Child and Adolescent Physical Activity and Nutrition (CAPANS) Survey: 2008 Final Report

Transcription

1 Move and Munch Final Report Trends in physical activity, nutrition and body size in Western Australian children and adolescents: the Child and Adolescent Physical Activity and Nutrition Survey (CAPANS) 2008

2 Move and Munch Trends in physical activity, nutrition and body size in Western Australian children and adolescents: the Child and Adolescent Physical Activity and Nutrition Survey (CAPANS) 2008 Final Report Page i

3 CONTRIBUTION AND ACKNOWLEDGEMENTS Project management team Physical activity consultants Nutrition consultants Report writers Report background contribution Project coordinator Field-work coordinator Child consent coordinator Team leaders Field team Work experience staff Staff Training Manual Food Coding Manual Physical activity coders Food coders Data entry Data merging Statistics consultant Data analysis PATF Evaluation and Monitoring Working Group PATF Project Manager Funding Providers Page ii Dr Karen Martin (Project Manager), Edith Cowan University/The University of Western Australia, Associate Professor Michael Rosenberg, The University of Western Australia, Margaret Miller, Edith Cowan University Professor Fiona Bull, The University of Western Australia Professor Billie Giles-Corti, The University of Western Australia Dr Gavin McCormack, University of Calgary Steve Pratt, Cancer Council Dr Amanda Devine, Edith Cowan University Dr Anthea Magarey, Flinders University Dr Karen Martin, Sarah French, Associate Professor Michael Rosenberg, Margaret Miller Joanne Evans Stephanie McFaull Jennifer Tartaglia Bree Shields Dane Waters, Mark Miraudo, Natasha Hale, Claire South Gill Aston, Lisa Bennett, Nancy Lee Boultbee, Fabienne Byrne, Michael Clow, Laura Drummy, Amy Ekin, Lynda Enright, Amy Fairburn, Natalie Harold, Sun Leong, Daniela Miloseski, Melanie Oddy, Hannah Pierce, Jenny Paul, Sian Pulham, Hayley Saunders, Lisa Shuttleton, Sharon Slater, Catie Stephenson, Nao Suzuki, Claire Thomson, Jessica Truong, Karyn West, Carole Holywel, Gemma Whitman. Hannah Pierce, Melissa Burford, Danica Keric Dr Karen Martin, Stephanie McFaull Margaret Miller, Stephanie McFaull Bree Shields (Coordinator), Natasha Hale, Dane Waters, Claire South, Laura Drummy, Nancy Lee Boultbee, Hannah Pierce Stephanie McFaull (Coordinator), Mark Miraudo, Karen West, Nicole Steele, Dionne Marshall Axis Data Jonathon Kur Professor Max Bulsara, Notre Dame University Sarah French, Dr Karen Martin Rex Milligan, Steve Pratt, Geoffrey Jalleh Jo Davies (previously Jennifer Riatti and Graeme Webb) Healthway, Department of Education and Training, Department of Health, Department of Planning and Infrastructure, Department of Sport and Recreation.

4 SUGGESTED CITATION Martin, K., Rosenberg, M., Miller, M., French, S., McCormack, G., Bull, F., Giles-Corti, B., Pratt, S. Move and Munch Final Report. Trends in physical activity, nutrition and body size in Western Australian children and adolescents: the Child and Adolescent Physical Activity and Nutrition Survey (CAPANS) Any enquiries regarding this publication should be directed to Physical Activity Taskforce Secretariat, Department of Sport and Recreation, PO Box 329, Leederville, Western Australia, Government of Western Australia There is no objection to the publication being copied in whole or in part provided there is due acknowledge of any material quoted from the publication. ISBN: This report is available at Published by the Western Australian Government Page iii

5 MINISTER S FOREWORD Sufficient physical activity and a nutritious diet are vital for the growth and development of healthy active children. With declining physical activity levels, changing recreation activity patterns and many unhealthy food options, it is important we have an understanding of what our children do and eat, to encourage healthy growth into adulthood. To monitor the activity levels and dietary behaviours of Western Australian children, the 2008 Child and Adolescent Physical Activity and Nutrition Survey (CAPANS) was commissioned by the Physical Activity Taskforce. This followed a previous survey from 2003, which alarmed authorities by identifying one in four children as above a healthy weight. Since the 2003 survey, national physical activity guidelines have been released on the amount of physical activity that children and adolescents need for good health, as well as the maximum amount of screen-based leisure they should engage in. CAPANS 2008 measures against these new national guidelines, as well as provides comparisons to the previous survey results. Of concern, CAPANS 2008 shows that more than half of Western Australian children are at risk of health problems as adults because they are still not participating in enough healthy activities. The key findings show the majority of children are not active enough and many are not eating enough fruit and vegetables. This behaviour usually worsened into adolescence. The research also shows the level of overweight and obesity has not changed since Therefore, one in four Western Australian children remain above a healthy weight. While these levels remain unacceptably high, we should be encouraged that efforts to encourage healthy behaviours in young people appear to have had some positive effects. There is also good news with significant increases in the proportion of secondary school students actively commuting home from school. There are also positive nutrition findings, with increases in consumption of healthier food choices, accompanied by decreases in consumption of unhealthier food choices. Under the guidance of the Taskforce, it is vital that research such as CAPANS continues to monitor physical activity and nutrition amongst children and adolescents so that, the outcomes of policies and programs can be monitored and our successes celebrated. Terry Waldron MLA Minister for Sport and Recreation Page iv

6 EXECUTIVE SUMMARY INTRODUCTION Optimising the health of Australian youth is a national priority, and the increasing evidence suggesting children s health behaviour transitions into adulthood 1, 2 reinforces the importance of investing in childhood health promotion programs. Addressing Australian children s declining physical activity participation, the quality of dietary intake and high levels of overweight and obesity requires a multi-faceted and multi-sectoral approach. Australian Physical Activity Recommendations suggest that children 3 and adolescents 4 participate in a minimum of 60 minutes, and up to several hours, of moderate to vigorous intensity physical activity every day, and that children accumulate no more than two hours screen time for entertainment each day. The Dietary Guidelines for Children and Adolescents 5 and the Australian Guide to Healthy Eating 6 provide guidance on the types and amounts of foods that should be included in the typical daily diet to meet recommended nutrient intakes and to promote good health. Recent evidence 7 suggests that a large proportion of Australian children and adolescents are not meeting these recommendations. In Western Australia, the first Child and Adolescent Physical Activity and Nutrition Survey (CAPANS) commissioned by the Premier s Physical Activity Taskforce was completed in A repeat study was commissioned by the Physical Activity Taskforce and completed by a team of researchers from Edith Cowan University and the University of Western Australia in This report builds on the CAPANS 2008 Key Findings report released in December METHODS The target population was Western Australian children and adolescents in the primary school years three, five, and seven (referred to throughout as primary school children ), and secondary school years eight, ten and 11 (referred to throughout as secondary school children ). No year seven children attending secondary school were sampled. The sample was structured to obtain proportional representation according to Western Australia s population figures. The Australian Centre for Education Research selected the school samples in both years using systematic random sampling from the total Western Australian government and non-government funded school population of; primary metropolitan, primary non-metropolitan, secondary metropolitan, and secondary non-metropolitan. In 2008, 46% of selected schools agreed to participate in the study, compared with of schools approached for the 2003 survey. Data were collected during terms three and four of the Western Australian school year (i.e. from July to December) in both the 2003 and 2008 surveys. In 2008 an overall child response rate of 58.8% was achieved, with response rates of 79.5% for primary school children and 46.2% for secondary school children. In 2003, the overall child response rate was 55.8%, with response rates at primary and secondary schools of 58.8% and 52.1% respectively. Page v

7 In 2008 and 2003, children could participate in one or more of the three survey components: 1) Physical Activity Questionnaire and pedometer record; 2) 24-hour Food Diary and Food Frequency Questionnaire; and/or 3) Anthropometric measurements (including height, weight, waist, umbilicus and hip measures). Small participant numbers of children aged seven and 17 in selected year groups resulted in their removal from the 2008 and 2003 samples. Descriptive results were weighted to the Western Australian population by sex (when appropriate), age and home neighbourhood socio-economic status (SES) derived from the Australian Socio- Economic Index For Areas (SEIFA) with population data derived from 2006 Australian Census data. 8 All statistical analyses of differences between proportions and means have been adjusted for sex, age, home neighbourhood SES and school level clustering. Statistical significance was determined at the level of RESULTS Physical activity Self-report overall physical activity In 2008, less than one-half (41.2%) of the primary school boys surveyed reported participating in a daily 60 minutes or more physical activity (Australia s Physical Activity Recommendations 3 ) on all of the last seven days. However, this was a significantly greater proportion than the 27.4% of primary school girls surveyed who participated in 60 minutes or more of daily physical activity on all of the last seven days. Only one in ten (10.1%) of the secondary school girls surveyed reported doing 60 minutes or more of daily physical activity on all of the last seven days (Australia s Physical Activity Recommendations 4 ) in This was significantly less than the one-third (37.6 %) of secondary school boys surveyed who reported participating in 60 minutes or more of daily physical activity on all of the last seven days. Slightly more than one-third of primary school children surveyed recorded the recommended pedometer step counts 9 in both 2008 (37.7%) and 2003 (36.6%). Sport, exercise, dance and active play Primary school boys surveyed reported jogging/running (77.7%) and movement-based video games (70.6%) as their most common sport/exercise/dance and active play activities in The most common sport/exercise/dance and active play activities in 2008 for primary school girls surveyed were jogging/running (75.6%) and playing with pets (74.7%). Basketball was the most commonly reported (50.5%) sport/exercise/dance activity and movement-based video games the most prevalent (43.2%) active play activity in 2008 for secondary school boys surveyed. In 2008, the most common sport/exercise/dance and active play activities for secondary school girls surveyed were walking for exercise (52.7%) and playing with pets (46.5%). Page vi

8 School physical education Around two-thirds of primary school children surveyed reported quite often or always being very active during physical education in 2008 (boys: 61.6%, girls: 63.9%) and 2003 (boys: 70., girls: 70.6%). Although the proportions were lower in 2008 there were no significant differences between survey years. Around three-quarters of secondary school boys surveyed reported being very active quite often or always during physical education in 2008 (77.1%) and 2003 (71.8%). Significantly more secondary school girls surveyed reported being very active quite often or always in physical education in 2008 (66.) compared with 2003 (58.2%). Significantly fewer secondary school girls surveyed reported not participating in physical education in 2008 (6.9%) compared with 2003 (14.5%). School recess and lunch physical activity Just over three-quarters of primary school boys surveyed reported they ran around and played quite a lot or most of the time during recess in 2008 (79.7%) and 2003 (78.2%) and four out of five reported running around and playing quite a lot or most of the time during lunch in 2008 (84.3%) and 2003 (81.6%). The differences in the proportions between survey years were not significant. Around one-half of primary school girls ran around a played quite a lot or most of the time during recess in 2008 (49.9%) and 2003 (53.4%) and two-thirds reported running around and playing quite a lot or most of the time during lunch in 2008 (61.4%) and 2003 (66.2%). The differences in the proportions between survey years were not significant. The proportion of secondary school children who reported running around and playing quite a lot or most of the time during recess (girls 5.7%; boys 38.5%) and lunch (girls 5.5%; boys 39.9%) in 2008 was much lower than the proportion of primary school children reporting this level of activity during recess (girls 49.9%; boys 79.7%) and lunch (girls 5.7%; boys 38.5%). Significantly more secondary school boys reported running around and playing quite a lot or most of the time during recess and lunch in 2008 (recess: 38.5%, lunch: 39.9%) compared with 2003 (recess: 17.8%, lunch: 28.8%) Very small proportions of secondary school girls reported running around and playing quite a lot or most of the time during recess and lunch in 2008 and 2003 (range 3.1% - 5.7%). Active commuting In 2008, there were no significant differences to 2003 in the proportions of primary school boys (31.8% vs. 34.) or girls (26. vs. 34.7%) who actively commuted to school on the day of the survey. Similarly there were no significant differences in the proportion of primary school children actively commuting home from school on the day prior to the survey (boys 41.9% vs. 40.8%; girls 34.5% vs. 38.6%) Amongst secondary school children, no significant differences between 2008 and 2003 were noted in the proportions of boys (57.9% vs. 46.7%) or girls (46. vs. 35.1%) actively commuting to school on the day before the survey. However, a significantly higher proportion of secondary school children actively commuted home from school on the day prior to the survey in 2008 (boys: 63.2%, girls: 57.3%) compared with 2003 (boys: 50., girls: 45.6%). Page vii

9 In 2008, just over one-half (boys: 51.8%, girls: 55.5%) of primary school children surveyed reported actively commuting to school at least once in the last seven days. A significantly higher proportion of secondary school boys (60.7%) surveyed reported actively commuting to school at least once in the past seven days, compared with secondary school girls (47.9%). Less than one-half (boys: 45.5%, girls: 43.3%) of primary school children surveyed in 2008 reported actively commuting to friend s houses in the last seven days. In 2008, significantly more secondary school boys than girls surveyed actively commuted to sport venues (45.9% vs. 28.1% respectively) and skate ramps/parks/ovals/playgrounds (32.4% vs. 17.8% respectively) at least once in the last seven days. Sedentary activity In 2008, most primary school boys (70.9%) and girls (75.2%) surveyed reported participating in more than two hours of electronic media activity on all of the last seven days. Amongst secondary school children in 2008, around four out of five secondary schools boys (78.7%) and girls (83.) used electronic media for more than two hours on all of the last seven days. There were no significant differences in the proportions of boys and girls meeting Australian Physical Activity Recommendations 3, 4 in 2008 on electronic media use on all of the last seven days. Nutrition Energy from macronutrients There were no significant differences between 2008 and 2003 in mean total energy intakes recorded in the 24-Hour Food Diary for primary school girls and boys and secondary school boys. For secondary school girls, a 1 lower energy intake was observed in 2008 than 2003, this difference was statistically significant. In 2008, approximately one-half (48.1% %) of daily energy intake came from carbohydrates, a third (32.7% %) from fats and the remainder from protein (17.4% - 18.). In 2008, nearly one-half of the fat consumed by children was saturated fat, contributing between 14. and 14.7% of energy intake. The proportions of energy from fat and saturated fat consumed by children were higher than the maximum recommended levels (3 and 1 respectively), with no significant differences between 2003 and Micronutrient intakes In 2008, mean micronutrient intakes substantially exceeded the Estimated Average Requirements (EARs) for all nutrients for all children with the exception of calcium and magnesium amongst secondary school girls. Proportion consuming food groups On the day of the 24-Hour Food Diary in 2008, more than nine in ten children reported consuming cereal and cereal products (97.5% of primary school children and 94. of secondary school children) and milk products and dishes (91.1% of primary school children and 86.5% of secondary school children). Cereal-based products or dishes were consumed by 73.8% of primary school children and 70.9% of secondary school children. Page viii

10 In 2008, three-quarters of children reported consuming vegetable products and dishes (75.9% of primary school children and 78.1% of secondary school children) and four in five consumed meat, poultry and game products (81. of primary school children and 79.7% of secondary school children). Three in five consumed fruit or fruit products (68.6% of primary school children and 62.7% of secondary school), whereas one-quarter consumed snack foods (27.3% of primary school children and 25.5% of secondary school children) and around two in five consumed confectionary or other sugar products and dishes (35.6% of primary school children and 44.2% of secondary school children) in The proportion of primary school children consuming confectionary and cereal bars in 2008 was significantly lower than in 2003 (35.6% vs. 48.3%). The proportion of secondary school girls consuming sugar products and dishes was also significantly lower in 2008 compared with 2003 (33.2% vs. 56.1%). Food habits over the last 12 months Usual vegetable intakes In 2008, 42.1% of primary school boys and 43.1% of primary school girls reported meeting dietary guidelines for vegetable consumption (3 serves per day). These proportions did not differ significantly from those in In 2008, 28.1% of secondary school boys and 23.6% of secondary school girls reported meeting dietary guidelines for vegetable consumption (4 serves per day). Amongst secondary school girls this represents a significant higher proportion than the 2003 survey. Usual fruit intakes In 2008, 62.9% of primary school boys and 70.2% of primary school girls usually met dietary guidelines for fruit consumption (1 serve per day). These proportions were significantly higher than in In 2008, 22.2% of secondary school boys and 28.3% of secondary school girls usually met dietary guidelines for fruit consumption (3 serves per day). The proportion of secondary school girls usually meeting dietary guidelines for fruit consumption (3 serves per day) was significantly greater in 2008 (28.3%) compared with 2003 (13.5%), however no difference was noted amongst secondary school boys. Breakfast habits In 2008, 61.5% of secondary school girls reported consuming breakfast daily, compared to a larger majority of primary school children (90.1% boys; 83.2% girls) and secondary school boys (71.5%). The proportion of secondary school girls who consumed breakfast daily was significantly higher in 2008 than 2003 (61.5% vs. 51.3% respectively), although no differences were observed for primary school children or secondary school boys. In 2008, about half (range 48.3% %) of all children prepared or helped to prepare their breakfast most days of the week (five to seven days). Page ix

11 Lunch and snack habits In 2008, one-quarter of secondary school boys (24.3%) and girls (24.6%), reported usually helping to prepare their lunch most days compared with a somewhat lower proportion of primary school children (11.1% boys, 16.6% girls) with a further one-third of all children helping some days. In 2008, approximately four in ten primary school children (43.2% boys, 39.4% girls) and onehalf of secondary school children (51.2% boys, 50.4% girls%) reported purchasing food or drinks from the school canteen at least once per week, with secondary school children (19.8% boys, 12. girls) being more likely than primary school children (4.7% boys, 5.9% girls) to purchase on most days of the week. In 2008, about one-half of secondary school children (boys: 51.3%, girls: 55.9%) reported making their own snack decisions, whereas for most primary school children (boys: 67.2%, girls: 70.5%), parents were also involved. Evening meal habits In 2008, the majority of children had eaten their evening meal with family on most days of the week, with the proportion higher for primary school boys (82.5%) and girls (84.2%) than secondary boys (66.3%) and girls (68.4%). One-quarter of primary school boys (23.6%) watched television whilst eating dinner on most days of the week in 2008, a result similar to 2003 (19.). One in eight primary school girls (12.5%) watched television whilst eating dinner on most days of the week in 2008, a significantly lower amount than 2003 (19.5%). Significantly lower proportions of secondary school boys and girls indicated they watched television while eating dinner in 2008 than in 2003 (boys 16.1% vs. 30.1%; girls 20. vs. 31.5%). In 2008, up to 5% of children of all ages helped with dinner preparation most days, whereas about one- third (primary: 38.3%, secondary: 43.4%) of boys and one-half (primary: 51.8%, secondary: 53.) of girls helped on between one and four days per week. Fast food In 2008, approximately one-third of primary school children (boys: 33.8%, girls: 34.9%) and secondary school boys (33.7%) reported usually consuming fast food chain meals or snacks at least once a week. These proportions were not significantly different between 2003 and The proportion of secondary school girls usually consuming fast food at least once a week was significantly lower in 2008 (18.4%) compared with 2003 (34.6%). Type of milk In 2008, at least 95% of children usually consumed milk in the last 12 months; however secondary school girls (53.8%) were more likely to consume reduced fat or skimmed milk than primary school children (42.3% boys, 41.8% girls) or secondary school boys (37.5%). The proportion consuming reduced fat or skimmed milk was higher in 2008 than 2003 for primary school boys (42.3% vs. 34.5%) and girls (41.8% vs. 35.6%) and secondary school girls (53.8% vs. 40.3%), however these differences were not statistically significant. Page x

12 Type of cereal At least 9 of children surveyed in 2003 and 2008 had eaten breakfast cereal at least once in the previous 12 months. A wide range of cereal types were consumed, the most prevalent was plain wheat cereal, consumed by one-third (34.) of children in The most substantial difference in the type of cereal consumed was a lower proportion consuming highly sweetened cereals in 2008 compared with 2003 (17.2% vs. 22. respectively). Dietary supplements Two in five children usually consumed vitamin or mineral supplements over the previous 12 months. This proportion was significantly higher in 2008 than 2003 (44.5% vs. 37.4% respectively). A higher proportion of girls consumed supplements more frequently; 19% of primary and 19.6% of secondary school girls consumed supplements five to seven times per week in 2008, compared with 13.6% of primary and 13.4% of secondary school boys. Food Frequency over the last 12 months Foods consumed more often in 2008 compared with 2003 were predominantly from the healthier food categories, particularly different types of fruit, vegetables and wholegrain bread. Foods eaten less frequently in 2008 compared with 2003 were predominantly the less healthy foods including baked good, white bread, meat pies/sausage rolls/other savoury pastries, chocolate/chocolate bars, lollies/confectionary, potato chips/corn chips/similar snacks, fancy sweet biscuits, ice cream, cordial, regular soft drink/flavoured mineral water and potato cooked with fat (chips). Body size The proportions of primary school boys and girls classified as overweight or obese were not significantly different between 2008 (boys: 26.7%, girls: 18.7%) and 2003 (boys: 20.7%, girls: 26.). There was also no difference in the proportions of secondary school boys who were overweight or obese between 2008 (15.9%) and 2003 (24.7%). However, the proportion of secondary school girls who were classified as overweight or obese was significantly lower in 2008 (15.9%) compared with 2003 (23.1%). Notably, a significantly higher proportion of both primary and secondary school girls were underweight in 2008 (primary: 9.9%, secondary: 9.4%) than in 2003 (primary: 4.2%, secondary: 5.5%). No significant differences in underweight proportions were evident for primary or secondary school boys between 2008 (primary: 5.8%, secondary: 5.2%) and 2003 (primary: 3.8%, secondary: 3.6%). Page xi

13 CONTENTS CONTRIBUTION AND ACKNOWLEDGEMENTS... ii SUGGESTED CITATION... iii MINISTERS FOREWARD...iv EXECUTIVE SUMMARY... v TABLE OF CONTENTS...xii LIST OF TABLES...xiii LIST OF FIGURES...xiv CHAPTER 1: BACKGROUND...1 CHAPTER 2 : METHODS...3 GENERAL PROCEDURES...4 DATA COLLECTION...4 Instruments...4 School visits...5 Data coding and cleaning...7 Data merging...8 Data treatment and analysis...8 CHAPTER 3: RESULTS...11 SAMPLE DEMOGRAPHICS...11 PHYSICAL ACTIVITY...12 Self-report overall physical activity...12 Pedometer measured daily steps taken by children and adolescents...13 Physical activities reported by children and adolescents...14 School physical activity...20 Active commuting...24 Inactivity and sedentary behaviour...28 NUTRITION Hour Food Diary...32 Food Habits...45 Food Frequency...56 BODY SIZE...81 CHAPTER 4: DISCUSSION...83 REFERENCES...90 Page xii

14 LIST OF TABLES Table 1: Frequency of consumption conversion...9 Table 2: Weight adjustment due to clothing, 2003 and Table 3: Participant demographics in the Child and Adolescent Physical Activity and Nutrition Survey, 2003 and 2008 (unweighted)...11 Table 4: Average daily step counts and proportion of children meeting recommended step counts, 2003 and 2008: primary school children Table 5: Average daily step counts and proportion of children meeting recommended step counts, 2003 and 2008: secondary school children Table 6: Average minutes of daily by domain, 2008: secondary school children Table 7: Frequency of being very active (or huffing and puffing for year three) during physical education, 2003 and 2008: primary school children Table 8: Frequency of being very active during physical education, 2003 and 2008: secondary school children Table 9: Usual activity during recess, 2003 and 2008: primary school children Table 10: Usual activity during recess, 2003 and 2008: secondary school children Table 11: Usual activity during lunch, 2003 and 2008: primary school children Table 12: Usual activity during lunch, 2003 and 2008: secondary school children Table 13: Response to active commuting barriers and facilitators: year five and seven children...26 Table 14: Response to active transport barriers and facilitators: secondary school children...26 Table 15: Frequency of intensity of sedentary activity behaviour, 2008: year three children Table 16: Mean daily minutes spent in sedentary activities, 2008: year five and seven children Table 17: Mean daily minutes spent in sedentary activities, 2008: secondary school children Table 18: Mean 24 hour energy intake and proportion of energy from macronutrients, 2003 and Table 19: Mean intake of macronutrients (grams), 2003 and Table 20: Mean 24 hour micronutrient intakes, 2003 and Table 21: Proportion of children consuming food from main food group, 2003 and Table 22: Mean daily intake (grams per person) for consumers of main food groups, 2003 and Table 23: Mean daily intake (grams per person) of food from main food groups (all participants), 2003 and Table 24: Mean proportion of daily energy (excluding dietary fibre) from food groups for all participants regardless of consumption, 2003 and Table 25: Differences in 12 month frequency of food consumption, 2003 and Table 26: Proportions (%) of primary school children classified as underweight, healthy, overweight and obese by sex and overall, 2003 and Table 27: Proportions (%) of secondary school children classified as underweight, healthy, overweight and obese by sex and overall, 2003 and Page xiii

15 LIST OF FIGURES Figure 1: Self-reported number of days participating in 60 minutes or more of physical activity in the last seven days, 2008: primary school children Figure 2: Self-reported number of days participating in 60 minutes or more of physical activity in the last seven days, 2008: secondary school children...13 Figure 3: Prevalence of physical activities undertaken in the last seven days, 2008: Year 5 and 7 primary school boys Figure 4: Prevalence of physical activities undertaken in the last seven days, 2008: Year 5 and 7 primary school girls Figure 5: Prevalence of physical activities undertaken in the last seven days, 2008: secondary school boys Figure 6: Prevalence of physical activities undertaken in the last seven days, 2008: secondary school girls Figure 7: Proportion of children participating reporting at least one activity for each physical activity domain in the last seven days, Figure 8: Prevalence (%) of children active commuting to school on the previous school day, 2003 and Figure 9: Prevalence (%) of children active commuting home from school on the previous school day, 2003 and Figure 10: Proportion of children reporting actively commuting to local destinations in the last seven days, 2008: Year 5 and 7 children...27 Figure 11: Proportion of children reporting actively commuting to local destinations in the last seven days, 2008: secondary school children...28 Figure 12: Proportion of children meeting guidelines for electronic media use 6,7 on each of the last seven days...29 Figure 13: Proportion of children usually meeting recommended daily vegetable intake, 2003 and Figure 14: Usual serves of vegetables per day, 2003 and 2008: primary school boys Figure 15: Usual serves of vegetables per day, 2003 and 2008: primary school girls Figure 16: Usual serves of vegetables per day, 2003 and 2008: secondary school boys Figure 17: Usual serves of vegetables per day: secondary school boys by location Figure 18: Usual serves of vegetables per day, 2003 and 2008: secondary school girls Figure 19: Proportion of children usually meeting recommended daily fruit intake, 2003 and Figure 20: Usual daily serves of fruit, 2003 and 2008: primary school boys Figure 21: Usual daily serves of fruit, 2003 and 2008: primary school girls Figure 22: Usual daily serves of fruit, 2003 and 2008: secondary school boys Figure 23: Usual daily serves of fruit, 2003 and 2008: secondary school girls Figure 24: Proportion of children who consume breakfast daily, 2003 and Figure 25: Frequency usually consume breakfast, 2003 and 2008: primary school boys Page xiv

16 Figure 26: Frequency usually consume breakfast, 2003 and 2008: primary school girls...54 Figure 27: Frequency usually consume breakfast, 2003 and 2008: secondary school boys Figure 28: Frequency usually consume breakfast, 2003 and 2008: secondary school girls Figure 29: Frequency of children reporting usually preparing or helping to prepare breakfast, 2003 and 2008: primary school boys Figure 30: Frequency of children reporting usually preparing or helping to prepare breakfast, 2003 and 2008: primary school girls Figure 31: Frequency of children who usually prepare or helping to prepare breakfast, 2003 and 2008: secondary school boys Figure 32: Frequency of children who usually prepare or helping to prepare breakfast, 2003 and 2008: secondary school girls Figure 33: Frequency of children reporting usually preparing or helping to prepare lunch, Figure 34: Frequency of children reporting usually preparing or helping to prepare dinner, 2003 and 2008: primary school boys Figure 35: Frequency of children reporting usually preparing or helping to prepare dinner, 2003 and 2008: primary school girls Figure 36: Frequency of children reporting usually preparing or helping to prepare dinner, 2003 and 2008: secondary school boys Figure 37: Frequency of children reporting usually preparing or helping to prepare dinner, 2003 and 2008: secondary school girls Figure 38: Frequency of purchasing food or drinks from the school canteen, 2008: primary school children Figure 39: Frequency of purchasing food or drinks from the school canteen, 2008: secondary school children Figure 40: Proportion of children eating evening meal with family five to seven days per week, 2003 and Figure 41: Proportion of children watching television while eating evening meal five to seven evenings per week, 2003 and Figure 42: Frequency children watch television while eating evening meal, 2003 and 2008: primary school boys Figure 43: Frequency children watch television while eating evening meal, 2003 and 2008: primary school girls Figure 44: Frequency children watch television while eating evening meal, 2003 and 2008: secondary school boys Figure 45: Frequency children watch television while eating evening meal, 2003 and 2008: secondary school girls Figure 46: Who usually decides what children eat for meals: Figure 47: Who usually decides what children eat for snacks: Figure 48: Proportion of children consuming food or snacks from fast food chain at least once a week, 2003 and Page xv

17 Figure 49: Proportion of children attending metropolitan and non-metropolitan schools consuming food or snacks from fast food chain at least once a week, 2003 and Figure 50: Frequency children consume meals or snacks from fast food chain, 2003 and 2008: secondary school boys Figure 51: Frequency children consume meals or snacks from fast food chain, 2003 and 2008: secondary school girls Figure 52: Frequency children consume meals or snacks from fast food chain, 2008: primary school children Figure 53: Type of milk usually consumed, 2003 and 2008: primary school boys Figure 54: Type of milk usually consumed, 2003 and 2008: primary school girls Figure 55: Type of milk usually consumed, 2003 and 2008: secondary school boys Figure 56: Type of milk usually consumed, 2003 and 2008: secondary school girls Figure 57: Type of breakfast cereal usually consumed, 2003 and Figure 58: Proportion of children consuming dietary supplements, 2003 and Figure 59: Frequency of vitamin and mineral supplements consumption, 2003 and 2008: primary school boys Figure 60: Frequency of vitamin and mineral supplements consumption, 2003 and 2008: primary school girls Figure 61: Frequency of vitamin and mineral supplements consumption, 2003 and 2008: secondary school boys Figure 62: Frequency of vitamin and mineral supplements consumption, 2003 and 2008: secondary school girls Page xvi

18 CHAPTER 1: BACKGROUND Decreasing levels of physical activity participation, the poor quality of dietary intake and high levels of overweight and obesity in Australian youth are of concern and require concerted multisectoral efforts to improve. Both National 7 and State 10, 11 surveys have, in recent years, examined the proportions of children who meet recommended physical activity, nutrient intake guidelines and who are of a healthy weight. The Australian Physical Activity Recommendations suggest that children 3 and adolescents 4 participate in 60 minutes, and up to several hours, of moderate to vigorous physical activity every day and that children accumulate no more than two hours screen time for entertainment each day. National survey data collected in found that only 32% of children aged 9-16 years met the physical activity guidelines on all of the previous seven days and only 7% met the screen guidelines on all of the previous seven days. Likewise, the 2007 national survey found low compliance of 9-16 year olds with the Dietary Guidelines for Children and Adolescents in Australia, 5 especially low consumption of fruit, vegetables, cereal foods and dairy foods, and high fat and sugar intakes. The Australian Bureau of Statistics (ABS) 12 found that approximately one-quarter of children aged 5-17 years nationally were overweight or obese, with 8% classified as obese. The ABS identified increases between 1995 and 2008 in the proportion of boys who were obese and the proportion of girls who were overweight. The Premier s Physical Activity Taskforce (the Taskforce) was established in 2001 following research showing low physical activity levels in the Western Australian population. The Taskforce is a coalition of senior representatives from the Departments of Education, Health, Planning, Sport and Recreation and Transport, the Western Australian Local Government Association, Lotterywest and Healthway, a leading academic in the field and a community representative. The purpose of the Taskforce is to oversee the development and implementation of a whole of community physical activity plan for Western Australia. To achieve improved health for Western Australians, in 2001 a target was set to increase the proportion of sufficiently physically active adults by 5% (from 58% to 63%) over 10 years. Research examining this target remains a key role of the Taskforce through its Evaluation and Monitoring Advisory Committee (EMAC). No target was set for West Australian children due to the absence of adequate state level data. The first Child and Adolescent Physical Activity and Nutrition Survey (CAPANS) in 2003 collected information on children s: participation in different types of physical activity; physical activity motivation factors; barriers to physical activity participation; pedometer measured daily step counts; body measurements including body mass index (BMI) determined overweight and obesity; information on key nutrient intake; and eating patterns. Page 1

19 The study made a number of recommendations including ongoing monitoring of child and adolescent physical activity, nutrition and growth status. The CAPANS 2008 survey was undertaken to make comparisons with the CAPANS 2003 research and to assist in the development of future directions for physical activity and nutrition promotion. While most questions in the CAPANS 2008 questionnaires remained the same as in CAPANS 2003, changes in policy (such as the introduction of Australia s Physical Activity Recommendations 3, 4 in 2004) since the first study, and the need to optimise ease and timing of completion, led to some questionnaire modification. Thus, not all 2008 data are comparable with the CAPANS 2003 data. However, where possible, comparisons between data from the two surveys have been made. This report details the findings of the CAPANS 2008 survey and provides comparisons with CAPANS 2003 data for physical activity, nutrition and body size. CHAPTER 2: METHODS This section describes the study design, sample and data collection procedures for the Child and Adolescent Physical Activity and Nutrition Survey (CAPANS) 2008 survey and includes a summary of methods reported for the CAPANS 2003 survey. Further study procedures for CAPANS 2008 are available in the CAPANS 2008 Study Protocol. Further details of the CAPANS 2003 methods can be found in the Physical Activity and Nutrition Levels in Western Australian Children and Adolescents Report, 13 Results of Western Australian Child and Adolescent Physical Activity and Nutrition Survey 2003; Physical Activity Technical Report 14 and Nutrient Intakes in Western Australian Children and Adolescents Report. 15 The protocol used for 2008 data collection closely followed the methods reported in the CAPANS 2003 survey; however some differences in child self-selection and data collection may have occurred. Ethics Approval The University of Notre Dame Australia Ethics Committee approved the protocol for CAPANS Approval was provided for the CAPANS 2008 survey by the Edith Cowan University Human Research Ethics Committee. School recruitment and response rates The Physical Activity Taskforce coordinated the selection and recruitment of schools. The Australian Council for Educational Research selected a random sample of government and non-government schools using a two-stage stratified design with primary and secondary schools. The sampling frame was divided into four strata; primary metropolitan, primary non-metropolitan, secondary metropolitan, and secondary non-metropolitan. Principals at randomly selected schools were mailed a letter from the Directors General of the Departments of Sport and Recreation, and Education and Training inviting their school to participate in the project. A School Information Sheet and School Consent Form were included with the letter. Signed principal Consent Forms were returned to the Physical Activity Taskforce by facsimile or post. In 2008, contact was made with 74 schools to achieve 34 participant schools, giving an overall school response rate of 45.9%. This rate was lower than that achieved in 2003, when 36 schools agreed to participate from a total of 60 schools approached, giving a school response rate of. Page 2

20 Timing of Data Collection CAPANS 2008 data were collected during Term 3 (22 July to 26 September) and Term 4 (14 October to 18 December) during the 2008 Western Australian school year. This was comparable with the data collection period for CAPANS GENERAL PROCEDURES Participating schools were contacted via a letter from the Research Team. To assist with communication between the Research Team and the school, an individual teacher at each school acted as a liaison. Suitable dates for data collection were coordinated through this person. Staff training A project coordinator, field coordinator, consent coordinator, four team leaders and 26 research assistants were recruited to complete the 2008 data collection. Staff participated in a comprehensive four-day training course in data collection techniques. This incorporated training in questionnaire administration, food diary administration and checking, pedometer use, managing children, ethical considerations and anthropometric measurement (height, weight and waist, hip and umbilicus girth) using ISAK protocols. 16 Teacher briefing session At each school the consent coordinator, or a team leader, provided a briefing to the teachers of selected classes about the study and its benefits. The teacher s roles in the study were explained, specifically to encourage children to participate in the study, collect consent forms, complete pedometer step count records (primary schools only) and assist with collecting unreturned pedometers. A Teacher Information Pack was sent to schools that declined a teacher briefing session. Child recruitment In primary schools, where possible, a number of random classrooms were selected to acquire approximately 25 children from years 3, 5 and 7. All children in these classes were invited to participate in the study. As random classroom recruitment was not possible in most secondary schools, the principal, school liaison or fieldwork coordinator chose classes with appropriate class timetabling to participate in the study. The consent coordinator, or a team leader, provided a ten minute recruitment session to children and distributed children s Information Sheets and Consent Forms at each school (see Study Protocol for further details). Children were informed about the study and their role in data collection if they chose to participate. Correct use of the pedometer was demonstrated, and children s questions were answered. Children were provided a due date to return Consent Forms signed by their parents/ guardian. Multiple strategies were used to maximise participation and these are described in the Study Protocol. Participant response rates Based on the total number of consent forms distributed in CAPANS 2008, an overall child response rate of 58.8%, was achieved with response rates of 79.5% for primary school children and 46.2% for secondary school children. The overall child response rate in CAPANS 2003 was 55.8%, with primary and secondary school child response rates of 58.8% and 52.1% respectively. Page 3

21 DATA COLLECTION Instruments The survey instruments used in CAPANS 2003 were reviewed and modified for the CAPANS 2008 survey. Demographic data Demographic data for children in CAPANS 2008 were collected from a variety of data sources including class lists, the Physical Activity Questionnaire, Food Frequency Questionnaire and the child s consent form. Home neighbourhood SEIFA (based on postcode) was used to represent home socio-economic status (SES). Physical activity instruments Physical Activity Questionnaire Three versions of the Physical Activity questionnaire were used; year three, year 5/7 and secondary school. This questionnaire sought to establish the physical activity behaviour of children including the types of physical activity in which children participated in over the past seven days, the time they spent in these activities (for secondary school children) and the number of days children participated in physical activity for 60 minutes or more. Extensive consultation with experts in the physical activity research field led to several changes to the Physical Activity Questionnaire for CAPANS Questions on the year 5/7 and secondary school Physical Activity Questionnaire about the frequency of physical activities and sedentary activities were rephrased; in the CAPANS 2003 version usual physical activity participation in a typical week was used, whereas CAPANS 2008 asked about physical activity participation during the last seven days. This change prevented direct comparison of the 2008 and 2003 data for this question. Two additional questions were included on the year three, year 5/7 and secondary school Physical Activity Questionnaire in CAPANS These questions asked children to indicate the number of days out of the last seven that they had been physically active for 60 or more minutes and the number of days out of the last seven that the child had participated in screen-based activity (other than for homework) for two hours or more. These questions were adapted from Prochaska s single physical activity question, which has been shown to be reliable for children with an average age of 12 years. 17 Questions related to active transport (walking, cycling, scootering or skateboarding) to local destinations 18 as well as barriers to active commuting to school 18 were added to the year 5/7 and secondary school 2008 Physical Activity Questionnaires to obtain data on independent mobility. Questions relating to physical activity motivators and barriers which displayed only small response variability in CAPANS 2003 were removed from CAPANS Pedometer and Pedometer Diary Yamax Digiwalker (SW-700 or SW 200) pedometers were used to collect step count data. These are valid and reliable objective instruments for measuring step counts. 19 Elastic and a safety-pins were provided to attach the pedometer to clothing, which assisted with reducing pedometer loss. Page 4

22 Nutrition instruments 24-Hour Food Diary The food and nutrient intakes of children and adolescents were examined using a 24-Hour Food Diary. 20 This dietary assessment method requires participants to record the type, amount and source of all foods, beverages and supplements consumed over a 24-hour period. Food Frequency Questionnaire The Food Frequency Questionnaire was designed to collect information about children s and adolescents usual pattern of eating over the previous 12 months. This instrument was based on the 1995 National Nutrition Survey Food Frequency Questionnaire 7 with the addition of food items and questions related to children. Section one asked about frequency of consumption per day, week or month of 110 specific food items, four supplement items and eight alcoholic beverage items (secondary school only). This section collected only frequency information about food consumed; no quantities were specified. The Food Frequency Questionnaire section two asked questions about food and meal habits. 21 Questions about school canteen use and food decision maker/s for the child were added to this section in Anthropometric measurements Height, weight and waist girth measures taken from each child followed ISAK international protocols. 16 Calibration assessment of weight scales between each school visit using 30 kg weights indicated that scales were measuring within 300 grams of the calibrated weight. Calibration assessment of the stadiometers between each school field visit, using a calibrated one meter rule (Supercraft Steel Rule R093076), indicated that all of the four stadiometers were measuring within 2mm of the calibrated length. School visits A minimum of three visits were made to each school. At least one team leader was in attendance for each school visit. School Visit 1 The team leader met with the school liaison and assisted with assembling children who had provided consent to participate. Each child was provided with their individual survey pack labelled with a unique identifier (ID). Depending on which study components the child had consented to participate in, packs contained: Physical Activity Questionnaire; pedometer (with elastic and a safety pin), Pedometer Diary; 24-hour Food Diary; measuring cups and spoons; Food Frequency Questionnaire; a 2B pencil and an eraser. The classroom was set up into four stations and children split into groups: Station 1: Physical Activity Questionnaire Children completed the Physical Activity Questionnaire as a group under the guidance of a research assistant. Enlarged laminated copies of the questions were used to provide step-by-step instructions to children for estimating time spent in physical activities and sedentary activities. The questionnaire took approximately 20 minutes to complete. Page 5