Purpose: Using a single question to assess an individual’s diet quality could reduce researcher burden when screening potential participants for dietary interventions. Thus, the purpose of this study was to determine if United States (US) adolescents can accurately assess the quality of their diet.

Methods: Data from two cycles of National Health and Nutrition Examination Survey (NHANES), 2015-2016 and 2017-2018, were used for this study. Self-assessed diet quality was measured with a single question asking adolescents, aged 16-19 years, how healthy is their diet? The five responses included excellent, very good, good, fair, and poor. Measured diet quality was assessed using the 2015 Healthy Eating Index (HEI-2015) and based on 24-hour dietary recalls. HEI-2015 total scores were categorized using a 10-point grading scale as A (90-100), B (80-89), C (70-79), D (60-69) and F (0-59). The following matches between self-assessed and measured diet quality were classified as accurate assessments: excellent=A, very good=A or B, good=B or C, fair=C or D, and poor=D or F. All others were classified as inaccurate assessments. Descriptive statistical methods for complex survey designs were used to analyze the data.

Results/findings: Based on 1086 adolescents, 7%, 18%, 41%, 29%, and 6% self-assessed their diet as excellent, very good, good, fair, and poor, respectively. For measured diet quality, <1%, 1%, 3%, 11%, and 85% scored grades of A, B, C, D, and F, respectively. Overall, 12% of adolescents accurately assessed their diet quality with accuracy percentages as high as 100% in the poor self-assessment group and less than 10% in each of the other four self-assessment groups. Of the 956 adolescents who inaccurately assessed their diet quality, all but 2 overrated the healthfulness of their diet.

Conclusions: In general, US adolescents cannot accurately assess the quality of their diet with the exception of those assessing the healthfulness of their diet as poor. The tendency of US adolescents to overrate their diet quality suggests that work is needed to educate adolescents about what constitutes a healthful diet with knowledge gained potentially leading to more healthful dietary intake.

Purpose: Before school care within the out-of-school-hours care sector offers morning care to primary/elementary school-aged children. To date there have been limited studies examining the health promotion environments in before school care services, which offer opportunities for targeted settings-based approaches to child overweight and obesity prevention. This study examined the physical activity, sedentary behaviour and healthy eating environments of before school care services.

Methods: A cross-sectional observational study was conducted with 25 before school care services in New South Wales, Australia. Each service was visited twice from March to June 2021. Promotion practices for physical activity and healthy eating were captured via short interviews and the validated System for Observing Staff Promotion of Physical Activity and Nutrition (SOSPAN) tool. Physical activity levels of children were collected using Actigraph accelerometers and analysed using Evenson cut-points. Food provision was assessed using direct observation and categorised according to the Australian Health Survey food classification system and the Australian Dietary Guidelines.

Results/findings: Physical activity data were collected for 654 child days. The average wear time of accelerometers was 63 minutes (> 30 minutes wear time excluded) with children spending 24 minutes/hour sedentary, 36 minutes/hour physically active, and 9 minutes/hour in moderate- to vigorous-intensity physical activity. On the 49 observation days, food provided to the children by services consisted of breakfast cereals and dairy on 100%, other grains on 95.5%, fruit on 20.5%, and vegetables on 2.3% of days. Grain variety was wholemeal/wholegrain 58.6% of the time it was provided. Staff promoted healthy eating on 4.2% of days and discouraged healthy eating on 4.2% of days. Children were involved in preparing their own breakfast on 52.1% of days and had the ability to serve themselves on 54.2%.

Conclusions: Opportunities exist in before school care services to increase the amount of time that children are physically active and the frequency of fruit and vegetables provided. Further research and interventions to promote PA and healthy eating in the setting are warranted.

Purpose: Families are complex, dynamic systems. For instance, prior research has shown that child characteristics, such as weight gain, can increase the likelihood of weight-focused parent-child conversations, and these conversations are, in turn, associated with child health outcomes such as disordered eating. Disentangling these dynamic health and family relationships with traditional statistical approaches is limited, suggesting a need for additional methods that can adequately capture these complex relationships. Systems science approaches, such as systems dynamics, agent-based modeling (ABM), and systems mapping, are a set of tools well-suited to model this complexity. In this presentation, we will: (1) discuss the advantages of using systems science approaches to study families and health, and (2) highlight the application of an ABM that simulates the effects of different parent-targeted interventions aimed at reducing child obesity and disordered eating as they age from adolescence into young adulthood.

Methods: Literature and other sources (e.g., content expertise, comparable models) were used to inform the discussion of leveraging systems science approaches, the inputs to the ABM, and the parent interventions simulated. The ABM was developed using Repast Simphony (version 2.7) and implemented in Eclipse (version 4.12.0). Data from four waves of the Project EAT (Eating and Activity over Time) studies (1998-2016) were used to parameterize and calibrate the model. 

Results: We present three key advantages to using systems science approaches, such as ABMs, to study families. (1) These approaches capture the system of family dynamics, which can change and adapt over time. (2) Before devoting time and resources, models can test and estimate the future effects of proposed family interventions, allowing those most promising to be identified for real-world implementation. (3) Models allow indirect effects and their full impact to be understood over time, including whether unintended consequences are produced (e.g., family interventions that reduce obesity while increasing disordered eating). We use the ABM to illustrate each of these.

Conclusions: Systems science approaches are a valuable set of tools for understanding the complex relationships among parents and children and may advance how best to guide, cultivate, and promote healthy weight and well-being outcomes among families.

Purpose: A more dynamic school day that includes less sitting and more physical activity throughout the day may support health in primary school children. We assessed how Dutch primary school teachers currently use physical activities during their program, and what wishes and needs both pupils and teachers have with respect to a more dynamic school day.

Methods: We used mixed methodologies; we assessed current practice regarding a dynamic school day, wishes and needs of both teachers and pupils through an online questionnaire. Thereafter, we conducted in-depth interviews with classroom teachers and physical education teachers to assess facilitators and barriers for a more dynamic school day. The interview data were transcribed verbatim, and thematic analysis was conducted guided by the framework for innovation.

Results: 336 teachers (207 schools) and 801 pupils (9-12 years old, 10 schools) completed the questionnaire. The physical environment of Dutch primary schools does not stimulate children to be physically active during the school day. Children prefer to be physically active together with classmates and also as an energizer between lessons in the classroom.

Results from the interviews with 24 teachers showed that the facilitators and barriers of teachers to implement a dynamic school day could be categorized into four themes: the teacher, the school, the class/pupils and practical restrictions. If we focus on the barriers the teachers themselves perceived, the main barriers for a more dynamic school day were insufficient knowledge and skills.

Conclusion: Although children like to be more physically active during their school day, teachers report many barriers for the implementation of a more dynamic school day that includes more physical activity and less sitting time. For the implementation of a more dynamic school day, it is probably not enough to only make the environment more stimulating for the pupils. In order to support the implementation of a more dynamic school day, we are currently working on a set of implementation strategies that are tailored to the reported barriers by teachers. 

Purpose: In 2018, Lebanon’s first physical activity report card for children and youth was published, highlighting several intervention priorities and gaps in the literature. To verify how the Lebanese situation evolved, the Lebanese Active Healthy Kids Work Group (LAHKWG) implemented once again an exhaustive synthesis of all recent literature.

Methods: The LAHKWG identified all peer reviewed literature, national surveys, and gray literature (e.g. government reports) that were published since December 2017 on 10 common indicators adopted by the Active Healthy Kids Global Alliance (AHKGA) for the inception of “Global Matrix 4.0”. These indicators were: overall physical activity (PA), organized sport and PA, active play, active transportation, sedentary behaviors, physical fitness, family and peers, school, community and environment, and government. Two additional indicators (sleep and weight distribution) were added by the LAHKWG. The literature search revealed 764 records. Two independent researchers reviewed titles and abstracts to decide whether articles should be fully reviewed. Twenty-eight articles met inclusion criteria and were scrutinized by four researchers. Data from nationally representative samples for ages 5 to 17 years and related to established benchmarks were retrieved and served as the basis for grading the report card.

Results: Data on six indicators from one nationally representative sample were available for ages 13-17 years. No nationally representative data were available for ages below 13. According to AHKGA’s grading rubric, five indicators received an “Incomplete” (Organized sport and PA; Active Play; Physical Fitness; Family and Peers; Community and Environment); two indicators received a D- (Overall PA and school); two indicators received a D+ (active transportation and sleep); two indicators received a C+ (sedentary behaviors and weight status); the government indicator received a C.

Conclusion: Since 2019, Lebanon has been going through difficult times with overwhelming economic and political situations that are exacerbated by the COVID-19 pandemic. Hence, efforts to promote and offer physical activity opportunities for children and youth are essential components to foster mental health, wellbeing, and resilience. This report card highlights multiple areas for the improvement of PA services in Lebanon, and relevant stakeholders are strongly encouraged to take actions for change.