"What concerns me or what is most interesting to me": A qualitative study about what influences adolescent engagement with public health issues.

ISSUES ADDRESSED: Promoting public health messages in adolescence may influence future health outcomes. A better understanding of what influences adolescent engagement with public health issues is needed. METHODS: Adolescents aged 13-19 years from New South Wales, Australia, were recruited via study advertisements to participate in an online focus group. All provided informed consent and completed a short survey including demographics and selection of leading public health issues of concern. Participants attended a 75-90 min focus group conducted through Zoom teleconference that explored top public health issues of concern to participants, and barriers/enablers to engage with these issues. Qualitative data was thematically analysed using NVivo. A working group reached consensus on final themes. RESULTS: Out of 18 participants (mean 15.4 [SD: 2.2] years; 50% female), most attended high school (83%), spoke predominantly English at home (89%), and resided in metropolitan areas (94%). The top public health issues of concern selected were mental health (56%) and the environment/climate change (56%). From the thematic analysis, underlying drivers of adolescent engagement with public health issues included: personal connection to these issues, broader societal impact, and exposure to public health issues on digital media. Barriers included feeling unempowered, and a lack of support and opportunities. CONCLUSIONS: This study provides insights on the barriers and enablers of adolescents engaging with public health issues of concern to them. SO WHAT?: Understanding this may help health professionals and researchers to design more influential public health campaigns and interventions, including through co-design processes, which may improve future health outcomes.

Food choices made by primary carers (mothers/ grandmothers) in West Java, Indonesia.

BACKGROUND: Indonesian children currently face a decreasing prevalence of underweight and an increasing prevalence of overweight. For children aged 0-12 years, mothers/grandmothers hold the primary role in feeding practices. This study specifically aimed to explore mothers'/grandmothers' decision-making around food choices in West Java, Indonesia. METHODS: Twelve focus groups discussions were conducted between June and October 2016. Ninety-four carers of children aged under-five and 7-12 years from three socioeconomic groups participated. Data analysis followed a grounded theory approach. RESULTS: We developed six main themes: 1) Decisions on food served at home, which were mainly influenced by socioeconomic status and family member requests. 2) Attitudes toward instant noodles consumption. The low and intermediate SES children consumed noodles on a daily basis, even up to five times daily, while the high SES children only consumed noodles as 'emergency' food. 3) Decisions on food/snacks and drinks consumptions. Low and intermediate SES children bought snacks/sugary drinks from street vendors while the high SES children bought them at supermarket. 4) Feelings about food/snacks and drinks choices. All carers shared similar concerns and uneasiness about their children's choices. 5) Consideration of money issues, which were prominent among the low and intermediate SES carers. 6) Consideration of Halal issues, which were only mentioned by high SES carers. Most similarities were found between the low and intermediate SES groups, while most differences arose between these two groups compared to the high SES. CONCLUSIONS: The six interrelated categories affected one another around participants' decision-making around the family's food consumption. Developing countries could improve their multi-sectoral collaboration in ensuring better availability and affordability of healthier food. Education targeted at behavior modification toward healthier lifestyles should be implemented countrywide.

The double burden of malnutrition in Association of South East Asian Nations (ASEAN) countries: a comprehensive review of the literature.

BACKGROUND AND OBJECTIVES: The double burden of malnutrition (DBM) - a combination of undernutrition and overnutrition - is a problem faced by many countries. This study aimed to comprehensively review the DBM in ASEAN (Association of South East Asian Nations) countries, including levels (population [including country, city, or any community], household, or individual), types (the type of undernutrition and overweight), and prevalence. METHODS AND STUDY DESIGN: Data were sourced from four electronic databases, Medline via OvidSP, Scopus, Global Health via OvidSP and Web of Science, from January 1990 until May 2017. We only included studies that reported prevalence of DBM, were published in English language peer-reviewed journals and were available in full text. Studies were formally assessed against a published critical appraisal tool to produce a robust narrative review. RESULTS: We included 48 studies in the review from eight countries. No study was found from Singapore or Brunei Darussalam. Most studies were from Indonesia and there was only one study from Lao PDR. There were a range of criteria for anthropometry used in these studies, hence comparison is impossible. DBM happened at community, household, and individual levels, with different types of undernutrition (stunting/ underweight/wasting/thinness) in combination with overweight/obesity. At the household level, DBM ranged from 5.0% in Vietnam to 30.6% in Indonesia. CONCLUSIONS: ASEAN countries may need to strengthen surveillance using WHO standards to improve the comparability of data, further develop strategies to address under- or overweight issues and investigate potential "double-duty actions" as suggested by the World Health Organization.

Perceptions of overweight by primary carers (mothers/grandmothers) of under five and elementary school-aged children in Bandung, Indonesia: a qualitative study.

BACKGROUND: The prevalence of childhood overweight has increased in the past two decades in Indonesia. Even though prevalence is escalating, there is a lack of qualitative evidence to assist in the design and implementation of strategies to tackle this issue. This study aimed to explore the view of primary carers (mothers and grandmothers) from different socio-economic-status groups, on childhood overweight in the Greater Bandung Area, Indonesia. METHODS: We conducted 12 focus groups discussions with a total of 94 carers of under-five and 7-12 years children, from June to October 2016. We used the grounded theory approach in our analysis. RESULTS: Three main categories emerged: the concept of overweight, factors contributing to overweight, and awareness and feelings towards overweight children. Most carers from all SES groups defined overweight subjectively, while a few from the low SES group defined it objectively. Most carers from low and high SES groups agreed with the concept "chubbier is healthier". All carers had some knowledge of the main factors that contribute to childhood overweight: dietary factors, activity levels and sedentary behavior, and hereditary factors. Carers from all SES groups described similar characteristics of overweight; carers from low and intermediate SES groups had mixed feelings while all high SES carers have negative feelings about overweight children, mostly related to stigma. However, carers who identified their own children as being overweight expressed sensitivity about this weight status, especially their physical abilities. Almost all carers knew their children's current weight while less than two thirds knew their children's height. CONCLUSIONS: There are several policy implications. Firstly, health-related knowledge of the primary carers is of great importance and needs augmenting. To increase that knowledge, there is a role for front-line health practitioners (doctors/midwives/nurses) to be more active in educating the community. Secondly, simpler and more effective ways to disseminate healthy lifestyle messages to carers is required. Thirdly, by placing more emphasis on carers monitoring their children's growth may encourage carers to take steps to keep their children in the healthy weight and height ranges. Fourthly, the Department of Education may need to improve the quality and quantity of physical activity in schools.

Are stunted young Indonesian children more likely to be overweight, thin, or have high blood pressure in adolescence?

OBJECTIVES: To determine whether stunted young children are at greater risk of (1) overweight/obesity or thinness, and (2) high blood pressure (HBP) in adolescence. METHODS: A secondary data analysis using the Indonesian Family Life Survey waves 1 (1993) to 4 (2007). We generated a 14-year follow-up cohort (1993-2007) and two 7-year cohorts (1993-2000 and 2000-2007) of children aged 2.0-4.9 years. Stunting (HAZ < -2), thinness (BMIZ < -2), and overweight/obesity (BMIZ > +1) were determined based upon the WHO Child Growth Standards. HBP (>90th percentile) was interpreted using the 4th Report on the Diagnosis of HBP in Children and Adolescents. RESULTS: 765, 1083, and 1589 children were included in the 14-year cohort, and the two 7-year cohort analyses, respectively. In the 7-year cohorts, early life stunting was inversely associated with overweight/obesity (prevalence ratio 0.32 and 0.38, respectively; P < 0.05), but no significant association was found with the 14-year cohort. There was no significant association between childhood stunting and thinness at adolescence or in the odds/likelihood of having high systolic or diastolic blood pressure. CONCLUSIONS: We found no association between early life stunting and overweight/obesity, thinness and HBP in adolescence.

Stunting, Underweight and Overweight in Children Aged 2.0-4.9 Years in Indonesia: Prevalence Trends and Associated Risk Factors.

OBJECTIVE: The double burden of malnutrition affects many low and middle-income countries. This study aimed to: a) determine temporal trends in the prevalence of underweight, stunting, and at risk of overweight/ overweight or obesity in Indonesian children aged 2.0-4.9 years; and b) examine associated risk factors. DESIGN: A repeated cross-sectional survey. This is a secondary data analysis of waves 1, 2, 3, and 4 (1993, 1997, 2000, and 2007) of the Indonesian Family Life Survey, which includes 13 out of 27 provinces in Indonesia. Height, weight and BMI were expressed as z-scores (2006 WHO Child Growth Standards). Weight-for-age-z-score <-2 was categorised as underweight, height-for-age-z-score <-2 as stunted, and BMI-z-score >+1, >+2, >+3 as at-risk, overweight and obese, respectively. RESULTS: There are 938, 913, 939, and 1311 separate children in the 4 waves, respectively. The prevalence of stunting decreased significantly from waves 1 to 4 (from 50.8% to 36.7%), as did the prevalence of underweight (from 34.5% to 21.4%). The prevalence of 'at-risk'/overweight/obesity increased from 10.3% to 16.5% (all P<0.01). Stunting and underweight were related to lower birth weight, being breastfed for 6 months or more, having parents who were underweight or had short stature, and mothers who never attended formal education. Stunting was also higher in rural areas. Being at-risk, or overweight/obese were closely related to being in the youngest age group (2-2·9 years) or male, having parents who were overweight/obese or having fathers with university education. CONCLUSIONS: The double burden of malnutrition occurs in Indonesian children. Development of policy to combine the management of chronic under-nutrition and over-nutrition is required.

Stunting coexisting with overweight in 2·0-4·9-year-old Indonesian children: prevalence, trends and associated risk factors from repeated cross-sectional surveys.

OBJECTIVE: The persistence of undernutrition, along with overweight and obesity, constitute the double burden of malnutrition. The present study aimed to: (i) describe the prevalence and trends of concurrent stunting and overweight in Indonesian children; (ii) identify potentially associated risk factors; and (iii) determine whether stunted children are at greater risk of overweight compared with those of healthy height. DESIGN: A secondary data analysis of children aged 2·0-4·9 years in four cross-sectional studies of the Indonesian Family Life Survey. Children's height and BMI Z-scores were calculated based on the WHO Child Growth Standards (2006). We defined 'concurrent stunting and overweight' as height-for-age Z-score +1. Multivariate generalised linear latent and mixed models were used to determine associated risk factors. SETTING: Thirteen out of twenty-seven provinces in Indonesia. SUBJECTS: Children (n 4101) from four waves of the Indonesian Family Life Survey (1993-2007). RESULTS: There were inconsistent trends in the prevalence of concurrent stunting and overweight from waves 1 to 4. Children were more likely to be stunted and overweight when they were in the youngest age group (2·0-2·9 years), were weaned after the age of 6 months, had short-statured mothers or lived in rural areas. Stunted children were significantly more likely to be overweight than healthy-height children (OR>1) but did not differ significantly different across each wave (OR=1·34-2·01). CONCLUSIONS: Concurrent stunting and overweight occurs in Indonesian children aged 2·0-4·9 years. Current policies and programmes need to be tailored for the management of this phenomenon.