Sociodemographic moderators of longitudinal changes in active play between childhood and adolescence in Australia.

Physical activity (PA) participation is prone to decline during childhood and adolescence. In Australia, this decline has been shown to particularly occur in active play. This study aimed to identify sociodemographic moderators of change in active play between 10-11y and 12-13y among Australian youth. The data were sourced from Waves 6-7 of the Longitudinal Study of Australian Children (n = 3567). Active play participation was measured using one-day time-use diaries (TUDs) completed by youth. Potential sociodemographic moderators were tested using multilevel mixed modelling, adjusted for pubertal development, body mass index z-score and TUD contextual variables (school attendance and season). Active play declined more among girls (ß= -7.6 min/day, 95% CI = -13.3, -1.8), those who spoke English at home (ß= -12.3 min/day, 95% CI = -22.0, -2.7) and marginally among those in regional/remote areas (ß= -6.3 min/day, 95% CI = -12.8, +0.1). A widening gap in active play by sex was observed, while differences by language spoken at home and geographical remoteness weakened or became marginal over time. Interventions to promote active play could target girls in the transition to adolescence. Future studies could investigate whether active play declines earlier than 10-11y among youth who speak languages other than English at home and those living in urban areas.

The effect of experiential learning interventions on physical activity outcomes in children: A systematic review.

BACKGROUND: This systematic review examined the effectiveness of experiential learning interventions for improving children's physical activity knowledge, attitudes, and behaviours. It also aimed to identify intervention characteristics that resulted in the greatest impact. METHODS: Four databases: Education Research Complete, Scopus, Web of Science and PsychINFO were searched from database inception to January 2023. Eligible studies: (1) included children 0-12 years; (2) assessed the effect of physical activity outcomes on children's physical activity knowledge, attitudes or behaviour and (3) were randomised controlled trials conducted in any setting. Study risk of bias was assessed by two independent reviewers using the Cochrane risk of bias tool. Intervention approaches were categorised, and effect sizes were compared across studies for each outcome. RESULTS: Twelve studies were included in the review: ten in school age and two in below five years. For behavioural outcomes, six of eight studies showed medium to large effects (effects size (ES) range: 0.3-0.9), two of the three studies that assessed attitudinal outcomes displayed medium effects (ES range: 0.4-0.5) and both studies that assessed knowledge outcomes displayed medium to large effects (ES range: 0.4-1.3). The two experiential learning interventions among children < 5 years demonstrated small to medium effects on behaviour change (ES range: 0.2-0.5). Effective interventions combined enjoyable practical activities (fitness activities, games and challenges), with behaviour change techniques (goal setting, and self-monitoring), were underpinned by a behaviour change theory, and were often of short duration (< 4 months) but intense (several sessions/week). Moderate to high statistical heterogeneity was observed for behaviour outcomes and risk of bias across studies was generally high. CONCLUSIONS: This review provides some evidence supporting the effectiveness of experiential learning interventions in improving physical activity outcomes in school-aged children. Additional evidence is needed in children <5 years old. Future experiential learning interventions need to strengthen the evidence with rigorous methodological quality and clear reporting of the experiential learning components.

Making 'being less sedentary feel normal' -investigating ways to reduce adolescent sedentary behaviour at school: a qualitative study.

BACKGROUND: Adolescents spend over 50% of a 24-hour period and 63% of the school day sedentary. Few comprehensive qualitative studies have explored teachers' and students' perceptions of potential strategies to reduce sedentary behaviour (SB) in the secondary school setting. This project aimed to elicit students' and teachers' perspectives of feasible and acceptable ways to encourage adolescents to "sit less and stand or move more" during the school day. METHODS: Students, teachers, and executives from four schools in the Illawarra and surrounding areas (New South Wales) Australia, were invited to participate. Focus group implementation used a participatory research design ('problem and solution tree'). Participants were interviewed in three groups, younger adolescents, older adolescents and teachers/executives. Firstly the 'problem' (high rates of SB) was explained, participants were then asked to identify contributing school related factors, and to suggest feasible ideas to reduce SB during the school day. RESULTS: Fifty-five students (24 from Years 7/8 aged 12-14 years and 31 from Years 9/10 aged 14-16 years), and 31 teachers consented to participate. Thematic analysis elicited five main 'problems': lesson structure, non-conducive classroom environment/structure, non-conducive break-time environment, curricular pressures and school-related factors increasing sedentary behaviour outside of school. Suggested 'solutions' included: changes to classroom layout/furniture, pedagogical changes, hands-on learning, outdoor lessons, more comfortable uniforms, more breaks during class time, compulsory physical activity, and outdoor equipment. CONCLUSIONS: The proposed solutions to reduce adolescent SB during the school day have potential to be feasibly implemented in the school setting, even with limited funding.

Cross-sectional and longitudinal associations of domain-specific physical activity composition with health-related quality of life in childhood and adolescence in Australia.

BACKGROUND: Health benefits have been linked with physical activity (PA), as well as some domains of PA among youth (e.g. organized PA and active transport). However, less is known about whether some PA domains are more beneficial than others. There is also a lack of evidence about whether health outcomes are related to the composition of PA (i.e. the share of PA spent in different domains). This study aimed to identify: (1) how the absolute durations of organized PA, non-organized PA, active transport and active chores/work at 10-11y are individually associated with physical, psychosocial and total health-related quality of life (HRQOL) at 10-11y and 12-13y; and (2) how the domain-specific composition of PA at 10-11y is associated with HRQOL at 10-11y and 12-13y. METHODS: Data from the Longitudinal Study of Australian Children were used in cross-sectional (n ≥ 2730) and longitudinal analyses (n ≥ 2376). Measurement included the Pediatric Quality of Life Inventory (PedsQL™) for HRQOL domains and one-day time-use diaries (TUDs) for PA domains. Robust linear regression models were used, controlling for age, sex, pubertal status, socioeconomic position, body mass index and TUD context (season and school attendance). Compositional models additionally adjusted for total PA duration and longitudinal models controlled for baseline PedsQL™ scores. RESULTS: Non-compositional models indicated that the duration of organized PA, and to a lesser extent non-organized PA, were positively but weakly associated with some HRQOL outcomes at 10-11y. These trends were not reflected in longitudinal models, although a 30-min increase in non-organized PA per day did predict marginally better psychosocial HRQOL at 12-13y (+ 0.17%; 95%CI = + 0.03%, + 0.32%). Compositional models revealed that a 30-min increase in organized PA relative to other domains was positively but weakly associated with physical (+ 0.32%; 95%CI = + 0.01%, + 0.63%), psychosocial (+ 0.41%; 95%CI = + 0.11%, + 0.72%) and total HRQOL (+ 0.39%; 95%CI = + 0.12%, + 0.66%) at 10-11y. However, the overall PA composition at 10-11y was not related to HRQOL at 12-13y. CONCLUSIONS: Non-compositional and compositional models generally concurred on the direction of cross-sectional and longitudinal relationships (and lack thereof) between PA domains and HRQOL outcomes. The strongest associations were cross-sectional between organized PA and HRQOL at 10-11y. However, all associations between PA domains and HRQOL outcomes were weak and may not be clinically meaningful.

Free public transport and older people: An ethnographic study of an Australian bus service.

OBJECTIVES: This study explores older people's use of a free bus service in Wollongong, Australia. The research focus was on understanding the experiences of people over the age of 60 who use the service and the extent to which it contributes to their physical, mental and social well-being. METHODS: The ethnographic research utilised fieldwork and interviews for data collection. Participant observations took place on the bus, and interviews were undertaken at bus stops. Data were analysed using an inductive thematic approach. RESULTS: The research highlighted how bus services can be caring places for older people and a bus journey could be characterised as a therapeutic milieu. Travelling on the bus provided opportunities for health promotion due to active transport. Subsidised access to public transport supported people to maintain social connections throughout the city. CONCLUSIONS: Bus travel has contributed positively to the physical, mental and social well-being of people over the age of 60 in Wollongong.

Prevalence of Smartphone Addiction and Its Association with Sociodemographic, Physical and Mental Well-Being: A Cross-Sectional Study among the Young Adults of Bangladesh.

Smartphones have made our lives easier and have become indispensable for everyday life; however, their uncontrolled and excessive use can trigger "smartphone addiction" (SA). SA is a rising public health issue, particularly among young people around the world. There is a dearth of empirical research about SA and its impacts on young adults, particularly in developing countries such as Bangladesh. This cross-sectional study is an attempt to fill this gap. The data were collected from 440 eligible young adults in Bangladesh using an online survey between July 2021 and February 2022. Study results revealed that 61.4% of the young adults were addicted to their smartphone. Logistic regression analysis showed that being male, aged ≤25, unemployed and living with a large family size (≥8) were the significant sociodemographic predictors of SA. Smartphone-addicted participants were more likely to be less physically active, suffer from insomnia, be overweight or obese and use their phones while driving, walking and eating. In addition, the SA group were more likely to have physical and mental well-being problems. This study brings to light significant implications for policy makers and indicates a need for an SA community awareness programme which aims to reduce SA at the societal level.

24-Hour movement behaviours and COVID-19 among children in the Kingdom of Saudi Arabia: A repeat cross-sectional study.

This study investigated how children's 24-hour (24-h) movement behaviours were affected by SARS-CoV-2 (COVID-19) in the Kingdom of Saudi Arabia. Previous research examined 24-h movement behaviours in Saudi Arabia seven months after the World Health Organization (WHO) declared COVID-19 a global pandemic. This repeat cross-sectional study examined changes in 24-h movement behaviours 12 months after the WHO declaration. The Time 2 survey repeated five months (1 March - 15 May 2021) after Time 1 survey (1 October - 11 November 2020). The survey was distributed to parents of children aged 6-12 years across Saudi Arabia via an online survey. Children were classified as meeting 24-h movement guidelines if they reported uninterrupted sleep for 9-11 â€‹h per night, ≤ 2 â€‹h of recreational sedentary screen time (RST) per day and ≥ 60 â€‹min of moderate-to vigorous-intensity physical activity (MVPA) per day. A total of 1 045 parents from all regions of Saudi Arabia responded (42.4%). Only 1.8% of children met all components of the guidelines, compared to 3.4% in Time 1. In the present study, girls spent more days per week in MVPA ≥ 60 â€‹min duration than boys (3.0 vs 2.6; p â€‹= â€‹0.025), while boys had spent more days per week engaged in activities that strengthened muscle and bone than girls (3.0 vs 2.8; p â€‹= â€‹0.019). Healthy levels of physical activity (PA), sedentary behaviour (SB) and sleep further declined in Saudi children five months after the Time 1 survey. These challenges require urgent intervention to ensure children's movement behaviours improve as Saudi Arabia moves out of the COVID-19 pandemic.

Changes in subdomains of non-organized physical activity between childhood and adolescence in Australia: a longitudinal study.

BACKGROUND: Physical activity (PA) participation among youth tends to be insufficient and is prone to decline with age. In Australia, this decline has been shown to particularly occur in the domain of non-organized PA (e.g. active play and informal sport) between childhood and adolescence. However, information about changes in more specific groupings of activities within non-organized PA (i.e. subdomains) is needed, as this could support more targeted intervention strategies. This study aimed to investigate changes in the duration of specific subdomains of non-organized PA between late childhood (10-11 years) and early adolescence (12-13 years) in Australia, as well as whether these changes are moderated by sex. METHODS: Data were sourced from Waves 6 and 7 of the Longitudinal Study of Australian Children (n = 3614). Youth time-use diaries (24-h) were used to measure the duration of eight subdomains of non-organized PA at both waves (athletics/gymnastics, ball sports, cycling/motor/roller sports, fitness/gym/exercise, martial arts/dancing, water/ice/snow sports, active play and other outdoor/nature PA). Multilevel mixed modelling was used to explore longitudinal changes between waves and the potential moderation effect of sex. RESULTS: Active play declined the most of all subdomains (ß = -20.5 min/day; 95% CI = -23.4, -17.6, p < 0.001). A smaller decline was observed in the subdomain of non-organized ball sports (ß = -4.1 min/day; 95% CI = -5.9, -2.3, p < 0.001). Other subdomains remained stable or had only very small changes in participation. The decline in active play was moderated by sex, with a steeper decline among girls. No other notable moderation effects were observed. CONCLUSIONS: Future studies may seek to explore and test the acceptability of PA promotion strategies to encourage active play participation, such as 'reframing' childhood play activities to be appropriate for adolescents. Such studies might particularly seek the perspectives of girls in the transition to adolescence.

Changes in 24-Hour Domain-Specific Movement Behaviors and Their Associations With Children's Psychosocial Health During the Transition From Primary to Secondary School: A Compositional Data Analysis.

BACKGROUND: Little is known about the influence of 24-hour movement behaviors on children's psychosocial health when transitioning from primary to secondary school. This study described changes in 24-hour domain-specific movement behavior composition and explored their associations with changes in psychosocial health during this transition. METHODS: Data were drawn from the Longitudinal Study of Australian Children. The analytical sample (n = 909) included children who were enrolled in primary school at baseline (2010) and in secondary school at follow-up (2012). Time spent in 8 domains of movement behaviors was derived from the child-completed time-use diaries. Psychosocial health was examined using the self-report version of the Strengths and Difficulties Questionnaires. Analyses included repeated-measures multivariate analysis of variance and compositional regression. RESULTS: Children reported engaging in more social activities and sleeping less over the transition period. Increased time spent in social activities (ßilr = -0.06, P = .014) and recreational screen use (ßilr = -0.17, P = .003) (relative to other domains) were associated with decreased prosocial behavior in boys. Changes in movement behavior composition were not associated with changes in girls' psychosocial health. CONCLUSION: This study found considerable changes in children's 24-hour movement behavior composition, but a lack of consistent association with changes in psychosocial health during the primary to secondary school transition.

Impact of the COVID-19 virus outbreak on 24-h movement behaviours among children in Saudi Arabia: A cross-sectional survey.

BACKGROUND: In March 2020, the World Health Organization (WHO) declared the coronavirus (COVID-19) outbreak as a pandemic. This led many governments to place restrictions on population movement to aid in pandemic control. These restrictions were expected to produce some type of impact on the daily lives of children and their families. The purpose of this study was to investigate the impact of COVID-19 on 24-h movement behaviours among Saudi children aged 6-12 years, during the pandemic. METHODS: An online survey of Saudi parents (n = 1021) was conducted between 1 October to 11 November 2020 to gather information about the impact of the COVID-19 outbreak on children's 24-h movement behaviours, parent and child factors that may be associated with movement behaviours, and perceived changes in children's movement behaviours. RESULTS: Only 3.4% of Saudi children met all components of 24-h movement guidelines. Compared with before COVID-19, children's PA levels declined, they slept more, and their use of electronic screen devices significantly increased. The perceived changes in PA and SB were more unfavourable among girls than boys. Children of older parents, mothers, and those with lower education levels and lower monthly incomes were more likely to meet 24-h movement guidelines. CONCLUSION: The COVID-19 virus outbreak unfavourably affected Saudi children's movement behaviours, more specifically, girls, which should be taken into account in future research. The results provide an insight into what has changed because of the COVID-19 restrictions and could be considered as part of the response strategies in Saudi Arabia.

A collaborative approach to adopting/adapting guidelines. The Australian 24-hour movement guidelines for children (5-12 years) and young people (13-17 years): An integration of physical activity, sedentary behaviour, and sleep.

BACKGROUND: In 2018, the Australian Government updated the Australian Physical Activity and Sedentary Behaviour Guidelines for Children and Young People. A requirement of this update was the incorporation of a 24-hour approach to movement, recognising the importance of adequate sleep. The purpose of this paper was to describe how the updated Australian 24-Hour Movement Guidelines for Children and Young People (5 to 17 years): an integration of physical activity, sedentary behaviour and sleep were developed and the outcomes from this process. METHODS: The GRADE-ADOLOPMENT approach was used to develop the guidelines. A Leadership Group was formed, who identified existing credible guidelines. The Canadian 24-Hour Movement Guidelines for Children and Youth best met the criteria established by the Leadership Group. These guidelines were evaluated based on the evidence in the GRADE tables, summaries of findings tables and recommendations from the Canadian Guidelines. We conducted updates to each of the Canadian systematic reviews. A Guideline Development Group reviewed, separately and in combination, the evidence for each behaviour. A choice was then made to adopt or adapt the Canadian recommendations for each behaviour or create de novo recommendations. We then conducted an online survey (n=237) along with three focus groups (n=11 in total) and 13 key informant interviews. Stakeholders used these to provide feedback on the draft guidelines. RESULTS: Based on the evidence from the Canadian systematic reviews and the updated systematic reviews in Australia, the Guideline Development Group agreed to adopt the Canadian recommendations and, apart from some minor changes to the wording of good practice statements, maintain the wording of the guidelines, preamble, and title of the Canadian Guidelines. The Australian Guidelines provide evidence-informed recommendations for a healthy day (24-hours), integrating physical activity, sedentary behaviour (including limits to screen time), and sleep for children (5-12 years) and young people (13-17 years). CONCLUSIONS: To our knowledge, this is only the second time the GRADE-ADOLOPMENT approach has been used to develop movement behaviour guidelines. The judgments of the Australian Guideline Development Group did not differ sufficiently to change the directions and strength of the recommendations and as such, the Canadian Guidelines were adopted with only very minor alterations. This allowed the Australian Guidelines to be developed in a shorter time frame and at a lower cost. We recommend the GRADE-ADOLOPMENT approach, especially if a credible set of guidelines that was developed using the GRADE approach is available with all supporting materials. Other countries may consider this approach when developing and/or revising national movement guidelines.

Changes in 24-hour movement behaviours during the transition from primary to secondary school among Australian children.

This study examined concurrent changes in all components of 24-h movement behaviours (24-h MB) (sleep, sedentary behaviour [SB] and physical activity [PA]) and compliance with the Australian 24-Hour Movement Guidelines over the primary to the secondary school transition period. The analytical sample included 83 children (60.2% girls) who provided valid accelerometer-measured 24-h MB data during their final year of primary school (T1) and first year of secondary school (T2). Self-reported participation in domain-specific SB and PA, socio-demographic characteristics and weight status were also assessed. Change in 24-h MB composition from T1 to T2 was analysed using a compositional multivariate linear model for repeated measures. The difference in the proportion of meeting the 24-hour integrated movement guidelines was assessed using a McNemar-Bowker test. An unfavourable change was observed in the 24-h MB composition (p < .0001), with increased time spent in SB (+58 min/day) and decreased time in sleep (-13 min/day), Iight-intensity PA (-13 min/day) and moderate- to vigorous-intensity PA (-14 min/day). Domain-specific SB results indicated an increase in recreational screen time (+45 min/day) and out-of-school educational activities (+25 min/day). No significant changes were observed for domain-specific PA. The proportion of children meeting the 24-hour integrated movement guidelines also declined (20.5% vs. 3.6%; p < .0001). Change in 24-h MB was larger on weekdays than weekends (p < .0001); but this was not moderated by socio-demographic characteristics or weight status. These findings suggest that an integrated intervention approach targeting weekdays may be beneficial to promote adherence to healthy 24-h MB during the primary to the secondary school transition period.HighlightsThis study investigated how the 24-hour movement behaviour composition (i.e., time spent in sleep, sedentary behaviour and physical activity) changes and its impact on children's compliance with the 24-hour integrated movement guidelines during the primary to secondary school transition period.There was an unfavourable change in the accelerometer-measured 24-hour movement behaviour composition, with increased time spent in sedentary behaviour and decreased time in sleep, light-intensity physical activity and moderate- to vigorous-intensity physical activity. The change in weekday composition was significantly more prominent than change on weekends.The observed increase in sedentary behaviour may be attributed in part to an increase in recreational screen time and out-of-school educational activities in secondary schools.These behavioural changes were reflected in decreased compliance rates with the individual and integrated 24-hour movement guidelines, with the largest decline observed in the sleep guideline.Our findings highlight the need for an integrated intervention approach to support children to develop and/or maintain healthy movement behaviour habits throughout the school transition period.

Smartphone Addiction and Associated Health Outcomes in Adult Populations: A Systematic Review.

BACKGROUND: Smartphones play a critical role in increasing human-machine interactions, with many advantages. However, the growing popularity of smartphone use has led to smartphone overuse and addiction. This review aims to systematically investigate the impact of smartphone addiction on health outcomes. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to carry out the systematic review. Five electronic databases including Medline, Web of Science, PsycINFO, PubMed, and Scopus were searched to identify eligible studies. Eligible studies were screened against predetermined inclusion criteria and data were extracted according to the review questions. This review is registered in PROSPERO (CRD42020181404). The quality of the articles was assessed using the National Institutes of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. RESULTS: A total of 27 of 2550 articles met the inclusion criteria. All of the studies were cross-sectional and focused on physical, mental, and neurological health outcomes. The majority of the studies focused on mental health outcomes and consistent associations were observed between smartphone addiction and several mental health outcomes. Anxiety and depression were commonly found to mediate mental health problems. A wide range of physical health sequelae was also associated with smartphone addiction. Furthermore, there was an association between smartphone addiction and neurological disorders. CONCLUSIONS: Our findings suggest that there are consistent associations between smartphone addiction and physical and mental health, especially mental health. Social awareness campaigns about smartphone addiction and its impact on physical and mental health are needed. Further studies, especially randomized controlled trials, are warranted to validate the impacts of smartphone addiction.

Systematic Review of the Relationships between 24-Hour Movement Behaviours and Health Indicators in School-Aged Children from Arab-Speaking Countries.

The Australian and Canadian 24-hour movement guidelines for children and youth synthesized studies in English and French or other languages (if able to be translated with Google translate) and found very few studies published in English from Arabic countries that examined the relationship between objectively measured sedentary behaviour (SB), sleep and physical activity (PA) and health indicators in children aged 5-12 years. The purpose of this systematic review was to investigate the relationships between 24-hour movement behaviours and health indicators in school-aged children from Arab-speaking countries. Online databases MEDLINE, EMBASE, SPORTdiscus, CINAHL, PsycINFO and Scopus were searched for English, French and Arabic studies (written in English), while Saudi Digital Library, ArabBase, HumanIndex, KSUP, Pan-Arab Academic Journal, e-Marefa, Al Manhal eLibrary and Google Scholar were searched for Arabic studies. The Grading of Recommendations Assessment, Development and Evaluation framework was used to assess the risk of bias and the quality of evidence for each health indicator. A total of 16 studies, comprising 15,346 participants from nine countries were included. These studies were conducted between 2000 and 2019. In general, low levels of PA and sleep and high SB were unfavourably associated with adiposity outcomes, behavioural problems, depression and low self-esteem. Favourable associations were reported between sleep duration and adiposity outcomes. SB was favourably associated with adiposity outcomes, withdrawn behaviour, attention and externalizing problems. PA was favourably associated with improved self-esteem and adiposity outcomes. Further studies to address the inequality in the literature in the Arab-speaking countries to understand the role of 24-hour movement behaviours and its positive influence on health outcomes across childhood are urgently needed.

Cross-Sectional and Longitudinal Associations between 24-Hour Movement Behaviours, Recreational Screen Use and Psychosocial Health Outcomes in Children: A Compositional Data Analysis Approach.

It remains unclear whether the time-use composition of 24-h movement behaviours (sleep, sedentary time (ST), physical activity (PA)) and recreational screen use are independently associated with psychosocial health. This study examined the cross-sectional and longitudinal associations between 24-h movement behaviour composition, recreational screen use and psychosocial health outcomes in children. Measures completed at baseline (n = 127; 11.7 years) and follow-up (n = 88; 12.8 years) included accelerometer-based 24-h movement behaviours, self-reported recreational screen use and psychosocial health (Strengths and Difficulties Questionnaire, Kessler's Psychological Distress Scale). Linear mixed models were used to examine the cross-sectional and longitudinal associations between the 24-h movement behaviour composition and recreational screen use levels with psychosocial health outcomes. Overall, the movement behaviour composition (p < 0.05) and recreational screen use levels (p < 0.01) were both cross-sectionally but not longitudinally associated with psychosocial health outcomes. Relative to other behaviours, sleep was negatively associated, while light-intensity PA was positively associated with internalising problems and total difficulties scores. ST was positively associated with internalising problems. High levels of recreational screen use (>2 h/day) were associated with greater externalising problems, total difficulties scores and psychological distress. These findings reinforce the importance of achieving a balance between different types of movement behaviours over a 24-h period for psychosocial health.

Building Public Health Capacity through Organizational Change in the Sport System: A Multiple-Case Study within Australian Gymnastics.

Sports clubs increasingly are settings for health promotion initiatives. This study explored organizational change processes and perceived facilitators and barriers relevant to implementing a health promotion initiative within gymnastics settings in New South Wales (NSW), Australia. A multiple-case design investigated the experiences of the state association (Gymnastics NSW) and five clubs from one region of NSW in a participatory Health-Promoting Gymnastics Clubs (HPGC) program. The program aimed to build the capacity of Gymnastics NSW to support affiliated clubs to become health-promoting settings. Interviews with organizational representatives explored their experiences of the program and identified factors that enabled or inhibited program adoption, implementation and sustainability. Facilitators and barriers identified included leadership and champions; organizational capacity and culture; priorities and timing; and characteristics of the HPGC framework. This multi-level, organizational change intervention demonstrated potential to create health-promoting gymnastics settings. Tailoring strategies in diverse club contexts required involvement of organizational leaders in program development and action planning. Despite positive impacts, pre-existing organizational culture inhibited integration of health promotion as a core value. Sustained organizational change may result from professional regulatory requirements (e.g., accreditation and affiliation), and policy directives and funding (for organizational change, not program delivery) from relevant government departments.

School Flexible Learning Spaces, Student Movement Behavior and Educational Outcomes among Adolescents: A Mixed-Methods Systematic Review.

BACKGROUND: To achieve sustainability, we must consider scalable improvements in student movement behavior in the classroom setting, educational priorities. Flexible learning spaces that employ student-centered pedagogy and contain a range of furniture and layout options, implemented to improve educational outcomes, may enable unintended health benefits. In this review, we summarize the evidence on the effects of flexible learning spaces on adolescent student movement behaviors and educational outcomes. METHODS: We searched 5 databases, retrieving 5 quantitative and one qualitative article meeting the review criteria. RESULTS: Students in flexible learning spaces spent less time sitting, and more time standing and moving. Students were also more engaged, on-task, and collaborated and interacted more. Academic results for English, Mathematics and Humanities for those in flexible learning spaces were higher than peers in traditional classrooms. CONCLUSION: Evidence from the reviewed studies suggests that there may be beneficial outcomes across some movement behaviors as well as learning outcomes in classrooms that employ student-centered pedagogy and use a built environment that facilitates autonomy and choice around where and how to learn. These learning environments present an opportunity for an interdisciplinary approach to address sedentary behavior in classrooms.

Estimating Child Mortality at the Sub-national Level in Papua New Guinea: Evidence From the Integrated Health and Demographic Surveillance System.

BACKGROUND: Child mortality is an important indication of an effective public health system. Data sources available for the estimation of child mortality in Papua New Guinea (PNG) are limited. OBJECTIVE: The objective of this study was to provide child mortality estimates at the sub-national level in PNG using new data from the integrated Health and Demographic Surveillance System (iHDSS). METHOD: Using direct estimation and indirect estimation methods, household vital statistics and maternal birth history data were analysed to estimate three key child health indicators: Under 5 Mortality Rate (U5MR), Infant Mortality Rate (IMR) and Neonatal Mortality Rate (NMR) for the period 2014-2017. Differentials of estimates were evaluated by comparing the mean relative differences between the two methods. RESULTS: The direct estimations showed U5MR of 93, IMR of 51 and NMR of 34 per 1000 live births for all the sites in the period 2014-2017. The indirect estimations reported an U5MR of 105 and IMR of 67 per 1000 live births for all the sites in 2014. The mean relative differences in U5MR and IMR estimates between the two methods were 3 and 24 percentage points, respectively. U5MR estimates varied across the surveillance sites, with the highest level observed in Hela Province (136), and followed by Eastern Highlands (122), Madang (105), and Central (42). DISCUSSION: The indirect estimations showed higher estimates for U5MR and IMR than the direct estimations. The differentials between IMR estimates were larger than between U5MR estimates, implying the U5MR estimates are more reliable than IMR estimates. The variations in child mortality estimates between provinces highlight the impact of contextual factors on child mortality. The high U5MR estimates were likely associated with inequality in socioeconomic development, limited access to healthcare services, and a result of the measles outbreaks that occurred in the highlands region from 2014-2017. CONCLUSION: The iHDSS has provided reliable data for the direct and indirect estimations of child mortality at the sub-national level. This data source is complementary to the existing national data sources for monitoring and reporting child mortality in PNG.

Socio-ecological predictors of non-organized physical activity participation and decline between childhood and adolescence.

Physical activity (PA) tends to decline during late childhood and adolescence. In Australia, this decline has been shown to particularly occur non-organized PA (e.g., active play, informal sport). This study aimed to explore predictors of non-organized PA at 13y; and decline between 11y and 13y. Data were sourced from the Longitudinal Study of Australian Children. Non-organized PA was measured using time-use diaries. Analyses included Cragg hurdle and binary logistic regressions. The likelihood of non-organized PA at 13y was predicted by PA enjoyment (OR = 1.36, p = 0.007), number of siblings (OR = 1.11, p < 0.001), sex (females) (OR = 0.66, p < 0.001) and home computer use at 11y (OR = 0.98, p = 0.002) (n = 3,193). Females also engaged in less non-organized PA at 13y (ß = -77.77, p = 0.048) (n = 3,193). Significant predictors of decline in non-organized PA were socioeconomic position (OR = 0.92, p = 0.047) and sugary drink consumption at 11y (OR = 1.06, p = 0.033) (n = 3,222). Strategies to promote non-organized PA may include targeting females and those of lower socioeconomic position, and focusing on types of PA that may replace the perceived benefits of computer use.

Interventions to Change School Recess Activity Levels in Children and Adolescents: A Systematic Review and Meta-Analysis.

BACKGROUND: The school environment is globally recognised as a key setting to promote child and adolescent physical activity. School recess contributes up to 40% of the school day and recommended physical activity levels, providing a critical physical activity promotion opportunity for children and adolescents. OBJECTIVE: To examine the effectiveness of school recess interventions on children's and adolescents' physical activity (PA) and sedentary behaviour (SED) during this time. DESIGN: Systematic review and meta-analysis. DATA SOURCES: EBSCOhost (Academic Search Complete, Education Source, ERIC, Global Health, MEDLINE complete, SPORTDiscus), Scopus, and ProQuest electronic databases with full text. RESULTS: Forty-three studies were included in the systematic review, trialling eight different intervention strategies including loose equipment, structured recess, and multicomponent studies. The meta-analysis included 16 studies. Overall, between group mean difference for: (i) time spent in moderate to vigorous-intensity physical activity (MVPA) for randomised controlled trials (RCTs) (n = 6) was 0.18 (95% CI - 0.00 to 0.36) with a marginal significant effect of Z = 1.93 (p = 0.05), (ii) time spent in MVPA for non-RCTs (n = 7) was 0.52 (95% CI - 0.01 to 1.03) with an overall effect of Z = 1.99 (p = 0.05), (iii) time spent in sedentary behaviour for RCTs (n = 3) was - 0.48 (95% CI - 1.38 to 0.43) with an overall effect of Z = 1.03 (p = 0.30). All outcomes had high heterogeneity. CONCLUSION: School recess interventions show promise for increasing MVPA. It was difficult to draw strong conclusions due to low study numbers in the meta-analysis and varied intervention designs. Interventions may need to focus on single component strategies (e.g., loose equipment) to improve understanding of outcome effects for future studies.