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Boelens M, Raat H, Jonkman H, Hosman CMH, Wiering D, Jansen W. Effectiveness of the Promising Neighbourhoods community program in 0-to 12-year-olds : A difference-in-difference analysis. SSM Popul Health 2022; 19:101166. [PMID: 35859931 PMCID: PMC9289725 DOI: 10.1016/j.ssmph.2022.101166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 07/04/2022] [Accepted: 07/04/2022] [Indexed: 11/30/2022] Open
Abstract
Objective The purpose of this study was to evaluate a collaborative community-based program that aims to a) increase the health, safety and talent development of youth, and b) contribute to the reduction of socioeconomic inequalities. Methods A difference-in difference design with two separate cross-sectional samples in 2018 (n = 984) and 2021 (n = 413) among 0- to 12-year-olds with an intervention and comparator condition was used. The program, called Promising Neighbourhoods, consists of collaboration with community stakeholders, data-based priority setting, knowledge-and theory-based policies, and evidence-based interventions. The program was implemented in three neighbourhoods which were compared with three similar comparator neighbourhoods in which the program was not implemented. Logistic difference-in-difference regression was used to test effectiveness of the intervention on informal parenting support, outdoor-play, sport club membership, general health and risk of emotional and behavioural difficulties and to examine differences in intervention effects between children with a lower or higher socioeconomic status. Results A significant intervention effect of the Promising Neighbourhoods program after two-years was found for outdoor-play (OR 0.61; 95%CI 0.37, 0.99). No other significant intervention effects were found for other outcomes. No different interventions effects were found for children with a lower or higher socioeconomic status on outcomes. Conclusion The findings of this study indicate a positive intervention effect for one of the outcomes in 0- to 12-year-olds. Further mixed-methods evaluation research and using longer follow-up periods are needed to examine the value of these type of programs. Further development of Promising Neighbourhoods seems warranted. Trial registration This study was prospectively registered in the Netherlands National Trial Register (Number: NL7279) on 26 September 2018. A collaborative neighbourhood program involving stakeholders was evaluated. The program included joint priority setting to promote child health/well-being. A positive intervention effect was found for one outcome in 0- to 12-year-olds. No reduction in socioeconomic inequalities was found in 0- to 12-year-olds.
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Affiliation(s)
- Mirte Boelens
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Clemens M H Hosman
- Department of Health Promotion, Maastricht University, Maastricht, the Netherlands.,Department of Clinical Psychology, Radboud University, Nijmegen, the Netherlands.,Hosman Prevention and Innovation Consultancy, Berg en Dal, the Netherlands
| | - Denis Wiering
- Department of Social Development, Municipality of Rotterdam, Rotterdam, the Netherlands
| | - Wilma Jansen
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Social Development, Municipality of Rotterdam, Rotterdam, the Netherlands
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Kobes A, Kretschmer T, Timmerman MC. Prevalence of overweight among Dutch primary school children living in JOGG and non-JOGG areas. PLoS One 2021; 16:e0261406. [PMID: 34919583 PMCID: PMC8682899 DOI: 10.1371/journal.pone.0261406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 12/01/2021] [Indexed: 11/19/2022] Open
Abstract
Background One of the most influential integrated approaches towards reducing childhood obesity is EPODE, a program that has been translated to over 20 different countries worldwide. Aim The goal of this study was to explore how JOGG–the Dutch EPODE adaptation–might reduce overweight prevalence among children. Methods To compare whether overweight prevalence was different in JOGG areas vs. non-JOGG areas, in long-term JOGG areas vs. short-term JOGG areas, and in low SES JOGG areas vs. middle/high SES JOGG areas, secondary anthropometric and personal data of 209,565 Dutch children were mapped onto publicly available JOGG data. Results Findings showed that overweight prevalence decreased from 25.17% to 16.08% in JOGG-areas, and from 32.31% to 18.43% in long-term JOGG areas. However, when taking into account SES, the decrease in prevalence was mainly visible in low SES long-term JOGG areas. Conclusion JOGG appeared to be successful in targeting areas where overweight was most prevalent. Low SES areas that had implemented JOGG for a longer period of time, i.e., six years, appeared to be successful in decreasing overweight prevalence.
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Affiliation(s)
- Annita Kobes
- Faculty of Behavioural and Social Sciences, Department of Pedagogical and Educational Sciences, University of Groningen, Groningen, The Netherlands
- * E-mail:
| | - Tina Kretschmer
- Faculty of Behavioural and Social Sciences, Department of Pedagogical and Educational Sciences, University of Groningen, Groningen, The Netherlands
| | - Margaretha C. Timmerman
- Faculty of Behavioural and Social Sciences, Department of Pedagogical and Educational Sciences, University of Groningen, Groningen, The Netherlands
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Almeida C, Azevedo J, Gregório MJ, Barros R, Severo M, Padrão P. Parental practices, preferences, skills and attitudes on food consumption of pre-school children: Results from Nutriscience Project. PLoS One 2021; 16:e0251620. [PMID: 34033667 PMCID: PMC8148319 DOI: 10.1371/journal.pone.0251620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/30/2021] [Indexed: 11/25/2022] Open
Abstract
The association between family environment and child’s eating behaviors is well established but a multidimensional approach to study this relation is lacking. This study aimed to assess the proprieties of a questionnaire created to evaluate parental practices, preferences, skills and attitudes regarding fruit and vegetables (F&V), sugar and salt. Participants (n = 714) were families of pre-school children (aged 2–6 years old) of the Nutriscience Project–a web-based gamification program–who answered a questionnaire assessing socio-demographic characteristics, nutrition knowledge, and a scale evaluating parental practices, preferences, skills and attitudes, at the baseline of the project. Exploratory factorial analysis was applied to the scale: 21 items and 5 factors were extracted (52.4% of explained variance) with a Kaiser-Meyer-Olkin (KMO) value of 0.770: 1. Modelling/active promotion of F&V consumption (α = 0.73), 2. Skills for choosing/preparing healthy food (α = 0.75), 3. Food preferences and satiety perception (α = 0.70), 4. Awareness regarding sugar/salt intake (α = 0.61), 5. Allowance regarding F&V consumption (α = 0.55). Kruskal-Wallis and Mann-Whitney tests were conducted to compare factors according to socio-demographic characteristics. Higher scores for parental modelling and active promotion of F&V consumption were observed in older parents, those with higher nutrition knowledge and who reported to live without income difficulties. Regarding food preferences, higher scores were observed in mothers, with higher nutrition knowledge and from higher educated groups. Higher awareness regarding salt and sugar consumption were observed in older parents, with higher education, higher nutrition knowledge and with female children. Older parents and with female children also registered higher scores of skills for choosing/preparing healthy food. The scale showed satisfactory proprieties and may contribute to assess family food environment using a multidimensional approach. It also highlighted the importance of considering socio-demographic characteristics in interventions to promote healthy eating.
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Affiliation(s)
- Carla Almeida
- Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Porto, Portugal
| | - José Azevedo
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal | ITR—Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional
- Faculdade de Letras da Universidade do Porto, Porto, Portugal
| | - Maria João Gregório
- Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Porto, Portugal
| | - Renata Barros
- Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Porto, Portugal
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal | ITR—Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional
| | - Milton Severo
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal | ITR—Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Patrícia Padrão
- Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Porto, Portugal
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal | ITR—Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional
- * E-mail:
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4
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Lockyer S, Spiro A. Socio‐economic inequalities in childhood obesity: Can community level interventions help to reduce the gap? NUTR BULL 2019. [DOI: 10.1111/nbu.12410] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- S. Lockyer
- British Nutrition Foundation, London London UK
| | - A. Spiro
- British Nutrition Foundation, London London UK
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5
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Azevedo J, Padrão P, Gregório MJ, Almeida C, Moutinho N, Lien N, Barros R. A Web-Based Gamification Program to Improve Nutrition Literacy in Families of 3- to 5-Year-Old Children: The Nutriscience Project. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2019; 51:326-334. [PMID: 30579894 DOI: 10.1016/j.jneb.2018.10.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 09/29/2018] [Accepted: 10/13/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Assess the impact of a web-based gamification program on nutrition literacy of families and explore differences in impact by socioeconomic status. DESIGN Quasi-experimental. SETTING Thirty-seven kindergartens from Portugal. PARTICIPANTS Eight hundred seventy-seven families. INTERVENTION Web-based social network of participants' interactions, educational materials, apps and nutritional challenges, focused on fruit, vegetables, sugar, and salt. MAIN OUTCOME MEASURES Parental nutrition literacy (self-reported survey - 4 dimensions: Nutrients, Food portions, Portuguese food wheel groups, Food labeling). ANALYSIS General linear model - Repeated measures was used to analyze the effect on the nutrition literacy score. RESULTS Families uploaded 1267 items (recipes, photographs of challenges) and educators uploaded 327 items (photographs, videos) onto the interactive platform. For the intervention group (n = 106), the final mean (SD) score of nutrition literacy was significantly higher than the baseline: 78.8% (15.6) vs 72.7% (16.2); P < .001, regardless of parental education and perceived income status. No significant differences in the scores of the control group (n = 83) were observed (final 67.8% [16.1] vs initial 66.4% [15.6]; P = .364). CONCLUSIONS AND IMPLICATIONS Gamified digital interactive platform seems to be a useful, easily adapted educational tool for the healthy eating learning process. Future implementations of the program will benefit from longer time intervention and assessment of the eating habits of families before and after intervention.
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Affiliation(s)
- José Azevedo
- Faculdade de Letras, Universidade do Porto, Porto, Portugal; EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.
| | - Patrícia Padrão
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal
| | - Maria J Gregório
- Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal; EpiDoC Unit, Centro de Estudos de Doenças Crónicas (CEDOC) da NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Carla Almeida
- Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal
| | - Nuno Moutinho
- Faculdade de Economia and Center for Economics and Finance, Universidade do Porto, Porto, Portugal
| | - Nanna Lien
- Department of Nutrition, University of Oslo, Oslo, Norway
| | - Renata Barros
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal
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Karacabeyli D, Allender S, Pinkney S, Amed S. Evaluation of complex community-based childhood obesity prevention interventions. Obes Rev 2018; 19:1080-1092. [PMID: 29768728 DOI: 10.1111/obr.12689] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 02/13/2018] [Accepted: 02/20/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Multi-setting, multi-component community-based interventions have shown promise in preventing childhood obesity; however, evaluation of these complex interventions remains a challenge. OBJECTIVE The objective of the study is to systematically review published methodological approaches to outcome evaluation for multi-setting community-based childhood obesity prevention interventions and synthesize a set of pragmatic recommendations. METHODS MEDLINE, CINAHL and PsycINFO were searched from inception to 6 July 2017. Papers were included if the intervention targeted children ≤18 years, engaged at least two community sectors and described their outcome evaluation methodology. A single reviewer conducted title and abstract scans, full article review and data abstraction. Directed content analysis was performed by three reviewers to identify prevailing themes. RESULTS Thirty-three studies were included, and of these, 26 employed a quasi-experimental design; the remaining were randomized control trials. Body mass index was the most commonly measured outcome, followed by health behaviour change and psychosocial outcomes. Six themes emerged, highlighting advantages and disadvantages of active vs. passive consent, quasi-experimental vs. randomized control trials, longitudinal vs. repeat cross-sectional designs and the roles of process evaluation and methodological flexibility in evaluating complex interventions. CONCLUSIONS Selection of study designs and outcome measures compatible with community infrastructure, accompanied by process evaluation, may facilitate successful outcome evaluation.
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Affiliation(s)
- D Karacabeyli
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - S Allender
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
| | - S Pinkney
- BC Children's Hospital Research Institute, Vancouver, Canada
| | - S Amed
- Faculty of Medicine, University of British Columbia, Vancouver, Canada.,BC Children's Hospital Research Institute, Vancouver, Canada
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7
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Frank S, Gonzalez K, Lee-Ang L, Young MC, Tamez M, Mattei J. Diet and Sleep Physiology: Public Health and Clinical Implications. Front Neurol 2017; 8:393. [PMID: 28848491 PMCID: PMC5554513 DOI: 10.3389/fneur.2017.00393] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 07/24/2017] [Indexed: 11/25/2022] Open
Abstract
This mini-review examines the complex relationship between diet and sleep and explores the clinical and public health implications of the current evidence. Dietary quality and intake of specific nutrients can impact regulatory hormonal pathways to alter sleep quantity and quality. Sleep, in turn, affects the intake of total energy, as well as of specific foods and nutrients, through biological and behavioral mechanisms. Initial research in this field focused primarily on the effects of short sleep duration on nutritional quality. However, more recent studies have explored the dynamic relationship between long sleep duration and diet. Current evidence suggests that extremes of sleep duration alter sleep patterns, hormonal levels, and circadian rhythms, which contribute to weight-related outcomes and obesity, and other risk factors for the development of chronic disease such as type 2 diabetes and cardiovascular disease. These patterns may begin as early as childhood and have impacts throughout the life course. Given that non-communicable diseases are among the leading causes of death globally, deeper understanding of the interactions between sleep and nutrition has implications for both public health and clinical practice.
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Affiliation(s)
- Sarah Frank
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Kelli Gonzalez
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Lorraine Lee-Ang
- Department of Social and Behavioral Sciences, Harvard T.H Chan School of Public Health, Boston, MA, United States
| | - Marielle C Young
- Department of Social and Behavioral Sciences, Harvard T.H Chan School of Public Health, Boston, MA, United States.,Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Martha Tamez
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Josiemer Mattei
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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8
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Water Consumption in European Children: Associations with Intake of Fruit Juices, Soft Drinks and Related Parenting Practices. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14060583. [PMID: 28561769 PMCID: PMC5486269 DOI: 10.3390/ijerph14060583] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/17/2017] [Accepted: 05/27/2017] [Indexed: 12/15/2022]
Abstract
Background: High intake of fruit juices and soft drinks contributes to excessive weight gain and obesity in children. Furthermore, parenting practices play an important role in the development of children's dietary habits. The way parents play this role in the development of their children's choices of beverages is still unclear. Objectives: To study the associations: (1) of both fruit juices and soft drinks consumption with water consumption of children and (2) The associations between parenting practices towards fruit juices and soft drinks and water consumption of children. Design: Cross-sectional data from 6 to 8 year old children from seven European communities (n = 1187) were collected. Associations among fruit juices, soft drinks, the respective parenting practices and the child's water consumption were assessed by parental questionnaires. Results: The consumption of water was inversely associated with that of soft drinks but not with the consumption of fruit juices. The child's water intake was favorably influenced when stricter parenting practices towards soft drinks were adopted (e.g., less parental allowance, low home availability and high parental self-efficacy in managing intake). There was less influence observed of parenting practices towards fruit juices. Fruit juices were consumed more often than soft drinks. Conclusions: Low consumption of soft drinks-and not of fruit juices-was associated with high water consumption in children in the current study. Moreover, parenting practices towards both fruit juices and soft drinks were associated with the water intake of the children, irrespective of their socio-economic status.
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9
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Mantziki K, Renders CM, Vassilopoulos A, Radulian G, Borys JM, du Plessis H, Gregório MJ, Graça P, de Henauw S, Handjiev S, Visscher TLS, Seidell JC. Inequalities in energy-balance related behaviours and family environmental determinants in European children: changes and sustainability within the EPHE evaluation study. Int J Equity Health 2016; 15:160. [PMID: 27680964 PMCID: PMC5041563 DOI: 10.1186/s12939-016-0438-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 09/07/2016] [Indexed: 11/17/2022] Open
Abstract
Background Increasing social inequalities in health across Europe are widening the gap between low and high socio-economic groups, notably in the prevalence of obesity. Public health interventions may result in differential effects across population groups. Therefore, the EPHE (EPODE for the Promotion of Health Equity) project analysed the added value of community-based programmes, based on the EPODE (Ensemble Prévenons l’Obésité Des Enfants-Together Let’s Prevent Obesity) model, to reduce socio-economic inequalities in energy balance-related behaviours of children and their family-environmental related determinants in seven European communities. This study presents the changes between baseline and follow-up after the one-year interventions and their sustainability one year after. Methods This is a prospective study with a one school-year intervention, followed by one year of follow-up. In all, 1266 children (age 6-8 years) and their families from different socio-economic backgrounds were recruited at baseline. For 1062 children, information was available after one year (T1) and for 921 children after two years (T2). A self-reported questionnaire was completed by the parents to examine the children’s energy balance-related behaviours and family- environmental determinants. Socio-economic status was defined by the educational level of the mother. The Wilcoxon signed-rank test for paired data was used to test the differences between baseline and intermediate, and between intermediate and final, measurements for each of the socio-economic status groups. Results Post-intervention effects in energy-balance related behaviours showed the following improvements among the low socio-economic status groups: increased fruit consumption (Netherlands), decreased fruit juices amount consumed (Romania) and decreased TV time on weekdays (Belgium). Whereas in only the latter case the behavioural change was accompanied with an improvement in a family-environmental determinant (monitoring the time the child watches TV), other improvements in parental rules and practices related to soft drinks/fruit juices and TV exposure were observed. A few of those effects were sustainable, notably in the case of Belgium. Conclusions Inequalities in obesity-related behaviours could be potentially reduced when implementing community-based interventions, tailored to inequality gaps and using the EPODE methodology. Within-group changes varied widely, whereas monitoring of interventions and process evaluation are crucial to understand the observed results. Electronic supplementary material The online version of this article (doi:10.1186/s12939-016-0438-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Krystallia Mantziki
- Department of Health Sciences, VU University Amsterdam, De Boelelaan 1085, 1081HV, Amsterdam, The Netherlands.
| | - Carry M Renders
- Department of Health Sciences, VU University Amsterdam, De Boelelaan 1085, 1081HV, Amsterdam, The Netherlands
| | - Achilleas Vassilopoulos
- Department of Agricultural Economics and Rural Development, Agricultural University of Athens, Athens, Greece
| | | | | | | | - Maria João Gregório
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
| | - Pedro Graça
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal.,Directorate General of Health, Lisbon, Portugal
| | | | - Svetoslav Handjiev
- Bulgarian Association for the study of Obesity and related diseases, Sofia, Bulgaria
| | - Tommy L S Visscher
- Department of Health Sciences, VU University Amsterdam, De Boelelaan 1085, 1081HV, Amsterdam, The Netherlands.,Research Centre for the Prevention of Overweight, Windesheim University of Applied Sciences Zwolle, Zwolle, The Netherlands.,Research Centre for the Prevention of Overweight, VU University, Zwolle, The Netherlands
| | - Jacob C Seidell
- Department of Health Sciences, VU University Amsterdam, De Boelelaan 1085, 1081HV, Amsterdam, The Netherlands
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10
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Mantziki K, Vassilopoulos A, Radulian G, Borys JM, Du Plessis H, Gregório MJ, Graça P, De Henauw S, Handjiev S, Visscher TL, Seidell JC. Inequities in energy-balance related behaviours and family environmental determinants in European children: baseline results of the prospective EPHE evaluation study. BMC Public Health 2015; 15:1203. [PMID: 26630926 PMCID: PMC4668694 DOI: 10.1186/s12889-015-2540-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 11/23/2015] [Indexed: 11/24/2022] Open
Abstract
Background Tackling inequalities in overweight, obesity and related determinants has become a top priority for the European research and policy agendas. Although it has been established that such inequalities accumulate from early childhood onward, they have not been studied extensively in children. The current article discusses the results of an explorative analysis for the identification of inequalities in behaviours and their determinants between groups with high and low socio-economic status. Methods This study is part of the Epode for the Promotion of Health Equity (EPHE) evaluation study, the overall aim of which is to assess the impact and sustainability of EPODE methodology to diminish inequalities in childhood obesity and overweight. Seven community-based programmes from different European countries (Belgium, Bulgaria, France, Greece, Portugal, Romania, The Netherlands) participate in the EPHE study. In each of the communities, children aged 6–8 years participated, resulting in a total sample of 1266 children and their families. A parental self-administrated questionnaire was disseminated in order to assess the socio-economic status of the household, selected energy balance-related behaviours (1. fruit and vegetable consumption; 2. soft drink/ fruit juices and water consumption; 3. screen time and 4. sleep duration) of the children and associated family environmental determinants. The Mann–Whitney U test and Pearson’s chi-square test were used to test differences between the low and high education groups. The country-specific median was chosen as the cut-off point to determine the educational level, given the different average educational level in every country. Results Children with mothers of relatively high educational level consumed fruits and vegetables more frequently than their peers of low socio-economic status. The latter group of children had a higher intake of fruit juices and/or soft drinks and had higher screen time. Parental rules and home availability were consistently different between the two socio-economic groups in our study in all countries. However we did not find a common pattern for all behaviours and the variability across the countries was large. Conclusions Our findings are indicative of socio-economic inequalities in our samples, although the variability across the countries was large. The effectiveness of interventions aimed at chancing parental rules and behaviour on health inequalities should be studied. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2540-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Krystallia Mantziki
- Department of Health Sciences, VU University Amsterdam, Amsterdam, The Netherlands.
| | - Achilleas Vassilopoulos
- Department of Agricultural Economics and Rural Development, Agricultural University of Athens, Athens, Greece
| | | | | | | | - Maria João Gregório
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
| | - Pedro Graça
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal.,Directorate General of Health, Lisbon, Portugal
| | | | - Svetoslav Handjiev
- Bulgarian Association for the study of Obesity and related diseases, Sofia, Bulgaria
| | - Tommy Ls Visscher
- Department of Health Sciences, VU University Amsterdam, Amsterdam, The Netherlands.,Research Centre for the Prevention of Overweight, Windesheim University of Applied Sciences Zwolle & VU University, Zwolle, The Netherlands
| | - Jacob C Seidell
- Department of Health Sciences, VU University Amsterdam, Amsterdam, The Netherlands
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11
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Lipek T, Igel U, Gausche R, Kiess W, Grande G. Obesogenic environments: environmental approaches to obesity prevention. J Pediatr Endocrinol Metab 2015; 28:485-95. [PMID: 25928754 DOI: 10.1515/jpem-2015-0127] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 04/02/2015] [Indexed: 11/15/2022]
Abstract
Childhood obesity is a major concern for public health. There are multiple factors (e.g., genetic, social, and environmental) that contribute to unhealthy weight gain. Drawing from findings on "obesogenic environments" and core principles of preventive strategies to reduce health inequalities, this paper gives an overview of recent childhood prevention programs that target aspects of the physical environment ("environmental changes"). Out of the ten reviews we screened (including more than 300 studies), we identified very few that addressed aspects of the environment. We focus here on 14 programs that follow different approaches to environmental changes (e.g., access to/quality of playgrounds, changes in school cafeterias). Altering the environment offers opportunities for healthier behaviors and seems to be an effective strategy to prevent childhood obesity. However, the evaluation of those (mostly) multidimensional interventions does not allow drawing firm conclusions about the single effect of environmental changes. We conclude that obesity prevention programs should combine person-based and environmental approaches.
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12
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Hillier-Brown FC, Bambra CL, Cairns JM, Kasim A, Moore HJ, Summerbell CD. A systematic review of the effectiveness of individual, community and societal level interventions at reducing socioeconomic inequalities in obesity amongst children. BMC Public Health 2014; 14:834. [PMID: 25113624 PMCID: PMC4137097 DOI: 10.1186/1471-2458-14-834] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 07/29/2014] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Tackling childhood obesity is one of the major contemporary public health policy challenges and vital in terms of addressing socioeconomic health inequalities.We aimed to systematically review studies of the effectiveness of interventions (individual, community and societal) operating via different approaches (targeted or universal) in reducing socio-economic inequalities in obesity-related outcomes amongst children. METHODS Nine electronic databases were searched from start date to October 2012 along with website and grey literature searches. The review examined the best available international evidence from interventions that aimed to prevent obesity, treat obesity, or improve obesity-related behaviours (diet and/or physical activity) amongst children (aged 0-18 years) in any setting and country, so long as they provided relevant information and analysis on both socioeconomic status and obesity-related outcomes. Data extraction and quality appraisal were conducted using established mechanisms and narrative synthesis was conducted. RESULTS We located 23 studies that provided the 'best available' (strongest methodologically) international evidence. At the individual level (n = 4), there was indicative evidence that screen time reduction and mentoring health promotion interventions could be effective in reducing inequalities in obesity. For the community level interventions (n = 17), evidence was inconclusive - with some studies suggesting that school-based health promotion activities and community-based group-based programmes were effective in reducing obesity - others not. Societal level evaluations were few (n = 1). However, there was no evidence to suggest that any of these intervention types increase inequalities and several studies found that interventions could at least prevent the widening of inequalities in obesity. The majority of studies were from America and were of 6-12 year old children. CONCLUSIONS The review has found only limited evidence although some individual and community based interventions may be effective in reducing socio-economic inequalities in obesity-related outcomes amongst children but further research is required, particularly of more complex, societal level interventions and amongst adolescents.
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Affiliation(s)
- Frances C Hillier-Brown
- />Department of Geography, Wolfson Research Institute for Health and Wellbeing, Durham University Queen’s Campus, Stockton-on-Tees, TS17 6BH UK
- />School of Medicine, Pharmacy and Health, Wolfson Research Institute for Health and Wellbeing, Durham University Queen’s Campus, Stockton-on-Tees, TS17 6BH UK
- />Wolfson Research Institute for Health and Wellbeing, Durham University Queen’s Campus, Stockton-on-Tees, TS17 6BH UK
| | - Clare L Bambra
- />Department of Geography, Wolfson Research Institute for Health and Wellbeing, Durham University Queen’s Campus, Stockton-on-Tees, TS17 6BH UK
- />Wolfson Research Institute for Health and Wellbeing, Durham University Queen’s Campus, Stockton-on-Tees, TS17 6BH UK
| | - Joanne-Marie Cairns
- />Department of Geography, Wolfson Research Institute for Health and Wellbeing, Durham University Queen’s Campus, Stockton-on-Tees, TS17 6BH UK
- />Wolfson Research Institute for Health and Wellbeing, Durham University Queen’s Campus, Stockton-on-Tees, TS17 6BH UK
| | - Adetayo Kasim
- />Wolfson Research Institute for Health and Wellbeing, Durham University Queen’s Campus, Stockton-on-Tees, TS17 6BH UK
| | - Helen J Moore
- />School of Medicine, Pharmacy and Health, Wolfson Research Institute for Health and Wellbeing, Durham University Queen’s Campus, Stockton-on-Tees, TS17 6BH UK
- />Wolfson Research Institute for Health and Wellbeing, Durham University Queen’s Campus, Stockton-on-Tees, TS17 6BH UK
| | - Carolyn D Summerbell
- />School of Medicine, Pharmacy and Health, Wolfson Research Institute for Health and Wellbeing, Durham University Queen’s Campus, Stockton-on-Tees, TS17 6BH UK
- />Wolfson Research Institute for Health and Wellbeing, Durham University Queen’s Campus, Stockton-on-Tees, TS17 6BH UK
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