Abstract
To assess to what extent eight behavioural health risks related to breakfast and food consumption and five behavioural health risks related to physical activity, screen time and sleep duration are present among schoolchildren, and to examine whether health-risk behaviours are associated with obesity. Cross-sectional design as part of the WHO European Childhood Obesity Surveillance Initiative (school year 2007/2008). Children's behavioural data were reported by their parents and children's weight and height measured by trained fieldworkers. Descriptive statistics and logistic regression analyses were performed. Primary schools in Bulgaria, Lithuania, Portugal and Sweden; paediatric clinics in the Czech Republic. Nationally representative samples of 6-9-year-olds (n 15 643). All thirteen risk behaviours differed statistically significantly across countries. Highest prevalence estimates of risk behaviours were observed in Bulgaria and lowest in Sweden. Not having breakfast daily and spending screen time ≥2 h/d were clearly positively associated with obesity. The same was true for eating 'foods like pizza, French fries, hamburgers, sausages or meat pies' >3 d/week and playing outside <1 h/d. Surprisingly, other individual unhealthy eating or less favourable physical activity behaviours showed either no or significant negative associations with obesity. A combination of multiple less favourable physical activity behaviours showed positive associations with obesity, whereas multiple unhealthy eating behaviours combined did not lead to higher odds of obesity. Despite a categorization based on international health recommendations, individual associations of the thirteen health-risk behaviours with obesity were not consistent, whereas presence of multiple physical activity-related risk behaviours was clearly associated with higher odds of obesity.
Highlights
MethodsSampling of children Countries applied a nationally representative schoolbased cluster sampling design, whereby primary schools were the primary sampling units (except the Czech Republic, where the primary sampling unit was composed of paediatric clinics)
The present paper describes the findings of these five countries (Bulgaria, Czech Republic, Lithuania, Portugal and Sweden) that collected data on all questions related to children’s lifestyle behaviours on the family form and provided their data to WHO according to the Childhood Obesity Surveillance Initiative (COSI) protocol[13]
Children’s characteristics The initial sample included 19 494 children who were present on the day of the measurements and of whom the highest number of refusals was observed in Bulgaria (13·3 %) and Sweden (11·8 %)
Summary
Sampling of children Countries applied a nationally representative schoolbased cluster sampling design, whereby primary schools were the primary sampling units (except the Czech Republic, where the primary sampling unit was composed of paediatric clinics). Primary schools were selected randomly from the list of all primary schools centrally available in each country through the Ministry of Education or the national school registry (or in the Czech Republic, the national list of primary-care paediatricians) Anthropometric outcome measures, such as BMI, were the initial main outcomes of interest of COSI implementation. Stratification of the primary sampling units was applied if it was expected that differences in these measures across strata would be observed. This was done by the Czech Republic by region and level of urbanization and by Lithuania by district and level of urbanization. Detailed sampling characteristics have been described elsewhere[12,14]
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