International Study Of Childhood Obesity, Lifestyle And The Environment Research Articles

Assessing Lifestyle Patterns and Their Influence on Weight Status in Students from a High School in Sibiu, Romania: An Adaptation of ISCOLE Questionnaires and the Child Feeding Questionnaire.

The escalation of global obesity is driving research to understand environmental influences on this process, particularly during vulnerable developmental stages such as childhood and adolescence. Efforts include the development of various structured data collection tools. We aimed to adapt a series of previously validated questionnaires from the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE), the Child Feeding Questionnaire, and elements from the World Health Organization Childhood Obesity Surveillance Initiative (COSI) in order to assess local lifestyle patterns among Romanian high school students and their families that may predispose them to obesity. To this goal, an expert committee was formed as part of a research partnership to oversee the questionnaire's translation and adaptation. It consisted of education and school management specialists, clinical research professionals, language experts, and public health experts. The adapted questionnaires were then applied to 114 students enrolled in the 9th and 10th grades attending a high school situated in Sibiu, and their parents. The variables measured were investigated for correlations with overweight and obesity and, as a secondary objective, academic performance. The study revealed several critical findings, including suboptimal sleep durations and physical activity levels among students, a significant amount of screen time, and correlations between weight status and physical activity, sedentary time, and maternal weight status and education levels. The adapted questionnaires proved to be effective tools in capturing the multifaceted factors implicated in adolescent obesity, providing a foundation for targeted interventions and broader public health strategies to address this issue.

Assessing Obesogenic School Environments in Sibiu County, Romania: Adapting the ISCOLE School Environment Questionnaire.

The impact of the school environment on childhood weight status has garnered significant attention in recent years. This study aimed to adapt and validate the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) School and Environment questionnaire in order to assess the potential obesogenic impact of school environments in Sibiu County, Romania. The ISCOLE questionnaire was chosen for its rigorous methodology. It was derived from a comprehensive study conducted across 12 countries which aimed to capture multifaceted influences on childhood weight while emphasizing educational settings in the collection of data. To guide the translation and adaptation of the questionnaire, a multidisciplinary committee was assembled which comprised experts in teaching and school administration to ensure target responder relevance, experts in clinical research to ensure methodological robustness, experts in language adaptation to preserve the original intent of the survey, and experts in public health to steer the interpretation of the results, with potential policy implications. The data were analyzed by distinguishing between urban and rural settings, and a two-step cluster analysis was implemented to identify potential intervention targets. To assess the validity of the adapted tool, the questionnaire's construct validity and internal consistency were explored. A response rate of 71.2% of the approached schools in Sibiu County was achieved. Of the 84 responding school representatives, 37 (44%) were from a rural setting. The rural schools had significantly more limited access to gymnasiums, secured lockers, showers, and bicycle racks, and exhibited more serious problems regarding the inadequate disposal of garbage in the school vicinity. A two-step cluster analysis revealed distinct school categories, providing opportunities for public policy interventions. One of these primarily concerned rural schools with limited infrastructure but with proactive practices and policies which were termed "unable but willing"; on the opposing spectrum, the category "able but unwilling" mainly comprised urban schools which had available facilities but lacked local proactive initiatives. The findings emphasize the urgent need for targeted measures to bridge these discrepancies by investing in infrastructure in rural schools and promoting active school practices and policies in urban settings. The assessment of obesogenic school environments in Sibiu County provides a pilot model for broader applications due to the diverse school landscape and supportive local authorities. The results, which were achieved using low-cost methods, can guide future educational policies, health promotion initiatives, and preventive interventions.

Low movement, deep-learned sitting patterns, and sedentary behavior in the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE).

Sedentary behavior (SB) has both movement and postural components, but most SB research has only assessed low movement, especially in children. The purpose of this study was to compare estimates and health associations of SB when derived from a standard accelerometer cut-point, a novel sitting detection technique (CNN Hip Accelerometer Posture for Children; CHAP-Child), and both combined. Data were from the International Study of Childhood Obesity, Lifestyle, and the Environment (ISCOLE). Participants were 6103 children (mean ± SD age 10.4 ± 0.56 years) from 12 countries who wore an ActiGraph GT3X+ accelerometer on the right hip for approximately one week. We calculated SB time, mean SB bout duration, and SB breaks using a cut-point (SBmovement), CHAP-Child (SBposture), and both methods combined (SBcombined). Mixed effects regression was used to test associations of SB variables with pediatric obesity variables (waist circumference, body fat percentage, and body mass index z-score). After adjusting for MVPA, SBposture showed several significant obesity associations favoring lower mean SB bout duration (b = 0.251-0.449; all p < 0.001) and higher SB breaks (b = -0.005--0.052; all p < 0.001). Lower total SB was unexpectedly related to greater obesity (b = -0.077--0.649; p from <0.001-0.02). For mean SB bout duration and SB breaks, more associations were observed for SBposture (n = 5) than for SBmovement (n = 3) or SBcombined (n = 1), and tended to have larger magnitude as well. Using traditional measures of low movement as a surrogate for SB may lead to underestimated or undetected adverse associations between SB and obesity. CHAP-Child allows assessment of sitting posture using hip-worn accelerometers. Ongoing work is needed to understand how low movement and posture are related to one another, as well as their potential health implications.

Association between breastfeeding, parents’ body mass index and birth weight with obesity indicators in children

BackgroundChildhood obesity is potentially affected by breastfeeding, parents’ body mass index and birth weight. Thus, this study aimed to verify the association between breastfeeding, parents’ body mass index and birth weight with obesity indicators in children.MethodsThis is a cross-sectional study, including data from 402 schoolchildren between 9 and 11 of age in the city of São Caetano do Sul, Brazil. Parents or guardians answered a questionnaire about breastfeeding (month), birth weight (kg), and parental body weight and height (parents’ body mass index [kg/m2] was calculated). Body mass index (kg/m2), waist circumference (cm) and body fat (%), determined via bio-impedance, were measured and used as obesity indicators. Multi-level linear regression models were used to assess the respective associations adjusted for the potential confounders.ResultsConsidering body mass index of children, the overall prevalence of eutrophic, overweight and obese were 58.2%, 20.9% and 17.2%, respectively. Significant and positive correlations were observed between breastfeeding, maternal as well as paternal body mass index and the children’s body mass index, body fat and waist circumference. Birth weight was weakly and positively associated with body mass index and body fat but was not associated with waist circumference. After adjusting for school, sex, age, race/ethnicity, annual household income, sedentary time and moderate-to-vigorous physical activity, maternal body mass index and birth weight were positively associated with children’s body mass index (β: 0.228; 95%CI: 0.142; 0.314 and β: 0.001; 95%CI: 0.001; 0.002), body fat (β: 0.484; 95%CI: 0.297; 0.671 and β: 0.002; 95%CI: 0.001; 0.003) and waist circumference (β: 0.509; 95%CI: 0.304; 0.715 and β: 0.003; 95%CI: 0.001; 0.005). Breastfeeding was not associated with any obesity indicators.ConclusionMaternal body mass index and birth weight were associated with children’s obesity indicators. The perinatal environment, therefore, appears to be a critical contributor to childhood obesity and public policies need to address parental obesity in order to tackle childhood obesity.Trial registration:The International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) is registered at (Identifier NCT01722500).

Are all MVPA minutes equal? Associations between MVPA characteristics, independent of duration, and childhood adiposity

BackgroundThe inverse relationship between moderate-to-vigorous physical activity (MVPA) duration and childhood adiposity is well established. Less is known about how characteristics of MVPA accumulation may be associated with adiposity, independent of MVPA duration. This study aimed to investigate how the MVPA characteristics of children, other than duration (bout length, time of day, day-to-day consistency, intensity), were associated with adiposity.MethodsCross-sectional study of the Australian arm of the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) (participants: n = 424, age range 9–11, 44% male). Adiposity was determined by percent body fat via bioelectrical impedance. MVPA duration and characteristics (bout length, time of day, consistency, intensity) were derived from 7-day, 24-h accelerometry. Generalised estimating equations were used to examine the individual and multivariate associations between MVPA characteristics and adiposity.ResultsUnivariate analyses showed that higher MVPA duration (β range = − 0.26,-0.15), longer bouts of MVPA (β range = 0.15,0.22) and higher MVPA intensity (β range = − 0.20,-0.13) were all inversely associated with adiposity (all p < 0.05). When models were adjusted for MVPA duration, only MVPA intensity (β range = − 0.16,-0.04) showed consistent significant associations with adiposity.ConclusionsCharacteristics of MVPA other than duration and intensity appear to be unrelated to adiposity.

Robust cross-country comparison of children meeting 24-HR movement guidelines: an odds solution for binary effect efficiency measures

AimInternational comparisons of public health measures relative to observed best practice are increasingly important for evaluating community health promotion strategies and policies such as meeting or not meeting public health guidelines. This study aimed to identify methods enabling robust evaluation with such binary effect measures at a population level.Subject and methodsConventional efficiency comparisons of binary effect proportions are problematic due to a lack of consistency with alternate framing of resulting relative risks. In this paper, we illustrate such inconsistent efficiency measures comparing the proportion of school age children (9–11 years) meeting or not meeting integrated movement guidelines (IMGs) across the 12 countries from the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) study. IMGs jointly consider physical activity, sleep and sedentary behaviours. An odds method is developed to enable consistent efficiency comparison with alternative framing of binary effects.ResultsA novel odds solution to relative risk problems arising with conventional efficiency comparison of binary effects with alternative framing is shown to provide consistent efficiency measures relative to best practice. Furthermore, this technical advancement is shown to extend to consistent indirect comparison and evidence translation.ConclusionRobust methods for international cross-country comparison of binary effect measures such as meeting or not meeting guidelines are identified with a novel odds ratio method. This novel solution is particularly important for health promotion evaluation of IMGs given the need for consistent comparison in evaluating practice evidence of what works now and consistent evidence translation of treatment effects as and when they emerge.

NUTRITIONAL STATUS, PHYSICAL ACTIVITY, SEDENTARY BEHAVIOR, DIET, AND LIFESTYLE IN CHILDHOOD: AN ANALYSIS OF RESPIRATORY DISEASES IN ADOLESCENCE

ABSTRACTObjective: To evaluate the association between nutritional status, physical activity, sedentary behavior, diet, and lifestyle in childhood with respiratory diseases during adolescence.Methods: Prospective study conducted in São Caetano do Sul, São Paulo - Brazil, as part of the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE). During childhood, indicators of lifestyle (body composition, physical activity, sedentary behavior, diet) and family environment were measured in 2012 and 2013. After five years, participants answered the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire for the diagnosis of respiratory diseases (asthma and/or rhinitis). Analyses were determined by logistic regression.Results: A total of 168 schoolchildren (56% boys) were evaluated, and the prevalence of asthma and rhinitis accounted for 15.5 and 25.6%, respectively. Whole milk consumption (Odds Ratio [OR]=1.24; 95% confidence interval [95%CI] 1.03-1.49), having a television in the bedroom (OR=0.29; 95%CI 0.12-0.71), and attending physical education classes ≥2 times/week (OR=0.30; 95%CI 0.11-0.81) in childhood were associated with the presence of asthma in adolescence. Factors significantly associated with rhinitis were as follows: female participants (OR=2.45; 95%CI 1.20-4.98) and whole milk consumption (OR=1.21; 95%CI 1.04-1.40).Conclusions: Higher consumption of whole milk, not having a television in the bedroom, few physical education classes, and being a girl were factors associated with respiratory diseases. Public policies should be directed toward a healthier lifestyle and the prevention of respiratory diseases.

The Contemporary Research on The Conditions of Child and Youth Obesity, As Well As Proposals for Solving the Epidemic. The Preliminary Report

Aim. The aim of the report is to draw attention to the studies not included in system reviews and meta-analyzes which are important in the opinion of the authors of the paper - for: 1. estimating the size of the obesity phenomenon and its correlates on a global scale, 2. assessing the effectiveness of promoting physical activity and the approach to changing pro-health behaviors, with particular emphasis on the sedentary and inactive behavior. Material and methods. The effect of the preliminary literature search in the preparation of a systematic review of publications documenting the existence of regional differences in both the level of obesity and its growth rate in the last decades of the 21st century and assessing the effectiveness of interventions aimed at behavioral changes, mainly in the field of nutrition and physical activity in children and adolescents. Unobtrusive research, content analysis. Results. The report highlights the results of the research conducted as part of the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE). They were compared to other European and global results of solving the problem of overweight and obesity in school-age children and adolescents, and to assessing the potential of the determinants of physical activity in several dozen countries around the world. In addition, the American proposals to solve the obesity problem were indicated, with particular emphasis on the theoretical assumptions and practical implications of the NCOOR organization, included in the American four-volume study. Conclusions. 1.Each country and geographic jurisdiction has its own limited variation in the prevalence of obesity and each of the potentially modifying factors at different levels of prevalence but the international research is able to minimize variability in these factors. 2. The ecological approach to solving the determinants of physical activity and the methods of its evaluation based on the SEM model should be treated with greater interest in the social policy of the individual countries on different continents. 3. The theoretical assumptions of American behavioral epidemiology and solutions to the problem of obesity and the practical implications based on them, resulting from many years of experience in the approach to eliminating the obesity epidemic, should be more widely disseminated and used in the programming of the health promotion outside the United States and in shaping health-oriented physical fitness in children and adolescents Health Related Fitness (H-RF).

Association between dietary behaviours and weight status of school children: results from the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) -Kenya

ABSTRACT Background Sub-Saharan African countries are undergoing rapid urbanization resulting in vast changes in dietary habits. Dietary practices involving excess energy intake have been associated with overweight/obesity. We assessed the dietary behaviour of children and their relationships with weight status. Methods Data was collected in Kenya, as part of the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE). The study recruited 563 children aged 9–11 years from 29 schools in Nairobi. A seven-day food frequency questionnaire was used to assess dietary intake. Dietary behaviours such as consumption of breakfast, school lunch, meals prepared/eaten away from home, emotional eating and snacking while watching television were also assessed. Body mass index (BMI-for-age and sex) was used as the indicator of weight status. Results Of the sample, 53.5% were girls; 20.8% were classified as overweight/obese; 72.9% ate meals out of home regularly; 55.2% ate lunch provided by the school; and only 76% had breakfast on all weekdays. Eating more when happy, eating fried foods while watching television, and consumption of vegetables were positively associated with BMI. Majority of overweight children were female (56.6%) and the type of school attended predicted BMI, F(6, 536) = 18.371, p < 0.0001, R2 = 0.171. BMI was negatively associated with consumption of cakes/pastries (χ2 = 14.7, V = 0.165, p = 0.023), potato crisps (χ2 = 21.6, V = 0.197, p = 0.003), and fast foods (χ2 = 13.5, p = 0.036). ANOVA results revealed no significant differences in the consumption of foods with BMI except for vegetables (p = 0.003). Conclusions Children have healthy diets rich in fruits and vegetables and low in energy-dense foods. Also, less healthy diets were observed in children with lower BMI. There is need for interventions targeting the overweight/obese children, particularly those of higher SES.

International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE): Contributions to Understanding the Global Obesity Epidemic.

The purpose of this review is to summarize the scientific contributions of the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) in extending our understanding about obesity in children from around the world. ISCOLE was a multi-national study of 9 to 11 year-old children from sites in 12 countries from all inhabited continents. The primary purpose was to investigate relationships between lifestyle behaviors and obesity, and the influence of higher-order characteristics such as behavioral settings, and physical, social and policy environments. ISCOLE has made several advances in scientific methodology related to the assessment of physical activity, dietary behavior, sleep and the neighborhood and school environments. Furthermore, ISCOLE has provided important evidence on (1) epidemiological transitions in obesity and related behaviors, (2) correlates of obesity and lifestyle behaviors at the individual, neighborhood and school levels, and (3) 24-h movement behaviors in relation to novel analytical techniques. A key feature of ISCOLE was the development of a platform for international training, data entry, and data quality for multi-country studies. Finally, ISCOLE represents a transparent model for future public-private research partnerships across low, middle and high-income countries.

Association between breakfast frequency and physical activity and sedentary time: a cross-sectional study in children from 12 countries

BackgroundExisting research has documented inconsistent findings for the associations among breakfast frequency, physical activity (PA), and sedentary time in children. The primary aim of this study was to examine the associations among breakfast frequency and objectively-measured PA and sedentary time in a sample of children from 12 countries representing a wide range of human development, economic development and inequality. The secondary aim was to examine interactions of these associations between study sites.MethodsThis multinational, cross-sectional study included 6228 children aged 9–11 years from the 12 International Study of Childhood Obesity, Lifestyle and the Environment sites. Multilevel statistical models were used to examine associations between self-reported habitual breakfast frequency defined using three categories (breakfast consumed 0 to 2 days/week [rare], 3 to 5 days/week [occasional] or 6 to 7 days/week [frequent]) or two categories (breakfast consumed less than daily or daily) and accelerometry-derived PA and sedentary time during the morning (wake time to 1200 h) and afternoon (1200 h to bed time) with study site included as an interaction term. Model covariates included age, sex, highest parental education, body mass index z-score, and accelerometer waking wear time.ResultsParticipants averaged 60 (s.d. 25) min/day in moderate-to-vigorous PA (MVPA), 315 (s.d. 53) min/day in light PA and 513 (s.d. 69) min/day sedentary. Controlling for covariates, breakfast frequency was not significantly associated with total daily or afternoon PA and sedentary time. For the morning, frequent breakfast consumption was associated with a higher proportion of time in MVPA (0.3%), higher proportion of time in light PA (1.0%) and lower min/day and proportion of time sedentary (3.4 min/day and 1.3%) than rare breakfast consumption (all p ≤ 0.05). No significant associations were found when comparing occasional with rare or frequent breakfast consumption, or daily with less than daily breakfast consumption. Very few significant interactions with study site were found.ConclusionsIn this multinational sample of children, frequent breakfast consumption was associated with higher MVPA and light PA time and lower sedentary time in the morning when compared with rare breakfast consumption, although the small magnitude of the associations may lack clinical relevance.Trial registrationThe International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) is registered at (Identifier NCT01722500).

Sleep patterns and sugar-sweetened beverage consumption among children from around the world.

To examine the relationships between objectively measured sleep patterns (sleep duration, sleep efficiency and bedtime) and sugar-sweetened beverage (SSB) consumption (regular soft drinks, energy drinks, sports drinks and fruit juice) among children from all inhabited continents of the world. Multinational, cross-sectional study. The International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE). Children (n 5873) 9-11 years of age. Sleep duration was 12 min per night shorter in children who reported consuming regular soft drinks 'at least once a day' compared with those who reported consuming 'never' or 'less than once a week'. Children were more likely to sleep the recommended 9-11 h/night if they reported lower regular soft drink consumption or higher sports drinks consumption. Children who reported consuming energy drinks 'once a week or more' reported a 25-min earlier bedtime than those who reported never consuming energy drinks. Children who reported consuming sports drinks '2-4 d a week or more' also reported a 25-min earlier bedtime compared with those who reported never consuming sports drinks. The associations between sleep efficiency and SSB consumption were not significant. Similar associations between sleep patterns and SSB consumption were observed across all twelve study sites. Shorter sleep duration was associated with higher intake of regular soft drinks, while earlier bedtimes were associated with lower intake of regular soft drinks and higher intake of energy drinks and sports drinks in this international study of children. Future work is needed to establish causality and to investigate underlying mechanisms.

Prevalence and factors associated with body mass index in children aged 9–11 years

ObjectiveThis study aimed to identify the prevalence and factors associated with body mass index (BMI) in children aged 9–11 years. MethodsThe study is part of the International Study of Childhood Obesity Lifestyle and the Environment (ISCOLE). Body composition was determined using the bipolar bioimpedance technique. The mean BMI value was categorized as recommended by the World Health Organization. For seven consecutive days, participants used an accelerometer to objectively monitor sedentary behavior (SB) and moderate to vigorous physical activity. Individual factors (anthropometric and behavioral), family aspects, and family and school environment were provided by participants and parents and were analyzed by multilevel linear regression adjusted for gender, ethnicity, school, number of siblings, and total annual family income. ResultsThe mean BMI was 20.1kg/m2, and 51.8% of the children were overweight/obese (50.3% boys, 53.4% girls, p=0.014). Considering all participants, the associated factors of BMI were body fat percentage (BF%, β=0.0216, p<0.001) and screen time (ST, β=0.0050, p=0.006). In boys, the associated factors were BF% (β=0.0209, p<0.001), ST (β=0.006, p=0.036), and healthy eating policies or practices (β=0.0276, p=0.025). In girls, only BF% was associated (β=0.0221, p<0.001) with BMI. ConclusionsHigh prevalence of overweight/obesity was observed in children from São Caetano do Sul. Different associated factors were identified between the genders, with only BF% being common in both genders.

Proportion of children meeting recommendations for 24-hour movement guidelines and associations with adiposity in a 12-country study.

BackgroundThe Canadian 24-h movement guidelines were developed with the hope of improving health and future health outcomes in children and youth. The purpose of this study was to evaluate adherence to the 3 recommendations most strongly associated with health outcomes in new 24-h movement guidelines and their relationship with adiposity (obesity and body mass index z-score) across countries participating in the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE).MethodsCross-sectional results were based on 6128 children aged 9–11 years from the 12 countries of ISCOLE. Sleep duration and moderate-to-vigorous physical activity (MVPA) were assessed using accelerometry. Screen time was measured through self-report. Body weight and height were measured. Body mass index (BMI, kg · m−2) was calculated, and BMI z-scores were computed using age- and sex-specific reference data from the World Health Organization. Obesity was defined as a BMI z-score > +2 SD. Meeting the overall 24-h movement guidelines was defined as: 9 to 11 h/night of sleep, ≤2 h/day of screen time, and at least 60 min/day of MVPA. Age, sex, highest parental education and unhealthy diet pattern score were included as covariates in statistical models. Associations between meeting vs. not meeting each single recommendation (and combinations) with obesity were assessed with odds ratios calculated using generalized linear mixed models. A linear mixed model was used to examine the differences in BMI z-scores between children meeting vs. not meeting the different combinations of recommendations.ResultsThe global prevalence of children meeting the overall recommendations (all three behaviors) was 7%, with children from Australia and Canada showing the highest adherence (15%). Children meeting the three recommendations had lower odds ratios for obesity compared to those meeting none of the recommendations (OR = 0.28, 95% CI 0.18–0.45). Compared to not meeting the 24-h movement recommendations either independently or combined, meeting them was significantly associated with a lower BMI z-score. Whenever the MVPA recommendation was included in the analysis the odds ratios for obesity were lower.ConclusionsFor ISCOLE participants meeting these 3 healthy movement recommendations the odds ratios of being obese or having high BMI z-scores were lower. However, only a small percentage of children met all recommendations. Future efforts should aim to find promising ways to increase daily physical activity, reduce screen time, and ensure an adequate night’s sleep in children.Trial registrationThe International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) was registered at ClinicalTrials.gov (Identifier NCT01722500) (October 29, 2012).

Why are children sedentary: an examination using the International Study of Childhood Obesity, Lifestyle and the Environment.

Physical inactivity and sedentary behaviour have been independently associated with a wide range of negative health indicators including obesity, poor cardio-metabolic health, and poor psychosocial health. The overarching objective of this research was to gain a better understanding as to why children are sedentary and where we need to focus public health messages and interventions to reduce sedentary behaviour. Specifically, I aimed to provide insight on current awareness of sedentary behaviour guidelines, determine important correlates of total sedentary time (SED) and screen time (ST) in Canadian children, and understand correlates of SED and ST in a global context. The primary dataset used for this project was the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE). Background work was completed to review current literature on knowledge and awareness of Canadian physical activity and sedentary behaviour guidelines (in all age groups) and to understand the representativeness of the ISCOLE dataset. In addition to the 2 background papers, this dissertation includes 3 manuscripts, all prepared for submission in scientific, peer-reviewed journals: Canadian physical activity and screen time guidelines: do children know?, Correlates of objectively measured sedentary time and self-reported screen time in Canadian children, and Correlates of total sedentary time and screen time in 9-11 year-old children around the world: The International Study of Childhood Obesity, Lifestyle and the Environment. Overall, this work showed the majority of children around the world are accumulating large amounts of sedentary time, and exceeded current screen time guidelines. We found that the large majority of Canadian children are not aware of screen time guidelines; however, a greater proportion of children could identify physical activity guidelines. We also identified a number of correlates of SED and ST in Canadian children and in children around the world. The most common correlates included weight status and access to electronics in the house. Taken together, this work suggests that public health messaging should focus on increasing awareness of screen time guidelines. While increasing awareness of the guidelines, messaging can be tailored to promoting healthy weight status and reducing (or removing) children's access to electronic devices in hopes of reducing overall time spent sedentary.

Perceived and objective neighborhood support for outside of school physical activity in South African children

BackgroundThe neighborhood environment has the potential to influence children’s participation in physical activity. However, children’s outdoor play is controlled by parents to a great extent. This study aimed to investigate whether parents' perceptions of the neighborhood environment and the objectively measured neighborhood environment were associated with children's moderate-to-vigorous intensity physical activity (MVPA) outside of school hours; and to determine if these perceptions and objective measures of the neighborhood environment differ between high and low socio-economic status (SES) groups.MethodsIn total, 258 parents of 9–11 year-old children, recruited from the South African sample of the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE), completed a questionnaire concerning the family and neighborhood environment. Objective measures of the environment were also obtained using Geographic Information Systems (GIS). Children wore an Actigraph (GT3X+) accelerometer for 7 days to measure levels of MVPA. Multilevel regression models were used to determine the association between the neighborhood environment and MVPA out of school hours.ResultsParents’ perceptions of the neighborhood physical activity facilities were positively associated with children’s MVPA before school (β = 1.50 ± 0.51, p = 0.003). Objective measures of neighborhood safety and traffic risk were associated with children’s after-school MVPA (β = −2.72 ± 1.35, p = 0.044 and β = −2.63 ± 1.26, p = 0.038, respectively). These associations were significant in the low SES group (β = −3.38 ± 1.65, p = 0.040 and β = −3.76 ± 1.61, p = 0.020, respectively), but unrelated to MVPA in the high SES group.ConclusionsThis study found that several of the objective measures of the neighborhood environment were significantly associated with children’s outside-of-school MVPA, while most of the parents’ perceptions of the neighborhood environment were unrelated.

Correlates Of Moderate-to-vigorous Physical Activity In Brazilian Children

BACKGROUND: Few studies have studied ecological models of objectively measured moderate-to-vigorous physical activity (MVPA) in young children from middle-income countries. The purpose of this study was to examine potential correlates of objec¬tively measured MVPA in a sample of 9-11 year old Brazilian children. METHODS: Data from the Brazilian site of the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) were included in the analysis. An Actigraph GT3X+ accelerometer was used to monitor MVPA over 7 days. BMI and body fat percentage (BF%) were measured using a bioelectrical impedance scale. Questionnaires completed by the participants, their parents, and school personnel queried behavioral, family and home environment, and school environment correlates. Twenty two potential correlates of MVPA were examined using multi-level linear regression. All explanatory variables associated (p<0.10) with MVPA in univariate analyses were included in the final models. Variables that remained significant in the final models (p<0.05) were considered correlates of MVPA. Sex, ethnicity, school, number of siblings, and total annual household income were used as covariates in all multivariable models. RESULTS: A total of 328 participants (51.5% boys) were included in the analyses. Children averaged 59.3 min/day in MVPA (44.5% met MVPA guidelines: 63.9% boys; 25.1% girls: p<0.001). For boys and girls combined, significant correlates (p<0.05) of MVPA were waist circumference (β-.007), travel mode to school (β.140), maternal employment status (β-.119) and TVs in bedroom (β-.107). In boys, significant correlates of MVPA were waist circumference (β-.011), travel mode to school (β.133) and maternal employment status (β-.195). In girls, the only significant correlate of MVPA was travel mode to school (β.143). CONCLUSIONS: This study provides evidence for a high prevalence of physical inactivity. Several factors were identified as correlates of MVPA in Brazilian children; however, only travel mode to school was common for both boys and girls.

An introduction to the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE)

An introduction to the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE)

Are participant characteristics from ISCOLE study sites comparable to the rest of their country?

The International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) provides robust, multi-national information on physical activity, diet and weight status in 9-11-year-old children around the world. The purpose of this analysis was to examine the similarities and differences between participant characteristics from ISCOLE sites and data from nationally representative surveys from ISCOLE countries (Australia, Brazil, Canada, China, Colombia, Finland, Kenya, India, Portugal, South Africa, the United Kingdom and the United States). Distributions of characteristics were assessed within each ISCOLE country-level database, and compared with published data from national or regional surveys, where available. Variables of comparison were identified a priori and included body mass index (BMI), physical activity (accelerometer-determined steps per day) and screen time (child-report). Of 12 countries, data on weight status (BMI) were available in 8 countries, data on measured physical activity (steps per day) were available in 5 countries and data on self-reported screen time were available in 9 countries. The five ISCOLE countries that were part of the Health Behaviour in School-aged Children Survey (that is, Canada, Finland, Portugal, the United Kingdom (England) and the United States) also provided comparable data on self-reported physical activity. Available country-specific data often used different measurement tools or cut-points, making direct comparisons difficult. Where possible, ISCOLE data were re-analyzed to match country-level data, but this step limited between-country comparisons. From the analyses performed, the ISCOLE data do not seem to be systematically biased; however, owing to limitations in data availability, data from ISCOLE should be used with appropriate caution when planning country-level population health interventions. This work highlights the need for harmonized measurement tools around the world while accounting for culturally specific characteristics, and the need for collaboration across study centers and research groups.

Development and reliability of an audit tool to assess the school physical activity environment across 12 countries.

Schools are an important setting to enable and promote physical activity. Researchers have created a variety of tools to perform objective environmental assessments (or 'audits') of other settings, such as neighborhoods and parks; yet, methods to assess the school physical activity environment are less common. The purpose of this study is to describe the approach used to objectively measure the school physical activity environment across 12 countries representing all inhabited continents, and to report on the reliability and feasibility of this methodology across these diverse settings. The International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) school audit tool (ISAT) data collection required an in-depth training (including field practice and certification) and was facilitated by various supporting materials. Certified data collectors used the ISAT to assess the environment of all schools enrolled in ISCOLE. Sites completed a reliability audit (simultaneous audits by two independent, certified data collectors) for a minimum of two schools or at least 5% of their school sample. Item-level agreement between data collectors was assessed with both the kappa statistic and percent agreement. Inter-rater reliability of school summary scores was measured using the intraclass correlation coefficient. Across the 12 sites, 256 schools participated in ISCOLE. Reliability audits were conducted at 53 schools (20.7% of the sample). For the assessed environmental features, inter-rater reliability (kappa) ranged from 0.37 to 0.96; 18 items (42%) were assessed with almost perfect reliability (κ=0.80-0.96), and a further 24 items (56%) were assessed with substantial reliability (κ=0.61-0.79). Likewise, scores that summarized a school's support for physical activity were highly reliable, with the exception of scores assessing aesthetics and perceived suitability of the school grounds for sport, informal games and general play. This study suggests that the ISAT can be used to conduct reliable objective audits of the school physical activity environment across diverse, international school settings.