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The Intervention Level Framework: Using systems thinking to address the complexity of childhood obesity prevention
abstract
produits céréaliers, souvent riches en sucres et en gras saturés étaient vendus dans 76 % des écoles primaires, 97 % des écoles secondaires publiques et 64 % des écoles secondaires privées. Le pain blanc et les craquelins raffinés sont plus fréquents que les grains entiers. conclusion : La Politique-cadre pour une alimentation saine et un mode de vie physiquement actif lancée en 2007 pourrait supporter les améliorations nécessaires au regard de l’environnement alimentaire surtout l’offre de grignotines, de desserts et de collations. 238 child care: Implications for overweight/ obesity in canadian children? L. McLaren1, M. Zarrabi1, D. Dutton1, M. C. Auld2, and J.C. Herbert Emery1,2 Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; 2Department of Economics, University of Calgary, Calgary, Alberta, Canada 1
Introduction: Over recent decades, two prominent trends have been observed in Canada and elsewhere: an increasing prevalence of childhood obesity, and increasing participation of women (including mothers) in the paid labour force and resulting demand for child care options. Our objective was to examine the association between exposure to different types of child care and subsequent change in body mass index in children. Methods: Using data from Canada’s National Longitudinal Survey of Children and Youth, we examined exposure to five types of care at age 2/3 in relation to change in BMI percentile (continuous and categorical) between age 2/3 and 6/7 (and, secondarily, between age 2/3 and 10/11), adjusting for health and socio-demographic covariates. results: For girls, care in another’s home by a relative (e.g., grandparent’s house) was associated with a decrease in BMI over time. For boys, this type of care was associated with an increase in BMI, though the effect varied by household income status. Other forms of care associated with adverse BMI outcomes include care in own home by a relative (girls), care in a day care centre (girls), and care in other’s home by a non-relative (boys). conclusions: Considering the importance of the preschool-age period for an array of health and social outcomes, continued research on the implications of various forms of care for weight-related outcomes is important, particularly in regimes such as Canada where child care is left to the market and many families must rely on informal care options. 239 Food environments, healthy eating education, and healthy eating programs in canadian schools R.E. Laxer1, W. Pickett2, and I. Janssen3 1 School of Kinesiology and Health Studies, Queen’s University, Kingston, Ontario, Canada; 2Clinical Research Unit, Kingston General Hospital, Kingston, Ontario, Canada; 3School of Kinesiology and Health Studies, Queen’s University, Kingston, Ontario, Canada background: The food environment, healthy eating education, and healthy eating programs in schools may impact obesity by influencing children’s dietary habits. Currently, little is known about these school features at the national level. Objectives: To describe food environments, healthy eating education, and healthy eating programs in Canadian schools, and to report variations based on geographic status and grade. Methods: 407 schools from across Canada involved in the 2009/2010 Health Behaviour in School-Aged Children Survey were studied. An administrator from each school completed a questionnaire that contained 11 questions on the food environment, five questions about healthy eating education, and nine questions about healthy eating programs. Summary scores for the three domains were created. results: The percentage of schools with favourable responses on the
11 food environment questions ranged from 24% (fast food restaurant located close to school) to 81% (do not have vending machines with chips or candy). The percentage of schools that offered the five healthy eating education initiatives ranged from 26% (visit to farmer’s markets) to 67% (media literacy programs on healthy eating). The percentage of schools that offered the nine healthy eating programs ranged from 16% (junk food-free days) to 64% (committee that oversees nutrition policies). Primary schools had more favourable food environments than secondary schools. No urban/rural gradients were observed in the summary scores of the three domains. conclusions: This study demonstrates that there is significant room for improvement in food environments, healthy eating education, and healthy eating programs in Canadian schools. 240 the Intervention Level Framework: Using systems thinking to address the complexity of childhood obesity prevention L.M. Johnston, C.L. Matteson; and D.T. Finegood Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada Introduction: While there is growing support for integrating complex systems thinking into childhood obesity prevention and policy-making, approaches favouring individual and environmental interventions persist. We synthesized a subset of recommendations made by and for governments on childhood obesity according to our Intervention Level Framework, and analyzed the data to identify opportunities for further integration of complexity science in policy-making. Methods: Three hundred and seventy-one recommendations were obtained from eight documents produced either by or for local or national governments in Canada (4), the U.S. (2), England (1), and Australia (1). Data were coded by two researchers according to the five levels of the intervention level framework. Intercoder agreement for coding was high (98%). results: The majority of recommendations occur at the level of “structural elements,” where activities are easiest to implement and can have high impact on local systems, but not on change in the system overall. There are relatively few recommendations made at the levels of “feedback and delays” and “system structure.” These levels relate most to the flow of information across the system, and linkages between subsystems. In examining the low number of “goals,” we found that they were not always operationalized, but rather stated elsewhere in the text. conclusion: Relatively low distribution in the areas of “feedback and delays” and “system structure” suggest points of possible intervention for increasing the capacity of policy-making to address the complex problem of childhood obesity. Funding: This work was funded by Canadian Institutes of Health Research (MT-10574). 241 One size fits all? smoking status may influence weight management M.J. Abunassar1, and R.R. Dent2 University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada; 2 The Ottawa Hospital Weight Management Clinic, Ottawa, Ontario, Canada
1
Introduction: We previously discovered that smoking status is associated with patient motivation for weight management. The aim of this study was to investigate differences in program outcomes for 3,181 weight-management program patients based on smoking status. Methods: The Weight Management Clinic at the Ottawa Hospital has a behavioural program consisting of a year-long course in lifestyle modification with a meal replacement for the first 12 weeks. Between September 1992 and March 2009, 3,181 patients started this program.
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produits céréaliers, souvent riches en sucres et en gras saturés étaient vendus dans 76 % des écoles primaires, 97 % des écoles secondaires publiques et 64 % des écoles secondaires privées. Le pain blanc et les craquelins raffinés sont plus fréquents que les grains entiers. conclusion : La Politique-cadre pour une alimentation saine et un mode de vie physiquement actif lancée en 2007 pourrait supporter les améliorations nécessaires au regard de l’environnement alimentaire surtout l’offre de grignotines, de desserts et de collations. 238 child care: Implications for overweight/ obesity in canadian children? L. McLaren1, M. Zarrabi1, D. Dutton1, M. C. Auld2, and J.C. Herbert Emery1,2 Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; 2Department of Economics, University of Calgary, Calgary, Alberta, Canada 1
Introduction: Over recent decades, two prominent trends have been observed in Canada and elsewhere: an increasing prevalence of childhood obesity, and increasing participation of women (including mothers) in the paid labour force and resulting demand for child care options. Our objective was to examine the association between exposure to different types of child care and subsequent change in body mass index in children. Methods: Using data from Canada’s National Longitudinal Survey of Children and Youth, we examined exposure to five types of care at age 2/3 in relation to change in BMI percentile (continuous and categorical) between age 2/3 and 6/7 (and, secondarily, between age 2/3 and 10/11), adjusting for health and socio-demographic covariates. results: For girls, care in another’s home by a relative (e.g., grandparent’s house) was associated with a decrease in BMI over time. For boys, this type of care was associated with an increase in BMI, though the effect varied by household income status. Other forms of care associated with adverse BMI outcomes include care in own home by a relative (girls), care in a day care centre (girls), and care in other’s home by a non-relative (boys). conclusions: Considering the importance of the preschool-age period for an array of health and social outcomes, continued research on the implications of various forms of care for weight-related outcomes is important, particularly in regimes such as Canada where child care is left to the market and many families must rely on informal care options. 239 Food environments, healthy eating education, and healthy eating programs in canadian schools R.E. Laxer1, W. Pickett2, and I. Janssen3 1 School of Kinesiology and Health Studies, Queen’s University, Kingston, Ontario, Canada; 2Clinical Research Unit, Kingston General Hospital, Kingston, Ontario, Canada; 3School of Kinesiology and Health Studies, Queen’s University, Kingston, Ontario, Canada background: The food environment, healthy eating education, and healthy eating programs in schools may impact obesity by influencing children’s dietary habits. Currently, little is known about these school features at the national level. Objectives: To describe food environments, healthy eating education, and healthy eating programs in Canadian schools, and to report variations based on geographic status and grade. Methods: 407 schools from across Canada involved in the 2009/2010 Health Behaviour in School-Aged Children Survey were studied. An administrator from each school completed a questionnaire that contained 11 questions on the food environment, five questions about healthy eating education, and nine questions about healthy eating programs. Summary scores for the three domains were created. results: The percentage of schools with favourable responses on the
11 food environment questions ranged from 24% (fast food restaurant located close to school) to 81% (do not have vending machines with chips or candy). The percentage of schools that offered the five healthy eating education initiatives ranged from 26% (visit to farmer’s markets) to 67% (media literacy programs on healthy eating). The percentage of schools that offered the nine healthy eating programs ranged from 16% (junk food-free days) to 64% (committee that oversees nutrition policies). Primary schools had more favourable food environments than secondary schools. No urban/rural gradients were observed in the summary scores of the three domains. conclusions: This study demonstrates that there is significant room for improvement in food environments, healthy eating education, and healthy eating programs in Canadian schools. 240 the Intervention Level Framework: Using systems thinking to address the complexity of childhood obesity prevention L.M. Johnston, C.L. Matteson; and D.T. Finegood Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada Introduction: While there is growing support for integrating complex systems thinking into childhood obesity prevention and policy-making, approaches favouring individual and environmental interventions persist. We synthesized a subset of recommendations made by and for governments on childhood obesity according to our Intervention Level Framework, and analyzed the data to identify opportunities for further integration of complexity science in policy-making. Methods: Three hundred and seventy-one recommendations were obtained from eight documents produced either by or for local or national governments in Canada (4), the U.S. (2), England (1), and Australia (1). Data were coded by two researchers according to the five levels of the intervention level framework. Intercoder agreement for coding was high (98%). results: The majority of recommendations occur at the level of “structural elements,” where activities are easiest to implement and can have high impact on local systems, but not on change in the system overall. There are relatively few recommendations made at the levels of “feedback and delays” and “system structure.” These levels relate most to the flow of information across the system, and linkages between subsystems. In examining the low number of “goals,” we found that they were not always operationalized, but rather stated elsewhere in the text. conclusion: Relatively low distribution in the areas of “feedback and delays” and “system structure” suggest points of possible intervention for increasing the capacity of policy-making to address the complex problem of childhood obesity. Funding: This work was funded by Canadian Institutes of Health Research (MT-10574). 241 One size fits all? smoking status may influence weight management M.J. Abunassar1, and R.R. Dent2 University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada; 2 The Ottawa Hospital Weight Management Clinic, Ottawa, Ontario, Canada
1
Introduction: We previously discovered that smoking status is associated with patient motivation for weight management. The aim of this study was to investigate differences in program outcomes for 3,181 weight-management program patients based on smoking status. Methods: The Weight Management Clinic at the Ottawa Hospital has a behavioural program consisting of a year-long course in lifestyle modification with a meal replacement for the first 12 weeks. Between September 1992 and March 2009, 3,181 patients started this program.
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