Effect of a Fundamental Motor Skills Intervention on Fundamental Motor Skill and Physical Activity in a Preschool Setting: A Cluster Randomized Controlled Trial.

PURPOSE: To determine the effect of a 12-week fundamental motor skill (FMS) program on FMS and physical activity (PA) on preschool-aged children. METHOD: A cluster randomized controlled trial. The intervention (PhysicaL ActivitY and Fundamental Motor Skills in Pre-schoolers [PLAYFun] Program) was a 12-week games-based program, delivered directly to the children in childcare centers by exercise physiologists. Children in the control arm received the usual preschool curriculum. Outcomes included FMS competence (Test of Gross Motor Development-2) and PA (accelerometer) assessed at baseline, 12 weeks, and 24 weeks (12-wk postintervention). RESULTS: Fifty children (mean age = 4.0 [0.6] y; 54% male) were recruited from 4 childcare centers. Two centers were randomized to PLAYFun and 2 centers were randomized to the waitlist control group. Children attended on average 2.0 (1.0) 40-minute sessions per week. The PLAYFun participants demonstrated significant increases in object control (P < .001) and total FMS (P = .010) competence at week 12, compared with controls in a group × time interaction. Girls, but not boys, in PLAYFun significantly increased moderate to vigorous PA after the intervention (P = .004). These increases were not maintained 12-week postcompletion of PLAYFun. CONCLUSIONS: The PLAYFun Program is effective at improving FMS competence in boys and girls and increasing PA in girls. However, improvements are not maintained when opportunities to practice are not sustained.

Trends in overweight, obesity, and waist-to-height ratio among Australian children from linguistically diverse backgrounds, 1997 to 2015.

OBJECTIVE: To report the cross-sectional prevalence and 18-year trends in overweight, obesity and abdominal obesity among Australian children from culturally and linguistically diverse (CALD) backgrounds. SUBJECTS/METHODS: Four cross-sectional population health surveys conducted among children (age 4-16 years; n=26, 449) in 1997-2004-2010-2015 in New South Wales, (NSW) Australia. Adiposity outcomes were measured by trained field staff using standard procedures. Binomial regression models with a robust error variance were used to estimate prevalence ratio (PR) and 95% confidence intervals (CI) for overweight and obesity, obesity, and waist-to-height ratio (WHtR) ≥ 0.5 for children from Asian, European, and Middle Eastern language backgrounds compared with children from English-speaking backgrounds, adjusted for sociodemographic characteristics. RESULTS: Over time, children from Middle Eastern language backgrounds were consistently more likely to be overweight-obese (PR: 1.29-1.42), obese (PR: 1.49-1.65), and have WHtR ≥ 0.5 (PR: 1.42-1.90), compared with children from English-speaking backgrounds. Children from European language backgrounds generally had higher prevalence and children from Asian language backgrounds had lower prevalence, compared with children from English-speaking backgrounds. Between 1997 and 2015, there were significant trends in the prevalence of overweight and obesity combined among children from English-speaking (PR: 1.06, 95%CI: 1.02, 1.09), Middle Eastern (PR: 1.14, 95%CI: 1.05, 1.24), and Asian language backgrounds (PR: 1.14, 95%CI: 1.05, 1.24). The prevalence of WHtr ≥ 0.5 increased among children from English-speaking (PR: 1.21, 95%CI: 1.13, 1.31) and Middle Eastern (PR: 1.35, 95%CI: 1.16, 1.56) language backgrounds. CONCLUSIONS: Overall, the prevalence of overweight and obesity and abdominal obesity is high among NSW children from CALD backgrounds and has increased over time. This suggests that there is a greater scope in understanding, developing, and implementing interventions across the early life-course of children from CALD backgrounds.

Sustained low consumption of fruit and vegetables in Australian children: Findings from the Australian National Health Surveys.

ISSUE ADDRESSED: Intakes of fruit and vegetables in children are inadequate. Our purpose was to examine national data on the proportion of Australian children meeting the fruit and vegetable recommendations in 2011-2012 and 2014-2015, assessing changes over time and differences by age, sex and socio-economic status (SES). METHODS: Secondary analysis of 2011-2012 and 2014-2015 Australian National Health Surveys of Australian children aged 2-18 years. Percentages of children meeting fruit and vegetable recommendations by survey year, age group, sex and SES tertile were calculated using population weights supplied by the Australian Bureau of Statistics (ABS). Chi-squared tests and logistic regression were used to test for the relative influence of each factor. RESULTS: In 2011-2012, 64.6%, 5.1% and 4.6% of children met the recommended intake for fruit, vegetable and fruit-vegetable combined, respectively. In 2014-2015, 68.2%, 5.3% and 5.1% of all children met the recommended intake for fruit, vegetable and fruit-vegetable combined, respectively. There was a large reduction in proportions of children meeting both the fruit and vegetable recommendations between 3 and 4 years of age, which coincides with when most Australian children start pre-school. There were consistent differences by sex for both fruit and vegetables, but we found little evidence that SES is a significant factor predicting the difference in meeting the vegetable recommendations. CONCLUSION: The proportion of Australian children meeting fruit and vegetable recommendations are sub-optimal across all SES groups which suggests that a national approach across demographic strata is warranted. SO WHAT?: Future health promotion interventions should have a refocus on vegetables instead of "fruit and vegetables," particularly in the key transition period when children start pre-school.

The trends and prevalence of obesity and morbid obesity among Australian school-aged children, 1985-2014.

AIM: Children with obesity have a greater risk of adverse social and physical health outcomes. We examined temporal changes in body mass index (BMI) z-scores and the prevalence obesity and morbid obesity in children from 1985 to 2014. METHODS: Secondary data analysis of BMI data for children aged 7-15 years from five cross-sectional Australian datasets. Changes in age- and gender-adjusted BMI (BMI z-scores) and nutritional status were categorised using the International Obesity Task Force cut-off points. RESULTS: The percentage of children who were obese tripled between 1985 and 1995 from 1.6 to 4.7%, before plateauing between 1995 and 2014. The percentage of morbidly obese children was <1% in 1985 and 1995, increasing to 2% between 1995 and 2007, with no further increase between 2007 and 2014. The proportion of obese children classified as morbidly obese was 12% in 1985-1995, 24% in 2007-2012 and 28% in 2014. Between 1985 and 2012, the mean BMI z-score increased in children categorised as obese from 1.94 (standard deviation 0.15) to 2.03 (0.22), and then plateaued. For morbidly obese children, the mean BMI z-score was 2.4 (0.13) and remained similar over the study period. CONCLUSIONS: Our findings suggest that the relative fatness of children with morbid obesity, as measured by BMI z-score, has remained stable. The proportion of obese and morbidly obese children has also plateaued between 2007 and 2014. However, the prevalence of obesity remains high, and more dedicated resources are required to treat children with obesity to reduce the short- and long-term health impact.

Associations between childhood overweight, obesity, abdominal obesity and obesogenic behaviors and practices in Australian homes.

BACKGROUND: Despite emerging research about the role of the family and home environment on early childhood obesity, little is known on how weight-related behaviors, parent practices and the home environment influence overweight/obesity in older children and adolescents. METHODS: This analysis used data from a cross-sectional, representative population survey of Australian children age 5-16 years conducted in 2015. Data included measured anthropometry to calculate body mass index (BMI; kg/m2) and waist-to-height ratio (WHtR; waist circumference/height). Information on home-based weight-related behaviors (individual eating and screen time behaviors, parent influences including rules and home environment factors) were measured using established short questions, with parental proxy reporting for children in up to grade 4, and self-report for students in grades 6, 8 and 10. Logistic regression models were used to examine associations between weight status and home-based weight-related behaviors. RESULTS: Both children and adolescents who did not consume breakfast daily were more likely to be overweight/obese OR (95% CI) = 1.39 (1.07-1.81) p = 0.015, OR (95% CI) =1.42 (1.16-1.74) p = 0.001, respectively, adjusted for age, gender, socio-economic status, rural/urban residence and physical activity. There was also a significant positive association with higher waist-to-height ratio in both children and adolescents. Among children, having a TV in the bedroom was also associated with overweight and obesity OR (95% CI) = 1.54 (1.13-2.09) p = 0.006 and higher waist-to-height ratio. For adolescents, parenting practices such as having no rules on screen-time, OR (95% CI) = 1.29 (1.07-1.55) p = 0.008, and rewarding good behavior with sweets, OR (95% CI) = 2.18 (1.05-4.52) p = 0.036, were significant factors associated with overweight and obesity. The prevalence of these obesogenic behaviors were higher in certain sub-groups of children and adolescents, specifically those from social disadvantage and non-English-speaking backgrounds. CONCLUSIONS: Interventions to reduce the prevalence of obesity and overweight should include promoting daily breakfast, reducing screen-time, and encouraging health-promoting parenting practices. Interventions should particularly focus on those at some social disadvantage and from non-English-speaking backgrounds.

A 5-year longitudinal analysis of modifiable predictors for outdoor play and screen-time of 2- to 5-year-olds.

BACKGROUND: Early childhood is a critical time for establishing physical activity and sedentary behaviours. Identifying modifiable predictors of physical activity and sedentary behaviours in the early life stages can inform the development of early intervention programs. The aim of this study was to identify modifiable predictors of outdoor play (a proxy of physical activity) and screen-time in 2- to 5-year-olds. METHODS: A longitudinal data analysis was conducted using 5-year follow-up data from the Healthy Beginnings Trial undertaken in Sydney, Australia from 2007 to 2013. A total of 667 pregnant women were recruited for the study. Information on mothers' demographics, physical activity, screen-time, knowledge of child development, and awareness of childhood obesity during pregnancy (at baseline); children's tummy time (a colloquial term describing the time when a baby is placed on his or her stomach while awake and supervised) at 6 months old and screen-time at 1 year old was collected via interviews with participating mothers as potential modifiable predictors. Main outcomes were children's outdoor playtime and screen-time at ages 2, 3.5, and 5 years. Mixed linear and logistic regression models were built to determine these modifiable predictors. RESULTS: Mothers' screen-time during pregnancy (ß = 2.1, 95 % CI 0.17-4.12; P = 0.030) and children's daily screen-time at age 1 year (ß = 15.2, 95 % CI 7.28-23.11; P < 0.0001) predicted children's daily screen-time across ages 2 to 5 years after controlling for confounding factors. Practising tummy time daily (ß = 13.4, 95 % CI 1.26-25.52; P = 0.030), mother's physical activity level (ß = 3.9, 95 % CI 0.46-7.28; P = 0.026), and having been informed about playing with child at baseline (ß = 11.6, 95 % CI 1.56-21.54; P = 0.023) predicted children's outdoor playtime across ages 2 to 5 years. CONCLUSIONS: Mothers played an important role in their children's outdoor play and screen-time in the first years of live. Children's early exposure to screen devices could be associated with their later screen-time. Early interventions to improve young children's physical activity and sedentary behaviour should focus on improving pregnant women's physical activity, awareness of playing with their child, reducing their own screen-time as well as practicing daily tummy time for infants after giving birth. TRIAL REGISTRATION: The Healthy Beginnings Trial is registered with the Australian Clinical Trial Registry ( ACTRNO12607000168459 ). Registered 13 March 2007. Prospectively registered.

Associations of outdoor play and screen time with nocturnal sleep duration and pattern among young children.

AIM: Sleep duration and pattern have important implications for children's health. This study aims to investigate nocturnal sleep duration, sleep pattern and their relationships with outdoor play and screen time among children aged 2 to five years. METHODS: The study used data from the Healthy Beginnings Trial undertaken in Sydney, Australia. Data on children's sleep, outdoor playtime and screen time were reported by mothers via face-to-face interviews when children were 2, 3.5 and five years old. Both cross-sectional and longitudinal analyses were conducted. RESULTS: At age 2, 3.5 and five years, 497, 415 and 369 mother-child dyads participated. Significantly, there was an overall increase in children's nocturnal sleep duration, sleep latency and an earlier bedtime, and there was a decrease in the proportion of children who woke at night over time. Each additional hour of screen time was associated with three-minute (95% CI 0.6-5) shorter sleep, 1.6-minute (95% CI 0.59-2.63) longer sleep latency, four-minute (95% CI 1.8-6.0) later bedtime and less likely sleeping ≥10 hours per night with adjusted odds ratio 0.88 (95% CI 0.77-1.00), after controlling for mothers' demographics. CONCLUSION: Among young children, screen time and outdoor playtime were associated with sleep duration and pattern. Reducing screen time and increasing outdoor playtime might help improving children's sleep.

Translational research: are community-based child obesity treatment programs scalable?

BACKGROUND: Community-based obesity treatment programs have become an important response to address child obesity; however the majority of these programs are small, efficacy trials, few are translated into real-world situations (i.e., dissemination trials). Here we report the short-term impact of a scaled-up, community-based obesity treatment program on children's weight and weight-related behaviours disseminated under real world conditions. METHODS: Children age 6-15 years with a body mass index (BMI) ≥ 85th percentile with no co-morbidities, and their parents/carers participated in a twice weekly, 10-week after-school child obesity treatment program between 2009 and 2012. Outcome information included measures of weight and weight-related behaviours. Analyses were adjusted for clustering and socio-demographic variables. RESULTS: Overall, 2,812 children participated (54.2% girls; M(age) 10.1 (2.0) years; M(attaendance) 12.9 (5.9) sessions). Beneficial changes among all children included BMI (-0.65 kg/m(2)), BMI-z-score (-0.11), waist circumference (-1.8 cm), and WtHtr (-0.02); self-esteem (+2.7 units), physical activity (+1.2 days/week), screen time (-4.8 h/week), and unhealthy foods index (-2.4 units) (all p < 0.001). Children who completed ≥ 75% of the program were more likely to have beneficial changes in BMI, self-esteem and diet (sugar sweetened beverages, lollies/chocolate, hot chips and takeaways) compared with children completing <75% of the program. CONCLUSIONS: This is one of the few studies to report outcomes of a government-funded, program at scale in a real-world setting, and shows that investment in a community-based child obesity treatment program holds potential to produce short-term changes in weight and weight-related behaviours. The findings support government investment in this health priority area, and demonstrate that community-based models of child obesity treatment are a promising adjunctive intervention to health service provision at all levels of care.

Physical activity and screen-time of childhood haematopoietic stem cell transplant survivors.

AIM: Reduced bone mineral density, impaired cardiovascular fitness and increased risk of obesity are well-known late effects of haematopoietic stem cell transplantation (HSCT) in survivors of childhood cancer. These comorbidities can be mitigated through physical activity and limiting screen-time (ST). This study aims to increase the understanding of physical activity and ST behaviours for children following HSCT. METHODS: Children were recruited from two oncology follow-up clinics and completed a questionnaire on their physical activity levels and screen-time. Children were classified as short (≤2 years) and long-term (>2 years) survivors. RESULTS: Fifty-eight children were eligible, of whom forty children of age 6-18 years (60% males) participated in the study. Less than half (47.5%) met the daily recommendations for physical activity and one-third met the ST recommendations. Late survivors reported higher daily physical activity and less ST than early survivors. Among late survivors, females reported higher daily physical activity and less ST than males. CONCLUSION: Our findings suggest that the majority of children following HSCT were not sufficiently active and had excessive screen-time; however, this was comparable to healthy populations. Appropriately designed physical activity and screen-time intervention programmes should be explored early following transplant for children undergoing HSCT.

Role of general practice in the utilisation of the NSW Get Healthy Information and Coaching Service.

A lifestyle-modification telephone-based service is delivered in New South Wales (NSW; the Get Healthy Information and Coaching Service (GHS)) as an important obesity-prevention, population-wide program. The present study examined referrals from general practitioners (GP) versus self-referral to the GHS in terms of risk profile and effectiveness of outcomes. The study used a pre-post test design to assess changes in outcomes within the setting of a telephone-based lifestyle-support service available to NSW adults (18+ years) who self-referred or were referred by their health practitioner and/or GP, and registered for the GHS between February 2009 and August 2013 (n = 22 183). The GHS has two service components: (1) the provision of an information kit (one off contact) on healthy eating, being physically active and achieving and/or maintaining a healthy weight; and (2) a 6-month coaching program that includes 10 telephone calls aimed at achieving and maintaining lifestyle-related goals. Sociodemographic characteristics, referral source and self-reported anthropometric (height, waist and waist circumference (WC)) and behavioural risk factor (physical activity and nutrition-related behaviours) data were collected at baseline and at 6 months. Analysis revealed that GPs effectively recruited hard-to-reach subtargets, as well as adults who are obese and have an increased WC risk. Participants in the GHS coaching program, irrespective of GHS referral source, reported a mean weight loss of -3.8 kg, a decrease in WC of -5.0 cm and increases in both fruit and vegetable consumption and physical activity. In conclusion, GPs have an important role in GHS uptake (through proactive referral or as an adjunct to practice-based interventions) because they can recruit those most at need and facilitate improvements in their patients' risk factor profiles.

The development and validation of a golf swing and putt skill assessment for children.

The aim was to describe development of a process-oriented instrument designed to assess the golf swing and putt stroke, and to assess the instrument's discriminative validity in terms of age and reliability (intra-rater and re-test). A Delphi consultation (with golf industry professionals and researchers in movement skill assessment) was used to develop an assessment for each skill based on existing skill assessment protocols. Each skill had six components to be marked as present/absent. Individual scores were based on the number of performance components successfully demonstrated over two trials for each skill (potential score range 0 to 24). Children (n = 43) aged 6-10 years (M = 7.8 years, SD = 1.3) were assessed in both skills live in the field by one rater at Time 1(T1). A subset of children (n = 28) had consent for assessments to be videoed. Six weeks later 19 children were reassessed, five days apart (T2, T3). An ANOVA assessed discriminative validity i.e. whether skill competence at T1 differed by age (6 years, 7/8 years and 9/10 years). Intraclass correlations (ICC) assessed intra-rater reliability between the live and video assessment at T1 and test-retest reliability (between T2 and T3). Paired t-tests assessed any systematic differences between live and video assessments (T1) and between T2 and T3. Older children were more skilled (F (2, 40) = 11.18, p < 0.001). The live assessment reflected the video assessment (ICC = 0.79, 95% CI 0.59, 0.90) and scores did not differ between live and video assessments. Test retest reliability was acceptable (ICC = 0.60, 95% CI 0.23, 0.82), although the mean score was slightly higher at retest. This instrument could be used reliably by golf coaches and physical education teachers as part of systematic early player assessment and feedback. Key pointsGolf is becoming an increasingly popular sport among young children, however there is no standard protocol available to assess and identify skill deficits, mastery level, and talent identification in beginner young golf players.Process rather than product oriented outcomes better identify areas of skill deficit in young children.The proposed swing and putt instrument can reliably identify skill deficits in children of elementary school age who are new to golf and can be used by a range of stakeholders including golf coaches, generalist sport coaches and physical education teachers.

Temporal trends in weight and current weight-related behaviour of Australian Aboriginal school-aged children.

OBJECTIVES: To report 13-year trends in weight status of Australian Aboriginal children, and to describe weight-related behaviour in children in 2010, by Aboriginality. DESIGN, SETTING AND PARTICIPANTS: Cross-sectional population surveys of children aged 5-16 years (n = 18 983) conducted in New South Wales schools in Term 1 of 1997, 2004 and 2010. MAIN OUTCOME MEASURES: For trend analysis: body mass index and waist-to-height ratio (WtHr). Analyses of weight-related behaviour from 2010 survey data included indicators of dietary habits, screen time (ST) and physical activity. RESULTS: Between 1997 and 2010, the relative increase in prevalence of overweight/obesity and WtHr ≥ 0.5 was 22.4% and 113.6%, respectively, among Aboriginal children, and 11.8% and 3.4%, respectively, among non-Aboriginal children. In 2010, Aboriginal children had 1.52 (95% CI, 1.03-2.24) greater odds of having a WtHr ≥ 0.5 than non-Aboriginal children. Compared with non-Aboriginal children, Aboriginal children also had significantly lower odds of eating breakfast daily (adjusted odds ratio [AOR], 0.72; 95% CI, 0.52-0.99) and significantly greater odds of drinking ≥ 1 cup of soft drink daily (AOR, 1.61; 95% CI, 1.13-2.29), having a television in their bedroom (AOR, 2.75; 95% CI, 2.04-3.70), having no ST rules (AOR, 1.34; 95% CI, 1.04-1.73) and exceeding ST recommendations on weekdays (AOR, 1.78; 95% CI, 1.32-2.39). CONCLUSIONS: Overweight/obesity and WtHr have increased more rapidly in Aboriginal than non-Aboriginal children in NSW. Unhealthy weight-related behaviour was frequent among all children, but lack of daily breakfast, excessive ST and soft drink consumption appear particularly problematic among Aboriginal children. Raising awareness with families of the consequences of excessive ST and encouraging strategies to limit ST (such as rethinking placement of televisions in children's bedrooms and implementing ST rules) hold promise.

Recreational screen-time among Chinese adolescents: a cross-sectional study.

BACKGROUND: Rapid urbanization in China has led to a proliferation of electronic entertainment media among youth. Prolonged screen time (ST; includes watching television and playing on computers, video game consoles, or mobile phones) is linked to poor health profiles. The aim of this study was to report recreational ST behaviors and ST correlates among Chinese adolescents living in two regions with different degrees of urbanization. METHODS: A cross-sectional, school-based survey (n = 3461 adolescents; aged 12-14 years old) living in inner-city Shanghai and a peri-urban region of Hangzhou. Students completed a questionnaire including family characteristics, daily ST, and information on family environment related to screen use. Recreational ST was categorized into two groups according to recommendations by the American Academy of Pediatrics (< or ≥2 h/day). Parents reported their own ST and also reported educational attainment as a proxy for socioeconomic status. RESULTS: ST was higher among boys than girls and on weekends than weekdays. Peri-urban girls were more likely to exceed 2 h/day ST compared to inner-city girls on weekends. Having a father with no university degree, mother's TV viewing ≥2 h/day, no ST rules at home, and eating meals in front of the TV were associated with higher ST on both weekdays and weekends, and regional differences were found for weekend ST. CONCLUSIONS: TV viewing and playing on the computer were the most prevalent ST behaviors among Chinese adolescents. Mobile phone playing was less prevalent but persistent throughout the week. More population-level surveillance and research is needed to monitor the trends in ST behaviors and to better understand the characteristics of those who are at risk.

Reliability and validity of a short FFQ for assessing the dietary habits of 2-5-year-old children, Sydney, Australia.

OBJECTIVE: A simple FFQ which ranks young children's dietary habits is necessary for population-based monitoring and intervention programmes. The aim of the present study was to determine the reliability and validity of a short FFQ to assess the dietary habits of young children aged 2-5 years. DESIGN: Parents completed a seventeen-item FFQ for their children by telephone on two occasions, two weeks apart. Sixty-four parents also completed 3 d food records for their children. The FFQ included daily servings of fruit and vegetables, frequency of eating lean meat, processed meats, take-away food, snack foods (biscuits, cakes, doughnuts, muesli bars), potato crisps and confectionery, and cups of soft drinks/cordials, juice, milk and water. Weighted kappa and intra-class correlation coefficients were used to assess FFQ reliability and the Bland-Altman method was used to assess validity of the FFQ compared with the 3 d food record. SETTING: Seven pre-school centres in metropolitan Sydney, Australia. SUBJECTS: Seventy-seven children aged 2-5 years. RESULTS: The majority of questions had moderate to good reliability: κ w ranged from 0·37 (lean meat) to 0·85 (take-away food consumption). Validity analysis showed a significant increase in mean values from the food record with increasing ordered categories from the FFQ for servings of vegetables and fruit and cups of drinks (all trend P ≤ 0·01). Spearman rank correlation coefficient was >0·5 for vegetables, fruit, diet soft drinks and fruit juice. CONCLUSIONS: The FFQ provides reliable and moderately valid information about the dietary intakes and habits of children aged 2-5 years, in particular for fruit, vegetables and beverages.

Process evaluation of an up-scaled community based child obesity treatment program: NSW Go4Fun®.

BACKGROUND: Community-based obesity treatment programs for children that have a large program reach are a priority. To date, most programs have been small efficacy trials whose findings have yet to be up-scaled and translated into real-world settings. This paper reports on the process evaluation of a government-funded, translated obesity treatment program for children in Australia. It describes the characteristics and reach of children participating in the New South Wales (NSW) Ministry of Health Go4Fun® program. METHODS: Delivered across the state of NSW (Australia) by Local Health Districts (LHDs), Go4Fun® is a community-based, multidisciplinary family obesity treatment program adapted from the United Kingdom Mind Exercise Nutrition Do it (MEND) program that targets weight-related behaviours. Children aged 7-13 years with a BMI ≥85th percentile and no co-morbidities were eligible at no cost. Parents/carers self-refer via a toll-free phone number, text messages, online registration or via secondary referrals. LHDs deliver a 16 to 20-session program based on length of school term, holidays and recruitment challenges. Both parent/carer and child attend bi-weekly after school sessions. Parent-reported socio-demographic and measured child weight characteristics are presented using descriptive statistics. Differences between completers (attended at least 75% of sessions) and non-completers were assessed using chi-square tests, independent sample t-tests and adjusted odds ratios. Analyses were adjusted for clustering of programs. RESULTS: Between 2009 and 2012, a total of 2,499 children (54.8% girls; mean age [SD]: 10.2 [1.7 years]) participated in the Go4Fun® program. Children were mainly from low-middle socioeconomic status (76.5%), resided in major cities (63.3%), and 5.7% were Aboriginal. At baseline, 96.5% of children were overweight or obese. Mean BMI-z-score was 2.07 (0.41) and 94.5% had a waist-to-height ratio ≥0.5. More than half (57.9%) completed at least 75% of sessions. Amongst completers (N = 1,446), girls (56.8%; p = 0.02), non-Aboriginal children (95.9%; p < 0.01) and children residing in less socially disadvantaged areas (25.9%; p = 0.02) were significantly more likely to complete the program. CONCLUSIONS: The Go4Fun® program successfully reached the targeted population of overweight/obese children at socioeconomic disadvantage and is a rare example of an up-scaled translational program.

High prevalence of overweight and obesity among inner city Chinese children in Shanghai, 2011.

BACKGROUND: In China, the prevalence of overweight and obesity appears to be increasing at unacceptable levels among young people living in major cities undergoing rapid economic growth. OBJECTIVE: To report the prevalence of overweight and obesity among Shanghai inner city youth using the recently published International Obesity Task Force (IOTF) Asian definition. METHODS: Secondary analysis of children aged 8-15 years who participated in the Shanghai Schools' Physical Fitness Examinations, a representative school-based survey. Height and weight were measured and body mass index (kg/m(2)) was calculated. The prevalence of overweight and obesity was determined using the IOTF children's BMI cut-points for Asian populations, equivalent to an adult BMI of 23 g/m(2) (overweight) and 27 kg/m(2) (obese). RESULTS: The prevalence of combined overweight and obesity was 49.1% for boys and 30.8% for girls aged 8-15-years. Almost one-in-five boys were obese, compared with 8.4% of girls. In boys the prevalence of overweight appeared to increase from age 10 years. CONCLUSION: The high prevalence of combined overweight and obesity among urban Chinese youth, especially among boys, requires immediate health promotion intervention.

How to facilitate NHS professionals to recognise and use skills gained from global health engagement when back in the UK workforce? A participatory action research project to design, pilot and evaluate a series of online leadership workshops.

OBJECTIVES: Leadership knowledge and skills are known to be developed by health professionals during global health experiences overseas. However, volunteers struggle to recognise and use these new skills on return to their workplace. A series of bespoke leadership workshops were designed, delivered and evaluated by leadership experts to help enhance the transferability of leadership skills back to the UK National Health Service. DESIGN: A mixed-methods participatory action research methodology was employed to explore the impact of the workshops. This approach lends itself to a complex, situated project involving multiple partners. Quantitative and qualitative descriptive data were collected via online survey (n=29 participants) and focus groups (n=18 focus groups) and thematically analysed. SETTING: The authors delivered the tailored leadership workshops online to globally engaged National Health Service (NHS) healthcare professionals based in England who had all worked overseas within the past 5 years. PARTICIPANTS: 29 participants attended: 11 medical doctors; 6 nurses/midwives; 10 allied health professionals; 1 NHS manager and 1 student nurse (who was also working as a healthcare assistant). RESULTS: Participants were able to network both during the large group discussions and while in smaller breakout groups. Data highlighted the substantial benefits obtained from this networking, with 91% of participants reporting it enriched their learning experience, particularly within a multi-disciplinary context, and by having the time and space for facilitated reflection on leadership. Furthermore, 78% agreed that they learned new skills for influencing change beyond their position and 76% reported they could maximise the impact of this change for themselves and their employer. Participants also reported the development of systems and ethical leadership knowledge that they felt they could transfer to their NHS roles. CONCLUSIONS: This study extends explorations of global health experiences by moving beyond the skills gained while working in low-income and middle-income countries. The innovative online leadership workshops gave agency to individuals to recognise and use the skills gained from global health placements on return to the NHS.

A fizzy environment: availability and consumption of sugar-sweetened beverages among school students.

OBJECTIVE: Reducing sugar-sweetened beverage (SSB) consumption has been targeted in obesity prevention strategies internationally. This study examined associations between SSB availability at school and in the home, and consumption among Australian school students. METHOD: Secondary analysis of the 2010 New South Wales Schools Physical Activity and Nutrition Survey (n=8058) was conducted. Logistic regression analyses tested the impact of SSB availability at school and in the home on consumption category (low, ≤1 cup/week; moderate, 2-4 cups/week; high, ≥5 cups/week). RESULTS: Students in years K-10 (ages 4-16years) who usually purchased sugar-sweetened soft drinks or sports drinks from their school canteen were almost three times as likely to be high consumers (AOR 2.90; 95%CI 2.26, 3.73). Students in years 6-10 (ages 9-16years) were almost five times as likely to be high consumers if soft drinks were usually available in their home (AOR 4.63; 95%CI 3.48, 6.17), and almost ten times as likely to be high consumers if soft drinks were usually consumed with meals at home (AOR 9.83; 95%CI 6.06, 15.96). CONCLUSION: Limiting the availability of SSBs in the home and school environments is a prudent response to address high SSB consumption among school students, albeit only part of the solution for obesity prevention.

Prevalence and perceptions of overweight and obesity in Aboriginal and non-Aboriginal young people in custody.

OBJECTIVE: To describe prevalence of and risk factors for overweight, obesity and self-perceived weight gain of Aboriginal and non-Aboriginal Australian young people in custody at baseline and over 12 months of follow-up. DESIGN, SETTING AND PARTICIPANTS: Prospective cohort study of youths in custody in New South Wales, from August 2009, with follow-up at 3, 6 and 12 months. MAIN OUTCOME MEASURES: Body mass index at baseline, categorised as overweight or obese using international cut-points; waist-to-height ratio (WHtR) at baseline, categorised as increased metabolic risk (≥ 0.5) or low metabolic risk (< 0.5); and self-perceived weight change at follow-up. RESULTS: At baseline, 452 youths were incarcerated, 361 (79.9%) consented to participate, and complete anthropometry measurements were taken for 303 (67.0%). At 3, 6 and 12 months, there were 231 (76.2%), 158 (52.1%) and 143 (47.2%) participants, respectively. Two-hundred and sixty-four (87.1%) were male, 151 (49.8%) were Aboriginal, and 145 (47.9%) had been incarcerated for < 3 months at baseline. One hundred and forty-five (47.9%) were overweight or obese and 112 (37.0%) had a WHtR of ≥ 0.5 at baseline. However, only 72 (24.1%) perceived themselves as overweight at baseline, and 154 (71.6%) perceived a weight increase since incarceration despite improvements in diet and exercise. Longer incarceration time was strongly associated with overweight and obesity in Aboriginal youths at baseline and with self-perceived weight gain in non-Aboriginal youths at follow-up. CONCLUSIONS: Overweight and obesity were highly prevalent but poorly recognised in young people in custody. A longer incarceration time had the strongest association with overweight obesity and self-reported weight gain. From a population health and policy perspective, changes to the liberal food environment and the approach to increasing physical activity in custody are warranted.

Socio-cultural differences in Australian primary school children's weight and weight-related behaviours.

AIM: To examine whether there are socio-cultural differences in overweight/obesity and weight-related behaviours of Australian primary school children. METHODS: Secondary data analysis of the 2010 NSW Schools Physical Activity and Nutrition Survey (n = 4898). Height and weight were measured. Parents of Year K, 2, 4 children and Year 6 students completed a questionnaire on demographics and weight-related behaviours. Cardio-respiratory fitness was assessed by the 20-meter shuttle run test and categorised as adequately fit or unfit. Children were categorised according to the main cultural/ethnic backgrounds (Middle-Eastern, Asian and English-speaking backgrounds) and socio-economic status (SES) tertile. RESULTS: Within ethnic groups, SES was associated with weight-related behaviours, but not consistently, and not with body mass index status. Within ethnic groups, the odds were higher among low SES, compared with high SES to be inactive, unfit and have poorer dietary habits. Weight-related behaviours among each ethnic group also differed by gender. Compared with low SES children from English-speaking backgrounds, ethnic boys were two times as likely to be overweight/obese, and the odds were significantly higher among ethnic children to be inactive, unfit and have poor dietary patterns. CONCLUSION: The results indicate the need for obesity prevention initiatives to specifically target and reach children from low SES and Asian and Middle-Eastern backgrounds, and the importance of ensuring that such initiatives are culturally appropriate and address relevant issues.