This issue of Family & Community Health (28:2) focuses on the health of children and various contextual factors affecting healthful interventions. Correspondingly, the articles presented underline an ecological link between one's environment and subsequent behavior. This link, and its tenuous balance and ramifications, cannot be overstated but is often overshadowed. For example, social programming literature is replete with studies on interventions that specifically target children and their behaviors. However, the influence of compelling interpersonal and community contextual factors, which inhibit or enable targeted interventions, continue to receive only cursory study. It has been said that in the human condition "we know a great deal, yet remain convinced of too little." The 8 articles in this special issue present a convincing argument for attending to foundational contextual issues when targeting children's health issues via social programming.
Physical inactivity and childhood overweight has become a global problem of epic proportions. If we do not begin to significantly address some of these issues for our children and youth, then we will be sentencing these children to an adulthood of disease, poor health, and shortened lifespan. It is often the contextual factors in children's lives that hinder or support their ability to be active. The first 4 manuscripts address the contextual issues associated with physical activity and overweight:
The first article by Wu and Pender on the physical activity of Taiwanese youth shows that youth inactivity is not limited to the USA. This study examined a structural model of how individual characteristics, cognitions, and interpersonal influences predicted physical activity.
The findings suggest that gender, social support, modeling, self-efficacy, and perceived benefits and barriers to performing physical activity directly and indirectly influence the behavior of physical activity in Taiwanese youth. It is clear from these data that the development of youth physical activity interventions is a complex problem that requires us to consider many more variables than just physical activity if they are to be successful.
The second article by Grissom and her colleagues explores an important part of the child's context for physical activity in elementary physical education. Research has shown that while it is relatively easy to promote physical activity when the focus is on fitness, it is much more difficult to do this when the focus is on motor skill development. This study was significant in that a knowledgeable teacher was able to promote physical activity, even while attending to the motor skill development of the children. Interestingly, it seemed that the wearing of heart rate monitors did not make a difference in physical activity outcomes of children, more important was the role of the teacher in designing good activities. In line with other literature, this study found boys to be more active than girls, emphasizing the importance of specifically targeting girls in future interventions.
Our third and fourth articles focus on our younger preschool children. We believe that this young population is especially important in promoting child health as they are "little sponges" absorbing much of what we might have to offer relative to physical activity and health interventions. However, these articles demonstrate that many such young children face significant contextual challenges to child health and activity.
The third article by Rich and her colleagues examines parent perceptions of the health status and play activities of overweight Hispanic preschoolers. Despite being overweight, half of the parents indicated that they were not concerned about their child's weight. Many indicated access to safe outside play, although there were some gender differences. This study highlights the importance of health professionals in partnering with parents to learn about the risks of child overweight and in dealing with this critical issue.
The final article on physical activity by Goodway and Smith used qualitative methodology to examine the barriers faced by preschool children in underserved communities. Promoting physical activity among urban children is a critical health issue. However, the authors found that the nature of outside environments limited physical activity opportunities, and inside environments resulted in sedentary behaviors. Also, many of these communities had limited activity role models; despite this, the children enjoyed being physically active.
Given the findings of Goodway and Smith's article and of that by Rich and her colleagues, we believe that compensatory preschool programs need to carefully and systematically implement physical activity programs in their curricula. Many of these programs require parent involvement and we see these programs as a wonderful way to promote physical activity early and educate parents along the way.
The remaining 3 articles in this special issue continue to examine the contextual issues facing child health outcomes.
Lichtenstein et al's study addresses the problem of providing health insurance for children in rural America. Using a qualitative approach, the authors evaluate a local plan to provide access to health care for school children in a rural Alabama county. They conclude that progress was made in enrolling children into health services and that the most successful aspect of the program was a partnership between local leaders, health providers, and educators to provide impetus for a coordinated plan.
The study by Willems and her colleagues examined the contextual issues surrounding health inequalities in dental caries. They found that 18.5% of young children in a midsized city in Belgium had dental caries. Similar to the other studies, it was the contextual factors that were of importance. Living in a deprived neighborhood and the mother being an East European citizen at birth were the social variables with strongest association with early childhood caries. These variables were considered adequate criteria to identify groups at risk and those with which early intervention might occur.
The final study shows how a child's health is related to his or her parent's overall well-being and quality of life. Boling's article investigated family caregiver quality of life and its relationship to the health of children with cystic fibrosis. Disease severity data were collected for children with cystic fibrosis and caregiver's quality of life was assessed using the Beck Depression Inventory, and Caregiver Quality of Life for Cystic Fibrosis Scale. It was found that a relationship existed between the child and the caregiver's health. Programmatic recommendations to benefit family caregiver health and in turn benefit health of chronically ill children were also presented.
While unintended, the articles in this issue present compelling evidence about the broad social, economic, and cultural nature of children's health and the need for multifaceted interventions to improve their health status. Thus, in a manner of speaking this special issue on children's health is a call to action for adults. If we become convinced of the direct and indirect environmental impacts on children's health, effective interventions are more likely to be communicated to health policy makers and funding agencies. The result of which is likely to form the foundation for a very effective child health agenda in this country.