A great way to bring up health behaviour topics at playgroup: a qualitative evaluation of the Healthy Conversations @ Playgroup program.

BACKGROUND: The early years is a critical stage to establish optimal nutrition and movement behaviours. Community playgroups are a relaxed environment for parents with a focus on social connection and supporting parents in their role as 'First Teachers'. Playgroups are therefore an opportunistic setting to promote health behaviours in the early years. To support parents with young children around healthy lifestyle behaviours, the Healthy Conversations @ Playgroup program was delivered in urban and regional areas, across three Australian jurisdictions between 2021-2023. OBJECTIVE: This qualitative evaluation aimed to understand how the Healthy Conversations @ Playgroup program was experienced by parents, playgroup coordinators and peer facilitators. DESIGN: Semi-structured virtual interviews and focus groups were conducted with parents, playgroup coordinators (i.e., person responsible for coordinating the playgroup) and peer facilitators (i.e., trained facilitator for the program) that participated in the Healthy Conversations @ Playgroup study. Transcripts were analysed following a thematic analysis approach. RESULTS: Twenty-eight playgroup parents, coordinators or peer facilitators participated in one of 8 focus groups or 5 interviews. Four themes were developed: Program strengths and challenges; Setting strengths and challenges; Factors that impact program delivery; Participant's suggestions for future program delivery. CONCLUSIONS: The Healthy Conversations @ Playgroup program was valued by parents, providing validation and normalisation of parenting practices, and fostering a shared experience of parenting. Playgroups are a convenient setting for families to attend. The dynamic and distracting nature of the playgroup setting were carefully considered when designing the program. Strategies to further enhance program engagement could include use of coordinator or parent champions, tailored delivery, and extending the reach to other family members. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12621000055808, registered 22 January 2021, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380890.

Organizational readiness and implementation fidelity of an early childhood education and care-specific physical activity policy intervention: findings from the Play Active trial.

BACKGROUND: Many children do not accumulate sufficient physical activity for good health and development at early childhood education and care (ECEC). This study examined the association between ECEC organizational readiness and implementation fidelity of an ECEC-specific physical activity policy intervention. METHODS: Play Active aimed to improve the ECEC educator's physical activity practices. We investigated the implementation of Play Active using a Type 1 hybrid study (January 2021-March 2022). Associations between organizational readiness factors and service-level implementation fidelity were examined using linear regressions. Fidelity data were collected from project records, educator surveys and website analytics. RESULTS: ECEC services with higher levels of organizational commitment and capacity at pre-implementation reported higher fidelity scores compared to services with lower organizational commitment and capacity (all Ps < 0.05). Similarly, services who perceived intervention acceptability and appropriateness at pre-implementation to be high had higher fidelity scores (P < 0.05). Perceived feasibility and organizational efficacy of Play Active were associated with higher but nonsignificant fidelity scores. CONCLUSIONS: Results indicate that organizational readiness factors may influence the implementation of ECEC-specific physical activity policy interventions. Therefore, strategies to improve organizational readiness should be developed and tested. These findings warrant confirmation in the ECEC and other settings and with other health behavior interventions.

Movement behavior policies in the early childhood education and care setting: An international scoping review.

Background: Meeting 24-h movement behavior guidelines for the early years is associated with better health and development outcomes in young children. Early childhood education and care (ECEC) is a key intervention setting however little is known about the content and implementation of movement behavior polices in this context. To inform policy development this international scoping review examined the prevalence, content, development and implementation of ECEC-specific movement behavior policies. Methods: A systematic literature search of published and gray literature since 2010 was conducted. Academic databases (EMBASE, Cinahl, Web of Science, Proquest, Scopus, EBSCO, PubMed) were searched. A Google search was undertaken and limited to the first 200 results. The Comprehensive Analysis of Policy on Physical Activity framework informed data charting. Results: Forty-three ECEC policy documents met inclusion criteria. Most policies originated in the United States, were subnational and developed with government, non-government organizations and ECEC end-users. Physical activity was specified in 59% (30-180 min/day), sedentary time in 51% (15-60 min/day) and sleep in 20% (30-120 min/day) of policies. Daily outdoor physical activity was recommended (30-160 min/day) in most policies. No policy permitted screen time for children <2 years, with 20-120 min/day for children >2 years. Most policies (80%) had accompanying resources but few provided evaluation tools (e.g., checklists; action plan templates). Many policies had not been reviewed since the publication of 24-h movement guidelines. Conclusion: Movement behavior policies in the ECEC setting are often vaguely worded, missing a comprehensive evidence base, siloed in development and often not tailored for the 'real world.' A focus on evidence informed ECEC-specific movement behavior policies proportionally aligned with national/international 24-h Movement Behaviors Guidelines for the Early Years is needed.

Associations between the built environment and emotional, social and physical indicators of early child development across high and low socioeconomic neighbourhoods.

Emerging evidence indicates that the built environment influences early child development. Access to, and the quality of, built environment features vary with the socioeconomic status (SES) of neighbourhoods. It has not yet been established whether the association between built environment features and early child development varies by neighbourhood SES. We sought to identify built environment features associated with neighbourhood-level variations in the early child development domains of physical health and wellbeing, social competence, and emotional maturity, and how these associations differ among high and low SES neighbourhoods where child development patterns follow expected outcomes ("on-diagonal" neighbourhoods) and where child development patterns differ from expected outcomes ("off-diagonal" neighbourhoods). This cross-sectional study analysed data from the Australian Early Development Census (AEDC) for children residing in 3839 neighbourhoods in the Perth and Peel metropolitan areas of Western Australia. Children's AEDC scores were aggregated at the area-level and merged with Geographic Information Systems derived measures of neighbourhood residential density, parks, walkability, community facilities and public transport. Multivariate logistic regressions modelled the odds of low and high SES neighbourhoods having a higher proportion of children developmentally "on-track" (scores in the 26th to 100th percentile of the AEDC) or "not on-track" (scores in the bottom 25th percentile of the AEDC) for each built environment feature. In high SES neighbourhoods, better development across all three domains was associated with greater residential density and improved access to parks, public transport, learning, childcare and health services. Conversely, in low SES neighbourhoods, greater residential density was associated with better physical, but poorer social and emotional development; increased traffic and street connectivity were associated with poorer physical and emotional development; shorter distances to parks, learning, childcare and health services were associated with poorer physical and emotional development; and more services and public transport stops were associated with poorer emotional development. The mixed findings in low SES neighbourhoods suggest that positive associations with built environment features seen in one domain of early child development may be negative in other domains. The reasons for the mixed findings in low SES neighbourhoods are likely multifactorial and may include parental neighbourhood perceptions, as well as quality and usage of built environment features. These findings can be used to inform state and local governments to establish child-friendly town planning and urban design features. Further research is needed to confirm the interplay between SES, early child development, the built environment and other unmeasured factors to better inform public health policy.

Educators' Barriers and Facilitators to Physical Activity Policy Implementation in the Childcare Setting: Qualitative Findings From the Play Active Project.

PURPOSE: We explored childcare educators' perceived barriers and facilitators to policy implementation in order to inform the development and implementation of an early childhood education and care (ECEC) specific physical activity policy. This study was part of the Play Active (2019-2023) project which aimed to develop, implement and evaluate evidence-based physical activity policy to improve physical activity levels in children attending ECEC. APPROACH: Stakeholder focus groups. Setting: ECEC centers in Perth, Western Australia. Sample: Educators (n=66) from 11 ECEC centers participated in 13 focus groups (August-September 2019). METHODS: Semi-structured questions explored educators' perceptions of barriers and facilitators to implementing a new physical activity policy. A qualitative descriptive approach within a naturalistic framework informed data analysis. Focus group data were reviewed and grouped through several iterations to produce core themes. RESULTS: Four core themes resulted from focus groups: (1) leadership; (2) educator mindset: (3) parent engagement; and (4) organisational and educator capacity. Educators needed supportive leadership and a commitment of resources for physical activity policy implementation. Educators acknowledged physical activity practices can be influenced by knowledge, attitudes, beliefs and change capacity and stressed the need for parent engagement for successful implementation. CONCLUSIONS: Educators' voices are important for informing implementation of physical activity policy and practices leading to improvements in children's physical activity levels.

A cross-sectional study of factors associated with regular dog walking and intention to walk the dog.

BACKGROUND: Dog walking is important for public health and dog welfare, yet some owners do not walk with their dogs regularly. This study examined factors associated with participation in regular dog walking and intention to dog walk, in order to inform physical activity interventions. METHODS: 191 dog-owning adults from a UK community were surveyed about their participation in dog walking, intention to dog walk, attitudes and behavioural beliefs regarding dog walking, and dog and owner demographics. Principal components analysis identified owner profiles regarding attitudes and behavioural beliefs about dog walking. Univariable and multivariable logistic regression were used to identify factors associated with being a regular dog walker (achieving 150mins per week of dog walking) and having a high intention to dog walk (at least 30 mins per day for at least 5 days per week over the next month). RESULTS: Participants walked with their dogs for a median 7 times/week and 230 total minutes/week; regular dog walkers 9 times/week (400 minutes/week), compared to twice/week for irregular dog walkers (45 minutes/week). Being a regular dog walker was positively associated with having a high level of intention to walk the dog in the next month (OR=12.1 95%CI=3.5-42.4, P<0.001), being married or living with a partner (OR=33.5, 95%CI=2.5-458.8, P=0.01), and higher scores on a dog walking habit index (OR=2.1, 95%CI=1.3-3.5, P<0.01). However, higher support from friends for walking was negatively associated with being a regular dog walker (OR=0.3, 95%CI=0.1-0.7, P<0.01). High intention to dog walk was associated with female owners (OR=4.7, 95%CI=1.2-18.5, P=0.03), dogs that lay on the sofa (OR=6.9, 95%CI=1.5-31.8, P=0.01), high levels of self-efficacy to walk the dog over the next month (OR=5.8, 95%CI=1.5-21.9, P=0.01), owner type with an attitude of high responsibility and enjoyment from walking (OR=2.1, 95%CI=1.2-3.8, P=0.02), and higher scores on a dog walking habit index (OR=1.9, 95%CI=1.0-3.7, P=0.05). Reporting someone else walks the dog was negatively associated with high intention (OR=0.1, 95%CI=0.0-0.7, P=0.02). CONCLUSIONS: Interventions to promote dog walking may benefit from increasing intention to dog walk in male owners, forming schedules and routines that involve multiple household members in dog walking, and establishing habits around dog walking. Interventions may also need to address how to overcome barriers and perceived challenges in regards to self-efficacy of dog walking, that may prevent intention from being translated into action.

Study protocol for Healthy Conversations @ Playgroup: a multi-site cluster randomized controlled trial of an intervention to promote healthy lifestyle behaviours in young children attending community playgroups.

BACKGROUND: Early childhood is a critical window for preventing obesity and chronic disease. Yet, 1 in 4 Australian children aged 5 years and under are affected by overweight or obesity; and significant proportions of children under 5 years fail to meet guidelines for diet quality, physical activity (PA), screen time, and sleep. Consequently, effective interventions to promote healthy lifestyle behaviors and prevent obesity during early childhood are needed. Community playgroups provide an opportunity for parents, carers, and children to meet in a safe and relaxed environment to play and share information. The structure, low cost and reach of playgroups provide a unique platform to engage parents in a scalable program to promote healthful lifestyle behaviors and prevent childhood obesity. However, the evidence base for the effectiveness of health promotion programs delivered in community playgroup settings is limited and lacking credible evidence from rigorously conducted randomized controlled trials. METHODS: The Healthy Conversations @ Playgroup randomized controlled trial (RCT) aims to address the underlying behavioral risk factors for obesity by helping parents take effective steps to improve their child's dietary, PA, screen time, and sleep behaviors. The intervention program comprises 10 "healthy conversations" led by a trained peer facilitator, designed to increase parents' behavioral capability and self-efficacy to implement autonomy-supportive parenting practices. The program will be delivered biweekly during regularly scheduled playgroup sessions over 10-weeks. Effectiveness will be tested in a 2-arm cluster RCT involving 60 community playgroups in three states across Australia. After baseline assessments, participating playgroups will be randomly allocated to either intervention or wait-list control conditions. Primary outcomes (vegetable intake, discretionary foods, daily PA, screen time, sleep duration, and body mass index [BMI] z-score) will be assessed at baseline, immediately post-intervention (10-weeks; T2) and 6-months post-intervention (T3). Outcomes will be assessed for differential change at T2 and T3. DISCUSSION: The Healthy Conversations @ Playgroup trial will rigorously evaluate a novel peer-led intervention program to promote healthful lifestyle behaviors and prevent obesity in children and families attending community playgroups. If effective, the program could be immediately scaled-up and delivered in community playgroups across Australia. TRIAL REGISTRATION: Trial registered 22nd January 2021 with the Australian and New Zealand Clinical Trials Registry ( ACTRN12621000055808 ).

The Association Between Preschooler Physical Activity Duration and Intensity and Social Emotional Development: Findings From the PLAYCE Study.

BACKGROUND: Social emotional development is imperative to young children's long-term psychological and physical health. Physical activity (PA) may be important for young children's social emotional development. The association between preschooler PA duration and intensity and social emotional development was investigated. METHODS: Data from six hundred and fifty-one 2- to 4-year-olds in the Play Spaces and Environments for Children's Physical Activity (PLAYCE) study were analyzed. PA was measured using ActiGraph-GT3X accelerometers worn over 7 days. Social emotional development was measured using the parent-completed Strengths and Difficulties Questionnaire. Multilevel linear regression models examined the association between PA duration and intensity and Strengths and Difficulties Questionnaire subscales. RESULTS: Preschoolers did 158.2 (SD = 40.2) minutes per day of PA with 27% meeting the Australian Physical Activity Guidelines for the Early Years. There was a 1.74 point decrease in the total Strengths and Difficulties Questionnaire score for each additional hour of moderate-intensity PA per day (P < .05). Similar significant associations were found across all domains of social emotional development except hyperactivity, and were consistent across different intensities of light, moderate, and vigorous PA. CONCLUSIONS: These findings highlight the potential importance of PA, especially moderate-intensity play-based PA, for different aspects of preschool children's social emotional development. Longitudinal and intervention research is required to confirm whether promoting PA in the early years provides developmental benefit.

Exposomes and metabolic health through a physical activity lens: a narrative review.

In this narrative review, we provide an overview of the role of physical activity as part of differing exposomes (our combined non-genetic exposures from conception onwards) and environmental influences on metabolic health. We discuss 'beneficial' exposomes (green/natural outdoor spaces, sun exposure, healthy diets and features of built environments) that could synergise with physical activity to prevent metabolic dysfunction, particularly that related to lifestyle diseases of obesity, type 2 diabetes and metabolic syndrome. Physical activity may also reduce the capacity of some adverse exposomes, specifically those with significant levels of air pollution, to contribute towards metabolic dysfunction. Other exposomes, such as those experienced during pandemics (including COVID-19), potentially limit opportunities for physical activity, and there may be unexpected combined effects of physical activity with other infections (e.g. adenovirus-36) on metabolic health. Finally, we discuss how environments could be better optimised to create exposomes that promote the health benefits of physical activity and likely future directions of this research field.

The relationship between dog ownership, dog play, family dog walking, and pre-schooler social-emotional development: findings from the PLAYCE observational study.

BACKGROUND: Regular physical activity provides children with health and developmental benefits. This study investigated if active play and walking with the family dog was associated with better social-emotional development in young children. METHODS: We surveyed 1646 parents to ascertain if families with pre-schoolers owned a dog, and the frequency per week their child went on family dog walks or actively played with their dog. The parent-report version of the Strengths and Difficulties Questionnaire (SDQ) was used to measure children's social-emotional development. RESULTS: Children from dog-owning households had reduced likelihood of conduct problems (odds ratio (OR) = 0.70; 95% confidence interval (CI): 0.54, 0.90), peer problems (OR = 0.60; 95% CI: 0.46, 0.79), and total difficulties (OR = 0.77; 95% CI: 0.59, 0.99) and increased likelihood of prosocial behavior (OR = 1.34; 95% CI: 1.06, 1.68) compared with children without a dog. Within dog-owning households, family dog walking at least once/week (OR = 1.45; 95% CI: 1.02, 2.08) and active play with the family dog three or more times/week (OR = 1.74; 95% CI: 1.16, 2.59) increased the likelihood of prosocial behaviors. Family dog walking at least once/week also reduced the likelihood of total difficulties (OR = 0.64; 95% CI: 0.42, 0.96). CONCLUSIONS: Our findings highlight the possible physical activity and social-emotional developmental benefits of family dog ownership for pre-schoolers, and that these benefits may present in early childhood. IMPACT: Young children from dog-owning families had lower peer problems and conduct problems, and higher prosocial behaviors than children from non-dog-owning families. Children of dog-owning families who walked or played with their dog more often also had better prosocial behaviors. Positive social-emotional development was associated with dog ownership, family dog walking, and dog play in young children. Highlights that the social-emotional benefits of owning a dog may begin early in childhood. Due to the high level of pet ownership in households with children, these findings suggest having a dog and interacting with it through play and walking may be important mechanisms for facilitating young children's social-emotional development.

Development of physical activity policy and implementation strategies for early childhood education and care settings using the Delphi process.

BACKGROUND: The aim of this study was to gain consensus on an evidence informed physical activity policy template for early childhood education and care (ECEC) and determine best-practice dissemination and implementation strategies using the Delphi process. METHODS: Three-round modified Delphi methodology. During round one an expert working group developed an evidence informed ECEC specific physical activity policy template. Rounds two and three involved national online surveys to seek insight from a group of experts on the draft physical activity policy template. RESULTS: Ninety per cent of experts reported ECEC services are fully responsible for having a physical activity policy. There was consensus on the components of the policy and key physical activity and sedentary behaviour statements and recommendations. The most effective methods for disseminating a physical activity policy to ECEC providers included online (websites, social and electronic media), ECEC targeted launch events, direct mail outs and via professional associations. Twenty five key strategies related to management, supervisors and educators; the ECEC physical environment; communicating with families; and accreditation, monitoring and review, were identified as necessary for the successful implementation of physical activity policy in ECEC. Experts reached consensus on nine of these strategies indicating they were both easy to implement and likely to have a high level of influence. Key barriers and enablers to implementing ECEC-specific physical activity were also identified. CONCLUSIONS: This evidence informed physical activity policy template for ECEC provides recommendations on the amount of physical activity and sedentary time (including screen time) children should have whilst attending ECEC and aligns with national/international guidelines. A number of effective physical activity policy implementation strategies for ECEC were identified. An important next step is advocating for the introduction of legislative requirements for services to have and implement a physical activity policy.

Children's neighbourhood physical environment and early development: an individual child level linked data study.

BACKGROUND: Identification of features of the neighbourhood physical environment that have a causal association with positive child development is important for promoting long-term developmental health. Previous research on these associations have been conducted at the neighbourhood level, and do not account for individual variation in exposure to these features. METHODS: This cross-sectional study utilised de-identified linked administrative data. Neighbourhood features were measured with Geographic Information Systems and identified within a 1600 m service area around the child's home address. The study population included a random selection of 5024 Western Australian children who participated in the 2012 Australian Early Development Census (AEDC; median age 5 years, 5 months). Multi-level logistic regressions modelled the odds of children scoring in the bottom 10% on the physical, social or emotional AEDC domains as an outcome of neighbourhood features. RESULTS: After adjustment for individual and neighbourhood sociodemographic factors, lower odds of physical vulnerability were associated with increased neighbourhood residential density, presence of railway station, and higher counts of playgroups and kindergartens. Larger areas of neighbourhood home-yard space were associated with increased odds of physical and social vulnerability. Presence of high-quality green spaces was associated with lower odds of social vulnerability. Increased road traffic exposure was associated with higher odds of social and emotional vulnerability. CONCLUSIONS: The neighbourhood physical environment has a weak but significant association with early childhood development. Future research should consider the interplay between the neighbourhood environment and proximal influences, including parenting attributes and socioeconomic status, and how they influence early child development.

Dog owners are more likely to meet physical activity guidelines than people without a dog: An investigation of the association between dog ownership and physical activity levels in a UK community.

Previous research suggests that dog owners are slightly more physically active than those without dogs, but have only studied one household member, and it is unclear whether time spent dog walking replaces other physical activity (PA). A survey of 191 dog owning adults (DO), 455 non-dog owning adults (NDO), and 46 children, living in 385 households in West Cheshire UK, was conducted in July-August 2015. Objective (accelerometer) validation occurred on a subset (n = 28 adults). Survey PA outcomes were modelled using hierarchical logistic and linear multivariable regression modelling, accounting for clustering of participants in households. DO were far more likely than NDO to report walking for recreation (OR = 14.35, 95% CI = 5.77-35.79, P < 0.001), and amongst recreational walkers walked for longer per week (RR = 1.39, 95% CI = 1.27-5.91, P < 0.001). Other PA undertaken did not differ by dog ownership. The odds of DO meeting current physical activity guidelines of 150 mins per week were four times greater than for NDO (OR = 4.10, 95% CI = 2.05-8.19, P < 0.001). Children with dogs reported more minutes of walking (P = 0.01) and free-time (unstructured) activity (P < 0.01). Dog ownership is associated with more recreational walking and considerably greater odds of meeting PA guidelines. Policies regarding public spaces and housing should support dog ownership due to PA benefits.

Associations between the home yard and preschoolers' outdoor play and physical activity.

Objectives and importance of study: Young children's outdoor play mostly occurs within the home-yard space, yet the influence of the home yard on preschoolers' outdoor play and physical activity is poorly understood. We investigated the relationships between home-yard features and home-based outdoor play and physical activity in preschoolers (2-5 years old). STUDY TYPE: Cross-sectional observational study. METHODS: The PLAY Spaces and Environments for Children's Physical Activity (PLAYCE) study (2015-2017) included 1596 children aged 2-5 years attending early childhood education and care (ECEC) services throughout metropolitan Perth, Western Australia. In this study, a subsample of 224 parents from the PLAYCE study completed an online questionnaire about home-yard features (yard size, lawn quality, natural features, fixed and portable play equipment, and flowers and vegetables/herbs). Accelerometers measured the duration of preschoolers' moderate-vigorous physical activity (MVPA) on non-ECEC days. Parent-reported outdoor play at home, sociodemographic factors and social environment factors were collected via the PLAYCE parent survey. Multiple linear regression models were used to determine associations between home-yard features and preschoolers' outdoor play and physical activity. RESULTS: Children spent 68.9 (SD 2.2) minutes playing outdoors in the home yard per day, and 93.3 (SD 37.1) minutes in MVPA per day on non-ECEC days. After adjusting for child and parent factors, home-yard features positively associated with outdoor play included yard size, lawn quality, number of types of fixed and portable play equipment, natural features and play areas (all p ≤ 0.05). When all significant home-yard features were placed in a model, only the number of types of fixed play equipment was positively associated with minutes of outdoor play per day (ß = 5.3, p < 0.001). After adjusting for sociodemographic factors, the number of types of portable play equipment in the yard was positively associated with MVPA minutes per day (ß = 2.16, p = 0.019); however, this became nonsignificant after further adjusting for social environment factors. CONCLUSIONS: Features of the home-yard physical environment were positively associated with preschoolers' outdoor play and physical activity. Each additional type of fixed play equipment present was associated with an additional 5 minutes of outdoor play per day. These findings suggest that the home-yard space has the potential to facilitate increased outdoor play in young children. Further research is warranted to explore causal relationships between home-yard attributes and young children's outdoor play and physical activity.

'Hesitant compliers': Qualitative analysis of concerned fully-vaccinating parents.

OBJECTIVE: Some parents are hesitant about vaccines and yet still vaccinate their children. Vaccine behaviours are not fixed and parents who are concerned but nonetheless adherent to standard schedules could switch to an unconventional schedule, delaying or cherry-picking vaccines. There is a need to better understand vaccine hesitancy in specific contexts, acknowledging cultural and geographical variation, to ensure interventions targeting hesitancy are well directed and received. METHODS: To identify the behaviours, knowledge and attitudes of 'hesitant compliers' in Perth, Western Australia, nine one-on-one in-depth interviews were conducted with vaccinating parents of children (<5 years) who were identified as being hesitant. Interview transcripts were analysed qualitatively and themes developed inductively, following a constructivist paradigm. RESULTS: Parents saw vaccination as important for themselves and their community, despite their limited knowledge of vaccine preventable diseases. Parents reported concerns about potential side effects, and worried about the safety of the measles-mumps-rubella (MMR) and seasonal influenza vaccines. Concerned about the role of anti-vaccination information in the community, some sought to isolate themselves from parents who did not vaccinate, although others were concerned that this could entrench non-vaccinators' behaviours. Parents' views were all underlaid by two pivotal 'vaccine-related events' that had occurred in the community: the severe injury of a baby from seasonal influenza vaccination in 2010, and the death of a baby from whooping cough in 2015. CONCLUSIONS: Parents interpreted pivotal vaccine-related events in the community as requiring them to take personal responsibility for vaccine decisions. Their reports of continued vaccine fears (evident in international studies in recent decades) demonstrate that vaccine scares have long lasting effects. With vaccine rates high and stable, current strategies appear to be have little impact on addressing parental vaccine concerns. Further research is required to determine the prevalence of hesitancy amongst vaccinating parents and identify critical points for intervention.

The effect of siblings and family dog ownership on children's independent mobility to neighbourhood destinations.

OBJECTIVE: To investigate the effect of sibling age, gender and dog ownership on children's independent mobility and how this varies according to the destination visited. METHODS: Parents reported whether their child had an older sibling; if the child and older sibling were of the same gender; the number of older siblings; if they owned a dog; and whether their child was allowed to independently travel to school, friends' or family house, park/oval/sporting field and local shop. Data were analysed for 181 children aged 8-15 years. RESULTS: The strongest significant sibling effect for independently mobility to school, local shop and ≥3 destinations was for having an older sibling of the same gender (p≤0.05). For independent mobility to a friend's house and park, the strongest significant sibling effect was for having one older sibling (p≤0.05). Dog ownership was associated with increased odds of being independently mobile to ≥3 destinations (OR=2.43; 95%CI=1.03-5.74). CONCLUSIONS: Parents may be more likely to grant children licence to travel to local places if they are accompanied by an older sibling or the family dog. IMPLICATIONS: Understanding the effects of siblings and dog ownership on children's independent mobility will assist in identifying strategies through which independent mobility can be encouraged.

Factors associated with daily walking of dogs.

BACKGROUND: Regular physical activity is beneficial to the health of both people and animals. The role of regular exercise undertaken together, such as dog walking, is a public health interest of mutual benefit. Exploration of barriers and incentives to regular dog walking by owners is now required so that effective interventions to promote it can be designed. This study explored a well-characterised cross-sectional dataset of 276 dogs and owners from Cheshire, UK, for evidence of factors associated with the dog being walked once or more per day. RESULTS: Factors independently associated with daily walking included: number of dogs owned (multiple (vs. single) dogs negatively associated); size (medium and possibly large dogs (vs. small) positively associated); and number of people in the household (more people negatively associated). Furthermore, a number of factors related to the dog-owner relationship and the dog's behaviour were associated with daily walking, including: having acquired the dog for a hobby (positively associated); dog lying on furniture (positively associated); dog lying on laps (negatively associated); growling at household members (negatively associated); and playing chase games with the dog (negatively associated). CONCLUSIONS: These findings are consistent with the hypothesis that the strength and nature of the human-dog relationship incentivises dog walking, and that behavioural and demographic factors may affect dog walking via this mechanism. Future studies need to investigate how dog demographic and behavioural factors, plus owner behavioural factors and perceptions of the dog, influence the dog-human relationship in respect to the perceived support and motivation a dog can provide for walking.

Individual, Social, and Environmental Correlates of Healthy and Unhealthy Eating.

BACKGROUND: Few studies use comprehensive ecological approaches considering multilevel factors to understand correlates of healthy (and unhealthy) dietary intake. The aim of this study was to examine the association between individual, social, and environmental factors on composite measures of healthy and unhealthy dietary intake in adults. METHOD: Participants (n = 565) of the Australian RESIDential Environments (RESIDE) project self-reported dietary intake, home food availability, and behavioral and perceived social and physical environmental influences on food choices. A geographic information system measured proximity of supermarkets from each participant's home. "Healthy" and "unhealthy" eating scores were computed based on adherence to dietary guidelines. Univariate and multivariate models were constructed using linear regression. RESULTS: After full adjustment, "healthy" eating (mean = 6.25, standard deviation [SD] = 1.95) was significantly associated with having confidence to prepare healthy meals (ß = 0.34; 95% confidence interval [CI] = [0.13, 0.55]); having more healthy (ß = 0.13; 95% CI = [0.09-0.16]) and fewer unhealthy (ß = -0.04; 95% CI = [-0.06, -0.02]) foods available at home; and having a supermarket within 800 meters of home (ß = 1.39; 95% CI = [0.37, 2.404]). "Unhealthy" eating (mean = 3.53, SD = 2.06) was associated with being male (ß = 0.39; 95% CI = [0.02, 0.75]), frequently eating takeaway (ß = 0.33; 95% CI = [0.21, 0.46]) and cafe or restaurant meals (ß = 0.20; 95% CI = [0.06, 0.33]) and having fewer healthy (ß = -0.07; 95% CI = [-0.10, -0.03]) and more unhealthy (ß = 0.09; 95% CI = [0.07, 0.10]) foods available within the home. CONCLUSION: Initiatives to improve adherence to dietary guidelines and reduce the consumption of unhealthy foods needs to be multifaceted; addressing individual factors and access to healthy food choices in both the home and neighborhood food environment. Ensuring proximity to local supermarkets, particularly in new suburban developments, appears to be an important strategy for facilitating healthy eating.

The Effect of the Social and Physical Environment on Children's Independent Mobility to Neighborhood Destinations.

BACKGROUND: Relationships between context-specific measures of the physical and social environment and children's independent mobility to neighborhood destination types were examined. METHODS: Parents in RESIDE's fourth survey reported whether their child (8-15 years; n = 181) was allowed to travel without an adult to school, friend's house, park and local shop. Objective physical environment measures were matched to each of these destinations. Social environment measures included neighborhood perceptions and items specific to local independent mobility. RESULTS: Independent mobility to local destinations ranged from 30% to 48%. Independent mobility to a local park was less likely as the distance to the closest park (small and large size) increased and less likely with additional school grounds (P < .05). Independent mobility to school was less likely as the distance to the closest large park increased and if the neighborhood was perceived as unsafe (P < .05). Independent mobility to a park or shops decreased if parenting social norms were unsupportive of children's local independent movement (P < .05). CONCLUSIONS: Independent mobility appears dependent upon the specific destination being visited and the impact of neighborhood features varies according to the destination examined. Findings highlight the importance of access to different types and sizes of urban green space for children's independent mobility to parks.

How might we increase physical activity through dog walking?: A comprehensive review of dog walking correlates.

BACKGROUND: Physical inactivity and sedentary behaviour are major threats to population health. A considerable proportion of people own dogs, and there is good evidence that dog ownership is associated with higher levels of physical activity. However not all owners walk their dogs regularly. This paper comprehensively reviews the evidence for correlates of dog walking so that effective interventions may be designed to increase the physical activity of dog owners. METHODS: Published findings from 1990-2012 in both the human and veterinary literature were collated and reviewed for evidence of factors associated with objective and self-reported measures of dog walking behaviour, or reported perceptions about dog walking. Study designs included cross-sectional observational, trials and qualitative interviews. RESULTS: There is good evidence that the strength of the dog-owner relationship, through a sense of obligation to walk the dog, and the perceived support and motivation a dog provides for walking, is strongly associated with increased walking. The perceived exercise requirements of the dog may also be a modifiable point for intervention. In addition, access to suitable walking areas with dog supportive features that fulfil dog needs such as off-leash exercise, and that also encourage human social interaction, may be incentivising. CONCLUSION: Current evidence suggests that dog walking may be most effectively encouraged through targeting the dog-owner relationship and by providing dog-supportive physical environments. More research is required to investigate the influence of individual owner and dog factors on 'intention' to walk the dog as well as the influence of human social interaction whilst walking a dog. The effects of policy and cultural practices relating to dog ownership and walking should also be investigated. Future studies must be of a higher quality methodological design, including accounting for the effects of confounding between variables, and longitudinal designs and testing of interventions in a controlled design in order to infer causality.