Out Of Home Research Articles

Modeling Frequency and Duration of Out-of-Home Participation in Physical Activity by School-Age Children

This paper investigates the frequency and the duration of participation in physical activity by children who go to school in the city of Dhaka, Bangladesh. The study uses data from a 2012 activity-based travel diary survey of 245 students in Grades 6 to 10 in the Dhaka metropolitan area. To explore the trade-offs between factors that affect the frequency of out-of-home physical activity, including the use of active transportation, this study used a zero-inflated Poisson (ZIP) regression model. Additionally, parametric hazard models were estimated to examine the duration of physical activities. The results of the ZIP count model suggest that personal and household characteristics, attributes of the built environment, and time commitments for other mandatory and discretionary activities influence the frequency of participation in physical activity. For example, an increase in the number of children in the household and the presence of sidewalks increased the frequency of out-of home, out-of-school physical activity if everything else was held equal. In contrast, travel time to school, the presence of traffic intersections, and the time commitment for tutoring sessions negatively affected participation in physical activity. In the modeling of the duration of out-of-home physical activity, this study found that a Weibull parametric hazard model outperformed a log logistic model. The duration was influenced by sociodemographic characteristics, spatial context, and escort arrangements. For instance, car ownership and a parental escort increased the duration of physical activity. The paper offers an in-depth behavioral understanding of children's physical activities in a developing country.

Family eating out-of-home: a review of nutrition and health policies

Childhood obesity is a growing problem worldwide. In recent years, out-of-home (OH) eating has been highlighted as one of the many factors contributing to the obesogenic environment. This review seeks to identify a range of existing guidelines for the provision of healthy food options for families who eat OH frequently. Nationally available nutrition policies were identified using targeted and untargeted searches of the internet to identify established strategies for providing food for children in the family eating out sector in America (US), Australia, Canada and the WHO's European Region (EUR). These were categorised on the basis of eleven pre-defined criteria including: family eating out sector included as stakeholder; inclusion of children's food OH; cost strategies for healthier food choices; provision of nutrition information for customers; nutrition training of catering staff; and monitoring and evaluation structures. Fifty-five policies were reviewed, of which 71% addressed children's food served OH, but principally only for food available in schools. Two voluntary programmes, from Colorado and Slovenia, were identified as possible best practice models as they met a majority of the evaluation criteria. The most frequently used strategy by policies to promote healthier eating OH was the provision of nutrition information on menus, while monitoring and evaluation plans were poorly incorporated into any OH strategies, thus raising issues about their effectiveness. This review has identified a range of initiatives that could be employed to make healthier eating OH more accessible for families. However, to establish best practice guidelines for healthier OH food choices further investigations are required.

Cost analysis of the strengthening families program in reducing time to family reunification among substance-affected families

Decision makers typically face uncertainty in determining whether the outcomes of promising child welfare interventions justify the investment. Despite repeated calls for cost analysis in child welfare, original studies that evaluate the costs and effects of child welfare programs have been limited. Moreover, no cost analyses have focused on family reunification programs that address the needs of substance-affected families. The purpose of this study was to evaluate the costs and effects of a federally funded implementation of the Strengthening Families Program (SFP), a 14-week family training curriculum, on time to reunification with a substance-involved child welfare population. Based on event history analysis, we find the typical child participating in SFP spends 190 fewer days in out of home care when compared to a propensity score matched comparison group of children in out-of home care receiving treatment as usual. Re-entry rates between the two groups were not significantly different at follow-up. At an average out-of-home care rate of $86 per child per day in this state, SFP saves approximately $16,340 per participating child in out-of-home care costs. From a cost–benefit perspective, every $1 invested in SFP yields an average savings of $9.83 in this Midwestern demonstration. ► Cost analyses of child welfare interventions have been limited. ► Few studies have evaluated reunification programs with substance-affected families. ► The Strengthening Families Program (SFP) was evaluated in a child welfare setting. ► SFP decreases days in out-of-home care among children in substance-involved families. ► Every $1 invested in SFP yields an average savings of $9.83 in this demonstration.

Turning away from the public sector in children's out-of-home care: An English experiment

This paper reports on the evaluation of an English experiment which, for the first time, moved statutory social work support for children and young people in out-of-home care from the public to the private or independent sector. Five social work practices (SWPs), independent or semi-independent of local government, were established and evaluated using a matched control design with integrated process evaluation. Social work teams in the public sector, selected to correspond to key characteristics of the SWP sites, provided control sites. While most SWPs were perceived to be accessible and user-friendly organizations, children's and young people's accounts showed no differences between pilots and control sites in terms of workers' accessibility and responsiveness. Perceptions of SWP staff's decision-making were mixed. SWP staff reported spending more time in direct face-to-face work with children and families but this was attributed to reduced caseload size and a tight remit which excluded child protection work rather than to decreased bureaucracy. SWP staff morale was generally found to be high in terms of depersonalization and social support, reflecting an emphasis on staff supervision in these organizations. However, this was offset by slightly higher job insecurity which reflected the precariousness of employment in the independent as opposed to state sector. Staff retention varied between the SWPs, but although children and young people in the pilots were more likely to retain their key worker than those in control sites, they experienced disruption in the move into SWPs and back to public services when SWP contracts were not renewed. While some SWPs succeeded in reducing placement change rates for children and young people, a policy of switching placement providers to achieve flexibility and savings increased placement change rates in some SWPs. SWPs did not achieve financial independence from the local authority commissioners with only one assuming full responsibility for managing the placement budget. Payment by results was not used consistently. None of the commissioners interviewed considered that the SWP model had resulted in savings. The study highlighted the interdependence of public and private sectors. As small organizations, most of the SWPs succeeded in offering an accessible and personalized service, and public services should consider reorganizing to achieve similar outcomes. However, this evaluation found that contracted-out organizations struggled to provide children in out-of home care with the consistency and continuity they require. ► This paper reports on a national evaluation of a policy experiment in England. ► Social work for children in out-of-home care was moved to independent organizations. ► The evaluation employed a mixed methods, matched control design. ► Social workers in the new services enjoyed lower caseloads and greater autonomy. ► Privatization led to job insecurity and did not increase continuity for children.

An Ecological study on food consumption patterns and childhood obesity in schools

ObjectiveEvaluate the association between food consumption with overweight and obesity (OW+O), in a representative sample of school children in Mexico.MethodsWe assessed nutriment consumption (energy, carbohydrates, lipids, fiber and sodium) in 8,367 children with food and beverages consumption records during journey from home to school and back (out of home=OH), and global consumption (GC). We standardized average consumption by state. Ward clustering method was used to group consumption patterns. Analysis of variance was used for evaluate consumption patterns association with OW+O.ResultsWe selected 4 consumption groups: 1) all nutrients at average in OH and slightly lower in GC; 2) all nutrients high OH and high in all nutrients in GC but low in fiber; 3) all the nutrients were slightly lower OH and in average in GC; and 4) all the nutrients were low OH and all the nutrients in GC, but high in fiber. Tukey‐Kramer test shows a significant higher prevalence of OW+O in cluster 2 with respect to cluster 4.ConclusionHigher nutrient consumption OH and GC, with low fiber is associated with higher prevalence of OW+O.

Arab Parents' Attitudes toward Out-of-Home Placement of Their Adult Children with Psychiatric Disability

Background: The decision of out-of-home placement for the Arab population is a very stressful event that sometimes causes a real crisis situation for them, because of cultural assumptions and attitudes against placement. The tradition in the Arab culture is to take care of their offspring at home, no matter how serious the situation is. Mental health is also a case of chronic illness and it is very important for us to understand who are those who are willing to place their adult child and what the factors are that make them to do this decision. Better understanding will lead to better use of the services that the state offers them. The rate of placement in Arab society remains significantly lower than among the Jewish population of Israel. The aim of this study was to examine the attitudes of Arab parents who have an adult son or daughter with a psychiatric disability toward out-of home placement. Method: A convenience sample of 189 parents of adult children with a mental disability from the Arab population of Israel. The questionnaires included were assessing social support, emotional stress, cognitive appraisal of the situation, and various socio-demographic characteristics. Results: Parents who chose home placement reported being in a better financial position and were more religious than parents who chose out-of-home placement. Parents who chose to care for their children at home had a significantly higher perception of this as a challenge. The decision regarding the child's placement appears to depend mainly on the parents' education and financial situation. Conclusions: Financial situation, social support and perceiving the illness as a challenge are the most important factors in the process of the decision.

Eating out of home and its association with dietary intake: a systematic review of the evidence

During the last decades, eating out of home (OH) has gained importance in the diets worldwide. We document the nutritional characteristics of eating OH and its associations with energy intake, dietary quality and socioeconomic status. We carried out a systematic review of peer-reviewed studies in eight databases up to 10 March 2011. Of the 7,319 studies retrieved, 29 met the inclusion criteria and were analysed in this review. The quality of the data was assessed and a sensitivity analysis was conducted by isolating nationally representative or large cohort data from 6 and 11 countries, respectively. OH foods were important sources of energy in all age groups and their energy contribution increased in adolescents and young adults. Eating OH was associated with a higher total energy intake, energy contribution from fat in the daily diet and higher socioeconomic status. Two large studies showed how eating OH was also associated with a lower intake of micronutrients, particularly vitamin C, Ca and Fe. Although the studies were cross-sectional and heterogeneous in the way they classified eating OH, we conclude that eating OH is a risk factor for higher energy and fat intake and lower micronutrient intake.

Suicide Ideation, Depressive Symptoms, and Out-of-Home Placement Among Youth in the U.S. Child Welfare System

The objectives of this study were to describe the association between type of placement, depressive symptoms, and suicide ideation among a sample of youth (7 years and older) as they entered the child welfare system and to examine the longitudinal effect of prior out-of-home placements and prior depressive symptoms on subsequent suicide ideation among these at-risk youth. Results supported a statistically significant association between prior depressive symptoms and subsequent suicide ideation, after adjusting for prior suicide ideation and prior out-of-home placements. Tests of mediation supported the role of prior depressive symptoms as a mediator between prior out-of-home placements and subsequent suicide ideation. These results suggest that youth who enter the child welfare system and are put in an out-of home placement may be at an increased risk for depressive symptoms, which in turn may increase their risk for suicide ideation.

Factors associated with eating out of home in Vietnamese adolescents

Eating out of home (OH) is nutritionally important in some developing countries. This study identifies the factors associated with eating OH in Vietnamese adolescents. Data were obtained from a cross-sectional cluster survey of 502 adolescents in rural and urban areas in Vietnam. Factors associated with eating OH were recorded with a Likert scale and analysed using factor analysis. Data on eating OH was collected using a frequency questionnaire and a 1-day 24 h recall. A first pattern “Convenience” incorporated preparation time, price, variety, taste, proximity and social aspects as items associated with eating OH. A second pattern “Nutritional and food safety concerned” reflected concerns with regard to hygiene, fat and salt content of the food prepared OH. Adolescents characterised by the convenience pattern were more likely (OR =1.51, P < 0.001) to eat OH more frequently. The highest tertile of the Nutritional and food safety concerned pattern was less likely (OR = 0.61, P = 0.03) to eat OH compared to lower tertiles. Both patterns were not associated with the % energy from eating OH per day. Convenience and to a lesser extent Nutritional and food safety concerns are significant factors associated with the frequency of eating OH in Vietnamese adolescents.

Cambios en el consumo aparente de nutrientes en el Gran Santiago 1988-1997 en hogares según ingreso y su probable relación con patrón de enfermedades crónicas no transmisibles

the rise in the prevalence of obesity, diabetes, and other risk factors for cardiovascular diseases and cancer observed in Chile over the past decades may be related to changes in dietary patterns of the population.to report changes in household apparent food-nutrients consumption (HAFNC) for Metropolitan Santiago-Chile 1988-97.the analysis is based on data from household expenditure surveys conducted by the Instituto Nacional de Estadísticas (INE) on a representative sample of the population to define changes in food prices. Information on food and drink purchases were grouped by specific items and expen-ditures standardized across the two surveys. HAFNC was determined based on unit consumed at home and out of home by the total group and by income quintile using national food composition tables.apparent energy consumption increased over the study period by 25%, this was mainly explained by increased consumption of meat and dairy (rich in saturated fats of animal origin) and of processed foods (fat spreads, sweets and pastries) and foods rich in added sugars (sugary drinks and juices). Dietary fiber derived from whole grains, legumes and cereals decreased. The HAFNC of items protective against nutrition related chronic diseases, such as vegetables, fruits and other fiber rich foods remained stable or frankly decreased (legumes and non-starchy vegetables) Fish and other marine foods rich in omega- 3 fats remained low.the changes in apparent food consumption patterns can be characterized by an increase in energy dense, fat and sugar rich foods with a low consumption of fi sh, whole grains, legumes, vegetables and fruits.

Changes in household food and nutrient consumption in Metropolitan Santiago 1988-97 by income

the rise in the prevalence of obesity, diabetes, and other risk factors for cardiovascular diseases and cancer observed in Chile over the past decades may be related to changes in dietary patterns of the population. to report changes in household apparent food-nutrients consumption (HAFNC) for Metropolitan Santiago-Chile 1988-97. the analysis is based on data from household expenditure surveys conducted by the Instituto Nacional de Estadísticas (INE) on a representative sample of the population to define changes in food prices. Information on food and drink purchases were grouped by specific items and expen-ditures standardized across the two surveys. HAFNC was determined based on unit consumed at home and out of home by the total group and by income quintile using national food composition tables. apparent energy consumption increased over the study period by 25%, this was mainly explained by increased consumption of meat and dairy (rich in saturated fats of animal origin) and of processed foods (fat spreads, sweets and pastries) and foods rich in added sugars (sugary drinks and juices). Dietary fiber derived from whole grains, legumes and cereals decreased. The HAFNC of items protective against nutrition related chronic diseases, such as vegetables, fruits and other fiber rich foods remained stable or frankly decreased (legumes and non-starchy vegetables) Fish and other marine foods rich in omega- 3 fats remained low. the changes in apparent food consumption patterns can be characterized by an increase in energy dense, fat and sugar rich foods with a low consumption of fi sh, whole grains, legumes, vegetables and fruits.

Americans' Time Use

This paper describes a model of Americans' time use in which time spent with children in home and out of home influences activity and travel time allocation. Although the activities and travel of children are studied more in depth now than in the past, to date few studies have examined the time spent with children as a dependent variable within a time use model. Most existing models of activity and travel participation allocate time-to-work activities, followed by obligatory maintenance activities and nonobligatory discretionary activities. The model described in this paper expands the data into eight activity categories to determine whether these activities are more or less necessary than past research assumed. The results suggest that the total amount of time spent inside the home with children has a statistically significant and negative impact on work, leisure, and personal activities inside the home, but work duration and work travel have no significant or practical impact on time spent with children, everything else being constant. There is also some indication that more time spent in in-home activities is associated with greater travel time expenditures. Overall, the 2007 American Time Use Survey contains a variety of details that help illuminate the answers to many such questions.

Trajectories of risk behaviors and exiting homelessness among newly homeless adolescents

Using cluster analysis techniques, we identified two distinct clusters of newly homeless adolescents in Los Angeles (n = 261): those who are protected and doing relatively well while out of home with more protective than risk factors, and those who are risky with more risk than protective factors. The objective of this study was to examine the trajectories of human immunodeficiency virus (HIV) risk behaviors and exiting homelessness among protected newly homeless adolescents, compared to those who are classified as risky. HIV risk behavior included unprotected sex, having multiple sex partners and hard drug use. Logistic regression mixed-effects models were used to evaluate the trajectories of HIV risk behaviors and exiting homelessness over time. The adolescents in the protected group reported significantly less unprotected sex ( p = 0.0156), being abstinent or monogamous ( p < 0.0001) and less hard drug use ( p < 0.0001) compared to the adolescents in the risky group. In addition, the protected group reported more “exiting homelessness”, compared to the risky group ( p = 0.0007). However, the differences in the level of unprotected sex between the protected and risky groups decreased over time. Our findings confirm the notion that newly homeless adolescents are indeed heterogeneous. Given that the risk behavior profiles of protected group merges to the risky group over time, our findings underscore the need to mount tailored interventions to be designed for the protected group early in the process.

Eating out of home: energy, macro- and micronutrient intakes in 10 European countries. The European Prospective Investigation into Cancer and Nutrition

To assess the contribution of out-of-home (OH) energy and nutrient intake to total dietary intake, and to compare out- versus in-home nutrient patterns among 27 centres in 10 countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Between 1995 and 2000, 36,034 participants aged between 35-74 years completed a standardized 24-h dietary recall using a software programme (EPIC-Soft) that recorded the place of food/drink consumption. Eating OH was defined as the consumption of foods and beverages anywhere other than in household premises, irrespective of the place of purchase/preparation. Nutrient intakes were estimated using a standardized nutrient database. Mean intakes were adjusted for age and weighted by season and day of recall. Among women, OH eating contributed more to total fat intake than to intakes of protein and carbohydrates. Among both genders, and particularly in southern Europe, OH eating contributed more to sugar and starch intakes and less to total fibre intake. The contribution of OH eating was also lower for calcium and vitamin C intakes. The composition of diet at home was different from that consumed out of home in southern countries, but was relatively similar in the north. In northern Europe, OH and in-home eating are homogeneous, whereas southern Europeans consider OH eating as a distinctive occasion. In most centres, women selected more fat-rich items when eating out.

Eating out of home and obesity: a Brazilian nationwide survey

The aim of the present study was to investigate the relationship between out-of-home (OH) eating and overweight and obesity among adults in Brazil. Data were based on the 2002-2003 Household Budget Survey (48,470 households) conducted by The Brazilian Census Bureau. Foods and drinks purchased for OH eating during a one-week period were recorded by each participant. We considered OH eating as the purchase of at least one food or drink item for OH consumption during this period. We classified items as: soft drinks, deep-fried snacks, fast foods, sweets and sit-down meals. Urban areas in Brazil. 56,178 participants (26,225 men and 29,953 women), aged 25-65 years. The weighted prevalence of OH eating was 40.3 %. Overall, OH eating was positively associated with overweight (OR = 1.21; 95 % CI 1.10, 1.33) and obesity (OR = 1.35; 95 % CI 1.16, 1.57) among men, but not among women. Sit-down meals and soft drinks were the most frequently reported food groups. Both were positively associated with overweight (OR = 1.34 for meals; OR = 1.17 for soft drinks, P < 0.05) and obesity (OR = 1.51 for meals; OR = 1.39 for soft drinks, P < 0.05) among men, but negatively associated with overweight and obesity among women. OH eating was associated with overweight and obesity only among men, whereas, among women, eating sit-down meals out of home was protective for obesity, suggesting that women make healthier food choices when they eat out of home.

Who is doing well? A typology of newly homeless adolescents

There is growing evidence to support developing new typologies for homeless adolescents. Current typologies focus on the risks associated with being homeless, with less consideration of the positive attributes of homeless adolescents. The authors examined both risk and protective factors in a sample of newly homeless adolescents. Using cluster analysis techniques, they identified three distinct clusters of newly homeless adolescents: those who are protected and doing relatively well while out of home with more protective than risk factors, those who are at-risk, and those who are risky with more risk than protective factors. Over half (51.9%) of these newly homeless adolescents were in the protected cluster. This typology has implications for the design and implementation of services and interventions for newly homeless adolescents to reconnect them with stable housing situations.

Rationale and design of the Home Automatic External Defibrillator Trial (HAT)

Most cardiac arrests occur in the home, where emergency medical services (EMS) systems are challenged to provide timely care. Because a large proportion of sudden cardiac arrests (SCAs) are due to ventricular tachycardia or ventricular fibrillation, home use of an automated external defibrillator (AED) might offer an opportunity to decrease mortality in those at risk. Predicting who will have a cardiac arrest in the general population is difficult. Individuals at high risk are usually easily identified and may become candidates for implantable cardioverter defibrillators. It is within the population at lower risk where home AEDs may be most useful. The purpose of the Home Automatic External Defibrillator Trial (HAT) is to test whether providing home access to an AED can improve survival in patients at modest risk of SCA, such as those surviving an anterior myocardial infarction but in whom implantable cardioverter defibrillator therapy is not deemed necessary. Between January 23, 2003, and October 20, 2005, 7001 patients were enrolled, with completion of follow-up scheduled for September 30, 2007. Randomization was conducted in a 1:1 fashion between control therapy, comprising the standard lay response to SCA (calling the EMS and performing cardiopulmonary resuscitation), and the use of an AED first, followed by calling the EMS and performing cardiopulmonary resuscitation. The primary end point is all-cause mortality. Secondary outcomes include survival from SCA (witnessed and unwitnessed, in home and out of home), incremental cost-effectiveness, and quality of life measures for both the patient and the spouse/companion. The results of the trial should be available in mid 2008.

Eating out of home and its correlates in 10 European countries. The European Prospective Investigation into Cancer and Nutrition (EPIC) study

To compare the average out-of-home (OH) consumption of foods and beverages, as well as energy intake, among populations from 10 European countries and to describe the characteristics of substantial OH eaters, as defined for the purpose of the present study, in comparison to other individuals. Cross-sectional study. Dietary data were collected through single 24-hour dietary recalls, in which the place of consumption was recorded. For the present study, substantial OH eaters were defined as those who consumed more than 25% of total daily energy intake at locations other than the household premises. Mean dietary intakes and the proportion of substantial OH eaters are presented by food group and country. Logistic regression analyses were used to estimate the odds of being a substantial OH eater in comparison to not being one, using mutually adjusted possible non-dietary determinants. Ten European countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC). The subjects were 34 270 individuals, 12 537 men and 21 733 women, aged 35-74 years. The fraction of energy intake during OH eating was generally higher in northern European countries than in the southern ones. Among the food and beverage groups, those selectively consumed outside the home were coffee/tea/waters and sweets and, to a lesser extent, cereals, meats, added lipids and vegetables. Substantial OH eating was positively associated with energy intake and inversely associated with age and physical activity. Substantial OH eating was less common among the less educated compared with the more educated, and more common during weekdays in central and north Europe and during the weekend in south Europe. Eating outside the home was associated with sedentary lifestyle and increased energy intake; it was more common among the young and concerned in particular coffee/tea/waters and sweets.

Intercountry adoptees in out‐of‐home care: a national cohort study

To investigate risks of placements in out-of-home care for non-European adoptees. Intercountry adoptees born outside Europe 1973-1984 (n = 16,522) were compared with same age peers from the majority population (n = 1,026,523) using national demographic and child welfare registers. Multivariate analyses were performed using logistic regression models, and odds ratios (OR) for different forms of out-of-home care placements were calculated. After adjustments for socio-demographic background variables, the OR:s for placements of intercountry adoptees in residential care from age 10 were 5.1 (95% CI 4.6-5.8) and 3.0 (95% CI 2.6-3.6) for placements in foster care from age 10. For placements in all forms of out-of home care up to age 10, the odds were on par with the majority population. Higher child age at adoption, origin from Latin America, single parent adoption and maternal age above 35 at birth of the child were identified as significant predictors of out-of-home care from age 10. Intercountry adoptees emerge as a risk group for placements in out-of home care during adolescence, especially for entries into residential care (in Sweden usually triggered by persistent behaviour problems).

“Save the Crabs, Then Eat 'Em”: A Culinary Approach to Saving the Chesapeake Bay

The Academy for Educational Development, a nonprofit organization specializing in social change communications, implemented a campaign to reduce nutrient pollution flowing into the Chesapeake Bay from the greater Washington D.C. area. Funded by the Chesapeake Bay Program, the primary campaign goal was to convince area residents not to fertilize their lawns in the spring, when fertilizer runoff is most damaging to the Bay, but to do so in the fall, if at all. For the 16% of residents who hire a lawn service, the goal was to convince them to hire a Bay-friendly partner lawn service. To overcome message fatigue from previous Bay-oriented campaigns and motivate this urban audience with a meaningful connection to the Bay, the campaign message was framed not as an environmental appeal, but as a way to ensure the continued availability of Chesapeake Bay seafood. Television, newspaper, and out-of home ads ran for a seven-week period during March and April 2005. In spite of a small budget, a post-intervention survey showed increased awareness of lawn care behaviors that contribute to Bay pollution, and decreased intent to fertilize in the spring.