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Operationalising Agency: A Personalized Approach to Public Health

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      Abstract

      Our work brings together theories and methodologies from public health and the learning sciences to develop a culturally relevant community-based intervention aimed at promoting healthy childhood development. We present our approach to personalising a community-based family intervention to prevent childhood obesity that aims to enhance participants’ agency. We argue that situating obesity within the individual’s multi-layered context not only provides a more robust understanding of the causes, but also generates sustainable options for promoting healthy lifestyles. Our findings emphasise the importance of a situated approach to learning that leverages social systems as a key resource for better navigating the environmental, material and ideational infrastructures that support healthy lifestyles. Keywords: personalised health, community engagement, obesity prevention, community health education, community interventions

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      Most cited references 9

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      Self-efficacy: toward a unifying theory of behavioral change.

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        Childhood body-mass index and the risk of coronary heart disease in adulthood.

        The worldwide epidemic of childhood obesity is progressing at an alarming rate. Risk factors for coronary heart disease (CHD) are already identifiable in overweight children. The severity of the long-term effects of excess childhood weight on CHD, however, remains unknown. We investigated the association between body-mass index (BMI) in childhood (7 through 13 years of age) and CHD in adulthood (25 years of age or older), with and without adjustment for birth weight. The subjects were a cohort of 276,835 Danish schoolchildren for whom measurements of height and weight were available. CHD events were ascertained by linkage to national registers. Cox regression analyses were performed. In 5,063,622 person-years of follow-up, 10,235 men and 4318 women for whom childhood BMI data were available received a diagnosis of CHD or died of CHD as adults. The risk of any CHD event, a nonfatal event, and a fatal event among adults was positively associated with BMI at 7 to 13 years of age for boys and 10 to 13 years of age for girls. The associations were linear for each age, and the risk increased across the entire BMI distribution. Furthermore, the risk increased as the age of the child increased. Adjustment for birth weight strengthened the results. Higher BMI during childhood is associated with an increased risk of CHD in adulthood. The associations are stronger in boys than in girls and increase with the age of the child in both sexes. Our findings suggest that as children are becoming heavier worldwide, greater numbers of them are at risk of having CHD in adulthood. Copyright 2007 Massachusetts Medical Society.
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          Timing and tempo of first-year rapid growth in relation to cardiovascular and metabolic risk profile in early adulthood.

          Growth during infancy appears to be an important determinant of cardiovascular disease and type 2 diabetes later in life. To specify which period in the first year of life is related to determinants of cardiovascular disease and type 2 diabetes in early adulthood and to investigate the association between tempo of first-year weight gain (>0.67 SDs) and these determinants. Observational study using longitudinal data collected in the Programming Factors for Growth and Metabolism (PROGRAM) study of 217 healthy participants, aged 18 to 24 years, including a relatively large sample of participants born small for gestational age and participants with short stature, performed at a medical center in The Netherlands between August 2004 and September 2007. The association of cardiovascular disease and type 2 diabetes with tempo of weight gain was assessed in a subgroup of 87 participants. Associations between periods of first-year growth and tempo of weight gain and determinants of cardiovascular disease and type 2 diabetes in early adulthood. Weight gain in the first 3 months of life was inversely associated with insulin sensitivity (beta, -0.223; 95% confidence interval [CI], -0.386 to -0.060) and serum high-density lipoprotein cholesterol level (beta, -0.053; 95% CI, -0.090 to -0.016) and positively associated with waist circumference (beta, 1.437; 95% CI, 0.066 to 2.808), acute insulin response (beta, 0.210; 95% CI, 0.024 to 0.395), ratio of total cholesterol to high-density lipoprotein cholesterol (beta, 0.052; 95% CI, 0.010 to 0.094), and level of triglycerides (beta, 0.066; 95% CI, 0.003 to 0.129) in early adulthood. Rapid weight gain during the first 3 months of life resulted in a higher percentage of body fat, more central adiposity, and reduced insulin sensitivity in early adulthood than when slower weight gain occurred during the entire first year. Rapid weight gain in the first 3 months of life is associated with several determinants of cardiovascular disease and type 2 diabetes in early adulthood.
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            Author and article information

            Affiliations
            [1 ]University of Colorado Boulder
            [2 ]Vanderbilt University
            Contributors
            United States
            United States
            United States
            United States
            United States
            Journal
            Gateways: International Journal of Community Research and Engagement
            UTS ePRESS
            31 May 2018
            : 73-89
            10.5130/ijcre.v11i1.5806

            This work is licensed under a Creative Commons Attribution 4.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

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