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Michelle Ling

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Michelle Ling, Harrison Wagner, Courtney Chang, Evan Wylie, Logan Ellis, & Arian Sasani HEAL 200- Determinants of Health Have interventions that have been implemented (within developed nations) with the intention of reducing the inequality in levels of physical activity in children across different levels of socioeconomic status been effective? If so, how effective were they at narrowing the gap in activity? If not, why did they fail? - Regular physical activity (PA) is associated with numerous health benefits such as reduced risks of obesity, premature mortality, asthma, type II diabetes, coronary heart disease, cancer, & hypertension
- It is also known to improve sleep habits, lower depression and enhance self-esteem in children 10, 8 Childhood to Adulthood - An inactive, overweight child often becomes an inactive, overweight adult 11
- An estimated 42 million children under five from developed and developing countries are considered overweight 8
- Children in lower SES households in the U.S. and other developed countries are more likely to be overweight or obese 11
-The patterns and preferences children exhibit at age 2.9 have been found to be highly correlated with preferences at age 8 and continue their influence into adolescence and adulthood 8 Low SES & Physical Activity - Low-SES groups are more likely to have higher levels of obesity, an unhealthy diet and be physically inactive, putting them more at risk of developing type II diabetes and other health complications
- 40% more likely to have type 2 diabetes
- Physical activity interventions have the potential to influence individual health outcomes and reduce the overall cost on our health care system
IstanBul, Turkey: overweight and higher energy intake in middle/high SES children, underweight and lower physical activity levels in low SES children 7 HealthKick - Primary school-based nutrition and physical activity intervention located in low-income communities, in Cape Town, SA

- To promote healthful eating habits and increase physical activity in grade 4-6 students and reduce risk of chronic disease

What did they do?
- Curriculum component that encourages activities such as dance
- Emphasized how physical activity will make a difference in learners' health and well-being
- Any physical activity is better than nothing
- Physical activity is important for boys and girls
- Tool Kits 5

*The outcome of this intervention is yet to be measured* Benefits of Physical Activity - In school programs provide a larger benefit to low SES children due to minimal cost 1
- Health campaigning to increase parent awareness of childhood obesity and nutrition 4
- Combining Parental education within family and the community, along with school PA programs and screen time 4
- Effective programs were brief and targeted a specific gender and a specific disease such as obesity rather than aiming to generally increase physical activity 2 What was effective? - Short term interventions that do not involve parent engagement 4

- Interventions that focused only on school-based activities 12

- Interventions that did not include family lifestyle, school activities and community activities altogether 9 What was not effective? The Institute of Medicine recommended a multifaceted approach to prevent childhood obesity through using school based interventions, community wide and population based approaches

- Previous study conducted a meta-analysis of interventions for preventing childhood obesity
- Most effective interventions were brief and targeted female children and adolescents
- Programs that focused on obesity prevention were most effective for decreasing weight gain than programs that focused on numerous health problems such as smoking cessation and CVD
- Most successful studies done with children and adolescents in the prevention of overweight are school-based and short term (less than 12 weeks duration) focusing on healthy diets and increased physical activity 2 Hispanic Children and Overweight: Causes and Interventions - Head start: Community intervention program split into 2 years

- First year: Parents work alongside researchers to plan, and conduct community assessment to design family-centered obesity intervention.

- Second year: Parents implement intervention based on 4 components: Child's BMI, Community campaign to raise awareness of children's weight status, nutrition education, and a 6 week program to increase parents skill set 4 More Interventions for Reducing the Inequality in Levels of PA in Children Across Different Levels of SES - Available resources
- Awareness of Intervention (word of mouth)
- Acceptability of intervention
- Views and experiences of health professionals and health workers
- Information on health behaviors
- Existing attitudes towards health
- Perceived capabilities
- Current lifestyle
- Environmental factors
- Affordability 6 Barriers and facilitators to intervention implementation/participation - Childhood obesity and inactivity is a growing epidemic with a higher prevalence in children of low SES.
- School based interventions can be effective but past research shows no successful results when done alone.
- Successful interventions target the child's environment (including family, school and the community), psychological, sociocultural and physical environmental factors
- Successful interventions are specific to different cultures.
- To target each of these variables, interventions need to be created as specifically as possible
- Developing an intervention is a long process that needs to be done systematically and precisely
- Time, human resources and finances need to be accounted for so that the interventions are evidence based and relevant
12 Conclusion 1.Behrens, T, Lauersdorf, R, Liebert, M, Liguori, G, Schuna J. An objective assessment of children's physical activity during the keep it moving! after-school program. J Sch Health. 2013; 83:105-111.
2.Centrelle-Nigro, A. Hispanic children and overweight: causes and interventions. CNE Series. 2009; 35:352-356.
3.Colin-Ramirez E, Castilo-Martinez L, Orea-Tejeda A, Vergara-Castaneda A, Keirns-Davis C, Villa-Romero A. Outcomes of a school-based intervention (rescate) to improve physical activity patterns in Mexican children aged 8-10 years. Health Education Research. 2010; 25:1042-1049.
4.Davidson K, Jurkowski J, Kranz S, Lawson H, Li K. A childhood obesity intervention developed by families for families: results from a pilot study. IJBNPA Journal. 2013; 10:1-11.
5.Draper C, Villers A, Lambert E, Fourie J, Hill J, Dalas L et al. HealthKick: a nutrition and physical activity intervention for primary schools in low-income settings. BMC Public Health. 2010; 10:398.
6.Everson-Hock E, Johnson M, Jones R, Woods H, Goyder E, Payne N. Community-based dietary and physical activity interventions in low socioeconomic groups in the UK: A mixed methods systematic review. Preventive Medicine. 2013.
7.Hawthorne A, Shalbi G, Cleveland B, McFall S. Grand Canyon Trekkers: School-Based Lunchtime Walking Program. The Journal of School Nursing, 2010.
8.Lanigan J. The substance and sources of young children’s healthy eating and physical activity knowledge: implications for obesity prevention efforts. Child Care Health Dev. 2011; 37:368-376.
9.Puder J, Marques-Vidal P, Schindler C, Zahner L, Niederer I, Bürgi F, et al. Effect of multidimensional lifestyle intervention on fitness and adiposity in predominantly migrant preschool children (Ballabeina): cluster randomised controlled trial. BMJ Journals. 2012; 343:1-11 10.Singh, G. K., Kogan, M. D., Siahpush, M. P., & van Dyck, P. C. Independent and joint effects of socioeconomic, behavioral, and neighborhood characteristics on physical inactivity and activity levels among us children and adolescents. J Commun Health. 2008; 33:206-216.
11.Tandon, P. S., Zhou, C., Sallis, J. F., Cain, K. L., Frank, L. D., & Saelens, B. E. Home environment relationships with children’s physical activity, sedentary time, and screen time by socioeconomic status. IJBNPA Journal. 2012; 9:88-96.
12.Verbestel V, DeHenau S, Maes L, Haerens L, Marild S, Eiben G, et al. Using the intervention mapping protocol to develop a community-based intervention for the prevention of childhood obesity in a multi-centre European project: the IDEFICS intervention. IJBNPA Journal. 2011; 8:1-15. References School-Based Lunchtime Walking Program - Program was implemented during recess time, 3 days per week for 16 weeks
- Program Evaluation: pretest and post-test assesment of BMI, waist circumference, and cardio-respiratory fitness
- Students in kindergarten through sixth grade, American Elementary Schools
- Mileage cards
- No significant changes in BMI or waist circumference
- Cardio-respiratory fitness increased by 37.1% over baseline 7 Effects of Health Promotion at Schools on Children's PA - Children’s school and home environment has a large impact on promoting unhealthy eating and exercise habits which can lead to obesity
- Crucial period for adopting healthy habits such as physical activity: childhood and adolescence
- Study shows that levels of physical activity dramatically decreases during the first couple years of adolescence in lower SES individuals.
- Best place to promote physical activity: schools, due to its large influence on community and family
- Study: Effects of an intervention program in terms of PA pattern for 8-10 year old Mexican children in the low SES 3
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