Sugar-Sweetened Beverages: Children's Perceptions, Factors of Influence, and Suggestions for Reducing Intake.

OBJECTIVES: This study aimed to gain an in-depth understanding of children's perceptions of sugar-sweetened beverages (SSBs). DESIGN: Nine focus groups were conducted in grade 5 and 6 elementary schoolchildren. SETTING: Nine urban and rural elementary schools in London, Ontario, Canada. PARTICIPANTS: Fifty-one children, 58% of which were male, 52% of whom were in grade 5, and 84% of whom were Caucasian. PHENOMENON OF INTEREST: Children's views on sugar-sweetened beverages. ANALYSIS: Three researchers conducted inductive content analysis on the data independently using the principles of the immersion-crystallization method. RESULTS: Participants had a high level of awareness of beverages and their health effects, which was primarily targeted at the sugar content. Dominant factors that influenced children's beverage choices and consumption patterns included taste, parental control practices, accessibility, and advertising. Participants identified a wide array of strategies to reduce SSB consumption in children, including educational strategies for both children and parents and policy-level changes at both the government and school levels. CONCLUSIONS AND IMPLICATIONS: Despite a high level of awareness of SSBs, children believed that further education and policies regarding SSBs were warranted. These data may prove helpful in designing effective interventions targeted at children and parents to reduce SSB consumption by children.

Nutritional analysis of a long-term care menu before and after an increase in the raw food cost allowance.

PURPOSE: Regular, nontherapeutic menus were compared before and after an increase in the Ontario long-term care (LTC) raw food cost allowance (RFCA). The purpose was to determine whether any significant nutritional differences existed between the old and new menus and whether they met target values for adequacy, according to the Dietary Reference Intake (DRI) nutrient recommendations or other target values relevant to Ministry of Health and Long-Term Care standards. METHODS: A southeastern Ontario LTC facility fall/winter 2006/2007 menu and fall/winter 2007/2008 menu were used for nutrient analysis with ESHA Food Processor SQL 10.1.0. Each menu was compared with target values based on Canada's Food Guide (CFG) for 1992 and 2007, and with DRI nutrient recommendations. RESULTS: The 2007/2008 menu provided significantly more servings of vegetables and fruit, meeting the 2007 CFG recommendations, and significantly greater amounts of some nutrients (e.g., vitamin C, protein, magnesium, potassium, fibre, and total water). It also came closer to meeting DRI target recommendations. CONCLUSIONS: While some improvements have been made to the menu in this specific facility, further improvements, possibly through supplementation, must be made to ensure nutritional adequacy for all residents.

Screen-related sedentary behaviours of school-aged children: Principals' and teachers' perspectives.

OBJECTIVE: To solicit school principals' and teachers' perspectives on children's screen-related sedentary behaviour and to identify possible solutions to reduce sedentary behaviours among school-aged children. METHOD: In-person interviews using a semi-structured interview guide were conducted with school principals and grades five and six classroom teachers in 14 randomly selected elementary schools in London and Middlesex County, Ontario. Fourteen principals and 39 classroom teachers participated in the study. Inductive content analysis was performed independently by two researchers. RESULTS: Both principals and teachers were very concerned about children's excessive screen activities, but they did not perceive that they could play a key role in reducing these behaviours. Key barriers were identified to reducing screen-related sedentary behaviour and to children's active living both at and away from school. They included competing demands from other subjects, limited gym resources/space within the school, a lack of control over the home environment, and a perception that parents were poor role models. Notwithstanding the above barriers, principals and teachers still recommended increasing children's daily physical activity both within and outside of school hours. Furthermore, they stressed the need for parents to play a key role in reducing their children's screen-related sedentary behaviours and increasing their level of physical activity. CONCLUSION: School principals and teachers were very concerned about excessive screen-behaviour among school-aged children when away from school and suggested that interventions should emphasize increasing daily physical education, promoting recreational sports at or away from school, and engaging parents in regulating screen time at home.

Screen-related sedentary behaviors: children's and parents' attitudes, motivations, and practices.

OBJECTIVE: To investigate school-aged children's and parents' attitudes, social influences, and intentions toward excessive screen-related sedentary behavior (S-RSB). DESIGN: A cross-sectional study using a survey methodology. SETTING: Elementary schools in London, Ontario, Canada. PARTICIPANTS: All grades 5 and 6 students, their parents, and their teachers in the participating schools were invited to voluntarily participate; 508 student-parent pairs completed the surveys. MAIN OUTCOME MEASURE: Children's screen-related behaviors. ANALYSIS: Data were analyzed using the Independent Student t test to compare differences of continuous variables and the chi-square test to test for differences of categorical variables. RESULTS: Children spent 3.3 +/- 0.15 (standard error) hours per day engaged in screen-related activities. Entertainment, spending time with family, and boredom were cited as the top 3 reasons for television viewing and video game playing. Compared to "low-screen users" (ie, < 2 hours/day), "high-screen users" (ie, >or= 2 hours/day) had a less negative attitude toward excessive S-RSB and perceived loosened parental rules on screen use. Parents of high-screen users had a less negative attitude toward children's S-RSB, had fewer rules about their children's screen use, and were more likely to be sedentary themselves. CONCLUSIONS AND IMPLICATIONS: Intervention strategies aimed at reducing S-RSB should involve both parents and children and should focus on fostering behavioral changes and promoting parental role modeling.

Childhood overweight and obesity management: A national perspective of primary health care providers' views, practices, perceived barriers and needs.

BACKGROUND: Obesity and overweight in children are an escalating problem in Canada and worldwide. Currently, little is known about the manner in which primary health care providers are responding to Canada's obesity epidemic. OBJECTIVE: To determine the views, practices, challenges/barriers, and needs of a national sample of family physicians (FPs) and community paediatricians (CPs) with respect to paediatric obesity identification and management. METHODS: A self-administered questionnaire was mailed to a random sample of 1200 FPs and 1200 CPs across Canada between 2005 and 2006. RESULTS: A total of 464 FPs and 396 CPs participated. The majority of practitioners viewed paediatric obesity as an 'important'/'very important' issue. Although the majority reported providing dietary (more than 85%) and exercise (98%) advice to their overweight/obese patients, practitioners' perceived success rate in treating paediatric obesity was limited (less than 22%). Approximately 30% of FPs and 60% of CPs (P<0.05) used the recommended method to identify paediatric obesity. At least 50% of practitioners indicated that too few government-funded dietitians, a lack of success in controlling paediatric patients' weight, time constraints and limited training were key barriers to their success. To support efforts to identify or manage paediatric obesity, practitioners identified the need for office tools, patient educational materials and system-level changes. DISCUSSION: Canadian primary health care providers are not adequately equipped to deal with the paediatric obesity epidemic. Effective assessment tools and treatment resources, dissemination of clinical practice guidelines, enhanced undergraduate medical education and postgraduate continuing medical education, and system-level changes are urgently needed to address this health problem.

Understanding screen-related sedentary behavior and its contributing factors among school-aged children: a social-ecologic exploration.

PURPOSE: To explore the factors that contribute to children's screen-related sedentary (S-RS) behaviors. SETTINGS: Elementary schools. SUBJECTS: A random sample of children in grades five and six and their parents. MEASURES: The outcome measure was children's S-RS activity level measured by a self-administered questionnaire. A full spectrum of potential contributing factors for children's S-RS behaviors was obtained through surveys. Multilevel linear regression methods were used to determine the associations between these factors and children's screen time (hours per day) and results were expressed as regression coefficients (g). RESULTS: Of 955 child-parent pairs in 14 participating schools, 508 pairs (53%) completed the surveys. At an intrapersonal level, protective factors included being a girl (g = -.71); belonging to a sports team inside (g = -.56) or outside (g = -.49) of school; having a negative attitude toward S-RS activities (g = -.13); and having a positive attitude toward physical activity (g = .48). At the interpersonal and social levels, parental leisure S-RS behaviors (g = .32) were positively associated, whereas strict parental rules on computer use (g = -.27) and family income (g = -.32) were inversely correlated with S-RS behavior. At the environmental level, the presence of TVs in children's bedrooms (g = .44) and owning videogame devices (g = .58) increased the risk of S-RS behaviors, whereas after school programs (g = - .86) and schools' participation in the Turn Off the Screen Week campaign (g = -.91) decreased the risk. CONCLUSIONS: Public health interventions should target multilevel factors, including increasing children's awareness, promoting parental involvement in healthy lifestyle pursuits, and creating less screenogenic environments.