementation of brief (10-minute) physical activity breaks in organization practices, which has been shown to be effective for increasing physical activity. Activity breaks, along with training on use, are provided in the form of instructional CDs and DVDs for use in organizations. Dissemination strategies also include providing assistance to organizations on how to modify existing policies and practices to be able to incorporate physical activity breaks.

Objectives: At the end of this symposium participants will: 1. Understand the meta-volition model as it relates to implementing brief physical activity breaks into organizational settings; 2. Understand methods for partnering with professional athletes and sports organizations to promote healthy behaviors; and 3. Understand methods for incorporating brief activity breaks in three types of organizations, professional sporting events, schools/after school programs, and worksites.

Summary/Format:

Melicia Whitt-Glover- Introduction/Overview—overview of and rationale for the symposium

Antronette Yancey - Applying the Meta-Volition model to physical activity promotion - everybody needs a little push—brief overview of the theoretical model that drives this work. This is a new model so warrants a discussion prior to a discussion of the work, to implement activity breaks.

Jammie Hopkins - Engaging organizations in sustainable physical activity interventions—provides data from an ongoing project

Denise Woods - Incorporating brief spectator activity breaks during professional sporting events—provides information on the development of training tools for, and procedures used to recruit professional athletes to serve as health ambassadors to promote health. The athletes are featured on the activity break CDs and DVDs as a strategy for increasing participation, particularly among youth. Also provides data from ongoing project

Symposium

Jewel Mitchell - Incorporating brief activity breaks in elementary schools and after school programs—provides data from an ongoing project

Melicia Whitt-Glover - Disseminating strategies for incorporating physical activity breaks in community-based settings

Melicia Whitt-Glover - Summary/Discussion

Applying the Meta-Volition Model to physical activity promotion - Everybody needs a little pushAuthor:

Antronette Yancey - University of California, Los Angeles School of Public Health, Los Angeles, United States

Purpose: This presentation will review the meta-volition model (MVM), which provides a rationale for large scale adoption and implementation of policies and practices necessary to create substantive and sustainable change related to population-level strategies for increasing physical activity.

Background: Historically, social norm change has preceded wide-scale implementation of legislative policy. Sparkplugs, “boisterous” public health advocates, are key catalysts of organizational change, commanding the respect of leaders in other sectors and convincing them of the relative advantages of adopting such changes. Momentum from organizational change may leverage more sweeping societal changes. Meta-volition refers to the collective agency or volition of early adopter leaders motivated by rising health care costs, an aging workforce, budgetary constraints, escalating demands for service, or global competition to implement practice and policy changes in their own organizations to improve health and productivity.

Methods/Key Points: The MVM proposes six levels of dissemination triggered by organizational marketing to early adopter leaders carried out by “sparkplugs”: initiating (leader–leader), catalyzing (organizational–individual), viral marketing (individual–organizational), accelerating (organizational–organizational), anchoring (organizational–community) and institutionalizing (community–individual).

Conclusions: The MVM has been used to drive research strategies for promoting organization-level changes in physical activity. Push or “opt-out” activity-promoting organizational policies and practices may generate the visibility and political will to increase the likelihood of creation and successful adoption of policies to promote physical activity. The following presentations in this symposium will highlight research to disseminate physical activity strategies using the multi-level interactions and sequencing of diffusion included in the MVM.

Symposium

Engaging organizations in sustainable physical activity interventionsAuthors:

Jammie Hopkins - University of California, Los Angeles School of Public Health, Los Angeles, United States

Joyce Jones Guinyard - University of California, Los Angeles (UCLA) School of Public Health, Los Angeles, United States

William McCarthy - University of California, Los Angeles (UCLA) School of Public Health, Los Angeles, United States

Beth Glenn - University of California, Los Angeles (UCLA) School of Public Health, Los Angeles, United States

Annette Maxwell - University of California, Los Angeles (UCLA) School of Public Health, Los Angeles, United States

Roshan Bastani - University of California, Los Angeles (UCLA) School of Public Health, Los Angeles, United States

Antronette Yancey - University of California, Los Angeles (UCLA) School of Public Health, Los Angeles, United States

Purpose: Integrating physical activity and healthy nutrition-promoting practices and policies into the regular conduct of “business” within key organizational settings is a promising intervention approach for improving health and employee productivity. Adopting organizational strategies to incorporate daily short activity breaks on paid company time may directly engage captive audiences of high risk individuals.

Methods: Multiethnic employees of health and human services organizations participated in a 3-armed randomized control pilot study followed by a 2-armed wait-list randomized control trial (UCLA WORKING Project); structured dissemination project in key community settings (UCLA REACH US); and informally through passive dissemination of training and physical activity resources. Sites were provided training and resources to begin implementing worksite wellness programming based on a “menu” of core and elective push strategy options. Sites were offered technical assistance and troubleshooting throughout their intervention period to ensure proper implementation and maximize likelihood of program sustainability.

Quantitative outcome data were collected at the individual and organization level at baseline, 6 months, and/or 12 months. Process evaluation was conducted through routine interviews with peer leaders and organizational decision makers, and objective worksite environmental audits.

Results/Findings: Data analysis is ongoing. Process evaluation has identified six key characteristics related to successful program implementation and sustainability. A series of brief case studies have been created to illustrate successes, pitfalls, and lessons learned in selected organizations.

Conclusions: Innovative interventions targeting organizational cultural norm change may hold tremendous potential in engaging middle-aged, predominantly sedentary, ethnic minority populations in regular physical activity and actively promoting healthy nutrition behaviors.

Funding Source: Racial and Ethnic Approaches to Community Health U.S. (Grant No. 5 U58DP000999)

Symposium

Incorporating brief spectator activity breaks during professional sporting eventsAuthors:

Mona AuYoung - University of California, Los Angeles School of Public Health, Los Angeles, United States

Denise Woods - University of California, Los Angeles School of Public Health, Los Angeles, United States

Purpose: Previous organizationally-focused physical activity (PA) promotion interventions have primarily targeted schools or worksites. Local sports teams embody community identity, are fitness icons and have yet to be utilized in place-based efforts. Professional athletes are collectively seen as role models for embodying physical fitness. Furthermore, spectators attending sporting events represent a sedentary but sports-motivated population that may be introduced to an enjoyable PA experience.

Methods: As part of a community fitness initiative, Instant Recess! 10-minute exercise breaks, comprised of 9 baseball-inspired moves, were conducted before San Diego Padres Sunday home games. Breaks were led by team cheerleaders and sometimes celebrity guests during the pre-game show in the ballpark. Baseline data were conducted in July 2008. PA levels of spectators were objectively measured using the System for Observing Fitness Instruction Time. Observations were made on a random sample of individuals 10 minutes before, during, and after the Instant Recess! break. PA levels were quantified on a scale of 1 (sitting/lying down) to 4 (very active) every 10 seconds.

Results/Findings: Participants in the breaks were more physically active (mean score=2.22) than non-participants (mean score=1.82) at baseline. Nearly 60% of those observed were male and most were children or older adults. Follow-up data are currently being analyzed and will be presented.

Conclusions: Sporting events provide natural captive audiences that may be mobilized to spur social and cultural norm change. Training professional athletes as health ambassadors in promoting physical activity and other messages can help to drive widespread and durable community health improvement.

Incorporating brief activity breaks in elementary schools and after school programsAuthors:

Jewel Mitchell - Gramercy Research Group, Winston-Salem, United States

Melicia Whitt-Glover - Gramercy Research Group, Winston-Salem, United States

Irma Richardson - Gramercy Research Group, Winston Salem, United States

Dan Heil - Montana State University, Bozeman, United States

Antronette Yancey - University of California Los Angeles School of Public Health, Los Angeles, United States

Background: Regular physical activity (PA) is recommended for improvement of overall health and to facilitate weight control. Instant Recess is an innovative 10-minute, moderate intensity PA break that can be easily adapted across settings. Including brief bouts of exercise in the classroom may enhance children’s PA and fitness levels and outcomes of importance to educators, such as on-task behavior, decreased disruptiveness, and academic performance.

Symposium

Objectives: The goal of this study was to evaluate the impact of implementing a new policy by incorporating activity breaks in elementary schools and after school sites in Forsyth County, NC.

Methods: We employed a randomized, controlled design, using delayed implementation as the control condition. For logistical purposes, the activity level of students in grades three through five was observed using a modified version of the System for Observing Instructional Fitness Time (SOFIT). After baseline data collection, teachers/staff at intervention sites were encouraged to implement the exercise breaks and were asked to complete log sheets that report the number of 10-minute exercise breaks performed each day. The sheets were collected at the follow-up data collection visit. Control sites continued their regular daily activities. Data were collected at baseline and after 8 – 12 weeks.

Results: We successfully enrolled seven elementary schools and eight after school programs in the study. Data analyses are proceeding and outcomes will be presented.

Conclusions: These data suggest that we can successfully enroll elementary schools and after school programs into studies to implement changes in PA policies.

Funding Source: Supported by the Active Living Research Program of the Robert Wood Johnson Foundation (Grant # 65776) and the University of California at Los Angeles (subcontract #1916 GJC639).

Disseminating strategies for incorporating physical activity breaks in community-based settingsAuthors:

Melicia Whitt-Glover - Gramercy Research Group, Winston-Salem, United States

Irma Richardson - Gramercy Research Group, Winston-Salem, United States

Purpose: The primary purpose of this study was to examine the feasibility of disseminating activity break materials for use in schools and churches in the South.

Methods: Five hundred dollar mini-grants were given to 10 organizations in Forsyth County, North Carolina to develop innovative ways to incorporate the Lift Off concept into regularly scheduled organizational activities.

Each funded site recruited 20 participants to participate in strategies, of the organization’s choosing, for incorporating activity breaks. Organizations conducted activities for at least 6 months and participated in pre- and post-program evaluation. Physical activity data were collected using accelerometers and questionnaire.

Demographic data and process measures were also collected.

Results/Findings: There were a total of 199 participants enrolled across all sites (mean age 48.1 + 13.8 years [range 17 – 86 years], 87% female, 27% white, 72% African-American, mean body mass index [BMI] 31.7 + 7.5 kg/m2 [range 17.7 – 61.2 kg/m2]). At baseline, participants reported mean (SE) 838.8

Symposium

(85.1) MET-min./week in total activity on the IPAQ and 61.8 min/day in moderate-intensity PA based on accelerometer data. Organizations implemented a variety of creative strategies for implementing activity breaks. We observed statistically significant increases in self-reported activity overall and among white women. Similar non-significant trends were observed in other subgroups. Process measures showed increased awareness and enjoyment of activity breaks.

Conclusions: These data suggest the feasibility and acceptability of activity breaks implemented by organizations. This is a promising strategy for impacting lifestyle behaviors associated with chronic disease prevention.

Funding Source: This project was supported by a Transition Supplement from the Active Living Research program at the Robert Wood Johnson Foundation.

Symposium

S15 The role of school nutrition policy in shaping food practices: Cross sectional and longitudinal data from the United States and Europe

The role of school nutrition policy in shaping food practices: Cross sectional and longitudinal data from the United States and Europe

Chairperson: Leslie Lytle

Seattle Children’s Research Institute; University of Washington, Seattle, United States

Purpose: To examine the association between national policy and change in foods available in schools and selected student outcomes. This session is novel as it reports on the national policy in both the United States and across Europe.

Rationale: In the last decade we have seen national initiatives designed to impact school environments in order to enhance student wellness and to combat the childhood obesity epidemic. The 2004 Child Nutrition and WIC Reauthorization Act from the United States and the Norwegian initiative that instituted free fruits and vegetables in schools were national mandates targeting foods and beverages available in the school environment. In addition, countries in the European Union are also considering changing policies and practices to positively influence student health. Although policy approaches have great potential, we are still learning about issues related to implementation and the impact of policy at the school and student level.

Objectives: In this symposium we will present data on:

• the relationship between the availability of competitive foods (low-nutrient, energy-dense food/beverages) and having a school and/or district wellness council in the United States;

• how the quality and quantity of competitive foods has changed in the first two years after the enactment of the USDA WIC Reauthorization Act;

• the impact of policies and practices in schools across nine European countries on fruit and vegetable intake and obesity prevalence of students; and

• the history and impact of the Norwegian free fruit program

Summary: This session will examine how several nations are attempting policy initiatives to improve the school food environment. The discussant will summarize the role of the federal government in insuring healthy schools.

School and district wellness councils and availability of less-healthy-food in vending machines in middle and high schoolsAuthors:

Leslie Lytle - Seattle Chilren’s Hospital, Seattle, United States

Kian Farbakhsh - University of Minnesota, Minneapolis, United States

Symposium

Purpose: To assess the association between school and district wellness councils and availability of less-healthy-foods in school vending machines, following enactment in the U.S. of federal legislation requiring school districts participating in the federal school meal program to establish policy that included nutrition guidelines for all school food and involve key stakeholders in policy development.

Methods: In 2006/2007, a convenience sample of middle (n=35) and high (n=54) school principals in Minnesota reported whether their school and district had a wellness council. Trained research staff observed food and beverages in school vending machines accessible to students. Less-healthy-foods (snacks > 3 grams of fat or > 200 calories/serving, and soda, fruit/sport drinks, and 2%/whole milk) were grouped into 7 categories (e.g. high-fat baked goods, candy) and a less-healthy-foods score (0-7) was calculated. Cross-sectional, multivariate linear regression, adjusted for school characteristics, was used to examine associations between scores and a 3-category council variable (district-only; district and school; no council).

Results: Among schools, 53% had district councils, 38% district and school councils and 9% had no council. Schools with district-only (4.39; p=0.08) and district and school councils (4.04; p=0.03) had lower mean less-healthy-food scores than schools without councils (5.64).

Conclusion: The potential of wellness councils to impact availability of less-healthy-foods in school vending machines is promising. There appears to be added benefit to having both a school and district council.

Funding Source: This research was funded through a grant from the National Cancer Institutes as part of their Transdisciplinary Research in Energetics and Cancer Initiative. Grant# 1U54CA116849.

Examining change in competitive foods from 2006 to 2008 in a cohort of Minnesota schoolsAuthors:

Leslie Lytle - Seattle Children’s Research Institute, Seattle, United States

Kian Farbakhsh - University of Minnesota, Minneapolis, United States

Purpose: The Child Nutrition and WIC Reauthorization Act of 2004 required school districts receiving federally supported meals to create a wellness policy by the fall of 2006. That policy was to include recommendations regarding competitive foods offered in schools. The purpose of this presentation is to describe the changes in competitive foods available between 2006 and 2008 in a sample of urban/suburban secondary schools in Minnesota.

Methods: Data were collected as part of research examining the etiology of obesity. Youth participating identified the schools that they attended and data were collected on schools’ environments. Data were collected by direct observation of foods available in vending and a la carté and included information on the amount and quality of foods available in vending and the quality of foods offered via a la carté. Repeated measures analysis was conducted to examine change in environmental outcomes.

Symposium

Results/Findings: Data were available on 63 schools at both time points. Statistically significant change was seen between the two time points on the mean number of vending machines available in schools (from a mean of 9 to 7 machines; p<0.01); and on the proportion of foods in vending meeting a criteria of healthfulness based on calories, fat and sugar (from 24.6% to 34.7%; p<0.01). No statistically significant changes were seen in the healthfulness of foods and beverages available in a la carte.

Conclusions: Federal policy may have helped create the beginning of a movement toward a healthier school food environment.

Funding Source: National Cancer Institute, NIH (Lytle PI:5U54 CA116849).

School food policies and practices in nine European countries: The Pro Children ProjectAuthors:

Jorunn Sofie Randby - University of Oslo, Oslo, Norway

Knut-Inge Klepp - University of Oslo, Oslo, Norway

Background/Aims: The aims of this study were to examine headmaster awareness of national or regional policies and the association of this with school food policies and practices, and to assess whether having a school food policy or following healthful food practices was associated with fruit and vegetable intake and overweight in children in 9 European countries.

Methods: The Pro Children cross-sectional survey of school headmasters (n = 352) from nine European countries was conducted in 2003. School level data were matched with data on 11-year old children from child and parent surveys undertaken in the same schools. Descriptive statistics were used to examine awareness, existence and content of school polices and practices. Preliminary logistic regression analyses were conducted to study possible associations between school policies and practices and indicators of children’s health.

Results: Forty percent of headmasters were aware of either a national or regional policy related to food in school and 61% of all the schools had a school food policy. Teaching the importance of healthy eating was the most frequent policy component and restricting vending machines was the most frequent practice. Headmaster awareness of a national or regional policy increased the likelihood of a policy at school (OR = 3.53). Neither policy nor practices were associated with the health outcomes in children in the preliminary analyses.

Conclusion: Headmaster awareness of national or regional policies related to food in schools increased the likelihood that the school had its own policy and that certain healthful practices were followed.

Funding Source: EU and University of Oslo

Symposium

The implementation and impact of the Norwegian free school fruit programAuthors:

Elling Bere - University of Agder, Kristiansand, Norway

Knut-Inge Klepp - University of Oslo, Oslo, Norway

Purpose: In order to increase fruit and vegetable intake in Norway, a subscription program (for grades 1-10) was initiated in 1996, and made nation-wide in 2003, and a free program (without parental payment) has been implemented nation-wide from 2007 in all secondary elementary schools (grades 8-10) and all combined schools (grades 1-10). The purpose of this presentation is to present the implementation and impact of these programs.

Methods: Study 1: A longitudinal intervention study. In a pilot project, pupils at 9 schools received free school fruit during the school year 2001/02, and 9 schools participated in the subscription program. A total of 20 schools were included as control schools. This cohort (n=1950 6th and 7th graders in 2001) has been surveyed with questionnaires before the intervention started (2001), while the program was running (2002) and after the end of the pilot program (2003, 2005 and 2009). Study 2: Two repeated cross sectional surveys. At 27 schools, pupils were surveyed with questionnaires in 2001 (same survey as study 1, n=1488), and again in 2008 (n=1339). In this study, 5 schools were combined schools, and therefore included in the free school fruit program, and 10 schools participated in the subscription program, in 2008.

Results: Both programs increased fruit intake, but the free programs were; more effective than the subscription program, effective among all groups, and tended to decrease consumption of unhealthy snacks. The pilot version also indicates lasting effects.

Conclusion: Free school fruit appears effective in increasing school children’s fruit intake

Funding Source: Norwegian Research Council

Availability of junk food in U.S. secondary schoolsAuthor:

Terrence O’Toole - Centers for Disease Control and Prevention, Atlanta, United States

Purpose: To determine whether the percentage of schools in which students could not purchase junk foods changed between 2002 and 2008.

Significance: School food environments that promote consumption of junk foods are associated with poorer diets and higher body mass index among students.

Procedures: CDC’s School Health Profiles uses random, systematic, equal-probability sampling to produce representative samples of secondary schools among states. Principals reported on availability of chocolate candy, salty snacks, soda or fruit drinks that are not 100% juice, and sports drinks. Logistic

Symposium

regression analyses assessed significant (p<0.05) linear and quadratic time effects from 2002 to 2008. T-test analysis determined significant (p<0.05) differences between results from 2006 and 2008.

Findings: From 2002 to 2008, the percentage of schools in which students could not purchase junk foods increased in 37 of 40 states. The median percentage of schools in which students could not purchase junk foods increased from 45.7% in 2006 to 63.5% in 2008. The median percentage of schools in which students could not purchase soda increased from 37.8% in 2006 to 62.9% in 2008, and the median percentage of schools in which students could not purchase sports drinks increased from 28.4% in 2006 to 43.7% in 2008.

Conclusions: States made varied progress during 2002-2008 in increasing the percentage of secondary schools in which students could not purchase junk food. Greater efforts are needed to ensure that all foods and beverages outside of school meal programs meet strong nutrition standards.

Symposium

S16 Cancer prevention in health care settings: An opportunity to promote changes in diet and physical activity

Cancer prevention in health care settings: An opportunity to promote changes in diet and physical activity

Chairperson: Annie Anderson

Centre for Public Health Nutrition Research, University of Dundee, Scotland

Discussant: Annie Anderson

Centre for Public Health Nutrition Research, University of Dundee, Scotland

Purpose: To discuss the rationale, potential and ongoing research on promoting cancer risk reduction behaviours in clinical settings

Rationale: Whilst tobacco use remains a major challenge for cancer control programmes, it is becoming clear that, in non-smokers, obesity is now the major risk factor for many cancers. The promotion of changes in diet and physical activity in the clinical setting for cancer risk reduction can help to enhance and re-enforce public health efforts for disease reduction. For example, cancer screening provides opportunities to discuss and promote diet, activity and obesity management. In addition, a range of health professionals can act as role models and in many cases provide brief interventions. For many years cardio-vascular clinicians have taken a lead in endorsing behaviour change but such action is less evident amongst oncologists.

Objectives: 1. To examine current approaches to raising awareness and promoting individual behaviour change for cancer prevention in clinical settings; 2. To explore the potential (opportunities and challenges) of combining prevention interventions with cancer screening; and 3. To discuss the implications of current research investigations to promote cancer risk reduction behaviour change in a range of heath service settings.

Summary: The symposium will commence with an overview by Annie Anderson on ways in which healthcare settings can provide opportunities to enhance public health efforts for cancer risk reduction. This will be followed by three case study reports of on-going work relating to behaviours and cancer risk reduction. Lucia Leonie and Marci Campbell (United States) will explore the potential reasons for weight related disparities in cancer prevention behaviours and present possible strategies which can be used in primary care to tailor messages and strategies for obese individuals to encourage health promotion and cancer screening. Pratt (Australia) will discuss the brief intervention approaches (based on actions to ask, assess, advise, assist and arrange) for behaviour changes developed by the WA Cancer Council to assist primary care physicians undertake more preventive work. Anderson (Scotland) will then present the protocol of the Bewell randomised control trial which assesses the impact of a BodyWEight and physicaL activity intervention on adults at risk of developing colorectal adenomas.

Format: The symposium will be chaired by Anderson with contributors providing short formal presentations and conclude with a discussion around enhancing current efforts to promote diet and physical activity in healthcare settings.

Symposium

Increasing cancer prevention behaviors among obese womenAuthors:

Lucia Leone - University of North Carolina at Chapel Hill, Chapel Hill, United States

Marci Campbell - University of North Carolina at Chapel Hill, Chapel Hill, United States

Purpose: Compared to non-obese women, obese women are at higher risk for many cancers, but have lower rates of cancer prevention behaviors such as screening and physical activity (PA). U.S. guidelines recommend earlier/more frequent colorectal cancer (CRC) screening for certain high risk groups with personal/family histories, but do not advice physicians on recommending screening to individuals with known lifestyle-related risk factors. This presentation will explore weight-related disparities in cancer prevention behaviors and present possible strategies to target obese individuals for health promotion through primary care.

Methods: We conducted seven focus groups on cancer screening and PA with obese (BMI≥30) white and African American women, age 50 and older, who were not currently adherent to CRC screening guidelines (N=31). Discussions and coding were guided by the Health Belief Model.

Results: Women did not believe they were at risk for CRC and had poor knowledge of CRC prevention; they did not clearly understand the role of weight, screening or PA in cancer prevention. Cost and time were the most frequently mentioned barriers to screening. Further investigation revealed that women’s time and healthcare dollars were focused on more pressing co-morbidities. While most women relied on their physician to bring up important health issues, the internet was their most frequent source of information about prevention.

Conclusions: Primary care visits for obese women may focus more on treatment of co-morbidities rather than prevention. Expanding the screening conversation to include prevention may lead to increases in physical activity and other healthy behaviors.

Funding Source: Lineberger Comprehensive Cancer Center CCEP Fellowship

Brief interventions in general practice: Helping GPs to help patientsAuthors:

Steve Pratt - Cancer Council Western Australia, Perth, Australia

Lauren Atkinson - Cancer Council Western Australia, Perth, Australia

Jon Emery - University of Western Australia, Perth, Australia

General practitioners, as most patients first point of contact with the health care system, are in a unique position to educate and counsel patients on their risky health behaviours before they lead to more serious conditions.

In Australia, more than 80 percent of the population see a GP in any year, with a skew towards older age groups, however median GP consultation length is only 13 minutes. Despite considerable opportunity

Symposium

to reach higher risk groups, preventive activities in General Practice are limited by time and patient acceptability, but also by the GP’s confidence or knowledge of the specific recommendations.

To assist GPs, Cancer Council WA developed a summary guide to cancer prevention that covers smoking, alcohol, sun protection, nutrition, physical activity and weight. It is based on the 5As framework (ask, assess, advise, assist and arrange) and incorporates key parts of Royal Australian College of General Practitioners (RACGP) publications; “SNAP: A population health guide to behavioural risk factors in general practice” and “Guidelines for preventive activities in general practice.” This resource assists GPs to incorporate more prevention into their consultations with its clear and concise format. Importantly, it provides practical information on each of the 5As, including identifying and assessing patients with lifestyle risk factors, information to give the patient and suitable referral pathways.

Funding Source: Cancer Council Western Australia, Department of Health (Western Australia)

Development of the BeWEL trial: A trial to investigate the impact of a Body WEight and physicaL activity intervention on adults at risk of developing colorectal adenomasAuthors:

Annie Anderson - Univerity of Dundee, Dundee, United Kingdom

Angela Craigie - University of Dundee, Dundee, United Kingdom

Bob Steele - University of Dundee, Dundee, United Kingdom

Shaun Treweek - University of Dundee, Dundee, United Kingdom

Alison Kirk - University of Strathclyde, Glasgow, United Kingdom

Anne Ludbrook - University of Aberdeen, Aberdeen, United Kingdom

Purpose: To describe the procedures and results of preliminary work undertaken for the BeWEL trial

Methods: The WCRF (2007) review of Food, Nutrition, Physical Activity and cancer prevention provided comprehensive evidence on risk factors for colorectal cancer (CRC). Observational data on weight change and adenoma occurrence and recurrence was identified from the literature. The selection of outcome measures was discussed with members of the UK NCRI sub-committee on CRC screening and prevention. Use of the screening setting as an opportunity for interventions was explored through the literature, discussions were held with NHS staff involved in screening delivery, and feasibility work from The Bowel Health to Better Health (BHBH) study was considered (2009).

Results: Low physical activity and high body fat are graded as convincing risk factors for the development of CRC (by WCRF). Discussions with NCRI highlighted that repeat colonoscopy procedures constitute the most effective intervention to reduce CRC risk in people with previous adenomas. However, the CRC screening setting provides an opportunity to engage with people (aged 50 to 74 years) at a potentially “teachable moment” and an opportunity to decrease risk factors for a range of chronic obesity related disorders. Results from the BHBH study on recruitment (68%) and retention (84%) informed study size and contact procedures.

Symposium

Conclusions: The procedure resulted in a study design for a two–arm (intervention vs. usual care), multi-centre randomised control trial in adults who have had CRC adenomas removed and will focus on 12 month weight loss as the main outcome.

Funding Source: National Prevention Research Initiative (MRC)

Symposium

S17 Understanding habits: The practical and theoretical relevance for models on nutrition and physical activity

Understanding habits: The practical and theoretical relevance for models on nutrition and physical activity

Chairperson: Gert-Jan de Bruijn

University of Amsterdam, Amsterdam, Netherlands

Discussant: Paschal Sheeran

Department of Psychology, University of Sheffield, Sheffield, United Kingdom

Purpose: To provide an overview of studies that investigate the additive and interactive effect of habits (learned automatic responses to stable situational contexts) on dietary and physical activity behaviours. Furthermore, evidence is provided that shows how habits develop and whether habit strength impacts on known theoretical relationships and intervention effectiveness

Rationale: Most psychological models portray health-related behaviours as the outcome of a process of reasoned deliberation. However, recent evidence illustrates that the role of conscious motivation in health behaviour is more limited than these models assume. One concept that warrants more attention is habit strength. Habits are learned behaviours which are initiated automatically without deliberation, in response to commonly encountered situational features. This symposium aims to provide an overview of various studies that have investigated a) how habits develop in real life settings, b) the effect of habit strength in the explanation of health behaviour, and c) the relevance of habit strength measures in enhancing target group detection for effective intervention delivery, and d) moderating the impact of popular intervention strategies.

Objectives: To provide an overview of: 1. determinant studies that have investigated the additive role of habit strength and the interaction between habit strength and motivation, in the explanation of dietary and physical activity behaviours; 2. studies that have investigated the inclusion of habit strength to motivational and behavioural profiles; 3. studies that have investigated the moderating role of habit strength with regard to intervention effectiveness; and 4. the first study that has investigated how behavioural habits develop

Summary and Format:

Part 1: Introduction: why do we need to study habit strength in diet and physical activity (1. Gert-Jan de Bruijn, Amsterdam School of Communications Research. 2. Paschal Sheeran, Department of Psychology, University of Sheffield)

Part 2: Interaction analyses: does habit strength moderate the motivation-behaviour relationship in dietary and physical activity behaviours (Benjamin Gardner, University College London)

Part 3: Behavioural profiling: should motivation-behaviour profiles be extended with habit strength measures to better detect relevant target groups? (Gert-Jan de Bruijn,)

Part 4: How are habits formed in real life settings? A study of healthy eating and physical activity (Phillippa Lally, University College London)

Symposium

Does habit strength moderate the motivation-behaviour relationship in dietary and physical activity behaviours?Authors:

Benjamin Gardner - University College London, London, United Kingdom

Phillippa Lally - University College London, London, Uganda

Purpose: This paper presents the first systematic review of the moderating effect of habit on the intention-behaviour relationship in (un)healthy dietary choices and physical (in)activity.

Background: Unlike intentional behaviours, which are initiated through a conscious and effortful process, habits are automatic responses to situational cues. Subsequently, where somebody intends to perform a healthy behaviour in a given situation, but habitually performs unhealthily behaviour in that situation, the unhealthy behaviour will more likely be performed when the situation is encountered. This moderation effect, whereby the relationship between intention and behaviour depends upon habit strength, has been documented for various behaviours, but no systematic review of this effect in diet and physical activity has been conducted.

Method/Key points: A systematic review of studies measuring habits using the Self-Report Habit Index (SRHI; Verplanken and Orbell, 2003) was undertaken. A descendency search located papers which cited Verplanken and Orbell (2003). 8 unique study datasets were found to feature primary empirical data relating to diet and/or physical activity habits, intentions and behaviour. Of these, one focused on healthy eating, two on unhealthy eating, four on physical activity, and one on inactivity. The moderation effect was noted in seven (88%) studies, though the strength of the effect varied.

Conclusions: Results testify to the robustness of the moderation effect in diet and physical activity. Intervention strategies based on enhancing motivation to eat healthy or take exercise may have reduced impact for individuals with strong unhealthy habits. Methods for breaking unhealthy habits, and creating healthy habits, are discussed.

Behavioural profiling: Should motivation-behaviour profiles be extended with habit strength measures to better detect relevant target groups? Author:

Gert-Jan de Bruijn - University of Amsterdam, Amsterdam, Netherlands

Purpose: Most theoretical models on health behaviour outline intention as the primary determinant of health behaviour. Consequently, health behaviour interventions often target population segments created from intention and behaviour. With the presumed importance of habit strength in the explanation of a wide range of health behaviours, several studies explored the potential relevance of supplementing intention-health behaviour profiles with habit strength measures. Belief-based variables and concept from the theory of planned behaviour were used as predictors for profile membership.

Symposium

Methods: Data were available from undergraduate students (n=334-535), who completed validated questionnaires for fruit consumption, exercise behaviour and bicycle use for transportation purposes. Additionally, validated questionnaires were used to assess habit strength, while belief-based constructs were based on a qualitative survey in a subsample of the population. Profiles were created from meeting behavioural norms and median and midscale values (intention/habit strength) and analyzed using discriminant function analysis.

Results/Findings: Sixty percent of motivated sufficient cyclers had weak cycling habits, forty-seven percent of motivated exercisers with strong habits did not meet exercise norms, and forty-two percent of motivated strongly habitual fruit consumers did not meet fruit consumption norms. Various control beliefs distinguished these groups from their sufficiently active and fruit-consuming peers, whereas beliefs regarding health benefits of sufficient fruit consumption and physical activity were relatively unable to distinguish the created profiles.

Conclusions: Health behaviour change interventions may benefit by including habit strength measures for detecting more specific target groups. Emphasizing health outcomes may no longer be necessary in young adult populations.

How are habits formed in real life settings? A study of healthy eating and physical activity Author:

Phillippa Lally - University of Amsterdam, London, Uganda

Purpose: The aim of this study was to investigate how habits are formed in everyday life.

Methods: We asked 96 volunteers to choose an eating, drinking or activity behaviour to carry out daily in response to a salient daily event (for example, after breakfast) for 12 weeks. They completed 7 automaticity items from the Self Report Habit Index (SRHI) daily via a website and reported whether they had performed the behaviour. 82 participants provided adequate data for analysis. Nonlinear regressions were used to fit an asymptotic curve to each participant’s data, relating number of repetitions to automaticity scores.

Results/Findings: The model fitted for 62 individuals, of whom 39 showed a good fit (e.g. with a plausible asymptote score). The average time to reach the asymptote was 66 days (range = 18 to 254). Performing the behaviour more consistently was associated with better model fit. It took participants performing activity behaviours 50% longer to reach their asymptote than those performing eating or drinking behaviours, although this was not a significant difference. Participants who missed an opportunity to perform the behaviour on one occasion showed little decrease in habit strength.

Conclusion: In conclusions with repetition of a behaviour in a consistent context, automaticity increases following an asymptotic curve which can be modeled at the individual level. More research is needed to explain the large variation in the time it takes for a behaviour to reach its maximum automaticity.

Symposium

Does habit strength moderate the effectiveness of behaviour change interventions? The case of implementation intentions Authors:

Gert-Jan de Bruijn - University of Amsterdam, Amsterdam, Netherlands

Phillippa Lally - University College London, London, United Kingdom

Purpose: Implementation intentions (II) are plans stipulating time, place and manner and facilitate the enactment of positive intentions, thereby creating new healthy habits. Identifying critical environmental cues is pivotal for II to be successful. No research to date has incorporated the automatic nature towards this critical cue in determining II effectiveness.

Methods: Prospective data were available from 124 undergraduate students who reported to have a positive intention for substituting unhealthy snacks for healthy fruits. Participants were asked to identify personal critical cues in which snacking behavior was highly likely (i.e. Tuesday evening at eight o’clock when my favorite TV-show is on I eat a chocolate bar) and reported habit strength for this particular behavior in this particular cue using the Self-Reported Habit Index. Next, they were asked to formulate II regarding this particular cue (i.e. when it is Tuesday evening eight o’clock and my favorite TV-show is on, instead of a chocolate bar I will eat a banana). Tertile scores for habit strength measures were used to create groups for low, medium, and high habit strength for unhealthy snacking. Two weeks later, participants reported their success in changing unhealthy dietary choices into healthy dietary choices (+2=very successful;-2=very unsuccessful) in the past two weeks.

Results: Those who had strong unhealthy habits reported to be more successful in changing their dietary unhealthy habits into dietary healthy habits when compared with those who had weak unhealthy habits (mean difference=.520, p=.039).

Conclusion: Formulating II is more effective amongst those who had initial stronger unhealthy snacking behavior.

Symposium

S18 Engaging low-income parents in childhood obesity prevention: Translational research on parental involvement in educational and environmental interventions

Engaging low-income parents in childhood obesity prevention: Translational research on parental involvement in educational and environmental interventions

Chairperson: Katherine Dickin

Division of Nutritional Sciences, Cornell University, Ithaca, United States

Discussant: Katherine Dickin

Division of Nutritional Sciences, Cornell University, Ithaca, United States

Purpose: To address a significant challenge in childhood obesity prevention by identifying effective strategies for engaging parents of young children in interventions promoting healthy eating and activity, in diverse populations and intervention settings.

Rationale: Despite parents’ critical roles in influencing children’s food and activity choices and home environments, many interventions neglect parental influences or encounter barriers to reaching parents.

Low-income parents are particularly difficult to reach, yet their children are at high risk of unhealthy weight gain. Learning from research experience on engaging parents is imperative for effective prevention of childhood obesity.

Objectives: To examine (1) parents’ interests and roles in interventions aimed at shaping behavior and environments to prevent childhood obesity, (2) the effectiveness and feasibility of strategies to engage parents, and (3) the implications of socio-demographic characteristics of families.

Summary: This symposium will cover promising strategies for engaging parents and compare data on the success of strategies in a variety of settings and interventions promoting healthy weights among preschool and elementary school-aged children. Simone French will present findings on parental response to an early childhood education intervention that reaches parents and children to promote parenting skills applied to healthy eating and activity. Vera Verbestel will present process evaluation data from a large sample of Belgian parents on their involvement in a community-based intervention, and discuss the influences of socioeconomic status and program setting. Teresa Shamah will present research results on parents’ views and roles in a school-based intervention in Mexico and the implications for scaling up the program. Tisa Hill will present data on parental motivations, factors influencing attendance in parenting workshops, and the results of efforts to engage low-income parents in environmental change activities.

Format: The four presentations cover data on outreach strategies to parents within different types of childhood obesity prevention interventions, providing the opportunity to compare results and increase understanding of how programs can effectively leverage the important influence of parents on children’s eating and activity.

Presentations:

Simone French: Reaching African-American parents through early childhood education: Feasibility and parental response.

Symposium

Vera Verbestel: Parents’ awareness, involvement and participation in a community-based intervention for the prevention of childhood obesity.

Teresa Shamah: Parents’ views on their roles in a school-based intervention in Mexico: Formative research to develop a large-scale program.

Tisa Hill: Engaging low-income parents in behavioural and environmental change interventions to promote effective parenting, healthy eating and activity.

Reaching African-American parents through early childhood education: Feasibility and parental responseAuthors:

Simone French - University of Minnesota, Minneapolis, United States

Jerica Berge - University of Minnesota, Minneapolis, United States

Lisa Harnack - University of Minnesota, Minneapolis, United States

Anne Gerlach - University of Minnesota, Minneapolis, United States

Kimberly Diggles - University of Minnesota, Minneapolis, United States

Purpose: To evaluate the feasibility of a community-based, parent-targeted preschooler obesity prevention intervention among low-income African American parents of preschool children.

Methods: Researchers partnered with Minneapolis Early Childhood and Family Education (ECFE) program staff to implement a parenting-based obesity prevention program in a community setting. Two 12-week programs were conducted with parents of African American preschool children (May 2009; n=7; October 2009; n=14). General parenting skills with a content focus on healthy food choices, reduced screen time, and increased physical activity were targeted. Weekly two-hour classes were held jointly staffed by trained researchers and ECFE educators. Meals were provided and gift cards for weekly attendance. Body weight and behavioral survey measures were completed at session one and twelve.

Results: Session attendance was high (80%; > 10 sessions). Parent evaluations were extremely positive. Average parent BMI was 29.3 kg/m2; 75% reported income < $20,000/year. 75% < high school education; 96% single parents; average 3 children in household. 71% households > 4 televisions and 71% no household rules about television watching. Households reported food sources: grocery stores (100%); discount stores (50%); food shelves (43%). Parents reported a median of 12 vegetables and 10 fruits present in the household; 100% fruit juice (100%); fruit drinks (57%); sugar-sweetened soft drinks (36%); and bottled water (71%).

Conclusions: Parents of lower income African American preschool children attended and evaluated positively a community-based parenting program that addressed general parenting skills with a content focus on healthy eating, reducing screen time and increasing physical activity.

Funding Source: National Institutes of Health 1U54CA116849

Symposium

Parents’ awareness and involvement in a community based intervention for the prevention of childhood obesityAuthors:

Vera Verbestel - Ghent University, Ghent, Belgium

Stefaan De Henauw - Ghent University, Ghent, Belgium

Natalia Lascorz - Ghent University, Ghent, Belgium

Gabriele Eiben - Ghent University, Ghent, Belgium

Giani Barba - Ghent University, Ghent, Belgium

Eva Kovacs - Ghent University, Ghent, Belgium

Kenn Konstabel - Ghent University, Ghent, Belgium

Michael Tornaritis - Ghent University, Ghent, Belgium

Antje Hebestreit - Ghent University, Ghent, Belgium

The IDEFICS intervention is a community-based intervention program to prevent obesity in 2-8 year old children. A process evaluation investigated 1. parents’ awareness and involvement in intervention efforts after one year of implementation and 2. differences between the target behaviors (increasing fruit, vegetables and water consumption, reducing screen time, increasing physical activity and sleep duration), settings (schools vs. community), and socioeconomic groups.

Methods: The sample consisted of 242 parents in the Belgian intervention region. Process evaluation data were collected by a parental questionnaire assessed after one year of implementation. Descriptive statistics were used to report cross-sectional study findings.

Results: After one year of implementation, 66% of the sample had heard about the IDEFICS intervention. More parents heard about the intervention through schools (83%) than through the community (36%). Among all parents who were aware of the IDEFICS intervention, 92% were of high socio-economic status. For all target behaviors, more parents noticed efforts and more parents reported to be involved in efforts through schools than through the community. The promotional efforts that reached the most parents, through schools and community respectively, were those targeting fruit and vegetable consumption (93%, 34%), water (88%, 23%), and physical activity (88%, 41%).

Conclusions: Intervention efforts reached more parents through the school setting and were most effective in reaching parents with high socio-economic background. Not all promotions of the target behaviors reached parents to the same extent, with intervention efforts related to dietary behaviors and physical activity being the most visible.

Funding Source: Worked out within the IDEFICS Study (www.idefics.eu) and funded by the EC, FP 6, Contract No. 016181 (FOOD)

Symposium

Parents’ views on their roles in a school-based intervention in Mexico: Formative research to develop a large-scale programAuthors:

Teresa Shamah - National Public Health Institute, Cuernavaca, Mexico

Ericka Escalante - National Public Health Institute, Cuernavaca, Mexico

Carmen Morales - National Public Health Institute, Cuernavaca, Mexico

Claudia Amaya - National Public Health Institute, Cuernavaca, Mexico

Araceli Salazar - National Public Health Institute, Cuernavaca, Mexico

Purpose: To understand parents’ perceptions of school children’s feeding and physical activity behaviors related to overweight and obesity, and to inform development of a large school-based intervention.

Methods: Focus groups were conducted with two groups of 6-8 parents from elementary school parents’ committees, invited by the school principal. Discussions covered fruit and vegetable consumption, student lunches, foods sold in school cooperatives, safe spaces to be active, time available for activity, and physical education classes. Discussions were recorded and translated, then analyzed using phenomenology theory.

Results/Findings: Parents were engaged in the discussions and willing to provide input and their suggestions validated those of children and teachers. Parents suggested strategies such as providing nutritious lunches, prohibiting the sale of junk food in schools, and using appealing food displays to increase fruit and vegetable consumption. Parents identified school as the ideal place for physical activity; they do not allow children to play in the street or in public places because of safety concerns in the community. In both groups, parents viewed school as the best place to get information but cautioned that school events for parents should be mandatory and free because parents face many constraints that could lower attendance.

Conclusions: Parents understood the importance of factors related to preventing childhood obesity and could be fundamental factors in interventions. Based on parents’ views that time constraints limit their participation in school-based activities, intervention plans were adapted to include special events targeting families. Focus group discussions were an effective approach for engaging parents.

Symposium

Engaging low-income parents in behavioural and environmental change interventions to promote effective parenting, healthy eating and activityAuthors:

Tisa Hill - Cornell University, Ithaca, United States

Katherine Dickin - Cornell University, Ithaca, United States

Megan Lent - Cornell University, Ithaca, United States

Jamie Dollahite - Cornell University, Ithaca, United States

Purpose: Process evaluation to investigate the participation and engagement of low-income parents in a childhood obesity prevention intervention integrating nutrition and parenting education with community action to create healthy environments.

Methods: Within a programmatic context in New York, new educational and environmental activities were developed and tested. Parent participation and engagement was assessed by recruitment and retention rates in 8-week educational workshop series and feedback collected from staff and parents after workshops. Card sort and focus group discussion data were collected to examine parents’ interests and motivations for participating.

Results: Parents expressed interest in being healthy role models, cooking, and making healthy choices as a family. Eligible parents were recruited primarily through partner agencies. Among those attending more than 1-2 sessions (n= 364), 74% completed the series. Parents responded positively to the behavioural, dialogue-based curriculum and reported trying new food and activity behaviours with their children. Program graduates significantly improved key practices and reported that barriers such as limited access to healthy, affordable foods and play spaces for children motivated their interest in community action. Involvement of parents in promoting environmental changes outside the home was limited by time constraints and program staff inexperience in community action.

Conclusions: Participation of low-income parents can be enhanced by working with agencies serving these families; ensuring that activities are accessible, relevant, and fun; and offering multiple avenues for involvement. Sustained engagement of low-income families in promoting environmental change requires support from program staff and development of strategies specific to each community.

Symposium

S19 Preschool obesity prevention: The role of child care setting policies and practices

Preschool obesity prevention: The role of child care setting policies and practices

Chairperson: Mary Story

Discussant: Simone A. French

Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, United States

Purpose: To present the results of research about policies and practices to promote healthful food choices and prevent obesity among preschool children by targeting environmental variables in child care settings.

Rationale: 80% of U.S. children spend time in non-parental care at some time during the preschool years. The preschool child care environment is an important influence on child food choices. Effective intervention strategies need to be identified that target child care policies and food environments.

Objectives: To present data on the effects of environmental strategies and policies on the foods offered to children and preschool children’s food choices. To discuss the implications of these data for food policies in child care settings.

Summary: The four presentations were funded by the Healthy Eating Research Program of the Robert Wood Johnson Foundation. Dr. Harnack will present the findings from an intervention that evaluated the effects of three different preschool meal serving strategies on the fruit and vegetable intake of preschool children. Dr. Johnson will present results from an analysis of the food spending and nutritional quality of foods served in the USDA child and adult food care program. Dr. Samuels will present findings from a statewide study of child care food practices in California child care centers and discuss policy implications for state and federal policy. Dr. Ward will present data from an observational study of child care staff food-related behaviors. Data about preschool children’s child care environments can inform policies that can be adopted to promote healthful food choices and prevent obesity among preschool children.

Format: Preschool children’s food behaviors will be addressed as part of four data-based presentations of environmental interventions and policy analyses of programs that impact child care nutrition environments.

Presenters:

1. Lisa J. Harnack –Results from an Experimental Trial at a Head Start Center to Evaluate Meal Service Approaches to Moderating Energy Intake of Preschool Aged Children

2. Donna Johnson – Measuring, Analyzing and Examining Food Spending & Nutritional Quality in Family Day Care Participants in the USDA Child and Adult Care Food Program

3. Sarah Samuels – Child Care in California: From Practice to Policy

4. Dianne S. Ward - Food Policies and Feeding Behaviors at Child Care: Do policies affect staff behavior?

Symposium

Results from an experimental trial at a Head Start center to evaluate meal service approaches to moderating energy intake of preschool aged children Authors:

Lisa Harnack - University of Minnesota, Minneapolis, United States

Simone French - University of Minnesota, Minneapolis, United States

J. Michael Oakes - University of Minnesota, Minneapolis, United States

Farhiya Farah - University of Minnesota, Minneapolis, United States

Sarah Rydell - University of Minnesota, Minneapolis, United States

Gretchen Taylor - Minnesota Department of Health, St Paul, United States

A randomized crossover design experiment was conducted to evaluate the independent effects of two meal service strategies on intake of fruits, vegetables, and energy among preschool children: Serving fruits and vegetables in advance of other menu items at lunch and pre-plating meals. Children at a Head Start center in Minneapolis, MN were recruited. The trial was conducted over a six week period, with each of the meal service strategies under study implemented during lunch for two randomly ordered one-week periods. Two one-week control periods were also included. Children’s lunch intake was observed at each meal during each experimental condition as a measure of food and nutrient intake. The analysis sample (n=53) was predominantly African American (75.5%). Notable proportions were obese (24.5%) or overweight (11.3%). Results showed that fruit intake was significantly higher during the weeks when fruits and vegetables were served in advance of other meal items (0.79 servings) compared to control weeks when they were served in tandem with other menu items (0.64 servings). In contrast, fruit intake was significantly lower during the weeks when meals were pre-plated (0.49 servings) relative to control weeks when family style meal service was utilized (0.64 servings). Vegetable intake (excluding potatoes) was similar across experimental conditions. Energy intake during the weeks when fruits and vegetables were served first was similar to that observed during control weeks (237 versus 223 kcals). In contrast, energy intake was significantly higher (284 kcals) during the pre-plating meal weeks compared with the control weeks (223 kcals).

Funding Source: Robert Wood Johnson Foundation Health Eating Research Program

Food expenditures and food quality in child care homes: The impact of CACFP reimbursements for food Authors:

Donna Johnson - University of Washington, Seattle, United States

Pablo Monsivais - University of Washington, Seattle, United States

Shannon Kirkpatrick - University of Washington, Seattle, United States

Purpose: USDA Child and Adult Care Food Program (CACFP) reimbursements to family home child care providers are “tiered” to provide lower reimbursement to some providers. These providers within Seattle received a unique city sponsored supplement while comparable providers outside the city did not. This

Symposium

study tested the hypothesis that higher reimbursement is associated with increased food expenditures and better nutritional quality of child care menus.

Methods: Sixty providers (30 high/30 low reimbursement) in King County (WA) were recruited in 2008-2009.

The two groups shared similar demographic profiles. Participants provided a 5-day menu of meals/snacks served and food shopping receipts. Menu nutrients (5-day averages) were assessed using portions standardized for a 3-5 year old child. Nutritional quality measures included energy density (kcal/g) and mean nutritional adequacy (mean % of dietary reference intake) for eight nutrients of concern for child health. Food expenditures (per day and per 1000 kcal) were calculated by linking receipt and menu data. Analysis included descriptive statistics and T-tests for independent samples.

Results: High reimbursement providers showed significantly higher menu expenditures than the lower reimbursement group ($2.36 vs. $1.97/day, p = 0.039). Reimbursement level was not associated with a difference in calories (591 vs. 604 kcal/day, p = 0.695) or with energy density (1.21 vs. 1.25 kcal/g, p = 0.365).

However, menus of high reimbursement providers showed a significantly higher nutritional adequacy (90.7 vs. 79.6%, p = 0.025).

Conclusions: CACFP reimbursement rates are positively associated with food expenditures and nutritional quality of foods in child care.

Funding Source: Robert Wood Johnson Foundation, Healthy Eating Research Program S19.3

Child care in California: From practice to policyAuthors:

Sarah Samuels - Samuels & Associates, Oakland, United States

Lorrene Ritchie - University of California - Berkeley, Berkeley, United States

Maria Boyle - Samuels & Associates, Boston, United States

Patricia Crawford - University of California - Berkeley, Berkeley, United States

Kumar Chandran - California Food Policy Advocates, Oakland, United States

Kenneth Hecht - California Food Policy Advocates, Oakland, United States

Purpose: To assess food and physical activity practices and policies relating to 2-5 year old children in licensed childcare facilities in California and develop policy recommendations to improve nutrition and physical activity in such facilities.

Methods: This multi-method research project employed a statewide survey of childcare providers (n=429) and stakeholder interviews (n=31) of federal, state, and local childcare program administrators and experts. Licensed childcare was divided into six categories based on two factors hypothesized to influence the quality of the nutrition and physical activity environments, the type of facility (center versus home) and participation in the federally funded Child and Adult Care Food Program (CACFP): Head Starts; State preschools; centers that participate in CACFP; non-CACFP participating childcare centers; CACFP participating family childcare homes; and non-CACFP participating family childcare homes.

Symposium

Results/Findings: Survey responses and interviews revealed that sites participating in CACFP served more healthful food. High food cost was identified by childcare providers as the greatest challenge to providing more nutritious foods. Stakeholders agreed that CACFP standards should be strengthened and that all licensed childcare facilities should be required to follow the CACFP meal pattern. Approximately half of survey respondents reported children received more than 60 minutes of activity while in child care.

Conclusions: Childcare settings provide a unique opportunity for influencing nutrition and physical activity and helping to prevent obesity among young children. Findings from this research and the policy recommendations that emerged could significantly impact efforts to provide healthier nutrition and physical activity environments to children in childcare.

Food policies and feeding behaviors at child care: Do policies affect staff behavior?Authors:

Dianne Ward - University of North Carolina, Chapel Hill, United States

Derek Hales - University of North Carolina, Chapel Hill, United States

Christina McWilliams - University of North Carolina, Chapel Hill, United States

Amber Vaughn - University of North Carolina, Chapel Hill, United States

Purpose: Investigate associations between childcare food policies and food-related staff behaviors.

Methods: Data were collected in 50 childcare centers in North Carolina using the Environment and Policy Assessment and Observation (EPAO) instrument. Both the observation format and revised self-report (SR) EPAO were used. Trained research staff conducted the EPAO which included document reviews and staff observations; EPAO-SR was completed by directors and staff. Presence of food-related policies was compared to staff behaviors using ANOVA.

Results: Centers with policies related to amount of fruit/veggies served had staff who reported using behaviors to encourage healthy eating (F=3.89, df=49, p=.05). When policies addressed types of foods staff could bring to the center, staff reported consuming less unhealthy food at work (F=4.68, df=49; p<.05). However, if centers had policies related to serving 100% fruit juice, observers noted higher consumption of fast food, cookies, and candy (F=13.02, df=47; p<.001). Family-style eating policies had staff with more positive food encounters with children (F=7.71; df=44; p<.01). However, where centers with a “no gum or candy” policy staff were observed eating more unhealthy foods (F=13.87; df=49;p<.001). Positive encouragements to try new foods resulted when centers had a policy related to encouraging new foods (F=5.10; df=47;p<.03).

Conclusions: Food-related staff behaviors at childcare were associated with several food-related policies. Some punitive policies (no candy/gum) related to unhealthy staff behaviors, while family-style feeding resulted in opportunities for positive food encounters. It is unclear whether SR data affect these associations. More work is needed to understand how food policies affect staff behavior.

Symposium

S20 Investigating the interaction between environmental characteristics and individual cognitions of physical activity

Investigating the interaction between environmental characteristics and individual cognitions of physical activity

Chairperson: Frank van Lenthe

Department of Public Health, Rotterdam, The Netherlands

Discussant: Frank van Lenthe

Department of Public Health, Rotterdam, The Netherlands

Purpose: To explore the interaction between environmental characteristics and individual cognitions of physical activity and to discuss the implications of the results for theory and frameworks of determinants of physical activity.

Rationale: According to the ecological models of health behavior, physical activity needs to be understood in its broader environmental context. Several studies have shown associations between individual cognitions (e.g. attitude, self-efficacy) and physical activity. Over the past years, the role of the environment has also been increasingly recognized for explaining physical activity. Studies now often include both environmental and individual characteristics. However, only few of them acknowledge and explore the interaction between environmental and individual determinant of PA. In this symposium, we will present three studies in which this interaction was investigated. By presenting results from recent research in this field, we would like to discuss if and how this interaction operates, and what the implications are for current models, specifically the often used dual-process framework develop by Kremers, et al.

Objectives and Summary: In this symposium we will present the dual-process framework in which currently no interaction between environmental and individual cognitions is proposed. Subsequently, three separate presentations will discuss the existence of individual-environment interactions in different research populations. The results will be summarized and the consequences of these interactions with respect to the conceptual framework will be discussed.

Format:

Introduction to dual process framework - Stef Kremers, PhD

Sports facility availability moderates the intention–sports participation association in adolescents - Anke Oenema, PhD

The interaction between individual cognitions and perceived neighborhood safety on sport participation in adults - Mariėlle Beenackers, MSc

Interactions between environmental and cognitive factors in relation to active commuting - Jenna Panter, BSc

Discussion leader: Frank van Lenthe, PhD

Symposium

Exploring availability of sports facilities as a moderator of the intention: Sports participation association in an adolescent sample Authors:

Rick Prins - Erasmus MC, Univeristy Medical Center, Rotterdam, Netherlands

Saskia te Velde - VU University Medical Center, Amsterdam, Netherlands

Anna Timperio - Deakin University, Melbourne, Australia

Frank van Lenthe - Erasmus MC, University Medical Center, Rotterdam, Netherlands

David Crawford - Deakin University, Melbourne, Australia

Johannes Brug - VU University Medical Center, Amsterdam, Netherlands

Purpose: Physical environmental factors such as the availability of sports facilities have been postulated as potential determinants of physical activity behaviors. These factors can have a direct effect, an indirect effect (through individual cognitions) or moderate the relations between individual cognitions and behavior. This study aims to identify individual and environmental predictors of adolescents’ sports participation and whether availability of sports facilities moderates the intention – behavior relation.

Methods: Data were obtained from the longitudinal ENDORSE study (baseline 2005/2006 – follow-up 2007/2008). A total of 247 adolescents (48% boys, mean age at follow-up 15 years) were included in the analyses. Sports participation was assessed at baseline and follow-up, and individual cognitions (attitude, subjective norm, perceived behavioral control, intention) at baseline, using self-report questionnaires. Objective measures of availability of sports facilities were used. Multiple logistic regression analyses were conducted to test associations between availability of sports facilities, individual cognitions and availability of intention interaction with sports participation at follow-up. Simple slopes analysis was conducted to decompose the interaction effect.

Results: Attitude (OR =2.36; 95% CI = 1.15 - 4.88), subjective norm (OR =1.86; 95% CI = 1.02 - 3.40) and the availability*intention interaction term (OR: 1.10; 95% CI: 1.00-1.20) were significantly associated with sports participation. Simple slopes analysis showed that intention was more strongly associated with sports participation when more facilities were available.

Conclusions: In this study the intention-sports participation association appeared to be stronger when more facilities were available. Thus availability of sports facilities can facilitate sports behavior for adolescents with a positive intention.

Funding Source: ZonMw, The Netherlands organization for research in health care

Symposium

The interaction between individual cognitions and perceived neighborhood safety on sports participation in adultsAuthors:

Mariëlle Beenackers - Erasmus MC, Rotterdam, Netherlands

Carlijn Kamphuis - Erasmus MC, Rotterdam, Netherlands

Frank J. van Lenthe - Erasmus MC, Rotterdam, Netherlands

Purpose: More evidence arises that neighborhood circumstances influence physical activity. However, little is known about the way individual cognitions (such as attitude, self-efficacy, and subjective norm) interact with these neighborhood influences. Our aim was to investigate whether perceived neighborhood safety influences associations between individual cognitions and sports participation.

Methods: Cross-sectional data were obtained from 23-82 year old adults participating in the Dutch GLOBE study in 2005 (N=2475), residing in 87 neighborhoods in the city of Eindhoven (the fifth largest city in the Netherlands). Interactions between individual cognitions and perceived neighborhood safety on sports participation (yes/no) were analyzed with multilevel logistic regressions.

Results: Perceived neighborhood safety interacted significantly with self-efficacy (b=0.446, p<0.05) and attitude (b=-1.128, p<0.05) in its association with sports participation. Among people who perceived their neighborhood as safe, a positive attitude was strongly associated with sports participation (OR=2.00, 95%CI=1.48-2.71). In contrast, attitude was not associated with sports participation in people who perceived their neighborhood as unsafe (OR=0.65, 95%CI=0.34-1.23). For self-efficacy, the interaction was inversed.

Although high self-efficacy increased the probability of participating in sports in people who perceived their neighborhood as safe (OR=1.19, 95%CI=1.05-1.36), this association was even stronger in those who perceived their neighborhood as unsafe (OR=1.86, 95%CI=1.61-2.16).

Conclusions: Associations between physical activity and individual cognitions regarding physical activity can depend on neighborhood circumstances such as perceived neighborhood safety. In the implementation of interventions, it is important to be aware of interactions between behavioral determinants and neighborhood circumstances in which the intervention is implemented.

Symposium

Is there an interaction between habit and environmental factors in relation to active commuting?Authors:

Jenna Panter - University of East Anglia, Norwich, United Kingdom

Esther van Sluijs - MRC Epidemiology Unit, Cambridge, United Kingdom

Andy Jones - University of East Anglia, Norwich, United Kingdom

Nick Wareham - MRC Epidemiology Unit, Cambridge, United Kingdom

Purpose: This study investigates the moderating effects of habit strength for walking and cycling on the associations between objectively measured environmental factors and active commuting in a sample of older English adults.

Methods: 2479 adults (mean age 60.4 years, SD=5.4) from the European Prospective Investigation into Cancer (EPIC) Norfolk cohort who were in full-time employment, lived within 10km of work, and did not report a limitation that precluded walking were included in this analysis. Travel mode to work and habit strength were reported using questionnaires and neighbourhood and route environmental characteristics were estimated using a Geographical Information System. Using logistic regression analyses, adjusting for age, BMI and social class, the environmental correlates of active commuting were examined. Interaction terms were fitted between statistically significant correlates and habit to assess the moderating effects of habit.

Results: 25% of the sample actively commuted to work. Strong habits for walking and cycling and short distance to work were the strongest predictors of active commuting (p<0.01). In a multiple regression model, having higher road density in the neighbourhood, a short distance to work and not having a main or secondary road on route were associated with an increased likelihood of active commuting (all p<0.05). Habit did not moderate the associations between these environmental factors and active commuting.

Conclusions: These findings indicate that similar environmental factors influence active commuting, despite individual’s habit strength. Thus, the promotion of habit development appears key but the efficacy of environmental interventions may not depend on prior habit development.

Funding Source: UEA studentship

Symposium

S21 Methodological approaches to collecting community and policy data from communities nationwide: The Bridging the Gap Community Obesity Measures Project

Methodological approaches to collecting community and policy data from communities nationwide: The Bridging the Gap Community Obesity Measures Project

Chairperson: Dianne Barker

Barker Bi-Coastal Health Consultants, Inc., Calabasas, United States

Discussant: Joseph Sharkey

School of Rural Public Health, College Station, United States

Purpose: This session will describe recent methodological work associated with the collection of key environmental and policy measures related to food and physical activity from U.S. communities. This work is being conducted as part of the Robert Wood Johnson Foundation-supported Bridging the Gap (BTG) Project, a multi-year, national research project conducted by the University of Illinois at Chicago Health Policy Center, in partnership with the University of Michigan Institute for Social Research (ISR). BTG aims to improve understanding of the effects of policies, practices, and other environmental factors on youth diet, physical activity, and weight outcomes.

Rationale: The BTG Community Obesity Measures Project (BTG-COMP) focuses on community level policy and environmental factors that are likely to be important determinants of healthy eating, physical activity, and obesity among adolescents, which are key components of the ISBNPA’s overall mission.

Objectives: In preparation for data collection in 200 U.S. communities per year, the BTG team has designed and implemented several methodological studies to refine sampling approaches, measures and fieldwork procedures. This session will feature four recent BTG methodological studies: (a) Results of a large scale validation study in 450 census tracts (stratified by income, race, ethnicity and urbanicity) to assess both count and classification errors in two commercial outlet lists of food stores and restaurants; (b) Results of a pilot study from 57 U.S. communities to collect and measure local ordinances and regulations, zoning policies and regulations, as well as comprehensive plans and/or master plan elements related to the built and food policy environment; (c) Results of a reliability study to develop a tool to assess walkability and bikeability features on street segments and determine the most efficient way to collect these data (walking versus driving), as well as how to construct a representative sample of arterial and residential streets in a community; and, (d) Results of reliability studies to refine instruments measuring the availability, pricing, marketing/promotion, and labeling of select food and beverage items in food stores, fast food restaurants, and other characteristics of these food outlets.

Summary: Presenters will discuss findings, lessons learned, and how these individual project components fit into the full scale data collection effort that will occur in spring 2010 in a nationally representative sample of communities; place BTG in the context of previous studies measuring the food and built community environment; and describe the relevance of these measures for similar U.S. and international studies.

Symposium

Approaches for measuring county/municipal built environment and food environment related policiesAuthors:

Jamie Chriqui - University of Illinois at Chicago, Institute for Health Research and Policy, Chicago, United States

Sally Hubbard - University of Illinois at Chicago, Institute for Health Research and Policy, Chicago, United States

Sandy Slater - University of Illinois at Chicago, Institute for Health Research and Policy, Chicago, United States

Dianne Barker - Barker Bi-Coastal Health Consultants, Inc., Calabasas, United States

Frank Chaloupka - University of Illinois at Chicago, Institute for Health Research and Policy, Chicago, United States

Purpose: Communities throughout the U.S. are employing policy strategies as a core environmental approach to reduce childhood obesity. We present a methodology for collecting and evaluating local policies, with pilot study results.

Methods: County and municipal codes, ordinances, and master plans from 54 counties and municipalities governing 15 sites from the 2009 Monitoring the Future study were collected using a triangulated approach involving Internet, telephone and mail. We developed separate policy evaluation instruments to measure the built and food environment. Census data were utilized in logistic regression models examining factors associated with policy characteristics.

Results/Findings: Built environment-related policies were more prevalent than food environment policies. Preliminary analyses indicate that master plans including bicycling, pedestrian, trail, open space, and park/recreation-related elements contained more active-living language (Χ2=49.92, p<.000). Communities with pedestrian-oriented zoning were more likely to include walking/biking-related provisions (Χ2=33.3, p=.001), and contain a higher proportion of residents who were black, married, and had longer commutes. After controlling for community characteristics, communities with active living-oriented plan elements were significantly more likely to have active living-oriented zoning code provisions (OR=28.76, p=.014). Only a limited number of zoning codes addressed farmers markets, community gardens, or menu labeling. Forty-four percent of communities restricted fast food restaurants; where permitted, these restaurants were allowed primarily in commercial areas except in some Traditional Neighborhood Developments.

Conclusions: Built environment and food environment-related policies from U.S. communities can be collected and measured, allowing linkage between master plans and community codes/ordinances.

Measuring the built environment using a street segment instrumentAuthors:

Sandy Slater - University of Illinois at Chicago, Chicago, United States

Chris Quinn - University of Illinois at Chicago, Chicago, United States

Dianne Barker - Barker Bi-Coastal Health Consultants, Los Angeles, United States

Symposium

Purpose: We developed and tested an audit instrument to assess walkability/bikability across urban, suburban and rural settings for future use in a nationwide study on the built environment. Both the reliability of items and the efficiency of driving vs. walking were measured.

Methods: After reviewing existing tools, we consulted an expert panel to develop a brief, one-page instrument to collect walkability/bikability features on street segments. Sixteen field staff participated in a 2.5 day training prior to being sent out in pairs to an urban, suburban and rural site. Each pair audited about 20 street segments per site (total N = 491 segments). To test inter-rater reliability, each team member audited street segments separately. To test method reliability, teams first walked the street segment, and then two weeks later, the same team drove the segment. Kappa statistics/ICCs were calculated. A census of all streets in these communities was then conducted.

Results/Findings: Inter-rater reliability ranged from 0.19-1.00 (% agreement 68-100%) and walk vs. drive reliability ranged from 0.38-1.00 (% agreement 77-100%). Measures with low reliability were either dropped or training was revised on measures felt too important to exclude from data collection. Census data indicate a moderate proportion of streets can be measured to represent walkability/bikability in the community. Results show that overall the audit tool is reliable and that the measures can be reliably collected by either walking or driving streets, which will help reduce the amount of time needed to collect these data in the field.

Funding Source: The Robert Wood Johnson Foundation

Validation study of commercial food store and restaurant availability in commercial business listsAuthors:

Euna Han - University of Illinois at Chicago, Chicago, United States

Tamkeen Khan - University of Illinois at Chicago, Chicago, United States

Christopher Quinn - University of Illinois at Chicago, Chicago, United States

Purpose: This study validated the information on available food stores and restaurants found in two commercial business lists.

Methods: Ground-truthed data on food stores and restaurants were compared to business list data from Dun & Bradstreet (D&B) and InfoUnited States for 425 randomly drawn census tracts from the Chicago MSA and its 50 mile buffer. Validity was assessed for the full sample and across tracts by racial, ethnic, income and urbanicity characteristics. We estimated sensitivity and positive predictive value, each of which measured the extent to which the commercial lists contained retailers on ground and the extent of those listed retailers existed on ground, respectively.

Results: Among all food stores observed on ground, 39.53% and 44.02% existed in Dun & Bradstreet and InfoUnited States, respectively. The positive predictive values for D&B and InfoUnited States, respectively, were 47.64% and 58.19%, respectively. Significant differences across tracts by income, race and ethnicity were found only for D&B, whereas both lists had significant differences by urbanicity. 53.22% and 63.17% of

Symposium

restaurants observed on ground were found, and 62.44% and 76.59% of listed restaurants were observed on ground in D&B and InfoUnited States, respectively. No statistically significant differences were found for restaurants by income, although there were some differences by race, ethnicity and urbanicity. Validity also varied by store and restaurant type.

Conclusions: The results imply that the validity of those commercial business lists varies by census tracts, in particular by urbanicity characteristics, and researchers need to address this in generalizing their results based on those lists.

Funding Source: This research was supported by the Robert Wood Johnson Foundation through the Bridging the Gap the ImpacTeen project.

Results from reliability studies in food stores and fast food restaurantsAuthors:

Leah Rimkus - University of Illinois at Chicago, Chicago, United States

Dianne Barker - Public Health Institute, Oakland, United States

Elissa Resnick - University of Illinois at Chicago, Chicago, United States

Frank Chaloupka - University of Illinois at Chicago, Chicago, United States

Purpose: In this study, we tested the reliability of select measures of product availability, pricing, and promotion in food stores and fast food restaurants for future use in a nationwide study on the community food environment.

Methods: An inter-team reliability study was conducted in 166 food stores and an inter-rater reliability study in 134 fast food restaurants in the Chicago MSA to measure agreement among observations of exterior advertisements, product availability, product pricing, and the availability of nutrition information.

Results/Findings: Preliminary results indicate good to excellent reliability for total number of food and beverage ads outside of food stores (ICC ≥ 0.79) and fast food restaurants (ICC ≥ 0.65), but relatively poor reliability for other ad characteristics, such as presence of child-targeted marketing and health claims. The food store study illustrated that reliability was good to excellent (ICC = 0.73-0.97) for counts of total fresh, canned, and frozen fruits and vegetable options, while the fast food study showed good inter-observer agreement on prices for specified food and beverage menu items (ICC ≥ 0.70). Reliability was also good for measuring the availability of nutrition information at the point of purchase in fast food restaurants (ICC = 0.77-1.00), but relatively poor for measures of availability of healthy side options on the dollar and kids’ menus.

Conclusions: Results from both pilots indicate that most items can be reliably obtained from two different observers or teams. Lessons learned will be discussed and applied to an upcoming nationwide study of 150-200 communities per year.

Symposium

S23 Transdisciplinary research on physical activity and cancer: From basic science to public health, prevention, and survivorship

Transdisciplinary research on physical activity and cancer: From basic science to public health, prevention, and survivorship

Chairperson: Audie Atienza

National Cancer Institute, HPRB/BRP/DCCPS, Bethesda, United States

Purpose: This symposium will discuss transdisciplinary research in physical activity and cancer. It will highlight studies in basic science, epidemiology, intervention, public health, and survivorship research. By integrating perspectives from various research disciplines including the behavioral sciences, a better understanding of the potential complex pathways where physical activity may influence cancer-related outcomes can be gained.

Rationale: A growing body of research indicates that physical activity is linked to cancer risk and survivorship (IARC, 2001; AICR/WCRF, 2007). Understanding how physical activity influences cancer-related outcomes requires collaboration among researchers from different disciplines. Findings from basic science can inform behavioral intervention and community-based research. Understanding the pathways through which physical activity influences carcinogenesis will facilitate the development of more effective primary and secondary prevention programs, and increase the well-being of cancer survivors.

Objectives: 1. Review epidemiologic research linking physical activity to cancer risk and cancer survivorship. 2. Discuss the relationships between exercise and cancer-related biomarkers in animal models. 3. Discuss the relationships between exercise and biomarkers in human intervention research. 4. Discuss the relationships between physical activity and biomarkers in community-based prevention research.

Summary: The symposium will discuss transdisciplinary research on the relationship between physical activity and cancer. The session Chair will provide an overview of the NIH Transdisciplinary Research on Energetics and Cancer (TREC) initiative and provide an overview of the symposium presentations. Dr. Christine Friedenreich (Alberta Health Services-Cancer Care) will give a presentation entitled “Epidemiology of the association between physical activity and cancer risk and survival.” Dr. Nathan Berger (Case Western Reserve University) will give a presentation entitled “Transgenic mouse models to study the effects of exercise on cancer prevention and survivorship.” Dr. Anne McTiernan (Fred Hutchinson Cancer Research Center) will give a presentation entitled “Exercise effects on breast cancer biomarkers.” Dr. Donna Spruijt-Metz (University of Southern California) will give a presentation entitled “The relationship between physical activity, sedentary behavior and biomarkers in peripubertal minority females.” A summary and discussion involving the audience will conclude the session.

Format: 1. Overview, Dr. Audie Atienza [5 min]. 2. Dr. Christine Friedenreich [20 min]. 3. Dr. Nathan Berger [20 min]. 4. Dr. Anne McTiernan [20 min]. 5. Dr. Donna Spruijt-Metz [20 min]. 6. Question and answer with panel [5 min].

Symposium

Epidemiology of the association between physical activity and cancer risk and survivalAuthor:

Christine Friedenreich - Alberta Health Services, Calgary, Canada

This presentation reviews the epidemiologic observational evidence regarding the role of physical activity in cancer risk and survival.

Background: Physical activity, as a modifiable lifestyle risk factor has been clearly demonstrated to reduce the risk of several chronic diseases. There is now fairly strong and consistent evidence that physical activity decreases cancer risk. Recently, evidence has begun to emerge for a role of physical activity in improving survival after cancer.

Methods: The published epidemiologic literature was reviewed until January 2010 using a variety of methods including database searches and hand searches of relevant articles.

Results: There is now considerable scientific evidence that physical activity reduces the risk of several different cancer types with the evidence being classified as convincing for colon cancer, probable for breast cancer and possible for endometrial and prostate cancers. There is also increasing evidence that physical activity improves cancer prognosis and quality of life after diagnosis, although there have not yet been any reported clinical trials on the effect of physical activity on the risk of cancer recurrence or survival. While several hundred studies have examined the association between physical activity and cancer risk, less than 15 studies have examined some aspect of physical activity and cancer survival.

Conclusions: Sufficient evidence exists to recommend physical activity as a means for decreasing several different cancer types and improving survival after cancer although the exact type, dose, and time period in life when physical activity has the greatest benefit require more clarification.

Transgenic mouse models to study the effects of exercise on cancer prevention and survivorshipAuthors:

Nathan Berger - Case Western Reserve University, Cleveland, United States

Parvin Hakimi - Case Western Reserve University, Cleveland, United States

Joseph Nadeau - Case Western Reserve University, Cleveland, United States

Gemma Casadesus - Case Western Reserve University, Cleveland, United States

James Swain - Case Western Reserve University, Cleveland, United States

Richard Hanson - Case Western Reserve University, Cleveland, United States

Purpose: We used a transgenic mouse model to investigate the effect of increased physical activity on aging, cytokines and the development of gastrointestinal neoplasia.

Symposium

Methods: Mice that over-express the gene for the cytosolic form of Phosphoenolpyruvate carboxykinase(PEPCK-C-musmice) were compared with controls for aging and aging characteristics. PEPCK-C-musmice were bred with APCmin mice to determine interaction of genetics with enhanced exercise phenotype and compared to APCmin mice for effects on polyp development and survival.

Results: PEPCK-C-musmice over-express PEPCK in skeletal muscle by 90-fold as compared to controls and show enhanced exercise, increased activity and increased endurance over their life span. Compared to controls, PEPCK-C-musmice are more active, eat more, weigh less, have stronger bones, demonstrate sustained fertility, and live longer. Cytokine and hormone analysis show PEPCK-C-musmice have lower insulin, leptin and IGF-1 levels. APCmin mice on a PEPCK-C-musgenetic background show later appearance and slower development of intestinal polyps. APCmin- PEPCK-C-musmice have significantly increased survival compared to control APCmin mice.

Conclusion: Enhanced exercise by the PEPCK-Cmus mice is associated with decreased levels of insulin, leptin, IGF-1, reduced signs of aging and greater longevity. Compared to controls, APCmin mice, on the PEPCK-C-mus genetic background show delayed appearance of intestinal neoplasia, slower tumor progression and longer survival. PEPCK-C-musmice are excellent models to study the effects of enhanced exercise on hormone and cytokine levels, cancer development and progression and overall survival and aging.

Funding Source: TREC Grant #U54CA117867, Aging CA Grant #P30CA043703, Matabolic Regulation of PEPCK Isozymes #DK58620

Exercise effects on breast cancer biomarkersAuthor:

Anne McTiernan - Fred Hutchinson Cancer Research Center, Seattle, United States

Purpose: This talk reviews evidence from randomized exercise trials with breast cancer biomarker endpoints.

Background: Breast cancer risk increases with a sedentary lifestyle and with increasing blood concentrations of estrogens, androgens, inflammatory markers, glucose, insulin, and other metabolic hormones.

Methods: In two trials we tested exercise effects on breast cancer biomarkers in middle-aged to older overweight/obese, sedentary postmenopausal women aged 50-75.The first randomly assigned 173 women to a 12-months aerobic exercise intervention (45 minutes/day, 5 days/week) or control. The second, also 12-months, randomized 438 women to 1 of 4 arms: 1. exercise (45 minutes/day, 5 days/week); 2. reduced calorie diet weight loss (goal 10% weight loss); 3. combined exercise and dietary weight loss; 4. control.

Results: Women randomized to exercise completed ~ 80% of goal exercise minutes/week in both trials, and attrition was low (2% and 9% in the two trials, respectively). Compared to controls, women randomized to exercise experienced statistically significant decreases in serum estrone, estradiol, insulin,

Symposium

insulin resistance, c-reactive protein, and prolactin, but no change in insulin-like growth factor. Effect of exercise was greatest with higher adherence, i.e. minutes/week of exercise, and in women who lost greater amounts of body fat.

Conclusions: Exercise may reduce breast cancer risk through its effects on several biomarkers including sex and metabolic hormones, inflammation, and other markers. Future research needs will be outlined.

Funding Source: U.S. National Cancer Institute

The Longitudinal relationship between moderate to vigorous physical activity (MVPA), sedentary behavior (SB) and Insulin Sensitivity (SI) in peripubertal Hispanic and African American (AA) femalesAuthors:

Donna Spruijt-Metz - University of Southern California, Los Angeles, United States

Britni Belcher - University of Southern California, Los Angeles, United States

Chih-Ping Chou - University of Southern California, Los Angeles, United States

Ya-Wen Hsu - University of Southern California, Los Angeles, United States

Marc Weigensberg - University of Southern California, Los Angeles, United States

Michael Goran - University of Southern California, Los Angeles, United States

Purpose: During the pubertal transition in minority females, PA and SI decrease. This is the first longitudinal study to examine temporal relationships between the pubertal decline in PA and SI, and to combine direct measures of SI with quarterly objective PA measures to study these relationships. We hypothesized that lower baseline SI would predict a steeper annual decline in PA in peripubertal minority girls.

Methods: Participants were 53 Hispanic (77.4%) and AA (22.6%) females, baseline age 9.4± 0.93 years. Measures were: baseline SI by frequently sampled intravenous glucose tolerance test; MVPA and SB by accelerometry at 3.68±1.61 month intervals over ~1 year. Longitudinal linear mixed effects modeling was used to determine the effect of baseline SI on temporal trends in MVPA and SB. Covariates were: ethnicity, age, baseline pubertal stage, body fat & lean weight (by air displacement plethysmography).

Results: MVPA at baseline (46.80±27.31 minutes daily) decreased by ~15% (6.96±4.30 minutes, p <0.001) over the year. After controlling for covariates, baseline SI predicted the decline in MVPA (F = 3.87, p = 0.05). SB at baseline (201.71±27.28 min/day) increased by ~12% (24.60±8.29 minutes, p = 0.001) over the year, regardless of baseline SI (F = 0.01, p = 0.93).

Conclusions: This is the first study to show that lower SI at baseline predicts the decline in MVPA in peripubertal girls, regardless of body fat, supporting the concept that the pubertal decline in PA is partially biologically programmed, emanating from the “trigger” of lower baseline SI.

Funding Source: NCI U54 CA 116848

Symposium

S24 Applying best practice for a school-based nutrition and physical activity intervention: The HealthKick intervention in Western Cape primary schools, South Africa

Applying best practice for a school-based nutrition and physical activity intervention: The HealthKick intervention in Western Cape primary schools, South Africa

Chairperson: Estelle Vicki Lambert

UCT/MRC Research Unit for Exercise Science and Sports Medicine, Sports Science Institute of South Africa, Cape Town, South Africa

Discussant: Anniza De Villiers

Medical Research Unit of South Africa, Cape Town, South Africa

Purpose: This symposium will present the HealthKick intervention in Western Cape primary schools, South Africa. The HealthKick intervention was developed as part of a study that aimed to address diabetes risk factors in Grade 4-6 learners in primary schools within low resource settings in the Western Cape, South Africa. Members of the HealthKick research team will present findings from the formative assessment, as well as aspects of the intervention that are currently underway and are being evaluated.

Rationale: South Africa has a complex mix of over- and under-nutrition, and concerning levels of inactivity in children. Currently no interventions in the Western Cape address nutrition and physical activity in disadvantaged settings. Original plans for an intervention included the adoption of a ‘tool-kit’ approach and took into account best practice for school-based interventions, and this included the following components: parents, curriculum, environment and policy. Other recommendations for school-based interventions were also included, such as school self-assessment and action planning. The application of these recommendations in low resource settings such as South Africa has received little attention, and lessons learnt from the HealthKick intervention indicate that these recommendations need to be tailored to suit low resource settings where the burden of communicable diseases is high and schools have a number of priorities that compete with non-communicable disease and obesity prevention. HealthKick is currently being implemented in 16 schools, 8 of which are classified as co-implementation schools, and 8 as self-implementation schools.

Objectives: The objectives of this symposium will be to report on the development of and rationale for the HealthKick intervention, implementation of an action planning process, and the process of developing the curriculum component of the intervention. The evaluation framework for the HealthKick intervention will also be presented.

Summary and format: The chair will provide an introduction to the symposium by briefly outlining the development of the intervention and its components. This will be followed by a presentation of formative assessment results with learners that provide a rationale for a school-based nutrition and physical activity intervention in low resource settings. The next presentation will outline the implementation of an action planning process, followed by a presentation of how the HealthKick intervention has been aligned with the Life Orientation curriculum for Grades 4 to 6. Lastly, the evaluation framework for the HealthKick

Symposium

S24 Applying best practice for a school-based nutrition and physical activity intervention: he HealthKick intervention in Western Cape primary schools, South Africa

intervention will be briefly outlined. The symposium will end with a discussion around lessons learned from experiences of implementing school-based interventions.

Rationale for a school-based nutrition and physical activity intervention in South African schools: Nutritional and physical activity status of grade 4 learners in disadvantaged settings in the Western Cape Authors:

Jean Fourie - Medical Research Council of South Africa, Cape Town, South Africa

Anniza De Villiers - Medical Research Unit of South Africa, Cape Town, South Africa

Catherine Draper - University of Cape Town, Cape Town, South Africa

Jillian Hill - Medical Research Council of South Africa, Cape Town, South Africa

Lucinda Dalais - Medical Research Council of South Africa, Cape Town, South Africa

Estelle Vicki Lambert - University of Cape Town, Cape Town, South Africa

Nelia Steyn - Human Sciences Research Council of South Africa, Cape Town, South Africa

Background: As part of the HealthKick formative assessment, priority was given to assessing nutritional status and fitness levels of Grade 4 learners.

Methods: Learners from self- and co-implementation schools completed a questionnaire assessing nutrition and physical activity knowledge, attitudes and behaviours; individual dietary intake, anthropometric measurements and fitness testing concluded the assessment.

Findings: Grade 4 learners consumed less than one item of fruit and/or vegetables and lacked variety in their diet the day before testing (n=730). Although overweight was not identified as a problem in this sample, z-scores for height-for-age ranged between -0.13 and -1.91. Results of the fitness testing (n=793) indicated that flexibility and cardiovascular fitness were low. The questionnaire revealed poor nutrition knowledge, with only 14% of learners recognizing the importance of dietary carbohydrate as the basis of most meals. Only 26% were aware of the recommended daily intake of fruit and vegetable serves. However, between 80% and 90% of learners indicated that they enjoyed the taste of fruit and vegetables and could eat more of these foods daily. Learners participating in school sport and leisure-time physical activity were generally positive towards physical activity. However, some environmental constraints were noted (42% said it was not safe to play outside where they lived). More than 50% indicated watching television for more than 2 hours per day.

Conclusions: While overweight and obesity are not imminent concerns among learners from disadvantaged settings in the Western Cape, the physical activity and dietary behaviour of these children are not optimal and warrant attention.

Funding Source: World Diabetes Foundation

Symposium

Development of the HealthKick intervention: Kick-starting diabetes prevention through nutrition and physical activity in primary schoolsAuthors:

Anniza De Villiers - Medical Research Council of South Africa, Cape Town, South Africa

Background: The HealthKick intervention was developed as part of a study that aimed to address diabetes risk factors in Grade 4-6 learners in primary schools within low resource settings in the Western Cape, South Africa. South Africa has a complex mix of over- and under-nutrition, and concerning levels of inactivity in children.

Key points: Intervention mapping was used to prioritise key environment and behavioural outcomes regarding nutrition and physical activity, focusing on learners. The intervention mapping process, along with formative evaluation findings, led to the development of HealthKick goals for the behaviour of learners, which have guided the intervention thus far. HealthKick is currently being implemented in 16 schools, 8 of which are classified as co-implementation, and 8 as self-implementation schools. The two components of the HealthKick intervention are the ‘toolkit’, and action planning. The toolkit comprises a resource pack with information on food and nutrition, physical activity, chronic diseases of lifestyle and school policy and environment (all of which are locally available or via internet access); a container with basic physical activity equipment; and a resource guide listing available resources to address nutrition and physical activity in the school environment. Self-implementation schools received “HealthKick Tips for Healthy Schools” and the resource guide. Action planning, a self-assessment and goal-setting process, was conducted with co-implementation schools.

Conclusions: HealthKick, which aims to apply best practice for school-based nutrition and physical activity interventions, is novel within these types of settings in South Africa and may impact on policy and practice within these settings.

Funding Source: World Diabetes Foundation S24.3

Aligning the HealthKick intervention to the Life Orientation curriculumAuthors:

Symposium

Background: Within South Africa’s National Curriculum, Life Orientation (LO) has the following learning outcomes: health promotion, social development, personal development and physical development and movement. Through intervention mapping, it became evident that for sustainability, HealthKick would need to align with the LO. This was supported by formative assessment findings that identified educators’ capacity as a barrier to the implementation of school-based health promotion programmes.

Key Points: Through collaboration with a LO curriculum expert, HealthKick goals for learners (increase fruit and vegetable intake, increase food variety, decrease intake of high fat, high sugar foods, increase the number of learners eating breakfast and bringing a healthy lunchbox to school, increase physical activity participation at and after school) were linked with assessment standards for the four learning outcomes for Grades 4 – 6, such as ‘Investigates menus from various cultures and suggests plans for healthy meals’. These were broken down into knowledge, skills and values required to fulfil the assessment standards. Furthermore, activities (classroom and home-based) and assessments were suggested. During the course of 2009, workshops were held with educators from co-implementation schools to explain the relevance of HealthKick to LO, and indicate ways in which HealthKick supports its implementation. In 2010, further workshops will take place with educators to clarify the links mentioned above.

Conclusions: Due to the nationalisation of the LO curriculum, it is possible that the curriculum component of HealthKick may be able to be applied elsewhere in South Africa and also has relevance for similar interventions globally.

HealthKick evaluation frameworkAuthors:

Background: Evaluation of the HealthKick intervention comprises formative, outcome and process evaluation. Evaluation activities have run parallel with intervention activities throughout its implementation.

Key Points: Formative evaluation included a situational analysis (interview with principals and an observational schedule of the school environment at 100 schools within the selected education districts).

Symposium

The health status of Grade 4-6 teachers was assessed at 82 schools. Furthermore, testing of Grade 4 learners from self- and co-implementation schools involved a questionnaire on their nutrition and physical activity knowledge, attitudes and behaviour, an individual dietary intake assessment, anthropometric measurements and fitness testing. These tests form the baseline data for the outcome evaluation to be repeated at 18 and 24 months on the same cohort. The outcome evaluation will include quantitative and qualitative evaluation of action planning strategies, with a focus on the reach, implementation fidelity, perceived success of strategy, and factors contributing to and/or hindering success of these strategies at co-implementation schools. Process evaluation will include the qualitative evaluation of the feasibility and acceptability of the action planning process and the extent of use of the ‘toolkit’ (resource guide, resource box, physical activity bin) at these schools. At self-implementation schools, a similar evaluation will analyse the extent to which they used the resource guide and “HealthKick Tips for Healthy Schools”.

Conclusions: The paucity of research conducted with school-based nutrition and physical activity interventions in disadvantaged settings highlights the need for dissemination trials to determine the effectiveness of interventions in these settings.

School self-assessment and action planning: A great idea, but what actually works? Authors:

Background: The action planning component of the HealthKick intervention has drawn heavily on ‘Action Schools!’ British Columbia and the Centres for Disease Control School Health Index. The aim was to guide the school’s HealthKick ‘champion’, principal, staff and individuals affiliated to the school through a process to assess areas for action related to nutrition and physical activity, identify priorities and set feasible goals. Key points: The action planning process was designed to cover at least seven ‘zones’: Life Orientation (curriculum component); food and nutrition; physical activity; health promotion for staff; school policy and environment; and family and community involvement. Limited cooperation from schools and educators and the lengthy nature of action planning sessions hindered their successful implementation, which began in the second half of 2008. In particular, very few educators were willing to commit to a plan of action, and even fewer attempted to carry out these actions. Therefore the action planning process was shortened and refined with a more focused format amalgamating the original ‘zones’ into two sections: nutrition and physical activity, focusing specifically on the intended behavioural outcomes of the intervention. This process was then presented to the 8 co-implementation schools before the school year ended in 2009.

Symposium

Conclusions: While self-assessment and goal setting are vital tools in a school-based intervention, the action planning process proved not to be feasible in HealthKick intervention schools. The extent to which action planning (at the end of 2009) will lead to changes within the school environment remains to be demonstrated.

Symposium

S25 The “Energy Project”: Obesity prevention in 10 to 12 year olds (European energy balance research to prevent excessive weight gain among youth)

The “Energy Project”: Obesity prevention in 10 to 12 year olds (European energy balance research to prevent excessive weight gain among youth)

Chairperson: Lea Maes

Department of Public Health, Ghent, Belgium

Discussant: Tom Baranowski

Baylor College of Medicine, Houston, United States

Purpose: To present the systematic reviews, which provide the evidence base of the ENERGY-project, a European project focusing on the prevention of obesity in 10 to 12 year olds with the aim to develop a new theory- and evidence-based multicomponent intervention.

Rationale: Over the last decades, prevalence rates of overweight and obesity have been steadily increasing, also among youth. Overweight is the result of a positive energy balance. Dietary and physical activity behaviours are considered to play an important role in this. The transition from childhood to adolescence is a critical period for these behaviours. At this age, it is supposed that parents still have a major influence on their children’s behaviour. Also little is known about the influences of the school environment with regard to dietary and physical activity behaviours. Within the ENERGY-project several systematic reviews have been conducted to produce a solid basis for the intervention that will be the final product of the ENERGY-project. The systematic reviews focused on the identification of energy balance-related behaviours that contribute to the onset of overweight among youth and their determinants. Furthermore, to identify successful intervention components, the effect of parental involvement, moderating factors and financial intervention strategies in school-based health behaviour interventions were assessed.

Objectives: To examine:

· Which are the most important energy balance-related behaviours contributing to energy balance in 10-12 year old children, and their most important modifiable determinants?

· What is the impact of parental involvement in school-based health behaviour interventions?

· Which are the factors moderating the interventions concerning energy-balance behaviours?

· Which are the economic incentives used in healthy diet and physical activity promoting interventions for 10 – 12 year old children, and what is the feasibility and effectiveness of these economic incentives?

Summary and Format:

Amika Singh: Introduction of the ENERGY-project

Helen Moore: Main findings of the review on identifying the most important energy balance behaviours

Maité Verloigne: Main findings of the review(s) on determinants of the identified energy-balanced behaviours

Wendy Van Lippevelde: Main findings of the review(s ) on parental involvement in school-based health interventions

Symposium

Mine Yildirim: Main findings of the review identifying the moderators of interventions concerning energy balance behaviours

Jorgen Jensen: Main findings of the reviews on the role of financial incentives for school-based dietary and physical activity behaviour

Tom Baranowski will comment on the European evidence and experience and add the American perspective as an introduction to the discussion

The ENERGY-project: background information and conceptual ideasAuthors:

Amika Singh - EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam

Saskia te Velde - EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam

Mai Chin A Paw - EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam

Johannes Brug - EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam

There is an urgent need for more carefully developed public health measures in order to curb the obesity epidemic among youth. The overall aim of the ENERGY-project is the development and formative evaluation of a theory-informed and evidence-based multi-component school-based and family-involved intervention program ready to be implemented and evaluated for effectiveness across Europe. This program aims at promoting the adoption or continuation of health behaviors that contribute to a healthy energy balance among school-aged children. Earlier studies have indicated that school and family environments are key determinants of energy balance behaviors in children. Schools are an important setting for health promotion in this age group, but school-based interventions mostly fail to target and involve the family environment. Led by a multidisciplinary team of researchers from eleven European countries and supported by a team of Australian experts, the ENERGY-project is informed by the Environmental Research Framework for Weight gain Prevention, and comprises a comprehensive epidemiological analysis including 1. systematic reviews, 2. secondary analyses, 3. focus group research, and 4) a cross European school-based survey. The theoretical framework and the epidemiological analysis will subsequently inform stepwise intervention development targeting the most relevant energy balance-related behaviors and their personal, family-environmental and school-environmental determinants applying the Intervention Mapping protocol. The intervention scheme will undergo formative and pilot evaluation in five countries. The ENERGY-project is an international, multidisciplinary effort to develop and test evidence-based and theory-informed intervention program for obesity prevention among school-aged children.

Funding Source: 7th Framework Programme (CORDIS FP7) of the European Commission, HEALTH (FP7-HEALTH-2007-B)

Symposium

Identifying the most important energy balance behaviours among 10-12 year olds that are associated with excessive weight gain and overweightAuthors:

Wayne Douthwaite - Durham University, Durham, United Kingdom

Helen Moore - Durham University, Durham, United Kingdom

Carolyn Summerbell - Durham University, Durham, United Kingdom

Purpose: To identify the most important energy balance behaviours among children aged 10-12 years that are associated with excessive weight gain and overweight for use in development of a new intervention.

Background: The starting point for intervention development to promote healthful energy balance behaviours is identification of the most important and modifiable behaviours contributing to overweight/obesity. Specific behaviours should be identified to determine more precise goals for obesity prevention interventions.

Methods/Key Points: A systematic search of the literature was conducted to identify relevant primary studies, (published after 1990); a systematic search of the literature was also conducted to identify relevant systematic reviews for their primary studies, (from 1995 onwards). 14 prospective cohort studies (22 papers) with relevant data were identified from 9755 papers, and the epidemiological evidence reviewed showed that the only diet and physical activity exposures that were associated with subsequent excess weight gain and obesity were the consumption of sugar-sweetened soft drinks and fruit juices (girls only), higher levels of protein intake at one year of age, and high levels of dietary restraint in the mother. Higher levels of physical activity, or participation in sport, and lower levels of sedentary behaviour were generally associated with lower levels of subsequent excess weight gain and obesity.

Conclusions: The interpretation of the results of this review requires careful consideration, given the problem of correlation versus causation. Although this review identified some exposures as being associated with subsequent excess weight gain and obesity, this does not prove that that they are causative.

Funding Source: Seventh Framework Programme (Health Theme)

Identifying family- and school-based determinants of energy-balance related behaviours in 10- to 12-year old childrenAuthors:

Maité Verloigne - Ghent University, Ghent, Belgium

Purpose: To identify family- and school-based determinants of specific energy-balance related behaviours (EBRB’s), that is physical activity (PA), sedentary behaviour, breakfast consumption and sugar-sweetened beverage consumption.

Symposium

Background: The first step in health promotion is to identify specific EBRB’s which are related to overweight and obesity. Next, determinants of these behaviours need to be identified in order to develop an effective intervention to prevent overweight. At the age of 10-12, parents and the school are of major importance for children’s nutrition and activity behaviour. Therefore, it is imperative to study family- and school-based determinants in this group.

Methods/Keypoints: Observational studies exploring at least one potential family- or school-based determinant of the specific EBRB’s in 10- to 12-year olds were included. 62 articles were retrieved after the search. Family-based variables were found to be important determinants of the child’s PA level. The most important predictors of the child’s PA level are parental activity, attitudes and encouragement. For sedentary behaviour, breakfast and sugar-sweetened beverage consumption, there was generally only one study per determinant. Also, family-based determinants were more studied than school-based determinants of EBRB’s.

Conclusions: Interventions should focus on improving the modifiable determinants in order to promote healthy behaviours. Future studies need to explore determinants of sedentary behaviour, breakfast and sugar-sweetened beverage consumption which would make it possible to draw conclusions. Also school-determinants need to be explored, since the school environment could be an ideal setting for health promotion. Finally, future research should aim at longitudinal studies in order to indicate causality.

Effect of parental participation in school-based health behaviour interventionsAuthors:

Wendy Van Lippevelde - Ghent University, Ghent, Belgium

Purpose: To determine the effect of parental participation in school-based interventions on health behaviours in ten- to twelve-year-old children.

Background: As ten- to twelve-year-old children begin to have more decision-making power about what to eat and how to spend their leisure time, transition from childhood to adolescence is a critical period for developing unhealthy behaviours. School can be considered a good setting for health promotion, although parents continue to have the biggest influence on children’s health behaviour. Therefore, intervention strategies for this age group should include parents. However to date, few studies focus on the additional effect of parent participation in school-based interventions.

Methods: A systematic review of European school-based health behaviour interventions with parent participation was conducted. Five electronic databases were searched and reference lists were screened, this resulted in thirteen studies. Since none of the studies compared interventions conditions with or without parent participation, parental involvement effect cannot be isolated. However, an analysis of intervention components was conducted through a matrix based on effective school-based intervention models. This includes intervention delivery level (class, school, parent) and intervention type (education, policy, rules or regulations, and structural measures).The matrix identifies a proportional relation between study effectiveness and number of included components. Furthermore, the number of parental activities and targeted determinants appears to be of importance.

Symposium

Conclusion: School-based health behaviour interventions including most whole school components and parent participation tend to be successful. However, the parent component has to address all important characteristics of the home environment through various activities.

For whom do school-based interventions aimed at energy balance behavior work and under what circumstances? Systematic review on moderatorsAuthors:

Mine Yildirim - EMGO Institute for Health and Care Research, Amsterdam, Netherlands

Maartje M van Stralen - EMGO Institute for Health and Care Research, Amsterdam, Netherlands

Mai JM Chinapaw - EMGO Institute for Health and Care Research, Amsterdam, Netherlands

Johannes Brug - EMGO Institute for Health and Care Research, Amsterdam, Netherlands

Jos W.R. Twisk -EMGO Institute for Health and Care Research, Amsterdam, Netherlands

Willem van Mechelen - EMGO Institute for Health and Care Research, Amsterdam, Netherlands

Saskia J te Velde - EMGO Institute for Health and Care Research, Amsterdam, Netherlands

Purpose: To systematically review the results and quality of studies investigating the moderators of school-based interventions aimed at improving energy balance related behaviors.

Background: Considering that school based interventions may not be equally effective across subgroups (e.g. race-, age-, gender-), it is important to plan intervention strategies, which deal with the needs and characteristics of different subgroups in the population.

Methods: We systematically searched the electronic databases of Pubmed, EMBASE, Cochrane, PsycInfo, ERIC and Sportdiscus with the time limit from January 1990 to October 2009. In total 12,173 articles were identified and 61 articles were included. Studies were included if they were 1) randomized controlled trials or quasi-experimental studies aimed at primary prevention of overweight; 2) targeted energy-balance related behaviors (physical activity, sedentary and dietary behaviors) in order to prevent overweight or overweight related diseases; 3) were conducted among children and adolescents aged between 4 and 18 years; 4) applied an appropriate moderation analysis (i.e. conducted an interaction test) with situational, personal and psychosocial moderators. Gender, age, weight status, ethnicity and baseline values of outcomes were the most frequent studied potential moderators. The moderator with the highest level of evidence was gender with mainly girls responding better to the interventions.

Conclusions: Due to the inconsistent results, the large numbers of studies reporting a non-significant moderating effect and the moderate methodological quality of the studies, it was impossible to state strong conclusions regarding the moderators of intervention effects. Future studies investigating moderation effects need to consider adequate power for moderation analysis.

Funding Source: The Seventh Framework Programme (CORDIS FP7) of the European Comission, HEALTH

Symposium

Main findings of the reviews on the role of financial incentives for school-based dietary and physical activity behaviorAuthors:

Jorgen Dejgaard Jensen - University of Copenhagen, Copenhagen, Denmark

Anika de Mul - VU University Amsterdam, Amsterdam, Netherlands

Helene Hartmann - University of Copenhagen, Copenhagen, Denmark

Jantine Schuit - National Institute for Public Health and the Environment, Amsterdam, Netherlands

Purpose: To review the existence of economic incentives for good nutritional behavior and physical activity in the school setting, as well as the evidence for the effectiveness, feasibility and costs of such economic incentives.

Background: Many suggested interventions to improve children’s energy balance behaviour address the physical availability of healthy foods or facilities for physical activity, or the adults’ responsibilities as role models for the children. On the other hand, existing research in the role of economic conditions and incentives seems to be less focused.

Methods: The study was conducted as a semi-structured literature review. Studies published in English that included either baseline and/or outcome data in school children were eligible for inclusion. A systematic search of the literature in The Cochrane Library, ScienceDirect, Web-of-science, Pubmed, Google Scholar and Econlit formed the basis for the study. This systematic search was supplemented with a more explorative review of literature regarding adjacent areas (e.g. worksite health promotion).

Conclusion: The study yields a directory of economic incentive mechanisms that may be utilized in the design of interventions to improve school children’s dietary behavior and physical activity – for the schools, for the parents and for the children. Assessments of effectiveness or feasibility of economic incentives however lacked for many of the reviewed studies, so there is a need for more research in the area.

Funding Source: EU 7th Framework Programme

Symposium

S26 Issues on active commuting to school among children and adolescents

Issues on active commuting to school among children and adolescents

Chairperson: Elling Bere

University of Agder, Faculty of Health and Sport, Norway

Discussant: Johannes Brug

EMGO Institute for Health and Care Research, University Medical Center, Amsterdam, the Netherlands

Rationale: Active commuting to school is one of the activities that could be an important component of the daily recommended level of physical activity for adolescents. An increasing number of publications have been published on active commuting to school during the last years. However, several issues are still not consistently or adequately described in the literature. An increased insight in these issues will help improving interventions aimed at promoting active commuting.

Purpose: The purpose of this symposium is to present data on issues on commuting to school that are not consistently or adequately described in the literature.

Objectives: In this symposium we want to:

- report data from longitudinal studies

- assess determinants of active commuting to school

- r eport data from more comprehensive questionnaires; e.g. we will separate walkers from cyclist, and we will report on seasonal variation

- assess cost-effectiveness of programs to increase active commuting to school

Presenters:

- Dr. Ilse de Bourdeaudhuij - Ghent University (Belgium) will present longitudinal data on patterns of active commuting to school from age 10 to age 16 in relation to sex and SES: LEA Study (Longitudinal Eating and Activity Study, Belgium).

- Dr. Anke Oenema - Erasmus MC, University Medical Center (Netherlands) will present longitudinal data from the Endorse study with a specific focus on ethnicity and SES.

- Dr. Elling Bere - University of Agder (Norway) will present cross-sectional and longitudinal data on the association between active commuting to school and weight status: Endorse study (the Netherlands) and the Youth in balance study (Norway).

- Ms. Line Anita Bjorkelund Borrestad - University of Agder (Norway) will present data on active commuting to school in the different seasons of the year in relation to sex, SES and ethnicity in Norway: The Active transportation to school and work in Norway study.

- Dr. Leslie Lytle - University of Minnesota (United States) will present data from the TAAG2 study (United States) that is examining the patterns of movement (including modes of transportation, location of destinations and eating patterns) of adolescent girls when they are out of school but away from home.

Symposium

- Dr. Marj Moodie - Deakin University (Australia) will present data on cost-effectiveness of two Australian programs to increase active transport to school, the Walking School Bus program and the Travelsmart Schools program.

Patterns of cycling to school from age 10 to 16 in relation to gender and SES: The LEA Study (Longitudinal Eating and Activity Study, Belgium)Authors:

Greet Cardon - Ghent University, Ghent, Belgium

Purpose: To explore changes in cycling to school over a six year period from childhood into adolescence and to investigate if these changes differ according to gender or SES.

Methods: Longitudinal design in which children were included in the 5th grade of elementary school (59 schools) in 2002 and remeasured in 2003, 2004, 2005 and 2008. Demographics and active commuting to school were measured by means of self-reports. The baseline sample consisted of 51.9% boys, (age=10,sd=0.4). At first measurement (2002) data from 1670 5th graders were gathered. These measurements were repeated after one year (n=1557), two (n=1151) and three years (n=807), and after 6 years (n= 798).

Results: A gradual increase was found from age 10 to age 16 in the percentage of youngsters cycling to school. About 50% cycled to school in 5th grade, 46% in 6th grade, 52% in 7th grade, 57% in 8th grade and 60% in 10th grade. An increase in mean minutes of cycling was also found in cyclists, going from 8 to 10 minutes between 5th and 7th grade, but doubling to 18 minutes in 8th grade and 21 minutes in 10th grade. Time by gender and time by SES interactions were not significant, showed that the pattern of cycling over time was independent of gender or social class.

Conclusions: A gradual increase in percentage and minutes of cycling to school was revealed between ages 10 and 16 in Belgium. This increase was not different for boys and girls or from different social classes.

Identifying demographic, cognitive and perceived environmental predictors of daily walking and cycling to school among adolescentsAuthors:

Rick Prins - Erasmus MC, University Medical Center, Rotterdam, Netherlands

Saskia te Velde - VU University Medical Center, Amsterdam, Netherlands

Johannes Brug - VU University Medical Center, Amsterdam, Netherlands

Symposium

Purpose: Walking or cycling to school is one of the physical activity sub-domains that can contribute importantly to the total daily physical activity of adolescents. The present study aims to identify demographic, cognitive and environmental predictors and inter-relationships between these variables of active transport to school among adolescents.

Methods: Data were retrieved from the longitudinal ENDORSE study. Self-reported data on walking and cycling to school, individual cognitions (attitude, descriptive norm, subjective norm, perceived behavioural control, intention, habit), parental rules, perceived safety and facilities for walking and cycling in the home and school environment, were assessed at baseline and two years follow-up. A total of 430 adolescents (mean age at baseline 12.5 years, 44% girls, 47% Western ethnic background) were included in the analyses.

Results: At baseline 60% of the adolescents walked or cycled to school every day and at follow-up 56%. Multiple logistic regression analyses adjusted for behaviour at baseline, showed that at follow-up adolescents from non-Western ethnic backgrounds were less likely to walk or cycle to school daily. Furthermore, intention and habit at baseline were the strongest cognitive predictors of walking and cycling to school at follow-up, whereas of the environmental factors, only perceived availability of cycling paths in the school environment was related. Mediation and moderation analyses will be performed to identify whether the ethnic difference between daily walking and cycling to school can be explained by differences in cognitions, stability of cognitions, perceived environmental factors and distance to school.

Conclusions: The results of this study show that a positive intention and a higher habit strength are positively related to daily walking and cycling to school. Thus, interventions aimed at improving walking and cycling to school could focus on improving intention and habit.

Funding Source: ZonMw, The Netherlands organization for health research and development

Active commuting to school and weight statusAuthors:

Elling Bere - University of Agder, Kristiansand, Norway

Anke Oenema - Erasmus University Medical Centre, Rotterdam, Netherlands

Rick Prins - Erasmus University Medical Centre Rotterdam, Rotterdam, Netherlands

Stephen Seiler - University of Agder, Kristiansand, Norway

Johannes Brug - VU University Medical Centre, Amsterdam, Netherlands

Purpose: Active transportation is a behavior that might contribute to energy balance. However, no clear association between active commuting to school and weight status has been reported in the international literature. New studies indicate that cycling to school might have a greater health potential than walking to school. The purpose of the present study is to assess the potential association between cycling to school and weight status in two European cities, Rotterdam and Kristiansand, where cycling to school remains common.

Methods: Data from two studies ENDORSE (Rotterdam) and YOUTH IN BALANCE (Kristiansand) were used including respectively 1361 and 1197 adolescents with mean ages of 14.1 and 14.4 years. The adolescents

Symposium

were categorized as cyclist or non-cyclist based on questionnaires on usual mode of transportation to school.

Results: A total of 25 and 18% were categorized as overweight, and 35 and 31% were categorized as cyclists, in Rotterdam and Kristiansand respectively. In multilevel logistic analyses, after adjusting for potential moderators, the odds ratio (OR) for cyclists being overweight compared to non-cyclists were respectively 0.63 (95%CI=0.45-0.89) and 0.52 (95%CI=0.34-0.78) in Rotterdam and Kristiansand.

Discussion: The results presented clearly show a negative association between cycling to school and overweight among adolescents both in Rotterdam and Kristiansand. However, longitudinal studies are needed in order to assess the etiology. Recently, new data have been collected, and now both studies are longitudinal. Longitudinal data of the relationship between commuting to school and weight status will be presented.

Funding Source: The ENDORSE project is part of CEPHIR: the Center for Evidence-based Public Health in the Rotterdam area, and was financially supported by grants from ZonMw, the Netherlands Organization for Health Research and Development (grant ID no 2100.0103). YOUTH IN BALANCE project is a collaboration between University of Agder, the city of Kristiansand and Sørlandet Hospital health enterprise, and was financially supported by the Competence Development Fund of Southern Norway.

Commuting to school in relation to season, sex, parental education level and distance to school in NorwayAuthors:

Line Anita Bjorkelund Borrestad - Institute of Sports Science and Clinical Biomechanics, Odense, Denmark

Lars Bo Andersen - Institute of Sports Science and Clinical Biomechanics, Odense, Denmark

Elling Bere - Faculty of Health and Sport, Kristiansand, Norway

Objective: To report main mode of commuting to school in Norway in relation to season, sex, parental education level and distance to school.

Methods: Cross-sectional data from the ATN study, including1345 10-12 year olds from 28 schools. Mode of commuting and socio-demographic variables were assessed by questionnaire. Based on the average number of trips/week the pupils were categorized into one specific mode of commuting if more than 50% of the trips were conducted by that specific mode. This was conducted for the fall, winter and spring separately and for the whole year in total.

Results: The proportions of the participants categorized as walkers, cyclists, car- and bus commuters (whole year) were 28%, 36%, 3% and 13% respectively (20 % not categorized). Regarding seasonality, a trend of cyclists converting to being walkers or car commuters during winter time was observed. A total of 52%, 3% and 50% were categorized as cyclist in fall, winter and spring, respectively. The same figures were respectively 24%, 64% and 25% for walkers and 4%, 8% and 3% for car commuters. Girls and not native Norwegians were more likely to be walkers, while boys and children of parents with higher

Symposium

education were more likely to be cyclists. Those living more than 4km away from school were more likely to be car- and bus commuters.

Conclusion: Most children reported to be active commuters to school. Seasonal variation and significant associations with sex, parental education level, ethnicity and distance were observed.

Understanding adolescent girls transport patterns to and from schoolAuthors:

Leslie Lytle - Seattle Children’s Research Institute, Seattle, United States

Robin Beckman - RAND Corporation, Santa Monica, United States

Deborah Cohen - RAND Corporation, Santa Monica, United States

Purpose: The purpose of this study is to add to our understanding of what predicts adolescent girls’ mode of transportation to and from school.

Methods: Data were collected as part of the Trial of Activity of Adolescent Girls-2 (TAAG2) Study, a longitudinal observational study of physical activity and nutrition behaviors of adolescent girls in California and Minnesota. Adolescent girls (mean age 15.9;n=303) participated in baseline data collection for TAAG 2.The dependent variable was mode of transportation used to get back and forth from school in the past day. Predictive factors examined included: demographic characteristics, perceptions of the safety of their neighborhoods, access to cars, employment status, participation in sports teams and parental and peer support for being activity.

Results/Findings: Fewer than 10% reported walking to and from school; no student reported biking to school. Approximately one-third of teens reported getting to and from school in a car driven by a teen; 47% were driven to school by an adult. In the multivariate model examining predictors of the mode of transportation used by girls the following emerged as significant predictors: if they had their driver’s license or permit (p=0.02), the number of cars that were in the household (0.02), and if they had a job (0.06). Site (MN versus CA) also predicted mode of transportation.

Conclusions: Access and work issues, rather than safety, support and out of school activities, appear to be important predictors in the mode of transportation used by girls to get to and from school.

Funding Source: National Heart, Lung and Blood Institute, NIH ( Lytle, PI: R01HL71244)

Symposium

Cost-effectiveness of active transport to school programs as childhood obesity prevention measuresAuthors:

Marj Moodie - Deakin University, Melbourne, Australia

Rob Carter - Deakin University, Melbourne, Australia

Boyd Swinburn - Deakin University, Melbourne, Australia

Purpose: Whilst governments are funding active transport initiatives targeting children, they lack information about which interventions offer ’value for money’. The cost-effectiveness of two active transport to school programs -the Walking School Bus and the TravelSMART Schools – were evaluated as obesity prevention initiatives targeted at Australian primary school children.

Methods: The interventions were evaluated as part of the Assessing Cost-Effectiveness in Obesity (ACE-Obesity) project using an evidence-based, standardised approach. A societal perspective was assumed. The interventions were modeled for one year, and the time horizon for measuring all the associated costs and benefits, including long-term cost-offsets, was rest of life or 100 years. Incremental cost-effectiveness ratios (ICER) were reported as cost per BMI unit saved and per disability-adjusted life year (DALY) saved. The interventions were also assessed against a series of 2nd stage filter criteria (strength of evidence, equity, acceptability, feasibility, sustainability and side effects) to reflect broader considerations of importance to decision-makers.

Results: The net ICER results were AUD 117,000 for TravelSMART Schools and AUD760,000 for the Walking School Bus program per DALY saved. Both interventions exceeded the commonly-used threshold value in Australia of AUD50,000 per DALY.

Conclusions: The cost-effectiveness of these active transport programs as childhood obesity initiatives was not demonstrated under current modeling assumptions. However, it was nonetheless potentially achievable through attention to the high operating costs, low participation rates, low levels of physical activity per participant and capacity that is not utilized.

Funding Source: Victorian Department of Human Services

Symposium

S27 Healthy school canteens, the necessity of a multi-component strategy

Healthy school canteens, the necessity of a multi-component strategy

Chairperson: Fréderike Mensink

Netherlands Nutrition Centre, The Hague, The Netherlands

Discussant: Margret Ploum

Netherlands Nutrition Centre, The Hague, The Netherlands

Purpose: To stress the importance of a healthy school environment: every student in secondary school should have access to healthy products in the school canteen and healthy eating should be promoted through the curriculum. Also to emphasize that healthier school canteen policies for secondary schools should be realized.

Rationale: The prevalence of obesity continues to grow and teenagers have an unhealthy food pattern containing too much saturated fats, sugars, and a lack of dietary fibre. Schools are increasingly being named as key settings for interventions related to healthy eating. Both food service as well as the curricula are considered as important.

Objectives: The proposed symposium brings together practice based researchers and professionals from several organizations and countries that develop and apply interventions promoting healthy school canteens. The symposium addresses the role school environments play when it comes to healthy eating, the choices teenagers make and the influence their choices have on their well being. We hope to target those working in practice and inspire them to motivate and support schools in adopting healthier school canteen policies. Enough time will be dedicated to the open discussion so that symposium participants can come up with new ideas, suggestions and insights.

Summary: Three projects will be briefly presented with a focus on content and effect evaluations. Each presenter will provide a few propositions to encourage the open discussion. Ms. Fréderike Mensink (The Netherlands) will present The Healthy School Canteen, a multi component programme for Dutch secondary schools. Prof. Bent Egberg Mikkelsen (Denmark) will present a whole school approach to healthy eating in Danish schools. Ms. Anne Gerlach (United States) will present outcomes of the TACOS Study, an environmental intervention to promote healthy food choices among adolescents in 20 Minnesota secondary schools.

Format: The symposium will consist of three short presentations (15 minute presentation followed by 5 minutes of discussion; a total of max. 60 minutes).

During the next half hour four topics (according to the propositions and moderated by the discussant) will be discussed:

- A multicomponent whole school approach;

- Effective approaches to a sustainable school policy;

- The tension between curriculum and food service;

- How to reach the target group.

Symposium

Netherlands Nutrition Centre Healthy School Canteen programmeAuthors:

Fréderike Mensink - Netherlands Nutrition Centre, The Hague, Netherlands

Margret Ploum - Netherlands Nutrition Centre, The Hague, Netherlands

Purpose: The Netherlands Nutrition Centre (NNC) Healthy School Canteen programme (HSC) for secondary schools, is a multi-component strategy which aims at sustainable improvement of the school setting with respect to obesity prevention by addressing all parties concerned and facilitating healthy choices.

Background: Development of the NNC HSC started in 2000. Crucial to the programme is the combination of curricular activities, a fundamental change to the food supply, embedment in school policies. Also essential is involving all action agents such as school board, teachers, students, caterers and parents and the Municipal Health Services. To further engage schools a bi-annual national HSC Award (now a total of 160 participants) takes place and a HSC Brigade provides tailored advice.

Methods/Key Points: The HSC consists of a three step roadmap that schools need to follow and that facilitates a planned approach:1) Agenda setting, to inform and to motivate, 2) Action plan, and 3) Implementation, evaluation and embedding. Results of the various studies carried out to determine adoption and implementation of the HSC programme and evaluations of (need for) support and guidance, and feasibility, and adequacy of offered materials will be presented.

Conclusions: The HSC programme contributes to the Dutch governmental aim of making all school canteens healthy by 2015, e.g. our research shows that half of school canteen caterers consider an all healthy school canteen possible and students make healthier choices after adapting vending machines.

The influence of school canteens have on the health of teenagersAuthors:

Bent Egberg Mikkelsen - Aalborg University, Ballerup, Denmark

Purpose: The prevalence of obesity is growing and schools are increasingly being used for healthy eating interventions. Studies show evidence that interventions might lead to healthier eating. In addition whole day schools are getting popular, thus school canteens is spreading in many countries including DK. The Evius study show that publically provided food tends to be nutritionally superior to lunchboxes and competitive foods. However taking lunch in new canteens is based on a voluntary decision as opposed to IT, SE, FI etc. where school food is for everybody. Thus older students often don’t use the canteen. The purpose of this study was to develop an intervention that could increase use of healthy school canteens among secondary students.

Method: Three schools were enrolled in a participatory intervention with the aim of developing an attractive eating space and meal offer to increase the canteen use. The food were meeting official

Symposium

guidelines. Participation was measured before and after intervention and student group interviews were performed.

Results: Pupils were engaged and excited to be involved in setting up their own canteen lounges and invested time and interest in the intervention. However despite a positive process, canteen attendance did not increase. Interviews showed that this was partly due to canteen logistic problems and perceived poor meal quality.

Conclusion: School food is a promising strategy to improve eating patterns, but if it should have a nutritional impact it must be for all. In addition for secondary school pupils it is essential to involve them in the design of the food service.

School nurses as leaders in promoting school wellness for students, faculty and parentsAuthor:

Mary Anne Wesoloski - Barrington School District 220, Barrington, United States

Purpose: School nurses can be leaders in setting policy and developing and implementing programs and practices to improve the school environment around food and fitness. With leadership training, school nurses advocate for and lead multi-component efforts including nutrition education; improved school food; and physical activity.

Background: School nurses in the United States are often the only medical professional in school buildings and are therefore ideal leaders for improving the school environment related to food and fitness. Many school districts do not provide opportunities for school nurses to lead health promotion efforts.

Methods/Key Points: This session will highlight wellness policies and program strategies created by school nurses that participated in the successful School Nurse Leadership Program of the Healthy Schools Campaign, in Chicago, IL. Ms. Wesoloski will describe successes in changing the foods offered to students and fitness programs in a suburban school district, including reduction in the number of vending machines and offering healthier choices; introducing fresh fruits and vegetables daily; setting healthier nutrition standards for school lunches; affecting changes in foods for classroom parties; encouraging non-food incentives; increasing daily physical education time; providing more physical activity during the school day; and providing after-school and evening classes for students and families.

Conclusions: Universities and other entities should offer leadership training to school nurses, and school district administrators and school boards need to recognize the capacity of school nurses to be leaders for wellness.

Funding Source: Private Foundations in the United States

Symposium

An environmental intervention to promote healthy food choices in secondary schools: Outcomes of the TACOS StudyAuthors:

Anne Gerlach - Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, United States

Simone French - Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, United States

Mary Story - School of Public Health, University of Minnesota, Minneapolis, United States

Jayne Fulkerson - School of Nursing, University of Minnesota, Minneapolis, United States

Peter Hannan - Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, United States

Purpose: To evaluate a cafeteria environmental intervention to increase sales of lower-fat foods in 20 Minnesota secondary schools. To describe food-related policies and practices of secondary schools statewide.

Methods: Twenty secondary schools were randomly assigned to either an environmental intervention or a control group for a 2-year period. The intervention increased the availability of lower-fat foods and implemented student-based promotions. School food policies were assessed by surveys mailed to members of a statewide professional organization for secondary school principals (n=610), and to the food service directors and principals of the 20 participating schools.

Results: The intervention resulted in significantly greater sales of lower-fat foods in year 2 (33.6% intervention vs. 22.1% control, p=.04). Within the 20 participating schools, principals (5.9%) and food service directors (27.8%) reported the presence of school policies related to nutrition and food. Statewide (response rate of 75%; n=463), 65% of the principals reported that only healthy food choices should be provided to their students, yet only 32% reported that their school had an overall policy about nutrition and food. Even fewer reported the presence of specific policies about the types of foods and beverages sold in vending machines, school stores, or at school functions.

Conclusions: School-based environmental interventions to increase availability and promotion of healthy foods can increase purchase of these foods among adolescents. Few school food policies are reported, despite supportive attitudes among school principals and food service directors.

Symposium

S28 Global perspectives on local foods: Economic and policy issues to promote healthy, local food networks

Global perspectives on local foods: Economic and policy issues to promote healthy, local food networks

Chairpersons: Simone French

Kenneth Meter

Crossroads Resource Center, Minneapolis, United States

Purpose: To inform ISBNPA participants about broad issues in the global food system.

Rationale: A vibrant global movement calling for local foods is emerging rapidly. Typically the word “local” serves as a shorthand way to express a vision for food that is community-based, and ecologically and nutritionally healthy. Under this vision, farmers and farm workers will have more secure livelihoods and safer workplaces. Lesser-developed countries will be able to focus more on feeding themselves and will be less dependent on export commodities. Consumers will eat better and will know more about how the foods they eat are produced,. Producers and processors will be more deeply linked into business networks that blend cooperation with competition. These community-based food systems will seek to achieve more than simply financial outcomes; measuring themselves on how well they produce healthy lifestyles, social connectivity, and personal capacity, and environmental quality, as well as building wealth in local communities.

Objectives: Issues to be addressed include how local foods take on different qualities in diverse regions of the world, how local foods practitioners connect with each other to create robust food initiatives and build fair trading relationships, what obstacles this movement faces, and what public policies are needed to promote vibrant local foods networks.

Summary: Mr. Meter will present an analysis of the local food economy in Minnesota and highlight the local food networks. Mr. Pirog will outline a “communities of practice” model for building local capacities and providing technical assistance, including the process of networking local foods practitioners into effective multi-organizational collaborations across the state of Iowa. Ms. Berkencamp will discuss how federal policies being promoted around local food systems entail this more inclusive notione of health that involves nutrition as well as the economic, ecological and social health of communities.

Format: Four speakers will present data on local food economic and policy issues.

1. Kenneth Meter: “Minnesota local food economy and local food networks: Impact on local and national food economy”.

2. Rich Pirog: “Building nested local food networks in Iowa: A community of practice approach”.

3. JoAnne Berkencamp: “Policy approaches to encouraging healthy, locally integrated food systems”.

Symposium

Systems levers for community-based food systemsAuthors:

Kenneth Meter - Crossroads Resource Center, Minneapolis, United States

Results: Results from a recent study, “Mapping the Minnesota Food Industry,” [http://www.crcworks.org/mnfood.pdf] showed that public policy will play a key role in fostering community-based food systems. The state is the seventh-largest farm state in the U.S., with $13 billion in farm sales, and is home to seven food manufacturing firms that rank among the state’s top 20 manufacturing firms, with revenues totaling $114 billion per year. Yet farmers spent $465 million more in production expenses than they received by selling their products over each of the past 10 years. Minnesota residents purchase more than $12 billion of food each year, mostly sourced outside the state. Health outcomes are problematic: only 24% of adults eat the recommended five servings of fruit and vegetables per day, and the Centers for Disease Control estimates the costs of treating obesity-related diseases in Minnesota to be $1.3 billion. Potential scarcity of fossil fuels also poses sharp dilemmas. Interviews with CEOs of several multi-million dollar food businesses in the state showed they belived that the key to their business success was not simply hard-nosed cost cutting — though this was important. Even more significant was developing relationships of trust with their suppliers and consumers. The study highlighted three main qualities that characterize the food businesses that currently define the emergent edge of community-based food systems: relationships, resilience, and recycling. Ten system “levers” which must be shifted in order to create sustainable community food systems were also identified.

Funding Source: Blue Cross and Blue Shield of Minnesota Center for Prevention

The Regional Food Systems Working Group: An Iowa network of local food groupsAuthors:

Richard Pirog - Leopold Center for Sustainable Agriculture, Ames, United States

Although demand for local food continues to increase, efforts to make the case for strong community support for a more localized food system have not been networked in a manner to make the work more additive across an entire region or state. Iowa’s Regional Food Systems Working Group, coordinated by the Leopold Center for Sustainable Agriculture, provides an opportunity for a diverse array of community leaders, farmers and health professionals to learn and support each other’s work in developing more resilient local food systems in Iowa. Through quarterly meetings, seed funding, and development of a social network site, Iowa’s local food leaders have an opportunity to accelerate the learning curve to address challenges and take advantage of opportunities to increase production and consumption of healthy local foods. Leaders from more than a dozen local food groups and organizations as well as local government and health officials from half of Iowa’s counties currently participate with the goal of all of Iowa’s 99 counties actively participating in this unique community by 2011. Existing local groups act as mentors to help new groups that participate. The networking framework has increased access to funding

Symposium

opportunities from foundations and state and federal government and has sparked four of Iowa’s counties to make investments in local food as part of their development strategy. Group activities have leveraged funds for Farm to School projects, private and non-profit food distribution ventures, and infrastructure development.

Funding Source: Leopold Center for Sustainable Agriculture and Wallace Center for Sustainable Agriculture

Building infrastructure, partnerships and policy for local food systemsAuthors:

JoAnne Berkenkamp - Institute for Agriculture and Trade Policy, Minneapolis, United States

David Wallinga - Institute for Agriculture and Trade Policy, Minneapolis, United States

The US Farm Bill, Child Nutrition Act and other federal legislation are critical drivers of the food choices available to the American public. However, action at the local level is also important for changing “default” food environments such that they improve access to and availability of healthier foods, and support the development of healthier eating habits. In this presentation, the Institute for Agriculture and Trade Policy will explore strategies for shifting policy in ways that can contribute to systemic improvements in our food environments. Practical strategies for leveraging policy change to support healthier eating in contexts ranging from farmers markets to neighborhood corner stores and school cafeterias will also be addressed.

Funding Source: Wm. T. Grant Foundation

Symposium

S29 Night eating behavior from middle childhood to emerging adults: Characterization and relationships with psychosocial, socio-cultural and biologic variables in Transdisciplinary Research in Energetics & Cancer (TREC) studies

Night eating behavior from middle childhood to emerging adults: Characterization and relationships with psychosocial, socio-cultural and biologic variables in Transdisciplinary Research in Energetics & Cancer (TREC) studies

Chairperson: Carolyn Levers-Landis

University Hospitals Case Medical Center, Cleveland, United States

Discussant: Carolyn Levers-Landis

University Hospitals Case Medical Center, Cleveland, United States

Purpose: The purpose is to better characterize the phenomenon of night eating behavior from middle childhood to emerging adults across several ethnic groups and to further examine the relationship of this pattern of dietary intake with psychosocial, socio-cultural and biologic variables. This symposium will present data from three geographically diverse Transdisciplinary Research in Energetics and Cancer (TREC) centers.

Rationale: The incidence of an eating pattern characterized by consuming a significant percentage of calories in the evening and nighttime has not yet been well described among children and emerging adults across a variety of ethnic groups. Further data are needed to determine the correlates of this behavior with indices of mental and physical health among children and emerging adults. Results will enhance our understanding of this phenomenon and its possible role in pediatric obesity and may inform screening practices and identification of intervention targets.

Objectives: 1) To provide a conceptual overview of night eating behavior, including definitional criteria, assessment approaches, and issues in the field; 2) To explore associations between night eating patterns and stress, anxiety, depression as well as related physiological factors (e.g., cortisol, body fat) in 60 8-11 year old Latino and African American girls; 3) To examine night eating patterns, family routines at dinnertime, clustering in siblings, and body mass index z-scores in 175 12- to 17-year-old African American and Hispanic adolescents in a community sample; and 4) To examine the association between night eating and measures of stress, depression, body composition, and blood markers of inflammation in 140 predominantly Caucasian women (18-24 years).

Summary: This symposium, drawing upon a multi-center initiative (TREC), will present data relative to night eating behavior and its physical and mental health correlates from multi-ethnic studies spanning the developmental continuum from childhood to emerging adulthood.

Format: Dr. Spruijt-Metz (USC) will present the conceptual overview, Dr. Nguyen-Rodriguez (USC) will present objective 2, Dr. Ievers-Landis (Case) will discuss objective 3, and Dr. Arikawa (UMN) will present objective 4. Finally, Dr. Ievers-Landis (Case) will summarize findings from all three TREC centers.

Symposium

Defining the evening hyperphagia symptom of night eating syndrome: Can one definition suffice?Authors:

Selena Nguyen-Rodriguez - University of Southern California, Los Angeles, United States

Purpose: To examine different definitions of evening hyperphagia (a.k.a. night eating), one of the symptoms of night eating syndrome (NES), as described in the literature.

Background: Evening hyperphagia, is one of the main criteria for NES and common to all definitions of the NES. NES was first described in 1955 as a potential contributor to obesity. It has since been linked to a host of other negative health and psychosocial outcomes, and identified in overweight as well as normal weight populations. However, evening hyperphagia is not uniformly defined, making research results difficult to compare, and definitions will influence research findings. Various criteria for evening hyperphagia include, but are not limited to, % of total caloric intake after dinner or ‘last evening meal’, % of total caloric intake after a certain time, or number of night eating events classified in several different ways. Is there a ‘good’ definition, or is it important that the definition be ‘fitted’ to the population under study?

Methods/Key Points: This is a thematic literature review that will examine the definition of evening hyperphagia in the context of study populations. Presentation points include: 1) overview of definitions, 2) how characteristics of the study population might influence choice of definition, and 3) the ramifications of choice of definition on research findings.

Conclusions: NES has been related to a host of adverse outcomes. This presentation will reflect on how best to define evening hyperphagia, a symptom of NES, and provide a springboard for the empirical studies in this symposium.

Funding Source: NCI USC-CTREC U54 CA 116848

Correlates of Night-Eating (NE) in a sample of African American (AA) and Latina (L) girlsAuthors:

Selena Nguyen-Rodriguez - University of Southern California, Los Angeles, United States

Purpose: To explore associations among NE, psychological and physiological factors in a minority sample of girls.

Methods: 54 L and AA 8-11 year-old girls provided data on: dietary intake (3-day diet records); night eating (≥25% of total caloric intake after7:30pm); stress, anxiety and depressive symptoms (self-report questionnaires); body fat; and salivary cortisol. Cross-sectional correlations and t-tests were performed.

Symposium

Results/Findings: Participants were 80% Latino, mean age 9.35 years (SD=0.95). 83% percent of girls ate after 7:30pm, with 14.8% engaging in NE. Correlations showed no associations with psychological variables or body fat. Percent of calories eaten after 7:30pm was positively associated with total caloric intake (r=.377, p=.005), fat (r=.362, p=.007), carbohydrate (r=.333, p=.014), protein (r=.295, p=.030), and sugar intakes (r=.307, p=.024). T-tests revealed that girls who ate after7:30pm on ≥2days had significantly lower awakening cortisol response (t=2.181, p=.035) and better body image (t=-2.865, p=.006) vs. those eating after 7:30pm on ≤1day.

Conclusions: Although we found no association to BMI, since higher evening dietary intake related to higher caloric intake, this could later lead to increased BMI. Girls with better body image may be less vigilant of eating patterns, hence less likely to adhere to conventional patterns. The lower awakening cortisol response in girls who night-eat more frequently may explain why night eaters may experience morning anorexia, as cortisol has been shown to stimulate appetite. Results provide insight into the psychological and physiological significance of NE.

Funding Source: NCI USC-CTREC U54 CA 116848

Night eating patterns, Body Mass Index and family dinnertime routines among minority adolescents in a community sampleAuthors:

Carolyn Levers-Landis - Case Western Reserve School of Medicine and University Hospitals, Cleveland, United States

Marco Yzer - University of Minnesota, Minneapolis, United States

Megan MacDougall - Case Western Reserve School of Medicine, Cleveland, United States

Deanna Shuster - Case Western Reserve School of Medicine, Cleveland, United States

Stephanie McClure - Case Western Reserve University, Cleveland, United States

Suzanne Gorovoy - Case Western Reserve University, Cleveland, United States

Alicia Thomas - Case Western Reserve School of Medicine and University Hospitals, Cleveland, United States

Nathan Berger - Case Western Reserve School of Medicine, Cleveland, United States

Purpose: To examine night eating, body mass index (BMI) and family routines among minority youth in a community sample.

Methods: A cross-sectional study of adolescent lifestyle behaviors provided data from 124 African-American and Hispanic children, ages 12 to 17 (54% female) and their caregivers. Parent questionnaires provided demographics and family routines data; children completed two 24-hour dietary recall interviews and had their height and weight measured. T-tests and correlations were conducted with regressions controlling for child age.

Results/Findings: Average BMI z-score was .87 (SD=1.05; range=-2.03 to 2.86). Mean total calories was 2174.07 (SD=748.51) with average dinnertime at approximately 7:30 p.m. Average percentage of calories consumed after 7:30 p.m. was 32.59% (SD = 15.03; range=4.45-67.85%). Approximately 12% ate more than half of their intake after 7:30 p.m. Correlations indicated significant relationships between higher BMI z-scores and earlier dinnertimes (r = -.207, p = .032) and between a larger percentage of calories eaten

Symposium

after 7:30 p.m. and fewer total calories (r = -.256, p = .019); these remained significant after controlling for child age. A t-test indicated a trend for girls’ parents to report more family dinnertime routines than boys’ parents (p=.088).

Conclusions: Among these minority adolescents, approximately 12% reported evening hyperphagia – a symptom of night-eating syndrome. However, later dinnertimes and more night eating were related to lower BMI z-scores and total calories, respectively. Perhaps youth who are obese may eat more right after school. Further investigation is also warranted of whether parents stress family dinnertime routines more for girls.

Funding Source: NCI TREC U54CA116867

Correlates of night-eating behavior in a sample of emerging adult women

Authors:

Andrea Arikawa - University of Minnesota, St. Paul, United States

Maureen O’Dougherty - University of Minnesota, St. Paul, United States

MIndy Kurzer - University of Minnesota, St. Paul, United States

Purpose: To examine the association between night eating and psychosocial and physiological factors in a sample of young, predominantly Caucasian women.

Methods: Cross-sectional data from 145 women aged 18-24 years participating in a clinical trial provided dietary intake from three-day food records; measures of stress, symptoms of depression and weight concerns from questionnaires; blood markers of inflammation (adiponectin, leptin, and C-reactive protein); and body composition (via DXA). Night eating was defined as consuming 25% or more of total daily calories after dinner. Comparisons between night eaters and non-night eaters were tested using analysis of variance, and p-values were adjusted for multiple comparisons.

Results/Findings: Twenty-four percent of women (n = 35) reported at least one day of night eating. Night eaters reported significantly higher intakes of saturated fat (114±57g versus 88±44 g) and sodium (3.4±1.2g versus 2.9±1.0g) compared to non-night eaters. No significant group differences were observed for total calories (1962±343 kcals for night eaters vs 1846 ± 535 kcal for non-night eaters) and macronutrients, nor were differences observed for inflammatory markers, BMI, fat mass, stress, depressive symptoms, and weight concerns.

Conclusions: Among young women in this sample, 24% reported evening hyperphagia. This symptom of night-eating syndrome was associated with increased sodium and saturated fat intake but not with the psychosocial and physiological measures analyzed. Because prior research indicates that overweight night eaters were normal weight before developing this pattern, research with larger, diverse samples is needed to determine whether missing text.

Funding Source: National Cancer Institute

Symposium

S30 Transformation to eating competence: Rationale, research, reconstruction

Transformation to eating competence: Rationale, research, reconstruction

Chairperson: Barbara Lohse

The Pennsylvania State University, University Park, United States

Discussant: Barbara Lohse

The Pennsylvania State University, University Park, United States

Purpose: Introduce the Satter eating competence (ecSatter) model, examine the relationship between ecSatter and body mass index, weight satisfaction, fruit and vegetable intake, cardiovascular risk factors, and emotional health; and describe strategies and issues to transform health promotion and education using the ecSatter model.

Rationale: ecSatter addresses problems affecting an international audience: obesity, eating disorders, inadequate food selection and preparation behaviors, and increased cardiovascular risk factors. Inclusion in this conference will facilitate informing nutrition educators with an international perspective.

Objectives: 1) Introduce the Satter Eating Competence model, 2) Report on peer-reviewed, published research (e.g. found in the Journal of Nutrition Education and Behavior and Journal of the American Dietetic Association) relating ecSatter to healthful eating outcomes including dietary patterns, blood lipid levels, weight status, and other nutrition and eating related behaviors, 3) Identify relationships between ecSatter and food insecurity, 4) Describe difficulties transforming to the ecSatter model and delineate how transformative education principles (as described by Boyd and Myers in The International Journal of Lifelong Education) factor into reconstructing health education and promotion using ecSatter.

Summary: Eating competence, a bio-psychosocial model for intrapersonal approaches to eating and food-related behaviors, is associated with less weight dissatisfaction, lower body mass index, more healthful affective and cognitive behaviors, a decreased risk for cardiovascular disease, and a more healthful dietary pattern. Current approaches to obesity prevention and healthful eating behaviors have not proven successful. Transformation of health education and promotion efforts to a new model, one that leads to eating competence, shows more success; nutrition educators and researchers will benefit from learning about this innovative strategy. Presentations will be given by Ellyn Satter, (Ellyn Satter Associates, Madison, WI) Dr. Barbara Lohse (The Pennsylvania State University), and Dr. Jodi Stotts Krall (University of Pittsburgh Medical Center). Presentations will include a description of ecSatter, relevant published research (on dietary intake, lipid levels, low-income groups, weight management, and psychosocial health), strategies for adoption of the model, and the involvement of principles related to transformative education.

Format: The symposium will include three lectures by speakers listed above and an audience exchange interlude to encourage examination of the model and adoption implications; this discussion will be scheduled just prior to the closing talk about incorporating transformative education principles to reconstruct dietary behavioral practice using ecSatter.

Symposium sponsored by General Mills

Symposium

A paradigm shift in nutrition education: The Satter Eating Competence ModelAuthors:

Ellyn Satter - Ellyn Satter Associates, Madison, United States

Barbara Lohse - The Pennsylvania State University, University Park, United States

Jodi Stotts Krall - University of Pittsburgh Medical Center, Pittsburgh, United States

Purpose: Indicate gaps in current nutrition education principles and practices. Explain and demonstrate how transformation of nutrition education and health promotion to the Satter Eating Competence Model (ecSatter) addresses those gaps.

Background: Current approaches to nutrition education and obesity prevention, which are formulaic, have not proven successful. ecSatter outlines a new model, emphasizing sustainable cognitions, attitudes and behaviors that ensure getting fed. Adults with high eating competence (EC) achieve détente between permission and discipline: 1) permission to eat preferred foods in satisfying amounts, and 2) discipline of maintaining structured dietary patterns and devoting time and attention to eating. As measured by the validated Satter Eating Competence Inventory (ecSI), subjects with higher EC show more desirable nutritional status, biological health indicators, and patterns of social and emotional functioning.

Methods/Key Points: 1) Current approaches are not working. Demonstration (videotape), review of surveys; indication of trends with respect to adherence to nutrition policy including BMI guidelines. 2) Definition of ecSatter, including introduction to ecSI. Historical and didactic review. 3) ecSatter stresses the practical task of getting fed. Principles and examples. 4) ecSatter conforms to nutrition policy without becoming prescriptive. Didactic comparison.

Conclusion: Making the paradigm shift to ecSatter allows nutrition educators to comprehensively use their professional skills and resources in working toward an achievable goal: empowering participants to be positive and capable with eating. An understanding of the principles of transformative education eases that shift.

Three unique samples reveal eating competence associated with dietary quality and reduced cardiovascular disease riskAuthors:

Purpose: Present the relationship of eating competence (EC), as defined by the Satter Eating Competence Model (ecSatter), to dietary quality and reduced cardiovascular disease (CVD) risk.

Methods: EC was assessed with ecSatter Inventory (ecSI). Study 1: 48 hypercholesterolemic adults in a clinical trial measuring biological parameters. Study 2: 638 PREDIMED participants, mean age 67 years, completed food frequency questionnaires and a validated Mediterranean Diet Questionnaire. Study 3:

Symposium

149 low-income women, participating in a federal nutrition assistance program completed three 24-hour, telephone dietary recalls over 3 weeks. Nutrition Data System for Research software assessed food group and dietary reference intakes; Healthy Index Eating scores were calculated.

Results/Findings: Study 1: ecSI score correlated with HDL-cholesterol (HDL-C; (r=0.36, P=.03)) and systolic blood pressure (r= -0.50, P=.005). Non-EC adults were 5 times more likely than EC to have LDL-C ≥ 130 mg/dL (OR 4.7, CI 1.2 – 18.6). Study 2: EC persons showed a lower BMI (P=.057), higher HDL-C (P=.025), greater Mediterranean diet adherence (P<.05) and lower incidence of blood glucose > 100 mg/dL (OR 0.71, CI 0.51 – 0.98) and HDL-C < 40 mg/DL (OR 0.70, CI 0.68 – 1.00). Study 3: Mean ecSI score was 29.54 ±7.7. EC females had higher intakes of several macro and micronutrients. Factor analyses revealed two diet patterns: Western and Prudent. ecSI scores correlated positively (r=.20, P=.01) with the Prudent, but not the Western pattern (P=.99). Non-EC females showed significantly higher prevalence of “at risk” intakes.

Conclusions: Nutrition education that emphasizes tenets of ecSatter may achieve desired dietary and health outcomes.

Funding Source: U.S. Department of Agriculture’s Food and Nutrition Service through PENNSYLVANIA NUTRITION EDUCATION TRACKS as part of Supplemental Nutrition Assistance Program - Education (SNAP-Ed)

Validation of a measure of eating competence for low-income females Authors:

Purpose: To evaluate the validity of a version of the ecSatter Inventory (ecSI) measure of cognitive, attitudinal, and affective eating behavior modified for use in a low-income (LI) population. Determine whether eating competence (EC) profiles, as defined by the Satter EC Model (ecSatter), identified for the ecSI with a general population sample would hold true for the ecSI for LI (ecSI/LI) within a LI population.

Methods: A random sample of 507 female food stamp recipients, ages 18 to 45 years, completed an online survey including ecSI/LI and measures of food preference/practice, meal preparation, and food security. Concurrent validity was assessed with Pearson correlations and comparison of eating attitudes and behaviors between dichotomous EC categories using independent t-tests and chi-square, which were evaluated based on a priori hypotheses.

Results/Findings: EC females (ecSI/LI scores > 32) were significantly more likely to have high/marginal food security (P<.001), be physically active (67% vs 44%; P<.001), report food acceptance (P<.001), meet fruit/vegetable intake recommendations (P<.01), enjoy cooking (P<.001), and practice food planning/resource management (P<.01) than individuals without EC (ecSI/LI < 32). EC females also had significantly lower BMI scores (28.44±7.86 vs 31.23±8.44; P<.01) and lower levels of psychosocial attributes related to disordered eating as well as were less likely to report dissatisfaction with their body weight (P<.001)

Symposium

or tendency to overeat in response to external or emotional stimuli (P<.001) compared to individuals without EC.

Conclusions: The ecSI/LI is a valid measure of ecSatter, providing a tool to explore factors affecting EC of LI females.

Funding Source: U.S. Department of Agriculture’s Food and Nutrition Service through PENNSYLVANIA NUTRITION EDUCATION TRACKS as part of Supplemental Nutrition Assistance Program - Education (SNAP-Ed)

Symposium

S31 Using qualitative and quantitative methods to understand environmental influences on food choice among very low income Mexican Americans in Texas colonias

Using qualitative and quantitative methods to understand environmental influences on food choice among very low income Mexican Americans in Texas colonias

Chairperson: Joseph Sharkey

School of Rural Public Health, College Station, United States

Discussant: Mark Daniel

University of Montreal, Canada

Purpose: The purpose of this session is to describe qualitative and quantitative methods to understand influences on food choice among very low-income Mexican American families in areas of colonias along the South Texas border with Mexico. The symposium will include a promotora (indigenous community health worker, a regional director of an academic-community partnership, and two researchers; all will present data from qualitative and quantitative studies that examine the role of pulgas (flea markets), mobile food vendors, and family constraints in the selection and preparation of foods.

Rationale: Low-income Mexican American families in the growing colonias along the Texas/Mexico border reside in a marginalized area with high rates of childhood and adult overweight and obesity, persistent poverty, and neighborhood deprivation. Obesity and related health conditions predominate among Mexican Americans in the Lower Rio Grande Valley of Texas. Of great concern are increases in overweight and obesity among Mexican American children in the area.

Objectives: The aims of this session are to: 1) examine family behaviors and patterns of eating through the eyes of the mother using photovoice; 2) describe pulga environment as a source for food; 3) characterize household food issues using a community assessment of almost 600 participants in two areas of colonias; and 4) using multiple ethnographic methods to characterize the role of mobile food vendors in providing meals and snacks in areas of colonias along the Texas-Mexico border.

Summary: Although obesity has risen at alarming rates among all segments of the population, prevalence is significant among Mexican Americans and continues to increase among the poor and near-poor. Understanding the factors that influence food choice and healthful eating is critical to addressing the obesity problem. Especially among limited resource families, neighborhood and household access to healthy foods may be a key factor. The first presenter (Garibay - United States) will describe the household food choice through the eyes of the mother using photovoice. The second presenter (Dean - United States) will describe the contributions of pulgas (flea markets) to the availability of fresh and prepared foods. The third presenter (St. John - United States) will characterize household and community food availability in two large areas of colonias using a community food assessment. The fourth presenter (Sharkey - United States) will describe the role of mobile food vendors in providing access to food in hard-to-reach colonia neighborhoods.

Symposium

Observation of food choice from the perspective of mothers in Texas colonias, using PhotoVoiceAuthors:

Joseph Sharkey - School of Rural Public Health, College Station, United States

Aracely Garibay - School of Rural Public Health, San Benito, United States

Julie St. John - School of Rural Public Health, San Benito, United States

Wesley Dean - School of Rural Public Health, College Station, United States

Cassandra Johnson - School of Rural Public Health, College Station, United States

Background: The purpose of this study is to understand how Mexican American mothers in the colonias make choices about what to buy, cook, and feed her children as well as how she identifies herself as a household food manager and mother.

Methods: Ten participants were recruited by team promotores from the Colonia Household Food Inventory Study. Four trained promotores conducted two sequential interviews in Spanish. During the first visit, participants completed a brief survey and interview, related to their food experience; and were trained in the use of a disposable camera to document their food experience. During the second visit, participants were provided their photographs; and using a semi-structured interview guide, discussed selected pictures. All interviews were audio recorded, transcribed verbatim in Spanish, translated into English, and analyzed.

Results: Mothers expressed that they had not ever seen their families in such detail. Many were reminded of their childhood and how important family is to them. These families were also living with the effect of the last hurricane and working on finishing their homes. Even with the challenges the families are making the best that they can with their daily lives. Overall, participants used the pictures to elaborate on their role in providing food for their family. Mothers spoke of a new realization of their importance to their family. “That they were responsible for making sure food was there.”

Conclusions: Findings expand our understanding of contextual elements in food choice and explaining why role of mothers in the colonias is important.

Funding Source: This research was supported with funding from the National Center on Minority Health and Health Disparities grant # 5P20MD002295 and the Centers for Disease Control and Prevention, Prevention Research Centers Program, through the Center for Community Health Development cooperative agreement #5U48DP000045.

Exploring the contribution of traditional pulgas (flea-markets) to the retail food environment in south Texas coloniasAuthors:

Wesley Dean - School of Rural Public Health - TAMHSC, College Station, United States

Joseph Sharkey - School of Rural Public Health - TAMHSC, College Station, United States

Symposium

Purpose: Little is known about non-traditional retail food sources utilized by colonia residents along the Texas border with Mexico. Many colonias are located near pulgas (flea markets). The main purpose of this study is to provide preliminary data on food availability in pulgas.

Methods: Five pulgas were identified by local informants as the principal pulga for colonias in Hidalgo County. Two separate teams of promotoras conducted observations on multiple occasions over 30 days using an observation guide, wrote field notes, and surveyed vendors in each pulga.

Results/Findings: Traditional foods, prepared foods, and fresh fruit and vegetables were available. Traditional foods included staples such as tortillas (corn and wheat flour); meal items such as tamales, menudo (tripe soup), carnitas de puerco (roast pork), chicharrones de puerco (deep fried pork skin), tripas (deep fried pork intestine), and hot dogs; and snacks and sweets nieves such as (ice cream), raspas (snow cones), elotes (corn, either on the cob or shaved with mayonnaise, cream and chile), and puestos de churros (fried dough). Prepared foods were available in small stands run by independent operators, and each pulga had permanent restaurants which served prepared foods. A large variety of fresh fruit and vegetables were also available.

Conclusions: Further studies should attempt to provide a more complete account by identifying alternative retail sources used by local residents. One such alternative retail food-source, the pulga, provides a range of traditional food stuffs, prepared food items, and fruits and vegetables that complement conventionally studied aspects of the retail food-environment.

Funding Source: This research was supported with funding from the Centers for Disease Control and Prevention, Prevention Research Centers Program, through the Center for Community Health Development cooperative agreement #5U48DP000045.

Community and household food availability: Insights from a community nutrition assessment conducted in two large areas of colonias along the Texas-Mexico borderAuthors:

Julie St. John - School of Rural Public Health, College Station, United States

Background: Little is known about the challenges to good nutrition faced by Mexican Americans who reside in areas of colonias along the Texas-Mexico border. The purpose of this study is to describe food security, perceived food environment, and dietary intake among 600 adults.

Methods: As part of the Progresso/ La Feria Community Nutrition Assessment, four trained promotoras walked all the neighborhoods in two areas of colonias and recruited adults to respond to face-to-face survey.

Results/Findings: 100% considered themselves as Mexican or Mexican American (70% born in Mexico); 63% were married; 61% completed < 10 years of education; 94% reported a household income<$700/

Symposium

mo; and 50% receive SNAP benefits. 95% travel ≥10 mi one-way for groceries and 36% rely on someone for transportation. Participants said there was little variety in food available in their community and there were few supermarkets. Participants lacked food security; 92% worried that they would run out of food before they received more money or benefits; the food they bought didn’t last and they didn’t have money to get more (91%); ran out of foods needed to put together a meal (90%); in 30% of households, children are not eating enough because they can’t afford enough food; and in 29% of households, children are hungry. 54% eat ≤ 2 servings of fruit/day and 62% ≤ 2 servings of vegetables. Participants regularly rely on mobile food vendors and pulgas for food purchases.

Conclusions: Findings suggest that there is great need for strategies to improve community and household food availability.

Using multiple ethnographic methods to characterize the role of vendores (mobile food vendors) in providing meals and snacks in areas of colonias along the Texas-Mexico borderAuthors:

Julie St. John - School of Rural Public Health, San Benito, United States

Background: In many parts of the world, mobile food businesses are part of the neighborhood culture; provide culturally accepted food at lower prices; and are an important livelihood, especially for women. The purpose of this project was to examine the role of mobile food vendors in providing access to food in hard-to-reach colonia neighborhoods.

Methods: Four promotores (indigenous community health workers) were trained to conduct field observations and make field notes. 10 mobile vendores (2 female) who market a variety of products in several colonias in the western and eastern parts of Hidalgo County were recruited. Promotores administered a survey, conducted several field observations (field notes and photographs), used mobile GPS, and conducted in-depth interview.

Results: All vendors lived in a colonia and marketed from a van/truck, bicycle cart, or carrito empujado (push cart). They worked up to 15 hours a day on weekdays and weekends; marketed food items from U.S. and Mexico, especially “traditional” foods; designed their schedule based on children; and targeted food items to children.Foods marketed included ice cream, elotes (roasted corn), sodas, raspas (snow cones), chips, ronpope (similar to a freezer pop), popsicles, chicharróne(fried scraps/pork rinds), and candy.Vendors saw themselves as part of the community, and “provide a service to residents in isolated colonias.”

Symposium

Conclusions: Use of multiple quantitative and qualitative methods pulled together three dimensions of mobile vendors’ life experiences: 1) where preparation and marketing experiences occurred; 2) what preparation and marketing experiences looked like; and 3) how food vendor experiences unfolded.

Symposium

S32 Utilizing knowledge on parenting styles and practices in influencing children’s weight status: Application of an integrated theoretical frameworktheoretical framework

Utilizing knowledge on parenting styles and practices in influencing children’s weight status: Application of an integrated theoretical framework

Chairperson: Stef Kremers

Maastricht University, Department of Health Promotion, Maastricht, The Netherlands

Discussant: Teresia O’Connor

Purpose: This symposium will integrate constructs of general parenting styles and specific food- and activity-related parenting practices in the prevention or treatment of childhood overweight.

Rationale: Observational studies examining the influence of general parenting styles on children’s weight status and related health behaviors are emerging. There is a need to apply this knowledge to develop prevention programs for childhood overweight.

Objectives: Review the current evidence that can inform intervention development that recognizes the impact of general parenting styles on children’s health outcomes; Draw attention to available intervention programs focusing both on parenting styles and practices in the prevention of childhood overweight; Discuss the implications of how to intervene with parents to promote healthful parenting in order to improve children’s food and activity behaviors.

Format and Summary: First, Ester Sleddens will present findings of a systematic review regarding the influence of parenting styles on children’s weight status and related health behaviours, resulting in the presentation of a theoretical framework. Second, Sanne Gerards will provide an overview of existing interventions that incorporate parenting styles to prevent or reduce excessive weight gain. This will be followed by presentations on three relevant novel intervention programs. Sanne Gerards will present results of the Dutch pilot intervention ‘GO4fit’. This program is aimed at increasing healthy parenting in order to reduce excessive weight gain in overweight 4-year-old children. Rebecca Golley wil lpresent results from an Australian RCT evaluating the ‘Healthy Eating and Lifestyle through Positive Parenting’ (HELPP) program for parents of overweight children aged 6 to 9. This program combines traditional lifestyle advice with parenting skills training to enhance parental competence in modifying children’s dietary and activity patterns. Finally, AmberVaughn will present on the US ‘My Parenting SOS’ intervention, including an overview of the intervention design and results from the formative work that contributed to the development of this obesity prevention program for preschool children.

The impact of general parenting style on children’s weight status and related health behaviors: A systematic literature review from a theoretical perspectiveAuthors:

Sanne Gerards - Maastricht University, Maastricht, Netherlands

Symposium

S32 Utilizing knowledge on parenting styles and practices in influencing children’s weight status: Application of an integrated theoretical frameworktheoretical frameworktheoretical framework

Carel Thijs - Maastricht University, Maastricht, Netherlands

Purpose: Summarizing evidence regarding the impact of general parenting styles on children’s weight status and related dietary and activity behaviors, using a conceptual framework to guide determinant research.

Background: Despite efforts to investigate the influence parents have on their children’s health behaviors, empirical research appears to lack a theoretical perspective regarding the role of general parenting styles.

Methods/Key Points: A range of electronic databases (PubMed, PsycINFO, Scopus) were searched together with lateral searching techniques (reference tracking and author searching). In total, we included more than 30 observational studies reporting both general parenting style and at least one of the following child health outcomes: weight status, dietary intake (behaviors), physical (in)activity. Studies of children eating with disorders were excluded. The sample sizes of the included studies ranged from 45 to > 4000, and represented different characteristics in terms of age, gender, ethnicity and weight status. Results indicate that general parenting dimensions can have differential influence on children’s health outcomes. The results appear to depend on characteristics of the child and the parents, and are attributable to different conceptualizations of parenting.

Conclusions: In general, children raised in authoritative homes ate healthier and were more physically active, compared to children who were raised with a different style. However, findings of the few studies assessing moderation underline the importance of acknowledging interactions (between parenting style and either parent or child characteristics) in research and intervention efforts.

Funding Source: Netherlands Heart Foundation, grant number 2008B112

Are interventions addressing general parenting styles effective in preventing overweight?Authors:

Sanne Gerards - Maastricht University, Maastricht, Netherlands

Pieter Dagnelie - Maastricht University, Maastricht, Netherlands

Purpose: To describe the content and effectiveness of interventions addressing general parenting styles in order to prevent childhood overweight.

Background: Determinant studies increasingly emphasize the role of general parenting in the development of childhood overweight and obesity. The next step is to investigate whether interventions focusing on parenting styles indeed lead to a reduction of overweight and obesity.

Methods/Key Points: Several electronic literature databases (PubMed, PsycINFO, Scopus) were systematically searched for relevant studies. We used the following inclusion criteria: a) the study has to

Symposium

S32 Utilizing knowledge on parenting styles and practices in influencing children’s weight status: Application of an integrated theoretical frameworktheoretical framework

focus on children (aged 0-18 years), b) the primary aim of the study is the prevention of overweight, obesity or excessive weight gain, c) the intervention has to incorporate general parenting, and d) anthropometric measurements are undertaken at baseline and follow-up to describe the effectiveness. In total, seven studies were included which met the inclusion criteria. All interventions incorporated group sessions with the parents; the number of sessions varied between nine and seventeen. All studies showed favorable results on one or more outcome measures.

Conclusions: Despite the emerging observational evidence of the role of parenting on weight-related outcomes, only few interventions addressing general parenting in the prevention of childhood overweight have been developed until now. More intervention studies addressing general parenting style are needed. To illustrate, a newly developed intervention focusing on changing the physical and social home environment of 4-year-old overweight children, called GO4fit, will be introduced.

Funding Source: ZonMw, the Dutch Organization for Health Research

Parental outcomes following a family-focused weight management program for six to nine-year-olds utilising parenting skills training and lifestyle informationAuthors:

Rebecca Golley - University of South Australia, Adelaide, Australia

Lynne Daniels - Queensland University of Technology, Brisbane, Australia

Anthea Magarey - Flinders University of South Australia, Adelaide, Australia

Purpose: Providing parents with knowledge, skills and confidence to change children’s lifestyle behaviours is crucial for effective obesity treatment and prevention. The study objective was to assess the impact on parental outcomes of a 6-month parent-targeted, family-focused child weight management program.

Methods: Participants were 111 parents of overweight 6-9 year olds recruited to the Healthy Eating and Lifestyle through Positive Parenting (HELPP) randomised controlled trial. The study compared three groups; standardised parenting skills training plus lifestyle advice; parenting skills only; 12 month wait-listed control. Outcome measures were assessed using validated tools at baseline, 6 months (post-intervention) and 12 months. Outcomes reported here are parent sense of competency (PSOC, parenting satisfaction and self-efficacy), health-related quality of life (HR-QOL, including family functioning) and parental BMI. Linear mixed models assessed change over time and differences by study group.

Results/Findings: PSOC tended to be higher at 6 and 12 months in the intervention groups, approaching statistical significance for overall PSOC (groupxtime, p=0.07) and parenting satisfaction (groupxtime, p=0.06). HR-QOL family functioning scores were higher at 12 months in both interventions groups (time, p<0.02) but not in the control group. Parental BMI was lower at 12 months in the interventions groups, but this was only statistically significant for fathers BMI (p=0.01).

Conclusion: A parent-led family-focused child weight management program resulted in improvements in parental outcomes. These findings add to previously published child weight outcomes that a program

Symposium

S32 Utilizing knowledge on parenting styles and practices in influencing children’s weight status: Application of an integrated theoretical frameworktheoretical frameworktheoretical framework

utilising parenting skills training is a beneficial approach to support parents to change weight-related behaviours in their children.

Funding Source: Australian Health Management Group Assistance to Health and Medical Research. Dr Rebecca Golley is supported by a NHMRC Postdoctoral Fellowship.

Development of the Parenting SOS obesity prevention interventionAuthors:

Amber Vaughn - University of North Carolina at Chapel Hill, Chapel Hill, United States

Deborah Jones - University of North Carolina at Chapel Hill, Chapel Hill, United States

Laura McKee - University of North Carolina at Chapel Hill, Chapel Hill, United States

Dianne S. Ward - University of North Carolina at Chapel Hill, Chapel Hill, United States

Background: More than 26% of U.S. children ages 2-5 yrs are classified as overweight or obese. Parents greatly influence the behaviors their children adopt, including those which impact weight (e.g., diet and physical activity). Unfortunately, parents often fail to recognize the risk for excess weight gain in young children and may not be motivated to modify behavior.

Purpose: To describe formative and initial pilot work that informed the development of the Parenting SOS program - an obesity prevention intervention for parents of preschool children.

Methods: A series of 8 focus groups with lower income mothers of overweight children were conducted to explore concerns about and barriers to healthy child weight. A second series of 3 focus groups with African American mothers explored preferences for potential intervention strategies and messages. Findings were used to develop a brief 4-workshop intervention and pilot it in one childcare center. Lessons learned from these efforts were used to develop the current Parenting SOS program.

Results: Time constraints, lack of control and discipline, and money were major challenges revealed during initial focus groups. Group sessions were seen as a beneficial intervention approach because they allowed parents to learn from one another. Although the sample in the initial pilot was small, results suggested that parenting stress decreased while parents’ demandingness and responsiveness increased. Based on these findings and participant feedback, the final program was expanded to 12 sessions: initial sessions focus on general parenting skills (stress management, effective parenting styles, child behavior management, co-parenting, and time management) and later session apply these skills to promote healthier eating and physical activity habits.

Conclusions: Testing of these new approaches contributes to our understanding of how general and weight-specific parenting practices influence child weight, and whether or not they can be changed to promote healthy weight trajectories.

Funding Source: National Institutes of Health, National Heart, Lung and Blood Institute

Symposium

S33 The food environment: New data, new contexts, and new applications to better understand food access, diet and diet-related disease

The food environment: New data, new contexts, and new applications to better understand food access, diet and diet-related disease

Chairperson: Tamara Dubowitz

RAND, Pittsburgh, United States

Discussant: Steven Cummins

Purpose: The proposed symposium uses new quantitative and qualitative data to characterize food environments across multiple contexts and how features of the food environment interact with other environmental factors to influence food access, diet, and related disease in diverse populations. Extending current research on the food environment, we present on work that aims to: 1) understand how relationships play out for different population subgroups (e.g., women, people of color, low-income, urban, rural) and at different geographies (i.e., cities, nationwide) and 2) integrate methods that allow for a more complete examination of the food environment. The presentations and discussion will highlight complexities in the impact of the food environment on diet and health.

Rationale: The symposium centers on new data and methods critical to moving the field forward in behavioral aspects of nutrition. While questions in research and in policy remain around which aspects of the food environment matter most, the work we will present seeks to identify methods, populations, and aspects of the environment that seem to matter for policy and program intervention.

Objectives: The symposium centers on four main questions: 1) What features of the social and food environment contribute most to diet and obesity?; 2) What is the role of the food environment as a potential moderator?; 3) How does the impact of the food environment differ for subgroups?; and 4) How can we methodologically advance our understanding of food access and the food environment in different communities?

Summary: The session will consist of four individual presentations and a discussant. The first presentation investigates effects of neighborhood ‘healthy’ and fast food outlet availability on BMI and hypertension among women enrolled the Women’s Health Initiative study. The second presentation examines the potential moderating effect of neighborhood food outlet availability on relationships between multiple psychosocial stressors (physical environment, social environment, safety, unfair treatment, acute life events) and diet among multiethnic urban adults. The third presentation examines the relationship of the food environment (perceived and objective measures) with food hardships and fruit and vegetable intake among rural adults. The fourth presentation highlights the application of multiple qualitative methodologies including ethnographic interviews, participant observation and photo-elicitation to examine food environments and food access in African Americans residing in a low-income neighborhood in Chicago. Finally, the discussant will lead conversation on methodological issues in quantifying food environments and assessing their impact on health outcomes.

Symposium

The neighborhood social and food environment, obesity and hypertension in the Women’s Health InitiativeAuthors:

Tamara Dubowitz - RAND, Pittsburgh, United States

Bonnie Ghosh-Dastidar - RAND, Arlington, United States

Mary Ellen Slaughter - RAND, Pittsburgh, United States

Christine Eibner - RAND, Arlington, United States

Meena Fernandes - RAND, Santa Monica, United States

Chloe Bird - RAND, Santa Monica, United States

Jose J Escarce - RAND, Santa Monica, United States

Eric Whitsel - University of North Carolina Gillings School of Global Public Health and School of Medicine

Background: Research on the food environment has progressed substantially, yet limitations remain. Few analyses have concurrently investigated ‘unhealthy’ and ‘healthy’ outlets (e.g., fast food outlets and grocery stores) as well as other neighborhood features such as population density and socioeconomic characteristics. Furthermore, most examinations to date have been constrained in their definition of geographic boundaries and have been unable to tap into national data.

Methods: Using data from the Women’s Health Initiative Clinical Trial (WHI-CT), a study of postmenopausall women of ages 50 to 79 years at randomization, we analyzed associations between the density of food outlets surrounding a women’s residence, social factors of their neighborhood environments, body mass index (BMI), and blood pressure (BP). We consider food outlet density within 0.75, 1.5 and 3 mile radii surrounding each woman’s specific residential address.

Results: We found neighborhood socioeconomic status (NSES), fast food outlet density, and healthy food outlet density to be associated with BMI and blood pressure. We observed opposing effects of the fast food and healthy food environment; fast food outlet density had a significant direct association with BMI and healthy food outlet density had a significant inverse association with BMI. We observed associations in all geographic buffers.

Conclusions: It is necessary to examine both social and physical aspects of neighborhood environments when trying to understand how neighborhoods affect health. For women across the United States, multiple aspects of missing text

Funding Source: NIH

Do obesogenic neighborhood food environments exacerbate effects of psychosocial stressors on “comfort” food intake?Authors:

Amy Schulz - University of Michigan, Ann Arbor, United States

Graciela Mentz - University of Michigan, Ann Arbor, United States

Symposium

Barbara Israel - University of Michigan, Ann Arbor, United States

Murlisa Lockett - Detroit Department of Health and Wellness Promotion, Detroit, United States

Purpose: This study examined whether obesogenic neighborhood food environments exacerbate effects of psychosocial stressors on ‘comfort’ food intake.

Methods: We drew on data from the Detroit Healthy Environment Partnership’s 2002 survey with a stratified proportional probability sample of 919 African-American, Hispanic, and White adults and mapping of food stores (supermarket, large-grocery, small-grocery, convenience, liquor) in respondents’ neighborhoods (0.5-mile radial buffer). We measured multiple chronic and acute psychosocial stressors: neighborhood safety, social environment, physical environment, everyday unfair treatment, acute unfair treatment, and acute life events. Derived from food frequency questionnaire data, comfort food intake was a mean number of daily servings of high-fat and high-sugar foods. Two-level regression models with cross-level interactions between each stressor and neighborhood store availability estimated relationships, adjusting for energy intake and demographics.

Results: Both greater everyday unfair treatment and an acute experience of unfair treatment in the past year were positively associated with comfort food intake in the presence of a convenience store in the neighborhood. Among those with a large grocery store in the neighborhood, greater everyday unfair treatment and neighborhood physical environment stress were negatively related to comfort food intake. Neighborhood physical environment stress was positively associated with comfort food intake among those with a small neighborhood mom-and-pop store.

Conclusions: Extending laboratory research that has found availability of palatable high-fat, high-sugar foods promotes consumption in response to stress, our findings suggest that in real-world settings effects of psychosocial stress on consumption of comfort foods may depend on the neighborhood food environment.

Funding Source: NIH K01NR10540, R01ES10936

Food access and perceptions of the community and household food environment as correlates of fruit and vegetable intake among rural seniorsAuthors:

Cassandra Johnson - School of Rural Public Health, College Station, United States

Objective: To examine the associations among individual and neighborhood characteristics, perceived and objective measures of food access, and fruit and vegetable intake in rural seniors.

Methods: A cross-sectional analysis using data from the 2006 Brazos Valley Health Assessment (mail survey) for 589 rural seniors, who were recruited by random digit dialing; ground-truthed food store data (location and inventory of fruit and vegetables) from the Brazos Valley Food Environment Project.

Symposium

Results: 14% consumed ≥three daily servings of fruit; 4% consumed ≥ five daily servings of vegetables; and less than 29% consumed ≥five fruits and vegetables daily. The median distances to fresh fruit and vegetables were 5.6 miles and 6.5 miles, respectively. The inclusion of canned and frozen fruit changed the median distance to 3.6 miles, and 3.3 miles. More than 13% reported that food supplies did not last and there was not enough money to buy more. Seniors reported there were few grocery stores or supermarkets in their community (59%); there was little variety of foods (31.6%); and food prices were high (79%). Increased distance to food store with a good variety of fresh and processed fruit, or food store with a good variety of fresh and processed vegetables was associated with decreased daily consumption of fruit and vegetables, after controlling for the influence of individual characteristics and perceptions of community and home food resources.

Conclusions: Findings suggest that interventions designed to increase fruit and vegetable consumption among rural seniors should consider strategies to ameliorate differential access to healthy food.

Funding Source: The analysis and drafting of the manuscript was supported by USDA RIDGE Program; National Center on Minority Health and Health Disparities grant #5P20MD002295; and Centers for Disease Control and Prevention, Prevention Research Centers Program, through the Center for Community Health Development cooperative agreement #1U48DP001924-01.

Applying multiple qualitative methodologies to understand black women’s perceptions of neighborhood food environments and overweight: Implications for policy and neighborhood-level interventions to expand food accessAuthors:

Angela Odoms-Young - University of Illinois at Chicago, Chicago, United States

Olamide Bamidele - University of Illinois at Chicago, Chicago, United States

Charles Tate - University of Illinois at Chicago, Chicago, United States

Purpose: Black women in the U.S. are at high risk for obesity. Previous studies report associations between neighborhood food availability, diet, and weight status; yet, studies examining Black women’s perceptions of these relationships are limited. This study employed multiple qualitative methodologies to identify factors that influence relationships between neighborhood food availability, food choice and overweight in Black women.

Methods: Using a grounded theory approach, four in-depth individual interviews, photo elicitation, and neighborhood observations were conducted with 12 Black women residing in neighborhoods with limited food resources in Chicago. Verbatim interview transcripts, observation field notes, and photo narratives were input into Atlas.ti and coded using constant comparative analysis. Coded text units were grouped into categories and reviewed to identify themes and develop participant typologies related to food access and food choice.

Results/Findings: Women described several factors that influenced relationships between neighborhood food availability and food choice including personal priorities, economic/social resources, neighborhood perceptions, role and responsibilities, and perceptions of discrimination and unfair treatment. However,

Symposium

in spite of perceiving their neighborhood as having few food resources, the majority of women indicated that neighborhood food availability had a limited impact on community residents’ weight status.

Conclusions: Strategies to reduce obesity in Black women should target multiple levels of influence including food availability, economic resources, and individual food choice. Community-based advocacy initiatives should also attempt to create awareness about environmental contributors to health behaviors and health status to increase public support for macro-level obesity prevention efforts.

Funding Source: Consortium to Lower Obesity in Chicago Children (CLOCC)

Symposium

S34 Promoting physical activity to children and young people: The construction of evidence based guidelines for policy, practice and research

Promoting physical activity to children and young people: The construction of evidence based guidelines for policy, practice and research

Chairperson: Ilse De Bourdeaudhuij

Faculty of Medicine and Health Sciences, Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium

Discussant: Jean-Michel Oppert

Department of Nutrition, Pitie-Salpetriere Hospital (AP-HP), Paris, France

Aims: To present the findings of a comprehensive systematic review of different approaches to promote physical activity for children and young people. To debate the strengths and limitations of this type of approach to developing guidelines for public health policy, practice and research.

Overview: Many international public health agencies are developing recommendations for how to promote physical activity for key population groups. These recommendations are often based on formal synthesis of evidence plus assessments of the applicability and transferability of effective interventions in practice. But what impact do these guidelines have in influencing policy, practice and research, and how transferable are these approaches between countries?

This symposium will present the findings of a large systematic review on different approaches to promote physical activity to children and young people. This review was produced by the UK’s national public agency – the National Institute for Health and Clinical Excellence (NICE). Recommendations were based on reviews that covered not only the epidemiology and correlates of physical activity behaviour but also four groups of physical activity interventions under 8’s, young girls, active travel and family and community interventions. The results of these reviews will be presented alongside the final set of recommendations for policy, practice and research.

Dr. Charlie Foster will outline the process of constructing NICE guidance, the rationale, and conceptual framework of the reviews. Professor Stuart Biddle will present the results from reviews of the epidemiology, correlates and reviews of intervention to promote physical activity interventions for young girls. Dr. Trish Gorley will present the findings from the reviews of interventions for Under 8s, and family and community based interventions for children and young people. D.r Foster will then briefly conclude with the results of interventions to promote active travel and an overview of the final recommendations produced for policy, practice ad research. Professor Jean-Michel Oppert will open a debate for symposium participants with a discussion of the strengths and limitations of these reviews and their usefulness in translating research evidence into public health guidelines for policy and practice. Symposium participants will be invited to offer their views and experiences on the challenges faced by researchers in translating their work into policy and practice.

Symposium

Constructing evidence based guidelines for physical activity promotion - NICE rationale and processesAuthors:

Charles Foster - University of Oxford, Oxford, United Kingdom

Nick Cavill - University of Oxford, Oxford, United Kingdom

Since 2005, the construction of the evidence base for public health interventions in the U.K. has been the function of the National Institute for Health and Clinical Excellence (NICE). NICE is an independent organisation with responsibility for providing national guidance on the promotion of good health and the prevention and treatment of ill health in England. Last year saw the publication of recommendations for the promotion of physical activity for children and young people.

These recommendations were based on reviews that covered not only the epidemiology and correlates of physical activity behaviour but also four groups of physical activity interventions under 8’s, young girls, active travel and family and community interventions. Each recommendation was tested with possible users of such evidence before finalising.

The rationale for such a broad and inclusive approach to evidence was based on our experience of the limitations of purely examining one type of evidence - interventions evidence. Such an approach ignored the possible inclusion and assessment of other types of evidence in order to generate a whole system view of a problem and possible solution. The NICE review process incorporates different types of evidence, from epidemiology, health economics, cross sectional correlate studies, and qualitative literature. This overview provides a background and context to review the intervention and cost effectiveness evidence, within a strong conceptual framework for different types of evidence for physical activity promotion.

Interventions to change physical activity in adolescent girls: A systematic reviewAuthors:

Andrew Atkin - Loughborough University, Loughborough, United Kingdom

Charlie Foster - University of Oxford, Oxford, United Kingdom

Adolescent girls have been identified as a key group to target for physical activity. We conducted a systematic review of interventions designed to increase physical activity in this group outside of the school physical education context.

Searches were performed from January 1990 with 153 titles (including 28 studies identified from other sources) assessed to be potentially relevant and full papers retrieved. Twelve studies were accepted

Symposium

for full data extraction and varied in scale from 57 to 1,040 female participants. They were conducted singly or in combination in schools, primary health care, or in unspecified settings, targeting physical activity alone or in combination with other health behaviours. Mediated, counseling and educational interventions were used.

The overall effectiveness of interventions was mixed, with 6 studies showing positive effects and 6 showing no intervention effects. The two moderators showing greatest effect were the targeting of girls alone and older adolescent girls.

Evidence suggests that achieving successful behaviour change for physical activity in adolescent girls is more likely if the intervention targets girls alone rather than boys and girls together, and is targeted at older adolescent girls, using an intervention focussed on physical activity rather than additional health behaviours. Other approaches, such as mediated, counseling or stage-matched tailored interventions, have not demonstrated consistent effects in promoting physical activity in this population group.

Funding Source: The Department of Public Health

Interventions to promote physical activity in children under 8 and through family and community settings: Two systematic reviewsAuthors:

Andrew Atkin - University of Cambridge, Cambridge, United Kingdom

We conducted two systematic reviews examining the effectiveness of interventions to promote physical activity in (1) children under 8 years and (2) in family and/or community (FC) settings. Literature searches were performed from January 1990 to the most recently published version of the database (May 2007 Under 8’s, August 2007 FC) with 169 (Under 8’s) and 341 (FC) titles assessed to be potentially relevant and full papers retrieved for further examination. Five studies were included in the under 8’s review which varied in scale and design. The results suggest that physical activity and education sessions at nursery/preschool, and lunch-time clubs in primary schools, do not increase activity levels outside of these sessions. Thirty-two interventions were included in the FC review. These were grouped according to setting: family (n=11 studies), primary health care (n=4), after-school clubs (n=7), mass media (n=1), community agencies (n=2) and combined family and school (n=7). Evidence of effectiveness varied across setting. There was evidence that combined family and school based interventions and social marketing interventions could lead to positive changes in physical activity. There was equivocal evidence for family based interventions. Interventions based in community groups, out of school clubs or primary care did not appear to result in behaviour change. Measurement challenges, lack of follow up period, and limited reporting of the intervention process made interpretation of the existing evidence difficult. Further evidence for the efficacy and sustainability of interventions promoting physical activity in the under 8’s, and in family and community settings, is needed.

Funding Source: Department of Public Health

Symposium

Interventions to promote active travel in children and young people: A systematic reviewAuthors:

Adrian Davis - Davis Associates, Bristol, United Kingdom

Asha Kaur - University of Oxford, Oxford, United Kingdom

We examined the evidence for the effectiveness of active travel interventions in increasing use of active travel modes (i.e. walking and/or cycling) for all children and young people of up to 18 years of age. Searches were performed from January 1990 with 95 titles assessed to be potentially relevant and full papers retrieved.

We identified seventeen studies, with different experimental study designs, and found four different categories of approaches: cycle promotion, safe routes to school/school travel plans, walking buses, walking promotion. Fifteen of the studies were conducted in the United Kingdom, one in the United States and one in Australia.

We found that the most promising studies were confined to school settings. These studies delivered a mixture of strategies including, promotional materials, incentives and rewards, enlisting parental support, classroom based student and teacher activities, using specialist school travel plan consultants, parking restrictions, and volunteer–led walking groups. We were surprised to find no interventions outside of school settings and feel the quality of studies limits the current evidence base. There is a need for action to address the paucity of evidence and potentially the paucity of research given that children make other journeys through which active travel modes are possible options for a least local travel.

Symposium

S36 Objective measurement of physical activity and sedentary behaviors in young children

Objective measurement of physical activity and sedentary behaviors in young children

Chairperson: Greet Cardon

Discussant: Greet Cardon

Purpose: To increase insights into current and possible future ways of objectively assess physical activity (PA) and sedentary behaviors in young children by presenting original empirical data.

Rationale: In early childhood the assessment of specific activity dimensions is important to identify factors related to improved health outcomes, and those to target for intervention. Although accelerometers have become popular measurement instruments in preschoolers, activity intensity thresholds for accelerometer counts are still unclear and relatively little is also known about the validity among children under the age of 3. Inclinometry may provide a useful supplement or alternative to accelerometry. ActivPALs have been shown to have great utility in school-aged children and adults. Little is known, however, of the feasibility of using these monitors with preschool-aged children, or of the accuracy and utility of data collected. In addition, there is increasing interest in more detailed and quantitative measurement of the components of sedentary behavior and components of light intensity PA in young children, including non-exercise activity thermogenesis (NEAT) – this requires the measurements of relatively new but potentially important constructs such as posture and fidgeting .

Objectives:

- Discuss the complex relationship between accelerometer-derived and direct observation data in young children.

- Discuss the validity of Actical and Actigraph cut-points for preschool children in children between the ages of 1 and 2.

- Compare the use of ActivPALS with Actical use in young children.

- Discuss the methodology for measurement of posture (sitting vs standing) and fidgeting in young children, making use of Dynaport Movemonitors and ActivPALS

Summary: This symposium will present new data in the field of objectively measuring PA and sedentary behavior in young children. The first two presentations will compare accelerometer-derived with direct observation data in preschoolers. Next, findings from a calibration study will be presented to determine

Actigraph and Actical intensity related count thresholds for children 1 to 2 years of age. A fourth presenter will report on the feasibility of using ActivPALS with children aged 3-4 years and will compare activity data simultaneously assessed using ActivPAL inclinometers and Actical accelerometers for convergent

Symposium

validity. Finally, validation of the Dynaport Movemonitor and ActivPAL against direct observation for measurement of posture and fidgeting in free-living young children will be discussed.

Format: The symposium will consist of 5 oral presentations. A discussant will briefly overview the main issues and will facilitate discussion.

Calibration and comparison of accelerometer cut points in preschool childrenAuthors:

Eveline Van Cauwenberghe - University of Ghent, Ghent, Belgium

Valery Labarque - HUBrussel, Brussels, Belgium

Stewart Trost - Oregon State University, Corvallis, United States

Ilse De Bourdeaudhuij - University of Ghent, Ghent, Belgium

Greet Cardon - University of Ghent, Ghent, Belgium

Purpose: The present study aimed (1) to develop accelerometer cut points to classify activities by intensity in preschoolers and (2) to investigate discrepancies in physical activity levels when applying various accelerometer cut points.

Methods: To calibrate the accelerometer, 18 children (5.8 ± 0.4 years) performed ten structured activities and one free play session while wearing a GT1M ActiGraph accelerometer using 15 s epochs. Structured activities were chosen based on the direct observation system Children’s Activity Rating Scale (CARS) and the criterion measure of physical activity intensity during free play was provided using a second-by-second observation protocol (modified CARS). Receiver Operating Characteristic (ROC) curve analyses were used to determine cut points for each activity level. To examine the classification differences, accelerometer data of 4 consecutive days from 114 children (5.5 ± 0.3 years) was classified by intensity according to previously published and the newly developed accelerometer cut points for preschoolers. Differences in predicted activity levels were evaluated using repeated measures ANOVA and Chi Square test.

Results: Cut points were identified at 373 counts.15 s-1 for light (sensitivity: 86%; specificity: 91%; Area under ROC curve: 0.95), 585 counts.15 s-1 for moderate (87%; 82%; 0.91) and 881 counts.15 s-1 for vigorous activities (88%; 91%; 0.94). Applying various accelerometer cut points resulted in statistically and biologically significant differences in activity levels.

Conclusions: Accelerometer cut points were developed with good discriminatory power for differentiating between activity levels in preschoolers. The present comparison illustrates that the choice of accelerometer cut points can result in large discrepancies.

Funding Source: The present study was financially supported by grants from the Research Foundation - Flanders (FWO B/10525/01) and by a PWO-grant of HUBrussel from the Flemish Ministry of Economics, Science and Innovation.

Symposium

What can we learn about MVPA in preschool aged children based on observation, accelerometer and proxy measures? Authors:

Marja Cantell - University of Calgary & Alberta Children’s Hospital, Calgary, Canada

Susan Crawford - Alberta Children’s Hospital, Calgary, Canada

Deborah Dewey - University of Calgary & Alberta Children’s Hospital, Calgary, Canada

Purpose: To compare three different physical activity measures in quantifying preschool aged children’s MVPA on weekdays and weekends.

Methods: A sample of 43 children (24 boys and 19 girls; M= 4.43 years, SD=.81). Twelve children were cared for at home full time, and 31 were in daycare full or part-time. PA was assessed for five days with accelerometer and a parental proxy measure (based on Barr et al., 1988). Observational data was collected twice with a handheld device (PDA) by two observers, in average 161 minutes. Inter-rater reliability was adequate (ICC’s ranged from .74 to .91).

Results: Accelerometer data indicated that children spent 12.5% of their time in MVPA on weekdays, and 12.8% on weekends. In contrast, parental proxy data indicated that children attained 32% of MVPA on weekdays, and 34% on weekends. The observational data showed that children attained between 7% and 41% of MVPA depending on environment (home, childcare, school). The lowest proportions of MVPA were attained indoors on weekends and the highest at outdoor playgrounds on weekends. When these measures were compared, significant differences in the proportion of time spent in MVPA were found between the proxy and accelerometer, and the proxy and observational data (p’s <.001).

Conclusions: The three different measures indicated that preschool aged children attained different proportions of daily MVPA. More objective measures indicated that these children spent less time in MVPA. Different environments had an impact on children’s PA: the more time was spent outdoors, the higher the level of PA.

Funding Source: Alberta Children’s Hospital Foundation

Identification of accelerometer cut-points for toddlersAuthors:

Stewart Trost - Oregon State University, Corvallis, United States

Paul Loprinzi - Oregon State University, Corvallis, United States

Bronwyn Fees - Kansas State University, Manhattan, United States

Accelerometers have become the method of choice for measuring physical activity in young children. Although accelerometer cut-points have been developed for children aged 3-5 y, no cut-points have been developed for toddlers under the age of the 3 y. Purpose: The aim of this study was to determine Actical (AC) and ActiGraph (AG) cut-points for sedentary (SED), light (LPA) and moderate-to-vigorous physical activity (MVPA) in toddlers.

Symposium

Methods: Twenty-two (8 boys, 14 girls) toddlers (mean age: 2.1 ± 0.4 yr) were videotaped while wearing an AC and AG accelerometer (15-sec epochs) during a randomly selected 15-minute (14.6 ± 0.2 min) period at childcare. The monitors were housed in a customized neoprene vest which secured the monitors against the trunk just above the left hip. Videos were coded using a modified Children’s Activity Rating Scale (CARS) (range 1-4) by two independent raters (inter-rater reliability, ICC = 0.95). An average CARS score for each 15-sec interval (matched with the AC and AG) was calculated by multiplying each numeric activity code with the percentage of time in that code and summing the products. Intervals with an average CARS score of less than 2 were classified as SED, while intervals with an average CARS rating of 3 or greater were classified as MVPA. Receiver operating characteristic (ROC) curve analysis was performed to determine accelerometer cut-points.

Results: For AG, the SED cut-point was 0-48 counts, LPA was 49-418 counts, and MVPA was > 418 counts. Sensitivity (Se), specificity (Sp), and area under the ROC curve (AUC) for SED were 58.6%, 78.9%, and 0.74, respectively. Se, Sp, and AUC for MVPA were 85.7%, 88.3%, and 0.90, respectively. For AC, the SED cut-point was 0-114 counts, LPA was 115-697 counts, and MVPA was > 697 counts. Se, Sp, and AUC for SED were 71.8%, 81.1%, and 0.71, respectively. Se, Sp, and AUC for MVPA were 83.3%, 97.4%, and 0.95, respectively.

Conclusion: The AG and AC cut-points established can be used to estimate the time toddlers spend in different PA intensities.

Funding Source: University Scholars Research Grant, Kansas State University

Utility and accuracy of ActivPAL inclinometers in assessing preschoolers’ physical activityAuthors:

Melody Oliver - Auckland University of Technology, Auckland, New Zealand

Grant Schofield - Auckland University of Technology, Auckland, New Zealand

Purpose: ActivPAL inclinometers have shown great utility in assessing sitting, standing, and walking in school-aged children and adults, however, little is known of the feasibility of using these monitors with preschool-aged children, or of the accuracy and utility of data collected. The aim of this study was to assess the feasibility and accuracy of ActivPAL inclinometers for measuring activity and sedentary time in preschoolers.

Methods: Participants were recruited through early childhood education settings in Auckland, New Zealand. ActivPAL inclinometers were placed in sealed pouches and attached to an elastic belt. ActivPAL belts were placed anteriorly on the right thigh, and Actical accelerometers were worn on an elastic belt worn at the waist, with the accelerometer above the right iliac crest. Monitors were set to collect data in 15 second epochs and were worn by children during movement skill sessions at each setting. Descriptive statistics and agreement between ActivPAL sitting, standing and walking classifications and differing accelerometer count thresholds for sedentary, light, and moderate-to-vigorous intensity activity were determined.

Symposium

Results: Data were collected from 15 children aged 3-4 years. On average, children sat or stood 35% of the time, and were active for the remainder of the sessions. Agreement between ActivPAL classifications and accelerometer-derived intensities were generally substantial (kappa range= 0.58, 0.86).

Conclusions: ActivPAL inclinometers may be useful for objectively quantifying activity and time spent sedentary in preschoolers. Further testing is needed to assess the acceptability of the units and accuracy of data collected over longer measurement durations and multiple days.

Funding Source: Melody Oliver is supported by a National Heart Foundation of New Zealand Post-doctoral Research Fellowship

Single unit monitors for the measurement of posture in young children: Validation, challenges and considerationsAuthors:

Gwyneth Davies - University of Glasgow, Glasgow, United Kingdom

John J Reilly - University of Glasgow, Glasgow, United Kingdom

Philippa M Dall - Glasgow Caledonian University, Glasgow, United Kingdom

Malcolm H Granat - Glasgow Caledonian University, Glasgow, United Kingdom

James Y Paton - University of Glasgow, Glasgow, United Kingdom

Purpose: Sitting may be an important component of sedentary behavior, but validated measures of posture and posture transitions (a possible proxy for fidgeting) in pre-school children are lacking. We investigated the validity of two single unit monitors, the activPALTM and Dynaport MicroMod (MoveMonitor 1.2).

Methods: We videoed 30 pre-school children for one hour undertaking usual activities in the nursery while wearing activPALTM and Dynaport MicroMod monitors as well as an Actigraph accelerometer (for sedentary behavior). Video (gold standard) was analyzed on a second-by-second basis and compared with monitor output.

Results: From direct video observation, the proportion of time spent was sit/lie 46%; stand 35%; and walk/run 16%. The remaining 3% of time was spent in non-sit/lie/upright postures (e.g. crawl, crouch, kneel up) although transitions involving these contributed disproportionately to total posture transitions. The number of sit-stand posture transitions on direct observation was not associated with time spent sedentary. Overall sensitivity for time detected as activPALTM sit/lie was 87%, specificity 97% and positive predictive value 96%. Dynaport MicroMod sensitivity for sit was lower but specificity remained high (91%).

Conclusions: Accelerometry systems capable of detecting posture may help evaluate sedentary behavior in young children, beyond the capabilities of commonly used objective monitors such as the Actigraph. However the role of (and importance of objectively capturing) posture transitions, including non-sit/lie/upright postures requires further investigation. Knowledge of posture and postural transitions may provide a better understanding of movement and activity in young children today

Funding Source: Scottish Higher Educational Funding Council

Symposium

S37 Preventing childhood obesity: The role of context in developing an intervention aimed at school children

Preventing childhood obesity: The role of context in developing an intervention aimed at school children

Chairperson: Peymane Adab

Department of Public Health, Epidemiology & Biostatistics, The University of Birmingham, Birmingham, United Kingdom

Discussant: Miranda Pallan

The University of Birmingham, Birmingham, United Kingdom

Purpose: The aim of this symposium is to describe the use of the Medical Research Council (MRC) framework for complex interventions in the development of an obesity prevention intervention and to discuss the importance of context in the design and delivery of such interventions.

Rationale: Childhood obesity is a serious concern across the globe, but as yet prevention interventions have had limited success. There is a growing realisation of the importance of social, cultural and environmental influences on the development of obesity, and a need to articulate these influences and address them in intervention design. The studies we plan to present in this symposium employed similar methods to access valuable local contextual information, which shaped intervention development and could also be used in implementation planning.

Objectives:

1) To describe three studies from different countries which followed the MRC framework in developing an intervention programme aimed at preventing obesity in preadolescent children;

2) To discuss the findings from stakeholder focus groups in each setting;

3) To compare and contrast the findings in relation to intervention planning; and

4) To discuss the importance of context in the design and delivery of interventions

Summary: The theoretical and modeling phases of the MRC framework for complex intervention development and evaluation were used in urban communities in England, Iran and Qatar to develop intervention programmes aimed at preventing obesity in children aged 6 to 8. A key part of the development process in each setting was accessing local knowledge through focus groups held with a range of stakeholders (including parents and teachers). The resulting data, together with other local information and existing international research evidence, informed development of the intervention programmes. A comparison of the three studies provides an insight into the complexities of addressing childhood obesity, and the importance of the local context and in particular, the cultural context in which this takes place.

Format: The session will begin with an overview of the three studies and the use of the MRC framework for complex intervention development and evaluation. Three separate presentations will then follow on the individual studies, outlining key findings from the stakeholder focus groups and other methodologies, and how they were used in designing the intervention programme. To conclude, the findings of the studies will be compared and the importance of accessing and using this type of contextual information discussed, with particular reference to transferability of interventions to different settings.

Symposium

Developing a childhood obesity prevention programme for children in the United Kingdom, focusing on South Asian communitiesAuthors:

Miranda Pallan - The University of Birmingham, Birmingham, United Kingdom

Peymane Adab - The University of Birmingham, Birmingham, United Kingdom

Purpose: In the United Kingdom, childhood obesity is increasing year after year. South Asians are at higher risk, yet relatively understudied. Systematic reviews of prevention interventions are inconclusive and call for a focus on intervention development, incorporating views of local communities. This is coherent with the process described by the MRC framework for complex interventions, the theoretical and modeling phases of which we used to develop an obesity prevention programme for primary children, focusing on South Asians.

Methods: Several methods were combined iteratively to develop the intervention. A central part was running focus groups (FG) with key stakeholders to explore beliefs on childhood obesity and generate ideas for perceived feasible interventions. Findings were considered by an expert group taking account of published evidence and local resources, to ensure coherence and sustainability.

Results: Beliefs on causes were grouped into five overlapping areas. An example of family and cultural influences was that of grandparents: “My mum, because she is a grandmother, she will say, oh leave it, let them eat something else…”. Regarding potential interventions, those aimed at families focusing on conferring skills, emerged as important. “It comes down to the parents doesn’t it?...whatever the school does... when I take them home, you know, the school doesn’t know what’s being put down there.” Based on these findings, the expert group defined a set of principles to guide intervention development.

Conclusion: Rich data on local context gained from FGs shaped the intervention design, informing the expert group and the delivery of intervention.

Funding Source: National Prevention Research Initiative (administered through MRC)

Developing a childhood obesity prevention programme for children in Tehran, Iran Authors:

Behnoush Mohammadpour-Ahranjani - The University of Birmingham, Birmingham, United Kingdom

Purpose: Iran faces an increasing burden of childhood obesity but lacks evidence on how to develop prevention interventions. The aim of this study was to obtain contextual information to explain why behaviours that promote obesity occur, and to gain insights on barriers and facilitators that would help tailor an intervention programme to the community.

Symposium

Methods: Focus groups with parents and schools staff from primary schools representing three districts (affluent, middle-class and deprived) in Tehran were undertaken. A topic guide was used to facilitate discussion exploring participants’ perceptions of the causes of childhood obesity, barriers and facilitators to healthy weight, and views on potential components for preventive intervention. All FG discussions were tape-recorded and transcribed. Content analysis was used to identify key themes.

Findings: Participants were aware of a range of causes of obesity. A social preference for overweight children was mentioned: “We prefer fat children, …we like him, we hug him”. Cultural norms were also implicated: “…this is our attitude: when girls grow up it would not be nice to be active. She should be like a lady, polite, and calm...”. In terms of interventions, there was consistent emphasis on the need for family education. The role of Central Government and powerful influence of teachers on pupils’ and families’ behaviour was mentioned by most groups.

Conclusions: Whilst some emerging themes are similar to those found in other settings, some context specific findings also emerged which enable tailoring of future interventions more appropriately to the local setting.

Funding Source: Overseas research scholarship award

Preventing childhood obesity in the state of QatarAuthors:

Amal Al-Muraikhi - The University of Birmingham, Birmingham, United Kingdom

Purpose: Qatar has undergone rapid industrialisation. Childhood obesity is emerging as a problem, although there is little information on determinants of obesity and its prevention. The aim of this study was to investigate factors contributing to childhood obesity and identify potential components for a preventive intervention.

Methods: The study consisted of two parts: 1) Focus groups with key stakeholders: Topic guides were used to explore concepts on overweight and perceptions on potential prevention interventions. Sessions were tape-recorded and transcribed. 2) Cross-sectional survey of parents of 12 primary school children linked to the child’s BMI data.

Results: Participants recognised obesity as a growing problem and identified two important influences, resulting from rapid societal change since oil production. Affluence has increased availability and affordability of energy-dense foods and resulted in an influx of immigrants. Working mothers, lack of parenting skills and role of fathers in determining what is eaten at home were also highlighted. Lack of space, the climate and cultural norms for girls were described as barriers to physical activity. Lack of recognition of obesity by parents was also discussed.

In terms of interventions, the school setting and influence of teachers was described: “children learn from school more than they learn from their mothers”. The importance of education for parents, particularly mothers was a constant theme. Some findings were confirmed by the cross-sectional survey.

Symposium

Conclusions: The findings inform the development of future obesity prevention interventions. The focus group data provide important contextual information and validated some findings from the cross-sectional study.

Funding Source: Hamad Medical Corporation, The State of Qatar

Discussion on the role of context in the design and delivery of childhood obesity prevention interventionsAuthor:

Purpose: To compare the findings of the papers presented from the three different communities, discuss the importance of the contextual information elicited in informing design and delivery of childhood obesity prevention interventions, and consider the implications of this in terms of transferability of intervention programmes between communities.

Methods: Similarities and differences in findings from the community focus groups (FGs) and other methods employed in the three studies will be presented and discussed. An interactive discussion will follow, centred around the question ‘to what extent are childhood obesity prevention interventions transferrable between different communities?’

Results: One difference between opinions of FG participants from the United Kingdom based study compared to the Middle Eastern studies was the favoured setting for prevention interventions, with the United Kingdom participants perceiving the family as the most important setting compared to the school setting for FG participants from the other studies.

Conclusions: On the face of it, intervention programmes often contain similar elements, but it is only by understanding the beliefs and opinions of the target communities, that we can begin to map out the contributors to the behaviours that are related to the development of obesity, and how the interventions may influence these. It may be that interventions are broadly transferrable, but a degree of tailoring is required, which involves a detailed understanding of the target community.

Funding Source: National Prevention Research Initiative, administered by MRC

Symposium

S38 Childhood obesity prevention policies: The case of Mexico

Childhood obesity prevention policies: The case of Mexico

Chairperson: Lucie Levesque

Physical Education Centre, Kingston, Ontario, Canada

Juan A. Rivera-Dommarco

Instituto Nacional de Salud Publica, Morelos, Mexico

Purpose: To discuss the limitations of the current policy context in Mexico to address the rising childhood obesity epidemic. This presentation will present results from a comprehensive inventory of Mexican policies at the national, state, and regional levels that are related to childhood obesity pathways as conceptualized via an ecological lens. Policy gaps and recommendations will be presented. Ongoing efforts and processes to address policy change will be discussed.

Rationale: Childhood obesity rates have increased alarmingly in Mexico within the last decade. This epidemic requires the development of strategies and interventions supported by political will that promotes social and cultural contexts specific to obesity prevention. In order to assure policy acceptance and successful implementation, policy development should be responsive to regional cultures and norms in addition to addressing multiple levels of influence on obesogenic behaviours as conceptualized through an ecological framework. Currently there is no childhood obesity prevention-specific policy framework. Thus, there is a need to develop comprehensive and complimentary policies across levels of government to create supportive environments that promote healthy weights in children.

Objectives:

1. To describe the current national, state, and regional level policies in Mexico that are related to childhood obesity pathways as conceptualized via an ecological lens;

2. To discuss the policy process and design of a national health policy to prevent childhood obesity in Mexico; and

3. To propose alternative frameworks and recommendations to design policies to prevent childhood obesity based on ecological theorizing.

Summary: A description of the obsegoenic environment and its correlation with the policy and normative gaps in Mexico will be presented. Next, results from an inventory of policies related to childhood obesity at the national, state, and regional levels will be presented. This will be followed by a presentation of current policy efforts to address the obesity epidemic in Mexico. Finally, a discussion of alternative frameworks and recommendations for childhood obesity prevention in the Mexican context will be presented.

Format: The symposium will include an overview of the session, 3 presentations of 15 min. each, a summary of salient issues presented, and a discussion among presenters and attendees.

Symposium

Developing national obesity and non-communicable chronic disease prevention policies for Mexico

Authors: Simon Barquera - Departamento de Enfermedades Cronicas Centro de Investigaciones en Nutricion y Salud Instituto Nacional de Salud Publica, Cuernavaca, Mexico Margarita Safdie - Queen’s University, Kingston, Canada

Background: Given the rise in nutrition-related chronic diseases observed in Mexico during the last 30 years, diverse strategies to improve diet and increase physical activity have been considered by the Ministry of health, researchers, and academics. The main purpose of these strategies is to identify mechanisms to promote reductions in total energy, sodium, sugars, and fats in the most frequently consumed foods in the country; and at the same time to promote increased consumption of water, whole grains, fruits, and vegetables.

Purpose: To describe the process involved in the design of the Mexican National Obesity and Non-Communicable Chronic Disease Policy.

Methods/Key Points: The Ministry of Health, with support from the National Institute of Public Health (INSP), initiated an effort to configure a national policy. The design of the policy included a large number of national meetings with consumers, food industry, and local and international scholars on issues related to caloric beverages, physical activity, sodium, fats, and added sugar and an overall Nutrient Profiling system. Responses by the food industry, consumers, and scholars to the policy making process will be described.

Conclusions: The food industry has been both a supporter and critic of the overall thrust and proposed regulations related to food labeling. The Medical societies have been very supportive while selected nutritional scholars have been critical. A large number of major food companies and some local food companies and major distributors are expected to support this new action.

Funding Source: CAMBIO Project, IDRC

A comparative review of childhood obesity prevention policies in MexicoAuthors:

Margarita Safdie - Queen’s University, Kingston, Canada

Lucie Lévesque - Queen’s University, Kingston, Canada

Simon Barquera - Departamento de Enfermedades Cronicas Centro de Investigaciones en Nutricion y Salud

Instituto Nacional de Salud Publica, Cuernavaca, Mexico

Juan Rivera - Departamento de Enfermedades Cronicas Centro de Investigaciones en Nutricion y Salud Instituto

Nacional de Salud Publica, Cuernavaca, Mexico

Background: Childhood obesity rates have increased alarmingly in Mexico and within the last decade the childhood obesity doubled. This epidemic requires the development of strategies and interventions

Symposium

supported by political will that promote social and cultural contexts specific to obesity prevention. A first step in the development of childhood obesity prevention policies that have the potential to be accepted by stakeholders and successfully implemented at the national and state levels is to determine how existing policies adhere to or contradict current international recommendations.

Purpose: To compare Mexican childhood obesity prevention policies, broadly defined, with international policy recommendations as defined by international experiences/organizations.

Methods/Key Points: A catalogue of childhood obesity prevention policies for developing countries was compiled based on a literature-review conducted according to International Obesity Task Force (IOTF) and Institute of Medicine (IOM) policy recommendations. Current Mexican policies to prevent childhood obesity and/or policies related to childhood obesity were compared with the policy catalogue. Two expert coders independently coded the Mexican policies to determine absence/presence of IOTF/IOM recommendations.

Discrepancies were discussed until consensus was reached.

Conclusions: The environment in Mexico is highly obesogenic and lacking in policies. Current international recommendations are not being met, and there is a need to develop comprehensive and complimentary policies across levels of government to create supportive environments that promote healthy weights in children. Alternative frameworks and recommendations to design policies to prevent childhood obesity based on ecological theorizing will be discussed.

Funding Source: CAMBIO Project, IDRC

Symposium

S39 Funding nutrition research: Who can you trust

Funding nutrition research: Who can you trust

Chairperson: Sylvia Rowe

SR Strategy, Washington, DC, United States

Discussant: Sylvia Rowe

SR Strategy, Washington, DC, United States

There has been significant public debate about the susceptibility of research to bias as a result of industry funding. The nutrition and food science community has faced similar issues; specifically that industry-funded research is biased towards results that favor the sponsors. Given the critical role that industry has played and will continue to play in the research process, the International Life Sciences Institute (ILSI)

North America has proposed conflict-of-interest guidelines for industry funding of nutrition, food, and food safety science research in order to ensure the integrity and credibility of the scientific record. Eight principles have been developed specifying ground rules for industry-sponsored research. These principles are intended to be dynamic, prompting ongoing discussion by the nutrition research community and further refinement. The symposium will provide participants with information on the nature of academic-industry relationships in research including identifying key issues, presenting views from different stakeholders, and offering a forum for discussion of the guiding principles to manage them. Concerns about conflict of interest threaten to decrease public support for science. Concern about industry-funded research is being addressed by the scientific community but has not yet been addressed in any major way by the nutrition and food science community. This effort is unique because it focuses on the issues from the perspective of nutrition researchers and was developed with representatives from academia, industry, and government. Therefore, this symposium will be of interest to nutrition researchers from all sectors. The session will also include a presentation of the results of a recent study that examined the relationship between quality of research and Funding Source using the American Dietetic Association’s (ADA) Evidence Analysis Library data. The study provides insights into specific areas for improvement in research, design and reporting and it especially highlights the need to move toward more rigorous methodology for review and synthesis of primary results.

Funding food science and nutrition research: Financial conflicts and scientific integrityAuthor:

Sylvia Rowe - ILSI NA, Washington, DC, United States

The purpose of the paper is to articulate, in the sophisticated, industrialized, modern world in which we find ourselves, principles defining and protecting the integrity and maintaining the credibility of the scientific record, particularly that part of it devoted to health, nutrition, and food safety science.

Background: In recent years there has been an evolving discussion among scientists, government officials, and interested members of the public about the role that financing plays in shaping and directing

Symposium

S39 Funding nutrition research: Who can you trust

scientific research, as it relates to health, food safety, and nutrition. To date, the discussion has taken place inside various, disparate organizations. The International Life Sciences Institute North America (ILSI NA) initiative was intended to create a broad collaboration of scientists addressing this difficult issue.

Methods/Key Points: ILSI NA assembled a working group of food industry, academic, and government scientists and professionals charged with reviewing the literature and developing a set of principles. A paper enumerating eight principles regarding funding bias was drafted and, after thorough discussion and refinement, submitted to 48 outside reviewers whose comments informed a final draft.

Conclusions: Broad collaboration was achieved: the paper was published simultaneously in six peer-reviewed scientific journals: American Journal of Clinical Nutrition, Journal of the American Dietetic Association, Journal of Food Science, Nutrition Reviews, Nutrition Today, and Journal of Nutrition. A call to action has been sounded: scientific researchers within academia and industry are urged to embrace principles such as those enumerated in this project and to stimulate a dialogue about managing all potential biases.

Financial conflicts and scientific integrity: A view from academiaAuthor:

Jeanne Goldberg - Tufts University, Boston, United States

Purpose: To discuss the issues that arise when academic scientists participate in industry funded projects and to describe a set of principles to guide these collaborations.

Background: Attitudes toward the appropriateness of industry funding of scientific research vary within the academic community. At one extreme, some are unwilling to participate in research funded by the food industry. Others, with a more moderate position, are comfortable if the research follows the basic principles of good science and agreements to design, conduct and publish the results are specified a priority. At the other extreme, legitimate questions have been raised about the relationship between Funding Sources and the conduct and dissemination of study results.

Methods: To address the issue of financial conflicts and scientific integrity in funding of food science and nutrition research, a group of experts from academia and representatives of the food industry engaged in a dialogue on the management of potential bias that might result from industry funding of science.

Results: The dialogue led to a set of eight guiding principles to guide the conduct of “all relevant parties” involved in public/private research relations. This presentation discusses the guidelines and their implications from the perspective of an academic researcher.

Conclusions: A common set of rules to manage difficult issues that arise in the conduct of public/private partnerships for scientific research is an important step toward a more level playing field, eliminating inappropriate claims of bias based on the source of funding rather than the quality of the research.

Funding Source: Self

Symposium

S40 Application of the Healthy Eating Index-2005: A diet quality metric for multi-level study

Application of the Healthy Eating Index-2005: A diet quality metric for multi-level study

Chairperson: Jill Reedy

National Cancer Institute, Division of Cancer Control and Population Sciences, Bethesda, United States

Purpose: To introduce how the Healthy Eating Index-2005 (HEI-2005) can be used to assess the quality of various micro- and macro-environments—such as schools, restaurants, worksites, and the aggregate food supply—as well as individual-level diets. Applying a standard measure, such as the HEI-2005, to multiple levels of the socio-ecological model can provide insights into relationships among U.S. food policy, food availability, and dietary intake.

Rationale: Public health researchers are increasingly aware that alterations in the food environment are necessary to allow all individuals the opportunity to achieve healthier diets. That is, individuals cannot be expected to make healthy choices if those options are not readily available in the home, at work, at school, and in the community. For this reason, researchers are developing robust measures of the food environment to investigate the effects of the food environment on individual dietary behavior, inform policymaking, and reduce the prevalence of obesity through targeted interventions.

It would be beneficial to have a common metric for assessing the food environment that could be used across all levels of the socio-ecological model, including individual-, community-, and macro-levels. Many of the measures available are instruments for gathering data, such as checklists and inventories, but there are relatively few that provide a summary assessment of the quality of foods in a particular environment. The HEI-2005 is a tool designed to measure diet quality based on standards derived from the 2005 Dietary Guidelines for Americans and the My Pyramid food guide.

Objectives:

The aims of the session are as follows:

1. To introduce the application of theHEI-2005 at the individual level, the community level, and the food supply level;

2. To present research findings based on the application of the Healthy Eating Index-2005 with U.S. national intake data, restaurant menus, and the U.S. national food supply;

3. To introduce a Healthy Eating Index-2005 Web-based Calculator, a tool for researchers; and

4. To discuss study possibilities and analyses that would link findings based on theHEI-2005 across multiple levels of the socio-ecological spectrum.

Format:

1. Jill Reedy - National Cancer Institute, Bethesda, United States

2. Susan Krebs-Smith - National Cancer Institute, Bethesda, United States

3. Response from Panelists: Lisa Powell and Leslie Lytle

Symposium

Application of the Healthy Eating Index-2005: A diet quality metric for multi-level study Authors:

Jill Reedy - National Cancer Institute, Bethesda, United States

Susan Krebs-Smith - National Cancer Institute, Bethesda, United States

Purpose: To introduce the Healthy Eating Index-2005 and illustrate applications at the individual-, community-, and food-supply level.

Background: We developed a process to apply the Healthy Eating Index-2005 (HEI-2005) at multiple levels of the food environment. The HEI-2005, a tool designed to evaluate concordance with the 2005 Dietary Guidelines, has previously been used to monitor the quality of diets consumed by Americans at the individual level.

Key Points: Because the HEI-2005 is not tied to individual requirements and is scored on a per 1000 kcal basis, it can be used to assess the overall quality of any mix of foods. The tool captures the multi-dimensional nature of diet; reflects the appropriate balance in a given amount of food because it was developed on a density basis and is energy independent; and provides a single set of standards that is grounded in national dietary guidance. The steps are to: 1) identify the set of foods under consideration; 2) determine the amount of each relevant dietary constituent in the set of foods; and 3) derive pertinent ratios of dietary constituents to energy and score each HEI-2005 component using the relevant standard.

Conclusions: Because the HEI-2005 can be applied to environmental- as well as individual-level data, it provides a useful metric for studies linking data across levels of the socio-ecological framework of dietary behavior. Applying a standard measure, such as the HEI-2005, to multiple levels of the socio-ecological model can provide insights into relationships among US food policy, food availability, and dietary intake.

Evaluation of individual-level diets and foods available at the community- and macro-level using the Healthy Eating Index-2005 Authors:

Susan Krebs-Smith - National Cancer Institute, Bethesda, United States

Jill Reedy - National Cancer Institute, Bethesda, United States

Purpose: To evaluate the healthfulness of individual-level diets and foods available at the community- and macro-level using the Healthy Eating Index-2005 (HEI-2005)

Methods: We applied the HEI-2005 to U.S. population intakes reported in the 2003-04 National Health and Nutrition Examination Survey, a fast-food menu, and data on the U.S. food supply. Individual-level data and the dollar menu displayed at a fast-food restaurant were coded and linked to the My Pyramid Equivalents Database. The U.S. Food Supply, 1970-2007, was measured with food availability data, loss-adjusted food availability data, nutrient availability data, and salt institute data.

Symposium

Results: According to the HEI-2005 (total score = 100 possible points), for individual-level diets (57.5 points), the offerings at a local fast-food restaurant (43.4 points), and the 2005 U.S. Food Supply (54.9 points) to align with national dietary guidance, substantial shifts would be necessary: a concomitant addition of fruit, dark green vegetables, orange vegetables, legumes, and non-fat milk; replacement of refined grains with whole grains; and reduction in foods and food products containing sodium, solid fats, and added sugars.

Conclusions: Striking similarities exist between individual-level diets and the quality of choices in the food environment. Similar analyses could be applied to food outlets in other types of food systems or micro-environments, including food stores, restaurants, schools, and worksites, and results could be linked to individual-level diets in the community. These findings suggest that new dietary guidance could target not only individuals but also the architects of our food environment.

O01 Nutrition in children

Nutrition in childrenO01.1

FoodBEAMS: Food and beverage environment assessment and monitoring system

Author:

Sally Lawrence Bullock, Lisa Craypo, Sarah Samuels

Background: Across the country, states and school districts are developing school nutrition policies that regulate the sale of a la carte foods on school campuses. School districts are implementing these policies; however, the lack of available nutrient information makes monitoring adherence challenging. The Food and Beverage Environment Assessment and Monitoring System (FoodBEAMS) is a computer-based tool that enables school stakeholders to efficiently and effectively understand the competitive school food environment, and identify areas for improvement within schools.

Methods: 1) Developed a database cataloging over 5500 competitive foods and beverages sold in schools, grades K-12. 2) Designed, developed, and tested a computer-based tool for data collection of competitive school food and beverage data. 3) Adapted the tool to allow users to assess nutrient profiles of competitive foods sold on school campuses and adherence to nutrient standards. 4) Tested the reliability of the tool among researchers and non-researchers

Results: FoodBEAMS was successfully developed and is being piloted in research studies assessing the school food environment in California and Washington. Baseline data collected from the schools demonstrated that schools are implementing the standards; however, to varying degrees. Inter-rater reliability among researchers and non-researchers was high.

Conclusions: The FoodBEAMS electronic data collection system and nutrient database enables food service directors, nutritionists, school personnel, parents, advocates, and other stakeholders to assess adherence to the state and local school nutrition policies, and to identify which foods and beverages need to change to increase adherence and create a healthy school nutrition environment.

Funding Source: Grant Number R43DK078457 from the National Institute of Diabetes and Digestive and Kidney Diseases

Do child care centers participating in Child And Adult Care Food Program (CACFP) provide better nutrition compared with Non-CACFP child care centers?

Authors:

Josephine Emunah, Derek Hales, Christina McWilliams, Amber Vaughn, Dianne Ward

About 56% of all children, ages 3-6 years receive 50 to 75% of their daily food intake at childcare facilities. For this reason, the child care facility serves as an important environment for launching the young child’s life-long dietary behaviors.

Purpose: To compare differences in the foods provided at child care between CACFP centers and non-CACFP centers.

Method: Data were collected in 50 childcare centers in North Carolina by trained research staff who observed the nutrition environment at each center over four consecutive days - from before the first eating occasion until the end of the day. Potatoes, meats, grains, fruits, vegetables, fruit drinks, fruit juices, milk and water were observed. Center directors also completed a short demographic questionnaire. Comparisons between CACFP and non-CACFP centers were conducted using SAS through General Linear Model. Enrollment fee and number of children were included in each model to control for cost and center size.

Results and Findings: The sample included 27 CACFP centers and 23 non-CACFP centers. CACFP centers offered significantly more servings of milk (2%, 1% and skim) p<.05, milk total p<.03, fruit total p<.02, fruit and vegetable total p<.01, fruit juice p<.03, while non-CACFP centers provided significantly more water p<.002.

Conclusions: These results indicate important differences in food served in CACFP centers compared to those not participating in CACFP.

Funding Source: Supported by a Robert Wood Johnson Healthy Eating Research Grant

Are center or center director characteristics related to diet quality at childcare?

Authors:

Stephanie Mazzucca, Derek Hales, Rachel Tabak, Amber Vaughn, Dianne Ward

Purpose: To identify relationships between childcare center and director characteristics and types and amounts of foods and beverages served.

Methods: Data were collected in 50 childcare centers in North Carolina. Using the Environment and Policy Assessment and Observation (EPAO), trained research staff observed the nutrition environment at each center over four days from before the first eating occasion until the end of the day. Observations included

food served, staff behavior, daily routines, and physical environment. Center directors also completed a demographic questionnaire.

Results: Few associations between center characteristics (weekly fees, star rating, director education, and director BMI) and types and amounts of foods and beverages served reached statistical significance. However, higher weekly fees and higher star rating were significantly associated with less canned fruit [F(2,35)=4.39,p<0.001 and F(2,34)=4.41,p<0.001], less 100% fruit juice [F(2,24)=2.83,p<0.01 and F(2,23)=2.45,p<0.05], and less water servings [F(2,24)=5.29,p<0.001 and F(2,23)=3.38,p<0.01], controlling for total fruit and beverages. Lower director BMI was significantly associated with more canned fruit servings [F(2,29)=4.01,p<0.001]. Higher director education was significantly associated with more fresh fruit [F(3,34)=2.33,p<0.05] and more water servings [F(3,22)=2.33,p<0.05], controlling for total fruit and beverages. While not statistically significant, some interesting and clinically meaningful associations were found between lower director BMI and higher percentage of whole grains and more low-fat milk (1% or skim) served. Also, higher star rating was associated with more fresh fruit served, and whole milk was served less at centers with directors who had professional degrees.

Conclusions: These associations highlight important relationships between center and director characteristics and diet quality.

Funding Source: Robert Wood Johnson Foundation Healthy Eating Research program

Acceptance of novel whole grain commodity products in school meals

Authors:

Yen Li Chu, Len Marquart, Marla Reicks

Purpose: The perception that children do not like whole grain foods may affect whether whole grains are made available in school meals. The purpose of this study was to test the acceptance of novel whole grain products provided by the USDA commodity program for school meals.

Methods: Refined and whole grain pancakes and tortillas were served in eight elementary, one middle, and one high school in a Midwest metropolitan area over a 4 month period in spring and fall, 2009. Products of each grain type made with white and red wheat flour were served a mean of 4 times. Aggregate plate waste was collected to determine consumption. ANOVA was applied to compare percent consumption when whole grain or refined products were served. Students completed taste rating forms and the chi-square test was used to compare responses.

Results/Findings: Elementary school students had lower consumption of whole grain compared to refined pancakes (77% vs. 69%, p<0.0001) and tortillas (75% vs. 70%, p=0.006). Selection of an alternate entree option was 12% higher (p<0.0001) when whole grain pancakes were served. No differences were observed at the middle and high schools in intake. Ratings on taste, color, and texture were fairly positive, but differed by grain-type.

Conclusions: Substituting novel whole grain options for refined products led to slightly lower but still substantial intake of whole grain by elementary school children. Rating form responses and selection of alternate options suggest that acceptance was affected by perceived differences in taste, color and texture.

Funding Source: Subcontract with Texas A&M University for USDA, Food and Nutrition Service

Video game play induced dietary, but not activity, change among children

Authors:

Tom Baranowski, Janice Baranowski, Debbe Thompson, Richard Buday, Russ Jago, Dina Abdelsamad, Kathleen Watson

Objective: Evaluate the outcome of playing the “Escape from Diab” (Diab) and “Nanoswarm: Invasion from Inner Space” (Nano) video games on children’s diet, physical activity and body composition.

Background: Video games designed to promote behavior change are a promising venue to enable children to learn healthier behaviors.

Design: Children randomly assigned to treatment or control groups. Treatment group played Diab and Nanoswarm in sequence. Control Group played diet and physical activity knowledge based games on popular websites. Assessments occurred at baseline (O1), immediately after Diab (O2), immediately after Nano (O3) and two months later (O4).

Measures: At each point of assessment: 4 non-consecutive days of 24 hour dietary recalls, 5 days of physical activity using accelerometers, and assessment of height, weight, waist circumference and triceps skinfold.

Statistical Analysis: Repeated Measures – Analysis of Variance

Results: Children playing these video games increased their fruit and vegetable consumption by about 1serving per day, but not water, and marginally increased moderate to vigorous physical activity by about 6 min/per day. No effect on body composition or possible mediating variables.

Conclusions: Playing Diab and Nano resulted in as large an increase in fruit and vegetable intake as appears in the dietary change intervention literature; a possible marginal change occurred in moderate to vigorous physical activity. Research is needed on the optimal design of intervention components to maximize change.

Funding Source: National Institute of Diabetes and Digestive and Kidney Diseases

Association of breastfeeding duration with maternal feeding responsiveness in infancy and toddlerhood

Authors:

Katherine Isselmann DiSanti, Eric Hodges, Jennifer Orlet Fisher

Purpose: Protective effects of breastfeeding (BF) on child obesity risk are thought to be, in part, behavioral. The extent to which BF entrains feeding practices that are responsive to child hunger and satiety, however, is relatively unexplored. This research evaluated the association of BF duration with feeding practices used by mothers of infants (7-11 months) and toddlers (20-24 months). Longer BF durations were hypothesized to be associated with more responsive feeding practices.

Methods: A secondary data analysis was performed on cross-sectional data from a study of 150 infants and toddlers (52 Hispanic, 45 Black, 45 white). Mothers’ self-reports of BF duration (any BF including exclusive) were categorized based on U.S. public health recommendations: BF<3 mo, BF 3-6 mo, or BF > 6 months. The Infant Feeding Styles Questionnaire was utilized to measure 12 maternal feeding practices including responsiveness to satiety cues, pressuring, restriction, and indulgence (Thomson et al., 2009). ANCOVA was used to evaluate the association of BF and feeding practices, while controlling for potentially confounding maternal (e.g. education, income, and BMI) and child (e.g. weight-for-length) characteristics.

Results: Mean breastfeeding duration was 5.9 months. Mothers of infants and toddlers who BF>6 mo reported lower pressuring compared to mothers with shorter BF duration. Mothers of infants who BF > 6 mo also reported less restriction. Alternatively mothers of infants who BF<3 mo reported lower responsiveness to infant satiety compared mothers who BF longer.

Conclusions: These findings suggest that longer BF durations may promote responsive feeding practices, particularly during infancy.

Funding Source: Nestle Infant Nutrition, Florham Park, NJ and 5K01DK061319-03

O02 Policies: Physical activity and nutrition

Policies: Physical activity and nutritionO02.1

Do childcare center policies affect the physical activity levels of children?

Authors: Palma Chillón, D. Hales, C. McWilliams, A. Vaughn, D. Ward

Purpose: Policies may influence children’s experience at childcare. The main aim was to study the associations between written and common-practice (unwritten) policies of childcare centers and children’s physical activity (PA) levels.

Methods: Data were collected in 50 childcare centers in North Carolina. Center directors identified written and common-practice policies from a list of 29 items. Children’s PA was measured over 4 days using the GT1M accelerometer (programmed to collect data in 15s epochs) and summarized using a SAS program. The final sample included 47 centers with complete PA data. Associations between policy and PA levels were examined with ANOVA and regression analysis adjusted by center characteristics (years in operation, cost/week and number of children enrolled). Association between both policies was examined with Spearman correlation.

Results: The number of written and common-practice policies reported by center directors was significantly correlated (p<0.001; r = -0.525). Four policies (1 written, 3 common-practice) related to staff and equipment were significantly associated with PA levels (p values ranging from 0.009 to 0.042); and 2 common-practice policies related to TV use showed borderline associations with PA levels (p values from 0.066 to 0.085). Policies about staff behavior and the size of active play space explained 29.8% of the variance in PA, and center characteristics increased the variance to 34.1%.

Conclusions: Staff and equipment policies seem to be related to children’s PA levels at childcare. Although written policies are encouraged, practice-based policies may be of equal importance to PA levels of children.

Funding Source: Supported by a Robert Wood Johnson Healthy Eating Research Grant

Impact of school nutrition policy on the healthfulness of foods sold to students in low-income schools participating in the Healthy Eating Active Communities program

Authors:

Lisa Craypo, Krista Hutchinson, Sarah Samuels

Purpose: Children, particularly in low-income communities, are subjected regularly to environments that hinder or discourage healthy eating and contribute to childhood obesity. California policy-makers recognized that school environments are uniquely positioned to introduce and reinforce healthy eating behaviours. The Healthy Eating, Active Communities program (HEAC) supports school districts in six low-income communities throughout California to improve school food environments. This session will

describe the extent to which implementation of a state-mandated school nutrition policy was able to improve the healthfulness of foods sold to students.

Methods: Data were collected in 2005 and 2008 at the 19 HEAC school campuses. An inventory was taken of all a la carte foods and beverages available for sale in vending machines, school stores, and in the cafeteria. Data were linked to a nutrient database and analyzed for adherence to school nutrition standards.

Results: Between 2005 and 2008 the HEAC schools significantly changed the types of snack foods sold to students on campus. Analysis of food items found improvements in nutritional quality of foods sold after implementation of California school nutrition standards. The presenter will describe the California school nutrition policy, present findings on the impact of the policy on schools and describe the HEAC communities’ policy implementation strategies.

Conclusions: Schools in disadvantaged communities are successfully implementing policies to improve their nutrition environments as part of community-wide efforts to prevent childhood obesity. HEAC school districts are a model for other schools hoping to improve the health of children by improving access to healthier food

Funding Source: The California Endowment

Have U.S. school districts incorporated the IOM Standards into their competitive food policies?

Authors:

Linda Schneider, Jamie Chriqui, Camille Gourdet, Amy Bruursema, Kristen Ide, Frank Chaloupka

Purpose: In 2007, the Institute of Medicine (IOM) issued competitive food recommendations. These standards are considered the “gold” standard in terms of restrictions on fats, sugars, and calories for foods/beverages sold at school. This paper examines the extent to which U.S. school districts have incorporated the IOM recommendations into their wellness policies as of the 2008-09 school year.

Methods: Wellness policies were collected from a nationally representative sample of ~600 U.S. public school districts. The policies were evaluated to assess the competitive food/beverage restrictions by the IOM standards for each location of sale (e.g., vending, a la carte, stores, fundraisers, etc.) and separately by grade level (elementary, middle, and high schools). All data were analyzed using SPSS and STATA.

Findings: Preliminary, unweighted data indicate that policies governing elementary levels are more likely to meet the IOM standards or ban competitive foods, particularly with regard to vending machine and school store sales. IOM standards or complete bans were seen in over 1/3 of districts at the elementary level for sugars, fats, calories, and caffeine content of beverages as compared to less than 20% at the middle school level and less than 10% at the high school levels. The remaining districts either adopted lesser restrictions than the IOM or did not restrict competitive foods at all.

Conclusions: Within one-year following the issuance of the IOM standards, some districts have incorporated these recommendations into their wellness policies; particularly policies governing younger as compared to older school-age children.

A look back at the first three years of school district wellness policies in the U.S.: Progress and opportunities

Authors:

Jamie Chriqui, Linda Schneider, Camille Gourdet, Amy Bruursema, Kristen Ide, Frank Chaloupka

Purpose: As of the 2006/2007 school year, all school districts participating in federal child nutrition programs in the U.S. were required to develop and implement a wellness policy that addressed nutrition education, school meals, competitive foods, physical activity, and implementation. This paper will present new data from an ongoing nationwide evaluation of wellness policies for the first three years following the required implementation date.

Methods: Wellness policies were collected from a nationally representative sample of ~600 school districts/year located throughout the U.S. Policies were collected using a triangulated method—Internet research followed by telephone and mail follow-up. The policies were coded using an adaptation of a reliable and valid coding scheme developed by Schwartz et al. (2009, JADA) and separately for each grade level of applicability (elementary, middle, and high school). All data were analyzed using STATA.

Findings: Preliminary, unweighted data indicate that three years out—virtually all districts have a wellness policy in place that generally included the basic goals/elements required by federal law; however, the specifics of the policies varied greatly. Nutrition education and PA provisions were stronger than other required elements; however, while still in small numbers, districts are increasingly developing detailed implementation plans. Competitive food bans only applied to elementary schools and competitive food restrictions were weaker for secondary schools. Although not required, many policies included PE-related provisions and districts increasingly restricted marketing of unhealthy foods/beverages.

Conclusions: While progress has been made in the wellness policies over the first three years, opportunities for improvement still exist.

O03 Measurement: Issues in children and adults

Measurement: Issues in children and adultsO03.1

Assessment of overweight among 5-year-old children; comparison of body mass index and waist circumference

Authors:

Lydian Veldhuis, Ineke Vogel, Amy van Grieken, Mirjam Struijk, Carry Renders, Remy HiraSing, Hein Raat

Purpose: The most common measure to assess overweight is the Body Mass Index (BMI), but literature suggests that also other indicators, such as Waist Circumference (WC) should be considered. The aim of this study was to compare overweight (including obesity) categorization according to BMI and WC cut-off points among 5-year-old children.

Methods: 13,833 parents were invited to participate in the ‘Be active, eat right’ study and 64% provided informed consent. Youth health care professionals used standardised methods to measure body weight, height and WC. Age and gender specific cut-off points for BMI (Cole et al, 2000) and WC (Fredriks et al, 2005) were used. Agreement was investigated by cross-tabulation and was expressed as observed agreement and Cohen’s kappa.

Results: The prevalence of overweight was 9.1% (according to BMI cut-off points) and 8.5% (WC cut-off points). The observed agreement for weight status between BMI and WC was 94.6% for boys and 91.7% for girls. The kappa coefficient was 0.58 (boys) and 0.57 (girls). Overall correlation was 0.72 (boys) and 0.76 (girls). Compared to the children in the subgroup ‘overweight according to WC but not according to BMI’ children in the subgroup ‘overweight according to BMI but not according to WC’ were more often girls (64.4% versus 53.9%), were shorter (3.5 cm) and heavier (0.9 kg).

Conclusion: Further research is needed to investigate whether BMI or WC is a better indicator of excess body fat, especially among the taller children, or whether and how they can be combined into one measure.

Funding Source: Research relating to this abstract was funded by ZonMw-grant 6230.0042, (Netherlands Organization for Health Research and Development).

Validation of a questionnaire to assess physical activity in preschool children

Authors:

Otmar Bayer, Joachim Fische, Marc Jarczok, Ruediger von Kries, Freia De Bock

Purpose: Despite its relevance to obesity and other health outcomes, physical activity (PA) remains hard to measure and is often neglected as covariate in studies e.g. assessing determinants of overweight. This study aims to validate a recently proposed questionnaire tool for the simple assessment of PA in children [1] by comparison with accelerometry and heart rate recordings.

Methods: Preschool children aged 2.3 to 6.7 years were categorized as either physically active or non-active, based on their parents’ answers to the five-item questionnaire. Children’s activity and heart rate were recorded for six days (Actiheart, CamNTech, Cambridge, UK). After removing sleep periods during the night these measurements were used to estimate time spent in moderate to vigorous physical activity (MVPA) and sedentary behavior (SB). Non-parametric tests (Mann-Whitney-Wilcoxon) were used for statistical comparisons.

Results/Findings: 748 (90.6 %) questionnaires were filled out sufficiently for classification. Children classified as physically active showed 9.5 % higher mean activity counts (p < 0.001), spent 11.7 % more time in MVPA (p = 0.003), and insignificantly less time in SB.

Conclusions: With validated PA questionnaires for preschoolers lacking, the proposed questionnaire appears a reasonable option. It allows to include PA assessment in epidemiological studies where accelerometers or more elaborate measurement are unavailable. We are currently refining this tool by further improving its validity and generating finer categorization. Probably a few items will be added. The core questions will be kept to ensure backward compatibility.

Reference: [1] Bayer et al. (2009) Public Health Nutr 12, 1242-1247 Corrigendum 1308.

Funding Source: Landesstiftung Baden-Württemberg, Stuttgart (Germany)

Temporal invariance of transtheoretical model constructs measures for physical activity

Authors:

Karly Geller, Claudio Nigg, Robert Motl, Caroline Horwath, Rod Dishman

Purpose: Cross-sectional and longitudinal applications of the Transtheoretical Model (TTM) to physical activity (PA) research require measures that have factorial validity and measurement invariance between groups and across time. We recently provided evidence for the factorial validity and multi-group invariance of such measures in a multi-ethnic cohort of adults. The current analysis tested the longitudinal measurement equivalence/invariance (ME/I) of the TTM constructs across 3- and 6-month periods.

Methods: Adult (N=700, mean age=47.0 years, 63.3% female) from a multiethnic sample living in Hawaii (31.6% Asian, 22.2% Native Hawaiian/Pacific Islander, 37.8% Caucasian, 8.4% other) completed questionnaires that assessed each TTM construct: decisional balance, barrier self-efficacy, temptations, and processes of change, on three occasions separated by 3 months. Following tests of factor structure validity, sequential model constraints evaluated the longitudinal ME/I of factor loadings, factor variances, and item uniqueness for each construct. Longitudinal ME/I comparisons were examined using confirmatory factor analysis with full information maximum likelihood across shorter (3-month) and longer (6-month) time periods.

Results: Analyses supported the longitudinal ME/I for decisional balance, barrier self-efficacy, and temptation constructs, demonstrating equivalence between each nested model and comparative fit index (CFI) values ranging from 0.950 to 0.980 and from 0.933 to 0.980 at 3- and 6-months, respectively.

Additional evidence for longitudinal ME/I was found for two, adjusted process-of-change measurement models, with CFI values ranging from 0.931 to 0.935 and 0.939 to 0.949 at 3- and 6-months, respectively

Conclusion: Researchers can now examine change in PA across 3- and 6-month time periods using the TTM construct measures.

Funding Source: Funded by the National Cancer Institute R01 CA109941 (PI, Nigg)

Accuracy of caloric estimations for healthy and unhealthy foods among restrained and unrestrained eaters

Authors:

Anne-Sophie Bourlaud, Kathleen Cloutier, Karine Gravel, Véronique Provencher

Purpose: To assess whether food items categorization influence the accuracy of caloric estimations and to verify if accuracy of caloric estimations differs according to the restrained status.

Methods: Female students (n=99) were asked to rate eight “healthy” and eight “unhealthy” food items on perceived ‘‘healthiness,’’ and ‘‘capacity to affect weight’’ by using the Food Healthfulness Questionnaire. They were then asked to estimate the caloric content of each food. Discrepancy between actual and estimated caloric content was calculated. Concerns about dieting and weight were measured with the Restraint Scale, and women were categorized as restrained (≥15) or unrestrained (<15) eaters.

Results: Caloric content of “healthy” foods was significantly underestimated by all participants (125.7 ± 79.8 kcal vs. 200.0 kcal; p<0.0001) while no difference between estimated and actual caloric content was observed for “unhealthy” foods. When compared to unrestrained eaters, restrained eaters had a lower mean caloric discrepancy for both “healthy” (p<0.05) and “unhealthy” (p<0.04) foods. Restrained eaters also rated “healthy” foods as having a lower capacity to affect weight gain than did unrestrained eaters (p<0.05) while the reverse was observed for “unhealthy” foods (p<0.04).

Conclusions: Underestimation of the caloric content of “healthy” foods suggests some confusion about nutritional health benefits that may bias caloric estimations. While restrained eaters were more accurate in their caloric estimations than unrestrained eaters, they still significantly underestimated caloric content of “healthy” foods and perceived these foods as less fattening. Further studies are needed to verify the impact of caloric estimations and food beliefs on food intake.

O04 Nutrition and physical activity: Health risk and disease outcomes

Nutrition and physical activity: Health risk and disease outcomesO04.1

Influences of physical activity and sedentary behavior on adolescent medicine use in 17 countries

Authors:

Ronald Iannotti, Alberto Borraccino

Purpose: Physical activity (PA) has been related to a variety of positive health indices and sedentary behavior (SB) has been related to negative health indices. The present analyses examine relationships of adolescent PA and SB with medicine use (MU) and the potential mediating effect of symptoms for common health problems.

Methods: Self-reported PA, SB, MU for four common health problems (headache, stomachache, difficulties sleeping, and nervousness), and symptoms for common health problems were assessed in nationally representative samples of 11-, 13-, and 15-year-old students in 17 countries participating in the Health Behavior in School-Aged Children study (N = 76,863). Results: In hierarchical linear models, there were significant country effects for all relationships. Moderate PA and vigorous PA were negatively related to symptoms and to MU and SB was positively related to symptoms and MU. Furthermore, it appears that self-reported symptoms mediated the relationship between PA and MU, eliminating the effect of moderate PA and reducing the effect of vigorous PA. Conclusions: Adolescents who spend more time engaged in sedentary activities are more likely to take medicine for common health problems but the effect of physical activity on reduced medicine use may be a function of experiencing fewer health problems. Cultural differences in these relationships need to be recognized.

Funding Source: Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development

Metabolic syndrome and cardiorespiratory fitness in Azorean adolescents

Authors:

Carla Moreira, Rute Santos, Susana Vale, Luisa Soares-Miranda, Ana Marques, Paula Santos, Jorge Mota

Introduction: The metabolic syndrome (MetS) is a cluster of various risk factors for cardiovascular disease and type 2 diabetes mellitus. Until now, prevalence of MetS in Azorean adolescents is not known. Therefore, the aim of this study was to estimate the prevalence of MetS, and to analyze the relationship between MetS and cardio respiratory fitness (CRF) in Azorean adolescents.

Methods: A cross-sectional school-based study –The Azorean Physical Activity and Health Study II - of 517 adolescents (297 girls) aged 15–18y from Azorean Islands was conducted. Waist circumference was determined by standard anthropometric method. Arterial blood pressure was also measured. Fasting intravenous blood samples were analyzed (HDL-cholesterol, triglycerides, and glucose). CRF was determined by the maximal number of laps attained in the 20m Shuttle Run Test, and adolescents were

O04 Nutrition and physical activity: Health risk and disease outcomes

classified in two groups according to FITNESSGRAM 8.0 reference standards: under healthy zone vs healthy zone or above. MetS was defined according to the International Diabetes Federation 2007guidelines for adolescents.

Results: The prevalence of MetS was 5% (4.7% in girls and 5.5% in boys, p>0.05). In whole sample 26.7% was classified as belonging to the healthy zone or above. CRF was significantly higher in boys than girls (p<0.001). Logistic regression analysis, adjusted for maturation, showed that MetS were negative and significantly associated with CRF (β=-0.047, OR=0.954, p=0.001).

Conclusions: High CRF was associated to lower prevalence of MetS. It is of great importance the early identification of adolescents who have the syndrome in order to implement and develop preventive strategies of public health.

Funding Source: Supported by FCT-MCTES Grant (BD/44422/2008).

O04.3Length of time in sedentary work and risk of subsite-specific colorectal cancer

Authors:

Terry Boyle, Jane Heyworth, Fiona Bull, Lin Fritschi

Purpose: The aim of this study was to identify if length of time in sedentary work is associated with colorectal cancer risk, and to determine if this association differs between subsites (right colon, left colon, rectum).

Methods: A case-control study of colorectal cancer was conducted in Western Australia in 2005-2007. A total of 918 cases and 1021 controls participated. Data were collected on occupational history and various demographic and lifestyle-related colorectal cancer risk factors. Occupational physical activity was based on job title, using the strength rating from the U.S. Dictionary of Occupational Titles. Years of sedentary work was classified into 4 categories: less than 5; 5-9; 10-19; and 20 or more. The estimated effect of sedentary work on the risk of cancers of the right colon, left colon and rectum was analysed using multinomial logistic regression.

Results/Findings: The risk of left-sided colon and rectal cancers significantly increased as the number of years in sedentary work increased (p<0.05). Compared with participants who held a sedentary job for less than 5 years, and after controlling for confounders, participants who worked in a sedentary occupation for 20 or more years had an almost 3-fold increase in the risk of left-sided colon cancer (OR=2.95, 95% CI=1.72-5.04) and an almost 2-fold increase in the risk of rectal cancer (OR=1.74, 95% CI= 0.99-3.08). Sedentary work did not significantly affect the risk of right-sided colon cancer.

Conclusion: Increasing length of time in sedentary work is associated with an increased risk of left-sided colon cancer and rectal cancer.

Funding Source: Australian National Health and Medical Research Council

O05 Food availability, convenience food and eating out

Food availability, convenience food and eating outO05.1

Ready meal consumption is associated with weight status and cooking skills

Authors:

Klazine van der Horst, Thomas Brunner, Michael Siegrist

Purpose: The ready meals market has grown considerably in recent years. At the same time, a degradation of traditional cooking skills is observed. Ready meals are often rich in energy, fat and sugar and lack vegetables, however, studies investigating associations between ready meal consumption and overweight are lacking. In this study is examined if socio-demographics, overweight, attitudes, beliefs and cooking skills are associated with ready meal consumption.

Methods: Ready meal consumption, weight status, cooking skills, beliefs about the taste and nutritional value of ready meals, attitudes towards convenience foods (CF) and demographic variables were assessed with self-administered questionnaires among 1017 adults from the German-speaking part of Switzerland. Data was analyzed with t-tests, one-way ANOVA and regression analysis.

Results: Overweight adults (BMI>25), considered CF as more healthy and positive and were more positive about the amount of nutrients and vitamins in ready meals, compared to normal weight adults. Multivariate analysis showed that ready meal consumption was associated with attitudes toward CF (b=.271), cooking skills (b=-.174), age 40-64 (b=-.146), age >=65 (b=-.132), overweight (b=.102), socio-economic status (b=-.095), gender (b=.093) and taste (b=-.068).

Conclusions: This study provided evidence for an association between ready meal consumption and overweight. Further research should examine the importance of ready meals and CF for the overweight epidemic. Also cooking skills were identified as a strong predictor of ready meal consumption. The importance of cooking skills as a barrier to healthy eating should be explored, as it is plausible that cooking skills will further decrease in the future.

Food sources for family dinner and associations with overweight status, percent body fat, and metabolic syndrome among adolescents and their parents

Authors:

Jayne Fulkerson, Kian Farbakhsh, Leslie Lytle, Keryn Pasch, Mary Hearst, Martha Kubik

Purpose: Examine associations between food sources for family dinners and parent and adolescent weight/fat indicators.

Methods: Adolescent/parent dyads (n=723) from two obesity studies participated. Parents reported demographics and family dinner purchases from: 1) fast food restaurants, 2) other restaurants, 3) home delivery, and 4) take-out. Weight/fat outcomes were measured by trained staff. Associations between family dinner sources and overweight status, percent (%) body fat, and metabolic syndrome (adolescents

only) were examined with logistic regression and general linear modeling using GEE (adjusted for family dinner frequency, parent education and work status, free/reduced lunch, study, gender and race/ethnicity.

Results: Compared to families who did not report purchasing dinner from these sources, the odds of adolescent overweight were significantly greater when parents reported weekly dinner purchases from home delivery (OR=2.0, CI=1.3-3.0), take-out (OR=1.8, CI=1.2-2.6), fast food (OR=1.8, 1.3-2.7) or other restaurants (OR=1.5, CI=1.1-2.1). Adolescent % body fat and metabolic syndrome were positively associated with purchases of family dinner from fast food restaurants and take out (all p’s<.05). Adolescent overweight (OR=4.1, CI=1.8-9.3) and % body fat (p=0.012) increased incrementally as families purchased dinner from all four sources compared to families who did not. Similar findings were found for parent overweight status and % body fat.

Conclusions: Although frequent family dinners may be beneficial in many ways for adolescents, the types of dinners eaten by families may be more important in maintaining a healthy weight among both adolescents and their parents. Interventions should focus on encouragement of healthful family meals.

Funding Source: The study was funded as part of the IDEA study (PI: Leslie Lytle, PhD) funded by NCI’s Transdisciplinary Research in Energetics and Cancer Initiative (NCI Grant 1 U54 CA116849-01, Examining the Obesity Epidemic Through Youth, Family, and Young Adults, PI: Robert Jeffery, PhD) and the ECHO study (Etiology of Childhood Obesity; PI: Leslie Lytle, PhD) funded by NHLBI (R01 HL085978).

Fast food restaurant taxes, soda taxes, and weight outcomes among U.S. adults

Authors:

Lisa Nicholson, Jamie Chriqui, Lisa Powell

Purpose: To assess the potential of fast food restaurant and soda taxes as potential policy instruments to address the obesity epidemic among U.S. adults.

Methods: We use pooled cross-section data from the 1997-2008 Behavioral Risk Factor Surveillance System (BRFSS) matched by state and year to state-level tax data to examine the effect of fast food restaurant and soda taxes on body mass index (BMI) and obesity (BMI≥30) among adults ages 20-64. Weighted multivariate logistic regression analyses controlling for sociodemographic characteristics, cigarette taxes, year, and state, examined the relationship between taxes and the probability of obesity and linear regression for BMI.

Findings: Across all states, the average tax rate for soda was 4.3% and 4.99% for fast food. Three states specifically taxed restaurant sales (apart from normal sales tax scheme) at an average of 8.87%. The average BMI was 26.97 and 23.44% were obese. Among adults living in states with a soda tax, the probability of obesity was reduced by 3% and BMI was reduced by .07 kg/m2, with stronger effects among middle income. Adults living in states with a specific restaurant tax reduced the probability of obesity by 15% and reduced BMI by .44 kg/m2; while no effect was seen for states that use the standard sales tax scheme for their restaurant sales.

Conclusions: While some evidence suggests an effect of taxes on weight outcomes, current fast food and soda tax rates are too small to generate substantial changes in consumption or weight outcomes, although restaurant-specific taxes hold more potential.

Food acquisition patterns of newly-arrived African refugees in Australia

Authors:

Shawn Somerset, Caroline Pereira

Resettlement by refugees in a new country requires adaptation to different cultural and food environments. Lack of availability and accessibility to traditional foods, differences in taste of food and disconnection with traditional culture intensifies and accelerates a form of nutrition transition which renders humanitarian immigrants particularly susceptible to chronic disease risk. The food neighbourhoods, food acquisition patterns, and dietary habits of newly arrived refugees were investigated to identify opportunities for food-based nutrition education intervention. Ten humanitarian migrants (belonging to separate households) who had arrived from sub-Saharan Africa in the preceding 12 months were recruited to this study through snowball sampling. Subjects maintained a 7-day travel diary recording details of all occasions of travel outside their homes. The purchase, consumption and acquisition of food was recorded within these diaries. A series of 24 hr diet recalls also were collected independent of the travel diary to determine usual food intake. Despite low socio-economic status, this study population seemed not to live in food deserts, having access to major grocery retailers and fruit and vegetable retailers within 2km of their homes. Participants usually frequented the nearest major grocery retailer to their domicile. However, the independent grocer used was not necessarily the closest, showing possible ulterior motives for the choice of these types of shops. Those living within 1km from a major grocery retailer reported higher consumption of vegetables, compared to those living further away. No significant difference (p<0.05) was found between dietary intake and duration of stay. There was a dichotomy between ethnic African food prepared at home (eaten either at home or elsewhere) and at friends’ homes, and “Australian” food eaten at training programs and other public events attended by subjects. Training programs and other formal meeting occasions were the major access points to local Australian food habits, and may represent an important potential setting to influence the trajectory of dietary acculturation.

O06 School based nutrition interventions

School based nutrition interventionsO06.1

The New Moves approach: Can individual sessions using motivational interviewing be integrated into school-based interventions?

Authors:

Colleen Flattum, Sarah Friend, Dianne Neumark-Sztainer

Purpose: Evaluate the addition of an individual session component as part of the New Moves program, a school-based program aimed at preventing weight-related problems in adolescent girls. A description of the individual sessions using motivational interviewing, feasibility of implementing, session satisfaction, and impact of the sessions will be examined.

Methods: New Moves included 1) an all-girls physical education class, focusing on physical activity, nutrition and self-empowerment; 2) individual coaching sessions; 3) lunch meetings; and 4) parent outreach. The program was conducted at six intervention and six control high schools. All intervention participants (n=182) could meet up to 7 times with their individual coach. Participants mean age was 15.7 (SD 1.13), 47% were overweight or obese, and 73% were racial/ethnic minorities. Visits focused on choosing one of the 8 New Moves health messages. Information such as number of meetings and type of goal set was collected after each session. Girls also completed a survey at the end to assess satisfaction.

Results: Satisfaction with the sessions was very high: 95% of the girls indicated they were satisfied (41%) or very satisfied (54%). Over 80% of the girls met five or more times during the program and on average, set 5 goals over the course of their visits. The most popular goals were increasing physical activity, eating more fruits and vegetables, and eating breakfast.

Conclusions: Personalized individual sessions, as part of a health behavior change program, were shown to be feasible, well received, and have the potential to help adolescents to make healthy changes.

Funding Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health

Impact of an intervention to improve middle school student breakfast participation rates

Authors:

Jayna Dave, Kathleen Bachtel Watson, Karen Weber Cullen

Purpose: Breakfast consumption is related to healthy weight. The goal of this study was to improve school breakfast (SB) participation among low-income middle school students.

Methods: The study schools were primarily Hispanic, and >75% of the students were eligible for free/reduced price meals. The intervention included promotional flyers for teachers, parents, and students in the 3 intervention schools in early January, 2008. In 2 intervention schools, all children could receive

a free breakfast and the teachers and principals offered encouragement to eat SB. In school 3, reduced price students could receive a free SB. Participation rates by free, reduced, and full pay meal status were obtained from the district Food Service Office for the 3 intervention and 2 matched control schools. Participation rates of the intervention and control schools were compared for spring, 2008, and for the previous 3 semesters. Two-factor ANOVA was used to detect significant differences in mean percentages of SB consumers by group and semester. Significant interactions were investigated by computing differences in semesters by each group separately.

Results: Significant main effects for group (p<0.001), semester (p<0.001) and for their interaction (p<0.001) were found. Spring 2008 consumption rates were significantly higher for intervention schools (58.8%) compared with control schools (34.5%).

Conclusion: The intervention had a positive impact on SB participation. Interventions to promote SB participation are most effective when SB is offered for free and staff offer positive encouragement. Future studies should assess whether SB participation influences school indicators like nurse and discipline visits by students.

Funding Source: National Institute of Health (NIH)

Romp & Chomp: Improving young children’s eating and activity behaviours through an environmental intervention in Family Day Care

Authors:

Rachel Boak, Andrea de Silva-Sanigorski, Debbie Elea, Peter Kremer, Boyd Swinburn

Purpose: Romp & Chomp (R&C) was an intervention conducted in Geelong, Australia (2004-2008) which aimed to prevent childhood obesity and promote healthy eating and active play in 0 to 5 year old children through community capacity-building and environmental (policy, socio-cultural, physical) interventions in early-childhood settings. This paper presents the intervention impacts in Family Day Care (FDC), a government funded and accredited home-based childcare service.

Methods: Evaluation of R&C was cross-sectional and quasi-experimental with a comparison sample. An environmental questionnaire was completed by FDC providers at follow-up in 375 services in intervention (n=28) and comparison (n=347) samples. The 30-item survey captured information about the nutrition and physical activity environment.

Results: Post intervention, children in the intervention sample spent significantly less time watching television (P<0.001) and using computer/electronic games (P<0.05). Intervention children spent significantly less time in organised active play (P<0.001), and free inside play (P<0.001), but were taken more often for active play at another location (P<0.001) and minimum time in outside play was higher (P<0.05) compared to the comparison sample. Related to healthy eating, FDC providers in the intervention area had significantly higher odds of: written guidelines related to appropriate foods/drinks for parents to send to care (OR:2.49, 95%CI:1.61-3.86), rules related to healthy eating (OR:1.46, 1.14-1.88) and, taking

action if foods provided do not meet guidelines (OR:3.63, 2.63-4.99).

Conclusions: The improvements made in the FDC service through the R&C intervention have created more opportunities for children to be physically active and eat more nutritious foods during their time in care.

Funding Source: Department of Human Services, Victoria Australia

Fight for your right to fruit: Promoting fruit intake in youth using a Manga-style comic

Authors:

May May Leung, Melanie Green, Marci Campbell, Jianwen Cai, Deborah Tate, Alice Ammerman

Purpose: Innovative interventions addressing childhood obesity are needed to capture the attention of youth living in a multi-media environment. The purpose of this study was to determine if a Manga-style comic (Japanese comic art) with embedded messages promoting fruit intake changed related psycho-social variables in middle-school youth.

Methods: A three-group, randomized single-session study was conducted. Participants included 263 middle-school youth, ranging from 9 and 17 years old. Participants were randomly assigned to one of three groups: 1) Attention-Control (newsletter about Ancient Greece), 2) Comparison (newsletter about fruit), or 3) Comic group (Manga-style comic) and received one newsletter or comic. Outcome expectations, self efficacy and knowledge related to fruit intake were measured at baseline and immediately after reading. Secondary outcomes included transportation (how much participants were immersed in their media), enjoyment, and engagement (measured by reading time), measured at post-test. Data was analyzed using regression analyses. Focus groups were conducted to evaluate acceptability and perceived impact of the Comic.

Results/Findings: Comic group participants reported greater outcome expectations compared to Control group (p=0.03) and greater transportation (p<0.01), enjoyment (p<0.05) and engagement (p=0.00) than Control and Comparison groups. Focus group data show majority of Comic group participants enjoyed the graphics and storyline, understood the main message about fruit and felt like eating more fruit after reading the comic.

Conclusions: Study results are promising and suggest that Manga comics may be a useful format to promote positive health beliefs in youth. Further research should be conducted to explore its impact on health behaviors.

Funding Source: American Association of University Women Dissertation Fellowship

O07 Diet, physical activity and mental state: Interventions

Diet, physical activity and mental state: InterventionsO07.1

Eating identities of rural African American’s in the southern U.S.

Authors:

Christine Blake, Sonya Jones, Ann Washington, Jody Ellison

Purpose: The purpose of this study was to determine the eating identities of participants in a chronic disease prevention program. Prior studies have shown that people with healthy eating identities are more receptive to standard nutrition messages and intervention approaches. Assessment of other eating identities may allow for better tailoring of nutrition interventions.

Methods: This study used a mixed-methods sequential exploratory design. A grounded theory approach with in-depth interviews (30 adults over age 35) and the constant comparative method of data analysis were employed. Qualitative results informed development of a cross-sectional survey of 187 rural, African American adults age 35-65 enrolled in an intervention. Hierarchical cluster analysis was used to determine eating identity groups. ANOVA and qualitative findings were used to interpret clustering results.

Results/Findings: Qualitative results yielded insight into types and dimensions of eating identity that provided guidance on the development of 25 eating identity statements. Quantitative cluster analysis of agreement with these statements yielded five eating identities. ANOVA results suggested that clusters could be characterized as picky emotional eaters; emotional overeaters; healthy meat eaters, healthy eaters for health reasons, and moderate adventurous eaters. There was substantial agreement between qualitative eating identity types and quantitative clusters.

Conclusions: These findings provide insight into the eating identities of rural, southern African American adults, an understudied population at higher risk of chronic disease than the general population. A better understanding of eating identity in this population may allow for more meaningful tailoring of nutrition interventions.

Funding Source: Richland Community Health Care Association O07.2

Mediators of weight loss in a multi-site randomized trial of a commercial weight loss program: The role of restraint and disinhibition

Authors:

Nancy Sherwood, Cheryl Rock, Shirley Flatt, Njeri Karanja, Bilge Pakiz, Cynthia Thomson

Background: Successful weight loss and maintenance are challenging, underscoring the importance of understanding mediators of short and longer-term success. Factors such as disinhibition and restraint have been linked with unhealthy eating patterns, but also with successful weight control. Several dimensions of restraint (i.e., flexible, rigid) and disinhibition (i.e., internal, external) have been identified. These analyses examine whether subscale dimensions of restraint, disinhibition and hunger are mediators of weight loss in women enrolled in a randomized clinical trial of a commercial weight loss program.

Method: Adult women (n=442) were randomized to one of three treatment arms, Jenny Craig (JC) Centre-based, JC Direct (telephone-based), and usual care (UC) and are being followed for 24 months. Sub-scales from the Eating Inventory, including Total, Internal and External Disinhibition, Total, Flexible, and Rigid Restraint, and Total, Internal Locus and External Locus Hunger, are examined as mediators of 6- and 12-month weight change.

Results: Treatment group weight change differences were observed at 6 (JC=-8.9 kg (sd=5.0) vs UC=-3.1 kg (sd=5.0), p < .005) and 12 months (JC=-9.9 kg (sd=7.6) vs UC = -2.8 kg (sd=6.7), p < .0003). External disinhibition and total, rigid, and flexible restraint were significant mediators of 6-month weight change. Significant mediators of 12-month weight change included total (B=-0.77), flexible (B=-.346), and rigid (B=-.086) restraint.

Conclusions: Results suggest that changes in external disinhibition, and multiple aspects of restraint are important mediators of weight loss. Future analyses will examine the importance of these constructs for long-term weight loss maintenance.

Funding Source: Jenny Craig

Change in mediators of children’s physical activity and the moderating effect of weight status after the first year of HEIA, a multi-component intervention study

Authors:

Ingunn Holden Bergh, Mona Bjelland, May Grydeland, Nanna Lien, Lene Frost Andersen, Knut-Inge Klepp, Sigmund Alfred Anderssen, Yngvar Ommundsen

Purpose: We examined the effect of the 1st year of the intervention on mediators of change in children’s physical activity and whether effects differed for normal weight versus overweight/obese children.

Methods: Participants were 11-year old children at baseline (control=934; intervention=531). A 2 by 2 between–groups analysis of covariance was conducted with baseline measures of mediators as covariates. Independents were intervention versus control and BMI-category according to IOTF-criteria. Dependents were enjoyment, self-efficacy, perceived social support from teachers and parents at follow-up 1.

Results: We observed no intervention main effect on change in enjoyment and this effect did not differ according to weight status. No intervention main effect on change in self-efficacy was observed. However, an interaction effect of weight status was revealed [F(459,62)=5.05, p=.03]; partial eta square =.004 indicating that, following the intervention normal weight children increased their level of self-efficacy from baseline to follow-up whereas no change in self-efficacy could be observed for the overweight/obese ones. An intervention main effect on change in teachers’ social support was found F(420,39)=9.33, p=.002; partial eta square=.007 indicating that intervention school teachers provided enhanced social support for children’s physical activity from baseline to follow-up. Children’s weight status did not moderate this intervention effect. Regarding change in social support from parents, no intervention main effect, nor moderating effect of children’s weight status could be observed.

Conclusion: Overweight/obese children seemed not to benefit from the intervention regarding self-efficacy enhancement. Nevertheless, teachers may be in the position to enhance levels of physical activity in this group.

Funding Source: The study Health In Adolescents (HEIA) was funded by the Norwegian Research Council with supplementary funds from the Throne Holst Nutrition Research Foundation, University of Oslo and also from the Norwegian School of Sport Sciences.

Identifying specific action plans for young adults: A discriminative analyses approach regarding fruit consumption and exercise behavior

Author:

Gert-Jan de Bruijn

Purpose: The intention-behavior gap is largely caused by inclined abstainers, as compared with inclined actors. Formulating action plans is a self-regulatory strategy facilitating translation of positive intentions into behavior. Research on action plans and health behavior has commonly investigated mediation or moderation aspects of planning in the intention-health behavior relationship and has often not taken past behavior into account. The present study investigated which action plans could be used to distinguish inclined abstainers from inclined actors regarding both fruit consumption and exercise behavior. Behavioral profiles were extended with past exercise and fruit consumption behavior.

Methods: Prospective data were available from 412 undergraduate students, who completed measures of fruit consumption and exercise behavior, intention and planning (when, where, with whom, what kind, how often) at T1. Two weeks later, exercise and fruit consumption behavior were assessed again. Profiles were created from midscale values (intention:yes/no) and meeting public health guidelines (fruit consumption and exercise: yes/no). Data were analyzed using discriminant function analysis (DFA).

Results: Amongst those who held positive intentions (exercise:n=237; fruit:n=238), 43.46% and 38.24% did not follow up on these positive intentions. Regarding exercise behavior, action plans regarding when to exercise and with whom to exercise distinguished inclined actors from inclined abstainers. Regarding fruit consumption, action plans regarding which fruits and when to eat fruit, distinguished inclined actors from inclined abstainers. Results were relatively similar when past behavior was taken into consideration.

Conclusions: The formulation of specific action plans makes behavioral action more likely. A DFA approach enables the identification of these specific plans.

O08 Physical activity in adults

Physical activity in adultsO08.1

Psychometric traits predict reduction in fat mass following a supervised exercise intervention

Authors:

Catherine Gibbons, Phillipa Caudwell, Graham Finlayson, Mark Hopkins, Neil King, John Blundell

Purpose: Eating behaviour traits are associated with food intake and energy balance (Bryant et al, 2008). The extent to which an exercise intervention is successful may be moderated by changes in these traits.

Methods: A 12-week supervised aerobic exercise intervention was conducted in overweight or obese men (n=7) and women (n=14), mean age 43.62±8.29 years, BMI 30.9±4.3kg/m2. Exercise was individually prescribed to expend 2500kcal p/w. At week 0, 6 and 12, psychometric trait characteristics were assessed using Three Factor Eating Questionnaire (TFEQ), Binge Eating Scale (BES) and Power of Food Scale (PFS).

Results: Repeated measures ANOVAs revealed a significant change in body mass (-1.33kg±2.77, p<0.05), fat mass (-1.9kg±2.73, p<0.05), lean mass (+0.52kg±0.87, p<0.05), waist circumference (-4.11cm±3.15, p<0.001) and VO2max (+0.54L/min±0.29, p<0.001). Correlations showed fat loss was significantly associated with decreased TFEQ Hunger and PFS total scores (r=0.556, p<0.01 and r=0.486, p<0.05), but not BES scores. Higher baseline traits of TFEQ Hunger, BES and PFS were associated with greater reductions in fat mass (r=-0.568, p<0.001, r=-0.560, p<0.001 and r=-0.495, p<0.05 respectively).

Conclusions: Psychometric traits TFEQ Hunger, BES and PFS can be considered as psychomarkers of people susceptible or resistant to weight loss during exercise.

Funding Source: Biotechnology and Biological Sciences Research Council Grant Number BB/G530141/1 O08.2

The impact of high-calorie-expenditure exercise on quality of life and exercise enjoyment in high-risk older adults

Authors:

Lizzy Pope, Jean Harvey-Berino, Patrick Savage, Philip Ades, Janice Bunn, Maryann Ludlow, Neil Oldridge

Purpose: The purpose of this study was to assess the acceptability and feasibility of a high-calorie-expenditure (HCE) exercise program in older patients with coronary heart disease participating in a behavioral weight control program.

Methods: Seventy-four patients (mean age=64 years; 60 men; BMI: 32+4kg/m2) were randomly assigned to a 5-month intervention of either HCE exercise (3000-3500 kcal/wk) or standard cardiac rehab (CR) exercise (700-800 kcal/wk). The HCE group performed 45-60 minutes of daily walking while the CR group exercised for 30-40 minutes three times/wk. Both groups received counseling to achieve a dietary caloric deficit of 3500 kcal/wk. Assessments were performed at baseline and 5-months and included self-reported measures of quality of life (MacNew, SF-36) and psychosocial variables (Perceived Stress Scale, Physical Activity Enjoyment Scale, and Geriatric Depression Scale).

Results: Weight loss was significantly greater in the HCE condition (8.2+4 versus 3.7+5kg, p<0.001, n=71). No baseline psychosocial or physical function variables were significantly related to weight loss or exercise outcomes. Changes from baseline to 5-months on scores of physical, emotional, and social functioning were greater for the HCE vs. CR group (p<0.05). HCE exercise also resulted in greater positive change in exercise enjoyment (p=0.05).

Conclusions: As part of a behavioral weight-loss program, HCE exercise resulted in greater weight loss and improvements in self-assessments of physical, social and emotional functioning, as well as greater increases in exercise enjoyment than standard CR. Therefore, even high-risk older adults can be successful in a rigorous exercise program and experience no adverse physical or emotional changes.

Funding Source: NIH grants RO1-HL72851 and the General Clinical Research Center, University of Vermont College of Medicine (RR-109)

Moderate and vigorous physical activity action control: Exploring the role of Conscientiousness and Extroversion

Authors:

Gert-Jan de Bruijn, Ruben de Groot, Bas Van den Putte, Ryan E Rhodes

Purpose: Positive physical activity (PA) intentions do not always lead to behavioural enactment, urging researchers to focus on variables that can identify relevant predictors of PA action control. Research on PA action control has commonly focused on behaviour-specific concepts from cognitive theories, such as the theory of planned behaviour (tpb) and the transtheoretical model. Very little research has studied global behavioural personality dimension as predictors of action control, even though research indicates that personality is related to health and health behaviour. The present study investigated the differential role played by Conscientiousness and Extroversion in action control regarding both moderate and vigorous activity.

Methods: Prospective data were available from 186 respondents, who completed measures of tpb-concepts, extroversion and conscientiousness at T1. Physical activity was assessed at T1 and T2 (=T1+4weeks) with IPAQ. Stepwise logistic regression analyses were performed to predict successful enactment in moderate and vigorous PA respectively using public health guidelines for sufficient PA.

Results: One hundred and sixty-four (88.17%) respondents and 145 (63.41%) respondents, respectively, intended to be sufficiently moderately and vigorously active. At T2, 104 (63.41%) and 112 (77.24%) were, respectively, sufficiently moderately and vigorously active. After controlling for tpb-concepts and past PA, higher scores on Extroversion made successful enactment in moderate PA more likely (OR=1.48, p<.05), while higher scores on Conscientiousness made successful enactment in vigorous PA more likely (OR=1.82,p<.05).

Conclusion: Findings illustrate the differential role played by Conscientiousness and Extroversion in PA action control.

Energy expenditure and motivation differences in Wii Fit games among young adults

Authors:

Elizabeth Lyons, Deborah Tate, Dianne Ward

Purpose: Active video games may encourage physical activity if users are motivated to play. However, little is known about one of the most popular active games, Wii Fit, and how different styles of play may affect energy expenditure or motivation levels. It is possible that some portions of the game, called mini games, may be more active or motivating than others.

Methods: 100 young adults aged 18-35 were randomized to play two Wii Fit mini games (one aerobic and one balance) for 10 minutes each: either jogging or hula hooping (aerobic), and either skiing or penguin slide (balance). Energy expenditure was measured by indirect calorimetry and motivation by the Intrinsic Motivation Inventory. A repeated measures ANOVA was performed with category (aerobic/balance) as a within-subjects and mini game as a between-subjects variable.

Results/Findings: For energy expenditure, an interaction was found between category and mini game (F(1,98)=23.82, P<.001, partialh2=.196). Jogging produced the greatest energy expenditure (5.10 ± 1.70 METs), followed by hula hooping (3.80 ± 1.13 METs). The balance mini games produced lower expenditure (skiing, 1.76 ± 0.49 METs and penguin slide, 1.73 ± 0.42 METs). A main effect of category was found for intrinsic motivation (F(1,95)=20.69, P<.001, partial η2=.179). Balance (31.67 ± 10.58) mini games were significantly more motivating than aerobic (25.97 ± 12.30) mini games.

Conclusions: Portions of Wii Fit considered “light activity” were more motivating than mini games that produced “moderate activity”. Players may choose less active minigames while playing Wii Fit due to their higher reinforcing value, which may affect the game’s health impact.

Funding Source: Robert Wood Johnson Foundation O08.5

Changes in physical activity and nutrition in a behavioral intervention pilot study: Passport to Brain Wellness

Authors:

Leah Hanson, Nancy Sherwood, A. Lauren Crain, Marcia Hayes, Patrick O’Connor, Rachel Matthews, Jacob Cooner

Purpose: Empirical evidence suggests potential benefits of cardiovascular fitness, healthy diet, social integration and participation in cognitively stimulating activities for maintaining cognitive function. We have developed and pilot tested a cognitive-behavioral, phone and mail based intervention to promote such lifestyle changes in older adults.

Methods: Cognitively intact, sedentary adults aged 61-80 years recruited from HealthPartners’ membership. Baseline assessments included cognitive function, biomarkers, lifestyle factors, and physical traits. In phase one, 21 participants were recruited and assigned (non-randomized) to receive a course

book, pedometer, tool kit and 7 bi-weekly phone coaching calls. In phase two, 42 participants were recruited and randomized to either the Guided Intervention (n=22) or a Self-Directed (n=20) group, who received intervention materials but no coaching. We completed 6 month follow-up measures with 58 (92%) subjects.

Results: Enrolled subjects (N=63) were female (60%), 70 years old, highly educated (73%), retired (81%), non-Hispanic White (71%;) married (65%), overweight, normotensive and normocholesterolemic. Mixed-model analyses indicated a time*treatment group effect on objectively monitored MVPA (p<.05), with a significant increase in the guided group. We find a significant effect of time on saturated fat intake (p<.05), with a pre-post reduction among Guided participants. Similar patterns were observed for intake of fruits, vegetables and dietary fiber. Finally, we observed a time effect on intake of fish high in omega-3 fatty acids, driven by an increase in the non-randomized group (p<.05).

Conclusions: Passport shows promise for improving lifestyle behaviors hypothesized as important for the primary prevention of cognitive decline in older adults.

Funding Source: National Institute of Aging

O08.6 Walking and cycling computer workstations: Can office workers be active and productive?

Authors: Leon Straker, Amity Campbell , Jim Levine

Background: Traditional computer workstations require office workers to be seated, resulting in very low occupational physical activity. This represents a major and growing public health risk.

Purpose: The purpose of this study was to determine if office workers could productively use walking and cycling computer workstations.

Methods: Thirty office workers (16 female) performed standardized computer tasks using a traditional sitting workstation and active workstations: walking at 1.6kph and 3.2kpm and cycling at 5 watts and 30 watts. Repeated measures analysis of variance with pairwise contrasts were used to assess differences between workstations.

Results: Heart rate increased during active workstation conditions (walking 1.6khp 83 ±10bpm, 3.2 kph 88 ±11bpm; cycling 5 watts 79 ±10 bpm, 30 watts 89 ±11 bpm) compared with sitting (75 ±10 bpm). Typing speed was slightly reduced during active workstation use (50-53 words per minute) compared with sitting (54 words per minute). Mouse pointing was slower during active workstation use (990-1100 msec) compared with sitting (940 msec). Combined typing and mouse use was also slower during active workstation use (10-12 words) compared with sitting (12.5 words per minute).

Funding Source: Curtin University

O09 Parenting and childhood physical activity and BMI

Parenting and childhood physical activity and BMIO09.1

Do families who eat together also encourage healthy eating?

Authors:

Keryn Pasch, Andrew Springer, Cayley Velazquez, Steven Kelder, Deanna Hoelscher

Purpose: To explore the relationship between family meals and parental encouragement of healthy eating.

Methods: Participants included 2895 ethnically diverse U.S. eighth grade students participating in the Central Texas CATCH Middle School project (m age=13.9; 51.6% Female). Students completed a self-report survey with previously validated items on family meals and parental encouragement of healthy eating behaviors. Family meal frequency was measured with one item on how many times in the past 7 days all or most of the family ate a meal together (range 0-7 or more). Parental encouragement of healthy eating behaviors assessed how often parents encourage the student to eat fruits and vegetables, drink water, eat whole-grain bread, eat breakfast and drink low-fat milk (never to always). An overall scale of parental encouragement of healthy eating was also created (range = 0 to 20). Mixed-effect regression analyses were run controlling for gender, race, age, socio-economic status, and school-level clustering.

Results: Students who had more meals with all or most of their family were also more likely to have parents who encouraged healthy eating behaviors (p<0.001). Family meals were also independently associated with encouragement of each of the healthy eating behaviors: fruits and vegetable, drinking water instead of soda, eating whole-grain bread instead of white bread, eating breakfast every morning, and drinking low-fat, skim or non-fat milk (p<0.0001).

Conclusions: Families who eat together are more likely to also encourage healthy eating in adolescents. These data indicate that interventions to promote healthy eating in adolescents should target family eating patterns.

Funding Source: Michael & Susan Dell Foundation

Parent and child physical activity and sedentary time: Do active parents foster active children?

Authors:

Russell Jago, Kenneth Fox, Angie Page, Rowan Brockman, Janice Thompson

Purpose: Many children do not meet physical activity recommendations and exceed screen-viewing guidelines. Parents are likely to be an important influence on children’s behaviors.

Methods: Year 6 children and their parent were recruited from 40 UK primary schools. Mean minutes of moderate to vigorous physical activity (MVPA), minutes of sedentary time per day and counts per minute were assessed by accelerometer. Self-reported hours of TV viewing were coded into 3 groups (< 2 hours

per day, 2-4 hours per day and >4 hours per day. Linear and multi-nominal regression models were run by child gender to examine parent-child associations.

Results: In linear regression models there was an association for the overall sedentary time of girls and their parents (t= 2.04. p=.020) but there was no association between girls’ and parents’ physical activity. For girls, the risk of watching more than 4 hours of TV per day, (reference = 2 hours of TV per day), was 3.67 times higher if the girl’s parent watched 2-4 hours of TV per day (p = 0.037). For boys, the risk of watching more than 4 hours of TV per day, was 10.47 times higher if the boy’s parent watched more than 4 hours of TV per day (p = 0.038).

Conclusions: Higher parental TV viewing was associated with an increased risk of high levels of TV viewing for both boys and girls. There were no associations between the time that parents and children spend engaged in physical activity.

Funding Source: This study was funded by a project grant from the British Heart Foundation (ref PG/06/142). This report is also research arising from a Career Development Fellowship (to Dr Jago) supported by the National Institute for Health Research. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health.

Patterns of maternal feeding responsiveness during infancy

Authors:

Eric Hodges, Todd Schwartz, Margaret Bentley

Purpose: A chronic mismatch between a caregiver’s feeding behavior and the infant’s state of hunger or fullness has been proposed to contribute to childhood obesity. Yet due to a lack of longitudinal studies we know nothing about patterns of maternal feeding responsiveness (MFR) during infancy. This study aims to characterize these patterns.

Methods: A secondary analysis was performed on a dataset of first time, low-income African-American mother-infant pairs assessed at infant age 3, 6, 9, 12, and 18 months. A subsample with the 15 highest, middle, and lowest infant BMI Z-scores at 18 months was selected (n=45). Feeding responsibility (1 [completely mother fed] to 5 [completely self-fed]) and MFR (1 [highly unresponsive] to 5 [highly responsive]) were assessed using the Responsiveness to Child Feeding Cues Scale (Fisher, et al., unpublished). Using a random intercepts, mixed-effects, polynomial linear model, differences in MFR were tested over consecutive time points. Nominal p-values are reported.

Results: For responsiveness to eating receptiveness,no significant changes were found. For responsiveness to fullness cues, drops were detected between 3-6 months (-.56±.15, p<.001) and 6-9 months (-.19±.06, p=.002); an increase was noted between 12-18 months (.28±.13, p=.03). Ninety-one percent were completely fed by mother at 3 months compared to 16% at 18 months. In contrast, 2% of infants were self-feeding with little or no assistance at 3 months compared to 66% at 18 months.

Conclusions: Mothers may be less responsive to infant fullness cues during developmental transitions in which feeding responsibility is largely shared by mother and infant.

Funding Source: NIH DK56350

Is parental care a moderator for the association between parenting practices and health behaviours of children aged 10-11 in Finland?

Authors:

Eva Roos, Carola Ray, Mirjam Kalland

Purpose: Parenting style, including parental care, is a general interaction between parent and child, whereas through parenting practices parents perform their parental duties like having practices about bed screen time. Parenting practices have been associated with more favorable health behaviours among children. The aim is to examine whether parental care is a moderator for this association. Our hypothesis is that parenting practices have a stronger association with children’s favorable health behaviours if children perceived parental care compared to no care.

Methods: Cross-sectional study in Helsinki region in 2006. 1271 children aged 10-11 (response rate 79%) and 816 parents (64%) answered questionnaires. 801 matching child parent pairs used in analysis. Children were asked about food frequency intake, meal pattern, screen time, sleep duration, parenting practices and parental care. Parents reported additional parenting practices. Logistic regression used in analyses.

Results: Interaction analysis between parenting practices and parental care for children’s health behaviours showed no interactions. Stratified analyses showed trends; the amount of practices increased the odds of having a higher intake of nutrient dense food and a regular meal pattern if children perceived parental care but not when children did not perceive care. In screen time amount of practices increased the odds of having less screen time only when children perceived no parental care.

Conclusion: Stratified analyses gave some support for our hypotheses that parenting practices are more strongly related to health behaviours when children perceived care at same time. Further studies in a larger population are needed to confirm this hypothesis.

Funding Source: Samfundet Folkhälsan, The Päivikki and Sakari Sohlberg Foundation, the Signe och Ane Gyllenbergs Foundation, Juho Vainion Säätiö, Victoria Stiftelsen

Parents’ use of food choice coping strategies: Associations with work and family conditions and dietary quality

Authors:

Christine Blake, Carol Devine, Elaine Wethington, Tracy Farrell, Carole Bisogni

Purpose: Work and family conditions are important behavioral contexts that influence diet. A pilot telephone survey was conducted to study relationships between employed parents’ work and family conditions, food choice coping strategies, and dietary quality.

Methods: Survey respondents were Black, white and Hispanic employed mothers (25) and fathers (25) randomly recruited from low/moderate income urban zip codes; 78% of those reached and eligible participated. The survey assessed parents socio-demographic characteristics, work conditions (e.g. hours, shift), use of 22 food choice coping strategies, and dietary intake (2-24 hour recalls). Cluster analysis, chi-square and Fisher’s exact test were used to investigate associations between parents’ work and family conditions, food choice strategies, and dietary intake. Cluster differences in dietary quality (Healthy Eating Index-2005 (HEI)) were assessed with ANOVA.

Results: Three clusters differed significantly on food choice coping strategies, diet quality and behavioral contexts. Individualized Eating and Missing Meals clusters were characterized by non-standard work hours, having a working partner, single parenthood, eating family meals away from home, grabbing quick food instead of a meal, using convenience entrees at home, and missing meals or individualized eating. Home Cooking included more married fathers with non-employed spouses. HEI scores differed significantly by cluster.

Conclusions: Work and family conditions serve as behavioral contexts that influence use of food choice coping strategies associated with diet quality among working parents. Combinations of strategies used by working parents’ and related work and family conditions suggest policy and research approaches to improve family nutrition.

Funding Source: National Cancer Institute and USDA

Parenting styles, parenting practices and physical activity in 10-11 year olds

Authors:

Russell Jago, Kirsten Davison, Rowan Brockman, Angie Page, Janice Thompson, Kenneth Fox

Purpose: To examine how parenting styles and parenting practices are associated with children’s physical activity.

Methods: Cross-sectional survey of 792, 10-11 year old children. Accelerometer assessed physical activity and mean minutes of moderate to vigorous physical activity per day (Mean MVPA) and mean counts per minute (Mean CPM) were obtained. Parenting style and physical activity parenting practices were self-reported. Analysis of variance and regression models were used to examine associations.

Results: Girls with permissive parents had a higher Mean MVPA than girls with authoritative parents (33.71 vs. 28.23 minutes per day). Boys with permissive parents had a higher Mean CPM than boys with authoritative parents (673.0 vs. 586.6 CPM). Permissive parenting (ref Authoritative) was associated with Mean MVPA among girls (t = 4.24, p<.001) and Mean CPM (t= 2.57, p = 0.014) among boys. Maternal logistic support was associated with Mean CPM for girls (t=3.43, = 0.001), while paternal logistic support was associated with boys’ Mean MVPA (t=2.03, p = 0.049) and Mean CPM (t=2.58, p = 0.014).

Conclusions: Permissive parenting was associated with higher levels of physical activity among 10-11 year old boys and girls. Gender specific parental logistic support was associated with higher levels of physical activity. Gender specific facilitation of children’s physical activity and parenting styles are likely to be important influences on children’s physical activity.

Funding Source: This study was funded by a project grant from the British Heart Foundation (ref PG/06/142). This report is also research arising from a Career Development Fellowship (to Dr Jago) supported by the National Institute for Health Research. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health.

O10 Neighborhood and physical activity

Neighborhood and physical activityO10.1

Variations in observed park physical activity intensity level by gender and race across age groups

Authors:

Andrew Kaczynski, Sonja Wilhelm Stanis, Tanis Hastmann, Gina Besenyi

Purpose: Parks are important settings for physical activity (PA), but few studies have documented the actual behaviors of park users. This study explored whether PA intensity levels differed between park users by gender/race and across age groups.

Methods: In July/August 2009, four large parks in Kansas City, Missouri were observed using the System for Observing Play and Recreation in Communities (SOPARC). Trained observers recorded the age group, gender, race, and intensity level (sedentary, moderate, or vigorous) of all park users present in 83 activity areas, scanned at hourly intervals across 39 hours over two weekends (Fri, Sat, Sun) at each park. Logistic regression examined whether, compared to female-non-White users (reference group), male-White, female-White, and male-non-White users were more likely to be observed engaging in moderate-to-vigorous PA (MVPA) rather than sedentary activity. These differences were examined across four age groups.

Results: In total, 8612 users were observed during the study (child=1857; teen=495; adult=5798; senior=462). In the child age group, relative to female-non-White, male-White users were significantly more likely to be observed in MVPA (OR=1.46,95% CI=1.12-1.91). For teens, female-White (OR=.50,CI=.29-.89) and male-White (OR=.49,CI=.28-.85) users were less likely to engage in MVPA than female-non-White users. For both adults and seniors, female-White (ORadults=1.36,CI=1.15-1.61; ORseniors=3.15, CI=1.23-7.72) and male-White (ORadults=1.45,CI=1.23-1.72; ORseniors=4.23, CI=1.78-10.35) users were more likely to be observed in MVPA.

Conclusions: Our findings showed that male-White and female-White users generally were more likely to engage in MVPA, though this trend was reversed among teens. Future interventions should emphasize culturally-sensitive park design that promotes increased MVPA among diverse groups.

Generational differences in park-based physical activity: Implications for health

Authors:

Sonja Wilhelm Stanis, Ingrid Schneider

Purpose: Public parks are important places for leisure time physical activity (LTPA) and public health. Despite research that indicates age can influence physical activity, studies examining generational differences in park-based LTPA and factors influencing it are scarce. Therefore, this study examined differences in self-reported park-based LTPA, motivations, constraints, and negotiation strategies among

Baby Boomers (born 1946-1964), Generation-X (GenX; born 1965-1978) and Generation-Y (GenY; born 1979-1989) adult visitors.

Methods: Data were collected among Afton State Park visitors in Minnesota via onsite and follow-up questionnaires May through September 2007 (74.1% response rate; n=426). The instrument included questions on respondent demographics, motivations, constraints, negotiation strategies, and LTPA at Afton State Park. LTPA was measured using questions selected from the Behavioral Risk Factor Surveillance System querying frequency, duration and intensity, resulting in total hours of LTPA at the site over the past 12 months for each intensity level (moderate and vigorous). Analysis of variance followed by Tukey’s HSD tested for differences by generation.

Results: The largest generation group of visitors was Baby Boomers (39.7%), followed by GenX (33.6%) and GenY (26.7%). When differences emerged, GenY respondents were consistently different than the others: they reported less moderate LTPA at Afton State Park than Baby Boomers (F=3.95, p<.05), greater achievement motivation (F=3.29, p<.05) and greater use of interpersonal coordination strategies (F=7.90, p<.001).

Conclusions: As park and recreation areas strive to improve opportunities for physical activity and subsequent citizen health, examining these generation differences provides both insight for management and guidance for future research.

Funding Source: University of Minnesota; Graduate School Fellowship: Natural Resources Science and Management Graduate program

The longitudinal influence of home and neighbourhood environments on children’s body mass index and physical activity over five years: The CLAN study

Authors:

David Crawford, Verity Cleland, Anna Timperio, Jo Salmon, Nick Andrianopoulos, Billie Giles-Corti, Louise Baur, Kylie Ball

Purpose: Determine the contributions of family and neighbourhood environments to changes in youth physical activity and BMI z-score over five years.

Methods: In 2001, 2004 and 2006, 301 children (10-12 years at baseline) had their height and weight measured (body mass index was converted to z-scores) and moderate-to-vigorous intensity physical activity (MVPA) assessed using accelerometers. In 2001, parents reported on the home environment (social support, role modeling, rules and restrictions, physical environment) and neighbourhood environment (local traffic, road safety, sporting venues, public transport), and GIS were used to map the neighbourhood environment (destinations, road connectivity, traffic exposure). Generalised estimating equations were used to predict average BMI z-score and MVPA over time from baseline home and perceived and objective neighbourhood environments.

Results: Among boys, maternal education and heavy traffic were inversely associated, and sibling activity and maternal role modeling of MVPA and the presence of dead-end roads, were positively associated

with MVPA. Having unmarried parents, maternal MVPA role modeling, and number of home sedentary items were positively associated with BMI z-score among boys. Among girls, having siblings, paternal MVPA role modeling, physical activity rules, and parental physical activity co-participation were positively associated with MVPA. Having unmarried parents and maternal sedentary behaviour role modeling were positively associated, and number of sedentary behaviour rules and physical activity items were inversely associated, with BMI z-score among girls.

Conclusions: Physical activity and weight gain programs among youth should focus on parental role modeling, rules around sedentary and active pursuits, and parental support for physical activity.

Funding Source: National Health and Medical Research Council; Financial Markets Foundation for Children

Cross-sectional and longitudinal associations between the neighbourhood environment and sedentary behaviours among children: The CLAN study

Authors:

Jenny Veitch, Jo Salmon, Anna Timperio, David Crawford, Gavin Abbott, Billie Giles-Corti

Purpose: There is concern that children are spending too much time in sedentary screen-based activities and this is having a negative impact on their health. This longitudinal study examined how features of neighborhood public open spaces (POS) and other environmental features may influence children’s participation in sedentary behaviour.

Methods: In 2004 and 2006, parents completed a survey reporting the time their child usually spent watching TV and using computers and screen based electronic games; and proportion of sedentary time was objectively measured. Parents also reported on their perceptions of the physical and social neighbourhood environment, and an audit was completed for the POS located closest to each participant’s home.

Results: Data were analysed for 171 children, mean age 9 years. Cross-sectional analyses showed that living near a POS with a water feature was negatively associated with time spent in computer/e-games. Greater parental satisfaction with the quality of neighbourhood parks and playgrounds was also negatively associated time spent in computer/e-games. The number of recreational facilities was positively associated with objectively-assessed sedentary time. Longitudinally, greater parental satisfaction with the quality of the parks and playgrounds in the neighbourhood in 2004 was negatively associated with TV viewing in 2006. Having a walking path in the POS in 2004 was positively associated with time spent in computer/e-games in 2006. Living in a cul-de-sac was negatively associated with computer/e-games in 2006.

Conclusions: These findings suggest that some features of the neighborhood environment may influence the time children spend in sedentary behaviours and this has important implications for future research.

Funding Source: National Health and Medical Research Council; Finanical Markets Foundation for Children

Use of cognitive testing to assess the perceived walkability of specific built environment attributes

Authors:

Nicolas Oreskovic, Suzanne Lanyi Charles, Dido Tsigaridi, Pablina Roth, Kathrine Shepherd, Moshe Bar

Purpose: The built environment (BE) has been proposed as a means to promote physical activity. Determining which BE attributes are most useful to promote walking, however, is less clear. We aimed to determine the perceived walkability of specific BE attributes.

Methods: Cognitive testing was used to assess the degree to which various BE attributes unconsciously promote one’s desire to walk. 424 color photographs of street-scenes were separately rated by two architects on the presence of 4 BE attributes (street-wall height, street-wall plane, presence of ground-level windows, and focal points). Twenty-nine adult (>18 years) subjects viewed each image for 1 second on a computer, then rated the image for perceived walkability on a continuous 1-5 scale. Pearson correlations, multivariate linear regression, and mixed-effects models were used to assess for associations between BE attributes and walkability.

Results: In bivariate analysis, statistically significant associations were found between walkability and plane, windows, and focal point, but not height. Variation in street-wall plane was inversely associated with perceived walkability, whereas windows and a focal point were positively associated. In multivariate analyses, plane, windows, and focal point remained significantly associated with walkability (p<0.01 for all), with a model r-squared of 0.285 (p<0.001). Findings were similar using mixed-effects.

Conclusions: Identifying design attributes that unconsciously promote an individual’s desire to walk could allow for the construction of healthier spaces with real public health benefits. We demonstrate that specific attributes - the plane of a building, amount of ground floor windows, and presence of focal points - significantly enhance a given space’s walkability.

Funding Source: The Harvard Catalyst | The Harvard Clinical and Translational Science Center (NIH Grant #1 UL1 RR 025758-01 and financial contributions from participating institutions.

Associations between neighbourhood walkability and adolescents’ physical activity: The BEPAS Youth Study

Authors:

Greet Cardon, Ilse De Bourdeaudhuij, Benedicte Deforche, Femke De Meester

Purpose: Research on the impact of neighbourhood environmental factors on adolescents’ physical activity (PA) is scarce. This study examined the associations between neighbourhood walkability and socio-economical status (SES) and the level of PA in adolescents.

Methods: In Ghent (Belgium), 32 neighbourhoods were selected based on their walkability and SES. For each neighbourhood a walkability index was calculated using 3 environmental features of the neighbourhood: residential density, connectivity and land use mix. Those 3 features were determined using Geographic Information Systems (GIS). The neighbourhood SES was based on neighbourhood income data. In the participating adolescents (n=466, aged 13 to 15), PA was assessed using the validated Flemish Physical Activity Questionnaire. Furthermore, the participants were asked to wear an accelerometer during 7 consecutive days.

Results: The accelerometer data revealed that adolescents living in high walkable neighbourhoods engaged in more moderate PA (23.5±16.1 min/day vs. 18.9±11.3min/day) (p<0.001) and moderate to vigorous PA (24.9±17.1 min/day vs. 20.3±12.6 min/day) (p<0.001) than adolescents in low walkable neighbourhoods. Adolescents in low SES neighbourhoods reported more active transport (37.0±27,0min/day vs. 26.2±22.7min/day) (p<0.001) than adolescents in high SES neighbourhoods. Furthermore, adolescents in low SES neighbourhoods were also more sedentary (723.0±96.9min/day vs. 692.9±112.9min/day) (p=0.022) than adolescents in high SES neighbourhoods.

Conclusions: The results of this study indicate that there is a clear association between neighbourhood walkability and SES and Belgian adolescents’ PA.

Funding Source: Support for this study was provided by a research grant from Ghent University.

O11 Socioeconomic disadvantage

Socioeconomic disadvantageO11.1

Processes and outcomes of a capacity building intervention to promote physical activity among underserved youth

Authors:

Paula Louise Bush, Enrique García Bengoechea, Sharon Parry

Purpose: Organization-University collaborations can be an effective means to build organizational capacity to promote physical activity (PA). However, collaborative research designs are lacking in youth PA intervention research. In this study, university researchers collaborate with a local YMCA to co-created relevant means to promote PA to adolescents of an underserved community. Specifically, the ways in which the YMCA’s capacity to promote meaningful PA opportunities to the neighbourhood adolescents changes, as a result of the collaboration, is explored.

Methods: The YMCA’s adoption, implementation, and potential long-term use (maintenance) of various PA promotion strategies were assessed. Field notes, interview transcripts, meeting minutes, emails, and various organizational documents were analyzed using constant comparison procedures. Analysis was guided by a framework of relevant capacity building indicators regarding organizational development and the fostering of partnerships and networks.

Results/Findings: Results of this ongoing intervention indicate the YMCA is beginning to change regarding the use of effective planning strategies. Specifically, strategies of social marketing (e.g., population segmentation, use of appropriate communication channels) have been adopted, employees reflect on how and why things are done, and a youth advisory council is being developed. Also, partnerships with other community organisations have been created and are fostered.

Conclusions: Findings suggest that a collaborative approach is an effective means to build the capacity of a YMCA by developing PA promotion knowledge that is relevant to the centre. Lessons learned about the processes of collaboration can be applied to other settings concerned with the promotion of adolescent PA.

Funding Source: Fonds Québecois de la recherche sur la société et culture (FQRSC) Doctoral Student Award

Associations of home food availability and children’s food intake with body mass index (BMI) of Native American children and their parents

Authors:

Chrisa Arcan, Mary Story, Jayne Fulkerson, Peter Hannan, John Himes, Mary Smyth, Teri Burgess-Champoux

Purpose: To assess associations of home food availability and children’s food and beverage intake with BMI of Native American kindergarten children and their parents/caregivers.

Method: A cross-sectional analysis of baseline data collected as part of a school-based obesity prevention trial (Bright Start) on a Northern Plains Indian reservation. Children in kindergarten (n= 418, 51% male; mean age=5.8 years, 30% overweight/obese) and parents/caregivers (89% female; 85% overweight) had their height/weight measured and parents/caregivers completed surveys on home food availability and children’s food intake. Mixed model multivariate analysis was used to examine associations of home food availability scores (sugar-sweetened beverages, fruits, vegetables (no potatoes), sweet and salty snacks, energy dense foods) with child BMI z-score and parent/caregiver BMI. Associations between child’s intake scores of the same foods and child BMI z-score were also examined. Analyses were adjusted for socioeconomic status; study condition; child or parent/caregiver gender and age; and the random effect of school.

Results: Compared to normal weight, parental BMI was associated with higher probability of child overweight (p=0.024) and obesity (p<.0001). Fast food intake (p=0.018) was associated with higher probability of child overweight while home vegetable availability (p=0.048) and intake (p=0.017) were associated with lower probability of obesity. Among parents/caregivers, availability of sugar-sweetened beverages (p=0.045) and salty snacks (p= 0.036) were associated with higher probability of being overweight and obese, respectively.

Conclusion: Findings indicate that home food availability and intake are important in relation to weight status of Native American family members. Obesity interventions with this population should also include a focus on increasing the home availability of vegetables and decreasing availability of sugar-sweetened beverages.

Funding Source: R01 HL078846 (PI: M. Story)

Socioeconomic disadvantage and obesity: Who is “resilient”?

Authors: Kylie Ball, Gavin Abbott, Verity Cleland, Anna Timperio, Johannes Brug, Abby King, Robert Jeffery, David Crawford

Purpose: Socioeconomic disadvantage is inversely associated with obesity risk amongst women, but not all women experiencing disadvantage become obese. Understanding characteristics of women who appear ‘obesity-resilient’ despite their disadvantaged circumstances represents a novel avenue to inform obesity prevention efforts. This study aimed to explore predictors of obesity and ‘resilience’ to obesity amongst women living in socioeconomically disadvantaged neighbourhoods.

Methods: Data on height, weight, sociodemographic, behavioural, personal, social and environmental factors were collected in a postal survey completed by 3756 women living in 80 neighbourhoods of Victoria, Australia. Bivariable logistic regression analyses examined factors associated with a healthy weight category, as opposed to being overweight/obese. Structural equation modelling was used to test a multivariable model of the key factors predicting body weight.

Results: ‘Obesity-resilient’ women tended to be younger; born overseas; speak a language other than English at home; not yet married; more educated; have a higher household income; and not have children. Behaviourally, obesity-resilient women were more likely to consume more fruit and fruit juice, but fewer pies/pasties/sausage rolls and soft drinks; spend more time in leisure-time physical activity and

less time watching TV and in overall screen viewing; and to never have smoked. A theoretically-derived multivariable model predicting body weight from key personal, behavioural, social, and environmental factors showed a good fit to the data.

Conclusions: These results highlight key factors that are associated with resilience to obesity amongst a high-risk target group. Interventions targeting these factors may assist in promoting healthy weight amongst others experiencing socioeconomic disadvantage.

Funding Source: Australian National Health and Medical Research Council

Overweight/obesity and dietary and physical activity practices among regular and alternative high school students in Minnesota

Authors:

Karen Johnson, Martha Kubik, Barbara McMorris

Purpose: To compare overweight/obesity prevalence and dietary/physical activity (PA) practices among students attending alternative high schools (AHS) and regular high schools (RHS) in Minnesota. Found in many countries, AHS’s serve students at-risk for academic failure who are disproportionately minority and low-income. Previous findings from the US, which are more than a decade old, indicated disparities between AHS and RHS students.

Methods: Cross-sectional analyses of the 2007 Minnesota Student Survey (RHS students=87,468; mean age=15.93; 51% female; 22% minority; AHS students=2,847; mean age=16.96; 46% female; 44% minority) were examined. Prevalence estimates, adjusted for age and race/ethnicity, were compared for selected practices and BMI, based on self-reported height/weight.

Results: AHS students were more likely than RHS students to report dieting (22% vs. 19%, p=.001) or taking diet pills (7% vs. 4%, p<.0001) to lose weight, and eating ≤ 5 daily servings of fruits/vegetables (86% vs. 83%, p=<.0001), but less likely to report exercising to lose weight (38% vs. 49%, p<.0001), vigorous PA (52% vs. 62%, p<.0001) and participating on school (19% vs. 51%, p<.0001) or community (22% vs. 48%, p<.0001) sports teams. More AHS than RHS students were overweight (37% vs. 28%, p<.0001) and obese (18% vs. 12%, p<.0001).

Conclusions: The higher prevalence of overweight/obesity and unhealthy dietary/PA practices among AHS students places them at increased risk for chronic health conditions during adolescence and adulthood. Further study is warranted in Minnesota and elsewhere to understand associated factors and effective strategies that support a healthy weight among this high-risk student population.

Funding Source: This research was supported by a grant from NIH/NIDDK R21DK072948 and by the Adolescent Health Protection Program grant number T01-DP000112 from the Centers for Disease Control and Prevention (CDC). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC.

Socioeconomic differences in weight-control behaviors among a population-representative group of mid-aged adults

Authors:

Jessica Siu, Katrina Giskes, Gavin Turrell

Purpose: This study examined socioeconomic differences in weight-control behaviors.

Methods: Data was obtained from 1012 men and women aged 45 to 60 years residing in Brisbane, Australia (69.6% response rate). Data were collected by a postal questionnaire, which provided information on past and current weight-control behaviors. Socioeconomic position was characterised by highest attained education, household income and occupation.

Results: Socioeconomically-disadvantaged participants were less likely to report engaging in weight-control in the past 12 months. Those with secondary school or lower education (OR= 0.58, 95% C.I. 0.41-0.82), working in a blue-collar profession (OR= 0.36, 95% C.I 0.22- 0.60), not in the work force (OR= 0.62, 95% C.I. 0.41- 0.94), or who belonged in the 1st quartile of equivalised household income (OR= 0.64, 95% C.I. 0.41- 0.98) were less likely to report trying to lose weight and/or avoid weight gain in the past 12 months. There were no significant differences between socioeconomic groups in engaging in potentially health-promoting or health-damaging weight-control behaviors.

Conclusion: Socioeconomic differences in weight status may be due to differences in engaging in weight-control behaviors. However among those who do wish to maintain or lose weight, there are no socioeconomic differences in the nature of the strategies they employ.

Funding Source: from Queensland University of Technology

Tracking overweight emergence in a national sample of children between kindergarten and fifth grade: Association with household food stamp program participation

Authors:

T. Elaine Prewitt, Shelly Lensing, Zoran Bursac, Martha Phillips

Purpose: To investigate the association of baseline food stamp program participation with weight trajectory between kindergarten and fifth grade in a national sample.

Methods: Participants in the Early Childhood Longitudinal Study (ECLS-K) class of 1998-1999 who were 5th- <85th percentile for age- and gender- adjusted BMI (CDC 2000 growth charts) during their kindergarten year comprised the analysis cohort (n=7446). Household food stamp participation, physical activity, BMI percentile, gender and race at kindergarten were investigated in a weighted logistic regression model predicting 5th grade weight status (>85th vs. <85th percentile).

Results/Findings: Overall, 26% of the kindergarteners were ≥85th percentile by fifth grade. Sixteen percent of the children were from households that received food stamps. Thirty-four percent of food

stamp participants in kindergarten were overweight by fifth grade compared with 25% for children whose families were not receiving food stamps (P<0.001). In multivariable analyses predicting overweight, gender interacted significantly with food stamp participation. Girls whose households received food stamps were 4.2 times more likely to be overweight by 5th grade as compared to their female counterparts (P<0.001). The impact of food stamps was not significant in boys. Race also significantly interacted with food stamp participation. Notably, 43% of whites from families receiving food stamps were overweight by 5th grade compared with 23% of whites not receiving food stamps.

Conclusions: Food stamp participation at kindergarten is associated with being overweight by 5th grade, and gender and race have differential effects on this relationship.

O12 Physical activity and healthy eating promotion in children (#1)

Physical activity and healthy eating promotion in children (#1)O12.1

Can young children’s eating behavior be improved by a preschool educational intervention? Results from a cluster-randomized trial in Germany

Authors:

Freia De Bock, Luise Breitenstein, Joachim Fischer

Purpose: To assess the impact of a nutritional intervention on eating behavior and anthropometric measures in south German preschoolers.

Methods: A cluster-randomized trial approach was used, which involved randomizing preschool-bound clusters of children to either the intervention or wait list control arm, after stratifying them according to geographical location and aggregate social status. The six-month intervention consisted of once weekly practical nutrition lessons and joint activities for children and parents, delivered by a nutritional expert. Assessments, conducted before the intervention then at six and twelve months, were performed using a parental questionnaire focusing on children’s nutritional behavior and anthropometric data (weight, BMI, skin-fold thickness). Using random effects panel regression models, we evaluated the intervention impact on primary outcomes (fruit and vegetable intake, water and sugared drinks consumption) and secondary outcomes (BMI, skin fold sum and waist-to-height-ratio). All analyses were adjusted for age, gender and maternal education.

Results/Findings: The majority (79%) of all eligible preschoolers were recruited from 18 preschools in three south German regions. Based on the sufficiency of data available, 348 preschoolers (mean age 4.3; 47% girls) were included in the study. The intervention significantly increased children’s reported fruit and vegetable intake (p<0.001 and p><0.05, respectively). No significant change by intervention was found for children’s reported consumption of water, sugared drinks or measured anthropometric data.

Conclusions: Nutritional interventions in preschools may have the potential to alter eating behaviors early in young children and might therefore be relevant to improving child public health.

Funding Source: Landesstiftung Baden-Wuerttemberg, Stuttgart (Germany)

Healthy body weight: From theory and strategy to the implementation of a nationwide program in switzerland - Lessons learnt from the field

Authors:

Jvo Schneider, Chiara Testera Borelli, Quinta Schneiter

Published every five years, Swiss Health Surveys in 1992, 1997 and 2002 showed a significant increase in overweight and obesity. In 2006, Health Promotion Switzerland (HPS) - a national foundation - defined a clear strategy and important goals: Decelerate the trend for increasing overweight prevalence among children and youth until 2010. Improve the number of people with healthy body weight until 2018. Since

2006, HPS has established different monitoring projects regarding physical activity, behavioral nutrition and body weight.

In 2007, HPS has started its “cantonal programs for health body weight” focusing projects with children and youth in Swiss federal states (cantons). The program consists of four levels: intervention level: children and youth; policy level: federal states; capacity building (communities, federal states, networks and organizations); public relations / communication. The programs are embedded in a national campaign, nationwide events and projects to mobilize the target groups and cooperation with alliances and networks.

In 2007, cooperation started with seven cantons. In 2009, we cooperate with 22 out of 26 cantons. Based on our new state of the art report (to be published in June 2010) we are going to present our lessons learnt: from theory and strategy to implementation and evaluation - cases from the field; results from policy monitoring on federal and state level; media monitoring; monitoring regarding behavioral nutrition, physical activity and body weight; overview of research centers and projects as well as players, networks and alliances; future outlook on making such programs sustainable.

Funding Source: Swiss Federal States / Health Insurance Levy

Obesity prevention and youth sport: What do we really know?

Authors:

Toben Nelson, Megan Thomas, Nicole LaVoi, Katherine Bauer, Steven Stovitz, Dianne Neumark-Sztainer

Purpose: To review existing research on obesity prevention in youth sport and assess how the snacks and beverages commonly consumed by youth sport participants compare to the energy expended in sport.

Background: Participation in youth sport is recommended for increasing physical activity, but little research exists on whether it can prevent obesity.

Methods/Key Points: We conducted a systematic review comparing sport participants with non-participants on weight status, physical activity and dietary habits. We also estimated energy balance in youth sport by comparing energy intake from snacks and beverages commonly consumed youth sport participants with expenditure based on the Compendium of Energy Expenditures for Youth (Ridley et al., 2008). Many youth sport participants are overweight, these trends have increased over time, and the evidence on whether sport participants are less likely to be overweight is mixed. Sport participants are more physically active than those who do not participate. Little research has compared dietary behaviors between sport participants and nonparticipants but available studies suggest that participants consume more sugar-sweetened beverages, fast food and overall calories than nonparticipants. Marketing of unhealthy food and beverages is common in sport. Sport participation may paradoxically place youth in energy surplus if they consume foods and beverages that are widely available in youth sport settings.

Conclusions: The promise of obesity prevention in youth sport requires wider understanding of how sport contributes to energy balance. Greater attention to the dietary habits of youth sport participants and the marketing of unhealthy food and beverages to this audience is needed.

Funding Source: National Cancer Institute Transdisciplinary Research on Energetics and Cancer

Use rabbit or rhino to sell a carrot? The importance of character-product congruence in making vegetables more appealing to children

Authors:

Simone de Droog, Moniek Buijzen, Patti Valkenburg, Gert-Jan de Bruijn

Brand characters are used extensively to market unhealthy foods to children. In light of the child obesity debate, the consumption of healthy foods could be promoted by placing brand characters on fruit and vegetables. In previous research, preschoolers have displayed a greater preference for character-branded fruit packages over non-branded fruit packages. Even more promising, character-branded fruit evoked liking and purchase request ratings that were comparable to candy. The present study explored the role of character design (i.e., character-product congruence) in predicting the success of unfamiliar brand characters. In a repeated measures experiment among 121 preschoolers, we investigated the role of (1) conceptual congruence and (2) perceptual congruence between the character and the product. In a repeated measures design, we assessed the children’s liking of and preference for the following five character-product combinations: conceptually congruent (carrot and rabbit), perceptually congruent (carrot and orange rhino), both conceptually and perceptually congruent (carrot and orange rabbit), incongruent (carrot and rhino), and familiar (carrot with licensed TV-character). Results showed that preschoolers matched characters and products primarily based on conceptual cues. The conceptually congruent, both conceptually and perceptually congruent, and TV-character combinations where liked and preferred the most, while non-congruent combinations where liked and preferred the least. Our results indicate that even unfamiliar characters can make healthy products more appealing to preschoolers, and potentially increase their willingness to try and eat the product, provided that the character conceptually matches with the product.

Children’s activity levels, lesson context and teacher involvement during pre-school physical education

Authors:

Eveline Van Cauwenberghe, Jessica Gubbels, Valery Labarque, Ilse De Bourdeaudhuij, Greet Cardon

Objective: Well-delivered Physical Education (PE) classes can contribute to reach the recommended PA levels on preschool attending days. The present study aims to describe PA engagement levels during preschool PE lessons and to evaluate how they are predicted by lesson variables and teacher involvement.

Methods: A random sample of 573 pre-schoolers (age: 4.8 ± 0.4; 50% boys) from 35 different preschools, wore an accelerometer during one PE class. Additionally, the lessons were videotaped and quantified according to the System for Observing Fitness Instruction Time (SOFIT). Multilevel analyses were conducted to examine the contribution of lesson variables and teacher involvement to PA engagement, taking clustering of children within preschools into account.

Main Results: According to the accelerometer output 56% of the lesson times was spent sedentary, 30% in MVPA, with no gender differences. The most prevalent lesson context was skill practice (42%)

and the teachers were instructing during the majority of the lesson time (48%). Significant predictors of higher percentages of MVPA engagement during PE were: less general lesson content (time allocated to transition, management, break) (p= 0.02), more skill practice lesson content (p= 0.03), less teacher involvement in promoting fitness (p= 0.05), longer lessons (p< 0.001) and more space per child (p= 0.02).

Conclusion: Efforts are needed to manage preschool PE lesson time in order to include more MVPA. Besides striving for more time allocation to PE and quality PE lessons already in preschool, there is also a need to move beyond the PE curriculum to promote PA.

Funding Source: The Research Foundation-Flanders and the Flemish Ministry of Economics, Science and Innovation

Promoting physical activity through positive social reinforcement and goal-setting: The effects of Marathon Kids on low-income elementary school students in Texas

Authors:

Andrew Springer, Steve Kelder, Nalini Ranjit, Heather Hochberg-Garrett

This study assessed the impact of participation in the Marathon Kids program, a low resource-intensive school and community-based program that promotes running and walking and healthy eating for elementary school children, on self-reported physical activity (PA) engagement, fruit and vegetable consumption (FVC), and related psycho-social factors in a sample of 4th and 5th public elementary school children (mean age: 10 years; n=511) from 8 low-income schools in the Houston and Austin areas. Primary intervention strategies included structured school running time, behavioral goal setting/tracking, and celebratory events.

Methods: Using a quasi-experimental design with 3 comparison (non-MK) and 5 intervention schools (MK), students were assessed at baseline in the fall and at three time points post-program initiation during 2008-09. Self-reported measures were adopted from previously validated instruments. Mixed-effect regression methods were used to model pooled means, adjusting for baseline estimates and socio-demographic variables.

Results: MK students reported a higher mean number of times of running over the three pooled measurement periods compared to non-MK students (mean = 4.70 times in past week vs. 4.29, respectively. p=.045), with a standardized effect size of 0.11. Students attending MK schools were also found to report a higher athletic identity self-concept (p=.002), higher self-efficacy for PA (p=.002), and higher positive PA outcome expectations (p=.006). Marginal differences in FVC were observed (p<.08).

Conclusion: These findings provide initial evidence of the positive impact of a low-resource intensive program for promoting physical activity and related psycho-social outcomes in 4th and 5th grade children from diverse socio-economic and ethnic backgrounds.

O13 Community and worksite

Community and worksiteO13.1

Understanding New York City community food environment: Towards systems and policy change

Authors:

Pamela Koch, Heewon Lee, Isobel Contento

Purpose: To examine the food environment in a low-income NYC community as baseline data for Kellogg Foundation’s Food & Fitness Initiative that has the goal of creating systems and policies that will lead to communities where “healthy choices are the easy choices.”

Methods: Data were collected on: number of healthy retail outlets, using Geographic Information Systems (GIS); food consumption and health status data from NYC District Public Health Offices; and perception of safety in the areas around healthy retail outlets from community interviews.

Results/Findings: Our focus community has fewer healthy food outlets per square kilometer than in other more affluent areas of NYC. For dietary intake, when compared to the rest of NYC, more people in our focus community drank sugar-sweetened soda (14% vs. 8%); and fewer ate more than 5 servings of fruit and vegetables (8% vs. 10%). Our focus community had higher rates of overweight and obesity (63% vs. 56%); diabetes (15% vs. 9%); and hypertension (34% vs. 28%). Interviews found that community members perceived the farmer’s market in the neighborhood to improve community safety, “I would never come to this street if the farmer’s market wasn’t here, I would not feel safe.”

Conclusions: Our focus community had fewer healthy food retail outlets compared to other areas of NYC, more unhealthy food patterns, and higher chronic disease risks. Systems and policy change efforts, with close community participation from local organizations, will improve the food environment in this area.

Funding Source: W.K. Kellogg Foundation

Weight status, diet, physical activity and stress by job category: Results from the Working on Wellness (WOW) study

Authors:

Kim Gans, Judith Salkeld, David Upegui, Julie Zhao, Suzanne Brodney-Folse

Purpose: Worksite wellness programs may help to improve employee health. Employees with certain job types may have greater need for such programs. We examined the relationship between job type and weight status, diet, physical activity (PA) and stress in the WOW project, a group randomized trial in 24 worksites studying the effectiveness of a multilevel weight gain prevention intervention.

Methods: A randomly-selected longitudinal employee cohort was recruited at each worksite. Employees completed a baseline survey (n=1700), an in-person survey and anthropometric measures (n=1568). Employees were classified into job categories of white collar (n=1297), blue collar (n=303), or service

worker (n=92) (with 8 unknown) using U.S. Department of Labor classifications. The associations of weight, fat, fruit and vegetable (F&V) intake, PA, and stress levels with job type were analyzed using Chi-Square and GLM procedures, as appropriate.

Results: Job category was associated with weight status (p<0.0001), fat intake (p=0.004), F&V intake (p<0.003), PA in MET-minutes/week (p<0.0001), and stress levels (p<0.0001). Service and blue-collar workers had higher rates of obesity/overweight, and fat intake, but also higher PA levels and higher F&V intake (mainly from higher juice intake). White-collar workers had higher stress levels. Further analyses will determine how much the associations by job type are being driven by demographic differences.

Conclusions: Service and blue-collar workers may benefit from targeted efforts to reduce overweight and obesity and improve diet, while white-collar workers may benefit from programs to reduce stress and encourage PA. Implications of these findings will be discussed further.

Funding Source: National Institutes of Health, National Institute for Diabetes, Digestive and Kidney Diseases, Grant # R18- DK071946

Test of a multi-component counseling intervention to increase long-term adherence to regular exercise in cardiac rehabilitation outpatients: A randomized controlled trial

Authors:

Jana Kocourek, Monika Slovinec D’Angelo, Robert Reid, Jennifer Harris

Purpose: Cardiac rehabilitation programs (CRPs) help patients with heart disease achieve recommended levels of exercise. The challenge is to motivate patients to attain regular exercise after leaving the structured setting. This pilot study evaluated the efficacy of a motivational support (MS) intervention, offered within the context of a standard CRP, in increasing adherence to regular exercise among cardiac patients.

Methods: 50 participants were recruited from an out-patient CRP and randomly assigned to a MS counseling or an attention control group (UC). Participants in the intervention group received standard CRP components plus five brief counseling sessions delivered by an exercise counselor, focusing on enhancing autonomous motivation and self-efficacy for exercise, formulating attainable exercise goals and plans, problem solving, and facilitating links to community-based exercise programs. The primary outcome was change in reported and measured exercise activity over a 7-day period, at 12 and 26 weeks after baseline assessment.

Results/Findings: Preliminary results from the pilot study showed significantly higher physical activity in the MS group (n=10) compared to UC group (n=10) at 12 weeks (44.2 ±16.5 km vs. 22.9 ±11.5 km, respectively; p=.004). Current 6 month results based on only 12 individuals, indicate reduced physical activity in both groups, but the positive trend for the MS group continues, (31.2 ±10.4 km and 24.3 ±13.9 km, for MS and UC respectively; p=.325).

Conclusions: Preliminary results support the efficacy of the MS intervention in increasing exercise levels among cardiac patients, and further compliments the standard CRP components by helping patients integrate regular exercise into their lives outside of the structured CRP setting.

Funding Source: Heart and Stroke Foundation of Ontario

Evaluation of the Middlesbrough Healthy Towns programme: A public health initiative using community engagement and social marketing approaches

Authors:

Claire Pedley, Carolyn Summerbell, Peter Heywood

Purpose: In November 2008, Middlesbrough was selected as one of nine Change4Life Healthy Towns, a concept based on EPODE which aims to prevent obesity. The programme consists of 32 community-based projects relating to one of the following themes; active travel, youth health, physical environment and play, and urban farming. Projects aim to improve physical activity levels and/or dietary intake of local residents. The purpose of this evaluation is to assess the feasibility, impact, and sustainability of all 32 projects.

Methods: A standardised process and outcome evaluation is being conducted for all 32 projects (Tier 1), and an in-depth outcome evaluation is being conducted for four of these projects (Tier 2). The Tier 1 evaluation uses a mixed-methods approach involving interviews, focus groups, monitoring participant engagement, and questionnaires. Qualitative data will undergo thematic analysis to assess feasibility and sustainability of the projects. Quantitative data will be analysed to assess the impact within and between all projects.

Results: Data will be collected between March 2009 and March 2011. Preliminary analysis suggests that utilizing existing networks is of key importance for recruitment to community-based projects. Education and empowerment have emerged as common themes which are expected to influence sustainability. Further baseline data and early process data will be reported at the conference meeting.

Conclusions: We anticipate that findings from this evaluation will make a significant contribution to the existing evidence base on community-based interventions for the prevention of obesity, and in turn help shape policy and practice.

Funding Source: Department of Health, UK.

Small Steps Are Easier Together: An ecological, locally adapted, walking and healthy eating intervention for small rural worksites

Authors:

Carol Devine, Mary Maley, Tracy Farrell, Barbour Warren

Purpose: “Small Steps are Easier Together” is an ecological intervention to increase employee walking and healthy eating at small rural worksites.

Methods: Five rural worksites, recruited through Cornell Cooperative Extension, used an ecological needs assessment to identify, select, and apply strategies to increase walking steps over individualized baseline and increase healthy eating choices. Daily steps (measured by pedometer) and food choices were reported weekly on a project website. Pre-and post-intervention questionnaires evaluated psycho-social and behavioral changes. Three comparison worksites completed baseline and follow-up questionnaires and steps.

Results: The intervention (n=226) and comparison (n=95) participants who provided baseline data were primarily white women with a mean age of 44 years and self-reported mean body mass index of 28. More of the intervention group had completed college. Thirty-four percent of intervention participants met the weekly walking goal on 8 or more weeks, 52% met the healthy eating goal. There was a statistically significant mean step increase in the intervention group of about 1700 steps daily; the small step difference in the comparison group was not significant. Eighty-nine percent of participants reported dietary changes, most commonly substituting water for caloric beverages and substituting fruits and vegetables for less healthy foods at work. At post-intervention (compared to pre-) intervention group participants reported significantly (p=<0.05) higher efficacy for: substituting water and fruits and vegetables for less healthy foods and beverages and eating smaller portions.

Conclusions: Workers can use site-specific changes in worksite food and activity environments to increase walking steps and healthy food choices.

Funding Source: USDA CSREES

Demographic, behavioral and psychosocial correlates of using the website-component of a worksite physical activity and healthy nutrition promotion program

Authors:

Suzan Robroek, Wendy Brouwer, Dennis Lindeboom, Anke Oenema, Alex Burdorf

Purpose: This study aims to gain more insight in the use of the website component of a worksite behavior change intervention, and to identify demographic, behavioral and psychosocial factors associated with website use.

Methods: The study is an observational study among participants of 5 companies in a cluster randomized controlled trial. After filling out a baseline questionnaire, workers had the opportunity to participate in a health check and to use a website. Participants in the intervention group had additional website opportunities compared with the reference group. Website use was monitored by registering website access. Complete data were available for 726 employees. Logistic regression analyses were conducted to identify characteristics of employees who visited and used the website.

Results: In total, 43% of the participants visited the website after an e-mail to promote website visit. Participants who were insufficiently physically active were less likely to visit the website (OR=0.63, 95%CI:0.45-0.88), whereas more individuals with an elevated total cholesterol level visited the website (OR=1.44, 95%CI:1.05-1.98). The monthly e-mails in the intervention group resulted in higher website use (OR=3.96,95%CI:2.30-6.82). Participants with a positive attitude towards increasing physical activity were less likely to visit the website (OR=0.54, 95%CI:0.31-0.93) or to use the additional website functions (OR=0.50,95%CI:0.25-0.99).

Conclusions: Almost half of the participants used the website component of a worksite behavior change program. Monthly e-mails were a prompt to visit the website, but website use remained low. This health promotion program did not provide an indication that healthier subjects are more susceptible for health promotion.

Funding Source: ZonMw, The Netherlands Organization for Health Research and Development (Project number 62300039)

O14 Physical activity and fitness measurement in children

Physical activity and fitness measurement in childrenO14.1

Environmental influences on children’s physical activity: Quantitative estimates using a genetically-sensitive design

Authors:

Abigail Fisher, Cornelia van Jaarsveld, Clare Llewellyn, Jane Wardle

Purpose: There is a need for research designs that produce unbiased estimates of environmental influences on physical activity. Twin studies offer a ‘natural experiment’ which can quantify environmental and genetic effects as well as attribute the environmental component to shared vs non-shared factors. We hypothesized that fidgetiness and enjoyment of activity would be more genetically determined, but that in a pediatric sample, objectively-measured daily activity would show a stronger shared environmental effect.

Participants and Methods: In a sample of 9-12 year-old, same-sex, twin pairs (234 individuals; 57 MZ, 60 DZ pairs) three dimensions of physical activity were examined using twin-modeling analysis: i) objectively-measured physical activity over four days using accelerometry, ii) ‘fidgetiness’ using a standard psychometric scale, and iii) enjoyment of physical activity from both parent ratings and children’s self-reported preferences in a discrete choice task.

Results: Shared environment effects explained the majority (73%) of the variance in objectively-measured total physical activity (95% CI:63-81%) with a smaller unshared environmental effect (27%; CI: 19-37%) and no significant genetic effect. In contrast, fidgetiness was primarily under genetic control, with additive genetic effects explaining 75% (CI: 62-84%) of the variance, as was children’s enjoyment of ‘high impact’ activities (85%; CI: 78-90%) and their expressed preferences for active pastimes (60%, CI: 42-72%).

Conclusions: The findings are consistent with our hypothesis. They give a strong impetus to research that can identify the specific environmental drivers of children’s activity, and support the value of interventions focused on home or school environments.

Funding Source: This research was supported by the Biotechnology and Biological Sciences Research Council and Cancer Research UK.

Objective measurement of preschoolers’ physical activity and energy expenditure in everyday settings

Authors:

Jan Henkel, Marc N. Jarczok, Joachim Fischer, Freia De Bock

Purpose: Decreased physical activity (PA) and high-caloric food-intake are possible causes of the increasing prevalence of childhood overweight. The objective assessment of preschoolers’ everyday PA thus seems important in developing effective prevention programs.

Methods: Cross sectional data was collected from 338 children (50.5% girls, mean age 4.9±0.7 years). Children’s PA was measured by combined accelerometer (counts/15s) and heart rate monitoring during waking hours on four consecutive days (Actiheart, CamNtech). Activity-related energy expenditure (AEE, kcal) was calculated using an algorithm, which bases on simultaneously measured heart rate and accelerometry data (Brage et al., 2005). Mean AEE and accelerometer counts (ACC) were calculated for three age groups (<4, 4-5, >5 years) as well as for overweight (>90th BMI-percentile) and normal-weight children separately. Two-sided student’s t-tests/ANOVA were conducted to detect differences in mean ACC and AEE between the groups.

Results: Mean AEE during waking hours in boys and girls aged five ore more years were 599.3 kcal and 473.1 kcal, respectively. In the age group of five or more years, boys showed significantly higher AEE and ACC than girls. In the age groups four or more years, AEE was significantly higher in overweight than in normal-weight children, however, there were no significant differences in ACC.

Conclusions: The algorithm-based AEE levels in our sample are comparable to previous results based on doubly labeled water technique (Montgomery et al., 2004). With no differences in objectively measured PA between overweight and normal-weight children, PA might not be crucial for the prevention of overweight at this early age.

Funding Source: Landesstiftung Baden-Wuerttemberg, Germany

Field based fitness assessment in young people: The ALPHA health-related fitness test battery for children and adolescents

Authors:

Jonatan R Ruiz, José Castro-Pińero, Vanesa Espańa-Romero, Enrique G Artero, Francisco B Ortega, Magdalena Cuenca-García, María José Girela-Rejón, Palma Chillón, Jesús Mora, Michael Sjöstróm, Manuel J Castillo

Purpose: Physical fitness is an important marker of health already in children and adolescents. Health-related fitness is measured across European countries using different tests and methodologies. A consensus of a standard health-related fitness battery needs to be determined and tested for e.g. European Health Monitoring activities. The present study summarizes the work developed by the ALPHA (Assessing Levels of Physical Activity) Fitness-Group and describes the procedures followed to select the tests to be included in the ALPHA health-related fitness test battery for children and adolescents.

Methods: We performed a review on physical fitness and health in young people mainly focused on findings from cross-sectional studies. Furthermore, we performed 3 systematic reviews dealing with: (i) the predictive validity of health-related fitness, (ii) the criterion validity of field-based fitness tests, and (iii) the reliability of field-based fitness tests in young people. We also carried out 11 methodological studies to determine the criterion validity and the reliability of several field-based fitness tests for young people. Finally, we performed a study in the school setting to examine the reliability, feasibility and safety of the selected tests based on the evidence found. The whole process was closely followed and supported by a group of international experts.

Results/Findings: Based on the results obtained from the reviews and methodological studies we selected those tests that were related with well established health markers, and that were valid, reliable, objective

and feasible to be used in children and adolescents: (i) the 20m shuttle run test to assess cardiorespiratory fitness; (ii) the handgrip strength and (iii) standing broad jump to assess musculoskeletal fitness, and (iv) body mass index, (v) and waist circumference to assess body composition. The time required to administer this battery to a group of 20 children by one physical education teacher is less than 2 hours.

Conclusions: We propose a valid, reliable, feasible and safe test battery for the assessment of health-related physical fitness in children and adolescents to be used for health monitoring purposes at population level.

Funding Source: This work was supported by the European Union, in the framework of the Public Health Programme (ALPHA project, Ref: 2006120), the Swedish Council for Working Life and Social Research, the Spanish Ministry of Education (EX-2007-1124; AP-2004-2745; and AP2005-4358), and the Spanish Ministry of Education and Science-FEDER funds (Acciones Complementarias DEP2007-29933-E).

A new technology for measuring our journeys: Results from a pilot study

Authors:

Paul Kelly, Charlie Foster

Purpose: Active travel such as walking and cycling is known to have potential in increasing physical activity levels in sedentary individuals. There have been recent calls for technology that will improve our ability to measure and understanding of active travel behaviour. The purpose of this study is to investigate the potential efficacy of a new device, SenseCam, in travel behaviour surveillance and research.

Methods: Participants (n=20) were required to wear the SenseCam device for one full day of travel. The device passively records approximately 2000 time-stamped images during a day. Participants also completed a self-report travel diary for the same period. Limit of agreement (Bland-Altmann) plots were used to assess the level of verification between the two measures.

Results: The new SenseCam device recorded more journeys than the travel diary. In this pilot, self-reported journey duration was over-reported by almost 4 minutes per journey. Magnitude of over estimation appears to be a function of both responder and journey mode, with cycling over-reported by more than walking and car travel. The device also provided visual data that was used for directed interviews about destinations, travel environments and choice of routes.

Conclusions: This new technology shows considerable potential in the field of travel research and may offer the chance to deepen our understanding of travel behaviour.

O15 Policy/community leadership: Nutrition and physical activity intervention

Policy/community leadership: Nutrition and physical activity interventionO15.1

Strong women move mountains: Leadership characteristics of women who promote health in their communities

Authors:

Sara Folta, Rebecca Seguin, Jennifer Ackerman, Miriam Nelson

Purpose: Leadership is identified as critical to the social change process in general and to health outcomes specifically. Leadership skills have been studied and described extensively, especially in the business sector; yet what comprises effective leadership in the public health sector is still not well understood. This qualitative study is designed to examine this question.

Methods: Key informant interviews were conducted with 13 women leaders in the public health sector from November 2008 through December 2009. The sample represented a broad spectrum of leaders from across the United States, identified through web searches and through networks of academic and professional colleagues. Questions were designed to determine leaders’ career path, motivation, characteristics, definition of success, and perceptions about leadership. The initial coding framework was based on the questioning structure. Additional themes emerged, which were added to the framework, using a grounded theory approach. The NVivo program was used to help code the data.

Findings: Three main themes emerged as characteristics of these leaders: a sense of vision coupled with a strong drive to carry it out; persistence; and being a good listener. Having specific goals and staying focused on the mission were mentioned as important to success. Definitions of success most often included changing the lives of others in a sustainable way. Mentoring was important.

Conclusions: These findings may be used to help develop a nonprofit leadership model to improve the training and nurturance of leaders who promote health in their communities and beyond.

Funding Source: Omidyar Foundation

Dietary and eating behaviors associated with sugar-sweetened beverage (SSB) consumption among 8th grade students in schools with restricted access to vending machines

Authors:

Courtney Byrd-Williams, Deanna Hoelscher, Andrew Springer, Nalini Ranjit, Alexandra Evans, Steven Kelder

Purpose: Concerns about the obesity epidemic have led to school policies that limit vending machine access during school hours, but few studies have examined dietary habits as a result of this environmental change. The purpose of this study is to identify dietary and eating habits that are associated with the consumption of SSB among adolescents with restricted access to vending machines.

O15 Policy/community leadership: Nutrition and physical activity intervention

Methods: This is a cross-sectional, baseline assessment of 1854 8th grade students (mean age: 13.9y) from 30 middle schools in central Texas, USA. SSB intake, diet, and eating habits during a regular school week were assessed via validated self-report questionnaire. SSB intake included usual weekday consumption of regular soft drinks, punch, sports drinks, and fruit-flavored drinks. Multi-level regression analyses adjusting for school, gender, ethnicity, and perceived socio-economic status were conducted.

Results: Three-fourths of students reported consuming > one SSB/school day. Students who consumed more SSB consumed more diet soda (β=0.30,p<0.001), refined bread products (β=0.32,p<0.001), and fruit juice (β=0.24,p<0.001). They were more likely to purchase lunch from school snack bar lines (β=0.09,p<0.001) and buy food and sweetened drinks from school vending machines (β=0.30 and β=0.23, p<0.001). Students who consumed fewer SSB consumed more vegetables (β=-0.13,p<0.001) and water (β=-0.15,p<0.001) and reported eating breakfast at home (β=-0.07,p<0.05).

Conclusions: In schools with restricted access to vending machines, high consumption of SSB is associated with unhealthful dietary intake and obtaining food from convenient food sources; thus, future studies should examine whether eliminating convenient, unhealthful food sources would reduce SSB intake.

Participant and market data from Fresh to You: An innovative, public-private partnership to increase fruit and vegetable (F&V) consumption

Authors:

Kim Gans, Gemma Gorham, Arlene Ayala, Eliza Lawson

Background: Low income families eat inadequate F&V. Barriers for eating more include cost, limited availability and hectic lifestyles. Fresh To You (FTY), an innovative, public-private partnership between F&V distributors, farmers, Brown University and RI Department of Health was created to address these barriers. The F&V distributor/farmer provides high-quality, fresh F&V directly to community-based organizations (CBO) at discounted prices. FTY was piloted and recently expanded to 6 CBO serving low-income families to evaluate feasibility and effectiveness.

Methods: A baseline survey was conducted with 139 market participants who had children aged 3-13. Process evaluation was conducted at 21 F&V markets.

Results: Participants were 90% female, 71% Hispanic; 67% were born outside the US; 46% were on food stamps; 38% were employed full-time; median annual family income was less than $25K. Participants reported eating an average of 2.07 cups of F&V per day (lower than the recommendation 4+ cups). Over half underestimated the daily-recommended amount of F&V for their child. The greatest barrier to eating more F&V was cost. Market participation varied by site but averaged 32 people. Sales per market averaged $319.48 (19% food stamps). F&V prices averaged 15-25% below supermarket prices. F&V sold most included mangos, bananas, yucca and grapes.

O15 Policy/community leadership: Nutrition and physical activity interventionand youth

Conclusions: Low-income families need both access and educational interventions to improve F&V consumption, which FTY is providing. The presentation will include a larger sample (n > 500 from > 150 markets), data on mediators of F&V consumption as well as preliminary data on FTY’s effectiveness on increasing F&V consumption.

How robust are policy data on access to healthier food retail outlets? An evaluation of environmental supports for fruit and vegetable intake in South Carolina

Authors:

Angela Liese, James Hibbert, Natalie Colabianchi, Darcy Freedman

Purpose: The CDC’s State Indicator Report on Fruits and Vegetables provides data on policy and environmental supports for fruit and vegetable (F&V) consumption. We replicated the CDC’s approach and assessed the robustness of secondary data sources for policy-level indicators.

Methods: Geocoded data from Dun & Bradstreet (D&B) and InfoUSA were obtained for 8 counties, limited to primary North American Industry Classification System (NAICS) codes for supermarkets and grocery stores, F&V markets, and warehouse clubs. A contemporaneous, validated, GPS-based database was used as the gold standard in which each outlet was assigned a type based on business name, internet and phone research. The outcome of interest was the proportion of Census tracts having at least one healthier food retailer within a 1/2-mile exterior buffer.

Results: The field census identified 166 healthier food retailers that support F&V intake, D&B 297 outlets and InfoUSA 233 outlets. The percent of census tracts that had at least one healthier food retailer was 82% (123/150) in the validated field census, 87% (131/150) in InfoUSA and 92% (139/150) in D&B. Both secondary data sources demonstrated a high sensitivity for identifying tracts with a healthier food retailer (InfoUSA 95%, D&B 97%) but poor specificity (InfoUSA 48%, D&B 26%).

Conclusions: If based exclusively on NAICS codes, secondary data sources will likely yield marked overestimates in the number of outlets available and small to moderate overestimates in the percent Census tracts with a healthier food retailer. Caution is needed when interpreting these policy indicators derived from secondary data sources.

Funding Source: NIH

Physical activity and healthy eating promotion in children (#2)O16.1

Short- and long-term effects of FATaintPHAT, a computer-tailored intervention to prevent unnecessary weight gain among adolescents

Authors:

Nicole Ezendam, Anke Oenema, Johannes Brug

Purpose: FATaintPHAT (VETisnietVET in Dutch) is a computer-tailored intervention that aims to prevent unnecessary weight gain among adolescents. We assessed the effectiveness of FATaintPHAT on BMI and waist circumference after 2-years follow-up and on energy balance-related behaviours (consumption of sugar-sweetened beverages, snacks, fruit, vegetables and whole wheat bread, physical activity and sedentary behaviours) after 4-months and 2-years follow-up.

Methods: Cluster-randomized trial among 883 students (12-13 years) from 20 schools for secondary education using measured BMI, waist circumference, pedometer count and shuttle-run-test and self-reported behaviours as outcome. Descriptive and (linear and logistic) multilevel regression analyses were performed on the total population and on students at risk (i.e. students who did not meet recommendations at baseline).

Results: Among students at risk, FATaintPHAT had no effect on BMI and waist circumference. However, the intervention was effective in improving dietary behaviours: snacks (pieces per day): b=-0.97, fruit (pieces per day): b=0.39 and vegetables (grams per day): b=16.7) at 4-months follow-up. In contrast, the intervention resulted in inverse effects on sports participation (yes vs. no: OR=0.51) at 4-months follow-up.

Discussion: The computer-tailored intervention FATaintPHAT was efficacious in improving dietary behaviours among adolescents in the short term, but not in sustaining these effects over the longer term. Explanation of the unexpected effects for sports participation will be further explored. The lack of effect on anthropometric outcomes may be the result of positive changes in dietary intake being too small and unsustained, or of the opposing results for dietary and physical activity behaviours.

Funding Source: ZonMw, the Netherlands organization for health care research and development

Active electronic games: Can children be active and play electronic games?

Authors:

Leon Straker, Rebecca Abbott, Clare Pollock, Jan Piek, Jemma Coleman

Background: Many children play electronic games and the low activity levels recorded during traditional electronic game use has lead to calls to restrict electronic game playing by children. However new ‘active’ electronic games may enable children to enjoy these games and be active.

Purpose: The purpose of this study is to determine if children could play electronic games and be active in a real world setting.

Methods: Twelve children (6 females) 10-12 years old participated for 6 months. Each child completed 2 months in each of 3 conditions: 1) no home access to electronic games, 2) access to electronic games with gamepad input and 3) access to electronic games with dancemat and EyeToy input. Actical accelerometers were worn for one week at the end of each condition.

Results: Accelerometer assessed energy expenditure for non-school days was 1.073 kcal/min (95% CI 0.792-1.355) during the no game condition, compared to 0.908 (95%CI 0.653-1.163) during sedentary game condition and 1.194 (95%CI 1.037-1.350) during active games condition.

Conclusions: These findings suggest that children are less active when they have access to traditional electronic games but with active electronic games they can play electronic games and still maintain activity levels.

Getting active with video games? A randomized controlled trial

Authors:

Louise Foley, Ralph Maddison, Yannan Jiang, Cliona Ni Mhurchu, Andrew Jull, Anthony Rodgers, Harry Prapavessis, Maea Hohepa

Purpose: This paper presents results of the eGAME trial to determine the effects of active video games on: body composition, physical activity, physical fitness, video game play, and food snacking in New Zealand in overweight children. This is the largest trial of its kind to date to investigate these issues.

Methods: Two-arm parallel randomized controlled trial. Children (n =322) aged 10-14 years (M =11.6, SD= 1.08) were randomized to either receive an upgrade (hardware and games) to their existing video game technology to enable them to play active computer games (n=160) or to a control group (no change; n=162). Randomization was stratified by sex (Female/Male) and ethnicity. Height, weight, physical fitness (shuttle run test), physical activity (Actigraph accelerometer and Physical Activity Questionnaire for Children) and self-reported video game play, food snacking were assessed at baseline, three and six months. All outcome variables were analyzed as change from baseline at three and six months using the Repeated Measure analysis, adjusting for baseline outcome measure and important demographics. Intervention effect was evaluated over the whole study period if there was no significant interaction between treatment groups and visits.

Results: Significant differences were found for BMI (Mean difference= -0.3, SE=0.1, p=0.009), and zBMI (-0.08, SE=0.04, p=0.02) favoring the intervention group. A significant difference was found favoring the intervention group for time spent in active (Mean difference 10.03 min, SE=1.92, p<0.001) and non-active video games (Mean difference -9.4 min/day, SE=5.08, p=0.06).No significant differences were found between groups for physical fitness, time spent in moderate to vigorous physical activity, and total energy consumed from snack foods (mean difference = -387 KJ, SE= 280, p=0.16) at six months.

Conclusion: The observed differences in body composition are likely to have been mediated by increased time spent playing active video games and reduced energy intake from snack foods.

Funding Source: Health Research Council of New Zealand

An evaluation of a creative dance programme in preschool children: Quantitative findings from a 10 week pilot controlled trial

Authors:

Helen Moore, Sally McLure, Louisa Ells, Janine Ogilvie, Rachel Kurtz, Jo Templey, Rebekah McNaughton, Janet Shucksmith

Purpose: To evaluate a 10-week creative dance intervention, using anthropometric measurements and total physical activity levels in pre-school children (aged 2-6) attending designated centres for children across North-East England.

Methods: A cluster controlled trial with three arms: 1) Intervention; children received a 10-week programme of weekly 60 minute dance activity delivered by a specialist professional dance company; 2) Active play; children received a 10-week programme of weekly 60 minute ‘active play’ sessions such as gym tots; 3) Non-directed play control; children received a 10-week programme of weekly 60 minute open/non-directed play sessions. Anthropometric measures were recorded at week 0 and 10. Total physical activity was measured using the Actigraph accelerometer (Model GT256) over a period of 8 consecutive days at week 0, 5 and 10.

Results: 31 children: carer pairs signed up for the study (Group 1 (11 pairs); Group 2 (10); Group 3 (10)). 13% were found to have a BMI above the 91st (clinically overweight) centile of the British 1990 growth reference charts. ANOVA analyses identified no significant changes in anthropometric measures pre- and post-intervention. All groups showed an increase in average activity and step counts. However, repeated measure analyses found no significant changes over time.

Conclusions: This offered a unique opportunity to create and build an understanding of the health and well-being benefits of dance. The power of this study was reduced due to attrition; a consistent theme with this age group, and is important for the design of any future studies in this area.

Funding Source: Department of Health/Dance City

O17 Correlates of physical activity and dietary intake in children and youth

Correlates of physical activity and dietary intake in children and youthO17.1

Influence of a healthy and welcoming environment on girls’ participation in club sport

Authors:

Warren Payne, Eime Rochelle, Jack Harvey, Melinda Craike, Caroline Symons

Purpose: A healthy and welcoming environment (HWE) in a sports club (SC) is assumed to encourage girls to participate in the SC. This has not been tested. We sought to determine the perceived influence of a HWE on girls’ participation in a SC.

Methods: Schoolgirls in Years 7 (n=471) and 11 (n=243) from 31 randomly selected schools stratified by location, socio-economic status and school type in Victoria, Australia, completed a self-report survey regarding SC membership, sports and physical activity (PA) participation, and perceived importance of HWE factors. Healthy factors included: being smokefree, having ‘Sunsmart’ practices, being responsible in serving alcohol (RSA), and having injury-prevention strategies. Welcoming factors included: knowing someone at the club, friendliness of coach, skill of coach, friendliness of club, and day/time of competition/practice. The data were analysed using logistic regression and odds ratios (ORs).

Results/Findings: Welcoming factors positively influenced higher proportions of respondents (65.0%-90.8%) than healthy factors (30.0%-66.8%). Except for day/time, Year 11 girls were significantly (p<0.05) more likely than Year 7 girls to be influenced by welcoming factors (ORs:1.68-2.14) and less likely to be influenced by healthy factors ‘smokefree’, ‘Sunsmart practices’ and RSA (ORs:0.45-0.69). Non-participants in sport or PA were less influenced than existing club members by welcoming factors (ORs:0.24-0.43) and injury prevention strategies (OR:0.52). There were no significant differences between the groups for: smokefree, ‘Sunsmart’ practices and RSA.

Conclusions: Welcoming factors appear to be more influential for SC participation than healthy factors. This trend is stronger in current SC members and in older adolescents.

Funding Source: Victorian Health Promotion Foundation, Sport and Recreation Victoria

Examining social-cognitive determinants of physical activity in Iranian female adolescents using structural equation modeling

Authors:

Parvaneh Taymoori, Ryan Rhodes, Tanya Berry, Mohamah Ali, Bolorain Kord

Purpose: Adolescent Iranian girls are at high risk for physical inactivity due to cultural barriers such as restrictions regarding exercising in public and research is needed to explore ethnic and gender-related factors associated with physical activity participation.The purpose of this study was to test the fit and

strength of barriers self-efficacy, outcome expectations, self-regulation, and social support in explaining physical activity in female Iranian adolescents. No studies have yet applied SCT to PA in Iranian female adolescents but SCT could provide a useful framework for this understudied population.

Methods: Female adolescents (n=570) were recruited using cluster random sampling methodology. Descriptive statistics and bivariate correlations of all variables were computed. Analyses of the social cognitive model used path analysis with maximum likelihood estimation and a covariance matrix.

Finding: Using path analysis, social support was modeled as an antecedent of self-efficacy and outcome expectations, while self-efficacy was modeled as an antecedent of outcome expectations, self-regulatory planning and physical activity. Outcome expectations and self-regulatory planning were subsequently modeled as additional antecedents of physical activity. The model explained 52% of the variance in physical activity. The two significant (p < .05) direct effects were from self-efficacy and outcome expectations. Social support from mothers, fathers, and friends had significant indirect effects on physical activity through self-efficacy.

Conclusions: These results will allow for future research and interventions not only for female Iranian adolescents but for similar cultural and immigrant groups that have been neglected to date in the PA literature.

Funding Source: Kurdistan University of Medical sciences

Patterns in U.S. adolescent physical activity, sedentary behavior and diet: Latent class analysis of the health behavior in school-aged children survey

Authors:

Ronald Iannotti, Jing Wang

Purpose: To identify healthful and unhealthful patterns in adolescents’ physical activity (PA) and dietary choices and their relationship to overweight status, weight control, and mental health.

Methods: A nationally-representative sample of 9,011 U.S. adolescents ages 11 to 16 (52% female; 43% White; 20% African-American; 26% Hispanic; 11%>Other=) participated in the Health Behavior in School-Aged Children survey assessing height, weight, PA, screen-based sedentary behavior (SSB), frequency of health and unhealthy food items, weight status (BMI), weight control behavior, and mental health (depression). Latent Class Analysis (LCA) was used to identify patterns of PA, SSB and diet.

Results: A model with three latent classes best fit the data: Class 1 with high PA, and fruit and vegetable intake and low SSB and intake of sweets, soft drinks, chips and fries; Class 2 with high SSB and intake of sweets, soft drinks, chips and fries; and Class 3 with low PA, low fruit and vegetable intake, and low intake of sweets, chips and fries. Membership in the three classes was related to age, race/ethnicity, SES, and depression as expected. Although both Class 2 and 3 were related to overweight/obesity, Class 1 adolescents were more likely to engage in healthful methods for weight control.

Conclusions: Patterns of adolescent behaviors support lifestyles reflecting healthful physical activity, sedentary behavior, and diet, unhealthful physical activity, sedentary behavior, and diet, and a third

pattern indicating low overall dietary intake of healthful and unhealthful foods. These patterns relate to depression, weight control behavior and weight status.

Funding Source: Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development

Predicting breakfast consumption of low-fat dairy by primarily Hispanic adolescents: An application of the Theory of Planned Behavior

Authors:

Diane E Carson, Joseph R Sharkey, Wm. Alex McIntosh, Karen S Kubena, Patricia Goodson

Purpose: Use group-randomized control trial to test the effectiveness of a nutrition education intervention, based on the Theory of Planned Behavior (TPB) to improve breakfast consumption of low-fat dairy (cheese, yogurt, milk) in low-income adolescents.

Methods: Sample of 106 primarily Hispanic adolescents aged 12- to 14-years was recruited from an after-school program in Los Angeles County. After-school sites were randomly assigned to treatment or control. Treatment participants (n = 57) received the TPB-based curriculum in grade-specific groups, which met 60 minutes/week for seven weeks. The curriculum focused on identifying those attitudes, subjective norms and perceived behavioral controls that were associated with breakfast consumption of low-fat dairy foods. Results were estimated using multiple regression models.

Results/Findings: Compared to time 1 (T1), changes in attitude toward consuming low-fat cheese and yogurt at T2 were positively associated with the intention to consume low-fat cheese (p < .0001) and yogurt (p < .0001). Subjective norms were significant in predicting intention at T2 to consume low-fat yogurt (p < .01). Changes in intention to drink skim, 1%, and 2% milk improved at time 2 (p < .05). Changes in intention to drink 1% milk at T2 was predicted by group membership, subjective norms, and perceived behavioral control at T2 (p < .01).

Conclusions: These results show multiple factors influence healthful dietary choices adolescents make, and that it is important to consider subjective norms and perceived behavioral controls to change attitudes among adolescents to increase consumption of more healthy foods.

O18 Cognitive determinants of diet and physical activity

Cognitive determinants of diet and physical activityO18.1

Predicting dietary practice behavior among type 2 diabetics using the Theory of Planned Behavior and Mixed Methods Design

Authors:

David Omondi Okeyo, Mary Khakoni Walingo, Grace M. Mbagaya, Lucas O.A. Othuon

Purpose: Most studies that have used the Theory of Planed Behaviour are common in the developed world with limited literature specific for the Sub-Saharan Africa. The purpose of this study was to apply the TPB model in predicting dietary behaviour among Type 2 diabetics in a Kenyan environment.

Methods: The study was conducted within the diabetic clinic at Kisii Hospital, Kenya. It adopted sequential mixed methods design combing both qualitative and quantitative phases. Data was collected using Focus Group Discussions for the qualitative phase and structured questionnaire for the quantitative phase. Qualitative data was analyzed using grounded theory analysis. Structural equation modeling using maximum likelihood was used to analyze quantitative data.

Results/Findings: The results based on the common fit indices revealed that the theory of planned behavior fitted that data acceptably well among the Type 2 diabetes and within dietary behavior {(Χ2 = 223.3, df = 77, p = .02, Χ2/df = 2.9, n=237; TLI = .93; CFI =.91; RMSEA (90CI) = .090(.039, .146)}. The results also revealed that both attitude and subjective norms was the most powerful predictor of intention to follow healthy diet.

Conclusions: The study has generated knowledge on the efficacy of the TPB in predicting dietary practice among Type 2 diabetics in Kenya. This outcome is relevant to health professionals intending to promote healthy dietary practice among these patients. The study has also stressed the fact that the theory applies in any type of environment and is not limited to the environment of origin.

Funding Source: APHRC/African Dessertation Doctoral Research Fellowship and CODESRIA Small Grant for Thesis Writing

Do not “Just do it!”: Intrinsic motivation moderates the association of physical activity with psychological well-being in overweight women

Authors:

António Palmeira, Eliana Carraça, Marlene Silva, Silvia Coutinho, Paulo Vieira, Pedro Teixeira

Purpose: The aim of the study is to analyze the moderation effect of the quality of exercise motivation on the association between physical activity (PA) and psychological well being (PWB: self-esteem, anxiety, vitality and mental health), in a weight management program.

Methods: Participants were 201 overweight premenopausal women (37.6±7.1y, BMI=31.3±4.1) engaged in a long-term RCT weight management program. Weight was assessed at baseline and 12 months.

Moderate and vigorous PA (7-d PAR), exercise intrinsic motivation (IMI), exercise locus of causality (LCE), and PWB: self-esteem (Rosenberg), anxiety (STAI), vitality and mental health (SF36) were measured at 12 months. Moderation effects were assessed by multiple linear regression, controlling for group participation and weight change.

Results: The intervention group lost more weight (p<.001), and had higher values of PA, intrinsic motivation, locus of causality, and lower anxiety (p<.001). PWB was associated with PA, intrinsic motivation and locus of causality (p<.05). Three separate moderation analysis to predict PWB resulted in significant main effects of intrinsic motivation (p<.006) and the interaction term (p<.05). Specifically, PWB was highest (smallest for anxiety) when PA and intrinsic motivation were high, whilst lower levels of PWB (higher for anxiety) were present for high PA and low intrinsic motivation. No moderation was detected for locus of causality.

Conclusion: The quality of motivation may affect the expected association of exercise with psychological well being in overweight women. This is independent of weight loss. Future interventions in this population should evaluate and increase exercise intrinsic motivation to maximize its psychological benefits.

Funding Source: Portuguese Science and Technology Foundation (FCT-POCI/DES/57705/ 2004) and the Calouste Gulbenkian Foundation (grant number 65565/2004).

What if snacks are both unhealthy and pleasurable? The role of attitudinal ambivalence towards snacking behavior on the intention-fruit consumption relationship.

Author:

Gert-Jan de Bruijn

Purpose: The obesogenic environment arguably promotes unhealthy dietary choices and the simultaneous promotion of healthy diets (i.e. by governments) and unhealthy diets (i.e. by fast food companies) may make attitudes towards unhealthy ambivalent, mixed or conflicted. That is, snacking may be simultaneously considered to be both unhealthy and pleasurable. Because the obesity epidemic is caused by a variety of behaviors, rather than a single behavior, research on how ambivalence towards unhealthy dietary behaviors influences healthy dietary choices may allow for the development of more effective interventions targeting an increase in healthy diets. This study investigated the effect of attitudinal ambivalence towards snacking on the intention-fruit consumption relationship.

Methods: Prospective data were available from 334 undergraduate students, who completed measures of intention, attitudes, and ambivalence regarding snacking behavior and fruit consumption at T1. Two weeks later, fruit consumption behavior was assessed again. Data were analyzed using analysis of variance and regression models.

Results: Those who had positive attitudes towards limited snacking and were less ambivalent towards snacking behavior consumed more fruits than those who either held negative attitudes towards limited or were more ambivalent towards snacking behavior (mean difference=.44 pieces of fruit per day). Further, the intention-fruit consumption relationship was stronger amongst those who were less ambivalent

(b=.487, p<.001) than those who were highly ambivalent (b=.197,p=.173).

Conclusions: Less ambivalence towards snacking consumption is not only related to higher fruit consumption, but also relates to a stronger intention-fruit consumption relationship.

What are the influences on children’s diet quality? Insights from the READI study

Authors:

Sarah McNaughton, David Crawford, Karen Campbell, Kylie Ball

Purpose: The aim of this study was to identify the personal, social and environmental correlates of healthy eating patterns among children aged 5-12 years from socio-economically disadvantaged areas.

Methods: Women aged 18-45 years living in socioeconomically disadvantaged neighbourhoods in Victoria, Australia with dependent children aged 5-12 years completed postal surveys which assessed dietary intake, potential influences on diet and a range of socio-demographic factors. Analysis was based on 493 children with complete data. Children were classified according to a diet quality index with higher scores reflecting a diet consistent with national dietary guidelines. Personal, social and environmental influences were informed by a Social Ecological theoretical framework. Logistic regression was used to identify associations between these factors and the likelihood of having a diet quality score in the top tertile, adjusting for covariates (child age, maternal education, employment and marital status).

Results/Findings: In multivariable models, maternal nutrition knowledge, maternal diet quality, child feeding strategies, using foods as rewards and perception of dietary adequacy were independently associated with diet quality after adjustment for covariates (p<0.05). Factors such as home availability of high-energy foods and fruits and vegetables, perceptions of the neighbourhood food environment, family barriers, frequency of family dinners, social norms and practises and outcome expectancies for fruit and vegetables were not significantly associated with diet quality.

Conclusions: This study highlights several social factors are associated with healthy eating patterns in children. These findings will assist in the development of interventions to improve the diets of socio-economically disadvantaged families.

Funding Source: National Health and Medical Research Council, National Heart Foundation of Australia, Victorian Health Promotion Foundation

O19 Home and family

Home and familyO19.1

A qualitative study to develop a parent intervention for improving physical activity and diet in underserved adolescents: The Teens Talkin’ Health Study

Authors:

Sara St. George, Dawn Wilson

Purpose: Given recommendations to increase the use of qualitative methods in African American communities to design relevant obesity prevention programs, this study used an ecological framework to better understand the interactive influences of family, peer, and intrapersonal factors related to physical activity (PA) and diet in African American youth. Qualitative data provided the basis for developing an innovative obesity prevention intervention.

Methods: Nine focus groups were conducted with African American adolescents (n=45, 51% girls, 12.6±1.2 years, 29% obese) who lived within two low-income, high crime communities. Sessions were audio-taped, transcribed, and coded by independent pairs of raters (r =.75). QSR NVivo 8 was used to determine themes.

Results/Findings: Themes related to parenting indicated that parents used a combination of specific and unspoken/value-centered rules with youth to shape their behaviors. Although adolescents expressed a desire to increase autonomy and reduce restrictions, they valued parental monitoring as a way for parents to show they cared and ensure their safety. Additionally, while adolescents recognized some of the difficulties of engaging in positive health behaviors around their peers, they acknowledged that parents and peers each had unique opportunities in their lives to promote healthy PA and diet. These findings were used to design an interactive parent-based intervention that integrates parenting variables (parent monitoring, rules, autonomy) to facilitate positive peer interactions around health behaviors.

Conclusions: Shaping the immediate social context of African American adolescents by using parents to promote positive peer relationships may be important for promoting PA and a healthy diet in underserved youth.

Funding Source: National Institute of Health

Local food purchasing habits and dietary intake among North Carolina families: Results from the Children’s Health Assessment Survey (CHAMPS)

Authors:

Alice Ammerman, Alison Gustafson, Ziya Gizlice, Molly De Marco, Robin Crowder

Background: Recently, the relationship between access and consumption of fruits and vegetables (F&V) has gained greater attention. Due to growth in farmers’ markets, pick-your-own, CSAs, and gardening there is increased interest in whether local food acquisition improves diet quality.

O19 Home and family

Methods: The North Carolina Child Health Assessment and Monitoring Program (CHAMP) measures health characteristics and behaviors of children, aged 0 to17. Eligible participants are drawn from participants in the Behavioral Risk Factor Surveillance System telephone survey, who are adults, aged 18 and older. Questions to assess local food purchasing habits among parents were developed for use in the 2008 CHAMP survey (n = 2,987). Pearson’s X2 tests were used to assess the bivariate correlations between local food purchasing and socioeconomic variables. Multivariate logistic regression was used to model the association between parental purchasing of locally grown food and F&V intake among their children using weighted data.

Results: In 2008, 70% of parents reported having purchased locally grown food at least once (mean 19 purchases/year, median 6 purchases/year) and 40% of children were reported to have consumed 5 or more servings of F&V per day. Children of parents who reported purchasing locally grown food had higher odds of consuming 5 or more servings of F&V per day compared to those whose parents rarely or never purchased local food [OR: 1.49 (95% CI 1.11, 2.01)] when controlling for child’s race/ethnicity, age, and sex.

Conclusion: Our results suggest that purchasing locally grown fruits and vegetables may influence F&V intake among children.

Funding Source: Gillings Innovations Labs, Gillings School of Global Public Health at UNC Chapel Hill

Home and family influences on sedentary behaviour in 5-year-old children

Authors:

Lydian Veldhuis, Ineke Vogel, Amy van Grieken, Mirjam Struijk, Anke Oenema, Carry Renders, Remy HiraSing, Hein Raat

Purpose: The aim of this study was to examine the influence of home and family characteristics on sedentary behaviour in 5-year-olds.

Methods: 13,833 parents were invited to participate in the study ‘Be active, eat right’, and were mailed a questionnaire including items on demographic, home and family characteristics and sedentary behaviour (hours/minutes of television watching on both weekdays and weekend days). Participation was 64%. Data were analysed using logistic regression analyses.

Results: Parent’s mean age was 36.8 years (SD 4.5) and 31.6% were overweight (obesity included). Of the children 18.3% watched television more than two hours per day. After adjustment, the OR (95% CI) for watching television more than two hours per day was 1.2 (1.1 – 1.4) for children of overweight parents; 1.6 (1.4 – 1.8) for children of low-educated parents; 1.7 (1.3 – 2.1) for children of single parents; 4.9 (4.2 – 5.7) for children of parents who themselves watched television more than two hours per day; 2.5 (2.1 – 2.9) for children with a non-Dutch ethnicity; 1.7 (1.5 – 2.0) for children who played outside more than two hours; 1.3 (1.1 – 1.6) for children with more than two televisions in the household; 1.5 (1.3 – 1.9) for children with their own television in their room; and 1.5 (1.2 – 2.0) for children with an unsafe neighbourhood to play outside.

O19 Home and family

Conclusion: The results of this study show home and family factors influence sedentary behaviour in young children. Especially parental modeling has a large influence. Intervention programs to reduce sedentary behaviour should therefore focus on the family-level.

Funding Source: Research relating to this abstract was funded by ZonMw-grant 6230.0042, (Netherlands Organization for Health Research and Development).

The association between neighbourhood and household environmental variables and fruit consumption: Exploration of mediation by individual cognitions and habit strength in the Globe study

Authors:

Nannah Tak, Saskia te Velde, Carlijn Kamphuis, Kylie Ball, David Crawford, Johannes Brug, Frank van Lenthe

Purpose: Home and neighbourhood environmental influences and potential mediation through cognitive variables and/or habit strength has not been explored for adults’ fruit consumption. Therefore the current study examined associations between different home and neighbourhood environmental variables and fruit consumption and explored whether these associations were mediated by variables derived from the Theory of Planned Behaviour (TPB) and habit strength.

Methods: For this study, we included data for 333 adults (mean age 58 years, 54% female), of the Dutch GLOBE study on household and neighbourhood environment, fruit intake and related factors by completion of a questionnaire. Additional information about the ‘fruit neighbourhood’ was retrieved from interviews and audits. Multiple mediation analyses were conducted using regression analyses to assess the association between environmental variables and fruit consumption and mediation of these associations by TPB variables and habit strength.

Results: Fruit intake was associated with intention, perceived behaviour control (PBC), subjective norm, and habit strength. Modelling behaviour of family members was the only environmental variable that was associated with fruit intake. Modelling was associated with all TPB variables and home fruit availability was associated with attitude, subjective norm and habit strength. Only these two relationships appeared to be partly mediated by TPB variables (72.4% and 45.4% respectively).

Conclusions: Modelling by family members and home availability were directly and indirectly associated with fruit intake, while none of the neighbourhood variables were associated with fruit intake. This suggests that future interventions should address the home environment, TPB variables and habit strength for fruit intake.

Funding Source: Funding for this study was supported by The World Cancer Research Fund (Grant number; 2007/47) _ WCRF-NL.

O20 TV, food intake and physical activity

TV, food intake and physical activity

Abdominal obesity, television viewing time and prospective declines in exercise over five years for men and women: The AusDiab study

Authors:

Jeroen Lakerveld, David Dunstan, Sandra Bot, Jo Salmon, Jacqueline Dekker, Giel Nijpels, Neville Owen

Purpose: To examine the prospective relationships of abdominal obesity status and television (TV) viewing time with five-year reductions in exercise levels for men and women.

Methods: We used data from the Australian Diabetes, Obesity and Lifestyle Study (AusDiab), a population-based cohort study with measures collected at baseline in 1999-2000 and at follow-up in 2004-2005. Abdominal obesity status was determined by objectively-measured waist circumference, and TV viewing time and exercise level were assessed using established interviewer-administered questionnaires. In data from 2 544 men and 3 174 women aged ≥25 years, odds ratios (ORs) of 5-year reductions from sufficient to insufficient or no physical activity, and from insufficient to no activity were estimated with logistic regression. We adjusted for sociodemographic characteristics.

Results/Findings: The adjusted ORs of reducing exercise levels from baseline to the follow-up survey was 1.44 (1.13 – 1.84) and 1.56 (1.25 – 1.98) for obese men and women, respectively, compared to those with a normal waist circumference. Women, but not men, with higher levels of TV viewing time had higher risk of reducing their exercise levels (OR 1.52; 1.05 – 2.22), independent of waist-circumference status.

Conclusions: Abdominal obesity is associated prospectively with reductions in exercise level, and prolonged TV viewing time can have an additional adverse influence for women.

Funding Source: Lakerveld was supported by an EMGO+ Travel Grant and an EFSD Albert Renold Fellowship. The AusDiab study is supported by an NHMRC project grant.

Characteristics of children in the U.S. who have a TV in their bedroom: National Survey of Children’s Health 2007

Authors:

Susan Sisson, Stephanie Broyles, Robert Newton, Birgitta Baker, Steven Chernausek

Excessive TV viewing has been associated with negative health outcomes in children and we postulated the presence of TV in the bedroom (TVB) would further influence this relationship.

Purpose: To 1) determine demographic characteristics associated with TVB and 2) examine the association of TVB, independent of total viewing volume, with behavior.

Methods: 48,687 children (51.1% boys, 11.5 ± 0.04 years) from the 2007 National Survey of Children’s Health were included. Descriptive characteristics were calculated. Logistic regression analysis was used to

determine which variables predicted presence of TVB. Logistic regression analyses were used to predict several behavioral characteristics from TVB, adjusted for age, sex, ethnicity, poverty, family structure, and region of the country. TV viewing volume was included to determine independent relationship of TVB. Results: Nearly half (49.3%) of children have TVB, which was associated with 69% higher odds of watching >1 hr/day of TV. Older age, non-white ethnicity, greater poverty level, family structure, and region of country were associated with higher odds of TVB. Female and residence in Alaska were associated with lower odds of TVB. TVB, independent of TV viewing volume, was significantly negatively associated with family meals ≥4 times/week (0.87: 0.79-0.96); weekly attendance at religious services (0.72: 0.65-0.79); engagement in school (0.84: 0.74-0.96); and participation in extracurricular activities (0.69: 0.59-0.81). Prior to adjustment for total TV volume, participation in physical activity ≥4day/week was negatively associated with TVB (0.90: 0.82-0.99).

Conclusion: Presence of TVB was associated with negative behavioral and social characteristics, regardless of total volume of TV viewing.

Health discourse in Swedish television food advertising during children’s peak viewing times

Authors:

Hillevi Prell, Eva Palmblad, Lauren Lissner, Christina Berg

Purpose: The primary purpose was to analyse the different meanings that food is given within the health discourse in television food advertising to children. Food marketing influences children’s food and beverage preferences, purchase requests and consumption and is an important area to focus on in the prevention of child obesity.

Methods: In total, 82 food commercials (collected within an international study on television food advertising to children) from 66 hours of television, recorded during children’s peak viewing times on the most popular commercial channels with children in Sweden (TV3, TV4 and Channel 5), were analysed. Discourse theory according to Laclau and Mouffe, were used to distinguish discourse types. Rhetorical features of food commercials were also brought to light.

Results: Physical, mental and social health aspects were found in 58 commercials (71%). Three qualitatively different health discourse types; a medical (food as protection and treatment), a hedonic (food as feeling good) and a social discourse type (food as caring) were discerned. Aspects of these were used in the promotion of some foods carrying unhealthy associations; in particular these were often presented as healthy. Elements open to different interpretations; the heart, lifestyle and nature/the natural, were also introduced in attempts to modify some unhealthy connotations.

Conclusions: This analysis raises awareness about the meanings that are at stake so that it is possible to provide alternative health information. Health practitioners and nutrition educators should help children develop their critical thinking about how television food advertising may influence social norms and dietary practices.

Funding Source: FAS Swedish council for working life and social research

Is sedentary behaviour associated with dietary intake in adults?: A systematic review

Authors:

Natalie Pearson, Stuart Biddle

Purpose: To review associations between sedentary behaviours and dietary intake in adults.

Background: Although an association has been shown between television viewing (TV) and body fatness in adults, factors that mediate this relationship are less clear. TV viewing may not only facilitate low energy expenditure but may also provide an opportunistic environment for increased energy intake. A greater understanding of the associations between sedentary behaviour and dietary intake in adults will provide an important step towards developing effective interventions for the prevention of obesity.

Methods: Published English language studies were located from computerised and manual searches. Observational research reporting a measure of dietary intake and data on at least one sedentary behaviour were included.

Results: One longitudinal and twelve cross-sectional studies were identified. TV viewing was assessed in all thirteen studies. TV viewing was positively associated with consumption of energy-dense snacks, soft drinks, percentage energy from fat, and total energy intake. TV viewing was negatively associated with fruit and vegetable consumption. TV viewing in adults appears to be associated with poor dietary behaviour.

O21 School based physical activity interventions

School based physical activity interventions O21.1

Kilocalorie expenditure in standing desk vs. sitting desk classrooms among fourth and fifth graders

Authors:

Beth Lewis, Eric Statt, Abby Brown

Purpose: Schools are in a unique position to influence the obesity epidemic by implementing policies and practices that help prevent obesity among children. The purpose of our study was to examine kilocalorie expenditure among students using standing desks vs. traditional sitting desks in the classroom. We also examined gender differences associated with kilocalorie expenditure.

Methods: Fourth and fifth grade students (n=101) wore accelerometers (i.e., ActiGraphs) for ten school days to assess kilocalorie expenditure. In each classroom, half of the students used standing desks and the other half used traditional sitting desks for the first five days of the study. The students switched to the opposite type of desk during days 6-10. Results: There were no differences on kilocalorie expenditure for standing vs. sitting desks. However, there was an overall effect of gender on kilocalorie expenditure. Specifically, after controlling for weight, boys expended significantly more kilocalories during the school day than girls on both standing desk days, f(1,73)=10.41, p < .05 and sitting desk days, f(1,73)=10.55, p < .01.

Conclusions: There are several potential reasons for the lack of kilocalorie differences between the standing and sitting desks. It is possible that the accelerometer was not sensitive to the standing vs. sitting position or perhaps students did not properly use the standing desks (e.g., stools were available for the standing desks). Interestingly, boys expended more kilocalories than girls, which has implications for obesity prevention. Additional research is needed to better understand the effect of standing desk classrooms and gender on kilocalorie expenditure.

Funding Source: Center for Applied Research and Educational Improvement (CAREI) Collaborative Grants, University of Minnesota

Improving school PE and after school physical activity in low-income communities to increase physical activity levels

Authors:

Krista Hutchinson, Sarah Samuels, Lisa Craypo, Brian Cole, Antronette Yancey

Purpose: Improvements to the quality and quantity of school physical education (PE) classes may still not provide students adequate amounts of moderate-to-vigorous physical activity (MVPA) on a daily basis. This study explores whether after school programs provided significant additional opportunities for students to be physically active.

Methods: The Healthy Eating, Active Communities program (HEAC) partnered with school districts in six low-income communities throughout California to improve school PE and after school physical activity

(PA). The school sample included 19 schools at baseline and endpoint. The after school sample included 19 programs at baseline and 14 programs at endpoint. An observational tool (SOFIT) was used to rate student physical activity levels in PE and after school PA at both points in time.

Results: Across all grade levels, student MVPA remained lower in PE classes than in after school program PA at both baseline and endpoint. At the secondary school level, students spent nearly twice as much time engaged in MVPA in after school as they did in school PE at endpoint.

Conclusions: Findings suggest that after school programs provided valuable opportunities for students to engage in MVPA. In conjunction with PE activity, this may help students, especially those living in low-income communities, meet the physical activity guidelines of Healthy People 2010.

Effects of a school-based intervention on the basis of Pender’s Health Promotion Model to improve physical activity among high school girls

Authors:

Parvaneh Taymoori, Mohamah Ali, Bolorain Kord

Purpose: Due to cultural barriers, decline physical activity during the high school years is consistently lower among adolescent girls than adolescent boys. However, little intervention research has been conducted to try to increase PA participation rates with this population. This study reports the first evidence of the effectiveness of a PA intervention based on Pender’s HP model combined with stage of change to increase PA among Iranian high school girls.

Methods: This randomized control study evaluated the effectiveness of a 24-week exercise education program to improve cognitive and psychosocial factors associated with physical activity and to promote physical activity in adolescent girls (n =106), were randomly allocated to one of two conditions: an intervention based on Pender’s Health Promotion model, and a control group. The program included educational sessions and tailored counseling.

Results: There was an increase of 45 minutes for daily physical activity in the experimental group compared to their baseline. After intervention, the training group had a positive significant progression in stages along with significant improvements in self-efficacy, enjoyment of physical activity, interpersonal influences, planning for physical activity, and also a decrease in perceived barriers to physical activity and competing preferences (p≤ .0001-0.04).

Conclusions: The high proportion of the people in action and maintenance in experimental group compared to the baseline are promising findings of school-based intervention based on Pender’s health promotion model. These results will allow for future research and interventions for PA not only for female Iranian adolescents but for similar cultural and immigrant groups that have been neglected.

Funding Source: Kurdistan University of Medical sciences

Impact of a walking school bus program on children’s active commuting to school and physical activity

Authors:

Jason Mendoza, Kathy Watson, Tom Baranowski, Theresa Nicklas, Doris Uscanga, Marcus Hanfling

Purpose: Conduct a pilot evaluation of a Walking School Bus (WSB) program’s impact on students’ active commuting to school (ACS) and moderate-to vigorous-physical activity (MVPA).

Methods: We conducted a randomized controlled trial in 8 low income, elementary schools in Houston, TX, USA. Students (n=149) were ethnically diverse 4th graders. The intervention was a WSB program for 5 weeks; study staff walked with students to and from school up to 5-days/week. Outcomes were measured pre-intervention and 5 weeks later. The main outcome was the weekly rate of ACS. Daily MVPA, measured by accelerometers, was a secondary outcome (n=75). Potential covariates included child demographics and psychosocial variables, i.e. self-efficacy and outcome expectations. We used mixed-model regression to account for clustering by school; included two-way interactions with group to identify moderators; and used stepwise procedures with backward elimination of non-significant interactions and covariates to identify significant moderators and predictors.

Results: Intervention students had 26.4% +/- 30.8% higher rates of ACS and had 9.2 +/- 5.4 more minutes of daily MVPA than controls at post assessments, controlling for baseline outcomes. Baseline ACS and parent outcome expectations were significant moderators of ACS at post assessment. As expected, baseline ACS was more strongly related to post ACS in the control schools. Intervention group students whose parents had high outcome expectations at baseline were more likely to do ACS at post assessment whereas the relationship was weaker among the controls.

Conclusions: A WSB program appears promising to improve ACS and MVPA among urban, low income, elementary students.

Funding Source: National Cancer Institute and Active Living Research of the Robert Wood Johnson Foundation

O22 Diet and physical activity interventions with women

Diet and physical activity interventions with women O22.1

Statewide implementation and outcomes from an evidence-based community exercise program with older women

Authors:

Rebecca Seguin, Julia Kuder, Miriam Nelson

Purpose: Strength training (ST) exercises are an important health behavior for aging women. These exercises help maintain strength, function, and reduce risk for chronic diseases such as osteoporosis and arthritis. This study assessed change in physical fitness following participation in a ST program implemented and evaluated by community leaders.

Methods: The Strong Women Program (SWP) is a nationally disseminated, evidence-based, community ST program active in forty states. The Kentucky Department for Public Health supported statewide implementation of the SWP in 2007. Community leaders were trained on how to implement and evaluate the SWP during an intensive workshop. The Senior Fitness Test (SFT) was the primary evaluation tool; it assesses upper and lower body strength, upper and lower body flexibility, aerobic fitness, and agility. Height, weight, and age were collected at baseline; SFT data were collected prior to and following participation in the twelve-week SWP.

Findings: The SFT data were available for 92 female SWP participants, mean age 68 (±9) years; BMI was available for 57 participants (27.6±4.6). Attendance to twice weekly classes was 76%. Pair t-tests were used to analyze pre-post change. Significant improvements were observed (p<0.001) in all SFT measures. Percent change for improvement were as follows: arm curl (28.5%), chair stand (50.1%), back scratch test (59.9%), sit and reach (>100%), two-minute step test (50.2%), and up-and-go test (15.9%).

Conclusions: This study demonstrates that it is feasible for community leaders to conduct pre-post physical fitness evaluations with participants, and that participants experienced improvements across the six areas of physical fitness.Funding Source: NIA T-32 Postdoctoral Fellowship: 5T32AG027677-03 (through Group Health Research Institute)

Eating occasion need states in midlife women: Implications for prevention of weight gain

Authors:

Courtney Perry, Dennis Degeneffe, Jean Kinsey, Marla Reicks

Purpose: The primary objective was to identify distinct “need states” based on rational and emotional needs surrounding specific eating occasions experienced by midlife women (40-60 yrs).

Methods: A segmentation analysis was conducted using nationwide cross sectional data from 1,926 women reporting on 7,630 eating occasions. A mailed survey collected food record and needs/benefit information for four eating occasions for a one-day period.

Results/Findings: Mean age of women was 49.6 + 7 yrs. Most were non-Hispanic white, employed, fairly well educated, married and overweight. Six “need states” were identified: “healthy express,” “comforting interludes,” “indulgent escapes,” “nurturing family meals,” “sensible meals,” and “fast fueling.” “Nurturing family meals” and “sensible meals” were likely to be dinner meals, “indulgent escapes” tended to be snacks, while “healthy express” occasions occurred at breakfast or lunch. Women consumed less fat and more fruit and whole grain foods in health-oriented eating occasions compared to “indulgent escapes” and “fast fueling” occasions which were highest in total, trans, and saturated fat, refined grains, and sweetened beverages. “Nurturing family meals” occasions took the longest to prepare (80%>11 minutes) and consume (62%>16 minutes). For 60% of all occasions, women indicated they decided what to consume immediately before eating. Most occasions (41-69%) within all need states occurred alone, except for “nurturing family meals” which had at least one other adult (~50%) or child (54%) present.

Conclusions: Segmenting eating occasions represents a new approach to tailor weight grain prevention for women specific to individual needs regarding food choice.

Funding Source: National Research Initiative Grant 2007-55215-17907 from the USDA National Institute for Food and Agriculture

Effects of individual and combined exercise and dietary interventions on health-related quality of life in sedentary postmenopausal women

Authors:

Ikuyo Imayama, Catherine Alfano, Catherine Duggan, Karen Foster-Schubert, Ching-Yun Wang, Anne McTiernan

Purpose: To examine the individual and combined effects of 12-month diet and exercise interventions on health-related quality of life (HRQOL) in postmenopausal women.

Methods: Sedentary, overweight or obese postmenopausal women (n=439) aged 50-75 years were randomly assigned to a reduced-calorie weight loss diet (n=118), aerobic exercise (n=117), combined diet + exercise intervention (n=117), or control (n=87). HRQOL was assessed by theMOS 36-item short-form health survey (SF-36) at baseline and 12 months. Eight subscales of SF-36 were calculated. Changes in HRQOL from baseline to 12 months were compared across intervention arms using analysis of covariance adjusting for baseline scores. Fifty seven participants (8.7%) were missing 12-month HRQOL data. The missing data were imputed using last observation carried forward (intent-to-treat).

Results/Findings: The diet, exercise, and diet + exercise groups lost 8.6, 2.3, and 10.6 % of baseline body weight, respectively. The exercise group met a mean 83% of the goal of 225-minutes/week aerobic activity. Twelve-month changes in 4 aspects of HRQOL differed by intervention arm. The diet + exercise group improved physical functioning, role-physical, vitality, and mental health vs. controls (all p≤0.01). The diet alone group increased vitality (p=0.0008), while the exercise alone group did not improve any aspects of HRQOL vs. controls.

Conclusions: A 12-month diet + exercise intervention has positive effects on HRQOL that may be greater than diet or exercise alone. Future studies could investigate mediators of HRQOL changes to determine reasons for the observed group differences, and assess the impact of HRQOL changes on behavior maintenance.

Funding Source: NCI R01 CA105204-01A1, NCI U54-CA116847, NIH 5KL2RR025015-03

Exercise adherence among overweight, sedentary postmenopausal women in a randomized controlled trial of exercise or exercise plus diet

Authors:

Caitlin Mason, Liren Xiao, Karen Foster-Schubert, Catherine Duggan, C.Y. Wang, Kristin Campbell, George Blackburn, Anne McTiernan

Purpose: To investigate differences in exercise adherence to a one-year aerobic exercise intervention (45 min/day, 5 days/week moderate intensity activity (MVPA)) prescribed alone or in combination with a calorie-reduced diet.

Methods: Overweight, sedentary, post-menopausal women were randomly assigned to exercise alone (N=117) or in combination with a group-based dietary intervention with a goal of 10% reduction in body weight (N=117). There were no significant differences between groups at baseline. Daily activity logs, pedometers, and treadmill testing were used to assess exercise adherence. Demographic data, body composition, pedometer steps/day (7day) and VO2max were collected at baseline and 12-months, with 9% attrition. Between-group differences in frequency, intensity, and type of activities were examined.

Findings: There were no significant differences in exercise adherence between intervention groups, except in pedometer steps/day (p=0.0063). On average, women randomized to exercise alone participated in MVPA on 3.4 (SD: 1.4) days/wk (72% of goal) for 163.3 (SD:70.6) mins/week (80% of goal); increased average pedometer steps/day by 2426 (SD:2765); and VO2max by 0.17 L/min (SD:0.36). Women randomized to exercise + diet participated on 3.6 (SD:1.2) days/wk (77% of goal) for 171.7 (SD:62.7) mins/week (85% of goal); increased their pedometer steps by 3468 (SD: 2999); and VO2max by 0.13 L/min (SD:0.35).

Conclusions: Sedentary, overweight women randomized to two interventions (exercise + diet) had similar or better exercise adherence than women randomized to exercise alone, and were able to achieve significantly greater weight loss (-10.8% vs. -2.4%, p<.001). Thus, simultaneous diet intervention does not negatively affect exercise adherence.

Funding Source: U54 CA116847 McTiernan (PI) NIH R01 CA102504, NCI U54-CA116847, NIH 5KL2RR025015-03, NCI R25, Canadian Institutes for Health Research

Poster Sessions

Poster session 1: Community interventions

Poster session 1: Community interventions P001

To develop an integrated community based model for strengthening of adolescent sensitivity to health: An experience from western state of India

Authors:

Gaurav Aggarwal, Renu John

Adolescence is the period in life characterized by significant change like biological, psychological and social learning that occurs at an astonishing rate. Adolescents are more capable of making decisions and are often given more freedom to do so. It is also a time when youth are particularly impressionable and vulnerable to many factors that positively or negatively influence their future health behaviors. Adolescents are a very diverse population segment because they are in the different stages of development, living in different geographical conditions, their marital status, or have different needs and diverse problems. Adolescent risk behaviors can affect their current and future health. Indeed it can affect the entire life course. Adolescent risk behaviors and choices tend to occur in a social context and may be synergistic. Therefore it is necessary to identify risk behaviors and factors that make them more vulnerable. This present study was planned to assess the health risk behaviors of adolescents in Rajasthan. Strategies for Health promoting activities were framed and a community based model is being developed to sensitize adolescents towards health. Specific objectives of the study were “to develop an integrated community based model for strengthening the adolescent sensitivity to health”.

Study Methodology: Different schools from Rajasthan were considered and self administered questionnaire adapted from GSHS questionnaire of WHO were used to assess the risk behaviors. Age group considered was 15-18 and sample size was 1600 students. Informed consent was taken. Results Mean age of students was 16. PERSONAL HYGEINE: 100 % reported to brush regularly; 96% reported they take baths regularly; 65% reported washing hands regularly. But only 58% washed hands with soap or any solution. MENSTRUAL HYGEINE: Mean age of menarche is 13; 89% had regular menstrual periods;90% reported using sanitary napkins of which, only 57% reported changes at least 2 napkins each day. 10% of them reported using clothes out of which 53% reported changing fresh clothes everyday; remaining used waste clothes and wash it and reuse it. DIET PATTERN: 98.5% reported they prefer fruits of which 74.5% consume daily; 90.5% consume vegetables regularly. Physical Activity: 32% perform intensive physical activity everyday ;20.5% reported for 5-7 days in a week;20% for 3-5 days;21% reported no intensive physical activity. SUBSTANCE ABUSE: 4% reported that they have tried at least once ; 1% reported that they consume regularly; 0.5% reported use of tobacco forms on school campus; 7% reported consumption of alcohol regularly. SEXUAL BEHAVIOR: Only one girl (0.05%) has stated that sexual relationship below 18 years is acceptable.

Poster Sessions

Texas I-CAN! teacher implementation of physically active lesson plans

Authors:

John Bartholomew, Esbelle Jowers, Lauren Grieco

Purpose: The Texas I-CAN! Curriculum is designed to achieve regular education goals through 10-15 min of physical activity. Earlier research found these to be well-received by teachers and to increase physical activity regardless of child BMI, sex, or ethnicity (Bartholomew, et al., 2009). That said, their success depends upon teacher implementation. This study was designed to examine predictors of teacher implementation rates.

Method: Eight schools were randomly assigned to experimental or control conditions. Within the experimental condition, 25 3rd grade teachers were provided lesson plans, equipment, and 8 hrs of Texas I-CAN! Training. These teachers were asked to implement lessons on at least 4 of 5 d/wk over 6 months. Teachers provided the following self-reported data: (a) implementation rates; (b) perceived lesson quality; (c) self-efficacy to implement lessons; (d) perceived barriers to implementation; (e) years teaching; € 7-day physical activity recall; and (f ) teacher BMI.

Results: Given the small sample (n=25) data were analyzed through bivariate correlations. Percent of lessons completed were associated with teacher ratings of lesson quality (r = 0.52), self-efficacy (r = 0.47), and perceivedbarriers (r = - 0.58). Lesson quality was associated with teaching experience (r = 0.45), and perceived barriers (r = 0.42). Self-efficacy to implement lessons were associated with perceived barriers (r = - 0.84). Neither teacher physical activity nor their BMI were associated with lesson implementation.

Conclusion: These data have implications for the design of future teacher training to enhance implementation for these and similar physically active lessons.

Funding Source: National Institutes of Health: NIH R21 DK071975-02

The Healing Station: The role of the African American church as a change agent for health

Author:

Dorine Brand

Purpose: To create a model to predict the readiness of a church to engage in health promotion programming by examining the relationship between the African American church infrastructure (physical structure, personnel, funding, and social/cultural support) and readiness to engage in health promotion programming. This study will answer the following research question: What is the relationship between the infrastructure of African American churches and their readiness to engage in health promotion programming?

Methods: Thirty-six key informant interviews (KI) will be conducted with pastors, program facilitators and congregants from a sample of churches to identify key infrastructure attributes necessary for health

Poster Sessions

programming. Data collected from KI will be used to develop a questionnaire to assess whether a church has these attributes and be pilot tested in a sample of 30 churches. Item response theory, factor analysis, and principal components analysis will be used to analyze data collected from the survey in addition to mean +/- standard deviation, median, and frequency to present descriptive statistics.

Results/Findings (Anticipated): Infrastructure attributes will be identified and the model will be able to predict the readiness of a church to engage in health programming.

Conclusions: The ability to identify readiness early on will be useful for developing, implementing, and evaluating faith-based programs, such as nutrition and physical activity related, which is a key factor for sustainable and effective programs.

Funding Source: National Institute of Health-NHLBI

The San Diego Padre’s FriarFit Initiative: A professional sports team gets into the childhood obesity prevention game

Authors:

Sally Lawrence Bullock, Sarah Samuels, Mariah Lafleur, Vikki Lassiter, Shiriki Kumanyika

Purpose: To examine the impact of the San Diego Padres professional baseball teams’ innovative fitness and healthy food initiative on the availability of food and physical activity opportunities at PETCO Ballpark in San Diego, California.

Methods: A mixed-methods approach was used. An original survey tool was developed to assess the availability of healthy food in the ballpark and a modified SOFIT (System for Observing Fitness Instruction Time) tool was used to assess physical activity levels of children participating in the fitness component. These data were collected in 2008 and 2009. An intercept survey was conducted with ballpark patrons and an assessment of the business case was also obtained through structured and conversational interviews with key stakeholders and analyses of sales data for healthy food items.

Results: The percent of food venues in the ballpark offering initiative designated healthy foods increased from 5% in 2008 to 35% in 2009. Individuals engaged in the physical activity component of the initiative were significantly more active than those not engaged. Perceptions of success and support for the initiative were high among key stakeholders. 23% of intercept survey respondents stated that they attended more baseball games because of the initiative.

Conclusions: The involvement of professional sports teams in childhood obesity prevention work is growing and research is needed to determine the impact of these initiatives. The best practices, research tools, and business case developed for San Diego Padres initiative can inform the development and evaluation of obesity prevention initiatives other sports teams pursue.

Poster Sessions

Fresh produce, fresh start: Effect of a free fruit and vegetable program on attitudes of Head Start families

Authors:

Carmen Byker, Elena Serrano

Purpose: To examine the effect of a free fruit and vegetable delivery program (FVDP) on produce access and consumption for low-income families enrolled in Head Start, a government funded pre-school program.

Methods: Mothers from a Head Start were recruited to participate in the study and receive a weekly bag of fresh, locally grown produce (3 serving/day), delivered to their house. Weight/height was collected at baseline and questionnaires were administered at baseline and after 8-week intervention to gather socio-demographic information and assess attitudes and behaviors toward local food, produce, food preparation, and purchasing habits.

Results/Findings: Twenty-one of 38 eligible (55.3%) Head Start mothers were recruited for the study. Reasons for decline were assessed through survey. Participants were predominantly young (mean 32.9 years old), white (80.9%), single (61.9%), and overweight or obese (76.2%), with avg. 3.7 children. At baseline, participants reported shopping at local grocery stores and superstores, while none shopped at farmers markets. Participants reported having high food preparation confidence, and making a combination of fresh and ready-to-eat products at baseline. From a scale of 1 to 10, they rated their awareness of benefits of fruits and vegetables as 7.6 and confidence in eating them as 6.4 at follow-up. Follow-up benefits reported were saving money (between $30 and $100) and mothers and their children were healthier.

Conclusions: A free FV program was very attractive to Head Start mothers and future research should examine the extent to which such a program increases access and consumption of FV in the home.

Evaluating the effectiveness of a nutrition and health intervention for elementary students

Authors:

Alena Clark, Deborah Givray

The “Plugged-In” Nutrition and Health Intervention was a fifteen week pilot and interdisciplinary effort to promote healthy behaviors in elementary students. Elementary students were assigned to a cohort upon receiving informed consent. Intervention group one participated in a nutrition education curriculum taught by dietetic students and in a school health curriculum taught by health education students. Intervention group two consisted of the elementary students only participating in the school health curriculum. Control group received no intervention. Pre- and post-tests were administered to determine changes in knowledge, attitudes and behaviors in relationship to nutrition and health practices. Descriptive statistics, t-tests and ANOVAS were determined using SPSS 17.0 (p<.05). Height and weight

Poster Sessions

were measured and BMI was calculated at pre- and post-test. Forty elementary students participated in the pilot. On average, students were at the 90th percentile for BMI (at risk of overweight). Intervention group one increased consumption of calcium, vegetables, milk and meat and decreased consumption of sodium as assessed by three day food records (no significance detected); no student met the MyPyramid recommendations. Healthy behaviors of increasing safe food practices and wearing seatbelts were also shown. In the next phase, more schools will be solicited to increase sample size to detect significant differences and more parent involvement will be obtained to potentially affect overall environment. In conclusion, undergraduate students learned more about the procedures on how to educate youth on health and nutrition issues and elementary students exhibited positive behavior changes that may affect their health now and later in life.

Funding Source: University of Northern Colorado Faculty Research and Publication Board

Digital photography to measure pasta consumption in elementary school children

Authors:

Andrea Cornelius, Len Marquart, Renee Rosen, Beth Arndt, Sofia Horvath

Purpose: Few studies have been conducted to examine children’s intake of pasta in a school lunch setting. Pasta is often difficult to measure accurately given its form and consistency. This pilot-study investigated the validation of digital photography versus plate waste using a pasta side dish in an elementary school lunch.

Methods: Pre- and post-digital photographs were taken of labeled trays served to ~300 elementary students in grades K through 6 during one lunch period. Pre-photos were taken at a designated area after payment and condiment selection. At the end of the lunch period children brought their trays to a designated area where post-photos and plate waste was completed. Using digital photographs, trained observers estimated portion size consumed in ten percent increments. Those estimates were compared to actual plate waste collected and evaluated for inter-rater reliability.

Results: About two-thirds of the children selected the pasta as a side item. Students on average ate 88% of the pasta serving based on digital photographs.Trained observers’ estimates of portion sizes of the pasta using digital photographs were correlated at 0.98. There was no difference in pasta consumption as measured by visual estimates or by plate waste.

Conclusion: These results indicate that trained observers using visual estimates from digital photography of pasta appear to be a valid, non-invasive, and a potentially less costly method to estimate consumption in an elementary school environment.

Funding Source: ConAgra Foods Inc

Poster Sessions

RHEALTH: Results of a pilot intervention promoting healthy eating among men in residential drug treatment facilities

Authors:

Jennifer Cowan, Carol Devine

Purpose: The study aim was to assess the outcomes of RHEALTH, a pilot behavioral and environmental intervention designed to promote healthy eating, increase self-efficacy, and reduce weight gain among men in residential drug treatment facilities, a population at high risk for obesity and chronic disease.

Methods: RHEALTH included weekly on-site nutrition and food preparation classes and changes in the treatment facilities to increase opportunities for healthy eating via menu guidelines and food procurement and food access policies. The intervention was delivered in 6 residential drug treatment facilities in a large city in Upstate New York. A nonrandom sample of 55 multi-ethnic men completed the intervention. Men were interviewed at baseline, pre-intervention and post-intervention using a quasi-experimental evaluation design, including food frequency, measured weight and height, and psychosocial measures.

Results: Participation in RHEALTH was positively and significantly associated with: reduction in energy from sweets & desserts, increased servings of fruits & vegetables, reduced waist circumference, and increased self-efficacy for healthy eating and readiness for dietary change, in the intervention compared to the control period.

Conclusions: Men living in residential drug treatment facilities may benefit from interventions targeting specific dietary behaviors, body composition, and diet-related psychosocial factors. Further research is needed to confirm these findings and to assess the sustainability of outcomes.

Funding Source: NIH training grant

Evaluation of sprouting healthy kids: A comprehensive garden-based intervention for low-income middle school student

Authors:

Alexandra Evans, Nalini Ranjit, Ronda Rutledge, Jose Medina, Andrew Smiley, Rose Jennings, Melissa Stigler, Deanna Hoelscher

Purpose: The Sprouting Healthy Kids (SHK) intervention is a garden-based intervention targeting students enrolled in middle schools located in underserved, ethnically-diverse communities. SHK consists of six components: 1) in-class lessons, 2) after-school gardening program, 3) cafeteria component, 4) farmers’ visits to the schools, 5) fresh fruit and vegetables (F&V) sampling, 6) field trips to local farms. The purpose of this study was1) To measure the effects of different levels of exposure to a multiple-component garden-based intervention on middle school students’ F&V consumption and related variables; 2) To determine the separate effects of each of the intervention components on F&V consumption.

Poster Sessions

Methods: The research design for this study was a treatment-control post-test only. Participants included 213 middle-school students (59% Hispanic; 70% low-income). Outcome variables included F&V consumption; Motivation for eating F&V; Self-efficacy for eating F&V; Preference for F&V; Preference for unhealthy foods; and Knowledge. Analyses included regression models controlling for gender, ethnicity/race, and family income.

Results: Compared to students who were exposed to one or none intervention components, students who were exposed to two or more components scored significantly higher on scales assessing F&V intake, Self-efficacy, and Knowledge and lower on the Preference for unhealthy foods scale (p<.05). The farmers’ visits, fresh F&V sampling, and in-class lessons components produced significant changes in F&V intake.

Conclusions: Interventions targeting F&V behavior change in adolescents need to include multiple components, which may consist of interactive presentations by farmers, taste testing and sampling of F&V and classroom lessons about food systems and healthy eating.

Funding Source: Michael & Susan Dell Foundation; Robert Wood Johnson Foundation

Regularity and accuracy of reported physical activity

Author:

Camille Gagné

Purpose: Based on Menon’s model (1997), the hypothesis of this study is that daycare workers who consider that they make preschoolers exercise regularly will provide a better estimate of the physical activity of the children compared to daycare workers who consider that they make the children exercise irregularly.

Method: Daycare workers and parents in Québec City were invited to participate. A correlational design was used. The physical activity of preschoolers (n=39) was measured with an Accelerometer Actigraph GT1M. Mean of movement captured every 15 seconds between 9h00 and 15h30 for the days that the children were at the daycare was computed. For three days, daycare workers (n=10) assessed the physical activity of children who wore the accelerometer based on the following question: Indicate, in your opinion, to what extent the children wearing the accelerometer exercised today (little or no exercise, some exercise, enough exercise, a lot of exercise). They also indicated if they make preschoolers exercise regularly. A multilevel analysis was used to analyze data.

Findings: Preliminary findings indicated that among daycare workers who considered that they made children exercise regularly, the reported physical activity of children explained 35% (p=.01) of the variance of data obtained from the accelerometers whereas it was 3% (p=.46) among daycare workers who considered that they made the children exercise irregularly (F(3,27)=6.87, p=.00).

Conclusion: The findings of this study indicate that regularity is an important variable that must be taken into consideration when assessing the precision of the estimate of reported physical activity.

Funding Source: Social Science and Humanities Research Council of Canada and Sport Canada

Poster Sessions

School-based obesity prevention intervention effect on weight and academic performance: Three year results

Authors:

Danielle Hollar, Sarah Messiah, Gabriela Lopez-Mitnik, Lucas Hollar

Purpose: Childhood onset obesity and related health consequences are major clinical and public health issues. Healthier Options for Public Schoolchildren (HOPS) was an elementary school-based obesity prevention intervention with nutrition and physical activity components targeting ages 6-12. We hypothesized that interventions would improve weight and academic scores in intervention participants.

Methods: HOPS, implemented in August 2004, included ~3,200 children (48% Hispanic) attending four elementary schools in central Florida. Demographic, anthropometric (height, weight, body mass index [BMI]) and academic (Florida Comprehensive Assessment Test [FCAT]) data were collected each fall and spring for 3 school years. Interventions included modified dietary offerings, nutrition and lifestyle educational curricula, school gardens, and other wellness projects.

Results/Findings: Repeated measures analysis showed that over a 3 year study period intervention Z weight scores decreased significantly among boys (0.81 to 0.71, P<0.001) with a trend among girls (0.56 to 0.51, P < 0.07). Within ethnicity, a significant decrease in Z weight score for Hispanics (0.66 to 0.59 P <0.01) and whites (0.62 to 0.54, p< 0.02) was shown. Over the same time period, FCAT math scores improved significantly among girls (308 to 319, p<0.001) and reading scores improved significantly among boys (299 to 307, P<0.01). Within ethnicity, Hispanics significantly improved both their FCAT math (298 to 309, p<0.001) and reading (286 to 301, p<0.0001) scores.

Conclusions: School-based obesity prevention interventions that use both nutrition and physical activity components show promise in improving health and academic performance in elementary-aged children, and among Hispanics in particular.

Funding Source: Agatston Research Foundation

A grocery store intervention designed to increase fruit, vegetable, and healthy snack purchases among parents of young children

Authors:

Ashley Holmes, Elena Serrano

Grocery stores represent a unique opportunity to integrate availability, access, incentives, and awareness campaigns in a single location. The aim of this study was to develop and evaluate a multi-faceted, child-focused grocery store intervention that included a point-of-purchase kiosk featuring 32 fresh fruits, vegetables, and healthy snacks as well as a sampling pod, comprised of food items from the kiosk. An observational uninterrupted time-series design was implemented in one grocery store for twelve weeks. The study measures consisted of three components: examination of changes in sales data for featured

Poster Sessions

products, provided by the grocery chain; candid, unobtrusive, blind observations of customers near and around the intervention; and brief questionnaires of customers, who engaged at some level with the kiosk and sampling pod. The results yielded an overall increase in the proportion of the sales of the featured items to total store sales during the intervention period. Individual items that increased sales during the intervention period, included whole-wheat mini bagels, bananas, radishes, honey, sunflower, baked tortilla chips, and almond butter (p<.05). Almost two-thirds (61.7%) of the patrons interviewed noticed the healthy kids kiosk, with about one-quarter (28.7%) indicating that they purchased at least one item. 58% of patrons surveyed reported that the kiosk encouraged them to buy healthier foods. Promoting healthy foods at point-of purchase locations can result in increased purchases of these foods among parents with young children. These findings have provided insight into the effectiveness of grocery store interventions on purchasing patterns and behaviors of families.

Promoting increased fruit and vegetable consumption and refreshing body and mind among Danish teenagers: The Boost project

Authors:

Rikke Krølner, Anne Kristine Aarestrup, Thea Suldrup Jorgensen, Pernille Due

Purpose: To develop, implement and evaluate a school-based intervention which promotes increased fruit and vegetable (FV) consumption among school children enhancing academic achievement and well-being. Secondly, to develop and test strategies that will reach subgroups with low FV intake (boys and low social class).

Methods: Selection of target group and development of the intervention was guided by the intervention mapping protocol, the Pro Children study and systematic reviews of determinants of FV consumption and intervention studies. The intervention will be tested employing a cluster-randomized trial design where a random selection of 40 Danish schools (≈4000 students) are randomly allocated to an intervention- and control group. The intervention will run from August 2010-May 2011. Baseline, 1st and 2nd follow-up surveys will be conducted in August 2010, May 2011 and May 2012. The implementation of the intervention will be monitored by a thorough process evaluation.

Results: The need assessment identified 13-year-olds as a target group. Program activities were organized within three levels: School: Daily provision of free FV in schools for 9 months; guided classroom activities integrated in different school subjects; computer tailored messages for 13-year-olds; one-day-course for teachers. Families: guided student-parent activities; newsletters. Local area: guided student visits in grocery stores; field work strategies to increase access to healthy food in sport clubs.

Conclusions: The project will provide new insights on effective strategies to increase FV intake among teenagers in general and in specific risk groups, on factors influencing implementation of these strategies and opportunities for including the local community in interventions.

Funding Source: The Tryg Foundation

Poster Sessions

Barriers and enablers for teenagers’ fruit and vegetable intake: Focus group results from the “Boost project”

Authors:

Rikke Krolner, Anne Kristine Aarestrup, Thea Suldrup Jorgensen, Pernille Due

Purpose: The aim of the Boost project is to develop an intervention which increases 13-year-olds’ fruit and vegetable (FV) consumption. Secondly, to develop and test strategies that will reach subgroups with low FV intake (boys and low social class). As part of need assessment we explored low income adolescents’ views of barriers and enablers for their FV intake.

Methods: Two gender-homogeneous focus group discussions were conducted with 8 boys and 8 girls (13-14-year-olds) from a Danish school with many low income families. The tape-recorded interviews were transcribed verbatim. Themes were coded systematically using open coding (the 1st analytical step of grounded theory).

Findings: In agreement with other qualitative studies our findings support the importance of taste preferences, home availability/accessibility, school FV subscription programs, variation, quantity, quality, price, preparation, appearance and texture. Additionally, teenagers valued the immediate benefits of eating FV: more energy for sports; increased wellbeing; getting stronger and taller. Especially girls ate FV to stay slim. Computer use was mentioned as a barrier to FV intake. It was suggested that parents encouraged FV consumption by placing FV next to computers.

Conclusions: This study gained valuable insights into potential determinants of 13-year-olds’ FV intake. The Boost project will e.g. catch teenagers’ interest by emphasizing the immediate effects of eating FV instead of long-term health effects. Furthermore the study provided some valuable input on what to include in parent newsletters e.g. increasing FV availability at the computer. The findings from this small explorative study should be tested in larger epidemiologic studies.

Funding Source: Tryg Foundation P015

Chefs’ use of whole grains in independent restaurants in Minneapolis-St. Paul

Authors:

William Lendway, David Hesse, Marla Reicks, Joellen Feirtag, Len Marquart

Purpose: This study examined chefs’ use of whole grains (WG) in independently operated restaurants, along with barriers and potential opportunities for inclusion in standard menus.

Methods: 20 executive chefs/chef-owners from independent restaurants in the Minneapolis-St. Paul metropolitan area were recruited by telephone and email. A 10-item questionnaire was developed and pilot-tested for use in 1-hour individual interviews. Three researchers collected and thematically analyzed the data. Eight distinct topics were identified based on the grouping of coded themes and frequency and intensity of response.

Poster Sessions

Results/Findings: Menu design was based primarily upon supply chain factors such as….. Restaurants most likely to serve WGs were flexible and more independent. Most chefs believed that serving WGs positively influenced their restaurants image. Common WGs, such as faro and oats were served instead of WG bread and pasta products. Interestingly, chefs reported WG sensory qualities as primary advantages to serving WGs in restaurants, while consumer-related issues were perceived as disadvantages. Resources used regarding WG preparation were primarily written, but chefs saw a dire need for more general and specific information on WGs. Ideas for potential uses of WGs were also compiled.

Conclusions: This study provides valuable knowledge about chefs that will help develop interventions in independent restaurants to address current barriers and opportunities regarding whole grain availability, use and consumption.

Utility of personal risk screening on nutritional behavior for a community based cardiovascular disease intervention: A “Go Red North Dakota” study

Authors:

Arupendra Mozumdar, Gary Liguori

Purpose: The purpose of this study is to investigate the effect of health education and awareness of personal CVD risk on the behaviors of ‘eating out’ (EO) and ‘green vegetable intake’ (GV) on a sample of North Dakota working women.

Method: At baseline, participants (N=302) were screened for BMI, blood pressure (BP), and waist circumference (WC), with two or more ‘at risk’ measurements (BMI >= 25, BP >= 140/90 mm Hg, WC >=35 inches) classifying a women as ‘high risk’ for CVD. To determine EO and GV, participants were asked at baseline and year two, “On average, how many times per week do you eat meals prepared outside the home?” and “Weekly how often did you eat green vegetables?” Women assigned to the intervention group (n=192) received two years of AHA health education aimed at reducing CVD. The control group only had exposure to the statewide ‘Go Red’ program.

Results: Repeated measure ANOVA revealed that the frequency of EO was affected by the risk status of the participants, as all high risk participants, regardless of group assignment, significantly reduced their EO (F= 19.24, p<.001). For GV, group assignment had a significant effect on the high risk participants (F= 29.76, p<.001), as those in the intervention group increased GV, while the controls did not. However, all non-high-risk participants increased their GV regardless of group assignment (F= 5.08, p=.025).

Conclusion: Health education coupled with personal risk screening may be an effective means of reducing individual CVD risk in a community setting.

Funding Source: Dakota Medical Foundation

Poster Sessions

Active Girls Healthy Futures Program and evaluation

Authors:

Christina Mills, Gemma Dale, Renee Ferguson, Michael Rosenberg, Darcy Bosch

Purpose: The Active Girls Healthy Futures (AGHF) pilot program was a community based physical activity and healthy eating initiative run by Sports Medicine Australia. The program was conducted in 2009 and targeted girls aged 11-13 years. The aim of this program was to facilitate healthy eating habits and encourage participants to engage in school/community based physical activity prior to the time when many adolescent girls withdraw from organised sport. The purpose of the evaluation was to assess whether or not program objectives had been met.

Methods: Participant data was collected via an age appropriate pre/post test (paper based) survey and asked questions about physical activity/healthy eating status, attitudes/beliefs and participation in sporting activities. The parents of participants were asked to complete an online survey relating to their child’s physical activity/healthy eating behaviour and program satisfaction. Results/Findings: As a result of participating in the program, 95% of participants indicated that their awareness of the benefits of physical activity/healthy eating had increased. A19% increase in physical activity and an 11% increase in the consumption of vegetables at recommended levels were reported. The majority of participants planned to continue exercising (89%) after the program had finished. Parents also indicated that their child had continued to exercise following the end of the program (93%). Satisfaction with the program was high amongst both participants and parents.

Conclusions: The program was successful at promoting physical activity and healthy eating to 11-13 year old girls. If funding is available, it was recommended that the program continue.

Feasibility study of an obesity “Prevention Plus” intervention targeting children and parenting practices: Helping HAND

Authors:

Teresia O’Connor, Angela Hilmers, Kathy Watson, Tom Baranowski

Purpose: Test for feasibility an obesity intervention targeting 5-8 year old children with BMI 85-99%tile in community primary care clinics.

Methods: Randomized controlled trial with child and parenting data obtained pre and post intervention. Based on social cognitive and parenting theories, the intervention was delivered monthly for 6 months and families self-selected from 7 child behaviors and corresponding parenting practices. Mixed model analyses of variance tested group differences over time while controlling for baseline parent and child BMI, child age, and parenting practices.

Results: Sample (n=40) characteristics: 80% girls, mean age 6.8 years (sd 1.0), mean BMI z-score 1.84 (0.35); 82.5% Hispanic, 12.5% black, 5% white; and 65% had income <$30,000/year. 85% attended ≥4/6

Poster Sessions

session. Attrition was 15%. ‘Be more Active’ was the most commonly targeted behavior. There was no significant group x time interaction of BMI z-score, as expected in a pilot study. Controlling for covariates, the change in TV viewingwas clinically relevant F(1,29)=2.7, p=.11, with change in intervention group - 4.6 (3.0) vs. control group +2.4 (3.1) hrs/wk. However, only 50% targeted TV viewing as a behavior. Intervention subjects mean change in TV viewing for those targeting TV was -8.1 (5.1) vs. not targeting +0.7 (6.6) hrs/wk. Families targeting TV had trends showing increased parenting TV restriction and less co-viewing compared to controls and those not targeting TV.

Conclusions: This Prevention-Plus intervention was feasible given low attrition and showed promise for decreasing TV viewing and improving associated parenting practices.

Funding Source: United States Department of Agriculture

Improving school breakfast program participation: Results of a pilot project of homeroom breakfast delivery

Authors:

Temitope Olaleye, Qi Wang, Marilyn Nanney

Purpose: To test the feasibility of a homeroom delivered grab-n-go school breakfast menu. Evaluate the impact upon school breakfast program participation among diverse boys and girls, ages 11-15 years old attending a non-severe needs middle school.

Methods: Eight sixth grade homerooms were self-selected into four control and four intervention groups. Breakfast menu in compliance with IOM dietary recommendations was served in the intervention homerooms for 6-weeks. Students (n=156) were asked to participate in pre, mid and post survey’s assessing breakfast behavior patterns. Teachers (n=4) collected daily process evaluations rating student behavior, messiness, and disruptiveness in the intervention group homerooms.

Results: Teachers rated breakfast foods as not messy, serving/eating process as not disruptive and excellent or good student behavior 95-98% of times. Students were satisfied (83%) with receiving breakfast in the homerooms, while, about two thirds agreed that breakfast consumption helps to focus in school. For the 8 homerooms, average daily school breakfast intake increased from 18 to 66 students. Weekly frequency of school breakfast consumption increased for the intervention group (1.8 vs. 0.6 times, p<.0001), but not for the control group (1.1 vs. 1.1 times, p=0.89). Significant increases differed by meal enrollment (1.9 times for free and reduced vs. 0.7 times for full paid, p=.04). An increasing trend was noted in reports that school breakfast tastes good, in seeing most students eating school breakfast, and intentions to eat school breakfast most days next week.

Conclusion: Improving accessibility to school breakfast is feasible, acceptable, non-disruptive and increases breakfast consumption in schools.

Poster Sessions

Exposure to community-based partnership interventions is associated with reduced risk of excessive gestational weight gain

Authors:

Christine Olson, Myla Strawderman, Nancy Wells

Purpose: To evaluate the impact of exposure to intervention programs developed and conducted by a partnership of community-based health and nutrition professionals (the Healthy Start Partnership-HSP) on the risk of excessive gestational weight gain (egwg).

Methods: Two cohorts of pregnant women were recruited as they entered prenatal care in a large primary care clinic and hospital system in rural New York. The first (N=210) served as an historical control and the latter (N=264) as the intervention group with the potential to be exposed to intervention activities. Data were collected by self-administered questionnaires and an audit of the women’s medical records. Weights were measured. Chi-square and logistic regression analyses were conducted to examine associations between intervention exposure and egwg.

Results: The proportions of women with egwg were similar in control and intervention cohorts (50 vs. 53% respectively). Data for low-income women (58% of sample) were examined separately because they are more likely to experience postpartum weight retention with egwg. In this group, 63% reported exposure to the intervention activities concerning weight, diet and physical activity. Overall exposure was not significantly associated with egwg, but among the high BMI women and parous women, exposure to HSP intervention activities significantly reduced the risk of egwg (p≤0.05).

Conclusions: The interventions of the community-based partnership had weaker overall effects on egwg than an earlier clinical intervention in the same community. However, the interventions of the HSP were successful in reducing egwg in the highest risk group of women, low-income overweight women.

Funding Source: National Research Initiative of the USDA Cooperative State Research, Education and Extension Service, grant number 2005-35215-15427.

40-week multidisciplinary falls prevention intervention for older people aged 65+ in a community setting

Author:

Gareth Samuel Parry

Purpose: Examine the effectiveness of a 40-week falls prevention intervention within a community setting for people aged 65+ at risk of falling.

Methods: Following completion of a Falls Risk Assessment Tool participants who met the inclusion criteria were referred to a 40-week falls prevention programme. The first cohort (mean age = 77 years + 6.87)completed four physical function tests (Sit to Stand, Timed Up and Go, 4-point Balance Scale, 180 Degree Turn) at weeks 0, 10, 20, 30 and40. A falls self-efficacy scale (FES-I) and the SF-12 Health Survey were

Poster Sessions

completed at weeks 0, 20, and 40. At programmes end a focus group was conducted to elicit participants’ perceptions of their involvement as well as opinions about their subsequent referral onto a community based physical activity programme. Quantitative data were analysed by repeated measures ANOVAs. Qualitative data were subjected to inductive content analysis.

Results: There were significant improvements for each of the four physical function tests and in self-efficacy between weeks 0 and 40. SF-12 data showed improvements in physical and mental health. Focus group data showed participants enjoyed the programme and will continue to be active within the centre.

Conclusion: Physical function, self efficacy and quality of life results indicated the positive effect of the 40-week intervention and the importance of its duration. Focus group data highlighted the importance of the community setting for adherence as well as the importance of social interaction, and opportunities for transition into follow-on activities.

Funding Source: ESRC

Feasibility of “guided goal-setting” to reduce risk of pediatric overweight among low-income families: Preliminary results

Authors:

Mical Shilts, Christine Davidson, Larissa Leavens, Stephanie Sitnick, Kathryn Sylva, Lenna Ontai, Marilyn Townsend

Purpose: To reduce risk of pediatric overweight, behaviorally focused parental education is needed. This study examined the feasibility of guided goal setting (preformatted goals to choose from based on a personal assessment) in a pediatric obesity prevention intervention for low-income parents of young children.

Design: Parents from Head Start participated in a 5-week nutrition/physical activity intervention including guided goal setting (n=31). At each intervention session, data was collected on goal selection, goal effort and goal attainment. A subset of parents completed in-depth individual interviews at the conclusion of the intervention (n=16).

Results: Parents reported a high level of goal effort (88%) and goal achievement (79%). A majority (94%) preferred to select a new goal each week rather than working on the same goal. Of those selecting a new goal, 49% selected a goal generated from the guided goal setting procedure while 51% created their own goals. Parents reported preference for goal personalization. Parents liked having the option to choose from several goals each week. They reported a sense of accomplishment when goals were achieved. In general, parents did not find the goal contract or weekly goal tracking motivating. They reported time limitations as a barrier for goal achievement.

Conclusion: Guided goal setting is a feasible behavioral strategy for the parents in this study. Parents engaged in the guided goal setting process and reported a high level of satisfaction with the intervention. Because participants volunteered for the intervention, this strategy should also be evaluated with parents participating as a captive audience.

Funding Source: This project was supported by National Research Initiative grant 2009-55215-05019 from the USDA Cooperative State Research, Education and Extension Service.

Poster Sessions

Nutrition education curriculum in accordance with school lunch program improves calcium knowledge, attitude, and eating behaviors of third and fifth grade school children in Taipei

Authors:

Min-Su Tzeng, Tzu-Chin Wei, Ya-Hui Chen, Yu-Qi Wu

Purpose: The main purpose of the study was to improve school children’s eating behavior through a sustainable whole healthy diet strategy which includes nutrition education curriculum and good food environment which school lunch program provided by dietitians.

Methods: Three dietitian-run school lunch schools were selected as nutrition education experiment group and two school lunch provided by central kitchen as control group were selected from Taipei County. Study subjects were the third and fifth grade students from selected schools. There were 4 classes from each grade and each study group. A high calcium food education curriculum based on social cognitive theory was developed. School teachers and dietitians conducted four high calcium food educations according to the curriculum within one month. School dietitians incorporated high calcium foods to school lunch menus during nutrition education intervention period. High calcium food frequency questionnaire, knowledge, attitude and behavior questionnaire, and body height and weight were used as indicators to evaluate the effects of the program.

Results/Findings: The results showed that nutrition knowledge, attitude, and eating behavior of high calcium foods among the third or fifth grade students were enhanced. Self-efficacy of calcium intakes among school children also improved even 10 weeks after the education program. The overall effectiveness seemed to be better among the fifth grade students. Although all students grew taller and heavier, there was no difference between the experimental and control group.

Conclusions: The high calcium food education curriculum in accordance with school lunch programs could enhance calcium nutrition knowledge, attitude and behavior of primary school children.

Funding source: Department of Health, Executive Yuan, Taiwan

Product health-information in supermarkets and stores: Effects on purchase behaviour

Authors:

Jonathan Van ‘t Riet, Marcel Kornelis

Purpose: To provide an overview of empirical evidence on the effectiveness of product health-information in supermarkets and stores.

Background: Increasingly, information about healthy and unhealthy nutrients or other relevant health information is displayed on food products’ packages. This kind of product health-information offers the possibility to influence product perceptions at the time and place of product choice. Many studies have

Poster Sessions

investigated the effects of product health-information on attitudes and intentions, but the empirical evidence becomes more sketchy when the focus of research is actual purchase behaviour.

Methods: In this study we provide an overview of available empirical evidence by means of a systematic literature review. Only studies were included that assessed the effect of product health-information in supermarkets and stores on actual purchase data.

Conclusions: The results showed that 1) many studies found non-significant effects of product health-information, 2) studies which assessed purchase behaviour for longer than one year showed greater effects on purchase behaviour than studies which assessed purchase behaviour for a shorter period, and 3) one study found that product health-information resulted in increased purchases for some healthy products, but in decreased purchases for other healthy products. This latter finding suggests the existence of a substitution effect, in which costumers compensate healthy purchases in one domain with unhealthy purchase in another domain. It is concluded that the overall effectiveness of product health-information seems limited.

Funding Source: Wageningen University and Research Centre

Free school fruit: Does an extra piece of fruit every school day prevent weight gain?

Authors:

Froydis Nordgard Vik, Knut-Inge Klepp, Elling Bere

Purpose: The evaluation of a pilot version of a free school fruit program in Norway has reported that this program was effective in increasing fruit and vegetable intake, it tended to decrease consumption of unhealthy snacks, and it also reported lasting effects after the end of the pilot program. The purpose of the present study is to evaluate the effect of the free fruit pilot program on weight status.

Methods: A total of nine schools received free school fruit for a school year (October 2001 until June 2002), and 29 schools were included in the study as control schools (n=1950, initial age 10-12). Questionnaire surveys were conducted in September 2001, May 2002, May 2005 and September 2009. Weight and height were only reported in 2005 and 2009. Perceived weight status were assessed by a question on dieting, dichotomising the alternatives into;1=I am too heavy, 0=my weight is OK.

Results: A total of 13% in the free fruit group and 12% in the control group (p=0.64) were overweight in 2005, while 15% in the free fruit group and 26% in the control group (p=0.03) were overweight in 2009. The proportion that perceived themselves to be too heavy were not significantly different between the groups (p>0.05) at any of the time points.

Conclusion: It appears that those receiving free school fruit in 2001/02 were less overweight in 2009. However, low participating rate in 2009 (only 16%) and no baseline measures of height and weight are clear limitations of this study.

Poster Sessions

Pennsylvania Supplemental Nutrition Assistance Program Education Intervention improves fourth grade students’ vegetable knowledge

Authors:

Denise Wall, Christine Least, Judy Gromis, Barbara Lohse

Local agencies partner with Pennsylvania schools to deliver a variety of classroom-based Supplemental Nutrition Assistance Program Education (SNAP-Ed). Previous statewide outcome evaluation was unable to measure program effect. The purpose of this study was to deliver a standardized intervention and conduct impact assessment. Changes in student knowledge were assessed. A curriculum consisting of four vegetable-focused lessons was derived from extant materials. The intervention aligned with Pennsylvania State Academic Standards, included active learning components (e.g. activities and food tastings) and was delivered in fourth grade classrooms over a 3-5 week timeframe. Pennsylvania SNAP-Ed Management Office conducted curriculum and evaluation protocol training for local agency educators. Schools were stratified by agency and a sample was randomized to control and intervention groups. One classroom in each school was selected to participate. Intervention classrooms completed pre-survey before lesson 1 and post-survey after lesson 4. Control classrooms completed the survey at two time points with no intervening vegetable-related SNAP-Ed. A total score was calculated for five knowledge items focused on vegetable health benefits, variety, and recommended daily intake; students with complete data were included in analyses (n=1050). Independent t-tests compared score changes for study groups. Mean age of the sample was 9.3 ± 0.5 years; 50.2% were female. Significantly larger knowledge score improvement was evident for intervention group (1.18 ± 1.45), as compared to control group (0.15 ± 1.19), p<.001. Standardized nutrition education intervention enabled impact assessment. Knowledge score results indicate positive intervention effect.

Funding Source: This study was funded by the United States Department of Agriculture’s Supplemental Nutrition Assistance Program through the Pennsylvania Department of Public Welfare and Penn State University.

The impact of an environmental intervention on the physical activity social environment in residential children’s homes of North and South Carolina

Authors:

Lauren Workman, Ruth Saunders, Marsha Dowda

Purpose: Social environments can have positive impacts on population health. However, they are rarely the primary intervention focus. This study examined the effect of the Environmental Interventions in Children’s Homes (ENRICH) Intervention on the physical activity (PA) social environment.

Methods: ENRICH was a two-year environmental intervention designed to promote PA and healthy eating in residential children’s homes (RCH) in North and South Carolina. A two-group, pre- and post-test, group randomized design was utilized to evaluate intervention effect; the control group received a

Poster Sessions

delayed intervention. Sustainability and delayed intervention effects were assessed two years later. The Physical Activity and Dietary Environmental Assessment (PADEA), based on the structural ecologic model, was used to assess the RCH PA environment. This study examined the PA social environment, including adult encouragement, modeling, activity choice, and media messages about PA. Intervention impact was assessed with repeated measures ANOVA (Group=2, Time=3) with RCH as a random variable. LSMEANS were compared using t-tests when F-test indicated significant main effects.

Results: Early (n=12) compared to delayed intervention RCHs (n=11) scored significantly higher on PADEA PA social environment at post-test (2.5 and 2.2, respectively; p<0.05). At follow up, the PA social environment mean remained unchanged in early intervention group (2.5) and had increased significantly in the delayed intervention group (2.7; p< .05).

Conclusions: ENRICH was effective in making sustainable changes in the PA social environment in the early compared to delayed intervention group; results also suggest an effect in the delayed intervention. Future work is needed to explore the social environment in organizational settings.

Funding Source: The Duke Endowment

Poster Sessions

Poster session 1: Measurement methods

Poster session 1: Measurement methods P028

Regression models are not accurate in predicting physical activity energy expenditure and METs in children and youth

Authors:

Sofiya Alhassan, Cheryl Howe, Sarah Kozey, Kate Lyden, Ogechi Nwaokelemeh, Patty Freedson

Purpose: To examine the validity of several commonly used regression equations for the Actigraph and Actical accelerometers for predicting physical activity energy expenditure (PAEE) and estimating METs in children and adolescents across a range of activities.

Methods: Sixty healthy 8-16 yrs participants were recruited for this study (mean±SD age=11.5±2.4yrs, BMI=19.7±4.1kg/m2). Participants completed four treadmill (TM, 0.89 to 2.24 m.sec-1 at 0% and 3% grade) and five self-paced activities of daily living (ADLs) in random order. During each activity, PAEE and METs were measured using a portable metabolic unit. Four Actigraph and three Actical prediction models were used to estimate PAEE and METs and compared to indirect calorimetry. Repeated measures ANOVA was used to assess differences in predicted versus measured PAEE and METs using accelerometer counts inserted into the monitor-specific prediction equations.

Results: Measured PAEE for all the activities combined was 4.2±0.1kcal.min-1 (3.9±0.1METs). Compared to the measured PAEE, only the Freedson and the Trueth equations accurately estimated PAEE for all participants across all activities. For TM activities, PAEE was correctly estimated by one equation (Trueth), significantly overestimated by one equation (Freedson) and significantly understated by five equations. For ADL activities, PAEE was significantly underestimated by all equations. Over and underestimation of calculated METs for TM and ADL ranged between -0.3-2.4 and 0.4-2.5 METs, respectively.

Conclusion: Prediction equations did not yield accurate point estimates of PAEE and METs. Future studies should focus on refining the processing techniques to estimate PAEE and METs from accelerometer counts in children and adolescents. Supported by NIH:R01CA121005-03S1

Funding Source: Supported by NIH: R01 CA121005-03S1

Children’s accuracy of portion size estimation using digital food images: Effects of interface design and size of picture

Authors:

Tom Baranowski, Janice Baranowski, Kathleen Watson, Shelby Martin, Alicia Beltran, Noemi Islam, Hafza Dadabhoy, Karen Cullen

Purpose: Test effect of small versus large images and presence of food size cues on accuracy of child portion size estimation.

Poster Sessions

Methods: Children were randomly assigned to seeing images with or without food size cues (utensils & checkered tablecloth), and were randomly presented with 16 food models (foods commonly eaten by children) in varying portion sizes, one at a time. They matched the food models’ portion sizes to a digital food image. The food images were randomly presented in two ways: small, graduated portion size pictures all on one screen or scrolling across large graduated portion size picture per sequential screen.

Results/Findings: Average percent of correctly classified foods was 60.3%. There were no differences in accuracy by any design factor or demographic characteristic. Children who saw small pictures on the screen at once took about half the time to estimate portion size as those who scrolled through the large pictures. No other factors influenced time to completion. Larger pictures had more over estimation of size.

Conclusion: Multiple images of successively larger portion sizes of a food on one computer screen at the facilitated quicker portion size responses with no decrease in accuracy. This is the method of choice for portion size estimation.

Using sessions of physical activity (PA) to characterize Australian populations: Epidemiologic approaches to streamlining PA surveillance

Author:

Adrian Bauman

Purpose: Physical activity surveillance typically comprise survey questions asking about duration and frequency of participation. One surveillance instrument, the Active Australia questionnaire, has been used for PA surveillance in Australia for 14 years. National data were collected to 2001. This re-analysis assess whether achieving the physical activity recommended levels can be accurately classified using only ‘sessions of PA’ [frequency], and omitting questions on time spent active [duration].

Methods: Active Australia national surveys 1997-2001 asked three questions on ‘number of sessions’ and three on total weekly time for walking, vigorous, and moderate-intensity physical activities. This epidemiologic analysis [Receiver Operator Characteristic (ROC curves)] assessed classification of ‘sufficient PA for health’ based on sessions only. Three different criteria were used to describe ‘sufficient PA’: ‘achieving 150 minutes’, ‘five sessions and 150 minutes’, and ‘five sessions of ≥30 minutes each’.

Findings: Overall, activity time and sessions were summed for 12190 Australian adults; total weekly minutes 252.1 [sd=275.1]; total sessions 5.7 [sd =5.0]. Analyses comprised ROC curves [plots of sensitivity against 1-specificity]. Areas under the curve [AUC] values were highly significant, for 150 minutes, AUC was 0.858 [95%CI .851-.864], for “fivex150 minutes”, AUC was 0.961 [95%CI 0.959-0.963], and for ‘five sessions of ≥30mins’, AUC=0.895 [95%CI 0.892-0.898]. AUC values were similar by age group, gender and ethnicity, and similar in recent state-based data 2001-2008.

Conclusions: Population indicators of ‘sufficient PA for health’ can be characterized by fewer questions [sessions only] using the Active Australia questionnaire. Streamlining PA surveillance systems is a desirable population monitoring objective.

Poster Sessions

Development of an online food frequency questionnaire for Switzerland

Authors:

Christine Brombach, Norman Böttcher, Stephanie Good, Sibille Meier, Claudia Müller, Nina Steinemann, Janice Sych, Beatrice Baumer

In Switzerland, there is currently no validated online method available that allows to measure dietary intake of population groups, both qualitatively and quantitatively. Therefore, an internet-based food frequency questionnaire (FFQ) was developed in three languages (d, f, i) and tested at the Zurich University of Applied Sciences, Switzerland.

Method: Based on Swiss statistics of frequencies for daily consumption of different foods a representative selection of 127 food items was included in the FFQ. To assist study participants and to minimize errors during completion of the FFQ, photographs were taken of all selected food items and at different portion sizes. The database of SwissFir and the Bundeslebensmittelschlüssel (BLS) provided the basis for the calculation of all nutrients, allowing immediate processing of nutritional data. The PAL-values (physical activity level) were used to assess the energy requirements.

Results: The FFQ is available in three official languages in Switzerland (German, French, Italian) and can be completed online using an internet homepage. The link to data bases SwissFir and BLS data result in much time savings and improved accuracy. In addition, study participants benefit by receiving an immediate feedback after completing the FFQ : their nutrient intake is compared with current nutritional recommendations (D-A-CH references)

Conclusions: The online FFQ offers an ideal basis for assessing the eating behavior of population groups in Switzerland. All information is available electronically, which allows to easily adjust the FFQ for special focus groups in different studies. Ongoing is a feasibility test which will be followed by a validation study.

Measuring aerobic fitness by heart rate recovery in preschoolers: Feasibility of a new field-based approach

Authors:

Freia De Bock, Marc N. Jarczok, Joachim Fischer, Jan Henkel, Herbert Renz-Polster

Purpose: The exact measurement of an individual child’s fitness is a precondition for developing effective physical activity (PA) programs. In this study, we assess the feasibility of measuring aerobic fitness of preschool children in their local preschool setting by heart rate recovery (HRR) after submaximal exercise.

Methods: Cross sectional data was collected from 782 three to six year old children in 52 preschools in Southern Germany between 2008-2009. A field-adapted fitness test encompassing 3 minutes rest, 2 minutes circle-running with submaximal exertion and 3 minutes post-exercisal rest was conducted with the children. Measures include combined heart rate (HR) and accelerometry monitoring during the fitness test as well as the assessment of anthropometric data. Mean peak HR during running, absolute

Poster Sessions

and relative 1 and 3 minute mean HRR and the corresponding PA intensity as measured by accelerometry were analyzed. Bivariate correlation analysis was used to define factors associated with preschoolers’ HRR.

Results: In our study sample (mean age 4,8 years, 51% boys), children’s mean peak HR during running was 185±15 beats per minute (bpm). Accelerometry monitoring showed that, on average, 87% of the running time was spent in moderate-to-vigourous PA. Mean absolute 1 and 3 min HRR values in our sample were 69±19 bpm (relative: 37%) and 79±17 bpm (43%), respectively. HRR values were positively associated with age and gender (p<0.05), but not with socioeconomic status.

Conclusions: Fitness tests based on HRR in the field appear to be feasible in preschool children, with 1 minute HRR potentially reflecting aerobic fitness.

Funding Source: Landesstiftung Baden-Wuerttemberg, Germany

An evaluation of the quantity and quality of physical activity behavior in preschool children

Authors:

Margaret Dunn-Carver, Jean Harvey-Berino, Greg Dana, Anne Dorwaldt, Brian Flynn, Jennifer Otten

Purpose: The purpose of this pilot project was to quantify and characterize the physical activity of preschool children enrolled in childcare centers.

Methods: Physical activity (PA) of children aged 4-5 from 7 different centers was objectively measured by accelerometry (SenseWear® Armbands [SWA]) and direct observation. PA behavior was coded as inside or outside and free vs. teacher-guided play. Children wore the SWA for approximately 8 hours. Average METs and percent of time spent in sedentary, moderate, vigorous, and very vigorous PA was matched with the activity coded by observation. Data were evaluated using descriptive statistics as mean +/- standard deviation or frequency and percent.

Results/Findings: Subjects (n=61) had a BMI of 15.9 (+/-1.3) kg/m˛ and a mean age 4.5 (range: 4-5); 16% were obese, 25% overweight, and 51% male. Overall, 19,581 minutes of PA were recorded by SWA. Children spent a total of 58.1% of the recorded time sedentary, 36.8% in moderate, 4.4% in vigorous, and 0.7% in very vigorous activity. Children spent less time sedentary (34.6% vs. 40.6%) and more time in vigorous activity (12.7% vs. 6.8%) during teacher-guided compared to free playtime. Indoor playtime was 62.7% sedentary and 32.5% moderate activity whereas outdoor playtime consisted of 27% of sentary activity and 65.4% moderate activity.

Conclusions: Children are most active in outdoor environments and energy expenditure is higher when teachers lead play activities. This data will be used to develop and conduct intervention studies that willl train providers to provide high quality teacher-led phyiscal activities for preschool children.

Funding Source: USDA CSREES 2008-33498-19329 awarded to Dr. Harvey-Berino

Poster Sessions

Development and evaluation of neural network models to identify types of physical activity among adults using accelerometers, global positioning systems and heart rate monitors

Authors:

Sanne I. de vries, Francisca Galindo Garre, Marieke W. Verheijden, Luuk H. Engbers

Purpose: The purpose of the study was to develop artificial neural network (ANN) models based on single-sensor accelerometer data for the identification of types of physical activity and to examine whether the accuracy of the developed models improves by adding heart rate or velocity data.

Methods: Twenty-six adults (8 males, 18 females) performed a controlled sequence of activities: sitting, standing, climbing stairs, and walking and cycling at two self-paced speeds. All subjects wore a uni-axial ActiGraph accelerometer on the hip and the ankle, a GPS and a Polar heart rate monitor. First, ANN models were fitted for the hip and the ankle accelerometer data respectively. The following accelerometer signal characteristics were used: 10th, 25th, 75th, and 90th percentiles, absolute deviation, coefficient of variability, and lag-one autocorrelation. Next, heart rate and velocity data were added.

Results: The ANN model based on accelerometer data only correctly classified activity type 61.8% of the time with the hipmodel, and 56.5% of the time for the ankle model. After the inclusion of GPS and heart rate data the hip model correctly classified activity type 69.7% of the time, the ankle model 60.7%. Walking and cycling, especially brisk walking and cycling, were better classified with these models. However, the new models performed worse when classifying sitting and standing.

Conclusion: The developed models could identify a number of physical activities of adults relatively well based on accelerometer data. The addition of GPS and/or heart rate data did not substantially improve the models.

Measuring food-related parenting: Developing a tool to capture parents actions, words and interactions that shape children’s dietary intake and weight status

Authors:

Rebecca Golley, Gillian Hendrie, Sarah Marshall

Purpose: Parents model dietary behaviours to children via their actions, words and interactions. There are limited tools which characterise different types of food-related parenting. The study objective was to determine whether existing questionnaires measuring the family food environment could be used to characterise different types of food-related parenting and to determine whether types of food-related parenting shape children’s intake in different ways.

Methods: An exploratory analysis was performed on cross-sectional data from 129 4-13 year olds and their parents collected at baseline of a dietary behaviours intervention study in 2009. Parents completed a questionnaire which pooled 56 parenting items from three existing tools. Factor analysis was used to

Poster Sessions

identify underlying dimensions (factors)of the 56-items reflecting parenting. Linear regression examined the association between different types of parenting with children’s dietary intake and weight status.

Findings: While there was some loading of items according to the questionnaires from which items were derived, a unique five-factor structure was extracted reflecting different types of food-related parenting. Thirty-three items were retained, accounting for 44% of the total variance. Differences were found in the strength and direction of the association between parental modelling factors, children’s dietary intake and weight status.

Conclusions: Different types of food-related parenting can be characterised and complement indirect measures of modelling (e.g. comparing parent and child dietary intakes). Understanding the different way in which parenting influences children’s dietary intake will improve advice to parents on ways to promote healthy eating with their children.

Funding Source: Dr Rebecca Golley is supported by a NHMRC Postdoctoral Fellowship. Project funded by CSIRO and Dairy Australia.

Objective examination of sedentary behavior across step indices

Authors:

Elizabeth K. Grimm, Scott J. Strath, Ann M. Swartz, Susan E. Cashin, Nora E. Miller

Purpose: To compare sedentary behavior across various step indices in a group of older adults, aged 50-80 years.

Methods: One hundred and forty older adults (32 men, 64.9±8.0y; 108 women, 64.4±5.9y) participated in this study. Each participant wore a belt-mounted accelerometer (ACC; Actigraph) and pedometer (PED; New Lifestyles) for 7 consecutive days. ACC output was categorized into accumulated time spent (min/d) in sedentary behavior (≤50 cts/min). PED derived steps/day (s/d) were categorized into ≤4,999 (inactive; n=50), 5,000-7,499 (low active; n=55), and ≥7,500(active; n=35). Means±SD are presented for all PA classifications. Gender comparisons were made using independent samples t-tests. A two-way ANOVA was conducted to explore s/d indices and age category (≤64y, n=70; ≥65y, n=70) differences in ACC derived sedentary behavior.

Results: On average participants wore the ACC for 7.0d, 992±89 min/d and the PED for 6.8±0.5 d. Participants spent 9.5 h/d being sedentary and walked 6,160±2,717 s/d. There were no gender differences in ACC derived sedentary behavior or PED s/d. There was a significant main effect for step indices [F(2, 134)=6.3, p<0.001] between the inactive (608±113 min/d) and active step group (511.6±130.1 min/d) and the low active (572±78 min/d) and active step group. The main and interaction effect for age did not reach statistical significance.

Conclusion: Older adults walking ≤7,500 s/d did not differ in their sedentary behavior compared to those walking ≤4,999 s/d. Physical inactivity and sedentariness are separate constructs that both need to be assessed to profile daily behavior.

Poster Sessions

How many days of monitoring predict physical activity and sedentary behavior in older adults?

Authors:

Teresa Hart, Scott Strath, Ann Swartz, Susan Cashin

Purpose: To establish the number of days of pedometer, accelerometer, and physical activity (PA) log monitoring are needed to predict average PA and sedentary behavior levels in older adults.

Methods: Fifty-four older men and women (Mean age = 69 ± 7 years, range = 55-86 years; mean BMI = 27.5 ± 4.7kg/m2) wore a Yamax Digiwalker SW 200 pedometer and an ActiGraph 7164 accelerometer concurrently while completing a PA log for 21 consecutive days (mean wear/completion time = 823.1 ± 103.3 min/day). Spearman-Brown Prophecy Formulas based on Intraclass Correlations for all 21 days and a reliability of .80 were used to predict the number of days of wear/completion needed to represent total PA (pedometer steps, total accelerometer counts, and total PA log MET-min/day) and sedentary behavior (total minutes from accelerometer with ≤50 activity counts/min).

Results: Four days of monitoring from a pedometer and PA log was deemed necessary and 3 days from an accelerometer to reliably predict total PA behavior. Eight days of monitoring was necessary to reliably predict sedentary behavior using an accelerometer.

Conclusions: Depending on the behavior of interest, these results suggest the number of days of monitoring needed to determine typical PA or sedentary behavior in older adults. The number of days to determine PA was consistent across both objective (pedometer and accelerometer) and subjective (PA log) instruments. However, more days were needed to determine typical sedentary behavior in this population.

Objectively-measured physical activity in adults in North East England: Prevalence depends critically on measurement method

Authors:

Frances Hillier, Alan Batterham, Carolyn Summerbell

Purpose: To investigate physical activity levels of free-living adults in North East England using two objective methods of measurement.

Methods: Physical activity levels of 75 adults (mean age 34.6, SD ±11.2 years) were measured over 7 consecutive days using waist-mounted accelerometry (GT3X [uniaxial mode], Actigraph, Pensacola, FL, USA), and synchronised heart rate and accelerometry (Actiheart, CamNtech, Cambridge, UK). Minutes per day of moderate to vigorous physical activity (MVPA; estimated energy expenditure of ≥3 METs, accelerometry cut-point 2020 counts·min-1) and vigorous physical activity (VPA; ≥6 METs, accelerometry cut-point 5999 counts·min-1) were calculated for each method.

Poster Sessions

Results:

GT3X Actiheart

Mean (SD) Mean (SD)

Minutes MVPA day-1 34.7 (59.7) 97.3 (25.1)

Minutes MVPA day-1 (accumulated in bouts ≥10 minutes) 10.8 (5.0) 35.3 (33.2)

Minutes VPA day-1 2.9 (5.3) 11.8 (14.0)

Only one participant (1.4%) achieved the recommended level of physical activity1 based on the accelerometry data. Via synchronised heart rate and accelerometry, however, the sample point prevalence was 20% (31.0% in men, n=9 and 12.2% in women, n=5). The between-method difference in prevalence was 18.6% (95% CI, 9 to 29%, P=0.0002).

Conclusions: The remarkably low prevalence of accelerometry-determined physical activity reflects recent survey findings using identical methods2. However, accelerometry fails to capture the totality of physical activity energy expenditure and prevalence estimates are influenced markedly by choice of count cut-point. We conclude that physical activity prevalence may be grossly underestimated by accelerometry alone.

Department of Health (2004). At least five a week. NHS Information Centre (2009). Health Survey for England 2008.

How much is enough: Do serving sizes for children meet their nutrient needs?

Authors:

Samantha Ramsay, Laurel Branen, Susan Johnson

Purpose: To determine whether serving size recommendations for young children meet dietary standards for nutrient adequacy.

Methods: We examined 3 recommendations for children’s serving sizes (1T per year of age [T/y], MyPyramid and Child and Adult Care Food Program [CACFP]) to determine whether they meet the Estimated Average Requirements (EAR) for children ages 2-5y. Fourteen days of menus (3 meals and 2 snacks/day) were constructed by randomly selecting meals and snacks from 72 CACFP approved menus. Menus were analyzed and mean daily nutrient contents were calculated. Nutrient contents were compared to EARs for male and female children 2 – 5y and ANOVA and Kruskal-Wallis tests were used to compare the 3 approaches.

Results: Nutrient requirements were met for most nutrients by all approaches. However, EARs for fat, vitamin E, chromium, and potassium were not met by any approach in any year or for both sexes. In contrast, protein and carbohydrate contents were well over the EAR for all approaches. The T/y resulted in energy contents below the EAR for each year of age and for both sexes (range 72-90% EAR). For age 2y, the T/y was lower in carbohydrate and fiber (p < .001) for both sexes. For ages 3-4y, T/y had lower energy, protein, carbohydrate and fiber (p < .05),and for age 5y protein was lower (p < .001) for T/y.

Poster Sessions

Conclusions: The T/y approach is a simple rule of thumb for estimating initial serving sizes and providing adequate nutrients to young children.

Funding Source: USDA NRI Grant # 2006-55215-16726

The relationship between the food environment and eating: Developing tools to measure the food environment of adolescents

Authors:

Amelia A Lake, Rachel L Tyrrell, Fiona Greenhalgh, Elaine Stamp, Martin White, John C Mathers, Ashley J Adamson

Purpose: It is hypothesised that the food environment influences eating behaviour and contributes to excessive intakes but there is little research on individual food access and obesity, and few reliable tools. This research aimed to develop methods and tools to characterise the impact of the food environment on adolescent diet.

Methods:Three methodological studies were conducted and four tools were developed: a home food environment questionnaire and three Measuring Food Environment (MFE) tools (for shops, cafés/restaurants, and vending machines) which measure availability and variety of food; levels of nutritional information; barriers and facilitators to healthful choices; and cost. Four-day food diaries recorded diet and location, type and number of environments from which each adolescent obtained food. Each environment was visited by two researchers, classified, then scored using MFE tools and inter-rater reliability assessed. Nutrients and foods were assigned to the environment where food was obtained.

Results: In studies 2 and 3 (n=42, mean age 17.7 years) respondents obtained food from home and 164 food environments. Inter-rater reliability in MFE tools was high and improved between studies. Scores indicated trends that foods obtained healthier environments had higher intakes of protein(g), % energy protein, vitamin C, NSP, iron, folate, fruit and vegetables with lower intakes of % energy saturated fat, NME sugars, % energy carbohydrate. However only vegetables were significantly different (p=0.012).

Conclusion: These studies identified and characterised the food environments to which individual adolescents were exposed and provide an insight into the environmental context of food choices made at this important life-stage. Further research is needed to provide definitive characterisation of the relationship between food environment and body weight in adolescents.

Funding Source: National Institute of Health Research Personal Award for Amelia A Lake

Poster Sessions

Do young adults participate in surveys that “go green”? Comparing web and mail survey response rates among young adults in a longitudinal study of eating, physical activity, and weight-related behaviors

Authors:

Nicole Larson, Dianne Neumark-Sztainer, Peter Hannan, Marla Eisenberg, Eileen Harwood

Purpose: Studies in populations with listed e-mail addresses and established Internet access suggest that web surveys are a useful means for conducting research. However, little research has been conducted in demographically diverse populations. This study among a population-based sample of young adults aimed to 1) examine response to a mixed-mode survey invitation that encouraged on-line participation and 2) identify demographic correlates of response mode.

Methods: Young adults who participated in previous study waves were invited to participate in the third wave of a 10-year longitudinal study (Project EAT-III), examining dietary intake, physical activity, weight status, and factors associated with these outcomes. In 2008, young adults were mailed survey invitation letters providing the web address and a unique password for completing the web form. Non-responders were mailed three reminder invitations. The second reminder included the paper form, and all other mailings included a postage-paid card for requesting the paper form. Results: A total of 2,287 young adults (66.4%) returned surveys that were at least 25% complete. The majority of respondents completed the web form (86.5%). Completing the web versus paper form of the survey was related to higher socioeconomic status and postsecondary student status (p<0.001). Survey mode was unrelated to gender, race, or age.

Conclusions: Results indicate that web surveys are an effective strategy for conducting research relating to nutrition and physical activity behaviors among diverse young adults. However, providing alternate modes for response may be important to help ensure the participation of non-students and those from lower socioeconomic backgrounds.

Funding Source: NHLBI grant #R01HL084064

Developing a scale to measure outcome-expectancy value of leisure-time physical activity for use among African Americans

Authors:

Kaigang Li, Dong-Chul Seo, Mohammad R. Torabi, Chao-Ying J Peng, Noy S. Kay, Lloyd J. Kolbe

Objective: Numerous studies have measured outcome expectation of physical activity (PA), a belief about the outcomes of PA, but not the outcome-expectancy value (OE-V), the multiplicative combination of the outcome expectation and corresponding perceived importance/value of an expected outcome. The reliability and validity of a scale measuring (OE-V) of leisure-time physical activity (LTPA) for African Americans (Aas) were examined using confirmatory factor analytic techniques.

Poster Sessions

Methods: Using the Social Ecological Framework, a scale was developed to measure OE-V (both positive and negative), as one of the contributory factors to LTPA. The questionnaire was administered to 649 participants in 27 AA churches in Indianapolis. A split-sample cross-validation was conducted to evaluate psychometric properties of the scale, including exploratory factor analysis (EFA), internal consistency reliability, and multiple-group confirmatory factor analysis (CFA).

Results: Two factors were retained that represent the OE-V. The internal consistency measures were acceptable – Cronbach’s α = 0.815 for the positive OE-V (n=5 items) and 0.753 for the negative OE-V (n=5 items). The positive (r=0.117, p < .001), negative (r=0.129, p < .001) subscales, summated total score (r=0.186, p < .001) ofOE-V were significantly correlated with LTPA.

Conclusions: The two-factor solution with positive and negative OE-V subscales was supported based on EFA and multiple-group CFA across the calibration and validation samples. The results support the factorial and construct validity ofOE-V scale which was applied to assess LTPA among church-going Aas. Significant correlations between the two OE-V scales and LTPA provide evidence of the criterion validity of this scale.

Examining the stability of exercise identity

Authors:

Vincent Liardi, Jacqueline Simatovic, Lindsay Duncan, Craig Hall

Given the rising incidences of obesity and other preventable diseases, research devoted to increasing exercise in all populations is imperative. Thus, the purpose of this study is to examine the link between exercise identity and measurable exercise behaviors. The second purpose of this study is to examine whether an educational intervention can influence the stability of one’s exercise-related identity. Kinesiology students (n=148) reported their current exercise levels and had their exercise identity measured with the Exercise Identity Scale (EIS). They were subsequently randomly divided into two groups and presented with an “exercise education session” two weeks post-baseline. The first (minimal) group was presented information as if the definition of an exerciser was an easy-to-obtain standard (lower than the American College of Sports Medicine (ACSM) standard). The second (maximal) group was presented information as if the definition of an exerciser was a highly challenging standard (higher than the ACSM standard). Exercise identity was re-assessed immediately following each of these presentations. Results showed that subjects with higher exercise identities reported greater frequency, intensity, and duration of exercise. Further, subjects who were presented with the minimal exercise standards saw a significant boost in exercise identity scores (pre=33.79, post=35.68, p<0.05). Changes were non-significant for the maximal group (i.e., their exercise identity did not decrease as expected). The research extends the line of thinking that individuals who possess a higher exercise identity engage in behaviors that confirm their identity (i.e., greater exercise doses). Additionally, it is implied that exercise identity is not a stable trait, and can be manipulated, even in individuals with above-average physical activity knowledge.

Funding Source: Social Sciences and Humanities Research Council (SSHRC) Master’s Scholarship

Poster Sessions

Accuracy of food outlet type designation in two secondary data sources

Authors:

Angela Liese, Natalie Colabianchi, Archana Lamichhane, Timothy Barnes, Michele Nichols

Purpose: Secondary data used to characterize the built food environment are known to harbor count errors, but the accuracy of food outlet type designations based on North American Industry Classification System (NAICS) codes has not been assessed.

Methods: Data from over 1,000 food outlets in 8 South Carolina counties were available from InfoUSA, Dun & Bradstreet (D&B) and a field census. Outlet types were stores (STORES: convenience, dollar, drug, specialty, groceries) and restaurants (REST: full and limited service). Subcategories included grocery stores (GROC: supermarkets, supercenters, warehouse clubs, other groceries) and full service restaurants (FSREST). Types were assigned based on primary NAICS codes in InfoUSA/D&B data vs. review of each outlet utilizing business name, internet and phone research for our data. Positive predictive values (PPV) were calculated comparing InfoUSA and D&B to our data.

Results: Both InfoUSA and D&B had high and identical PPVs for STORES (94%, 95%CI 92-96%) and REST (99%, 95%CI 98-99%). The GROC PPV was markedly lower in InfoUSA (72%, 95%CI 65-80%) due to designation of convenience stores as GROC and very poor in D&B (37%, 95%CI 31-43%) due to designation of dollar and convenience stores as GROC. The PPV of FSREST was poor in InfoUSA (50%, 95%CI 46-53%) due to inclusion of limited service restaurants, but moderate in D&B (78%, 95%CI 73-83%).

Conclusions: NAICS code based food outlet types were reasonably accurate for broad classifications but moderate to poor for subcategories. Data cleaning and validation efforts are essential for reliable use of these secondary data in research.

Funding Source: NIH

Development and psychometric evaluation of a theory of planned behavior dietary questionnaire for individuals at risk for coronary heart disease

Authors:

Amy Mark, Dana Riley, Lisa McDonnell, Andrew Pipe, Robert Reid

Purpose: A healthy diet is important for the prevention of coronary heart disease (CHD), the leading cause of death in North America. Understanding the factors that influence dietary behavior in individuals at risk for CHD is important; the theory of planned behavior (TPB) may be beneficial. Currently no questionnaire exists to measure behavioral, normative and control beliefs towards eating a healthy diet in individuals at risk for CHD. The purpose of this study was to develop an appropriate questionnaire and test the psychometric properties of it.

Poster Sessions

Methods: The current questionnaire was developed for use as part of a randomized control trial of a lifestyle intervention in individuals with a family history of CHD and ≥1 additional risk factor. The elicitation questionnaire was administered to sub-sample of 30 participants, and was comprised of a series of nine open-ended questions related to behavioral belief, normative belief, and control belief. A psychometric evaluation of the questionnaire was completed in a separate sample of 17 participants over a two week period. Cronbach’s alpha was used to test the reliability of the questionnaire.

Results: Responses from the elicitation questionnaire were coded and analyzed qualitatively to determine common themes, and used to develop the healthy eating opinion questionnaire. The reliability was good with Cronbach’s coefficient alphas of 0.93, 0.93, 0.96 and 0.95 for behavioral belief, normative belief, control belief and intention, respectively.

Conclusions: The TPB nutrition questionnaire was found to be a reliable measure of participants’ behavioral, normative and control beliefs towards eating a healthy diet.

Funding Source: Heart & Stroke Foundation of Ontario

The EFQM: Criteria in physical activity programmes for elderly people —a descriptive study

Authors:

Ana Marques, Pedro Soares, Luisa Soares-Miranda, Carla Moreira, Rute Santos, Susana Vale, Paula Clara-Santos, Joana Carvalho

In the past years there has been a growing concern in conceiving physical activity (PA) programmes for elderly people since the evidence point out that health promotion interventions may reduce the deleterious effects of the aging process. Quality is an important issue in a PA programme for older people. In Portugal, the Public Administration is the sector that offers the largest supply of goods and services and as such, it is the sector that must devote most attention to Quality and to the definition of quality standards. Some studies support the Excellence Model of the European Foundation for Quality Management (EFQM) as an operational framework for Total Quality Management (TQM). Therefore, the aim of this study was to characterise the management models of the PA programmes developed by the Portuguese Local Administration to enhance quality of life for elderly people, according to the criteria of the EFQM Excellence Model. We conducted a methodological triangulation in 26 PA programmes using questionnaire surveys, semi-structured interviews and document analysis. We found that Processes, Leadership (61,03%), Customer results (58,46) and People (51,28%) had high percentage occurrences of quality practices. In contrast, Partnerships and resources (45,77%), People results (41,03%), Policy and strategy (37,91%), Key performance results (19,23%) and Society results (19,23%) had lower percentage occurrences. Although there are some good practices in PA programmes, there are still relevant areas that require improvement.

Funding Source: FCT: SFRH/BD/36796/2007

Poster Sessions

Can childcare staff provide reliable and valid information on children’s outdoor time and teacher-led outdoor activities using the Environment and Policy Assessment and Observation Self-Report (EPAO-SR)?

Authors: Christina McWilliams, Derek Hales, Dianne Ward

Accurate and convenient assessment tools are needed to examine physical activity characteristics of childcare environments.

Purpose: To examine the ability of childcare staff to report how much time children spend out of doors and the number of outdoor occasions of teacher-led activity using a new self-report (SR) instrument.

Methods: Items from the Environment and Policy Assessment and Observation (EPAO) instrument were revised using cognitive interviewing and formatted into a SR instrument for childcare staff. Validity evidence for the SR instrument was determined using direct observation as the “gold standard” to evaluate the physical activity childcare environment. Trained research staff observed physical environments at 50 childcare centers in North Carolina over four consecutive days from before the first eating occasion until the end of the day. Observations included minutes of outdoor playtime and outdoor occasions of teacher-led activity.

Results/Findings: The single measure ICC was moderate (ICCsingle=0.54) for staff reported minutes of outdoor time. With all four days the ICC was (0.83). The correlation between center staff report and the EPAO observation was moderate to larger (r =0.69) Unfortunately, reliability (ICCsingle=0.19) and validity evidence (r = 0.13) did not support the ability of staff to self-report outdoor teacher led physical activity.

Conclusions: Results show that across multiple days, staff can reliably self-report the minutes of outdoor time. Due to low reliability and validity scores, modifications are needed to improve outdoor teacher-led activity obtained by self-report.

Funding Source: Robert Wood Johnson Healthy Eating Research Grant and Active Living Research Grant

Is the Environment and Policy Assessment and Observation Self-Report Instrument (EPAO-SR) reliable and valid for assessing the child care physical environment?

Authors: Christina McWilliams, Derek Hales, Dianne Ward

Purpose: To examine reliability and validity evidence for a self-report measure of the childcare physical environment (EPAO-SR).

Methods: Using cognitive interviewing, the Environment and Policy Assessment and Observation (EPAO) instrument was revised into a self-report for childcare directors and staff to complete. Validity evidence

Poster Sessions

for the SR instrument was determined using direct observation as the “gold standard” to evaluate the physical activity childcare environment. Trained research staff observed physical environments at 50 childcare centers in North Carolina over four consecutive days from before the first eating occasion until the end of the day. In addition, center directors and staff completed the EPAO-SR on each observation day. Observations included the outdoor natural environment and outdoor and indoor physical environment (i.e. portable and fixed play equipment and sedentary equipment such as TVs).

Results/Findings: Reliability (ICCsingle = 0.94) and Validity (r = 0.70) evidence suggest that the center directors can adequately report the natural elements (i.e. trees, hills) within the center play space. In addition, staff assessments of the sedentary, portable, and fixed equipment were moderate (ICCsingle= 0.69, 0.48, 0.65). Lower estimates were obtained for the report of fixed equipment use (ICCsingle = 0.27).

Conclusions: The findings provide evidence that childcare directors and staff can reliably self-report the outdoor natural and outdoor/indoor physical environment. For some measures more than one day of reporting may be required to obtain acceptable levels of reliability.

Funding Source: Robert Wood Johnson Healthy Eating Research Grant and Active Living Research Grant

Validation of the CFPQ in a Norwegian sample of tween parents

Authors:

Elisabeth Lind Melbye, Torvald Øgaard, Nina Cecilie Øverby

Introduction: So far, most measures of parental feeding practices have included only a subset of feeding practices. The Comprehensive Feeding Practices Questionnaire (CFPQ) is a new 12-factor feeding practices measure that examines multiple feeding behaviours.

Purpose: The CFPQ is originally designed for use with parents of children ranging in age from about 2 to 8 years of age. The purpose of the present study was to test the validity of this measure with parents of older children (10-to-12-year-olds; “tweens”).

Methods: In the present study the CFPQ was adapted to fit Norwegian parents of 10-to-12-year-old children. Four items were considered irrelevant to parents of 10-to-12-year olds, and were therefore removed. Thus, the adapted version of the CFPQ consisted of 45 items tapping 12 aspects of parental feeding practices. The CFPQ items were translated into Norwegian, back translated into English, and pre-tested prior to data collection. A standard scale validation procedure was followed testing the validity of the CFPQ with tween parents [1].

Results: A sample of 963 Norwegian parents (response rate: 66%) completed the CFPQ. Preliminary scale analyses shows a factor structure similar to previous findings, but with some interesting exceptions.

Conclusions: Results from preliminary analyses suggest that the CFPQ, with some adaptations, may be an applicable tool for measuring multiple parental feeding practices with parents of 10-to12-year-olds. However, further development is needed to improve the psychometric properties of the instrument.

Poster Sessions

[1]Two aspects were measured with only one and two items respectively. Thus; these items were not included in the scale analyses.

Funding Source: University of Stavanger

The development of an independent audit tool to evaluate and improve healthy food options

Authors:

Christina Mills, Renee Ferguson, Michael Rosenberg, Sarah Kepert, Sharonna Freeman, Blanche Waddell, Jo Clarkson

Purpose: The Western Australian Health Promotion Foundation (Healthway) sponsors sport, arts and racing organisations (e.g. motor racing, horse racing) in exchange for the promotion of health messages and the implementation of policies (e.g. healthy food policies) so as to create healthy environments. The purpose of this study was to develop and pilot test an audit tool that could be used to record the types of foods/drinks offered at Healthway sponsored racing venues. The tool was developed with the view that the information collected could be used to provide feedback to organisations about how they could improve the food/drink options made available to patrons.

Methods: Twelve vendors were audited between November 2008 and February 2009. Trained auditors conducted a scan of the products available using a 52 item list of foods/drinks typically available at popular entertainment events. Auditors recorded whether or not the items listed were offered, if healthy options were available and portion sizes. The audit took 30 minutes to complete.

Results/Findings: Overall, 50% of vendors offered sandwiches/rolls, while 42% sold burgers, chips, hot dogs, ice creams, icy poles and pies/pasties/sausage rolls. All vendors sold soft drinks and water, while 50% sold alcohol. All vendors that sold food also offered patrons at least one healthy food option.

Conclusions: The audit proved useful at gathering information about the types of food/drink options available at racing venues. The audit will be used by Healthway and its partner organisations to assess and make recommendations regarding the healthy food options offered at sponsored events.

Testing an instrument to measure caregiver’s food environment control practices that impact children’s food intakes

Authors:

Megumi Murashima, Sharon Hoerr, Sheryl Hughes

Purpose: To test the reliability and validity of an instrument to measure primary food caregivers’ (PFCs) feeding practices that structure preschoolers’ food environment.

Methods: A 12-item instrument was generated based on previous studies and tested in 257 female PFCs (19-62yr) recruited from 19 Head Start sites in Michigan. The frequency with which their child (3-

Poster Sessions

5yr, 52% boys) ate nutrient-dense/energy-dense foods during the past week was also assessed, and the child’s height and weight were measured. Test-retest data were collected from 35 PFCs within one week. Exploratory factor analysis resulted in 12 items loading onto 4 factors (having the child sit during meals, structuring mealtime physical contexts, home food availability/accessibility, and setting regular eating times). The item scores were averaged within the factors. Cronbach’s alphas, test-retest reliability and correlations between the factors and child’s BMI percentile and nutrient-dense/energy-dense food frequencies were analyzed.

Results/Findings: The factor loadings ranged 0.42-0.81, and the Cronbach’s alphas for the factors 0.53-0.60. Test-retest correlations (Pearson’s r) of the factors ranged 0.73-0.83 (p<0.001). Having the child sit during meals and structuring mealtime physical contexts were positively correlated with the child’s nutrient-dense food frequency (r=0.147; p=0.019, r=0.216, p=0.001, respectively), whereas Home food availability/accessibility and setting regular eating times negatively related to energy-dense food frequency (r=-0.241; p=0.003, r=-0.217; p=0.007, respectively). No factors were correlated with the child’s BMI percentile.

Conclusions: The instrument had acceptable levels of test-retest reliability and concurrent validity. Future studies should include food environment structuring feeding practices as an important aspect relating to children’s food intake.

Funding Source: Michigan Agricultural Experiment Station P052

A biochemical and socio-behavioural analysis of nutritional status of elderly Indians

Authors:

Rishi Nigam, Parul Rishi

Purpose: Ageing is an issue of global concern as well as of immense importance in developing countries like India. Increased life expectancy and improved living conditions are responsible for increasing population of aged people. As people grow older there occurs physical, physiological, and psychological changes which leads to changed needs and require constant and regular health supervision. Looking at the specialized nutritional and psychosocial needs of elderly the study of urban elderly population was done to asses their nutritional status and psychosocial behavior.

Method: A sample of 85 senior citizens ( age<60 years) of both the genders was selected from various areas through geriatric health camps held in Bhopal city of Central India. To assess nutritional status and general health assessment, mini nutritional assessment chart nestle SF and anthropometrics measures like body mass index (BMI), height, weight and waist circumference were used. Biochemical parameters like serum protein, cholesterol, serum iron and hemoglobin were assessed and correlated with anthropometric and behavioral measures (Geriatric Depression Scale).

Result/Findings : Normal to high BMI was found with the prevalence of Iron and protein deficiency. Besides incidence of hypercholesterolemia was also found with a significant correlation with waist

Poster Sessions

circumference. Gender differences in incidence of depression were also found with the females reporting more depression than females.

Conclusions: Results were analyzed in line with cultural and social framework of Indian Lifestyle and dietary habits and recommendations were made for total dietary management, lifestyle and dietary behavioral management as per their nutritional status.

Do as we say, not as we do: A social network composition analysis of young women’s physical activity

Authors:

Maureen O’Dougherty, Mary Hearst, Kathryn Schmitz, Mindy Kurzer

Purpose: To explore effects of participant and network member composition characteristics on young women’s physical activity (PA). Given the low levels of physical activity in the population, we hypothesized that descriptive norms and companionship support (engaging in physical activity together) would be limited in the women’s networks.

Methods: Sixty participants (healthy but sedentary women aged 18-30 years) described five members of their social networks, frequency of contact, usual activities, and assessed network members’ PA (descriptive norm) and social supports for participants’ PA. Multinomial logistic regression assessed network-level characteristic effects on participants’ self-reported leisure time PA and submaximal fitness.

Findings: Most network members (77%) verbally supported participants’ PA, but only 34% were physically active with them. Most network activities (81%) of participants with network members were inactive. Participants described network PA levels as widely ranging. Other than education, there were no associations between perceived levels of network members’ PA and participants’ PA and fitness, but several characteristics trended toward significance (marital status, work/school hours, race/ethnicity, relationship, amount of contact, body mass index, residence).

Conclusions: The findings support our hypothesis: descriptive norms were too broad to provide a consistent social norm for PA; companionship support was limited; even verbal/emotional supports for PA were weakly influential. Network activities produced a norm of inactive, sedentary socializing. Together the norms may suggest: do as we say, not as we do. More research is needed employing specific constructs of social support and social norms to further examine the ways networks support or discourage physical activity.

Poster Sessions

Food activity diary is an important tool to use in patients management to create room for more nutrition education and counseling, physical activity and support

Authors:

Alice Ojwang Ndong, Regina Mbochi

Purpose: The purpose of this study was to determine if patients who completed their food and activity diary changed some unhealthy dietary practices and lost more weight compared to patients who did not complete their food and activity diary.

Methods: Retrospective study in a weight management program in Kenya. Data was collected from patient’s files who had been followed up for 6 months and were compared to patients who had come in the same period and had not completed the FAD.

Results: Patients, who complete the Food and Activity Diary made better progress in weight loss, received more nutrition education and were more likely to change their behavior. The results indicate a significant reduction in weight loss and some behavior change in regard to dietary practices of patients who completed their FAD.

Conclusion: Patients, who complete the Food and Activity Diary made better progress in weight loss, received more nutrition education and were more likely to change poor Nutrition practices behavior.

Funding Source: Center for Nutrition Education and Research

My child at mealtime: Development and validation of a tool to assess risk for parenting behaviors associated with pediatric obesity

Authors:

Lenna Ontai, Stephanie Sitnick, Katheryn Sylva, Larissa Leavens, Christine Davidson, Mical Kay Shilts, Marilyn Townsend

Purpose: There is increasing evidence for the role parenting assumes in child feeding and obesity in young children. As obesity rates rise for young children in the United States, assessment tools aimed at parenting are needed to increase the efficacy of prevention and intervention efforts. The development of such assessment tools targeting the most vulnerable populations – low-income families of preschool aged children - have been recommended by the Institute of Medicine. This research developed and evaluated the face validity of an assessment tool focused on parenting behaviors associated with child obesity.

Design/Methods: A sample of low-income, English-speaking parents recruited from Head Start completed cognitive interviews (n=77). Items were based on a validated instrument designed to measure parenting styles associated with feeding. Parent feedback was used to simplify text and develop content relevant photographs.

Poster Sessions

Results: The resulting version of the client-driven assessment tool, My Child at Mealtime, contains 27 items with visuals reflecting five sub-scales (control, autonomy, contingency management, communication, and access to food), with a Flesch-Kincaid level of 2.1. Eleven other determinants of child obesity are represented in a second tool, Healthy Kids, containing 45 items with visuals. Clients reported that the visually-enhanced tool: captured their attention, was easy to read, had pictures that helped them understand the text, and made them think about their parenting.

Conclusion: My Child at Mealtime has adequate face validity in this target population and is ready for further study of reliability and factor analysis followed by validation using convergent and criterion measures.

Funding Source: USDA-CSREES-National Research Initiative 2009-55215-05019.

Steps that count: Translating physical activity recommendations into a steps per minute goal

Authors:

Julian Pillay, Estelle Victoria Lambert, Tracy Kolbe-Alexander

Background: Pedometers are useful tools for monitoring ambulatory physical activity, typically measuring total number of steps, independently of intensity/cadence. Brisk walking has been identified as one of the activities meeting the current recommendation for moderate intensity physical activity (PA). Translating this recommendation into a pedometer-based steps/minute guideline could therefore, improve public uptake of physical activity.

Aim: To determine the “optimal” steps/minute rate for moderate intensity PA and to establish how this relates to self-paced brisk walking.

Methods: A convenience sample (N=32, 19 men; 13 women, 34+8yrs), wearing pedometers and a heart rate monitor, completed a self-paced “brisk walk” for 10 minutes in an indoor setting. Participants subsequently walked under similar conditions for five metronome-regulated sessions (ranging from 60-120 steps/minute) to determine an “optimal” steps/minute rate for moderate intensity PA.

Results: The optimal steps/minute rate was 111±11 (113±6 and 109±16 for men and women respectively; p=0.27). The mean steps/minute rate of the self-paced brisk walk was 118±10 (115±10 and 123±8 for men and women respectively; p=0.016). No statistical difference was obtained between actual and targeted heart rates in the brisk and 120 steps/minute walks (p=0.685 and 0.835 respectively) only. The steps/minute rate of the brisk walk was faster than the optimal steps/minute rate (p=0.022). Only 5 participants (15.6%) in the brisk walk, walked slower than their optimal steps/minute rate.

Discussion: These findings concur with recent step/minute recommendations and also indicate that the optimal steps/minute target of an individual is similar to that of self-paced brisk walking.

Poster Sessions

Comparison of physical activity levels estimated by two methods

Authors:

Catarina Prima, Luiz Anjos, Vivian Wahrlich, Daniele Souza, William Waissmann, Maria Teresa Olinto, Fabio Gome

Purpose: In order to evaluate population’s physical activity levels (PAL), many instruments are used, and commonly the International Physical Activity Questionnaire (IPAQ) and 24h physical activities recalls (PAR24h). This paper compares PAL estimated by these two instruments.

Methods: Subjects answered the PAR24h and the long form of the IPAQ by telephone (n = 83). They answered 3 interviews of PAR24h in the summer and 3 in the winter, 4 weekdays and 2 weekend days. The IPAQ has referred to one typical week of the previous year. The PAL according to the PAR24h was estimated by using the average daily physical activity energy intensity indicated by metabolic equivalents of tasks (MET)-hours/day: (1) Inactive: < 1.5 MET; (2) Moderate - MOD: 1.5 - 2.9 MET; (3) very active - VA: ≥ 3.0 MET. The analysis of the IPAQ followed the criterion recommended for the questionnaire.

Results: The IPAQ identified 68% of the adults as VA, while nobody was identified as being VA by the PAR24h. The proportion of subjects categorized as inactive and MOD was significantly higher (p<0,05) when the PAR24h was used, in comparison with the IPAQ for both sexes and for women separately. The agreement among the PAL categories defined by the two methods corroborates these findings (κ = 0.12).

Conclusions: The proportions of individuals by PAL categories had significantly differed according to these two methods. Especially when the interest is on the comparison between studies, it is important to take into account the method and the differences on estimates.

Funding Source: Brazilian National Research Council (Conselho Nacional de Desenvolvimento Científico e Tecnológico _ CNPq) P058

Video recordings of school meals: Descriptive analysis of eating and non-eating behaviors of children

Authors:

Renee Rosen, Nikki Warren, Allison Dostal, Beth Arndt, Len Marquart

Purpose: To help curb the childhood obesity epidemic many aspects including physical activity and eating behaviors need to be examined. The Dyadic Interaction Nomenclature for Eating (DINE) has been used to investigate eating patterns and behaviors of children with various disease states in their homes. This research investigated children’s eating and non-eating behaviors in a “free living” school cafeteria.

Methods: 78 children were video recorded ~1- 6 times while eating a variety of meals during school lunch. The camera was positioned at the end of a designated table which ran continuously throughout lunch until the last child left the table. The School Lunch Observation Nomenclature for Eating (SLONE) method was established using a modified DINE protocol. Eating behaviors and non-eating behaviors were

Poster Sessions

defined, coded and recorded in10-second intervals on score sheets. Amounts eaten were also observed and recorded in Ľ serving increments. Reliability was assessed on 30% of the video recordings. Kappa were calculated based on agreement for number of bites/sips and behaviors within each 10-second interval.

Results/Findings: Average kappa across all video recordings was 0.88. Children in higher grade levels selected fewer food items and spent less time eating. Food items selected by children at lunch differed by grade. However, overall consumption of the meal did not differ by grade. Eating behaviors and activities were also reported.

Conclusions: This method, which was piloted in a “free living” environment, may establish basic procedures and provide potential insight into children’s eating and non-eating behaviors during school meals.

Funding Source: ConAgra Foods, Inc

Obesity assessment method does not alter relationship with health-related quality of life in older women

Authors:

Aubrianne E. Rote, Ann M. Swartz, Scott J. Strath, Susan E. Cashin, Nora E. Miller, Elizabeth K. Grimm

Purpose: To examine the relationship between health-related quality of life (HRQL) and obesity as assessed by body mass index (BMI) and body fat (%BF) in older women.

Methods: One-hundred sixty-four women (63.6+5.8y; 30.7+5.5kg/m2; 42.9+5.9 %BF) completed this cross-sectional investigation. Height and mass were measured. BMI was calculated. Dual-energy x-ray absorptiometry (DXA) was used to estimate %BF. Overall HRQL was assessed with the SF-36 survey. Seven-day physical activity (PA) was measured by New Lifestyles NL-800 pedometer. Level of obesity was categorized from BMI and %BF using standard guidelines. Data were analyzed using descriptive statistics, hierarchical regression analyses to determine contributions of obesity to HRQL, and crosstabs to determine percent agreement between the two estimates of obesity.

Results: Age, steps/d, and BMI accounted for 3.1% (p=0.044) of the variance in HRQL, while age, steps/d and %BF accounted for 2.8% (p=0.058). The hierarchical regression model revealed that obesity, whether estimated by BMI (β=0.097, p=0.237) or %BF (β=-0.07, p=0.347), was not an independent predictor of HRQL. These factors only explained 0.8 and 0.5% of the variance, respectively, after controlling for age and steps/d. Crosstabs indicated 70% agreement (kappa=0.48, p<0.001) for BMI and %BF when categorizing obesity.

Conclusion: Results from this study indicate that either estimate of obesity is acceptable when assessing relationships with HRQL and that obesity is not a significant contributor to HRQL in older women. In concordance with previous research, results from this study underscore the importance of PA for positive self-reported HRQL, regardless of obesity level or measure.

Poster Sessions

If body fat were uncoupled from physical activity in the thrifty Asian Indians?

Authors:

Stéphane Sinnapah, Sophie Antoine Jonville, Olivier Hue

Purpose: It has been proposed that thrifty genotypes could predispose some human groups to type 2 diabetes. Asian Indians have several times been reported to be overexposed to the disease. A differentiated relationship between physical activity and body fat could support this phenomenon.

Methods: We examined the relationship between body fat and physical activity (PA) in 330 Guadeloupian adolescents taking ethnicity into account. The subjects responded to the modifiable activity questionnaire and bioimpedancemetry assessed their percentage of body fat. We then studied the effect of leisure time-physical activity (LTPA) and ethnicity on the percentage of body fat (%BF). The alpha risk retained was 0.05.

Results/Findings: The subjects reporting LTPA greater than 20 and 70MET-Hr/week were less fat than the others (p<0.05). LTPA less than 70MET-Hr/week was associated with greater variance in %BF (Bartlett p<0.05). Asian Indians had higher %BF even when matched with controls for age, sex and quartile of LTPA. The analysis failed to evidence that PA was associated with lower body fat in this group.

Conclusions: The higher dispersion of body fat for low levels of PA supports the hypothesis that self-regulation of energy intake at low levels of activity is not possible. We further suggest that the non-association of PA with body fat in Indians is consistent with the hypothesis of the thrifty genotype.

Funding Source: Government

The use of travel diaries to assess food access and acquisition in a young adult population

Authors:

Shawn Somerset, Penny Beatty

Neighborhood food environments can influence food access, and therefore dietary habits. Methods describing how individuals interpret their food neighborhood to acquire food rely on geographic mapping combined with various dietary intake assessments. Non-food-centric reference frameworks may provide additional insight into food acquisition. Travel is a key conduit for food access, and was assessed for its feasibility as a framework for understanding food acquisition. A purposive sample of 47 young adults (18-25 years) recorded their travel movements for 7 consecutive days (incorporating all food acquired during that time). Food outlets within 2 km of each subject’s home were mapped. Of the 97.7% of subjects with car access, only 44% used a car for the primary purpose of grocery shopping and 19% purchased groceries via trip chaining (secondary to a primary purpose such as travel to/from work). A similar proportion of car trips were made to buy groceries and to buy food for immediate consumption (44.7 vs 42.6%) although the maximum distance travelled for each varied (19.8 vs 99km, respectively).

Poster Sessions

Car travelers made the majority (91.5%) of trips for reasons unrelated to food acquisition, in contrast to walkers (10.6%). The acquisition of food via trip chaining indicates that domiciliary food environments may be a less important determinant of food access in some groups. A longer data collection duration is required since purchase cycles for some foods extend beyond 1 week. The travel diary framework provides significant scope to align food acquisition with other health behaviors such as physical activity, alcohol intake, and smoking, as well as social networking, work/school commitments, shopping and environmental sustainability factors.

Reliability of two self-report physical activity questionnaires among Chinese-Australian youth

Authors:

Claudia Strugnell, Andre Renzaho, Kate Ridley, Jisheng Cui, Cate Burns

Purpose: To determine the reliability and internal consistency of two self-report physical activity (PA) questionnaires (The PA participation & Self-reported barriers to PA participation questionnaires) among Chinese-Australian youth (11-14y). This study is unique because little is known about the reliability of self-report PA questionnaires’ among Culturally And Linguistically Diverse (CALD) youth.

Methods: Modified questionnaires from the Western Australian Child and Adolescent PA and Nutrition Survey, were administered on two occasions, 7d apart, to 77 students (50% male) from 3 Chinese weekend cultural schools in metropolitan Melbourne. The test-retest reliability of individual items was determined using Kappa statistics for categorical variables and intraclass correlation coefficients (ICC) for continuous variables. Internal consistency was examined through factor analyses.

Results/Findings: The mean and standard deviation of the Kappa (k) statistic for dichotomous responses to a 34item PA checklist were k= 0.61 ± 0.25 (95%CI: 0.52; 0.70). Duration and frequency totals of the 34 item checklist averaged a ICC of 0.43 ± 0.26 (95%CI: 0.14; 0.72) for frequency and 0.47 ± 0.27 (95%CI: 0.16; 0.78) for duration, but the ICC was stronger for Mon-Fri activities than Sat or Sun. Factor analysis of the 37 item second survey revealed 11 factors (Cronbach Alpha: 0.32-0.82), all of which demonstrated reliability above ICC≥ 0.41, mean = 0.74 (95%CI: 0.67; 0.81).

Conclusions: The combined surveys provide reliable estimates of self-reported barriers to PA and type, frequency and duration of PA for weekdays but not weekend. This may reflect poor reliability of the instrument and/or true variation in weekend PA behaviour.

Funding Source: Claudia Strugnell is supported by a Deakin University Postgraduate Research Scholarship

Poster Sessions

Validation of the German Self Report Habit Index for physical activity

Authors:

Julia Thurn, Jens Bucksch

Purpose: Worksite health promotion provides the opportunity to change physical activity (PA) behavior. In order to stabilize one’s PA we should take habit strength into account. The purpose of our study was to validate a German version of the Self Report Habit Index (SRHI) in terms of doing sports and moderate PA within the research project “GemNet”.

Methods: We conducted a cross sectional study in two German companies. 321 employees (study I) and 537 employees (study II) completed a computer based questionnaire on SRHI and stages of change (Prochaska & Velicer, 1997). Reliability in study I was evaluated according to internal consistency. To evaluate convergent validity in study II we examined the score of SRHI along the five stages of change.

Results: We found high internal consistency of SRHI for both PA facets (α = .96 - .97). Significant stage effects were revealed for habit strength of doing sports as well as for moderate PA. The score of SRHI increased along the stages and was highest in maintenance. Effect size of doing sports (η˛ = .485) was high and medium for moderate PA (η˛ = .292).

Conclusion: The German version of the SRHI in terms of PA showed satisfying results regarding reliability and validity. Further validation with objective criteria of PA is warranted. Future research will use the German version of the SRHI as a measurement tool in intervention studies within the project, GemNet“.

Funding Source: This study was supported by BMBF and the European Union (ESF).

Healthy kids: Development and initial validation of a risk assessment tool for pediatric obesity prevention among Head Start participants

Authors:

Marilyn Townsend, Kathryn Sylva, Christine Davidson, Larissa Leavens, Stephanie Sitnick, Mical Kay Shilts, Lenna Ontai

Purpose: With a tripling of obesity rates for young children in the United States, development of obesity risk assessment and intervention evaluation tools is recommended by the Institute of Medicine targeting low-income families with preschool children where literacy is a major issue. This research developed and evaluated the face validity of an assessment tool focusing on 12 determinants of obesity.

Design/Methods: A sample of low-income English-speaking parents recruited from the Head Start Program completed cognitive interviews (n=77). Parents recommended simplified text, as well as culturally and educationally relevant photographic content. Many of the photos were taken with client’s permission in their homes and using their children as models.

Poster Sessions

Results: Using a 5-step process, the resulting version of the client-driven assessment tool known as Healthy Kids contains 45 text items with visuals reflecting 11 sub-scales. The 12th, parenting, is represented in a second tool, My Child at Meal Time, containing 27 items with visuals. The 45-item tool generated a Flesch-Kincaid grade level score of 1.3, indicating low reading difficulty for low-literate parents.

Clients reported that the new visually-enhanced tool captured their attention, stimulated their interest in the assessment process, improved their understanding of the behaviors in question, enhanced readability by reducing the word count and provided cues to understanding the text.

Conclusion: This version of the assessment tool Healthy Kids has adequate face validity in this target population and is ready for further study of reliability and factor analysis followed by validation using convergent and criterion measures.

Funding Source: Funding provided by USDA-CSREES-National Research Initiative 2009-55215-05019.

Poster Sessions

Poster session 1: Policy

Poster session 1: Policy P065

Changes in state competitive foods laws in U.S. elementary schools

Authors:

Tanya Agurs-Collins, Frank Perna, Louise Masse

Purpose: The purpose of this study was to examine change in the number of states with competitive food laws affecting elementary schools between 2003 and 2007 using the National Cancer Institute School Nutrition Environment State Policy Classification System (SNESPCS).

Methods: The SNESPCS is comprised of school nutrition categories indicative of competitive foods and beverages, including a la carte sold in cafeterias; non-meal food and beverages sold in vending machines; food items sold in school stores; and fundraising items and activities during school. For 2003 and 2007, the presence or absence of laws regulating these categories of competitive foods in elementary schools was dichotomously coded for 50 states and the District of Columbia. Chi Square analyses compared the relative frequency of states with and without competitive food laws between 2003 and 2007.

Results: Overall, the number of states with any competitive food laws increased significantly from only 16 States (31%) in 2003 to 27 States (60%) in 2007 (P<0.05). Significant increases were found for several categories of competitive foods including vending (p<0.05), a la carte food items (p<0.05) and school store food items (p<0.05). In 2003, only 5 States (9.8%) had laws related to competitive foods used in fundraising, which increased significantly to 14 states (25.5%) in 2007.

Conclusion: State competitive food laws and regulations pertaining to U.S. elementary schools have increased significantly between 2003 and 2007 and positively impacted the school environment. Research is needed to understand what effect competitive food laws have on nutrition behaviors and body mass index.

Funding Source: National Cancer Institute, NIH

A profile of lifestyle behavioural factors in grade four learners in disadvantaged schools in Cape Town, South Africa: Recommendations for the development of a diabetes prevention programme

Author:

Sharmilah Booley

Aim: To assess the weight status, dietary intake, eating behaviour, and physical activity of grade four learners to formulate recommendations for the development of a diabetes prevention intervention.

Methods: 121 grade four learners (9-11 years) from four randomly selected primary schools in Cape Town were interviewed using a questionnaire and data collection tool in the form of a game developed and standardised for this study.

Poster Sessions

Results: The majority of the learners had a normal BMI (80.2%), 19.8% were either at risk of becoming overweight or were overweight. Most (+/-90%) learners consumed breakfast, lunch and supper and snacks during the school day. Depending on the day of the week 50.4 -71.1% brought a lunchbox, 45.3-83.8% brought money, 6-8.6% brought nothing to school and 20.5-33.8% received food from the feeding scheme. General nutrition knowledge was poor. Most indicated it was important to consume fruit (74.4%) and vegetables (88%) to be healthy. The mean frequency of intake per/week for fruit was 4.3+/-2.1 and 3+/-2.1 for vegetables. Sugar/sweets/crisps were consumed daily. Physical activity at break (playing games and non-organised sport) was common (+/-70%), but uncommon after school. TV watching/computer activities increased from 18.8% in early afternoon to 60% after supper. Participation in organised sport is uncommon (<10%). Total active time was134 minutes and total sedentary times 203 minutes.

Conclusion: Intervention programmes need to focus on weight mangement, nutrition knowledge and physical activity. Successful implementation therof requires consideration of the conduciveness of the learners’ environment (school and home) to adopting the recommended heatlh behaviours.

Funding Source: Research grant

Community perspectives on obesity prevention in children

Author:

Annina Catherine Burns

Childhood obesity has become the focus of local, state, and national initiatives. Many of these efforts are centered on the community environment in recognition of the role of environmental factors in individual behaviors related to food and physical activity.

In order to better understand the role of community led efforts in childhood obesity prevention, IOM held two workshops—in June 2008 and May 2009. The purpose was to learn from individuals who are actively engaged in community- and policy-based obesity prevention programs. The first workshop held separate focus group discussions with program leaders and evaluators of community-based obesity prevention programs. The second workshop featured presentations and discussions with program leaders, policy advocates and local policymakers. Community perspectives were elicited on the challenges involved in undertaking policy and programmatic interventions aimed at preventing childhood obesity, and on approaches to program implementation and evaluation that have shown promise.

These efforts have shown that the seemingly simple formula for preventing obesity of consuming fewer calories than expended must take into account the social, environmental, and policy-related factors that affect eating and physical activity. Otherwise, success is almost impossible to sustain over the long term. Carried out in diverse settings and with diverse populations, these efforts have resulted in many promising approaches that encompass the community context. These community efforts vary in scope and scale; overall, however, they remain fragmented, and little is known about their effectiveness. At the local level, communities are struggling to determine which obesity prevention programs to initiate and how to evaluate their impact.

Poster Sessions

Assessing the potential of local government to use legal approaches for obesity prevention and control: A systematic review

Authors:

Charles Foster, Gill Cowburn, Colin Mitchell

Purpose: We conducted a systematic review of published and grey literature to explore the potential for legal approaches for obesity prevention by local government.

Background: Local government is a key player in the fight against obesity and has direct powers to shape the environment and services in which we live and work. Their use of legislation, regulation, and policy to tackle factors that contribute to obesogenic environments is frequently voiced by academic literature. We identified in an earlier review that this contribution is often stronger in theory than practice. Our study aimed to identify real examples of how legislation was used to combat obesity by local government.

Methods: Searches were performed from January 2000 to September 2009 with 219 titles assessed to be potentially relevant and full papers retrieved. 48 studies were included in the review. Thirty two papers were from the USA with only 9 from the UK, 7 from Australia or New Zealand and one from Africa. We found half the papers presented studies of how planning, advertising, licensing, transport and local school regulations were used to combat obesity, with the rest postulating the theoretical impact and reach of such approaches.

Conclusions: Our review identified the possibilities for regulatory actions by local government, especially using planning laws. Future research must be developed by multi-disciplinary teams of legal and obesity researchers in order to understand the legal mechanisms that must be followed by a local government. This will translate theoretical opportunities to use the regulatory environment into deliverable actions.

Funding Source: National Heart Forum & Department of Health - UK

Assessing the options for local authorities to use the regulatory environment to prevent obesity: A qualitative study

Authors:

Colin Mitchell, Gill Cowburn, Charles Foster

Purpose: National policy has identified that UK local government has the potential to reclaim a leading role in the prevention of obesity; however the precise nature of this contribution remains unclear. Our study aimed to identify what this contribution could be, who the key players in local government are and how existing or new regulations could be used to prevent obesity.

Methods: We identified over 30 stakeholder organisations who work with relevant sectors or services of UK local government (e.g. town planning, sustainable transport, licensing, legal risk and liability, taxation). We conducted 25 semi structured interviews with key representatives of these organisations and analysed interview transcripts using thematic analysis.

Poster Sessions

Results/Findings: Our analysis identified 3 key themes, (i) specific examples of local powers that could be used to promote physical activity or healthy eating and examples of regulations that hinder this goal, (ii) common reporting of a gap between the health and local government sectors around the importance and value of addressing public health issues in difficult economic circumstances, and (iii) identification of the best mechanisms through which knowledge transfer between health and local government sectors might be improved.

Conclusions: This study identifies possible options for action by local government to contribute to the prevention of obesity. Successful local initiatives will be dependent on political will and strong leadership. This research provides the means to make the right case, to the right people, with the right evidence.

Funding Source: National Heart Forum & Department of Health - UK

Efficacy of the current public health recommendations for resistance training to improve physical function in community-dwelling older adults

Authors:

Keith Gennuso, Scott Strath, Susan Cashin

Purpose: To examine the effectiveness of the current American College of Sports Medicine and the American Heart Association resistance training guidelines to improve physical function (PF) in older adults with functional impairment.

Methods: This study consisted of an eight-week randomized controlled intervention trial. Participants were screened for reduced function and randomly assigned to a resistance training (RT; n=11) group or control (n=11) group. Training included eight exercises for one set of 10 repetitions at a moderate intensity, twice a week for eight weeks. The primary outcome was the short physical performance battery (SPPB); comprised of standing balance, chair-stand, and gait speed sub-scores. The SPPB was used to assess PF and determine functional classification. Mixed between-by-within ANOVA and dependent t-tests were used to examine changes in PF.

Results: The average age and body mass index of the RT group was 74.1±5.9 yrs and 30±4.7 kg/m2; and of the control was 70.6±5.7 yrs and 29.9±4.1 kg/m2. Pre-intervention values for PF did not differ between groups. The RT group experienced significant improvements in the SPPB total score (7.8±1.2 to 10.9±1.2; p<.005) and the chair-stand sub-score (1.2±0.8 to 3.1±1.2; p<.005). No significant change in the SPPB total score was found for the control group. Ten out of 11 participants in the RT group were reclassified from a low or moderate level to a moderate or high level of functioning.

Conclusion: These results provide support for the effectiveness of the current RT guidelines to improve PF in older adults with functional impairment.

Poster Sessions

Quebec en Forme: Public and philanthropic alliance to support communities mobilization on active living and healthy eating environments

Authors:

Lucie Lapierre, Remi Coderre, Steeve Ager, Manon Paquette, Karine Boucher, Christine Faubert, Eric Lamothe, Sylvain Deschênes, Diane Le May, Helene Potvin, Chantal Grandchamp

Quebec en Forme (QEF) is a population based initiative stemming from philanthropy and government partnership. It aims to change individual behavior and to build healthy eating and active living (HEAL) environments for children and youth, through an extensive support of local communities’ mobilization projects, including native communities. After one year of extensive support to lover 100 local communities, preliminary analyses of the actions plans show local communities’ endeavors still being nested in familiar roles (activity programming, installation sharing and resources’ training). While community mobilization is recommended for many reasons, it challenges the common understanding of the environmental correlates of HEAL and the ability to identify the strategic levers susceptible to induce long lasting effects within the community. In light of this preliminary analysis, efforts in knowledge transfer and application will be reinforced and as regard to strategic planning, work is already undertaken based on the ANGELO[1] grid.

[1]Swinburn B, Egger G, Raza F. Dissecting obesogenic environments: The development and application of a framework for identifying and prioritizing environmental interventions for obesity. Preventive Medicine 29, 563-570 (1999).

Funding Source: Fondation Lucie et André Chagnon, Gouvernement du Québec

Understanding New York City physical activity environment: Towards systems and policy change

Authors:

Heewon Lee, Pamela Koch, Isobel Contento

Purpose: To examine the physical activity environment in a low income NYC community as baseline data for Kellogg Foundation’s Food & Fitness Initiative to create systems and policy change in communities.

Methods: Data were collected on: traffic calming devices (e.g., speed bumps), pedestrian fatalities and severe injuries rates, block parties and play streets, bicycle infrastructure, GIS proximity of residents to safe open spaces, department of transportation’s office of sustainability programs such as weekend walks program and public plazas program, and crime rates.

Results/Findings: Compared to other affluent neighborhoods, there was a lack of traffic calming devices and city programs on installing more traffic calming devices in the focus community. There were slightly more pedestrian fatalities (2.5 vs. 1.9 per year) and bicyclist injuries (54 vs. 53 per year) and a lack of bike lane and bicycle infrastructure in our focus area. There were 7 organized weekend walking events in summer of which 3 events were in our focus area. Most focus area neighborhoods have access to as much

Poster Sessions

open space as other affluent neighborhoods. However, there were higher incidents of murder, assault, and rape in our focus area.

Conclusions: Our community had lack of physical activity infrastructure such as bike lanes. Our finding indicates that even though there is enough open space accessible to our community residents, street safety should be ensured to improve their active living. Systems and policy change efforts, with close community participation and youth engagement from the focus neighborhoods, may contribute to improve the physical activity environment in this area.

Funding Source: W.K. Kellogg Foundation

Assessing potential public health impact and dissemination readiness in policy-level interventions: The Center-TRT Criteria

Authors:

May May Leung, Janice Sommers, Jennifer Leeman, Alice Ammerman

Purpose: To describe review criteria developed by the CDC-funded, Center of Excellence for Training and Research Translation (Center-TRT), to assess the potential public health impact and dissemination readiness of policy-level obesity prevention-related interventions.

Background: Policy change interventions have become a priority, in an attempt to widely promote physical activity and nutrition behaviors to reverse the obesity epidemic. However, limited knowledge is available as to which policy-level interventions may have the greatest potential impact. The Center-TRT has developed criteria to assess the potential public health impact and dissemination readiness of such interventions. This criteria can help contribute to the “best available evidence” (IOM, 2008), which will assist public health practitioners in their decision-making process.

Methods/Key Points: The review criteria developed for policy-level interventions was adapted from a model developed by Center-TRT to assess potential public health impact and dissemination readiness of behavior and environmental-change obesity interventions. Two independent experts review multiple components of a policy, including development, enactment, implementation, enforcement and its intended outcomes. This process assesses a policy intervention’s dissemination readiness and potential public health impact using review criteria informed by the components of the RE-AIM framework: Reach, particularly to populations at greatest risk; Effectiveness of improving outcomes; feasibility of Adoption; Implementation and Maintenance of the policy.

Conclusions: The review and dissemination of policy-level interventions is a relatively new area in translation work. The criteria, developed by the Center-TRT, may contribute to the knowledge base of the “best available evidence” to help guide decisions made by public health practitioners.

Funding Source: Centers for Disease Control and Prevention-SIP 09-04

Poster Sessions

Continuous quality improvement in physical activity programmes for elderly people: Customers’ satisfaction

Authors:

Ana Marques, Pedro Soares, Rute Santos, Paula Clara-Santos, António Oliveira-Tavares, Luisa Soares-Miranda, Carla Moreira, Joana Carvalho

Introduction: Physical activity (PA) programmes for elderly people play an outstanding role to one’s health, quality of life and autonomy. The benefits of such programmes depend upon adherence to exercise. Continuous quality improvement of the organizations that promote elderly PA programmes can be useful and critical for elderly satisfaction and adherence. In the light of the fundamental concept relating to “customer focus”, particularly on customers’ satisfaction, from the European Foundation for Quality Management Model, the purposes of this study were 1) to examine the existence of customers’ satisfaction measurement in Portuguese PA programmes for elderly people, comparing it with programmes’ characteristics and 2) to examine the associations between the different evaluated items.

Methods: Data were collected by an on-line questionnaire sent to 26 Coordinators of PA Programmes. Descriptive statistics were used in order to characterize de PA programmes and customers’ satisfaction evaluation items. Statistical analysis was performed using Fisher’s Exact Test and Pearson’s Qui-square test.

Results: 76.9% of the programmes evaluate customers’ satisfaction. Most of them had 1000 or less participants (86,4%; p≤0.05). Statistically significant associations were found between the following customers’ satisfaction items: programme content, activities timetable, hygiene/cleanliness, information availability, variety of materials, adequacy of materials and loyalty.

Conclusion: Although most of the programmes evaluate customers’ satisfaction, there is still a considerable percentage that does not include this evaluation in their practices, namely those with more than 1000 participants. Furthermore, there are significant differences between customers’ satisfaction evaluation items chosen by each programme.

Funding Source: Supported by FCT Grant SFRH/BD/36796/2007 P075

The association of state law with physical education staffing and curriculum practice in U.S. public schools

Authors:

April Oh, Frank Perna, Tanya Agurs-Collins

Purpose: The Physical Education–Related State Policy Classification System (PERSPCS) classified codified state physical education (PE) laws in the USA (Mâsse et al., 2007). The purposes of this paper are to: demonstrate compatibility of PERSPCS database with other national databases to examine the association of State PE laws to staffing and curriculum standards in public schools as assessed by the School Health Policies and Programs Survey (SHPPS) (Lee et al., 2006).

Poster Sessions

Methods: PERSPCS codes were assigned to schools sampled in the 2006 SHPPS by state. SHPPS school data were coded and combined to form a scale of 0-3 where 0 was the least stringent or no requirement and 3 was the most stringent requirement. Two sets of models were tested (staffing and curriculum standards) at each school level: elementary, middle, and high school.

Results: Accounting for school-related demographic factors, PERSPCS code was positively associated with increased staffing standards (p < .05) at the high school level. However, relationships between state laws with reported curriculum standards were not observed.

Conclusions: Our analyses indicate that codified state law was associated with staffing standards in schools at the high school level only. Findings suggest the relevance that laws both require and specify staffing standards and examination of other contextual factors such as poverty and urbanicity that may be associated with school PE curriculum practices.

Concordance in physical education and nutrition laws for elementary schools: 2003-2007

Authors:

Frank Perna, April Oh, Tanya Agurs-Collins

Purpose: Federal law in 2004 required states to address nutrition and physical education (PE) in schools. However, there has not been uniform enactment of State laws regarding PE time and access to competitive foods. This study empirically assessed the relative frequency of states that required or did not require PE time or limits on competitive foods and determined the relative concordance between changes in competitive food and PE laws.

Method: For 2003 and 2007, the presence or absence of PE time requirement and competitive food laws pertaining to elementary schools were coded for each state using NCI School Policy Classification System (NCI-PCS) scores. Chi Square analyses compared the relative frequency of states with competitive food and PE laws. Nonparametric tests compared the relative stringency of PE laws in states that adopted or failed to adopt law requiring limits on competitive foods.

Results: In 2003, states were more likely to have PE time requirements (74.5%) than to limit competitive foods (25.5 %), (p < .05). While there was little change in PE time requirements laws (p = ns), competitive food laws significantly strengthened over time (p < .05). Further, states that enacted competitive food requirement laws also required more PE than states that did not enact these laws.

Conclusion: Data suggest concordance between favorable changes in PE and Nutrition laws pertaining to elementary schools. In comparison to states that do not require limits on competitive foods, States enacting competitive food laws were more likely to enact stringent PE-time requirement laws.

Poster Sessions

Outdoor and indoor activity levels in center-based childcare: Are new policies needed?

Authors:

Amanda Tillotson, Derek Hales, Christina McWilliams, Amber Vaughn, Dianne Ward

Purpose: To describe preschool children’s activity levels during the course of a typical day in center-based childcare.

Methods: Data were collected in 50 childcare centers in North Carolina. Using the Environment and Policy Assessment and Observation (EPAO) protocol, trained research staff observed each center’s physical activity environment over four consecutive days (from arrival of children in the morning, through end of the day) to assess staff behavior, daily routines, and physical environment. Additionally, 4-12 children per center wore a GT1M accelerometer (programmed with a 15s epoch) while at the center. Date and time stamps from the EPAO and accelerometer data were used to determine activity levels during select activities.

Results: Children spent on average 376 minutes inside (88%) and 53 minutes outside (12%) each day. As seen in previous research, children engaged in more moderate to vigorous physical activity (MVPA) while outside (24.6% in MVPA) than while inside (6.8% in MVPA ), and more sedentary behavior inside (56.5% in MVPA) than outside (22.2% in MVPA). Inside, children spent 72 min/day in learning center activities (10% in MVPA) and 24 min/day in teacher-led circle time activities (6% in MVPA). The amount of MVPA during circle time is comparable to levels of activity during nap/rest time and TV time.

Conclusion: Health-promoting activity at childcare is low. Policies should be developed to increase activity by requiring more time outside and by instituting staff training to add movement to curricular activities.

Funding Source: Robert Wood Johnson Foundation Active Living Research

Poster Sessions

Poster session 2: Diet/physical activity and disease

Poster session 2: Diet/physical activity and disease P078

Assessment and analysis of severity and type of obesity in depressed women and its relationship with thyroid hormones, leptin and food consumption

Authors:

Seyed Mehdi Ahmadi, Mohammad Hassan Eftekhari, Ali Firoozabadi, Abdolreza Rajaeefard, Mahmood Soveid

Introduction: Studies revealed an association between depression and obesity. the aim of this study was to assess and analysis of severity and type of obesity in depressed women and it’s relationship with thyroid hormones, leptin and food consumption.

Material & methods: A case-control study was performed among women aged 15-49 years who were refered to Shahid Motahari Clinic (Shiraz). A sample of 30 depressed obese women & 30 depressed normal women & 33 non depressed obese women were selected. Height, weight, hip circumference, waist circumference, skin fold thickness (biceps, triceps, supscapular, suprailiac) were measured and body mass index, total body fat, waist to hip ratio were calculated. Depression and its severity were determined by beck inventory. The food consumption pattern was evaluated by a 3 days dietary recall questionnaire, macro & micro nutrient components were calculated by using DFP 1.1 software. Serum sample were collected and assayed for thyroid & leptin hormones.

Results: Pearson’s correlation coefficients showed a significant association between severity of depression & BMI & TBF. Comparison of thyroid hormone between depressed obese women & depressed women with normal body weight didn’t show a significant difference. Although there was a significant difference between two mentioned group in leptin concentration. Comparison of thyroid hormones and leptin between depressed obese women & non depressed obese women didn’t show any significant difference.

Conclusion: The present study supported the “jolly fat” hypothesis previously restricted to men and extend the hypothesis to women. Measurement of thyroid hormones revealed that there were any significant association between these hormones & obesity & body fat distribution in depressed obese & non depressed obese women.

Physical activity and quality of life in young adult cancer survivors: A Canadian Provincial Survey

Authors:

Lisa Belanger, Ronald Plotnikoff, Alexander Clark, Kerry Courneya

Objectives: Physical activity (PA) improves quality of life (QoL) in several cancer survivor groups but no studies have focused on young adult cancer survivors (YACS). This study determined the prevalence of PA in YACS and examined dose-response associations with QoL.

Poster Sessions

Methods: A random sample of 2000 YACS between the ages of 20-44 were identified through a Canadian provincial cancer registry and mailed a survey that included the Leisure-Time Exercise Questionnaire, the Medical Outcomes Study 36-Item Short Form (SF36) survey, and several validated psychosocial scales. The primary endpoint was the physical component summary (PCS) of the SF36.

Results: Completed questionnaires were received from 588 YACS. In terms of PA prevalence, 23% were completely sedentary, 25% were insufficiently active, 22% were active within public health guidelines, and 29% were active above public health guidelines. Analyses of covariance adjusted for important medical and demographic confounders showed statistically significant and clinically meaningful associations between PA and the PCS (p<0.001), the mental component summary scale (p=0.002), depression (p<0.001), stress (p<0.001) and self-esteem (<0.001). For the primary endpoint of PCS, there was a dose-response association from completely sedentary to within guidelines that spanned 6.3 points. Associations with QoL were much stronger for YACS that had previously received chemotherapy.

Conclusions: PA is strongly associated with QoL in YACS but only half of YACS are meeting public health guidelines and almost a quarter are completely sedentary. Randomized controlled trials examining intervention strategies to increase PA and improve outcomes in this understudied patient population are warranted.

Wellness for women: Teaching rural midlife prehypertensive women about healthful eating behaviors

Authors:

Linda Boeckner, Cami Wells, Carol Pullen, Susan Noble Walker, Patricia Hageman, Julie Ehlers

Purpose: The Wellness for Women project based on the Health Promotion Model reached pre-hypertensive women, ages 40-69, from a Midwest rural region with tailored messages to facilitate improvement in biomarkers and eating behaviors conducive to a healthful lifestyle.

Methods: The 289 rural women (aged 55.9±6.4 years) enrolled in a 12-month clinical controlled trial were screened to be in a pre-hypertensive category (BP 120-139 mmHg systolic or 80-89 mmHg diastolic). Education related to the Dietary Approaches to Stop Hypertension (DASH) diet was delivered at baseline by an extension educator. Women were randomly assigned to regularly receive tailored educational messages via Internet (n=116) or Mail (n=115). They also received periodic counseling calls to assist with goal setting toward healthful eating. The third group (control, n=58) received usual standard advice only at baseline. Dietary information, obtained with an on-line food frequency assessment tool, and standardized physical measures were taken by a registered nurse at baseline, 6, and 12 months.

Results/Findings: Diastolic and systolic blood pressure (mmHg) decreased significantly (p=.0001) in all three groups but there were no differences between groups in the amount of the decline. Using RM ANOVA, a significant Time X Group interaction was found for both fruit/vegetable and dairy product intakes indicating their respective patterns of changes from baseline across the 12-month period were not the same in all three groups, and favored either the Internet or Mail groups.

Poster Sessions

Conclusions: Internet or mail-delivered tailored messages may be a helpful adjunct to usual care in reaching rural midlife women.

Funding Source: National Institute of Nursing Research, National Institutes of Health

Dietary intake of fruits and vegetables and risk of the metabolic syndrome

Authors:

Jackie Boucher, Jeffrey VanWormer, Riva Touger-Decker

High fruit and vegetable intake has been associated with a reduced risk of chronic diseases. Limited data exists on the relationship between fruit and vegetable intake and the metabolic syndrome. The purpose of this study was to evaluate the relationship between fruit and vegetable intake and the prevalence of the metabolic syndrome. Fruit and vegetable intakes were assessed using a one-item fruit/vegetable screening question. Anthropometric measurements were made and blood pressure was assessed according to standard methods. Fasting blood samples were taken for biochemical measurements. The metabolic syndrome was defined based on a modified version of the National Cholesterol Education Program Adult Treatment Panel III guidelines, as recommended by the AHA and the NHLBI in a Scientific Statement. Unadjusted analyses revealed that participants who reported eating less than 5 fruits/vegetables per day had 88% higher odds of having the metabolic syndrome relative to participants who reported eating 5 or more fruits/vegetables per day. The final multivariate regression model revealed that, after adjusting for the confounding variables of age (OR=1.02[1.02, 1.03], χ2=40.35, p<0.001) and physical activity level (OR=1.61[1.31, 1.98], χ2=20.12, p<0.001), participants who reported eating less than 5 fruits/vegetables per day had two times higher odds of having the metabolic syndrome relative to participants who reported eating 5 or more fruits/vegetables per day (OR=2.03[1.49, 2.75], χ2=20.50, p<0.001). Higher intakes of fruit and vegetables are associated with lower prevalence of the metabolic syndrome. These findings support recommendations to increase dietary intakes of fruits and vegetables as a measure to prevent cardiovascular disease.

Funding Source: Allina Hospitals & Clinics

Dietary habits and exercise behaviors in persons at risk for peripheral arterial disease: A Pilot Study

Authors:

Kimberly Henderson, Scott Lunos, Tracie Collins

Purpose: Diet and exercise modify risk factors for peripheral arterial disease (PAD). We sought to determine dietary habits and exercise behaviors in a racially diverse group of patients at risk for PAD.

Methods: Participants included Blacks, Latinos, Whites, and Native Americans with at least one risk factor for PAD. Telephone surveys were used to ascertain ethnicity, exercise behaviors and eating patterns. During in-person visits, participants were screened for PAD using the ankle-brachial index (ABI).

Poster Sessions

Results/Findings: We enrolled 50 participates with mean age 64.4± 11.5 years and mean ABI was 0.98 (SD 0.15). On the Eating Patterns Questionnaire, the scores for avoiding fried foods (SE) were 2.80 (0.11) for Blacks, 3.06 (0.13) for Latinos, 3.31 (0.11) for Whites, and 3.54 (0.13) for Native Americans (P=0.0002). For fat trimming, the scores were 2.54 (0.17) for Blacks, 2.87 (0.21) for Native Americans, 3.02 (0.18) for Whites, and 3.15 (0.22) for Latinos (P=0.0288). For substituting lower-fat products, the scores were 1.74 (0.15) for Blacks, 2.25 (0.19) for Latinos, 2.44 (0.16) for Whites, and 2.59 (0.18) for Native Americans (P=0.0039). On the Exercise Behaviors Questionnaire, mean minutes of weekly exercise were 112.8 (22.2) for Blacks, 132.4 (28.0) for Latinos, 135.0 (23.5) for Whites, and 171.3 (26.5) for Native Americans (P=0.3873).

Conclusions: Blacks appear most vulnerable, having worse eating habits as compared to other ethnicities and although not statistically significant, reported fewer minutes of weekly exercise. Initiatives should focus on ethnically sensitive approaches for improving dietary habits and physical activity in persons at risk for PAD.

Funding Source: University of Minnesota, President’s Faculty Multicultural Research Award, 2007

A study of metabolic syndrome and physical activity in middle-aged adults

Authors:

Ranjana Mahna, Mehak Sharma

Asian Indians have a high predisposition to metabolic syndrome due to a marked shift in lifestyle caused by economic growth, urbanization and dietary westernization. Lifestyle changes focusing on increasing physical activity could help to prevent the exploring epidemic of metabolic syndrome, coronary heart disease and diabetes. The present study was done to assess the association of physical activity with metabolic syndrome in a middle aged population. A hospital based study was done with 307 subjects. Anthropometrics and blood lipid profile were assessed. Physical activity was determined using a suitable questionnaire and Physical Activity Levels (PAL ) were calculated. By NCEP (ATP III) criteria, 175 subjects (37.2% males and 62.8% females) were categorized as metabolic syndrome (MS) and 125 as non-metabolic syndrome (NMS) subjects. Majority of MS subjects were in the age range of 50-55 years (38%). Biochemical parameters showed elevated blood glucose in 60%, elevated triglyceride in 63%, low HDL levels in 96% and high blood pressure in 62% of the subjects. Waist circumference was more than desirable in 85%. PAL values indicated that 67.3% females and 50.8% males were sedentary. Dietary intakes revealed that more than 50% of MS subjects, especially females, had more than recommended intake of energy and more than 30% of energy from fat. Of the NMS subjects also, more than 50% were sedentary and had a high intake of fat. The study showed that low HDL and high waist circumference combined with low physical activity were the main components of metabolic syndrome in a large number of subjects.

Poster Sessions

Lose the blues: How physical activity and genetics influence depression

Authors:

Jutta Mata, Renee J. Thompson, Ian H. Gotlib

Purpose: Physical activity is associated with a range of positive health outcomes, including fewer depressive symptoms. Few studies, however, have looked beyond a correlation of habitual exercise level and depressive symptoms to examine mechanisms underlying this relation. One such plausible mechanism involves Brain-Derived Neurotrophic Factor (BDNF), a protein hypothesized to limit or repair the damage caused by stress. Physical activity increases expression of BDNF, which may enhance brain health. BDNF expression is controlled by the BDNF gene. Compared with individuals without a BDNF met allele, met-allele carriers have a lower expression of BDNF, which has been associated with Major Depressive Disorder.

Methods: Eighty-two healthy adolescent girls were genotyped for the BDNF val66met polymorphism, and their depressive symptoms and physical activity were assessed using self-report measures. Main outcome measures were BDNF genotype, Children’s Depression Inventory, and the Physical Activity Questionnaire for Older Children and Adolescents.

Results: The BDNF polymorphism was found to moderate the relation between exercise and depressive symptoms (B= -0.49, p=.02): being physically active was protective for girls with a BDNF met allele (fewer depressive symptoms) but not for girls with the val/val polymorphism.

Conclusion: By integrating psychological and biological factors, the present study enhances our understanding of how physical activity contributes to resilience in psychopathology. These findings underscore the importance of considering biological factors in the context of health behaviors, for example genetics. In turn, they may elucidate parameters of change in other health behaviors, such as eating, that often have limited effects in individuals with depression.

Funding Source: Stanford University, German Science Foundation, NIMH

Objectively measured physical activity intensity and quality of life in older adults

Authors:

Nora Miller, Ann Swartz, Scott Strath, Susan Cashin

Purpose: To examine the relationship between physical activity intensity (PAI) and health related quality of life (HRQOL) in a sample of community dwelling older adults.

Methods: Two hundred and thirty-four older adults (67 men, 65.5±8.3y; 167 women, 62.9±7.2y) participated in this study. Height and mass were measured; BMI was calculated. Participants wore an accelerometer (Actigraph, Pensacola, FL) during waking hours for 7 consecutive days to classify physical activity intensity (PAI) and completed the Medical Outcomes Short-Form Health Survey (SF-36) to determine HRQOL. ACC intensity was categorized into average mins/day as inactive (≤99counts/min),

Poster Sessions

light (100-759 counts/min), moderate walking (modwalk: 1952-5724 counts/min), moderate-vigorous (modvig: ≥760), and vigorous (vig: ≥5725 counts/min). Hierarchical regression analyses determined the contributions of PAI to HRQOL after controlling for total PA (average ACC counts/day).

Results: On average, participants spent 10.2±1.7 hours/day being inactive, 4.2±1.0 hours/day in light, and 25.2±19.4 minutes/day in modwalk PAI. Further, they spent 1.7±0.8 hours/day in modvig and 1.6±45.2 minutes/day in vig PAI. Total PA, not intensity, was a significant independent predictor of 5 indices of the SF-36 including: physical functioning, social functioning, vitality/fatigue, general health perception, as well as total HRQOL (p<0.05). Total PA explained 1.8-2.5% of the variance, after effects of age, gender, and BMI were controlled.

Conclusion: Results from this data show that time spent in various intensities of PA does not explain a significant additional amount of variation above total PA when predicting HRQOL in older adults.

The association between self-image with eating behaviors and metabolic risk factors in middle aged older adults

Authors:

Yumi Ohmori, Motohiko Miyachi, Akemi Morita, Naomi Aiba, Makiko Nakade, Tsunetsugu Munakata, Sayuri Hashimoto, Shaw Watanabe

Purpose: Previous studies suggested that depressive symptoms induces metabolic syndrome. We hypothesized that unfavorable eating behavior inducing metabolic syndrome is associated with self-image and depressive symptoms. Therefore we investigated the associations among self-image, eating behavior, and metabolic syndrome.

Methods: This cross-sectional analysis was performed on 1237 subjects (510 female and 777 male, 30-74 years of age) who had undergone a complete medical health check-up in the Saku Central Hospital in 2009. Participants completed the self-administered questionnaires including self-image (such as self-esteem and anxiety), depressive symptoms and eating behavior. Covariance structure analysis was used for a self-image caused depressive symptoms and a distortion of the eating behavior, and predicting the metabolic syndrome

Results/Findings: In both men and women, the unfavorable eating behavior influenced obesity (p<0.001), and obesity was associated with the incidence of metabolic syndrome incidence (p<0.001). The better self-image prevented the unfavorable eating behavior (p<0.01), which also had quite prevented depressive symptoms (p<0.001). Moreover, depressive symptoms influenced the risk of metabolic syndrome in female (β=0.21, p<0.01), although it’s association was not significant in males (β=0.10, n.s.).

Conclusions: The results of the present study suggest that it is effective to change one’s self-image better to prevent the unfavorable eating behavior and depressive symptoms that is associated to metabolic syndrome. The health service provider may need a counseling skill to improve the self-image of clients.

Poster Sessions

Health risk behaviour associated with chronic health conditions in cooperate organizations in Kenya

Authors:

Alice Ojwang Ndong, Theuri Gitahi

Objective: To determine the prevalence of health risk behaviours associated with the leading causes of CVD, cancer and premature death.

Materials and Methods: A questionnaire with 5 questions on physical activity, fruit, vegetable meat and alcohol intake was developed to collect data on health risk behaviour. This was administered in five different organizations, 593 responses were analysed. Cholesterol, Blood glucose, BMI and waist circumference were also checked.

Results and Findings: 210 (35.4%), intended to be physically active between 3-6 months and 184 (31%) did not intend to be physically active in the next six months, 117 (19.7%) and 218 (36.8%) do not eat fruits and vegetables regularly. 100 (16.9%) ate meat with every meal while 225 (37.9%) ate meat very regularly. 35 (5.9%) took alcohol everyday and 152 (25.6%) drank alcohol on the weekend. Men got involved in physical activity more regularly than the females. Females ate more fruits and vegetables as compared to the males.

Conclusion: Health promotion on physical activity and nutrition should be targeted at worksites to reduce risk of chronic diseases and premature death.

Dietary patterns and physical activity among patients with esophageal squamous-cell carcinoma

Authors:

Bahram Rashidkhani, Bahareh Hajizadeh

Aims: We conducted a study to examine the association of dietary patterns and physical activity among patients with esophageal squamous-cell carcinoma in Iran.

Material and Methods: In total, 47 patients with esophageal squamous-cell carcinoma underwent face-to-face interviews. Physical activity was obtained using a self reported-based questionnaire and expressed as metabolic equivalents hour/day (METs-h/day) in which nine different MET levels were ranged on a scale from sleep/rest (0.9 METs) to high-intensity physical activities (>6 METs). Factor analysis was used to detect dietary patterns. Pearson correlations and their 95% confidence intervals (CIs) were used to assess the association between physical activity and dietary patterns.

Results: We defined two major dietary patterns in this population: “Healthy Diet” (high in vegetables, nuts, fruits, low-fat dairy, and fish), and “Western Diet” (high in solid oil, sugar, sweets, tea, egg, pickles, and

Poster Sessions

processed meat). Healthy pattern score was non-significantly associated with decreased physical activity (r=-0.20). Unhealthy pattern scores was significantly associated with increased physical activity (r=0.29).

Conclusions: Further studies are needed to assess the association of dietary patterns and physical activity especially among patients with esophageal squamous-cell carcinoma

Vegetarian dietary patterns are associated with a lower risk of metabolic syndrome: The Adventist Health Study 2

Authors:

Nico S. Rizzo, Joan Sabate, Karen Jaceldo-Siegel, Gary E. Fraser

Purpose: To compare dietary patterns categorized as vegetarian, semi vegetarian and non vegetarian in their relationship with metabolic risk factors and MetS (metabolic syndrome).

Methods: Cross sectional analysis of 773 subjects (mean age 60 years) from the Adventist Health Study 2 Calibration Study (AHS2CS). Dietary pattern was categorized based on a food-frequency questionnaire and classified as vegetarian (35%), semi vegetarian (16%) and non vegetarian (49%). ANCOVA was used to determine associations between dietary pattern and metabolic risk factors (LDL, HDL, triglycerides, glucose, systolic and diastolic blood pressure, waist circumference and BMI) while controlling for possible confounding factors such as sex, age, ethnicity and physical activity. Binary logistic regression analysis was used in calculating odds ratios (OR) for MetS.

Results: A vegetarian dietary pattern was associated with a significantly lower risk of having the MetS(non adjusted OR=0.52, CI=0.37-0.74, P<0.001) when compared to a non vegetarian dietary pattern. The relationship was strengthened when adjusting for possible confounding factors (adjusted OR=0.44, CI=0.30-0.64, P<0.001).Metabolic risk factors (triglycerides, glucose, systolic and diastolic blood pressure and waist circumference) were significantly lower (P<0.05) for those following a vegetarian dietary pattern when compared to those following a non vegetarian pattern. HDL levels tended to be highest in those following a vegetarian dietary pattern. Semi vegetarians tended to have intermediate values.

Conclusions: A vegetarian dietary pattern is related to a more favourable profile of metabolic risk factors and a lower risk of having the MetS. This favourable relationship persists after adjustments for other lifestyle factors including smoking, physical activity and dietary energy intake.

Funding Source: NIH/NCI Grant 5 R01 CA094594

Poster Sessions

Dietary monounsaturated fat added isoenergetically to usual diets can reduce coronary risk in overweight subjects

Authors:

Shawn Somerset, Leanne Graham, Katherine Markwell, Karam Kostner, David Colquhoun

Excess adiposity (overweight) is one of many factors which increase risk of cardiometabolic diseases. Most risk reduction strategies rely on weight reduction through dietary energy restriction. However, long-term intentional weight reduction in overweight populations has proven difficult to achieve. Therefore, it is important to identify strategies to reduce risk which do not necessarily rely on weight loss. We used a randomised controlled trial design to study the effects of maintaining usual energy intake, but manipulating dietary lipid profile in a group of 64 overweight (BMI>25), otherwise healthy, subjects. For the intervention group, energy intakes of usual (baseline) diets were calculated from multiple 3 day diet diaries, and saturated fat was replaced with MUFA to 50%E by adding macadamia nuts to the diet. Both control and intervention groups received advice on national guidelines for physical activity and adhered to the same protocol for diet diary record keeping and trial consultations. Anthropometric and clinical measures were taken at baseline and 10 weeks. Significant decreases in HDL and Leptin (p<0.05) were noted in the control group, and significant decreases in true waist, total cholesterol, HDL (p<0.05), Leptin and ICAM-1 (p<0.01) in the monounsaturated diet group over this period. No significant changes were observed for blood pressure, BMI or inflammatory markers. In groups where adherence to dietary energy-reduction is poor, isoenergetic interventions which address cardiometabolic risk factors other than body weight may be beneficial.

Funding Source: Horticulture Australia

Poster Sessions

Poster session 2: Individual interventions

Poster session 2: Individual interventions P091

HealthForce: A feasibility study of a personalised body weight and lifestyle management programme for cardiovascular risk screening participants

Authors:

Angela Craigie, Jill Belch, Edwin Van Teijlingen, Brian Williams, Alison Kirk, Allan Struthers, Graeme Houston, Annie Anderson

Purpose: To evaluate the delivery and acceptability of a 3-month lifestyle intervention (IV) in adults aged over 40 from deprived backgrounds participating in a cardiovascular disease screening programme.

Methods: The intervention comprised 3 personalised, face to face counselling sessions (using DVD, educational and motivational materials) at monthly intervals (plus telephone contact) focusing sequentially on activity, diet and weight maintenance. Outcomes included: anthropometry; plasma vitamin C levels; physical activity; lifestyle and psycho-social questionnaires. Acceptability of both IV and assessments were evaluated by exit questionnaires and in-depth interviews.

Results: Over an 8 month period, 302 volunteers participated in the screening programme and 121 eligible individuals were recruited to Healthforce (HF) IV or comparison groups. Ninety-five percent completed follow-up assessments. Physical activity goals were achieved by 63% and body weight goals by 82% of the IV group. At baseline, 56% of the IV group reported eating 5 portions fruit and vegetables per day, increasing to 85% at follow-up. Participant feedback highlighted the value of being offered lifestyle “checks” and the realisation that previous habits were less than optimal. Reasons for completion included personalisation, assistance with the organisation of change, feeling “healthier“ through participation and the effect of observation.

Conclusions: The (low cost) HF intervention proved deliverable and acceptable to participants. HF was associated with objective measures of change in health behaviours over a 3 month period. However, further work is required to recruit more eligible adults from deprived backgrounds.

Funding Source: National Prevention Research Initiative (MRC)

Research project INGA 60+: Information behaviour on nutrition and health claims - Focus on consumers aged 60+

Authors:

Mareike Banka, Ingrid-Ute Leonhaeuser

Purpose: Significant changes in food availability and eating habits have occurred and the healthy eating trend is growing. Due to demographic changes and increasing diet-related diseases nutritional education has become more important for elderly consumers. Food labels provide an important source of

Poster Sessions

information and the number of foods labeled with claims increases. Nevertheless, most consumers have no time or motivation to use them. Therefore the main objective of this study is to analyze information behavior, nutrition knowledge and attitudes of consumers aged 60+ with regard to claims.

Methods: A target-group-specific secondary analysis (descriptive) of the “Second German National Nutrition Survey” (cross-sectional study) provides results of health related issues regarding elderly consumers (n=2865). Qualitative in-depth interviews (n=27) gain a detailed understanding of consumer behavior on claims. Taped interviews have been transcribed and categorized. A content analysis after Mayring will be adopted. Finally quantitative and qualitative data will be triangulated to provide an overall picture of elderly using claims.

Results: The quantitative results show that food packages are the second most prevalent source for nutrition information for elderly Germans. Besides adequate drinking, fat, vitamins and cholesterol are important. Healthiness is one of the four most relevant motives for food shopping. However, elderly report that functional food is less important to them. Results of the qualitative study are worked out currently.

Conclusions: The results form the basis for precise action recommendations, concerning claims for consumers, policy makers and food industry. Thus, target-group-specific actions should be initiated, empowering the elderly to make healthier choices.

Exercise and appetite control: Regular moderate exercise reduces passive overconsumption in obese

Authors:

Phillipa Caudwell, Catherine Gibbons, Graham Finlayson, Mark Hopkins, Neil King, John Blundell

Purpose: Passive overconsumption is recognised as a risk factor for weight gain and obesity (Blundell and Macdiarmid (1997). The aim of this study was to examine the impact of regular exercise on passive overconsumption in obese women.

Methods: 14 overweight and obese women (BMI=30.4±3.0,Age=43.1±9.1) completed 12 weeks of supervised exercise. At weeks 0, 6 and 12 passive overconsumption was assessed using test meal probe days either high (>50% energy from fat) or low fat (<25% energy from fat). Following a fixed energy breakfast and lunch, EI was assessed from an ad libitum dinner. Passive overconsumption was calculated by the difference between the high and low fat dinner EIs. Body composition and other health markers were also assessed at weeks 0, 6 and 12.

Results: Repeated measures ANOVAs revealed a small change in body mass across the 12 weeks (-0.7±2.7kg, Ns. p>0.05), a significant decrease in % body fat (-1.4±2.0%, p=0.012), fat mass (-1.4±2.6kg, p=0.049), and waist circumference (-4.7±3.3cm,p<0.0001); and a significant increase in lean mass (+0.7±0.9kg,p=0.041) and VO2max (0.55±0.25l/min-1, p<0.0001). There was also a significant reduction in passive overconsumption across the 12 weeks (-241.2±126.8kcal, p=0.049), which was significantly correlated with the reduction in fat mass (r = 0.74, p<0.001).

Poster Sessions

Conclusion: Long term regular exercise can decrease an important risk factor for weight gain (passive overconsumption) in obese women and this is associated with a reduction in fat mass. In addition the exercise intervention also resulted in numerous health benefits independent of weight change. This research was funded by the Biotechnology and Biological Sciences Research Council (BB/G530141/1).

Funding Source: Biotechnology and Biological Sciences Research Council (BB/G530141/1).

Design and outcomes of a mothers in motion behavioral intervention pilot study

Authors:

Mei-Wei Chang, Susan Nitzke, Roger Brown, Diana Hazard, Regina Pool, Kobra Eghtedary

Objective: This paper describes the design and findings of a pilot Mothers In Motion (P-MIM) program. Design: A randomized control trial that collected data via telephone interviews and finger stick at 3 time points: baseline and 2- and 8-month post intervention. Setting: Three Women, Infants, and Children programs in southern Michigan. Participants: 129 overweight and obese African American and white mothers 18-34 years old. Intervention: The 10-week theory-based culturally sensitive intervention messages were delivered via a series of 5chapters in a DVD and complemented by 5 peer support group teleconferences. Outcome Measures: dietary fat, fruit, and vegetable intake; physical activity, stress, feelings, body weight, and blood glucose. Analysis. General linear mixed model was applied to assess treatment effects across 2 and 8-months post intervention.

Results: No significant effect sizes were found in primary and secondary outcome variables at 2- and 8-month post intervention. However, changes in body weight and blood glucose showed apparent trends consistent with the study’s hypotheses.

Conclusions and Implications: The P-MIM showed promise for preventing weight gain in low-income overweight and obese women. However, a larger experimental trial is warranted to determine the effectiveness of this intervention.

Funding Source: NIH-NIDDK

When “fit” leads to fit and when “fit” leads to fat: How message framing and intrinsic v. extrinsic exercise outcomes interact in promoting physical activity

Authors:

Kristel Gallagher, John Updegraff

Purpose: A unique aspect of exercise is that people may choose to engage in it to achieve a variety of outcomes, ranging from extrinsic (appearance, health) to intrinsic (satisfaction, enjoyment). The present study examines how the impact of framed exercise messages (i.e., benefit focused “gain” messages or consequence focused “loss” messages) depends on the type of outcome emphasized. Drawing from

Poster Sessions

regulatory focus theory (Higgins, 1997), we predicted that gain-framed messages would “fit” with intrinsic outcomes and loss-framed messages would “fit” with extrinsic outcomes, but the effect of such a fit on subsequent behavior would depend on participants’ level of engagement with the message.

Methods: These hypotheses were tested with a sample of 177 sedentary young adults who read a message promoting exercise that had a randomly-assigned frame (gain/loss) and outcome (intrinsic/extrinsic). Message engagement was measured with the variable need for cognition (NC). Participants provided daily reports of exercise over the following week as the outcome variable.

Results: The predicted significant interaction between frame, outcome, and NC was found (p = .005), such that a “fit” message promoted exercise for those with high NC, but a “non-fit” message promoted exercise for those with low NC.

Conclusions: The present study is the first to specifically investigate the relationship between message frame and motivation for increasing exercise behavior. The results of this study may help those in the health promotion field to identify concrete strategies to improve the effectiveness of messages that promote exercise and offer a fruitful direction for future research.

Funding Source: Kent State University- Department of Psychology

The effectiveness of variety and breaks in weight loss treatment

Authors:

Melanie Jaeb, Patti Laqua, Robert Jeffery, Andrew Flood, Nathan Mitchell, Ericka Welsh, Shelby Langer, Rona Levy

Purpose: Current behavioral weight-loss treatments produce clinically significant weight-loss in most people. However sustaining weight-loss is difficult with regain beginning after 6 months. Based on the hypothesis that people become bored with traditional weight-loss techniques, the Maintenance-Tailored Treatment (MTT) intervention, was developed. The purpose was to test the effectiveness of an intervention that featured variety, planned breaks and adaptation to change with the aim of improving long-term weight loss.

Methods: MTT consisted of six 8-week units with 4-week breaks in-between; each had a distinct theme capable of promoting weight-loss. This was compared to Standard Behavioral Therapy (SBT); 6 months each of weekly, biweekly and monthly meetings with topics of energy balance, self-monitoring and exercise. Adults from the Minneapolis area (n=213; 53% female; 67% Caucasian; mean age 49; BMI 30 - 39 kg/m2) were randomly assigned to MTT or SBT for 18 months of treatment followed by 12 months of no-treatment.

Results/Findings: Major behavioral differences in MTT and SBT during final 6 months of treatment included higher rate of homework completion (p < 0.001), and increased enjoyment, satisfaction and motivation toward weight-loss (p < 0.02). Both groups lost weight during the first 12 months of treatment. In the next 6 months: MTT continued to lose 0.3 kg whereas SBT gained 1.7 kg (p < 0.01). A somewhat slower weight gain was observed in MTT at 30-month follow-up (p=0.11).

Poster Sessions

Conclusions: These findings suggest that adding variety to treatment, planned breaks and focus on adaptation to change may improve weight- loss maintenance.

Funding Source: NIDDK grant DK064596 to Dr. Robert W. Jeffery

Effects of weight loss on biomarkers, body composition and quality of life in overweight and obese postmenopausal breast cancer survivors

Authors:

Beth Kaufman, Andrea Arikawa, Mindy Kurzer

Purpose: Overweight (OW) or obese (OB) breast cancer survivors (BCS) are at increase risk of breast cancer (BC) recurrence and mortality. The purpose of this study was to evaluate effects of a 12-week weight loss intervention on body composition, biomarkers associated with BC recurrence, and quality of life (QOL) in OW and OB postmenopausal BCS.

Methods: Twenty-one OW and OB BCS were randomized into a calorie restriction plus exercise (CR) or weight-management counseling (WM) intervention for 12 weeks. Insulin, glucose, inflammatory markers (CRP, IL-6), leptin, adiponectin, and growth factors were measured. Fitness was evaluated by submaximal treadmill tests, body composition was assessed by dual energy x-ray absorptiometry, and QOL was evaluated via questionnaires.

Results/Findings: 20/21 women completed the study (95%). There were significant differences between the CR and WM groups in changes in weight (-10.6% vs. -2.65%, p<0.001), body fat (-4.16% vs. -0.76%, p=0.002), and fitness (+28.9% vs. +9.66%, p=0.036). Leptin and CRP decreased significantly more in the CR group (p<0.05). Insulin, glucose, IL-6, and adiponectin trended towards significant decreases in the CR group. QOL increased in both groups, although significant increases from baseline were only in the psychological domain (p=0.006).

Conclusions: This study demonstrated beneficial effects of CR on body composition, BC biomarkers, and QOL. The high adherence demonstrates feasiblity in this population. This is the first study to demonstrate the effect of CR on a range of biological, physical and psychological variables, and may lead to further interventions to improve health and QOL and decrease BC recurrence.

Physical activity behaviour and weight loss following bariatric surgery

Authors:

David Jacobi, Cecile Ciangura, Charles Couet, Jean-Michel Oppert

Purpose: The aims were to provide a first review of the evolution of physical activity behavior and to identify the relationship between physical activity and amount of weight loss following bariatric surgery.

Poster Sessions

Background: Physical activity is a cornerstone in the management of obesity and could be important for weight loss following bariatric surgery. No overview is available on the relationship between physical activity and weight loss following bariatric surgery.

Methods/Key Points: A Medline search was carried out for articles describing physical activity in relation to bariatric surgery (excluding studies that reported physiological outcomes only). The search identified 20 publications (19 studies) reporting physical activity data in relation to bariatric surgery. All studies were observational. Self assessment of physical activity was used in all the studies. Pedometers were used in 2 studies. The time-frame for physical activity assessment varied: before surgery in 2 publications, after surgery in 9, and longitudinal pre to postoperative evolution in 9. The latter 9 publications found an increase in physical activity after bariatric surgery. In 10/13 studies where it was described, there was a positive relationship between physical activity level and amount of weight loss.

Conclusions: Observational evidence of self-reported physical activity suggest that physical activity increases after bariatric surgery and that physical activity is associated with surgically-induced weight loss. However, there is a lack of data based on objective measures of physical activity and further evaluation in controlled trials appears needed.

Going seldom to the gym: Predicting gym’s attendance with exercise behavioral regulations

Author:

António Palmeira

Purpose: The aim of this study is to analyze the predictive effect of behavioral regulations for exercise (BRE) on the gym’s attendance for 3mo. The analysis have considered the past attendance (last 6mo) and seldom (<2session/week) versus more attendance during the following 3mo.

Methods: Participants were 440 regular exercisers at several gyms in the Lisbon area (34.4±11.3y, last 6mo=1.9±1.2 sessions/week, 62.8% women). Attendance was monitored weekly by using the computerized records of membership cards at the turnstile entrance of the gym (6mo before and 3mo after psychometric testing). Exercise motivation was measured with the BREQ-2 (Palmeira, Markland et al, 2007).

Results: Past attendance was positively correlated with introjected (p=.037), identified (p=.028) and intrinsic (p<.001) BRE. Future attendance was positively associated with past behavior (p<.001) and intrinsic motivation (p=.011). Multiple regression analysis forcing past behavior on the first step and analyzing BRE (stepwise) on the second step, showed that none of the BRE were predictive of future attendance. Removing past behavior revealed that intrinsic motivation independently explained 2% of future presences (p=.010). External regulation explained 6% of future behavior (p<.001) for those that went seldom to the gym. For those that went more than twice per week, past behavior explained 37% of future attendance (p<.001).

Conclusion: While past attendance is the strongest predictor of future attendance at the gym, this study showed that exercisers that seldom attend to the gym might be using external regulations for their exercise behavior, which might constraint the maintenance of this health promotion behavior.

Poster Sessions

Effect of probiotic yogurt on performance of the Tehrani endurance young adult women swimmers

Authors:

Nahid Salarkia, Leili Ghadamli, Farid Zaeri

Introduction: Intensive exercise affects the athletes’ capability during the exercise period and the competitions. This study was carried out to determine the effect of receiving Probiotic yogurt on performance of Tehrani endurance girl swimmers.

Methods: In a randomized controlled trial 46 girl endurance swimmers aged 11 to 17 years with mean age 13.8±1.8 years, weight 48.6± 7.5 kg, height 159±5.6 cm, who had taken part in the national 400 and 800 m crawl swimming competitions of 2009, were studied. The subjects were randomly selected to two groups as follows: 1: Receiving 400 ml yogurt Probiotic containing 4× 1010 cfu/ml (Colony forming unit per millimeter) comprising of Lactobacillus Acidophilus SPP, Lactobacillus Delbrueckii Bulgaricus, Bifidobacterium Bifidum, and Streptococcus Salivarus Thermnophilus, (n=23) and group 2: Receiving similar dose of ordinary yogurt, as a control (n=23). The 400 m free swimming record was conducted, and Harvard Step test was employed to measure VO2max.These tests were performed at the beginning and end of week eight.

Results: The average rate of change made in the records of the intervention and control groups was 3.9 and 0.5 second, respectively (P= 0.22). The rate of change in VO2max by the intervention and control group was 0.56 and 0.01 ml/kg-1.min-1, respectively, (P = 0.02).

Conclusion: Results showed the consumption of the probiotic yogurt helps athletes stay healthy. Further studies are required to be elaborated on the effects of the probiotic nutrition on athletes’ health and performance.

Acute affective responses following a nature simulated indoor moderate intensity run

Authors:

Jacqueline Simatovic, Lindsay Duncan, Craig Hall, David Markland

Purpose: This study sought to examine changes in affective state during and following a 30-minute moderate intensity run while watching a nature simulation video.

Methods: Regular runners (N = 72) were randomized to jog for 30 minutes at a moderate intensity while watching one of four videos: (a) nature simulation, (b) view from a window, (c) television program, or (d) no video. Affective responses were measured before, during, and after exercise using the Exercise-Induced Feeling Inventory (Gauvin & Rejeski, 1993), the Short-Form Profile of Mood States (Shacham, 1983), and the Feeling Scale (FS; Hardy & Rejeski, 1989).

Poster Sessions

Results: Positive affective responses were found to significantly (p<.05) increase following exercise among the four conditions. More specifically, revitalization increased significantly (p<.05) among each condition, and positive engagement increased significantly (p<.01) in the window condition. FS responses increased over time in both the nature and window condition, and decreased over time in the television program condition. Furthermore, reported levels of enjoyment were significantly (p<.05) higher in the nature and window condition. Enjoyment of the video predicted positive changes in tranquility (p<.05), and FS responses between 20 to 25 minutes (p<.05) and 25 to 30 minutes (p<.05).

Conclusion: Videos that expose exercisers to the natural environment while running appear to positively influence enjoyment and affective responses to exercise.

Walking and cycling computer workstations: Can office workers be active and productive?

Authors:

Leon Straker, Amity Campbell, Jim Levine

Background: Traditional computer workstations require office workers to be seated, resulting in very low occupational physical activity. This represents a major and growing public health risk.

Purpose: The purpose of this study was to determine if office workers could productively use walking and cycling computer workstations.

Methods: Thirty office workers (16 female) performed standardized computer tasks using a traditional sitting workstation and active workstations: walking at 1.6kph and 3.2kpm and cycling at 5 watts and 30 watts. Repeated measures analysis of variance with pairwise contrasts were used to assess differences between workstations.

Results: Heart rate increased during active workstation conditions (walking 1.6khp 83 ±10bpm, 3.2 kph 88 ±11bpm; cycling 5 watts 79 ±10 bpm, 30 watts 89 ±11 bpm) compared with sitting (75 ±10 bpm). Typing speed was slightly reduced during active workstation use (50-53 words per minute) compared with sitting (54 words per minute). Mouse pointing was slower during active workstation use (990-1100 msec) compared with sitting (940 msec). Combined typing and mouse use was also slower during active workstation use (10-12 words) compared with sitting (12.5 words per minute).

Poster Sessions

Providing healthier comfort food alternatives to increase subjects’ ability to comply with dietary advice

Authors:

Øydis Ueland, Hanne Sivertsen

Purpose: Foods high in protein are known to satiate more fully than foods high in other constituents. Due to lower palatability, one challenge is making these types of food the preferred choice. This study was aimed at developing Frankfurter style of sausages with high level of protein that would regulate food intake as well as being the preferred food choice of the consumer.

Methods: Four sausage varieties (Protein Energy % 20 and 40, and with or without added 3% rapeseed oil) were selected for satiety testing. 27 students (20-28 yrs., BMI 19.6-20.9) were recruited based on liking and frequency of consumption of sausages. The students were served a sausage meal at the same time during five consecutive days, and filled out a questionnaire on hunger, satiety, fullness, desire to eat, prospective consumption measured on a visual analogue scale. Satiety registrations were conducted for four hours, from right before and right after the meal, every half hour until the next meal was served, and right after the second meal. ANOVA was used to analyze the effects of the factors in the 24 factorial design.

Results: The high protein sausages were perceived as more satiating the first 90 minutes after the first meal. These sausages also had high liking scores. There was also an indication that high protein sausages with added vegetable oil were more satiating.

Conclusions: This study showed that it is possible to produce high-protein comfort food that increase perception of satiety and, thus, has food intake regulating properties.

Funding Source: EU-IP, 6th FP, DiOGenes Diet, Obesity and Genes, FOOD-CT-2004-513946; Research Council of Norway; Levy for Research on Agricultural Products, Norway

The effect of a competent-eating based nutrition education intervention on clients’ behavioral regulations: A Self Determination Theory perspective

Authors:

Amy Welch, Eunice Bassler, Warren Franke, Michelle Roling, Jennifer Hornbaker

Purpose: This study assessed the motivational mechanisms underpinning an intervention based on Satter’s (2007) Competent Eating Model. Competent Eating approaches to nutrition education place emphasis on developing an enjoyment of eating. Within this client-centered approach, professionals are encouraged to develop a strategy that supports the client in taking themselves to nutrition competence (Johnson-Taylor & Hubbard, 2007). This perspective appears to align well with the tenets of Self Determination Theory (Deci and Ryan, 2000), where self-determination of a behavior is characterized by intrinsic, autonomous regulation of that behavior.

Poster Sessions

Method: Participants were thirty-six volunteer clients of students engaged in an advanced nutrition education course at a large Midwestern university. Behavioral regulations were assessed before and after a 5-session nutrition education intervention using the BREQ-2, and perceptions of autonomy support were assessed at the end of the intervention using the HCCQ (both modified for use in nutrition education).

Results: A significant reduction in introjected regulation (e.g., feelings of guilt; t= 2.46; p < .05) and a significant increase in the relative autonomy index (i.e., the degree to which clients felt their behavior was self-determined; t= -4.40; p < .01) were observed. In addition, perceived autonomy support was negatively correlated with a motivation post intervention (r= -.446; p < .01).

Conclusion: Results indicate that competent eating–focused nutrition education appears to increase the degree to which clients feel their eating behavior is self-determined. Given previous support for the outcomes of competent eating, the provision of autonomy support, and identification of ways to reduce extrinsic forms of regulations for nutrition behaviors are encouraged.

Poster Sessions

Poster session 2: Parents and children

Poster session 2: Parents and children P105

Understanding childhood and parental body mass index (bmi) relationships: An ex post facto, correlational, non-experimental study

Author:

David Bang

Objective: This article examined parental influence on the childhood BMI variable for children aged 6 and 11 to determine parental-child BMI relationships.

Design: A multiple regression model was built to determine mother, father, both parents combined, and age of child effects on the child BMI.

Setting: Secondary numeric data sets, the Household Adult and Youth Questionnaires from the National Health and Nutrition Examination Survey (NHANES) III.

Participants: The NHANES III sample cases were selected for which all 7 variables of interest—mother’s height and weight, father’s height and weight, child’s height and weight, and child’s age---were recorded (4902 cases). This study focused on children aged 6 and 11. These age bands contained 208 and 265 cases respectively.

Main Outcome Measure(s): Childhood BMI was the outcome or dependent variable (y) and the parental BMI and age of child were the independent variables (x). Each variable was measured using a stepwise procedure.

Analysis: At each stepwise procedure of the built model, The Statistical Package for the Social Sciences (SPSS) Graduate Pack Version 15 was used for quantitative analysis to determine R squared and R squared change for statistical significance.

Results: There was no level of influence on child BMI for children aged 6 and 11 based on the variables used.

Conclusions and Implications: For both 6- and 11-year olds, BMI was related to their mother’s BMI, but not to their father’s BMI or age of child. There was a positive significant coefficient for mother’s BMI in both cases, suggesting that mothers with a high BMI tend to have children that have a higher BMI as well. However, the explanatory power of both models was low, with 10% of the variance explained for 6-year olds, and 9.3% in the other. The most likely reason is other factors that affect children’s BMI were not included in the model.

Poster Sessions

Does family matter? Associations between the family environment and physical activity, television use, dietary intake, and body composition among adolescent girls at risk for obesity

Authors:

Katherine Bauer, Dianne Neumark-Sztainer, Jayne Fulkerson, Peter Hannan, Mary Story

Purpose: Examine relationships between the family environment and physical activity (PA), TV use, soft drink and fruit and vegetable (FV) intake, and body composition among a diverse sample of adolescent girls at high risk for obesity.

Methods: Subjects included girls (mean age = 15.7, SD = 1.1) and one of their parents. Parents completed surveys assessing the family environment. Girls’ PA and TV use were measured by 3-Day Physical Activity Recall, and dietary intake by survey measures. BMI was measured by study staff, and body fat by dual-energy X-ray absorptiometry. Hierarchical linear regression models were used to test univariate and mutually-adjusted relationships between family environment factors and girls’ outcomes.

Results: In univariate and mutually-adjusted models, parental modeling of PA, TV, and soft drink and FV intake were positively associated with girls’ behavior. In univariate models, family support for PA was positively associated with girls’ total PA (p=.011) and moderate-to-vigorous PA (p=.016). Home availability of soft drinks and FV was positively associated with girls’ intake (p<.001 and p<.001, respectively), and family meal frequency was positively associated with FV intake (p=.0123). Media resources and number of televisions in the home were positively associated with girls’ BMI (p=.018 and p=.03, respectively), while family meal frequency was negatively associated with BMI (p=.023).

Conclusions: Helping parents improve their own activity and dietary intake practices, as well as provide support for their adolescents’ PA, promote having family meals, and ensure healthy home food availability can aid in adolescent girls’ efforts to be active and eat healthfully.

Funding Source: R01 DK063107 (PI: Neumark-Sztainer), J.B. Hawley Student Research Awards, Division of Epidemiology and Community Health, University of Minnesota, University of Minnesota Graduate School’s Doctoral Dissertation Fellowship

Parenting style and family meals: Cross-sectional and 5-year longitudinal associations

Authors:

Jerica M. Berge, Melanie Wall, Dianne Neumark-Sztainer, Nicole Larson, Mary Story

Objective: Research on family meals in the last decade has shown a positive association between family meal frequency and adolescent healthy dietary intake. However, less is known about factors within the home environment, such as parenting style, which may be associated with family meal patterns. The

Poster Sessions

purpose of this study is to test cross-sectional and five-year longitudinal associations between parenting styles (authoritative, authoritarian, permissive, neglectful) and the frequency of family meals among adolescents.

Methods: Data were from Project EAT (Eating Among Teens), a population-based study comprised of youth (n = 4,746) from diverse ethnic/racial and socioeconomic backgrounds. Two cohorts of adolescents (middle school, high school) completed in-class surveys in 1999 (Time 1) and mailed surveys in 2004 (Time 2). Multiple regression models were used to predict mean frequency of family meals at Time 1 and Time 2 from adolescent report of parenting style at Time 1.

Results: Cross-sectional results for daughters indicated a positive association between maternal and paternal authoritative parenting style and frequency of family meals. For sons, maternal authoritative parenting style was associated with more frequent family meals. Longitudinal results indicated that authoritative parenting style predicted higher frequency of family meals five years later, but only between opposite sex parent/adolescent dyads.

Conclusions: Future research should investigate mealtime behaviors of authoritative parents to: (a) identify specific behaviors that dietitians and other health care providers could share with parents to increase family meal frequency, and (b) to develop effective interventions targeting parenting style that will result in increased family meals.

Intake and perceived availability of sugar sweetened beverages, fruit and vegetables reported by mothers, fathers and children in the HEIA-study

Authors:

Mona Bjelland, Nanna Lien, May Grydeland, Ingunn H. Bergh, Sigmund A. Anderssen, Yngvar Ommundsen, Knut-Inge Klepp, Lene F. Andersen

Purpose: To investigate the intake of sugar sweetened beverages (SSB), fruit and vegetables (FV) among the children and their mother and father, and to explore differences in perceived availability.

Methods: In total 1455 11-year-olds in the eastern part of Norway participated in the HEIA-study. Intake of SSB (soft drink and squash with sugar) was assessed by frequency and amounts, while consumption of fruit, raw and cooked vegetables was assessed by frequency. Perceived availability at home and at school (FV brought from home) were reported by all three groups.

Results: Preliminary analyses show that there were significant differences in intake between boys and girls concerning foods, except for raw vegetables (p = 0.06). The intake of SSB was low on weekdays, but doubled during a weekend day. This pattern was also observed for the parents. The fathers reported a lower frequency of intake of FV than the others. For cooked vegetables the frequency was similar for all three groups. Compared to the children, mothers reported lower availability of SSB and a higher availability of vegetables, while fathers perceived the availability to be higher for SSB and lower for FV at school (FV brought from home) than the children.

Conclusion: The intake of SSB seemed to be restricted to the weekend among both children and adults, and the fathers reported eating fruit and raw vegetables less frequently than the children and mothers.

Poster Sessions

The mothers reported their children’s availability of SSB to be lower and vegetables to be higher than the availability reported by the children.

Funding Source: The study Health In Adolescents (HEIA) was funded by the Norwegian Research Council with supplementary funds from the Throne Holst Nutrition Research Foundation, University of Oslo and also from the Norwegian School of Sport Sciences.

Does parenting style predict weight related behaviors in children? A review

Authors:

Claudia Fox, Simone French, Mark Pereira

Purpose: The purpose of this review was to synthesize the published literature which examined the association between parenting style and fruit, vegetable, fat, and sugar consumption, physical activity and sedentary behavior in children.

Background: Parenting style has been identified as a potential contributor to childhood obesity. An authoritative parenting style, characterized by high demandingness and responsiveness, is associated with favorable developmental outcomes among children. Therefore, it has been hypothesized that this style may also foster healthy weight related behaviors in children.

Methods/Key Points: Ovid Medline and Psych Info were searched using the following terms: parenting style, parent child relations, eating, obesity, feeding behavior, feeding style, eating behavior, food preference, physical activity, and television. Studies included in this review were those written in English which measured parenting style and the following dependent variables: fruit, vegetable, fat, and sugar sweetened beverage consumption, physical activity and television viewing in children (ages 0 to 18 years). Analyses that included only measures of parenting practices, such as parent feeding practices, were excluded. In all, seven studies were identified that met these criteria, five of which were cross-sectional. The results of these studies were inconclusive about the presence of an association between an authoritative parenting style and healthy weight related behaviors in children. The limitations of these studies which may account for the divergent results were discussed.

Conclusions: Parents’ and childrens’ gender, culture, and economic status, and children’s developmental stage may modify the association between general parenting style and children’s weight related behaviors.

Funding Source: This abstract was supported in part by the Adolescent Health Protection Program (School of Nursing, University of Minnesota) grant number T01-DP000112 (PI: Bearinger) from the Centers for Disease Control and Prevention (CDC).

Poster Sessions

What should parents do to reduce youth obesity?

Authors:

Marilyn Frenn, Claire Schmidt, Amy Heinrich

Purpose: To explore parenting style, dietary fat and exercise contributions to youth body mass index (BMI), BMI percentile and BMI z scores.

Methods: Sample: 5th grade diverse, low income students (N=36) and parents (n=11). Instruments/

Analysis: Student’s BMI was regressed on physical activity (Child Adolescent Activity Log - CAAL), percentage dietary fat (Food Habits Questionnaire - FHQ), and the Food/Activity Practices Questionnaire (FAPQ). Parents completed the parent version of the FAPQ, the International Physical Activity Questionnaire (IPAQ) short form and the FHQ, as well as demographics.

Results: The model explained 50% of the variance in student BMI [Adj. R2= 0.50; F (4, 19) = 6.84; p= 0.001]. Significant predictors included: dietary fat (Beta = 0.38; p=0.02); food (Beta = 0.40; p= 0.03) and exercise (Beta = 0.39; p= 0.04) components of the FAPQ. Findings were similar with BMI percentile and BMI z score.

Conclusions: Student perceptions of parenting style for both food and exercise, along with percentage dietary fat were most predictive of their BMI. Students have an accurate estimate as to whether they are under or overweight, but parents do not have an accurate estimate of their child’s weight status or activity level. The number of days parents were moderately active was related to student duration of activity as was their encouragement to avoid sedentary activity. Students’ perceptions that their parents decided portion sizes, the right kind of foods and controlled their activity were associated with a lower BMI. Further research and intervention are needed.

Funding Source: Delta Gamma Chapter International Nursing Honor Society

Home social and physical environment characteristics associated with children’s self-reported fruit, juice and vegetable intake

Authors:

Tanis Hastmann, Richard Rosenkranz, Candice Shoemaker, David Dzewaltowski

Purpose: The home social and physical environment has great possibilities for influencing children’s healthy behaviors and decreasing their risk for obesity. The purpose of this study was to determine which home environment variables were associated with children’s self-reported fruit, juice and vegetable consumption (FJV).

Poster Sessions

Methods: As part of a larger gardening intervention, children (n=359) in grades 4-5 (48% male, 51% white, 27% free/reduced lunch status), completed the Day in the Life Questionnaire, a validated one-day FJV recall for children. Parents completed a questionnaire to assess the availability of fruit, juice, vegetables and gardening tools (home physical environment); parent social support for gardening, physical activity (PA), FJV consumption, sedentary behavior, and eating out (home social environment). Linear regression was used to assess whether FJV intake was associated with home social and physical environmental characteristics.

Results: On average, children consumed 1.8 servings of FJV per day (SD=1.7). Female sex (beta=0.25, p<0.001) and socioeconomic status (beta=0.15, p=0.007) were positively associated with FJV intake. Parent reported social support for FJV (beta=0.14, p=0.022), social support for eating out (beta=-0.11, p=0.046), and fruit availability (beta=-0.12, p=0.043) were associated with child FJV intake. There were no associations between juice, vegetable, and gardening availability, social support for gardening, PA, sedentary behavior, and children’s FJV intake.

Conclusions: Our findings support previous research showing that children report low FJV intake. Additionally, parental social support for FJV was positively associated with child FJV intake. Future studies should examine the influences on FJV with objective home and FJV measures (USDA NRI 2007-55215-18206).

Funding Source: National Research Initiative Grant (no. 2007-55215-18206) from the United States Department of Agriculture Cooperative State Research, Education, and Extension Service Human Nutrition and Obesity Program

Predictors of change in children’s dietary intake following an intervention targeting the family food environment

Authors:

Gilly Hendrie, Rebecca Golley

Purpose: Parents are the gatekeepers of the family food environment, making them a key agent of behaviour change in interventions to improve children’s dietary intake. This study targeted parents, as a means to change the family food environment and improve children’s dietary intake.

Methods: Families, with children aged 4-13 years (n=129), participated in a 12-week, family focused intervention, providing parents with behaviour change strategies and support to improve children’s dietary intake. Child outcomes included BMI and dietary intake, and were assessed at baseline and 12 weeks. Three, multiple pass 24-hour recalls conducted with a dietitian provided data on children’s dietary intake including saturated fat and fruit/vegetable intake . Self-reported, validated questionnaires provided data on the family environment including parent’s nutrition knowledge, feeding practices, and opportunities for role modelling.

Results: Children (42% girls), with a mean age of 7.5±2.7 years, had a mean BMI z-score of 0.28±0.99 (1.67 – 2.90). The majority of parents were mothers, with a mean BMI of 27.01kg/m2. At baseline children’s saturated fat intakes ranged from 10.9-22.6% of total energy and average intake of fruit/vegetables

Poster Sessions

was 301g. Aspects of the food environment were associated with child outcomes at baseline –parents’ promotion of healthy habits, parents’ perceived responsibility at meal times, and the use of foods to shape children’s behaviours. The association between change in food environment and change in child outcomes were examined.

Conclusion: Providing parents with practical strategies and support to alter their family home environment is an effective means to change children’s food and nutrient intakes.

Funding Source: Dairy Australia

Exploring determinants of vegetable parenting practices

Authors:

Melanie Hingle, Alicia Beltran, Janice Baranowski, Deborah Thompson, Teresia O’Connor, Tom Baranowski

Purpose: Food parenting practices show promise for positively influencing child dietary intake. However, it is unclear what factors motivate parents to engage in vegetable parenting practices. We developed a Model of Goal Directed Vegetable Parenting Practices (MGD-VPP), and used qualitative methods to explore parents’ attitudes, subjective norms, perceived behavioral control, positive and negative anticipated emotions, and habit related to VPP by parents of pre-school aged children.

Methods: Semi-structured intensive interviews were conducted over the telephone by trained study staff following standard procedures and scripts. Calls were audio-recorded, transcribed, and checked for accuracy by the interviewers. A codebook was constructed and QSR NVivo 8.0 used to facilitate data coding, retrieval, and analysis.

Results/Findings: Fifteen parents (5 AA, 5 White, 5 Hispanic) completed the interview. Improved health and energy, good behavior, setting a good example, weight management, and meeting nutrition guidelines were cited as reasons why child vegetable consumption was important. VPPs used to increase intake were bribery or force, hiding vegetables in other foods, changing preparation methods, or increasing availability/accessibility. Parents attributed preferences, preparation skills, availability, family and friends’ opinions, and cost as major influences on their use of VPP. Parents reported positive (excitement, happiness) and negative emotions (frustration, disappointment) in response to hypothetical child consumption scenarios.

Conclusions: Parents stated the importance of vegetable consumption, yet almost all reported their child did not meet nutrition guidelines. Parents reported many barriers to regular consumption as well as some solutions, and appeared to need guidance on how to implement VPP to improve intake.

Funding Source: National Institute of Child Health and Human Development Training Grant 5T32HD007445

Poster Sessions

Maternal physical activity: How the community responses during pregnancy and birth weight in developing country

Authors:

Shambhu Joshi, Kalpana Panday

Background: Developing country like Nepal’s quality of maternal health is not satisfactory. Since it was in war conflict for 12 years. It is also seen an inverse relationship between physical activity and birth weight in rural women who had high levels of physical activity related to agricultural and domestic activities. There are no data on urban women from a wide range of socio-economic backgrounds with varying levels of physical activity. This study assessed the role of different domains of physical activity during pregnancy and its relation to birth weight.

Methods: Data on maternal anthropometry and maternal physical activity level were collected at the 1st trimester (baseline), the 2nd trimester and the 3rd trimester of pregnancy (2007 Oct-2009 Sept) Birth weight for463 live born babies was measured immediately after delivery. Data were edited and analyzed by Epi Info program.

Results: The time spent in sedentary activities (median “cut-off” of 165 min/d) was significantly associated with maternal body weight in the first trimester of pregnancy (51.2 kg vs. 54.1 kg, p < 0.001). Women in the highest tertile of physical activity level in the 1st trimester were 1.58 times (95% CI: 1.02-2.44) more likely of having a baby in the lowest tertile of birth weight with reference to the first tertile. This significant association continued after adjustment for maternal weight and energy intake.

Conclusion: The present study shows that physical activity in the first trimester is associated with low birth weight among babies. Lack of nutrition support, traditional lifestyle, heavy work during pregnancy, illiteracy, gender inequalities, poverty are contributing factors towards the health of women in developing country.

Fruit and vegetable consumption among socially disadvantaged primary caregivers and offerings to their preschoolers

Authors:

Leanne Liggett, Andrew Gray, Winsome Parnell, Rob McGee

Purpose: The amounts of fruit and vegetables (F&V) offered to children is determined by various factors. This study aims to explore the associations between primary caregiver’s F&V consumptions and offerings to their child.

Methods: Baseline data from the Healthy Me and You study were used. Participants (n=135) were recruited by Health and Social Service agencies in the lower half of the South Island, New Zealand. Data consisted of caregiver interviews and 5-day F&V tick-lists. F&V consumption measures are described

Poster Sessions

for caregivers along with offerings to their children. Associations between these are calculated using Spearman’s correlations, both overall and for subgroups of interest defined by child sex, number of adults in household, presence of other children, and ethnicity.

Results: Median fruit consumption for caregivers was 2 servings and the median number of fruit offerings to children was 3. The same values were found for vegetable servings and offerings. The correlation between fruit and vegetable consumption for adults was 0.24 (p=0.005) and the correlation between offerings for children was 0.42 (p<0.001). The correlation between caregiver fruit consumption and child fruit offerings was 0.28 (p<0.001), and for vegetables was 0.32 (p<0.001). Bootstrapping was used to compare correlations between subgroups as defined above. A tendency for a difference between boys and girls for fruit was noted (girls 0.44 and boys 0.15, p=0.071).

Conclusions: Results show small but important correlations between caregiver and children for F&V. Therefore caregivers need to be aware of the possible impact of their own behaviour on their child’s eating habits.

Funding Source: Ministry of Health via the HEHA Innovations Fund, Southland District Health Board and Sport Southland

Physical activity levels among socially disadvantaged primary caregivers and their pre-school children

Authors:

Leanne Liggett, Andrew Gray, Rob McGee, Winsome Parnell

Purpose: To explore associations between primary caregivers’ physical activity (PA) and their preschool children’s PA.

Methods: Baseline data from the Healthy Me and You study were used. Participants (n=135) were recruited by Health and Social Service agencies in the lower half of the South Island,New Zealand. Assessments included caregiver interviews and accelerometer data. PA measure included median daily minutes of activity (moderate to vigorous (MV) PA for caregivers, any PA for children), median daily step counts, and the presence of any Extra PA (MVPA for caregivers, any PA for children). Extra PA is activity not captured by the accelerometer e.g. swimming, cycling, and for caregivers only, strength type activities. Associations between child and caregiver PA were explored using Spearman’s correlations and logistic regression, both overall and for subgroups of interest (males vs female, by number of adults in household and presence of other children, and by ethnic group).

Results: Caregiver and child median daily minutes of activity were not statistically significantly correlated (r=0.17, p=0.062). For median daily step counts, the correlation was stronger and statistically significant with r=0.32, (p=0.004). Extra PA in caregivers was associated with Extra PA in children (OR=2.9, 95% CI 1.4-6.0, p=0.004).These associations did not vary as a function of socio-demographic variables.

Poster Sessions

Conclusion: Results show potentially important associations between a caregiver’s PA and their child’s PA, with a strong association for Extra PA type activities. Therefore caregivers need to be more aware of the possible impact of their own behaviour on their child’s activity levels.

Funding Source: Ministry of Health via the HEHA Innovations Fund, Southland District Health Board and Sport Southland

The benefits of shared family mealtimes: A qualitative study in Brazil

Authors:

René Lion, Pia de Wit, Vi Dinh, Lizette Arkesteijn, Renata Cassar, Maria-Carla Leone, Marle Alvarenga

Purpose: Research in the US has shown significant correlations between shared family mealtimes and benefits ranging from diet quality to school performance. Outside the US similar research is lacking. The objective was to explore the benefits associated with increased frequency and quality of shared mealtimes in Brazil.

Methods: Twenty-six families in Sao-Paolo, Brazil (2 or less shared family mealtimes per week) were asked to have at least 2 additional shared family dinners during weekdays with the core family and no distractors (e.g., TV, mobile phone) for 4 weeks. Using a discourse-analysis approach, semi-structured individual interviews with 20 mothers were content analysed on the benefits experienced during the 4-week period.

Results/Findings: The intervention was successful and perceived to be do-able: none of the families dropped out and most sustained an increase in behaviour. Families were surprised by the positive impact of shared familydinners. Mothers perceived a) more and better conversations; b) a father that was closer to the children; c) an improved social life of the adolescents; d) better school performance; e) greater cooperation from the family during mealtimes and f ) better nutrition.

Conclusions: The benefits of shared family mealtimes are also experienced in cultures outside the U.S. The design for an intervention study – an increase in shared family mealtimes for 4 weeks – is realistic and possible. Next steps include setting up a full intervention study to provide causal evidence for the role of shared family mealtimes and its associated benefits.

Funding Source: Unilever

Project Fit for Delivery: 10 specific dietary recommendations for pregnant women, to prevent excessive weight gain

Authors:

Nina Cecilie Øverby, Linda Reme Sagedal, Ingvild Vistad, Hilde Lohne-Seiler, Elling Bere

Purpose: Overweight has become increasingly prevalent in Norway, also among women of childbearing years. Weight gained during pregnancy affects the health of both mother and child. Our aim was to

Poster Sessions

develop specific dietary recommendations to prevent excessive (more than recommended) weight gain during pregnancy. The recommendations are to be used in the study Fit for delivery.

Methods: Fit for delivery is an intervention study including nutritional counselling and exercise groups, aiming to reduce excessive weight gain during pregnancy, as well as delivery complications. It is a prospective, randomized, controlled trial including 300 women in each arm. The developed recommendations are based on current national guidelines, but they are simplified, more concrete and made into ten easy-to-remember statements.

Results: The following 10 specific dietary recommendations were developed:

1. Eat regular meals

2. Drink water when thirsty

3. Eat vegetables for dinner every day

4. In between meals - eat fruits and vegetables

5. Eat sweets/snacks only when you really appreciate it

6. Do not eat until you are more than full

7. Choose small portion sizes of unhealthy food

8. Limit your intake of added sugar

9. Limit your intake of salt

10. Read the nutritional declaration of foods carefully before buying.

The participants in the intervention arm receive these recommendations in a pamphlet, and also through two telephone consultations about nutrition.

Conclusion: General guidelines for pregnant women do exist in Norway, but more concrete recommendations were needed and developed for the purpose of the present study.

A family-based intervention to increase fruit and vegetable consumption in adolescents: A pilot study

Authors:

Natalie Pearson, Andrew J Atkin, Stuart J H Biddle, Trish Gorely

Purpose: To evaluate the feasibility and effectiveness of a pilot family-based intervention to increase fruit and vegetable (FV) consumption among adolescents.

Methods: Family-based (n=49 parents and adolescents), two-group randomised control trial. Two newsletter packs, containing educational resources based on behavioural choice and social cognitive theories, were delivered to intervention families over a one-month period via postal mail. Outcome

Poster Sessions

measures included adolescent FV consumption, barriers to eating FV, FV habits and preferences, along with parent FV consumption, and parent reported knowledge, encouragement, home availability and accessibility of FV. Repeated measures ANOVA was used to detect differences in behavioural and psychosocial outcomes between groups, time, and group-by-time. In addition, the Baron and Kenny (1986, J Pers & Soc Psych) causal steps approach was used to assess mediation.

Results: At post-intervention and at 6 weeks follow-up, adolescents in the intervention group had significantly higher fruit (p<0.01) and vegetable (p<0.05) consumption and higher preferences for vegetables (p<0.01), compared to those in the control group. At post-intervention and follow-up, parents in the intervention group had significantly higher fruit (p<0.001) and vegetable (p<0.01) consumption and reported higher accessibility of fruit and vegetables (p<0.001), compared to those in the control group. Preferences for vegetables mediated 18%, parental vegetable intake 23%, and home accessibility of fruit and vegetables 22% of the total effect of the intervention on changes in adolescent fruit consumption. No mediators were found for adolescent vegetable intake.

Conclusion: Family-based, newsletter interventions promoting fruit and vegetable consumption to adolescents appear to be feasible and effective at increasing fruit and vegetable consumption.

Individual and family correlates of calcium intake in parents of early adolescent children

Authors:

Marla Reicks, Miriam Ballejos, Siew Sun Wong, Carol Boushey, Christine Bruhn, Mary Cluskey, Scottie Misner, Beth Olson

Purpose: Few studies have examined how parenting practices that enable intake of healthy foods by children affect intake by parents themselves. This cross-sectional study identified factors that were associated with calcium intake by parents of early adolescent children.

Methods: A convenient sample self reporting as Asian, Hispanic or non-Hispanic white (n=661) was recruited from nine states. Parents completed 14 scales to assess attitudes/preferences and parenting practices regarding calcium rich foods (CRF) and a calcium-specific food frequency questionnaire. Multivariate regression analyses identified demographic, attitude/preference and behavioral factors associated with calcium intake from all food sources, dairy foods, and milk.

Results/Findings: Most respondents were women (~90%), about half were >40 years old and employed, and 38%had a college degree. Between 23%-37% of the variance in calcium intake from all food sources, dairy foods, and milk was explained in these models, respectively. Parent education was positively associated with calcium intake from all food sources, dairy foods, and milk, while having an Asian spouse was negatively associated with calcium intake from all food sources and dairy foods. No parenting practices were associated with calcium intake from all food sources, however, encouragement and expectations for child’s beverage consumption were positively associated with intake from dairy foods. Concern over adequacy of parents’ own intake was negatively associated while perception of health benefits from CRF was positively associated with calcium intake from all food sources.

Poster Sessions

Conclusions: Personal factors may be an important focus along with positive parenting practices for osteoporosis prevention programs for parents.

Funding Source: Minnesota Agricultural Experiment Station

Parental practices, television viewing and physical activity habits among preschoolers from low-income minority populations in Houston, Texas

Authors:

Ru-Jye Chuang, Shreela Sharma

Purpose: To describe the parental practices, television viewing (TV) and physical activity habits of 3 to 5 year old children from low-income, minority populations in Houston, Texas.

Methods: This cross-sectional study was conducted in 2008- 2009 among parents of 3 to 5 year-old children in Head Start preschools, Texas. A validated self-administered questionnaire evaluating the home environment and parental psychosocial factors was used (Healthy Home Survey) (n=874 parents). Unpaired t-test and Pearson’s chi-square test were used to determine ethnic differences.

Results/Findings: The participants were 51% Hispanic and 49% Non-Hispanic (43% African American, 5% Non-Hispanic White). 47.1% of the parents used TV time as a reward for their preschooler some or most of the time. 71% reported not having enough room in their homes for active play; 19.6% restricted active play indoors and 35.6% restricted outdoor play.62.2% had >3 working TV’s at home, and 66.7% had a TV in their child’s bedroom. More Non-Hispanic children had >3 working TV’s in their home (p=0.000) and, a TV in their bedroom (p=0.002) as compared to Hispanics.64.3% of parents reported their child were physically active >30 minutes 5 -7 times/week. 35.7% of Non-Hispanic children were active 5-7 times/week as compared to only 28.6% of Hispanics (p=0.000). 20.9% of the preschoolers were participating in sports teams with the prevalence being higher among Non-Hispanics (p=0.037).

Conclusions: These analyses show a high prevalence of a home environment and parental practices conducive to sedentary behaviors in this population of preschoolers with significant ethnic differences.

Funding Source: U.S. Dept of Health and Human Services; The University of Texas, School of Public Health, Michael & Susan Dell Center for Advancement of Healthy Living

Home social environment and child diet

Authors:

Rachel Tabak, Derek Hales, Maria Bryant, Amber Vaughn, June Stevens, Dianne Ward

Purpose: The current study expands on research demonstrating the impact of the home social environment on child diet.

Poster Sessions

Background: The environmental contribution to obesity is well recognized. Parents control the home and can support healthy dietary habits in their children by creating an environment which fosters healthy eating.

Methods/Key Points: Eighty two families with a child 3-8 years participated. The home social environment (ex: where meals are eaten at home) was assessed via telephone interview using the Healthy Home Survey, and parents completed a paper food frequency questionnaire to assess child diet. Exploratory factor analysiswas used to reduce the number of items, and revealed 3 factors: meal environment (4 items, α=-0.93), parental control (4 items, α=-0.53), and self-serve (2 items, α=-0.44). Four items were not included in the factor solution (due to low factor loadings or cross-loading) and were analyzed as individual items (seconds, dinner away from home, modeling healthy eating, and modeling avoiding snacks). After adjustment for income, number of Children and adults in the home, occupation, and race, positive correlations were observed between intake of sweet snacks and the self-serve subscale (r = 0.32, p = 0.004) and vegetable intake and the modeling healthy eating item (r = 0.31, p = 0.005). Negative correlations were observed between energy intake and seconds (r = -0.26, p = 0.04) and soda intake and modeling healthy eating (r = -0.24, p = 0.05).Conclusion: These results suggest important relationships exist between the home social environment and child diet.

Funding Source: Funding for this research was provided by an unrestricted grant from ‘Get Kids in Action’, a partnership between the Gatorade Company and The University of North Carolina at Chapel Hill

Are parent feeding style and practices associated with child weight outcomes?

Authors:

Amber Vaughn, Rachel Tabak, Dianne S. Ward

Background: The family home environment, specifically parent practices, may influence child dietary intake and weight. Purpose: To explore the association between multiple measures of parental feeding practice and child weight.

Methods: Ninety families with at least one child 2-5 y provided baseline data as part of a larger study. Child height, weight, and tricep skinfold were measured by trained staff; child BMI percentile and percent body fat (using Denzenberg 1999 equation) were calculated. Parental feeding style and practices were assessed by: Hughes’ Caregiver Feeding Style Questionnaire (child- and parent- centered feeding strategies), Musher-Eizenman’s Comprehensive Feeding Practices Questionnaire (child control, encouraging balance and variety, involvement, modeling, monitoring, pressure to eat, teaching about nutrition, restriction for weight, and restriction for health), Wardle’s Parent Feeding Style Questionnaire (instrumental feeding, emotional feeding, encouragement, and parent control), and Baughcum’s Preschooler Feeding Questionnaire (structure during feeding interactions only). Pearson correlations examined associations between parental feeding scales and child BMI percentile and percent body fat.

Results/Findings: Mean child BMI percentile was 56.3 (SD=30.6), mean percent body fat was 11.2 (SD=8.1). BMI percentile was significantly correlated with restriction for health (r=0.23, p=.03 and percent body fat with restriction for weight (r=0.25, p=.02), parent-centered feeding strategies (r=-0.23, p=.03), and parent control (r=0.25, p=.02). No other significant associations were found.

Poster Sessions

Conclusions: Although these findings add to a growing body of research to determine how parent feeding style and practices relate to child weight, consistent measures administered to different samples are needed to inform development of healthy weight interventions for children.

Funding Source: National Institutes of Health, National Heart, Lung and Blood Institute

Associations among food insecurity and parental influences of children’s dietary intake

Authors:

Kathleen Watson, Karen Cullen, Pamela Diamond, Asha Kapadia

Purpose: To assess the overall relationships among food insecurity, parent mediators, and parent behaviors towards children’s dietary behavior in a predominantly Hispanic population.

Methods: This cross-sectional study was a secondary analysis of baseline data from women with families who participated in a food and nutrition education intervention program for limited-resource families. The following data was obtained: demographics, effective (EPP)/ineffective parenting practices (IPP), parent self-efficacy (PSE) to provide/encourage healthy diets for their children, menu planning and grocery shopping practices (MP), modified parent/family barriers (mPB) to eating FJV, modified family food preparation practices (mFFPP), home FJV availability (HA), and the USDA’s food insecurity (FI) scale. A multi-group structural equation model (M-SEM) was used to assess the relationships among parenting influences overall and by FI status.

Results: The women (n=861) were Hispanic (88%), White (4%), African American (8%), and Other race (0.3%), 43.0% FI and 34.2 (+9.3) years. There were no FI group differences from the M-SEM. Overall results did support expected relationships. The model fit (χ2=585.75,df=298,p<0.001, RMSEA=0.05, CFI=0.97). Increased mPB significantly predicted increased IPP. In contrast, decreased mPB moderately predicted increased EPP. PSE positively predicted EPP, MP, HA, and mFFPP. The relationship between PSE and IPP was weak.

Conclusions: Obesity intervention studies targeting parent/family barriers and self-efficacy to provide/encourage healthy diets may result in an increase in parent behaviors which promote healthy eating among children. Future research should include investigating complex causal pathways to determine whether parental changes in the mediators ultimately lead to an increase in children’s healthy dietary behavior.

Funding Source: Data from intervention study funded in part by federal funds from the USDA/ARS under Cooperative Agreements No. 143-3AEL-2-80121 and 58-6250-6001.

Poster Sessions

Poster session 2: Technology

Poster session 2: Technology P125

Use of a computer-aided wellness program to encourage physical activity among inactive adults

Authors:

Brenda Bruner, Lucie Lévesque, Jennifer Murphy-Mills

Purpose: To assess the utility of an on-line physical activity (PA) tracker, designed to capture all activity as step counts, for encouraging inactive adults to engage in regular PA (i.e., 10,000 steps per day). Because engaging sedentary adults in PA is a challenging endeavor, novel approaches to increase PA adoption are required.

Methods: Height, weight, and waist circumference were measured in 62 participants (mean age = 45.1 ± 12.6 years; 92% female). Participants also provided self-reported PA, internet usage, and demographics including age, sex and socioeconomic status. Following the initial assessment, participants were given a tutorial on the use of the on-line tracker, a goal of accumulating 10,000 steps per day and asked to register to use the on-line activity tracker and to track daily leisure-time PA. Descriptive statistics assessed the use of the on-line PA tracker for 6 months and greater.

Results: Of the 62 participants who completed the baseline assessment, 60% (n=37) used the activity tracker, 14% (n=9) registered but did not track their activity and 26% (n=16) did not register to use the tracker. Of the participants using the activity tracker, over 30% logged their activity for less than one month, 16% for one month, and < 10% for 6 months.

Conclusions: Findings suggest the continued challenge of engaging adults to participate in regular PA. Despite this innovative approach for promoting PA, and participants’ stated intention to register and use the tracker, many individuals did not use the technology. Further research should explore the reasons for non-use.

Funding Source: Queen’s University Senate Advisory Research Committee

The effects of a pedometer-based behavioral modification program with telephone support on physical activity and sedentary behavior in type 2 diabetes patients: A randomised controlled clinical trial

Authors:

Karlijn De Greef, Benedicte Deforche, Johannes Ruige, Jacques Bouckaert, Catrine Tudor-Locke, Jean-Marc Kaufman, Ilse De Bourdeaudhuij

Purpose: To investigate the effects of a pedometer-based behavioral modification program with telephone support on physical activity (PA) and sedentary behavior in type 2 diabetes patients.

Poster Sessions

Methods: Ninety-two type 2 diabetes patients from the endocrinology department of the Ghent University Hospital (Belgium) were assigned to either an intervention or control group using random allocation. Participants of the intervention group received one individual face-to-face session, a pedometer and seven telephone follow-ups during six months. The selection criteria were (1) age 35-75; (2) BMI 25-35; (3) treated for type 2 diabetes; (4) no PA limitations. PA and sedentary behavior were measured using a pedometer, accelerometer and the international PA questionnaire.

Results: After the 24-weeks intervention, the intervention group increased their steps/day by 2744 and total PA by 23 min/day and decreased sedentary behavior by 23 min/day. One year after baseline, the intervention group still had an increase of 1872 steps/day and 11 min in total PA per day and a decrease of 12 min in sedentary behavior per day. In contrast, the control group decreased in steps and PA and increased in sedentary behavior.

Conclusions: This 24-weeks pedometer-based behavioral modification program with telephone support showed a positive impact on steps/day, PA and sedentary behavior for at least half a year after the intervention (and one year post-baseline).

Funding Source: University Grant

The relationship of website utilization to weight loss success in an online behavioral obesity treatment program

Authors:

Courtney L. DeHaan, Delia Smith West, Paul R. Buzzell, Jean Harvey-Berino

Purpose: On-line behavioral obesity treatment programs can produce clinically significant weight losses, although response varies substantially. Utilization of web components may help explain treatment success. The purpose of this study was to evaluate differences in website utilization patterns for participants who were successful and unsuccessful in a 6-month online behavioral weight control intervention.

Methods: Participants in a 6-month online weight loss program (n=159) were divided into weight loss tertiles. Web features evaluated included logins, self-monitoring journal usage and chat group attendance. Web usage by tertile was examined over the first 6 weeks, last six weeks and entire 6 months of treatment using ANOVA and multivariate repeated measures.

Results/Findings: Average weight loss during the intervention was 0.2%, 5.5% and 11.7% of baseline weight for Low, Medium and High tertiles, respectively. Internet usage for logins, journal and chat was significantly greater in High than either Low or Medium (p < 0.001) over six months. Low and Medium were not different from each other. Usage of all web components decreased over time with no difference in this pattern between tertiles in the first vs. last 6 weeks.

Conclusions: Individuals in the highest weight loss tertile were more engaged with web treatment components. Those in the lower two tertiles of weight loss were using web components less frequently early in the intervention suggesting that the first 6 weeks of treatment can predict outcomes.

Funding Source: NIH R01 DK056746 awarded to Dr. Harvey-Berino

Poster Sessions

Stealth health: Youth innovation, mobile technology, and informal learning to promote physical activity

Authors:

Scott Going, Melanie Hingle, Barron Orr, Nobuko Hongu, Nirav Merchant, Mimi Nichter, Kirk Astroth, Lynne Borden

Purpose: Develop a sustainable youth-driven approach for increasing physical activity and healthy eating using mobile technologies and an informal learning approach.

Background: Childhood obesity prevalence continues to rise. Contributive causes are many including inactivity driven by “screen time.” The current consensus is that many programs combat obesity with limited, short-lived success. Reaching the significant majority of youth who traditionally do not participate in formal healthy lifestyle education programs requires an informal approach that engages youth where they are in everyday life, e.g. by capitalizing on mobile phone technology and online social networks.

Methods: Phase I is characterized by youth-driven development and design, which includes developing software applications; conducting formative analysis and participatory development; and focus group testing of ideas and technology. Phase II is ‘proof of concept.’ We will assess the impact of the technology in an informal learning context, and evaluate youth physical activity, dietary choices, knowledge, and behavioral mediators. In Phase III, we will seed the diffusion of the innovations to the general public through a nationwide contest held by our partners (YMCA, America On the Move, National 4-H).

Conclusions: Our approach will 1) make popular technology part of the solution; 2) obtain youth buy-in by engaging them in research and development; 3) incorporate mobile technology into youth programs as an informal learning tool; 4) seed the broader diffusion of the technology by harnessing the contagion potential of social networking websites, with the help of national organizations such as America on the Move, National 4-H Council, and YMCA.

Funding Source: National Research Initiative Grant 2009552150518 from the USDA Cooperative State Research, Education and Extension Service

Role of immersion (transportation) in health video games

Authors:

Amy Shirong Lu, Debbe Thompson, Janice Baranowski, Richard Buday, Tom Baranowski

Purpose: Recent empirical studies have shown that narratives can serve as powerful tools for health behavior change. According to theory, the more a narrative immerses or transports a person into a story world, the more consistent their beliefs and behaviors should be with the narrative. As the first analysis of immersion in health video games, the present research addressed three research questions: Is videogame immersion a stable trait? Will players be more immersed when the main characters are similar to players? Are increased levels of immersion related to more positive health outcomes? 103 children 10 to 12 years of age played Escape from the Diab and Nanoswarm: Invasion from Inner Space, two video games designed

Poster Sessions

to reduce risk for type 2 diabetes and obesity. Demographic information, immersion, and psychosocial variables (e.g. self-efficacy, motivation, etc.) were recorded and analyzed.

Results/Findings: Adolescence is the period in life characterized by significant change like biological, psychological and social learning that occurs at an astonishing rate. Adolescents are more capable of making decisions and are often given more freedom to do so. It is also a time when youth are particularly impressionable and vulnerable to many factors that positively or negatively influence their future health behaviors. Adolescents are a very diverse population segment because they are in the different stages of development, living in different geographical conditions, their marital status, or have different needs and diverse problems. Adolescent risk behaviors can affect their current and future health. Indeed it can affect the entire life course . Adolescent risk behaviors and choices tend to occur in a social context and may be synergistic. Therefore it is necessary to identify risk behaviors and factors that make them more vulnerable. This present study was planned to assess the health risk behaviors of adolescents in Rajasthan. Strategies for Health promoting activities were framed and a community based model is being developed to sensitize adolescents towards health. Specific objectives of the study were “to develop an integrated community based model for strengthening the adolescent sensitivity to health”.

Study Methodology: Different schools from Rajasthan were considered and self administered questionnaire adapted from GSHS questionnaire of WHO were used to assess the risk behaviors. Age group considered was 15-18 and sample size was 1600 students. Informed consent was taken. Results Mean age of students was 16. PERSONAL HYGEINE:100% reported to brush regularly; 96% reported they take bath regularly; 65% reported washing hand regularly. But only 58% washed hands with soap or any solution. MENSTRUAL HYGEINE Mean age of menarche is 13; 89% had regular menstrual periods; 90% reported using sanitary napkins of which, only 57% reported changes at least 2 napkins each day .10% of them reported using clothes out of which 53% reported changing fresh clothes everyday; remaining used waste clothes and wash it and reuse it. DIET PATTERN: 98.5% reported they prefer fruits of which 74.5% consume daily; 90.5% consume vegetables regularly Physical Activity: 32% perform intensive physical activity everyday ;20.5% reported for 5-7 days in a week;20% for 3-5 days;21% reported no intensive physical activity. SUBSTANCE ABUSE: 4% reported that they have tried at least once ; 1% reported that they consume regularly; 0.5% reported use of tobacco forms on school campus; 7% reported consumption of alcohol regularly. SEXUAL BEHAVIOR: Only one girl (0.05%) has reported stated that sexual relationship below 18 years is acceptable, Immersion scores (18 items, alphas >.89) were highly correlated (r=.72, p<.001) across games. Black (M=40.50) and Hispanic (M=40.74) participants had higher immersion levels than white participants (M=34.70) (ps<.01) as both games featured main characters with black/Hispanic resemblance. Immersion correlated positively with increases in preference for fruit/juice/regular vegetables, physical activity self efficacy, and motivation to consume water between baseline and follow-up (rs >.29, p<.01).

Conclusions: Immersion appears to be a stable personal trait which may be enhanced when ethnic/racial backgrounds of characters are similar to that of the players. Immersion may be a mediating mechanism for relationships between narrative health video games and their intervention effects. More studies should explore immersion in maximizing intervention outcomes.

Funding Source: National Institute of Diabetes and Digestive and Kidney Diseases

Poster Sessions

“I’m the momma”: Using PhotoVoice to understand matrilineal influence on family food choice

Authors:

Cassandra Johnson, Joseph Sharkey, Alex McIntosh, Wesley Dean

Background: Many complex and subtle aspects relating to mothers and food choice are not well understood. Mothers play a primary role in their children’s food choices, but research has not specifically examined how matrilineal family members, such as a mother’s mother, aunt, or grandmother, influence the current family’s food choices.

Methods: Seven participants were recruited from the Household Food Inventory Study in the Bryan, Texas. All participants completed two sequential interviews and a photovoice activity. Interview transcripts were analyzed, and “Mom” or the matrilineal influence was salient within and across participants’ transcripts from both interviews.

Results: Participants discussed the following themes relating to the matrilineal influence on their families’ food choices: Mother’s Relationship with Mom, Their Mothers’ Daughters, Kinda like Mom, Not like Mom, Support vs. Sabotage, and The Connection. Overall, participants used the pictures to elaborate on how they were similar or different to their mothers, as well as how their mothers either support their food-related decisions or undermine their control over their children’s food choices. The “Mom effect” or matrilineal influence of mothers, aunts, and grandmothers on a mother’s food choices was omnipresent, even though the mothers, aunts, and grandmothers were no longer living with the participants.

Conclusions: We found the “Mom effect” to have a residual and persistent influence on a family’s food choices. This finding may be helpful for understanding the contextual elements of food choice and explaining why it is sometimes difficult to change mothers’ food habits.

Funding Source: The data collection, analysis and drafting of the manuscript was supported by National Center on Minority Health and Health Disparities grant #5P20MD002295; and Centers for Disease Control and Prevention, Prevention Research Centers Program, through the Center for Community Health Development cooperative agreement #5U48DP000045.

Application of environmental feedback in an Internet-delivered computer-tailored nutrition education intervention for adults in the Netherlands

Authors:

Linda Springvloet, Anke Oenema, Lilian Lechner

Purpose: Most computer-tailored nutrition education interventions have tried to motivate individuals to change behavior by focusing predominantly on individual-level determinants. The effect sizes of these interventions are mostly small. The efficacy of such interventions can potentially be improved by using environmental-level factors as tailoring variables, since environmental factors are thought to be among

Poster Sessions

the important determinants of dietary behavior. This presentation is aimed to outline the rationale and possibilities of providing environmental feedback in a computer-tailored nutrition intervention aimed at adults from higher and lower socio-economic groups.

Rationale: Regarding dietary intake, perceived availability of healthy food options has found to be associated with dietary intake. Making individuals more aware of the availability and accessibility of healthy food options may, therefore, contribute to dietary change. Increased awareness of availability may, for example help in improving self-efficacy, or may help in guiding formation of implementation intentions.

Possibilities: Awareness of healthy food options can be improved by providing feedback on the availability and accessibility of healthy foods in supermarkets an individual usually visits. This feedback can be provided by linking databases with information on availability and location of food products in supermarkets, to the tailoring databases.

Discussion: The efficacy of existing computer-tailored nutrition interventions shows the need for improvement, for example by using more and more powerful behavior change strategies, or by tailoring the information on novel determinants. Perceived availability of healthy food options in the environment may be an important determinant of nutrition behavior and can be addressed in computer-tailored interventions.

Funding Source: ZonMw, the Netherlands organisation for health research and development

Creative design and implementation of an exercise DVD for the overweight/obese pediatric population

Authors:

Mcneill Vicki, Karen Young, Razzaq Samiya, Ramsey Teresa, Kellam Valerie, Gross Glenn, Danils Kerri, Wendy Ward-Begnoche

Purpose: A major challenge for the clinicians working with obese youth is the lack of availability of appropriate, fun exercise options. Here we describe the creative design and implementation of an exercise DVD specifically for overweight/obese youth. While an exercise DVD is only one form of exercise that can be recommended to patients, a structured indoor option is often advantageous (due to neighborhood safety, daylight hours, weather, social discomfort, etc.).

Background: We completed a systematic review of commonly available workout DVDs for youth (n = 19) assessing the following dimensions: racial diversity, size diversity, duration of exercise, difficulty level, modifications due to physical fitness level, etc (Ward-Begnoche, et al., under review). None were sufficiently appropriate for obese youth.

Methods/Key Points: The team met to: 1) design the exercise curriculum, 2) discuss financial support options, 3) identify volunteers and obtain informed consent, 4) identify setting/date for videotaping, 5) identify educational information for inclusion, 6) obtain bids, and 7) preview/edit the DVD. Financial coverage was available via a grant from the State Attorney General’s office, which required inclusion of

Poster Sessions

nutrition information. Challenges that arose were 1) financial (cost of DVDs), 2) technical (limits of DVD media), and 3) recruitment of volunteers (time obligation required and poor body image/social anxiety). A formal evaluation is under way in a multidisciplinary obesity clinic.

Conclusions: The exercise DVD created provides an option for obese youth, to include with other physical activity options.

A pilot study to determine the effectiveness of delivering a behavioral weight loss program via a human-supported web-based program

Authors:

Kelly Webber, Karen Bryla-McNees, Helen Moseley, Kimberly Ensslin

Purpose: To compare the effectiveness of a face-to-face (F2F) behavioral weight loss program to a human-supported web-based (HSWB) program.

Methods: Twenty-nine males and females at a large university (X (SD) age 49.3 (12.1) years; BMI 33.5 (7.0) kg/m2; 89.7% Caucasian) self-selected to be part of one of the two intervention groups. Both groups received a 10-week behavioral weight loss program. The F2F group (N=16) met weekly in a group setting on campus. The HSWB group (N=13) met weekly in an online group format. Weight was measured at baseline and ten weeks in the F2F program and self-reported in the HSWB group. Group attendance was taken and self-monitoring diaries were collected at each session. Motivation, self-efficacy, and social support were also measured at baseline and 10 weeks.

Results: Both groups lost a significant amount of weight over the 10 weeks, an average of 2.1 (1.6) kg, p<0.001. The difference in weight loss between the two groups was not significant, p=0.74. There was no difference between the groups in number of self-monitoring diaries completed, p=0.46, average number completed = 4.9. Participants in the F2F group attended more sessions than the participants in the HSWB group, 8.9 vs. 5.7, p<0.001.

Conclusions: Both the F2F and HSWB programs were effective in producing significant short-term weight loss. The HSWB program may be a viable option for providing behavioral weight loss programs to audiences at a great distance from academic and clinic settings. Further research is needed to determine the long-term efficacy of the HSWB program.

Poster Sessions

Poster session 3: Environmental correlates

Poster session 3: Environmental correlates P134

The link between workplace environment and energy balance-related behaviors of workers: A review and multilevel framework for future research

Authors:

Phatcharin Charoenbut

Purpose: The aim of this paper is to review and present a model of workplace influences and the energy balanced-related behaviors (EBRBs) of workers.

Background: Obesity is a major public health problem in many countries. Numerous studies show that poor EBRBs or the combination of unhealthy dietary behaviors and low levels of physical activity often leads to obesity. In the workplace, more equipment operations increased workers engage in sedentary behaviors. Workers mayalso access to energy-dense food in and around their workplaces. To date, it is lack of the conceptual model considering multilevel of influences and EBRBs for addressing obesity in workplace.

Methods/Key Points: A review literature was conducted. Relevant studies and reviews published that explored the association between workplace factors, and worker EBRBs and weight status variables were included. Most of worksite studies applied the social-ecological models addressed potential environmental factors on EBRBs and obesity. However, the link of environment to behaviors and weight outcome were not clear. Among the social-ecologics model found in peer-review studies, the recent framework so-called Environmental Research framework for weight Gain prevention (EnRG) found its usefulness to apply to worksite obesity prevention. A multilevel model of this paper developed from relevant factors in available studies and the application of EnRG framework. A model links casual relationships of workplace environmental factors (physical, political, economic, and sociocultural) with EBRBs and body weight.

Conclusion: Application of the proposed model may guide the policy maker and public health researchers for designing effective obesity prevention programs in occupational settings.

Factors predicting eating lunch at school among high school students

Authors:

Dominique Beaulieu, Gaston Godin

Purpose: Easy access to fast-food restaurants in the immediate environment of a high school is such that a high proportion of students do not remain in school for lunch. Hence, the probability that they will eat a healthy meal is reduced. The aim of this study was to identify the behavioral determinants of “staying in school to eat lunch” among high school students.

Poster Sessions

Methods: At baseline, 153 randomly-selected high school students completed the study questionnaire based on an extended version of the Theory of Planned Behavior. Behavior was self-reported two weeks later. Logistic regression analyses were performed.

Results: Overall, 52.3% of students remained to eat at school every day during the follow-up period of two weeks. Regression analyses showed that intention (OR: 16.22; 95% CI7.08-37.21) was the sole predictor of behavior. In turn, intention was determined by descriptive norm (OR: 12.67; 95% CI3.39-47.27), perceived behavioral control (OR: 11.46; 95% CI 4.53-29.04) and attitude (OR: 2.70; 95% CI1.06-6.85).

Conclusions: The results suggest that a combination of interventions targeting both various individual determinants and environmental factors would increase the likelihood that youngsters remain at school to eat their lunch. This information should be useful to those interested in developing interventions to promote that students stay at school to eat their lunch instead of going out at fast food restaurants in the near-by environment.

Funding Source: Centre de recherche en prévention de l’obésité (CRPO), Heart and Stroke Foundation of Canada, Canadian Institutes of Health Research.

Hot chips and fizzy drinks: Findings from a food audit at a large community event in western Australia

Authors:

Renee Ferguson, Christina Mills, Michael Rosenberg, Lisa Wood, Jo Clarkson, Lindsay Lovering, Sarah Kepert

Purpose: With rising rates of overweight/obesity there is growing interest in the role of food and drink consumed outside of the home environment. The availability of healthy food and drink options at community events is one factor that may influence consumption behaviour. As a major sponsor of the Perth Royal Show, the Western Australian Health Promotion Foundation aims to increase the availability of healthy choices. The purpose of this study was to collect baseline data of the food and drinks purchased by patrons.

Methods: A 68 item food/drink audit tool classified products as ‘red’ (not recommended), ‘amber’ (eat in moderation) or ‘green’ (should eat everyday). This food classification system is based on dietary guidelines and is increasingly used in West Australian school canteens. Auditors used the tool to observe and record items as they were purchased by patrons from a sample of food vendors.

Results: A total of 350 patrons were observed. Of those who purchased food (n=313), 12% purchased at least one ‘green’ food product, 32% purchased at least one ‘amber’ food product and 75% purchased at least one ‘red’ food product. Of those patrons who purchased both food and drinks (n=120), 8% purchased ‘green’ food and drink options, with one half (50%) purchasing ‘red’ food and drink products.

Conclusions: Patrons predominately purchased unhealthy products from vendors. The availability of food/drink options at the Perth Royal Show will be explored further in relation to patron perceptions, norms and the desirability of healthy choices.

Poster Sessions

Influence of environmental factors on the level of physical activity of preschoolers attending daycare

Author:

Camille Gagne

Purpose: Based on Cohen’s theoretical framework, the aim of this study is to verify whether environmental factors such as availability of material, space layout and having the opportunity to play outside influence the physical activity of preschoolers attending daycare. To the best of our knowledge, this is the first time that the impact of environmental factors on the physical activity of preschoolers is verified in Quebec, Canada.

Method: Daycare centres in Québec City were chosen randomly. Daycare workers and parents were invited to participate. A correlational design was used. Variables related to the environment of the daycare were measured by direct observation with a validated tool. The physical activity of preschoolers was measured with an Accelerometer Actigraph GT1M worn for four days while children were at daycare. Mean of movement captured every 15 seconds between 9h00 and 15h30 for the days that the children were at the daycare was computed. A multilevel analysis was used to analyze data.

Results: Preliminary findings obtained among 10 daycare centres and 115 preschoolers indicated that the model was statistically significant F(3,6)=5.43, p=.04. Among the variables studied, only playing outside had a predictive power (p=.03) (availability of material, p=.87; space layout, p=.10). Playing outside explained 19% of the variance of the physical activity of preschoolers.

Conclusion: The data collected in Québec City are similar to data obtained in other areas and suggest that children who are given the opportunity to play outdoors at daycare centres are more active.

Funding Source: Social Sciences and Humanities Research Council of Canada and Sport Canada

Correlates and feasibility of incidental physical activity within desk-based worksettings

Authors:

Jason Bennie, David Dunstan, Anna Timperio, David Crawford, Jo Salmon

Purpose: Physical inactivity in the workplace is a major contributor to low levels of daily energy expenditure; a known risk factor associated with several chronic diseases. Engaging in non-structured incidental physical activity is one potential strategy to increase daily energy expenditure within workplace settings. Incidental activity may include activities such as interrupting sitting time by standing up and walking at low speeds. Currently, the key influences on incidental activity in the workplace are not well understood. The purpose of this study was to describe correlates of incidental activity among those in desk-based occupations.

Poster Sessions

Methods: A random sample of 801 adults (274 men, 527 women) employed in desk-based occupations located in metropolitan Melbourne, Australia completed a survey examining the barriers and feasibility of incidental activity. A sub-sample of 143 adults (53 men, 90 women) wore accelerometers to obtain objective measures of physical activity during working hours.

Results: Accelerometry data suggested 75% of work time was spent sedentary (<100 counts per minute [CPM]) and 22% was spent in light-intensity activity (101-1951 CPM). Most disagreed that high work demands, stress, and lack of time were barriers to incidental physical activity during work hours. Approximately 90% perceived it feasible to regularly get up from a seated position and move around their workplace.

Conclusion: This study is among the first to examine incidental physical activity within the context of desk-based occupations. These results may used to form workplace interventions that adopt the novel approach of promoting incidental physical activity during work hours.

Commute times, food retail gaps, and weight status in rural and urban North Carolina counties

Authors:

Stephanie Jilcott, Haiyong Liu, Justin Moore, Jeffrey Bethel, Jim Wilson, Alice Ammerman

Introduction: In the U.S., there is greater obesity prevalence in rural compared to urban and suburban areas, yet mechanisms related to obesity in rural areas are not well understood. Thus, we examined associations between rural versus urban residential location, commute times, food retail gap per capita, and body mass index (BMI) among residents of North Carolina counties.

Methods: Urban versus rural residential status was determined using Census 2000 criteria. Census data were used to obtain mean commute times in 1990 and 2000 for each county. We calculated county-level food retail gap per capita using economic data from the North Carolina Department of Commerce (2008) and the Office of Management and Budget population estimates (2007). Height and weight were obtained from the North Carolina Behavioral Risk Factor Surveillance System. Pearson’s correlation coefficients were used to examine county-level associations among percent rural residents, commute times, food retail gap per capita, and county-level mean BMI. We used multi-level regression models to examine cross-sectional associations between individual-level BMI (n = 9375) and county-level commute times and retail gap per capita.

Results: Counties with a greater percentage of rural-dwelling residents had longer commute times and greater food retail gaps. Longer commute times and greater retail gaps were positively associated with county-level and individual-level BMI.

Conclusions: Longer commute times and greater retail gaps may be associated with the rural obesity disparity. Future research should examine these relationships longitudinally, as well as test potential effective community-level obesity prevention strategies especially in rural areas.

Poster Sessions

Association between natural amenities and Body Mass Index in rural and urban North Carolina counties

Authors:

Stephanie Jilcott, Justin Moore, Kindal Shores, Satomi Imai, David McGranahan

Introduction: In the U.S., rural areas have greater obesity prevalence than do urban /suburban areas. This disparity may be due in part, to inequities in the physical activity (PA) environments. However, rural areas do have natural amenities, emphasis of which may be one way to increase PA. The purpose of this research was to examine the association between county-level natural amenities scores (NAS) and body mass index (BMI), among 100 North Carolina Counties.

Methods: The U.S. Department of Agriculture’s NAS is a composite of the following area characteristics: (1) Warm winter; (2) Winter sun; (3) Temperate summer; (4) Low summer humidity; (5) Topographical variation; and (6) Water area. The NAS is not the product of the development of obesity. We examined the following covariates: %rural, % below poverty, and diversity index. BMI was calculated from self-reported height and weight. Linear regression analyses were conducted to examine the relationship between NAS (independent variable) and BMI (dependent variable).

Results: The following bivariate associations were all statistically significant: The correlation between percent rural and NAS (r = 0.19, p = 0.05); Percent below poverty and NAS (r = -0.19, p = 0.05); Diversity index and NAS (r = -0.52, p < 0.0001); BMI and NAS (r = -0.48, p < 0.0001). Unadjusted and adjusted multivariate linear regression models showed that BMI and NAS were negatively associated (parameter estimate = -44.43 (11.58), p = 0.0002).

Discussion: Future work should examine these relationships at the individual-level to examine the influence of NAS on PA.

Does the availability of supermarket and fast-food outlet differ by neighborhood socioeconomic status and race composition?

Authors:

Archana Lamichhane, Angela Liese, Robin Puett, Dwayne Porter

Purpose: We aimed to explore the availability of supermarkets (SUP) and fast-food (FF) outlets in relation to neighborhood characteristics in a largely rural state with a high proportion of minority residents.

Methods: Using geocoded food outlet data from InfoUSA, we characterized 867 South Carolina tracts for presence of SUP and FF outlets. Data on median household income and race composition of tracts from the U.S. Census were used to compare tracts with and without a given type of outlet in descriptive and logistic regression.

Results/Findings: The tracts with SUP had a significantly higher income ($38,121) and lower minority population(34%) compared to those without SUP ($35,508;39%). Surprisingly, the same relationship

Poster Sessions

was found for tracts with FF ($37,816;34%) vs. without FF ($34,898;40%). SUP availability odds were significantly lower for low vs. high (OR=0.5;95%CI:0.4-0.8) and medium vs. high (OR=0.6;95%CI:0.4-0.8) income tracts, and for predominantly black vs. white tracts (OR=0.3;95%CI:0.1-0.6) adjusting for rurality. Similar associations were observed for FF availability odds by income (low vs. high: OR=0.5,95%CI:0.4-0.8 and medium vs. high: OR=0.5,95%CI:0.4-0.8), and race composition (predominantly black vs. white: OR=0.3,95%CI:0.2-0.5) of tracts. Further evaluation of spatial distribution of SUP and FF outlets showed a substantial clustering, with 41.4% of tracts having both SUP and FF,31.8% having neither, 5.4% having only SUP and 21.4% having only FF.

Conclusions: Similar associations of supermarket and fast-food availability with neighborhood characteristics and clustering of these outlets suggest that joint explorations of food environment are important in any future studies exploring the impact of food environment on diet and health.

Association of built food environment with BMI and waist circumference among youth with diabetes

Authors:

Archana Lamichhane, Dwayne Porter, Matteo Bottai, Elizabeth Mayer-Davis, Robin Puett, Angela Liese

Purpose: The food environment has been increasingly thought to influence the risk of obesity. We examined the separate and joint associations of supermarkets (SUP) and fast-food (FF) outlets availability with body mass index z-score (BMI z-score) and waist circumference (WC).

Methods: Information on residential location, BMI z-score and WC for 845 youth with diabetes residing in South Carolina was obtained from the SEARCH for Diabetes in Youth study. Using geocoded SUP and FF outlets data from InfoUSA, we constructed SUP and FF availability measures around the participant’s residence and examined their associations with BMI z-score and WC.

Results/Findings: Increased availability of SUP was significantly associated with lower BMI z-score adjusting for individual demographic and socio-economic characteristics, and population density. Each additional SUP and SUP/sq. mile was associated with -0.05(95%CI=-0.10,-0.01) and -0.23(95%CI=-0.39,-0.06) lower BMI z-score, respectively. The associations of SUP availability and WC were in similar direction as BMI z-score, however did not reach the statistical significance (count:estimate=-0.21,95%CI=-0.71,0.28;density:estimate=-1.05,95%CI=-2.63,0.54). FF availability was not associated with either BMI z-score or WC. Further adjustment for FF availability in the SUP model did not attenuate the association between SUP availability and BMI z-score.

Conclusions: The built food environment supporting healthy diet such as SUP may significantly influence BMI and WC in youth population. However the influence of FF, commonly considered as a source of energy-dense unhealthy food, on BMI and WC remains inconclusive. Future studies should explore both home and school FF environment that can equally influence the eating behavior and hence the health outcome.

Poster Sessions

Situational characteristics of young adult eating occasions

Authors:

Melissa Nelson Laska, Dan Graham, Stacey Moe, Leslie Lytle, Jayne Fulkerson

Purpose: To examine (a) situational characteristics of young adult eating occasions (EO) including social influences, multitasking, and away-from-home eating, and (b) how these situational characteristics are associated with specific types of foods/beverages consumed at meals and snacks.

Methods: Forty-eight participants (18-23 years, n=27 females) used pre-programmed handheld devices to log various characteristics of all EO in real-time during a 7-day period (n=1237).

Results/Findings: Overall, 54% of EO occurred with others, and 46% did not involve multitasking (e.g., watching television, using a computer). EO occurring alone included more snack foods, like cookies/baked goods; EO with others included more fruits/vegetables and entrée items, as well as sweetened beverages (p<0.05). Compared to eating while watching television, EO in the absence of other activities included more water, fruits/vegetables and entrées, and fewer sweetened beverages. Among 36 participants not living in college dormitories, EO at home (59% of EO) included more cookies/baked goods, frozen dessert items, and cereals/grains, and away-from-home EO included more entrée items, fried side sides and candy. EO among dormitory-residing participants (n=12) yielded less consistent on-campus (versus off-campus) patterns.

Conclusions: Among these young adults, eating at home appeared to be associated with higher intakes of snack foods and fewer traditional meal items (i.e., entrees). More traditional meal settings (i.e., eating with others in the absence of multitasking) may result in healthier dietary patterns, including more fruits/vegetables. Additional research is needed to understand young adult mealtimes. Effective strategies to promote healthy eating patterns, including home meal preparation, among young adults are urgently needed.

Funding Source: Funding for this study was provided by the National Cancer Institute (NCI), Transdisciplinary Research in Energetics & Cancer Initiative (NCI Grant 1 U54 CA116849-01, PI: Robert Jeffery). Additional support was provided by Award Number K07CA126837 from NCI (PI: Melissa Nelson Laska).

Food environment in childcare centers: Opportunities for nutrition education

Authors:

Pascale Morin, Marie-Andrée Roy, Christine Giguere, Karine Demers, Lyne Mongeau

Purpose: To describe the food environment in childcare centers.

Methods: This cross-sectional study took place in 33 childcare centers in the Sherbrooke area (Québec). Thirty-three center managers completed a face-to-face semi-structured interview and 33 caregivers (one

Poster Sessions

in each center) completed a self-administered questionnaire. The interview with the managers included questions about food policy, menu planning and composition, food preparation and food service staff training. The questionnaire for caregivers included questions about feeding practices at mealtime.

Results: More than 82 % of centers did not have a food policy but offered meals complying with the Canadian Food Guide including at least one serving of vegetables and a glass of milk on a regular basis. A third of the centers used vegetable oil shortening in food preparation and occasionally offered fried frozen entrées. Fifty-one percent of centers required food service staff to have a diploma in professional cooking. No centers had provided nutrition training to foodservice staff. Most caregivers promoted healthy eating to children at mealtimes. However, they occasionally used practices such as pressuring (63 %) and promising rewards (93 %) to get children to eat or showing disapproval of children for not eating their meal (72 %).

Conclusions: Some aspects of the food environment in childcare centers must be improved. Appropriate training in meal planning and food preparation to food service staff must be provided. Caregivers must receive training about appropriate feeding practices at mealtime with children.

Funding Source: Centre de recherche en prévention de l’obésité (CRPO).

Availability of grocery stores is associated with increased overweight and obesity among rural women

Authors:

Christine Olson, Leigh Gantner, Meredith Graham, Nancy Wells

Purpose: To determine the relationship between the retail food store environment and women’s risk of overweight and obesity in a 19 county, rural area of NY State.

Methods: This is an observational study that integrates data from several sources. The residential addresses of 555 women entering prenatal care in a rural health system were mapped using ArcGIS. 870 retail food stores within a 20 mile radius of each woman’s residence were observed and addresses mapped. Early pregnancy weight, height, age, parity, income and home address were collected from the women’s medical records. Area level socio-economic (SES) data were compiled from the 2000 US Census. Logistic regression analysis, controlling for women’s age, parity and income were conducted to examine the relationship between the number and type of stores within a 5 mile radius of women’s homes and risk of obesity and overweight. Census tract level SES measures were then added to models.

Results: The most consistent and interesting findings were between the number of grocery stores within 5 miles of women’s homes and the outcomes. Women with a higher number of grocery stores were more likely to be overweight compared to normal weight (OR=1.47; 95% CI 1.32, 1.90) and overweight and obese compared to normal weight (OR=1.33, 95%CI 1.08, 1.64). Adding 5 different census tract SES variables did not change the risk of overweight and obesity (OR=1.38, 95% CI 1.11, 1.72).

Poster Sessions

Conclusions: Results from this rural area are opposite of those from similar studies conducted in urban areas of the US.

Funding Source: National Research Initiative of the USDA Cooperative State Research, Education and Extension Service, grant number 2005-35215-15427 and NIH Training Grant 5T32 DK-007158 32.

Rural urban differences in weight, body image and physical activity among Malaysian school girls

Author:

Roxana Omar Dev

Background: Body image plays an important role in managing one’s body weight especially in female adolescent.

Purpose: The purpose of this study is to compare the relationship between body weight, physical activity and body image in a convenience sample of rural and urban girls in Malaysia.

Methods: This representative study sample consisted of 200 female school girls in secondary schools (aged13-14 years old) who reside in Gombak, Malaysia. The girls were from four public schools in urban and rural area of Gombak. Weight, height, waist and hip circumferences were measured. Body image was determined by asking participants to indicate which five silhouettes of a female body most closely resembled her own current body size. We also asked them to select the silhouette that closely resembled their mother’s current body size. Physical activity was conducted by using the Physical Activity Questionnaire for Older Children (PAQ-C).

Results: Using the Centers for Disease Control and Prevention reference standards, 30% of the girls were overweight (>85th percentile) and 3% were > 95th percentile. Overweight was more prevalent in urban than rural girls. About two thirds (65.3%) of the girls were in low physical activity level category, 32.3% in the moderate physical activity level and only 2.4% of the girls were in the high physical activity level category. The associations between physical activity with rural –urban status and body mass index were not significant. But there was a significant difference between urban and rural respondents in the body image perception and the desired body image [t(198)=4.57, p<0.05). Furthermore, girls’ perception of how their mothers viewed their bodies differed from how the girls viewed their own bodies.

Conclusions: The result of this research shows that there is a need to consider not only the health risks associated with overweight and its distribution on the body, but also the weight and body image in the design of public health intervention programs especially among female adolescents.

Poster Sessions

Rural urban differences in body image perception, body mass index and dieting behaviour among Malay adolescent Malaysian schoolgirls

Author:

Roxana Omar Dev

Body image plays an important role in managing one’s body weight especially in female youth. This research identifies the different body image perception, body mass index (BMI) and dieting behavior among female secondary school students in urban and rural area of Gombak district, Malaysia. Body mass index (BMI) was carried out on 200 Malay students at four secondary schools around Gombak. It was found that there is no significant difference in BMI of female students in the urban secondary schools (19.27 ± 3.83kg/m˛) and rural secondary schools (18.65 ± 3.60kg/m˛). Respondents answered questions regarding demography and body silhouette chart. Average age of respondents in urban area is 14.53 ± 0.520 years with a family income of RM4570 ± 1890 and the rural area is 14.56 ± 0.47 years with a family income of RM1690 ± 580 (p=0.002, p<0.05). Body image perception was done by asking the respondents to identify own body image through five picture diagrams provided (Body Silhouette Chart). Although more of urban respondents giving inaccurate perception compared to rural respondents, however there is no significant difference in body image perception as compared to body mass index among urban and rural respondents [t(198)=1.18, p=0.23, p>0.05]. But there is significant difference between urban and rural respondents in the body image perception and the desired body image [t(198)=4.57, p<0.05]. Overweight was found to occur among urban female as compared to rural female adolescents because of the economic status of the urban adolescents being higher than their rural counterparts. Furthermore, body image perception among urban and rural adolescents differ from their mother’s perception. Meanwhile, Index of Mild Dieting showed high and moderate mean scores while Index of Extreme Dieting Behaviour showed moderate and low mean scores, indicating that the respondents generally were some what taking actions to control their dietary intake. Urban adolescents seemed to score more on the Index of Mild Dieting and Index of Extreme Dieting Behaviour, significant differences were seen with their rural counterparts (t=3.2, p=0.02; p<0.05) and (t=2.45, p=0.03; p<0.5) respectively. The result of this research shows that body image and dieting behavior should also be given more attention in promoting healthy living style especially among female adolescents.

The role of sports facilities location in adolescents physical activity levels and participation in formal sports

Authors:

MM Pereira, AN Pizarro, J Mota, MP Santos

Purpose: This study purpose was to verify if there is any relation or association between the location of sports facilities and adolescents Physical Activity Levels (PAL) and participation in Formal Sports (FS).

Methods: 104 Adolescents (56 boys and 48 girls) from four parishes of Vila Nova de Gaia (Portuguese municipality) with a mean age of 16,85±2,49 answered a questionnaire regarding their home address, PAL

Poster Sessions

and participation in FS. To assess PAL a group of five questions was used on the frequency of sport-time outside school, participation levels in physical activity in leisure-time and the time dedicated to physical and sporting activities and competitive sports (FS). Each question has 4 or 5 answer options (Likert scale) which were then added to calculate PAL. Adolescents’ homes were geocoded using Google Earth and all public sports facilities from the study site were geocoded using a portable GPS. The distance between each adolescent home and the nearest sports facility was calculated using ArcMap 9.3. This information was then gathered in a single dataset. Pearson Correlation was performed on PAL and distances and Spearman Correlation was used to assess the relation between participation in FS and distances.

Results: Although there is no statistic significance, both PAL and distances (r=-0,113/r=-0,123/r=-0,237) and FS and distances (ρ=-0,204/ρ=-0,380/ρ=-0,124) are negatively associated in three of the four parishes.

Conclusion: The results suggest that adolescents nearer sports facilities have higher PAL and tend to practice FS. This study was supported by grant: FCT/PTCD/DES/099018/2008

Funding Source: FCT/PTCD/DES/099018/2008

Support for low-fat food choices at eating establishments on a large college campus

Authors:

Melissa Reznar, Wen Guo, Kristin Long, Kathryn Lawson, Megumi Murashima, Tanya Horacek, Sharon Hoerr

Purpose: Assess how well eating establishments at a large college campus support low-fat food choices.

Methods: The Nutrition Environment Measures Survey for restaurants (NEMS-R) was adapted and used to evaluate 20% of off- and on-campus restaurants. Thirty restaurants were evaluated, 20 off-campus (2 bar/pub, 5 fast casual, 5 fast food, and 8 sit-down) and 10 on-campus (4 dining halls, 4 student union restaurants, and 2 snack bars/cafes). Scores were calculated by weighting the importance and presence of the following: availability of nutrient information, physical restaurant environment, low-fat menu items, facilitators and barriers of healthy menu options, and pricing. Entrees and salads ≤800 kcal (≤3349 kJ), ≤30% energy fat, and ≤10% energy saturated fat were characterized as low-fat (Saelens B et al., 2007).

Results/Findings: The median score for off-campus restaurants was 12.5 (range 3 - 32) out of a maximum 66, and the median score for on-campus restaurants was 29.0 (range 6 - 39) out of a maximum 100. Sit-down restaurants scored higher (median 16.0) than other types of off-campus restaurants (median 12.0). Dining halls scored higher (median 33.5) than other on-campus establishments (median 22.0). Restaurants that scored highly had nutrient information available and several low-fat entrees. On-campus scores benefited from presence of salad bars; vegetarian options; milk alternatives; and low-sugar, high-fiber cereals.

Conclusions: On-campus establishments scored well with the presence of salad bars and low-sugar/high-fiber cereals. Off-campus restaurants could improve their scores by providing nutrient information and offering additional low-fat entrees and salads.

Funding Source: This project was supported by National Research Initiative Grant 2009-55215-05460 from the USDA National Institute for Food and Agriculture.

Poster Sessions

Are meteorological factors related to objectively measured physical activity in children and adolescents? The European Youth Heart Study

Authors:

Nico Rizzo, Maria Hagströmer, Michael Sjostrom

Purpose: Few studies have measured the relationship between meteorological factors and objectively measured physical activity (PA) in children and adolescents. The present study can add new insights in PA behaviors of younger population groups in relationship with weather patterns.

Methods: Mixed linear model analysis of 429 Swedish children (232 girls, 197 boys), mean age 9.6±0.4 years and 354 adolescents(198 girls, 156 boys),mean age 15.6±0.4 years. Total PA and time spent at various intensity levels were measured by accelerometry. Meteorological data included day length, temperature, wind gust and precipitation. Measurements were controlled for BMI and socioeconomic status and differentiated by school days and weekends.

Results: Day length was positively associated with total PA and moderate-vigorous PA both in children and adolescents (p<0.02). Wind gust was negatively associated with total and moderate-vigorous PA in 9 year old boys (p<0.001). In adolescent boys wind gust was negatively associated with total PA on weekends (p<0.05) but not on school days. Precipitation was negatively associated with moderate-vigorous PA in 9 year old girls (p<0.05) and 15 year old boys (p<0.05) on weekends.

Conclusion: PA is associated with meteorological factors in children and adolescents. Associations may be differentiated by sex and age group and between school days and weekends. Day length may be of special interest to populations living in areas of higher latitude.

Funding Source: Stockholm Council

Psychosocial and demographic correlates of objectively measured physical activity in structured and unstructured after-school recreation sessions

Authors:

Richard Rosenkranz, Gregory Welk, Tanis Hastmann, David Dzewaltowski

Purpose: Few studies have assessed psychosocial and demographic correlates of physical activity (PA) within identical social and physical environments. This study’s purpose was to investigate the psychosocial and demographic correlates of PA in free-play and structured after-school recreation sessions.

Methods: School records, questionnaires, and anthropometry were used to obtain demographic and psychosocial variables. Third and fourth-grade children (n = 230) from seven schools wore Actigraph GT1M accelerometers up to six times per year during after-school programming. Accelerometer data were processed to determine the percentage of time spent in moderate-to-vigorous PA (T scores were computed for each session and averaged across sessions). Pearson correlations and hierarchical linear regressions were used to determine significant associations with PA for both structured and unstructured periods.

Poster Sessions

Results/Findings: For structured sessions, a model containing gender (beta = .21, p = .006) and PA enjoyment (beta = .16, p = .032) explained 9% of the variance in structured session PA (p = .001). For free-play sessions, a model containing gender (beta = .25, p = .001), body mass index z-score (beta = .20, p = .006) PA task self efficacy (beta = .25, p = .036) explained 12% of the variance in free-play session PA (p = .001).

Conclusions: Despite equal opportunities to participate in active recreation, boys were more active than girls, and children varied in PA level partly due to psychosocial factors. Our results showed that self efficacy explained variability in PA levels during free play sessions, while enjoyment explained variability in structured PA sessions.

Funding Source: National Research Initiative Grant (no. 2005-35215-15418) from the United States Department of Agriculture Cooperative State Research, Education, and Extension Service Human Nutrition and Obesity Program

Dog ownership and family physical activity and weight status

Authors:

John Sirard, Mary Hearst, Carrie Heitzler, Melissa Nelson

Purpose: Positive associations between dog ownership and health outcomes in adults have been observed but research involving youth is lacking. The purpose of this paper was to determine the relationship between family dog ownership and adolescent and parent physical activity (PA) and weight status.

Methods: Participants were 689 adolescent/parent pairs. Number of dogs owned was self-reported by parents and recoded to Yes/No. The ActiGraph accelerometer, model 7164 (Pensacola, FL) was used to collect adolescent PA data. Parent PA data was collected using the IPAQ-Long Form. Adolescents self-reported age, gender, depressive symptoms, and pubertal status. Trained staff measured adolescent and parent BMI and % body fat was calculated by impedance. All protocols and materials were approved by the University of Minnesota Institutional Review Board.

Results: Adolescents were 49% male, and 15+1.8 years old. White and higher SES adolescents were more likely to own at least one dog. Adolescents with dogs attained 49+28.1 minutes of moderate-to-vigorous physical activity/day versus 40+22.9 for those without dogs (p<0.001). Adolescents with a dog had slightly lower % body fat compared to those without a dog (20.8+10.6 vs. 22.1+10.4, respectively, p= 0.04). In adjusted models, adolescent physical activity remained significantly associated with dog ownership (p<0.001). No significant results were observed for any other adolescent or parent variables.

Conclusions: Dog ownership was associated with more physical activity in these adolescents although the same was not true for the parents. Further research using longitudinal data will help clarify the role dogs may have in adolescent physical activity.

Funding Source: NCI’s Transdisciplinary Research in Energetics & Cancer Initiative (NCI Grant 1 U54 CA116849-01), Examining the Obesity Epidemic Through Youth, Family & Young Adults, PI: Robert Jeffery, PhD). Also supported by grant number R01HL085978 from the National Heart, Lung, and Blood Institute.

Poster Sessions

Supermarket and fast food accessibility in Copenhagen: Associations with socioeconomic and demographic characteristics

Authors:

Chalida Svastisalee, Helene Nordahl Jensen, Charlotte Glümer, Bjoern E. Holstein, Lisa Powell, Pernille Due

Purpose: To investigate whether fast food outlets and supermarkets are socially patterned in the city of Copenhagen.

Methods: The study was based on a cross-sectional multivariate approach to examine the association between the number of fast food outlets, supermarkets, and neighborhood level socio-economic indicators in 2006. Food business addresses were obtained from commercial and public business locators for all neighborhoods in the city of Copenhagen (n = 400). We applied area-level socio-economic and demographic information from Statistics Denmark. Counts of fast food outlets and supermarkets were regressed on SES indicators (ethnic minorities, low education, unemployment, home rental, female-headed households, average income, and cars/person) using negative binomial analysis.

Findings: Univariate results indicate that moderately low-income neighborhoods were exposed to approximately half as many supermarkets and fast food outlets as higher income ones (p = 0.0355 and 0.0228, respectively). Low education was associated with less exposure to supermarkets (p = 0.0424). Neighborhoods with higher proportions of home renters had 56% higher fast food outlet exposure (p = 0.0094), and areas of low car ownership had 28% greater exposure (p = 0.048). There was no association between access to fast food or supermarkets and proportions of immigrants, unemployed or female-headed households.

Conclusions: We detected a socio-economic gradient in the patterning of supermarkets and fast food outlets, such that low-income areas had less exposure to food outlets than higher income ones. Neighborhoods with higher proportions of home renters or car ownership had higher exposure to fast food outlets, which may affect healthy eating behavior.

Funding Source: The Danish Health Foundation, The Danish Heart Foundation, The Nordea Foundation

Physical activity and the built environment among 11-15 yr-olds living in Denmark: Cross-sectional study

Authors:

Chalida Svastisalee, Jasper Schipperijn, Bjoern Holstein, Lisa Powell, Pernille Due

Purpose: To investigate the association between risk of not meeting recommended levels of physical activity and the number of recreation facilities.

Methods: Using information from the Health Behavior in School-Aged Children 2006 survey, we measured self-reported physical activity in boys and girls (n = 6177). We conducted multi-level logistic analyses to examine the relationship between the risk of not meeting physical activity recommendations

Poster Sessions

and the number of recreation facilities surrounding each school (n = 80). We controlled for confounding variables at the individual level (family social class, perceived neighborhood wealth, and neighborhood deprivation) and the neighborhood level (average household income).

Findings: Preliminary analyses show a social gradient in levels of physical activity in boys. Boys in social class VII were 2.34 times less likely to meet physical activity recommendations than those in social class I. Boys from poor areas were 1.55 times less likely to meet recommendations compared to those from well-off neighborhoods. Family social class was not a significant predictor for levels of physical activity in girls, but those living in very poor areas were 2.89 times less likely to achieve physical activity recommendations than those from well-off neighborhoods.

Conclusions: We were unable to detect an association between levels of physical activity and the number of exercise facilities in each school neighborhood. However, levels of physical activity were significantly associated with family social class and perceived neighborhood wealth, indicating that social class continues to be a strong predictor of physical activity.

Funding Source: The Danish Heart Foundation

Exploring the environmental determinants of diet: A mediating role for culture?

Authors:

Claire Thompson, Steve Cummins, Rosemary Kyle, Tim Brown

Purpose: The aim of this poster is to critically incorporate research on socio-cultural food practices within existing work on the environmental determinants of diet, with a focus on ‘culture’ as a mediating variable between individuals and their food environments.

Background: Research on neighbourhood food environments has focused on physical risks, such as access to fast-food outlets. This assumes that variations in opportunities to purchase and consume food are uniformly translated into differences in diet. However, convincing causal evidence for the effect of food environments on diet has yet to be generated. This may stem from the use of relatively unsophisticated conceptual models. These models have been criticised for failing to address the symbolic processes and relationships that exist between people and their environment.

Methods/Key Points: This poster is based upon a review of recent research on diet and obesity. Investigations of the cultural environment as a mediating factor may be as important as explorations of physical environmental risk factors in helping to elucidate how causal pathways may operate. This criticism is important as ‘non-physical’ cultural factors may obscure significant associations between environmental exposures and health outcomes and act as barriers to the uptake of environmental interventions to improve diet.

Conclusions: Diet-related ‘obesogenic’ behaviours can be regarded as culturally constructed and transmitted. In order to examine the interrelationship between socio-cultural food practices and physical environmental risk factors future research must explore qualitatively how individuals interact with their food environments.

Poster Sessions

Poster session 3: Individual behavioral and psychological correlates

Capturing physical activity, the food environment, and obesity in 443 adults with intellectual disability

Authors:

Timothy L Barnes, Rebecca A Meriwether, Suzanne McDermott, Joshua R Mann, Haikun Bao

Purpose: Adults with intellectual disabilities (ID) have similar rates of obesity as the general population. However, few studies have objectively measured physical activity (PA) and nutrition in this population. We sought to examine the relationship between body mass index (BMI), PA, and the home food environment (HFE) in adults with ID living in different residential settings.

Methods: PA was objectively measured over seven days using Actigraph accelerometers. Using direct observation, the availability of fruits, vegetables, grains, high and low fat foods, sweetened beverages and snacks in the home was recorded to capture the HFE. Direct body measurements were used to calculate BMI. We used descriptive and categorical analytic methods to describe the study population.

Results/Findings: Of 443 participants 50.3% (n=183) resided in a group home and 58.2% (n=258) resided in either a family home or an apartment. The mean BMI for the group home and non-group home residents was not significantly different and was approximately 32-33 kg/m2. The moderate and vigorous physical activity (MVPA) of group home participants was lower (98.0 minutes/week) compared to the non-group home participants (119.2 minutes/week). Additionally, we found that only 24.6% of participants met national recommendations for 150 minutes/week of MVPA. As for the HFE, we discovered for all food groups there was higher availability in the group homes. No differences were found for the availability of food by BMI category.

Conclusions: This study, as in the general population, demonstrates that obesity is a multi-dimensional problem requiring creative strategies to address PA and nutrition.

Funding Source: Primary Author supported in part by NIH research training grant T32-GM08174

Theoretical correlates and key beliefs for targeted interventions to increase physical activity in children

Authors:

Ariane Bélanger-Gravel, Gaston Godin

The aim of this study was to investigate the theoretical correlates of physical activity behaviour among children and the related theoretical key beliefs to better inform interventions. A total of 321 fifth graders completed a computer-based questionnaire to evaluate the Theory of Planned Behaviour (TPB) constructs and physical activity behaviour. Additional information was obtained from parents by means

Poster Sessions

of a self-administered questionnaire. Correlates of children’s physical activity were intention (β = 0.25, p < 0.001) and self-identity (β = 0.19, p < 0.01), explaining 14% of the variance of this behaviour. Determinants of intention among boys were self-efficacy, self-identity and attitude, explaining 55% of the variance. These three latter variables were also significant determinants of girls’ intention, with the addition of practicing sedentary activities as a negative determinant of intention (β = -0.13, p < 0.05) for girls (R2 = 0.38). Parental variables (e.g., level of physical activity, involvement in sport organisation, transportation, etc.) were mediated through cognitions, supporting the TPB framework. Key beliefs of boys and girls were related to time management and difficulty associated with physical activity. For girls, social identification as an active girl was another important belief related to positive intention. The results suggest that emphasis should be in the development of self-identity regarding physical activity and the development of children’s motivation by focussing on the management of specific barriers to physical activity such as time management of conflicting activities and perceived difficulty of physical activities.

Funding Source: Canadian Institutes of Health Research

Health care providers’ perceived role in changing environments to promote healthy eating and physical activity: Findings from healthcare providers participating in the Healthy Eating, Active Communities program

Authors:

Maria Boyle, Sarah Samuels, Liz Schwarte, Sally Bullock, William McCarthy

Purpose: To describe how healthcare providers address obesity prevention in their clinical practice and to assess health care providers’ role in advocacy for various policies designed to prevent childhood obesity through improving community food and physical activity environments.

Methods: At baseline and endpoint, a survey was administered to healthcare providers practicing in The California Endowment’s Healthy Eating Active Communities grantee sites (n=248 at baseline, n=173 at endpoint).The survey consisted of an 18-item questionnaire and was self-administered, either at provider trainings or meetings or electronically via e-mail. Survey questions focused on: BMI measurement and tracking, counseling with basic prevention messages, referrals to community programs, engagement in community advocacy efforts to change food and physical activity environments, tools and resources needed to engage in advocacy work

Results/Findings: Respondents were nearly unanimous (95%) about the importance of healthcare providers being engaged in prevention and early detection of childhood obesity. Almost all report having engaged in at least one advocacy activity and over 40% report having engaged in three or more, which was a large increase from baseline. At baseline, 43% of respondents reported taking BMI measurements “usually” or “always” whereas the corresponding percentage on the follow-up survey was 68 percent.

Conclusions: For most healthcare providers, the idea of focusing on changing the environment to prevent obesity is still new. Healthcare providers need time, training, resources and institutional support to improve their ability to communicate obesity prevention messages in both clinical practice and as community policy.

Poster Sessions

Perceptions of food: Relations between perceived health value and type, quantity and diversification of food

Author:

Rachel Burns

Purpose: The decision-making literature indicates that, as predicted by prospect theory (Kahneman & Tversky, 1979), the benefits associated with accumulating gains and the costs associated with accumulating losses grow in asymptotic functions. The aim of the current study is to explore the health-related value people associate with various types and quantities of food. It is predicted that the perceived health benefits associated with eating an additional piece of fruit will diminish, as will the perceived health costs associated with eating additional sweets.

Methods: Fifty-five undergraduate participants used a 13-point scale to rate the health value of the foods listed in 100 questionnaire items. Questionnaire items were designed such that three dimensions—type (prototypically healthy or unhealthy), quantity (1 to 5 pieces of food) and diversification (same food, variety of foods)—could be examined. Within-subject ANOVA was used to analyze data.

Results: A significant 3-way interaction (type x quantity x diversification) was found (p<.001). For healthy foods, eating the same fruit produced a decrease in the perceived health value as quantity increased, whereas the perceived value of eating a variety of fruits remained stable. For unhealthy foods, the perceived health value linearly decreased with quantity, regardless of the sweets being the same or varied.

Conclusions: Individuals do not view the perceived health value of foods in a pattern suggested by prospect theory. Importantly, individuals see little, if any, value in eating more than one piece of fruit. This could explain the low levels of fruit consumption in the United States.

Physical activity in retirement: Differences between bridge-employed and retired adults

Authors:

Jennifer Copeland, Jon Doan, Lesley Brown

Purpose: The context of retirement is changing and “bridge-employment” -defined as temporary or part-time employment taken up after retirement- is becoming increasingly common. This trend may have implications to the health and lifestyle behaviours of older adults. The purpose of this study was to compare physical activity levels between bridge-employed and retired individuals.

Methods: A comprehensive questionnaire package examining physical activity, current work status, and work history was delivered to 1000 adults aged 55 and older who were participating in a provincial event that included athletic competitions and social activities. Current leisure-time and work-related activity was assessed using the Physical Activity Scale for the Elderly (PASE) and a work activity questionnaire (WAQ). PASE scores were compared between groups using ANOVA with age as a covariate.

Poster Sessions

Results: 196 participants returned complete questionnaire packages. 112 respondents between the ages of 58 and 75 were either completely retired (N=71, age = 68.1±4.2 yrs) or bridge-employed (N=41, age = 66.8±4.5 yrs). Bridge-employed respondents reported working an average of 12.6±10.4 hours in the previous 7 days and rated their average daily exertion from work activities as 11.2±2.4 (“fairly light”) on the perceived exertion scale of the WAQ. PASE scores were significantly higher in bridge-employed compared to retired respondents (p<0.01).

Conclusion: These results demonstrate that among a unique sample of active and engaged older adults, individuals who have permanently withdrawn from the workforce have lower self-reported levels of physical activity than those who continue to work in some capacity.

Funding Source: University of Lethbridge Research Fund

Associations between major patterns of dietary intake in adolescents and weight status: Findings from Project EAT

Authors:

Gretchen Cutler, Andrew Flood, Peter Hannan, Dianne Neumark-Sztainer

Purpose: Examine the association between dietary patterns and weight status in the Project EAT (Eating Among Teens) cohort.

Methods: EAT-I collected data on 4746 middle (younger cohort) and high school (older cohort) students in 1998-1999. EAT-II resurveyed 2516 of the original cohort in 2003-2004. Dietary intake was assessed using the Youth/Adolescent Food Frequency Questionnaire. Analyses were run separately by age cohort and gender. Factor analysis identified 4 dietary patterns at EAT-I (vegetable, fruit, starchy food, snack food). We examined the relationships between dietary patterns identified at EAT-I and weight status at EAT-I and EAT-II using logistic regression. All analyses were adjusted for socioeconomic status, race/ethnicity and activity level (longitudinal analyses also adjusted for EAT-I weight status). Results: A ‘vegetable’ pattern was associated with lower odds of being overweight/obese in older girls (EAT-I: OR=0.90 95% CI: 0.81-0.99, EAT-II: OR=0.84, 95% Confidence Interval: 0.71-1.00). A ‘fruit’ pattern was associated with increased odds of being overweight/obese in younger boys (EAT-I: OR=1.22, 95% CI: 1.05-1.42, EAT-II: OR=1.37, 95% CI: 1.00-1.87). A ‘snack food’ pattern was associated with lower odds of being overweight/obese in all boys at EAT-I only (OR=0.87, 95% CI: 0.79-0.95 (older); OR=0.76, 95% CI: 0.65-0.88 (younger)). Conclusions: Dietary pattern analysis has rarely been used in adolescents. We did not find consistent or intuitive associations between dietary patterns and weight status. Identified patterns may not capture the elements of diet that are truly important in determining adolescent weight, or diet may not be the primary driver in determining weight status at this age.

Funding Source: This study was supported by Grant R40 MC 00319 (PI: Neumark-Sztainer) from the Maternal and Child Health Bureau (Title V Social Security Act), Health Resources and Service Administration, Department of Health and Human Services. The first author was supported in part by the Adolescent Health Protection Program (School of Nursing, University of Minnesota) grant number T01-DP000112 (PI: Bearinger) from the Centers for Disease Control and Prevention (CDC). The contents of this paper are solely the responsibility of the authors and do not necessarily represent the official views of the CDC.

Poster Sessions

Which preschoolers participate in organized sports? Differences by immigrant background

Authors:

Freia De Bock, Simone Becker, Joachim Fischer

Purpose: The promotion of physical activity (PA) and organized sports are promising methods in preventing childhood obesity. Yet, in young children and particularly those from immigrant backgrounds, different strategies or approaches to foster participation may be needed. In this study, we investigate factors associated with sports club participation (SCP) in preschool children with and without an immigrant background.

Methods: We evaluated cross-sectional survey data collected from the parents of 789 children in 52 preschools in south Germany between 2008-2009 using bivariate and multivariate regression analyses. SCP was defined as at least once weekly PA as part of a sports club, team or other organization. Independent variables were socio-demographic and lifestyle characteristics as well as other factors relevant to child health.

Results/Findings: Significantly more children without an immigrant background participated in organized sports (75% versus 51%). With increasing parental education and child age, children in both groups were more likely to participate in organized sports. In children without an immigrant background, moderate parental PA was positively and parental tobacco use was negatively associated with SCP. Among children with an immigrant background, only television time was a significant negative predictor. Our models explained a greater proportion of SCP variance in children with an immigrant background compared to children without (R2 =0.2517 vs. R2= 0.1353).

Conclusions: Our results suggest that different factors and approaches need to be considered when promoting sports club participation, particularly in children with an immigrant background.

Gender differences in the factors associated with objectively measured physical activity in preschoolers

Authors:

Freia De Bock, Simone Becker, Joachim Fischer

Purpose: To investigate factors associated with objectively measured physical activity (PA) in German preschool children.

Method: Cross-sectional data was collected from 678 children aged three to six years old (51% boys) in 52 preschools from three regions in south Germany between autumn and spring 2008/09. Factors influencing children’s PA, objectively measured by accelerometry over 5.5 days, were tested in bivariate and multivariate logistic regression models. Using a median split, children were classified as above and

Poster Sessions

below average active. Covariates included in the regression analysis were age, sex, parental education, child BMI, internal drive to be active, participation in organized sports and TV time.

Results/Findings: The adjusted odds of being active above the median were significantly higher in boys who participated regularly in organized sports (OR=1.86, p≤0.05). In girls, the adjusted odds of being active were significantly higher if their parents were highly active (OR=1.75, p≤0.10), but did not increase significantly with regular sports club participation. There were no significant associations with socioeconomic and immigration status nor parent or child BMI.

Conclusion: We found gender differences in factors associated with objectively measured PA in preschoolers, which suggests that gender-specific intervention approaches might be needed. However, many factors related to overweight in preschoolers are not associated with objectively measured PA, which may also have ramifications for interventions.

Perceived facilitators and barriers of heart healthy behaviors among African-Americans in Arizona

Authors:

Cheryl Der Ananian, Donna Winham, Sharon Thompson

In Arizona, African-Americans (AAs) comprise less than 4% of the population yet they have the highest mortality rates from coronary heart disease (CHD). Understanding AAs’ perceptions regarding behaviors that contribute to CHD is necessary for creating culturally relevant interventions.

Purpose: To examine perceived facilitators and barriers of heart healthy behaviors including physical activity (PA) and nutrition among AAs in Arizona.

Methods: Fifteen focus groups (FGs) and two interviews were conducted. FGs were stratified by gender and age (25-39 and 40-65 years). Trained moderators led the FGs using a standard guide. All FGs were audio-taped and transcribed verbatim. N-Vivo text analysis software was used to aid theme classification.

Results: Perceived facilitators of healthy eating that emerged from FGs were: education (n=8), availability and/or accessibility (n=7), and affordability (n=5). Other enablers mentioned were having the motivation to change, planning meals, cultural acceptability and being a role model. Perceived barriers to eating healthy included cost (n=12), time or convenience (n=7), cultural acceptability (n=12), accessibility and/or availability (n=7), and knowledge or skills (n=7). Few consistent themes emerged regarding perceived facilitators of PA. Facilitators mentioned included: being physically active as a child, having role models and making exercise part of one’s routine. Common barriers to PA that emerged included: a lack of motivation (n=10), a lack of time (n=8), cost or affordability (n=7), and safety concerns (n=5).

Conclusion: Participants identified several potentially modifiable targets for intervention efforts designed to improve eating and PA habits that could improve cardiovascular disease outcomes.

Funding Source: Arizona Department of Health Services

Poster Sessions

Evaluation of food consumption among Jordanian pregnant women during first, second and third trimester Author:

Jafar El-Qudah

Introduction: Pregnant women need more food than normal person for the proper nourishment of the growing fetus. Although many health improvements have been achieved in Jordan, women during pregnancy still face many nutritional problems.

Objective: The aim of this study was to evaluate the food and nutrient intake of the respondents in each trimester of pregnancy and compare the intake with the recommended dietary allowances (RDA).

Methods: A cross-sectional survey of pregnant women was conducted in Jordan. A sample of 103 pregnant women (18 to 40 years old) was randomly selected from Al-Balqa district . A questionnaire, including a Food Frequency Questionnaire and 24 hour recall method of diet survey were applied for the collection of dietary information at each trimester.

Results: Mean total weight gain was 8.1±1.2 kg. More than 50% of the sample reported that they did not eat breakfast, due to lack of appetite as a main cause. Even though, caloric intake was below recommendation, significant increases were observed between first and second trimester for energy, carbohydrates, zinc, fat, proteins, calcium and iron (p < 0.05). From second to third trimester, differences (p < 0.05) were significant only for vitamin A, folic acid, magnesium and zinc. A high proportion of pregnant did not reach recommendations for energy, folate, calcium and zinc. Food intake pattern did not change significantly among trimesters.

Conclusions: Special educational programs are strongly recommended for pregnant women and integrated strategies should be considered to promote increased intakes to meet nutrient recommendations.

Assessment of lifestyle status in obese children

Authors:

Fatemeh Esfarjani, Asieh Mansour, Marjan Khalafi, Neda Ghasemnejad, Roshanak Roustaee, Monerah Dadkhah, Homa Haidari, Telma Zoghi

Background: Obesity is a multifactorial consequence that in addition to genetic and metabolic effects, changes in lifestyle habits such as inappropriate diet and reduced physical activity and sedentary are the main causes of obesity, so this study was conducted to identify lifestyle status in elementary school children of Tehran in 2010.

Materials and Methods: This was a descriptive, cross-sectional study, where samples (all 7 year-old obese pupils, BMI≥95th percentile, n=156) were selected from 3 area health clinics in Tehran (2010). weight, height, body mass index, waist and hip circumference were measured. For each subject a questionnaire

Poster Sessions

Poster Session 3: Individual Behavioral and Psychological Correlates

on demographic characteristics and physical activity were completed by interviewing their mothers. Data were analyzed using SPSS.

Results: Mean age, birth weight and height of children, were respectively 80±3.8 (month), 3.3± 0.6 (Kg) and 50.14± 3.1 (Cm). Evaluating anthropometric indices, showed that the mean weight, height, waist and hip circumference, and BMI in children were 37.3± 6.2(Kg), 1.3± 4.8(Cm), 78.8± 5.6(Cm) and 73.9± 6.1(Cm) and 23.0±2.8(Kg/ m2) respectively. 85% family size, belonging to 4≥ households. The highest level of education was academic, 55% and 50% in fathers and mothers respectively. 72% of mothers were housewives. 81% of them, had a behavior of sedentary and only 38% of them had special physical activity weekly. 67% of them use to eat while watching TV and playing computer game. Only 15% of them had gone to school by walking.

Conclusion: Considering the increasing of obesity and non-communicable diseases are the threat for the health of next generations, not only affect the current situation of children, but also in the future the development of community will be challenged. Therefore, implementing appropriate intervention programs with emphasis to reduce sedentary, is highly recommended.

Surveying the efficacy of education on nutritional and dental caries knowledge of obese children’s parents

Authors:

Fatemeh Esfarjani, Ghasem Ansari, Arghavan Etebarian, Marjan Khalafi, Neda Ghasemnejad

Background: Obesity, dental caries and periodontal diseases are among major public health concerns and common chronic disease in relation to sugary items. The aim of this study was to determine nutritional and dental caries knowledge of obese children’s parents.

Materials and Methods: This semi-experimental study was conducted to investigate the impact of nutritional and dental caries educational program (32 hours) on knowledge of 75 parents was randomly selected from Health clinic in Tehran (2010). A questionnaire was filled for each subject, based on their demographic data, nutritional and dental caries knowledge, that considered into three categories namely: good, moderate and weak. Data were analyzed using SPSS.

Results: 52% of obese children was girl. 85% family size, belonging to 4≥ households. The highest level of education was academic, 55% and 50% in fathers and mothers respectively.39% of Fathers were individual employee. 72% of mothers (mean age 35.62 ±6 ), were housewives. Scores of nutritional and dental caries knowledge in three categories (good, moderate, weak) were: (3.6%, 50.9%, 45.5% ) before, and (58.2%, 61.8%,0% ) after education, respectively (p≤ 0.000)

Conclusion: Considering to the results, education on nutritional and dental caries knowledge is an effective approach to promote knowledge by using attractive modern technology is highly recommended.

Poster Sessions

National prevalence of objectively measured physical activity and sedentary behaviors among pregnant women: NHANES 2003-2006

Authors:

Kelly Evenson, Fang Wen

Purpose: Physical activity is recommended for pregnant women, provided that there are no medical or obstetric complications. To date, surveillance indicators of this behavior rely on self-reported physical activity. The aim of this study was to describe the prevalence of objectively measured physical activity and sedentary behavior among a national sample of pregnant women.

Methods: Using data collected from the 2003-2006 National Health and Nutrition Examination Survey (NHANES), 536 pregnant women >=16 years wore an ActiGraph accelerometer for one week. Step counts were collected and reported for 2005-06 only (n=314).Estimates were weighted to reflect the United States population.

Results: Participants were diverse: 56.4% Non-Hispanic White, 21.4% Hispanic, 16.6% Nonhispanic Black, and 5.6% Other. Each trimester of pregnancy was represented in the sample (27.4% first, 36.1% second, 36.5% third trimester). Using the NHANES cutpoints, women participated in a mean of 8.2 minutes/day (standard error (SE) 0.63) of moderate activity and 0.3 minutes/day (SE 0.07) of vigorous activity. Mean moderate-to-vigorous physical activity varied by trimester: 8.4 minutes/day first trimester, 10.4 minutes/day second trimester, and 5.3 minutes/day third trimester. Participants spent on average 61.5% of their monitored time or 5.2 hours/day in sedentary behaviors. On average, women accumulated 6368 steps/day; when censoring out steps taken at <500 counts/minute, the average dropped to 3615 steps/day.

Conclusion: Pregnant women spend most of their day in sedentary pursuits. If accelerometer collection continues, these data could be used to monitor trends in physical activity and sedentary behavior among pregnant women over time.

Funding Source: American Heart Association

Predicting exercise behavior in college students: Utility of an integrated model of health behavior based on the Transtheoretical Model and Self-Determination Theory

Authors:

Rabiollah Farmanbar, Shamsaddin Niknami, Alireza Hidarnia, David Revalds Lubans

Purpose: The purpose of this study was to evaluate a theoretical model explaining the exercise behavior of Iranian college students based on constructs from the Transtheoretical Model (TTM) and Self-determination Theory (SDT).

Method: Participants were 418 first year students of Guilan University of Medical Sciences completed translated versions of the God in and Shephard’s Leisure Time Exercise Questionnaire (LTEQ) and another

Poster Sessions

questionnaire which included constructs from the TTM and SDT. Data were analyzed using SPSS 16 and LISREL 8.80 using bivariate correlation and structural equation modeling.

Results: The relationship between exercise behavior andall of the constructs from the TTM and SDT (except external regulation) was statistically significant. Relative autonomy index accounted for 48% of the variance in current exercise behavior. The model accounted for 82% of the variance in current exercise behavior.

Conclusions: Study findings support the application of an integrated model of health behavior combining constructs from the TTM and SDT to explain the exercise behavior of Iranian college students.

Is nutritional status related with physical activity in Italian adolescents?

Authors:

Giacomo Lazzeri, Stefania Rossi, Valentina Pilato, Andrea Pammolli, Rita Simi, Mariano Giacchi

Purpose: This study examined the relationship of age and gender with physical activity (PA) and how meeting of PA guidelines (PAGL) is related to nutritional status.

Methods: Data were collected from 11, 13, and 15 years old students participating in the Italian HBSC survey 2005/2006. A self-completed questionnaire assessed weekly moderate-to-vigorous PA (MVPA) for a week. The total number of valid questionnaire for this analysis is 3.872 (1232 of 11ys, 1319 of 13ys. and 1321 of 15ys).

Results/Findings: On the whole only 589 out of 3872 (15.2%) met the PAGL. None of the three age groups of adolescents averaged enough MVPA to meet PAGL. Even the pattern of MVPA across age and gender was consistent among all the adolescents. The older children were significantly less active when compared with the youngest children (P<0.001); girls were significantly less active than boys (P<0.001). Nutritional status was not significantly associated with the amount of reported MVPA and PAGL. Only 539 out of 589 reported complete data to calculate the nutritional status. Out of 539 adolescents, that reported at least one hour of PA every day a week, the obese group showed the higher prevalence (18.1%).

Conclusions: In our sample levels of MVPA during adolescence showed consistent patterns in relation to age and gender. Nutritional status, age and gender did not influence meeting of PAGL in Italian adolescents. Some studies, demonstrating low effect of age on PA in countries with low influence of social class, suggested a possible buffering effect of on text in the habits acquisition during childhood.

Funding Source: DGR/RT n. 4580/24/08/2005

Poster Sessions

The effects of acute and chronic exercise on gut peptides, appetite and eating behaviour: A systematic research review

Authors:

Catherine Gibbons, Phillipa Caudwell, Graham Finlayson, Mark Hopkins, Neil King, John Blundell

Purpose: The purpose of this research was to assess the impact of acute and chronic exercise on gut peptides, appetite and eating behaviour.

Background: Acute exercise is unlikely to have lasting effects on appetite, however chronic exercise interventions produce minimal weight loss suggesting compensatory mechanisms may operate over longer periods of regular exercise.

Methods: A systematic review of research yielded twenty nine scientific studies that assessed the effect of exercise on gut peptides. Relevant research was identified using 5 electronic databases (Medline, Embase, Sports Discus, PsycLIT, Cochrane Library), bibliographic searches and hand searches of recent relevant journals. Studies were included if: (1) the study population consisted of healthy adults; and (2) the intervention consisted of aerobic exercise. Exercise protocols were categorised according to acute (1 bout), short-term (>1 consecutive bouts) and chronic (>6 weeks regular bouts).

Conclusions: Study results demonstrated large variations in exercise protocols, study design and sample populations. Acute exercise results in temporary suppression of acylated ghrelin and a more enduring effect on GLP-1, accompanied by lower relative energy intake. Evidence indicates that weight loss is a driver of increased total ghrelin and deacylated ghrelin, whilst acylated ghrelin remains unchanged. These findings suggest that exercise training has a role in normalising ghrelin levels without amplifying the orexigenic component of the hormone. It is important to analyse postprandial peptide profiles before and after chronic exercise to establish the response to actual food intake and to compare people susceptible and resistant to weight loss.

Funding Source: Biotechnology and Biological Sciences Research Council Grant Number BB/G530141/1

Associations between restrained eating and intuitive eating among normal-weight and overweight/obese women

Authors:

Karine Gravel, Sonia Pomerleau, Anne-Sophie Bourlaud, Véronique Provencher

Purpose: To investigate the associations between restrained eating and intuitive eating among normal-weight and overweight/obese women.

Methods: During an experimental session, women filled out the Intuitive Eating Scale assessing three key behavioral aspects of eating: 1) unconditional permission to eat (eating when hungry and allow to eat what food is desired); 2) eating for physical rather than emotional reasons; and 3) reliance on internal hunger and satiety cues to determine when and how much to eat (21 items).The Restraint Scale was used

Poster Sessions

to assess concerns about dieting and weight control (10 items), and women were then categorized as restrained eaters (scores≥ 15) or unrestrained eaters (scores< 15). Weight and height were also measured in all participants, and body mass index (BMI; kg/m2) was then calculated.

Results: Preliminary data of 78 women were available. When compared to unrestrained women (n=46), restrained women (n=32) had a higher BMI (27.3 kg/m2 vs. 24.2 kg/m2; p<0.02). They were also less likely to give themselves unconditional permission to eat (p<0.005), to eat for physical rather than emotional reasons (p<0.0004), and to rely on internal hunger and satiety cues (p<0.006). All associations observed between restrained eating and intuitive eating remained significant after controlling for BMI.

Conclusions: Restrained eating is negatively associated with all key aspect of intuitive eating, independently of BMI status. Interventions focusing on lowering restrained eating and eating more intuitively could be promising for women, as these attitudinal and behavioral aspects of eating have been related to positive indexes of well-being.

Funding Source: CIHR, FRSQ and Danone Institute

Identifying physical activity gender differences among youth

Authors:

Ivan Guillory, Deborah Thompson

Purpose: Physical activity (PA) is an important part of a healthy lifestyle and reduces risk of certain chronic diseases. Many youth do not currently meet PA guidelines; evidence suggests that girls are less active than boys at all ages. PA differences need to be understood so that gender-specific interventions can be developed. Therefore a literature review was conducted to explore this issue.

Background: Relevant studies were located by searching Medline, Science Citation Index, Social Science Citation Index, CINHAHLARC Service, and Psychinfo; a manual review of reference lists of identified articles was also conducted. Search terms included combinations of: PA, children, gender, psychosocial, family, peers. Full text articles were reviewed.

Methods/Key Points: Inclusionary criteria were studies that focused on healthy children in grades K-8, published in English, used self-report or objective PA measures, and appeared in peer-reviewed journals from 1989 to 2009. Exclusionary criteria were studies that involved children with health or medical conditions that limited PA or did not meet inclusionary criteria. One hundred thirty-seven articles were identified and screened; of these 68 were excluded, while 69 met the criteria and will be examined for gender differences related to frequency, duration, intensity, psychosocial factors, and preferences.

Conclusions: Understanding gender differences in PA will provide a foundation for development of interventions specifically tailored to the needs and interests of boys and girls.

Poster Sessions

Changes in 10-12 year olds’ fruit and vegetable intake in Norway from 2001 to 2008 in relation to gender and socio economic status

Authors:

Marit Hilsen, Knut-Inge Klepp, Elling Bere

Purpose: To compare the fruit and vegetable (FV) intake among Norwegian 6th and 7th graders in 2001 and 2008 in relation to gender and socioeconomic status. Potential mediators (accessibility and preferences) were also assessed.

Methods: The baseline questionnaire survey for the FVMM cohort project was conducted in September 2001 at 38 randomly chosen schools in two Norwegian counties. A second survey was conducted at the same schools in September 2008. A total of 27 schools participated in both surveys (2001 n=1488, 2008 n=1339).FV intake was measured by four food frequency questions (times/week). Socioeconomic status was based on parents’ reports of their own educational level (dichotomised). Data were analysed with multilevel regression models (MIXED procedure in SPSS 14).

Results: A non-significant decrease in FV intake from 14.4 to 13.8 times/week among 6th and 7th graders at the 27 schools was observed from 2001 to 2008 (p=0.08). The year*parental educational level interaction was significant (p=0.01). The FV intake decreased among pupils of parents without higher education (13.9 vs. 12.6 times/week in 2001 and 2008, respectively), but increased among pupils of parents with higher education (14.8 vs. 15.0 times/week, respectively). When including preferences and/or accessibility in the model, the year*parental educational level interaction was no longer significant. The year*sex interaction was not significant (p=0.54).

Conclusion: This study shows an increase in SES disparities in 6th and 7th graders FV intake from 2001 to 2008, partly mediated by accessibility and preferences.

Physical activity, sedentary behaviour and dietary patterns of 6-8 year old children within North East England: The Gateshead Millennium Study

Authors:

Angela Jones, Laura Basterfield, Mark Pearce, John Reilly, Ashley Adamson

Purpose: The Gateshead Millennium Study (GMS) is a longitudinal study investigating growth and related characteristics from birth in a cohort of 1029 children born in 1999/2000. The purpose of this study was to examine the prevalence of overweight and obesity in the GMS children when they were aged 6-8 years and to describe their physical activity (PA), sedentary behaviour (SB) and dietary patterns.

Methods: PA and SB were measured objectively for 7 days using Actigraph GT1M accelerometers. Food intake was observed using a 4-day food diary and composite ‘unhealthy’ and ‘healthy’ dietary indicator scores were created. Fruit and vegetable intake was also examined. Height and weight were measured and BMI was calculated. Weight status was determined using IOTF criteria.

Poster Sessions

Results/Findings: Data from 425 children were included in analyses. 17.6% of children were overweight and 6.4% obese. PA levels were low with only 31 children achieving an average of at least 60 minutes of moderate to vigorous physical activity (MVPA) per day; 77.7% of time was spent sedentary. Children consumed a median of 5.3 and 5.0 ‘unhealthy’ and ‘healthy’ indicator foods respectively. Fruit and vegetable intake was low with a median of 1.7 portions consumed daily.

Conclusions: Our findings show that in this cohort of children where a concerning number were overweight or obese, standard guidelines for PA and nutrition were not being met. Given the global obesity epidemic, effective strategies are urgently required to improve health related behaviours in children to both prevent overweight and obesity and maintain good health.

Funding Source: The National Prevention Research Initiative (NPRI)

Exercise attitudes and behaviors: A comparison of obese and non-obese women

Authors:

Lucia Leone, Dianne Ward

Purpose: Exercise in older age improves quality of life and reduces disease burden in women, independent of weight status. Research exploring why obese women have low rates of exercise has been largely anecdotal. Our goal was to compare exercise attitudes and behaviors of older obese and non-obese women.

Methods: An online survey was completed by 109 obese and 98 non-obese women age≥ 50. Survey questions, developed with the help of pre-study focus groups with obese women, included measures of current exercise and related psychosocial constructs. Chi-square tests were used to compare responses between weight groups.

Results: Among women who reported they were actively trying to lose weight, obese women were less likely to report using exercise to do so (39.0% vs. 57.4%, p=0.03). Across groups, most women (>95%) agreed with exercise benefits however, only 56.9% of obese women reported enjoying exercise, compared with 73.5% of non-obese women (p=0.01). Obese women also reported greater agreement with every barrier, most notably: “my current weight makes it difficult for me to exercise.” Obese women were more than twice as likely as non-obese women to agree that they usually only exercise when trying to lose weight (p<0.0001). Results support focus group findings: obese women recognized the health benefits of exercise, but they felt it was more important for women who were overweight. Even so, most obese women did not believe that exercise could effectively help them lose weight.

Conclusion: Interventions which emphasize exercise’s benefits, independent of weight loss, may increase exercise among obese women.

Funding Source: Lineberger Comprehensive Cancer Center CCEP Fellowship

Poster Sessions

Dietary supplement usage among toddlers in Taipei, Taiwan

Authors:

Wei Lin, Chi-Ming Hang, Hsiao-Chi Yang

Purpose: The purpose of this study is to understand the dietary supplement intake among 2 years old toddlers in Taipei.

Methods: The data were collected by a questionnaire designed by researcher. A total of 494 toddlers’ parents completed the questionnaire. Logistic Regression was performed to analyze the predictors of vitamin/mineral (VM) and non- vitamin/mineral (non-VM) dietary supplements parent’s dietary attitude was the significant predictors for giving VM supplements but not for non-VM supplements.

Results: A total of 43% of toddlers received dietary supplement from their parents. Among those, nearly 40%toddlers received two or more types of supplements. About 27% received VM supplements and 24.1% received non-VM supplements (probiotics, herbal medicine, etc.). The mother was the key decision maker of giving toddlers supplements, and both VM and non-VM supplements were given mainly for health-related reasons (concerned about toddler’s insufficient dietary intake, used supplement as a way of prevention, etc.). Giving toddlers supplements due to health-related reasons was the significant predictor for both VM and non-VM supplements usage.

Conclusions: Parents providing dietary supplements to 2 years old toddlers is a common practice in Taipei. The main reason is probably that parents didn’t have confidence in feeding toddlers foods that have sufficient nutrients. Therefore it is very important to teach parents about the adequate diet of toddlers and function and side effect of supplements; also to advise them to consult with health professionals before giving toddlers supplements.

Funding Source: National Science Council, Taiwan

Breakfast skipping in japanese university students and their lyfestyle, dietary intake, dietary awareness and mental distress

Authors:

Makiko Nakade, Kanako Furuya, Junko Kawakami, Naomi Aiba

Purpose: To examine the factors related to breakfast skipping of university students in Japan.

Methods: Subjects were 234 female university students who answered a questionnaire about their lifestyle and diet in 2009. The students were classified into either breakfast eater (who eat breakfast 7 days per week) or breakfast skipper (who skip breakfast at least once a week) and compared their lifestyle, dietary intake, dietary awareness and mental distress.

Results: A total of 124 students (53%) were breakfast skippers. Eighteen percent of them started skipping breakfast when they were elementary school students, and among the students who have lived alone and skipped breakfast, 52% of the students started skipping breakfast after entering university. The main

Poster Sessions

reasons for skipping breakfast were ‘‘I would rather sleep than eat’’, ‘‘I do not have time to eat breakfast’’, ‘‘I have little appetite in the morning’’. Breakfast skippers went to bed later and felt sluggish more frequently than breakfast eaters. Breakfast skipping was significantly and negatively associated with intakes of energy, protein, carbohydrate, cereals, seaweed, beans, seafood and fruits, while positively with that of beverages. More students in breakfast eaters were looking forward to eat meals.

Conclusions: Our study revealed breakfast skipping was related to unhealthy lifestyle, less nutrient intake and indefinite complaint. To prevent breakfast skipping of university students, more studies are needed to examine the factors that influence students’ bedtime, pleasure of a meal and the triggers to start skipping breakfast in their childhood.

An epidemiological study to assess the physical activities amongst the people of Ahmedabad, India

Authors:

Himanshu Nayak, Sheetal Vyas, Alpesh Shah, Rachna Kapoor

Purpose: Physical activities (PA) and proper nutrition are the most important in preventing lifestyle related diseases. This study was performed to know the socio-demographic profile of study population, to know the pattern of physical activity and to know the association between PA & health problems.

Methods: Cross sectional community based study was carried out in all the six zones of Ahmedabad Municipal corporation areas. Stratification of Sample was carried out in one ward from each zone. Information was collected in standard predesigned and pretested proforma by house to house survey in selected areas.

Result: Total 904 subjects participated in the study. 741 (82%) people were not doing any type of physical activity while only 163 (18%) were doing it. 111(26%) male & 52 (10.9%) female were doing PA (P<0.0001). Mean age of persons doing and not doing PA was 47.1±15.6, 43.6±15.8 respectively (P<0.05). 154(19.3%) persons from sedentary and 9(8.5%) of moderate occupation were doing PA (P<0.001). Out of those doing PA, maximum 64 (39.3%) were educated up to college,128(78.5%) were married, 72 (44.2%) from socioeconomic class 1,52 (31.9%) were consumed 1600-1900kcal/day. Majority 141(86.5%) were doing PA daily, 138(84.6%) were doing once a day, 129(79.1%) had brisk walking and only 4 (2.5%) had Bicycling. Out of 163, 73 (44.8%) had BMI≥25 (P>0.05), 79 (48.5%) had weight of 61 75Kg.(P<0.0001),49(30.1%)had Hypertension(P>0.05)and 41(25.2%) had Diabetes(P<0.001).

Conclusion: Physical activity was less among study population (18%). PA was significantly higher among male, educated, sedentary occupation, Higher SES, calorie consumption and persons with diabetes.

Poster Sessions

Advancing the theory of planned behavior within dietary and physical activity domains among type 2 diabetics using mixed methods design

Authors:

David Omondi Okeyo, Mary Khakoni Walingo, Grace M. Mbagaya, Lucas O.A. Othuon

Background: Physical activity and dietary behaviours are key lifestyle related factors in the management of type 2 diabetes at primary level. Promoting the two factors may be best achieved through individual based theoretical models.

Purpose: Studies have focused on using the Theory of Planned Behaviour (TPB) in predicting health behaviours among unique populations. However, a new paradigm is emerging where focus is now directed to modification and expansion of the TPB model rather than utilization of the traditional theory. This review proposed new models modified from the Theory of Planned Behaviour and suggest an appropriate study design that can be used to test the models within physical activity and dietary practice domains among type 2 diabetics in Kenya.

Method: The review was conducted by means of literature search in the field of nutrition behaviour, health psychology and mixed methods design.

Results/Findings: The results identify pre-intention and post intention gaps within the TPB model that need to be filled. Additional psychosocial factors including knowledge, perceived susceptibility, benefit, severity and cues to action, action plan, action control and maintenance self efficacy are proposed to be included in the model.

Conclusions: The review suggested that new behaviour change models can be generated from the original TPB model and the efficacy of these models tested within the paradigms of mixed methods design. Improved versions of the Theory of Planned Behaviour can be used to promote healthy diet and physical activity among Type 2 diabetes patients in developing country and worldwide.

The role of physical activity in improving healthy lifestyle in children

Author:

Chinyere Okonkwoh

Purpose: Many children have unhealthy eating patterns with less exercise and this has a negative consequence for their health. The objective of this research is to discover ways to promote knowledge, and change behaviors among children and their parents on more exercise and healthier eating patterns and improve health, intellectual development, and overall quality of life.

Background: Poor diet and lack of physical activity causes obesity in children and this causes series of problems such as low self esteem, low self worth, diabetes, hypertension and heart related problems. To get children to exercise more there might have to be some cooperation between parents, children and

Poster Sessions

maybe even their schools. This is due to children not being able to take control over their lives themselves most of the time. They need their parents to drive them to physical activity.

Methods/Key Points: Literature review carried out revealed that health campaigns directed towards parents have had more success than health campaigns directed towards children. In addition, physical activity in children supervised by their parents have been proven to be successful.

Conclusions: To achieve this change, students, their parents and teachers, school officials, community and business leaders, and local, state, and federal program administrators must be actively involved in ensuring that healthy behaviour patterns is promoted among children.

Are adolescents’ perceptions of dietary practices associated with their dietary behaviors?

Authors:

Cayley Velazquez, Keryn Pasch, Nalini Ranjit, Gita Mirchandani, Deanna Hoelscher

Purpose: To explore the relationship between dietary behaviors and perception of dietary practices among eighth and eleventh grade students.

Methods: Participants included eighth and eleventh grade students (N=15,283) (m age=15, sd=1.6; 45.7% white/other, 42.9% Hispanic, 11.4% African-American; 50.3% economically disadvantaged) in Texas, USA. Students completed surveys that included validated questions regarding dietary behaviors and self-perception of dietary practices. Dietary behavior was measured by self-report of foods eaten the day before survey administration. Composite scores of unhealthy and healthy eating were also created. Perception of dietary practices included fat content of foods usually eaten and healthiness of usual eating habits. Regression analyses were used to examine whether perception of dietary practices was consistent with actual behavior. Models were adjusted for sex, grade, and race/ethnicity and accounted for complex sampling design.

Results: Higher perceived fat content of foods eaten was associated with increased consumption of unhealthy foods, meats, snack foods, and sugar-sweetened beverages (SSB) and decreased consumption of healthy foods overall, fruits, and vegetables (p for all trends <0.001). Higher scores on perceived healthiness of usual eating were associated with increased consumption of healthy foods, grains, fruits, and vegetables and decreased consumption of unhealthy foods, meats, snack foods, and SSB (p for all trends <0.01).

Conclusions: Adolescents’ perceptions of their dietary practices were significantly associated with their dietary behaviors, indicating that they know the relative nutrient content of foods they eat. Thus, interventions which move beyond dietary knowledge and create changes in the physical and social environment are needed.

Funding Source: Texas Department of State Health Services with funds from the Centers for Disease Control and Prevention Health and Human Services Block Grant, and the Michael & Susan Dell Foundation

Poster Sessions

Youth risk behaviors and body composition: Does risk in one area predict risk in the other?

Authors:

Keryn Pasch, Cayley Velazquez, Leslie Lytle, Melissa Laska, Stacey Moe

Purpose: To determine longitudinal associations between objective measures of body composition and youth risk behaviors.

Methods: Participants included 349 youth in the IDEA (Identifying Determinants of Eating and Activity) Study. Youth were mostly white (93.4%). Mean age was 15.4 years. Body composition (BC) was measured objectively and included body mass index percentile (BMIP) and percent body fat (PBF). Self-reported risk behaviors included alcohol use, drunkenness, cigarette smoking, marijuana use, and school truancy. Generalized estimating equation models, to account for clustering at the school level, were run to determine the association between body composition and risk behaviors adjusting for age, gender, socio-economic status, race, and baseline outcome levels.

Results: Baseline PBF significantly predicted higher current smoking (p=0.04) and past month marijuana use (p=0.004) three years later. PBF was not associated with alcohol use, drunkenness, or school truancy. BMIP did not significantly predict any risk behaviors. Baseline past month alcohol use and drunkenness significantly predicted increased BMIP three year later (p=0.02, p=0.009 respectively). Baseline current smoking and past month marijuana use approached significance (p=0.07, p=0.08 respectively). Baseline ever smoking and school truancy did not predict BMIP. Baseline risk behaviors did not predict PBF, however marijuana use approached significance (p=0.06).

Conclusion: Different measures of BC result in differential associations with risk behaviors. PBF predicts increased smoking and marijuana use, while BMIP does not. However, alcohol use predicts BMIP. While risk behaviors do appear to be associated with BC, further research is needed to determine why these differential associations exist.

Funding Source: NCI Transdisciplinary Research in Energetics & Cancer Initiative (NCI Grant 1 U54 CA116849-01)

Are Australian immigrants at risk of being physically inactive?

Authors:

Jayantha Dassanayake, Lyle Gurrin, Vijaya Sundararajan, Shyamali Dharmage, Warren Payne

Purpose: Many first generation migrant groups have relatively poor health when compared to their native-born host country counterparts. Also, physical inactivity is an acknowledged health risk factor. Therefore, it is surprising that few studies have examined the physical inactivity risk of a broad range of first generation migrants compared to their native-born host country counterparts. Migrants from over 200 countries comprise 24% of the Australian population and therefore Australia is an ideal setting

Poster Sessions

to examine this issue. We examined whether physical inactivity risk differed between Australian first generation migrant sub-groups and the Australian-born population.

Methods: Data from the Australian National Health Survey (2001) and each resident’s country of birth were classified into one of 13 regions. Data were gathered on physical activity level in the fortnight preceding the survey. Data from 4956 first generation migrants were selected from the data base. Multivariate logistic regression, adjusted for potential confounders (age, sex, personal income, educational qualifications, occupation and year of arrival in Australia), was conducted and Odds Ratios (ORs) calculated.

Results/Findings: Immigrants from South East Asia, Other Asia, Other Oceania, the Middle East, and Southern and Eastern Europe were at a significantly higher risk of being physically inactive compared to those born in Australian (ORs:1.25-2.04). In contrast, immigrants from New Zealand, UK and Ireland were at a significantly lower risk of being physically inactive compared to the Australian-born population (ORs:0.77, 0.82, respectively).

Conclusions: There is considerable variation in the physical inactivity risk status of first generation migrants to Australia.

Is sedentary behaviour associated with dietary intake in young people?: A systematic review

Authors:

Stuart Biddle, Natalie Pearson, Monique Raats

Purpose: To review associations between sedentary behaviours and dietary intake in young people.

Background: Although an association has been shown between television viewing (TV) and body fatness in young people, factors that mediate this relationship are less clear. While engaging in sedentary behaviours such as TV viewing, increased opportunities to eat snacks and exposure to food advertisements may influence food intake. The interaction of sedentary behaviour and dietary intake may contribute to a positive energy balance. A greater understanding of the associations between sedentary behaviour and dietary intake in young people will provide an important step towards developing effective interventions for the prevention of obesity.

Methods: Published English language studies were located from computerised and manual searches. Observational research reporting a measure of dietary intake and data on at least one sedentary behaviour were included.

Conclusions: Cross-sectionally (n=27 studies), TV viewing was negatively associated with fruit and vegetable consumption, and positively associated with consumption of energy-dense snack foods and sugar-sweetened beverages, and with total energy intake and percentage of energy from fat. Longitudinally (n=7 studies), changes in TV viewing were negatively associated with changes in fruit and vegetable consumption, and positively associated with changes in consumption of energy-dense snacks and sugar-sweetened beverages, and changes in total energy intake. TV viewing is associated with poor dietary behaviour in young people and may partly account for the association between TV viewing and weight status.

Poster Sessions

Practises of weight regulation among elite athletes in combat sports: A matter of physical advantage?

Authors:

Stefan Pettersson, Marianne Pipping-Ekström, Christina Berg

The combination of extensive weight loss and inadequate nutritional strategies to rapidly lose weight for competition in weight-category sports could negatively affect athletic performance and health. Despite this knowledge, weight-regulation practises continue.

Purpose: The aim of this paper is to explore elite athletes’ reasoning about rapid weight loss and regain prior to competitions.

Methods: Transcripts from 14 individual semi-structured interviews with athletes (9 male, 5 female) from the Swedish national teams in the Olympic sports of wrestling, judo and taekwondo together with other sources of non-technical information (athletes web pages, blogs, newspapers) were analysed using a grounded theory analytical method.

Results: Analysis of the data generated the theory building core category, stating that weight regulation is of great mental importance for the combat sport athlete. The psychologically enhancing effect of weight regulation concerns both the pre-competition preparations, as well as during the competition, due to a feeling of extra motivation and commitment and improved self-esteem. Moreover, weight loss is important as a part of an athlete’s identity; significant weight loss signals professionalism, toughness and success.

Conclusions: These results indicate that the phenomenon of weight regulation prior to competition is far more complex than the common notion that combat sport athletes merely reduce their weight in order to gain advantages in leverage, power and strength over their opponents. Therefore, the psychologically enhancing effect of weight regulation should be taken into account when trying to discourage unhealthy rapid weight loss practises among athletes.

Participation in organized and non-organized physical activity in relation to adolescents’ independent mobility

Authors:

Andreia Isabel Pizarro, Maria Paula Santos, Margarida Pereira, José Carlos Ribeiro, Jorge Mota

Purpose: Time spent outdoors is positively associated with physical activity in children. Some studies showed the importance of spontaneous outdoor play for children’s motor development and physical health. However, the role of children’s independence in choosing their physical activity behaviours and time spent outdoors is not well understood. The purpose of this study was to assess the relationship between participation in organised (OPA) and non-organised physical activity (NOPA) with independent mobility described herein as licence or degree of independence to move around in the neighbourhood.

Poster Sessions

Methods: Participants were 856 adolescents aged 16.6±1.3 years old. Independent mobility was assessed using two questions “My parents allow me to walk in our neighbourhood on my own” and “My parents allow me to bike on my own” with response options of disagree and agree. Participation in organised sports activities (OPA) was defined as “sportive activities guided by a trainer or other sports authority” and/or non-organised sports activities (NOPA), defined as “non-guided sport activities” with response options of Yes or No.

Results: Logistic regression analyses showed an association between agreeing with the statement “My parents allow me to bike on my own” and engagement in a NOPA (OR=2.68 95%CI 1.10-6.53). No significant association was found between the participation in OPA and adolescents who agreed that parents would let them walk or bike on their own.

Conclusion: Promote greater independent mobility in adolescents appears to be an important factor considering the participation in NOPA.

Funding Source: This study was supported by grant: FCT/PTDC/DES/099018/2008

Potential dietary consequences of food insecurity among Australian adults residing in urbanized disadvantaged areas

Authors:

Rebecca Ramsey, Katrina Giskes

Purpose: Food insecurity is the limited/uncertain availability, access to or ability to acquire nutritionally-adequate, culturally-relevant and safe foods. Adults suffering from food insecurity are at risk of inadequate nutrient intakes or, paradoxically, overweight/obesity and the development of chronic disease. Despite the global financial crisis and rising costs of living, there are few studies investigating the potential dietary consequences of food insecurity among the Australian population. This study examined whether food insecurity was associated with weight status and poorer intakes of fruits, vegetable and takeaway foods among adults residing in socioeconomically-disadvantaged urbanised areas.

Methods: In this cross-sectional study, a random sample of residents (n = 1000) were selected from the most disadvantaged suburbs of Brisbane city (response rate 51%). Data were collected by postal questionnaire which ascertained information on socio-demographic information, household food security status, height, weight, fruit and vegetable intakes and takeaway consumption. Data were analysed using chi-square and logistic regression.

Results/Findings: The overall prevalence of food insecurity was 31%. Food insecurity was not associated with weight status among men or women. Among women, food security was not associated with intakes of fruit, vegetable or takeaway consumption. Contrastingly, among men food security was associated with vegetable intakes and consumption of takeaway food: men reporting food insecurity had lower

Poster Sessions

intakes of vegetables and were more likely to consume takeaway foods compared to those that were food secure.

Conclusion: Food insecurity has potential dietary consequences that may adversely affect the health of food-insecure groups, most notably men residing in food-insecure households.

Is consumption of sugar-sweetened beverages associated with dietary practices and physical activity among adolescents?

Authors:

Nalini Ranjit, Alexandra Evans, Courtney Byrd-Williams, Deanna Hoelscher

Purpose: The purpose of this study was to explore the relationship between self-reported consumption of sugar-sweetened beverages (SSB) and dietary practices and physical activity among eighth and eleventh grade students.

Methods: Participants included eighth and eleventh grade students in Texas, USA (N=15,283) (m age=15, 45.7% white/other, 42.9% Hispanic, 11.4% African-American). Students completed self-report surveys with validated items on an array of food and meal choice items and various measures of physical and sedentary activity. Consumption of SSBs included items on regular soda and fruit-flavored drinks and was coded to range from 0-3 or more servings per day. Regression analyses were used to determine whether degree of SSB consumption was associated with dietary practices and physical activity. Models were adjusted for gender, grade, socioeconomic status and race.

Results: Higher consumption of SSBs was significantly associated with increased consumption of unhealthy meats, snack foods and desserts, and decreased consumption of vegetables, milk and fruit juice. Adolescents reporting higher SSB consumption spent increased time in sedentary behavior, and were less likely to participate in organized physical activity or engage in vigorous physical activity (p for trend <.001 in all cases).

Conclusions: Adolescents’ consumption of SSB is significantly associated with other potentially obesogenic behaviors, including various dietary and physical activity outcomes. Interventions targeting SSB consumption need to create environmental changes to facilitate healthy eating and physical activity and reduce opportunities for unhealthy eating and sedentary behaviors.

Funding Source: This study was funded by the Texas Department of State Health Services with funds from the Centers for Disease Control and Prevention Health and Human Services Block Grant, and the Michael & Susan Dell Foundation.

Poster Sessions

Determinants of loss to follow-up in a worksite health promotion program

Authors:

Suzan Robroek, Alex Burdorf

Purpose: Determinants of loss to follow-up in lifestyle intervention studies are scarcely investigated. Since selective loss to follow-up may induce bias, knowledge of these determinants is important. This study investigates loss to follow-up in a worksite health promotion program on physical activity and healthy nutrition.

Methods: This study is an observational study within an ongoing cluster randomized controlled trial. Workers from 6 companies were invited to participate. After filling out a baseline questionnaire, workers had the opportunity to participate in a physical health check and to use a website. Participants in the intervention group had additional website opportunities compared to the control group. Participants not responding to the 1-year follow-up questionnaire were considered lost to follow-up. With logistic regression analyses individual, lifestyle, health- and work-related determinants of loss to follow-up were studied.

Results: In total, 273 of the initial 966 participants were lost to follow-up. In the multivariate analysis, employees not complying with the recommendation for physical activity (OR=1.50, 95%CI:1.04-2.16) and smokers (OR=1.99, 95%CI:1.29-3.07) were more likely lost to follow-up than individuals with healthy lifestyle behaviours. Employees with a decreased maximum oxygen uptake (OR=1.66, 95%CI:1.16-2.37) were also more likely lost to follow-up.

Conclusions: Participants with unhealthy behaviours and a lower fitness level were more likely lost to follow-up in this lifestyle program. This loss-to-follow-up may also be reflected in lack of sustained participation and, hence, reduce the likelihood to observe intervention effects.

Funding Source: ZonMw, The Netherlands Organization for Health Research and Development (Project number 62300039)

Meal pattern and overweight among 9-11-year-old children in Finland

Authors:

Reetta Lehto, Carola Ray, Marjaana Lahti-Koski, Eva Roos

Purpose: In many studies breakfast has been associated with normal weight. Other meals and a regular 3-meal-a-day meal pattern are less studied. The aim of this study was to examine whether a regular meal pattern or separate regular meals are associated with weight status in children.

Methods: The study was a cross-sectional study conducted in Helsinki region in 2006 with a sample of 604 children (312 girls) aged 9-11. Response rate was 78 % for the study questionnaire and 54 % for the measurement of anthropometrics. Children were measured and weighted by research staff and overweight was defined according to international BMI limits. Children filled in a study questionnaire on

Poster Sessions

health behavior, including meals. A regular meal was defined as eating the meal usually every school day. Regular meal pattern was defined as eating breakfast, school lunch and dinner alike usually every school day. Logistic regression analysis was used as the statistical analysis method.

Results: Irregular breakfast (OR: 3,07 95 % CI:1,11-8,49) and irregular meal pattern (OR: 4,01 95 % CI:1,48-10,88) were associated with increased risk of overweight, as was irregular dinner in the fully adjusted model. School lunch was not associated with overweight.

Conclusions: This study supports the idea that regular meal pattern is associated with normal weight, although breakfast was the only meal that was associated with weight status in all statistical models. It seems that regular breakfast is most consistently associated with weight status in children, but research on other meals is still needed.

Funding Source: Folkhälsan Research Center, Juho Vainio foundation, Päivikki and Sakari Sohlberg foundation, Signe and Ane Gyllenberg foundation

Food shopping behaviour in times of restricted budget

Authors:

Juliane Yildiz, Ingrid-Ute Leonhaeuser

Purpose: Household income, household size, and household type have a significant influence on the amount of food expenditures. Households with relatively low income, e.g. solitarily women and single parents, spend a high amount of the distributable income for consumption goods. Certain household types seem to be vulnerable to a lower budget or increasing prices. Restricting food expenditures can influence the variety of food purchase and, consequently, the nutrition behavior.

Methods: A quantitative secondary analysis of the second German National Nutrition Survey[1] is implemented. The analysis includes generation of different household-types by cluster-analysis. The cluster-comparison shows differences among the types regarding changes in food purchasing, abandonment of certain foods and choice of low-priced alternatives for certain foods when budget is restricted.

Results: Modifications in food purchasing differ between the household-clusters and between different food groups. 15% would abstain from or drink less mineral water; comparison indicates no differences between the clusters. 38% would abstain from or drink less coffee; comparison appears differences of >10% between the clusters. Low-income clusters would choose more often low-priced alternatives for meat, one of them wouldn’t for milk products.

Conclusions: The secondary analysis generates indications (differences among clusters and foods) but no explanations of behavior. Therefore, a mixed-methods approach is applied. Qualitative interviews will be conducted to gain in-depth information on consumers’ attitudes, motives and response strategies. Findings will enable the development of precise intervention-activities regarding healthy food-choice. Risk groups which are obliged to change their food expenditure structure due to external causes will be identified.

Poster Sessions

[1]A cross sectional study with participants aged 14-80 years done by the Federal Research Institute for Nutrition and Food (Max Rubner-Institute). Data have been collected between November 2005 and November 2006.

The relationship between low fruit and vegetable intake, heavier drinking, and socio-economic position: The SHAPE Study

Authors:

Scott Shimotsu, Rhonda Jones-Webb, Richard MacLehose, Toben Nelson

Purpose: Poor diet and heavier drinking are major contributors to chronic disease morbidity and mortality in the U.S. However, it is unclear whether low fruit and vegetable intake and heavier drinking are associated, and whether socioeconomic position plays a role in how these health behaviors are patterned. The purpose of the study is to examine the relationship among fruit and vegetable intake, heavier drinking, and socioeconomic position in a multi-ethnic sample of 9,959 adults from Hennepin County, Minnesota, U.S.

Methods: Data were drawn from the Survey of the Health of Adults, the Population, and the Environment Study (2002), a random digit dial telephone survey that assessed individual behaviors and perceived environmental conditions related to nutrition, body weight, physical activity, and alcohol use. Fruit and vegetable intake was measured using two items that assessed servings per day. Heavier drinking was measured using two items based on quantity and frequency of drinking per week. Measures of socioeconomic position included education, employment status, household income, and household poverty level. Multivariate linear regression with sample weights was used to estimate effects.

Results/Findings: Heavier drinking was significantly associated with lower fruit and vegetable intake (β= -0.02; p=0.001). The relationship was significant among men (β= -0.03; p=0.02) and women (β= -0.02; p=0.002). However, the relationship between heavier drinking and fruit and vegetable intake did not vary by socio-economic position.

Conclusions: Heavier drinking and lower fruit and vegetable intake may cluster together. If so, interventions are needed that target multiple health behaviors simultaneously.

Poster Sessions

Nutrients and foods consumed by New Zealand children on school days and non-school days

Authors:

Paula Skidmore, Jennifer Rockell, Asher Regan, Noela Wilson, Winsome Parnell

Purpose: To describe and compare food and nutrient intakes in New Zealand (NZ) children on school and non-school days.

Methods: Secondary analysis of cross-sectional data from 2572 participants (aged 5-14 years) in the NZ 2002 Children’s Nutrition Survey. Dietary intake was assessed using computer-assisted multi-pass 24-hour diet recalls in the home. Data were adjusted for survey weightings to be representative of the NZ population. The effect of day category on nutrient intake, and likelihood of consumption of food categories were determined using linear and logistic regression.

Results: There were differences in the proportion consuming some food groups between school days and non-school days, although the majority of nutrient intakes, including energy, did not differ by day category. Mean cholesterol intake was higher on non-school days (189mg vs 170mg on school days); dietary fibre (17g vs 15g on non-school days), available carbohydrate (262g vs 241g), in particular sucrose and fructose, were higher on school days (P<0.05 for all). Hot chips were twice as likely to be consumed on a non-school day. Soft drink consumption was higher on non-school days. More children consumed snack bars (OR for consumption compared to non-school day=4.26), Fruit (OR=1.99) Sandwiches (OR=2.79), Biscuits/crackers (OR=1.6) and Snack foods (OR=2.06) on school days.

Conclusions: Proportions of consumers of a variety of foods differed significantly between non-school and school days; few nutrient intakes differed. This study indicates that family food, wherever it is consumed, is the mainstay of nutrition for NZ school children.

Funding Source: New Zealand Ministry of Health

Correlates of fruit and vegetable consumption in secondary school students in New Zealand

Authors:

Paula Skidmore, Sandra Mandic, Kylie Jessop, Sarah Featherstone, Emily Stevens, Sarah Swinbourn, Maria Polak

Purpose: To identify correlates of fruit and vegetable (F&V) consumption in secondary school students in Otago, New Zealand.

Methods: A web-based survey of 1858 students (13-18 years) from 19 secondary schools in Otago was conducted to collect information on food consumption, using a short, validated FFQ, and potential correlates of F&V consumption. We examined the associations between F&V consumption and potential correlates using the χ2 test.

Poster Sessions

Results: 53.9% of participants (50.9% of boys, 57.2% of girls, p<0.001) ate F&V daily and a higher proportion of students from urban schools ate F&V daily compared to those from rural schools. A higher proportion of girls (79.4%) considered that the healthiness of the foods that they consumed was important, compared to boys (63.9%, p=0.001). The ease of getting food was important when making food choices for more boys (62.6% ) than girls (55.7%, p=0.009) as was the ease of eating. These two factors were also considered important by a higher proportion of rural students than those at urban schools. A higher proportion of those who consider the healthiness of food important eat fruit daily (67.3% vs. 41.6%, p<0.001). Conversely, a higher proportion of those who consider the easiness of food to get are less likely to eat fruit daily (56.8% vs. 64.4%, p<0.001). Parental encouragement to eat F&V and parents own consumption of F&V was also associated with students’ F&V consumption.

Conclusions: F&V consumption differed significantly by gender and school location. Both students’ and parents’ beliefs and attitudes are related to F&V consumption.

Funding Source: Dunedin City Council, Otago Regional Council

Changes in sugar sweetened soft drink pattern in Norwegian children from 2001 to 2008

Authors:

Tonje Holte Stea, Nina Cecilie Řverby, Knut-Inge Klepp, Elling Bere

Purpose: Between 2001 and 2008 there has been an increased focus on sugar sweetened soft drink consumption in relation to health status among children. The aim of this study was to analyze changes in this soft drink pattern from 2001 to 2008 in general and according to gender, parental educational level and number of adults in household.

Methods: Within the project Fruits and Vegetables Makes the Marks (FVMM), 1488 6th and 7th grade pupils from 27 Norwegian elementary schools completed a food frequency questionnaire in 2001 and 1339 pupils from the same schools completed the same questionnaire in 2008. Data were analyzed by multilevel linear mixed models.

Results: In total 67% and 45% of the participants reported to drink sugar sweetened soft drinks twice a week or more often in 2001 and 2008 respectively (p<0.001). More boys (59%) than girls (53%) (p=0.004), and more children with low educated parents (62%) than high educated parents (50%), reported a high frequency of consumption (p<0.001). These differences did not change in the mentioned time period. Between 2001 and 2008 children living with two parents reduced the frequency of soft drink consumption to a greater extent (67 to 38%) than children living with one parent (66 to 52%) (interaction time* adults in household: p =0.005).

Conclusion: There has been a significant reduction in frequency of sugar sweetened soft drink consumption between 2001 and 2008 among Norwegian children. Living with two parents seems to be positively related to soft drink consumption reduction in this time period.

Funding Source: The Research Council of Norway

Poster Sessions

Attitude and eating occasion need state of midlife women and the relationship to indicators of obesity

Authors:

Noriko Sudo, Courtney Perry, Alisha Wood, Marla Reicks

Purpose: To determine the relationship between attitude and need state segments of midlife women and obesity.

Methods: A one-day food record and general questionnaire on eating habits, attitudes toward food, physical activity, and body weight and height were mailed to 1684 women aged 40-60 years. Need states based on motivations underlying food choices were repeatedly measured for four eating occasions by the same questionnaires but one need state was randomly selected from each woman for this analysis. Cluster analyses were used to segment women by attitude and need state. The dependent variables of the general linear model (GLM) were BMI and total daily energy intake and fixed factors were attitude and need state segments. Since the interactions between attitude and need state segments were not significant, they were removed from the models. The Type III sum of square method was used in the GLM univariate procedure.

Results/Findings: Attitude segments were significant predictors of BMI but need states were not. Estimated marginal means of BMI were highest in “limited time cooks,” followed by “boredom binger,” “live to eat,” “creative cooks,” “health conscious,” “family before self,” and “hate to cook” segments. Both attitude and need state segments were significant predictors of energy intake. Energy intake was highest when “boredom bingers” were in need states of “indulgent escapes” (2307kcal/day) and “”nurturing family meals” (2171kcal/day).

Conclusions: Tailoring weight management programs according to attitude and need state segments related to high BMI or energy intake may improve the ability to create effective intervention strategies.

Funding Source: National Research Initiative Grant 2007-55215-17907 from the National Institute of Food and Agriculture, United States Department of Agriculture

Change in overweight status among very young children: Recent longitudinal findings from national US data on toddlers and preschoolers

Authors:

Judy Temple, Christopher Moore, Jayne Fulkerson

Purpose: To assess the frequency of overweight onset and persistence among young children aged 2 to 4 in the US and to examine family characteristics and practices associated with changes in overweight status in early childhood. Limited evidence exists on the overweight status of children in early childhood, a time that might be ideal for engaging in preventive actions to reduce the prevalence of overweight onset.

Poster Sessions

Methods: Data on child weight and age were obtained from the birth cohort of the Early Childhood Longitudinal Study, which follows a nationally representative group of over 10,000 US children born in 2001. Overweight status was based on weight for height. Given changes in overweight status between age two and age four, children were assigned to four mutually exclusive groups categories: never overweight (55.7%), overweight onset(10.7%), persistent overweight (17.8%) and overweight remission (15.8%). Multinomial probit estimation is used to estimate the importance of factors associated with the probability of belonging to each category.

Results: Almost 30% of children were either persistently overweight or became overweight during their preschool years, while 16% were overweight as toddlers but not by age four. Significant differences exist in these prevalence rates by race. Initial results indicate that maternal education and family income predict overweight onset and persistence. Initial results suggest that family meals and family activity levels do not explain much of the changes in overweight status at these young ages.

Conclusions: The Centers for Disease Control and the American Academy of Pediatrics recommend screening for overweight and obesity beginning at age two. Clear increases in overweight and obesity are noticeable between ages two and four in a recent large nationally representative data set. Opportunities to prevent child obesity should be considered in the preschool years.

Funding Source: Food, Healthy Lives Institute (University of Minnesota)

Community matters: The exploration of overweight and obesity within a representative sample of lesbians

Authors:

Amy Thayer, Paul Estabrooks

Purpose: To examine how a lesbian sexual identity contributes to body weight.

Methods: A feminist ethnographic inquiry was conducted between April 2009 and October 2009. Participant observation served as the primary method of data collection; semi-structured and informal interviews were also conducted and artifact data were analyzed. Three research questions guided this study: 1) How does this lesbian social community serve as a context for its lesbian members to understand body weight? 2) What is the relationship between women’s lesbian identities and their body weight? 3) What sub-cultural customs exist that permit or prohibit healthy eating and physical activity by women in this lesbian community?

Results/Findings: Specific social practices were revealed that put weight into the context of the lesbian culture. The following three primary themes were identified: (1) valuing weight, (2) coping and socialization behavior, and (3) living in a paradoxical environment. These themes explicate how lesbians create innovative ways to appreciate a wide range of acceptable female body weight. By claiming their lesbian identity women become empowered to assert resistance to hetero-normative values and to increase self-acceptance; however, still members of the non-dominant sexual culture, their experience with discrimination and shame also seem to facilitate unhealthy coping strategies often manifested through excessive eating and alcohol consumption.

Poster Sessions

Conclusions: Although there are many social contextual properties of the lesbian community permitting the presence of overweight members, there are also enforced norms indicating attention should be paid to developing culturally sensitive methods for improving weight management efforts in this population.

Funding Source: Gay and Lesbian Medical Association’s Lesbian Health Fund

The relationship between sugar sweetened beverages added sugar intake, dietary glycemic index, and Body Mass Index

Authors:

Brie Turner-McGrievy, Deborah Tate, Barry Popkin

Purpose: A large portion of U.S. energy intake is consumed from sugar sweetened beverages (SSB). The CHOICE study is a randomized trial designed to answer the question of whether replacement of caloric beverages with water or non-caloric sweetened beverages can produce weight loss. The purpose of this study was to explore the relationship between body mass indices (BMI), the glycemic index (GI), and intakes of SSB and added sugars.

Methods: The CHOICE study is a 6-month, randomized 3-group, behavioral weight loss trial among overweight and obese (BMI 25-50 kg/m2) men and women. Two days of 24-hour food recalls, along with anthropometrics, were collected at baseline.

Results: Participants (49 males; 266 females) had a mean BMI of 36.3 ± 5.9 kg/m2 and mean age of 42.0 ± 10.7 years. BMI was significantly, positively related to SSB intake (r = 0.23; p <0.001), percentage of kcals from added sugars (r = 0.18; p<0.01), and GI (r = 0.13; p<0.05), even after controlling for total energy intake. Participants whose BMI was > 35 kg/m2 (n=178) had a greater percentage of energy from added sugars (20.2% vs. 17.3%; p < 0.01), greater consumption of SSB (3.0 vs. 2.0 servings/day; p <0.001), and a higher dietary GI (89.2 vs. 87.2; p <0.05).

Conclusions: Consistent with the literature, consumption of SSB, as well as other sources of added sugars, may be contributing to a higher BMI and a greater dietary GI among overweight and obese adults.

Funding Source: Nestle

Influence of different patterns of physical activity on Body Mass Index in pre-school children

Authors:

Susana Vale, Rute Santos, Luísa Soares-Miranda, Carla Moreira, Carla Ręgo, Pedro Moreira, Jonahan Ruiz, Jorge Mota

Aim: The aim of this study was to analyze the influence of different patterns of physical activity, adjusted some potencial counfounders on actual children’s BMI.

Poster Sessions

Methods: The sample comprised 281 boys and girls aged 4-6 years old. Height and weight were assessed by standard protocols. The BMI z-score BMI, adjusted for gender and sex, was then obtained and used for assigned children to non-overweight group (N-OW) and overweight/obese (OB) group, respectively. The birth weight and the first two years BMI were obtained prospectively by questionnaire, and children were classified according the previous methodology. Gestational Weight gain and maternal smoking during pregnancy were assessed by the same questionnaire. Children’s physical activity was assessed by accelerometers during at least 4 consecutive days (at least 1 weekend). The epoch length was set at 5 seconds. Daily time spent TV viewing/ playing video-games and sleeping time were assessed by questionnaire. Mother’ education and BMI was also computed.

Results: No statistical significant differences were found in total and moderate activity. However, we found that a lower proportion of OV children (13.9%) were classified low vigorous PA than NW children (35.5%) were (pŁ0.05). Final stepwise multiple logistic regression model showed that children with low VPA (OR=5.6; 95%CI: 1.6-19.6; p=0.007) and middle VPA (OR=4.2; 95%C: 1.2-14.4; p=0.024)were more likely to be classified as OV compared with NW peers, adjusted for BMI at first and second years of life, GWG and mother obesity(p≤0.05 all of them).

Conclusion: Our data suggested that Vigorous PA were strong predictors of OV at pre-school age.

Funding Source: FCT

Socio-demographic determinants of sedentary behavior and physical activity in preschool children: The Generation R Study

Authors:

Lenie van Rossem, Vincent Jaddoe, Albert Hofman, Johan Mackenbach, Hein Raat

Purpose: We studied socio-demographic determinants of high levels of sedentary behavior and low levels of physical activity in preschool children to identify risk groups for these behaviors.

Methods: Participants were 4,784 children in a population-based birth cohort in Rotterdam, the Netherlands. The mothers completed questionnaires during pregnancy (mother’s educational level, household income, mother’s job status, and mother’s ethnicity). At the child’s age of 36 months mothers completed questionnaires regarding sedentary behaviors (watching television and passive transportation by buggy or car; hours/day), and physical activity (playing outside; hours/day). We dichotomized sedentary behaviors and physical activity into ‘≥2 hours/day’ or ‘<2 hours/day’. We used multiple logistic regression to obtain independent estimates for socio-demographic determinants.

Results: At 36 months, 10.1% of children had at least 2 hours/day of screen time, 11.1% was passively transported for more than 2 hours/day, and 23.9% did not play outside for at least 2 hours/day. Low maternal educational level (OR: 2.98, 95% CI 2.16-4.11) and non-native ethnicity (OR: 1.91, 95% CI 1.56-2.32) were independently associated with high levels of sedentary behavior at 36 months. Non-native ethnicity was associated with low levels of physical activity (OR: 0.81, 95% CI 0.67-0.97). Job status and income were not independently associated with sedentary behavior or physical activity.

Poster Sessions

Conclusions: Sedentary behaviors and physical activity are established at a very young age and are associated with educational level and ethnicity of the parents. Prevention should focus at high risk groups. This may reduce social inequalities in overweight at a later age.

Funding Source: ZonMW - The Netherlands Organization for Health Research and Development

Are time constraints and cooking effort associated with fast food consumption?

Authors:

Klazine van der Horst, Thomas Brunner, Michael Siegrist

Purpose: Time constraints are reported as a barrier to healthy eating and are associated with not meeting nutrition guidelines. Next to time pressure, mental and physical effort for preparing meals might be an important factor. As fast food by definition minimizes time and effort in preparing, consuming and cleaning up, this study aimed to examine associations of time pressure, mental and physical effort with fast food consumption.

Methods: Fast food consumption, time pressure, mental effort, physical effort and demographic variables were assessed with self-administered questionnaires among 1017 adults from the German-speaking part of Switzerland. Data was analyzed with Spearman correlations and logistic regression analysis.

Results: Time pressure, physical and mental effort, were found to correlate with fast food consumption. However in the multivariate logistic regression analysis no significant association was found for time pressure and for physical effort. For mental effort a marginal association was found with fast food consumption (OR= 1.21; p=0.07).

Conclusion: Although fast food minimizes time and effort, these factors did not predict consumption. In our busy world almost everybody tries to save time and effort whenever possible and it might be that time or effort related variables do not differentiate people’s fast food consumption. It might also be that time and effort are decisive in a specific situation when the decision for a food product is made. Therefore, it should be better explored how these factors can be assessed and how they influences our food patterns.

Lifestyle behaviors and academic performance in Spanish adolescents: The AFINOS study

Authors:

Oscar Veiga, David Martinez-Gomez, Belen Zapatera, Sonia Gómez-Martinez, Maria Calle, David Martinez-Hernandez, Ascension Marcos

Purpose: To study the independent and combined influence of lifestyle behaviors on academic performance in adolescents.

Poster Sessions

Methods: A cross-sectional sample of 1825 Spanish adolescents reported their grades in language and math. Adolescents also self-reported their body mass index, family structure, school contentment, repeating ≥1-yr and skipping classes. Adolescents were dichotomized based on meeting (healthy) or not meeting (unhealthy) specific lifestyle public health recommendations of physical activity (60-min x 5-d), watching TV (2h/d), sleep duration (8h/d) and fruit consumption (2 servings/d). A cluster of healthy lifestyle behaviors (0-4) was calculated for each adolescent.

Results/Findings: An incomplete family structure, low school contentment, repeating ≥1-yr and skipping classes were inversely associated with academic performance in adolescent boys and girls, but not an overweight (including obesity) status. There were no significant independent and combined influences of lifestyle behaviors on academic performance in adolescent boys. However, healthy lifestyle behaviors such as physical activity (Odds ratios: 1.69 for math and 1.72 for passing both subjects) and fruit consumption (Odds ratios: 3.10, 1.70, 1.96 for language, math and passing both subjects, respectively) were positively associated with academic performance in girls (all P<0.05). Moreover, girls who met 3-4 healthy behaviors had higher odds of passing language (Odds ratio: 3.18), math (Odds ratio: 1.75) and both subjects (Odds ratio: 2.32).

Conclusions: A multiple combination of healthy lifestyle positively influenced academic performance in Spanish adolescent girls, whereas adolescent boys were more influenced by family context and other academic characteristics.

Funding Source: This study was supported by the DEP2006-56184-C03-02/PREV and AP2006-02464 grants from the Spanish Ministry of Education and Science (MEC).

A Longitudinal study of adolescents’ perceived barriers and benefits to physical activity

Authors:

Vera Verbestel, Lea Maes, Greet Cardon, Ilse De Bourdeaudhuij

Purpose: Adolescence is characterised by a decrease in physical activity (PA) which is associated with an increased risk for obesity. Therefore, PA promoting efforts in adolescents are needed. Perceived barriers and benefits, considered to be appropriate targets for PA promotion, are not well documented in young adolescents and previous research is mainly relying on cross-sectional data. Therefore, this study investigated sex related changes in these intra personal variables during this period of life.

Methods: Belgian adolescents were questioned in 7th and 10th grade of elementary school (mean age at baseline 12 ±0.4 years; 50% boys; n=1146). Perceived barriers (lack of time, interest and perseverance, health barriers, personal problems, not skilled enough, too expensive, no transportation) and benefits (body image, health benefits, social contact, enjoyment, opportunities for competition, psychological benefits, admiration of others, relaxation) were measured through a self-administered questionnaire.

Results: From 7th to 10th grade, opportunities for competition, body image, health benefits, lack of time and interest were perceived to be more important in both sexes while relaxation and enjoyment were

Poster Sessions

found to become less important. The importance of body image and lack of time increased more for girls compared to boys. Opportunities for competition increased more in boys and lack of perseverance was found to decrease more in boys than in girls (all p<0.05).

Conclusion: These data show sex-related changes in perceived barriers and benefits to PA during adolescence. In order to intervene more efficaciously, these findings suggest sex and age related strategies during this period of life.

Objectively measured correlates of active school transport: A systematic review

Authors:

Bonny Yee-Man Wong, Guy Faulkner, Ron Buliung

Purpose: To examine the relationships between objectively measured built environment (BE) features and active school transport (AST) in children and adolescents and to critically examine GIS methodologies used in this context.

Background: Emerging frameworks to examine AST commonly emphasize the built environment as a primary influence on travel mode decisions. To understand the impact of the environment, objective measures of environmental attributes have been recommended. An updated systematic review on the relationships between GIS-measured BE and AST is required to inform future research in this area.

Methods/Key Points: Six electronic databases, and websites were systematically searched, and reference lists were searched and screened to identify studies examining AST in students aged five to 18 and reporting GIS as an environmental measurement tool. Eight cross-sectional studies were identified. Only distance was consistently found to be negatively associated with AST. No consistent findings were found for land use mix, residential density, and intersection density. Potential modifiers of any relationship between these attributes and AST included age, am or pm trip, and travel mode (walking versus cycling). Measurement was inconsistent particularly in terms of methods used for geocoding, selection of buffer methods and sizes, and the quality of road and pedestrian infrastructure data.

Conclusions: The inconsistent application of GIS currently limits the ability to draw conclusions about the relationship between objectively measured environmental attributes and AST. Future research should explore standardizing buffer size, assess the quality of street network datasets and, if necessary, customizing existing datasets, and explore further attributes linked to safety.

Funding Source: Built Environment, Obesity and Health Strategic Initiative of the Heart and Stroke Foundation and CIHR

Longitudinal effects of GALM on physical activity, health and fitness of older adults

Documents

Transcript of Longitudinal effects of GALM on physical activity, health and fitness of older adults

MANUALE D'ISTRUZIONI - iFIT Heath & Fitness

HIV-1 fitness landscape models for indinavir treatment pressure using observed evolution in longitudinal sequence data are predictive for treatment failure

Kung Fu Training Improves Physical Fitness Measures in Overweight/Obese Adolescents: The “Martial Fitness” Study

Longitudinal Surveys of Children

fitness - Muscle by Gymscanner.com

dual function machines - Muscle D Fitness

Anytime Fitness Business Plan NA

Owner's Manual - Orbit Fitness

Longitudinal Wires Transverse Wires

Quality- Fitness of Use

P5 Fitness unit 9

MANUALE d'ISTRUZIONI - Fitness Service Store

FITNESS PROFESSIONAL OF THE YEAR - CanFitPro

THE INDUSTRY'S BEST PERSONAL TRAINING & FITNESS ...

ANNUAL REPORT - Planet Fitness Investor Relations

PR3000 Home Gym - Flaman Fitness

INFORMATION DOCUMENT IMPULSE FITNESS SOLUTIONS

Grandparenting and psychosocial health among older Chileans: A longitudinal analysis

KetogenicBodybuildingROE2.pdf - Rob Goodwin Fitness

Weight Training and Fitness