A short dutch questionnaire to measure fruit and vegetable intake: relative validity among adults and adolescents

Twelve Month Efficacy of Computer-Tailored Communication in Boosting Fruit and Vegetable Consumption Among Adults Aged Forty and over: A Three-Level Meta-Analysis and Systematic Review of Randomized Controlled Trials

Computer-tailored health communication (CTC) can enhance fruit and vegetable (F&V) intake and, consequently, health by providing personalized feedback. However, few studies have examined the long-term effects of such interventions in middle-aged and older adults. This research aimed to assess the 12-mo efficacy of CTC in promoting F&V consumption and potentially identify who among middle-aged and older adults changed their diet after the intervention. The protocol was registered at the International Prospective Register of Systematic Reviews (PROSPERO) on 2021-12-09, code CRD42022330491. The research was performed without external funding. We searched 6 databases (MEDLINE via PubMed, EMBASE, Scopus, Web of Science Core Collection, Cochrane Library, and PsycINFO) for randomized controlled trials (RCTs) comparing CTC interventions for increasing F&V intake with usual care/no intervention control in adults aged ≥40, measured 12 mo after the pretest. The search covered the period from 1 January 1990 to 1 January 2022. We selected 16 RCTs with 25,496 baseline participants for the review systematic literature reviews (SLR) and 11 RCTs with 19 measurements for the meta-analysis (MA). We assessed risk of bias with the JBI Critical Appraisal Checklist. The SLR revealed that at 1-y postCTC intervention, most of the treatment groups increased F&V intake more than the control groups. The overall bias in the data set was not high. The MA model on 11 RCTs revealed a significant effect size for F&V consumption in intervention groups compared with control, standardized mean difference of 0.21 (confidence interval [CI]: 0.12, 0.30), P = 0.0004. The evidence suggests that CTC is a suitable strategy for public interventions aiming to increase F&V intake in adults aged ≥40. The design of CTC for public interventions should consider the process of change and stages of change addressing awareness, attitudes, self-efficacy, and social influence as promising concepts for influencing behavior change.

An explorative study with convenience vegetables in urban Nigeria—The Veg-on-Wheels intervention

Nigerian consumers have been found to view vegetables as healthy and health is a principal motivation for consumption; however, consumers also experience barriers related to preparation time and availability of vegetables. We therefore conducted a Veg-on-Wheels intervention, in which ready-to-cook, washed and pre-cut green leafy vegetables (GLV) were kept cool and sold for five weeks at convenient locations near workplaces and on the open market in Akure, Nigeria. Surveys were conducted prior to the intervention with 680 consumers and during the final week of the intervention with 596 consumers near workplaces and 204 consumers at the open market. Both buyers and non-buyers of the intervention were included; 49% buyers in the workplace sample and 47% in the open market sample. The Veg-on-Wheels intervention was successful, with high awareness, positive attitudes and high customer satisfaction. GLV intake was higher for Veg-on-Wheels buyers compared with non-buyers after the intervention, i.e., 10.8 vs. 8.0 portions per week, respectively. Also the intake of other vegetables was higher in the intervention group. The motives and barriers for buyers and non-buyers differed across the selling locations: main barriers were trust in the vendor and GLV source. These trust issues and vendor preferences were viewed as more important to respondents at the market than those near workplaces. This study is the first intervention study on the selling of ready-to-cook convenience vegetables in urban Nigeria. It shows that a market exists for convenience vegetables and that they have the potential to increase vegetable intake. Insights on both the food environment and consumers’ motives and behaviour was crucial for designing and evaluating the intervention.

Examining food intake similarities in adolescent best friend dyads using longitudinal Actor-Partner Interdependence Models

Little is known about how adolescent best friends may affect each other's food intake. This study explored whether friendship selection and socialization mechanisms explained potential food intake similarities in adolescent reciprocated best friend dyads. We also tested whether socialization processes were moderated by dyad member's relative zBMI. Members of 145 same-gender best friendship dyads (56% female; Mage = 12.79; SDage = 0.61) reported on their intake of food obtained from home and from outside the home at the beginning and the end of the school year through food frequency questionnaires. Longitudinal Actor-Partner Interdependence Models results showed no indication of selection or socialization, and very limited evidence for the moderation of socialization processes by relative zBMI. These findings indicate that focusing on adolescent reciprocated best friends in dietary interventions may not be valuable.

Measures of Perceived Neighborhood Food Environments and Dietary Habits: A Systematic Review of Methods and Associations

Access to healthy food is a necessity for all people. However, there is still a lack of reviews on the assessment of respondent-based measures of neighborhood food environments (perceived food environments). The aim of this systematic review was to evaluate the measurement tools for perceived food environments by five dimensions of food access and to obtain the overview of their associations with dietary habits among people aged 18 years and older in middle- and high-income countries. Observational studies using perceived food environment measures were identified through a systematic review based on two databases for original studies published from 2010 to 2020. A total of 19 final studies were extracted from totally 2926 studies. Pertaining to the five dimensions of food access, 12 studies dealt with accessibility, 13 with availability, 6 with affordability, 10 with acceptability, 2 with accommodation, and 8 with a combination of two or more dimensions. Perceived healthy food environments were positively associated with healthy dietary habits in 17 studies, but 8 of them indicated statistically insignificant associations. In conclusion, this review found accessibility and availability to be major dimensions of perceived food environments. The relationship between healthy food environments and healthy diets is presumably positive and weak.

The first semi-quantitative toddler's food frequency questionnaire (T-FFQ) in Iran

Background: Only few food frequency questionnaires (FFQs) have been specifically designed and validated for toddlers. There is no valid instrument to assess usual intakes of Iranian toddlers. The present study was designed to develop a FFQ, and to examine its validity and reliability among toddlers. Material and methods: This cross-sectional study was conducted in 2019 in Iran. Mothers of 100 toddlers completed a semi-quantitative FFQ with 99 items as well as three non-consecutive dietary records. Data on maternal age, education, toddler gender, birth order, birth weight, current weight and height, and the age of beginning complementary foods were collected. By comparing the results obtained from dietary records and the FFQ, we assessed the relative validity. Reliability was evaluated by intra-class correlation coefficients between results of two FFQs administered with four weeks intervals to the same participants (n=20), as well as weighted kappa. The Bland-Altman plots were used to assess the level of agreement between two FFQs. Results: Mean and standard deviation (SD) of age was 32.71 (4.76) years and 22.42 (3.52) months, for mothers and toddlers, respectively. The FFQ showed acceptable validity and reliability. The correlation coefficients for the first FFQ were 0.82 (energy), 0.81 (fats), 0.60 (carbohydrate), 0.96 (calcium), 0.39 (iron) and 0.24 (vitamin C), all P-values were <0.001, except for vitamin C (P: 0.02). Reliability coefficients were between 0.77 (vitamin C) and 0.99 (calcium, potassium, phosphorus, zinc, riboflavin, vitamin B12, vitamin E and D). The Cronbach's Alpha was 0.91, showing high reliability. Conclusion: The present study provided a thorough assessment of both validity and reliability of T-FFQ, and indicated acceptable validity as compared with three-day dietary records and good reliability. Therefore, this FFQ could be a useful tool to evaluate usual dietary intake of toddlers.

Development and validation of the FiberScreen: A short questionnaire to screen fibre intake in adults

Background

Health effects of dietary fibres are the topic of many studies. Eligibility criteria often include a certain fibre intake, which requires dietary screening during recruitment. However, dietary assessment methods are extensive and burdensome for both the researcher and participant. Therefore, we developed and validated a short questionnaire (FiberScreen) to screen fibre intake.

Methods

The initial five‐item questionnaire assessed fruit, vegetable, whole grain, pasta/rice/potato and legume intake. The optimised FiberScreen included 18 items, which further specified intake of the above‐mentioned categories, and included nuts and seeds. The FiberScreen was completed during two fibre promoting interventions. In Study A, participants without constipation completed the five‐item FiberScreen and a food frequency questionnaire (FFQ) during screening (n = 131), and the 18‐item FiberScreen and a FFQ at 3‐month follow‐up (n = 87). In Study B, 29 constipated participants completed the 18‐item FiberScreen at screening and a FFQ during the first study visit.

Results

The fibre estimate from the five‐item FiberScreen and the FFQ was moderately correlated (r = 0.356, p < 0.001). Importantly, the 18‐item FiberScreen and FFQ, when data of both studies were combined, had a strong correlation (r = 0.563, p < 0.001). The 18‐item FiberScreen had a lower fibre estimate compared to the FFQ (Δ = 1.2 ± 5.9 g, p = 0.030) but the difference was relatively small. Bland–Altman plots showed a good agreement between the questionnaires. Completion time of the 18‐item FiberScreen was 4.2 ± 2 min.

Conclusions

The 18‐item FiberScreen is a suitable short screening questionnaire for ranking the fibre intake of adults. The 18‐item FiberScreen can help to reduce screening burden for both the participant and researcher.

 

Dietary screening during recruitment is more elaborate than is often needed, and burdensome for both the researcher and participant.

An 18‐item FiberScreen questionnaire to screen fibre intake was developed and validated in Dutch adults with and without gastrointestinal complaints.

The 18‐item FiberScreen had a good agreement with a food frequency questionnaire.

Completion time of the 18‐item FiberScreen was around 4 min, compared to 45–60 min for the food frequency questionnaire.

Development and preliminary validation of the Adolescent Food Parenting Questionnaire: Parent and adolescent version

Suitable instruments for measuring Food Parenting Practices (FPP) among adolescents and their parents that also measure the perception of adolescents about their parent's FPP are rare. The current study describes the development and preliminary testing of a short 16-item Adolescent Food Parenting Questionnaire (AFPQ) for parents (AFPQ-p) and adolescents (AFPQ-a) that may enable future large-scale research on potentially eminent parent-child FPP discrepancy. Participants included 381 parents (73.8 % mothers; M_age 45.9, 26.2% fathers; M_age 49.1) and their adolescent children (aged 12-16) who participated in the Dutch "G(F)OOD together" study. Most parents finished higher professional education (mothers: 44.3 %; fathers: 34.4 %) and performed a paid job of 32 h per week or more (mothers: 22.1 %; fathers: 60.0 %). The theoretical framework of Vaughn (2016) was leading in the development of the AFPQ. Exploratory factor analysis (EFA) was performed on a random split sample of parent-adolescent dyads and confirmatory factor analysis (CFA) was performed on the other half. The EFA in both parent and adolescent samples resulted in a clear 5 factor solution explaining 61.6 % (AFPQ-p) and 64.2 % (AFPQ-a) of the variance respectively, representing the factors Autonomy Support (α = 0.79/.82), Coercive Control (α = 0.85/.83), Snack Structure (α = 0.79/75), Healthy Structure (α = 0.78/74) and Modelling (α = 0.69/85). CFA confirmed good model fit for the AFPQ-p and the AFPQ-a. Associations with adolescent self-reported food intake were in the expected direction, confirming the preliminary convergent validity of the instrument among a moderate to highly educated group of parent-adolescent dyads. Although the AFPQ provides a promising short instrument, future research in more diverse samples is needed to build evidence on the instrument's psychometric characteristics in other groups.

Higher Levels of Physical Activity Are Associated with Greater Fruit and Vegetable intake in Older Adults

OBJECTIVE

High levels of physical activity (PA) and optimal nutrition independently improve healthy aging, but few data are available about how PA may influence food preferences in older populations. Therefore, the aim of our study was to establish if there is an association between habitual PA and intake of nutrient-dense foods (i.e. fruits and vegetables).

DESIGN

A cross-sectional survey was conducted.

SETTING

The Netherlands.

PARTICIPANTS

2466 older adults (56% male, age 62±9 yr).

MEASUREMENTS

PA was assessed using the short questionnaire to assess health (SQUASH) and participants were classified into quintiles of weekly PA (MET-h/wk). Total fruit and vegetable intake was assessed using a validated food frequency questionnaire (FFQ) and were corrected for energy intake (g/kcal/d) in the analyses. Multiple regression analyses were performed to determine the association between PA and fruit and vegetable intake, including covariates.

RESULTS

Being in the higher quintiles of PA (Q3, Q4 and Q5) was positively associated with more daily fruit and vegetable consumption, even after correction for total energy intake (Q3; β=0.089, P<0.001, Q4; β=0.047, P=0.024, Q5; β=0.098, P<0.001).

CONCLUSIONS

Older adults who are moderately to highly physically active tend to consume more fruit and vegetable compared to less active peers, when corrected for total energy intake. Female gender, under- and overreporting dietary intake (Goldberg score), non-smoking, high level of education, less alcohol consumption and a lower body mass index positivity affected this relationship. Our data will help health-care professionals to accelerate their efforts to treat and prevent chronic diseases.

The added value of frequent physical activity group sessions in a combined lifestyle intervention: A cluster randomised trial in primary care

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A combined lifestyle intervention improves lifestyle in overweight and obese subjects.

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Real-world setting study shows that changed lifestyle after a combined lifestyle intervention can be sustained.

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Adding group sessions with a physiotherapist had no added value.

Combined lifestyle interventions (CLIs) that target both physical activity (PA) and diet have been shown to improve PA and health of adults who are overweight; however, optimal amount of guidance remains unclear. This study evaluated the effects of adding PA group sessions to a standard CLI in primary care in the Netherlands. 411 participants (BMI 34.5 ± 4.4 kg/m²) in thirty locations were randomised into a one year CLI or CLI+. CLI comprised individual meetings with lifestyle coach (LSC) and physiotherapist, and group meetings with dietician. PA group sessions were added in CLI+. Primary outcome was minutes of moderate to vigorous PA per week. Secondary outcomes of PA, diet and cardiovascular risk factors (i.e. waist circumference, HbA1c and blood pressure) were evaluated after 12 and 24 months with multilevel analyses. Data were collected from 2010 to 2015. Significant between-group effects were only found for waist circumference, which was significantly lower at twelve months in the CLI+ group (p = 0.011), no other between-group differences were found. Several within-group changes were significant. After participating in the intervention, walking time increased with 83 ± 35 min/week and 100 ± 38 min/week, and BMI decreased with 0.7 ± 0.3 kg/m² and 1.5 ± 0.3 kg/m² in CLI and CLI+ respectively (p < 0.001). Diet, HbA1c and systolic blood pressure changed favourably in both groups. Adding PA group sessions did not elicit added, sustained benefits. A programme with individual meetings with LSC and physiotherapist, and group meetings with dietician can be sufficient to facilitate a healthy lifestyle and reduce cardiovascular risk factors in a population with overweight.

Mindfulness is not associated with dissonant attitudes but enhances the ability to cope with them

Background

Explicit and implicit attitudes have been studied extensively, but there is less attention to reducing dissonance between them. This is relevant because this dissonance (IED) results in distress and has inconsistent effects on behavior, e.g. less physical activity but more smoking. Mindfulness decreases dissonance between self-related explicit and implicit constructs. This study investigates if, and which, specific mindfulness subskills are associated with decreased dissonance between explicit and implicit attitudes, and whether mindfulness subskills moderate the relationship between IED and intention/behavior.

Method

At baseline and one and three months thereafter, participants’ (N = 1476) explicit attitudes, implicit attitudes, red meat consumption (RMC), intention to reduce RMC as well as levels of trait mindfulness were assessed.

Results

Mindfulness subskills were not associated with decreased IED. IED was associated with lower RMC and a higher intention to reduce RMC. The mindfulness subskill acceptance buffered the effect of IED on intention, seemingly offering a skill to deal with dissonant attitudes, which was unidentified until now.

Conclusion

The mindfulness subskill accepting without judgment functions as a way to deal with dissonance. Future research should use this novel finding and investigate whether mindfulness can be used as a buffer in contexts where dissonance results in maladaptive behaviors.

Is Adolescents' Food Intake Associated with Exposure to the Food Intake of Their Mothers and Best Friends?

Both mothers’ and best friends’ food intake are associated with adolescents’ food intake, but they are rarely investigated simultaneously. In this study, we tested the associations of mothers’ and best friends’ food intake with adolescents’ intake of unhealthy and healthy food, obtained from home and from outside the home, and the moderating role of adolescents’ exposure to their food intake. Participants included 667 adolescents (53% female, M_age = 12.9) and 396 of their mothers. Within this adolescent sample, 378 best friend dyads were identified. All participants completed food frequency questionnaires. Mothers separately reported on their food intake in the presence and absence of their child, and adolescents indicated how often they ate and drank together with their best friend during school breaks. Mothers’, but not best friends’, food intake was positively related to adolescents’ intake of unhealthy and healthy food obtained from home and healthy food obtained from outside the home. Exposure to mothers’ healthy food intake magnified mother-child similarities in healthy food intake. Exposure to best friends’ intake of unhealthy food moderated adolescent-friend similarities in unhealthy food intake. Future work should assess the mechanisms that underlie these similarities, and should investigate these associations over time and in later developmental periods.

The Role of Recreational Online Activities in School-Based Screen Time Sedentary Behaviour Interventions for Adolescents: A Systematic and Critical Literature Review

Sedentary behaviours are highly associated with obesity and other important health outcomes in adolescence. This paper reviews screen time and its role within school-based behavioural interventions targeting adolescents between the years 2007 and 2019. A systematic literature review following PRISMA guidelines was conducted across five major databases to identify interventions targeting screen time—in addition to TV/DVD viewing. The review identified a total of 30 papers analysing 15 studies across 16 countries aiming at addressing reduction of recreational screen time (internet use and gaming) in addition to television/DVD viewing. All of the interventions focused exclusively on behaviour change, targeting in the majority both reduction of sedentary behaviours along with strategies to increase physical activity levels. A mix of intervention effects were found in the reviewed studies. Findings suggest aiming only for reduction in time spent on screen-based behaviour within interventions could be a limited strategy in ameliorating excessive screen use, if not targeted, in parallel, with strategies to address other developmental, contextual and motivational factors that are key components in driving the occurrence and maintenance of adolescent online behaviours. Additionally, it raises the need for a differential treatment and assessment of each online activity within the interventions due to the heterogeneity of the construct of screen time. Recommendations for enhancing the effectiveness of school-based sedentary behaviour interventions and implications for public policy are discussed.

Implicit attitudes and explicit cognitions jointly predict a reduced red meat intake: a three-wave longitudinal study

Background: Despite nutritional benefits, a high consumption of red meat is not without risks as it is linked to the development of certain types of cancer as well as to other non-communicable diseases, such as type II diabetes or cardiovascular diseases. Moreover, the production of meat has negative effects on the environment. Therefore, a transition to a less meat-based diet could be beneficial. It is unclear how explicit cognitions towards red meat consumption and implicit attitudes jointly influence intention and consumption. We tested the additive pattern (both types of cognitions explain unique variance) and interactive pattern (both types interact in the prediction).

Method: At baseline (T0; N = 1790) and one (T1; n = 980) and three months thereafter (T2; n = 556), explicit cognitions, red meat consumption, and implicit attitudes were assessed among a Dutch sample.

Results: Only explicit cognitions were associated with red meat consumption. Implicit attitudes moderated the effect of self-efficacy on T0-RMC; negative implicit attitudes strengthened this effect. T0-intention was associated with explicit cognitions and implicit attitudes. Additionally, negative implicit attitudes strengthened the effect of social norms on T0 and T2-intention. Regarding red meat consumption, support for the interactive pattern was found. For intention there was support for the interactive and additive pattern.

Conclusion: Interventions aiming to reduce red meat consumption in the general public might profit from changing implicit attitudes in addition to explicit cognitions.

Adolescents' Weight Management Goals: Healthy and Unhealthy Associations with Eating Habits and Physical Activity

BACKGROUND

This study aims to quantify associations between one's weight management goal and eating behaviors and physical activity among teenagers.

METHODS

Weighted logistic regressions were performed predicting healthy behaviors from weight goal separately for boys and girls while controlling for age, body mass index, socioeconomic indicators, school type, and region using data from the 2010 to 2011 Enquête québécoise sur la santé des jeunes du secondaire, a survey of a representative sample of Quebec adolescents (N = 32,040).

RESULTS

About 18%, 31%, 19%, and 34% of boys and 32%, 34%, 5%, and 25% of girls were respectively trying to lose weight, maintain their weight, gain weight, and not trying to do anything about their weight. Trying to lose weight was associated with lower likelihood of eating breakfast daily (boys: odds ratio [OR] = 0.72; 95% confidence interval [CI] = 0.61, 0.84 girls: OR = 0.61; 95% CI = 0.54, 0.70). Among girls, trying to lose weight was also associated with higher likelihood of consuming at least 5 portions of fruits and vegetables (OR = 1.20; 95% CI = 1.04, 1.37), lower likelihood of drinking sugar-sweetened beverages daily (OR = 0.77; 95% CI = 0.66, 0.90). Each weight-related goal was associated with unhealthy behaviors but most of them were also associated with adoption of healthier ones.

CONCLUSION

Having a weight related goal cannot inherently be thought of as health promoting goal.

Longitudinal analysis of health disparities in childhood

OBJECTIVE

Combatting disparities in health outcomes among children is a major public health concern. This study focuses on two questions: (1) To what extent does socioeconomic status (SES) contribute to disparities in health outcomes? and (2) To what extent can social inequalities in health outcomes be explained by differences in children's health behaviours?

DESIGN

This study included 2-year follow-up data of 1259 children (4-12 years of age) who participated in the 'Healthy Primary School of the Future' project (ClinicalTrials.gov NCT02800616). SES was measured by maternal and paternal education and household income (adjusted for family size). Health outcomes were body mass index (BMI) z-score, health resource use, school absenteeism, health-related quality of life and psychosocial health, measured over 2 years of follow-up (2015-2017). Health behaviours included physical activity, and consumption of fruits, vegetables and sweetened beverages. Associations between SES and baseline health behaviours were examined, and mixed models for repeated measures were used to assess associations between SES and health outcomes over 2 years of follow-up.

RESULTS

A high socioeconomic background was significantly associated with better health outcomes (all outcomes). For example, children with a low SES had higher BMI z-scores (beta coefficient: 0.42, 95% CI 0.22 to 0.62) and higher consumption healthcare costs (ratio of mean costs: 2.21, 95% CI 1.57 to 3.10). Effects of SES changed very little after controlling for health behaviours.

DISCUSSION

Our findings strongly suggest that socioeconomic background has a pervasive impact on disparities in child health, but gives little support to the idea that social inequalities in child health can be tackled by means of lifestyle interventions.

Drivers of Vegetable Consumption in Urban Nigeria: Food Choice Motives, Knowledge, and Self-Efficacy

Objective: This study aimed to provide insights into vegetable consumption behavior of urban Nigerian consumers across different Socio-Economic Classes (SEC), their main food choice motives, and the associations of these motives and other drivers with vegetable consumption. Methods: An online survey was conducted in which 1220 women from Lagos (N = 808) and Ibadan (N = 412) metropolis from different SEC participated. Results: On average, respondents reported to consume 2.6 portions of vegetables per day. Most vegetables were bought at open and traditional markets, were bought fresh rather than processed, and were consumed cooked. Respondents from the second richest and upper middle SEC consumed most vegetables () and higher SEC consumed a larger variety of vegetables compared to those from lower classes. Respondents who reported to have a higher knowledge of vegetable consumption, had a higher belief in one’s own ability to prepare vegetables (self-efficacy), and those that valued the food motive Mood and Health more, reported a higher vegetable intake. Conclusions: Vegetable consumption in the studied cities in Nigeria was below recommendations. Increasing knowledge and self-efficacy might be a way to increase consumption, especially in combination with interventions in the food environment and product design focused on the motives Health and Mood, and considering the importance of differences between SEC.

Enhancing Executive Functions Among Dutch Elementary School Children Using the Train Your Mind Program: Protocol for a Cluster Randomized Trial

Background

Executive functions are higher cognitive control functions, which are essential to physical and psychological well-being, academic performance, and healthy social relationships. Executive functions can be trained, albeit without broad transfer, to this date. Broad transfer entails the translation of improved cognitive functions to daily life (behaviors). The intervention Train your Mind was designed to train executive functions among elementary school children aged 9 to 11 years, and obtain broad transfer in terms of enhanced physical activity, healthy eating, and socioemotional regulation.

Objective

This paper aims to describe the cluster randomized trial to test the effectiveness of the Train your Mind intervention.

Methods

Train your Mind was integrated into the existing school curriculum for 8 months (25 weeks excluding holidays). The effectiveness of the intervention was tested in a cluster randomized trial comprising 13 schools, 34 groups (school classes), and 800 children, using a battery of 6 computer tasks at pre- and postmeasurement. Each of the 3 core executive functions was measured by 2 tasks (Flanker and Go/No-Go; N-Back and Running Span; Attention Switching Task and Dots/Triangles). Moreover, we administered questionnaires that measure emotion-regulation, cognitive errors, physical activity, dietary habits, and the psycho-social determinants of diet and physical activity. Body mass index was also measured. Multilevel analyses will account for clustering at the school and group levels, and randomization took place at the school level.

Results

Results are currently being analyzed.

Conclusions

The main purpose of this study is to test Train your Mind’s effectiveness in enhancing executive functions. Second, we investigate whether increased executive functions lead to improved physical activity and healthy eating. If found effective, executive function training could easily be integrated into school curricula everywhere, and as such, boost health, academic performance, and emotion-regulation of elementary school children, in a cost-effective manner.

Trial Registration

Netherlands Trial Register NTR5804; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5804 (Archived by WebCite at http://www.webcitation.org/6z9twosJ8)

Registered Report Identifier

RR1-10.2196/7908

Socio-economic differences in the change of fruit and vegetable intakes among Dutch adults between 2004 and 2011: the GLOBE study

Objective

To investigate socio-economic differences in changes in fruit and vegetable intake between 2004 and 2011 and explore the mediating role of financial barriers in this change.

Design

Respondents completed a self-reported questionnaire in 2004 and 2011, including questions on fruit and vegetable intake (frequency per week), indicators of socio-economic position (education, income) and perceived financial barriers (fruits/vegetables are expensive, financial distress). Associations were analysed using ordinal logistic regression. The mediating role of financial barriers in the association between socio-economic position and change in fruit and vegetable intake was studied with the Baron and Kenny approach.

Setting

Longitudinal GLOBE study.

Subjects

A total of 2978 Dutch adults aged 25–75 years.

Results

Respondents with the lowest income in 2004 were more likely to report a decrease in intake of cooked vegetables (P-trend<0·001) and raw vegetables (P-trend<0·001) between 2004 and 2011, compared with those with the highest income level. Respondents with the lowest education level in 2004 were more likely to report a decrease in intake of fruits (P-trend=0·021), cooked vegetables (P-trend=0·033), raw vegetables (P-trend<0·001) and fruit juice (P-trend=0·027) between 2004 and 2011, compared with those with the highest education level. Financial barriers partially mediated the association between income and education and the decrease in fruit and cooked vegetable intake between 2004 and 2011.

Conclusions

These results show a widening of relative income and educational differences in fruit and vegetable intake between 2004 and 2011. Financial barriers explained a small part of this widening.

Long-term effects of a web-based cancer aftercare intervention on moderate physical activity and vegetable consumption among early cancer survivors: a randomized controlled trial

BACKGROUND

The number of cancer survivors is growing. Negative physical and psychosocial consequences of cancer treatment can occur during survivorship. Following healthy lifestyle recommendations is beneficial to increase quality of life and to reduce the risk of cancer recurrence and comorbidities. To meet individual needs, web-based interventions can supply a large population of cancer survivors with easily accessible and personalized information. Evidence concerning the long-term effects of web-based cancer aftercare interventions on lifestyle outcomes is limited. The present study evaluates the 12-month effects of a fully automated web-based cancer aftercare intervention. We investigated whether the previously determined 6-month effects on moderate physical activity and vegetable intake were maintained over 12 months. Possible moderator effects of using specific intervention modules, gender, age, and education were also explored.

METHOD

A two-armed randomized controlled trial was conducted using online self-report questionnaires among survivors of various types of cancer (N = 462). The intervention group had access to the online intervention for 6 months, and the control group received access after 12-months. Multilevel linear regression analyses (complete cases and intention-to-treat) were conducted to explore 12- month effects.

RESULTS

A significant intervention effect after 12 months was found for moderate physical activity (complete cases: B = 128.475, p = .010, d = .35; intention-to-treat: B = 129.473, p = .011). Age was the only significant moderator (p = .010), with the intervention being effective among participants aged younger than 57 years (B = 256.549, p = .000, d = .59). No significant intervention effect remained for vegetable consumption after 12 months (complete cases: B = 5.860, p = .121; intention-to-treat: B = 5.560, p = .132).

CONCLUSION

The online cancer after care intervention is effective in increasing and maintaining moderate physical activity in the long term among early cancer survivors younger than 57 years. Short-term increases in vegetable consumption were not sustained in the long term. These findings indicate the value and potential of eHealth interventions for cancer survivors. Based on the study results, web-based self-management interventions could be recommended for younger cancer survivors (<57 years of age) as a possible method to increase physical activity.

TRIAL REGISTRATION

Dutch Trial Register NTR3375 . Registered 29 March 2012.

Relative validity of fruit and vegetable intake estimated by the food frequency questionnaire used in the Danish National Birth Cohort*

Objective: To validate the fruit and vegetable intake estimated from the Food Frequency Questionnaire (FFQ) used in the Danish National Birth Cohort (DNBC). Subjects and setting: The DNBC is a cohort of 101,042 pregnant women in Denmark, who received a FFQ by mail in gestation week 25. A validation study with 88 participants was made. A seven-day weighed food diary (FD) and three different biomarkers were employed as comparison methods. Results: Significant correlations between FFQ and FD-based estimates were found for fruit (r=0.66); vegetables (r=0.32); juice (r=0.52); fruit and vegetables (F&V) (r=0.57); and fruit, vegetables, and juice (F&V&J) (r=0.62). Sensitivities of correct classification by FFQ into the two lowest and the two highest quintiles of F&V&J intake were 58—67% and 50— 74%, respectively, and specificities were 71—79% and 65—83%, respectively. F&V&J intake estimated from the FFQ correlated significantly with urinary flavonoids (r=0.39, p<0.005), plasma β-carotene (r=0.21, p<0.05) and erythrocyte folate (r=0.33, p<0.005); all average biomarker levels increased across increasing quintiles of F&V&J intake. Conclusion: Data on F&V&J recorded by FFQ in DNBC can be used in etiological analyses of associations between fruit and vegetable intake and health outcomes, provided that the potential misclassification of dietary exposure is kept in mind.

Development of a computer-tailored nutrition and physical activity intervention for lower-educated women of Dutch, Turkish and Moroccan origin using content matching and ethnic identity tailoring

Background

Unhealthy dietary and physical activity (PA) patterns are highly prevalent in most Western countries, especially among lower-educated and ethnic minority groups. Therefore, interventions to promote healthy eating and physical activity that can reach large numbers of lower-educated people are needed. When developing interventions, the ethnic diversity of the lower-educated population may be taken into account to make intervention material more appealing to the target group. This article describes the development and evaluation of two computer-tailored nutrition and physical activity interventions for lower-educated Dutch, Turkish and Moroccan women. One version is tailored to sociocognitive variables (traditional tailoring), while the other is additionally tailored to ethnic identity (EI-tailoring).

Method

Using intervention mapping, two evidence- and theory-based interventions were developed. In the traditional tailoring intervention, messages are tailored to health behavior, awareness of own behavior, attitude and self-efficacy. The behavior change techniques used to address these factors are: descriptive and evaluative feedback, arguments, modeling, goal setting, planning, barrier identification and advice on how to deal with barriers, stimulating resistance to social pressure, mobilization of social support (nontailored), active learning (nontailored) and iterative feedback. In the EI-tailoring intervention, the material is additionally tailored to ethnic identity (EI). This means that recipients who feel strongly attached to their ethnic background receive different intervention material than recipients with a weak attachment to their background. This includes, for instance, the use of more traditional colors, role models that match with their origin and advice messages that refer to their ethnicity of origin.

Discussion

Developing an intervention that matches the needs of this specific target population was challenging due to the little evidence regarding the determinants of their health behavior, as well as the behavioral change techniques that have not been tested among Turkish and Moroccan women in the Netherlands before. Based on previous research among this and other target populations we hypothesize, however, that the determinants and strategies we use will be suitable. A randomized controlled trial will show whether the interventions are effective among our specific target group and whether EI-tailoring is beneficial.

Trial registration

Dutch Trial Registry NTR4506, registration date: 1^st may 2014

Determinants of Forward Stage Transition from Precontemplation and Contemplation for Fruit Consumption

Purpose.

To examine associations between decisional balance, self-efficacy, fruit intake, and stage of change transition from precontemplation and contemplation with cross-sectional and longitudinal methods.

Design.

A longitudinal cohort study with the use of electronic questionnaires was conducted. Three measurements were analyzed cross-sectionally, and the two intervals between the measurements were analyzed longitudinally.

Setting.

A random sample of 1500 individuals from an existing Dutch Internet panel resulted in a cohort of 735 individuals. Of the cohort, 648 (response rate 88%), 592 (response rate 81%), and 570 (response rate 78%) respondents completed questionnaires at the start of the present study (T1), 53 days after T1 (T2), and 106 days after T1 (T3), respectively.

Subjects.

Mean age was 37.5 years, 51% were women, and 57% ate less than the recommended intake of 250 g of fruit per day.

Measures.

Questionnaires included items measuring stage of change, factors favoring (pros) or working against (cons) behavior change, and self-efficacy. A food frequency questionnaire was used to assess fruit intake.

Results.

Logistic regression analyses showed that pros, fruit intake, and self-efficacy predicted forward stage transition from precontemplation. Self-efficacy predicted forward stage transition from contemplation. Cons did not predict stage transitions. Results from longitudinal analyses were similar to cross-sectional results, except for self-efficacy: no differences between early stages in self-efficacy were found, whereas self-efficacy predicted these early stage transitions.

Conclusions.

Within the limitations posed by the sampling frame, results provided support for the Transtheoretical Model, although determinants might not always be stage specific.

The Healthy Primary School of the Future: study protocol of a quasi-experimental study

BACKGROUND

Unhealthy lifestyles in early childhood are a major global health challenge. These lifestyles often persist from generation to generation and contribute to a vicious cycle of health-related and social problems. This design article presents a study evaluating the effects of two novel healthy school interventions. The main outcome measure will be changes in children's body mass index (BMI). In addition, lifestyle behaviours, academic achievement, child well-being, socio-economic differences, and societal costs will be examined.

METHODS

In close collaboration with various stakeholders, a quasi-experimental study was developed, for which children of four intervention schools (n = 1200) in the southern part of the Netherlands are compared with children of four control schools (n = 1200) in the same region. The interventions started in November 2015. In two of the four intervention schools, a whole-school approach named 'The Healthy Primary School of the Future', is implemented with the aim of improving physical activity and dietary behaviour. For this intervention, pupils are offered an extended curriculum, including a healthy lunch, more physical exercises, and social and educational activities, next to the regular school curriculum. In the two other intervention schools, a physical-activity school approach called 'The Physical Activity School', is implemented, which is essentially similar to the other intervention, except that no lunch is provided. The interventions proceed during a period of 4 years. Apart from the effectiveness of both interventions, the process, the cost-effectiveness, and the expected legal implications are studied. Data collection is conducted within the school system. The baseline measurements started in September 2015 and yearly follow-up measurements are taking place until 2019.

DISCUSSION

A whole-school approach is a new concept in the Netherlands. Due to its innovative, multifaceted nature and sound scientific foundation, these integrated programmes have the potential to form a template for primary schools worldwide. The effects of this approach may extend further than the outcomes associated with well-being and academic achievement, potentially impacting legal and cultural aspects in our society.

TRIAL REGISTRATION

The study protocol was registered in the database ClinicalTrials.gov on 14-06-2016 with the reference number NCT02800616 .

The Role of Vitality in the Relationship Between a Healthy Lifestyle and Societal Costs of Health Care and Lost Productivity: A Mediation Analysis

PURPOSE

To examine the mediating effect of vitality in the relationship between healthy lifestyle characteristics and health-care and productivity-related costs.

DESIGN

Observational prospective cohort study with 2 measurements. Online questionnaires were filled out in 2013 (T0) and 2014 (T1).

SETTING

A random sample of a Dutch online interview panel was obtained.

SUBJECTS

Data of 4231 Dutch adults who had complete data at T0 and T1 were used in the present study. Participants were representative for the Dutch adult population in terms of age, gender, and having chronic disease(s).

MEASURES

Healthy Lifestyle Index (HLI), vitality, and health-care and productivity-related costs. The HLI consisted of the sum of 6 healthy lifestyle characteristics, including a healthy BMI (yes/no), meeting physical activity, fruit, vegetable, and alcohol consumption guidelines (yes/no), and smoking status (yes: non or former smoker/no: current smoker). Health-care and productivity-related costs were measured using a utilization questionnaire.

ANALYSIS

Linear regression analysis.

RESULTS

The HLI was related to vitality. In addition, vitality was related to health-care costs and productivity-related costs. Furthermore, vitality was found to transmit 28.4% of the effect of HLI on health-care costs and 39.4% of the effect of HLI on productivity-related costs.

CONCLUSION

Lifestyle was related to vitality and vitality to health-care and productivity-related costs. Vitality mediated the relationship between lifestyle and health-care and productivity-related costs. Therefore, we recommend to sustain and improve both vitality and lifestyle.

Stages of Change for Fruit and Vegetable Consumption in Deprived Neighborhoods

This article describes the association of external and psychosocial factors on the stages of change for fruit and vegetable consumption, among 2,781 inhabitants, aged 18 to 65 years, in deprived neighborhoods (response rate 60%). To identify correlates of forward stage transition, an ordinal logistic regression model, the Threshold of Change Model (TCM), was used to analyze the data. The results indicate that men, those from Dutch origin, those with (rather) low health locus of control, those displaying risk behaviors, and those without knowledge of dietary guidelines were less likely to move from one stage to another and therefore were more likely to be in a lower stage-of-change category. The results make it possible to distinguish target groups, which should receive more attention in future health promotion campaigns, and to identify factors to be addressed in those programs.

The telephone lifestyle intervention 'Hartcoach' has modest impact on coronary risk factors: A randomised multicentre trial

BACKGROUND

Unhealthy diets and inactivity are still common among patients with cardiovascular diseases. This study evaluates the effects of the telephonic lifestyle intervention 'Hartcoach' on risk factors and self-management in patients with recent coronary events.

DESIGN

This was a randomised trial in five Dutch hospitals.

METHODS

Patients (18-80 years), less than eight weeks after hospitalisation for acute myocardial infarction or (un)stable angina pectoris were randomised to the Hartcoach-group, who received telephonic coaching every four weeks for a period of six months (in addition to usual care), and a control group receiving usual care only. Simple random allocation was used (without relation to prior assignment). Measurements were taken by research nurses blinded for group allocation. Differences after six months of participation were compared using linear or logistic regression models with treatment-group and baseline score for the outcome under analysis as covariates, resulting in adjusted mean change (b).

RESULTS

Altogether 374 patients were randomised (173 Hartcoach + usual care, 201 usual care only). Follow-up was obtained in 331 patients who still participated after six months. Hartcoach had significant favourable effects on body mass index (BMI) (b = -0.32; 95% CI:(-0.63- -0.003)), waist circumference (b = -1.71; 95% CI:(-2.73- -0.70)), physical activity (b = 15.08 (score); 95% CI:(0.13, 30.04)) daily intake of vegetables (b = 13.41; 95% CI:(1.10-25.71)), self-management (b = 0.11; 95% CI:(0.00-0.23)) and anxiety (b = -0.65; 95% CI:(-1.25- -0.06)). Hartcoach slightly increased the total number of risk scores on target (b = 0.45; 95% CI:(0.17-0.73)).

CONCLUSIONS

Hartcoach has modest impact on BMI, waist circumference, physical activity, intake of vegetables, self-management and anxiety. Therefore, it may be a useful maintenance programme in addition to usual care, to support patients with recent coronary events to improve self-management and reduce risk factors.

Lifestyle-related effects of the web-based Kanker Nazorg Wijzer (Cancer Aftercare Guide) intervention for cancer survivors: a randomized controlled trial

Purpose

The web-based Kanker Nazorg Wijzer (Cancer Aftercare Guide) responds to the needs of cancer survivors and oncology care providers to improve the counseling related to self-management of lifestyle and psychosocial challenges. In present study, overall intervention effects and the effects of using specific components were evaluated on vegetable, fruit, whole grain bread, and fish consumption, physical activity (PA), and smoking behavior.

Methods

Cancer survivors from 21 Dutch hospitals were recruited for a randomized controlled trial (N = 432). Intervention effects after 6 months were evaluated using multilevel linear regression analysis (complete cases and intention-to-treat). By conducting moderation analyses, additional effects of following the behavior-related modules were explored. The false discovery rate correction was applied to account for multiple testing.

Results

After 6 months, 409 participants completed follow-up (dropout = 11.5 %). Indications were found that access to the intervention may result in increases of moderate PA and vegetable intake. The moderate PA increase was meaningful: 74.74 min p/w higher increase in the intervention condition. Effect sizes of moderate PA (d = .25) and vegetable (d = .37) consumption were comparable to prior effective interventions. Visiting behavior-related modules affected moderate PA, fruit, and fish consumption. However, after correction for multiple testing, significances expired. No significant intervention effect was found on smoking behavior due to low numbers of smokers.

Implications for Cancer Survivors

Although the effectiveness was only shown only to a limited extend, this study provided several indications that this theory-based, comprehensive, and personalized eHealth intervention provides valuable content to complement usual cancer aftercare.

Exploring individual cognitions, self-regulation skills, and environmental-level factors as mediating variables of two versions of a Web-based computer-tailored nutrition education intervention aimed at adults: A randomized controlled trial

BACKGROUND

This study explored whether the determinants that were targeted in two versions of a Web-based computer-tailored nutrition education intervention mediated the effects on fruit, high-energy snack, and saturated fat intake among adults who did not comply with dietary guidelines.

METHOD

A RCT was conducted with a basic (tailored intervention targeting individual cognitions and self-regulation), plus (additionally targeting environmental-level factors), and control group (generic nutrition information). Participants were recruited from the general Dutch adult population and randomly assigned to one of the study groups. Online self-reported questionnaires assessed dietary intake and potential mediating variables (behavior-specific cognitions, action- and coping planning, environmental-level factors) at baseline and one (T1) and four (T2) months post-intervention (i.e. four and seven months after baseline). The joint-significance test was used to establish mediating variables at different time points (T1-mediating variables - T2-intake; T1-mediating variables - T1-intake; T2-mediating variables - T2-intake). Educational differences were examined by testing interaction terms.

RESULTS

The effect of the plus version on fruit intake was mediated (T2-T2) by intention and fruit availability at home and for high-educated participants also by attitude. Among low/moderate-educated participants, high-energy snack availability at home mediated (T1-T1) the effect of the basic version on high-energy snack intake. Subjective norm mediated (T1-T1) the effect of the basic version on fat intake among high-educated participants.

DISCUSSION

Only some of the targeted determinants mediated the effects of both intervention versions on fruit, high-energy snack, and saturated fat intake. A possible reason for not finding a more pronounced pattern of mediating variables is that the educational content was tailored to individual characteristics and that participants only received feedback for relevant and not for all assessed mediating variables.

TRIAL REGISTRATION

Netherlands Trial Registry NTR3396.

Comparative validity of the ASSO-Food Frequency Questionnaire for the web-based assessment of food and nutrients intake in adolescents

BACKGROUND

A new web-based food frequency questionnaire (the ASSO-FFQ) was developed within the ASSO Project funded by the Italian Ministry of Health.

OBJECTIVE

The aim of the present study is to assess the validity of the ASSO-FFQ at food groups, energy, and nutrients level.

DESIGN AND SUBJECTS

The validation study compared the ASSO-FFQ against a weighted food record (WFR) measuring foods, beverages and supplements intake, compiled during the week following the ASSO-FFQ administration. Ninety-two subjects aged 14-17, recruited from secondary schools in Palermo (Italy), completed the ASSO-FFQ and WFR. The intake of 24 food groups, energy, and 52 nutrients were taken as main outcomes. Tests for paired observations, Spearman and Pearson's correlation coefficients (cc), kappa statistics and classification in quintiles, Bland-Altman plots and multiple regressions, on untransformed and transformed data were used for the statistical analysis.

RESULTS

High cc (≥0.40) were found for soft drinks, milk, tea/coffee, vegetables, and lactose; fair energy-adjusted cc (0.25-0.40) for water, alcoholic drinks, breakfast cereals, fishery products, savory food, fruit juice, eggs, and 19 nutrients. The subjects classified in the same or adjacent quintile for food groups ranged from 40% (alcoholic drinks) to 100% (dried fruit); for energy and nutrients from 43% (phosphorus, thiamin, niacin) to 77% (lactose). Mean differences were not significant for water, soft drinks, meat, sweets, animal fats, milk and white bread, and vitamin B12 and folate. Limits of Agreement were broad for all food groups and nutrients. School, gender, alcohol consumption and between meals mainly affected most food groups' intake differences. Gender stratification showed females had increased Pearson's cc for energy and 28 nutrients, such as almost all fats, carbohydrates, vitamins and minerals.

CONCLUSIONS

The ASSO-FFQ could be applied in epidemiological studies for the assessment of dietary consumption in adolescents to adequately rank food, energy and nutrient intakes at a group level.

Long-term efficacy of a Web-based computer-tailored nutrition education intervention for adults including cognitive and environmental feedback: a randomized controlled trial

Background

Unhealthy diets are prevalent in Western countries, especially among low-educated people. To have an effect on health, it is important that dietary changes are sustained over time. This study examines long-term effects of a cognitive and environmental-feedback version of a Web-based computer-tailored (CT) nutrition education intervention targeting fruit, vegetables, high-energy snacks and saturated fat.

Methods

A randomized controlled trial was conducted with a basic (tailored intervention targeting individual cognitions and self-regulation processes; n = 456), plus (additionally targeting environmental-level factors; n = 459) and control group (generic nutrition information; n = 434). Participants were recruited from the general population and randomly assigned to a study group. Online self-reported questionnaires assessed fruit, vegetable, high-energy snack and saturated fat intake, self-regulation, self-control, and Body Mass Index (BMI) at baseline and nine-months post-intervention. Linear mixed model analyses examined group differences in change over time. Educational differences were examined by ‘group X time X education’ interaction terms. Effects were examined in the total sample and among participants who did not comply with dietary- or BMI guidelines.

Results

The effects on vegetable intake in the total sample differed according to educational level (p = 02). Among low/moderate-educated participants, the basic version was significantly more effective in increasing vegetable intake than the control program (effect size (ES) = 0.32) and plus version (ES = 0.22). No effects were found for high-educated participants. Self-regulation change was significantly larger in the control group than in the basic (ES = 0.18) and plus (ES = 0.16) group.

Conclusions

In general, both intervention versions did not result in long-term intervention effects. The exception was an effect of the basic version on self-reported vegetable intake among low/moderate-educated adults in the total sample. More research is needed on how targeting self-regulation processes and environmental-level factors in Web-based CT nutrition education interventions can increase long-term efficacy.

Trial registration

Netherlands Trial Registry NTR3396.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-1707-4) contains supplementary material, which is available to authorized users.

Comparison of single questions and brief questionnaire with longer validated food frequency questionnaire to assess adequate fruit and vegetable intake

OBJECTIVE

The aim of this study was to determine if a single question (SQ) for fruit and a SQ or five-item questionnaire for vegetable consumption (VFQ) could replace a longer food frequency questionnaire (FFQ) to screen for inadequate versus adequate intakes in populations.

METHODS

Participants (109) completed three test screeners: fruit SQ, vegetable SQ, and a five-item VFQ followed by the reference 74-item FFQ (version 2 of the Dietary Questionnaire for Epidemiological Studies [DQESv2]) including 13 fruit and 25 vegetable items. The five-item VFQ asked about intake of salad vegetables, cooked vegetables, white potatoes, legumes, and vegetable juice. The screeners were compared with the reference (DQESv2 FFQ) for sensitivity, specificity, and positive and negative predictive powers (PPV, NPV) to detect intakes of two or more servings of fruit and three or more servings of vegetables. Relative validity was examined using Bland-Altman statistics.

RESULTS

The fruit SQ showed a PPV of 56% and an NPV of 83%. The PPV for the vegetable SQ was 30% and the NPV was 89%. For the five-item VFQ, the PPV was 39% and the NPV was 85%. Bland-Altman plots and linear regression equations showed that although the screener showed good agreement for fruit (unstandardized b1 coefficient = 0.04) for vegetable intake the difference between methods increased at higher intake levels (unstandardized b1 coefficients = -0.3 for the SQ, b1 = -0.6 for five-item VFQ).

CONCLUSION

The fruit SQ and the five-item VFQ are suitable replacements for longer FFQs to detect inadequate intake and assess population mean but not individual intakes.

Short- and medium-term efficacy of a Web-based computer-tailored nutrition education intervention for adults including cognitive and environmental feedback: randomized controlled trial

BACKGROUND

Web-based, computer-tailored nutrition education interventions can be effective in modifying self-reported dietary behaviors. Traditional computer-tailored programs primarily targeted individual cognitions (knowledge, awareness, attitude, self-efficacy). Tailoring on additional variables such as self-regulation processes and environmental-level factors (the home food environment arrangement and perception of availability and prices of healthy food products in supermarkets) may improve efficacy and effect sizes (ES) of Web-based computer-tailored nutrition education interventions.

OBJECTIVE

This study evaluated the short- and medium-term efficacy and educational differences in efficacy of a cognitive and environmental feedback version of a Web-based computer-tailored nutrition education intervention on self-reported fruit, vegetable, high-energy snack, and saturated fat intake compared to generic nutrition information in the total sample and among participants who did not comply with dietary guidelines (the risk groups).

METHODS

A randomized controlled trial was conducted with a basic (tailored intervention targeting individual cognition and self-regulation processes; n=456), plus (basic intervention additionally targeting environmental-level factors; n=459), and control (generic nutrition information; n=434) group. Participants were recruited from the general population and randomly assigned to a study group. Self-reported fruit, vegetable, high-energy snack, and saturated fat intake were assessed at baseline and at 1- (T1) and 4-months (T2) postintervention using online questionnaires. Linear mixed model analyses examined group differences in change over time. Educational differences were examined with group×time×education interaction terms.

RESULTS

In the total sample, the basic (T1: ES=-0.30; T2: ES=-0.18) and plus intervention groups (T1: ES=-0.29; T2: ES=-0.27) had larger decreases in high-energy snack intake than the control group. The basic version resulted in a larger decrease in saturated fat intake than the control intervention (T1: ES=-0.19; T2: ES=-0.17). In the risk groups, the basic version caused larger decreases in fat (T1: ES=-0.28; T2: ES=-0.28) and high-energy snack intake (T1: ES=-0.34; T2: ES=-0.20) than the control intervention. The plus version resulted in a larger increase in fruit (T1: ES=0.25; T2: ES=0.37) and a larger decrease in high-energy snack intake (T1: ES=-0.38; T2: ES=-0.32) than the control intervention. For high-energy snack intake, educational differences were found. Stratified analyses showed that the plus version was most effective for high-educated participants.

CONCLUSIONS

Both intervention versions were more effective in improving some of the self-reported dietary behaviors than generic nutrition information, especially in the risk groups, among both higher- and lower-educated participants. For fruit intake, only the plus version was more effective than providing generic nutrition information. Although feasible, incorporating environmental-level information is time-consuming. Therefore, the basic version may be more feasible for further implementation, although inclusion of feedback on the arrangement of the home food environment and on availability and prices may be considered for fruit and, for high-educated people, for high-energy snack intake.

TRIAL REGISTRATION

Netherlands Trial Registry NTR3396; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3396 (Archived by WebCite at http://www.webcitation.org/6VNZbdL6w).

Can individual cognitions, self-regulation and environmental variables explain educational differences in vegetable consumption?: a cross-sectional study among Dutch adults

BACKGROUND

Educational differences in health-related behaviors, where low- and moderate-educated individuals have poorer outcomes than high-educated individuals, are persistent. The reasons for these differences remain poorly understood. This study explored whether individual cognitions, self-regulation and environmental-level factors may explain educational differences in vegetable consumption.

METHODS

A cross-sectional study was conducted among 1,342 Dutch adults, of whom 54.5% were low/moderate-educated. Individuals completed an online questionnaire, assessing education, vegetable consumption, demographics, individual cognitions (attitude towards consuming 200 grams of vegetables a day, self-efficacy, subjective norm, intention, perception of vegetables as being expensive), self-regulation (general self-regulation, vegetable-specific action- and coping planning) and environmental-level factors (perception of availability of vegetables in the supermarket and availability of vegetables at home). The joint-significance test was used to determine significant mediation effects.

RESULTS

Low/moderate-educated individuals consumed less vegetables (M = 151.2) than high-educated individuals (M = 168.1, β = -0.15, P < .001). Attitude and availability of vegetables at home were found to partially mediate the association between education and vegetable consumption (percentage mediated effect: 24.46%).

DISCUSSION

Since attitude and availability of vegetables at home partially explain the difference in vegetable consumption between low/moderate- and high-educated individuals, these variables may be good target points for interventions to promote vegetable consumption among low/moderate-educated individuals.

Socioeconomic differences in selected dietary habits among Norwegian 13-14 year-olds: a cross-sectional study

BACKGROUND

Social inequalities in health are a major and even growing problem in all European countries.

OBJECTIVE

The aim of the present study was to describe 1) differences in dietary habits among Norwegian adolescents by gender and socioeconomic status; 2) differences in self-reported knowledge of dietary guidelines among their parents according to socioeconomic status.

DESIGN

In 2012, a cross-sectional study where students filled in a web-based food frequency questionnaire at school was conducted in nine lower secondary schools in Vest-Agder County, Norway. Socioeconomic status (SES) and knowledge of dietary guidelines were obtained from the parents using a web-based questionnaire. In total, 517 ninth-grade students (mean age 13.9) out of 742 invited students participated in the study, giving a participation rate of 69.7%. The total number of dyads with information on both parents and students was 308 (41.5%).

RESULTS

The findings indicate that there is a tendency for girls to have a healthier diet than boys, with greater intake of fruits and vegetables (girls intake in median 3.5 units per day and boys 2.9 units per day), and lower intake of soft drinks (girls 0.25 l in median versus boys 0.5 l per week). Students from families with higher SES reported a significant higher intake of vegetables and fish, and lower intake of soft drinks and fast food than those from lower SES. Parents with higher SES reported a significantly better knowledge of dietary guidelines compared to those with lower SES.

CONCLUSIONS

Differences in dietary habits were found between groups of students by gender and SES. Differences were also found in parents' self-reported knowledge of dietary guidelines. This social patterning should be recognized in public health interventions.

Cross-sectional survey of daily junk food consumption, irregular eating, mental and physical health and parenting style of British secondary school children

BACKGROUND

Previous research has established that poor diets and eating patterns are associated with numerous adverse health outcomes. This study explored the relationships between two specific eating behaviours (daily junk food consumption and irregular eating) and self-reported physical and mental health of secondary school children, and their association with perceived parenting and child health.

METHODS

10 645 participants aged between 12 and 16 completed measures of junk food consumption, irregular eating, parental style, and mental and physical health through the use of an online survey implemented within 30 schools in a large British city.

RESULTS

2.9% of the sample reported never eating regularly and while 17.2% reported daily consumption of junk food. Young people who reported eating irregularly and consuming junk food daily were at a significantly greater risk of poorer mental (OR 5.41, 95% confidence interval 4.03-7.25 and 2.75, 95% confidence interval 1.99-3.78) and physical health (OR 4.56, 95% confidence interval 3.56-5.85 and 2.00, 95% confidence interval 1.63-2.47). Authoritative parenting was associated with healthier eating behaviours, and better mental and physical health in comparison to other parenting styles.

DISCUSSION

A worrying proportion of secondary school children report unhealthy eating behaviours, particularly daily consumption of junk food, which may be associated with poorer mental and physical health. Parenting style may influence dietary habits. Interventions to improve diet may be more beneficial if also they address parenting strategies and issues related to mental and physical health.

Intelligent mobile support for therapy adherence and behavior change

Mobile applications have proven to be promising tools for supporting people in adhering to their health goals. Although coaching and reminder apps abound, few of them are based on established theories of behavior change. In the present work, a behavior change support system is presented that uses a computational model based on multiple psychological theories of behavior change. The system determines the user's reason for non-adherence using a mobile phone app and an online lifestyle diary. The user automatically receives generated messages with persuasive, tailored content. The system was designed to support chronic patients with type 2 diabetes, HIV, and cardiovascular disease, but can be applied to many health and lifestyle domains. The main focus of this work is the development of the model and the underlying reasoning method. Furthermore, the implementation of the system and some preliminary results of its functioning will be discussed.

Associations of parental feeding styles with child snacking behaviour and weight in the context of general parenting

OBJECTIVE

To examine cross-sectional and longitudinal (one-year follow-up) associations of parental feeding styles with child snacking behaviour and weight in the context of general parenting, taking into account the multidimensionality of the controlling feeding style.

DESIGN

Linear regression analyses were performed. Parents completed a questionnaire to measure five feeding style dimensions (Instrumental Feeding, Emotional Feeding, Encouragement, Overt Control and Covert Control) and children's fruit, energy-dense snack and sugar-sweetened beverage (SSB) intakes. Children's height and weight were measured to calculate their BMI Z-scores. Moderation by parenting style was tested by adding interaction terms to the regression analyses.

SETTING

Observational study in the Netherlands.

SUBJECTS

Parent-child dyads (n 1275) participating in the INPACT (IVO Nutrition and Physical Activity Child cohorT) study; children were (on average) 9 years of age.

RESULTS

Instrumental Feeding and Emotional Feeding were negatively related to child fruit intake one year later and positively to (changes in) child energy-dense snack intake. Encouragement was negatively related to child energy-dense snacking and SSB intake one year later. Overt Control was cross-sectionally and prospectively related to (changes in) child energy-dense snacking and SSB intake in a negative direction. Covert Control showed similar associations with child energy-dense snacking and SSB intake as Overt Control. Although Covert Control was also positively related to child fruit intake and (changes in) child BMI Z-score, bootstrapping analyses revealed only a differential effect of Overt Control and Covert Control on child BMI Z-score one year later, with Covert Control displaying a stronger, positive association. Moderation analyses showed that some significant associations between parental feeding styles and outcome measures were dependent on the degree of psychological control and behavioural control.

CONCLUSIONS

Instrumental Feeding and Emotional Feeding may have a detrimental impact on children's snacking behaviour, while Encouragement, Overt Control and Covert Control may lead to less energy-dense snacking and less SSB intake. Overt Control and Covert Control have differential effects on child BMI Z-score one year later, which supports the idea that they should be treated as separate constructs. Prospective studies with a longer follow-up may elucidate the causal pathways between the various feeding styles and children's snacking behaviour and weight, as well as the moderating influences of psychological and behavioural control.

Correlates of parental misperception of their child's weight status: the 'be active, eat right' study

Objective

This study reported on correlates of parental perception of their child’s weight status. Associations between parental misperception (i.e., underestimation of the child’s weight) and parental intention to improve their child’s overweight-related health behaviors and their child meeting guidelines regarding these behaviors were also investigated.

Methods

Baseline data from the population-based ‘Be active, eat right study’ were used. The population for analysis consisted of 630 overweight and 153 obese five year-old children and their parents. Questionnaires were used to measure parental perception of the child’s weight status, correlates of misperception (i.e., child age, child gender, child BMI, parental age, parental gender, parental country of birth, parental educational level and parental weight status), overweight-related health behaviors (i.e., child playing outside, having breakfast, drinking sweet beverages, and watching TV), and parental intention to improve these behaviors. Height and weight were measured using standardized protocols. Multivariable logistic regression analyses were performed.

Results

In total, 44.40% of the parents misperceived their child’s weight status. Parental misperception was associated with lower child BMI, the parent being the father, a foreign parental country of birth, and a lower parental education level (p<0.05). Parental misperception was not associated with parental intention to improve child overweight-related health behavior, nor with child meeting the guidelines of these behaviors.

Discussion

This study showed that almost half of the parents with an overweight or obese child misperceived their child’s weight status. A correct parental perception may be a small stepping-stone in improving the health of overweight and obese children.

Test-retest reliability and construct validity of the DOiT (Dutch Obesity Intervention in Teenagers) questionnaire: measuring energy balance-related behaviours in Dutch adolescents

OBJECTIVE

Adequate assessment of energy balance-related behaviours in adolescents is essential to develop and evaluate effective obesity prevention programmes. The present study examined the test-retest reliability and construct validity of a questionnaire assessing energy balance-related behaviours in adolescents during the evaluation of the DOiT (Dutch Obesity Intervention in Teenagers) intervention.

DESIGN

To assess test-retest reliability, adolescents filled in the questionnaire twice (n 111). To assess construct validity, the results from the first test were compared with data collected in a personal cognitive interview (n 20, independent from the reliability study). For both reliability and validity, intraclass correlation coefficients for continuous data or Cohen's kappa coefficients for categorical data were calculated as well as percentage agreement.

SETTING

Data were collected during school time from February to May 2010.

SUBJECTS

Study participants were Dutch adolescents aged 12-14 years attending pre-vocational secondary schools.

RESULTS

In more than three-quarters of the ninety-five questionnaire items the test-retest reliability appeared to be good to excellent. Moderate reliability was found for all other twenty-one items. Fifty-one items (of ninety-five items) showed good to excellent construct validity. Construct validity appeared moderate in twenty-three items and poor in twenty-one items. Most items with poor construct validity concerned consumption of sugar-containing beverages and high-energy snacks/sweets.

CONCLUSIONS

Our study showed good test-retest reliability and largely moderate to good construct validity for the majority of items of the DOiT questionnaire. Items with poor construct validity (most of them found for items concerning energy intake-related behaviours) should be revised and tested again to improve the questionnaire for future use.

Differential effects of the computer-tailored FATaintPHAT programme on dietary behaviours according to sociodemographic, cognitive and home environmental factors

OBJECTIVE

To explore whether the effects on dietary behaviours of a computer-tailored intervention aimed to prevent excessive weight gain among adolescents, FATaintPHAT, were moderated by sociodemographic, cognitive and home environmental factors.

DESIGN

A two-group cluster randomized trial. Potential moderation of the outcome measures (consumption of sugar-sweetened beverages, snacks, fruits and vegetables) was studied by gender, education level, ethnicity, awareness of risk behaviour, intention and home availability.

SETTING

Twenty schools in the Netherlands.

SUBJECTS

Students (n 883) aged 12-13 years.

RESULTS

Of the twenty-four interactions tested, only three were significant. The intervention effect on sugar-sweetened beverages was moderated by level of education (P = 0·009); intervention effects were found only among academic preparatory students. The intervention effects on fruit and vegetable intake were moderated by awareness of fruit intake (P < 0·001) and home availability of vegetables (P = 0·007); an effect on fruit intake was found only among students who were aware of their low fruit intake at baseline and an effect on vegetable consumption was found only among students who reported that vegetables were always available at their home.

CONCLUSIONS

The effects of the intervention generally did not differ between sociodemographic subgroups. The moderation by home availability illustrates that the environment may influence the effects of educational interventions.

Effectiveness of a worksite mindfulness-based multi-component intervention on lifestyle behaviors

Introduction

Overweight and obesity are associated with an increased risk of morbidity. Mindfulness training could be an effective strategy to optimize lifestyle behaviors related to body weight gain. The aim of this study was to evaluate the effectiveness of a worksite mindfulness-based multi-component intervention on vigorous physical activity in leisure time, sedentary behavior at work, fruit intake and determinants of these behaviors. The control group received information on existing lifestyle behavior- related facilities that were already available at the worksite.

Methods

In a randomized controlled trial design (n = 257), 129 workers received a mindfulness training, followed by e-coaching, lunch walking routes and fruit. Outcome measures were assessed at baseline and after 6 and 12 months using questionnaires. Physical activity was also measured using accelerometers. Effects were analyzed using linear mixed effect models according to the intention-to-treat principle. Linear regression models (complete case analyses) were used as sensitivity analyses.

Results

There were no significant differences in lifestyle behaviors and determinants of these behaviors between the intervention and control group after 6 or 12 months. The sensitivity analyses showed effect modification for gender in sedentary behavior at work at 6-month follow-up, although the main analyses did not.

Conclusions

This study did not show an effect of a worksite mindfulness-based multi-component intervention on lifestyle behaviors and behavioral determinants after 6 and 12 months. The effectiveness of a worksite mindfulness-based multi-component intervention as a health promotion intervention for all workers could not be established.

Energy drinks, soft drinks, and substance use among United States secondary school students

OBJECTIVES

Examine energy drink/shot and regular and diet soft drink use among United States secondary school students in 2010-2011, and associations between such use and substance use.

METHODS

We used self-reported data from cross-sectional surveys of nationally representative samples of 8th-, 10th-, and 12th-grade students and conducted multivariate analyses examining associations between beverage and substance use, controlling for individual and school characteristics.

RESULTS

Approximately 30% of students reported consuming energy drinks or shots; more than 40% reported daily regular soft drink use, and about 20% reported daily diet soft drink use. Beverage consumption was strongly and positively associated with past 30-day alcohol, cigarette, and illicit drug use. The observed associations between energy drinks and substance use were significantly stronger than those between regular or diet soft drinks and substance use.

CONCLUSIONS

This correlational study indicates that adolescent consumption of energy drinks/shots is widespread and that energy drink users report heightened risk for substance use. This study does not establish causation between the behaviors. Education for parents and prevention efforts among adolescents should include education on the masking effects of caffeine in energy drinks on alcohol- and other substance-related impairments, and recognition that some groups (such as high sensation-seeking youth) may be particularly likely to consume energy drinks and to be substance users.

Mediators of longitudinal changes in measures of adiposity in teenagers using parallel process latent growth modeling

OBJECTIVE

The aim of the study was to evaluate mediating effects of energy balance-related behaviors on measures of adiposity in the Dutch Obesity Intervention in Teenagers-study (DOiT).

DESIGN AND METHODS

DOiT was an 8-month behavioral intervention program consisting of educational and environmental components and evaluated in 18 prevocational secondary schools in the Netherlands (n = 1,108, baseline age 12.7 years, 50% girls). Outcome measures were changes in body mass index (BMI), waist circumference, and sum of skinfold thickness. Self-reported consumption of sugar-containing beverages and high caloric snacks, active transport to/from school, and screen-viewing behaviors were the hypothesized mediators. Data were collected at 0, 8, 12, and 20 months. For the data analysis, parallel process latent growth modeling was used.

RESULTS

Total sugar-containing beverages consumption mediated the intervention effects on BMI (ab = -0.01, 95%CI = -0.20, -0.001). The intervention group lowered their sugar-containing beverages consumption more than controls (B = -0.14, 95%CI = -0.22, -0.11) and this, in turn, led to smaller increases in BMI. No significant mediated effect by the targeted behaviors was found for waist circumference or sum of skinfolds.

CONCLUSIONS

Future school-based overweight prevention interventions may target decreasing sugar-containing beverages consumption.

The use of a proactive dissemination strategy to optimize reach of an internet-delivered computer tailored lifestyle intervention

Background

The use of reactive strategies to disseminate effective Internet-delivered lifestyle interventions restricts their level of reach within the target population. This stresses the need to invest in proactive strategies to offer these interventions to the target population. The present study used a proactive strategy to increase reach of an Internet-delivered multi component computer tailored intervention, by embedding the intervention in an existing online health monitoring system of the Regional Public Health Services in the Netherlands.

Methods

The research population consisted of Dutch adults who were invited to participate in the Adult Health Monitor (N = 96,388) offered by the Regional Public Health Services. This Monitor consisted of an online or a written questionnaire. A prospective design was used to determine levels of reach, by focusing on actual participation in the lifestyle intervention. Furthermore, adequacy of reach among the target group was assessed by composing detailed profiles of intervention users. Participants’ characteristics, like demographics, behavioral and mental health status and quality of life, were included in the model as predictors.

Results

A total of 41,155 (43%) people participated in the Adult Health Monitor, of which 41% (n = 16,940) filled out the online version. More than half of the online participants indicated their interest (n = 9169; 54%) in the computer tailored intervention and 5168 participants (31%) actually participated in the Internet-delivered computer tailored intervention. Males, older respondents and individuals with a higher educational degree were significantly more likely to participate in the intervention. Furthermore, results indicated that especially participants with a relatively healthier lifestyle and a healthy BMI were likely to participate.

Conclusions

With one out of three online Adult Health Monitor participants actually participating in the computer tailored lifestyle intervention, the employed proactive dissemination strategy succeeded in ensuring relatively high levels of reach. Reach among at-risk individuals (e.g. low socioeconomic status and unhealthy lifestyle) was modest. It is therefore essential to further optimize reach by putting additional effort into increasing interest in the lifestyle intervention among at-risk individuals and to encourage them to actually use the intervention.

Trial registration

Dutch Trial Register (NTR1786) and Medical Ethics Committee of Maastricht University and the University Hospital Maastricht (NL2723506809/MEC0903016).