Assessment of causal link between psychological factors and symptom exacerbation in inflammatory bowel disease: a systematic review utilising Bradford Hill criteria and meta-analysis of prospective cohort studies.

BACKGROUND: Psychological stress is a prevalent factor in inflammatory bowel disease (IBD) with detrimental effects on patients' quality of life and possibly disease course. Although the aetiology of symptom exacerbation in IBD has been explored, determining any causation between psychological stress and symptom worsening remains challenging and requires a methodologically rigorous approach. AIM: The aim of this systematic review with meta-analysis was to determine a causal relationship between psychological stress and symptom exacerbation in IBD, subsequently utilising Bradford Hill's criteria (approach never used in this topic area before) to evaluate the likelihood of causal associations. METHODS: Medline, EMBASE, CINAHL and PsycInfo were searched for relevant studies up to July 20, 2019. Data extraction and quality appraisal were performed by two independent reviewers. Results of all retained papers were presented as a narrative synthesis. A random-effect meta-analysis was conducted on studies meeting the criteria for meta-analysis. Bradford Hill criteria were applied to assess the causality of the relationship between all psychological factors and symptom exacerbation. RESULTS: The searches yielded 2472 potential articles. Nineteen clinical prospective cohort studies were eligible for the narrative review with five suitable for the meta-analysis. Meta-analysis showed depression, anxiety and perceived stress did not have a statistically significant association with an increased risk of symptom exacerbation. Four of the Bradford Hill criteria were met which indicates that there is weak to moderate evidence of a causal association between all the psychological factors and disease activity. Inconsistent results and a dearth of studies using the same tools for measuring psychological factors suggest the need for more research to be done to facilitate more conclusive findings. CONCLUSIONS: This original review utilising Bradford Hill criteria in addition to meta-analysis to evaluate the causality of relationship between psychological factors and symptom exacerbation in IBD provides evidence that psychological factors have a weak to moderate causal involvement in IBD symptom exacerbation. However, when combining this finding with the outcomes of the meta-analysis, we can say that the results were inconclusive. Interventions to reduce the associated psychological impact should be part of the treatment plan for patients with IBD. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42012003143.

Establishing the efficacy of interventions to improve health literacy and health behaviours: a systematic review.

BACKGROUND: The primary aim of this review was to establish whether health literacy interventions, in adults, are effective for improving health literacy. Two secondary aims assessed the impact of health literacy interventions on health behaviours and whether health literacy interventions have been conducted in cardiovascular patients. METHODS: A systematic review (Prospero registration: CRD42018110772) with no start date running through until April 2020. Eligible studies were conducted in adults and included a pre/post measure of health literacy. Medline, Embase, Eric, PsychINFO, CINAHL, Psychology and Behavioural Science, HMIC, Web of Science, Scopus, Social Care Online, NHS Scotland Journals, Social Policy and Practice, and Global Health were searched. Two thousand one hundred twenty-seven papers were assessed, and 57 full text papers screened to give 22 unique datasets from 23 papers. Risk of bias was assessed regarding randomisation, allocation sequence concealment, blinding, incomplete outcome data, selective outcome reporting and other biases. Intervention reporting quality was assessed using the TIDieR checklist. RESULTS: Twenty-two studies were included reporting on 10,997 participants in nine countries. The majority of studies (14/22) were published in 2018 or later. Eight studies (n = 1268 participants) also reported on behavioural outcomes. Health literacy interventions resulted in improvements in at least some aspect of health literacy in 15/22 studies (n = 10,180 participants) and improved behavioural outcomes in 7/8 studies (n = 1209 participants). Only two studies were conducted with cardiovascular patients. All studies were at risk of bias with 18 judged as high risk. In addition, there was poor reporting of intervention content with little explication of the theoretical basis for the interventions. CONCLUSIONS: Health literacy interventions can improve health literacy and can also lead to changes in health behaviours. Health literacy interventions offer a way to improve outcomes for populations most at risk of health inequalities. Health literacy is a developing field with very few interventions using clear theoretical frameworks. Closer links between health literacy and behaviour change theories and frameworks could result in higher quality and more effective interventions. PROSPERO REGISTRATION: Prospero registration: CRD42018110772.

Micro-costing and a cost-consequence analysis of the 'Girls Active' programme: A cluster randomised controlled trial.

Physical inactivity has been identified as a leading risk factor for premature mortality globally, and adolescents, in particular, have low physical activity levels. Schools have been identified as a setting to tackle physical inactivity. Economic evidence of school-based physical activity programmes is limited, and the costs of these programmes are not always collected in full. This paper describes a micro-costing and cost-consequence analysis of the 'Girls Active' secondary school-based programme as part of a cluster randomised controlled trial (RCT). Micro-costing and cost-consequence analyses were conducted using bespoke cost diaries and questionnaires to collect programme delivery information. Outcomes for the cost-consequence analysis included health-related quality of life measured by the Child Health Utility-9D (CHU-9D), primary care General Practitioner (GP) and school-based (school nurse and school counsellor) service use as part of a cluster RCT of the 'Girls Active' programme. Overall, 1,752 secondary pupils were recruited and a complete case sample of 997 participants (Intervention n = 570, Control n = 427) was used for the cost-consequence analysis. The micro-costing analysis demonstrated that, depending upon how the programme was delivered, 'Girls Active' costs ranged from £1,054 (£2 per pupil, per school year) to £3,489 (£7 per pupil, per school year). The least costly option was to absorb 'Girls Active' strictly within curriculum hours. The analysis demonstrated no effect for the programme for the three main outcomes of interest (health-related quality of life, physical activity and service use).Micro-costing analyses demonstrated the costs of delivering the 'Girls Active' programme, addressing a gap in the United Kingdom (UK) literature regarding economic evidence from school-based physical activity programmes. This paper provides recommendations for those gathering cost and service use data in school settings to supplement validated and objective measures, furthering economic research in this field. Trial registration: -ISRCTN, ISRCTN10688342.

Marathon Kids UK: study design and protocol for a mixed methods evaluation of a school-based running programme.

INTRODUCTION: Schools are promising settings for physical activity promotion; however, they are complex and adaptive systems that can influence the quality of programme implementation. This paper presents an evaluation of a school-based running programme (Marathon Kids). The aims of this study are (1) to identify the processes by which schools implement the programme, (2) identify and explain the contextual factors affecting implementation and explications of effectiveness and (3) examine the relationship between the level of implementation and perceived outcomes. METHODS: Using a realist evaluation framework, a mixed method single-group before-and-after design, strengthened by multiple interim measurements, will be used. Year 5 (9-10 years old) pupils and their teachers will be recruited from six state-funded primary schools in Leicestershire, UK.Data will be collected once prior to implementation, at five discrete time points during implementation and twice following implementation. A weekly implementation log will also be used. At time point 1 (TP1) (September 2016), data on school environment, teacher and pupil characteristics will be collected. At TP1 and TP6 (July 2017), accelerometry, pupil self-reported physical activity and psychosocial data (eg, social support and intention to be active) will be collected. At TP2, TP3 and TP5 (January, March and June 2017), observations will be conducted. At TP2 and TP5, there will be teacher interviews and pupil focus groups. Follow-up teacher interviews will be conducted at TP7 and TP8 (October 2017 and March 2018) and pupil focus group at TP8. In addition, synthesised member checking will be conducted (June 2018) with a mixed sample of schools. ETHICS AND DISSEMINATION: Ethical approval for this study was obtained through Loughborough University Human Participants Ethics Subcommittee (R16-P032 & R16-P116). Findings will be disseminated via print, online media and dissemination events as well as practitioner and/or research journals.

Effectiveness of the 'Girls Active' school-based physical activity programme: A cluster randomised controlled trial.

BACKGROUND: Globally, adolescent girls' physical activity (PA) levels are low. The 'Girls Active' secondary school-based programme, developed by the Youth Sport Trust, aims to increase PA in adolescent girls. This paper explores the effectiveness of the 'Girls Active' school-based PA programme. METHODS: A random sample of girls aged 11-14 from 20 secondary schools (Midlands, UK) participated in a two-arm cluster randomised controlled trial. Ten schools received Girls Active and 10 continued with usual practice. Measurements were taken at baseline, seven- and 14-month follow-up. PRIMARY OUTCOME: wrist-worn accelerometer measured moderate- to vigorous-intensity PA (MVPA). SECONDARY OUTCOMES: overall PA, light PA, sedentary time, body composition, and psychosocial outcomes. Generalised estimating equations, adjusted for school cluster and potential confounders, were used and A priori subgroup analysis was undertaken. Micro-costing and cost-consequence analyses were conducted using bespoke collection methods on programme delivery information. Outcomes for the cost-consequence analysis were health related quality of life measured by the Child Health Utility-9D and service use. RESULTS: Overall, 1752 pupils participated, 1211 (69.1%) provided valid 14-month accelerometer data. No difference in MVPA (mins/day; 95% confidence intervals) was found at 14 months (1.7; -0.8 to 4.3), there was at seven months (2.4; 0.1 to 4.7). Subgroup analyses showed significant intervention effects on 14-month in larger schools (3.9; 1.39 to 6.09) and in White Europeans (3.1; 0.60 to 6.02) and in early maturers (5.1; 1.69 to 8.48) at seven months. The control group did better in smaller schools at 14-months (-4.38; -7.34 to -1.41). Significant group differences were found in 14-month identified motivation (-0.09; -0.18 to -0.01) and at seven months in: overall PA (1.39 mg/day; 0.1 to 2.2), after-school sedentary time (-4.7; -8.9 to -0.6), whole day (5.7; 1.0 to 10.5) and school day (4.5; 0.25 to 8.75) light PA, self-esteem. Small, statistically significant, differences in some psychosocial variables favoured control schools. Micro-costing demonstrated that delivering the programme resulted in a range of time and financial costs at each school. Cost-consequence analysis demonstrated no effect of the programme for health related quality of life or service use. CONCLUSIONS: Compared with usual practice, 'Girls Active' did not affect 14-month MVPA. TRIAL REGISTRATION: ISRCTN10688342.

How active are women who play bingo: a cross-sectional study from the Well!Bingo project.

BACKGROUND: The benefits of physical activity are well established, yet large numbers of people are not sufficiently active to gain health benefits. Certain population groups are less physically active than others, including older women from areas of high economic deprivation. The Well!Bingo project was established with the aim of engaging such women in the development of a health promotion intervention in a bingo club. This paper reports on the assessment of health status, physical activity and sedentary behaviour of women attending a bingo club in central Scotland, UK as part of the Well!Bingo project. METHODS: Women attending the bingo club were invited to provide information on demographic characteristics, and self-reported physical activity and sedentary behaviour via a self-complete questionnaire as part of a cross-sectional study (n = 151). A sub-sample (n = 29) wore an accelerometer for an average of 5.7 ± 1.4 days. Differences between younger (under 60 years) and older adults (60 years and over) were assessed using a chi-square test for categorical data and the independent samples t-test was used to assess continuous data (p < 0.05). RESULTS: The mean age was 56.5 ± 17.7 years, with 57% living in areas of high deprivation (Scottish Index of Multiple Deprivation quintile one and two). Sixty-three percent of women (n = 87) reported they were meeting physical activity guidelines. However, objective accelerometer data showed that, on average, only 18.1 ± 17.3 min a day were spent in moderate to vigorous physical activity. Most accelerometer wear time was spent sedentary (9.6 ± 1.7 h). For both self-report and accelerometer data, older women were significantly less active and more sedentary than younger women. On average, older women spent 1.8 h more than younger women in sedentary activities per day, and took part in 21 min less moderate to vigorous physical activity (9.4 mins per day). CONCLUSION: The findings of this study suggest that bingo clubs are settings that attract women from areas of high deprivation and older women in bingo clubs in particular would benefit from interventions to target their physical activity and sedentary behaviour. Bingo clubs may therefore be potential intervention settings in which to influence these behaviours.

Reducing sedentary time in adults at risk of type 2 diabetes: process evaluation of the STAND (Sedentary Time ANd Diabetes) RCT.

BACKGROUND: Reducing sedentary behaviour may have important health implications. This study evaluated the potential enablers and barriers for outcomes of a randomised controlled trial (RCT) designed to evaluate a pragmatic education based intervention designed to reduce sedentary (sitting) behaviour in young adults at high risk of type 2 diabetes. METHODS: Data were collected from participants in the intervention group immediately after an educational workshop addressing sedentary time and diabetes risk (n = 71), through phone interviews 6 weeks (n = 45) after the workshop, and at the conclusion of the 12-month trial (n = 10). The two education session facilitators were also interviewed about the intervention. RESULTS: The RCT showed no difference in sedentary time at 12 months between intervention and control arms. The lack of behaviour change appeared not to be attributed to the workshops, which were well led and very favourably received according to feedback. However, factors contributing to this lack of behaviour change include lack of perceived health risk from baseline measures feedback; the preference to adopt physically active behaviours rather than to sit less; certain barriers to sitting less; motivational drift after the 3-month follow-up measurements where participants had no contact for a further 9 months; and, for some, unreliability of the self-monitoring tool. CONCLUSIONS: The workshop was well led and well received by the attendees but future interventions need to consider more contact with participants, discuss any specific benefits around simply standing to reduce sitting time, address the barriers to sitting less, and provide a more user-friendly and reliable self-monitoring tool. TRIAL REGISTRATION: Current controlled trials ISRCTN08434554 , MRC project 91409. Registered retrospectively on 22 February 2011.

A Randomised Controlled Trial to Reduce Sedentary Time in Young Adults at Risk of Type 2 Diabetes Mellitus: Project STAND (Sedentary Time ANd Diabetes).

AIMS: Type 2 diabetes mellitus (T2DM), a serious and prevalent chronic disease, is traditionally associated with older age. However, due to the rising rates of obesity and sedentary lifestyles, it is increasingly being diagnosed in the younger population. Sedentary (sitting) behaviour has been shown to be associated with greater risk of cardio-metabolic health outcomes, including T2DM. Little is known about effective interventions to reduce sedentary behaviour in younger adults at risk of T2DM. We aimed to investigate, through a randomised controlled trial (RCT) design, whether a group-based structured education workshop focused on sitting reduction, with self-monitoring, reduced sitting time. METHODS: Adults aged 18-40 years who were either overweight (with an additional risk factor for T2DM) or obese were recruited for the Sedentary Time ANd Diabetes (STAND) RCT. The intervention programme comprised of a 3-hour group-based structured education workshop, use of a self-monitoring tool, and follow-up motivational phone call. Data were collected at three time points: baseline, 3 and 12 months after baseline. The primary outcome measure was accelerometer-assessed sedentary behaviour after 12 months. Secondary outcomes included other objective (activPAL) and self-reported measures of sedentary behaviour and physical activity, and biochemical, anthropometric, and psycho-social variables. RESULTS: 187 individuals (69% female; mean age 33 years; mean BMI 35 kg/m2) were randomised to intervention and control groups. 12 month data, when analysed using intention-to-treat analysis (ITT) and per-protocol analyses, showed no significant difference in the primary outcome variable, nor in the majority of the secondary outcome measures. CONCLUSIONS: A structured education intervention designed to reduce sitting in young adults at risk of T2DM was not successful in changing behaviour at 12 months. Lack of change may be due to the brief nature of such an intervention and lack of focus on environmental change. Moreover, some participants reported a focus on physical activity rather than reductions in sitting per se. The habitual nature of sedentary behaviour means that behaviour change is challenging. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN08434554.

Does activity-related social support differ by characteristics of the adolescent?

BACKGROUND: Previous research has shown a positive relationship between activity-related social support provided by parents and peers and adolescents' physical activity. However, more information is needed on whether activity-related social support differs by sociodemographic characteristics. The purpose of this study was to investigate differences in activity-related social support in a sample of adolescents, by characteristics such as age, gender, socioeconomic status (SES), ethnicity, and physical activity level and to determine which characteristics are the most important predictors of activity-related social support. METHODS: Information was provided by 578 boys and 588 girls (11-14 years) on demographic factors, physical activity, and activity-related support. ANOVA, correlations, and multiple regression were performed to address the purposes of the study. RESULTS: Boys, White British, younger, more physically active, and high-SES adolescents perceived more support for physical activity. Age predicted all types of support excluding peer support; ethnicity predicted mother logistic support and sibling support; gender predicted peer support, father explicit modeling, and father logistic support; and SES predicted mother and father logistic support. CONCLUSIONS: Families and peers of adolescents who are female, from Black and minority ethnic groups, older, of low-SES, and less active should be targeted for intervention.

Physical activity and body composition outcomes of the GreatFun2Run intervention at 20 month follow-up.

BACKGROUND: Physical inactivity is recognised as a public health concern within children and interventions to increase physical activity are needed. GreatFun2Run was a school-based healthy lifestyles intervention that showed positive changes in physical activity levels and body composition immediately post-intervention. The purpose of this paper was to examine whether these changes in physical activity and body composition were maintained 18-20 months after the intervention ended. METHOD: Participants (n = 589, aged 7-11 yrs) from 4 intervention and 4 control schools took part in the 10-month intervention, of which 421 (71%) were present for follow-up. The intervention comprised a CD-rom learning and teaching resource for teachers; an interactive website for pupils, teachers and parents; two highlight physical activity events (1 mile school runs/walks); a local media campaign; and a summer activity wall planner and record. Randomisation was not possible because of local media content. Outcome measures were objectively measured physical activity (pedometers and accelerometers) and body composition variables (body mass index, waist circumference, estimated percent body fat, and sum of skinfolds). Teacher interviews and participant focus groups were conducted. Multi-level modelling was employed for the data analysis. RESULTS: Both control and intervention participants had increased their physical activity at follow-up but there was no group by time interaction (control: 2726 steps per day increase; intervention 3404 steps per day increase, p > .05). There were significant increases in estimated percent body fat, sum of skinfolds, waist circumference and body mass index (BMI) with increasing age. In the control group, there was evidence for a plateauing in the rate of change in all body composition variables with increasing age, except BMI. In contrast, significant interaction terms suggest that the rate of change in waist circumference, BMI and BMISDS continued to increase with age in the intervention group. Teacher interviews suggested that because of time pressures, competing resources, curriculum demands and staff changes the majority of teachers had not continued to use the resources. CONCLUSIONS: While the intervention initially produced positive changes in physical activity levels and body composition, these changes were not sustained once the intervention ended. Facilitating long-term health behaviour change in children remains a challenge.

An assessment of self-reported physical activity instruments in young people for population surveillance: Project ALPHA.

BACKGROUND: The assessment of physical activity is an essential part of understanding patterns and influences of behaviour, designing interventions, and undertaking population surveillance and monitoring, but it is particularly problematic when using self-report instruments with young people. This study reviewed available self-report physical activity instruments developed for use with children and adolescents to assess their suitability and feasibility for use in population surveillance systems, particularly in Europe. METHODS: Systematic searches and review, supplemented by expert panel assessment. RESULTS: Papers (n=437) were assessed as potentially relevant; 89 physical activity measures were identified with 20 activity-based measures receiving detailed assessment. Three received support from the majority of the expert group: Physical Activity Questionnaire for Children/Adolescents (PAQ-C/PAQ-A), Youth Risk Behaviour Surveillance Survey (YRBS), and the Teen Health Survey. CONCLUSIONS: Population surveillance of youth physical activity is strongly recommended and those involved in developing and undertaking this task should consider the three identified shortlisted instruments and evaluate their appropriateness for application within their national context. Further development and testing of measures suitable for population surveillance with young people is required.

A family-based intervention to increase fruit and vegetable consumption in adolescents: a pilot study.

OBJECTIVE: To evaluate the feasibility and effectiveness of a pilot family-based newsletter intervention to increase fruit and vegetable (FV) consumption among adolescents. DESIGN: Family-based, two-group randomised control trial with baseline, post-intervention and follow-up measures. The intervention group received two FV newsletter packs over a 1 month period by postal mail. Social cognitive and behavioural choice theories provide the theoretical framework for the design and development of intervention materials. Control families were provided with all intervention materials at the end of the study. Adolescent FV consumption was assessed by an FFQ. Adolescent-reported barriers to eating FV, FV habits and preferences were the secondary outcomes, along with parent FV consumption, and parents reported knowledge, encouragement, home availability and accessibility of FV. Repeated-measures ANOVA was used to detect differences in behavioural and psychosocial outcomes between groups, time and group-by-time. SETTING: East Midlands, UK. SUBJECTS: Forty-nine parents and adolescents aged 12-14 years. RESULTS: Process evaluation indicated high reach, dose acceptability and fidelity of the intervention. At post-intervention and 6 weeks later at follow-up, adolescents in the intervention group had significantly higher fruit: (P < 0.01) and vegetable (P < 0.05) consumption and higher preferences for vegetables (P < 0.01), compared with the control group. At post-intervention and follow-up, parents in the intervention group had significantly higher fruit (P < 0.001) and vegetable (P < 0.01) consumption and reported higher accessibility of fruit and vegetables (P < 0.001), compared with those in the control group. CONCLUSIONS: Family-based, newsletter interventions promoting FV consumption to adolescents appear to be feasible and effective at increasing FV consumption.

The prevalence of leisure time sedentary behaviour and physical activity in adolescent boys: an ecological momentary assessment approach.

STUDY OBJECTIVE: To use ecological momentary assessment to describe how adolescent boys in the United Kingdom spend their leisure time. Design. Cross-sectional, stratified, random sample from secondary schools in 15 regions within the United Kingdom. The data are from a larger study of adolescent lifestyles (Project STIL). PARTICIPANTS: A total of 561 boys with a mean age of 14.6 years (range 12.7-16.7 years). The majority were white-European (86.5%). MAIN RESULTS: Television viewing occupied the most leisure time on both weekdays (131 minutes) and weekend (202.5 minutes) days. On weekdays the five most time consuming sedentary activities (television viewing, homework, motorised travel, playing computer/video games and shopping/hanging out) occupied on average 272.2 minutes. On weekend days, the five most time consuming sedentary activities (television viewing, shopping/hanging out, motorised travel, sitting and talking and playing computer/video games) occupied 405.5 minutes. In total, 54 minutes were occupied by active transport or sports and exercise per weekday and 81 minutes per weekend day. Only a minority watched more than 4 hours of TV per day (8.9% on weekdays and 33.8% on weekend days). Differences were noted in the means and prevalence between weekend and weekdays, reflecting the greater discretionary time available at the weekend. CONCLUSIONS: Adolescent boys engage in a variety of sedentary and active free time behaviours. It appears prudent to encourage adolescents to adopt overall healthy lifestyles by considering the combination of both active and sedentary pursuits an individual engages in and by moving beyond a focus on any one single behaviour.

Effectiveness of a pragmatic education program designed to promote walking activity in individuals with impaired glucose tolerance: a randomized controlled trial.

OBJECTIVE To investigate whether a pragmatic structured education program with and without pedometer use is effective for promoting physical activity and improving glucose tolerance in those with impaired glucose tolerance (IGT). RESEARCH DESIGN AND METHODS Overweight and obese individuals with IGT were recruited from ongoing screening studies at the University Hospitals of Leicester, U.K. Participants were randomly assigned to one of three groups. Group 1 received a 3-h group-based structured education program designed to promote walking activity using personalized steps-per-day goals and pedometers. Group 2 received a 3-h group-based structured education program designed to promote walking activity using generic time-based goals. Group 3 received a brief information leaflet (control condition). Outcomes included an oral glucose tolerance test, standard anthropometric measures, ambulatory activity, and psychological variables. Follow-up was conducted at 3, 6, and 12 months. RESULTS A total of 87 individuals (66% male, mean age 65 years) were included in this study. At 12 months, significant decreases in 2-h postchallenge glucose and fasting glucose of -1.31 mmol/l (95% CI -2.20 to -0.43) and -0.32 mmol/l (-0.59 to -0.03), respectively, were seen in the pedometer group compared with the control group. No significant improvements in glucose control were seen in those given the standard education program. CONCLUSIONS This study suggests that a pragmatic structured education program that incorporates pedometer use is effective for improving glucose tolerance in those with IGT. This result is likely to have important implications for future primary care-based diabetes prevention initiatives.

The prevalence of sedentary behavior and physical activity in leisure time: A study of Scottish adolescents using ecological momentary assessment.

OBJECTIVE: To report time and prevalence of leisure time sedentary and active behaviors in adolescents. METHOD: Cross-sectional, stratified, random sample from schools in 14 districts in Scotland, 2002-03, using ecological momentary assessment (n=385 boys, 606 girls; mean age 14.1 years; range 12.6-16.7 years). This is a method of capturing current behavioral episodes. We used 15 min time intervals. RESULTS: Television viewing occupied the most leisure time. The five most time consuming sedentary activities occupied 228 min per weekday and 396 min per weekend day for boys, and 244 min per weekday and 400 min per weekend day for girls, with TV occupying one-third to one-half of this time. In contrast, 62 min was occupied by active transport and sports/exercise per weekday and 91 min per weekend day for boys, with 55 min per weekday and 47 min per weekend day for girls. A minority watched more than 4 h of TV per day, with more at weekends. Other main sedentary behaviors for boys were homework, playing computer/video games, and motorised transport and, for girls, homework, motorised transport, and sitting and talking. CONCLUSION: Scottish adolescents engage in a variety of sedentary and active behaviors. Research into sedentary behavior must assess multiple behaviors and not rely solely on TV viewing.

Family correlates of breakfast consumption among children and adolescents. A systematic review.

Regular breakfast consumption can have a multitude of positive health benefits, yet young people are more likely to skip breakfast than any other meal. Given the evidence that dietary behaviours established in childhood and adolescence track into adulthood along with evidence that breakfast skipping increases with age, identifying correlates of children's and adolescent's breakfast behaviours is imperative. The family environment is an important influence on the dietary behaviours of young people, and therefore we systematically reviewed the literature on family correlates of children and adolescent's breakfast consumption. From the 24 papers reviewed, 6 studied children and 19 studied adolescents. Few studies have examined the same specific family correlates of breakfast consumption, limiting the possibilities of drawing strong or consistent conclusions. Research in this area is relatively new and this review has identified areas for further investigation. Parental breakfast eating and living in two-parent families were the correlates supported by the greatest amount of evidence in association with adolescent's breakfast consumption. The results suggest that parents should be encouraged to be positive role models to their children by targeting their own dietary behaviours and that family structure should be considered when designing programmes to promote healthy breakfast behaviours.

The prevalence of leisure time sedentary behaviour and physical activity in adolescent girls: an ecological momentary assessment approach.

STUDY OBJECTIVE: To use ecological momentary assessment to describe how adolescent girls in the United Kingdom spend their leisure time. DESIGN: Cross-sectional, stratified, random sample from secondary schools in 15 regions within the United Kingdom. The data are from a larger study of adolescent lifestyles (Project STIL). PARTICIPANTS: A total of 923 girls with a mean age of 14.7 years (range 12.5-17.6 years). The majority were white-European (88.7%). MAIN RESULTS: Across all behaviours, television viewing occupied the most leisure time on both weekdays and weekend days. The five most time consuming sedentary weekday activities occupied on average 262.9 minutes per weekday and 400 minutes per weekend day. In contrast, only 44.2 minutes was occupied by active transport or sports and exercise per weekday, and 53 minutes per weekend day. Only a minority watched more than 4 hours of TV per day (3.3% on weekdays and 20.7% on weekend days). Computer use is low in this group. Some differences were noted in the means and prevalences between weekend and weekdays, most likely reflecting the greater discretionary time available at the weekend. Few age differences were noted. CONCLUSIONS: Adolescent girls engage in a variety of behaviours that contribute to an overall lifestyle that may be active or sedentary. Effective physical activity promotion strategies must focus on facilitating shifts towards healthy overall patterns of behaviour rather than shifts in any one single behaviour.

Couch kids: correlates of television viewing among youth.

The purpose of this study was to review the published empirical correlates of television/video viewing among youth (2 to 18 years). A descriptive semi-quantitative review was conducted based on 68 primary studies. Variables consistently associated with TV/video viewing were ethnicity (non-white +), parent income (-), parent education (-), body weight (+), between meal snacking (+), number of parents in the house (-), parents TV viewing habits (+), weekend (+) and having a TV in the bedroom (+). Variables consistently unrelated to TV/video viewing were sex, other indicators of socio-economic status, body fatness, cholesterol levels, aerobic fitness, strength, other indicators of fitness, self-perceptions, emotional support, physical activity, other diet variables, and being an only child. Few modifiable correlates have been identified. Further research should aim to identify modifiable correlates of TV/video viewing if interventions are to be successfully tailored to reduce this aspect of inactivity among youth.