Suchergebnisse

Purpose. To examine associations between children's perceptions of the neighborhood environment and walking and physical activity. Design. Cross-sectional study of a school-based sample. Setting. Elementary schools in Melbourne, Australia. Subjects. 280 children aged 10 years (response rate 78%). Measures. A self-report survey assessed children's perceptions of the neighborhood physical and social environments and their weekly walking frequency. Physical activity was also objectively measured using accelerometers. Results. Multiple linear regression analyses showed a positive association between walking frequency and the number of accessible destinations in the neighborhood among boys; having a neighborhood that was easy to walk/cycle around and perceiving lots of graffiti were positively associated with walking frequency among girls. Perceiving lots of litter and rubbish was positively associated with boys' overall physical activity, but no environmental variables were associated with girls' overall physical activity. Conclusion. Several different environmental factors were associated with walking and physical activity. Perceptions of the neighborhood environment were more strongly associated with girls' walking than with objectively-measured physical activity. Future studies should confirm these findings using objective measures and prospective study designs.

Purpose. To examine associations among individual, social, and environmental barriers and children's walking or cycling to school. Design. Exploratory cross-sectional study. Setting. All eight capital cities in Australia. Subjects. Parents (N = 720) of school-aged children (4–13 years; 27% response rate; 49% parents of boys). Measures. Multivariate-adjusted odds ratios (OR) and 95% confidence intervals (CI) for parental reporting of barriers to their children's walking or cycling to school, based on a computer-assisted telephone interview. Results. Forty-one percent of children walked or cycled to school at least once per week. Multivariable analyses found inverse associations with individual ("child prefers to be driven" [OR = 0.4, 95% CI = 0.3–0.6], "no time in the mornings" [OR = 0.5, 95% CI = 0.3–0.8]); social ("worry child will take risks" [OR = 0.6, 95% CI = 0.3–0.9], "no other children to walk with" [OR = 0.7, 95% CI = 0.4–0.99], "no adults to walk with" [OR = 0.6, 95% CI = 0.4–0.9]); and environmental barriers ("too far to walk" [OR = 0.1, 95% CI = 0.0–0.1], "no direct route" [OR = 0.4, 95% CI = 0.2–0.7]) and positive associations with "concern child may be injured in a road accident" (OR = 1.9, 95% CI = 1.1–3.1) and active commuting. Conclusion. Working with parents, schools, and local authorities to improve pedestrian skills and environments may help to overcome barriers.

BACKGROUND: Scaling up population health interventions is a context-orientated, dynamic and multi-stakeholder process; understanding its influences is essential to enhance future scaling efforts. Using physical activity and nutrition interventions in Australia as case examples, the aim of this paper is to identify core influences involved in scaling up physical activity and nutrition interventions, and how these may differ by context and stakeholder. METHODS: A qualitative study involving semi-structured telephone interviews with individuals representing academic, government and non-government organizations with involvement in scaling up state and national physical activity and nutrition interventions. Interview questions were derived from the WHO report "20 Questions for Developing a Scaling up Case Study", and mapped against four key principles and five core areas in the WHO ExpandNet framework for scaling up: (1) The innovation; (2) User organization; (3) Environment; (4) Resource team and; (5) Scale up strategy. Data were analyzed thematically. RESULTS: Nineteen interviews were conducted (government = 3; non-government = 5; and academic = 11 sectors) involving eight scaled up interventions, targeting nutrition (n = 2), physical activity (n = 1) or a combination (n = 5). Most themes aligned to the "Environment", including: (i) political (e.g., personal agendas); (ii) social (e.g., lack of urgency); and (iii) sector/workforce (e.g., scale up accountability) factors. Themes relating to "Scale up strategy" (e.g., flexibility and evaluation transparency) were next most commonly occurring. Whilst themes were broadly consistent across participants, government participants had a more policy-oriented perspective on the scale up process. Academics discussed a tension between the generation and use of evidence, and the influence of political climates/interest on scale up decisions. CONCLUSION: Attributes of the "Environment" and "Scale up strategy" consistently featured as major influences on successful outcomes, while ...

BACKGROUND: Sustainable shifts in population behaviours require system-level implementation and embeddedness of large-scale health interventions. This paper aims to understand how different contexts of scaling up interventions affect mechanisms to produce intended and unintended scale up outcomes. METHODS: A mixed method study combining a realist perspective and systems analysis (causal loop diagrams) of scaled-up physical activity and/or nutrition interventions implemented at a state/national level in Australia (2010–18). The study involved four distinct phases: Phase 1 expert consultation, database and grey literature searches to identify scaled-up interventions; Phase 2 generating initial Context-Mechanism-Outcome configurations (CMOs) from the WHO ExpandNet framework for scaling up; Phase 3 testing and refining CMOs via online surveys and realist interviews with academics, government and non-government organisations (NGOs) involved in scale up of selected interventions (Phase 1); and Phase 4 generating cross-case mid-range theories represented in systems models of scaling up; validated by member checking. Descriptive statistics were reported for online survey data and realist analysis for interview data. RESULTS: Seven interventions were analysed, targeting nutrition (n = 1), physical activity (n = 1), or a combination (n = 5). Twenty-six participants completed surveys; 19 completed interviews. Sixty-three CMO pathways underpinned successful scale up, reflecting 36 scale up contexts, 8 key outcomes; linked via 53 commonly occurring mechanisms. All five WHO framework domains were represented in the systems models. Most CMO pathways included 'intervention attributes' and led to outcomes 'community sustainability/embeddedness' and 'stakeholder buy-in/perceived value'. Irrespective of interventions being scaled in similar contexts (e.g., having political favourability); mechanisms still led to both intended and unintended scale up outcomes (e.g., increased or reduced sustainability). CONCLUSION: This paper ...

Background: Sustainable shifts in population behaviours require system-level implementation and embeddedness of large-scale health interventions. This paper aims to understand how different contexts of scaling up interventions affect mechanisms to produce intended and unintended scale up outcomes. Methods: A mixed method study combining a realist perspective and systems analysis (causal loop diagrams) of scaled-up physical activity and/or nutrition interventions implemented at a state/national level in Australia (2010–18). The study involved four distinct phases: Phase 1 expert consultation, database and grey literature searches to identify scaled-up interventions; Phase 2 generating initial Context-Mechanism-Outcome configurations (CMOs) from the WHO ExpandNet framework for scaling up; Phase 3 testing and refining CMOs via online surveys and realist interviews with academics, government and non-government organisations (NGOs) involved in scale up of selected interventions (Phase 1); and Phase 4 generating cross-case mid-range theories represented in systems models of scaling up; validated by member checking. Descriptive statistics were reported for online survey data and realist analysis for interview data. Results: Seven interventions were analysed, targeting nutrition (n = 1), physical activity (n = 1), or a combination (n = 5). Twenty-six participants completed surveys; 19 completed interviews. Sixty-three CMO pathways underpinned successful scale up, reflecting 36 scale up contexts, 8 key outcomes; linked via 53 commonly occurring mechanisms. All five WHO framework domains were represented in the systems models. Most CMO pathways included 'intervention attributes' and led to outcomes 'community sustainability/embeddedness' and 'stakeholder buy-in/perceived value'. Irrespective of interventions being scaled in similar contexts (e.g., having political favourability); mechanisms still led to both intended and unintended scale up outcomes (e.g., increased or reduced sustainability). Conclusion: This paper provides the first evidence for mechanisms underpinning outcomes required for successful scale up of state or nationally delivered interventions. Our findings challenge current prerequisites for effective scaling suggesting other conditions may be necessary. Future scale up approaches that plan for complexity and encourage iterative adaptation throughout, may enhance scale up outcomes. Current linear, context-to-outcome depictions of scale up oversimplify what is a clearly a complex interaction between perceptions, worldviews and goals of those involved. Mechanisms identified in this study could potentially be leveraged during future scale up efforts, to positively influence intervention scalability and sustainability.

Purpose. Although the family environment is a potentially important influence on children's physical activity (PA), prospective data investigating these associations are lacking. This study aimed to examine the longitudinal relationship between the family environment and PA among youth. Design. A 5-year prospective cohort study. Setting. Nineteen randomly selected public schools in Melbourne, Australia. Subjects. Families of 5- to 6-year-old (n = 190) and 10- to 12-year-old (n = 350) children. Measures. In 2001, parents reported their participation in PA, family-based PA, and support and reinforcement for their child's PA. In 2001, 2004, and 2006, moderate to vigorous intensity PA (MVPA) was assessed among youth using accelerometers. Weekend and "critical window" (after school until 6:00 P.M.) MVPA were examined because we hypothesized that the family environment would most likely influence these behaviors. Analysis. Generalized estimating equations predicted average change in MVPA over 5 years from baseline family environment factors. Results. Maternal role modeling was positively associated with boys' critical window and weekend (younger boys) MVPA. Paternal reinforcement of PA was positively associated with critical window and weekend MVPA among all boys, and paternal direct support was positively associated with weekend MVPA (older boys). Among girls, maternal coparticipation in PA predicted critical window MVPA, and sibling coparticipation in PA was directly associated with weekend MVPA (younger girls). Conclusions. Longitudinal relationships, although weak in magnitude, were observed between the family environment and MVPA among youth. Interventions promoting maternal role modeling, paternal reinforcement of and support for PA, and maternal and sibling coparticipation in PA with youth are warranted. (Am J Health Promot 2011;25[3]:159–167.)

Purpose. To examine how perceptions of the local neighborhood relate to adolescents' walking and cycling. Design. Exploratory cross-sectional study. Setting. Birth cohort from the Nepean Hospital, Sydney, Australia. Subjects. Three hundred forty-seven adolescents (79.1% response rate; 49.6% boys; mean age = 13.0 ± 0.2 years) and their parents. Measures. Self-report and parental-report questionnaires. Results. Multiple linear regressions, adjusted for level of maternal education, revealed that boys who reported having many peers to hang out with locally, cycled for recreation (β = 0.242, p = .006) or for transport (β = 0.141, p = .046) more often, and walked for transport for longer (β = 0.129, p = .024) on weekdays. For girls this variable was related to cycling for recreation on weekends (β = 0.164, p = .006) and walking to school (β = 0.118, p = .002). Adolescents who waved/talked to neighbors walked for transport more often (boys, β = 0.149, p = .037; girls, β = 0.119, p = .012). Girls who perceived local roads to be safe spent more time walking for transport on weekdays (β = 0.183, p = .007) and for exercise on weekends (β = 0.184, p = .034). Parents' perception of heavy traffic was negatively associated with boys' walking for transport (β = −0.138, p = .037) and many aspects of girls' walking and cycling. Conclusion. Social interaction and road safety may be important predictors of adolescents' walking and cycling in their neighborhood. Limitations are the use of self-report and cross-sectional data. Longitudinal studies may clarify these relations.

Overweight and obesity has doubled among children in Australia. There is an urgent need to develop primary prevention strategies to prevent current and future unhealthy weight gain. The aims of this paper are to describe a randomized controlled trial "Switch-Play" developed to prevent unhealthy weight gain among 10-year-old children and to report the findings of the process evaluation. Children from three government primary schools were randomized by class to one of four conditions: a behavioural modification group (BM; n = 69); a fundamental motor skills group (FMS; n = 73); a combined BM and FMS group (n = 90); or a control (usual classroom lessons) group (n = 61). Children in the BM group participated in 19 sessions that encouraged them to reduce screen-based behaviours, and identified physical activity alternatives. The FMS group participated in 19 lessons that focused on mastery of six skills: run, throw, dodge, strike, vertical jump and kick. The combined group participated in all the BM and FMS activities. The intervention specialist teacher reported that the children showed high enjoyment and engagement (88% lessons attended) in most aspects of the programme. At-home tasks were completed by 62% of the children, and 92% completed the in-class tasks. Two-thirds of the children in the BM group participated in the behavioural contracting to switch off the TV. Most of the children reported high enjoyment of the programmes, and only a small proportion 17% reported difficulties in switching off their nominated TV shows. More than half the children reported reducing their TV viewing; however, less than half reported increasing their physical activity. It was found that most aspects of the intervention arms of the programme were successfully delivered to the majority of children participating in "Switch-Play"; that the programmes were delivered as intended; and that the programmes were favourably evaluated by participating children and their parents.

Introduction: Understanding how the weather affects physical activity (PA) may help in the design, analysis, and interpretation of future studies, especially when investigating PA across diverse meteorological settings and with long follow-up periods. The present longitudinal study first aims to examine the influence of daily weather elements on intraindividual PA patterns among primary school children across four seasons, reflecting day-to-day variation within each season. Second, we investigate whether the influence of weather elements differs by day of the week (weekdays vs weekends), gender, age, and bodymass index. Method: PA data were collected by ActiGraph accelerometers for 1 wk in each of four school terms that reflect each season in southeast Australia. PA data from 307 children (age range 8.7-12.8 yr) were matched to daily meteorological variables obtained from the Australian Government" s Bureau of Meteorology (maximum temperature, relative humidity, solar radiation, day length, and rainfall). Daily PA patterns and their association with weather elements were analyzed using multilevel linear mixed models. Results: Temperature was the strongest predictor of moderate and vigorous PA, followed by solar radiation and humidity. The relation with temperature was curvilinear, showing optimum PA levels at temperatures between 20 degrees C and 22 degrees C. Associations between weather elements on PA did not differ by gender, child" s age, or body mass index. Conclusions: This novel study focused on the influence of weather elements on intraindividual PA patterns in children. As weather influences cannot be controlled, knowledge of its effect on individual PApatternsmay help in the design of future studies, interpretation of their results, and translation into PA promotion.

Degraded parks in disadvantaged areas are underutilized for recreation, which may impact long-term health. Using a natural experiment, we examined the effects of local government refurbishments to parks (n = 3 intervention; n = 3 comparison) in low socioeconomic areas (LSEA) of Melbourne on park use, health behavior, social engagement and psychological well-being. Amenities promoting physical activity and sun protection included walking paths, playground equipment and built shade. Outcomes were measured via systematic observations, and self-report surveys of park visitors over three years. The refurbishments significantly increased park use, while shade use increased only in parks with shade sails. A trend for increased social engagement was also detected. Findings infer improvement of quality, number and type of amenities in degraded parks can substantially increase park use in LSEA. Findings support provision of shade over well-designed playgrounds in future park refurbishments to enhance engagement and sun protection behavior. Further research should identify park amenities to increase physical activity.

Introduction: Physical inactivity has been described as a global pandemic. Interventions aimed at developing skills in lifelong physical activities may provide the foundation for an active lifestyle into adulthood. In general, school-based physical activity interventions targeting adolescents have produced modest results and few have been designed to be 'scaled-up' and disseminated. This study aims to: (1) assess the effectiveness of two physical activity promotion programmes (ie, NEAT and ATLAS) that have been modified for scalability; and (2) evaluate the dissemination of these programmes throughout government funded secondary schools. Methods and analysis: The study will be conducted in two phases. In the first phase (cluster randomised controlled trial), 16 schools will be randomly allocated to the intervention or a usual care control condition. In the second phase, the Reach, Effectiveness, Adoption, Implementation and Maintenance (Re-AIM) framework will be used to guide the design and evaluation of programme dissemination throughout New South Wales (NSW), Australia. In both phases, teachers will be trained to deliver the NEAT and ATLAS programmes, which will include: (1) interactive student seminars; (2) structured physical activity programmes; (3) lunchtime fitness sessions; and (4) web-based smartphone apps. In the cluster RCT, study outcomes will be assessed at baseline, 6 months ( primary end point) and 12-months. Muscular fitness will be the primary outcome and secondary outcomes will include: objectively measured body composition, cardiorespiratory fitness, flexibility, resistance training skill competency, physical activity, self-reported recreational screen-time, sleep, sugar-sweetened beverage and junk food snack consumption, self-esteem and well-being. Ethics and dissemination: This study has received approval from the University of Newcastle (H-2014- 0312) and the NSW Department of Education (SERAP: 2012121) human research ethics committees.

Background: Despite the health benefits of regular physical activity, most children are insufficiently active. Schools are ideally placed to promote physical activity; however, many do not provide children with sufficient in-school activity or ensure they have the skills and motivation to be active beyond the school setting. The aim of this project is to modify, scale up and evaluate the effectiveness of an intervention previously shown to be efficacious in improving children's physical activity, fundamental movement skills and cardiorespiratory fitness. The 'Internet-based Professional Learning to help teachers support Activity in Youth' (iPLAY) study will focus largely on online delivery to enhance translational capacity. Methods/Design: The intervention will be implemented at school and teacher levels, and will include six components: (i) quality physical education and school sport, (ii) classroom movement breaks, (iii) physically active homework, (iv) active playgrounds, (v) community physical activity links and (vi) parent/caregiver engagement. Experienced physical education teachers will deliver professional learning workshops and follow-up, individualized mentoring to primary teachers (i.e., Kindergarten – Year 6). These activities will be supported by online learning and resources. Teachers will then deliver the iPLAY intervention components in their schools. We will evaluate iPLAY in two complementary studies in primary schools across New South Wales (NSW), Australia. A cluster randomized controlled trial (RCT), involving a representative sample of 20 schools within NSW (1:1 allocation at the school level to intervention and attention control conditions), will assess effectiveness and cost-effectiveness at 12 and 24 months. Students' cardiorespiratory fitness will be the primary outcome in this trial. Key secondary outcomes will include students' moderate-to-vigorous physical activity (via accelerometers), fundamental movement skill proficiency, enjoyment of physical education and sport, cognitive control, performance on standardized tests of numeracy and literacy, and cost-effectiveness. A scale-up implementation study guided by the RE-AIM framework will evaluate the reach, effectiveness, adoption, implementation, and maintenance of the intervention when delivered in 160 primary schools in urban and regional areas of NSW. Discussion: This project will provide the evidence and a framework for government to guide physical activity promotion throughout NSW primary schools and a potential model for adoption in other states and countries. Trial registration Australia and New Zealand Clinical Trials Registry ( ACTRN12616000731493 ). Date of registration: June 3, 2016. ; Other UBC ; Non UBC ; Reviewed ; Faculty