Purpose: Differential exposure to food marketing may be contributing to gender disparities in diet, weight status, and health outcomes. Research has established that food marketers target adolescents on social media; however, little research has examined if and how food and beverage marketing on digital media differs by gender. The objective of this study was to explore whether or not adolescents viewed dissimilar food and beverage categories, food and beverage marketing, and food and beverage marketing techniques on social media, based on their gender.

Methods: This study was a secondary analysis of 49 adolescents’ (aged 12-16) exposures to food and beverage marketing. Content analysis of marketing techniques in each marketing exposure was performed. Chi-square or Fischer exact tests were performed to compare the number of marketing exposures, the healthfulness of food marketing exposures, and the marketing techniques to which boys and girls were exposed.

Results: Overall, adolescent boys and girls were exposed to similar levels of food marketing instances (X= 3.1 for boys and X = 3.2 for girls) per 10-minute period of social media use. Girls observed more marketing for fast food items (n=52, 57% vs n=23, 37%) and ultra-processed foods (n=61, 88%) compared to boys (n=30, 71%; x2 = 5.094, p=0.024). Girls also viewed a greater proportion of exposures that included the presence of adolescents (n=12, 13%, p=0.046), whereas boys viewed a higher proportion of marketing exposures that exhibited appeals to achievement (n=14, 23%, p=0.006), athleticism (n=16, 26%, p=<0.001), and featured an athlete (n=11, 18%, p=<0.001).

Conclusions: This research indicates that gender plays a role when it comes to the digital marketing of unhealthy food and beverages. Marketing techniques, healthfulness of foods, and food categories appear to differ based on the gender of the viewer. Gender is a determinant of health and must be considered in policies that address obesogenic environments. Additional research investigating the gender-based differences of digital food and beverage marketing is necessary to advise the construction of gender-sensitive policies intended to limit unhealthy food marketing to adolescents.

Purpose: In Denmark, 110-130 children are diagnosed with Cerebral Palsy (CP) each year resulting in lifelong challenges affecting the whole family. The Elsass Foundation is a private foundation aiming to improve quality of life for people with CP and their families. The foundation offers a 4-day intensive program to families with 0-4-year-old children with CP, structured as a family-centered intervention. “God Start” means “a good start” and refers to supporting families with children with CP through the early phases of their new life circumstances. The program seeks to improve quality of life by increasing family empowerment and sense of parental competence, including integrating the intensive training-need for these children in everyday life. The purpose is to present the overall outline of the evaluation of “God Start”.

Methods: A logic model, looking at causal mechanisms between program-activities and expected outcomes, developed in spring 2021 together with the “God Start”-staff, formed the basis for the research design.

Data collection is carried out between October 2021 and September 2022. Four independent “God Start" programs will be followed providing data from 24 families.

Data collection consists of:

·      Questionnaires on family empowerment, sense of competence, and quality of life, collected from parents before, two weeks and six months after the program.

·      Observations during the program.

·      Interviews focusing on parent’s experiences with the program will be conducted two-three weeks and six months after the program.

·      Interviews with staff from “God Start” focusing on the interdisciplinary approach will be conducted after the four programs.

Results/findings: At present, no results have been fully evaluated. Preliminary results will, however, be presented at the ISBNPA conference in May 2022. An increase in family empowerment, sense of competence, and quality of life after participating in “God Start” is expected. Additionally, changes in the families’ experience of managing everyday life (e.g. integrating training) is also expected.

Conclusion: The “God Start” program is a potential best-practice example on how to support everyday life and quality of life for families with children with CP, and furthermore, how a family-centered program with an interdisciplinary approach influences the integration of training into everyday life.

Background: Hypertension is the leading modifiable risk factor for cardiovascular disease and mortality. Adopting lifestyle modifications, like increasing physical activity (PA), can be an effective strategy in blood pressure (BP) control, but many adults are not meeting PA guidelines. Financial incentive interventions have the power to increase PA levels but are often limited due to cost. Further, mHealth technologies can make these programs more scalable. There is a gap in the literature about the most feasible and effective financial incentive PA framework, thus pay-per-minute (PPM) and social impact bond (SIB) frameworks were explored.

Objectives: 1) Determine the feasibility (recruitment, engagement, acceptability) of an eight-week mobile-based PPM and SIB hypertension prevention PA program, and 2) explore the effects of PPM and SIB interventions relative to control on PA levels, BP, and PA motivation.

Methods: Adults aged 40-65 not meeting the Canadian PA Guidelines were randomized into the following groups: financial incentive groups, PPM or SIB, or a control group. Feasibility outcome measures (recruitment, engagement, acceptability) were assessed. At baseline and follow up, BP and PA motivation were measured. Changes in PA outcomes relative to baseline were compared among groups at four and eight weeks. Changes in BP and PA motivation relative to baseline were compared at follow-up.

Results: 55 participants were randomized to PPM (n=19), SIB (n=18), control (n=18) groups. There was a 77% recruitment rate and 65% engagement rate. The intervention received positive feedback, with 90% of comments praising the intervention structure, financial incentive, and educational materials. Relative to control at four weeks, the PPM and SIB arms increased their MVPA with medium effect (PPM: η²_p=0.06; SIB: η²_p=0.08). At eight weeks, PPM maintained a small effect relative to control (η²_p=0.003) and SIB displayed a medium effect (η²_p=0.07). Small effects were observed for PPM and SIB relative to control for BP and PA motivation.

Conclusion: The recruitment, engagement, and acceptability results suggest that future full-scale RCT examining the efficacy of SIB, PPM relative to control is feasible. Further, the SIB arm may have a larger effect than PPM in increasing MVPA per week relative control at eight weeks.

Purpose: Accurate heart rate (HR) measures can improve energy expenditure estimates, but motion artifacts limit photoplethysmography (PPG) signal in free-living settings. Reliable automated artifact detection is a necessary first step toward artifact removal and data preservation. Current wearable PPG devices use proprietary algorithms for detecting and removing artifacts, rendering the data unverifiable. The purpose of the current study is to describe an open-source metric of poor PPG signal quality and examine the association with estimated HR accuracy.

Methods: Two datasets were used to develop and validate the ‘self-consistency’ metric of signal quality. The first dataset (Brno University of Technology Smartphone PPG; BUT PPG) was used to derive signal quality cut points. The second dataset (original data collection) was used to validate cut points. Participants were 11 healthy adults (Age 20-42) who completed 19 stationary bike trials while wearing a PPG device and Polar HR monitor. Algorithm derived signal quality metrics were compared with the gold standard criterion of spectrogram visual inspection for motion artifact corrupted data.We used ROC curves to identify area under the curve (AUC) and sensitivity/specificity for different values of the signal quality metric. Correlations were used to examine the association between signal quality and HR error (Mean absolute error [MAE] Root Mean Square Error [RMSE]) between PPG and criterion HR estimates.

Results: ROC analysis on BUT PPG data revealed an AUC of .741 (95% CI .589 to .883) for the self-consistency signal quality metric. We identified a cut-score of >30 for poor signal (sensitivity = .615/specificity .80). In the validation dataset, 6 of 19 observations were identified as poor-quality. There was substantial agreement in poor signal quality detection between self-consistency and visual inspection criterion (Kappa = .872). Signal quality was correlated (r = .79 to .82) with error (MAE and RMSE) between PPG and Polar HR.

Conclusions: This proof-of-concept work can inform measurement of free-living activity outside the lab, where motion artifacts are a reality. The open-source availability makes this tool approachable to applied researchers, thereby overcoming a limitation of the field whereby advances in engineering are not readily adopted in applied public health research.

Purpose: Lifestyle behaviors such as physical activity, healthful eating, and sleep are associated with weight status and overall health, although the focus is often on understanding the behavioral exposures related to development of outcomes such as obesity and chronic diseases. The aim of this study was to examine lifestyle behavioral exposures in the United States adolescent population and their association with the outcome of excellent self-rated health.

Methods: The FLASHE study, a cross-sectional survey conducted by the National Cancer Institute, provided publicly available self-report data. Participants included adolescents (n=1350, mean age=14.5y) with complete data for self-rated health, lifestyle exposures (beneficial and detrimental food intake in accordance with literature on prevention of obesity and cancer, importance of family meals, free time physical activity and sedentary time, meeting sleep guidelines, having a regular bedtime, and having trouble sleeping), and potential confounders (weight status, smoking, age, sex, race/ethnicity, economic status). Logistic regression analyses were used to evaluate associations between lifestyle behavioral exposures and the outcome of excellent self-rated health.

Results: Fewer than half of males (47%) and females (35%) reported having excellent self-rated health. In fully adjusted models, four lifestyle behavioral exposures were significantly associated with excellent self-rated health: beneficial food intake frequency (p=0.004; OR=1.065, 95%CI=1.020–1.112 for each additional exposure); importance of family meals (p<0.001, OR=1.885, 95%CI=1.351–2.630, strongly agree vs not agree); frequency of physical activity in free time (p<0.001; OR=2.167, 95%CI=1.197–3.922, very often vs none); and trouble sleeping (p<0.001; OR=0.416, 95%CI=0.272–0.636, yes vs no). In contrast, the other lifestyle behavioral exposures were not significantly associated with excellent self-rated health: detrimental food intake (p=0.932); sedentary time (p=0.162); having a regular bedtime (p=0.910); and meeting sleep guidelines (p=0.974).

Conclusions: Certain lifestyle behaviors were associated with adolescents’ excellent self-rated health. These findings support interventions targeting improvements in nutrition, physical activity, and sleep among adolescents.

Background: The Borg scale for Ratings of Perceived Exertion (RPE) assesses subjective experiences of physical activity (PA) intensity. While perceived exertion is related to objective measures of exertion, RPE is subjective and can vary between people and within a person depending on time or context. Affect can influence people’s perceptions of pain; therefore, it stands to reason that perceived exertion might be influenced by affect. This study aimed to assess if the link between objectively measured PA and perceived exertion is moderated by negative affect.

Methods: Timeseries data from Fitbits (Charge-2) were collected over a 3-month period from 13 children (7-15 years, 47% female) with overweight/obesity as part of a pilot study examining kidney health. Participants completed daily surveys about their affect over the past day (10-item Abbreviated Positive and Negative Affect Schedule). Surveys were administered 2x/week on random days. Participants completed the Borg scale when they reported engaging in physical activity. Youth had an average of 30 valid days of Fitbit wear (range= 3-53) and completed an average of 11surveys (range= 2-19).

Results: Youth averaged 12.0 minutes of VPA (±8.8) and 50.5 minutes of MVPA (±22.1) daily. On days when youth had higher Borg ratings, they had significantly more VPA (B = 27.6, 95% CI= 4.4, 50.7). For every 1 unit increase in Borg rating, youth had 27.6 minutes more VPA compared to their usual VPA. Increased Borg ratings were not linked with increases in MVPA. Relative increases in negative affect were not associated with changes in MVPA or VPA. The association between change in Borg rating and VPA was moderated by average negative affect. Specifically, among youth with higher average negative affect (compared to their peers) the association between changes in Borg rating and VPA was attenuated (B = -3.0, 95%CI= -5.6, -0.3). Negative affect did not significantly moderate the association between daily Borg rating and MVPA.

Conclusion: Minutes of VPA is less associated with perceived exertion among youth with higher average negative affect. Future studies may include measures of affect prior to intervention engagement to tailor how interventions are delivered.

Purpose: College students’ BMI have been found to increase during the four-year college time, and this puts them at risk of developing weight-related diseases. Many factors relate to this change, like nutrition perception, knowledge and cognition. Undergraduates’ level of healthy eating knowledge is general, but their detailed knowledge is a concern. The purpose of the study was to assess associations between BMI and eating habits among a cohort of college students at a southeastern university in the United States.

Methods: This cross-sectional study assessed demographic characteristics and eating habits of college students (n=1271, aged 18-24) using an online survey. Multiple linear regression analysis assessed participants’ knowledge of healthy eating, problems associated with healthy eating, and feeling about healthy eating as predictors of BMI.

Results: In total, 72.6% of the participants were female, 87.3% were Caucasian, and 36.4% were overweight/obese. BMI was negatively associated with knowledge of healthy eating and feeling about healthy eating. However, there was a positive association between BMI and problems associated with healthy eating. The multiple linear regression model was statistically significant, F (10, 1260) = 12.16, P < .000, and accounted for approximately 8.1% of the variance of the participants’ BMI (R²= 0.088, Adjusted R²= 0.081). BMI was significantly predicted only by knowledge of healthy eating and problems associated with healthy eating.

Conclusions: The findings of this study underscore the need for good knowledge of eating healthy. Understanding and addressing problems associated with eating healthy is key to maintaining good eating habits. This information is vital for nutrition interventions aimed at college students.

 

Purpose: Rapid infant weight gain (RIWG; upward crossing of >1 major centile space on the WHO growth reference chart) is associated with greater risk of childhood obesity. Formula-fed infants are at higher risk of RIWG than breastfed infants. Two possible mechanisms have been hypothesised to explain this association: the formula milk itself and/or bottle-feeding behaviour. The present study used the most detailed data on infant feeding methods collected to date to disentangle whether ‘what’ (formula milk vs. breast milk) or ‘how’ an infant is fed (bottle vs. breast) places them at greater risk of RIWG. 

Methods: Data were from Gemini, a population-based sample of n=4800 British twins born in 2007. Parent-reported infant milk-feeding methods from birth to 3-months of age were categorised into; i) exclusive breastfeeding, ii) breastfeeding and expression of breastmilk, iii) exclusive expression, iv) breast and formula feeding, v) breastfeeding expression and formula feeding, vi) expression and formula, and vii) exclusive formula feeding. The outcome measure was change in weight–SDS from birth to 3- and 12- months. Two General Linear Models examined associations between feeding methods and weight-SDS change, adjusting for infant health and socioeconomic characteristics, excluding infants born <36 weeks’ gestation.

Results/findings: At 3-months (n=2,655) and 12-months of age (n=1,360), infants fed through either exclusive formula feeding (3-months; n=971, β = 0.37, 95% CI: 0.24, 0.52 , 12-months; n=428, β = 0.19, 95% CI: 0.00, 0.40), breastfeeding and formula feeding (3-months; n=896, β = 0.22, 95% CI: 0.08, 0.36 , 12-months; β = 0.24, 95% CI: 0.05, 0.43), and breastfeeding, formula feeding, and expression (3-months; n=148, β = 0.32, 95% CI: 0.10, 0.52, 12-months; n= 85; β = 0.35, 95% CI: 0.05, 0.63) showed significantly higher increases in weight-SDS than exclusively breastfed infants. Infants fed expressed breastmilk did not differ from exclusively breastfed infants (3-months; n=52, β = 0.23, 95% CI: -0.11, 0.57 , 12-months; n= 33, β = 0.00, 95% CI: -0.39, 0.40).

Conclusions: Formula-fed infants, but not expressed milk-fed infants, showed greater RIWG. Hence, ‘what’ (i.e. formula milk) rather than ‘how’ (i.e. through a bottle) might place infants at greater risk of RIWG.

Purpose: Observational studies have reported positive associations between screen time and body mass index (BMI) in early childhood. However, the evidence remains weak since there is a lack of large, longitudinal studies controlling for appropriate confounders, including behaviours competing with screen time. We examined the associations of screen time at age 2 and 3.5 years with BMI from age 3.5 to 7.5 years in 14,220 children from the French nationwide ELFE birth cohort study.

Methods: At age 2 and 3.5 years, parents declared their child’s time spent watching TV, using smartphones, tablets and computers, and playing video games on a typical week and weekend days. At ages 2 months, 1, 2, 3.5, 5.5 and 7.5 years, parents reported their child’s weight, height and measurement dates recorded in their child’s  health booklet. Weight and height measures were modelled using the nonlinear mixed-effect Jenss-Bayley growth model, and BMI (in kg/m²) at age 2, 3.5, 5.5 and 7.5 years was estimated. Associations of daily total and device-specific screen time with BMI were assessed by linear regression adjusted for confounders, including sociodemographic factors, parental BMI, and frequency of children’s outdoor/active plays.

Results/findings: At age 2 and 3.5 years, children accumulated on average (SD) 0.77 (SD: 0.98) and 1.17 (1.01) h/day of total screen time, respectively, predominantly TV time. Mean (SD) BMI was 15.6 (1.3) and 15.3 (1.9) kg/m² at age 3.5 and 7.5 years, respectively. In unadjusted models, total screen time at age 2 years was associated with greater BMI at age 3.5 y (b [95% CI]: 0.06 [0.04, 0.09] kg/m² per one hour increase) and 7.5 y (0.07 [0.03, 0.10] kg/m² per hour). After adjustment, these associations vanished towards the null (-0.01 [-0.01, 0.00] and 0.01 [-0.02, 0.03], respectively). Associations were similar when examining device-specific screen time and screen time at age 3.5 y.

Conclusions: Our results show weak to null associations between early childhood screen time  and  their BMI at a later age after controlling for sociodemographic and behavioural confounders. It supports the time displacement hypothesis suggesting that screen time leads to greater BMI by displacing more active activities.

Purpose: Breakfast can be one of the most problematic behavioral problems in children with feeding difficulties. Important nutrients might be under or overconsumed. The purpose was to examine breakfast consumption, nutrient profile, and food sources of children with feeding difficulties. 

Methods: This was a cross-sectional study with 137 children (M= 3.91, 95%CI 3.39, 4.42 years; 63.5% male) with complaints of feeding difficulties from the childcare center. Socio-demographic characteristics were pulled down from the clinical anamnesis. Parents self-reported their children's diet intake via a 24h-recall. Breakfast consumers were defined as those consuming the first meal of the day between 5-10 am, comprising any energy-containing food/beverages. Nutrient profiles were identified, and energy food sources were classified according to the adapted NHANES/WWEIA classification system. Descriptive statistics, Kruskal-Wallis, and t-student test with a significant level of 5% (p<0.05) were used. 

Results: The majority of children were consuming breakfast (80.3%) and 63.95% of the children were picky/fussy eaters, followed by 31.58% with limited appetite. The median energy intake for breakfast was 54.67kcal (IQR 16.54, 115.20). Comparing the nutrient profiles with age groups, infants consumed higher amounts of carbohydrates, protein, vitamin A, zinc, phosphorus, thiamin, niacin, vitamin B6, and vitamin K as compared to preschoolers and schoolers. Alternatively, schoolers have a higher intake of vitamin C, calcium, magnesium, dietary fiber, potassium, and, iron. Preschoolers showed higher intakes for trans-fat, cholesterol, riboflavin, vitamin B12. Baby-food formulas, baby cereals, milk, and bread were among the top energy food sources, regardless of age group, sex, and type of feeding difficulties. 

Conclusion: Infants presented better vitamin and nutrient intake as compared to older children. Food sources have been limited and this situation is not satisfactory. Thus, there is a need for actions to improve regular and well-balanced breakfast for children with feeding difficulties. 

Purpose: Exclusively breastfed (EBF) newborns wake more often than partially breastfed, or exclusively formula fed (EFF) newborns, yet have equivalent 24hr sleep durations. Contextual factors during the first weeks of life related to these associations are understudied. We examined relationships among post-birth experiences, sleep-wake patterns, and feeding practices through three weeks post-delivery.

Methods: English or Spanish speaking mothers (n=36) and their full-term (≥37wk), singleton infants were recruited from Phoenix, Arizona. Mothers were 31.9±4.5y, 41.7% identified as Hispanic, 22.2% with < high school degree, and 36.1% were enrolled in the federal Women, Infants, and Children program. Infants were born normal weight (2500-4000g) and without major complications. Mothers completed the Brief Infant Sleep Questionnaire-Revised and an adapted Infant Feeding Practices Study-II questionnaire at three weeks post-delivery. Pearson correlations and t-tests examined relationships between sleep-wake patterns (e.g., nocturnal wake duration, sleep duration [diurnal, nocturnal, 24hr], and sleep quality), and feeding practices at birth and 3 weeks post-delivery.

Results: At birth, all mothers attempted breastfeeding, 37.1% of infants received formula, and 14.3% received sugar water at the hospital. Mean time for milk to come in was 2.6 days (range: 1-5). At three weeks, three mothers were EFF, 47.2% (n=17) were EBF, and 44.4% (n=16) were mixed feeding. Infant sleep-wake patterns included: nocturnal wake duration of 1:47±1:04; nocturnal and diurnal sleep duration was 8:40±1:50 and 7:40±2:50, respectively; 24hr sleep duration of 16:20±3:07; and 58.3% reporting their infants slept well/very well at night. Breastmilk feeding frequency was positively related to nocturnal wake duration (r=.42, p=.012) and nocturnal sleep duration (r=.36, p=0.03). Formula feeding frequency was negatively related to nocturnal wake duration (r=-.42, p=0.012) and nocturnal sleep duration (r=-.41, p=0.016). Greater time for milk to come in was associated with greater diurnal sleep duration (r=.38, p=0.03), poorer nocturnal sleep quality (t[-11.9]=31.1, p<0.001), and greater likelihood of receiving sugar water in the hospital (t[2.9]=12.7, p=0.013).

Conclusions: Feeding experiences and ability to breastfeed during the first days of life may play a role in the quality and patterning of sleep among newborns. Future research should investigate whether these associations persist into later infancy

Physical activity is a critical issue that cannot be ignored in promoting the sustainable development of humans. In China, the national education policy affects how college physical education courses can improve the overall quality of young people through the means of improving physical activity, and promoting the overall development of their physical and mental health, This study’s primary aim was to examine the effect of physical education on physical activity and mental health at a university in China through a longitudinal investigation.

Methods: Convenience sampling was used, which collected a total of 264 Chinese students attending university. The students were followed from the beginning to the end of the school year (October 2020 to June 2021). The participants were given questionnaires to assess their physical activity (PA), self-efficacy, self-esteem, resilience, and anxiety. ANOVA was used to test gender and age differences, the relationship between PA, self-efficacy, self-esteem, resilience, and anxiety have tested by Pearson correlation coefficient, the repeated measures analysis of PA, self-efficacy, self-esteem, resilience, and anxiety in university students that were examined by t-test.

Result: The main finding showed that PA, self-efficacy, and self-esteem developed over the course of 8 months of physical education; the result proved gender differences that were found in PA, self-esteem, resilience, and anxiety had age differences. PA (t= -11[-.45,-.31]), self-efficacy (t=3.6[-2.0,-.59]), and self-esteem (t=1.9[-1.3,.09])  had developed significantly over the course of 8 months of physical education. 

 

Conclusion: In China, the lack of sports competitions may affect the resilience of college students when improving their health via physical education.

 

 

Purpose: Stakeholder input is vital to defining adaptive implementation strategy approaches that tailor intensity of implementation support delivery to optimize resources for broader scalability. This study sought to (a) collect stakeholder input on crucial decision points and tailoring variables and (b) use this input to specify an adaptive implementation strategy matched to site needs.

Methods: The current study’s focus is on the evidence-based nutrition program, Together, We Inspire Smart Eating (WISE). Stakeholders with prior experience in WISE (e.g., food service staff, teachers, administrators) were recruited from ECE settings in two states in the southern USA to participate in semi-structured interviews or focus groups via video conference. Questions were designed to elicit feedback on crucial decision points and tailoring variables for an adaptive implementation strategy for WISE. Interviews and focus groups lasted 45-60 minutes. Data analysis included reviewing reflection notes, listening to recordings, and reading transcripts before coding and collating feedback across participants. A quasi-statistical approach to analysis summarized the most prevalent suggestions before consensus discussions across the research team.

Results: Stakeholder input contributed to 3 crucial decision points: 1) low intensity implementation support will include leadership commitments, local champions, an implementation blueprint, a classroom reminder for teachers, and task-focused facilitation at the site level; 2) response to low intensity will be assessed in October of the school year; and 3) sites not responding to low intensity by October will have the additional strategies of holistic individualized facilitation and tailored educational materials at the teacher level. This reflects that stakeholders emphasized that all sites need some facilitation; struggling sites need more. Stakeholders also helped to define the tailoring variable to identify non-response; stakeholders said that sites with a minority of classrooms achieving fidelity to WISE evidence-based practices (< 60%) would need high intensity support.

Conclusions:  This study illustrates the use of stakeholder feedback for defining the key elements of an adaptive implementation strategy. Our approach has significant potential to specify adaptive implementation strategies for scaling health-related EBPs in ECE and other settings (e.g., home visiting, worksites, and schools). The adaptive implementation strategies will be tested in a future, full-scale trial.

Purpose: Few studies describe sport participation patterns in the general population using multiple characteristics, which limits available information for designing and implementing programs aimed at improving physical activity levels. Since better insight into the natural evolution of sport participation will help inform more effective sport and physical activity programs, the objective of this study was to identify sport participation profiles during adolescence and to describe transitions across profiles from grades 5 to 12 (age 10 to 18 years).

Methods: We used data from 916 participants (55% girls; age 10-12 years at inception) of the Monitoring Activities of Teenagers to Comprehend their Habits (MATCH) study. Participants self-reported involvement in 36 different sport and physical activities three times per year from grades 5 to 12 (maximum of 24 data collection cycles from 2011-2018). At each school grade, we derived four categorical variables of yearly sport involvement: number of organised sports (0, 1, 2, 3+), number of unorganised activities (0, 1, 2, 3+), weekly physical activity sessions (<7, 8-13, 14-20, >20), and number of year-round activities (0, 1, 2+). To identify sport participation profiles, we used latent class analysis at each grade. To identify transitions between sport participation profiles across grades, we used latent transition analysis.

Results: Five distinct sport participation profiles emerged: ‘non-participants’, ‘unorganised activity only’, ‘single-sport low frequency’, ‘single sport high frequency’, and ‘multi-sport’. While participants classified as ‘non-participants’ rarely transition towards higher active profiles, only ‘multi-sport’ participants were unlikely to be classified as ‘non-participants’ over time. Further, given the stability of the ‘non-participant’ profile, results study suggest that it will be difficult to improve physical activity levels of youth with this sport participation profile.

Conclusions: This study highlights the importance of encouraging multi-sport participation to protect against later non-participation in sport and physical activity, and helps identify important times to intervene for improving physical activity levels. Using multiple characteristics when describing sport and physical activity profiles provides unique insight into behavior patterns of teenagers. 

Fussy eating – a common behavior during toddlerhood – is a source of stress and concern to many parents. Addressing parents’ concerns about fussy eating is important, as concern for fussy has been shown to mediate the use of nonresponsive feeding practices, such as pressure and using food to reward eating. Previous research has reported on parents’ interest in accessing support online and the importance of using co-design methods to develop health promotion interventions.

The aim of this presentation is to describe the online, iterative ‘co-design sprints’ used to develop Fussy Eating Rescue, a web-based intervention to promote responsive feeding among parents concerned for toddler fussy eating.

Using the tenants of Agile Design, Fussy Eating Rescue was iteratively developed during three cycles of ‘co-design sprints,’ with each cycle occurring over a period of 5 to 9 days. The cycles consisted of four steps: (1) prototype development, (2) real-time prototype refinement with participants during online co-design interviews, (3) analysis, and (4) identifying and prioritizing refinements to be included in the next cycle’s prototype. A convenience sample of Australian parents concerned about their toddler’s fussy eating were recruited to participate. WordPress was selected for prototype development because its ‘what you see is what you get’ editing capabilities facilitated real-time co-design with end users. The final version of Fussy Eating Rescue underwent two rounds of usability evaluation, which included cognitive interviews and rating via the System Usability Scale (SUS).

Nineteen parents participated in the co-design sprints, providing input on the features, content, layout, and functionality of the web app. Based on feedback received during the co-design sprints, Fussy Eating Rescue underwent substantive changes. Eight parents participated in the first found of usability evaluation, which showed an acceptable mean SUS of 75 (SD 19.2). Refinements made based on cognitive interview findings resulted in a higher mean SUS in Round 2 (mean = 81, SD 7.2).

Online co-design sprints with a real-time prototyping platform was an effective means of developing an online intervention for parents concerned for fussy eating. An ongoing pilot randomized-control trial will provide further insights into its acceptability and efficacy.

Purpose: The aims are to (1) estimate the shape and number of cardiorespiratory fitness (CRF) trajectories from childhood to adolescence; and (2) verify whether CRF trajectory membership can be predicted by sex, biological maturation, body weight, body composition and physical activity (PA) in childhood.

Methods: Longitudinal data from QUALITY, an ongoing cohort study on the natural history of obesity, were used. Participants had at least one biological parent with obesity and the ones retained for analysis all performed a maximal cycling test at baseline. They attended a baseline visit (8-10 years, n=630) and follow-up visits two (n=564), and seven years (n=359) after baseline. Peak oxygen consumption (VO_2peak), assessed by an incremental cycling test, was used to assess fitness. Moderate-to-vigorous PA (Actigraphy) was analyzed in min/day. Height and body weight were measured using standardized methods and body composition was evaluated by DXA. Group-based trajectory analysis for relative VO_2peak (ml·kg^-1·min^–1) was performed (SAS/ACCESS® 9.4). A logistic regression model estimated the associations between baseline predictors of trajectory membership, including sex, age, biological maturation and weight (IBM SPSS Statistics, Version 25.0). Results: Mean age of the 454 participants retained for analysis was 9.7±0.9 years at baseline. Three distinct VO_2peak trajectories were identified a

nd all tended to decrease. Groups were labeled “Low-Decreaser”, “Moderate-Decreaser” and “High-Decreaser” (Reference trajectory), describing the starting point and slope. High-Decreasers were mostly prepubertal boys, had lower body weight and fat free mass index, higher PA levels and higher VO_2peak (ml·kg^–1·min^–1) at baseline (X² and t-test, p<0.05). Female sex and higher weight were associated with a greater likelihood of classification in the Low-Decreaser trajectory (OR=74.03, 95%CI=27.06-202.54; OR=1.48, 95%CI=1.36-1.60) while those with higher PA were less likely to be Low-Decreasers (OR=0.96, 95%CI=0.94-0.97) compared to the reference trajectory.

Conclusions: It appears that sex, body weight and PA are key determinants of VO_2peak (ml·kg^-1·min^–1) trajectories reflecting the transition from childhood to adolescence. The observation of an apparent role of PA in the attenuation of the decrease of VO_2peak over time provides an additional argument to encourage regular PA participation in childhood and adolescence.

Purpose: To estimate the shape and number of mechanical efficiency (ME) trajectories from childhood to adolescence; and verify whether ME trajectory membership can be predicted by sex, biological maturation, body weight, body composition and physical activity (PA) in childhood.

Methods: Longitudinal data from QUALITY, an ongoing cohort study on the natural history of obesity, were used. Participants had at least one biological parent with obesity and those retained for analysis performed a maximal cycling test at baseline. They attended a baseline visit (8-10 years, n=630) and follow-up visits 1 (n=564), and 2 (n=359). ME was assessed by an incremental cycling test at 50w (ME_50w,%) and at VO_2peak (ME_VO2peak,%). PA (Actigraphy) was analyzed in min/day. Height and body weight were measured using standardized methods and body composition was evaluated by DXA. Group-based trajectory analysis was performed. A logistic regression model estimated the associations between baseline predictors of trajectory membership, including sex, age, biological maturation and weight.

Results: Mean age of the 454 participants (boys=54%) was 9.7±0.9 years at baseline. Two distinct ME_50w trajectories were identified and all tended to decrease. No distinct trajectories emerged for ME_VO2peak; average ME_VO2peak increased over time. Thus, the difference between ME_VO2peak (∆) at baseline and follow-up was calculated for correlation analysis. Groups were labeled “Low-Decreaser” and “High-Decreaser” (Reference) for ME_50w, describing the starting point and slope. High-Decreasers were mostly prepubertal girls, had lower body weight and fat free mass index, lower PA and lower VO_2peak at baseline (χ²or t-test, p<0.05). Girls were less likely to be Low-Decreasers (OR=0.56, 95%CI=0.42-0.74), while having overweight/obesity predicted a greater likelihood of classification in the Low-Decreaser trajectory (OR=2.38, 95%CI=1.16-4.88). Those with higher PA were more likely to be Low-Decreasers (OR=1.02, 95%CI=1.01-1.04). Finally, concerning ME_VO2peak, sex, biological maturation, body weight, zBMI, fat free mass index, PA and VO_2peak were positively correlated with ∆ ME_VO2peak.

Conclusions: We found evidence that excess weight predicts low levels of ME in childhood and adolescence. Additionally, higher PA at baseline is not related to higher ME_50w levels. More research is needed to identify different approaches to explore this measure over time, especially at VO_2peak.

Purpose: The rate of adult obesity in the United States is over 42%. Obesity is a complex problem and is the result of many factors including unhealthy eating patterns, lack of physical activity, food insecurity, and low health literacy. For this reason, efforts to reduce obesity and obesity-related chronic disease must address these issues on multiple fronts.  The purpose of DFEND was to develop and implement a multimedia approach to enable and reinforce healthy eating patterns and physical activity in adults during the COVID-19 pandemic.

Methods: Participation was open to all adults over the age of 18 years.  DFEND was a 20-week mHealth program offering weekly live Zoom sessions focused on behavior change; weekly e-newsletters, weekly personalized sessions with experts in physical activity, behavior change, and nutrition; weekly YouTube demonstrations, a private Facebook group, and "Fast Facts" posted on the DFEND website.  A digital survey assessing health status, negative emotional state (DASS), sleep (PSQI), and dietary intake was administered pre-, mid-, and post-intervention and changes within individuals were compared using multilevel negative binomial regression.

Results: Between 40-100 unique participants joined weekly Zoom Sessions and 190 participants received the e-newsletter.  For all participants beginning DFEND and completing pre-assessment surveys (n=65, 86% females, mean age=40.5), the mean DASS depression score was 5.5 (SD 5.4, n=64), anxiety was 4.0 (4.3, n-65), stress was 6.7 (5.6, n=63) and the mean PSQI was 6.7 (4.7, n=51).  In participants who completed at least 2 assessments (n=33), DASS depression scores decreased from 10.7 (SE 3.4) at pre-assessment, to 8.9 (2.9) at mid-assessment, and 7.4 (2.5) at post-assessment (p=0.292). DASS anxiety scores decreased from 7.2 (SE 1.2) at pre-assessment, to 6.8 (1.2) at mid-assessment, and 4.0 (0.8) at post-assessment (p=0.004). DASS stress scores decreased from 10.9 (SE 2.5) at pre-assessment, 12.4 (2.8) at mid-assessment, and 8.4 (2.1) at post-assessment (p=0.129). Sleep scores did not change with 4.9 (SE 0.6) at pre-assessment, 4.6 (0.5) at mid-assessment, and 4.3 (0.6) at post-assessment (p=.687)

Conclusions: Participation in a multimedia mHealth program focused on behavior change improved sleep, depression, anxiety, and stress during the COVID-19 pandemic.  However, further research is needed. 

Purpose: Longitudinal data from the CDC suggests that the prevalence of obesity has increased from 19.3% to 22.4% over the pandemic months among 2-19 years of age and the rate of weight gain increased (Lange et al, 2021). The purpose of the current study is to compare the prevalence of obesity and body mass among 6th-8th grade children between pre-pandemic and post- pandemic periods in a rural mid-western community and evaluate body mass gains based on BMI classifications.

Methods: Students in grades 6-8 (n=1045, age = 12.8 ± 0.94 yrs) participated in school health screenings of body mass and stature in 2017. Students from the same school district in grades 6-8 (n=936, age = 13.2 ± 0.84 yrs) participated in screenings in 2021. To account for the significant difference in age, a weight-for-age ratio was determined. Weight status was defined using CDC age-and-gender growth charts.

Results: Although not significant, prevalence of obesity increased from 17.8% in 2017 to 19.1% in 2021 (p>0.05). Children in the normal weight category had a weight-for-age of 7.9 ± 1.2 lbs/yr in 2017 which was significantly greater in 2021 (8.3 ± 1.2 lbs/yr, p<0.05).  No significant differences were found in weight-for-age between 2017 and 2021 for children with overweight (10.2 ± 1.1 vs 10.3 ± 1.1 lbs/yr, p>0.05) or obesity (13.2 ± 2.2 vs 13.3 ± 2.3 lbs/yr, p>0.05).

Conclusion: Although not significant, over the pandemic, obesity prevalence increased 1.3% and body mass averages were higher. However, children in the normal weight category weighed significantly more, had higher BMI and weight-for-age ratios in the post pandemic period. The children in the normal weight category may have experienced greater life changes over the pandemic resulting in less activity and more unhealthy habits than the children with overweight or obesity.

Purpose: Studies show that rural schools may be less supportive of student fruit/vegetable (FV) consumption, but few studies have investigated the relationship between school locale and FVs. The aim of this research is to analyze the relationship between school locale (rural vs. urban) and students’ FV selection, consumption, and waste in elementary, middle, and high schools.

Methods: A cross-sectional analysis of 37 Arizona schools evaluated differences in the selection, consumption, and waste of fresh FVs from students (n=2525; 45.7% female; 41% non-white; mean age=11.6±3.3; 23.5% rural) using objective plate waste measures. Zero-inflated negative binomial regressions examined differences in FV grams selected, consumed, and wasted by urban vs. rural locale, adjusted for sociodemographics and school.

Results/findings: The percent of students who selected, consumed, and wasted zero grams of FVs were 14%, 21%, 20%, respectively. Among students with some (non-zero amounts), the average selected, consumed, and wasted FVs were 115.0±81.4g, 51.7.5±65.4g, 65.2±66.7g, respectively. Rural students (versus urban) had lower odds of selecting (OR=0.84, 95% CI: 0.60, 1.18), consuming (OR=0.87, 95% CI: 0.66, 1.16), and wasting (OR=0.71, 95% CI: 0.53, 0.95) any FVs, after adjusting for covariates. However, among students with some FVs on their plates, rural students selected (IRR=1.46, 95% CI: 1.39, 1.54), consumed (IRR=1.20, 95% CI: 1.08, 1.33) and wasted (IRR=1.71, 95% CI: 1.59, 1.84) more grams of FVs.

Conclusions: Rural students had reduced odds of selecting and consuming any FVs, but with lower odds of waste, perhaps due to reduced selection. Once some FVs were on the tray, likelihood of consumption and waste by rural students were greater. Results support interventions targeting rural students’ FV intake to reduce waste.

Purpose: The purpose of this study was to better understand the experience of dinner acquisition and preparation for caregivers of young children enrolled in childcare. Researchers also sought to assess caregiver experiences with food purchasing, dinner choices, and balancing caregiver responsibilities and dinner preparation.

Methods: This study utilized a non-probability, voluntary sample of families from three childcare sites recruited to participate in a pilot dinner service program (N=33). Participants were asked to complete a 45-60 minute individual interview session using a semi-structured interview guide focused on meal acquisition behaviors. Interviews and transcripts were recorded via Zoom transcription and later reviewed by research team members for accuracy. NVivo Qualitative software v.12 was used to code transcripts using a priori thematic analysis and to apply latent themes. Transcripts were blindly reviewed and coded by two researchers with any discrepancies reviewed and discussed. Inter-rater reliability in the code application was greater than 90%.

Results: Emerging themes centered around meal planning, food purchasing, dinner choices, and balance between caregiver responsibilities and dinner preparation. Participants discussed general feelings towards meal planning, time management, and dividing parental responsibilities. Many respondents reported that they liked cooking on weeknights (n=14, 44%), while other caregivers described cooking as stressful and time-consuming (n=8, 25%). Factors that appeared to affect food purchasing and dinner choices included whether family members would like or eat it (56%), cost (28%), convenience (12%), and the healthfulness of the food (34%). Dissatisfaction about dinner choices was often tied to disliking new meals (20%), fast food consumption (25%), feeling stressed (20%), and a hectic workday (15%). Support strategies that helped caregivers provide healthy dinners included meal planning, meal and shopping organization, time management, sharing responsibilities with partners, and using or purchasing outside support and resources.

Conclusions: This study provided a narrative of how parents of young children in childcare experience, structure, and think about dinner acquisition and preparation. The results of this study also highlight strategies and sources of support that could serve as potential avenues for future interventions aimed at providing home cooked, nutritious, affordable meals for families.

 

Purpose: Current guidelines recommend physical activity throughout pregnancy to achieve significant health benefits. Yet only ~15% of pregnant individuals meet the guidelines of 150 minutes of moderate intensity physical activity each week. In non-pregnant samples, weight stigma experienced in physical activity settings results in avoidance of moderate to vigorous physical activity but this has not been examined in pregnancy. Therefore, we aimed to explore experiences of weight stigma in physical activity settings during pregnancy.

Methods: An online cross-sectional survey was administered to Canadians who were ≥12 weeks pregnant. Participants were asked to indicate if they had experienced any form of weight stigma during their pregnancy, and if they have specifically experienced this in physical activity related contexts. If yes, an open-ended response option allowed for them to provide examples. A content analysis was completed on provided examples to conceptualize experiences of prenatal weight stigma specifically in relation to physical activity.

Results: Two-hundred and fifty-four pregnant individuals completed the survey.  Nearly half experienced weight stigma in the current pregnancy (n=121), and of those, 58% (n=71) specified weight stigma in physical activity-related contexts. Examples of weight stigma were provided and categorized into two main themes: 1) negative judgement and 2) exclusion from physical activity. Negative judgements were explicit statements or perceived judgement in physical activity related settings based on weight gain (e.g., being told one is ‘too heavy’ and therefore should be active). Exclusion was characterized as feeling as though others do not want or do not include individuals who are pregnant in physical activities because of their current weight or weight gain.

Conclusion: Pregnant individuals may experience weight stigma in physical activity related contexts, and future studies should explore whether this influences physical activity levels and guideline adherence. By understanding causes of weight stigma, mitigation strategies can be developed and implemented to improve inclusivity in prenatal physical activity.

Purpose: Our understanding of how the intervention process impacts socio-economic inequalities is limited. We aimed to explore this during the implementation and evaluation of the secondary school-based GoActive physical activity (PA) intervention.

 

Methods: The GoActive trial was a cluster-randomised control trial of a universal school based programme to increase moderate-to-vigorous PA (MVPA) among 13-14-year-old UK adolescents (n=2862 from 16 schools). Using school environment and student data, we investigated if and when socioeconomic inequalities arose across 6 stages in the intervention process, as follows: (1) the provision of and access to intervention resources at baseline (2) individual uptake of the intervention (3) differential intervention efficacy (accelerometer-assessed MVPA) (4) differential long-term compliance (5) differential response in evaluation (6) variation in health outcomes (e.g. BMI z-score, waist circumference). We explored these stages using a combination of self-report and objective measures. Data were analysed by individual- and school-level socioeconomic position (SEP) using a combination of classical hypothesis tests and statistical modelling.  

 

Results: (1) There was no difference in provision by school-level SEP. (2) There was no difference in intervention uptake and engagement by individual-level SEP. (3) At post-intervention, subgroup analyses showed a positive intervention effect on MVPA in low-SEP adolescents (3.13 minutes/day, 95%CI: -1.27,7.54) but not for middle/high (-1.49 minutes/day, 95%CI: -6.54,3.57). (4) At 10-months post intervention, this difference in effect increased (low SEP: 4.89 minutes/day, 95%CI: 0.96,9.70; middle/high SEP: -2.76; -6.78,1.26). (5) There was lower compliance to evaluation measures among low-SEP adolescents, which increased though the intervention process (e.g. % accelerometer non-compliance low vs. high SEP: BL: 11.6 vs. 7.5; post-intervention: 38.4 vs. 30.8; 10-month follow up: 45.5 vs. 29.8). (6) There was a suggestion of a favourable intervention effect on the BMI z-score of low-SEP adolescents (Low SEP: -0.96;-0.19,0.00, medium/high: 0.03;-0.047,0.12). 

 

Conclusions: These findings show the potential for school-based PA interventions to have a positive effect on PA and BMI in low-SEP adolescents, suggesting universal interventions could help to reduce existing inequalities. However, differential response to evaluation measures may have biased these conclusions. We therefore need to develop strategies to better engage adolescents from all backgrounds in the research process.

 

Purpose: Food addiction is a growing area of eating behavior research and most studies have occurred in the clinical population. College-attending young adults are at an emerging time period of life during which lifelong lifestyle behaviors are established. The purpose of this study is to investigate the prevalence of food addiction in college-attending young adults and its relationships with other eating styles and expectations. 

Methods: College students enrolled during the fall 2022 semester were invited to participate in an online survey via Qualtrics. Survey items used validated tools including food addiction using the Yale Food Addiction Scale 2.0, eating styles using the Three Factor Eating Questionnaire which has subscales of cognitive restraint, emotional eating, and uncontrolled eating, and anticipated effects of food using the Anticipated Effects of Food Scale. Descriptive statistics were computed for all variables. Food addiction scores were categorized into no, mild, moderate, and severe food addiction. One-way ANOVA was used to examine significant differences in mean eating styles and anticipated effects of food scores among each level of food addiction severity. All analysis was conducted using JMP Pro Version 16.0.

Results/Findings: Respondents (N=1645) were primarily female (76.2%) and had a mean age of 22.03 + 5.15. The prevalence of food addiction was 21.9%, with 5.7% having mild food addiction, 4.7% having moderate, and 11.5% having severe food addiction. One-Way ANOVA showed that more severe food addiction was significantly associated with lower cognitive restraint scores (p<.0001), higher uncontrolled eating scores (p<.0001), and higher emotional eating scores (p<.0001). More severe food addiction was also associated with higher negative expectancies for junk food (p<.0001) and healthy food (p<.0001), but not with higher positive expectancies for junk food (p= .07745) or healthy food (p=0.8255).

Conclusions: Results indicate that there is a significant prevalence of food addiction in college-attending young adults, and that individuals with food addiction have difficulties with emotional eating and controlling their food intake. Further, they may anticipate negative feelings after eating any type of food. These findings contribute to the understanding of the mental and emotional burden of food addiction.

Purpose: Accurate measurement of physical activity energy expenditure (PAEE) is critical to understanding the complex and interdependent relationship between PAEE and health outcomes. While accelerometry and heart rate (HR) devices provide objective measures of PAEE, validation studies of objective monitors to measure energy expenditure (EE) suggest the combination of HR and accelerometry may provide more accurate estimates than either method alone. The purpose of this systematic review and meta-analysis is to quantify the difference in PAEE estimates when measured via HR or accelerometry alone and in combination (accelerometry+HR).

Methods: Four electronic databases (i.e., PubMed, SportDiscus, ScienceDirect, and Web of Science) were systematically searched for published validation/calibration studies of objective, research-grade devices that examined the validity of using accelerometry and HR to estimate PAEE against criterion measures. To be included, studies had to estimate PAEE with HR or accelerometry alone and in combination in human populations. Search results were imported into Endnote for duplicate removal, pre-screened for exclusion terms and uploaded into Covidence for additional screening, review, study selection, and data extraction.

Results/findings: 42,792 articles were originally identified from the search strategy. After removing duplicates (n = 14,132) and pre-screening titles and abstracts based on certain exclusion words (n = 17,644), 11,016 were included in the initial title and abstract screen. To date, 7,719 articles have undergone title and abstract screening (70%), with 203 full-text articles retrieved and 9 articles identified for inclusion thus far. Preliminary analyses on the 9 included studies indicates accelerometry, HR, and accelerometry+HR explains 76.0% (SD=13.6%), 83.1% (SD=11.2%), and 90.9% (SD=4.4%) of the variance in PAEE, respectively. Meta-regression estimated accelerometry+HR explained 20% (95CI=10%, 30%) more variability in PAEE when compared to accelerometry and 13% (95CI=2.0%, 23%) more variability when compared to HR. Further, compared to accelerometry, HR explained 8.0% (95CI=-2.0%, 19.0%) more variability in PAEE, but the difference did not reach statistical significance.

Conclusions: Preliminary analyses from this ongoing systematic review and meta-analysis indicate the combination of accelerometry+HR explains substantially greater variability in PAEE than either HR or accelerometry alone and likely leads to more precise and accurate estimates. Final results will be presented at the conference.

 

Introduction: The Generation Health Program (GHP) is a community-based 10-week healthy living program designed for families with children (8-12 years of age) who are off the healthy weight trajectory (BMI ≥85^th percentile ). Due to the COVID-19 pandemic, the GHP was adapted to virtual delivery, which consisted of 10 weeks of weekly online group sessions and access to a self-guided online portal. The purpose of this study was to assess the effectiveness of the GHP program delivery during the COVID-19 pandemic. 

Objective: Evaluate the changes in children’s physical activity, eating behaviours as well as parental healthy living support behaviours pre and post the GHP intervention.

Methods: Families with children aged 8-12 years old with a BMI ≥85^th percentile were recruited in British Columbia, Canada. Virtual delivery GHP programs took place between April 2020 to July 2021. Families were asked to complete an online assessment pre and post GHP intervention. The program curriculum focused on family involvement, healthy eating, physical activity, sleep and mental health.  Parental support for child healthy eating and physical activity, child’s dietary behaviours and physical activity were assessed using validated questionnaires pre and post the program. Paired T-tests and effect size (Cohen’s d) were used to examine changes in intervention outcomes.

Results: Participants (n=106 families) were representative of the BC population (white: 60%; Bachelor’s degree or higher: 38%). Over the 10-week intervention, participating families spent an average of 421 minutes accessing the weekly e-sessions on the Family Portal. Children significantly improved moderate-to-vigorous physical activity levels (D = 0.42±1.99; p <.001, d=.21) relative to baseline. However, no significant changes in child fruit and vegetable intake were observed following the intervention. Parents significantly improved home healthy food environment (D = 2.10±0.89; p = .014; d=.24) and support for physical activity (D = -1.21±1.90; p < .001; d=.63) following the intervention.

Conclusion: The adapted virtual GHP showed potential effectiveness in improving children’s physical activity behaviour and parental support behaviours. Lessons learned from this COVID-adapted GHP can be used to further enhance virtual family-based childhood obesity management programs.

Purpose: The Generation Health Program (GHP) is a free, family-based 10-week healthy living program aimed to prevent and manage childhood obesity. Pre-COVID-19, GHP consisted of 10 weekly in-person and self-guided online sessions plus four additional community-based sessions. During the pandemic, GHP transitioned weekly in-person and community-based sessions to video conference delivery. The purpose of this study was to evaluate program implementation following transition to a virtual-only delivery model.

Methods: Families with children aged 8-12 years old with a BMI ≥85^th percentile were recruited in British Columbia (B.C.), Canada. Virtual delivery GHP programs took place in B.C. from April 2020 to July 2021. Family level implementation measures were reach, recruitment, satisfaction, and barriers/facilitators to participation. Program delivery level measures were adoption, acceptability, and barriers/facilitators to implementation. Data was collected through parent and child satisfaction surveys, attendance forms, and post-program parent and program leader interviews. Interviews were transcribed and categories identified. Descriptive statistics were used to examine recruitment and satisfaction.

Results: 106 families enrolled in the four program cycles affected by COVID-19; some families delayed enrollment to wait for in-person programs. 73 families commenced the program and 53 completed. Participants were representative of the B.C. population (white: 60%; Bachelor’s degree or higher: 38%). Parent and child satisfaction ratings were over 3/5 for all measures. Barriers to participation included: too much screen time (“Zoom-fatigue”) and holding participants’ attention; families reported few technology issues. Facilitators to participation included: time saved not travelling, no transportation concerns, free of cost, learning from the comfort of home, and complimentary recreation passes.

Program leader interviews showed acceptability across all sites (interview participation=93%). Barriers to implementation were recruitment, small group size, families arriving late, and families dropping to wait for in-person programs. Facilitators to implementation were increased participant attendance and engagement, and improved participant support from program leaders.

Conclusions: The virtual GHP was acceptable and feasible for both families and program delivery partners but additional benefits and challenges of virtual delivery were highlighted. These results can help improve future program delivery and scalability of GHP and other virtual family-based healthy living and childhood obesity management programs.

Psychologists and mental health clinicians have unique skills to assist interdisciplinary teams. Mental health clinicians help with the prevention and management of chronic diseases in primary care settings through health behavior change interventions.  This poster will describe the workflow of a Veterans Health Administration team of Primary Care- Mental Health Integration (PCMHI) clinicians in Veterans Integrated Service Network (VISN) 21 Clinical Resource Hub (CRH), and their implementation of behavioral medicine interventions via telehealth. Behavioral medicine referral reasons included Type 2 and pre-diabetes, sleep-related concerns, chronic pain, obesity, tobacco use, and at-risk alcohol use.  We examine patterns in total referrals, referral reasons, and percent change in referral trends as a function of clinic location and specialty of referring provider since program inception in 2018. Recommendations for program development and quality improvement are discussed.

Food addiction (FA) has been operationalized through the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) eleven diagnostic criteria for substance-related and addictive disorders (e.g., tolerance, withdrawal, higher than expected consumption, unsuccessful attempts to reduce). FA has been associated with greater psychopathological severity (e.g., higher psychiatric comorbidities, cravings, shape and weight concerns, and psychological distress) and even more when co-occurring with the binge eating disorder (BED). However, the important comorbidity between these two conditions makes it difficult to capture the contribution of FA to the global psychopathological severity. The purpose of this study was to examine the psychopathological severity according to the presence or absence of FA and BED. The sample included 158 adults (≥ 18 years old, BMI ≥ 25 kg/m²) consulting for weight and eating-related problems. They completed a diagnostic interview and questionnaires assessing eating behaviors (Yale Food Addiction Scale 2.0, Three Factors Eating Questionnaire, Binge Eating Scale, Grazing Questionnaire, and Food Craving Questionnaire - Trait, reduced), body satisfaction (Body-Esteem Scale for Adolescents and Adults), depressive symptoms (Beck Depression Inventory-II) and personality traits (Temperament and Character Inventory). Participants were separated into four groups: no diagnosis (n=42), FA (n=57), BED (n=8), and FA+BED (n=51). Comparative analyses (M/ANOVA) were performed without the BED group given the small number of participants in this group. Overall, for eating behaviors, body satisfaction, and depressive symptoms, the FA group showed higher severity than the no diagnosis group and the FA+BED group showed even higher severity compared to the other two groups. For personality traits, two differences (harm avoidance and self-directedness) between the FA+BED and no diagnosis groups were demonstrated. It seems important to consider FA as well as BED since both are associated with increased psychopathological severity. Although the study does not establish causality, it suggests that the combination of FA and BED is associated with even greater psychopathological severity. To get an accurate picture of the psychological severity of patients presenting with weight and eating-related problems, eating disorders evaluation and weight measurement are largely insufficient. The assessment of FA is a quick complement that fulfill this purpose.

Purpose: Cardiac telerehabilitation interventions could improve participation rates by addressing access barriers, but evidence to guide implementation in real-world clinical settings is lacking. We explored stakeholders’ perceptions about critical factors that are likely to impact on successful translation of cardiac telerehabilitation into clinical practice in Western Victoria, Australia.

Methods: We recruited consumers [adults with CAD/ACS]; cardiac rehabilitation (CR) practitioners; and CR providers [healthcare managers]) from one metropolitan and three regional healthcare centers. We conducted semi-structured interviews (with consumers) and focus group discussions (1 each with practitioners and providers per site) when coincidentally, Victoria, Australia had experienced a strict lockdown due to the COVID-19 pandemic. Two implementation research frameworks (Consolidated Framework for Implementation Research [CFIR] and Nonadoption, Abandonment, Scale-up, Spread, and Sustainability [NASSS]) were used to guide interviews and discussions with the participants. An inductive analysis was carried out to identify emerging themes.

Results: In total, 47 stakeholders participated in the study (16 consumers, female=5, 61.1±10.0y; 20 practitioners, female=14, 36.6±11.8y, primarily exercise physiologists; 11 providers, female=7, 46.2±9.2y, primarily coordinators). Data were collected between February–October 2020. We identified six emergent themes: (1) Targeting the participants, (2) Knowledge, (3) Resources, (4) Change management, (5) Design, and (6) Regulation, which altogether consisted of 23 sub-themes. The sub-themes included a range of barriers and facilitators perceived imperative by the participants to implement cardiac telerehabilitation successfully. Perceptions were generally consistent across study sites, but the value proposition may be site-specific, and there was some variation between stakeholder groups.

Conclusion: Our study highlighted the need for a thorough strategy to address barriers and leverage facilitators for the successful implementation of cardiac telerehabilitation. Defining how cardiac telerehabilitation could be integrated into routine service adds value to the existing healthcare delivery practice.

Background: Built environment approaches are recommended to improve population physical activity levels. Implementation strategies are needed to improve uptake, but little is known about effective strategies in to translate research to practice in community settings.

Purpose: Inform implementation strategies through understanding delivery agents’ perceptions of 1) built environment approaches, 2) a toolkit developed to support implementation, and 3) other required implementation strategies.

Methods: A toolkit was developed to detail the process of partnering to change the built environment and provide examples of built environment approaches (e.g., walking paths, traffic calming). Data were collected through focus groups (N=3) with Extension Agents (n=46) in 2020. The semi-structured focus group script was based on the Consolidated Framework for Implementation Research and the Technology Acceptance Model. Rapid content analysis techniques and an inductive, grounded theory approach were used to interpret the data.

Results: Focus groups generated meaning units coded into themes of perceptions of the intervention (subthemes: barriers, resources needed, and facilitators) and perceptions of the toolkit (subthemes: components to add, positive perceptions, helpful components). The most common resources needed were coalition guidance and funding.

Conclusions: Agents experience barriers and facilitators to implementing built environment approaches and have specific needs for support. Based on the results, we created implementation strategies: 1) Places for Physical Activity toolkit, 2) Coalition Coaching, and 3) Mini-Grants. Future work is needed to investigate the effectiveness of these implementation strategies.

4-H is a worldwide youth development program found in over 50 countries. The goal is to increase the likelihood that a child will grow into a successful, thriving adult. The “H’s” stand for Head, Heart, Hands, and HEALTH. In the United States, poor diet quality and obesity are major obstacles to healthy living.  A top reason cited for this by Americans is a lack of food preparation skills, which results in the purchase and consumption of ready-made fast and prepared foods high in ultra-processed ingredients. In order to address this barrier to healthful eating, the 4-H Youth Development Program teaches cooking skills to children and teens using a teens-as-teachers approach. 

Partnering with federally funded nutrition education programs, 4-H uses the motivational force and educational pedagogy of having older teens and young adults teach to children in out-of-school group settings. This harnesses the desire of adolescents to have increasingly meaningful responsibilities (care and contribute), to work with peers (connect), and to gain employment experience for future college and career success (competence and confidence). By integrating positive youth development theories into nutrition programs, we increase not just the likelihood for dietary change, but also for broader improvements in the adolescents intellectual and emotional development.
Afterschool sites in 3 counties in California participated in the Cooking Academy. Fifty youth completed the pre/post standardized national Expanded Food and Nutrition Education Program Surveys. The data is being entered into the federal WebNEERS system for analysis.
Preliminary analysis show that 91% of youth improved their abilities to choose nutritious foods. Qualitative findings regarding teen perception of leadership skills will be presented. Teens also reported positively on their experience as a teen teacher, with scores ranging from 3.3 to 4.0 on a 4 point scale. 
Nutrition education has primarily relied on psychology (and to a lesser degree educational) research to guide its approaches. By recognizing that the field of youth development can provide significant contributions and suggestions, and integrating these principles into nutrition education programs, we can continue to improve the effectiveness of our interventions.

Purpose: In Denmark, 110-130 children are diagnosed with Cerebral Palsy (CP) annually resulting in lifelong challenges affecting the whole family. The Elsass Foundation is a private foundation aiming at improving quality of life for people with CP and their families throughout a lifespan. Among many initiatives, the foundation has developed a 4-day intensive program (“God start”) for families with 0-4-year-old children with CP. “God Start” means “a good start” and refers to supporting families with children with CP through the early phases of their new life circumstances. The program is structured as a family-centered intervention where physio- and occupational therapists and psychologists work in interdisciplinary teams to meet each family’s individual challenges. The program seeks to improve quality of life by increasing family empowerment and sense of parental competence. The purpose of this abstract focuses on integrating the children’s intensive training-needs into everyday life using a playful approach, which serves as a huge challenge for many families.University of Southern Denmark serves as evaluators of the “God Start” program.

Methods: Data collection is carried out between October 2021 and September 2022. Four independent “God Start” programs are assessed, providing data from a total of 24 families. Data includes observations during the program; questionnaire surveys on family empowerment, sense of parental competence and quality of life; interviews with families and professional staff.

Results/findings: For now, no results have been fully evaluated. However, preliminary results will be presented at the ISBNPA 2022 conference. It is expected that the developed program focusing on ‘playful training’ instead of ‘training as training’ will have a positive impact on the families’ senses of competences, quality of life and experience of managing everyday life.

Conclusion: The “God Start” program is a potential best-practice example on how to approach families with children with CP. The evaluation will contribute to the rather limited knowledge on how to support everyday life and quality of life for families with children with CP. Furthermore, the study will contribute to the knowledge of switching focus from a training approach to a playful approach when working with 0–4-year-old-children and their families.

Pediatric weight management interventions (PWMI) are shown to reduce child weight status but detailed information on implementation fidelity is needed to determine under which circumstances the intervention is effective. The purpose of this study is to report on the inter-rater agreement between an expert direct observer and trainees for a piloted fidelity direct observation assessment of a PWMI, Building Healthy Families (BHF). Direct observations occurred weekly for 12 weeks in 4 Midwest micropolitan communities. Three additional communities will implement BHF in the Spring of 2022.

 

A qualitative iterative process was used to create and refine a fidelity assessment to capture adherence to protocol, dose, quality of delivery, and participant engagement (n=8 research team members). We developed and piloted a fidelity checklist specific to the core BHF components to measure the session structure (e.g., adherence to core program components, the learning objectives met, and the planned activities completed) and process (e.g., the quality of delivery and adaptations). Items for activities completed and if adaptations occurred were scored yes or no, and the session objectives, structure, and process items were scored on a 3-point scale (0=did not cover, 1=inconsistently covered, 2=completely covered). An expert observer trained direct observers (n=6) by attending and completing assessments at sessions together until interrater agreement of >85% was reached for two consecutive sessions. On disagreements, observers were required to be within plus or minus one point of the expert observer to observe sessions independently. Sessions were recorded for future training purposes in the event of turnover or additions to staff to decrease burden of traveling.

 

All observers reached >85% agreement with the expert observer by their second session and were able to observe community BHF sessions independently. The observers agreed on 144 out of 172 (83.7%) observations over 5 BHF sessions and were within plus or minus one point for 100% of the observations. Observers have attended 5 cohorts of BHF and performed direct observations for approximately 60 BHF sessions.

 

Fidelity assessment is essential to identify which components of BHF contribute to outcomes and provides guidance to translate a PWMI into diverse settings.

Purpose: Insufficient physical activity tends to be more prevalent among socioeconomically disadvantaged groups. There is evidence that this group might be more effectively reached through environmental and community-based approaches than through individual interventions, meaning that local physical, political, economic and sociocultural factors could play a more important role in promoting physical activity. The aim of this study is to investigate the perceived environmental factors influencing recreational walking behavior among Flemish socioeconomically disadvantaged adults. This study is part of the CIVISANO-project (“a mixed-method project using community-based approaches to tackle disparities in health behaviors in the Flemish peri-urban environment”).

 

Methods: Purposeful convenience sampling was used to recruit 38 socioeconomically disadvantaged participants (16 males, 22 females) between 25 and 65 years old in two Flemish peri-urban municipalities in Belgium between July and November 2021. Individual walk-along interviews have been conducted in the neighborhood environment of the participants to identify the role of perceived environmental factors on recreational walking behavior. Furthermore, a short questionnaire assessing sociodemographic information and individual community-related empowerment have been conducted. After initial preliminary analysis, four focus groups (n=20) took place for member checking and to identify possible local actions based on the perceived environmental factors. After both the individual interview and focus group sessions the participants were asked to complete an evaluation form for process evaluation. Interviews and focus groups were recorded and transcribed ad verbatim. MaxQDA will be used for both inductive and deductive analysis. 

 

Results: These walk-along interviews and focus groups are expected to result in detailed and context-specific insights in the role of the local environment on recreational walking among Flemish socioeconomically disadvantaged adults. Furthermore, tangible actions and local policy recommendations will be proposed by the participants. Results will be available in the upcoming months. 

 

Conclusions: This community-based participatory approach will contribute to our understanding of how to maximize research impact in a local setting and to create effective evidence in linking recreational walking among socioeconomically disadvantaged adults with the physical, political, economic and sociocultural environment. 

Introduction: The demands of working and parenting young children create a challenge in finding time to plan and prepare nutritious family meals. A social cognitive approach was used to identify the importance of parental support, parental satisfaction, and self-confidence on food agency.

Methods: A cross-sectional survey was conducted in Cabarrus County, NC including 34 caregivers of preschool age students attending childcare. Participants completed a 67-item online survey via Qualtrics assessing parental responsibilities, self-efficacy, meal behavior patterns, and weight. A univariate analysis was conducted using SAS 9.4 version.

Results: Most of the respondents were non-Hispanic white (66%) and shared the responsibility of childcare with another adult in their home (84%). All of the participants reported being satisfied with their role as a parent and enjoyed spending time with their children. Similarly, 100% of the respondents reported having some level of confidence in their ability to prepare and serve healthy foods and beverages in an appetizing way (some confidence: 87.5%, completely confident: 12.5%) and create a positive atmosphere for mealtimes (some confidence: 81.3%, completely confident: 18.8%). Additionally, almost 97% of the participants responded to having some confidence in being able to properly prioritize spending time on locating healthy foods and beverages for purchase in preparation for cooking a healthy meal for their children.  Finally, three quarters of the parents reported having confidence in their ability to be a good role model for their children about healthy eating and drinking.

Discussion: The findings of this study suggest that the participants have a high level of parental satisfaction and self-efficacy in providing a healthy food environment for their children. These parents displayed the confidence in being able to plan and prepare meals in an appetizing way for their children. The shared responsibility of parenting with a partner in the home likely allows for time to confidently prepare nutritious meals. Future research should include evidence-based interventions that investigate the frequency of healthy meal preparation of parents who display high levels of confidence and healthy food access.

 

Purpose: Children in the United States consume less than the recommended amounts of fruits, vegetables, whole grains, and dairy. The National School Lunch Program (NSLP) serves nearly 30 million children daily, and has the potential to influence the diet quality of children. However, high levels of food waste in the NSLP have been observed, particularly for fruits and vegetables. The purpose of this descriptive study was to identify which school lunch menu items students wasted and fully consumed most frequently.

Methods: Students (n=2,881) from elementary, middle, and high schools (n=37) in Arizona, USA who received school lunch were randomly selected and assented for participation. Individual student lunch trays were photographed before and after the students ate their meal. Trained raters (3 per tray) visually estimated if menu items were untouched (0%), partially (1%-99%) or fully (100%) consumed. An expert adjudicator resolved any disagreements between raters. Menu items were standardized and categorized into the following menu categories: entrée, fruit, vegetable, and beverage. The frequency menu items untouched or fully consumed were summarized in percentages by menu category and stratified by elementary, middle, and high school level.

Results: Across all school levels, tortilla wraps, whole packaged apples, and cherry tomatoes were the most frequently untouched entrée, fruit, and vegetable menu items, with 40%, 57% and 70% of servings untouched, respectively. Chicken fingers, bananas, and tater tots were the most popular entrée, fruit, and vegetable menu items with 75%, 51% and 55% of servings fully consumed, respectively.  White milk and juice were the most untouched beverages, both of which had 20% of servings untouched. Cold vegetables were untouched with the greatest frequency, with 39% of all servings untouched. High school students fully consumed entrees, fruits, and vegetables with greater frequency than elementary and middle school students.

Conclusion: Results can help schools to plan menus with food items that are more popular among their students. Further research should also examine why high school students are fully consuming their meals more frequently than elementary and middle school students.

Purpose: To explore mothers’ experiences and perceptions of complementary feeding recommendations in the primary care setting.

Methods: Mothers of infants aged 4-11 months were recruited from WIC offices in Rhode Island and later through snowball sampling. Semi-structured telephone interviews were conducted in English and Spanish. Participants were asked about their experiences with infant feeding, what feeding advice they had received, what their child’s pediatrician had told them about infant feeding, and their overall impressions of child wellness visits. Inductive and deductive thematic analysis informed by Grounded Theory and the Fundamentals of Care theoretical framework, respectively, was performed to identify themes in the data.

Results: The average age of the sample (n=13) was 30 years, 62% were Latina, and 77% were receiving WIC benefits at the time of the interview. Five major themes were identified. Overall, mothers reported their wellness visits as positive with most being satisfied with their visits and the childcare recommendations they received, even when visits were virtual (theme 1). They trusted the information they received from their pediatrician and perceived them as knowledgeable about pediatric health and valued meaningful connections with them (theme 2). While all reported trusting the pediatrician, most also felt that many feeding recommendations are vague or not applicable to their child’s behaviors or their own cultural preferences (theme 3), and that they are comfortable using alternative sources of advice to fill these gaps (theme 4). The participants described ways to improve the feeding recommendations within well child visits, most notably the need for additional take-home materials on feeding (theme 5).

Conclusions: Despite having positive opinions of pediatric primary care, this predominantly Latina sample of mothers did not always perceive pediatricians’ infant feeding recommendations as comprehensive enough to meet their needs. Improving the content, delivery, and cultural relevance of infant feeding recommendations in primary care settings with more specific and tailored information may promote maternal adherence to evidence-based feeding practices.

Purpose: Specialized analytic techniques have gained popularity to account for multi-level or correlated/non-independent determinants of physical activity (PA) behavior, including those related to park use. However, no current research has compared different statistical approaches for analyzing correlated park use data. The objective of this study was to compare marginal and conditional modeling approaches for identifying neighborhood, park, and individual predictors of park use.

Methods: The current data were derived from the ParkIndex parent study, which occurred in 128 census block groups in Brooklyn (NY), Seattle (WA), Raleigh (NC), and Greenville County (SC). Adult survey respondents (n=320) provided demographic/behavioral characteristics and indicated parks within one half-mile of their block group used within the past month. Parks (n=263) were audited using the Community Park Audit Tool and a composite park quality metric was created. Measures were collected at the individual (park visitation, PA behavior, sociodemographic characteristics), park (distance to each park, park quality, park size), and block group (count of neighborhood parks, population density, age structure, racial composition, walkability) levels. For conditional and marginal modeling, generalized linear mixed models and generalized estimating equations were used, respectively. Ten-fold cross-validation was completed using Root Mean Squared Error (RMSE) to compare the predictive value of models.

Results/findings: In the conditional model, significant park use predictors included population >65yrs (β=0.02,p<.0001), distance from residence to park (β=0.56,p<.0001), park quality (β=0.03,p=.0024), participant race (non-White: β=-0.48,p=.0057), and participant education (2-4-year college: β=0.57,p=.0185; advanced degree: β=0.84,p=.0008). For the marginal model, significant park use predictors included population>65yrs (β=0.02,p<.0001), distance from residence to park (β=0.64,p<.0001), participant race (non-White vs White: β=-0.41,p=.0118), and participant education (2–4-year college: β=0.75,p=.0001; advanced degree: β=0.98,p=<.0001). RMSE for the conditional final model was 0.34, compared to 0.36 for the marginal model.

 

Conclusions: Conditional and marginal models identified similar park use predictors, with the only difference being the significance of park quality, but the conditional model showed the best predictive value. Results can inform research identifying multi-level determinants for park use by providing input on the most appropriate analytic techniques. 

Purpose: Prevention interventions often have an insufficient planning quality. Thus, an evidence-based development and a successful implementation are not guaranteed. Planning tools such as the Intervention Mapping Approach (IMA), which is a gold standard for project planning, cannot be used in practice without preconditions. Developing interventions according to the IMA is complex and requires resources such as time and personnel. Against this background, the research project WEPI was developed to design a digital evidence-based and user-oriented planning tool that promotes the planning process of childhood obesity prevention interventions. The project is funded by the Federal Ministry of Health, Germany.

Methods: From April 2019 to October 2020 the digital planning tool WEPI was developed. In October 2020 and February 2021, WEPI was tested by selected municipalities (n = 4) in Bavaria and schools (n = 4) in Lower Saxony for the first time. Test persons created prevention programs with WEPI and evaluated the comprehensibility and user-friendliness. Based on this, the modified version was tested a second time (05-11/2021) with a larger group of participants from municipalities and schools. Handling and acceptance of the planning tool were evaluated through a questionnaire survey.

Results: The first testing showed that aspects of content and wording as well as technical aspects should be optimized to improve the user-friendliness. Nevertheless, test persons described WEPI as structured and self-explanatory. WEPI offers evaluated and proven intervention methods as well as a download area, e.g. template for project application or summaries. This service had a high level of acceptance and helps to ensure planning quality. The second testing has already been completed by 6 municipalities (mainly health and district offices) and 4 people from the school sector. Initial feedback is already available.

Conclusions: WEPI helps practitioners to approach project planning in a structured way, with a balance of input and benefit. It was a challenge to implement the feedback of the first testing because scientific findings needed to be translated into practical logic and had to be simplified. After the second testing, further adjustments will be necessary. Nevertheless, prevention planning becomes more evidence-based and user oriented with WEPI.

Purpose

This study investigated relationships between body composition, low physical activity levels and sedentary behaviour in 12-year old children living in the North West Province of South Africa. It was assumed that sedentary behaviour will add to health risks in children. Limited information is available regarding health risk behaviour such as physical inactivity and overweight and obesity in South African children during later childhood, and this investigation can improve understanding of the contribution of these aspects to health risks in children.

Method

A cross sectional analysis within the NW-CHILD longitudinal study included 12.92±0.42, year-old children (N=587, boys=302, girls=282, white=151, black=433; Low SES, n=46, high SES, n=238). Fat percentage and BMI was used as body composition characteristics. Physical activity levels were assessed with the Physical Activity Questionnaire for Children (PAQ-C) and sedentary behaviour by means of the Sedentary Behaviour Questionnaire. Statistica for Windows was used to analyse data. Relationships were analysed using non-parametric Spearman Rank Order Correlations and were considered practically significant based on the following cut-points: 0.1 (small), 0.3 (medium) and 0.5 (large).

Results

A percentage of 18.01% overweight and obesity were found. A small percentage (10.79%) of the group was low active, while 58.56% were moderately active. Small relationships were established between BMI and fat percentage and physical activity which were influenced by race, gender and socio-economic status. Total sedentary time showed small, although higher correlations with fat percentage compared to with BMI, which was influenced by television viewing hours, travelling time and by other sedentary technologies. Sedentary behaviour during the week and weekend was the highest in high socio-economic status (SES) school’s and in girls.

Conclusion

Childhood obesity is a serious health risk that increase with alarming proportions, and physical inactivity and sedentary time in children are often linked to health risks like overweight and obesity. South African children is not excluded from these risks which is associated with increasing obesity. Health practitioners are therefore important to intervene and to assist children to receive adequate opportunities to be physically active.

Purpose:             Regular participation in physical activity improves health and well-being. This study therefore sought to establish the relationship between physical activity participation variables and cardiorespiratory fitness levels of members in Ghanaian fitness Clubs. 

 

Methods:                    A descriptive correlational design was used for the study. The sample for the study was 546 Club Members from 18 fitness clubs randomly selected from clubs within the Greater Accra Region of Ghana. Questionnaire and Cooper ‘12 minutes’ walk/run test were used to gather data for the study. Inferential statistics of Pearson Product Moment Correlation Coefficient and Multiple Regression were used to test hypotheses at 0.05 level of significance. 

 

Results/findings:       (74.9%) of the club members possess minimum levels of cardiorespiratory fitness (CRF) needed to develop health whilst (25.1%) had low levels that needed improvement, positive significant relationships existed between CRF and Physical Activity Index (PAI) (‘r’=.324,p=.000), Exercise Equipment and Machines (EEM) (‘r’=.178,p =.000), Variety of Physical Activity (VPA) (‘r’=.115,p =.007) while no positive significant relationship existed between CRF and Mode of Instruction (MOI) (‘r’= .065, p=.178 all 2-tailed; and(14.1%) of CRF was predicted by all variables (R square =.141) 

 

Conclusions:              The study concluded that members in Ghanaian fitness clubs had minimum levels of CRF required for health development implying that improvements in fitness levels can be achieved if the right knowledge on the specific aspects of exercise prescription is applied. It was recommended that stakeholders in the Ghanaian fitness industry should collaborate to institute national policies for the organization of mass sports.    

 

Purpose: COVID-19 restriction lockdown targeted at preventing the spread of the pandemic may also have deleterious effects on physical and psychosocial health. This study examined the levels and associations among Physical Activity (PA), sedentary behaviour, health-related quality of life (HRQoL), loneliness and sleep quality during the COVID-19 restriction lockdown in Nigeria.

Methods: 507 adult Nigerian citizens domiciled in the country completed an online links of the International Physical Activity questionnaire, SF-12 questionnaire, loneliness questionnaire, International Sedentary Activity questionnaire, and Pittsburgh Sleep questionnaire. Data were also obtained on sociodemographic information. Respondents were grouped into non-exercisers (reference group), non-regular exercisers and regular exercisers using the stages of change scale. Results: 66.7% of respondents were engaged in moderate-vigorous PA and 90.7% had good sleep qualities. The median scores for sedentary behaviour, the physical and mental components summaries of HRQoL, and loneliness were 5.0, 79.2, 55.0, and 7.0, respectively. Only physical component summary of HRQoL (B = 17.92, 95% CI 1.23 - 34.61) was positively associated with total PA after controlling for sociodemographic variables. Pre Covid-19 lockdown, the odds of reporting being regular exercisers was significantly higher for respondents 35 years and older compared to those who were 18-24 years old. During the Covid-19 lockdown, those who are age > 44 years (OR = 3.65, 95% CI 1.47 -9.07), 35-44 years (OR= 6.42 95% CI 2.75 - 14.96) and 25-34 years (OR = 2.35 95% CI 1.15 - 4.80), and, respectively) had significant higher odds of being regular exercisers compared to 18-24 years.

 

Conclusion: There was a high prevalence of physical inactivity in this sample with the Physical component summary of HRQoL being the only predictor of PA during the COVID-19 lock down restriction. Age was a significant predictor of perceived exercise behaviour pre- and during the COVID-19 lock down restriction. 

Purpose: To understand predictors of food insecurity among households with children in the United States (U.S.) during the COVID-19 pandemic.

Methods: A 52-question survey using validated instruments was created and distributed online between April and September 2020 across five states. Respondents who indicated residing in a household with at least one child during the COVID-19 pandemic (<18 years old) were included in this analysis (n=1,199). Logistic regression examined odds of food insecurity (i.e., lacking access to enough safe and nutritious foods) versus food security among U.S. households with children by urbanicity (measured using Rural-Urban Commuting Area codes), race/ethnicity, age, marital status, household size, education, federal nutrition assistance participation, economic hardship, and foods not available when shopping during the COVID-19 pandemic, a priori p<0.05. The model was informed by historical U.S. data on sociodemographic characteristics and food insecurity. Open-ended survey questions about the types of foods not available in stores were grouped by category.

Results: Urbanicity was not predictive of food insecurity (p>0.05) among households with children. Hispanic (compared to non-Hispanic white) respondents in households with children were 4.28 times more likely to report food insecurity (95%CI 1.90-9.75, p<0.01). Other predictors of food insecurity among households with children included: respondents between the ages of 25 and 44 (p<0.05); being widowed, divorced, or separated (OR 2.45, 95%CI 1.15-5.22; p<0.01), food assistance participation (OR 3.93, 95%CI 2.55-6.06; p<0.01), economic hardship during the COVID-19 pandemic (OR 4.93, 95%CI 3.15-5.87; p<0.01), and foods not available when shopping (OR 2.42, 95%CI 1.55-3.77; p<0.01). With each additional adult household member, odds of food insecurity increased (OR 1.37, 95%CI 1.14-1.63; p<0.05); the number of children in the household was not associated with food insecurity. Respondents (n=942) listed 3,104 food items as not available during the COVID-19 pandemic. These items were in majority grains (32%), proteins including meats, fish, and eggs (23%), dairy products (12%), and vegetables (10%).

Conclusions: The COVID-19 pandemic negatively impacted food security among U.S. households with children across five states and likely exacerbated existing nutrition and health inequities. Food supply interventions during crisis situations are also warranted to improve food security among households with children.

Building Healthy Families (BHF) is a 12-week, adapted evidence and family-based pediatric weight management intervention focusing on behavior change strategies, improved dietary intake, and increased physical activity. A backward design approach was used to create an online blueprint for implementation of BHF in micropolitan and surrounding rural communities. This process included identifying multiple user groups and solicitating feedback by each user group. The purpose of this study was to determine the initial utility of the BHF resources and program package based on feedback from health promotion practitioners.

We used a convergent parallel mixed methods design. Participants included 4 community advisory board members and 15 health promotion practitioners. Quantitative data collection included an adapted 31-item survey to measure perceptions of the innovation (BHF package) and factors that influence program adoption and implementation outcomes (e.g., intervention acceptability, appropriateness, and feasibility). Descriptive statistics were used to summarize results. All scales demonstrated good internal consistency reliability (α≥.81). Thematic coding was used for qualitative data collection and included an open-ended questionnaire to explore perceptions of BHF and functionality of the website.

Mean results from the survey indicated BHF is highly acceptable, appropriate, and feasible [4.49±.74, 4.50±.46, and 4.54±.49, respectively (maximum 5)]. Additionally, of a maximum 7 points, relative advantage (6.39±.59), ease of use (6.57±.67), and trialability (6.46±.83) of the package were rated favorably. Compatibility (5.61±1.05) and observability/result demonstrability (5.68±.74) of the package received moderately favorable scores. Qualitative responses were coded and grouped into three categories: acceptability (n=54), complexity (n=157), and adaptation (n=101). Overall, participants found the package, content, and program expectations acceptable. Responses indicated the website was easy to use, and suggested adaptations were straightforward fixes to content, resource formatting, and website functionality.

Results demonstrate positive overarching perceptions of the BHF packaged program and resources. Qualitative data provided excellent direction for modifications to reduce program complexity and improve acceptability. Action items as the result of this study included improvements to website aesthetics, flow of information, generalizability of content, reduction of repetitive content, and correction of errors in website navigation and document labeling.

Purpose: Excessive screen use in early childhood may cause serious consequences for health and development, such as decreased self-regulation and parent-child interactions. The American Academy of Pediatrics (AAP) suggests limiting screen time (ST) to one hour or less per day for children aged 2–to-5-years-old. Yet, prevalence and correlates of ST in Chinese preschoolers are unknown. This study determined (1) the prevalence of children ages 4-5 meeting (≤1 h/d) vs exceeding (>1 h/d) ST guidelines and (2) the correlates associated with failing to meet these guidelines.

Methods: A total of 2092 preschool children and their families were recruited from four kindergartens in Jiaxing, Zhejiang, China. Children’s screen-based sedentary time was assessed via parent-proxy report. Screen-based sedentary behaviors were categorized as (1) watching TV, (2) using tablets or mobile phones, and (3) using computers or other electronic devices. Time spent on sedentary behaviors was further quantified as (1)“no more than 30 minutes per day”, (2) “30 minutes to 60 minutes per day”, (3) “1 hour to 2 hours per day”, (4) “2 hours to 3 hours per day”, and (5)“more than 3 hours per day”. Potential correlates included caregivers (i.e., parents vs. grandparents), screen accessibility, parental perception on child ST, and ST rules were also collected. Descriptive analyses as to meeting vs exceeding guidelines were computed while factors associated with exceeding ST guidelines were examined using a generalized estimation equation.

Results/findings: Prevalence of preschoolers meeting and exceeding ST guidelines were 59.56% and 40.44%, respectively. Factors that were significantly associated with exceeding the ST guidelines were being cared by grandparents (X²=16.63, p<0.001), screens were more accessible (X²=132.82, p<0.001), less parental perception (X²=14.57, p<0.001), fewer ST rules (X²=90.19, p<0.001), and more parental ST (father: X²=94.71, p<0.001; mother: X²=100.80, p<0.001).

Conclusions: A large proportion of Chinese preschoolers are not meeting ST guidelines. Our findings have significant implications for health initiatives and educational campaigns aiming to reduce ST exposure in Chinese preschool-aged children. Future research to further explore potential home environment mediators of ST and how screens were used (e.g., solitary vs co-viewed) is warranted. 

Purpose: The prevalence of Type II diabetes and obesity has risen in Bangladesh. The aim of this work is to investigate the lifestyle behaviors among the Type II diabetic patients in Bangladesh. The scope of lifestyle behaviors studied in this survey includes food consumption, physical exercise, sleep duration and obesity grade in an integrated nutritional support program at rural and urban community settings.

Methods: A baseline cross-sectional study was carried out among 512 rural and 715 urban Type II diabetic patients aged 40-80 years randomly selected from two communities. Information about the participant's socio-economic and dietary patterns, physical exercise schedule, sleep duration and body mass index (BMI) measurement were collected by related appropriate techniques. Data was analyzed by using SPSS software.

Results: The prevalence of obesity (BMI≥30) among the Type-II diabetic patients was significantly different between genders (male 79.7% vs. female 65.8%) and community settings (rural 57.7% vs. urban 82.3%).  However, in females, the prevalence was higher in rural compared to urban areas. Food consumption for the energy, body-building and protective groups significantly differ between rural and urban settings but did not differ markedly between males and females. Various processed foods, sugary foods and beverage consumption patterns also significantly differed in rural and urban diabetic patients. The consumption rate of various sources of food from selected food groups for the rural and urban subjects were respectively: energy 47% and 34%, sugary foods and beverage 7% and 15%, processed foods 12% and 19%, body-building 18% and 23%, and protective foods 16% and 9%. Sleep duration was below the recommended level in both males and females and did not significantly differ between rural and urban subjects. The duration of physical exercise differed significantly (p< 0.05) between rural (27±7 minutes/d) and urban (20±5 minutes/d) areas.

Conclusions: The baseline survey exhibited lifestyle behavioral differences among Type II diabetes subjects in rural and urban settings in Bangladesh. Poor dietary behavior, insufficient sleep, and physical exercise may predispose to Type II diabetes and Obesity. Awareness of lifestyle behaviors among Type II diabetes patients is of critical importance based on the findings in this survey.

Purpose: Many children and older adults do not meet the WHO physical activity (PA) guidelines, despite the physical and mental benefits of sufficient PA levels. In recent years, increased attention has been devoted to intergenerational PA programs because they may have several benefits for children and older adults (e.g., learning skills from each other, improved social well-being, reduction of ageism). An intergenerational PA program focusing on grandchildren and -parents is innovative and may hold potential to promote PA and create better family ties in both children and their grandparents. We aim to develop such a program, using co-creation in order to facilitate future implementation and upscaling.

Methods: The theoretical framework Behaviour Change Wheel in combination with a co-creation approach will be used to develop a movement program for grandchildren and -parents. Five co-creation sessions will be organised: two with grandchildren, two with grandparents and one with both together. Eight grandchildren (6-10 years old) and eight grandparents will participate in the co-creation sessions. The barriers and motivators to be physically active together will be identified, activities that are enjoyable and feasible to do together in the sessions and at home will be explored, the needs and requirements for the movement program will be questioned and in the last session, some contents of the preliminary movement program will be tested.             

Results: Co-development with grandchildren and -parents is expected to result in an attractive and feasible program, because researchers take into account requirements of both age groups. Co-PA is expected to improve PA, psychosocial well-being, motivation to be physically active and family ties in grandchildren and -parents.

Conclusion: This intergenerational movement program could help to motivate grandchildren and their grandparents to become more active. In a next step, a pilot study and an RCT to evaluate the movement program will be conducted.

The physical and mental health of older adults is a critical issue in society. Past studies have confirmed that intergenerational activities and exercise can promote intergenerational communication and physical and mental health, including quality of life, satisfaction, well-being, and self-efficacy. Therefore, this study explored the effects of intergenerational exercise (IE) and multi-component exercise (MCE) on the functional fitness and quality of life of older adults and assessed the differences between IE and MCE.

A total of 77 older adults were recruited and divided into IE or MCE groups; all classes lasted 120 minutes and were taken twice a week for a total of 8 weeks. A pre- and post-test experimental design was utilized to test the effects of the interventions on functional fitness and quality of life, and dependent- and independent-sample t-tests were used to assess the differences between groups.

We observed significant differences in functional fitness and quality of life in the IE group, as well as significant differences in functional fitness in the MCE group. Significant changes in functional fitness and quality of life were also observed between the pre- and post-test performance differences in each group. Finally, the IE group demonstrated greater progress in functional fitness and quality of life compared with the control group.

The results demonstrated that IE courses can effectively improve physical and mental health, which can enhance the understanding between generations. Future studies should include a control group to compare results and explore different demographics, such as older adults in community institutions, nursing homes, and rural areas. Finally, utilizing a time-series research design could verify the differences between different intervention periods. The present research provides suggestions for future studies by academic or government-related institutions.

Purpose: In recent years, many countries have responded to an aging society by increasing the availability of physical fitness facilities at community parks and implementing environmental change and infrastructure strategies to provide opportunities for and promote physical activity among older adults. This study aimed to clarify the availability of outdoor exercise equipment and evaluate physical activity among older adults, in addition to exploring the integration, ease of use, and accessibility of information regarding outdoor exercise equipment at various community parks provided by domestic government units or formal reports.

Methods: This study used online questionnaires to collect data using the self-produced Community Senior Neighborhood Park Use Survey and the widely accepted International Physical Activity Questionnaire Short Form (IPAQ-SF). Data analysis was performed on 403 valid questionnaires using statistical methods, such as descriptive statistics, analysis of variance, and Pearson product-moment correlation coefficient.

Results: Significant differences were identified in the amount of physical activity reported by older individuals depending on access to outdoor exercise equipment and the likelihood of visiting the park; however, distance from the park had no significant effect on the amount of physical activity reported. The amount of physical activity performed by older adults was affected by environmental factors, including whether fitness facilities are available and whether individuals are likely to visit the park. No correlation was found between the distance from an individual’s home to a park and the amount of physical activity reported. Only five county governments in Taiwan provide open access to information on fitness facilities at local parks, and the names and descriptions of these facilities vary across governments, with no consensus in type and standard of facilities.

Conclusions: This study identified a correlation between physical activity of older adults and the availability of physical fitness equipment in community parks. Public disclosure regarding the availability of outdoor exercise equipment is not currently sufficient. The effects and health benefits of fitness facilities in parks among older adults requires additional research to verify these findings, and government departments must work to improve the accessibility and availability of information regarding sports equipment in park settings in the future.

Purpose: Families in Guelph (population: 135,000), Canada, waste approximately 3 kg/week of food that, if managed better, could have been eaten. This level of food waste has important economic, nutritional, and environmental consequences. Improving food literacy may reduce household food waste. The primary objective of this study was to assess the feasibility and acceptability of the Weeknight Supper Savers programme among 18 families with children aged 9-12 years. The secondary objective was to assess the effect of this programme on quantity of food waste and level of food literacy and waste-related knowledge, attitudes, and behaviours.

Methods: The 4-week intervention was delivered in October-November 2020, and included a chef-led online cooking class, a food waste toolkit, and tips to reduce food waste delivered via 4 text messages/week. At pre- and post-intervention, research staff conducted 4-week household waste audits and parents completed surveys assessing their satisfaction with the program, their food literacy, and waste-related knowledge, attitudes, and behaviours.

Results/findings: All 18 families attended their scheduled cooking class. All parents (18 out of 18) reported being satisfied with the overall programme, the cooking class, and the toolkit. Only 1 parent reported dissatisfaction with the number of text messages. Compared to pre-intervention, per capita avoidable fruit and vegetable waste and unavoidable other waste significantly decreased by 37% and 53%, respectively. More parents also reported being confident in reducing food waste at post-intervention.

Conclusions: The Weeknight Supper Savers programme was very well-received and may decrease both avoidable and unavoidable food waste, but sample size was small and a control group was not used. Therefore, a randomized controlled trial with a larger sample is warranted.

Purpose: Toddler milk, an ultra-processed milk-based drink marketed for children aged 9-36 months, often contains added sugar, and is not recommended by medical associations. Toddler milk packages have health claims that are not regulated by the US Food and Drug Administration. Little is known about toddler milk feeding practices and how toddler milk marketing influences parents in the US. This study qualitatively explored parents' experiences with, beliefs about, and attitudes towards toddler milk. We also explored parents' reactions to health claims and tested health warnings on toddler milk packages.

Methods: In 2021, we conducted 15 in-depth interviews and five focus groups (2-6 participants) virtually, with parents of young children 9-36 months old in the US, who had served toddler milk to their child. We used narrative analysis and systematic coding to identify salient themes related to the use, perceptions, and beliefs of toddler milk and parents' reactions to health claims and health warnings on toddler milk packaging. 

Results: When shown an image of toddler milk, parents could not easily discern toddler milk from infant formula and perceived toddler milk as part of a larger category of "formula.” Parents reported offering toddler milk for its convenience, nutrients, and perceived benefits tied to health claims present in the labels. When asked what stood out in an image of toddler milk, parents reported the health claims first grabbed their attention, and most participants did not express concern or skepticism over the veracity of the claims. A warning stating "this product is not intended for children <12 months" led participants to accurately believe that the product is inappropriate for infants. A warning "this product has added sugar" discouraged parents from wanting to serve toddler milk to their children. Parents reported confusion after being shown the toddler milk with a warning stating "this product is ultra-processed."

Conclusions: Findings suggest that health claims lead to more favorable perceptions of toddler milk among parents and that warning labels are a potentially promising approach for informing parents. Future research could investigate stronger regulations and parent-directed interventions for informing parents about the contents and risks of providing toddler milk. 

Purpose: Truck drivers experience health disparities in relation to the general United States (U.S.) population. The purpose of this case study was to explore factors that may influence the implementation of workplace health promotion initiatives among trucking company stakeholders in Louisiana using the Transtheoretical Domains Framework (TDF).

Methods: An explanatory mixed method research design was used. A pre-existing survey following the TDF was adapted (i.e., surface-level changes) to reflect trucking company workplace terminology. The TDF was used to explore the views of trucking company stakeholders who would be responsible in some part for facilitating the implementation of workplace health promotion initiatives (e.g., nutrition, physical activity, mental health, sleep, smoking cessation) for the benefit of company truck drivers. Trucking companies in Louisiana were located using publicly available online information. Recruitment to complete an online Qualtrics survey occurred via phone and email in 2021. A semi-structured phone interview to understand survey responses in more depth was initiated among survey respondents who indicated interest. Interviews were audio-recorded, transcribed, and coded to understand barriers and facilitators.

Results: Eleven trucking company stakeholders completed the online survey (human resources, n=2; compliance manager, n=1; safety director, n=4; president, n=1; CFO, n=1; operations manager, n=1; and financial coordinator, n=1); two completed a follow-up interview. Nine (82%) agreed offering workplace health promotion programs would save the company money; however, most did not currently offer workplace health promotion initiatives. Nutrition and physical activity programs were of the most interest. Motivation/goals and knowledge were noted facilitators of potential workplace health promotion initiatives and environmental/resources and skills were noted barriers. Qualitative evidence expanded on barriers, in particular, including time, profits, the nature of a truck driving job (transitory), the COVID-19 pandemic, and a perceived lack of interest among company truck drivers. Incentives were described as an opportunity to increase truck driver’s engagement in future workplace health promotion initiatives.

Conclusions: Nutrition and physical activity health promotion initiatives for truck drivers will likely require strategies to improve trucking company environmental context/resources in Louisiana. Perspectives from company truck drivers (end-users) may help to build momentum for workplace health programming to meet drivers where they are.

Purpose: The COVID-19 pandemic upset the lives of university students when the education system turned remote. Uncertainty about the future and isolation may trigger unhealthy dietary behaviors, subsequently with adverse health outcomes. However, there is scant literature on how this behavior has changed and emerged through the different waves of the pandemic. The current study aims at exploring university students’ perception of their dietary behavior during different waves of the pandemic.

Methods: To understand students’ perceptions, the study is informed by an interpretive paradigm through a phenomenological framework. Using convenience sampling, approximately fifteen graduate students are being recruited from a private university in southwest Texas. After receiving verbal consent, in-depth, face-to-face interviews are conducted using a semi-structured interview guide. Interviews are audio-recorded and transcribed. Transcripts are thoroughly revised multiple times to ensure no missing or incorrect data. Cleaned transcripts are entered into ATLAS.ti (v.9) for thematic analysis. 

Results: Three interviews were conducted as of date. All the participants were doctoral students, and currently living off-campus with roommates. Emerging themes from the existing data suggest that consumption of home-cooked meals, and frequency of snacking was higher during the first wave of the pandemic. Among all students, these food choices were associated with emotions such as boredom, stress, and homesickness. However, when they started going back to university post-vaccination, at the end of second-wave and during the third wave, the frequency of on-campus dining and restaurant food consumption increased. Some students compared the differences, in the influence of lifestyle behaviors on each other, when they were at home vs. went on-campus.

Conclusion: The study provides an opportunity to explore the changes in lifestyle behaviors of graduate students during the course of an unprecedented global pandemic. The findings present an emphasis on the importance of the availability and accessibility to healthy food options on the university campus. Additionally, they highlight the significance of considering affect while analyzing and intervening on dietary behaviors among young adults.

Purpose: There is consistent evidence that physical activity (PA) levels decline across childhood. Youth perceptions of PA may also change with age. Young children tend to engage in PA for enjoyment, while many young adults report exercising for extrinsic reasons, such as weight loss or appearance. Thus, this study aimed to examine youth perceptions of PA, and to determine whether and how these perceptions differ among children of different ages.

Methods: Children in grades K-12 (N=146) completed an individual interview to ascertain their perspectives about PA. Questions included: What is physical activity?, Why should kids do physical activity?, and What do you like most about physical activity? Responses were transcribed and categorized into themes; frequencies of responses were compared across age groups [grades K-4 (elementary), 5-8 (middle school), and 9-12 (high school)].

Results: Children’s descriptions of PA differed significantly by age group (X²=49.73, p<0.001). Elementary aged children mentioned movement (33%) or playing (25%) most frequently, whereas middle school children frequently mentioned movement (58%) or exercise (48%), and high school children mostly referenced movement (69%) or physiological activation (26%). Overall, the most frequently cited reason to do PA was to be healthy (58%). Elementary children also said to get stronger (26%) and have fun (23%), middle school children referenced future health (32%), and high school children also described cognitive and mental health benefits (20%). Only 3% of the total sample referred to body weight or appearance benefits. Aspects of PA children liked most included moving and playing (38% of grades K-4), building physical status (32% of grades 5-8), feeling good (43% of grades 9-12), social interaction (28% of grades 5-12), and having fun (24% overall).

Conclusions: Descriptions of PA focused more on exercise vs. informal play as children aged, and older children referenced more extrinsic reasons to be active (e.g., future health) compared to younger children (e.g., to have fun). However, children of all ages identified intrinsic reasons for liking PA, and very few children discussed PA in the context of losing weight or improving appearance. These results provide insight regarding future strategies to promote PA among children.

Purpose: As part of a larger study in the Western Cape Province of South Africa, adult female caregivers of children under 5 in two low-income settings were interviewed to explore how caregivers in these settings experience food, and other systems (e.g., healthcare), particularly during and immediately after a COVID lockdown.

Method: In-depth interviews (IDIs) were conducted via a phone or WhatsApp call with study participants in both sites (n=32). IDIs were recorded, transcribed, and thematically analysed. Guiding research questions and sub-questions provided a starting point for coding. A codebook was developed after two primary researchers independently coded initial transcripts.

Findings: Multiple themes emerged from the analysis. One of particular interest related to recent and current breastfeeding practices and the role clinics played in influencing these.

Overall, breastfeeding was reported as common practice. Women described a mixture of breastfeeding and formula feeding, depending particularly on work status. Many participants breastfed their most recent child, including exclusively for 4-6 months, and up to two years or longer, as per WHO guidelines. These women described doing so because it was affordable, because they enjoyed it, and because they were "staying at home anyway". Others reported hand-pumping while working. Additionally, given the high cost of formula, especially considering income pressures on households during COVID, women were highly motivated to breastfeed.

Participants emphasized the clinic’s role in advocating for breastfeeding; however, in cases where participants did not breastfeed (for whatever reason), they did not receive the needed counsel/support from the clinic). Participants did mention the ‘Road to Health’ booklet issued by clinics as a useful resource; however, not all participants used the booklet as specific guidance for infant and young child feeding and related nutrition guidelines.

Conclusions: Now that clinical guidelines are unambiguously pro-breastfeeding in the Western Cape, and many participants were at home due to COVID-related factors, breastfeeding guidelines were often possible to follow. However, guidance from clinics was still reported as not sufficient. Caregivers to children under 5 could benefit from improved, more nuanced, patient specific guidance from local clinics, especially as we continue to move out of COVID lockdowns.