Relationships between County Health Rankings and child overweight and obesity prevalence: a serial cross-sectional analysis.

BACKGROUND: The County Health Rankings (CHR) system provides health rankings for U.S. counties. These factors may have utility for evaluating and predicting health outcomes. This study examined the association between CHR factors and the prevalence of child overweight/obesity (OWOB) in the state of Pennsylvania over 3 years. METHODS: The prevalence of childhood OWOB was obtained for all Pennsylvania school districts for the 2009-10 through 2011-12 school years. Correlational and inferential statistical analyses were used to examine the associations between the prevalence of OWOB in grades K-6 (OWOB1) and 7-12 (OWOB2) and z-score for the overall CHR Health Factors rank, as well as for individual predictive factors (Health Behaviors, Clinical Care, Social and Economic Factors and Physical Environment). RESULTS: Low to moderate correlations (0.29-0.43) were found between OWOB1 and CHR factors. Weaker and less consistent correlations were found for adolescents. There was a significantly higher prevalence of OWOB in counties with poorer CHR scores. CONCLUSIONS: County-level adult indicators of health are significantly associated with levels of child obesity. Future studies should examine the relationship between CHR and other health outcomes.

Cross-Validation of Aerobic Capacity Prediction Models in Adolescents.

Cardiorespiratory endurance is a component of health-related fitness. FITNESSGRAM recommends the Progressive Aerobic Cardiovascular Endurance Run (PACER) or One mile Run/Walk (1MRW) to assess cardiorespiratory endurance by estimating VO2 Peak. No research has cross-validated prediction models from both PACER and 1MRW, including the New PACER Model and PACER-Mile Equivalent (PACER-MEQ) using current standards. The purpose of this study was to cross-validate prediction models from PACER and 1MRW against measured VO2 Peak in adolescents. Cardiorespiratory endurance data were collected on 90 adolescents aged 13-16 years (Mean = 14.7 ± 1.3 years; 32 girls, 52 boys) who completed the PACER and 1MRW in addition to a laboratory maximal treadmill test to measure VO2 Peak. Multiple correlations among various models with measured VO2 Peak were considered moderately strong (R = .74-0.78), and prediction error (RMSE) ranged from 5.95 ml·kg⁻¹,min⁻¹ to 8.27 ml·kg⁻¹.min⁻¹. Criterion-referenced agreement into FITNESSGRAM's Healthy Fitness Zones was considered fair-to-good among models (Kappa = 0.31-0.62; Agreement = 75.5-89.9%; F = 0.08-0.65). In conclusion, prediction models demonstrated moderately strong linear relationships with measured VO2 Peak, fair prediction error, and fair-to-good criterion referenced agreement with measured VO2 Peak into FITNESSGRAM's Healthy Fitness Zones.

Joint association of fatness and physical activity on resting blood pressure in 5- to 9-year-old children.

The purpose of this study was to determine the joint association of fatness and physical activity on resting blood pressure in children. Subjects included 157 children (age 5.5-9.5 years). Moderate-to-vigorous physical activity (MVPA, min/day), body fatness, and resting blood pressure were measured. Four categories were created by cross tabulation of high/normal levels of fatness and high/low levels of MVPA. There were significant differences in systolic blood pressure and mean arterial pressure across the fat/MVPA groups (p < .05). Regardless of participating in an acceptable level of MVPA, overfat children had higher resting systolic blood pressure than normal fat children. MVPA did not significantly attenuate blood pressure within a fat category.

Development and preliminary validation of a Family Nutrition and Physical Activity (FNPA) screening tool.

BACKGROUND: Parents directly influence children's physical activity and nutrition behaviors and also dictate the physical and social environments that are available to their children. This paper summarizes the development of an easy to use screening tool (The Family Nutrition and Physical Activity (FNPA) Screening Tool) designed to assess family environmental and behavioral factors that may predispose a child to becoming overweight. METHODS: The FNPA instrument was developed using constructs identified in a comprehensive evidence analysis conducted in collaboration with the American Dietetics Association. Two or three items were created for each of the ten constructs with evidence grades of II or higher. Parents of first grade students from a large urban school district (39 schools) were recruited to complete the FNPA screening tool and provide permission to link results to BMI data obtained from trained nurses in each school. A total of 1085 surveys were completed out of the available sample of 2189 children in the district. Factor analysis was conducted to examine the factor structure of the scale. Mixed model analyses were conducted on the composite FNPA score to determine if patterns in home environments and behaviors matched some of the expected socio-economic (SES) and ethnic patterns in BMI. Correlations among FNPA constructs and other main variables were computed to examine possible associations among the various factors. Finally, logistic regression was used to evaluate the construct validity of the FNPA scale. RESULTS: Factor analyses revealed the presence of a single factor and this unidimensional structure was supported by the correlation analyses. The correlations among constructs were consistently positive but the total score had higher correlations with child BMI than the other individual constructs. The FNPA scores followed expected demographic patterns with low income families reporting lower (less favorable) scores than moderate or high income families. Children with a total score in the lowest tertile (high risk family environment and behaviors) had an odds ratio (OR) of 1.7 (95% CI = 1.07 - 2.80) compared to children with a total score in the highest tertile (more favorable family environment and behaviors) but this effect was reduced when parent BMI was included as a covariate. CONCLUSION: The results support the contention that the FNPA tool captures important elements of the family environment and behaviors that relate to risk for child overweight.

Calibration and Validation of the Youth Activity Profile as a Physical Activity and Sedentary Behaviour Surveillance Tool for English Youth.

Self-reported youth physical activity (PA) is typically overestimated. We aimed to calibrate and validate a self-report tool among English youth. Four-hundred-and-two participants (aged 9-16 years; 212 boys) wore SenseWear Armband Mini devices (SWA) for eight days and completed the self-report Youth Activity Profile (YAP) on the eighth day. Calibration algorithms for temporally matched segments were generated from the YAP data using quantile regression. The algorithms were applied in an independent cross-validation sample, and student- and school-level agreement were assessed. The utility of the YAP algorithms to assess compliance to PA guidelines was also examined. The school-level bias for the YAP estimates of in-school, out-of-school, and weekend moderate-to-vigorous PA (MVPA) were 17.2 (34.4), 31.6 (14.0), and -4.9 (3.6) min·week-1, respectively. Out-of-school sedentary behaviour (SB) was over-predicted by 109.2 (11.8) min·week-1. Predicted YAP values were within 15%-20% equivalence of the SWA estimates. The classification accuracy of the YAP MVPA estimates for compliance to 60 min·day-1 and 30 min·school-day-1 MVPA recommendations were 91%/37% and 89%/57% sensitivity/specificity, respectively. The YAP generated robust school-level estimates of MVPA and SB and has potential for surveillance to monitor compliance with PA guidelines. The accuracy of the YAP may be further improved through research with more representative UK samples to enhance the calibration process and to refine the resultant algorithms.

Comparability of children's sedentary time estimates derived from wrist worn GENEActiv and hip worn ActiGraph accelerometer thresholds.

OBJECTIVES: To examine the comparability of children's free-living sedentary time (ST) derived from raw acceleration thresholds for wrist mounted GENEActiv accelerometer data, with ST estimated using the waist mounted ActiGraph 100count·min-1 threshold. DESIGN: Secondary data analysis. METHOD: 108 10-11-year-old children (n=43 boys) from Liverpool, UK wore one ActiGraph GT3X+ and one GENEActiv accelerometer on their right hip and left wrist, respectively for seven days. Signal vector magnitude (SVM; mg) was calculated using the ENMO approach for GENEActiv data. ST was estimated from hip-worn ActiGraph data, applying the widely used 100count·min-1 threshold. ROC analysis using 10-fold hold-out cross-validation was conducted to establish a wrist-worn GENEActiv threshold comparable to the hip ActiGraph 100count·min-1 threshold. GENEActiv data were also classified using three empirical wrist thresholds and equivalence testing was completed. RESULTS: Analysis indicated that a GENEActiv SVM value of 51mg demonstrated fair to moderate agreement (Kappa: 0.32-0.41) with the 100count·min-1 threshold. However, the generated and empirical thresholds for GENEActiv devices were not significantly equivalent to ActiGraph 100count·min-1. GENEActiv data classified using the 35.6mg threshold intended for ActiGraph devices generated significantly equivalent ST estimates as the ActiGraph 100count·min-1. CONCLUSIONS: The newly generated and empirical GENEActiv wrist thresholds do not provide equivalent estimates of ST to the ActiGraph 100count·min-1 approach. More investigation is required to assess the validity of applying ActiGraph cutpoints to GENEActiv data. Future studies are needed to examine the backward compatibility of ST data and to produce a robust method of classifying SVM-derived ST.

Construct Validity of an Obesity Risk Screening Tool in Two Age Groups.

Home environment influences child health, but the impact varies as children move into adolescence. The Family Nutrition and Physical Activity (FNPA) screening tool has been used to evaluate home environments, but studies have not compared the utility of the tool in different age groups. The purpose of this study was to examine the efficacy of the FNPA tool in first and tenth grade samples. Parents of first grade (n = 250) and tenth grade (n = 99) students completed the FNPA and results were linked to body mass index (BMI) data. FNPA scores were examined by gender, income, race, and school-level socioeconomic status (SES). Correlations examined associations between FNPA scores and several BMI indicators. Logistic and linear regression analyses evaluated the construct validity of the FNPA in both groups. Mean FNPA score differed by age group, by SES in both age groups, and by race in the first grade sample only. Correlations between FNPA score and BMI indicators were higher in the first grade sample, but SES was significantly associated with BMI only in tenth graders. The FNPA has stronger utility in younger children, while school SES is a stronger predictor of adolescent weight status.

Effects of Enhancing School-Based Body Mass Index Screening Reports with Parent Education on Report Utility and Parental Intent To Modify Obesity Risk Factors.

BACKGROUND: School-based body mass index screenings (SBMIS) have been controversial. We aimed to determine if parents would indicate improved utility with SBMIS when the report included parent education and whether parental intent to modify obesity risk factors would vary with report type or child weight. METHODS: A cluster-controlled trial was conducted with 31 elementary schools randomized to distribute a standard SBMIS report or the standard report plus education (SBMIS+). A random subsample of parents completed a mailed survey (731 SBMIS, 738 SBMIS+). Using a two-stage cluster sampling design, logistic regression models with school-level random effect were used to assess differences between conditions and by weight category. RESULTS: Parents in the SBMIS+ condition vs. the standard condition were more likely to indicate that the report provided useful information (not significant) and an intent to help their child get enough sleep (p < 0.001). Parents of children who were overweight or obese were less likely than parents of children who were not to indicate that the report provided useful information about their child's weight status (p < 0.001) or access to resources (p < 0.05). However, these parents were more likely to plan a visit to healthcare provider (p < 0.001) and to intend to limit sugar-sweetened beverages (p < 0.05). CONCLUSIONS: Parental education can enhance the utility of the SBMIS report and parental intention to modify at least one obesity risk factor. SBMIS reports prompted parents of children with overweight and obesity to seek clinical care and limit sugar-sweetened drinks.

Self-management strategies mediate self-efficacy and physical activity.

BACKGROUND: Self-efficacy theory proposes that girls who have confidence in their capability to be physically active will perceive fewer barriers to physical activity or be less influenced by them, be more likely to pursue perceived benefits of being physically active, and be more likely to enjoy physical activity. Self-efficacy is theorized also to influence physical activity through self-management strategies (e.g., thoughts, goals, plans, and acts) that support physical activity, but this idea has not been empirically tested. METHODS: Confirmatory factor analysis was used to test the factorial validity of a measure of self-management strategies for physical activity. Next, the construct validity of the measure was tested by examining whether self-management strategies mediated the relationship between self-efficacy and self-reported physical activity, independently of several social-cognitive variables (i.e., perceived barriers, outcome expectancy value, and enjoyment), among cross-sectional samples of 6th grade (n=309) and 8th grade (n=296) girls tested between February 14 and March 17, 2002. Data were analyzed in 2004. RESULTS: Consistent with theory, self-efficacy had direct effects on the social-cognitive variables. The primary novel finding is that self-management strategies mediated the association of self-efficacy with physical activity in both samples. CONCLUSIONS: The measure of self-management strategies for physical activity yields valid scores among adolescent girls and warrants experimental study as a mediator of the influence of efficacy beliefs on physical activity.

Environmental Correlates of Objectively Measured Physical Activity and Sedentary Behavior in After-School Recreation Sessions.

BACKGROUND: Active recreation sessions taking place within after-school programs (ASP) present an opportunity for attending children to attain part of the recommended 60 minutes of daily moderate-to-vigorous physical activity (MVPA). This cross-sectional study's purpose was to assess relationships between microlevel ASP environmental characteristics and physical activity and sedentary behavior (SED). METHODS: During 161 ASP active recreation sessions, 240 children from 7 schools wore Actigraph GT1M accelerometers and were observed up to 6 times per year, over 3 years. To provide microlevel environmental data, trained observers recorded session times, location, duration, organization, equipment, and number of children and staff. Unadjusted bivariate correlations and multivariable regression analyses were used to assess the influence of microlevel environmental variables on MVPA and SED, with regression models controlling for relevant covariates. RESULTS: Across all ASP active recreation sessions, children spent 39 ± 15% in MVPA and 16 ± 11% in SED. Session location, boy-to-girl ratio, and duration were significantly related to MVPA in the regression model. For SED, location and duration were significant influences in the model. CONCLUSIONS: Both location and duration appear to be modifiable correlates of group physical activity level, which may serve to inform intervention efforts to promote physical activity in ASP.

Environmental correlates of objectively measured physical activity and sedentary behavior in after-school recreation sessions.

BACKGROUND: Active recreation sessions taking place within after-school programs (ASP) present an opportunity for attending children to attain part of the recommended 60 minutes of daily moderate-to-vigorous physical activity (MVPA). This cross-sectional study's purpose was to assess relationships between microlevel ASP environmental characteristics and physical activity and sedentary behavior (SED). METHODS: During 161 ASP active recreation sessions, 240 children from 7 schools wore Actigraph GT1M accelerometers and were observed up to 6 times per year, over 3 years. To provide microlevel environmental data, trained observers recorded session times, location, duration, organization, equipment, and number of children and staff. Unadjusted bivariate correlations and multivariable regression analyses were used to assess the influence of microlevel environmental variables on MVPA and SED, with regression models controlling for relevant covariates. RESULTS: Across all ASP active recreation sessions, children spent 39 ± 15% in MVPA and 16 ± 11% in SED. Session location, boy-to-girl ratio, and duration were significantly related to MVPA in the regression model. For SED, location and duration were significant influences in the model. CONCLUSIONS: Both location and duration appear to be modifiable correlates of group physical activity level, which may serve to inform intervention efforts to promote physical activity in ASP.

Evaluation of youth pedometer-determined physical activity guidelines using receiver operator characteristic curves.

OBJECTIVE: Evidence-based pedometer guidelines have not been sufficiently validated in youth. The purpose of this paper was to evaluate the utility of current pedometer-determined physical activity guidelines for youth. METHODS: Participants (n=812, mean age 9.7 years) were from two Midwestern communities during Fall 2005. Participants completed 7 days of pedometer monitoring using a Digiwalker 200-SW. ROC analyses were utilized to assess the utility of the cutpoints in reference to weight status. The percentage of subjects meeting physical activity recommendations (steps/day) was determined using two published recommendations. RESULTS: The mean (SD) steps/day for boys, girls, and sexes combined were 12,709 (3,384), 10,834 (2562), and 11,665 (3028), respectively. Depending on the recommendation, approximately 55-75% of children did not meet the recommended number of steps/day. Sensitivity was high and specificity was low for both current guidelines evaluated. The ROC analysis indicated that lowering the steps/day cutpoint for boys and girls may increase accuracy. CONCLUSIONS: This study demonstrates that a large percentage of children from two Midwestern communities do not meet current pedometer-based physical activity recommendations. Because the percentage of children categorized as active or inactive depends on the criteria that are employed, it is recommended that researchers select cutpoints based on the preferred context of application.