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Lepe A, Muhamed TAS, Reijneveld SA, de Kroon MLA. Mediation by parent health literacy and behaviour of socioeconomic inequality in child overweight. Pediatr Obes 2024:e13156. [PMID: 39075886 DOI: 10.1111/ijpo.13156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 06/14/2024] [Accepted: 07/10/2024] [Indexed: 07/31/2024]
Abstract
BACKGROUND Socioeconomic inequalities contribute to childhood overweight. Identifying mediators could help reduce these inequalities. OBJECTIVE We assessed to what extent and how parental health literacy and health behaviours mediate the relationship between parental socioeconomic status and childhood overweight. METHODS Data were taken from the multigenerational prospective Dutch Lifelines Cohort Study. We included 6683 children, baseline age 9.8 years (SD = 2.6), with an average follow-up of 36.2 months (SD = 9.3). Overweight was defined using age- and sex-specific cut-offs. Three indicators of socioeconomic status were included: education, income and occupation. We assessed the mediating role of parental health literacy and health behaviours (smoking, diet, physical activity and alcohol) using causal mediation. RESULTS Four additional years of education and an SD-increase in both income and occupation decreased the odds of childhood overweight by 42%, 12% and 20%, respectively. Only parental smoking independently mediated the relationship of both education (6.6%) and occupation (5.7%) with overweight. Parental health behaviours jointly explained 8.4% (education), 19.4% (income) and 9.8% (occupation) per relationship. Lastly, adding parental health literacy explained 10.8% (education), 27.4% (income) and 13.3% (occupation) of these relationships. CONCLUSIONS We found large socioeconomic inequalities in childhood overweight. Remarkably, parental smoking was a key mediator. Therefore, prevention targeting smoking may reduce socioeconomic inequalities in childhood overweight.
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Affiliation(s)
- Alexander Lepe
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Tamool A S Muhamed
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sijmen A Reijneveld
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marlou L A de Kroon
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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Norman Å, Malek ME, Nyberg G, Patterson E, Elinder LS. Effects of Universal School-Based Parental Support for Children's Healthy Diet and Physical Activity-the Healthy School Start Plus Cluster-Randomised Controlled Trial. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024:10.1007/s11121-024-01697-4. [PMID: 38987407 DOI: 10.1007/s11121-024-01697-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2024] [Indexed: 07/12/2024]
Abstract
Health promotion from an early age is key to preventing unhealthy weight development in childhood, and parental involvement is essential. The school-based Healthy School Start intervention aims to promote healthy dietary and activity habits in the home environment and prevent child obesity through parental support. This study evaluated the effectiveness of the third iteration of the programme on children's dietary and activity behaviours, and body composition through a cluster-randomised controlled trial. The trial included 17 schools (8 intervention) in disadvantaged areas in mid-Sweden with 353 families with 5- to 7-year-old children. The primary outcomes were intake of selected healthy and unhealthy foods and beverages measured using photography. Secondary outcomes were physical activity and sedentary time measured by accelerometry, and measured weight and height. All outcomes were assessed at baseline and post-intervention (8 months). Linear multi-level regression showed significant favourable effects of the intervention for intake of sweet beverages (b = - 0.17, p = 0.04), intake of healthy foods (b = 0.11, p = 0.04), and more time in moderate to vigorous physical activity during weekdays (b = 5.68, p = 0.02). An unfavourable sub-group effect of the intervention was found for children from families with low education regarding sedentary time on weekends (b = 23.04, p = 0.05). The results align with the previous two trials of the programme, indicating that school-based parental support is a useful approach for health promotion in young children in disadvantaged areas. Trial registration: ClinicalTrials.gov: No. NCT03390725, retrospectively registered on January 4, 2018, https://clinicaltrials.gov/ct2/show/NCT03390725 .
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Affiliation(s)
- Åsa Norman
- Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden.
- Department of Clinical Neurosciences, Karolinska Institutet, Nobels Väg 9, 171 65, Solna, Sweden.
| | | | - Gisela Nyberg
- Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden
- The Swedish School of Sport and Health Sciences, Lidingövägen 1, 114 33, Stockholm, Sweden
| | - Emma Patterson
- Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden
- Section for Risk and Benefit Assessment, Swedish Food Agency, Box 622, 751 26, Uppsala, Sweden
| | - Liselotte Schäfer Elinder
- Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Region Stockholm, 104 31, Stockholm, Sweden
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Llauradó E, Pedret A, Valls RM, Solà R, Tarro L. A 16-month follow-up after a youth-led social marketing intervention to encourage healthy lifestyles in children (aged 9 at baseline and 11 at follow-up) from disadvantaged neighbourhoods: the European Youth Tackling Obesity-Kids project. Public Health 2024; 232:1-3. [PMID: 38714149 DOI: 10.1016/j.puhe.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/26/2024] [Accepted: 04/05/2024] [Indexed: 05/09/2024]
Abstract
OBJECTIVES The objective of this study was to assess the influence of the European Youth Tackling Obesity-Kids (EYTO-Kids) 10-month intervention, based on social marketing and peer-led methodologies, at 16 month of its ending. STUDY DESIGN Children (aged 9 at baseline and 11 at the follow-up) from disadvantaged neighbourhoods who participated in the 10-month EYTO-Kids parallel-cluster randomised controlled intervention study in Reus (Spain) were included. The number of participants was 252 (retention rate: 67.2%) in the intervention group (7 schools) and 226 (retention rate: 69.1%) in the control one (8 schools). Primary (physical activity and fruit consumption) and secondary (screen time; and vegetables, fast food, and sugary drink consumption) outcomes were assessed. RESULTS At follow-up, consumption of ≥1 fruit per day increased in girls (odds ratio [OR] (95% confidence interval [CI]) = 2.28 (1.2; 4.2), P = 0.012) and all children (OR (95%CI) = 2.28 (1.0; 2.6), P = 0.044) in the intervention group vs. the control one. Physical activity ≥6 h/week similarly increased in both groups. CONCLUSION At long-term effectiveness of a 10-month intervention on improving fruit consumption in children was observed. Therefore, peer-led and social marketing methodologies enhance healthy lifestyles by conveying children towards healthy choices.
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Affiliation(s)
- Elisabet Llauradó
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, Reus 43201, Spain; Institut Investigació Sanitària Pere i Virgili (IISPV), Reus-Tarragona 43204, Spain
| | - Anna Pedret
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, Reus 43201, Spain; Institut Investigació Sanitària Pere i Virgili (IISPV), Reus-Tarragona 43204, Spain
| | - Rosa Mari Valls
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, Reus 43201, Spain
| | - Rosa Solà
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, Reus 43201, Spain; Institut Investigació Sanitària Pere i Virgili (IISPV), Reus-Tarragona 43204, Spain; Hospital Universitari Sant Joan de Reus, Reus 43204, Spain.
| | - Lucía Tarro
- Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, Reus 43201, Spain
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Harakeh Z, Preuhs K, Eekhout I, Lanting C, Klein Velderman M, van Empelen P. Behavior Change Techniques That Prevent or Decrease Obesity in Youth With a Low Socioeconomic Status: A Systematic Review and Meta-Analysis. Child Obes 2024; 20:128-140. [PMID: 37204322 DOI: 10.1089/chi.2022.0172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Background: Interventions, targeting youth, are necessary to prevent obesity later in life. Especially youth with low socioeconomic status (SES) are vulnerable to develop obesity. This meta-analysis examines the effectiveness of behavioral change techniques (BCTs) to prevent or reduce obesity among 0 to 18-year-olds with a low SES in developed countries. Method: Intervention studies were identified from systematic reviews or meta-analyses published between 2010 and 2020 and retrieved from PsycInfo, Cochrane systematic review, and PubMed. The main outcome was body mass index (BMI), and we coded the BCTs. Results: Data from 30 studies were included in the meta-analysis. The pooled postintervention effects of these studies indicated a nonsignificant decrease in BMI for the intervention group. Longer follow-up (≥12 months) showed favorable differences for intervention studies, although that BMI change was small. Subgroup analyses showed larger effects for studies with six or more BCTs. Furthermore, subgroup analyses showed a significant pooled effect in favor of the intervention for the presence of a specific BCT (problem-solving, social support, instruction on how to perform the behavior, identification of self as role model, and demonstration of the behavior), or absence of a specific BCT (information about health consequences). The intervention program duration and age group of the study population did not significantly influence the studies' effect sizes. Conclusions: Generally, the effects of interventions on BMI change among youth with low SES are small to neglectable. Studies with more than six BCTs and/or specific BCTs had a higher likelihood of decreasing BMI of youth with low SES.
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Affiliation(s)
- Zeena Harakeh
- Department of Child Health, TNO, Netherlands Organization for Applied Scientific Research, Leiden, Netherlands
| | - Katharina Preuhs
- Department of Child Health, TNO, Netherlands Organization for Applied Scientific Research, Leiden, Netherlands
| | - Iris Eekhout
- Department of Child Health, TNO, Netherlands Organization for Applied Scientific Research, Leiden, Netherlands
| | - Caren Lanting
- Department of Child Health, TNO, Netherlands Organization for Applied Scientific Research, Leiden, Netherlands
| | - Mariska Klein Velderman
- Department of Child Health, TNO, Netherlands Organization for Applied Scientific Research, Leiden, Netherlands
| | - Pepijn van Empelen
- Department of Child Health, TNO, Netherlands Organization for Applied Scientific Research, Leiden, Netherlands
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Obita G, Alkhatib A. Effectiveness of Lifestyle Nutrition and Physical Activity Interventions for Childhood Obesity and Associated Comorbidities among Children from Minority Ethnic Groups: A Systematic Review and Meta-Analysis. Nutrients 2023; 15:nu15112524. [PMID: 37299488 DOI: 10.3390/nu15112524] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 05/17/2023] [Accepted: 05/19/2023] [Indexed: 06/12/2023] Open
Abstract
Lifestyle physical activity (PA) and nutrition are known to be effective interventions in preventing and managing obesity-related comorbidities among adult populations but less so among children and adolescents. We examined the effectiveness of lifestyle interventions in children from minority ethnic populations in Western high-income countries (HICs). Our systematic review included 53 studies, involving 26,045 children from minority ethnic populations who followed lifestyle intervention programmes lasting between 8 weeks and 5 years with the aim of preventing and/or managing childhood obesity and associated comorbidities, including adiposity and cardiometabolic risks. The studies were heterogenous in terms of lifestyle intervention components (nutrition, PA, behavioural counselling) and settings (community vs. schools and after-school settings). Our meta-analysis included 31 eligible studies and showed no significant effects of lifestyle interventions when they focused on body mass index (BMI) outcomes (pooled BMI mean change = -0.09 (95% CI = -0.19, 0.01); p = 0.09). This was irrespective of the intervention programme duration (<6 months vs. ≥6 months), type (PA vs. nutrition/combined intervention) and weight status (overweight or obese vs. normal weight) as all showed nonsignificant effects in the sensitivity analysis. Nonetheless, 19 of the 53 studies reported reductions in BMI, BMI z-score and body fat percentage. However, the majority of lifestyle interventions adopting a quasi-design with combined primary and secondary obesity measures (11 out of 15 studies) were effective in reducing the obesity comorbidities of cardiometabolic risks, including metabolic syndrome, insulin sensitivity and blood pressure, in overweight and obese children. Preventing childhood obesity in high-risk ethnic minority groups is best achieved using combined PA and nutrition intervention approaches, which jointly target preventing obesity and its comorbidities, especially the outcomes of diabetes, hypertension and cardiovascular disease. Therefore, public health stakeholders should integrate cultural and lifestyle factors and contextualise obesity prevention strategies among minority ethnic groups in Western HICs.
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Affiliation(s)
- George Obita
- School of Health and Life Sciences, Teesside University, Tees Valley, Middlesbrough TS1 3BX, UK
| | - Ahmad Alkhatib
- School of Health and Life Sciences, Teesside University, Tees Valley, Middlesbrough TS1 3BX, UK
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Anselma M, Altenburg TM, Twisk JWR, Wang X, Chinapaw MJM. How to Evaluate the Effectiveness of Health Promotion Actions Developed Through Youth-Centered Participatory Action Research. HEALTH EDUCATION & BEHAVIOR 2023; 50:199-210. [PMID: 34628967 PMCID: PMC10021122 DOI: 10.1177/10901981211046533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Most actions targeting children's health behaviors have limited involvement of children in the development, potentially contributing to disappointing effectiveness. Therefore, in the 3-year "Kids in Action" study, 9- to 12-year-old children from a lower-socioeconomic neighborhood were involved as coresearchers in the development, implementation, and evaluation of actions targeting health behaviors. The current study describes the controlled trial that evaluated the effects on children's energy balance-related behaviors, physical fitness, and self-rated health, as well as experienced challenges and recommendations for future evaluations. Primary school children from the three highest grades of four intervention and four control schools were eligible for participation. Outcome measures assessed at baseline, and at 1- and 2-year follow-up were as follows: motor fitness by the MOPER test (N = 656, N = 485, N = 608, respectively), physical activity and sedentary behavior by accelerometry (N = 223, N = 149, N = 164, respectively), and consumption of sugar sweetened beverages and snacks and self-rated health by a questionnaire (N = 322, N = 281, N = 275, respectively). Mixed-model analyses were performed adjusted for clustering within schools and relevant confounders. Significant beneficial intervention effects were found on self-reported consumption of energy/sports drinks at T2 versus T0, and on total time and ≥5-minute bouts of moderate-to-vigorous physical activity at T1 versus T0. Significant adverse effects were found on "speed and agility" and "coordination and upper-limb speed." No other significant effects were found. The inconsistent intervention effects may be explained by the dynamic cohort and suboptimal outcome measures. We advise future studies with a similar approach to apply alternative evaluation designs, such as the delayed baseline design.
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Affiliation(s)
- Manou Anselma
- Amsterdam UMC, Vrije Universiteit
Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health
research institute, Amsterdam, The Netherlands
- Manou Anselma, Department of Public and
Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam
Public Health research institute, Van der Boechorststraat 7, Amsterdam NL-1081
BT, Netherlands.
| | - Teatske M. Altenburg
- Amsterdam UMC, Vrije Universiteit
Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health
research institute, Amsterdam, The Netherlands
| | - Jos W. R. Twisk
- Amsterdam UMC, Vrije Universiteit
Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam Public Health
research institute, Amsterdam, The Netherlands
| | - Xinhui Wang
- College of Computer Science, Qinghai
Normal University, Xining, Qinghai, China
| | - Mai J. M. Chinapaw
- Amsterdam UMC, Vrije Universiteit
Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health
research institute, Amsterdam, The Netherlands
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Oral Health-Related Knowledge, Attitudes and Behaviours of Arab Dental Students: Multi-National Cross-Sectional Study and Literature Analysis 2000-2020. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031658. [PMID: 35162682 PMCID: PMC8835654 DOI: 10.3390/ijerph19031658] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 01/25/2022] [Accepted: 01/31/2022] [Indexed: 12/11/2022]
Abstract
Dental students are the future leaders of oral health in their respective communities; therefore, their oral health-related attitudes and behaviours are of practical value for primary disease prevention. The present study aimed to evaluate oral health-related knowledge, attitudes, and behaviours of dental students in Arab countries and explore the potential sociodemographic predictors of their oral health outcomes. A multi-centre, cross-sectional study was conducted during the academic year 2019/2020 in three Arab countries: Lebanon, Syria, and Tunisia. The study used a validated Arabic version of the Hiroshima University Dental Behavioural Inventory (HU-DBI) composed of original twenty items that assess the level of oral health-related knowledge, attitudes, and behaviours, and four additional dichotomous items related to tobacco smoking, alcohol drinking, problematic internet use, and regular dental check-up The HU-DBI score ranges between 0 and 12. A total of 1430 students took part in this study, out of which 60.8% were females, 57.8% were enrolled in clinical years, 24.5% were tobacco smokers, 7.2% were alcohol drinkers, and 87% reported internet addiction. The mean HU-DBI score was 6.31 ± 1.84, with Lebanon having the highest score (6.67 ± 1.83), followed by Syria (6.38 ± 1.83) and Tunisia (6.05 ± 1.83). Clinical students (6.78 ± 1.70) had higher HU-DBI scores than their preclinical peers (5.97 ± 1.86). The year-over-year analysis revealed that dental public health and preventive dentistry courses had significantly and positively impacted the undergraduate students’ knowledge, attitudes, and behaviours. The gender-based differences were not statistically significant, with a modest trend favouring males, especially oral health behaviours. Tobacco smoking, alcohol drinking, and problematic internet use were associated with lower HU-DBI scores. In the Arab world, the economic rank of the country where the dental students live/study was weakly correlated with the students’ mean HU-DBI score.
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van den Broek T. Early-Life Circumstances, Health Behavior Profiles, and Later-Life Health in Great Britain. J Aging Health 2020; 33:317-330. [PMID: 33345690 PMCID: PMC8120632 DOI: 10.1177/0898264320981233] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objectives: Drawing on UK Household Longitudinal Study data, this study assessed a pathway from early-life disadvantage to suboptimal later-life health via health behavior. Methods: Latent class analysis was used to identify distinct smoking, nutrition, alcohol, and physical activity health behavior profiles. Mediation analyses were performed to assess indirect effects of early-life disadvantage via health behavior on allostatic load, an objective measure of physiological wear and tear. Results: Four health behavior profiles were identified: (1) broadly healthy and high alcohol consumption, (2) low smoking and alcohol consumption, healthy nutrition, and physically inactive, (3) broadly unhealthy and low alcohol consumption, and (4) broadly moderately unhealthy and high alcohol consumption. Having grown up in a higher socioeconomic position family was associated with lower later-life allostatic load. This was partly attributable to health behavioral differences. Discussion: Growing up under disadvantageous socioeconomic circumstances may initiate a chain of risk by predisposing people to health behavior profiles associated with poorer later-life health.
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Ray C, Figueiredo R, Pajulahti R, Vepsäläinen H, Lehto E, Lehto R, Erkkola M, Roos E. Effects of the Preschool-Based Family-Involving DAGIS Intervention on Family Environment: A Cluster Randomised Trial. Nutrients 2020; 12:nu12113387. [PMID: 33158101 PMCID: PMC7694211 DOI: 10.3390/nu12113387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/30/2020] [Accepted: 11/02/2020] [Indexed: 11/29/2022] Open
Abstract
Interventions promoting young children’s healthy energy balance-related behaviours (EBRBs) should also examine changes in the family environment as this is an important determinant that may affect the effectiveness of the intervention. This study examines family environmental effects of the Increased Health and Wellbeing in Preschools (DAGIS) intervention study, and whether these effects differed when considering three parental educational level (PEL) groups. The DAGIS intervention was conducted in preschools and involving parents in Southern Finland from September 2017 to May 2018. It was designed as a randomised trial, clustered at preschool-level. Parents of 3–6-year-olds answered questionnaires recording PEL, parental role modelling for EBRBs, and the family environment measured as EBRBs availability and accessibility. Linear Mixed Models with Repeated Measures were used in order to detect intervention effects. Models included group by time interactions. When examining intervention effects separated by PEL groups, models with three-level interactions (group × time-points × PEL) were evaluated. There was an interaction effect for the availability of sugary everyday foods and drinks (p = 0.002). The analyses showed that the control group increased availability (p = 0.003), whereas in the intervention group no changes were detected (p = 0.150). In the analysis separated by PEL groups, changes were found only for the accessibility of sugary treats at home; the high PEL control group increased the accessibility of sugary treats (p = 0.022) (interaction effect: p = 0.027). Hence, results suggest that the DAGIS multicomponent intervention had a limited impact on determinants for children’s healthy EBRBs, and no impact was found in the low PEL group.
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Affiliation(s)
- Carola Ray
- Folkhälsan Research Center, Topeliuksenkatu 20, FI-00250 Helsinki, Finland; (R.F.); (R.P.); (E.L.); (R.L.); (E.R.)
- Department of Food and Nutrition, University of Helsinki, P.O. Box 66, FI-00014 Helsinki, Finland; (H.V.); (M.E.)
- Correspondence:
| | - Rejane Figueiredo
- Folkhälsan Research Center, Topeliuksenkatu 20, FI-00250 Helsinki, Finland; (R.F.); (R.P.); (E.L.); (R.L.); (E.R.)
- Clinicum, University of Helsinki, P.O. Box 63, FI-00014 Helsinki, Finland
| | - Riikka Pajulahti
- Folkhälsan Research Center, Topeliuksenkatu 20, FI-00250 Helsinki, Finland; (R.F.); (R.P.); (E.L.); (R.L.); (E.R.)
- Department of Food and Nutrition, University of Helsinki, P.O. Box 66, FI-00014 Helsinki, Finland; (H.V.); (M.E.)
| | - Henna Vepsäläinen
- Department of Food and Nutrition, University of Helsinki, P.O. Box 66, FI-00014 Helsinki, Finland; (H.V.); (M.E.)
| | - Elviira Lehto
- Folkhälsan Research Center, Topeliuksenkatu 20, FI-00250 Helsinki, Finland; (R.F.); (R.P.); (E.L.); (R.L.); (E.R.)
- Department of Teacher Education, University of Helsinki, P.O. Box 9, FI-00014 Helsinki, Finland
| | - Reetta Lehto
- Folkhälsan Research Center, Topeliuksenkatu 20, FI-00250 Helsinki, Finland; (R.F.); (R.P.); (E.L.); (R.L.); (E.R.)
- Department of Teacher Education, University of Helsinki, P.O. Box 9, FI-00014 Helsinki, Finland
| | - Maijaliisa Erkkola
- Department of Food and Nutrition, University of Helsinki, P.O. Box 66, FI-00014 Helsinki, Finland; (H.V.); (M.E.)
| | - Eva Roos
- Folkhälsan Research Center, Topeliuksenkatu 20, FI-00250 Helsinki, Finland; (R.F.); (R.P.); (E.L.); (R.L.); (E.R.)
- Department of Food and Nutrition, University of Helsinki, P.O. Box 66, FI-00014 Helsinki, Finland; (H.V.); (M.E.)
- Department of Public Health, University of Helsinki, P.O. Box 63, FI-00014 Helsinki, Finland
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Physical Activity in the Daily Life of Adolescents: Factors Affecting Healthy Choices from a Discrete Choice Experiment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186860. [PMID: 32961819 PMCID: PMC7559571 DOI: 10.3390/ijerph17186860] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/07/2020] [Accepted: 09/15/2020] [Indexed: 12/31/2022]
Abstract
Physical activity improves peoples’ well-being and can help in preventing weight gain, obesity, and related non-communicable diseases. Promoting healthy behaviors in the daily travels and transport choices of adolescents is very important in early establishing healthy habits that imply routine physical activity. For designing and developing effective strategies, it is relevant to study adolescents’ preferences for physical activity and what factors in the social and environmental contexts affect their preferences. The paper investigates these aspects by means of a discrete choice experiment, using data from more than 4300 16–17 year-old adolescents in Italy. The results show that adolescents generally prefer walking for long time alone. However, females prefer cycling, while adolescents from lower educated families prefer motorized means of transport. Environmental factors affect the adolescents’ preferences: living nearby a green area is associated with more active and healthier choices in their short daily travels. Conversely, adolescents living closer to an industrial or high traffic area prefer to use motorized vehicles. Such findings have been discussed and policy implications presented, in order to support policymakers in designing cross-sectoral policies to promote healthy choices related to physical activity in adolescence.
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Effects of the Preschool-Based Family-Involving DAGIS Intervention Program on Children's Energy Balance-Related Behaviors and Self-Regulation Skills: A Clustered Randomized Controlled Trial. Nutrients 2020; 12:nu12092599. [PMID: 32859118 PMCID: PMC7551940 DOI: 10.3390/nu12092599] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/19/2020] [Accepted: 08/24/2020] [Indexed: 01/11/2023] Open
Abstract
The study examines the effects of a preschool-based family-involving multicomponent intervention on children’s energy balance-related behaviors (EBRBs) such as food consumption, screen time and physical activity (PA), and self-regulation (SR) skills, and whether the intervention effects differed among children with low or high parental educational level (PEL) backgrounds. The Increased Health and Wellbeing in Preschools (DAGIS) intervention was conducted as a clustered randomized controlled trial, clustered at preschool level, over five months in 2017–2018. Altogether, 802 children aged 3–6 years in age participated. Parents reported children’s consumption of sugary everyday foods and beverages, sugary treats, fruits, and vegetables by a food frequency questionnaire, and screen time by a 7-day diary. Physical activity was assessed by a hip-worn accelerometer. Cognitive and emotional SR was reported in a questionnaire by parents. General linear mixed models with and without repeated measures were used as statistical methods. At follow-up, no differences were detected in EBRBs or SR skills between the intervention and control group, nor did differences emerge in children’s EBRBs between the intervention and the control groups when stratified by PEL. The improvement in cognitive SR skills among low PEL intervention children differed from low PEL control children, the significance being borderline. The DAGIS multicomponent intervention did not significantly affect children’s EBRBs or SR. Further sub-analyses and a comprehensive process evaluation may shed light on the non-significant findings.
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Optimism and Social Support Predict Healthier Adult Behaviors Despite Socially Disadvantaged Childhoods. Int J Behav Med 2020; 27:200-212. [PMID: 31933126 DOI: 10.1007/s12529-020-09849-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Studies have shown adverse effects of a disadvantaged childhood on adult health-promoting behaviors and related outcomes. Optimism and social support have been linked to greater likelihood of engaging in healthy behavior, but it is unclear whether these positive psychosocial factors may buffer harmful effects of early adversity. This study aims to determine if optimism and social support in adulthood can modify effects of childhood disadvantage on health behavior-related outcomes. METHODS Longitudinal data were analyzed from a subset of participants in a US birth cohort established in 1959-1966 (ns of 681-840, per outcome). An index of childhood social disadvantage was derived from adverse socioeconomic and family stability factors reported by mothers at child's birth and age 7 years. Health behavior-related outcomes were self-reported when participants were of mean age 47 years. Multivariable adjusted robust Poisson regressions were performed. RESULTS Regardless of level of childhood social disadvantage, we found higher levels of optimism and social support were both associated with higher probabilities of being a non-smoker (relative risk [RR]optimism = 1.17, 95% confidence interval [CI] = 1.09-1.26; RRsocial support = 1.24, 95%CI = 1.11-1.39), having a healthy diet (RRoptimism = 1.25, 95%CI = 1.10-1.43; RRsocial support = 1.27, 95%CI = 1.04-1.56), and a healthy body mass index (RRoptimism = 1.18, 95%CI = 1.00-1.40; RRsocial support = 1.29, 95%CI = 1.00-1.66). Interactions link higher optimism or social support with lower risk of smoking among those with moderate childhood disadvantage. CONCLUSIONS Overall, these findings are consistent with the possibility that positive psychosocial resources contribute to maintaining a healthy lifestyle in mid-adulthood and may buffer effects of childhood social disadvantage.
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Behavioural and social sciences to enhance the efficacy of health promotion interventions: redesigning the role of professionals and people. ACTA ACUST UNITED AC 2019. [DOI: 10.1017/bpp.2019.19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AbstractEvidence on the effectiveness of health promotion interventions is mixed, especially in terms of the magnitude of their impact and long-term adherence. This paper proposes a comprehensive approach informed by behavioural economics of developing behavioural change programmes, which is designed to educate, activate, engage and empower people by taking into consideration individual and social mechanisms. Three applied pilots and their results are presented in order to illustrate the approach using cognitive and social mechanisms to lead to better health outcomes, individually and community-wide. More research is needed to explore levers and barriers for the systemic adoption of this framework in implementing health promotion interventions.
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The Effect of Nurse-Led Diet and Physical Activity Program for Health on Diet and Physical Activity Behavior of Children. J Phys Act Health 2019; 16:504-511. [PMID: 31154916 DOI: 10.1123/jpah.2018-0278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 01/17/2019] [Accepted: 03/02/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Many health problems encountered in childhood, adolescence, and adulthood periods arise from problematic eating behavior, an unhealthy dietary approach, and inactive lifestyles. The aim of this study was to determine the effect of the Diet and Physical Activity Program for Health, under the leadership of a nurse, on the dietary and physical activity behaviors of children. METHODS This study was planned in a quasi-experimental design with pretesting, posttesting, follow-up testing, and a control group. The study was conducted with 114 students in 2 schools. A total of 12 hours of training was given to the experimental group for 6 weeks. Institutional permission required for performing the study and an ethical consent from the commission for clinical trials of Marmara University institute of health sciences were received. RESULTS The results of the study reveal that Diet and Physical Activity Program for Health in posttest and follow-up periods was effective in improving dietary and physical activity behaviors of children within the program. However, the program's effect on dietary and physical activity self-efficacy was limited. CONCLUSION The results of the study indicate that this program was effective in development of children's behavior regarding diet and physical activity.
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Tarro L, Llauradó E, Aceves-Martins M, Moriña D, Papell-Garcia I, Arola L, Giralt M, Solà R. Impact of a youth-led social marketing intervention run by adolescents to encourage healthy lifestyles among younger school peers (EYTO-Kids project): a parallel-cluster randomised controlled pilot study. J Epidemiol Community Health 2019; 73:324-333. [PMID: 30683803 PMCID: PMC6581153 DOI: 10.1136/jech-2017-210163] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 11/20/2018] [Accepted: 12/13/2018] [Indexed: 11/05/2022]
Abstract
BACKGROUND Encouraging healthy lifestyles in children is a challenge. This project aimed to improve lifestyles of younger peers by engaging adolescent creators (ACs) to design and implement peer-led and social marketing (SM) health-promoting activities. METHODS A 10-month parallel-cluster randomised controlled school-based pilot study was performed in disadvantaged neighbourhoods in Reus (Spain) spanning two academic years (2015-2016/2016-2017). Eight primary schools (n=375 children) and four high schools (n=94ACs) were randomly placed in the intervention group. The 94 ACs (12-14 years) designed and implemented four SM activities for their younger peers (9-11 years). Eight primary schools (n=327 children) and three high schools (n=98 adolescents) served as the control group and received no intervention. Primary (physical activity and fruit consumption) and secondary outcomes (screen time, vegetables, soft drinks, sweets and fast food consumptions) were assessed with validated questionnaires at baseline and at the end of the study. RESULTS After 10 months, fruit consumption and physical activity were maintained in the children who consumed ≥1 fruit/day and spent ≥6 hours/week physical activity. However, compared with the controls, the intervention significantly increased the physical activity of girls to 15.6 min/week, whereas the percentage of girls who consumed sweets, soft drinks and fast food decreased significantly by 8.4%, 14.5% and 5.9%, respectively. Additionally, the percentage of ≥2 hour/weekday of screen time by boys decreased significantly by 8.2%. CONCLUSION The European Youth Tackling Obesity-Kids, SM and peer-led intervention, effectively increased physical activity hours/week in girls, but was not effective in improving the percentage of children who consumed the recommended fruit. Moreover, the percentages of girls who consumed sweets, soft drinks and fast food and boys screen time decreased. TRIAL REGISTRATION NUMBER NCT02702336; Pre-results.
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Affiliation(s)
- Lucia Tarro
- Medicine and Surgery and Basical Medical Sciences, Universitat Rovira i Virgili, Facultat de Medicina i Ciències de la Salut, Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Health Education and Promotion, C/ Sant Llorenç, 21, Reus (43201), Spain, Reus, Spain
- Health and Nutrition, Eurecat, Centre Tecnològic de Catalunya, Unitat de Nutrició i Salut, Avinguda Universitat 1, Reus, Catalonia, Spain
| | - Elisabet Llauradó
- Medicine and Surgery and Basical Medical Sciences, Universitat Rovira i Virgili, Facultat de Medicina i Ciències de la Salut, Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Health Education and Promotion, C/ Sant Llorenç, 21, Reus (43201), Spain, Reus, Spain
| | - Magaly Aceves-Martins
- Medicine and Surgery and Basical Medical Sciences, Universitat Rovira i Virgili, Facultat de Medicina i Ciències de la Salut, Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Health Education and Promotion, C/ Sant Llorenç, 21, Reus (43201), Spain, Reus, Spain
| | - David Moriña
- Infections and Cancer-Information and Interventions, Unit of Infections and Cancer-Information and Interventions (UNIC-I&I), Catalan Institute of Oncology (ICO)-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Catalonia, Spain
| | - Ignasi Papell-Garcia
- Health and Nutrition, Eurecat, Centre Tecnològic de Catalunya, Unitat de Nutrició i Salut, Avinguda Universitat 1, Reus, Catalonia, Spain
| | - Lluis Arola
- Health and Nutrition, Eurecat, Centre Tecnològic de Catalunya, Unitat de Nutrició i Salut, Avinguda Universitat 1, Reus, Catalonia, Spain
- Bioquímica i Biotecnologia, Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Nutrigenomics Research Group, Campus Sescelades C/ Marcel·lí Domingo, 1 43007 Tarragona, Tarragona, Catalonia, Spain
| | - Montse Giralt
- Medicine and Surgery and Basical Medical Sciences, Universitat Rovira i Virgili, Facultat de Medicina i Ciències de la Salut, Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Health Education and Promotion, C/ Sant Llorenç, 21, Reus (43201), Spain, Reus, Spain
- Pharmacology, Universitat Rovira i Virgili Facultat de Medicina I Ciences de la Salut, C/ Sant Llorenç, 21, Reus (43201), Spain, Reus, Catalonia, Spain
| | - Rosa Solà
- Medicine and Surgery and Basical Medical Sciences, Universitat Rovira i Virgili, Facultat de Medicina i Ciències de la Salut, Functional Nutrition, Oxidation, and Cardiovascular Diseases Group (NFOC-Salut), Health Education and Promotion, C/ Sant Llorenç, 21, Reus (43201), Spain, Reus, Spain
- Health and Nutrition, Eurecat, Centre Tecnològic de Catalunya, Unitat de Nutrició i Salut, Avinguda Universitat 1, Reus, Catalonia, Spain
- Internal Medicine, Hospital Universitari Sant Joan de Reus, Avinguda Bellissens, 2, 43204 Reus, Spain, Reus, Catalunya, Spain
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Fröberg A, Jonsson L, Berg C, Lindgren EC, Korp P, Lindwall M, Raustorp A, Larsson C. Effects of an Empowerment-Based Health-Promotion School Intervention on Physical Activity and Sedentary Time among Adolescents in a Multicultural Area. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E2542. [PMID: 30428548 PMCID: PMC6267499 DOI: 10.3390/ijerph15112542] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 11/05/2018] [Accepted: 11/12/2018] [Indexed: 12/24/2022]
Abstract
Physical activity (PA) decreases with age, and interventions are needed to promote PA during adolescence, especially, among those in low-socioeconomic status (SES) areas. The aim of this study was to investigate whether a two-year, empowerment-based health-promotion school intervention had any effects on changes in (a) moderate-to-vigorous PA (MVPA), (b) sedentary time (SED), (c) exercise training (ET) frequency, and (d) ET duration, among adolescents. Participants (aged 12⁻13 years at baseline) from one intervention school and two control schools, were recruited from a multicultural area of Sweden, characterized by low-SES. During the course of the two-year intervention, a total of 135 participants (43% boys) were included in the study. The intervention was developed and implemented as a result of cooperation and shared decision-making among the researchers and the participants. MVPA and SED were measured with accelerometers, and ET frequency and duration was self-reported at the beginning of the seventh, eighth, and ninth grade, respectively. There were no significant effects of the two-year, empowerment-based health-promotion school intervention on changes in the accelerometer-measured MVPA and SED, or the self-reported ET frequency and duration, among the adolescents. Overall, the intervention was unsuccessful at promoting PA and reducing SED. Several possible explanations for the intervention's lack of effects are discussed.
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Affiliation(s)
- Andreas Fröberg
- Department of Food and Nutrition, and Sport Science, University of Gothenburg, 41120 Gothenburg, Sweden.
| | - Linus Jonsson
- Department of Food and Nutrition, and Sport Science, University of Gothenburg, 41120 Gothenburg, Sweden.
| | - Christina Berg
- Department of Food and Nutrition, and Sport Science, University of Gothenburg, 41120 Gothenburg, Sweden.
| | - Eva-Carin Lindgren
- Department of Food and Nutrition, and Sport Science, University of Gothenburg, 41120 Gothenburg, Sweden.
- School of Health and Welfare, Halmstad University, 30118 Halmstad, Sweden.
| | - Peter Korp
- Department of Food and Nutrition, and Sport Science, University of Gothenburg, 41120 Gothenburg, Sweden.
| | - Magnus Lindwall
- Department of Psychology, University of Gothenburg, 40530 Gothenburg, Sweden.
| | - Anders Raustorp
- Department of Food and Nutrition, and Sport Science, University of Gothenburg, 41120 Gothenburg, Sweden.
- Department of Sport Science, Linnaeus University, 391 82 Kalmar, Sweden.
| | - Christel Larsson
- Department of Food and Nutrition, and Sport Science, University of Gothenburg, 41120 Gothenburg, Sweden.
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Craike M, Wiesner G, Hilland TA, Bengoechea EG. Interventions to improve physical activity among socioeconomically disadvantaged groups: an umbrella review. Int J Behav Nutr Phys Act 2018; 15:43. [PMID: 29764488 PMCID: PMC5952843 DOI: 10.1186/s12966-018-0676-2] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 05/06/2018] [Indexed: 01/08/2023] Open
Abstract
Background People from socioeconomically disadvantaged population groups are less likely to be physically active and more likely to experience adverse health outcomes than those who are less disadvantaged. In this umbrella review we examined across all age groups, (1) the effectiveness of interventions to improve physical activity among socioeconomically disadvantaged groups, (2) the characteristics of effective interventions, and (3) directions for future research. Methods PubMed/MEDLINE and Scopus were searched up to May 2017 to identify systematic reviews reporting physical activity interventions in socioeconomically disadvantaged populations or sub-groups. Two authors independently conducted study screening and selection, data extraction (one author, with data checked by two others) and assessment of methodological quality using the ‘Assessment of Multiple Systematic Reviews’ scale. Results were synthesized narratively. Results Seventeen reviews met our inclusion criteria, with only 5 (30%) reviews being assessed as high quality. Seven (41%) reviews focused on obesity prevention and an additional four focused on multiple behavioural outcomes. For pre school children, parent-focused, group-based interventions were effective in improving physical activity. For children, school-based interventions and policies were effective; few studies focused on adolescents and those that did were generally not effective; for adults, there was mixed evidence of effectiveness but characteristics such as group-based interventions and those that focused on physical activity only were associated with effectiveness. Few studies focused on older adults. Across all ages, interventions that were more intensive tended to be more effective. Most studies reported short-term, rather than longer-term, outcomes and common methodological limitations included high probability of selection bias, low response rates, and high attrition. Conclusions Interventions can be successful at improving physical activity among children from socioeconomically disadvantaged groups, with evidence for other age groups weak or inconclusive. More high-quality studies in this population group are needed, which adopt strategies to increase recruitment rates and reduce attrition, report longer term outcomes, and provide adequate intervention details, to allow determination of the characteristics of effective interventions. We recommend that the benefits of physical activity be recognised more broadly than obesity prevention in future studies, as this may have implications for the design and appeal of interventions. Electronic supplementary material The online version of this article (10.1186/s12966-018-0676-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Melinda Craike
- Institute for Health and Sport, Victoria University, PO Box 14428, Melbourne, VIC, 8001, Australia.
| | - Glen Wiesner
- Institute for Health and Sport, Victoria University, PO Box 14428, Melbourne, VIC, 8001, Australia
| | - Toni A Hilland
- Institute for Health and Sport, Victoria University, PO Box 14428, Melbourne, VIC, 8001, Australia.,School of Education, College of Design and Social Context, RMIT, PO Box 71, Bundoora, VIC, 3083, Australia
| | - Enrique Garcia Bengoechea
- Institute for Health and Sport, Victoria University, PO Box 14428, Melbourne, VIC, 8001, Australia.,Department of Physical Education and Sport Sciences, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
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