(An item from the ISHN Member information service) A 2013 systematic review cited by the US-based Community Guide to Preventive Services as the basis for its recommendation that school-based physical education classes are effective in increasing student physical activity during the school day found that "Physical education (PE) that allows students to engage in moderate-to-vigorous physical activity (MVPA) can play an important role in health promotion. Unfortunately, MVPA levels in PE lessons are often very low. In this review, we aimed to determine the effectiveness of interventions designed to increase the proportion of PE lesson time that students spend in MVPA...From an initial pool of 12,124 non-duplicate records, 14 studies met the inclusion criteria. Students in intervention conditions spent 24% more lesson time in MVPA compared with students in usual practice conditions (standardized mean difference=0.62)....Given the small number of studies, moderate-to-high risk of bias, and the heterogeneity of results, caution is warranted regarding the strength of available evidence. However, this review indicates that interventions can increase the proportion of time students spend in MVPA during PE lessons." Readers will likely be interested in the listing of items in the ISHN Commentary The Value & Limits of School Physical Activity. Read more>>
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(An item from the ISHN Member information service) A multiple case history and systematic review of adoption, diffusion, implementation and impact of provincial daily physical activity (DPA) policies in Canadian schools was reported in the April 2015 Issue of BMC Public Health. "The purpose of this study was to understand the processes underlying adoption and diffusion of Canadian DPA policies, and to review evidence regarding their implementation and impact. Publicly available documents posted on the internet were reviewed to characterize adopter innovativeness, describe the content of their DPA policies, and explore the context surrounding policy adoption. Diffusion of Innovations theory provided a conceptual framework for the analyses. A systematic literature search identified studies that had investigated adoption, diffusion, implementation or impact of Canadian DPA policies. Results Five of Canada’s 13 provinces and territories (38.5%) have DPA policies. Although the underlying objectives of the policies are similar, there are clear differences among them and in their various policy trajectories. Adoption and diffusion of DPA policies were structured by the characteristics and capacities of adopters, the nature of their policies, and contextual factors. Limited data suggests implementation of DPA policies was moderate but inconsistent and that Canadian DPA policies have had little to no impact on school-aged children’s PA levels or BMI." Read more>>
(An item from the ISHN Member information service) A multi-level analysis Individual and school level correlates of moderate to vigorous physical activity among school-children in Germany was reported in the in April 2015 Issue of BMC Public Health. "We used data from the 2009/10 German Health Behaviour in School-aged Children study (HBSC)-sample (n=5,005 students aged 11–15 years) including self-reported moderate to vigorous intensity PA as well as a variety of biological, demographic and behavioral correlates and matched them with school-level data from the national school principals’ HBSC questionnaire. We analyzed the associations of individual- and school-level correlates with MVPA by gender-specific multi-level regression. Results Only a small share of the overall variation in student’s PA was attributable to the school-level. Consequently, the associations of individual-level correlates with PA were stronger than those of the school-level. Our analysis revealed significant associations of individual-level (i.e. age, consumption of softdrinks, overweight) as well as school-level correlates (i.e. the availability of a football ground and a swimming pool) with MVPA. We also observed some gender-specific findings especially for the school level correlates. Cross-level interactions between individual- and school-level were not apparent." Read more>>
(An item from the ISHN Member information service) An article in Issue #2, 2015 of Health Education Research reports on a cohort study of the adoption of obesity prevention policies and practices by Australian primary schools: 2006 to 2013. The authors reports that "The prevalence of all four of the healthy eating practices and one physical activity practice significantly increased, while the prevalence of one physical activity practice significantly decreased. The adoption of practices did not differ by school characteristics. Government investment can equitably enhance school adoption of some obesity prevention policies and practices on a jurisdiction-wide basis. Additional and/or different implementation strategies may be required to facilitate greater adoption of physical activity practices. Ongoing monitoring of school adoption of school policies and practices is needed." A slide presentation of tghe results is available here. Read more from the abstract of the article here.
(An item from the ISHN Member information service) Readers of this blog will know that ISHN has been tracking the changes in overweight/obesity among children and youth to determine if we are making any progress in preventing or reducing childhood obesity. Three articles in Supplementary Issue #2, 2015 of The European Journal of Public Health add to the ongoing observation that little progress is being made. These articles are based on trends analysis of the HBSC data in Western Europe and North America over the past decade. The article on obesity/overweight reported " Overweight prevalence increased among boys in 13 countries and among girls in 12 countries; in 10 countries, predominantly in Eastern Europe, an increase was observed for both boys and girls. Stabilization in overweight rates was noted in the remaining countries; none of the countries exhibited a decrease over the 8-year period examined. In the majority of countries (20/25) there were no age differences in trends in overweight prevalence." The second reported that "Multilevel logistic regression analyses showed an increase in daily fruit and vegetable consumption between 2002 and 2010 in the majority of countries for both genders and all three age groups" The third reported that "There was a slight overall increase in the number of youth reaching at least one hour of physical activity per day between 2002 and 2010 (17.0% and 18.6%, respectively). MVPA increased significantly (P ≤ 0.05) among boys in 16 countries. Conversely, nine countries showed a significant decrease." In our view, these results, despite considerable investments in physical activity programs and changes to school food policies, suggest that we need to reconsider our fundamental approach to address other factors such as structural/life-work circumstances, marketing of unhealthy foods and mental health considerations. Read more>>
(From the ISHN Member information service) An article in the March 2015 Issue of Preventing Chronic Disease reports on a detailed study. "We quantified the moderate-to-vigorous physical activity (MVPA, heart rate ≥140 bpm) of urban public elementary school children on school days with and schooldays without physical education (PE) class by using continuous heart rate monitoring. The heart rate of 81 students (93.8% black) in grades 3 and 5 was recorded in 15-second intervals. On the basis of 575 school-day observations (mean 7.1 days/student), students accumulated 44.4 minutes of MVPA on days with PE and 30.6 MVPA minutes on days without PE (P < .001)" On average, students accumulated 17.1 MVPA minutes during a 50-minute PE class. Recess contributed an average 5.5 MVPA minutes each school day, with no difference between days with and days without PE." These results are similar to other studies we have noted in our SH blog. The authors argue that PE should be mandatory every day based on these results. We suggest that other, less costly alternatives might be considered such as PA breaks in regular classes, more actual activity within PE classes and an expanded range of activity during recess. We also need to examine the actual health gains from these squeezed out minutes. Read more>>
(From the ISHN Member information service) A study examining the correlates of Portuguesechildren reaching the recommended 60 minutes per day of moderate or vigorous activity reveals that several factors may be beyond the reach of the school. As well, the goal of 60 minutes per day appears to be aspirational in nature. The authors report that " Physical activity (PA) was objectively assessed by accelerometry throughout seven days on 777 children. A count model using Poisson regression was used to identify the best set of correlates that predicts the variability in meeting the guidelines. Only 3.1% of children met the recommended daily 60 min of MVPA for all seven days of the week. Further, the Cochrane–Armitage chi-square test indicated a linear and negative trend (p < 0.001) from none to all seven days of children complying with the guidelines. The count model explained 22% of the variance in meeting MVPA guidelines daily. Being a girl, having a higher BMI, belonging to families with higher income, sleeping more and taking greater time walking from home to a sporting venue significantly reduced the probability of meeting daily recommended MVPA across the seven days. Furthermore, compared to girls, increasing sleep time in boys increased their chances of compliance with the MVPA recommendations. These results reinforce the relevance of considering different covariates’ roles on PA compliance when designing efficient intervention strategies to promote healthy and active lifestyles in children." Read More>>
(From the ISHN Member information service) An excellent illustration of a procedure to select evidence-based interventions to promote health is described in Issue #1, 2015 of Environmental Health Review. ISHN recommends the use of this type of planning tool but also suggests that, despite the rigour within this procedure used to select relevant research on better practices, other steps need to be taken to test our underlying assumptions before we begin as well as use our common sense in assessing the fit between the planned intervention and our local context, especially in regards to likely barriers that may be prevalent in our local communities, states or countries.
The illustration used in the journal article is focused on an urban setting, wherein the public health practitioners are looking for urban planning interventions to increase physical activity among children and adults in the community in response to rising obesity rates. The article takes the reader through several planning steps to identify such urban planning tools, eventually pointing to a credible research review published by the CDC in the United States that suggest that "Community-scale urban design and land-use regulations, policies, and practices" such as zoning regulations and building codes, and environmental changes brought about by government policies or builders’ practices. The latter include policies encouraging transit-oriented development, and policies addressing street layouts, the density of development, the location of more stores, jobs and schools within walking distance of where people live as well as "street-scale urban design and land use approaches" in small geographic areas, generally limited to a few blocks, such as improved street lighting or infrastructure projects that increase the ease and safety of street crossing, ensure sidewalk continuity, introduce or enhance traffic calming such as center islands or raised crosswalks, or enhance the aesthetics of the street area, such as landscaping can improve levels of physical activity. Once these two types of interventions are identified in the procedure, the remaining steps suggest the involvement of stakeholders, program development and building in evaluation and feedback mechanisms. One section of the procedure suggests "Assessing Applicability and Transferability of Evidence" but the focus in that section is on how the knowledge about the intervention can be transferred successfully to policy-makers and practitioners and mentions real-barriers related to feasibility such as costs, resources and other practical factors only briefly. We suggest here that this excellent illustration of a procedure to select an intervention to address a problem needs to be accompanied by at least three other processes. The first of these is to test our assumptions about the type of outcome we are seeking. The illustration in this article, where the fictional planners decide in advance that increased physical activity can prevent or reduce obesity and overweight is actually reflective of many real-life planners, who have done the same. The trouble is that there is increasing evidence, including from sources such as the CDC and the centre which has published this guide to selecting interventions, that increased physical activity alone, will have little impact on body weight unless it is very intense, well beyond the scope of the average person. The second process we suggest is a real hard look at the resources available in the community or organization. The research reviews identified in the article did note these barriers in their study. The barriers to community scale interventions include "1) changing how cities are built given that the urban landscape changes relatively slowly, 2) zoning regulations that preclude mixed-use neighborhoods, 3) cost of remodeling/retrofitting existing communities, 4) lack of effective communication between different professional groups (i.e., urban planners, architects, transportation engineers, public health professionals, etc.), and 5) changing behavioral norms directed towards urban design, lifestyle, and physical activity patterns" The real world barriers to street scale changes include: "the expense of changing existing streetscapes. In addition, street-scale urban design an land use policies require careful planning and coordination between urban planners, architects, engineers, developers, and public health professionals. Success is greatly enhanced by community buy-in, which can take time and effort to achieve. Inadequate resources and lack of incentives for improving pedestrian-friendliness may affect how completely and appropriately interventions are implemented and evaluated". The article suggests that the local context is an established urban setting. In most established cities, it is very difficult to make major changes in existing neighbourhoods, especially in these days where priority concerns might very well be crime, traffic and aging infrastructure. This real world observation leads us to the third major consideration that should be used in conjunction with this procedure to select evidence-based interventions. The third consideration needs to be an in-depth understanding of the core mandates, constraints and current concerns of the system that will carry the major part of the burden in implementing the intervention. In this case, it is the municipality. There are lots of examples of how such systems analysis can be done, but we close this ISHN Commentary with an appropriate example, also found by the same centre that has created this procedure for identifying evidence-based interventions. This systems planning guide that they suggest is from the province of Alberta, which suggests that program planners consider the characterisitcs of the system that will will host the intervention. These include the leadership, organization "slack" in committed vs available resources, staffing, time for implementation and more. In school health promotion, ISHN is pleased to be pat of a global dialogue being led by educators in regards to how health and social programs can be better integrated within education systems. We suggest that before we select an intervention from the research, we seek to truly understand the system that will carry the intervention over the long term. We also suggest we look closely ar practical barriers and that we check our assumptions. Read more>> (From the ISHN Member information service) An article in the March 2015 issue of Public Health Nutrition suggests that calorie focused thinking in regards to obesity "may mislead and harm public health". Prevailing thinking about obesity holds that quantifying calories should be a principal target for intervention. Part of this thinking is that consumed calories – regardless of their sources – are equivalent; . The article discusses various problems with the idea that ‘a calorie is a calorie’ and with a primarily quantitative focus on food calories. The authors argue for a greater qualitative focus on types of foods) and on the metabolic changes that result from consuming foods of different types. In particular, the authors consider how calorie-focused thinking is inherently biased against high-fat foods, many of which may be protective against obesity and related diseases, and supportive of starchy and sugary replacements, which are likely detrimental. Shifting the focus to qualitative food distinctions, a central argument of the paper is that obesity and related diseases are problems due largely to food-induced physiology (e.g. neurohormonal pathways) not addressable through arithmetic dieting (i.e. calorie counting). The paper considers potential harms of public health initiatives framed around calorie balance sheets – targeting ‘calories in’ and/or ‘calories out’ – that reinforce messages of overeating and inactivity as underlying causes, rather than intermediate effects, of obesity. Finally, the paper concludes that public health should work primarily to support the consumption of whole foods that help protect against obesity-promoting energy imbalance and metabolic dysfunction and not continue to promote calorie-directed messages that may create and blame victims and exacerbate epidemics of obesity and related diseases." Read more>>
(From the ISHN Member information service) The WHO fact sheet describing the response of health ministries to prevent and control NCDs indicates the collective, global intentions and strategies. The ideas and actions not mentioned on the page and in the action plan are as important as the ones that are highlighted. WHO summarizes the actions needed as follows:
" To lessen the impact of NCDs on individuals and society, a comprehensive approach is needed that requires all sectors, including health, finance, foreign affairs, education, agriculture, planning and others, to work together to reduce the risks associated with NCDs, as well as promote the interventions to prevent and control them. An important way to reduce NCDs is to focus on lessening the risk factors associated with these diseases. Low-cost solutions exist to reduce the common modifiable risk factors (mainly tobacco use, unhealthy diet and physical inactivity, and the harmful use of alcohol) and map the epidemic of NCDs and their risk factors. Other ways to reduce NCDs are high impact essential NCD interventions that can be delivered through a primary health-care approach to strengthen early detection and timely treatment. Evidence shows that such interventions are excellent economic investments because. The greatest impact can be achieved by creating healthy public policies that promote NCD prevention and control and reorienting health systems. Lower-income countries generally have lower capacity for prevention and control. Countries with inadequate health insurance coverage are unlikely to provide universal access to essential NCD interventions". Our initial comments: (1) The WHO is clearly medical, focused on health services rather than health promotion. (2) The absence of disease is the goal rather than overall health. (3) Other sectors are expected to be partners but a settings-based approach, essential to these partnerships, is neglected and forgotten. Read more>> |
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