Child nutrition and physical activity in the Monteverde Zone: An exploratory study

Child nutrition and physical activity in the Monteverde Zone: An exploratory study

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Child nutrition and physical activity in the Monteverde Zone: An exploratory study
Translated Title:
Nutrición y actividad fisica en los niños de Monteverde: Un estudio exploratorio
Green, Simone
Shuford, James
Vázquez-Otero, Coralia
Whitney, Melissa
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Text in English


Subjects / Keywords:
Costa Rica--Puntarenas--Monteverde--Monteverde Zone
Costa Rica--Puntarenas--Monteverde--Zona de Monteverde
Community Health 2011
Salud comunitaria 2011


This study assesses objective levels of children's physical activity as well as children's subjective perceptions of nutritional knowledge and physical activity in the Monteverde zone. ( English,Español,,,,,,,, )
Este estudio evalúa los niveles de los objetivos de la actividad física de los niños, así como las percepciones subjetivas de los niños de los conocimientos nutricionales y la actividad física en la zona de Monteverde.
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Student affiliations: University of South Florida

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Resource Identifier:
M38-00085 ( USFLDC DOI )
m38.85 ( USFLDC Handle )

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1 Child Nutrition and Physical Activity in the Monteverde Zone: A n Exploratory Study Child Nutrition and Physical Activity in the Monteverde Zone: An Exploratory Study Simone Green, James Shuford, Coralia V zquez Otero, and Melissa Whitney University of South Florida 2011


2 Child Nutrition and Physical Activity in the Monteverde Zone: A n Exploratory Study Background and Objectives To gain a broader understanding of the relationship between children's nutrition and PA as related vectors for general health, we conducted a mixed m ethods approach to assess objective levels of children's PA as well as children's subjective perceptions of nutritional knowledge and PA While previous research has been conducted in the Monteverde region on nutrition as well as on physical activity (PA) these t wo topics, which share a relationship as foundations of general health, have yet to be studied in tandem. While perceptions of nutrition have been researched from the point of view of adults, we wanted to assess how childre n view food and nutrition. The research focuses on children 7 12 years old because at this age children begin to become more independent, no longer relying on their parents for dietary survival ( Pereira and Altmann 1985 ) PA and nutrition are important for children s growth and development ( Cameron 2002 ) This research is relevant to the Monteverde zone because the physici an from the Monteverde clinic i s seeking to focus on children for the prevention of chronic diseases Children are an importan t population for health research because they are agents of change. Working with children is essential for population wide preventative health With this in mind, an objective was to create an educational tool to give back to the children. Literature revie w Research on nutrition in the Monteverde region has shown that with the increase in globalization, over nutrition, rather than under nutrition, has become more of a health problem in recent years ( Andia, et al. 2002 ) Res earch in the Monteverde zone has shown that the emphasis on tourism has resulted in dietary delocalization, whereby local communities increasingly rely on externally produced foods as local food production decreases through time ( Himmelgreen, et al.


3 Child Nutrition and Physical Activity in the Monteverde Zone: A n Exploratory Study 2006:310 ) Dietary delocalization leads to a form of food insecurity in which processed foods that are high in fat and sugar become more commonly consumed. When conducting research with children it is important to keep in mind the cognitive and physical dev elopment of children in order to tailor research methods in age appropriate ways. According to Pereira & Altmann (1985), juveniles (aged 7 13 years old) are defined as, pre pubertal individuals that are no longer dependent on their mothers (parents) fo r survival (Pereira & Altmann 1985 :236 ) Their growth is predictable, stable, and harmonious A round 7 to 8 years of age, a child is capable of concrete operations. They are able to arrange objects according to their size, weight, classification, and re lation ( Marlowe and Canestrari 2006 ) When a child reaches 11 to 12 years of age, they are capable of formal operations. They are able to reason not only on the basis of objects, but also on the basis of hypotheses, or of propositions ( Marlowe and Canestrari 2006:104 105 ) Thus, the nutrition game the research team conducted at the San Luis Health Fair and among various homes was a great example of children in the juvenile stage using their concrete and formal operations Traditionally, research on PA has relied on self reported data, however, self reporting as a method for assessing PA is problematic due to recall bias ( Murphy 2009:109 ; Troiano, et al. 2008:181 ) Objective measurement techniques have become an increasingly popular mode of gathering natio nal level survey data on PA, for example Colley e t al. 2011 and Troiano et al. 200 8 Measuring PA using accelerometry has several benefits. Accelerometers measure amount, frequency and duration of PA, and additionally capture free living" conditions, which like more structured forms of exercise have significant health benefits and have been shown to increase mortality rates ( Murphy 2009 ) Free living conditions are an especially important


4 Child Nutrition and Physical Activity in the Monteverde Zone: A n Exploratory Study element of overall PA among children, as younger children's PA tends to be dominated by unstructured activities (e.g. walking, running, play). Methods Two activities were conducted at the San Luis Health Fair to collect data for our investigation (this also doubled as entertainment for the children). The first activity con sisted of a collage that distinguished between exercise, PA, and play. Materials were provided for the children who were told to cut and paste and write whatever they thought fitted in the three categories. While the children worked on the collage, resea rch team members asked the children questions about how and why they were classifying activities in particular categories. The second activity consisted of a Nutrition Game that functioned as a variation on a pile sorting exercise. The game consisted of classif ying pictures of foods into four different categories: Foods I eat every day, My favorite foods, F oods I don t like, and H ealthy foods. The answers where not mutually exclusive (e.g. banana could be classified under foods I eat every day, fa vorite foods and healthy). Photos were taken of each category's contents after each child completed the game for later data analysis. This exercise was done with the children at the San Luis health fair as well as the participants from the accelerometer study. As children placed the pictures of foods into the four categories, they were asked how and why they were classifying foods in particular categories. All of the children's responses and general observations for the collage and the game were record ed in fieldnotes. Explanation of the investigation and the accelerometers was provided in Spanish by a native speaker. Informed consent was obtained from at least one parent of each participant. Anthropometric measurements of weight, height, arm circumf erence, waist circumference and tricep skinfold were collected following standard procedures (see appendix 1) The


5 Child Nutrition and Physical Activity in the Monteverde Zone: A n Exploratory Study accelerometers were worn on children s right hip for a total of 48 hours. A journal (see appendix 2 ) was given to the participants in order for the children to write about the PA t hey performed during those days They also recorded the time they went to sleep and the time they woke up, which was then used to measure activity only during waking hours The Freedson/Trost/NHANES age specific cut points were used to differentiate between sedentary, light, moderate, and vigorous. These cut points are widely accepted as the standard in the field, with <100 counts per minute for sedentary. Since the age of the children ranged from 7 12, we used cu t points for 9 year olds ( Sasaki, et al. 2010 ) Fin ally, a n individual accel erometer data with an age appropriate explanation. The purpose of the All About Me book was to give something back to the participants for their hel p in the resea rch Results A total of 8 children participated in the preparation of the collage, although not all did it at the same time. There were 3 girls and 4 boys and the ages ranged from 7 to 10 years. In the p hysical activity area of the paper the participants glued pictures of milking a cow, riding horses, sweeping the floor, watching television and people playing music. In the play area the participants glued pictures of a child climbing a tree, a girl pl aying with water, children playing in the snow, a video game console, jumping rope, children playing soccer, children playing tag and walking a dog. In the exercise area they glued pictures of women doing exercises, people running, walking and biking (se e appendix 3 ). When the children were asked to explain how they made their classifications, a nine year old girl said: Exercise is for losing weight El ejercicio es para bajar de peso and Play is for having fun Jugar es para divertirse


6 Child Nutrition and Physical Activity in the Monteverde Zone: A n Exploratory Study Taking information from the nutrition game, frequencies were calculated for each category (see appendix 4 ). These frequencies were used to create a test that categorized the forty one foods into healthy, unhealthy or neutral; 2010 USDA Dietary Guidelines were used to create these categories (see appendix 5 ). The children then received a score to identify healthy foods. C hildren performed better at not putting unhealthy foods in the healthy category than they did at putting healthy foods in the healthy categ ory. The data were divided into two groups: Children who reported eating more than 6 healthy foods and children who reported eating less than 6 healthy foods (see appendix 6) A Mann Whitney Test showed a significant difference in the median test score of the two groups of children with a p value of .021 (see appendix 7 ) Children who reported eating 6 or more healthy foods, received a mean score of 89% of identifying healthy foods. Children who reported eating 6 or less healthy foods, received a mean score of 43% of identifying healthy foods. In other words, t here was a significant relationship between children who reported eating more healthy food on a da ily basis and their score on the nutrition test. To obtain an estimate of time spent in moderate or vigorous activity per day, the total time spent above the moderate and vigorous time cutoffs for the 48 hour period were combined and divided by two excluding time spent sleeping This was compared to the 2011 Cen ters for Disease Control and Prevention recommended standard of 1hour of PA per day an d the children on average met this standard (see appendix 8 and 9 ) Conclusion There seems to be a trend in how the participants interpreted the different categories of the collage. The physical activity was related to chores and general activities li ke playing music. The play was associated with having fun and been entertained. Exercise was seen as


7 Child Nutrition and Physical Activity in the Monteverde Zone: A n Exploratory Study a more structured activity related to health. One interesting observation was that when the participants were told to draw, write or color wherever they wanted, they only drew in the play area of the paper. Children are also aware of healthy and unhealthy foods, and seem to be better able to perceive what is unhealthy Additionally, t here seems to be an association between food diversity and nutriti onal knowledge Despite the fact that the c hildren are achieving the recommended amount of daily activity half of the children fell with the overweight to obese BMI percentile Limitations and Recommendations For future accelerometer research, we recomm end having the children wear the accelerometers for a longer period of time, with seven to ten days being ideal. This would provide a more accurate representation of the child's activity during their free living time. We also recommend some degree of direc t observation of children while they are wearing the accelerometer in order be able to link their specific activity with their graphic information. Additionally, an environmental scan of each child's living area could also provide information relating to the ways in which their local environment constrains or encourages their physical activity. Although it is not statistically significant, there may be a correlation between age and amount of physical activity. After performing a Pearson Correlation we noticed a negative correlation ( .502), which demonstrated that as children grow older, they seem to be less active (see appendix 10) This same trend has been documented in a recent national survey conducted in the United States which found that PA decli nes dramatically during adolescence ( Troiano, et al. 2008:186 ) This is the same period of time in which children become increasingly nutritionally independent and is thus an ideal period for interventions that encourage PA as well


8 Child Nutrition and Physical Activity in the Monteverde Zone: A n Exploratory Study as support healthy eating choic es. More research needs to be done with larger sample sizes to look into this possible trend and to investigate possible interventions. In regards to the pile sorting nutrition game, we recommend using fewer food pictures due to the fact that having 41 different food choices seemed to be overwhelming for the children. More research needs to be done for categorizing traditional foods as either healthy or unhealthy. F or the collage, it would be better to provide more culturally appropriate magazines. Al so, the activity seemed to engage the girls more than the boys, so it would be beneficial to keep the learning styles of each gender in mind while developing re search tools and interventions. In order to acknowledge children as agents of chang e, r esearch with children should take into account their cognitive level when developing methods (e.g. i nteractive games). P lay should be used in health promotion and disease prevention progra ms to promote physical activity and nutrition Health promotion and prevention programs should educate the whole family about food nutritional value The family needs to be empowered to make better decisions about health. Building on the Costa Rican s healthcare system s focus on preventative and integral health, app lied research ers should listen to the perspectives of children Acknowledgements Dr. David Himmelgreen, Dr. Nancy Romero Daza, Dr. H eide Casta eda, Jenny Pe a, Kimberly Acosta Cruz, Ashley Gallentine, Kerri McIver, Kathleen Brelsford, Gene Cowherd, Daniel Vargas, Ernesto Ruiz, and the Community of San Luis, Santa Elena, and Cerro Plano; Especially to the families who participated in our study. Muchas Gracias!


9 Child Nutrition and Physical Activity in the Monteverde Zone: A n Exploratory Study References Andia, Jennifer, et al. 2002 Assessing Food Security in the Monteverde Zone : A Multi Method Approach. Monteverde, Costa Rica: Monteverde Institute. Cameron, N. 2002 Human growth and development: Academic Pr. Centers for Disease and Control 2011 /children.html Himmelgreen, D., et al. 2006 The Tourist Season Goes Down But Not the Prices. Tourism and Food Insecurity in Rural Costa Rica. Ecology of food and nutrition 45(4):295 321. Marlowe, B.A., and A.S. Canestrari 2006 Educational psychology in context: readings for future teachers: Sage Publications, Inc. Murphy, S.L. 2009 Review of physical activity measurement using accelerome ters in older adults: Considerations for research design and conduct. Preventive medicine 48(2):108 114. Pereira, M.E., and J. Altmann 1985 Development of social behavior in free living nonhuman primates. Nonhuman primate models for human growth and devel opment:217 309. Sasaki, Jeffer E., et al. 2010 Assessment of Time Spent in Physical Activity Intensity Categories using Direct Observation and Accelerometer Cut points. In ACSM 2010: American College of Sports Medicine (ACSM) 2010 Annual Meeting. Universi ty of Massachusetts, Amherst, MA. Troiano, R.P., et al. 2008 Physical activity in the United States measured by accelerometer. Medicine & Science in Sports & Exercise 40(1):181. References fot the All about me book


10 Child Nutrition and Physical Activity in the Monteverde Zone: A n Exploratory Study Appendix Appendix #1: Anthropometrics A ppendix #2: Journal for Children Martes Hora Qu hizo? Tuvo que respirar ms rapido? 1:00PM 5:00PM 5:00PM 10:00PM Mi rcoles Hora Qu hizo? Tuvo que respirar ms rapido? 7:00AM 11:00AM 11:00AM 1:00PM 1:00PM 5:00PM 5:00PM 10:00PM Name Age Sex Height Weight BMI BMI Percentile Arm Circumference Tricep Skinfold Waist Circumference 01G 10 Girl 137.5000 36.5000 19.3 78 21.5 13.00 24.83 02B 7 Boy 119.3000 27.2000 19.1 92 22.0 15.00 69.00 03G 7 Girl 117.5000 23.1000 16.7 72 19.0 10.00 59.93 05G 10 Girl 138.7000 43.3000 22.5 93 24.0 25.33 79.33 06G 12 Girl 127.0000 63.3000 28.6 97 30.0 36.67 96.93 07B 7 Boy 131.0000 26.7000 15.6 45 19.0 9.67 59.00 08G 10 Girl 151.0000 43.3000 19 78 24.0 20.33 68.00 09G 9 Girl 135.5000 40.8000 22.2 94 24.8 17.33 77.57


11 Child Nutrition and Physical Activity in the Monteverde Zone: A n Exploratory Study Jueves Hora Qu hizo? Tuvo que respirar m s rapido? 7:00AM 11:00AM 11:00AM 1:00PM 1:00PM 5:00PM 5:00PM 10:00PM Appendix #3 : Picture of Collage


12 Child Nutrition and Physical Activity in the Monteverde Zone: A n Exploratory Study Appendix #4 : Frequencies


13 Child Nutrition and Physical Activity in the Monteverde Zone: A n Exploratory Study


14 Child Nutrition and Physical Activity in the Monteverde Zone: A n Exploratory Study Appendix #5: Healthy/Unhealthy/Neutral Categories Healthy Unhealthy Neutral banana empanada milk mango chips meat (beef) cucumber ice cream plantain orange lollipop popcorn grapes donut bread pineapple hot dog coffee fish hamburger cheese broccoli chocolate peanuts green beans cookies eggs tomato pizza frescos apple coca cola tortilla avocado gallo pinto green pepper carrots strawberries water chicken chayote


15 Child Nutrition and Physical Activity in the Monteverde Zone: A n Exploratory Study Appendix #6 : High/Lo w Healthy Food Consumption Test


16 Child Nutrition and Physical Activity in the Monteverde Zone: A n Exploratory Study Appendix #7 : The Mann Whitney Test Appendix #8:


17 Child Nutrition and Physical Activity in the Monteverde Zone: A n Exploratory Study Appendix # 9: Appendix #10: Correlation between Age and Activity Level Correlations Age BMI percentiles (WHO) percent_Vamd M Age Pearson Correlation 1 .545 .502 Sig. (2 tailed) .162 .205 N 16 8 8 BMI percentiles (WHO) Pearson Correlation .545 1 .314 Sig. (2 tailed) .162 .449 N 8 8 8 percent_VamdM Pearson Correlation .502 .314 1 Sig. (2 tailed) .205 .449 N 8 8 8


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