Metabolic syndrome among adolescents in Dubai, United Arab Emirates, is attributable to the high prevalence of low HDL levels: a cross-sectional study.

BACKGROUND: Metabolic syndrome (MetS) describes a combination of risk factors that increase the risk of developing chronic diseases. The prevalences of MetS and its risk factors are increasing, especially in the Arab region. A cross-sectional study was carried out to assess the prevalences of MetS and its associated risk factors among adolescents in the United Arab Emirates (UAE). METHODS: A total of 596 students (308 boys and 288 girls) aged 10 to 15.9 years old were recruited from 14 public secondary schools in Dubai, UAE. Anthropometric and biochemical data were measured. RESULTS: According to the International Diabetes Federation (IDF) criteria, the prevalence of MetS was 3.7%, and it was more common among boys than girls (12 boys versus 10 girls). MetS was also more likely to be found in students who were obese or overweight than those with normal weight. The most prevalent and significant MetS risk factor was low high-density lipoprotein (HDL) cholesterol levels. CONCLUSIONS: This study indicates the importance of carrying out further investigations about the constituents of HDL and their atherogenic effects. Additionally, these results strongly recommend setting a consensus for HDL measurement, since small variations in methodologies may lead to substantial deviations in results.

A critical participatory pedagogical approach to enabling life orientation students to develop social literacy through HIV education.

HIV education is an important component of the life orientation curriculum, since an intersectional understanding of HIV provides an entry point to appreciate the interrelatedness of various social injustices. Yet, our interaction with predominantly white and privileged pre-service life orientation students led us to believe that they did not perceive HIV education as something that was relevant to their personal or professional lives. Their rigid, stigmatising belief systems and "othering" attitudes prevented them from embodying the inclusive and life-enhancing values that life orientation is supposed to develop. This paper explains how we used iterative cycles of reflection and action to enable 86 student teachers of life orientation to interrogate their misconceptions about HIV education and its applicability for their professional and personal contexts. Students were able to acknowledge their prejudices and privileges, which in turn created a willingness to engage with HIV education and to embody their learning to bring about change in their daily interactions. The knowledge generated from this study indicates how a critical, participatory pedagogical approach to HIV education can develop the social literacy of students to enable them to live out the life-enhancing values that underpin the life orientation curriculum.

The impact of enhanced recovery after surgery (ERAS) protocol compliance on morbidity from resection for primary lung cancer.

OBJECTIVE: The adoption of Enhanced Recovery After Surgery programs in thoracic surgery is relatively recent with limited outcome data. This study aimed to determine the impact of an Enhanced Recovery After Surgery pathway on morbidity and length of stay in patients undergoing lung resection for primary lung cancer. METHODS: This prospective cohort study collected data on consecutive patients undergoing lung resection for primary lung cancer between April 2012 and June 2014 at a regional referral center in the United Kingdom. All patients followed a standardized, 15-element Enhanced Recovery After Surgery protocol. Key data fields included protocol compliance with individual elements, pathophysiology, and operative factors. Thirty-day morbidity was taken as the primary outcome measure and classified a priori according to the Clavien-Dindo system. Logistic regression models were devised to identify independent risk factors for morbidity and length of stay. RESULTS: A total of 422 consecutive patients underwent lung resection over a 2-year period, of whom 302 (71.6%) underwent video-assisted thoracoscopic surgery. Lobectomy was performed in 297 patients (70.4%). Complications were experienced by 159 patients (37.6%). The median length of stay was 5 days (range, 1-67), and 6 patients (1.4%) died within 30 days of surgery. There was a significant inverse relationship between protocol compliance and morbidity after adjustment for confounding factors (odds ratio, 0.72; 95% confidence interval, 0.57-0.91; P < .01). Age, lobectomy or pneumonectomy, more than 1 resection, and delayed mobilization were independent predictors of morbidity. Age, lack of preoperative carbohydrate drinks, planned high dependency unit/intensive therapy unit admission, delayed mobilization, and open approach were independent predictors of delayed discharge (length of stay >5 days). CONCLUSIONS: Increased compliance with an Enhanced Recovery After Surgery pathway is associated with improved clinical outcomes after resection for primary lung cancer. Several elements, including early mobilization, appear to be more influential than others.

Problematizing official narratives of HIV and AIDS education in Scotland and Zimbabwe.

When human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) are framed within an intersectional approach, they have the potential to transform understandings of social justice within the curriculum and education policy and practice in general. Yet, this transformative potential is often hampered by official narratives that fail to position HIV and AIDS as an integral component of overlapping systems of oppression, domination and discrimination. This article explores how official HIV and AIDS narratives tend to promote systemic injustice and inequality within education policy and practice in both Scotland and Zimbabwe, despite their good intents. We frame our argument within a transformative education discourse which seeks to create participatory and emancipatory HIV-related messages at school, tertiary and community levels. Using a narrative enquiry design, a Foucauldian theoretical lens was used to analyse the narratives derived from key informant responses, supplemented by analysis of key documents that deal with HIV and AIDS in both Scotland and Zimbabwe. Four broad narratives emerged: the 'Gay' Narrative; the Migration Narrative; the Conspiracy Narrative; and the Religious Narrative. We discuss how each of these narratives entrench stigma across both developed and developing world contexts, and propose how a more intersectional interpretation would contribute to a deeper and less stigmatizing understanding of HIV, thus offering more useful insights into related policy and educational practices. This article will thus contribute to the growing body of intersectional HIV and AIDS knowledge that is relevant for schools, teacher education, public health and community settings, not only in the countries studied, but the world over.

Delivery and Receipt of a Self-Determination-Theory-Based Extracurricular Physical Activity Intervention: Exploring Theoretical Fidelity in Action 3:30.

The implementation, fidelity, and receipt of a self-determination-theory-based after-school physical activity intervention (Action 3:30) delivered by teaching assistants (TAs) was examined using a mixed-methods process evaluation. Physical activity motivation and need satisfaction were reported by 539 participants at baseline, the end of intervention, and 4-month follow-up. Pupil- and TA-reported autonomy-support and teaching efficacy were collected alongside interviews with 18 TAs and focus groups with 60 participants. Among intervention boys there were small increases in identified, introjected, and external motivation and no differences in need satisfaction. Among girls, intrinsic and identified motivation and autonomy and relatedness were lower in the intervention group. Qualitative evidence for fidelity was moderate, and boys reported greater need satisfaction than girls. TAs provided greater structure than involvement or autonomy-support and felt least efficacious when facing school-based challenges. The findings highlight the refinements needed to enhance theoretical fidelity and intervention effectiveness for boys and girls.

IJBNPA in 2016: Strategy for advancing the science of behavior change in nutrition and physical activity, and associated editorial priorities.

The goal of the International Journal of Behavioral Nutrition and Physical Activity (IJBNPA) is to be the leading diet and physical activity journal. To achieve this aim we embrace and publish a number of different research designs from small, but in depth, qualitative studies to large scale cohort studies. IJBNPA prioritises research based on randomised controlled trials (RCTs), systematic reviews (with or without meta-analyses, as appropriate), and well conducted observational studies that expand knowledge and understanding of the area. IJBNPA will also consider and publish other study designs that are of sufficient quality such as strong or ground-breaking methodological papers, rigorous qualitative studies, debate papers and commentaries. However, due to the demands on the journal, we publish pilot studies only in exceptional circumstances and we do not publish protocol papers or letters to the editors. The goal of this editorial is to highlight to our readers and authors the process by which we identify which papers to review and publish along with our editorial priorities.

Assessing Knowledge of, and Attitudes to, HIV/AIDS among University Students in the United Arab Emirates.

BACKGROUND: The Middle East and North Africa (MENA) region is among the top two regions in the world with the fastest growing HIV epidemic. In this context, risks and vulnerability are high as the epidemic is on the rise with evidence indicating significantly increasing HIV prevalence, new HIV infections and AIDS-related deaths. OBJECTIVE: The aim of the survey was to assess HIV/AIDS knowledge and attitudes related to HIV/AIDS among a wide group of university students in the United Arab Emirates (UAE). METHODS: In a cross-sectional survey, a total sample of 2,294 students (406 male; 1,888 female) from four universities in three different Emirates in the UAE were approached to take part in the study. Students self-completed a questionnaire that was designed to measure their knowledge and attitudes to HIV/AIDS. RESULTS: The overall average knowledge score of HIV.AIDS was 61%. Non-Emirati and postgraduates demonstrated higher levels of knowledge compared to Emirati and undergraduate students respectively. No significant differences between males and females; and marital status were found. Eighty-five percent of students expressed negative attitudes towards people living with HIV, with Emirati and single students significantly holding more negative attitudes compared to non-Emiratis and those that are married respectively. CONCLUSIONS: The findings provide strong evidence that there is a need to advocate for appropriate National HIV/AIDS awareness raising campaigns in universities to reduce the gaps in knowledge and decrease stigmatizing attitudes towards people living with HIV/AIDS.

Examining a conceptual model of parental nurturance, parenting practices and physical activity among 5-6 year olds.

RATIONALE: Parenting is an often-studied correlate of children's physical activity, however there is little research examining the associations between parenting styles, practices and the physical activity of younger children. OBJECTIVE: This study aimed to investigate whether physical activity-based parenting practices mediate the association between parenting styles and 5-6 year-old children's objectively-assessed physical activity. METHODS: 770 parents self-reported parenting style (nurturance and control) and physical activity-based parenting practices (logistic and modeling support). Their 5-6 year old child wore an accelerometer for five days to measure moderate-to-vigorous physical activity (MVPA). Linear regression was used to examine direct and indirect (mediation) associations. Data were collected in the United Kingdom in 2012/13 and analyzed in 2014. RESULTS: Parent nurturance was positively associated with provision of modeling (adjusted unstandardized coefficient, ß = 0.11; 95% CI = 0.02, 0.21) and logistic support (ß = 0.14; 0.07, 0.21). Modeling support was associated with greater child MVPA (ß = 2.41; 0.23, 4.60) and a small indirect path from parent nurturance to child's MVPA was identified (ß = 0.27; 0.04, 0.70). CONCLUSIONS: Physical activity-based parenting practices are more strongly associated with 5-6 year old children's MVPA than parenting styles. Further research examining conceptual models of parenting is needed to understand in more depth the possible antecedents to adaptive parenting practices beyond parenting styles.

Sedentary time among spouses: a cross-sectional study exploring associations in sedentary time and behaviour in parents of 5 and 6 year old children.

BACKGROUND: Sedentary time is associated with obesity and is a risk factor for other adverse health outcomes. We examined how sedentary time and screen viewing (SV) behaviours in parents of young children are associated and whether associations differed for weekdays versus weekend days. METHODS: Data were from a cross sectional study (B-ProAct1v) based in Bristol, UK investigating associations between physical activity and SV in children and parents. Parents were eligible for analysis if they and their partner had both provided valid accelerometer data (290 dyads) or had both provided valid screen-viewing data (325 dyads). Multivariable regression models were used to examine associations of (a) sedentary behaviours and (b) self-reported time spent on weekdays and weekend days watching TV, using a PC, and using a phone in the dyads. Models were adjusted for the number of media items in the house, mothers' age and body mass index, and household index of multiple deprivation. RESULTS: Sedentary behaviour was lower at weekends than on weekdays for fathers and mothers. In contrast, the proportion of parents watching at least 2 h TV was higher on weekend days than on weekdays. Adjusted multivariable linear regression models suggested that 3 min of sedentary time on weekend days in fathers were associated with an additional minute of mothers' sedentary time (B 0.38; 95 % CI 0.26 to 0.49). Logistic regression indicated that mothers' screen use was positively predicted by fathers' use (e.g., the odds of a mother watching more than 2 h TV on a weekend day were increased fivefold if the father also watched this amount OR 5.09, 95 % CI 3.30 to 7.86), except for PC use at weekends where the association was reversed and the odds of mothers using a PC for more than 30 min per weekend day was halved if the father used a PC for this amount of time (OR 0.45, 95 % CI 0.22 to 0.94). CONCLUSIONS: Programmes that encourage at least one adult in the household to decrease sedentary behaviour and become more active, particularly at weekends, should be developed.

Increasing children's physical activity through a teaching-assistant led extracurricular intervention: process evaluation of the action 3:30 randomised feasibility trial.

BACKGROUND: Many children do not engage in recommended levels of physical activity (PA), highlighting the need to find ways to increase children's PA. Process evaluations play an important role in improving the science of randomised controlled trials. We recently reported the results of the Action 3:30 cluster randomised feasibility trial illustrating higher levels of moderate to vigorous intensity PA among boys but not girls. The aim of this paper is to report the process evaluation results including intervention fidelity, implementation, context and how intervention components and trial design could be improved before proceeding to a definitive RCT. METHODS: Children's session enjoyment was assessed every two weeks. Reasons for non-attendance were provided by questionnaire at the end of the intervention. Post intervention interviews were held with participating teaching assistants (TAs) and school key contacts (KCs), and focus groups were conducted with children in all 10 intervention schools. Interviews and focus groups examined how recruitment and session attendance might be improved and established which elements of the programme that were and were not well received. RESULTS: Data indicated good intervention fidelity with TA's adopting enjoyment-focussed teaching styles and the sessions improving children's skills and self-esteem. Several positive aspects of implementation were identified, including high session variety, the opportunity to work in teams, the child-led sessions and the engaging leader style. In terms of context there was evidence that TA's faced difficulties managing challenging behaviour and that further training in this area was needed. TAs and KCs felt that recruitment could be improved by providing taster sessions during PE lessons and clarifying the days that the clubs would run at the point of recruitment. The programme could be improved to enhance interest for girls, by including training for managing disruptive behaviour and making some activities more age-group appropriate. CONCLUSIONS: Action 3.30 showed promise but could be improved by ensuring age appropriate activities, providing more appeal to girls and improving recruitment through taster sessions and early establishment of days of the week it is to be offered on. TRIAL REGISTRATION: ISRCTN58502739.

John porter lecture: waves of protest--direct action, deliberation, and diffusion.

The book Direct Action, Deliberation and Diffusion: Collective Action After the WTO Protests in Seattle argues that the process of diffusion is dependent on social processes in the receiving context. The most important in social movements is an egalitarian and reflexive deliberation among diverse actors. The book traces the direct action tactics associated with the Seattle protests against the World Trade Organization in 1999 and how these spread to activists in Toronto and New York City. It shows how the structure of the political field, racial and class inequalities, identity boundaries, and organizational and conversational dynamics limited deliberation among activists, and thus limited the diffusion of the Seattle tactics. By constraining the spread of the Seattle tactics, this slowed the global justice movement's wave of protest. In this paper, I explore the application of and implications of this model of protest tactic diffusion to the recent Idle No More mobilizations.

Parental control, nurturance, self-efficacy, and screen viewing among 5- to 6-year-old children: a cross-sectional mediation analysis to inform potential behavior change strategies.

BACKGROUND: Children's screen viewing (SV) is associated with higher levels of childhood obesity. Many children exceed the American Academy of Pediatrics guideline of 2 hours of television (TV) per day. There is limited information about how parenting styles and parental self-efficacy to limit child screen time are associated with children's SV. This study examined whether parenting styles were associated with the SV of young children and whether any effects were mediated by parental self-efficacy to limit screen time. METHODS: Data were from a cross-sectional survey conducted in 2013. Child and parent SV were reported by a parent, who also provided information about their parenting practices and self-efficacy to restrict SV. A four-step regression method examined whether parenting styles were associated with the SV of young children. Mediation by parental self-efficacy to limit screen time was examined using indirect effects. RESULTS: On a weekday, 90% of children watched TV for <2 hours per day, decreasing to 55% for boys and 58% for girls at weekends. At the weekend, 75% of children used a personal computer at home, compared with 61% during the week. Self-reported parental control, but not nurturance, was associated with children's TV viewing. Parental self-efficacy to limit screen time was independently associated with child weekday TV viewing and mediated associations between parental control and SV. CONCLUSIONS: Parental control was associated with lower levels of SV among 5- to 6-year-old children. This association was partially mediated by parental self-efficacy to limit screen time. The development of strategies to increase parental self-efficacy to limit screen-time may be useful.

Adherence to the Mediterranean diet among employees in South West England: Formative research to inform a web-based, work-place nutrition intervention.

OBJECTIVE: The aim of this study is to assess internet usage patterns and adherence to the Mediterranean diet among employees in South West England, UK and their differences by personal characteristics. METHOD: A cross-sectional survey was conducted in 2014 among 590 adults (428 women, 162 men, mean age 43.8 years), employees of four work-place settings. Mediterranean diet adherence was assessed using a validated food frequency questionnaire. Adherence differences were assessed by gender, marital status, education, number of children and food shopping and preparation responsibility. RESULTS: On average, participants reported moderate adherence to the Mediterranean diet. Higher adherence was reported for alcohol, vegetables, cereals and fruit. Few participants achieved high adherence to the Mediterranean diet recommendations for legumes (5.3%), fish (3.2%), dairy products (4.8%), red meat (11.9%), poultry (11.1%) and olive oil (18.2%). A higher Mediterranean diet score was reported among participants who were married/cohabiting, those with higher education attainment and shared responsibility for food preparation. CONCLUSION: Improvement in the consumption of several Mediterranean diet components is needed to increase adherence in this sample of adults. The findings have the potential to inform the development of a web-based intervention that will focus on these foods to promote the Mediterranean diet in work-place settings in South West England.

Treating 'AIDS blindness': a critical pedagogical approach to HIV education at tertiary level.

HIV and AIDS affect all South Africans, irrespective of gender, race, age and economic status. Teachers should therefore be able to meaningfully integrate HIV content into the school curriculum. However, pre-service teacher education programmes still do not pay adequate attention to HIV education, particularly in institutions where students are being prepared to work in environments that are perceived to be unaffected by the consequences of the pandemic. This article advocates that HIV education should be integrated into contexts of privilege and presents evidence of the influence that a critical pedagogical approach can have on changing student perceptions of the need to address HIV in and through their teaching. We led 109 Post-graduate Certificate of Education students through a series of activities that required them to critically reflect on their feelings, attitudes and perceived skills with regard to HIV and AIDS education; to identify potential areas of personal change; and to begin to imagine alternative professional possibilities. We generated qualitative data through drawings, group discussions, individual written reflections, and a voluntary focus group. A content analysis of the data revealed that the participating students initially felt incompetent to incorporate HIV and related issues into their teaching, and felt hesitant and uncomfortable at the prospect. However, a critical reflection on their thinking, both individually and in a group setting, served to shift them towards a more holistic, critical and humanising understanding of the pandemic and the role they could play as future teachers in helping to mitigate its impact. The findings provide evidence that a critical pedagogical approach - particularly with groups who believe that HIV and AIDS is not something that concerns them - can provide an effective way to mediate the knowledge, skills and attitudes that competent teachers need in today's world.

Randomised feasibility trial of a teaching assistant led extracurricular physical activity intervention for 9 to 11 year olds: Action 3:30.

BACKGROUND: Extracurricular programmes could provide a mechanism to increase the physical activity (PA) of primary-school-aged children. The aim of this feasibility study was to examine whether the Action 3:30 intervention, which is delivered by teaching assistants, holds promise as a means of increasing the PA of Year 5 and 6 children. METHODS: A cluster randomised feasibility trial was conducted in 20 primary schools. Ten schools received the Action 3:30 intervention and 10 schools were allocated to the control arm. The intervention was 40 one-hour sessions, delivered twice a week by teaching assistants. The proportion of participants recruited per school was calculated. Session delivery and session attendance was calculated for intervention schools. Weekday and after-school (3.30 to 8.30 pm) moderate to vigorous intensity physical (MVPA) was assessed by accelerometer at baseline (T0), during the last few weeks of the intervention (T1) and four months after the intervention had ended (T2). The costs of delivering the intervention were estimated. RESULTS: Five intervention schools ran all 40 of the intended sessions. Of the remaining five, three ran 39, one ran 38 and one ran 29 sessions. Mean attendance was 53%. The adjusted difference in weekday MVPA at T1 was 4.3 minutes (95% CI -2.6 to 11.3). Sex-stratified analyses indicated that boys obtained 8.6 more minutes of weekday MVPA than the control group (95% CI 2.8 to 14.5) at T1 with no effect for girls (0.15 minutes, 95% CI -9.7 to 10.0). There was no evidence that participation in the programme increased MVPA once the club sessions ceased (T2). The indicative average cost of this intervention was £2,425 per school or £81 per participating child during its first year and £1,461 per school or £49 per participating child thereafter. CONCLUSIONS: The effect of the Action 3:30 intervention was comparable to previous physical activity interventions but further analysis indicated that there was a marked sex difference with a positive impact on boys and no evidence of an effect on girls. The Action 3:30 intervention holds considerable promise but more work is needed to enhance the effectiveness of the intervention, particularly for girls. TRIAL REGISTRATION: ISRCTN58502739.

Associations between objectively assessed child and parental physical activity: a cross-sectional study of families with 5-6 year old children.

BACKGROUND: A number of studies have suggested that there is a need to increase the physical activity levels of children. Parents are important influences on children's behaviour. There is a lack of information about whether there are associations between the physical activity levels of young children and their parents. The current study examined the associations between the physical activity (PA) of parents and their children at age five to six years old, and determined whether any associations differed by child or parent gender or between week and weekend days. METHODS: Cross-sectional study, with 1267 Year 1 pupils (five to six years of age) and at least one parent from 57 primary schools. Children and parents wore an accelerometer for five days and mean minutes of moderate-to-vigorous intensity physical activity (MVPA) per day were derived. We used multivariable linear regression to investigate whether parental and child time spent in MVPA was associated with each other. Each model was adjusted for age, child gender, parent BMI and neighbourhood deprivation with subgroup analysis by child gender. RESULTS: 80% of parents met PA guidelines, however 29% of boys and 47% of girls aged five to six years failed to meet them. Fully-adjusted analyses suggested weak positive associations of parent's and children's time spent in MVPA. Every 10 additional minutes of parental MVPA were associated with one additional minute of child MVPA. There was no evidence of a difference in associations for boys and girls or between mothers and fathers. CONCLUSIONS: 29% of boys and 47% of girls aged five to six years did not meet PA guidelines indicating that these children would benefit from new approaches that focus on increasing physical activity. There were weak associations between the MVPA of 5-6 year old children and their parents, demonstrating that the time that children are active with their parents is not a major source of physical activity. Clinicians and public health professionals should encourage parents to create opportunities for their children to be active.

Cross-sectional associations between the screen-time of parents and young children: differences by parent and child gender and day of the week.

BACKGROUND: Greater time spent screen-viewing (SV) has been linked to adverse health outcomes. The aim of this study was to examine whether parental SV time is associated with child SV time on week and weekend days. METHODS: Cross-sectional survey of 1078 children aged 5-6 and at least 1 parent. Child and parent SV was reported for weekday and weekend days. Logistic regression examined whether parental SV time was associated with child SV time, with separate analyses for mothers and fathers and interaction terms for child gender. RESULTS: 12% of boys, 8% of girls and 30% of mothers and fathers watched ≥ 2 hours of TV each weekday. On a weekend day, 45% of boys, 43% of girls, 53% of mothers and 57% of fathers spent ≥ 2 hours watching TV. Where parents exceeded 2 hours TV-watching per weekday, children were 3.4 times more likely to spend ≥ 2 hours TV-watching if their father exceeded the threshold with odds of 3.7 for mothers. At weekends, daughters of fathers who exceeded 2 hours watching TV were over twice as likely as sons to exceed this level. Evidence that parent time spent using computers was associated with child computer use was also strongest between fathers and daughters (vs. sons) (OR 3.5 vs. 1.0, p interaction=0.027). CONCLUSIONS: Strong associations were observed between parent and child SV and patterns were different for weekdays versus weekend days. Results show that time spent SV for both parents is strongly associated with child SV, highlighting the need for interventions targeting both parents and children.

School travel mode, parenting practices and physical activity among UK Year 5 and 6 children.

BACKGROUND: School travel mode and parenting practices have been associated with children's physical activity (PA). The current study sought to examine whether PA parenting practices differ by school travel mode and whether school travel mode and PA parenting practices are associated with PA. METHODS: 469 children (aged 9-11) wore accelerometers from which mean weekday and after-school (3.30 to 8.30 pm) minutes of moderate-to-vigorous intensity PA (MVPA) and counts per minute (CPM) were derived. Mode of travel to and from school (passive vs. active) and PA parenting practices (maternal and paternal logistic support and modelling behaviour) were child-reported. RESULTS: Children engaged in an average of 59.7 minutes of MVPA per weekday. Active travel to school by girls was associated with 5.9 more minutes of MVPA per day compared with those who travelled to school passively (p = 0.004). After-school CPM and MVPA did not differ by school travel mode. There was no evidence that physical activity parenting practices were associated with school travel mode. CONCLUSIONS: For girls, encouraging active travel to school is likely to be important for overall PA. Further formative research may be warranted to understand how both parental logistic support and active travel decisions are operationalized in families as a means of understanding how to promote increased PA among pre-adolescent children.

The impact of the food-based and nutrient-based standards on lunchtime food and drink provision and consumption in secondary schools in England.

OBJECTIVES: To assess lunchtime provision of food and drink in English secondary schools and the choices and consumption of food and drink by pupils having school lunches, and to compare provision in 2011 with that in 2004. DESIGN: Cross-sectional data collected between October 2010 and April 2011. In each school, food and drink provision, including portion weights and number of portions of each item served at lunchtime, were recorded over five consecutive days. Caterers provided recipe information. SETTING: England. SUBJECTS: A random selection of 5969 pupils having school lunches in a nationally representative sample of eighty secondary schools in England. RESULTS: Compared with 2004, significantly more schools in 2011 provided main dishes, vegetables and salads, water, fruit juice and other drinks on 4 or 5 d/week (P < 0.005). The number of schools offering items not permitted under the food-based standards for school food on 4 or 5 d/week fell significantly over time (P < 0.005), while the number not offering these items on any day increased significantly (P < 0.005). Meals eaten by pupils were well-balanced in relation to macronutrients. CONCLUSIONS: Lunchtime food provision and consumption in secondary schools have improved considerably since 2004, following the introduction of new compulsory standards for school food in 2009. To maximise their energy and nutrient intake at lunchtime, pupils should be encouraged to select a full meal, and to take and eat more fruit and vegetables. Schools also need continued support to increase the micronutrient content of menus and recipes.