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Daas MC, Gebremariam MK, Poelman MP, Andersen LF, Klepp KI, Bjelland M, Lien N. Mediators and moderators of the effects of a school-based intervention on adolescents' fruit and vegetable consumption: the HEIA study. Public Health Nutr 2024; 27:e50. [PMID: 38269621 PMCID: PMC10882531 DOI: 10.1017/s1368980024000260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
OBJECTIVE To examine whether targeted determinants mediated the effects of the HEalth In Adolescents (HEIA) intervention on fruit and vegetable (FV) consumption and explore if these mediating effects were moderated by sex, parental education or weight status. DESIGN Cluster-randomised controlled trial. SETTING The HEIA study (2007-2009) was a Norwegian 20-month multi-component school-based intervention to promote healthy weight development. FV consumption and targeted determinants were self-reported at baseline, mid-way (8 months) and post-intervention (20 months). PARTICIPANTS Adolescents (11-13-year-old) in twenty-five control schools (n 746) and twelve intervention schools (n 375). RESULTS At post-intervention, more adolescents in the intervention group compared with the control group had knowledge of the FV recommendations (OR: 1·4, 95 % CI 1·1, 1·9) and reported a decreased availability of vegetables at home (β: -0·1, 95 % CI -0·2, 0·0). Availability/accessibility of FV at home, availability of vegetables at dinner, taste preferences for different types of FV and knowledge of the FV recommendations were positively associated with the consumption of FV. However, none of the post-intervention determinants significantly mediated the intervention effects on FV consumption. Although no moderating influences by sex, parental education or weights status were observed on the mediating effects, exploratory analyses revealed significant moderations in the b-paths. CONCLUSIONS Since none of the targeted determinants could explain the increase in FV consumption, it remains unclear why the intervention was effective. Reporting on a wide range of mediators and moderators in school-based interventions is needed to reveal the pathways through which intervention effects are achieved.
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Affiliation(s)
- Merel Celine Daas
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo0317, Norway
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen6700 AA, The Netherlands
| | - Mekdes Kebede Gebremariam
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo0318, Norway
| | - Maartje P Poelman
- Department of Social Sciences, Chair Group Consumption and Healthy Lifestyles, Wageningen University & Research, Wageningen6700 EW, The Netherlands
| | - Lene Frost Andersen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo0317, Norway
| | - Knut-Inge Klepp
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo0213, Norway
| | - Mona Bjelland
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo0317, Norway
| | - Nanna Lien
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo0317, Norway
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Randby JS, Ogden T, Lien N. Implementation and effectiveness of a school-based intervention to increase adherence to national school meal guidelines: a non-randomised controlled trial. Public Health Nutr 2024; 27:e25. [PMID: 38164650 PMCID: PMC10830359 DOI: 10.1017/s1368980023002938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 11/26/2023] [Accepted: 12/17/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Implementation of school meal guidelines is often inadequate, and evidence for effective implementation strategies for school-based nutrition interventions is limited. The aim of the present study was to examine the implementation and effectiveness of a multi-strategy implementation intervention to increase adherence to the Norwegian national school meal guideline. DESIGN The study was a school-based hybrid implementation effectiveness trial with a pre-post non-equivalent control group design, testing three implementation strategies: internal facilitation, training and an educational meeting. SETTING Primary schools and after-school services in two counties in south-east Norway. PARTICIPANTS School principals, after-school leaders and class teachers from thirty-three schools in the intervention county and principals and after-school leaders from thirty-four schools in a comparison county. RESULTS There was a significant difference of 4 percentage points in change scores between the intervention and the comparison groups at follow-up, after adjusting for baseline adherence (B = 0·04, seB = 0·01, t = 3·10, P = 0·003). The intervention effect was not associated with the school's socio-economic profile. School-level fidelity was the implementation dimension that was most strongly correlated (r s = 0·48) with the change scores in the intervention group, indicating that principals' support is important for gaining the largest intervention effects. CONCLUSIONS A school-based intervention with low intensity, based on trained teachers as internal facilitators, can increase adherence to the national school meal guideline among Norwegian primary schools, irrespective of local socio-economic conditions. Implementation fidelity, at an organisational level, may be a useful predictor for intervention outcomes in schools.
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Affiliation(s)
- Jorunn Sofie Randby
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Pb. 1046 Blindern, 0317Oslo, Norway
- Department of Child and Adolescent Health, Norwegian Directorate of Health, Pb. 220 Skøyen, 0213Oslo, Norway
| | - Terje Ogden
- Norwegian Center for Child Behavioral Development, P.b. 7053 Majorstuen, 0306Oslo, Norway
| | - Nanna Lien
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Pb. 1046 Blindern, 0317Oslo, Norway
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3
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Mekonnen T, Papadopoulou E, Lien N, Andersen LF, Pinho MGM, Havdal HH, Andersen OK, Gebremariam MK. Mediators of parental educational differences in the intake of carbonated sugar-sweetened soft drinks among adolescents, and the moderating role of neighbourhood income. Nutr J 2023; 22:43. [PMID: 37697383 PMCID: PMC10494387 DOI: 10.1186/s12937-023-00872-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 08/31/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Existing evidence suggests that the intake of sugar-sweetened beverages (SSB) among adolescents remains a public health concern and that socioeconomic differences in intake exist. Tackling these challenges requires identifying the factors associated with SSB intake and the mediators of socioeconomic differences in SSB intake among adolescents. Thus, this study aimed to explore (i) factors at different levels of the ecological model associated with the intake of carbonated soft drinks with added sugar (hereafter called soft drinks), (ii) mediators of the association between parental education and the intake of soft drinks(iii) whether neighbourhood income moderates the indirect effect of parental education on adolescents' soft drink intake through potential mediators. METHODS Data from 826 7th graders in Oslo, Norway, who participated in the TACKLE cross-sectional study conducted in 2020 were used. The association between factors at the individual, interpersonal and neighbourhood food environment levels and the intake of soft drinks among adolescents was assessed, as well as the mediating roles of these factors for the differences in intake by parental education, using multiple logistic regression and mediation analysis, respectively. Moderated mediation analyses were used to explore whether an indirect effect of parental education on adolescents' soft drink intake through potential mediators varies across neighbourhood income areas. RESULTS Higher perceived accessibility of SSB at home, increased parental modelling for SSB intake, and increased frequency of food/drink purchased from the neighbourhood store were associated with a higher intake of soft drinks among adolescents and mediated the differences in intake by parental education. Neighbourhood food environment factors were neither statistically significantly associated with adolescents' higher intake of soft drinks nor explained the differences in intake by parental education. Moderated mediation analysis showed that the mediating effect of perceived accessibility of SSB at home on the association between parental education and adolescent soft drink intake was stronger among those living in low neighbourhood income. CONCLUSIONS Our study identified modifiable factors at the intrapersonal level (perceived accessibility of SSB at home and frequency of food/drink purchased from neighbourhood shops) and interpersonal levels (parental modelling for SSB intake) associated with a higher intake of soft drinks among adolescents and mediated the differences in the intake by parental education. The modifiable factors identified in this study could be targeted in public health initiatives among adolescents aimed at reducing the intake of soft drinks and the related differences by parental education.
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Affiliation(s)
- Teferi Mekonnen
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Eleni Papadopoulou
- Division of Health Service, Global Health Cluster, Norwegian Institute of Public Health, Oslo, Norway
| | - Nanna Lien
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lene F Andersen
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Maria Gabriela Matias Pinho
- Department Environmental Sciences, Copernicus Institute of Sustainable Development, Utrecht University, Utrecht, the Netherlands
| | - Hanne Hennig Havdal
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Mekdes K Gebremariam
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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4
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Aguiar A, Gebremariam MK, Romanenko E, Önal F, Kopainsky B, Savona N, Brown A, Allender S, Lien N. System dynamics simulation models on overweight and obesity in children and adolescents: A systematic review. Obes Rev 2023; 24 Suppl 2:e13632. [PMID: 37753602 DOI: 10.1111/obr.13632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/19/2023] [Accepted: 07/22/2023] [Indexed: 09/28/2023]
Abstract
It has increasingly been recognized that developing successful obesity prevention policies and interventions requires understanding of the complex mechanisms driving the obesity pandemic and that models could be useful tools for simulating policies. This paper reviews system dynamics simulation models of mechanisms driving childhood overweight and obesity and/or testing of preventive interventions. A systematic literature search was conducted in six databases from inception to January 2023 using terms related to overweight/obesity, children, and system dynamics. Study descriptives, mechanisms, and where to intervene (the leverage points), as well as quality assessments of the simulation models were extracted by two researchers into a predetermined template and narratively synthesized. Seventeen papers describing 15 models were included. Models describing the mechanisms ranged from only intrapersonal factors to models cutting across multiple levels of the ecological model, but mechanisms across levels were lacking. The majority of interventions tested in the simulation models were changes to existing model parameters with less emphasis on models that alter system structure. In conclusion, existing models included mechanisms driving youth obesity at multiple levels of the ecological model. This is useful for developing an integrated simulation model combining mechanisms at multiple levels and allowing for testing fundamental system changes.
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Affiliation(s)
- Anaely Aguiar
- System Dynamics Group, University of Bergen, Bergen, Norway
| | | | | | - Furkan Önal
- System Dynamics Group, University of Bergen, Bergen, Norway
| | | | - Natalie Savona
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Andrew Brown
- Global Centre for Preventive Health and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Steven Allender
- Global Centre for Preventive Health and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - Nanna Lien
- Department of Nutrition, University of Oslo, Oslo, Norway
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5
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Nwosu E, Makwambeni P, Herstad SH, Etsebeth H, Hendricks G, Aguiar A, Alaba O, Blanchard L, Fismen AS, Lien N, Harbron J. Longitudinal relationship between adolescents' mental health, energy balance-related behavior, and anthropometric changes. Obes Rev 2023; 24 Suppl 2:e13629. [PMID: 37753607 DOI: 10.1111/obr.13629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/21/2023] [Accepted: 07/22/2023] [Indexed: 09/28/2023]
Abstract
Energy balance-related behaviors (EBRBs) are considered the immediate causes of adolescents' body weight increases, but adolescents have identified mental health as a contributor. Cross-sectional studies have reported associations between adolescents' mental health and obesity, but causal relationships and the role of EBRBs within this can only be established using longitudinal studies. This systematic review summarizes the findings of longitudinal studies investigating this relationship, in addition to the role of EBRB in the relationship. Multiple electronic databases were searched for longitudinal studies using keywords related to the adolescent population, mental health, EBRB, and body weight. In total, 1216 references were identified and screened based on previously defined eligibility criteria. Sixteen articles met the inclusion criteria. Most studies indicated that mental health-related measures like depression, anxiety, and body dissatisfaction were related to an increase in body weight later. As this review is focused on behavioral mediators, six studies reported associations between mental health-anthropometry dyad and EBRBs such as eating habits, screen time, physical activity, and sleep-as well as stressors like peer victimization. Future studies may focus on streamlining mental health measures and body weight outcomes to assess this relationship. Furthermore, more longitudinal investigations are needed to provide insight into the role of EBRBs in the mental health-body weight relationship during adolescence.
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Affiliation(s)
- Emmanuel Nwosu
- Research Centre for Health through Physical Activity, Lifestyle and Sport (HPALS), Human Biology Department, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- The Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Patricia Makwambeni
- Bongani Mayosi Health Sciences Library, University of Cape Town, Cape Town, South Africa
| | - Sondre Haugsbø Herstad
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Hanli Etsebeth
- Research Centre for Health through Physical Activity, Lifestyle and Sport (HPALS), Human Biology Department, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Gaironeesa Hendricks
- Research Centre for Health through Physical Activity, Lifestyle and Sport (HPALS), Human Biology Department, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Anaely Aguiar
- System Dynamics Group, Department of Geography, University of Bergen, Bergen, Norway
| | - Olufunke Alaba
- Health Economics Unit, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Laurence Blanchard
- Faculty of Public Health Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Anne-Siri Fismen
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Nanna Lien
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Janetta Harbron
- Research Centre for Health through Physical Activity, Lifestyle and Sport (HPALS), Human Biology Department, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Knai C, Savona N, Finegood D, Aguiar A, Blanchard L, Conway-Moore K, Helleve A, Klepp KI, Lien N, Luszczynska A, Vlad I, Rønnestad AM, Rutter H. Learning from the CO-CREATE project: A protocol for systems thinking across research (STAR). Obes Rev 2023; 24 Suppl 2:e13624. [PMID: 37753598 DOI: 10.1111/obr.13624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/20/2023] [Accepted: 07/22/2023] [Indexed: 09/28/2023]
Abstract
The CO-CREATE project aimed to work with young people to create, inform, and disseminate obesity-preventive evidence-based policies using a complex systems perspective. This paper draws lessons from this experience and proposes a protocol for embedding systems thinking within a research project. We first draw on existing systems thinking frameworks to analyze how systems thinking was translated across CO-CREATE, including the flow and relationship between the work packages and in the methods used. We then take the lessons from CO-CREATE and the principles of existing systems thinking frameworks-which focus on various points of intervention planning and delivery but not on research projects as a whole-to formulate a protocol for embedding systems thinking across a research project. Key lessons for future planning and delivery of systems-oriented research projects include incorporating "boundary critique" by capturing key stakeholder (adolescent) values and concerns; working to avoid social exclusion; ensuring methodological pluralism to allow for reflection and responsiveness (with methods ranging from group model building, Photovoice, and small group engagement); getting policy recipients to shape key questions by understanding their views on the critical drivers of obesity early on in the project; and providing opportunity for intraproject reflection along the way.
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Affiliation(s)
- Cécile Knai
- Faculty of Public Health Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Natalie Savona
- Faculty of Public Health Policy, London School of Hygiene and Tropical Medicine, London, UK
- Cordi Bright, London, UK
| | - Diane Finegood
- Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, Canada
- Morris J. Wosk Centre for Dialogue, Simon Fraser University, Burnaby, Canada
| | - Anaely Aguiar
- System Dynamics Group, University of Bergen, Bergen, Norway
| | - Laurence Blanchard
- Faculty of Public Health Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Kaitlin Conway-Moore
- Faculty of Public Health Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Arnfinn Helleve
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Knut-Inge Klepp
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
- Department of Nutrition, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Nanna Lien
- Department of Nutrition, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Aleksandra Luszczynska
- Trauma, Health, & Hazards Center, University of Colorado, Denver, Colorado, USA
- Warsaw School of Social Sciences and Humanities, Warsaw, Poland
| | | | | | - Harry Rutter
- Department of Social & Policy Sciences, University of Bath, Bath, UK
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Ulloa MA, Nesrallah S, Shafafi P, Lamar A, Gonçalves PCR, Gonçalves M, Nylander KS, Luszczynska A, Lien N, Bergstrøm E, Rutter H, Marki H, Klepp KI, Bouillon C. Designing a youth-led Dialogue Forum tool: The CO-CREATE experience. Obes Rev 2023; 24 Suppl 2:e13611. [PMID: 37753600 DOI: 10.1111/obr.13611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/04/2023] [Accepted: 07/08/2023] [Indexed: 09/28/2023]
Abstract
While obesity prevention represents an established field of research, the inclusion of young people, who are regularly cited as an important priority group, are rarely actioned in long-term studies. This paper focuses on the development of a dialogue tool intended to tackle this issue, engaging, and eliciting insights on the theme of obesity prevention, by young people and for young people. As part of the CO-CREATE project, this tool was co-developed by designers, public health, and youth participation experts, researchers, and young people. Co-creation is a key methodology in the design of the dialogue tool, as young people were involved in all stages of the development process. This paper elaborates on the process of co-designing a dialogue tool that helps explore obesity prevention policy ideas from multiple perspectives, and describes the design principles that informed the process and the final versions of the tool. The purpose of the Dialogue Forum tool is for youth to engage policymakers and other relevant stakeholders to discuss and refine co-created and youth-initiated ideas for healthier food and physical activity environments. We analyze how specific design principles were integrated into different prototypes and the value of this within the project and the field.
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Affiliation(s)
| | | | | | | | - Pedro Côrte-Real Gonçalves
- CO-CREATE Youth Task Force, Portugal
- CEIDSS Centre for Studies and Research in Social Dynamics and Health, Lisbon, Portugal
| | - Mafalda Gonçalves
- CO-CREATE Youth Task Force, Portugal
- CEIDSS Centre for Studies and Research in Social Dynamics and Health, Lisbon, Portugal
| | | | - Aleksandra Luszczynska
- CARE-BEH Center for Applied Research on Health Behavior and Health, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Nanna Lien
- Department of Nutrition, The Medical Faculty, University of Oslo, Oslo, Norway
| | - Elin Bergstrøm
- Centre for Development and the Environment, University of Oslo, Oslo, Norway
| | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| | | | - Knut-Inge Klepp
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
- Department of Nutrition, Faculty of Medicine, University of Oslo, Oslo, Norway
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Banik A, Knai C, Klepp KI, Rutter H, Rito A, Lien N, Baillergeau E, Szczuka Z, Boberska M, Kulis E, Luszczynska A. What policies are there and what policies are missing? A Photovoice study of adolescents' perspectives on obesity-prevention policies in their local environment. Obes Rev 2023; 24 Suppl 2:e13617. [PMID: 37753603 DOI: 10.1111/obr.13617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/15/2023] [Accepted: 07/13/2023] [Indexed: 09/28/2023]
Abstract
The aim of this study was to investigate adolescents' critical awareness of whether obesity prevention policies targeting physical activity (PA) and nutrition were operating in their local community. Participants were 41 adolescents (aged 16-18, 90% women) recruited from three communities in Poland. Prior to this study, they were involved in obesity-prevention participatory initiatives (conducted within the CO-CREATE project), where obesity-related public policy limitations were analyzed in a youth-led discussion. A Photovoice exercise was designed to capture obesity-related public policies that were either present or absent in young people's local environments. The photographs (N = 213) were coded and mapped according to the policy themes they illustrated, using the MOVING and NOURISHING frameworks. The public policies represented in the photographs are most frequently related to: healthy retail or food service environments; food advertising or promotion; structures and surroundings that promote PA; and infrastructure and opportunities that support public or active transport. Adolescents are critically aware of the presence and lack of specific public policies operating in their local environment, particularly policies affecting structural aspects of food and PA environments. Policy-oriented photovoice exercises may prompt critical awareness among adolescents and empower them to contribute to obesity prevention policy processes.
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Affiliation(s)
- Anna Banik
- CARE-BEH Center for Applied Research on Health Behavior and Health, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Cecile Knai
- London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, London, UK
| | - Knut-Inge Klepp
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
- Department of Nutrition, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| | - Ana Rito
- Centre for Studies and Research in Social Dynamics and Health - CEIDSS, Lisbon, Portugal
| | - Nanna Lien
- Department of Nutrition, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Evelyne Baillergeau
- Department of Sociology, University of Amsterdam, Amsterdam, The Netherlands
| | - Zofia Szczuka
- CARE-BEH Center for Applied Research on Health Behavior and Health, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Monika Boberska
- CARE-BEH Center for Applied Research on Health Behavior and Health, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Ewa Kulis
- CARE-BEH Center for Applied Research on Health Behavior and Health, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Aleksandra Luszczynska
- CARE-BEH Center for Applied Research on Health Behavior and Health, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
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9
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Conway-Moore K, Knai C, Finegood D, Johnston L, Brinsden H, Aguiar A, Kopainsky B, Önal F, Helleve A, Klepp KI, Lien N, Luszczynska A, Rito AI, Rønnestad AM, Ulstein M, Blanchard L, Savona N, Rutter H. Co-creating obesity prevention policies with youth: Policy ideas generated through the CO-CREATE project. Obes Rev 2023; 24 Suppl 2:e13623. [PMID: 37753599 DOI: 10.1111/obr.13623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/27/2023] [Accepted: 07/13/2023] [Indexed: 09/28/2023]
Abstract
Despite growing recognition of the importance of applying a systems lens to action on obesity, there has only been limited analysis of the extent to which this lens has actually been applied. The CO-CREATE project used a youth-led participatory action research approach to generate policy ideas towards the reduction of adolescent overweight and obesity across Europe. In order to assess the extent to which these youth-generated policy ideas take a systems approach, we analyzed them using the Intervention Level Framework (ILF). The ILF ascribes actions to one of five system levels, from Structural Elements, the least engaged with system change, up to Paradigm, which is the system's deepest held beliefs and thus the most difficult level at which to intervene. Of the 106 policy ideas generated by young people during the CO-CREATE project, 91 (86%) were categorized at the level of Structural Elements. This emphasis on operational rather than systems level responses echoes findings from a previous study on obesity strategies. Analyzing the distribution of systems level responses using the ILF has the potential to support more effective action on obesity by allowing identification of opportunities to strengthen systems level responses overall.
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Affiliation(s)
- Kaitlin Conway-Moore
- Faculty of Public Health Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Cécile Knai
- Faculty of Public Health Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Diane Finegood
- Biomedical Physiology and Kinesiology, Simon Fraser University, Vancouver, Canada
- Morris J. Wosk Centre for Dialogue, Simon Fraser University, Vancouver, Canada
| | - Lee Johnston
- Morris J. Wosk Centre for Dialogue, Simon Fraser University, Vancouver, Canada
| | | | - Anaely Aguiar
- System Dynamics Group, University of Bergen, Bergen, Norway
| | | | - Furkan Önal
- System Dynamics Group, University of Bergen, Bergen, Norway
| | - Arnfinn Helleve
- Centre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, Oslo, Norway
| | - Knut-Inge Klepp
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Nanna Lien
- Department of Nutrition, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Ana Isabel Rito
- National Institute of Health Dr.Ricardo Jorge, Lisbon, Portugal
| | | | | | - Laurence Blanchard
- Faculty of Public Health Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath, UK
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10
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Herstad SH, Grewal NK, Banik A, Klepp KI, Knai C, Luszczynska A, Mendes S, Rito A, Rutter H, Lien N. Adolescents' capacity to take action on obesity: A concurrent controlled before-and-after study of the European CO-CREATE project. Obes Rev 2023; 24 Suppl 2:e13622. [PMID: 37753601 DOI: 10.1111/obr.13622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/26/2023] [Accepted: 07/06/2023] [Indexed: 09/28/2023]
Abstract
This study evaluated the effect on reported readiness for action and attitudes toward obesity prevention among older adolescents (mean age 17) who took part in a youth-led participatory action research European initiative (CO-CREATE Youth Alliances) compared with a comparison group that acted as controls. This was a concurrent before-and-after controlled study across five countries and took place between September 2019 and October 2020. Adolescents (n = 159) recruited from schools and youth organizations came together with researchers and formed 15 Youth Alliances. An online questionnaire measuring their readiness for action and attitudes toward obesity prevention was administered. Alliance members (n = 62) who filled in the questionnaire at both baseline and postinitiative, and adolescents from the comparison group (n = 132) who completed the questionnaire twice were included in the main analysis. Two-level linear mixed models controlling for country-related variance were fitted. Alliance members scored significantly higher than the comparison group on two factors in each of the readiness for action, responsibility, and drivers of behavior concepts. The findings suggest that involving youth in co-creating policies to prevent obesity may increase adolescents' readiness for action and promote a shift in adolescents' conceptualization of obesity from an individual perspective to a societal responsibility and drivers of behavior.
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Affiliation(s)
| | | | - Anna Banik
- SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Knut-Inge Klepp
- Department of Nutrition, University of Oslo, Oslo, Norway
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Cecile Knai
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Sofia Mendes
- Center for Studies and Research on Social Dynamics and Health - CEIDSS, Lisbon, Portugal
| | - Ana Rito
- National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| | - Nanna Lien
- Department of Nutrition, University of Oslo, Oslo, Norway
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11
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Aguiar A, Önal F, Hendricks G, Blanchard L, Romanenko E, Fismen AS, Nwosu E, Herstad S, Savona N, Harbron J, Knai C, Samdal O, Rutter H, Lien N, Jalali MS, Kopainsky B. Understanding the dynamics emerging from the interplay among poor mental wellbeing, energy balance-related behaviors, and obesity prevalence in adolescents: A simulation-based study. Obes Rev 2023; 24 Suppl 2:e13628. [PMID: 37753604 DOI: 10.1111/obr.13628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/16/2023] [Accepted: 07/18/2023] [Indexed: 09/28/2023]
Abstract
Both obesity and poor mental wellbeing have a high prevalence in European youth. Adolescents in six countries identified mental wellbeing factors as main drivers of youth obesity through systems mapping. This study sought to (1) explore the dynamics of the interplay between poor mental wellbeing, energy balance-related behaviors, and adolescent overweight and obesity prevalence and (2) test the effect of intervention point scenarios to reduce adolescent obesity. Drawing on the youth-generated systems maps and a literature synthesis, we built a simulation model that represents the links from major feedback pathways for poor mental wellbeing to changes in dietary, physical activity, and sleep behaviors. The model was calibrated using survey data from Norway, expert input, and literature and shows a good fit between simulated behavior and available statistical data. The simulations indicate that adolescent mental wellbeing is harmed by socio-cultural pressures and stressors, which trigger reinforcing feedback mechanisms related to emotional/binge eating, lack of motivation to engage in physical activity, and sleep difficulty. Targeting a combination of intervention points that support a 25% reduction of pressure on body image and psychosocial stress showed potentially favorable effects on mental wellbeing-doubling on average for boys and girls and decreasing obesity prevalence by over 4%.
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Affiliation(s)
- Anaely Aguiar
- System Dynamics Group, Department of Geography, University of Bergen, Bergen, Norway
| | - Furkan Önal
- System Dynamics Group, Department of Geography, University of Bergen, Bergen, Norway
| | | | - Laurence Blanchard
- Faculty of Public Health Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Eduard Romanenko
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Anne-Siri Fismen
- Department of Health and Caring Services, Western Norway University of Applied Science, Bergen, Norway
| | - Emmanuel Nwosu
- Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Sondre Herstad
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Natalie Savona
- Faculty of Public Health Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Janetta Harbron
- Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Cécile Knai
- Faculty of Public Health Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Oddrun Samdal
- Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Harry Rutter
- Department of Social & Policy Sciences, University of Bath, Bath, UK
| | - Nanna Lien
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Mohammad S Jalali
- MGH Institute for Technology Assessment, Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Birgit Kopainsky
- System Dynamics Group, Department of Geography, University of Bergen, Bergen, Norway
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12
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Samdal O, Budin-Ljøsne I, Haug E, Helland T, Kjostarova-Unkovska L, Bouillon C, Bröer C, Corell M, Cosma A, Currie D, Eriksson C, Felder-Puig R, Gaspar T, Hagquist C, Harbron J, Jåstad A, Kelly C, Knai C, Kleszczewska D, Kysnes BB, Lien N, Luszczynska A, Moerman G, Moreno-Maldonado C, NicGabhainn S, Pudule I, Rakic JG, Rito A, Rønnestad AM, Ulstein M, Rutter H, Klepp KI. Encouraging greater empowerment for adolescents in consent procedures in social science research and policy projects. Obes Rev 2023; 24 Suppl 2:e13636. [PMID: 37753605 DOI: 10.1111/obr.13636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/23/2023] [Accepted: 07/25/2023] [Indexed: 09/28/2023]
Abstract
The United Nations Convention on the Rights of the Child emphasizes the importance of allowing children and adolescents to influence decisions that are important to them following their age and maturity. This paper explores the principles, practices, and implications around using parental versus child/adolescent consent when participating in social science research and policy development. Experiences from two studies are presented: The Confronting Obesity: Co-creating policy with youth (CO-CREATE) and the Health Behaviour in School-aged Children (HBSC) study, a World Health Organization (WHO) Collaborative Cross-National study. Although parental consent may be an important gatekeeper for protecting children and adolescents from potentially harmful research participation, it may also be considered an obstacle to the empowerment of children and adolescents in case they want to share their views and experiences directly. This paper argues that evaluation of possible harm should be left to ethics committees and that, if no harm related to the research participation processes is identified and the project has a clear perspective on collaborating with the target group, adolescents from the age of 12 years should be granted the legal capacity to give consent to participate in the research project. Collaboration with adolescents in the development of the research project is encouraged.
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Affiliation(s)
- Oddrun Samdal
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway
| | - Isabelle Budin-Ljøsne
- Department of Food Safety, Division of Climate and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Ellen Haug
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway
| | - Trond Helland
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway
| | | | | | - Christian Bröer
- Department of Sociology, University of Amsterdam, Amsterdam, The Netherlands
| | - Maria Corell
- Unit for Mental Health, Children and Youth, Public Health Agency of Sweden, Stockholm, Sweden
| | - Alina Cosma
- Department of Sociology, Trinity College Dublin, Dublin, Ireland
| | - Dorothy Currie
- School of Medicine, St. Andrews University, St. Andrews, UK
| | - Charli Eriksson
- Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Solna, Sweden
| | - Rosemarie Felder-Puig
- Department of Evidence and Quality Standards, Austrian National Public Health Institute, Vienna, Austria
| | - Tania Gaspar
- Psychology and health Sciences Department, Lusofona University, Lisbon, Portugal
| | - Curt Hagquist
- Department of Education and Special Education, University of Gothenburg, Gothenburg, Sweden
| | - Janetta Harbron
- Research Centre for Health Through Physical Activity, Lifestyle and Sport (HPALS), Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Atle Jåstad
- Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Colette Kelly
- Health Promotion Research Centre, University of Galway, Galway, Ireland
| | - Cecile Knai
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Dorota Kleszczewska
- Department of Child and Adolescent Health, Institute of Mother and Child, Warsaw, Poland
| | | | - Nanna Lien
- Department of Nutrition, University of Oslo, Oslo, Norway
| | | | - Gerben Moerman
- Department of Sociology, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | - Iveta Pudule
- Centre for Disease Prevention and Control, Riga, Latvia
| | - Jelena Gudelj Rakic
- Centre of Health Promotion, Institute of Public Health of Serbia, Beograd, Serbia
| | - Ana Rito
- Centre for Studies and Research in Social Dynamics and Health, Lisbon, Portugal
| | | | | | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| | - Knut-Inge Klepp
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
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13
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Wendt J, Scheller DA, Banik A, Luszczynska A, Forberger S, Zeeb H, Scheidmeir M, Kubiak T, Lien N, Meshkovska B, Lobczowska K, Romaniuk P, Neumann-Podczaska A, Wieczorowska-Tobis K, Steinacker JM, Mueller-Stierlin AS. Good practice recommendations on implementation evaluation for policies targeting diet, physical activity, and sedentary behaviour. BMC Public Health 2023; 23:1259. [PMID: 37380979 DOI: 10.1186/s12889-023-15775-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 04/27/2023] [Indexed: 06/30/2023] Open
Abstract
Health policies aim to achieve specific health goals through system-level changes, unlike common health interventions that focus on promoting specific health behaviors on individual level. However, reliable data on the feasibility and implementation of policy actions across Europe are lacking. Moreover, no practice-oriented guidance exists for policy makers and implementers on how to evaluate policy implementation.As part of the Policy Evaluation Network, we aimed to synthesise knowledge on how to evaluate the implementation of policies promoting healthy diets, physical activity, and reducing sedentary behaviours. The multidisciplinary working group comprised 16 researchers and conducted two scoping reviews, three systematic reviews, two meta-reviews, two qualitative case studies and one quantitative case study over three years. The target populations included the general population, those at risk for obesity, and school children. Based on these reviews and case studies, this article summarises and presents the findings and lessons learned regarding the implementation evaluation of policies in nine case reports.Drawing on these experiences, three critical requirements for policy implementation evaluation were set: 1) conduct a comprehensive policy implementation evaluation from a multi-level perspective, 2) use implementation frameworks to address processes, determinants, and outcomes, and 3) engage relevant stakeholders in policy implementation evaluation. Finally, the consensus process resulted in 10 steps for the implementation evaluation of policies to promote physical activity and a healthy diet and to reduce sedentary behaviours, which adhere to the requirements and resources of the targeted policy.The findings of an implementation evaluation can lead to a better understanding of why policies work or not and can serve as a basis for developing solutions. This practice-oriented guidance outlines factors that should be considered in policy implementation evaluation to address its complexity. In this way, involved researchers and practitioners are empowered to engage in the evaluation process to close the knowledge gap regarding policy implementation.
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Affiliation(s)
- Janine Wendt
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, University Hospital Ulm, Ulm, Germany
| | - Daniel A Scheller
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, University Hospital Ulm, Ulm, Germany
| | - Anna Banik
- Department of Psychology, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Aleksandra Luszczynska
- Department of Psychology, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Sarah Forberger
- Leibniz-Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Hajo Zeeb
- Leibniz-Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Marie Scheidmeir
- Health Psychology, Johannes Gutenberg University, Mainz, Germany
| | - Thomas Kubiak
- Health Psychology, Johannes Gutenberg University, Mainz, Germany
| | - Nanna Lien
- Department of Nutrition, University of Oslo, Oslo, Norway
| | | | - Karolina Lobczowska
- Department of Psychology, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Piotr Romaniuk
- Department of Health Policy, Medical University of Silesia, Katowice, Poland
| | | | | | - Jürgen M Steinacker
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, University Hospital Ulm, Ulm, Germany
| | - Annabel S Mueller-Stierlin
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, University Hospital Ulm, Ulm, Germany.
- Department of Psychiatry & Psychotherapy II, Ulm University, Günzburg, Germany.
- Institute for Epidemiology & Medical Biometry, Ulm University, Ulm, Germany.
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14
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Meshkovska B, Gebremariam MK, Atukunda P, Iversen PO, Wandel M, Lien N. Barriers and facilitators to implementation of nutrition-related actions in school settings in low- and middle-income countries (LMICs): a qualitative systematic review using the Consolidated Framework for Implementation Research (CFIR). Implement Sci Commun 2023; 4:73. [PMID: 37370179 DOI: 10.1186/s43058-023-00454-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Low- and middle-income countries (LMICs) are particularly vulnerable to the double burden of malnutrition: co-existence of underweight, overweight, obesity, and/or diet-related non-communicable diseases. Nutrition-related double-duty actions in school settings have been identified as one of the ways to address this challenge. However, to be able to take full advantage of the potential impact, it is important to understand their implementation as well. The aim of this paper is to systematically review qualitative research on barriers and facilitators to the implementation of nutrition-related actions in the school settings in LMICs. METHODS The following databases were searched: EMBASE, ERIC, MEDLINE, Global Health and PsycInfo (all on Ovid), Scopus (Elsevier), the Web of Science Social Sciences Citation Index, and Global Index Medicus from the World Health Organization. Of the 4253 identified records, 4030 were excluded after the abstract and title screen, leaving 223 for the full-text screen. A final 36 papers were included in this review. The consolidated framework for implementation research (CFIR) was used in the analysis. RESULTS We identified barriers and facilitators to implementation linked to the following CFIR constructs/sub-constructs: design quality and packaging, cost (intervention characteristics); target group needs and resources, cosmopolitanism, external policy and incentives (outer setting); structural characteristics, readiness for implementation (inner setting); knowledge and beliefs (characteristics of individuals) and engaging, executing (process). All identified constructs apart from target group needs and resources, knowledge and beliefs, and engaging were predominantly barriers. Available resources were the most prevalent barriers across studies. CONCLUSION This review identified barriers and facilitators to the implementation of nutrition-related actions based on qualitative articles in the school setting in LMICs, using the CFIR. Schools face continuous challenges in regard to funding and the government sector may have a role to play not only by offering financial assistance, but also through policy-making that would support healthy eating practices on school grounds. REGISTRATION PROSPERO ID: CRD42022296159.
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Affiliation(s)
- Biljana Meshkovska
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Blindern, P.O. Box 1046, 0316, Oslo, Norway.
| | - Mekdes Kebede Gebremariam
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Kirkeveien 166, Fredrik Holsts hus, 0450, Oslo, Norway
| | - Prudence Atukunda
- Center for Crisis Psychology, University of Bergen, Møllendalsbakken 9, 5009, Bergen, Norway
| | - Per Ole Iversen
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Blindern, P.O. Box 1046, 0316, Oslo, Norway
- Department of Haematology, Oslo University Hospital, Sognsvannsveien 20, 0372, Oslo, Norway
- Division of Human Nutrition, Stellenbosch University, Francie Van Zijl Drive, Tygerberg, Cape Town, South Africa
| | - Margareta Wandel
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Blindern, P.O. Box 1046, 0316, Oslo, Norway
| | - Nanna Lien
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Blindern, P.O. Box 1046, 0316, Oslo, Norway
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15
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Coutinho SR, Andersen OK, Lien N, Gebremariam MK. Neighborhood deprivation, built environment, and overweight in adolescents in the city of Oslo. BMC Public Health 2023; 23:812. [PMID: 37138266 PMCID: PMC10155174 DOI: 10.1186/s12889-023-15261-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 02/10/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Even though the social and built environment characteristics of neighborhoods have been studied as potential determinants of social inequalities in obesity among adults, fewer studies have focused on children. Our first aim was to investigate whether there were differences in the food and physical activity environments between different neighborhood deprivation levels in the city of Oslo. We also explored whether there was an association between the prevalence of overweight (including obesity) among adolescents and (i) neighborhood deprivation levels and (ii) food and physical activity environments of the neighborhoods they live in. METHODS We conducted a food and physical activity environment mapping (using ArcGIS Pro) in all neighborhoods of Oslo, which were defined by administrative boundaries (sub-districts). The neighborhood deprivation score was calculated based on the percentage of households living in poverty, unemployment in the neighborhood, and residents with low education. A cross-sectional study including 802 seventh graders from 28 primary schools in Oslo residing in 75 out of 97 sub-districts in Oslo was also performed. MANCOVA and partial correlations were ran to compare the built environment distribution between different neighborhood deprivation levels, and multilevel logistic regression analyses were used to explore the effect of neighborhood deprivation and the food and physical activity environments on childhood overweight. RESULTS We found that deprived neighborhoods had greater availability of fast food restaurants and fewer indoor recreational facilities compared to low-deprived neighborhoods. Additionally, we observed that the residential neighborhoods of the adolescents with overweight had greater availability of grocery and convenience stores when compared to the residential neighborhoods of the adolescents without overweight. Adolescents living in neighborhoods with high deprivation had a two-fold higher odds (95% CI = 1.1-3.8) to have overweight compared to adolescents living in neighborhoods with low deprivation, regardless of participants' ethnicity and parental education. However, the built environment did not determine the relationship between neighborhood deprivation and overweight in adolescents. CONCLUSION The neighborhoods in Oslo with higher deprivation levels had more obesogenic characteristics than the low-deprived neighborhoods. Adolescents living in high-deprived neighborhoods were more likely to have overweight than their counterparts from low-deprived neighborhoods. Thus, preventive measures targeting adolescents from high-deprived neighborhoods should be put in place in order to reduce incidence of overweight.
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Affiliation(s)
| | | | - Nanna Lien
- Department of Nutrition, University of Oslo, Oslo, Norway
| | - Mekdes K Gebremariam
- Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
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16
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Havdal HH, Fosse E, Gebremariam MEK, Stronks K, Andersen OK, Lien N. Does the socioeconomic positioned neighbourhood matter? Norwegian adolescents' perceptions of barriers and facilitators for physical activity. Scand J Public Health 2023; 51:275-287. [PMID: 35000501 PMCID: PMC9969305 DOI: 10.1177/14034948211066673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS A higher proportion of adolescents from lower socioeconomic position families tend to be less physically active than their counterparts from higher socioeconomic position families. More research is needed to understand the causes of these differences, particularly the influence of the neighbourhood environment. This qualitative study aims to explore how adolescents and their parents from higher and lower socioeconomic neighbourhoods perceive the social, organisational and physical environment influencing adolescents' physical activity behaviours. METHOD We conducted six semi-structured focus groups with 35 13-14-year-olds and eight interviews with some of their parents. The interviewees were recruited from one higher and two lower socioeconomic neighbourhoods in Oslo, Norway. Theme-based coding was used for analysis, and the results discussed in light of an ecological framework. RESULTS The results indicate that factors like social norms in a neighbourhood could shape adolescents' physical activity behaviour, and a social norm of an active lifestyle seemed to be an essential facilitator in the higher socioeconomic neighbourhood. Higher availability of physical activity and high parental engagement seemed to facilitate higher physical activity in this neighbourhood. In the lower socioeconomic neighbourhoods, the availability of local organised physical activity and volunteer engagement from parents varied. Programmes from the municipality and volunteer organisations seemed to influence and be essential for adolescents' physical activity behaviour in these neighbourhoods. CONCLUSIONS
The results illustrate the complexity of behaviour and environment interaction, and a limitation in explaining the phenomenon by focusing primarily on the individual level rather than an ecological perspective.
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Affiliation(s)
- Hanne Hennig Havdal
- Department of Nutrition, Institute of
Basic Medical Sciences, University of Oslo, Norway
- Hanne Hennig Havdal, Department of
Nutrition, University of Oslo, P.O Box 1046 Blindern, 0317 Oslo, Norway. E-mail:
| | - Elisabeth Fosse
- Department of Health Promotion and
Development, University of Bergen, Norway
| | | | - Karien Stronks
- Department of Public and Occupational
Health, University of Amsterdam, Netherlands
| | | | - Nanna Lien
- Department of Nutrition, Institute of
Basic Medical Sciences, University of Oslo, Norway
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17
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Grewal NK, Klepp KI, Banik A, Bröer C, Holbaek H, Luszczynska A, Macauley T, Rutter H, Lien N. Assessing adolescents' readiness for action and attitudes toward obesity prevention: Instrument development and psychometric properties. Obes Rev 2023; 24 Suppl 1:e13533. [PMID: 36458441 DOI: 10.1111/obr.13533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 08/19/2022] [Accepted: 10/15/2022] [Indexed: 12/03/2022]
Abstract
Engaging adolescents in obesity prevention is a main objective of the CO-CREATE project. This paper presents the development of a questionnaire to assess readiness for action and attitudes toward obesity prevention among adolescents. The questionnaire was developed based on literature searches and internal discussions with experts in the CO-CREATE consortium. The questionnaire was translated, back translated, and pretested for time and comprehensiveness by adolescents from five countries (the Netherlands, Norway, Poland, Portugal, and the United Kingdom). Exploratory factor analysis was performed, and internal reliability of the resulting factors was determined using baseline data from Poland and Norway. Furthermore, test-retest reliability was assessed in a sample of Norwegian adolescents. The exploratory factor analysis on readiness for action identified four factors. Analysis on attitudes toward obesity prevention identified four factors on responsibility and five factors on drivers of behavior. Six of the factors had a Cronbach's alpha value above 0.70, five factors had a value between 0.60-0.70, whereas the remaining two factors were below 0.60. The test-retest correlation ranged from 0.46 to 0.87. The exploratory factor analyzes on readiness for action identified the same factors as hypothesized in the development of the questionnaire, whereas attitudes toward obesity prevention identified more factors than initially assumed. The questionnaire is considered reliable as a tool for measuring adolescents' readiness for action and attitudes toward obesity prevention.
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Affiliation(s)
| | - Knut-Inge Klepp
- Department of Nutrition, University of Oslo, Oslo, Norway.,Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Anna Banik
- CARE-BEH Center for Applied Research on Health Behavior and Health, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Christian Bröer
- Department of Sociology, University of Amsterdam, Amsterdam, the Netherlands
| | - Helene Holbaek
- Department of Nutrition, University of Oslo, Oslo, Norway
| | - Aleksandra Luszczynska
- CARE-BEH Center for Applied Research on Health Behavior and Health, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Talia Macauley
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| | - Nanna Lien
- Department of Nutrition, University of Oslo, Oslo, Norway
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18
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Romanenko E, Homer J, Fismen AS, Rutter H, Lien N. Assessing policies to reduce adolescent overweight and obesity: Insights from a system dynamics model using data from the Health Behavior in School-Aged Children study. Obes Rev 2023; 24 Suppl 1:e13519. [PMID: 36416189 DOI: 10.1111/obr.13519] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/10/2022] [Accepted: 10/12/2022] [Indexed: 11/23/2022]
Abstract
Adolescent overweight and obesity (AdOWOB) in Europe has proven to be a persistent and complex problem, and appropriate systems methods may help in evaluating potential policy options. This paper describes the development of a system dynamics model of AdOWOB as part of the EU-funded CO-CREATE project. The model was developed using literature and data from the Health Behavior in School-Aged Children (HBSC) study across 31 European countries. We identified 10 HBSC variables that were included as direct or indirect drivers of AdOWOB in the dynamic model, seven at the level of the individual, and three related to the social environment. The model was calibrated to 24 separate cases based on four gender and perceived wealth segments for each of the five CO-CREATE countries (The Netherlands, Norway, Poland, Portugal, and the UK) and for Europe overall. Out of 10 possible intervention points tested, exercise, fruit, life dissatisfaction, school pressure, and skipping breakfast were identified as the top five most influential ones across the 24 cases. These model-based priorities can be compared with the policy ideas suggested by the CO-CREATE adolescents.
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Affiliation(s)
- Eduard Romanenko
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Jack Homer
- Homer Consulting and MIT Research Affiliate, Barrytown, New York, USA
| | - Anne-Siri Fismen
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway.,Center for Evaluation of Public Health Measures, Norwegian Institute of Public Health, Bergen, Norway
| | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| | - Nanna Lien
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
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19
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Klepp KI, Helleve A, Brinsden H, Bröer C, Budin-Ljøsne I, Harbron J, Knai C, Lien N, Luszczynska A, Nesrallah S, Oldridge-Turner K, Rito A, Samdal O, Savona N, Stensdal MK, Allender S, Hoelscher DM, Rutter H. Overweight and obesity prevention for and with adolescents: The "Confronting obesity: Co-creating policy with youth" (CO-CREATE) project. Obes Rev 2023; 24 Suppl 1:e13540. [PMID: 36623268 DOI: 10.1111/obr.13540] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 09/11/2022] [Accepted: 09/27/2022] [Indexed: 01/11/2023]
Abstract
The CO-CREATE project focuses on the need for research on obesity prevention in adolescents to move away from studies of single interventions, toward the investigation of systems-based research incorporating youth involvement. This paper provides an overview of the project, presenting the objectives, design, and novel methodologies applied, as well as findings to date and anticipated outcomes. Adolescents (16-18 years old) in five European countries participated. Methods applied in the project include monitoring and benchmarking of policies, systematic literature reviews, epidemiological surveillance, linking observed overweight and obesity trends to observed policy landscapes, group model building to identify perceived drivers of obesity, alliance building with adolescents, dialog with stakeholders, and system dynamics modelling to explore the potential impact of policy options. Outcomes include tools for developing policy ideas and investigation of prevention strategies with adolescents, including policy databases, system maps of drivers of obesity, protocols for organizing youth alliances, an intergenerational policy dialog tool, and system dynamic models exploring the impacts of cocreated policy ideas. These outcomes make an important contribution to building a pan-European infrastructure for designing and evaluating policies and for providing youth with the opportunity to make their voices heard in the development and implementation of obesity prevention measures.
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Affiliation(s)
- Knut-Inge Klepp
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway.,Department of Nutrition, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Arnfinn Helleve
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Christian Bröer
- Department of Sociology, University of Amsterdam, Amsterdam, The Netherlands
| | - Isabelle Budin-Ljøsne
- Department of Food Safety, Division of Climate and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Janetta Harbron
- Division of Physiological Sciences, Health through Physical Activity, Lifestyle & Sport (HPALS) Research Centre, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Cecile Knai
- Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Nanna Lien
- Department of Nutrition, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Aleksandra Luszczynska
- CARE-BEH Center for Applied Research on Health Behavior and Health, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | | | | | - Ana Rito
- Centre for Studies and Research on Social Dynamics and Health-CEIDSS, Lisbon, Lisbon, Portugal
| | - Oddrun Samdal
- Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Natalie Savona
- Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Steven Allender
- Global Obesity Centre, Institute for Health Transformation, Deakin University, Melbourne, Australia
| | - Deanna M Hoelscher
- School of Public Health Austin Campus, University of Texas Health Science Center at Houston (UTHealth), Austin, Texas, USA
| | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath, UK
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20
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Budin-Ljøsne I, Ayuandini S, Baillergeau E, Bröer C, Helleve A, Klepp KI, Kysnes B, Lien N, Luszczynska A, Nesrallah S, Rito A, Rutter H, Samdal O, Savona N, Veltkamp G. Ethical considerations in engaging young people in European obesity prevention research: The CO-CREATE experience. Obes Rev 2023; 24 Suppl 1:e13518. [PMID: 36416177 DOI: 10.1111/obr.13518] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/05/2022] [Accepted: 10/04/2022] [Indexed: 11/23/2022]
Abstract
Engaging youth in obesity prevention research and policy action is essential to develop strategies that are relevant and sensitive to their needs. Research with young people requires critical reflection to safeguard their rights, dignity, and well-being. The CO-CREATE project used various methods to engage approximately 300 European youth aged 15-19 years in the development of policies to prevent adolescent obesity. This paper discusses ethical considerations made in the project pertaining to the youth's voluntary participation, their protection from obesity stigma, respect for their time, data privacy and confidentiality, power balance, and equality of opportunity to participate in the research. We describe measures implemented to prevent or limit the emergence of ethical challenges in our interaction with youth and discuss their relevance based on our experience with implementation. While some challenges seemingly were prevented, others arose related to the youth's voluntary participation, time burdens on them, and the sustainability of participation under the Covid-19 pandemic. Concrete and ongoing ethical guidance may be useful in projects aiming to interact and build collaborative relationships with youth for long periods of time.
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Affiliation(s)
| | - Sherria Ayuandini
- Department of Sociology, University of Amsterdam, Amsterdam, The Netherlands
| | - Evelyne Baillergeau
- Department of Sociology, University of Amsterdam, Amsterdam, The Netherlands
| | - Christian Bröer
- Department of Sociology, University of Amsterdam, Amsterdam, The Netherlands
| | - Arnfinn Helleve
- Centre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, Oslo, Norway
| | - Knut-Inge Klepp
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway.,Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Bjarte Kysnes
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway
| | - Nanna Lien
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Aleksandra Luszczynska
- Wroclaw Faculty of Psychology, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | | | | | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| | - Oddrun Samdal
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway
| | - Natalie Savona
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Gerlieke Veltkamp
- Department of Sociology, University of Amsterdam, Amsterdam, The Netherlands
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21
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Bröer C, Ayuandini S, Baillergeau E, Moerman G, Veltkamp G, Luszczynska A, Budin-Ljøsne I, Rito AI, Stensdal M, Lien N, Klepp KI. Recruiting and engaging adolescents in creating overweight and obesity prevention policies: The CO-CREATE project. Obes Rev 2023; 24 Suppl 1:e13546. [PMID: 36623291 DOI: 10.1111/obr.13546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/09/2022] [Accepted: 12/14/2022] [Indexed: 01/11/2023]
Abstract
The CO-CREATE project aims to collaborate with adolescents across Europe in developing policy ideas that contribute to overweight and obesity prevention. In this paper, we present the theoretical basis and methodological approach to recruitment and engagement in the project. The principles of youth-led participatory action research were employed to design Youth Alliances in which adolescents and adults could collaborate. These Alliances should serve to promote and support adolescent participation and to develop policy ideas that would contribute to obesity prevention. Alliance members were recruited in two local geographical areas per country with a focus on reaching out to underrepresented youth. We started with fieldwork to assess locally relevant forms of inclusion and exclusion. The methodology entailed a handbook combining existing tools which could be used flexibly, a collaborative organization, and budgets for the alliances. Engagement started in local organizations, that is, schools and scouts, and with peers. Health- and overweight-related challenges were addressed in their immediate surroundings and supported the inclusion of experiential knowledge. Adolescents were then supported to address the wider obesogenic system when designing policy ideas. The CO-CREATE Alliances provide a concrete example of how to engage youth in public health, in a manner that strives to be participatory, transformative, and inquiry based.
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Affiliation(s)
- Christian Bröer
- Department of Sociology, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Evelyne Baillergeau
- Department of Sociology, University of Amsterdam, Amsterdam, The Netherlands
| | - Gerben Moerman
- Department of Sociology, University of Amsterdam, Amsterdam, The Netherlands
| | - Gerlieke Veltkamp
- Department of Sociology, University of Amsterdam, Amsterdam, The Netherlands
| | - Aleksandra Luszczynska
- CARE-BEH Center for Applied Research on Health Behavior and Health, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Isabelle Budin-Ljøsne
- Department of Food Safety, Division of Climate and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Ana Isabel Rito
- Centre for Studies and Research on Social Dynamics and Health-CEIDSS, Lisbon, Portugal
| | - Maja Stensdal
- PRESS, The Youth Organization of Save the Children Norway, Oslo, Norway
| | - Nanna Lien
- Department of Nutrition, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Knut-Inge Klepp
- Department of Nutrition, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
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22
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Wendt J, Scheller DA, Flechtner-Mors M, Meshkovska B, Luszczynska A, Lien N, Forberger S, Banik A, Lobczowska K, Steinacker JM. Barriers and facilitators to the adoption of physical activity policies in elementary schools from the perspective of principals: An application of the consolidated framework for implementation research-A cross-sectional study. Front Public Health 2023; 11:935292. [PMID: 36908436 PMCID: PMC9992422 DOI: 10.3389/fpubh.2023.935292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 01/24/2023] [Indexed: 02/24/2023] Open
Abstract
Background Studies have shown that policies to promote physical activity in schools can have a positive impact on children's physical activity behavior. However, a large research gap exists as to what determinants may influence the adoption of such policies. Applying the Consolidated Framework for Implementation Research (CFIR), we investigated barriers and facilitators to the adoption of physical activity policies in elementary schools in Baden-Wuerttemberg, Germany, from the perspective of school principals. Methods A cross-sectional study was conducted between May and June 2021. School principals from elementary and special needs schools (n = 2,838) were invited to participate in the study. The online questionnaire used was developed based on the CFIR and included questions on school characteristics and constructs of the CFIR domains inner setting, characteristics of individuals, and process. Logistic regression analyses were performed to examine associations between policy adoption and school characteristics as well as CFIR determinants. Results In total, 121 schools (4%) participated in the survey, of which 49 (40.5%) reported having adopted a policy to promote physical activity. Positive associations with policy adoption were found for general willingness among teaching staff [odds ratio (OR): 5.37, 95% confidence interval (CI): 1.92-15.05], available resources (OR: 2.15, 95% CI: 1.18-3.91), access to knowledge and information (OR: 2.11, 95% CI: 1.09-4.09), and stakeholder engagement (OR: 3.47, 95% CI: 1.24-9.75). Conclusions This study provides a first insight into potential barriers and facilitators at the organizational level of schools that may be relevant to the adoption of physical activity policies, from the perspective of school principals. However, due to a low response rate, the results must be interpreted with caution. A strength of this study includes theoretical foundation through the use of the CFIR. The CFIR could be well-adapted to the school setting and provided valuable support for developing the questionnaire and interpreting the study results.
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Affiliation(s)
- Janine Wendt
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine, University Hospital Ulm, Ulm, Germany
| | - Daniel A Scheller
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine, University Hospital Ulm, Ulm, Germany
| | - Marion Flechtner-Mors
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine, University Hospital Ulm, Ulm, Germany
| | - Biljana Meshkovska
- Department of Nutrition, Faculty of Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Aleksandra Luszczynska
- Department of Psychology, SWPS University of Social Sciences and Humanities, Wroclaw, Poland.,Melbourne School of Psychological Sciences, Melbourne Centre for Behavior Change, University of Melbourne, Melbourne, VIC, Australia
| | - Nanna Lien
- Department of Nutrition, Faculty of Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Sarah Forberger
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Anna Banik
- Department of Psychology, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Karolina Lobczowska
- Department of Psychology, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Jürgen M Steinacker
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine, University Hospital Ulm, Ulm, Germany
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23
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Hebestreit A, Do S, Wolters M, Mensink GBM, Garnica-Rosas L, Abu-Omar K, Messing S, Neumann-Podczaska A, Wieczorowska-Tobis K, Lien N, Stanley I, Ahrens W, Murrin C. Towards a harmonized European surveillance for dietary and physical activity indicators in young and adult populations. Eur J Public Health 2022; 32:iv21-iv31. [PMID: 36444107 PMCID: PMC9706124 DOI: 10.1093/eurpub/ckac061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The Policy Evaluation Network proposes a consolidated approach to measure comparable health indicators across European health surveillance systems to evaluate effectiveness of policy action. METHODS In a stepwise approach, questionnaire items used by the systems for measuring diet and physical activity data to describe health indicators were identified based on their validity, reliability, and suitability to monitor achievement of health recommendations. They were collated to unified questionnaire modules and discussed bilaterally with representatives of these systems to explore barriers and facilitators for implementation. Also, establishment of a methodological competence platform was proposed, in which the surveillance and monitoring systems agree on the priorities and common quality standards for the harmonization process and to coordinate the integration of questionnaire modules into existing systems. RESULTS In total, seven questionnaire modules were developed, of which two diet and two physical activity modules were proposed for implementation. Each module allows measurement of data reflecting only partial aspects of national and WHO recommendations related to diet and physical activity. Main barriers were the requirements of systems to monitor temporal trends and to minimize costs. Main facilitator for implementation was the systems' use of questionnaire items that were comparable to the unified modules. Representatives agreed to participate in a methodological competence platform. CONCLUSION We successfully took first steps in the realization of the roadmap towards a harmonization of European surveillance by introducing unified questionnaire modules allowing the collection of comparable health indicators and by initiating the establishment of a competence platform to guide this process.
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Affiliation(s)
- Antje Hebestreit
- Correspondence: Antje Hebestreit, Leibniz Institute for Prevention Research and Epidemiology—BIPS, Achterstrasse 30, 28359 Bremen, Germany, Tel: +49 (0) 421 218 56 849, e-mail: ,
| | - Stefanie Do
- Department of Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany,Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany
| | - Maike Wolters
- Department of Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
| | - Gert B M Mensink
- Department of Epidemiology and Health Reporting, Robert Koch Institute, Berlin, Germany
| | - Lina Garnica-Rosas
- Department of Epidemiology and Health Reporting, Robert Koch Institute, Berlin, Germany
| | - Karim Abu-Omar
- Department of Sport Science and Sport, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Sven Messing
- Department of Sport Science and Sport, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | | | | | - Nanna Lien
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Isobel Stanley
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
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24
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Kamphuis CBM, Forberger S, Lien N, Rehfuess E, Luszczynska A. Development of a framework to guide research into policies promoting physical activity and healthy diets in the European context: the system-based Policy Evaluation Network (PEN) framework. Eur J Public Health 2022; 32:iv3-iv9. [PMID: 36444110 PMCID: PMC9706121 DOI: 10.1093/eurpub/ckac068] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The Policy Evaluation Network (PEN) is a multidisciplinary Pan-European research consortium focussing on policies affecting dietary intake, physical activity and sedentary behaviour. At the start, the PEN consortium expressed the need for an overarching, system-based framework covering the complexities between the different domains of the policy process (design, implementation and outcomes) in order to execute all research activities in a coherent way. This article describes the PEN framework itself and its development process. METHODS A staged approach to the development of a system-based framework was executed between February 2019 and February 2022. We started with a point-of-departure framework, made use of existing models, collected PEN outputs at different project stages (through online meetings, e-mail exchanges and workshops with PEN researchers) and drew updated versions of the framework, which resulted in the system-based PEN framework. RESULTS The system-based PEN framework depicts the policy process as a complex system, visualizing the dynamic interrelations between and within policy domains (i.e. policy design, policy implementation and policy outcomes), the ways they interact with the context, and how to assure a focus on equity in each domain. CONCLUSIONS The system-based PEN framework may guide researchers and professionals involved in the evaluation of health- or sustainability-related policies to consider their evaluation in a comprehensive picture, including domain interactions, contextual influences and equity considerations, as these can have important implications for the scope of their research. The stage-based process as applied for the development of the PEN framework can serve as a template for other research projects wishing to develop their own framework.
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Affiliation(s)
- Carlijn B M Kamphuis
- Correspondence: Carlijn B.M. Kamphuis, Department of Interdisciplinary Social Science, Utrecht University, Padualaan 14, 3584 CH, Utrecht, The Netherlands, Tel: +31 (0) 30 253 3489, e-mail:
| | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
| | - Nanna Lien
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Eva Rehfuess
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Aleksandra Luszczynska
- Wroclaw Faculty of Psychology, SWPS University of Social Sciences & Humanities, Wroclaw, Poland
- Melbourne Centre for Behavior Change, Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
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25
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Zolfaghari M, Meshkovska B, Banik A, Kamphuis CBM, Kopainsky B, Luszczynska A, Murrin C, Lien N. Applying a systems perspective to understand the mechanisms of the European School Fruit and Vegetable Scheme. Eur J Public Health 2022; 32:iv107-iv113. [PMID: 36444113 PMCID: PMC9706111 DOI: 10.1093/eurpub/ckac054] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND For the past two decades, the percentage of European children who consume fruit daily has remained at around 40%, despite numerous school-based policy efforts and interventions. This study aimed to apply a systems approach to provide an integrated perspective of the mechanisms of the European School Fruit and Vegetable Scheme (the Scheme) to understand better how to increase its long-term impact on children's fruit and vegetable consumption. METHODS We developed a causal loop diagram by synthesizing peer-reviewed articles and national government documents related to the Scheme, following the conceptualization steps of system dynamics. The initial causal loop diagrams were then validated in three stages by consulting with experts (two individuals and a group) in school-based fruit and vegetable programmes, children's fruit and vegetable consumption and the Scheme, using disconfirmatory interview guidelines. RESULTS The findings suggest that a central self-reinforcing mechanism through which children socialize during fruit and vegetable consumption is critical in the habituation process. Additionally, the initial increase in children's fruit and vegetable consumption following the Scheme implementation is due to growth in three self-reinforcing loops related to motivation and capability mechanisms; however, this trend gradually slows and stops due to four balancing feedback loops with alternative goals related to opportunity mechanisms that reach their limits. CONCLUSIONS The scheme's design should incorporate activities that align the objectives of the implementers and recipients of the Scheme at all levels. This alignment should provide children with ongoing opportunities to consume fruits and vegetables and strengthen the motivation and capability mechanisms.
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Affiliation(s)
- Mahshid Zolfaghari
- Correspondence: Mahshid Zolfaghari, Department of Nutrition, University of Oslo, P.O. Box 1046 Blindern, 0317 Oslo, Norway, Tel: +47 45 91 70 38, e-mail:
| | | | - Anna Banik
- Wroclaw Faculty of Psychology, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Carlijn B M Kamphuis
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands
| | - Birgit Kopainsky
- Department of Geography, System Dynamics Group, University of Bergen, Bergen, Norway
| | - Aleksandra Luszczynska
- Wroclaw Faculty of Psychology, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Celine Murrin
- School of Public Health, Physiotherapy and Sport Science, University College Dublin, Dublin, Ireland
| | - Nanna Lien
- Department of Nutrition, University of Oslo, Oslo, Norway
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26
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Kelly L, Twohig C, Woods CB, Luszczynska A, Murrin C, Lien N, Meshkovska B, Kamphuis CBM, Poelman MP, Terragani L, Forberger S, Hebestreit A, Ahrens W, Harrington JM. Reaching consensus on definitions for food and physical activity policies: experience from the Policy Evaluation Network. Eur J Public Health 2022; 32:iv10-iv20. [PMID: 36444104 PMCID: PMC9706120 DOI: 10.1093/eurpub/ckac147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND An upsurge in policy evaluation research within public health sciences has led to multi-disciplinary research networks like the 'Policy Evaluation Network' (PEN). This multi-disciplinary collaboration highlighted the need for consensus on clear, common terminology and definitions to facilitate the multi-disciplinary research. This article outlines the development process of the PEN definitions glossary tool, with a focus on the key domains of policy design, implementation and outcomes as they apply to physical activity, sedentary behaviour and dietary behaviours. METHODS A project specific participatory process was undertaken, involving PEN researchers (n = 48) from seven European countries across various disciplinary backgrounds. All involved researchers were invited to identify and collate definitions that were commonly used in their research field. Terms and definitions were discussed and debated during three online workshops. Subsequently, the definitions were discussed and refined until consensus was reached. RESULTS Consensus definitions for 93 terms related to the evaluation of policy design, implementation and outcomes are provided. Consensus was reached on a range of terms where the terms were understood and used differently across represented disciplines (e.g. 'Outcome' and 'Impact'). A conceptual 'Inter-relations in policy-related concepts' diagram was developed to enable navigation through an online database with key terms. CONCLUSIONS The definitions resulting from this participatory process has supported PEN researchers and practitioners across disciplines to reach a shared understanding of different terms related to policy evaluation. Thus, providing a platform for avoiding conflicting use of the same terms in differing contexts over the course of the PEN work programme, facilitating clear and consistent communication, and allowing for clarity within collaborative multi-disciplinary projects and in public-facing messages.
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Affiliation(s)
- Liam Kelly
- Department of Physical Education and Sport Sciences, Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Cliona Twohig
- Centre for Health and Diet Research, School of Public Health, University College Cork, Cork, Ireland
| | - Catherine B Woods
- Department of Physical Education and Sport Sciences, Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Aleksandra Luszczynska
- Department of Psychology in Wroclaw, CARE-BEH Center for Applied Research on Health Behaviour and Health, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Celine Murrin
- School of Public Health, Physiotherapy, and Sports Science, University College Dublin, Dublin, Ireland
| | - Nanna Lien
- Department of Nutrition, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Biljana Meshkovska
- Department of Nutrition, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Carlijn B M Kamphuis
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands
| | - Maartje P Poelman
- Chair Group Consumption and Healthy Lifestyles, Wageningen University & Research, Wageningen, The Netherlands
| | - Laura Terragani
- Department of Nutrition, Faculty of Health Sciences, Oslo Metropolitan University (OsloMet), Oslo, Norway
| | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
| | - Antje Hebestreit
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
| | - Wolfgang Ahrens
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
| | - Janas M Harrington
- Centre for Health and Diet Research, School of Public Health, University College Cork, Cork, Ireland
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27
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Mekonnen T, Brantsæter AL, Andersen LF, Lien N, Arah OA, Gebremariam MK, Papadopoulou E. Mediators of differences by parental education in weight-related outcomes in childhood and adolescence in Norway. Sci Rep 2022; 12:5671. [PMID: 35383270 PMCID: PMC8983661 DOI: 10.1038/s41598-022-09987-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 03/31/2022] [Indexed: 11/30/2022] Open
Abstract
Studies exploring mediators of socioeconomic inequalities in excess weight gain in early-life and subsequent overweight/obesity (OW/OB) among youth are limited. Thus, this study examined the mediating role of prenatal and early postnatal factors and child energy balance-related behaviours (EBRB) in the effects of parental education on (i) excess weight gain from birth to 2 years and (ii) OW/OB at 5, 8 and 14 years. The Norwegian Mother, Father and Child Cohort Study was used to include participants at the ages of 2 (n = 59,597), 5 (n = 27,134), 8 (n = 28,285) and 14 (n = 11,278) years. Causal mediation analyses using the inverse odds weighting approach were conducted. Children of low-educated parents had a higher conditional excess weight gain at 2 years compared to children of high-educated parents (total effect, RRTE = 1.06; 95% CI 1.01, 1.10). The joint mediation effects of the prenatal and early postnatal factors explained most of the total effect of low education on conditional excess weight gain at 2 years. Children of low-educated parents had a higher risk of OW/OB at 5, 8 and 14 years compared to children of high-educated parents. The mediators jointly explained 63.7%, 67% and 88.9% of the total effect of parental education on OW/OB among 5, 8 and 14 year-old-children, respectively. Of the total mediated effects at 5, 8 and 14 years, the prenatal and early postnatal mediators explained 59.2%, 61.7% and 73.7%, whereas the child EBRB explained 10.3%, 15.8.0%% and 34.8%. The mediators included were found to have a considerable mediating effect in the associations explored, in particular the prenatal and early postnatal factors. If truly causal, the findings could indicate potential targets for interventions to tackle socioeconomic inequalities in OW/OB from birth to adolescence.
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Affiliation(s)
- Teferi Mekonnen
- Department of Nutrition, Faculty of Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.
| | - Anne-Lise Brantsæter
- Division for Climate and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Lene F Andersen
- Department of Nutrition, Faculty of Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Nanna Lien
- Department of Nutrition, Faculty of Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Onyebuchi A Arah
- Department of Epidemiology and Department of Statistics, University of California, Los Angeles (UCLA), Los Angeles, USA
- Research Unit for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Mekdes K Gebremariam
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Eleni Papadopoulou
- Global Health Cluster, Division of Health Service, Norwegian Institute of Public Health, Oslo, Norway
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Meshkovska B, Scheller DA, Wendt J, Jilani H, Scheidmeir M, Stratil JM, Lien N. Barriers and facilitators to implementation of direct fruit and vegetables provision interventions in kindergartens and schools: a qualitative systematic review applying the consolidated framework for implementation research (CFIR). Int J Behav Nutr Phys Act 2022; 19:11. [PMID: 35101084 PMCID: PMC8805256 DOI: 10.1186/s12966-022-01246-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 01/10/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Although children's intake of fruit and vegetables has seen a recent rise, almost half of adolescents do not eat even one piece of fruit or vegetables per day. One way to address this problem is through interventions that provide fruit and vegetables directly to children in kindergartens and schools. For such interventions to meet their intended goals, what is important to consider in addition to impact is implementation. Our objective is to systematically review qualitative results reporting on the determinants (barriers and facilitators) to implementation of interventions that entail direct provision of fruit and vegetables in kindergarten and school settings and conduct a framework analysis of those results using the Consolidated Framework for Implementation Research (CFIR). METHODS A systematic search was designed and run in November 2019 for: MEDLINE (Ovid), Embase (Ovid), PsychINFO (Ovid), ERIC (Ovid), Cochrane Library Reviews and Cochrane Library Trials. A keyword search of the journal Implementation Science was completed. Screening of titles and abstracts (n = 5427) and full texts (n = 227), led to 14 included articles. Coding and analysis were done using the framework method and CFIR. RESULTS The following CFIR constructs were found relevant: 1) intervention characteristics domain: 'design quality and packaging', 'adaptability' 'cost'; 2) outer setting: 'cosmopolitanism', 'external policy and incentives' 'patients' needs and resources'; 3) inner setting: 'implementation climate', 'readiness for implementation' and 'structural characteristics'; 4) characteristics of individuals: 'individual stage of change', 'knowledge and beliefs about the intervention' 5) process: 'engaging', 'executing' and 'reflecting and evaluating'. The review stresses the dual role of parents as both supporting the implementation and targets of the intervention, which could have implications for the design and implementation of future fruit and vegetables interventions. Positive child perceptions of the value of the intervention and perceived behavior change due to the intervention were reported as relevant facilitators to implementation across several studies, and should be taken into consideration in future design efforts. CONCLUSIONS CFIR offers a systematic way to identify and organize barriers and facilitators to implementation of interventions in the kindergarten and school setting. Revisions are encouraged to allow adequate space for perceptions of various implementation actors and the target group. PROSPERO REGISTRATION CRD42020167697.
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Affiliation(s)
| | - Daniel A. Scheller
- Division of Sports and Rehabilitation, Department of Internal Medicine II, Ulm University Medical Centre, Ulm, Germany
| | - Janine Wendt
- Division of Sports and Rehabilitation, Department of Internal Medicine II, Ulm University Medical Centre, Ulm, Germany
| | - Hannah Jilani
- Institute of Public Health and Nursing Research - IPP, University of Bremen and Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Marie Scheidmeir
- Department of Psychology, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Jan M. Stratil
- Institute for Medical Information Processing, Biometry, and Epidemiology – IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
| | - Nanna Lien
- Department of Nutrition, University of Oslo, Oslo, Norway
| | - on behalf of the PEN Consortium
- Department of Nutrition, University of Oslo, Oslo, Norway
- Division of Sports and Rehabilitation, Department of Internal Medicine II, Ulm University Medical Centre, Ulm, Germany
- Institute of Public Health and Nursing Research - IPP, University of Bremen and Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
- Department of Psychology, Johannes Gutenberg-University Mainz, Mainz, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology – IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
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Randby JS, Holbæk H, Lien N. Implementation of the Norwegian school meal guideline: Development and reliability of two questionnaires to measure adherence. Scand J Public Health 2021; 49:358-368. [PMID: 33302800 PMCID: PMC8135241 DOI: 10.1177/1403494820972590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 10/16/2020] [Accepted: 10/20/2020] [Indexed: 12/01/2022]
Abstract
Aims: This article reports on the development and reliability of two questionnaires that measure adherence to the Norwegian National Guideline on Food and Meals in School among primary schools and after-school services. Methods: Questionnaires for school principals and after-school leaders were developed systematically, using the following steps: (a) selection of scope, questions and adherence values; (b) face validity testing through expert review of initial drafts; (c) content validity testing through 19 cognitive interviews; (d) assessment of test-retest reliability in samples of principals (n = 54) and after-school leaders (n = 47); and (e) development of adherence indices. Results: The cognitive interviews led to substantial revisions of the draft questionnaires, increasing content validity through improved relevance and clarity. Test-retest assessment showed that Cohen's κ ranged from -0.03 to 1.0 for principals and from -0.05 to 0.98 for after-school leaders, with 64 and 53% of values rated as 'substantial' or better. Percentage agreement averaged 85% among principals and 82% among after-school leaders. Intraclass correlation for the adherence index scores was 0.84 for principals and 0.91 for after-school leaders. Guideline adherence had a wide range in our samples, with an average of 71% for schools and 76% for after-school services. Conclusion: The questionnaires for measuring adherence to the national school meal guideline among primary schools and after-school services are sufficiently reliable for future use in public health evaluation and research.
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Affiliation(s)
- Jorunn S. Randby
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Norway
- Department of Child and Adolescent Health, Norwegian Directorate of Health, Norway
| | - Helene Holbæk
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Norway
| | - Nanna Lien
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Norway
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Kristiansen AL, Himberg-Sundet A, Bjelland M, Lien N, Holst R, Andersen LF. Exploring intervention components in association with changes in preschool children's vegetable intake: the BRA-study. BMC Res Notes 2021; 14:214. [PMID: 34059115 PMCID: PMC8165990 DOI: 10.1186/s13104-021-05629-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 05/22/2021] [Indexed: 11/10/2022] Open
Abstract
Objective The present study aimed to explore kindergarten staffs’ perceived usefulness of intervention components in association with changes in children’s vegetable intake and vegetables served in the kindergarten. Assessment of the perceived usefulness of intervention components consisted of a paper-based questionnaire for the kindergarten staff assessing usefulness of posters, supplementary material and 1-day inspirational course. Children’s vegetable intake in the kindergarten was assessed by direct observation, while vegetables served was assessed by a 5-day weighted vegetable diary. Results Seventy-three kindergartens in two counties in Norway participated (response rate 15%) and parental consent was obtained for 633 children 3–5 years of age at baseline (response rate 39%). Mixed effect models indicated a tendency that posters were associated with increased child vegetable intake (P = 0.062). Surprisingly, a low degree of perceived usefulness of supplementary material was associated with the largest increase in child vegetable intake (P = 0.020). No significant associations between perceived usefulness of intervention components and vegetables served in the kindergarten were found. This study indicated a tendency that posters were associated with increased child vegetable intake; however, this may also be due to synergies between multiple intervention components. Trial registration International Standard Randomized Controlled Trials ISRCTN51962956 (http://www.isrctn.com/ISRCTN51962956). Registered 21 June 2016 (retrospectively registered). Supplementary Information The online version contains supplementary material available at 10.1186/s13104-021-05629-1.
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Affiliation(s)
- Anne Lene Kristiansen
- Faculty of Humanities, Sports and Educational Science, Department of Sports, Physical Education and Outdoor Studies, University of South-Eastern Norway, PO Box 235, 3603, Kongsberg, Norway. .,Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Blindern, PO Box 1046, 0317, Oslo, Norway.
| | - Anne Himberg-Sundet
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Blindern, PO Box 1046, 0317, Oslo, Norway
| | - Mona Bjelland
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Blindern, PO Box 1046, 0317, Oslo, Norway
| | - Nanna Lien
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Blindern, PO Box 1046, 0317, Oslo, Norway
| | - René Holst
- Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Blindern, PO Box 1122, 0317, Oslo, Norway
| | - Lene Frost Andersen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Blindern, PO Box 1046, 0317, Oslo, Norway
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Havdal HH, Fosse E, Gebremariam MK, Lakerveld J, Arah OA, Stronks K, Lien N. Corrigendum to 'Perceptions of the social and physical environment of adolescents' dietary behaviour in neighbourhoods of different socioeconomic position' [Appetite, Volume 159, 1 April 2021/105070]. Appetite 2021; 162:105230. [PMID: 33812659 DOI: 10.1016/j.appet.2021.105230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Hanne Hennig Havdal
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, PO Box 1046, Blindern, 0317, Oslo, Norway.
| | - Elisabeth Fosse
- Department of Health Promotion and Development, University of Bergen, PO Box 7807, 5020, Bergen, Norway
| | - Mekdes Kebede Gebremariam
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, PO Box 1046, Blindern, 0317, Oslo, Norway
| | - Jeroen Lakerveld
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam, UMC, Location VUmc, PO Box 7057, 1007, MB Amsterdam, the Netherlands
| | - Onyebuchi A Arah
- Department of Epidemiology, UCLA Fielding School of Public Health, 650 Charles E. Young Drive South, PO Box 951772, Los Angeles, CA, 90095, USA
| | - Karien Stronks
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, PO Box 22660, 1100, DD, Amsterdam, the Netherlands
| | - Nanna Lien
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, PO Box 1046, Blindern, 0317, Oslo, Norway
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Andersen OK, O'Halloran SA, Kolle E, Lien N, Lakerveld J, Arah OA, Gebremariam MK. Adapting the SPOTLIGHT Virtual Audit Tool to assess food and activity environments relevant for adolescents: a validity and reliability study. Int J Health Geogr 2021; 20:4. [PMID: 33461559 PMCID: PMC7814470 DOI: 10.1186/s12942-021-00258-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 01/07/2021] [Indexed: 12/12/2022] Open
Abstract
Background Physical inactivity and unhealthy diet are key behavioral determinants underlying obesity. The neighborhood environment represents an important arena for modifying these behaviors, and hence reliable and valid tools to measure it are needed. Most existing virtual audit tools have been designed to assess either food or activity environments deemed relevant for adults. Thus, there is a need for a tool that combines the assessment of food and activity environments, and which focuses on aspects of the environment relevant for youth. Objective The aims of the present study were: (a) to adapt the SPOTLIGHT Virtual Audit Tool (S-VAT) developed to assess characteristics of the built environment deemed relevant for adults for use in an adolescent population, (b) to assess the tool’s inter- and intra-rater reliability, and (c) to assess its criterion validity by comparing the virtual audit to a field audit. Methods The tool adaptation was based on literature review and on results of a qualitative survey investigating how adolescents perceived the influence of the environment on dietary and physical activity behaviors. Sixty streets (148 street segments) in six neighborhoods were randomly selected as the study sample. Two raters assessed the inter- and intra-rater reliability and criterion validity, comparing the virtual audit tool to a field audit. The results were presented as percentage agreement and Cohen’s kappa (κ). Results Intra-rater agreement was found to be moderate to almost perfect (κ = 0.44–0.96) in all categories, except in the category aesthetics (κ = 0.40). Inter-rater agreement between auditors ranged from fair to substantial for all categories (κ = 0.24–0.80). Criterion validity was found to be moderate to almost perfect (κ = 0.56–0.82) for most categories, except aesthetics and grocery stores (κ = 0.26–0.35). Conclusion The adapted version of the S-VAT can be used to provide reliable and valid data on built environment characteristics deemed relevant for physical activity and dietary behavior among adolescents.
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Affiliation(s)
| | | | - Elin Kolle
- Norwegian School of Sport Sciences, Ullevaal Stadion, PO Box 4014, 0806, Oslo, Norway
| | | | - Jeroen Lakerveld
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Upstream Team, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Onyebuchi A Arah
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA, USA.,Department of Statistics, College of Letters and Science, UCLA, Los Angeles, CA, USA.,Department of Public Health, Aarhus University, Aarhus, Denmark
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Havdal HH, Fosse E, Gebremariam MK, Lakerveld J, Arah OA, Stronks K, Lien N. Perceptions of the social and physical environment of adolescents' dietary behaviour in neighbourhoods of different socioeconomic position. Appetite 2020; 159:105070. [PMID: 33340607 DOI: 10.1016/j.appet.2020.105070] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 12/09/2020] [Accepted: 12/11/2020] [Indexed: 10/22/2022]
Abstract
A higher proportion of adolescents from families in a lower socioeconomic position (SEP) tends to have more unhealthy dietary behaviours, and overweight and obesity, than their counterparts in higher SEPs. More research is needed to understand the causes of these differences, in particular the influence of the neighbourhood environment, which has been explored less. The presented qualitative study explores how adolescents and their parents from higher and lower SEP neighbourhoods perceive the social and physical environment influencing adolescents' dietary behaviours. We conducted 6 semi-structured focus groups with 35 13-14 year olds and 8 interviews with some of their parents. The interviewees were recruited from one higher and two lower SEP neighbourhoods in Oslo, Norway. Theme-based inductive coding was used for analysis, and the results discussed in light of an ecological framework. The results indicate that all the adolescents experience several barriers to healthy dietary behaviours. For adolescents in the lower SEP neighbourhood, one or both parents desired their cultural cuisine served at home, whereas the adolescents wanted and often consumed western dishes. Fast-food restaurants or hanging out at the mall was perceived as the preferred social arena, often due to lack of involvement in either leisure-time physical activities or youth clubs as a safe, engaging option. The adolescents in the higher SEP neighbourhood perceived social norms which accentuated healthy dietary choices. When more possibilities for activities were present and the adolescents expressed being highly engaged in leisure-time physical activity, this also seemed to facilitate healthier dietary behaviours. These findings indicate how several factors simultaneously can influence dietary behaviour. Use of a multi-layered approach when exploring the environmental influences could increase knowledge about tackling social inequalities in dietary behaviours among adolescents.
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Affiliation(s)
- Hanne Hennig Havdal
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, PO Box 1046 Blindern, 0317, Oslo, Norway.
| | - Elisabeth Fosse
- Department of Health Promotion and Development, University of Bergen, PO Box 7807, 5020, Bergen, Norway.
| | - Mekdes Kebede Gebremariam
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, PO Box 1046 Blindern, 0317, Oslo, Norway.
| | - Jeroen Lakerveld
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC, Location VUmc, PO Box 7057, 1007MB, Amsterdam, the Netherlands.
| | - Onyebuchi A Arah
- Department of Epidemiology, UCLA Fielding School of Public Health, 650 Charles E. Young Drive South, PO Box 951772, Los Angeles, CA, 90095, USA.
| | - Karien Stronks
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, PO Box 22660, 1100DD, Amsterdam, the Netherlands.
| | - Nanna Lien
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, PO Box 1046 Blindern, 0317, Oslo, Norway.
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Mekonnen T, Havdal HH, Lien N, O'Halloran SA, Arah OA, Papadopoulou E, Gebremariam MK. Mediators of socioeconomic inequalities in dietary behaviours among youth: A systematic review. Obes Rev 2020; 21:e13016. [PMID: 32162413 DOI: 10.1111/obr.13016] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 02/11/2020] [Accepted: 02/16/2020] [Indexed: 02/02/2023]
Abstract
Children and adolescents with a lower socioeconomic position have poorer dietary behaviours compared to their counterparts with a higher socioeconomic position. A better understanding of the mechanisms behind such socioeconomic inequalities is vital to identify targets for interventions aimed at tackling these inequalities. This systematic review aimed to summarize existing evidence regarding the mediators of socioeconomic differences in dietary behaviours among youth. A systematic literature search of MEDLINE, Embase, PsycINFO, and Web of Science databases yielded 20 eligible studies. The dietary behaviours included in the reviewed studies were the intake of fruit and vegetables, sugar-sweetened beverages, unhealthy snacks/fast food and breakfast. The consistent mediators of the effects of socioeconomic position on dietary behaviours among youth were: self-efficacy, food preferences and knowledge at the intrapersonal level; and availability and accessibility of food items at home, food rules and parental modelling at the interpersonal level. Few studies including mediators at the organisational, community or policy levels were found. Our review found several modifiable factors at the intrapersonal and interpersonal levels that could be targeted in interventions aimed at combating inequalities in dietary behaviours among youth. Rigorous studies exploring organisational, community and policy level mediators are warranted.
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Affiliation(s)
- Teferi Mekonnen
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway
| | - Hanne Hennig Havdal
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway
| | - Nanna Lien
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway
| | - Siobhan Anne O'Halloran
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway
| | - Onyebuchi A Arah
- Department of Epidemiology and Department of Statistics, University of California, Los Angeles (UCLA), California, USA
| | - Eleni Papadopoulou
- Department of Environmental Exposure and Epidemiology, Norwegian Institute of Public Health, Norway
| | - Mekdes Kebede Gebremariam
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway
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Kristiansen AL, Medin AC, Bjelland M, Himberg-Sundet A, Lien N, Holst R, Andersen LF. Long-term effects of a cluster randomized controlled kindergarten-based intervention trial on vegetable intake among Norwegian 3-5-year-olds: the BRA-study. BMC Res Notes 2020; 13:30. [PMID: 31937362 PMCID: PMC6961274 DOI: 10.1186/s13104-020-4892-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 01/04/2020] [Indexed: 01/23/2023] Open
Abstract
Objective To report on long-term effects of a cluster randomized controlled kindergarten-based intervention trial, which aimed to increase vegetable intake among Norwegian preschool children (3–5 years at baseline). The effects of the intervention at follow-up 1 (immediately post-intervention) have previously been published. This paper presents the effects of the intervention from baseline to follow-up 2 (12 months post-intervention). Results Parental consents were obtained for 633 out of 1631 eligible children (response rate 38.8%). The effects of the intervention from baseline to follow-up 2 were assessed by mixed-model analyses taking the clustering effect of kindergartens into account. Children’s vegetable intake was reported by the parents at baseline (spring 2015), at follow-up 1 (spring 2016) and at follow-up 2 (spring 2017). No significant long-term effects in child vegetable intake were found. A mean difference of − 0.1 times per day (95% CI − 0.5, 0.2) (P = 0.44) was found for the daily frequency of vegetable intake. A mean difference of – 0.2 different kinds of vegetables eaten over a month (95% CI − 1.0, 0.7) (P = 0.70) was found and for daily amount of vegetables a mean difference of − 15.0 g vegetables (95% CI − 38.0, 8.0) (P = 0.19) was found. Trial registration International Standard Randomised Controlled Trials ISRCTN51962956 (http://www.isrctn.com/ISRCTN51962956). Registered 21 June 2016 (retrospectively registered)
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Affiliation(s)
- Anne Lene Kristiansen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, PO Box 1046, Blindern, 0317, Oslo, Norway.
| | - Anine Christine Medin
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, PO Box 1046, Blindern, 0317, Oslo, Norway.,Department of Public Health, Sport and Nutrition, Faculty of Health and Sport Sciences, University of Agder, PO Box 422, 4604, Kristiansand, Norway
| | - Mona Bjelland
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, PO Box 1046, Blindern, 0317, Oslo, Norway
| | - Anne Himberg-Sundet
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, PO Box 1046, Blindern, 0317, Oslo, Norway
| | - Nanna Lien
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, PO Box 1046, Blindern, 0317, Oslo, Norway
| | - René Holst
- Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, PO Box 1122, Blindern, 0317, Oslo, Norway
| | - Lene Frost Andersen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, PO Box 1046, Blindern, 0317, Oslo, Norway
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Himberg-Sundet A, Kristiansen AL, Gebremariam MK, Moser T, Andersen LF, Bjelland M, Lien N. Exploring the workplace climate and culture in relation to food environment-related factors in Norwegian kindergartens: The BRA-study. PLoS One 2019; 14:e0225831. [PMID: 31790486 PMCID: PMC6886843 DOI: 10.1371/journal.pone.0225831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 11/13/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Kindergartens represent an important arena for promoting vegetable intake when it is essential to establish healthy dietary behaviours early in life. To develop and implement successful interventions targeting dietary behaviours in kindergartens, a good understanding of the factors influencing their food environment and the interplay between these factors is essential. The present study aimed to explore associations between workplace climate and culture in the kindergarten setting and the staff's food-related practices, vegetables served and the possible mediating role of staff's food-related practices. METHOD Vegetables served, staff's food-related practices, and data on workplace climate and culture were collected using a 5-day, weighted, vegetable diary and three paper-based questionnaires. Seventy-three kindergartens in the Norwegian counties of Vestfold and Buskerud participated in the study. Spearman's rho was used to assess the association between workplace climate and culture, and staff's food-related practices and vegetables served. Mediation analyses were conducted to assess the mediating role of staff's food-related practices in the relationship between workplace climate and culture and vegetables served in this setting. RESULTS There was one significant positive correlation between factors in the workplace climate and culture, and staff's food-related practices and vegetables served. The staff's food-related practices were found to mediate the association between support from superior and the variety of vegetables served. They also mediated the association between commitment to the organization and the frequency, as well as the variety, of vegetables served. CONCLUSION The results identified commitment to the organization and support from superior as two important factors in the workplace climate and culture. Furthermore, these two factors seems to be important to target when developing kindergarten-based interventions aimed at increasing the variety and frequency of vegetables served as they were associated with more favourable food-related practices among staff.
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Affiliation(s)
- Anne Himberg-Sundet
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway
| | - Anne Lene Kristiansen
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway
| | - Mekdes K. Gebremariam
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway
| | - Thomas Moser
- Department of Educational Science, Faculty of Humanities, Sports and Educational Science, University of South-Eastern Norway, Norway
| | - Lene Frost Andersen
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway
| | - Mona Bjelland
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway
| | - Nanna Lien
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway
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Kristiansen AL, Bjelland M, Himberg-Sundet A, Lien N, Holst R, Frost Andersen L. Effects of a cluster randomized controlled kindergarten-based intervention trial on vegetable consumption among Norwegian 3-5-year-olds: the BRA-study. BMC Public Health 2019; 19:1098. [PMID: 31409342 PMCID: PMC6692927 DOI: 10.1186/s12889-019-7436-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 08/02/2019] [Indexed: 01/08/2023] Open
Abstract
Background Early childhood represents a critical period for the establishment of long-lasting healthy dietary habits. Limited knowledge exists on how to successfully increase vegetable consumption among preschool children. The overall aim of the present study was to improve vegetable intake among preschool children in a kindergarten-based randomized controlled trial. Methods The target group was preschool children born in 2010 and 2011, attending public or private kindergartens in two counties in Norway. Data about child intake of vegetables were collected by three methods. First, parents filled in a web-based questionnaire of the child’s vegetable intake. Second, among a subsample, trained researchers observed children’s vegetable intake in the kindergarten. Thirdly, a parental web-based 24-h recall assessing the child’s vegetable intake was filled in. For allocation of kindergartens to intervention and control groups, a stratified block randomization was used. Multiple intervention components were implemented from September 2015 to February 2016 and components focused at influencing the four determinants availability, accessibility, encouragement and role modelling. The effect of the intervention from baseline (spring 2015) to follow-up 1 (spring 2016) was assessed by mixed-model analysis taking the clustering effect of kindergartens into account. Results Parental consent was obtained for 38.8% of the children (633 out of 1631 eligible children). Based on the observational data in the kindergarten setting (n 218 in the control group and n 217 in the intervention group), a tendency to a small positive effect was seen as a mean difference of 13.3 g vegetables/day (95% CI: − 0.2, 26.9) (P = 0.054) was observed. No significant overall effects were found for the total daily vegetable intake or for the parental reported frequency or variety in vegetable intake. Conclusions Based on the observational data in the kindergarten setting, a tendency to a small positive effect was seen with a mean difference of about 13 g vegetables/day, while no other effects on child vegetable intake were found. Additionally, further research to understand the best strategies to involve parents in dietary interventions studies is warranted. Trial registration International Standard Randomised Controlled Trials ISRCTN51962956. Registered 21 June 2016 (retrospectively registered). Electronic supplementary material The online version of this article (10.1186/s12889-019-7436-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anne Lene Kristiansen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, PO Box 1046, Blindern, 0317, Oslo, Norway.
| | - Mona Bjelland
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, PO Box 1046, Blindern, 0317, Oslo, Norway
| | - Anne Himberg-Sundet
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, PO Box 1046, Blindern, 0317, Oslo, Norway
| | - Nanna Lien
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, PO Box 1046, Blindern, 0317, Oslo, Norway
| | - René Holst
- Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, PO Box 1122, Blindern, 0317, Oslo, Norway
| | - Lene Frost Andersen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, PO Box 1046, Blindern, 0317, Oslo, Norway
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Gebremariam MK, Arah OA, Bergh IH, Andersen LF, Bjelland M, Grydeland M, Lien N. Factors affecting the dose of intervention received and the participant satisfaction in a school-based obesity prevention intervention. Prev Med Rep 2019; 15:100906. [PMID: 31194160 PMCID: PMC6551552 DOI: 10.1016/j.pmedr.2019.100906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 05/13/2019] [Accepted: 05/20/2019] [Indexed: 01/22/2023] Open
Abstract
This study assessed factors associated with the perceived dose of intervention received and with the participant satisfaction in a school-based obesity prevention intervention. It also explored the variance in the dose of intervention received that was at the school level. Process evaluation data from a school-based intervention study conducted in Oslo in 2007-2009 were used. A total of 542 11-year-olds from 12 intervention schools were included. A web-based questionnaire was used to collect data. Descriptive analyses and multilevel regression analyses were conducted. Females and those with medium (vs. low) parental education had higher odds of reporting a high vs. low dose of intervention received at mid-way (8 months after baseline). Perceived social capital and perceived social support for physical activity from friends at baseline were positively associated with the dose of intervention received at mid-way. Perceived social capital at mid-way was positively associated with the dose of intervention reported post-intervention (20 months after baseline). Around 20% of the variance in the perceived dose of intervention received was at the school level. Satisfaction with the intervention was high overall and higher for females for several intervention components at mid-way and at post-intervention. The factors identified in this study should be taken into consideration when planning future obesity prevention interventions among youth.
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Affiliation(s)
- Mekdes K Gebremariam
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA, United States.,Department of Nutrition, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Onyebuchi A Arah
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA, United States.,UCLA Center for Health Policy Research, Los Angeles, CA, United States.,California Center for Population Research, UCLA, Los Angeles, CA, United States
| | - Ingunn H Bergh
- Department of Health and Inequality, Norwegian Institute of Public Health, Oslo, Norway
| | - Lene F Andersen
- Department of Nutrition, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Mona Bjelland
- Department of Nutrition, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - May Grydeland
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - Nanna Lien
- Department of Nutrition, Faculty of Medicine, University of Oslo, Oslo, Norway
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Gebremariam MK, Arah OA, Bergh IH, Andersen LF, Ommundsen Y, Totland TH, Bjelland M, Grydeland M, Lien N. Gender-specific mediators of the association between parental education and adiposity among adolescents: the HEIA study. Sci Rep 2019; 9:7282. [PMID: 31086277 PMCID: PMC6514034 DOI: 10.1038/s41598-019-43604-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 04/27/2019] [Indexed: 01/22/2023] Open
Abstract
Identifying the mechanisms behind socioeconomic inequalities in adiposity among youth is vital for efforts aimed at combating these inequalities. The study explored whether a broad range of behavioral and familial factors mediated the associations between parental education and indicators of adiposity among adolescents. Baseline data from a school-based intervention study conducted in 2007 among 11-year-old adolescents were used. Anthropometric outcomes, physical activity and sedentary time among adolescents were objectively measured. Other behavioral variables and parental waist circumference were self-reported. Mediation analyses were conducted. Among boys, maternal waist circumference (WC), paternal WC and TV viewing mediated 16%, 11.5% and 13% of the association between parental education and adolescent WC. The respective proportions when body fat percentage was used as the outcome variable were 22.5%, 16% and 21%. Among girls, maternal and paternal WC mediated 20% and 14% of the association between parental education and WC. The respective proportions when body fat percentage was used as the outcome variable were 14% and 10%. Other included variables did not play any mediating role. Parental WC was found to be a mediator of socioeconomic differences in adiposity in both genders; underlying mechanisms were however not investigated. Among boys, reducing TV time could contribute to the reduction of social inequalities in adiposity.
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Affiliation(s)
- Mekdes K Gebremariam
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, California, United States. .,Department of Nutrition, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Onyebuchi A Arah
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, California, United States.,UCLA Center for Health Policy Research, Los Angeles, California, United States.,California Center for Population Research, UCLA, Los Angeles, California, United States
| | - Ingunn H Bergh
- Department of Child Development, Norwegian Institute of Public Health, Oslo, Norway
| | - Lene F Andersen
- Department of Nutrition, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Yngvar Ommundsen
- Department of Coaching and Psychology, Norwegian School of Sport Sciences, Oslo, Norway
| | - Torunn H Totland
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Mona Bjelland
- Department of Nutrition, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - May Grydeland
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - Nanna Lien
- Department of Nutrition, Faculty of Medicine, University of Oslo, Oslo, Norway
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Hebestreit A, Thumann B, Wolters M, Bucksch J, Huybrechts I, Inchley J, Lange C, Lien N, Manz K, Slimani N, van der Ploeg HP, Ahrens W. Road map towards a harmonized pan-European surveillance of obesity-related lifestyle behaviours and their determinants in children and adolescents. Int J Public Health 2019; 64:615-623. [PMID: 30888434 DOI: 10.1007/s00038-019-01227-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 02/20/2019] [Accepted: 02/22/2019] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To develop a road map towards a harmonized pan-European surveillance system for children and adolescents. METHODS Representatives of five European surveillance systems and the German Health Interview and Examination Survey for Children and Adolescents contributed to the road map through a structured workshop in 2016. RESULTS A conceptual framework for this road map was developed with seven action points (APs) guiding the successive cross-country harmonization. First, key indicators of health behaviour and their determinants in children and adolescents will be identified (AP1, 2); short screening instruments will be developed and implemented to assess and monitor key indicators (AP3, 4). In parallel, optional supplementary modules could be implemented to provide objective data (AP5). This would allow mutual calibration and improvement of existing instruments before their progressive replacement by more comparable measurement tools (AP6). The establishment of a competence platform is envisaged for guiding the harmonization process (AP7). CONCLUSIONS This approach builds on existing systems, provides comparable key health indicators across European regions, helps to assess temporal trends and-once in place-will facilitate health reporting and monitoring of national and international health targets.
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Affiliation(s)
- Antje Hebestreit
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstr. 30, 28359, Bremen, Germany.
| | - Barbara Thumann
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstr. 30, 28359, Bremen, Germany
| | - Maike Wolters
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstr. 30, 28359, Bremen, Germany
| | - Jens Bucksch
- University of Education Heidelberg, Heidelberg, Germany
| | | | | | | | | | | | - Nadia Slimani
- International Agency for Research On Cancer, Lyon, France
| | | | - Wolfgang Ahrens
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstr. 30, 28359, Bremen, Germany
- University of Bremen, Bremen, Germany
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Hausken SES, Lie HC, Lien N, Sleddens EFC, Melbye EL, Bjelland M. The reliability of the general functioning scale in Norwegian 13-15-year-old adolescents and association with family dinner frequency. Nutr J 2019; 18:20. [PMID: 30917827 PMCID: PMC6437966 DOI: 10.1186/s12937-019-0447-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 03/21/2019] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Family environment is crucial to the development of health behaviors into adolescence and adulthood. The aims of this study were (1) to explore the reliability of the General Functioning Scale (GFS) among Norwegian 13-15-year-olds, and (2) to assess whether family functioning reported by adolescents was associated with family dinner frequency. METHODS In total 440 secondary-school students were invited to participate in this cross-sectional web-based questionnaire survey, with 54 participating in the test-retest study. Test-retest and internal consistency were assessed for the 12-item GFS-scale. Associations between family functioning and family dinner frequency were tested using multiple logistic regression. RESULTS The GFS had high internal consistency (corrected item-total correlations ranging from 0.40 to 0.65, Cronbach's α = 0.85), and excellent test-retest reliability (intra-class correlation coefficient = 0.83). In the logistic regression model, a higher score on GFS (poorer family functioning) was associated with a reduced likelihood of having dinner together on a daily basis (i.e., 6-7 times per week, OR = 0.36, CI = 0.20-0-64) after adjusting for age, gender, ethnicity, living situation and parental education level. CONCLUSIONS The GFS had high reliability. As poorer family functioning was associated with less frequent family dinners, the family environment may be an important (contextual) target to influence adolescent health behaviors. It would be of interest to further explore the role of family functioning in relation to adolescents' dietary habits, besides shared family meals, and to reveal the mechanisms underlying such relationships.
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Affiliation(s)
- Solveig E S Hausken
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, P.O.Box 1046, Blindern, NO-0316, Oslo, Norway.
| | - Hanne C Lie
- Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Nanna Lien
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, P.O.Box 1046, Blindern, NO-0316, Oslo, Norway
| | - Ester F C Sleddens
- Department of Health Promotion, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Elisabeth L Melbye
- Faculty of Social Sciences, Norwegian School of Hotel Management, University of Stavanger, Stavanger, Norway
| | - Mona Bjelland
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, P.O.Box 1046, Blindern, NO-0316, Oslo, Norway
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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. J Nutr Educ Behav 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Buck C, Loyen A, Foraita R, Van Cauwenberg J, De Craemer M, Mac Donncha C, Oppert JM, Brug J, Lien N, Cardon G, Pigeot I, Chastin S. Factors influencing sedentary behaviour: A system based analysis using Bayesian networks within DEDIPAC. PLoS One 2019; 14:e0211546. [PMID: 30699199 PMCID: PMC6353197 DOI: 10.1371/journal.pone.0211546] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 01/16/2019] [Indexed: 12/19/2022] Open
Abstract
Background Decreasing sedentary behaviour (SB) has emerged as a public health priority since prolonged sitting increases the risk of non-communicable diseases. Mostly, the independent association of factors with SB has been investigated, although lifestyle behaviours are conditioned by interdependent factors. Within the DEDIPAC Knowledge Hub, a system of sedentary behaviours (SOS)-framework was created to take interdependency among multiple factors into account. The SOS framework is based on a system approach and was developed by combining evidence synthesis and expert consensus. The present study conducted a Bayesian network analysis to investigate and map the interdependencies between factors associated with SB through the life-course from large scale empirical data. Methods Data from the Eurobarometer survey (80.2, 2013) that included the International physical activity questionnaire (IPAQ) short as well as socio-demographic information and questions on perceived environment, health, and psychosocial information were enriched with macro-level data from the Eurostat database. Overall, 33 factors were identified aligned to the SOS-framework to represent six clusters on the individual or regional level: 1) physical health and wellbeing, 2) social and cultural context, 3) built and natural environment, 4) psychology and behaviour, 5) institutional and home settings, 6) policy and economics. A Bayesian network analysis was conducted to investigate conditional associations among all factors and to determine their importance within these networks. Bayesian networks were estimated for the complete (23,865 EU-citizens with complete data) sample and for sex- and four age-specific subgroups. Distance and centrality were calculated to determine importance of factors within each network around SB. Results In the young (15–25), adult (26–44), and middle-aged (45–64) groups occupational level was directly associated with SB for both, men and women. Consistently, social class and educational level were indirectly associated within male adult groups, while in women factors of the family context were indirectly associated with SB. Only in older adults, factors of the built environment were relevant with regard to SB, while factors of the home and institutional settings were less important compared to younger age groups. Conclusion Factors of the home and institutional settings as well as the social and cultural context were found to be important in the network of associations around SB supporting the priority for future research in these clusters. Particularly, occupational status was found to be the main driver of SB through the life-course. Investigating conditional associations by Bayesian networks gave a better understanding of the complex interplay of factors being associated with SB. This may provide detailed insights in the mechanisms behind the burden of SB to effectively inform policy makers for detailed intervention planning. However, considering the complexity of the issue, there is need for a more comprehensive system of data collection including objective measures of sedentary time.
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Affiliation(s)
- Christoph Buck
- Leibniz Institute for Prevention Research and Epidemiology–BIPS, Bremen, Germany
- * E-mail:
| | - Anne Loyen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands
| | - Ronja Foraita
- Leibniz Institute for Prevention Research and Epidemiology–BIPS, Bremen, Germany
| | - Jelle Van Cauwenberg
- Research Foundation Flanders (FWO), Brussels, Belgium
- Department of Public Health, Ghent University, Ghent, Belgium
| | - Marieke De Craemer
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Ciaran Mac Donncha
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
| | - Jean-Michel Oppert
- Department of Nutrition, University Pierre et Marie Curie, Institute of Cardiometabolism And Nutrition (ICAN), Pitie-Salpêtrière Hospital (AP-HP), Paris, France
| | - Johannes Brug
- Amsterdam School for Communication Research, University of Amsterdam, Amsterdam, The Netherlands
| | - Nanna Lien
- Department of Nutrition, University of Oslo, Oslo, Norway
| | - Greet Cardon
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Iris Pigeot
- Leibniz Institute for Prevention Research and Epidemiology–BIPS, Bremen, Germany
- University of Bremen, Faculty of Mathematics and Computer Science, Bremen, Germany
| | - Sebastien Chastin
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
- Institute for Applied Health Research, School of Health and Life Science, Glasgow Caledonian University, Glasgow, United Kingdom
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Schoeppe S, Vandelanotte C, Bere E, Lien N, Verloigne M, Kovács É, Manios Y, Bjelland M, Vik FN, Van Lippevelde W. The influence of parental modelling on children's physical activity and screen time: Does it differ by gender? Eur J Public Health 2018; 27:152-157. [PMID: 28177458 DOI: 10.1093/eurpub/ckw182] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Stephanie Schoeppe
- Central Queensland University, School of Human Health and Social Sciences, Physical Activity Research Group, Rockhampton, Australia
| | - Corneel Vandelanotte
- Central Queensland University, School of Human Health and Social Sciences, Physical Activity Research Group, Rockhampton, Australia
| | - Elling Bere
- Department of Public Health, Sport and Nutrition, University of Agder, Kristiansand, Norway
| | - Nanna Lien
- Department of Nutrition, University of Oslo, Oslo, Norway
| | - Maïté Verloigne
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
| | - Éva Kovács
- Department of Paediatrics, University of Pécs, Pécs, Hungary, and Institute for Medical Information Processing, Biometrics and Epidemiology and German Centre for Vertigo and Balance Disorders, Ludwig Maximilian University, Munich, Germany
| | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science & Education, Harokopio University, Athens, Greece
| | - Mona Bjelland
- Department of Nutrition, University of Oslo, Oslo, Norway
| | - Frøydis Nordgård Vik
- Department of Public Health, Sport and Nutrition, University of Agder, Kristiansand, Norway
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Marijn Stok F, Renner B, Allan J, Boeing H, Ensenauer R, Issanchou S, Kiesswetter E, Lien N, Mazzocchi M, Monsivais P, Stelmach-Mardas M, Volkert D, Hoffmann S. Dietary Behavior: An Interdisciplinary Conceptual Analysis and Taxonomy. Front Psychol 2018; 9:1689. [PMID: 30298030 PMCID: PMC6160746 DOI: 10.3389/fpsyg.2018.01689] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 08/22/2018] [Indexed: 01/08/2023] Open
Abstract
Background: Dietary behavior encompasses many aspects, terms for which are used inconsistently across different disciplines and research traditions. This hampers communication and comparison across disciplines and impedes the development of a cumulative science. We describe the conceptual analysis of the fuzzy umbrella concept "dietary behavior" and present the development of an interdisciplinary taxonomy of dietary behavior. Methods: A four-phase multi-method approach was employed. Input was provided by 76 scholars involved in an international research project focusing on the determinants of dietary behavior. Input was collected from the scholars via an online mind mapping procedure. After structuring, condensing, and categorizing this input into a compact taxonomy, the result was presented to all scholars, discussed extensively, and adapted. A second revision round was then conducted among a core working group. Results: A total of 145 distinct entries were made in the original mind mapping procedure. The subsequent steps allowed us to reduce and condense the taxonomy into a final product consisting of 34 terms organized into three main categories: Food Choice, Eating Behavior, and Dietary Intake/Nutrition. In a live discussion session attended by 50 of the scholars involved in the development of the taxonomy, it was judged to adequately reflect their input and to be a valid and useful starting point for interdisciplinary understanding and collaboration. Conclusion: The current taxonomy can be used as a tool to facilitate understanding and cooperation between different disciplines investigating dietary behavior, which may contribute to a more successful approach to tackling the complex public health challenges faced by the field. The taxonomy need not be viewed as a final product, but can continue to grow in depth and width as additional experts provide their input.
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Affiliation(s)
- F. Marijn Stok
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Britta Renner
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Julia Allan
- Health Psychology, The Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Regina Ensenauer
- Experimental Pediatrics and Metabolism, University Children’s Hospital, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Sylvie Issanchou
- Centre des Sciences du Goût et de l’Alimentation, AgroSup Dijon, CNRS, INRA, Université Bourgogne Franche-Comté, Dijon, France
| | - Eva Kiesswetter
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Nanna Lien
- Department of Nutrition, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Mario Mazzocchi
- Department of Statistical Sciences, University of Bologna, Bologna, Italy
| | - Pablo Monsivais
- Centre for Diet and Activity Research, MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
| | - Marta Stelmach-Mardas
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- Department of Biophysics, Poznan University of Medical Sciences, Poznań, Poland
| | - Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Stefan Hoffmann
- Department of Marketing, Institute of Business Administration, Kiel University, Kiel, Germany
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Winpenny EM, van Sluijs EMF, White M, Klepp KI, Wold B, Lien N. Changes in diet through adolescence and early adulthood: longitudinal trajectories and association with key life transitions. Int J Behav Nutr Phys Act 2018; 15:86. [PMID: 30200990 PMCID: PMC6131755 DOI: 10.1186/s12966-018-0719-8] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 08/29/2018] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Early adulthood is a period associated with poor diet and rapid weight gain. This is also an age of transition, including environmental, social and lifestyle changes which may be associated with changes in diet. We assess longitudinal associations between four early adulthood life transitions (leaving home, leaving education, entering employment, and cohabitation) and changes in consumption of fruit, vegetables, confectionery and sugar-sweetened beverages (SSBs). METHODS Participants (n = 1100) from the Norwegian Longitudinal Health Behaviour Study, reported data on diet and life transitions on up to eight occasions from age 14 to age 30. Diet data were self-reported in response to questions on intake of fruit, vegetables, confectionery and sugar-sweetened beverages. Growth models were developed to describe changing intake of each of the four diet indicators with age. Fixed-effects regression models assessed associations between the four life transitions and within-individual changes in diet indicators, with adjustment for the remaining transitions and parenthood. RESULTS Diet indicators showed quadratic trajectories with age: fruit and vegetable intakes declined from age 14 to ages 23 and 21 respectively, before increasing to age 30. SSB and confectionery intakes increased to age 18, before subsequently decreasing. Leaving the parental home was associated with a decrease in fruit intake of - 0.54 times/week (95% confidence interval (95%CI): -0.87;-0.22) and vegetable intake of - 0.43 times/week (95%CI: -0.70;-0.15). Leaving education was associated with increases in confectionery (0.33 times/week (95%CI: 0.04;0.62)) and SSB intakes (0.49 times/week (95%CI: 0.10;0.87). CONCLUSIONS Leaving home and leaving education are associated with negative changes in diet and may present opportunities for effective diet and obesity intervention. Further study of these transitions is needed to understand the mechanisms mediating associations between life transitions and changes in diet.
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Affiliation(s)
- Eleanor M Winpenny
- Centre for Diet and Activity Research & MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK.
| | - Esther M F van Sluijs
- Centre for Diet and Activity Research & MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Martin White
- Centre for Diet and Activity Research & MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Knut-Inge Klepp
- Department of Nutrition, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Bente Wold
- Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Nanna Lien
- Department of Nutrition, Faculty of Medicine, University of Oslo, Oslo, Norway
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De Craemer M, Verloigne M, Ghekiere A, Loyen A, Dargent-Molina P, Brug J, Lien N, Froberg K, Wedderkopp N, Chastin S, Cardon G, Van Cauwenberg J. Changes in children's television and computer time according to parental education, parental income and ethnicity: A 6-year longitudinal EYHS study. PLoS One 2018; 13:e0203592. [PMID: 30192895 PMCID: PMC6128608 DOI: 10.1371/journal.pone.0203592] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 08/23/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To investigate changes in children's television and computer time according to three socio-economic status (SES) indicators. DESIGN Prospective cohort study. METHODS Data were drawn from the European Youth Heart Study and included longitudinal data collected in 1997 and 2003 in Denmark. Television and computer time were self-reported by children. Parental education, income and ethnicity were parent-reported. Baseline data were available for 549 children (47.0% boys, 9.6 years). Generalized linear mixed models analyzed whether changes in television and computer time from baseline to follow-up differed according to the SES-indicators. RESULT TV viewing time increased with 25% over time (ExpB = 1.25, 95% CI = 1.04-1.50). At both time points, children with two higher educated parents viewed 25% less hours of television than children with no higher educated parents (ExpB = 0.75, 95% CI = 0.60-0.94) and one higher educated parent (ExpB = 0.75, 95%CI = 0.59-0.97). Among children with no higher educated parents the odds of being in a higher category of computer time increased with 80% over time (OR = 1.80, 95% CI = 1.24-2.60). Among children with two higher educated parents the odds of being in a higher category of computer time decreased with 45% over time (OR = 0.55, 95% CI = 0.32-0.94). The association with ethnicity showed that white children had 42% lower odds (OR = 0.58; 95% CI = 0.34-1.00) of being in a higher category of computer time than non-white children. No significant associations were found for parental income. CONCLUSIONS The most important SES measure of screen-based behaviors in children was parental education. Ethnicity was only associated with computer time. Financial resources were less relevant for changes in television viewing and computer use.
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Affiliation(s)
- Marieke De Craemer
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
| | - Maïté Verloigne
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
- Research Foundation Flanders, Brussels, Belgium
| | - Ariane Ghekiere
- Department of Public Health, Ghent University, Ghent, Belgium
| | - Anne Loyen
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands
| | - Patricia Dargent-Molina
- Early Determinants of Children’s health and Development Team (ORCHAD), Inserm Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), Villejuif, Paris Descartes University, Paris, France
| | - Johannes Brug
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands
- Amsterdam School for Communication Research, University of Amsterdam, Amsterdam, the Netherlands
| | - Nanna Lien
- Department of Nutrition, Institute of Basic Medical Sciences, Oslo, Norway
| | - Karsten Froberg
- Department of Exercise Epidemiology, University of Southern Denmark, Odense, Denmark
| | - Niels Wedderkopp
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Sebastien Chastin
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, the United Kingdom
| | - Greet Cardon
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
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Stok FM, Renner B, Clarys P, Lien N, Lakerveld J, Deliens T. Understanding Eating Behavior during the Transition from Adolescence to Young Adulthood: A Literature Review and Perspective on Future Research Directions. Nutrients 2018; 10:E667. [PMID: 29794986 PMCID: PMC6024552 DOI: 10.3390/nu10060667] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 05/18/2018] [Accepted: 05/22/2018] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Eating behavior often becomes unhealthier during the transition from adolescence to young adulthood, but not much is known about the factors that drive this change. We assess the available evidence on this topic through a literature review and pay special attention to the research designs employed in the studies available as well as the modifiability of the factors investigated in previous research. METHOD We systematically conducted a scoping review by searching literature published in or after 2000 in three databases that described one or more factors associated with eating behavior or changes in eating behavior during the transition from adolescence to adulthood in the general population. Our search identified eighteen articles meeting these inclusion criteria. The socio-ecological DONE (Determinants of Nutrition and Eating) framework, a recently developed dynamic framework of factors shaping dietary behavior, was used to structure and categorize the factors identified. RESULTS Most factors identified in the literature were individual-level factors (67%) such as food beliefs, time constraints, and taste preferences; on the other hand, interpersonal-level factors (e.g., social support), environmental-level factors (e.g., product characteristics) and policy-level factors (e.g., market regulations) have been reported on less extensively. Furthermore, most factors discussed in the literature have been classified in the DONE framework as not easily modifiable. Moreover, previous studies largely used static research designs and focused primarily on one specific population (US freshmen). DISCUSSION This systematic scoping review identified several gaps in the available literature that hinder insight into the drivers of eating behavior (change) during the transition from adolescence to young adulthood. There is an urgent need for research on broader populations, employing dynamic repeated-measures designs, and taking modifiability of factors into account.
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Affiliation(s)
- F Marijn Stok
- Department of Psychological Assessment and Health Psychology, University of Konstanz, P.O. Box 47, 78457 Konstanz, Germany.
| | - Britta Renner
- Department of Psychological Assessment and Health Psychology, University of Konstanz, P.O. Box 47, 78457 Konstanz, Germany.
| | - Peter Clarys
- Department of Movement and Sport Sciences, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, 1050 Brussels, Belgium.
| | - Nanna Lien
- Department of Nutrition, University of Oslo, 0315 Oslo, Norway.
| | - Jeroen Lakerveld
- Department of Epidemiology and Biostatistics & the EMGO Institute for Health and Care Research, VU University Medical Center, 1081 BT Amsterdam, The Netherlands.
| | - Tom Deliens
- Department of Movement and Sport Sciences, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, 1050 Brussels, Belgium.
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Fry Vennerød FF, Nicklaus S, Lien N, Almli VL. The development of basic taste sensitivity and preferences in children. Appetite 2018; 127:130-137. [PMID: 29729324 DOI: 10.1016/j.appet.2018.04.027] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 04/17/2018] [Accepted: 04/21/2018] [Indexed: 12/26/2022]
Abstract
This study aims at understanding how preference and sensitivity to the basic tastes develop in the preschool years, and how the two relate to each other. To expand on the existing literature regarding taste preferences conducted in cross-sectional studies, a longitudinal design was applied with children from age four to six years old. During the springs of 2015, 2016, and 2017, 131 children born in 2011 were tested in their kindergartens. To investigate preferences for sweet, sour and bitter tastes, the children performed ranking-by-elimination procedures on fruit-flavored beverages and chocolates with three taste intensity levels. The beverages varied in either sucrose, citric acid, or the bitter component isolone. The chocolates varied in the bitter component theobromine from cocoa and sucrose content. Each year, the children also performed paired-comparison tasks opposing plain water to tastant dilutions at four concentrations. The stimuli consisted of the five basic tastes: sweet (sucrose) sour (citric acid monohydrate) umami (monosodium glutamate), salty (sodium chloride), and bitter (quinine hydrochloride dihydrate). Preference for sweetness levels increased with age, while preference for bitterness and sourness levels were stable. Concerning taste sensitivity, the children showed an increase in sensitivity for sourness and saltiness, a decrease for sweetness, and stability for umami and bitterness. A negative association was found between sweetness sensitivity and preference for sweetness. The study highlights different trajectories of sensitivity and preferences across tastes. On average, a reduction in sweetness sensitivity combined with an increase in preference for higher sweetness was observed from the age of four to six. The weak relationship between taste sensitivity and taste preference in our data suggests that taste preference development is shaped by a multitude of factors in addition to taste sensitivity.
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Affiliation(s)
- Frida Felicia Fry Vennerød
- Nofima AS, P.O. Box 210, 1431 Ås, Norway; Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, PO Box 1046, Blindern, 0316 Oslo, Norway.
| | - Sophie Nicklaus
- Centre des Sciences du Goût et de l'Alimentation, CNRS, INRA, Univ. Bourgogne Franche-Comté, F-21000 Dijon, France
| | - Nanna Lien
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, PO Box 1046, Blindern, 0316 Oslo, Norway
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Roos G, Langøien L, Terragni L, Rugseth G, Nicolaou M, Holdsworth M, Stronks K, Lien N. 5.10-P1Systematic mapping review of factors influencing physical activity and sedentary behaviour in ethnic minority groups in Europe: a DEDIPAC study. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky048.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- G Roos
- Consumption Research Norway, Oslo and Akershus University College of Applied Sciences, Norway
| | - L Langøien
- Norwegian School of Sport Sciences, Norway
| | - L Terragni
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Norway
| | - G Rugseth
- Norwegian School of Sport Sciences, Norway
| | - M Nicolaou
- Department of Public Health, Academic Medical Centre, University of Amsterdam, The Netherlands
| | - M Holdsworth
- Public Health Section, School of Health and Related Research, University of Sheffield, United Kingdom
| | - K Stronks
- Department of Public Health, Academic Medical Centre, University of Amsterdam, The Netherlands
| | - N Lien
- Department of Nutrition, University of Oslo, Norway
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