Socio-environmental influences on physical activity among young people: a qualitative study.

This multi-methods qualitative study aimed to identify environmental factors that influence physical activity participation among young people in Edinburgh, Scotland. School pupils (aged 11-13 years) took part using photography, computer blogs, maps and focus group discussions (FGDs). Eleven computer sessions (n = 131) and 14 FGDs (n = 63) took place. Factors influencing physical activity behaviour included proximity and access to local facilities, family and peers and the school physical activity environment. A variety of facilitators and barriers to participation were also reported. Most notable was the importance of cost and value for money when choosing physical activities which, although more evident among pupils attending schools in areas of low socio-economic status (SES), was relevant across all SES groups. Reporting easy access to sports facilities was more common among pupils attending schools from high/medium SES. Use of greenspace for physical activity was reported among pupils from all schools, but was more common among those from low SES schools. Pupils were, in general, satisfied with the facilities available at school, but felt time for physical education could be increased. Findings may help inform interventions, aimed at promoting physical activity at local level.

Evaluation of the effectiveness and cost-effectiveness of Families for Health V2 for the treatment of childhood obesity: study protocol for a randomized controlled trial.

BACKGROUND: Effective programs to help children manage their weight are required. Families for Health focuses on a parenting approach, designed to help parents develop their parenting skills to support lifestyle change within the family. Families for Health V1 showed sustained reductions in overweight after 2 years in a pilot evaluation, but lacks a randomized controlled trial (RCT) evidence base. METHODS/DESIGN: This is a multi-center, investigator-blind RCT, with parallel economic evaluation, with a 12-month follow-up. The trial will recruit 120 families with at least one child aged 6 to 11 years who is overweight (≥91st centile BMI) or obese (≥98th centile BMI) from three localities and assigned randomly to Families for Health V2 (60 families) or the usual care control (60 families) groups. Randomization will be stratified by locality (Coventry, Warwickshire, Wolverhampton).Families for Health V2 is a family-based intervention run in a community venue. Parents/carers and children attend parallel groups for 2.5 hours weekly for 10 weeks. The usual care arm will be the usual support provided within each NHS locality.A mixed-methods evaluation will be carried out. Child and parent participants will be assessed at home visits at baseline, 3-month (post-treatment) and 12-month follow-up. The primary outcome measure is the change in the children's BMI z-scores at 12 months from the baseline. Secondary outcome measures include changes in the children's waist circumference, percentage body fat, physical activity, fruit/vegetable consumption and quality of life. The parents' BMI and mental well-being, family eating/activity, parent-child relationships and parenting style will also be assessed.Economic components will encompass the measurement and valuation of service utilization, including the costs of running Families for Health and usual care, and the EuroQol EQ-5D health outcomes. Cost-effectiveness will be expressed in terms of incremental cost per quality-adjusted life year gained. A de novo decision-analytic model will estimate the lifetime cost-effectiveness of the Families for Health program.Process evaluation will document recruitment, attendance and drop-out rates, and the fidelity of Families for Health delivery. Interviews with up to 24 parents and children from each arm will investigate perceptions and changes made. DISCUSSION: This paper describes our protocol to assess the effectiveness and cost-effectiveness of a parenting approach for managing childhood obesity and presents challenges to implementation. TRIAL REGISTRATION: Current Controlled Trials http://ISRCTN45032201.

Irregular breakfast consumption in adolescence and the family environment: underlying causes by family structure.

Data from the 2002, 2006 and 2010 Scottish Health Behaviour in School-aged Children (HBSC) surveys were analysed using logistic multilevel regression for outcome variable irregular breakfast consumption (IBC). IBC prevalence in Scotland was higher among young people from reconstituted and single parent families, and particularly single father families. Family characteristics, found previously to be associated with breakfast consumption, such as number of siblings, perceived parenting, parental involvement and family affluence, differed by family structure. Family structure inequalities in IBC existed, also after adjustment for year and child's sex, age, grade and ethnicity. Across all family structures, IBC was more prevalent at the older age groups, among those who had difficult communication with their parents, and where household routines were infrequent. Greater number of siblings and lower family affluence were associated with higher odds of IBC in single mother and both parent families, while having a second home was associated with higher odds in reconstituted households. Fair parenting and being close to at least one parent was associated with reduced odds of IBC in single mother households, while being close to all parents was in single father households. In single mother homes, having a working mother was also positively associated with IBC. Family structure differences should be considered when addressing irregular breakfast consumption in adolescence.

Family structure and breakfast consumption of 11-15 year old boys and girls in Scotland, 1994-2010: a repeated cross-sectional study.

BACKGROUND: The benefits of breakfast during childhood and adolescence have been reported previously though few studies have considered family structure inequalities in breakfast consumption. The proportion of young people living in non-traditional family types has increased in recent years, strengthening the need to describe and monitor the impact of the changing family unit on adolescent breakfast consumption. This study aimed to describe changes in daily breakfast consumption among adolescents in Scotland between 1994 and 2010, while also considering family structure inequalities, and the degree to which these have changed over time. METHODS: Data from the 1994, 1998, 2002, 2006 and 2010 Scottish Health Behaviour in School-aged Children (HBSC) surveys were analysed using logistic multilevel regression models for binary outcome variable daily breakfast consumption. RESULTS: Daily breakfast consumption among adolescents increased between 1994 and 2010, although there were differences by age and sex. In fact those aged over 14.5 years saw decreases in breakfast consumption, and girls saw significantly larger increases than boys. Daily breakfast consumption was more prevalent among adolescents from 'both parent' families, with lowest prevalence among those from single parent families. Trends in daily breakfast consumption between 1994 and 2010 also varied by family structure. While prevalence of daily breakfast consumption increased among those living with 'both parents', the largest proportion of the population, prevalence decreased over time among adolescents of single parent families, and particularly among those living with their father. CONCLUSIONS: Family structure inequalities in daily breakfast consumption increased between 1994 and 2010, while breakfast consumption across the population as a whole increased. As the proportion of young people living in an alternative family structure continues to grow it is important to understand why these inequalities have increased and how these may be overcome. Possible reasons for family structure inequalities and their increase in recent years are discussed.

Adolescent risk behaviours and mealtime routines: does family meal frequency alter the association between family structure and risk behaviour?

Family structure is associated with a range of adolescent risk behaviours, with those living in both parent families generally faring best. This study describes the association between family structure and adolescent risk behaviours and assesses the role of the family meal. Data from the 2006 Health Behaviour in School-Aged Children survey were modelled using Multilevel Binomial modelling for six risk behaviour outcomes. Significantly more children from 'both parent' families ate a family meal every day and fewer 'hardly ever or never' did. Family structure was associated with boys' and girls' smoking, drinking, cannabis use and having sex and with girls' fighting. Frequency of eating a family meal was associated with a reduced likelihood of all risk behaviours among girls and all but fighting and having sex among boys. Eating a family meal regularly nullified the association between family structure and drinking alcohol for boys and girls and cannabis use for boys and reduced the effect size of alternative family structures on boys having sex and smoking. The family meal, associated with a reduced likelihood of many adolescent risk behaviours, reduces or eliminates the association with family structure and may therefore help to overcome inequalities in adolescent risk behaviours.

Young People's Views on Accelerometer Use in Physical Activity Research: Findings from a User Involvement Investigation.

The use of accelerometers to objectively measure physical activity is important in understanding young people's behaviours, as physical activity plays a key part in obesity prevention and treatment. A user-involvement qualitative study with young people aged 7-18 years (n = 35) was carried out to investigate views on accelerometer use to inform an obesity treatment research study. First impressions were often negative, with issues related to size and comfort reported. Unwanted attention from wearing an accelerometer and bullying risk were also noted. Other disadvantages included feeling embarrassed and not being able to wear the device for certain activities. Positive aspects included feeling "special" and having increased attention from friends. Views on the best time to wear accelerometers were mixed. Advice was offered on how to make accelerometers more appealing, including presenting them in a positive way, using a clip rather than elastic belt to attach, personalising the device, and having feedback on activity levels. Judgements over the way in which accelerometers are used should be made at the study development stage and based on the individual population. In particular, introducing accelerometers in a clear and positive way is important. Including a trial wearing period, considering practical issues, and providing incentives may help increase compliance.

Associations between the school environment and adolescent girls' physical activity.

This paper explores school sports facility provision, physical education allocation and opportunities for physical activity and their association with the number of days adolescent girls participate in at least 60 min of moderate-vigorous physical activity per week (MVPAdays). Data were collected through self-administered questionnaires from Scottish secondary school girls (n = 1978) and head teachers (n = 123) participating in the Health Behaviour in School-aged Children 2005/06 study. The best predictor of adolescent girls' MVPAdays was hours allocated to PE in fourth year of secondary school (ß = 0.27, 95% CI 0.06-0.48). Having shower facilities resulted in decreased MVPA (ß = -0.51, CI -0.90 to -0.12), as did providing less than two team sports clubs (ß = -0.69, CI -1.28 to -0.10), compared with schools who provided four or more. Compared with schools with no after school clubs, girls who attended schools with activities at least 1 day per week were likely to have increased MVPAdays. PE allocation and extra-curricular clubs are likely to be of greater importance to girls' participation than school facilities per se. This study demonstrates how schools can maximize their environment to increase girls' PA and offers encouraging findings for those with limited sports facilities.

Parental and peer influences on physical activity among Scottish adolescents: a longitudinal study.

BACKGROUND: This study investigated parental and peer influences on physical activity, examining gender and developmental differences during early-mid adolescence. METHODS: A 5-year longitudinal study tracking physical activity (measured by PAQ-C) among adolescents (n = 641) from final year of primary (P7) to fourth year of secondary school (S4). Peer support, peer socializing, parental support, and independent play were assessed. Logistic regression predicted physical activity, by year and gender, in relation to social influences. RESULTS: Boys reported higher physical activity, peer support, paternal support, and independent play than girls. Among both genders, peer, paternal, and maternal support decreased with age, whereas independent play increased. Time with friends was particularly important. Among high socializers (P7), odds of being active were over 3 times those of low socializers [boys: 3.53 (95% CI 1.77, 7.04), girls: 3.27 (95% CI 1.80, 5.92)]. Baseline physical activity was also a strong predictor among early secondary boys (OR 3.90 95% CI 2.10, 7.24) and girls (OR 4.15, 95% CI 2.00, 8.62). Parental support was less important than peer influences; only same-sex parental support remained significant in multivariables models. CONCLUSIONS: Parents and peers have important influences on adolescent physical activity. Significant gender and developmental effects are apparent through early-mid adolescence.

A systematic review of the clinical and cost-effectiveness of memantine in patients with moderately severe to severe Alzheimer's disease.

Alzheimer's disease (AD) is the most common form of dementia and is characterised by a worsening of cognition, functional ability, and behaviour and mood. The objective of this study was to review the clinical and cost-effectiveness of memantine for the treatment of patients with moderately severe to severe AD. To achieve this, a systematic search and review of the clinical and cost effectiveness literature for memantine was undertaken. The literature search covered the period from the inception of MEDLINE, Cochrane Library, EMBASE and other electronic databases until July 2004. The search included randomised controlled trials (RCTs) and full economic evaluations that assessed the use of memantine in patients with moderately severe to severe AD. Two published RCTs were included in this review; in one of these trials the participants were already being treated with donepezil. The two RCTs showed benefit for patients receiving memantine compared with placebo on the outcome measures of the Alzheimer's Disease Cooperative Study Activities of Daily Living Inventory modified for severe dementia, the Clinician's Interview-Based Impression of Change Plus Caregiver Input, and the Severe Impairment Battery, and that memantine appeared to be slightly more effective in patients already receiving a stable dose of donepezil. Five cost-effectiveness studies were included in the review. Although these studies reported cost reductions and improved outcomes with memantine, the evaluations were based on a number of assumptions. In conclusion, memantine appears to be beneficial when assessed using functional and global measurements. However, the effect of memantine on cognitive scores and behaviour and mood outcomes is less clear. Cost-effectiveness is dependent upon assumptions surrounding clinical effect and context-specific cost data.