Outdoor Playtime Research Articles

Kindergarten practitioners’ experience of promoting children’s involvement in and enjoyment of physically active play: Does the contagion of physical energy affect physically active play?

This research is based on interviews that explore the reflections of 10 Norwegian kindergarten practitioners with regard to the importance of their involvement in children’s physically active outdoor playtime. The data were analysed from a qualitative phenomenological perspective and resulted in basic themes that describe the practitioners’ experiences. The findings highlight the intersubjectivity, physical communication and reciprocity involved in promoting children’s involvement in and enjoyment of physically active play. From the practitioners’ perspectives, their ability to be involved in and share experiences of physically active play with the children is essential for encouraging children to be inspired and involved in such play. They see themselves as important role models, and think that offering support and sharing responses with children in these situations is valuable for children’s physical mastery. The findings from this study emphasize the importance of practitioners being involved and actively promoting children’s physically active play.

Association between Vitamin D and Circulating Lipids in Early Childhood.

Vitamin D is associated with established cardiovascular risk factors such as low density lipoprotein (LDL) in adults. It is unknown whether these associations are present in early childhood. To determine whether serum 25-hydroxyvitamin D (25(OH)D) is associated with serum non-high density lipoprotein (non-HDL) cholesterol during early childhood we conducted a cross-sectional study of children aged 1 to 5 years. Healthy children were recruited through the TARGet Kids! practice based research network from 2008-2011 (n=1,961). The associations between 25(OH)D and non-fasting non-HDL cholesterol (the primary endpoint), total cholesterol, triglycerides, HDL, and low density lipoprotein (LDL) cholesterol, were evaluated using multiple linear regression adjusted for age, sex, skin pigmentation, milk intake, vitamin D supplementation, season, body mass index, outdoor play, and screen time. Each 10 nmol/L increase in 25(OH)D was associated with a decrease in non-HDL cholesterol concentration of -0.89 mg/dl (95% CI: -1.16,-0.50), total cholesterol of -1.08 mg/dl (95%CI: -1.49,-0.70), and triglycerides of -2.34 mg/dl (95%CI: -3.23,-1.45). The associations between 25(OH)D and LDL and HDL were not statistically significant. 25(OH)D concentrations were inversely associated with circulating lipids in early childhood, suggesting that vitamin D exposure in early life may be an early modifiable risk factor for cardiovascular disease.

Action Research on Effective Ways of Outdoor Play for Three-Year-Old Children in Kindergarten

This study was conducted to effectively manage outdoor playtime for 3-year-old children in kindergarten and evaluate their responses. The subjects were 20 3-year-old children and 2 teachers at a private kindergarten in Seoul, Korea. To effectively manage outdoor play for 3-year-old children, the existing outdoor play environment and educational programs were examined for problems, and then the first program was implemented. The first program was developed to support organized planning and operation of outdoor play, diversity in outdoor space, and the growth of 3-year-old children. In the second program, the components of outdoor play areas were modified. Also, relationship building and consideration for others with older children who have much influence on outdoor activities was practiced and performed. As a result, for the children there was an increase in interest and participation in outdoor play, enhanced physical abilities and self-confidence, better peer relationships, and bonding with older children in kindergarten. The results of this study highlight the need for the effective management of outdoor play for 3-year-olds considering the physical and social environment. It is also significant in that it presents a detailed outdoor play program. In addition, the research suggests the need to organize space to improve outdoor play and for the development of age-specific and inter-age outdoor activities.

Low Vitamin D Levels Are Associated With Need For Surgical Correction In Pediatric Fractures

BACKGROUND: There is growing concern over a relationship between severity of pediatric fractures and low Vitamin D [25-hydroxyvitaminD, 25(OH)D] status. OBJECTIVE: Compare 25(OH)D levels and lifestyle of children with fractures to controls. Determine if 25(OH)D levels are associated with fractures and what the 25(OH)D fragility fracture threshold is within the fracture group. DESIGN/METHODS: Pediatric fracture and community controls were included. Bone health survey and medical record data was analyzed. Univariate and multivariable ordinal regression analyses were performed. Fractures were placed into groups using the Abbreviated Injury Score (AIS). AIS scores get progressively worse starting at AIS 1. AIS 3 were fractures requiring surgery. RESULTS: 369 fracture patients and 662 controls ≤ 18 years were included. Fracture and control groups’ 25(OH)D levels were not statistically different. Fracture group had mean 25(OH)D of 27.5 ± 8.9 vs 27.4 ± 9.1 in controls (p=0.914). However, among fracture patients, those with surgical fracture (AIS 3) had lower 25(OH)D levels (24.6) vs. nonsurgical fractures (AIS 1 & 2 with mean 30.0 and 28.3, respectively, p=0.001). The bone health survey found an association between increased outdoor play time and AIS fracture severity 3 (p=0.042). Adjusted odds ratios (OR) for Vitamin D levels on surgical fracture were calculated. Patients who had 25(OH)D <12 ng/mL were 20 times more likely to have a surgical fracture (OR 21.4, 95% CI 0.9-532, p=0.062). If 25(OH)D was <20ng/mL, the risk of surgical fracture was 3.5 times more likely (OR 3.5, 95% CI: 1.4-9.0, p=0.007). Patients who were <30ng/mL in 25(OH)D levels were twice as likely to have surgical fracture (OR 2.2, 95% CI: 1.0-4.7, p=0.059). Age, sex, and BMI were not found to be significant factors for AIS severity in this study. CLINICAL RELEVANCE: While the occurrence of a pediatric fracture was not associated with 25(OH)D levels in this study, kids with deficient Vitamin D levels appear to be at risk for more severe fractures. Ideal target serum level for 25(OH)D should be least 30ng/mL. Duration of outdoor play appears to be associated with more severe fracture risk. Future studies should investigate if this is due to increased exposure time to more at-risk activities while outdoors.

WHO European Childhood Obesity Surveillance Initiative: associations between sleep duration, screen time and food consumption frequencies.

BackgroundBoth sleep duration and screen time have been suggested to affect children’s diet, although in different directions and presumably through different pathways. The present cross-sectional study aimed to simultaneously investigate the associations between sleep duration, screen time and food consumption frequencies in children.MethodsThe analysis was based on 10 453 children aged 6–9 years from five European countries that participated in the World Health Organization European Childhood Obesity Surveillance Initiative. Logistic multilevel models were used to assess associations of parent-reported screen time as well as sleep duration (exposure variables) with consumption frequencies of 16 food items (outcome variables). All models were adjusted for age, sex, outdoor play time, maximum educational level of parents and sleep duration or screen time, depending on the exposure under investigation.ResultsOne additional hour of screen time was associated with increased consumption frequencies of ‘soft drinks containing sugar’ (1.28 [1.19;1.39]; odds ratio and 99% confidence interval), ‘diet/light soft drinks’ (1.21 [1.14;1.29]), ‘flavoured milk’ (1.18 [1.08;1.28]), ‘candy bars or chocolate’ (1.31 [1.22;1.40]), ‘biscuits, cakes, doughnuts or pies’ (1.22 [1.14;1.30]), ‘potato chips (crisps), corn chips, popcorn or peanuts’ (1.32 [1.20;1.45]), ‘pizza, French fries (chips), hamburgers’(1.30 [1.18;1.43]) and with a reduced consumption frequency of ‘vegetables (excluding potatoes)’ (0.89 [0.83;0.95]) and ‘fresh fruits’ (0.91 [0.86;0.97]). Conversely, one additional hour of sleep duration was found to be associated with increased consumption frequencies of ‘fresh fruits’ (1.11 [1.04;1.18]) and ‘vegetables (excluding potatoes)’ (1.14 [1.07;1.23]).ConclusionThe results suggest a potential relation between high screen time exposure and increased consumption frequencies of foods high in fat, free sugar or salt whereas long sleep duration may favourably be related to children’s food choices. Both screen time and sleep duration are modifiable behaviours that may be tackled in childhood obesity prevention efforts.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1793-3) contains supplementary material, which is available to authorized users.

Children's outdoor playtime, physical activity, and parental perceptions of the neighbourhood environment

The purpose of this study was to examine the association between the hours of outdoor play and objective measures of physical activity and identify the correlates of outdoor playing time in terms of parental perceptions of the neighbourhood environment. Time spent in outdoor play, both on a typical weekday and a typical weekend day, and neighbourhood perceptions, was assessed by parental self-report for 889 students attending grades 5 and 6 in Toronto, Canada (mean age: 10.50 ± 0.72 years). Physical activity was assessed by accelerometry. Ordered logit models were estimated to explore the influence of neighbourhood perceptions on the time spent playing outdoors. Regardless of a child's age and sex, duration of play was significantly correlated with minutes of moderate-to-vigorous physical activity. Parental concerns about strangers and fast drivers were inversely associated with duration of play on a typical weekday. Parental safety concerns continue to present a formidable barrier to greater outdoor play.

How are young children's outdoor play time and screen time associated with their social skills?

How are young children's outdoor play time and screen time associated with their social skills?

Links Between Preschool Children’s Social Skills and Observed Pretend Play in Outdoor Childcare Environments

As one of the most advanced play forms in childhood, pretend play often demonstrates positive associations with children’s development. However, results from research that examines the association between social skills and pretend play are mixed, especially when the complexity of pretend play is taken into account. Moreover, few studies on pretend play are conducted in outdoor environments; a setting which affords many opportunities for engagement in pretend play and unstructured social interactions. By observing children’s outdoor pretend play, the primary purpose of this study was to investigate the relationships between different types of pretend play and children’s social skills. Twenty-eight children from high quality childcare centers in a southeast suburban area were observed during outdoor free play time. Using a reliable time sampling protocol, each child’s play was observed and recorded for a total of 45 min to an hour over a 2-week time period. Lead teachers rated children’s social skills in the areas of cooperation, self-control, and assertiveness. Results showed high amounts of pretend play behavior overall, and differential relationships between the type of pretend play children engaged in and children’s social skills. Surprisingly, these relationships were not associated with gender. Findings are discussed in light of the value of pretend play to promote social skill development and the potential for outdoor contexts specifically to encourage these play behaviors.

Physical and Sedentary Activity Levels Among Preschoolers in Home-Based Childcare: A Systematic Review.

Although preschoolers' physical activity in center-based childcare has received considerable attention, less is known regarding this group's activity levels within home-based childcare. This review aimed to explore and synthesize the literature on preschoolers' physical and sedentary activity levels in home-based childcare. Outdoor playtime was also examined to contribute to the understanding of preschoolers' activity levels within this particular setting. Nine online databases were searched for peer-reviewed, English-language, primary studies that quantitatively measured physical and sedentary activity levels of preschoolers attending home-based childcare. Studies were excluded if they were nonprimary research, if they lacked a preschool-aged sample, if they did not quantitatively measure physical or sedentary activity, or if they took place in an ineligible environment. Seven articles were included in this review; 3 had objective measures of activity levels, and 4 relied on nonobjective measures. Accelerometry data suggest that preschoolers' average sedentary, moderate-to-vigorous, and total physical activity levels in home-based childcare ranged from 39.5 to 49.6, 1.8 to 9.7, and 10.4 to 33.8 min/hr, respectively. Outdoor playtime appears to be inconsistent in home-based childcare. Physical activity among preschoolers attending home-based childcare appears to be relatively low and widely varied. Sedentary time has received less attention in home-based childcare settings. Future research examining activity levels in this unique environment is warranted.

Associations of maternal influences with outdoor play and screen time of two-year-olds: Findings from the Healthy Beginnings Trial.

This study aims to investigate if maternal influences are associated with children's outdoor playtime and screen time at the age of 2 years. A cross-sectional study with 497 first-time mothers and their children was conducted using the data from the Healthy Beginnings Trial undertaken in Sydney, Australia during 2007-2010. Maternal influences included their own physical activity and screen time, television rules for their child, perceived neighbourhood environment, parental self-efficacy and parenting style (warmth and hostility). Children's outdoor playtime, screen time and maternal influences were collected through face-to-face interviews with participating mothers when the children were 2 years old. Logistic regression analysis was conducted to examine the associations between maternal influences and children's outdoor play and screen time. Mothers with low levels of parental hostility and high perceived safe outdoor play environment were more likely to have children playing outdoor for ≥ 2 h/day with adjusted odds ratio (AOR) 2.65 (95% confidence interval (CI) 1.68-4.20, P < 0.0001) and AOR 2.44 (95% CI 1.85-3.85, P < 0.0001) respectively. Mothers' own screen time was the sole factor associated with children's screen time (AOR 1.90 (95% CI 1.29-2.81, P = 0.001)). Different maternal influences were independently associated with children's outdoor play or screen time at an early stage of life. Therefore, different intervention strategies are needed to increase children's outdoor playtime and decrease their screen time.

Are context-specific measures of parental-reported physical activity and sedentary behaviour associated with accelerometer data in 2-9-year-old European children?

The aim of the present study was to investigate if context-specific measures of parental-reported physical activity and sedentary behaviour are associated with objectively measured physical activity and sedentary time in children. Cross-sectional study. Seven European countries taking part in the IDEFICS (Identification and Prevention of Dietary- and Lifestyle-induced Health Effects in Children and Infants) study. Data were analysed from 2-9-year-old children (n 5982) who provided both parental-reported and accelerometer-derived physical activity/sedentary behaviour measures. Parents reported their children's daily screen-time, weekly sports participation and daily outdoor playtime by means of the Outdoor Playtime Checklist (OPC) and Outdoor Playtime Recall Questions (OPRQ). Sports participation, OPC- and OPRQ-derived outdoor play were positively associated with accelerometer-derived physical activity. Television viewing and computer use were positively associated with accelerometer-derived sedentary time. All parental-reported measures that were significantly associated with accelerometer outcomes explained only a minor part of the variance in accelerometer-derived physical activity or sedentary time. Parental-reported measures of physical activity and sedentary behaviour are not useful as a proxy for 2-9-year-old children's physical activity and sedentary time. Findings do not preclude the use of context-specific measures but imply that conclusions should be limited to the context-specific behaviours that are actually measured. Depending on the aim of the study, future research should carefully consider the choice of measurements, including the use of subjective or objective measures of the behaviour of interest or a combination of both.

100: Non-Dairy Milk Consumption is Associated with Lower Serum 25-Hydroxyvitamin D in Early Childhood

Vitamin D fortification of cow's milk is the main dietary source of vitamin D in early childhood. The consumption of non-dairy milk, such as plant-based milk beverages and goat's milk is increasing. Vitamin D fortification of non-dairy milk is voluntary in North America. We hypothesize that the consumption of non-dairy milk may be associated with lower 25-hydroxyvitamin D in early childhood. For our primary objective, we aimed to determine if there is an association between daily volume of non-dairy milk consumption and serum 25-hydroxyvitamin D in healthy young Canadian children. For our secondary objective we aimed to explore whether cow's milk consumption modifies this relationship. Children attending one of seven pediatric or family medicine primary care practices were recruited during routine primary healthcare. For our primary analysis, a multiple linear regression model was developed to test the association between daily volume of non-dairy milk consumption and 25-hydroxyvitamin D, adjusted for age, gender, z-BMI, season, vitamin D supplementation, skin pigmentation, and daily outdoor play time. To explore whether cow's milk modifies this relationship, the interaction between non-dairy milk and cow's milk consumption was included in this model. A total of 2831 children were included in the analysis. Mean age was 2.9 years, 53% were male, 53% were taking a vitamin D containing supplement, 87% of children were consuming cow's milk and 13% of children consumed non-dairy milk daily. In the univariate analysis, each cup of non-dairy milk consumed per day was associated with a 2.3 nmol/L (P=0.005, 95% CI 1.0, 4.9) lower mean 25-hydroxyvitamin D concentration. Multiple linear regression, adjusted for clinically relevant covariates, revealed that each additional 250 ml cup of non-dairy milk was associated with a 3.8 nmol/L (95% CI 1.0 to 8.6; P=0.01) lower 25-hydroxyitmian D among children who drink cow's milk, and a non-significant increase in 25-hydroxyvitmain D of 0.3 nmol/L (95% CI −3.0 to 3.1; P=0.6) among children who do not drink cow's milk. Non-dairy milk consumption is associated with a lower 25-hydroxyvitamin D level in early childhood. This relationship appears to be modified by cow's milk consumption, suggesting that consumption of lower vitamin D containing non-dairy milk may be replacing consumption of higher vitamin D containing cow's milk.

Maternal Depressive Symptoms and Child Obesity in Low-Income Urban Families

ObjectiveTo characterize the relationship between maternal depressive symptoms and child weight status, obesity-promoting feeding practices, and activity-related behaviors in low-income urban families. MethodsWe conducted a cross-sectional survey of mothers with 5-year-old children receiving pediatric care at a federally qualified community health center. We used regression analyses to examine the relationship between maternal depressive symptoms (trichotomized: none, mild, moderate to severe) and 1) child weight status; 2) obesity-promoting feeding practices, including mealtime practices and feeding styles; and 3) activity-related behaviors, including sleep time, screen time, and outdoor playtime. ResultsThe sample included 401 mother–child pairs (78.3% response rate), with 23.4% of mothers reporting depressive symptoms (15.7% mild, 7.7% moderate to severe). Mothers with moderate to severe depressive symptoms were more likely to have overweight and obese children than mothers without depressive symptoms (adjusted odds ratio 2.62; 95% confidence interval 1.02–6.70). Children of mildly depressed mothers were more likely to consume sweetened drinks and to eat out at restaurants and were less likely to eat breakfast than children of nondepressed mothers. Mothers with depressive symptoms were less likely to set limits, to use food as a reward, to restrict their child’s intake, and to model healthy eating than nondepressed mothers. Children with depressed mothers had less sleep and outdoor playtime per day than children of nondepressed mothers. ConclusionsMaternal depressive symptoms are associated with child overweight and obese status and with several obesity-promoting practices. These results support the need for maternal depression screening in pediatric obesity prevention programs. Further research should explore how to incorporate needed mental health support.

A Pilot Study on Predictive Factors for Over Weight and Obesity in School Children of Coimbatore, Tamil Nadu, South India

Objective: To understand specific factors associated with overweight and obesity in children of Coimbatore through a non invasive method. Methodology: A cross - sectional study was conducted in four urban schools of Coimbatore and school children aged between 9 years and 17 years of age (n=252, mean age 13 ± 2.3 years, Boys n=142, Girls n=111) were recruited by purposive random sampling method. Children with physical limitations, mental disability or children undergoing any form of clinical therapy were not included in this study. Anthropometric assessment was done and data were analysed by Linear and Logistic regression models using SPSS (version 11, Chicago: SPSS, Inc.) P value less than 0.05 was considered as statistically significant. Results: The mean BMI in boys (16.7 ± 2.8 kg/m 2 ) was lower than the mean BMI of girls(19.1 ± 3.3 kg/m 2 ).The mean BMI and body weight in obese girls with “double chin” was 23.9 ± 2.6 kg/m2 and 56.8 kg respectively. Importantly, the mean body weight (49.4 kg) was higher in girls of parents with hypertension, followed by the mean body weight of girls (44.6 kg) of obese parents. Specific factors namely outdoor physical activity as playtime, dietary pattern were associated significantly with BMI (p<0.01, r 2 = 0.81) in the children of this study. The BMI of children with 'double chin' was comparatively high than children without double chin. Sedentary children who habitually consume snacks while watching television are at a higher risk (Odds ratios=1.44, p<0.01,) for obesity than children who do not. Progressive increase in frequency and duration of outdoor playtime significantly (Odds ratios: 2.54, p<0.01) reduces excess weight in overweight and obese children by nearly three times than those children who do not play.

A Pilot Study to Examine the Effect of Additional Structured Outdoor Playtime on Preschoolers' Physical Activity Levels

The impact of additional structured outdoor playtime on preschoolers'; physical activity (PA) level is unclear. The purpose of this pilot study was to explore the effects of increasing structured outdoor playtime on preschoolers'; PA levels. Eight full-day classrooms (n=134 children) from two preschool programmes were randomised into a treatment (STRUCT, n=4) or control (CON, n=4) condition. Both groups received an additional 30 minutes of outdoor playtime three days per week for four weeks. The STRUCT intervention consisted of previously tested structured outdoor playtime activities/games. The CON intervention consisted of free outdoor playtime. Children were individually recruited (n=75) for the objective assessment of PA levels. The PA levels of 67 children (age, 4.1±0.8 years; STRUCT, n=38; CON, n=29) were assessed at baseline and during week four for seven consecutive days using Actigraph accelerometers. Data were analysed using mixed-model analysis of variance. Time spent in vigorous PA significantly increased during the 30-minute intervention time for the STRUCT group compared with the CON group (group×time interaction: F(1, 36) = 4.91, p=0.04). Compared with baseline, a significant increase was observed in the STRUCT group's time spent engaged in moderate-to-vigorous PA (MVPA) during the intervention time, but this increase was not significant compared with the CON group (baseline: STRUCT, 1.7±2.0 min; CON, 1.9±2.4 min; week four: STRUCT, 4.9±3.1 min; CON, 3.3±2.5 min). Compared with the CON group, the STRUCT group spent a significantly greater percentage of time engaged in MVPA and a significantly lower percentage of time engaged in sedentary activity during the preschool day. In conclusion, this study provides preliminary evidence that increasing preschoolers'; exposure to structured activities during outdoor playtime could lead to improvements in their PA levels. The present intervention could be used to help preschoolers meet the recommended levels of PA.

Mediators of the effect of the JUMP-in intervention on physical activity and sedentary behavior in Dutch primary schoolchildren from disadvantaged neighborhoods

BackgroundImportant health benefits can be achieved when physical activity in children from low socio-economic status is promoted and sedentariness is limited. By specifying the mediating mechanisms of existing interventions one can improve future physical activity interventions. This study explored potential mediators of the long-term effect of the school-based multicomponent JUMP-in intervention on sport participation, outdoor play and screen time in Dutch primary schoolchildren from disadvantaged neighborhoods.MethodsIn total, 600 primary schoolchildren (aged 9.8 ± 0.7, 51% girls, 13% Dutch ethnicity, 35% overweight) from 9 intervention and 10 control schools were included in the analyses. JUMP-in was developed using Intervention Mapping, and targeted psychological and environmental determinants of physical activity. Outcome behaviors were self-reported sport participation, outdoor play, TV-viewing behavior and computer use. Potential mediators were self-reported psychological, social and physical environmental factors.ResultsJUMP-in was effective in improving sport participation after 20 months, but not in improving outdoor play, or reducing TV-viewing or computer time. JUMP-in was not effective in changing hypothesized mediators so no significant mediated effects could be identified. However, changes in self-efficacy, social support and habit strength were positively associated with changes in sport participation, and changes in social support, self-efficacy, perceived planning skills, enjoyment and habit strength were positively associated with changes in outdoor play. Changes in enjoyment was positively associated with changes in TV-viewing while parental rules were negatively associated. Having a computer in the bedroom and enjoyment were positively associated with changes in computer use, while changes in parental rules were negatively associated.ConclusionsBesides a significant positive effect on sports participation, no significant intervention effect on outdoor play, screen time or any of the potential mediators was found. This suggest that other (unmeasured) factors operated as mediating mechanisms of the intervention, that we used unsuccessful intervention strategies, that the strategies were inappropriately implemented, or that children are unable to accurately recall past activities and cognitions. Additionally, the school setting might not be the sole channel to influence leisure time activities. Still, several personal and environmental constructs were found to be relevant in predicting change in sport participation, outdoor play and screen behavior and seem to be potential mediators. Future interventions are recommended including more effective strategies targeting these relevant constructs, addressing different constructs (e.g. pedagogic skills of parents), and focusing on different implementation settings.Trail registrationISRCTN17489378

The Frequency of Outdoor Play for Preschool Age Children Cared for at Home-Based Child Care Settings

ObjectiveGiven that more than 34% of U.S. children are cared for in home-based child care settings and outdoor play is associated with physical activity and other health benefits, we sought to characterize the outdoor play frequency of preschoolers cared for at home-based child care settings and factors associated with outdoor play. MethodsCross-sectional study of 1900 preschoolers (representing approximately 862,800 children) cared for in home-based child care settings (including relative and nonrelative care) using the nationally representative Early Childhood Longitudinal Study, Birth Cohort. ResultsOnly 50% of home-based child care providers reported taking the child outside to walk or play at least once/day. More than one-third of all children did not go outside to play daily with either their parent(s) or home-based child care provider. There were increased odds of going outside daily for children cared for by nonrelatives in the child's home compared with care from a relative. Children with ≥3 regular playmates had greater odds of being taken outdoors by either the parents or child care provider. We did not find statistically significant associations between other child level (age, sex, screen-time), family level (highest education in household, mother's race, employment, exercise frequency), and child care level (hours in care, provider's educational attainment, perception of neighborhood safety) factors and frequency of outdoor play. ConclusionsAt a national level, the frequency of outdoor play for preschoolers cared for in home-based child care settings is suboptimal. Further study and efforts to increase outdoor playtime for children in home-based child care settings are needed.

Bone Mineral Density and Vitamin D Status Among African American Children With Forearm Fractures

To determine whether African American children with forearm fractures have decreased bone mineral density and an increased prevalence of vitamin D deficiency (serum 25-hydroxyvitamin D level ≤ 20 ng/mL) compared with fracture-free control patients. This case-control study in African American children, aged 5 to 9 years, included case patients with forearm fracture and control patients without fracture. Evaluation included measurement of bone mineral density and serum 25-hydroxyvitamin D level. Univariable and multivariable analyses were used to test for associations between fracture status and 2 measures of bone health (bone mineral density and 25-hydroxyvitamin D level) while controlling for other potential confounders. The final sample included 76 case and 74 control patients. There were no significant differences between case and control patients in age, gender, parental education level, enrollment season, outdoor play time, height, or mean dietary calcium nutrient density. Cases were more likely than control patients to be overweight (49.3% vs 31.4%, P = .03). Compared with control patients, case patients had lower whole body z scores for bone mineral density (0.62 ± 0.96 vs 0.98 ± 1.09; adjusted odds ratio 0.38 [0.20-0.72]) and were more likely to be vitamin D deficient (47.1% vs 40.8%; adjusted odds ratio 3.46 [1.09-10.94]). These data support an association of lower bone mineral density and vitamin D deficiency with increased odds of forearm fracture among African American children. Because suboptimal childhood bone health also negatively impacts adult bone health, interventions to increase bone mineral density and correct vitamin D deficiency are indicated in this population to provide short-term and long-term benefits.

Amount and environmental predictors of outdoor playtime at home and school: A cross-sectional analysis of a national sample of preschool-aged children attending Head Start

Outdoor play is an important contributor to children's physical activity and the prevalence, correlates, and environmental predictors of it among young children are not well characterized. This study aims to estimate the amount of time preschool-aged children attending Head Start spend playing outdoors at home and school, and whether aspects of the home and school environment are associated with greater outdoor play. We analyzed data (n=2529) collected in spring 2007 in the Head Start Family and Child Experiences Survey (FACES). Overall, 37.5% of children played outside at home >2h per weekday. Children who had a yard near home to play in or who had visited a park or playground or gone on a picnic with a family member in the last month were more likely to have >2h per weekday outdoor play at home, but having a playground within walking distance of the home was not related to home outdoor playtime. On average children played outdoors at Head Start for 36min per day. The amount of time children played outdoors at home was not related to school outdoor time.

Associations of birth weight and physical activity with sex steroids in preschool Japanese children

We aimed to assess the association of body size at birth or physical activity with sex steroid levels, independent of body mass among young children. The cross-sectional study was conducted in 2006. Subjects were 230 boys and 198 girls, aged 3-6 years. Birth weight was based on parents' reports. Questions about physical activity focused on outdoor playtime. Urinary estrone, estradiol, testosterone, and 5-androstene-3β,17α diol (3β,17α-AED) levels were measured by liquid chromatography-electrospray ionization tandem mass spectrometry. Urinary dehydroepiandrosterone level was measured with a radioimmunoassay. After adjustments for age and BMI, girls with lower birth weight had higher testosterone (trend p = 0.038) and 3β,17α-AED (trend p = 0.028). Girls with low birth weight and high birth weight had higher estrone (p = 0.014) and estradiol (p = 0.074) than those who had middle birth weight. Boys who were physically active had lower testosterone (p = 0.028) and 3β,17α-AED (p = 0.003) than those who were not active. Girls who were physically active had lower estrone (p = 0.015). Sex steroid levels in childhood might be affected by body size at birth or by physical activity during childhood. These effects might differ by sex.