Using a representative sample of elementary school students to determine the statewide prevalence of childhood overweight and obesity in Utah.
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Utah's Height and Weight Measurement Project was conducted with elementary school students periodically from 2002 to 2008. The 2002 pilot project was performed to establish variability rates between schools and within schools. It allowed us to accurately determine both the sample size and the number of schools that were required to calculate a reliable statewide estimate based on a random sample of schools and to establish sentinel grades. The sentinel grades identified were grades 1, 3, and 5. Use of randomly selected classes in the sentinel grades resulted in decreased sample size and less school disruption while maintaining sufficient precision. Standardized, calibrated equipment was purchased and given to school nurses for safekeeping. Lessons learned included establishing strong relationships with partners, especially school nurses, and obtaining support from upper management at the schools, school districts, and the Utah Department of Health. A significant difference in participation rates and obesity rates at the individual school level was observed depending on parental consent type; active consent was associated with lower student participation rates and lower observed obesity rates. Data were presented to both participating and nonparticipating schools, school nurses, district superintendents, and principals. For surveillance purposes, sampling is an efficient, cost-effective way to estimate childhood overweight and obesity rates.Keywords:
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Adolescent Obesity
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Reliable measures of growth in children are necessary for planning and evaluating obesity prevention programs. Currently, measured growth data are unavailable in Calgary for school-age children. This single sample, cross-sectional study included Grade 5 students and their parents. Height and weight measurements of 305 students (68% of those eligible) were taken in private in June 2007 and converted to Body Mass Index (BMI) categories. All but one student (99.7%) completed a questionnaire assessing perceptions of the measurement process. Parents received their child’s growth data, an information package on healthy eating and active living, additional resources, and a questionnaire. A third of parents completed the questionnaire. Most students (94.1%) reported feeling “OK” or “Happy” about being measured. In addition, 93.2% of parents reported having “Low” or “Neutral” concerns about the measurement. Furthermore, 28.1% of responding parents reported seeking additional resources or considered making a lifestyle change for their family following the pilot. Measurement of students completed in private by nurses was acceptable to participants.
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To address childhood obesity, several states and local school districts across the United States have adopted body mass index (BMI) measurement initiatives. This descriptive case study explored psychosocial, environmental, and behavioral factors among parents of sixth-grade students who received BMI Health Letters (BMIHLs) in one Florida County. A nonexperimental postintervention design was employed to gather quantitative data via self-report Likert-type questionnaire. Participants were parents/guardians of sixth-grade students attending one Hillsborough County public middle school ( n = 76). Results indicate three main findings: (a) most parents in this study (67.4%) who discussed the BMIHL with their child reported their child as “very” or “somewhat” uncomfortable with the discussion; (b) some parents of normal weight (NW) children responded by taking their child to a medical professional to control their weight; and (c) more parents of at risk of overweight/overweight (AR/OW) children (vs. NW) reported greater concern about their child’s weight, using food restriction and physical activity to control their child’s weight, and giving negative weight-related comments/behaviors. This case study illustrates the importance of adapting and tailoring state mandated BMIHLs for parents based on child’s BMI status.
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Abstract Research Objective Children and adolescents residing in rural environments with higher prevalence of an overweight population may develop inaccurate perceptions of a healthy weight. This study examines rural‐urban differences in perceptions of child overweight among overweight (85 ≤ BMI percentile < 95) and obese children (BMI percentile ≥ 95), their guardians and health care providers (HCPs), and children's concomitant weight control. Methods The cross‐sectional study was based on the 2005‐2010 NHANES data (1,844 overweight and obese children and adolescents, aged 8‐15 years). Rurality was defined using the 2003 RUCC. The weight status was based on the standardized measures of children's height and weight. Children reported whether they considered themselves overweight and whether they were trying to lose weight. Proxy respondents (ie, guardians) reported whether they considered their child to be overweight and whether an HCP had ever told them their child was overweight. Weighted percentages and predicted probabilities from multivariable logistic regressions were calculated, accounting for the complex, multistage, probability sampling design and nonresponse. Findings Rural residents comprised 18.8% of the study population; 41.8% of them were overweight and 58.2% were obese compared to 46.7% and 53.3% of urban peers, respectively. Misperceptions of children's weight status were 11.3 and 6.0 percentage points higher in rural children and their guardians, respectively. Recall of an HCP identification of child overweight was 6.3 percentage points lower among rural versus urban guardians. Conclusion Obesity prevention efforts may be fostered by improving accuracy of child overweight perceptions. This may be particularly impactful in rural settings, where weight misperceptions are high.
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We examined the health lit- eracy status of high school students in Kerman, Iran.This descriptive cross-sectional study was conducted at high schools in Kerman. Data concerning 3 dimensions of health literacy (health knowledge, health skills and health be- haviors) were collected from 312 students using an adapted version of a valid and reliable questionnaire developed by the Ministry of Health of China. Data analysis was performed by descriptive statistics and chi-square analysis using SPSS version 22.The average age of the students was 16 ± 3 years and 50% (N = 156) of them were girls. Twenty-nine percent of students gained a health literacy score between 37 and 47 (adequate). A statistically significant relationship was found between health literacy and type of school (p < .004), family income (p < .03), and parents' education level (p < .001).A large percentage of adolescents in Iran have inadequate health literacy requiring serious interventions by authorities and policy-makers. Incorporating subjects such as mental health, prevention of addiction, and puberty and sexual health into educational curricula can improve Iranian students' health literacy.
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Methods and representativeness of a European survey in children and adolescents: the KIDSCREEN study
Abstract Background The objective of the present study was to compare three different sampling and questionnaire administration methods used in the international KIDSCREEN study in terms of participation, response rates, and external validity. Methods Children and adolescents aged 8–18 years were surveyed in 13 European countries using either telephone sampling and mail administration, random sampling of school listings followed by classroom or mail administration, or multistage random sampling of communities and households with self-administration of the survey materials at home. Cooperation, completion, and response rates were compared across countries and survey methods. Data on non-respondents was collected in 8 countries. The population fraction (PF, respondents in each sex-age, or educational level category, divided by the population in the same category from Eurostat census data) and population fraction ratio (PFR, ratio of PF) and their corresponding 95% confidence intervals were used to analyze differences by country between the KIDSCREEN samples and a reference Eurostat population. Results Response rates by country ranged from 18.9% to 91.2%. Response rates were highest in the school-based surveys (69.0%–91.2%). Sample proportions by age and gender were similar to the reference Eurostat population in most countries, although boys and adolescents were slightly underrepresented (PFR <1). Parents in lower educational categories were less likely to participate (PFR <1 in 5 countries). Parents in higher educational categories were overrepresented when the school and household sampling strategies were used (PFR = 1.78–2.97). Conclusion School-based sampling achieved the highest overall response rates but also produced slightly more biased samples than the other methods. The results suggest that the samples were sufficiently representative to provide reference population values for the KIDSCREEN instrument.
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Abstract In this study, we examined and compared findings from four nationally representative studies of victimization of students by school staff in Israel. We explored whether levels of student victimization by school staff (teachers, principals, secretaries, janitors, etc.) have changed between 1998, 1999, 2002, and 2005, and whether patterns of group differences (gender, age, and cultural groups) were replicated across those four points in time. We employed representative samples stratified by ethnic affiliation and school levels. In 1998, there were 15,916 4th–11th grade students from 232 schools; in 1999, 16,414 4th–11th grade students from 239 schools; in 2002, 21,577 4th–11th grade students from 410 schools and in 2005, 27,316 4th–11th grade students from 526 schools across Israel. Overall, the results reveal that for the entire student population in Israel reports of victimization are quite similar across the four waves of data collection. Levels of physical victimization were consistently higher among boys and Arab students, but other group differences were less consistent, especially with regard to differences between age groups. Aggr. Behav. 34:1–8, 2008. © 2007 Wiley‐Liss, Inc.
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Participation rate and response rate are key issues in a cross sectional large-scale epidemiological study. The objective of this paper is to describe the study population and to evaluate participation and response rate as well as the key nutritional status variables in male and female adolescents involved in the HELENA study.A multi-stage random cluster sampling with a target sample of 3000 adolescents aged [12.5 to 17.5] years, stratified for geographical location and age, was carried out. Information for participants and non-participants (NP) was compared, and participation and response rates to specific questionnaires were discussed.3,865 adolescents aged [12.5 to 17.5] years (1,845 females) participated in the HELENA study, of whom 1,076 (568 females) participated in the blood sampling. 3,528 (1,845 females) adolescents were finally kept for statistical analysis. Participation rates for the schools and classes differed importantly between countries. The participation rate of pupils within the participating classes also differed importantly between countries. Sex ratio, mean age and BMI were similar between NP and participating adolescents within each centre, and in the overall sample. For all the questionnaires included in the database, the response rate of questionnaires was high (more than 80% of questions were completed).From this study it could be concluded that participation rate differed importantly between countries, though no bias could be identified when comparing the key study variables between participants and non-participants. Response rate for questionnaires was very high. Future studies investigating lifestyle and health in adolescents can optimize their methods when considering the opportunities and barriers observed in the HELENA study.
Stratified Sampling
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Abstract Improving nutrition knowledge, one determinant of dietary behavior, is a national health priority for adults and youth. Whereas sophisticated national surveillance systems have been established to monitor adult and youth cardiovascular risk factors and dietary habits as well as adults' nutrition knowledge, less attention has been given to monitoring knowledge levels in youth. This article reports development of two nutrition knowledge scales, one for grades two through three and the second for grades four through six, which were administered to a nationally representative sample of 3,107 youth from 129 schools. Internal consistency for the two scales exceeded conventional acceptability criteria for each major gender, ethnic, and geographic group surveyed, and the instrument appears viable for a large proportion of U.S. youth. Results indicate significant nutrition knowledge gaps among U.S. children, and several groups with excess knowledge deficits were identified. The instrument, and results reported herein, can serve as the basis for a national nutrition knowledge monitoring system, as well as a needs assessment and program evaluation tool for practitioners.
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Nutrition Education
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