Bakgrund: Övervikt och fetma är ett hälsoproblem som har ökat i samhället och globalt. Forskningen visar att barnen drabbas av livsstilssjukdomar i vuxen ålder. Distriktssköterskorna har en unik arbetsplats på barnavårdscentral och möter barn med viktproblem. Genom hälsosamtal med föräldrarna får föräldrarna de råd och upplysningar som det behövs för att bekämpa eller förebygga övervikt och fetma hos barn. Genom distriktsköterskornas hälsosamtal stöds föräldrar och barn med råd och information för att förebygga övervikt och framtida livsstilssjukdomar. Syfte: Syftet med denna litteraturöversikt var att belysa distriktssköterskors upplevelse av hälsosamtal med föräldrar till barn med övervikt och fetma. Metod: En litteraturöversikt genomfördes baserad på 15 originalartiklar. Artiklarna söktes fram i databaserna PubMed och CINAHL. Data analyserades med stöd av uppdaterad integrativ granskningsmetod enligt Whittemore och Knafl (2005). Analysen resulterade i tre kategorier och tolv underkategorier. Resultat: Resultatet visade att distriktssköterskor upplevde olika svårigheter som hindrade de att utföra ett effektivt arbete med övervikt och fetmaproblem hos spädbarn och barn under fem år. Det behövs aktuella riktlinjer och även utbildning till både föräldrar och distriktssjuksköterskor för att spädbarn och barn under fem år får en fetmafri barndom. Diskussion: Låg kunskapsnivå om övervikt och fetma hos föräldrarna kan ökas med hjälp av olika bland annat digitala verktyg. Distriktssjuksköterskorna kan i sina ordinarie arbetstider få regelbundna utbildningar och det är viktigt att organisationer uppdaterar riktlinjer. Slutsats: Samhället förändras och teknologi växer och i och med det, förändras mat- och aktivitetskultur hos samhället. Nya organisationsbestämmelser och riktlinjer behövs. Nya verktyg och uppdaterad kunskap hos distriktssjuksköterskor behövs för att säkerställa samhällets hälsa nu och i framtiden. / Background: Obesity are a health problem that has increased in society and globally. Research shows that children suffer from lifestyle diseases in adulthood. The district nurses have a unique workplace at the child care center and meet children with weight problems. Through health conversations with the parents, the parents receive the advice and information needed to fight or prevent overweight and obesity in children. Through the district nurses' health talks, parents and children are supported with advice and information to prevent obesity and future lifestyle diseases. Aim: The aim of this literature review was to shed light on district nurses' experience of health conversations with parents of overweight and obese children. Method: A literature review was conducted based on 15 original articles. The articles were searched in the databases PubMed and CINAHL. Data were analyzed using an updated integrative review method according to Whittemore and Knafl (2005). The analysis resulted in three categories and twelve subcategories. Results: The results showed that district nurses experienced various difficulties that prevented them from performing effective work with obesity and obesity problems in infants and children under five years of age. Current guidelines and also training for both parents and district nurses are needed for infants and children under the age of five to have an obesityfree childhood. Discussion: Low level of knowledge about overweight and obesity in parents can be increased with the help of various digital tools, among others. The district nurses can receive regular training during their regular working hours and it is important that the organization updates guidelines. Conclusion: Society is changing and technology is growing and with it, food and activity culture in society is changing. New organizational rules and guidelines are needed. New tools and updated knowledge of district nurses are needed to ensure the health of society now and in the future. / <p>Datum för godkännande: 2021-12-06</p>

Kwok Man Ki. / Accompanying CD-ROM entitled: DRAGON program 2005. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2006. / Includes bibliographical references (leaves 193-203). / Abstracts in English and Chinese; appendices also in Chinese. / Abstract --- p.i / Abstract (Chinese version) --- p.iii / Acknowledgement --- p.v / Table of contents --- p.vi / List of tables --- p.xi / List of figures --- p.xviii / Presentations --- p.xix / Chapter Chapter one: --- Introduction --- p.1 / Hong Kong preschoolers' nutritional health situation --- p.1 / Chapter (I) --- Breastfeeding & complementary feeding practices --- p.1 / Chapter (II) --- "Diet, mealtime and physical activity patterns" --- p.3 / Chapter (III) --- Weight status --- p.6 / Health risk factors accumulated up to preschool age --- p.8 / Childhood Obesity Prevention: School-based intervention --- p.12 / Chapter (I) --- Primary obesity prevention and health promoting schools --- p.12 / Chapter (II) --- Feasibility of health promotion initiatives in Hong Kong kindergartens --- p.14 / Chapter (III) --- Nutrition and physical activity intervention studies --- p.18 / Chapter (IV) --- Hong Kong kindergarten health initiative: DRAGON Program --- p.23 / Aim and scope of the DRAGON Program --- p.28 / Chapter Chapter two: --- Methodology --- p.30 / Kindergarten recruitment --- p.30 / Formative preparatory stage --- p.32 / Chapter (I) --- Teaching kit development --- p.32 / Chapter (II) --- Teaching kit pretesting --- p.33 / Chapter (III) --- Parents' focus group --- p.35 / Chapter (IV) --- Questionnaires development --- p.35 / Chapter (V) --- Ethics approval --- p.37 / Subject recruitment --- p.37 / Pre-intervention stage --- p.37 / Chapter (I) --- Anthropometric measurements --- p.37 / Chapter (II) --- Parental questionnaires --- p.38 / DRAGON Program implementation --- p.38 / Chapter (I) --- Preschoolers' health curriculum --- p.38 / Chapter (II) --- Pre-intervention data management and analysis --- p.39 / Chapter (III) --- Booster activities planning and implementation --- p.40 / Chapter (IV) --- Parents' newsletters --- p.42 / Post-intervention stage --- p.42 / Chapter Chapter three: --- Results --- p.46 / Enrollment and response rate --- p.46 / Between schools baseline comparison --- p.50 / Education vs. Control Schools baseline comparison --- p.53 / Chapter (I) --- Demographic and socioeconomic characteristics --- p.53 / Chapter (II) --- Children's dietary patterns --- p.60 / Chapter (III) --- "Regular meals, snack patterns and other mealtime behaviors" --- p.65 / Chapter (IV) --- Usual activity patterns --- p.67 / Chapter (V) --- Parents' health knowledge and preferred communication channels --- p.72 / Chapter (VI) --- Child's height and weight measurements --- p.77 / Chapter (VII) --- Factors associated with children's weight status --- p.79 / Chapter (VIII) --- "Associations between socioeconomic status (SES) and children's dietary, mealtime and activity patterns" --- p.81 / Process and outcome evaluations of the Dragon Program --- p.90 / Part a) 1st follow up after finishing all health curriculum --- p.90 / Chapter (I) --- Children's dietary patterns --- p.90 / Chapter (II) --- Mealtime behaviors --- p.95 / Chapter (III) --- Usual activity patterns --- p.99 / Chapter (IV) --- Health curriculum effectiveness evaluation by AM/PM sessions --- p.103 / Part b) 2nd follow up after finishing promotional activities --- p.107 / Chapter (I) --- Children's dietary patterns --- p.108 / Chapter (II) --- Mealtime behaviors --- p.116 / Chapter (III) --- Usual activity patterns --- p.122 / Between subgroups comparisons --- p.131 / Chapter (I) --- First follow up --- p.131 / Chapter (II) --- Second follow up --- p.132 / Parent Focus groups (baseline) --- p.136 / Chapter (I) --- Awareness of local adults' and preschoolers' health status --- p.136 / Chapter (II) --- Children's dietary habits and lifestyle --- p.137 / Chapter (III) --- Factors affecting their children's health behaviors --- p.139 / Parent Focus groups (booster activities) --- p.140 / Teachers´ةquestionnaires --- p.142 / Teachers after class assessment --- p.149 / Teachers´ة focus groups --- p.155 / Principals´ة Interviews --- p.157 / Chapter (I) --- Importance of creating healthy school environment --- p.157 / Chapter (II) --- Students' & teachers´ة performance in first half-year DRAGON Program --- p.158 / Chapter (III) --- Comments on implementing second half-year DRAGON Program --- p.160 / Chapter (IV) --- Recommendations for the development of the Program --- p.161 / Chapter Chapter four: --- Discussion --- p.163 / Implications of the findings --- p.164 / Chapter (I) --- Socioeconomic and demographic factors associated with preschoolers' diet and lifestyle at baseline --- p.164 / Chapter a) --- Association between SES and children´ةs dietary habits --- p.164 / Chapter b) --- Association between SES and children's weight status and their mealtime interactions with parents --- p.166 / Chapter c) --- "Association between children's weight status and their dietary mealtime, and activity patterns" --- p.167 / Chapter (II) --- Local preschool age children´ةs health situation --- p.170 / Chapter (III) --- Program Effectiveness assessment --- p.173 / Chapter a) --- After the implementation of the one-term health curriculum --- p.173 / Chapter b) --- After the implementation of health curriculum and promotional activities --- p.179 / Chapter (IV) --- Program acceptability and feasibility --- p.186 / Limitations --- p.189 / Recommendation for future preschool health program --- p.190 / Chapter Chapter five: --- Conclusion --- p.192 / References --- p.193 / Appendices --- p.204 / Chapter A1 --- School invitation letter with program briefing details (English version) --- p.204 / Chapter A2 --- School invitation letter with program briefing details (Chinese version) --- p.209 / Chapter B1 --- School background information (English version) --- p.213 / Chapter B2 --- School background information (Chinese version) --- p.217 / Chapter C1 --- DRAGON Program Teacher's Guide for nursery grade (Chinese version) --- p.221 / Chapter C2 --- DRAGON Program Teacher's Guide for lower level (Chinese version) --- p.244 / Chapter C3 --- DRAGON Program Teacher's Guide for upper level (Chinese version) --- p.269 / Chapter D1 --- Parents´ة focus group (Jan) (English version) --- p.297 / Chapter D2 --- Parents´ة focus group (Jan) (Chinese version) --- p.301 / Chapter E1 --- Teachers´ة self-administered questionnaires (English version) --- p.305 / Chapter E2 --- Teachers´ة self-administered questionnaires (Chinese version) --- p.324 / Chapter F1a --- Parents´ة self-administered questionnaires [baseline] (English version) --- p.344 / Chapter F1b --- Parents´ة self-administered questionnaires [1st follow up] (English version) --- p.349 / Chapter F1c --- Parents' self-administered questionnaires [2nd follow up] (English version) --- p.354 / Chapter F2a --- Parents´ة self-administered questionnaires [baseline] (Chinese version) --- p.359 / Chapter F2b --- Parents´ة'self-administered questionnaires [1st follow up] (Chinese version) --- p.364 / Chapter F2c --- Parents´ة self-administered questionnaires [2nd follow up] (Chinese version) --- p.369 / Chapter G1 --- Parents´ة consent form (English version) --- p.374 / Chapter G2 --- Parents´ة consent form (Chinese version) --- p.376 / Chapter H1a --- Sample health lesson worksheet for nursery grade (Chinese version) --- p.378 / Chapter H1b --- Sample health lesson worksheet for lower level (Chinese version) --- p.379 / Chapter H1c --- Sample health lesson worksheet for upper level (Chinese version) --- p.380 / Chapter 11 --- Sample parents´ة newsletter (English version) --- p.382 / Chapter 12 --- Sample parents´ة newsletter (Chinese version) --- p.387 / Chapter J1 --- Questions for pretest parents´ة newsletter (Chinese and English version) --- p.392 / Chapter K1 --- Principals´ة interview (English version) --- p.395 / Chapter K2 --- Principals´ة interview (Chinese version) --- p.397 / Table A_1 to A_17 --- p.399 / DiscAl DRAGON Program: teaching materials for health lessons --- p.414 / DiscA2 DRAGON Program: materials for three booster activities --- p.414 / DiscA3 DRAGON Program: health lesson worksheets --- p.414 / DiscA4 DRAGON Program: parents´ة newsletters --- p.414

Cheung Yuk Lin Porky. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2006. / Includes bibliographical references (leaves 236-248). / Abstracts in English and Chinese; appendices also in Chinese. / Acknowledgements --- p.i / Abstract --- p.ii / 論文摘要 --- p.iv / Table of Contents --- p.vi / List of Figures --- p.xii / List of Tables --- p.xiii / List of Abbreviations --- p.xix / Presentations --- p.xx / Chapter CHAPTER 1: --- INTRODUCTION --- p.1 / Chapter 1.1 --- Overview on Childhood Obesity --- p.1 / Chapter 1.1.1 --- Worldwide Situation --- p.1 / Chapter 1.1.2 --- Hong Kong Situation --- p.3 / Chapter 1.2 --- Consequences of Childhood Obesity --- p.4 / Chapter 1.2.1 --- Physiological Problems --- p.4 / Chapter 1.2.2 --- Psychosocial Problems --- p.6 / Chapter 1.2.3 --- Economic Problems --- p.6 / Chapter 1.3 --- Possible Causes and Associated Factors of Childhood Obesity --- p.7 / Chapter 1.3.1 --- Genetics --- p.7 / Chapter 1.3.2 --- Lifestyle Patterns --- p.8 / Chapter 1.3.2.1 --- Physical Activity --- p.8 / Chapter 1.3.2.2 --- Dietary Factors --- p.8 / Chapter 1.3.3 --- Environmental Influence --- p.10 / Chapter 1.3.3.1 --- Parental Influence and Home Environment --- p.10 / Chapter 1.3.3.2 --- Other External Environmental Factors --- p.10 / Chapter 1.4 --- Prevention and Treatment of Childhood Obesity --- p.12 / Chapter 1.4.1 --- Clinical Trials --- p.12 / Chapter 1.4.2 --- Family Based Interventions --- p.13 / Chapter 1.4.3. --- School Based Interventions --- p.14 / Chapter 1.4.4 --- Other Possible Measures --- p.17 / Chapter 1.5 --- Local Intervention Implementation --- p.17 / Chapter 1.6 --- "Study Rationale, Design，Aims and Objectives" --- p.18 / Chapter 1.6.1 --- Study Rationale --- p.18 / Chapter 1.6.2 --- Study Design --- p.19 / Chapter 1.6.3 --- Study Aims and Objectives --- p.21 / Chapter 1.7 --- Conceptual Framework and Hypothesis --- p.21 / Chapter 1.7.1 --- Conceptual Framework --- p.22 / Chapter 1.7.2 --- Hypothesis --- p.23 / Chapter CHAPTER 2: --- METHODOLOGY --- p.23 / Chapter 2.1 --- Sample --- p.23 / Chapter 2.1.1 --- School Recruitment --- p.23 / Chapter 2.1.2 --- Subject Recruitment --- p.23 / Chapter 2.2 --- Parental Consent --- p.24 / Chapter 2.3 --- Focus Groups --- p.24 / Chapter 2.4 --- Assessment Tools --- p.25 / Chapter 2.4.1 --- Weight and Height measures --- p.25 / Chapter 2.4.2 --- Physical Fitness Tests --- p.25 / Chapter 2.4.3 --- Student Questionnaire --- p.26 / Chapter 2.4.4 --- Parental Questionnaire --- p.27 / Chapter 2.4.5 --- Questionnaires Pre-testing --- p.27 / Chapter 2.5 --- Intervention --- p.28 / Chapter 2.5.1 --- Intervention A: Mighty Heart Health Promotion Program --- p.28 / Chapter 2.5.1.1 --- Materials --- p.28 / Chapter 2.5.1.2 --- Procedures --- p.30 / Chapter 2.5.2 --- Intervention B: Health Club --- p.31 / Chapter 2.5.2.1 --- Materials --- p.31 / Chapter 2.5.2.2 --- Procedures --- p.32 / Chapter 2.6 --- Evaluation --- p.35 / Chapter 2.6.1 --- Qualitative Evaluation --- p.35 / Chapter 2.6.2 --- Quantitative Evaluation --- p.35 / Chapter 2.7 --- Data Manasement --- p.36 / Chapter 2.8 --- Statistics --- p.37 / Chapter 2.8.1 --- Health Knowledge and Food Preferences Scores of Students --- p.37 / Chapter 2.8.2 --- "Health Knowledge, Dietary Habits and Home Food Availability Scores of Parents" --- p.40 / Chapter 2.9 --- Ethical Approval --- p.42 / Chapter CHAPTER 3: --- RESULTS --- p.43 / Chapter PART A: --- Baseline Focus Groups Results / Chapter 3.1 --- Baseline Focus Groups Results --- p.43 / Chapter 3.1.1 --- General Description of Participants --- p.44 / Chapter 3.1.2 --- "Views of ""Health"" held by students" --- p.44 / Chapter 3.1.3 --- "Views of ""Health"" of parents" --- p.45 / Chapter 3.1.4 --- "Views of ""Healthy Eating"" of students" --- p.46 / Chapter 3.1.5 --- "Views of ""Healthy Eating"" held by parents" --- p.47 / Chapter 3.1.6 --- "Perceived views on ""Physical Activity"" by students" --- p.48 / Chapter 3.1.7 --- "Views on ""Physical Activity"" of parents" --- p.49 / Chapter 3.1.8 --- Preferred delivery mode of activities communication channels --- p.50 / Chapter PART B: --- Baseline Profile of Participants / Chapter 3.2 --- Response Rate --- p.52 / Chapter 3.3 --- Baseline Characteristics and Socio-dem ograph ic Profile of Participants --- p.54 / Chapter 3.3.1 --- Students --- p.54 / Chapter 3.3.2 --- Parents --- p.56 / Chapter 3.4 --- "Self-perceived Important Values, Health and Weight Status at baseline" --- p.60 / Chapter 3.4.1 --- Students --- p.60 / Chapter 3.4.2 --- Parents --- p.62 / Chapter 3.5 --- Baseline Physical Activity --- p.63 / Chapter 3.5.1 --- Students --- p.63 / Chapter 3.5.2 --- Parents --- p.69 / Chapter 3.6 --- Baseline Dietary Aspects --- p.71 / Chapter 3.6.1 --- Students --- p.71 / Chapter 3.6.2 --- Parents --- p.81 / Chapter 3.7 --- Summary of Baseline associations between students，and parents 'parameters --- p.94 / Chapter 3.7.1 --- Factors associated with Students' weight status --- p.94 / Chapter 3.7.2. --- Factors associated with Studente´ة Dietary Habits --- p.97 / Chapter 3.7.3 --- Factors associated with students´ة physical Activity Habits --- p.104 / Chapter 3.8 --- Summary of Baseline Profile of Participants --- p.108 / Chapter PART C: --- Outcome Evaluation / Chapter 3.9 --- The Final MH activities Conducted --- p.111 / Chapter 3.10 --- Comparisons of Weight Status --- p.112 / Chapter 3.11 --- Comparisons of Self-perceived Health Status and Important Values --- p.114 / Chapter 3.12 --- Comparisons of Physical Activity Parameters --- p.118 / Chapter 3.12.1 --- Students --- p.118 / Chapter 3.12.2 --- Parents --- p.126 / Chapter 3.13 --- Comparisons of Dietary and Health Related Aspects --- p.129 / Chapter 3.13.1 --- Students --- p.129 / Chapter 3.13.2 --- Parents --- p.148 / Chapter 3.13.3 --- Home Food and Meal Environments --- p.167 / Chapter PART D: --- Results of Health Club / Chapter 3.14 --- Baseline Profile of the Participants --- p.180 / Chapter 3.14.1 --- Characteristics and Health Status --- p.180 / Chapter 3.14.2 --- Baseline Physical Activity --- p.181 / Chapter 3.14.3 --- Baseline Dietary Related Parameters --- p.183 / Chapter 3.15 --- The Final HC Lessons Conducted --- p.187 / Chapter 3.16 --- Outcome Evaluation of HC program --- p.188 / Chapter 3.16.1 --- Physical Fitness and Anthropometric Parameters --- p.188 / Chapter 3.16.2 --- Self-perceived Health Status and Important Values --- p.192 / Chapter 3.16.3 --- Physical Activity Related Aspects --- p.193 / Chapter 3.16.4 --- Dietary Aspects --- p.196 / Chapter 3.17 --- Summary of results of the HC Program --- p.201 / Chapter PART E: --- Process Evaluation / Chapter 3.18 --- Process Evaluations of Mighty Heart --- p.203 / Chapter 3.18.1 --- Students --- p.203 / Chapter 3.18.1.1 --- Comments on Program Activities and Materials --- p.203 / Chapter 3.18.1.2 --- Comments on Program Effectiveness and Acceptability --- p.204 / Chapter 3.18.1.3 --- Overall Comments and Suggestions --- p.204 / Chapter 3.18.2 --- Teachers --- p.205 / Chapter 3.18.2.1 --- Comments on Program Activities and Materials --- p.205 / Chapter 3.18.2.2 --- Comments on Program Effectiveness and Acceptability --- p.205 / Chapter 3.18.2.3 --- Overall Comments and suggestions --- p.206 / Chapter 3.19 --- Process Evaluations of the Health Club --- p.207 / Chapter 3.19.1 --- Students --- p.207 / Chapter 3.19.1.1 --- Comments on Program Activities and Materials --- p.207 / Chapter 3.19.1.2 --- Comments on Program Effectiveness and Acceptability --- p.208 / Chapter 3.19.1.3 --- Overall Comments and Suggestions --- p.208 / Chapter 3.19.2 --- Teacher --- p.209 / Chapter 3.19.2.1 --- "Comments on Program Activities, Educational Materials/Resources" --- p.209 / Chapter 3.19.2.2 --- Comments on Program Effectiveness and Acceptability --- p.210 / Chapter 3.19.2.3 --- Overall Comments and Suggestions --- p.211 / Chapter Chapter 4: --- Discussion --- p.212 / Chapter 4.1 --- Overall Effects of the MH Program --- p.213 / Chapter 4.1.1 --- Changes in PA-related Aspects --- p.213 / Chapter 4.1.2 --- Changes in Dietary-related Aspects --- p.216 / Chapter 4.1.3 --- Changes in Health Status related Aspects --- p.225 / Chapter 4.1.4 --- Acceptability and Appropriateness of the MH --- p.225 / Chapter 4.2 --- Overall Effects of the HC Program --- p.226 / Chapter 4.2.1 --- Changes in PA Related Aspects --- p.226 / Chapter 4.2.2 --- Changes in Dietary-related Aspects --- p.227 / Chapter 4.2.3 --- Changes in Health Status related Aspects --- p.228 / Chapter 4.2.4 --- Acceptability and Appropriateness of the HC --- p.229 / Chapter 4.3 --- Strengths and Limitations of the Study --- p.231 / Chapter 4.4 --- Implications and Recommendations for Future Research --- p.233 / Chapter Chapter 5: --- Conclusions --- p.234 / References --- p.236 / Appendix A Principal/ teacher Questionnaire --- p.249 / Appendix B Consent form for parents --- p.252 / Appendix C Focus group questionnaire - Students --- p.258 / Appendix D Focus group questionnaire - Parents --- p.262 / Appendix E Survey questionnaire -Students --- p.266 / Appendix F Survey Questionnaire - Parents --- p.274 / Appendix G Powerpoint material for teachers´ة monthly sharing --- p.282 / Appendix H Working sheets --- p.283 / Appendix I Newsletters for parents --- p.287 / Appendix J Teachers´ة guide for the “Mighty Heart´حprogram --- p.302 / Appendix K Teachers' guide for Health Club --- p.307 / Appendix L The student workbook --- p.311 / "Appendix M Discussion guide for students participating in the ""Mighty Heart ""program" --- p.312 / Appendix N Discussion guide for students participating in the Health Club --- p.313 / Appendix O Discussion guide for teachers conducting the Mighty Heart program --- p.314 / Appendix P Discussion guide for the teachers conducting the Health Club --- p.316

Sea Man Mei. / "September 2004." / Thesis (Ph.D.)--Chinese University of Hong Kong, 2004. / Includes bibliographical references (p. 194-218). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. Ann Arbor, MI : ProQuest Information and Learning Company, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. Ann Arbor, MI : ProQuest dissertations and theses, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web. / Abstracts in English and Chinese.

Chan, Yun Kwan. / Accompanying CD-ROM contains appendix H, I, J, and K. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2008. / Includes bibliographical references (leaves 161-170). / Abstracts in English and Chinese; three appendixes in Chinese only. / Library's copy: lacks accompanying CD-ROM. / Acknowledgement --- p.i / Abstract --- p.ii / Abstract (Chinese) --- p.iv / List of publications --- p.vi / Table of Contents --- p.viii / List of Figures --- p.xvi / List of Tables --- p.xvii / List of Abbreviations --- p.xxv / Chapter CHAPTER ONE: --- INTRODUCTION --- p.1 / Chapter 1.1 --- Global prevalence of childhood overweight --- p.1 / Chapter 1.2 --- Preschool health situation in HK --- p.2 / Chapter 1.2.1 --- Breastfeeding --- p.2 / Chapter 1.2.2 --- Diet and physical activity patterns --- p.3 / Chapter 1.2.3 --- Prevalence of childhood overweight --- p.5 / Chapter 1.2.3.1 --- Definition of childhood overweight --- p.5 / Chapter 1.2.3.2 --- Local prevalence of childhood overweight --- p.6 / Chapter 1.3 --- Consequences of childhood overweight --- p.7 / Chapter 1.3.1 --- Health consequences of childhood overweight --- p.7 / Chapter 1.3.2 --- Economic consequences of childhood overweight --- p.9 / Chapter 1.4 --- Risk factors of childhood overweight and obesity --- p.11 / Chapter 1.4.1 --- Family Socioeconomic status --- p.11 / Chapter 1.4.2 --- Parental overweight --- p.11 / Chapter 1.4.3 --- Breastfeeding --- p.12 / Chapter 1.4.4 --- Birth order --- p.13 / Chapter 1.4.5 --- Breakfast consumption --- p.13 / Chapter 1.4.6 --- Beverage consumption --- p.14 / Chapter 1.4.7 --- High calcium intake --- p.15 / Chapter 1.4.8 --- Fruit and vegetable consumption --- p.15 / Chapter 1.4.9 --- Physical inactivity --- p.15 / Chapter 1.4.9.1 --- Physical activity recommendations for preschoolers --- p.17 / Chapter 1.4.9.2 --- Screentime recommendations for preschoolers --- p.18 / Chapter 1.5 --- Child development --- p.18 / Chapter 1.5.1 --- Onset of overweight --- p.18 / Chapter 1.5.2 --- Early establishment of lifelong habits at preschool age --- p.19 / Chapter 1.5.3 --- Interaction with parents --- p.20 / Chapter 1.6 --- Justification of preschool multi-component health intervention in Hong Kong --- p.22 / Chapter 1.6.1 --- Local health promotion initiative at preschool --- p.22 / Chapter 1.6.2 --- Justification for DRAGON2006 modifications --- p.23 / Chapter 1.6.2.1 --- Inclusion of family-home component in school- based health intervention --- p.24 / Chapter 1.6.2.2 --- Child BMI monitoring and health report to parents --- p.24 / Chapter 1.7 --- Present school-based preschool health intervention --- p.25 / Chapter 1.8 --- Summary --- p.27 / Chapter 1.9 --- Aims and objectives --- p.27 / Chapter CHAPTER TWO: --- METHODOLOGY --- p.28 / Chapter 2.1 --- Recruitment of preschools and preschoolers --- p.28 / Chapter 2.2 --- Development of DRAGON2006 --- p.33 / Chapter 2.2.1 --- Ethics approval --- p.35 / Chapter 2.2.2 --- Focus groups with parents --- p.35 / Chapter 2.2.3 --- Amendment and pretest of the questionnaires --- p.35 / Chapter 2.2.4 --- Health lessons --- p.36 / Chapter 2.2.4.1 --- Development and adaptation of the health lessons --- p.36 / Chapter 2.2.4.2 --- Improvement of the teaching materials --- p.37 / Chapter 2.2.4.3 --- Lyrics reproduction and CD production --- p.37 / Chapter 2.2.4.4 --- Worksheets --- p.38 / Chapter 2.2.4.5 --- Process evaluation --- p.38 / Chapter 2.2.5 --- Teachers´ة training --- p.38 / Chapter 2.3 --- Intervention Activities and Components --- p.39 / Chapter 2.3.1 --- Opening ceremony --- p.39 / Chapter 2.3.2 --- Health Talks --- p.40 / Chapter 2.3.3 --- Health report --- p.40 / Chapter 2.3.4 --- Parental newsletters --- p.41 / Chapter 2.4 --- Outcome evaluation --- p.42 / Chapter 2.5 --- Data collection --- p.43 / Chapter 2.5.1 --- Recruitment of subjects --- p.43 / Chapter 2.5.2 --- Anthropometric measurements --- p.43 / Chapter 2.5.3 --- Parental baseline and evaluation questionnaire administration --- p.44 / Chapter 2.5.4 --- Teachers´ة pre- and post-intervention evaluation and process evaluation --- p.44 / Chapter 2.6 --- Data management --- p.44 / Chapter 2.6.1 --- Verification of data from the questionnaires --- p.44 / Chapter 2.6.2 --- Data coding --- p.45 / Chapter 2.6.3 --- Data entry and verification --- p.45 / Chapter 2.6.4 --- Data analysis --- p.45 / Chapter 2.5.4.1 --- Descriptive and association analysis --- p.45 / Chapter 2.5.4.2 --- Construction of BMI-for-age percentile and z- score curves --- p.46 / Chapter 2.5.4.3 --- Evaluation of the effectiveness of the program --- p.47 / Chapter CHAPTER THREE: --- RESULTS --- p.48 / Chapter 3.1 --- Organization of the results --- p.48 / Chapter 3.2 --- Baseline comparability between the EG and CG --- p.48 / Chapter 3.2.1 --- General sociodemographic characteristics --- p.48 / Chapter 3.2.2 --- Preschoolers' diet and meal behaviors --- p.54 / Chapter 3.2.3 --- Preschoolers´ة dental health --- p.61 / Chapter 3.2.4 --- Parental child feeding behaviors --- p.62 / Chapter 3.2.5 --- Preschoolers´ة physical activity and sedentary behaviors --- p.66 / Chapter 3.2.6 --- Summary --- p.67 / Chapter 3.3 --- Baseline comparability between the completes and dropouts --- p.69 / Chapter 3.3.1 --- Participant flow in the EG and CG --- p.69 / Chapter 3.3.2 --- General sociodemographic characteristics --- p.70 / Chapter 3.3.3 --- "Preschoolers´ة diet, meal and physical and sedentary activity behaviors and parental child feeding behaviors" --- p.74 / Chapter 3.3.4 --- Summary --- p.75 / Chapter 3.4. --- Evaluation of the effectiveness of the DRAGON2006 --- p.76 / Chapter 3.4.1 --- General demographic characteristics --- p.76 / Chapter 3.4.2 --- Effects on preschoolers´ة anthropometry and weight status --- p.77 / Chapter 3.4.3 --- Effects on preschoolers' diet and meal behaviors --- p.79 / Chapter 3.4.4 --- Effects on parental child feeding behaviors --- p.89 / Chapter 3.4.5 --- Effects on preschoolers´ة physical and sedentary activities --- p.92 / Chapter 3.4.6 --- Summary --- p.94 / Chapter 3.5 --- "Teaching staff members´ة attitudes, perceptions and practices with respect to addressing childhood overweight" --- p.95 / Chapter 3.5.1 --- General demographic characteristics --- p.95 / Chapter 3.5.2 --- Teachers' attitude toward addressing childhood overweight --- p.98 / Chapter 3.5.3 --- Teachers' behaviors toward addressing childhood overweight --- p.99 / Chapter 3.5.4 --- Teachers' perceived abilities to deal with some childhood overweight topics --- p.100 / Chapter 3.5.5 --- Teachers´ة reported helpful factors to implementing a new preschool health program --- p.101 / Chapter 3.5.6 --- Teachers´ة reported helpful factors for and barriers to parents´ة participation --- p.102 / Chapter 3.5.7 --- Comparisons between staff with and without self-reported weight and height --- p.103 / Chapter 3.5.8 --- Summary --- p.105 / Chapter 3.6 --- EG teachers´ة evaluation of the program --- p.106 / Chapter 3.6.1 --- Teachers' perception of DRAGON2006 program before the intervention --- p.106 / Chapter 3.6.2 --- DRAGON teachers´ة process evaluation of the DRAGON2006 curriculum --- p.113 / Chapter 3.6.3 --- DRAGON teachers´ة evaluation of DRAGON2006 program after the intervention --- p.118 / Chapter CHAPTER FOUR: --- DISCUSSION --- p.127 / Chapter 4.1 --- "Baseline findings about the preschoolers' weight status, diet, meal and physical and sedentary activity situation" --- p.127 / Chapter 4.1.1 --- Preschooler and parental overweight and obesity --- p.127 / Chapter 4.1.2 --- Preschoolers´ة diet and meal behaviors --- p.128 / Chapter 4.1.3 --- Preschoolers´ة physical and sedentary activity behaviors --- p.130 / Chapter 4.2 --- "Gender associations with preschoolers´ة diet, meal and physical and sedentary activity behaviors and parental child feeding behaviors" --- p.131 / Chapter 4.2.1 --- Gender associations with preschoolers´ة diet and meal behaviors --- p.132 / Chapter 4.2.2 --- Gender associations with parental child feeding behaviors --- p.134 / Chapter 4.2.3 --- Gender associations with preschoolers´ة physical and sedentary activity behaviors --- p.135 / Chapter 4.3 --- "Age associations with preschooler diet, meal and physical and sedentary activity behaviors and parental child feeding behaviors" --- p.136 / Chapter 4.3.1 --- Preschoolers' age associations with their anthropometry --- p.137 / Chapter 4.3.2 --- Preschoolers´ة age associations with their diet and meal behaviors --- p.137 / Chapter 4.3.3 --- Preschoolers' age associations with their dental health --- p.139 / Chapter 4.3.4 --- Preschoolers´ة age associations with parental child feeding behaviors --- p.139 / Chapter 4.3.5 --- Preschoolers´ة age associations with their physical and sedentary activity behaviors --- p.140 / Chapter 4.4 --- "Family income associations with preschooler diet, meal and physical and sedentary activity behaviors and parental child feeding behaviors" --- p.141 / Chapter 4.4.1 --- Family income associations with some general demographic characteristics of the sample --- p.143 / Chapter 4.4.2 --- Family income associations with preschoolers´ة diet and meal behaviors --- p.144 / Chapter 4.4.3 --- Family income associations with parental child feeding behaviors --- p.147 / Chapter 4.4.4 --- Family income associations with preschoolers' physical and sedentary activity behaviors --- p.148 / Chapter 4.5 --- Factors associated with preschool overweight and obesity --- p.148 / Chapter 4.5.1 --- Preschooler overweight and obesity associations with some general demographic characteristics of the baseline participants --- p.149 / Chapter 4.5.2 --- Preschooler overweight and obesity associations with parental overweight and obesity --- p.150 / Chapter 4.5.3 --- Preschooler overweight and obesity associations with preschoolers' meal behaviors --- p.150 / Chapter 4.5.4 --- Preschooler overweight and obesity associations with their physical and sedentary activity behaviors --- p.150 / Chapter 4.6 --- The evaluation of the effectiveness of DRAGON2006 --- p.151 / Chapter 4.6.1 --- Baseline comparison between the education (EG) and control group (CG) --- p.151 / Chapter 4.6.2 --- Baseline comparison between completers and dropouts --- p.151 / Chapter 4.6.3 --- Follow up comparison between the education (EG) and control groups (CG) --- p.152 / Chapter 4.6.3.1 --- The changes in preschooler anthropometry --- p.153 / Chapter 4.6.3.2 --- The changes in preschooler diet and meal behaviors --- p.154 / Chapter 4.6.3.3 --- The changes in preschooler physical and sedentary activity behaviors --- p.155 / Chapter 4.6.3.4 --- Parental child feeding behaviors --- p.156 / Chapter 4.7 --- The teachers´ة evaluation results of DRAGON2006 and of Color Me Healthy --- p.156 / Chapter 4.7 --- Strengths and limitations of the study --- p.157 / Chapter 4.8 --- Suggestions for improvement of DRAGON --- p.159 / Chapter CHAPTER FIVE: --- CONCLUSION --- p.160 / References --- p.161 / Appendices / Chapter AI --- Invitation letter for preschool (English) --- p.171 / Chapter AIII --- Invitation letter for preschool (Chinese) --- p.172 / Chapter AIII --- Invitation letter for CG preschool (Chinese only) --- p.173 / Chapter BI --- Research proposal (English) --- p.174 / Chapter BII --- Research proposal (Chinese) --- p.178 / Chapter CI --- Purpose and structure of DRAGON2006 health lessons (English) --- p.181 / Chapter CII --- Purpose and structure of DRAGON2006 health lessons (Chinese) --- p.185 / Chapter DI --- Teacher evaluation Part A (pre-intervention) (English) --- p.189 / Chapter DII --- Teacher evaluation Part A (pre-intervention) (Chinese) --- p.191 / Chapter EI --- Teacher evaluation Part B (process evaluation) (English) --- p.193 / Chapter EII --- Teacher evaluation Part B (process evaluation) (Chinese) --- p.205 / Chapter FI --- Teacher evaluation Part C (post-intervention) (English) --- p.218 / Chapter FII --- Teacher evaluation Part C (post-intervention) (Chinese) --- p.222 / Chapter GI --- Child health report (English) --- p.224 / Chapter GII --- Child health report (Chinese) --- p.226 / Chapter H --- Teaching kit --- p.228 / Chapter I --- Music sound track --- p.228 / Chapter J --- Curriculum worksheets (Chinese only) --- p.228 / Chapter K --- Parents´ة newsletters (Chinese only) --- p.228 / Chapter LI --- Focus group study questions (English) --- p.229 / Chapter LII --- Focus group study questions (Chinese) --- p.231 / Chapter MI --- Consent form for EG parents (English) --- p.233 / Chapter MII --- Consent form for EG parents (Chinese) --- p.235 / Chapter MII --- Consent form for CG parents (English) --- p.237 / Chapter MI --- Consent form for CG parents (Chinese) --- p.238 / Chapter NI --- Pre-internvetion parental questionnaire (English) --- p.239 / Chapter NII --- Pre-intervention parental questionnaire (Chinese) --- p.245 / Chapter OI --- Post-intervention parental questionnaire (English) --- p.250 / Chapter OII --- Post-internvetion parental questionnaire (Chinese) --- p.256 / Chapter PI --- Post-intervention staff survey (English) --- p.262 / Chapter PII --- Post-intervention staff survey (Chinese) --- p.264 / Chapter Q --- "Gender differences in preschoolers´ة diet, meal, physical and sedentary behaviors and parental child feeding behaviors" --- p.266 / Chapter R --- "Age differences in preschoolers´ة diet, meal, physical and sedentary behaviors and parental child feeding behaviors" --- p.296 / Chapter S --- "Income differences in preschoolers' diet, meal, physical and sedentary behaviors and parental child feeding behaviors" --- p.313 / Chapter T --- Factors associated with preschooler weight status --- p.334 / Chapter U --- "Maternal education level differences in preschoolers´ة diet, meal, physical and sedentary behaviors and parental child feeding behaviors" --- p.352 / Chapter V --- "Maternal birth place differences in preschoolers´ة diet, meal, physical and sedentary behaviors and parental child feeding behaviors" --- p.374 / Chapter W --- Test-retest reliability of DRAGON2006 questionnaire --- p.394

The present study employed a quantitative, non-experimental, multivariate correlational research design to test a hypothesized model examining associative paths of influence between ecological factors and weight status of urban, African-American adolescent females. Anthropometric and self-report survey data of 182 urban, African- American adolescent females were collected during after-school programs, health and physical education classes, and community events in an urban area in northeast Florida. Descriptive analyses were conducted to characterize the study participants based upon their age, study setting, and weight status. A scale reliability analysis was conducted to assess the internal consistency reliability of the sample data using selected measures within the context of the study’s specific population and subsequently guided the structural equation model (SEM) analyses. The SEM path analysis was used to develop two measurement models to control for observed error variance for variables demonstrating poor internal consistency reliability (diet behaviors and nutrition selfefficacy) and a final structural model to test the associative paths of influence between latent (diet behaviors and nutrition self-efficacy) and manifest variables (teacher social support and friend social support) on weight status. The results of the path analysis indicated that both teacher social support and friend social support demonstrated a positive, indirect influence on child weight status through nutrition self-efficacy and diet behaviors following two different and specific paths of influence. Diet behaviors, in turn, demonstrated a positive, direct effect on child weight status. These findings provide clear implications for educational leaders that call for the integration of health behavior change theory into traditional education and leadership practice and actively addressing the childhood obesity epidemic in the school environment by implementing health behavior change strategies at various ecological environmental levels.