Risk of food insecurity in undocumented migrant households in Birmingham, UK.

BACKGROUND: This study aimed to understand the extent of household food insecurity amongst undocumented migrant families in Birmingham,UK. METHODS: Cross-sectional survey of households (n = 74) with dependent children using the USDA 18-item household food security (HFS) module. All households had an irregular immigration status and were accessing an immigration advice drop-in service (n = 98 adults; n = 138 children) in Birmingham. RESULTS: About 95.9% of households were food insecure, and 94.6% of children lived in households with low or very low food security. Food insecurity varied within households. Around 91.8% of adults were food insecure, compared to 75.6% of children. Spearman's rank-order correlation indicated a statistically significant positive correlation between household food insecurity level and number of children (rho = 0.253, P = 0.031). A Kruskal-Wallis H Test indicated no statistically significant difference (P = 0.730) in HFS score between households supported by asylum support, children's social services or paid employment in the informal economy and those that had no regular income. CONCLUSIONS: Prevalence of HFS was higher in this sample of undocumented migrant households with dependent children in Birmingham, UK, than in the wider population, and larger households were more food insecure. Households without a regular income were no more likely to be food insecure than households with financial support.

The effect of social media interventions on physical activity and dietary behaviours in young people and adults: a systematic review.

BACKGROUND: The objectives of this systematic review were to update the evidence base on social media interventions for physical activity and diet since 2014, analyse the characteristics of interventions that resulted in changes to physical activity and diet-related behaviours, and assess differences in outcomes across different population groups. METHODS: A systematic search of the literature was conducted across 5 databases (Medline, Embase, EBSCO Education, Wiley and Scopus) using key words related to social media, physical activity, diet, and age. The inclusion criteria were: participants age 13+ years in the general population; an intervention that used commercial social media platform(s); outcomes related to changes to diet/eating or physical activity behaviours; and quantitative, qualitative and mixed methods studies. Quality appraisal tools that aligned with the study designs were used. A mixed methods approach was used to analyse and synthesise all evidence. RESULTS: Eighteen studies were included: randomised control trials (n = 4), non-controlled trials (n = 3), mixed methods studies (n = 3), non-randomised controlled trials (n = 5) and cross-sectional studies (n = 3). The target population of most studies was young female adults (aged 18-35) attending college/university. The interventions reported on positive changes to physical activity and diet-related behaviours through increases in physical activity levels and modifications to food intake, body composition and/or body weight. The use of Facebook, Facebook groups and the accessibility of information and interaction were the main characteristics of social media interventions. Studies also reported on Instagram, Reddit, WeChat and Twitter and the use of photo sharing and editing, groups and sub-groups and gamification. CONCLUSIONS: Social media interventions can positively change physical activity and diet-related behaviours, via increases in physical activity levels, healthy modifications to food intake, and beneficial changes to body composition or body weight. New evidence is provided on the contemporary uses of social media (e.g. gamification, multi-model application, image sharing/editing, group chats) that can be used by policy makers, professionals, organisations and/or researchers to inform the design of future social media interventions. This study had some limitations that mainly relate to variation in study design, over-reliance of self-reported measures and sample characteristics, that prevented comparative analysis. Registration number: PROPSERO; CRD42020210806 .

Social media use informing behaviours related to physical activity, diet and quality of life during COVID-19: a mixed methods study.

BACKGROUND: This mixed methods study explored how social media use informed physical activity and diet-related behaviours, and self-perceived Quality of Life (QoL) during COVID-19, and assessed the contextual factors that drive social media use for health-related behaviour change in diverse groups. During the COVID-19 lockdown periods there were reported changes to social media use and health behaviours, and this gave an opportunity to investigate potential relationships. METHODS: An explanatory sequential research design of two parts was used: (1) An online survey that assessed social media use in relation to physical activity levels, diet quality and QoL (n = 786; Mage 45.1 ± 19.1 (range 16-88) years; Female =69%); (2) 20 purposive focus groups (n = 69; Mage = 52.88 ± 18.45 years, Female n = 68%) to understand the contextual factors that drive social media use for health-related behaviour change. Descriptive and thematic analysis were conducted. RESULTS: Participants in this study reported that social media facilitated the self-management of behaviours related to physical activity, diet and QoL, through access to information to inform workouts and dietary quality, and the opportunities for interaction with peers, family members and within social groups. Contextual factors including work, home and lifestyle arrangements, pre-existing health-related knowledge and behaviours, and the perceived value of social media for health influenced the relationship between social media use and self-reported outcomes. Social media influencers, peers/family members, and official organisations influenced the application of health-related information accessed via social media. CONCLUSIONS: The evidence shows that participants were critical users of social media and were able to use social media to derive benefit for their health and wellbeing. Detailed guidance for those who use social media, as well as those who recommend and endorse social media content is required to maximise the potential of social media to support health behaviours. Future public health strategies and social media interventions should acknowledge diversity in contextual factors driving social media use for health behaviour change.

Daily Myofibrillar Protein Synthesis Rates in Response to Low- and High-Frequency Resistance Exercise Training in Healthy, Young Men.

The impact of resistance exercise frequency on muscle protein synthesis rates remains unknown. The aim of this study was to compare daily myofibrillar protein synthesis rates over a 7-day period of low-frequency (LF) versus high-frequency (HF) resistance exercise training. Nine young men (21 ± 2 years) completed a 7-day period of habitual physical activity (BASAL). This was followed by a 7-day exercise period of volume-matched, LF (10 × 10 repetitions at 70% one-repetition maximum, once per week) or HF (2 × 10 repetitions at ∼70% one-repetition maximum, five times per week) resistance exercise training. The participants had one leg randomly allocated to LF and the other to HF. Skeletal muscle biopsies and daily saliva samples were collected to determine myofibrillar protein synthesis rates using 2H2O, with intracellular signaling determined using Western blotting. The myofibrillar protein synthesis rates did not differ between the LF (1.46 ± 0.26%/day) and HF (1.48 ± 0.33%/day) conditions over the 7-day exercise training period (p > .05). There were no significant differences between the LF and HF conditions over the first 2 days (1.45 ± 0.41%/day vs. 1.25 ± 0.46%/day) or last 5 days (1.47 ± 0.30%/day vs. 1.50 ± 0.41%/day) of the exercise training period (p > .05). Daily myofibrillar protein synthesis rates were not different from BASAL at any time point during LF or HF (p > .05). The phosphorylation status and total protein content of selected proteins implicated in skeletal muscle ribosomal biogenesis were not different between conditions (p > .05). Under the conditions of the present study, resistance exercise training frequency did not modulate daily myofibrillar protein synthesis rates in young men.

Association of BMI category with change in children's physical activity between ages 6 and 11 years: a longitudinal study.

BACKGROUND/OBJECTIVES: To examine the association of body mass index (BMI) with change in children's physical activity and sedentary time between ages 6 and 11. PARTICIPANTS: A total of 2132 children participated from 57 schools in Southwest England, from the B-PROACT1V study. METHODS: Mean minutes of MVPA and sedentary time per day were derived from accelerometer-based measurements at ages 6, 9 and 11. Linear multilevel models examined the association of BMI categories with MVPA and sedentary time between 6 and 11, adjusting for seasonality, wear time, gender and household education. Differences in change over time were examined using interaction terms. RESULTS: Average weekday MVPA decreased between ages 6 and 11 by 2.2 min/day/year (95% CI: 1.9 to 2.5), with a steeper decline at weekends. Average sedentary time increased at a rate of 12.9 min/day/year (95% CI: 12.2 to 13.6). There were no differences in mean levels of MVPA by BMI categories at age 6, but differences emerged as children aged, with the gap between children who were healthy weight and overweight increasing by 1.7 min/day (95% CI: 0.8-2.6) every year, and between healthy and obese by 2.0 min/day (95% CI: 0.9-3.1) each year. Children who were overweight/obese engaged in less average weekday sedentary time at age 6 than those of healthy weight, but the gap closed by age 11. CONCLUSION: MVPA declines and sedentary time increases on average for all children between ages 6 and 11. While there are no differences in activity levels by BMI category at age 6, differences in MVPA emerge over time for those who are overweight and obese. Developing interventions that support children to retain activity levels as they approach older childhood, particularly those who are overweight/obese could improve public health.

Social networks and their influences on nutrient intake, nutritional status and physical function in community-dwelling ethnically diverse older adults: a mixed-methods longitudinal study.

BACKGROUND: The United Kingdom population is ageing and becoming increasingly diverse; thus, it is vital to develop and implement interventions supporting this population shift. Social networks (SN) significantly impact health outcomes in later life, however relatively little is known about SN of community-dwelling ethnically diverse older adults. This study aimed to: 1) profile SN and changes in SN in this population over 8 months; 2) examine associations between SN, dietary intake, nutritional status, and physical function. METHODS: SN were assessed using the Wenger Practitioner Assessment of Network Type. Energy and nutrient intakes were measured using multiple-pass 24-h recalls. The Mini Nutritional Assessment-Short Form (MNA-SF) assessed nutritional status. Physical function was measured using the Short Physical Performance Battery (SPPB) and handgrip strength. Data were collected at baseline and 8-months. Correlation and regression analyses examined relationships between SN, physical function, nutrient intake and nutritional status. Semi-structured interviews were conducted at baseline (n = 92) and follow-up (n = 81) to identify potential influences of SN. Interviews were transcribed verbatim and analysed using directed content analysis. RESULTS: Quantitative data were obtained from 100 participants at baseline and 81 at follow-up. Mean (SD) age was 70.8 (8.1) years (59% male), comprising African/Caribbean (60%), South Asian (34%), and other ethnicities (6%). Five SN typologies were identified under two broad areas: integrated-SN consisting of locally integrated (44%) and wider community (8%); and non-integrated-SN consisting of family dependent (25%), local self-contained (17%), and private restricted (6%). At follow-up, 37% remained in non-integrated networks, 19% transitioned to non-integrated networks, 11% transitioned to, and 33% remained in, integrated networks. Participants within integrated networks at baseline had higher SPPB scores at follow-up. Compared to the private restricted, local self-contained SN significantly predicted zinc, riboflavin and vitamin B6 intakes. Participants remaining in, or transitioning to, non-integrated networks had low MNA-SF scores. Qualitative findings indicate that participants with reductions in SN perceived it as causing poorer physical function and eating behaviours. CONCLUSION: In the present study, integrated SN were associated with higher physical function and nutritional status at 8-month's follow-up. These results can inform the design of interventions to improve social networks, physical function and healthy nutrition within this population.

Multidimensional motivation for exercise: A latent profile and transition analysis.

OBJECTIVES: To: a) identify motivational profiles for exercise, using Self-Determination Theory as a theoretical framework, among a sample of parents of UK primary school children; b) explore the movement between motivational profiles over a five year period; and c) examine differences across these profiles in terms of gender, physical activity and BMI. DESIGN: Data were from the B-Proact1v cohort. METHODS: 2555 parents of British primary school children participated across three phases when the child was aged 5-6, 8-9, and 10-11. Parents completed a multidimensional measure of motivation for exercise and wore an ActiGraph GT3X + accelerometer for five days in each phase. Latent profile and transition analyses were conducted using a three-step approach in MPlus. RESULTS: Six profiles were identified, comprising different combinations of motivation types. Between each timepoint, moving between profiles was more likely than remaining in the same one. People with a more autonomous profile at a previous timepoint were unlikely to move to more controlled or amotivated profiles. At all three timepoints, more autonomous profiles were associated with higher levels of MVPA and lower BMI. CONCLUSIONS: The results show that people's motivation for exercise can be described in coherent and consistent profiles which are made up of multiple and simultaneous types of motivation. More autonomous motivation profiles were more enduring over time, indicating that promoting more autonomous motivational profiles may be central to facilitating longer-term physical activity engagement.

The association of school-related active travel and active after-school clubs with children's physical activity: a cross-sectional study in 11-year-old UK children.

BACKGROUND: Physical activity is associated with improved physical and mental health among children, but many children do not meet the recommended hour per day of moderate-to-vigorous-intensity physical activity (MVPA). The aim of this paper is to investigate participation in active after-school clubs and active travel to and from school at age 11 and estimate the average daily minutes of MVPA associated with active club attendance and active travel. METHODS: Accelerometer data were collected on three weekdays for 1296 11-year-old children in a cross-sectional study. Children reported attendance at active after-school clubs and how they travelled to and from school for each day of the week. To account for repeat days within child and clustering within schools we used multilevel models with random effects at the school and child level, and fixed effects for all covariates. We calculated odds ratios for participation in active after-school clubs and active travel for gender, measures of socio-economic position and BMI category. We also explored the association between active club attendance, active travel and daily average MVPA. RESULTS: Boys and girls were equally likely to attend active after-school clubs. Boys were more likely to travel to school using active modes. Attendance at active after-school clubs and active travel home were not associated with each other. Attending an active after-school club was associated with an additional 7.6 min (95% CI: 5.0 to 10.3) average MVPA on that day among both boys and girls. Active travel was associated with an additional 4.7 min (95% CI: 2.9 to 6.5) average MVPA per journey for boys and 2.4 min (95% CI: 1.0 to 3.7) for girls. CONCLUSIONS: Both active after-school clubs and active travel are associated with greater physical activity on the day that children participate in these, and we saw no evidence that those attending active clubs do so at the expense of active travel home afterwards. While the increased daily MVPA is small to moderate, active after-school clubs and active travel on multiple days of the week could make important contributions as part of complex interventions aimed at increasing population levels of physical activity in children.

The community-based prevention of diabetes (ComPoD) study: a randomised, waiting list controlled trial of a voluntary sector-led diabetes prevention programme.

OBJECTIVE: This two-site randomised trial compared the effectiveness of a voluntary sector-led, community-based diabetes prevention programme to a waiting-list control group at 6 months, and included an observational follow-up of the intervention arm to 12 months. METHODS: Adults aged 18-75 years at increased risk of developing type 2 diabetes due to elevated blood glucose and being overweight were recruited from primary care practices at two UK sites, with data collected in participants' homes or community venues. Participants were randomised using an online central allocation service. The intervention, comprising the prototype "Living Well, Taking Control" (LWTC) programme, involved four weekly two-hour group sessions held in local community venues to promote changes in diet and physical activity, plus planned follow-up contacts at two, three, six, nine and 12 months alongside 5 hours of additional activities/classes. Waiting list controls received usual care for 6 months before accessing the programme. The primary outcome was weight loss at 6 months. Secondary outcomes included glycated haemoglobin (HbA1c), blood pressure, physical activity, diet, health status and well-being. Only researchers conducting analyses were blinded. RESULTS: The target sample of 314 participants (157 each arm) was largely representative of local populations, including 44% men, 26% from ethnic minorities and 33% living in deprived areas. Primary outcome data were available for 285 (91%) participants (141 intervention, 144 control). Between baseline and 6 months, intervention participants on average lost more weight than controls (- 1.7 kg, 95% CI - 2.59 to - 0.85). Higher attendance was associated with greater weight loss (- 3.0 kg, 95% CI - 4.5 to - 1.5). The prototype LWTC programme more than doubled the proportion of participants losing > 5% of their body weight (21% intervention vs. 8% control, OR 2.83, 95% CI 1.36 to 5.90) and improved self-reported dietary behaviour and health status. There were no impacts on HbA1c, blood pressure, physical activity and well-being at 6 months and, amongst intervention participants, few further changes from six to 12-months (e.g. average weight re-gain 0.36 kg, 95% CI - 0.20 to 0.91). There were no serious adverse events but four exercise-related injuries were reported in the intervention arm. CONCLUSIONS: This voluntary sector-led diabetes prevention programme reached a broad spectrum of the population and had modest effects on weight-related outcomes, but limited impacts on other diabetes risk factors. TRIAL REGISTRATION: Trial registration number: ISRCTN70221670, 5 September 2014 Funder (National Institute for Health Research School for Public Health Research) project reference number: SPHR-EXE-PES-COM.

Cultural adaptation of a children's weight management programme: Child weigHt mANaGement for Ethnically diverse communities (CHANGE) study.

BACKGROUND: Childhood obesity prevalence continues to be at high levels in the United Kingdom (UK). South Asian children (mainly Pakistani and Bangladeshi origin) with excess adiposity are at particular risk from the cardiovascular consequences of obesity. Many community-based children's weight management programmes have been delivered in the UK, but none have been adapted for diverse cultural communities. The aim of the Child weigHt mANaGement for Ethnically diverse communities (CHANGE) study, was to culturally adapt an existing children's weight management programme for children aged 4-11 years so that the programme was more able to meet the needs of families from South Asian communities. METHODS: The adaptation process was applied to First Steps, an evidence informed programme being delivered in Birmingham (a large, ethnically diverse city). A qualitative study was undertaken to obtain the views of South Asian parents of children with excess weight, who had fully or partially attended, or who had initially agreed but then declined to attend the First Steps programme. The resulting data were integrated with current research evidence and local programme information as part of a cultural adaptation process that was guided by two theoretical frameworks. RESULTS: Interviews or focus groups with 31 parents in their preferred languages were undertaken. Themes arising from the data included the need for convenient timing of a programme in a close familiar location, support for those who do not speak English, the need to focus on health rather than weight, nutritional content that focuses on traditional and Western diets, more physical activity content, and support with parenting skills. The data were mapped to the Behaviour Change Wheel framework and Typology of Cultural Adaptation to develop an intervention programme outline. The research evidence and local programme information was then used in the detailed planning of the programme sessions. CONCLUSIONS: The process of cultural adaptation of an existing children's weight management programme resulted in a theoretically underpinned programme that is culturally adapted at both the surface and deep structural levels. TRIAL REGISTRATION: ISRCTN81798055 , registered: 13/05/2014.

Longitudinal associations between parents' motivations to exercise and their moderate-to-vigorous physical activity.

OBJECTIVES: This study is the first examination of the longitudinal associations between behavioural regulation and accelerometer-assessed physical activity in parents of primary-school aged children. DESIGN: A cohort design using data from the B-Proact1v project. METHOD: There were three measurement phases over five years. Exercise motivation was measured using the BREQ-2 and mean minutes of moderate-to-vigorous physical activity (MVPA) were derived from ActiGraph accelerometers worn for a minimum of 3 days. Cross-sectional associations were explored via linear regression models using parent data from the final two phases of the B-Proact1v cohort, when children were 8-9 years-old (925 parents, 72.3% mothers) and 10 to 11 years-old (891 parents, 72.6% mothers). Longitudinal associations across all three phases were explored using multi-level models on data from all parents who provided information on at least one occasion (2374 parents). All models were adjusted for gender, number of children, deprivation indices and school-based clustering. RESULTS: Cross-sectionally, identified regulation was associated with 5.43 (95% CI [2.56, 8.32]) and 4.88 (95% CI [1.94, 7.83]) minutes more MVPA per day at times 2 and 3 respectively. In the longitudinal model, a one-unit increase in introjected regulation was associated with a decline in mean daily MVPA of 0.52 (95% CI [-0.88, -0.16]) minutes per year. CONCLUSIONS: Interventions to promote the internalisation of personally meaningful rationales for being active, whilst ensuring that feelings of guilt are not fostered, may offer promise for facilitating greater long-term physical activity engagement in parents of primary school age children.

Associations within school-based same-sex friendship networks of children's physical activity and sedentary behaviours: a cross-sectional social network analysis.

BACKGROUND: Physical activity in children is associated with better physical and mental health but many children do not meet physical activity guidelines. Friendship groups are potentially an important influence on children's physical activity and sedentary time. This paper examines the association between children of physical activity and sedentary time in school-based same-sex friendship networks, for both moderate-to-vigorous intensity physical activity (MVPA) and sedentary time. Moreover, considering the methodological challenges of conducting and interpreting these analyses, we provide examples of how to analyse these data and interpret results to encourage further work in the area. METHODS: Accelerometer data for 1223 children, aged 8-9 years, were collected in 2015-2016 and analysed in 2017. Mean accelerometer minutes of MVPA and sedentary time were calculated. Children named up to four school friends and same-sex school-based friendship networks were constructed. Network models, which include correlation between friends, were fitted by sex. RESULTS: Both MVPA and sedentary time were found to be associated via the friendship networks, for both boys and girls. The network autocorrelation was 0.21 (95% CI: 0.15 to 0.26) for boys' MVPA, and 0.14 (95% CI: 0.07 to 0.21) for sedentary time. Network autocorrelation between girls was weaker, with 0.13 (95% CI: 0.06 to 0.19) for MVPA and 0.11 (95% CI: 0.05 to 0.17) for sedentary time. CONCLUSIONS: Physical activity and sedentary time of boys and girls are associated with the physical activity and sedentary time respectively of others within same-sex friendship networks, and these associations are comparable to other known factors. In this study, the correlation between friends was stronger for boys than girls, and stronger for MVPA than for sedentary time. These findings suggest that friendship networks play a part in understanding children's physical activity and sedentary time and could play a valuable role in developing effective interventions.

Profiles of children's physical activity and sedentary behaviour between age 6 and 9: a latent profile and transition analysis.

BACKGROUND: Physical activity is associated with improved physical and mental health among children. However, physical activity declines and sedentary time increases with age, and large proportions of older children do not meet the recommended hour per day of moderate-to-vigorous-intensity physical activity (MVPA). The aim of this paper is to identify profiles of children based on the complex relationship between physical activity and sedentary time at ages 6 and 9 and explore how those profiles are associated with other covariates and how they change over time. METHODS: Valid accelerometer data were collected for 1132 children aged 6 and 1121 at age 9, with 565 children with data at both ages. We calculated the proportions of total wear time spent in sedentary, light and MVPA activity on both weekdays and weekends. Latent profile (class) analysis was applied separately to the two age groups to identify activity profiles. We then used latent transition analysis to explore transitions between profiles at the two time points. RESULTS: We identified five profiles of activity at age 6 and six profiles at age 9. Although profiles were not directly equivalent, five classes captured similar patterns at both ages and ranged from very active to inactive. At both ages, active profiles, where the majority achieved the recommended MVPA guidelines, were more likely to be active at weekends than on weekdays. There was substantial movement between classes, with strongest patterns of movement to classes with no change or a decrease in MVPA. Transition between classes was associated with sex, BMI z-score, screen-viewing and participation in out-of-school activities. CONCLUSIONS: This paper is the first to apply latent profile analysis to the physical activity of UK children as they move through primary school. Profiles were identified at ages 6 and 9, reflecting different weekday and weekend patterns of physical activity and sedentary time. There was substantial movement between profiles between ages 6 and 9, mostly to no change or less active profiles. Weekend differences suggest that greater focus on how weekend activity contributes to an average of 60 min per day of MVPA across the week may be warranted.

Parents' perspectives of change in child physical activity & screen-viewing between Y1 (5-6) & Y4 (8-9) of primary school: implications for behaviour change.

BACKGROUND: The aim of this study was to explore parents' responses to changes in children's physical activity and screen-time between Year 1 (5-6 years) and Year 4 (8-9 years of age) of primary school. A secondary aim was to identify how parents adapt their parenting to rapidly changing screen-based technology. METHODS: Data were from the longitudinal B-Proact1v Study. Semi-structured telephone interviews were conducted between July and October 2016 with a sub-sample of 51 parents who participated in the study at Year 4. The sample was drawn from 1223 families who took part in the B-Proact1v in which the children wore an accelerometer for 5 days and mean minutes of moderate to vigorous intensity physical activity (MVPA) and sedentary minutes per day were derived. This sample was stratified according to the child's MVPA and sedentary (SED) minutes per day, and by child gender. Data were thematically analysed. RESULTS: Analysis yielded five main themes: 1) Parents reported how children's interests change with free play decreasing and structured activity increasing. 2) Parents highlighted how their children's independence and ability to make choices in relation to physical activity and screen-viewing increase, and that parental influence decreased, as the child gets older. 3) Parents reported that the transition from Year 1 to Year 4 appeared to be a time of substantial change in the screen-based devices that children used and the content that they viewed. 4) Parents reported that managing screen-viewing was harder compared to three years ago and a third of parents expressed concerns about the difficulty of managing screen-viewing in the future. 5) Parents reported using general principles for managing children's screen-viewing including engaging the children with rule setting and encouraging self-regulation. CONCLUSIONS: Parents reported that children's physical activity and sedentary screen behaviours change between Year 1 and Year 4 with children obtaining increased licence to influence the type, location and frequency with which they are active or sedentary. These changes and rapid advances in screen-viewing technology are a challenge for parents to negotiate and highlight a need to develop innovative and flexible strategies to help parents adapt to a rapidly changing environment.

Examining the challenges posed to parents by the contemporary screen environments of children: a qualitative investigation.

BACKGROUND: The ubiquity of technology in modern society has led to the American Academy of Pediatrics adapting their screen-viewing (SV) recommendations for children. The revised guidelines encourage families to identify an appropriate balance between SV and other activities. The aims of this study were to explore parents' views of their child's SV time and how important it is for families to achieve a 'digital balance'. METHODS: Semi-structured telephone interviews were conducted with 51 parents of 8-9-year-old children, between July and October 2016. Inductive and deductive content analyses were used to explore parents' perceptions of their child's level of SV (low, medium, high), how parents feel about child SV, and the importance placed on achieving a digital balance. Parent report of child SV behaviours on weekdays and weekend days were assessed via questionnaire. RESULTS: Interview data revealed that because SV is considered the 'norm', parents struggle to limit it, partly because they want their children to be equipped for the modern technological world. While most parents believe SV to have negative effects on children, parents also report advantages to SV. Many parents feel that not all SV is equal, with tablets considered worse than television because of the isolated nature of activities, and educational SV considered more beneficial than non-educational SV. Most parents feel it is important for their family to achieve a digital balance, primarily to spend more quality family time together. Large variation was observed in parents' descriptions of child SV time on weekdays and weekend days. CONCLUSIONS: Parents recognise the importance of digital balance but want their children to fit into the ever-advancing digital world. Parents do not treat all SV equally. Watching television and engaging in educational SV may be encouraged, while 'playing' on tablets is discouraged. These findings highlight the challenge faced by researchers and policy makers to help families achieve a digital balance, and strategies are needed to support parents to plan child SV time.

Physical Activity, Sedentary Time, and Frailty in Older Migrant Women From Ethnically Diverse Backgrounds: A Mixed-Methods Study.

There is limited evidence examining the association between physical activity (PA), sedentary time (ST), frailty, and factors influencing PA behaviors in migrant older women from ethnically diverse backgrounds. The aims of this mixed-methods study were to: 1) examine PA levels and ST across frailty status; 2) identify any differences in PA/ST between ethnic and religious groups; and 3) qualitatively explore factors influencing PA among older (≥60 years) migrant women (n = 60). PA/ST were assessed using accelerometry and frailty status using the frailty phenotype. Key factors influencing PA were explored via semi-structured interviews (n = 36) and analyzed using thematic analysis. Participants were highly sedentary irrespective of frailty status. Moderate-to-vigorous-physical activity (MVPA) was independently associated with frailty. Participants spent 69% of waking time in ST, with only 15% meeting current weekly PA recommendations. Health-related and socio-cultural factors were reported as common barriers to achieving PA recommendations. Maintaining independence, preventing physical decline and depression were key factors promoting PA. Understanding the challenges and needs of this population can help to inform strategies to promote PA and thus optimize physical function.

Nutrient Intake and Factors Influencing Eating Behaviors in Older Migrant Women Living in the United Kingdom.

This study examines nutrient intake and factors influencing eating behaviors in a sample of 76 migrant older women (≥ 60 years) living in the UK. Nutrient intake was assessed using a 24-hr recall enhanced by an in-depth probing dietary interview. Median energy intake was significantly lower than the UK RNIs (5,125.4 v. 7,301.1 kJ/d, p < .001). Main nutrients of concern were retinol, vitamin D, magnesium, potassium, copper, selenium, and monounsaturated fatty acids. Semistructured interviews were conducted with a subsample (n = 46) and analyzed using thematic analysis. Although women were knowledgeable about what constitutes a healthy diet, factors such as the presence and awareness of obesity and noncommunicable diseases, changes to household roles, and dietary restrictions related to religious beliefs were identified key influences on participants' dietary intake. Strategies targeting this population need to promote not only a healthy energy balance, but also dietary adequacy to optimize nutrient intake.

Association of parents' and children's physical activity and sedentary time in Year 4 (8-9) and change between Year 1 (5-6) and Year 4: a longitudinal study.

BACKGROUND: Parents could be important influences on child physical activity and parents are often encouraged to be more active with their child. This paper examined the association between parent and child physical activity and sedentary time in a UK cohort of children assessed when the children were in Year 1 (5-6 years old) and in Year 4 (8-9 years old). METHODS: One thousand two hundred twenty three children and parents provided data in Year 4 and of these 685 participated in Year 1. Children and parents wore an accelerometer for five days including a weekend. Mean minutes of sedentary time and moderate-to-vigorous intensity physical activity (MVPA) were derived. Multiple imputation was used to impute all missing data and create complete datasets. Linear regression models examined whether parent MVPA and sedentary time at Year 4 and at Year 1 predicted child MVPA and sedentary time at Year 4. Change in parent MVPA and sedentary time was used to predict change in child MVPA and sedentary time between Year 1 and Year 4. RESULTS: Imputed data showed that at Year 4, female parent sedentary time was associated with child sedentary time (0.13, 95% CI = 0.00 to 0.27 mins/day), with a similar association for male parents (0.15, 95% CI = -0.02 to 0.32 mins/day). Female parent and child MVPA at Year 4 were associated (0.16, 95% CI = 0.08 to 0.23 mins/day) with a smaller association for male parents (0.08, 95% CI = -0.01 to 0.17 mins/day). There was little evidence that either male or female parent MVPA at Year 1 predicted child MVPA at Year 4 with similar associations for sedentary time. There was little evidence that change in parent MVPA or sedentary time predicted change in child MVPA or sedentary time respectively. CONCLUSIONS: Parents who were more physically active when their child was 8-9 years old had a child who was more active, but the magnitude of association was generally small. There was little evidence that parental activity from three years earlier predicted child activity at age 8-9, or that change in parent activity predicted change in child activity.

Change in children's physical activity and sedentary time between Year 1 and Year 4 of primary school in the B-PROACT1V cohort.

BACKGROUND: The aim of this study was to examine how children's and parents' physical activity changes from Year 1 (5-6) to Year 4 (8-9 years of age). METHODS: Data are from the Bristol (UK) B-PROACT1V cohort. Fifty-seven primary schools were recruited when the children were in Year 1, with 1299 children and their parents providing data. Forty-seven schools were re-recruited in Year 4, with 1223 children and parents providing data (685 of whom participated in Year 1). Children and at least one parent wore an accelerometer for 5 days including a weekend and mean minutes of sedentary time, moderate-to-vigorous intensity physical activity (MVPA) and accelerometer counts per minute (CPM) were derived. Multiple imputation was used to impute missing data for all 1837 families who took part, including those who participated at just one time. Paired t-tests examined if there was statistical evidence of change in accelerometer measures. RESULTS: Multiple imputation and observed data were comparable and results using complete observed data were mostly the same as those using imputed data. Imputed data showed that mean boys' CPM decreased from 747 to 673 (difference in mean 74 [95% CI 45 to 103]) and girls' from 686 to 587 (99 [79 to 119]). Boys' time spent in MVPA reduced from 72 to 69 (3 [0 to 6]) and girls' from 62 to 56 (7 [4 to 9]) minutes per day. There were increases in sedentary time for both boys (354 to 428 min, 74 [61 to 88]) and girls (365 to 448, 83 [71 to 96]). There was no evidence of change in parent CPM or MVPA. Mothers' sedentary time increased by 26 min per day [16 to 35]. CONCLUSIONS: There were similar increases in sedentary time in girls and boys between age 5-6 and 8-9, and decreases in MVPA that were more marked in girls. The similarity of multiple-imputed and complete observed data suggest that these findings may not be markedly affected by selection bias. Result support early interventions to prevent the age-related decline in children's physical activity.

Development of a brief, reliable and valid diet assessment tool for impaired glucose tolerance and diabetes: the UK Diabetes and Diet Questionnaire.

OBJECTIVE: Dietary advice is fundamental in the prevention and management of type 2 diabetes (T2DM). Advice is improved by individual assessment but existing methods are time-consuming and require expertise. We developed a twenty-five-item questionnaire, the UK Diabetes and Diet Questionnaire (UKDDQ), for quick assessment of an individual's diet. The present study examined the UKDDQ's repeatability and relative validity compared with 4 d food diaries. DESIGN: The UKDDQ was completed twice with a median 3 d gap (interquartile range=1-7 d) between tests. A 4 d food diary was completed after the second UKDDQ. Diaries were analysed and food groups were mapped on to the UKDDQ. Absolute agreement between total scores was examined using intra-class correlation (ICC). Agreement for individual items was tested with Cohen's weighted kappa (κ w). SETTING: South West of England. SUBJECTS: Adults (n 177, 50·3 % women) with, or at high risk for, T2DM; mean age 55·8 (sd 8·6) years, mean BMI 34·4 (sd 7·3) kg/m2; participants were 91 % White British. RESULTS: The UKDDQ showed excellent repeatability (ICC=0·90 (0·82, 0·94)). For individual items, κ w ranged from 0·43 ('savoury pastries') to 0·87 ('vegetables'). Total scores from the UKDDQ and food diaries compared well (ICC=0·54 (0·27, 0·70)). Agreement for individual items varied and was good for 'alcohol' (κ w=0·71) and 'breakfast cereals' (κ w=0·70), with no agreement for 'vegetables' (κ w=0·08) or 'savoury pastries' (κ w=0·09). CONCLUSIONS: The UKDDQ is a new British dietary questionnaire with excellent repeatability. Comparisons with food diaries found agreements similar to those for international dietary questionnaires currently in use. It targets foods and habits important in diabetes prevention and management.