Physical Activity and Sedentary Behaviors among Chinese Children: Recent Trends and Correlates.

OBJECTIVE: This study was aimed at examining the trends and correlates of physical activity (PA) and sedentary behaviors among Chinese children. METHODS: A total of 4,341 subjects (6,936 observations) aged 6-17 years who participated in the China Health and Nutrition Survey (2004-2015) were included. Of the subjects, 41% participated in the survey twice or more. Random-effects ordinal regression models and repeated-measures mixed-effects models were used to examine the PA trends. Quantile regression models were applied to examine the factors influencing PA and sedentary behaviors. RESULTS: From 2004 to 2015, the prevalence of physical inactivity among Chinese children aged 6-17 years increased by 5.5% [odds ratio ( OR), 1.51; 95% confidence interval ( CI), 1.19-1.90; P < 0.001]. The PA volume declined by 5.8 metabolic equivalent of task-hr/week ( P < 0.001), and the time spent in sedentary behaviors increased by 1.8 hr/week ( P < 0.001). Age, ethnicity, and region showed significant effects on the PA volume across the quartiles ( P < 0.001). Across the quartiles, sedentary time was significantly higher in the children residing in urban areas ( P < 0.001) or areas with high urbanization levels ( P ≤ 0.005) than in their counterparts. CONCLUSIONS: A declining PA trend among Chinese children aged 6-17 years was observed from 2004 to 2015, and certain subgroups and geographical areas are at higher risk of physical inactivity.

Adultification of Black Children in Pediatric Anesthesia.

BACKGROUND: Unconscious racial bias in anesthesia care has been shown to exist. We hypothesized that black children may undergo inhalation induction less often, receive less support from child life, have fewer opportunities to have a family member present for induction, and receive premedication with oral midazolam less often. METHODS: We retrospectively collected data on those <18 years of age from January 1, 2012 to January 1, 2018 including age, sex, race, height, weight, American Society of Anesthesiologists (ASA) physical status, surgical service, and deidentified anesthesiology attending physician. Outcome data included mask versus intravenous induction, midazolam premedication, child life consultation, and family member presence. Racial differences between all outcomes were assessed in the cohort using a multivariable logistic regression model. RESULTS: A total of 33,717 Caucasian and 3901 black children were eligible for the study. For the primary outcome, black children 10-14 years were 1.3 times more likely than Caucasian children to receive mask induction (adjusted odds ratio [AOR], 1.3; 95% confidence interval [CI], 1.1-1.6; P = .001). Child life consultation was poorly documented (<0.5%) and not analyzed. Black children <15 years of age were at least 31% less likely than Caucasians to have a family member present for induction (AOR range, 0.4-0.6; 95% CI range, 0.31-0.84; P < .010). Black children <5 years of age were 13% less likely than Caucasians to have midazolam given preoperatively (AOR, 0.9; 95% CI, 0.8-0.9; P = .012). CONCLUSIONS: This study suggests that disparities in strategies for mitigating anxiety in the peri-induction period exist and adultification may be 1 cause for this bias. Black children 10 to 14 years of age are 1.3 times as likely as their Caucasian peers to be offered inhalation induction to reduce anxiety. However, black children are less likely to receive premedication with midazolam in the perioperative period or to have family members present at induction. The cause of this difference is unclear, and further prospective studies are needed to fully understand this difference.

Everyday life situations in which mothers experience difficulty stimulating healthy energy balance-related behavior in their school-age children: a focus group study.

BACKGROUND: Parental support is an important element in overweight prevention programs for children. The purpose of this study was to examine everyday life situations in which mothers encounter difficulties encouraging healthy energy balance-related behavior in their school-age children. METHODS: We formed four focus groups containing 6-9 participants each. The participants were mothers of Dutch, Turkish, or Moroccan descent with a child 8-13 years of age. All focus group sessions were recorded, transcribed, and coded. Content was analyzed conventionally using ATLAS.ti 6. RESULTS: Twenty-seven difficult everyday life situations were identified in 14 settings. The five most frequently reported situations were a daily struggle regarding eating vegetables, eating breakfast on time before going to school, eating candy and snacks between meals, and spending excessive time watching television and using the computer. A perceived loss of parental control, the inability to establish rules and the failure to consistently enforce those rules were the most commonly cited reasons for why the mothers experience these situations as being difficult. CONCLUSIONS: We identified five difficult everyday life situations related to healthy energy balance-related behavior. These five difficult situations were used as the input for developing a web-based parenting program designed to prevent children from becoming overweight. We reasoned that if we use these situations and the underlying reasons, many parents would recognize these situations and are willing to learn how to deal with them and complete the e-learning.

Obesogenic Behaviors, Self-Efficacy, and Depressive Symptoms in American Indian Children.

BACKGROUND: American Indian (AI) children suffer from high rates of obesity, obesity-related disease, obesogenic behaviors, and depressive symptoms. OBJECTIVE: Study was designed to determine the associations between depressive symptoms and obesogenic behaviors in school-aged AI children in Oklahoma. METHODS: Study design was cross-sectional. Depressive symptoms, beverage intake, fruit and vegetable intake, meal frequency, physical activity, and screen time were self-reported. RESULTS: Mean participant age was 10.5 ± 1.6 years (n = 121); 64% were overweight/obese. Depressive symptoms were associated with dieting and screen time. CONCLUSION: AI chronic disease prevention efforts will benefit by including measures for depression and associations of obesogenic behaviors and depressive symptoms in treatment planning.

'My child did not like using sun protection': practices and perceptions of child sun protection among rural black African mothers.

BACKGROUND: Photodamage is partially mitigated by darker skin pigmentation, but immune suppression, photoaging and cataracts occur among individuals with all skin types. METHODS: To assess practices and acceptability to Black African mothers of sun protection equipment for their children living in a rural area, participants were recruited at the time of their child's 18-month vaccinations. Mothers completed a baseline questionnaire on usual sun behaviours and sun protection practices. They were then provided with sun protection equipment and advice. A follow-up questionnaire was administered two weeks later. RESULTS: Mothers reported that during the week prior to the baseline questionnaire, children spent on average less than 1 hour of time outdoors (most often spent in the shade). Most mothers (97%) liked the sun protection equipment. However, many (78 of 86) reported that their child did not like any of the sun protection equipment and two-thirds stated that the sun protection equipment was not easy to use. CONCLUSIONS: Among Black Africans in rural northern South Africa, we found a mismatch between parental preferences and child acceptance for using sun protection when outdoors. A better understanding of the health risks of incidental excess sun exposure and potential benefits of sun protection is required among Black Africans.

Story Immersion May Be Effective in Promoting Diet and Physical Activity in Chinese Children.

OBJECTIVE: To evaluate the effect of playing a health video game embedded with story immersion, Escape from Diab (Diab), on children's diet and physical activity (PA) and to explore whether children immersed in Diab had greater positive outcomes. DESIGN: Two groups, nonrandomized; 3 outcome assessments: at baseline, immediately after the game (post 1), and 8-10 weeks after the game (post 2). PARTICIPANTS: A total of 179 Chinese children aged 8-12 years. INTERVENTION: The treatment group played Diab; the control group received no intervention. MAIN OUTCOME MEASURES: Motivation; self-efficacy; preference for fruit, vegetables, water, and PA; as well as PA behavior. ANALYSIS: Adjusted changes to post 1 and post 2 by ANCOVA controlling for demographic and baseline variables. RESULTS: Children who played Diab had increased intrinsic motivation for fruit and water, self-efficacy for PA, and self-reported PA scores at post 1 (all P < .05). Children with higher immersion scores (above the median) had increased intrinsic motivation for fruit and water, and autonomous and controlled motivation for PA at post 1 (all P < .05). However, these were not significant at post 2. CONCLUSIONS AND IMPLICATIONS: Diab provides a promising innovative medium for promoting Chinese children's psychological correlates of diet and PA and PA behavior. However, its maintenance of effectiveness needs to be enhanced and mechanisms of change need to be investigated more thoroughly.

The association between overweight and internalizing and externalizing behavior in early childhood.

OBJECTIVE: The aim of this study was to examine bidirectional associations between overweight and behavior problems during early childhood taking into account the adiposity rebound, which is the turning point in the nonlinear development of Body Mass Index in early childhood. METHODS: Longitudinal data from 6624 Dutch children in the Generation R Study were used to analyze the association between measured overweight and scores on the internalizing and externalizing scale of the Child Behavior Checklist between one-and-a-half, three and six years. The adiposity rebound was determined for each child by estimating the lowest point in their growth curve. Cross-lagged modeling was used to test (bi)directional associations. RESULTS: Both body mass and behavior problems were modest to highly stable from age one-and-a-half to six years. Externalizing and internalizing behavior were both associated with later overweight, although effect sizes were small (ßs ranged between 0.06 and 0.07, ps < 0.05). No significant associations in the other direction were found. Controlling for adiposity rebound did not change the pattern of associations. There was a moderating effect of gender, and ethnicity, and timing of adiposity rebound. CONCLUSION: Behavior problems in early childhood may put children at risk for overweight at a later age. This implies that young children with behavior problems may benefit from careful monitoring of eating behavior and weight development. Future studies should take the adiposity rebound into account.

Comparing physical activity and sedentary time among overweight and nonoverweight preschoolers enrolled in early learning programs: a cross-sectional study.

Establishing appropriate physical activity and sedentary behaviours during early childhood is important to ensure children accrue the many associated health benefits. While physical activity levels have been reported as low within early learning programs, little research has explored the physical activity and sedentary time of Canadian preschoolers classified as overweight within these facilities. The purpose of this study was to compare objectively measured physical activity and sedentary time among preschoolers classified as overweight and nonoverweight in early learning programs. Direct assessment of physical activity and sedentary time of 216 preschool-aged children was collected via Actical accelerometers during early learning hours, while body mass index percentile was calculated based on preschoolers' objectively measured height and weight. Results of three 3-way ANOVAs suggest that rates of moderate to vigorous physical activity, total physical activity, and sedentary time (p > 0.05) did not significantly differ based on weight status, sex, and type of early learning facility. This study is one of few that has examined differences in overweight and nonoverweight preschoolers' sedentary time, and adds to the limited research exploring physical activity levels among overweight and nonoverweight preschoolers during early learning hours. Given the high rates of sedentary time reported, programming within early learning facilities is necessary to support preschoolers, regardless of weight status, to achieve increased physical activity levels and decreased sedentary time.

Latina mothers' influences on child appetite regulation.

Parents influence child weight through interactions that shape the development of child eating behaviors. In this study we examined the association between maternal autonomy promoting serving practices and child appetite regulation. We predicted that maternal autonomy promoting serving practices would be positively associated with child appetite regulation. Participants were low-income Latino children-a group at high risk for the development of childhood obesity. A total of 186 low-income Latina mothers and their 4-5 year old children came to a laboratory on two separate days. On the first day, mothers and children chose foods for a meal from a buffet and were audio/videotaped so that maternal autonomy promoting serving practices could be later coded. On the second day, children completed the Eating in the Absence of Hunger (EAH) task to measure child appetite regulation. Mothers also completed the Child Eating Behavior Questionnaire (CEBQ) to measure other aspects of child appetite regulation (food responsiveness, satiety responsiveness, and emotional overeating). Maternal autonomy promotion during serving was assessed using seven separate measures of child and maternal behavior. Principal components analyses of these serving measures yielded three components: allows child choice, child serves food, and mother does not restrict. Consistent with hypotheses, maternal autonomy promoting serving practices (i.e., allows child choice and does not restrict) were negatively associated with maternal reports of child food responsiveness and emotional overeating (CEBQ). The results for the EAH task were more complex-mothers who were autonomy promoting in their serving practices had children who ate the most in the absence of hunger, but this linear effect was moderated somewhat by a quadratic effect, with moderate levels of autonomy promotion during serving associated with the greatest child EAH.

Clustering of lifestyle behaviours and relation to body composition in European children. The IDEFICS study.

BACKGROUND: Dietary patterns, physical activity (PA) and sedentary behaviours are some of the main behavioural determinants of obesity; their combined influence in children has been addressed in a limited number of studies. SUBJECTS/METHODS: Children (16,228) aged 2-9 years old from eight European countries participated in the baseline survey of the IDEFICS study. A subsample of 11,674 children (50.8% males) were included in the present study. Children's food and beverage consumption (fruit and vegetables (F&V) and sugar-sweetened beverages (SSBs)), PA and sedentary behaviours were assessed via parental questionnaires. Sex-specific cluster analysis was applied to identify behavioural clusters. Analysis of covariance and logistic regression were applied to examine the association between behavioural clusters and body composition indicators (BCIs). RESULTS: Six behavioural clusters were identified (C1-C6) both in boys and girls. In both sexes, clusters characterised by high level of PA (C1 and C3) included a large proportion of older children, whereas clusters characterised by low SSB consumption (C5 and C6) included a large proportion of younger children. Significant associations between derived clusters and BCI were observed only in boys; those boys in the cluster with the highest time spent in sedentary activities and low PA had increased odds of having a body mass index z-score (odds ratio (OR)=1.33; 95% confidence interval (CI)=(1.01, 1.74)) and a waist circumference z-score (OR=1.41; 95%CI=(1.06, 1.86)) greater than one. CONCLUSION: Clusters characterised by high sedentary behaviour, low F&V and SSB consumption and low PA turned out to be the most obesogenic factors in this sample of European children.

Nutrient patterns and their association with socio-demographic, lifestyle factors and obesity risk in rural South African adolescents.

The aim of this study was to identify and describe the diversity of nutrient patterns and how they associate with socio-demographic and lifestyle factors including body mass index in rural black South African adolescents. Nutrient patterns were identified from quantified food frequency questionnaires (QFFQ) in 388 rural South African adolescents between the ages of 11-15 years from the Agincourt Health and Socio-demographic Surveillance System (AHDSS). Principle Component Analysis (PCA) was applied to 25 nutrients derived from QFFQs. Multiple linear regression and partial R2 models were fitted and computed respectively for each of the retained principal component (PC) scores on socio-demographic and lifestyle characteristics including body mass index (BMI) for age Z scores. Four nutrient patterns explaining 79% of the total variance were identified: PCI (26%) was characterized by animal derived nutrients; PC2 (21%) by vitamins, fibre and vegetable oil nutrients; PC3 (19%) by both animal and plant derived nutrients (mixed diet driven nutrients); and PC4 (13%) by starch and folate. A positive and significant association was observed with BMI for age Z scores per 1 standard deviation (SD) increase in PC1 (0.13 (0.02; 0.24); p = 0.02) and PC4 (0.10 (-0.01; 0.21); p = 0.05) scores only. We confirmed variability in nutrient patterns that were significantly associated with various lifestyle factors including obesity.

An obesogenic island in the Mediterranean: mapping potential drivers of obesity in Malta.

OBJECTIVE: The prevalence of childhood and adult obesity in Malta is among the highest in the world. Although increasingly recognised as a public health problem with substantial future economic implications for the national health and social care systems, understanding the context underlying the burden of obesity is necessary for the development of appropriate counter-strategies. DESIGN: We conducted a contextual analysis to explore factors that may have potentially contributed to the establishment of an obesogenic environment in Malta. A search of the literature published between 1990 and 2013 was conducted in MEDLINE and EMBASE. Twenty-two full-text articles were retrieved. Additional publications were identified following recommendations by Maltese public health experts; a review of relevant websites; and thorough hand searching of back issues of the Malta Medical Journal since 1990. SETTING: Malta. SUBJECTS: Whole population, with a focus on children. RESULTS: Results are organised and presented using the ANalysis Grid for Elements Linked to Obesity (ANGELO) framework. Physical, economic, policy and socio-cultural dimensions of the Maltese obesogenic environment are explored. CONCLUSIONS: Malta's obesity rates may be the result of an obesogenic environment characterised by limited infrastructure for active living combined with an energy-dense food supply. Further research is required to identify and quantify the strength of interactions between these potential environmental drivers of obesity in order to enable appropriate countermeasures to be developed.

Parental social support, ethnicity, and energy balance-related behaviors in ethnically diverse, low-income, urban elementary schoolchildren.

OBJECTIVE: This study assessed levels of child-reported parent and family social support associated with physical activity (PA) and fruit and vegetable consumption (FVC) by ethnicity among a lower-income sample of US elementary school students. DESIGN: Analysis of cross-sectional baseline data of an elementary school-based study from fall, 2010. SETTING: Nineteen schools in a large urban school district in central Texas. PARTICIPANTS: Fourth- and fifth-grade children (n = 581) and their parents. MAIN OUTCOME MEASURES: Child-reported parental and family social support, 7-day PA, previous day FVC, and weight status. ANALYSIS: Child-reported social support, PA, and FVC using descriptive statistics, ANOVA, chi-square tests, and multiple linear regressions were examined. RESULTS: Child-reported parent and family social support varied by ethnicity (P < .01), with Hispanic children consistently reporting the lowest support. Child-reported social support had a positive association across the 3 energy-balance related behaviors examined (P < .001). CONCLUSIONS AND IMPLICATIONS: Whereas child-reported social support was associated with energy balance-related behaviors across ethnic groups, lower perceived parental and family social support for Hispanic children may represent an important opportunity for intervention.

Influences on adherence to diet and physical activity recommendations in women and children: insights from six European studies.

BACKGROUND: Across Europe, poor health behaviours are associated with increased risks of non-communicable diseases. There is particular concern about young women, children and families, not least as health behaviours operating before and during pregnancy and in early postnatal life may have profound long-term consequences for children's health. Using findings drawn from 7 European countries, we aimed to identify barriers to the implementation and uptake of dietary and physical activity recommendations, and to consider how best to achieve changes in mothers' behaviours and thereby improve the adoption of health recommendations. Six studies across the 7 countries were used for this narrative synthesis of findings. KEY MESSAGES: A woman's education has a strong influence on her own and her children's health behaviours. Women's diets vary across ethnic groups and according to number of children, but psychological factors, such as self-efficacy and sense of control, which may be amenable to modification, are powerful, too, particularly in women with lower educational attainment. Maternal influences on children's behaviours are strong. Differences exist in infant feeding across countries, and there are apparent urban/rural differences in children's diets and physical activity. CONCLUSIONS: Interventions are needed before, as well as during, pregnancy to improve the diets of families with young children. Interventions to address psychological barriers to eating well and being more active are indicated.

Prenatal exposure to organophosphate pesticides and reciprocal social behavior in childhood.

Prenatal exposure to organophosphate pesticides (OPs) has been associated with adverse neurodevelopmental outcomes in childhood, including low IQ, pervasive developmental disorder (PDD), attention problems and ADHD. Many of these disorders involve impairments in social functioning. Thus, we investigated the relationship between biomarkers of prenatal OP exposure and impaired reciprocal social behavior in childhood, as measured by the Social Responsiveness Scale (SRS). Using a multi-ethnic urban prospective cohort of mother-infant pairs in New York City recruited between 1998 and 2002 (n=404) we examined the relation between third trimester maternal urinary levels of dialkylphosphate (ΣDAP) OP metabolites and SRS scores among 136 children who returned for the 7-9year visit. Overall, there was no association between OPs and SRS scores, although in multivariate adjusted models, associations were heterogeneous by race and by sex. Among blacks, each 10-fold increase in total diethylphosphates (ΣDEP) was associated with poorer social responsiveness (ß=5.1 points, 95% confidence interval (CI) 0.8, 9.4). There was no association among whites or Hispanics, or for total ΣDAP or total dimethylphosphate (ΣDMP) biomarker levels. Additionally, stratum-specific models supported a stronger negative association among boys for ΣDEPs (ß=3.5 points, 95% CI 0.2, 6.8), with no notable association among girls. Our results support an association of prenatal OP exposure with deficits in social functioning among blacks and among boys, although this may be in part reflective of differences in exposure patterns.

Physical activity and sedentary behaviour in European children: the IDEFICS study.

OBJECTIVE: To estimate the prevalence of physical activity and sedentary behaviours in European children, and to evaluate the relationship between media availability in personal space and physical activity in relation to total screen time. DESIGN: Data from the baseline IDEFICS (Identification and prevention of dietary- and lifestyle-induced health effects in children and infants) cross-sectional survey. Information on hours of television/digital video disk/video viewing and computer/games-console use (weekday and weekend days), media device availability in personal space, sports club membership, hours of active organized play and commuting (to and from school) were assessed via a self-reported parental questionnaire. Total screen time was defined as the sum of daily media use and subsequently dichotomized into meeting or not meeting the guidelines of the American Academy of Pediatrics. SETTING: Eight survey centres (Italy, Estonia, Cyprus, Belgium, Sweden, Germany, Hungary and Spain). SUBJECTS: Children (n 15 330; 51% males) aged 2-10 years. RESULTS: Percentage of children engaged in total screen time for >2 h/d was higher on weekend days (52% v. 20% on weekdays) and in the older group (71% in males; 57% in females), varying by country. Children with a television set in their bedroom were more likely not to meet the screen time recommendations (OR = 1·54; 95% CI 1·60, 1·74). CONCLUSIONS: Approximately a third of the children failed to meet current screen time recommendations. Availability of a television set in personal space increased the risk of excess total screen time. This information could be used to identify potential targets for public health promotion actions of young population groups.

A frequency questionnaire to estimate free-living physical activity among Tunisian preadolescent and adolescent children.

OBJECTIVE: To develop a child- and adolescent-appropriate physical activity frequency questionnaire (PAFQ) in Tunisia, North Africa. DESIGN: A PAFQ was developed from a physical activity (PA) inventory that comprised major activity components (at home, preparing meals, school time, transport, non-sport leisure, sports, prayer and sleeping time). Then, type and duration of each activity undertaken during the past week were estimated. Total energy expenditure (TEE) estimated by the PAFQ was compared with data derived from two criterion methods: heart-rate monitoring (HRM) and a 24 h PA recall (24h-R), both collected during a 3 d period including one weekday and two weekend days. SETTING: Two elementary schools and two high schools of the most developed and urbanized area, Greater Tunis. SUBJECTS: One hundred and forty-two volunteer children and adolescents aged 10-19 years. RESULTS: The PAFQ strongly was correlated with both HRM (r = 0·70; 95% CI 0·62, 0·76) and 24h-R (r = 0·81; 95% CI 0·77, 0·84). It featured acceptable agreement with both criterion measures, slightly underestimating TEE compared with 24h-R (-2·8%, mean of individual differences -272·7 kJ/d; 95% CI -490·6, -57·4 kJ/d) and moderately overestimating it compared with HRM (+11·3%, mean of individual differences +1106·2 kJ/d; 95% CI 845·8, 1366·6 kJ/d). Reliability ranged from moderate to good (weighted kappa coefficients from 0·47 to 0·78 and intra-class correlation coefficients between 0·79 and 0·86 for energy expenditure by PA categories), indicating strong agreement between the two assessments. CONCLUSIONS: This PAFQ could be useful in the description and surveillance of PA patterns or for the evaluation of population-based interventions directed at promoting PA in Tunisian children and adolescents.

Immigrant family skills-building to prevent tobacco use in Latino youth: study protocol for a community-based participatory randomized controlled trial.

BACKGROUND: Despite declines over recent years, youth tobacco and other substance use rates remain high. Latino youth are at equal or increased risk for lifetime tobacco, alcohol, marijuana, and other illicit drug use compared with their white peers. Family plays an important and influential role in the lives of youth, and longitudinal research suggests that improving parenting skills may reduce youth substance use. However, few interventions are oriented towards immigrant Latino families, and none have been developed and evaluated using a community-based participatory research (CBPR) process that may increase the effectiveness and sustainability of such projects. Therefore, using CBPR principles, we developed a randomized clinical trial to assess the efficacy of a family-skills training intervention to prevent tobacco and other substance use intentions in Latino youth. METHODS/DESIGN: In collaboration with seven Latino community-serving agencies, we will recruit and randomize 336 immigrant families, into intervention or delayed treatment conditions. The primary outcome is youth intention to smoke 6 months post intervention. The intervention consists of eight parent and four youth sessions targeting parenting skills and parent-youth relational factors associated with lower smoking and other substance use in youth. DISCUSSION: We present the study protocol for a family intervention using a CBPR randomized clinical trial to prevent smoking among Latino youth. The results of this trial will contribute to the limited information on effective and sustainable primary prevention programs for tobacco and other substance use directed at the growing US Latino communities. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01442753.

Does a culturally sensitive smoking prevention program reduce smoking intentions among Aboriginal children? A pilot study.

The aim of the study was to determine if a culturally sensitive smoking prevention program would have short-term impacts on smoking intentions among Aboriginal children. Two schools with high Aboriginal enrollment were selected for the study. A grade 4 classroom in one school was randomly assigned to receive the culturally sensitive smoking prevention program. A grade 4 classroom in the second school received a standard smoking prevention program delivered in this jurisdiction. Children in each classroom were tested pre- and post-intervention to measure attitude changes about smoking. There was a significant reduction in intentions to smoke among Aboriginal children who received the culturally sensitive smoking prevention program. The small overall sample size precluded a direct comparison of the efficacy of the culturally sensitive and standard programs. The present findings suggest a smoking prevention program that has been culturally adapted for Aboriginal children may reduce future smoking intentions among Aboriginal grade 4 students. Further research is needed to determine the extent to which school smoking prevention programs adapted to respect the long-standing use of tobacco in Aboriginal cultural traditions may be more effective than standard programs in reaching Aboriginal youth.

A socioecological framework to understand weight-related issues in Aboriginal children in Canada.

Obesity prevention efforts in Aboriginal (First Nations, Métis, or Inuit) communities in Canada should focus predominantly on children given their demographic significance and the accelerated time course of occurrence of type 2 diabetes mellitus in the Aboriginal population. A socioecological model to address childhood obesity in Aboriginal populations would focus on the numerous environments at different times in childhood that influence weight status, including prenatal, sociocultural, family, and community environments. Importantly, for Aboriginal children, obesity interventions need to also be situated within the context of a history of colonization and inequities in the social determinants of health. This review therefore advocates for the inclusion of a historical perspective and a life-course approach to obesity prevention in Aboriginal children in addition to developing interventions around the socioecological framework. We emphasize that childhood obesity prevention efforts should focus on promoting maternal health behaviours before and during pregnancy, and on breastfeeding and good infant and child nutrition in the postpartum and early childhood development periods. Ameliorating food insecurity by focusing on improving the sociodemographic risk factors for it, such as increasing income and educational attainment, are essential. More research is required to understand and measure obesogenic Aboriginal environments, to examine how altering specific environments modifies the foods that children eat and the activities that they do, and to examine how restoring and rebuilding cultural continuity in Aboriginal communities modifies the many determinants of obesity. This research needs to be done with the full participation of Aboriginal communities as partners in the research.