Obesity is one of the most pressing global population health issues, and importantly one that affects racial/ethnic minorities and those of low socioeconomic status disproportionately. Obesity tracks from childhood into adulthood and is related to serious medical and economic consequences throughout the life course. Childhood obesity is well recognized as a complex and multifaceted problem influenced by broader social, geographic and environmental factors. A social ecological framework that is transdisciplinary is needed to address individual-level influences and choices that lead to energy imbalance, but also to address the complex interactions among home and neighborhood environmental features that provide the context for health-related behavior change. The overall goal of this dissertation is to investigate multilevel factors that could influence outcomes of an intervention program aimed at addressing childhood obesity. Including studies that investigated the use of clear communication strategies to facilitate parents comprehension, home media environment related to change in children weight status and the neighborhood environmental context of families. This dissertation draws upon a social ecological model that acknowledges multiple levels of human interaction with the environment and represents a comprehensive approach to designing, implementing and evaluating interventions that which target multiple influences on health behaviors. The iChoose is a 3-month family-based childhood obesity treatment program developed under a community-based participatory research approach led by the Partnering for Obesity Planning and Sustainability (POPS) Community Advisory Board (CAB). The studies within this dissertation use clear communication evaluation and qualitative feedback from focus groups, intervention outcome data and home environmental surveys, as well as environmental audits of neighborhoods. To investigate multilevel factors could influence intervention outcomes, we used both multiple statistical analytical techniques and a Geographic Information System (GIS) spatial analysis to evaluate the iChoose program. / Ph. D.

Over 50 million children attend public elementary and secondary schools in the United States each day. Children spend a substantial portion of their waking hours in school and consume one-third to one-half of their daily calories there, making schools a promising site to influence dietary quality and potentially the risk of childhood obesity. Important policy revisions have been implemented in the National School Lunch Program (NSLP) to improve the nutritional quality of school meals. In 2010, the Healthy, and Hunger-Free Kids Act updated the NSLP standards. The revised nutrition standards required schools to increase the availability of fruits, vegetables, whole grains, and fat-free and low-fat fluid milk in school meals; reduce the level of sodium, saturated fat and trans fat; and meet the nutritional needs of school children within their calorie requirements. About 60% of elementary children participate in the NSLP at least once per week, with the remaining 40% of children bringing a packed lunch from home. While school lunches are guided by national standards and regularly monitored to ensure standards are maintained, the remaining 40% are not guided by national standards. The ultimate purpose of this research was to assess the current school lunch environment and increase the overall nutritional quality of elementary lunches. Data collection procedures included school and packed lunch observations, elementary parent questionnaires, and a pilot intervention to assist elementary parents in providing healthier packed lunches. Results from these studies provide insight on the nutritional differences in school and packed lunches, provide knowledge concerning the parental motivations and barriers to participating in the NSLP or packing lunch for a child, and contribute to the limited research on effective modalities for assisting parents in providing healthier lunches. This research has significant implications public policy and provides valuable information for health professionals, researchers, food service directors, parents, and elementary school administrators to encourage NLSP participation and/or develop interventions which assist parents in packing healthier lunches. Interventions can take the form of marketing strategies to potentially influence NSLP participation, interventions to increase the nutritional value of packed lunches, and/or improvements in school wellness policies. / Ph. D.

The thesis deals with physical activity in the prevention of childhood obesity. It is focused on children, namely pupils of the eighth and ninith grades of elementary school. Obesity is responsible for more human lives than both of the world wars and if we want this epidemic of obesity and problems associated with inactivity minimized, we have to start where it is most efficient and that is with children. The main objective is to explore physical activity in a selected group of pupils. Partial aim is to determine the prevalence of overweight and obesity in the investigated group of students using somatometric measurements in the selected location. Another objective is to determine how many of childrens parents did sports in the past or actualy do sports. The final goal is to prepare educational material for students about the importance of physical activity. The work is divided into two parts theoretical and practical. The theoretical part was compiled as a secondary data analysis. Sources of data and information originated from the Czech Republic and abroad in the form of scholarly books, journals and electronic resources. The contents of the theoretical part is focused on explenation of terms such as obesity, its consequences, complications, ways to prevent obesity, physical activity, appropriate kinds of physical activity and its effects on the human body. Distinctive part is the chapter dealing with the myths of obesity some of them are really surprising. The second part is practical part and includes its own research. The investigation was conducted in a primary school Komenského alej in Žatec for pupils of the eighth and ninth grades. File featured 107 pupils. The research was conducted as a quantitative survey complemented by measurements of somatometric indicators. The data were collected using a custom non-standardized questionnaire. The questionnaire contained 14 questions and two columns separated by line for recording the exact weight and height. We checked these data at pre-agreed periods.

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Abstract Aim The aim of this study was to describe levels and patterns of three-year-old children´s physical activity. Furthermore, to investigate if there were any weight status-, gender- and parental SES differences in three-year-old children’s physical activity levels, using objective and subjective measurements from Early Stockholm Obesity Prevention Project (Early STOPP). Methods Data from 93 children, three years of age, included in the Early STOPP study was used. Children wore an actigraph GT3X+ accelerometer for at least four consecutive days including one weekend day. Average activity in counts per minute (CPM), time spent in sedentary, light PA and moderate to vigorous physical activity (MVPA) was assessed (5 s epoch) and used to examine differences between gender, weight status (ISOBMI according to Cole et al) and socioeconomic status (SES). For this reason an index measuring SES was created using subjective data; parental reported information on living conditions and background characteristics, from the Early STOPP study. Differences between weekdays and weekend days was also examined.    Results The result showed neither any differences in PA between gender nor weight status and no differences between SES-groups. There was a difference in PA levels between weekdays and weekend days and a difference in PA between housing types. The children spent more time being active on weekdays and children living in apartments were more active than children living in villas. Children spent approximately 67% of their time being sedentary and an average of 12,5 minutes in MVPA. Conclusion The study concludes that PA-levels in children three years of age are low. There was a difference between housings, suggesting that parents/guardians play an important role in young children’s PA. However more research is needed to fully understand the PA-behavior of young children and their parents. The absence of PA differences between genders implies that gender differences later in childhood is an effect of social structures rather than innate differences. Objectively measured PA on children at this age is rare and therefore this study contributes to the knowledge regarding young children’s PA-behavior. Furthermore there is also a need to establish agreed upon definitions for SES and of thresholds to use when examining PA with accelerometer. / Sammanfattning Syfte Syftet med denna studie var att beskriva tre år gamla barns fysiska aktivitetsmönster och nivåer. Samt att undersöka om det fanns några skillnader i fysisk aktivitet (FA) beroende på viktstatus, kön och socioekonomisk tillhörighet genom objektiva och subjektiva mått från Early Stockholm Obesity Prevention Project (Early STOPP). Metod Data från 93 treåriga barn inkluderade I Early STOPP studien användes. Barnen använde en Actigraph GT3X+ rörelsemätare under minst fyra sammanhängande dagar med minst en helgdag. Genomsnittlig FA i slag per minut (CPM), tid i stillasittande, lätt aktivitet samt måttlig till kraftig fysisk aktivitet (MVPA) bedömdes (5 s intervaller) och användes för att undersöka om det fanns skillnader mellan kön, viktstatus (ISOBMI enligt Cole et al) samt socioekonomisk status (SES). Av denna anledning skapades ett index för SES med hjälp av subjektiva data; föräldrarapporterad information kring bakgrund och levnadsförhållanden från Early STOPP-studien. Även skillnader i FA mellan vardagar och helger undersöktes. Resultat Resultaten visade inga skillnader i FA mellan könen, viktstatus eller socioekonomisk tillhörighet. Det fanns däremot en skillnad mellan veckodagar och helger samt mellan boendeformer. Barnen var mer aktiva under veckodagarna och barnen boende i lägenhet var mer aktiva än barnen boende i villa. Ca 67 % av tiden spenderades i stillasittande och ungefär 12,5 min per dag spenderades i MVPA. Slutsats Studien drar slutsatsen att aktivitetsnivån hos tre år gamla barn är låg. Det fanns en skillnad i FA mellan boendeformer vilket indikerar att föräldrar/vårdnadshavare spelar en viktig roll för små barns aktivitet. Dock behövs mer forskning för att till fullo förstå barn och föräldrars aktivitetsmönster och hur dessa samvarierar. Avsaknaden av skillnader i FA mellan könen indikerar att könsskillnader senare i barndomen är en effekt av sociala strukturer snarare än medfödda skillnader. Objektivt uppmätt fysisk aktivitet hos barn i den här åldern är ovanligt och därför bidrar denna studie med kunskap kring små barns FA. Avslutningsvis drar denna studie slutsatsen att det finns ett behov av internationella bestämmelser kring definitioner av SES och av tröskelvärden att använda när FA mäts med accelerometri.

Master of Public Health / Human Nutrition / Sandra B. Procter / Background: Engaging community has become a fundamental approach to improving health outcomes in resource-limited settings. Community coalitions, comprised of resident activists that mobilize to improve local conditions, are frequently utilized as partners for community-engaged research. However, there is limited research that documents how these partnerships affect the coalitions. The purpose of this study was to evaluate the effects of researcher-coalition collaboration in the pilot year of a four-year intervention program targeting childhood obesity in rural, low-income communities. Methods: Twelve pre-established community coalitions from seven states were selected to partner with academic researchers in a quasi-experimental study, and then assigned to either the control (n=6) or intervention (n=6) group. Both study arms received funding and access to a menu of evidence-based tools, but the intervention groups were also provided a trained community coach. Member survey data from a Coalition Self-Assessment Survey (CSAS) tool was completed at baseline and at one-year follow-up. Results: CSAS data were analyzed to identify factors related to coalition function and efficacy, and significant changes in both experimental groups were identified. Change in measures of membership recruitment, coalition capacity and coalition communication were unique to the intervention group. Problems for participation were alleviated significantly on all measures in the control group. Comparison of the study groups at follow-up demonstrated that greater research involvement positively impacted membership recruitment and coalition action plan. Conclusion: The data suggest that coalitions with a higher degree of partnership interaction may be more successful in addressing problems impacting their communities.

Background: Reviews of primary research in developed countries and policy in the UK demonstrate there is a lack of evidence from well conducted RCTs on lifestyle interventions for childhood obesity (NICE 2006, SIGN 2003, Oude Luttikhuis et al. 2009). Objectives: To develop, implement and evaluate the Y W8? family focused childhood obesity treatment programme using a randomized controlled trial. Methods: The programme was developed using Bartholomew’s Intervention Mapping framework. Using this stepped process a needs analysis was undertaken, a steering group formed, focus groups were completed in local schools and interviews took place with parents of obese children. The determinants identified by these processes were combined with relevant theories and information gathered through a literature review to develop the programme. Y W8? is a 12 week course for families with children aged 8–13 years designed to assist with weight management. The RCT was designed as an individually randomised parallel-group trial with a waiting-list control group. Children in the intervention group (n=59) had their height, weight, self-reported physical activity levels, self-reported fruit and vegetable consumption and a measure of self-esteem recorded at pre- and post-assessment, whilst only height and weight was collected from the children in the control group (n=55). Results: Twelve week (post course) results showed a significant difference in change in BMI z-score between the control and intervention group, mean difference = -0.12 (95% CI: 0.09 to 0.16, F (1, 98) = 54.04, p < 0.0005), with the control group increasing and the intervention group decreasing their BMI z-score. Analysis showed this positive effect on weight status did not adversely affect linear growth. For the intervention group 81% of children completed the programme. Implications: This RCT offers evidence to support the use of family-based treatment programmes in the treatment of childhood obesity and displays positive results in the short-term, at a lower cost than similar interventions. The thesis also demonstrates how a public health programme can be implemented and sustained in routine NHS practice.

Epidemiologic surveillance indicates an increased susceptibility to obesity among children with special health care needs (SHCN) in comparison to children without. The present study investigated this disparity in weight severity between both groups, with a focus on the provision of obesity management counseling by physicians. This study consisted of a retrospective medical record review that acknowledged the effect of patient-provider interactions on health behaviors and risk perceptions. An independent sample t test compared the incidence of clinician-initiated obesity management counseling received by children with SHCN to that which was received by children without SHCN. This t test revealed a statistically significant difference between the weight management frequency received by youth with SHCN (M = 1.0, SD =.46498) and the weight management frequency received by youth without SHCN (M = 2.0, SD = .74975), t(100) = 7.826, p = .000, α =.05 over a 2-year timeframe. Bivariate correlation analysis validated a correlation between weight severity among children with SHCN and the incidence of clinician-initiated obesity management counseling. The results indicated a small but significant association between weight severity and weight management frequency among children with SHCN, r(50) = .287, p = .044, α =.05. These results support the need for a transformation in the delivery of preventive health services for children with SHCN, such as providing clinician-based obesity management strategies and increasing access to validated diagnosis-specific preventive health screening tools. These results promote positive social change by informing efforts to improve health outcomes and decrease health disparities experienced by people with SHCN.

Overweight and obesity in Mexican children substantiates the need to identify effective strategies and policies to address this problem. Instituto Nacional de Salud Publica (INSP) designed and implemented a randomized control trial (RCT) to assess an ecologically-based intervention program to modify the school environment to promote healthy lifestyle behaviours in children. The objectives of this thesis are to describe the design and impact of this RCT, to examine the program content through an ecological approach, and to examine policy activities that have been informed by the RCT findings. Four manuscripts address these objectives. Manuscript one is Promoting a Healthful Diet and Physical Activity in the Mexican School System for the Prevention of Obesity in Children: Rationale, Design and Methods. It describes the rationale, design, and methods of the two-year INSP-Secretaria de Educacion Publica (Secretary of Public Education, SEP) RCT. Manuscript two is Impact of a School-based Intervention Program on Obesity Risk Factors in Mexican Children. It reports on the environmental impact of the INSP-SEP intervention by comparing 16 intervention schools with 11 non-intervention schools. Results showed increased availability and food intake of healthy foods with a concomitant decrease in unhealthy food availability in intervention schools/children. Manuscript three is An Ecological and Theoretical Deconstruction of a School-based Obesity Prevention Program in Mexico. It reports on an assessment of the integration of ecological principles and theoretical constructs in the school-based behavioural change/obesity prevention intervention carried out by the INSP-SEP. Results showed that 32 intervention strategies were implemented in the school setting to engage target-groups; the most used SCT construct was Reciprocal Determinism. Manuscript four is titled Quality and Implementation of the Nutrition and Physical Activity School Policy Guidelines in Mexico City. It assesses the quality and implementation conditions of a policy and reports on the implementation and the uptake of the national school policy to prevent obesity in Mexico city through a policy analysis, WHO School Policy Framework (SPF) and indicators informed by the national policy. Findings showed that not all of the 10 implementation pre-conditions were met; School Guidelines mostly complied with SPF but were not fully implemented within our sample. / Thesis (Ph.D, Kinesiology & Health Studies) -- Queen's University, 2013-09-30 17:05:33.787

ABSTRACT ASSOCIATION BETWEEN SEDENTARY BEHAVIORS AND BMI IN US ADOLESCENTS: ANALYSIS OF THE 2015 YOUTH RISK BEHAVIOR SURVEY By SARAH SADRUDDIN KABANI April 27, 2017 INTRODUCTION: Research has shown a strong link between sedentary behaviors and obesity among adolescents. AIM: This study aims: 1) To determine sedentary behaviors in US high school adolescent nationally 2) To determine the association between sedentary behaviors and BMI after controlling for demographics, recreational behaviors, diet, and physical activity 3) To examine the association between engaging in more than one sedentary behavior and BMI after controlling for demographics, recreational behaviors, diet, and physical activity METHODS: The Youth Risk Behavioral Survey (YRBS) 2015 data was utilized in this study by using weighted percentages to determine the association between sedentary behaviors and BMI while controlling for demographics such as age, sex, race, and grade, recreational behaviors such as smoking and alcohol consumption, diet such as fruit, vegetable, and soda consumption, and physical activity. Univariate logistic regressions and multivariate logistic regressions were conducted to determine the association between sedentary behaviors and BMI. Adjusted and unadjusted odds ratio, 95% confidence intervals, and p-values were calculated. RESULTS: 81.6% of adolescents watched TV during a school day, while 18.4% did not watch TV during a school day. For video games/computer usage/social media (PG) usage, 82.6% engaged in PG usage during a school day, while 17.4% did not engage in PG usage during a school day. When stratifying by BMI, overweight adolescents and obese adolescents have significantly different sex distribution (p=<0.0001), race/ethnicity distribution (p=0.047), TV usage during a school day (p=0.04), PG usage during a school day (p=0.047), and TV & PG usage during a school day (p=<0.02). For TV & PG usage during the school days, adolescents who watch TV and PG, were at higher odds of being obese [AOR =1.3 (1.04, 1.6), p = 0.02] when comparing to adolescents who did not watch TV and PG. DISCUSSION: This study concludes that there is an association between obesity and adolescents who watch TV and use video games/computer/social media during a school day. Sociodemographic factors such as some races, age, and gender are also responsible for obesity among adolescents.