A virtual audit tool to assess obesogenicity of the build environment in neighbourhoods

A lack of physical activity and overconsumption of energy dense food is associated with overweight and obesity. The neighbourhood environment may stimulate or hinder the development and/or maintenance of a healthy lifestyle. To improve research on the obesogenicity of neighbourhood environments, reliable, valid and convenient assessment methods of potential obesogenic characteristics of neighbourhood environments are needed. In a study just published in pre-pub in the International Journal of Health Geographics -as part of the Spotlight project- we examined the reliability and validity of the SPOTLIGHT-Virtual Audit Tool (S- VAT), which uses remote sensing techniques (Street View feature in Google Earth) for desk- based assessment of environmental obesogenicity.
A total of 128 street segments in four Dutch urban neighbourhoods – heterogeneous in socio- economic status and residential density – were assessed using the S-VAT. Environmental characteristics were categorised as walking related items, cycling related items, public transport, aesthetics, land use-mix, grocery stores, food outlets and physical activity facilities. To assess concordance of inter- and intra-observer reliability of the Street View feature in Google Earth, and validity scores with real life audits, percentage agreement and Cohen's Kappa (k) were calculated.

The results suggest that the S-VAT is a reliable and valid remote sensing tool to assess potential obesogenic environmental characteristics.

Implementation evaluation of school-based obesity prevention programmes in youth; how, what and why?

In an ideal world, one combats public health problems with theory- and evidence-based programmes. In the real world, evidence-based programmes are often lacking and programmes that are developed and implemented are mainly practice-based. Furthermore, if evidence-based programs are available, these are often not implemented as intended, making the effectiveness in real life settings often much lower than ideal.
Three important generic implementation research questions in the context of programme evaluation are: (i) how to promote implementation as intended; (ii) what happens during implementation; and (iii) why did my programme (not) work? In an invited commentary just published in the journal Public Health Nutrition we -with soon-to-be Dr. Femke van Nassau as first author- discuss
these three questions, enriched by our experiences with the school-based obesity prevention programme DOiT(Dutch Obesity Intervention in Teenagers).

Parental modelling mediates parental education differences in children's TV time

Children from lower educated parents tend to have less positive health behaviours than kids from higher educated parents. Children's sport participation is a health behaviour, associated with positive health outcomes, while children's TV time -a sedentary behaviour- is associated with higher likelihood for overweight and obesity and lower cardiometabolic health. In a paper just published online in Preventive Medicine, we assessed whether differences in children's sport participation and TV time according to parental education were mediated by parental modelling, i.e. by 'example behaviour' of the parents. In other words: we wanted to explore if lower educated parents are less likely to participate in sports and watch more TV themselves and if these behaviours help explain the less positive health behaviours in their children. We used the data of the cross European ENERGY study. We found evidence that parental modelling was important for differences in children's health behaviours according to the level of education of their parents, especially regarding children's TV time.

DEDIPAC: Determinants of diet and physical activity Knowledge Hub

To address major societal challenges and enhance cooperation in research across Europe, the European Commission has initiated and facilitated ‘joint programming’. Joint programming is a process by which Member States engage in defining, developing and implementing a common strategic research agenda, based on a shared vision of how to address major societal challenges that no Member State is capable of resolving independently. Setting up a Joint Programming Initiative (JPI) should also contribute to avoiding unnecessary overlap and repetition of research, and enable and enhance the development and use of standardised research methods, procedures and data management. The Determinants of Diet and Physical Activity (DEDIPAC) Knowledge Hub (KH) is the first joint action of the European JPI ‘A Healthy Diet for a Healthy Life’. A paper describing the rationale, organisation and potential added value of DEDIPAC was just published in the International Journal of Behavioral Nutrition and Physical Activity. The objective of DEDIPAC is to contribute to improving understanding of the determinants of dietary, physical activity and sedentary behaviours. DEDIPAC KH is a multi-disciplinary consortium of 46 consortia and organisations supported by joint programming grants from 12 countries across Europe. The work is divided into three thematic areas: (I) assessment and harmonisation of methods for future research, surveillance and monitoring, and for evaluation of interventions and policies; (II) determinants of dietary, physical activity and sedentary behaviours across the life course and in vulnerable groups; and (III) evaluation and benchmarking of public health and policy interventions aimed at improving dietary, physical activity and sedentary behaviours. In the first three years, DEDIPAC KH will organise, develop, share and harmonise expertise, methods, measures, data and other infrastructure. This should further European research and improve the broad multi-disciplinary approach needed to study the interactions between multilevel determinants in influencing dietary, physical activity and sedentary behaviours. Insights will be translated into more effective interventions and policies for the promotion of healthier behaviours and more effective monitoring and evaluation of the impacts of such interventions.

An intervention aimed at interrupting sitting time in schoolchildren

Sedentary behaviour, especially prolonged uninterrupted sitting, may be bad for cardiometabolic health. Breaking up sitting time may be more effective for health promotion than reducing total sitting time. However, there are currently no studies available reporting intervention effects on breaking up children's sedentary time. In a study just published online in the journal Pediatric Exercise Science we report on a study in which we examined intervention effect on objectively measured number of breaks in sedentary time, number of sedentary bouts (≥10 mins) and total and average amount of time spent in those sedentary bouts among 10- to 12- year-old Belgian children. The total sample included 354 children aged 10-11 with valid ActiGraph accelerometer data at pre- and post-test. Only few and small intervention effects were found, namely on total time spent in sedentary bouts immediately after school hours and on average time spent in sedentary bouts before school hours  and immediately after school hours in favour of children from intervention schools. Unexpectedly, girls from intervention schools decreased the number of breaks during school hours
and increased the number of sedentary bouts on a weekend day, whereas girls in control schools showed an increase in number of breaks and a decrease in number of bouts. In conclusion, UP4FUN did not have a consistent or substantial effect on breaking up children's sedentary time and these data suggest that more intensive and longer lasting interventions are needed, if interrupting sitting time is to be further pursued.

Sedentary behaviour and health in children: Evaluating the evidence

There is much to do about sedentary behaviour -too much (prolonged) sitting, for example by means of TV watching, computer and other IT activities, long school or office days et cetera- as a possible risk factor for cardiometabolic health. Scientists have claimed that sedentary time is a risk factor for cardiometabolic health partly or largely independent of physical activity. I.e. even if you do enough exercise, if you sit most of the rest of the day, your cardiometablic health may be at unnecessary risk. Some countries have already proposed recommendations for maximum sedentary time and interventions to reduce or interrupt sedentary time have been developed and are being tested or implemented.
In a commentary just published in the journal Preventive Medicine, with Prof. Mai Chin A Paw as first author, we argue that the evidence for sedentary behaviour as an independent cardiometabolic risk factor for children and adolescents is certainly not yet convincing, and propose research that should be conducted first to see if a stronger case can be build for treating sedentary behaviour as a separate risk factor, before we start using the meagre means for preventative interventions on sedentary behaviour instead of promoting physical activity and healthy eating.

Personal, home- and friend-related factors regarding diet, physical activity and sedentary behaviours among schoolchildren in Europe

To design interventions that target energy balance-related behaviours -i.e. diet, physical activities (PA) and sedentary behaviours- among school-age children, knowledge the possible determinants of these behaviours is needed. In a study just published in PLOS ONE -with Dr. Saskia te Velde as first author- we investigated schoolchildren's  personal beliefs and attitudes, home- and friend-related variables regarding soft drink intake, fruit juice intake, breakfast consumption, TV viewing and physical activity in eight countries across Europe. This study was part of the ENERGY project.
A majority of the children reported unfavourable attitudes, preferences and subjective norms regarding soft drink, fruit juice intake and TV viewing accompanied with high availability and accessibility at home. Few children reported unfavourable attitudes and preferences regarding breakfast consumption and PA. Many children reported unfavourable health beliefs regarding breakfast consumption and TV viewing. Substantial differences between countries were observed, especially for variables regarding soft drink intake, breakfast consumption and TV viewing.
We concluded that children across Europe have favourable attitudes to some healthy behaviours (PA, breakfast intake) as well as to some unhealthy behaviours (soft drink consumption, TV viewing). Additionally, many children across Europe have personal beliefs and are exposed to social environments that are not supportive to engagement in healthy behaviours. Moreover, the large differences in personal, family and friend-related variables across Europe argue for implementing different intervention strategies in the different European countries.

Patterns in sedentary behaviour: data reduction issues

Sedentary behaviour may be another risk factor for obesity and cardiometabolic risk. Sedentary lipoprotein lipase activity, leading to a prolonged time in which cellular metabolism substrates are present in the vascular compartments.
behaviour is not the same as the opposite of lack of physical exercise: even people who have enough exercise may sit too much during the rest of the day. Recent evidence suggest that it may be prolonged, uninterrupted sitting -rather than total sitting time- that may increase cardiometabolic risk. Prolonged sitting leads to the loss of contractile stimulation in weight-bearing muscles, which suppresses skeletal muscle
However, measuring sitting time and sedentary patterns is not as straightforward as it may seem. Sedentary behaviour is maybe best measured with accelerometers, however, no consensus is yet established on such accelerometer data most validly reflect sedentary time or sedentary patterns.
In a study just published in PLOS ONE -with Prof. Mai Chin A Paw as first author- we aimed to establish evidence-based accelerometer data reduction criteria to accurately assess total sedentary time and sedentary patterns in children. More than 1000 children in five countries in Europe wore accelerometersfor at least 6 consecutive days. We explored 1) non-wear time criteria; 2) minimum daily valid wear time; 3) differences between weekday and weekend day; and 4) minimum number of days of accelerometer wear by comparing the effects of commonly used data reduction decisions on total sedentary time, and duration and number of prolonged sedentary bouts.
More than 60 consecutive minutes of zero counts was the optimal criterion for non-wear time. Increasing the definition of a valid day from 8 to 10 hours wear time hardly influenced the sedentary outcomes, while the sample size of children with more than 4 valid days increased from 69 to 81%. On weekdays, children had on average 1 hour more wear time, 50 minutes more total sedentary time, 26 minutes more sedentary time accumulated in bouts, and 1 more sedentary bout. At least 6 days of accelerometer data were needed to accurately represent weekly sedentary time and patterns.

No main effect of daily vitamin B-12 and folic acid supplementation on fracture incidence in elderly

Elevated plasma homocysteine concentrations are a risk factor for osteoporotic fractures. Lowering homocysteine with combined vitamin B-12 and folic acid supplementation may reduce fracture risk.
In a paper that just appeared in pre-publication in the American Journal of Clinical Nutrition -with Janneke van Wijngaarden and Karin Swart as the main authors- the methods and results of the B-vitamins for the PRevention Of Osteoporotic Fractures (B-PROOF)] study are presented. The rationale and full description of the design of this study was published in an earlier paper in BMC Geriatrics. This study aimed to determine whether vitamin B-12 and folic acid supplementation reduces osteoporotic fracture incidence in hyperhomocysteinemic elderly individuals.
This was a double-blind, randomized, placebo-controlled trial in 2919 participants aged ≥65 y with elevated homocysteine concentrations. Participants were assigned to receive daily 500 μg vitamin B-12 plus 400 μg folic acid or placebo supplementation for 2 y. Both intervention and placebo tablets
also contained 600 IU vitamin D3.
Osteoporotic fractures occurred in 61 persons (4.2%) in the intervention group and 75 persons (5.1%) in the placebo group. Osteoporotic fracture risk was not significantly different between groups. For persons >80 y, osteoporotic fracture risk appeared to be somewhat lower in the intervention group than in the placebo group. The total number of adverse events (including mortality) did not differ between groups. However, 63 and 42 participants in the intervention and placebo groups, respectively, reported incident cancer.
These data show that combined vitamin B-12 and folic acid supplementation had no effect on osteoporotic fracture incidence in this elderly population. Exploratory subgroup analyses suggest a beneficial effect on osteoporotic fracture prevention in the very old. However, supplement use was also associated with increased incidence of cancer, although the study was not designed for assessing cancer outcomes. Therefore, vitamin B-12 plus folic acid supplementation cannot be recommended at present for fracture prevention in elderly people.

Health related quality of life and survival in patients with head and neck cancer: A systematic review

In a study just published in the journal Oral Oncology -with Annette van Nieuwenhuizen as first author- we systematically reviewed the available scientific evidence on the association between health-related quality of life and survival in patients with head and neck cancer.
Nineteen studies were included in the review. We found strong evidence for a positive association between pre-treatment physical functioning and survival and between change in global quality of life from pre-treatment to 6 months after treatment and survival. I.e. patients with better physical functioning before treatment and with more positive or less negative changes in global quality of life had better survival.

The school nutrition environment in 7 countries in Europe

The school is an important setting for promoting healthy eating especially at the transition from childhood to adolescence. In a study just published in e-pub in the journal Health and Place, with Prof. Nanna Lien as first author, we explored differences in school nutrition environment factors in elementary schools across seven countries in Europe. A secondary aim was to explore whether any of these school nutrition environment factors were associated with soft drink consumption of young adolescents.  With questionnaires administered by school staff and management and by audits -i.e. direct systematic observations of the school food environment by our researchers- the school food environment was assessed. We looked at such issues as availability and accessibility of foods, rules and regulations regarding food and eating, and role modelling and actual teaching regarding healthy eating by school staff. A large variety of food policy and practices influencing the school food and nutrition environment were found within and between countries across Europe. However, only very few significant association with  the pupils׳ soft drink consumption were found.

Do children and parents agree on parenting practices regarding dietary, physical activity and sedentary behaviours?

Parents and their parenting practices play an important role in shaping their children's dietary and physical activity behaviours and the home environment where these behaviours develop and take place. Measurement of such parenting practices can be based on parent- or child reports, but parents and children may not necessarily agree on how they experience and report such parenting practices. In a study just published in pre-pub in the journal BMC Public Health we aimed to assess agreement between parent and child reports on parental practices regarding such lifestyle behaviours that contribute to energy balance, and risk for overweight and obesity.
We used the data from the ENERGY-project, in which a cross-sectional survey was conducted among 10-12 year old children and their parents in eight European countries. Both children and parents filled in a questionnaire on 14 parental practices regarding five different behaviours (i.e. soft drink, fruit juice and breakfast consumption, sports activity and watching TV) and socio-demographic characteristics. Children's weight, height, and waist circumference were measured at school. We calculated percentages of agreement between children and their parents and kappa statistics per practice and country and assessed factors associated with agreement using multilevel linear regression. Reports of 6425 children and their parents were available for analysis. Overall mean agreement between parent and child reports was 43% and varied little among countries. The lowest agreement was found for questions assessing joint parent-child activities, such as sports or watching TV, and for parental allowance of the child to have soft drinks, or to watch TV. In general, agreement was lower for boys, younger children, younger parents, parents with less than 14 years of education, single parents, and parents who had higher BMI's.
Parents and children thus perceive parental practices regarding dietary, physical activity and sedentary behaviours differently in all parts of Europe, with considerable variation across specific practices and countries.

Apps to promote physical activity among adults: a review and content analysis

Apps for smart phones and tablets are also used for promotion of health behaviors, including promotion opf phyiscal activity. In May 2013, the iTunes and Google Play stores respectively contained 23,490 and 17,756 apps categorized as Health and Fitness, respectively. It is, however, unclear if these apps are of good enough quality to make a difference. In a paper just published in preliminary form in the International Journal of Behavioral Nutrition and Physical Activity -with Anouk Middelweerd as first author - we reviewed a selection of these apps on to what extend these apps made use of evidence-based, established behavior change techniques. Sixty-four apps were downloaded, reviewed, and rated based on the taxonomy of behavior change techniques used in the interventions as proposed by Abraham and Michie. Mean and ranges were calculated for the number of observed behavior change techniques. Using nonparametric tests, we compared the number of techniques observed in free and paid apps and in iTunes and Google Play.On average, the reviewed apps included 5 behavior change techniques (range 2-8). Techniques such as self-monitoring, providing feedback on performance, and goal-setting were used most frequently, whereas some techniques such as motivational interviewing, stress management, relapse prevention, self-talk, role models, and prompted barrier identification were not. No differences in the number of behavior change techniques between free and paid apps, or between the app stores were found. Our study demonstrated that apps promoting physical activity applied an average 5 out of 23 possible behavior change techniques. This number was not different for paid and free apps or between app stores. The most frequently used behavior change techniques in apps were similar to those most frequently used in other types of physical activity promotion interventions.

Breakfast habits partly mediate differences in overweight according to SES and ethnicity

The purpose of a study just published online in Public Health Nutrition -with Dr. Yannis Manios as first author- was to investigate the associations of parental education, employment, and ethnicity with children's weight status and whether children's breakfast habits mediated differences in overweigh/obesity according to parental education and ethnicity.

As part of the ENERGY study, school-based survey among 10-12-year-old children was conducted in eight European countries. Children's weight and height were measured and breakfast habits and family sociodemographic characteristics were self-reported by 5444 children and their parents. International Obesity Task Force cut-off points were used to categorize children as overweight/obese or normal weight. Mediation analyses were used to test the potential mediating effect of children's breakfast consumption on the associations between family sociodemographic characteristics and children's overweight/obesity.
Children's reported daily breakfast consumption varied from 56 % in Slovenia to 92 % in Spain on weekdays and from 79 % in Greece to 93 % in Norway on weekends. Children of 'native' parents (i.e. parents that were born in the country of questionnaire administration), with both parents employed and with at least one parent having more than 14 years of education were more likely to consume breakfast daily and less likely to be overweight/obese. Mediation analyses revealed that the association of parental nationality and parental educational status with children's overweight/obesity was partially mediated by children's daily breakfast consumption.

Parents and friends both matter for schoolchildren's physical activity and diet

The family, and parents in particular, are considered the most important influencers regarding children's energy-balance related behaviours (EBRBs, i.e. physical activity, sedentary and eating behaviours). When children become older and gain more behavioural autonomy regarding different behaviours, the parental influences may become less important and peer influences may gain importance. In a study just published in the International Journal of Behavioral Nutrition and Physical Activity, we investigated simultaneous and interactive associations of family rules, parent and friend norms and parent and friend modelling with soft drink intake, TV viewing, daily breakfast consumption and sport participation among schoolchildren across Europe. We used the data from the ENERGY cross sectional study. Dr. Saskia te Velde is first author on this paper.
Children reported more unfavourable friend norms and modelling regarding soft drink intake and TV viewing, while they reported more favourable friend and parental norms and modelling for breakfast consumption and physical activity. Perceived friend and parental norms and modelling were significantly positively associated with soft drink intake, breakfast consumption, physical activity and TV time. Across the different behaviours, ten significant interactions between parental and friend influencing variables were found and suggested a weaker association of friend norms and modelling when parental rules were in place.
In conclusion: parental and friends norm and modelling are associated with schoolchildren's energy balance-related behaviours. Having family rules and  favourable parental modelling and norms seems to reduce the potential unfavourable influences of friends on EBRBs.

Increases in BMI, waist circumference and skin folds in Dutch teenagers between 2003 and 2011

In a paper just published in the journal Pediatric Obesity we compared anthropometrics of 12- to 14-year-old Dutch adolescents attending lower levels of education in 2011 with adolescents measured in 2003. Femke van Nassau is first author on this paper. We measured adolescents' body height and weight, skin-fold thickness, and waist circumference in 2003 among 1000 youngsters and in 2011 among 1898.
In boys, prevalence of overweight, waist circumference, triceps, biceps and subscapular skin-folds were significantly higher in 2011. This was also true for girls, except for the subscapular skin-fold. These data confirm that -despite the fact that Dutch youngsters are less likely to be overweight than in many other countries - Dutch adolescents have been getting bigger and fatter.

Determinants of exercise adherence and maintenance among cancer survivors: a systematic review

There is better and better evidence that exercise and physical activity is of utmost importance for health and quality of life for cancer survivors. Special exercise and physical activity-based cancer rehabilitation programs are therefore developed, tested and implemented. For such an exercise intervention to be successful, it is -evidently- important that cancer survivors adhere to the prescribed program. To be able to improve adherence and thus the effects of cancer rehabilitation, insights into the factors that may determine adherence to such programs is important. In a paper just published in the International Journal of Behavioral Nutrition and Physical Activity -with Caroline Kampshoff as first author- we aimed to systematically review determinants of exercise adherence and maintenance in cancer survivors. This review was part of the A-CaRe (Alpe D'Huzes Cancer Rehabilitation) research program Eighteen studies were reviewed in which a range of potential determinants of adherence were studied, but only very few of these potential determinants were supported by the available evidence. We found moderate evidence for a positive association between exercise history and exercise adherence, i.e. that patients who already were physically active before becoming a cancer patient, were more likely to adhere to exercise programs. Inconsistent findings were found for age, gender and education as well as for psychological factors such as stage of change, perceived behavioral control, self-efficacy, extraversion, attitude, intention, fatigue, and quality of life, and physical factors including cardiovascular fitness, body mass index, and baseline physical activity.

Interactive-Technology Health Behavior Promotion Program for Heart Failure Patients

In a paper just published in Journal of Medical Internet Research -Research Protocols- (with Rony Calo as first author), we describe a pilot study to explore the use of interactive technology to promote heart failure (HF) patients’ engagement in physical activity (PA) and adherence to medication. This IT-based interventions, called Motivate4Change, is a program for delivery in the hospital setting, and the development was guided by the Intervention Mapping protocol. The study is a collaboration between researchers from the EMGO Institute for Health & Care Research and Philips Research.

We used observations at a hospital in the United Kingdom and semistructured interviews with hospitalized HF patients and HF nurses following their completion of Motivate4Change. Results demonstrated that patient needs included empathic and contextual content, interactive learning, and support from others, including nurses and family members. The nurse needs included integration in current educational practices and finding opportunities for provision of the program.

Schoolchildren from lower educated parents and minority groups have less positive home environments and believes regarding energy balance behaviours

To explore differences in personal and home environmental factors that are regarded as determinants of energy balance-related behaviours (i.e. physical activity, sedentary and dietary behaviours; EBRBs) according to parental education and ethnic background among 10-12 year old schoolchildren across Europe, the data from the cross sectional study of the ENERGY project were analysed (also see the ENERGY website). The results of these analyses were just published in BMC Public Health.
A school-based survey among 10-12 year olds was conducted in eight countries across Europe. A range of personal and home environment variables relevant for soft drink consumption, daily breakfast, sport participation and TV time was assessed by means of child report. Personal factors included attitude, health beliefs, and preference/liking. Home environment factors included parental subjective norm, modeling, support, practices and home availability. Children were classified based on parental education (i.e., low vs. high) and ethnic background (i.e., native vs. non-native). Data from 6018 children in the eight countries were included in the analyses.
Our analyses analyses showed that the majority of the variables tested -and especially home environment variables- were more favorable among children from higher educated parents and from native ethnicity. None of the personal and home environment factors was found to be more favorable among children from lower educated parents or non-native ethnicity.

hand hygiene promotion contributes to a reduced infection rate among very low-birth weight infants

Hand hygiene in hospital settings is needed to reduce hospital infections. Adequate hand hygiene is seen as the most important intervention to prevent nosocomial infections. Compliance with hand hygiene protocols needs continuous promotion and facilitation. In a paper just published in the American Journal of Infection Control, with Dr. Onno Helder as first author, we describe a study of the effectiveness of sequential hand hygiene promotion among hospital workers in an intensive care unit in a children's hospital.
We conducted an observational study with an interrupted time series analysis of the occurrence of nosocomial bloodstream infections (NBSIs) among very low-birth weight (VLBW) infants. Interventions consisted of an education program, gain-framed (i.e. the positive effects of hand hygiene was communicated) screen saver messages, and an infection prevention week with an introduction on consistent glove use.
Almost 2,000 VLBW infants were studied admitted between 2002 and  2011. The proportion of infants with ≥1 NBSI decreased from 47.6%-21.2%; the number of NBSIs per 1,000 patient days decreased from 16.8-8.9. Pre-
intervention, the number of NBSIs significantly increased, while after the first intervention a significantly declining trend in NBSIs was observed, which stayed at this lower level during the sequential interventions.
We concluded that continuous sequential hand hygiene promotion contributes to a sustained low NBSI rate.

Successful DEDIPAC full consortium meeting

Yesterday and today the first full consortium meeting of the determinants of diet and physical activity knowledge hub (DEDIPAC) was held. On Thursday a plenary program informed the 175 DEDIPAC partners who had come to Amsterdam for this meeting about the progress made so far and were further inspired by short keynote speeches on ambulatory assessment of physical activity, sedentary and dietary behaviour and their determinants by Ulrich Ebner-Priemer, the president of the society for ambulatory assessment, on a paradigm shift in research on determinants towards systems-models of health behaviour change, by Stef Kremers, and on the INFORMAS framework for food environment and policy monitoring and benchmarking by Stefanie Vandervijvere. On the Thursday afternoon and Friday a series of workshops were conducted to further the work on DEDIPAC's three thematic areas, i.e. harmonisation of measurement and monitoring of diet, physical activity, sedentary behaviour and their determinants, gaining further insights in multilevel determinants of these behaviours, and evaluation of multilevel interventions and policies to promote and facilitate healthier diets, more physical activity and less sedentariness.

DEDIPAC website launched

The DEterminants of DIet and Physical Activity knowledge hub is the first joint action of the European Joint Programming Initiative for a Healthy Diet for a Healthy Life in Europe. The DEDIPAC KH is a multidisciplinary consortium of scientists from 46 research centres in 12 countries across Europe. The main objective of DEDIPAC is to understand the determinants of dietary, physical activity and sedentary behaviours and to translate this knowledge into a more effective promotion of a healthy diet and physical activity. DEDIPAC is now underway for a few months, and next week the firts full consortium meeting will be held in Amsterdam, at the EMGO Institute for Health and Care Research of the VU University and its medical center. The website for DEDIPAC was launched this week in preparation of the meeting.

Correlates of Active and Non-Active Gaming Among Dutch Adolescents

Playing video games contributes substantially to sedentary behavior in youth. A new generation of video games—active games—may be an alternative to such sedentary games to promote physical activity and reduce sedentary behavior. In order to promote active gaming, insight is needed in the correlates and potential determinants of such active gaming. In a paper just published in the e-journal JMIR serious games, with Monique Simons as first author, we reported the results of a survey among Dutch 12-16 y old youth to examine personal, social, and game-related correlates of both active and non-active gaming in adolescents.
Active gaming was significantly associated with a more positive attitude toward active gaming , a less positive attitude toward non-active games, more habitual gaming and having siblings and friends  who spend more time on active gaming, and a somewhat lower game engagement. Non-active gaming  was significantly associated with a more positive attitude toward non-active gaming, a stronger habit regarding gaming , having friends who spend more time on non-active gaming , and a more positive image of a non-active gamer.

Active video games as a tool to prevent excessive weight gain in adolescents: rationale, design and methods of a randomized controlled trial

Excessive body weight, low physical activity and excessive sedentary time in youth are major public health concerns. A new generation of video games, the ones that require physical activity to play the games -i.e. active games- may be a promising alternative to traditional non-active games to promote physical activity and reduce sedentary behaviours in youth. In a paper just published in the open access e-journal BMC Public Health, with Monique Simons as first author, we describe the design of a study evaluating the effects of a family oriented active game intervention. The study is a randomized controlled trial (RCT), with  adolescents aged 12 - 16 years old who spend much time in non-active gaming activities. The intervention is that they are provided with active game consoles, and active games as well as information and encouragements to promote use of console and games, and to exchange passive gaming for active gaming. We look at changes in body weight and composition and changes in physical activity, sedentary and dietary behaviours. In addition, a process evaluation is conducted, assessing the sustainability of the active games, enjoyment et cetera.

Obesogenic environments: a systematic review

Our 'physical' environment- i.e. the availability and accessibility of opportunities to be physically active and eat healthy foods- may be of influence on our odds to become overweight or not. E.g. in an environment that offers many opportunities for physical activity, and in which the health food choice is the default food choice the risk of gaining unnecessary weight may be slimmer than in a car friendly and fast food environment. Understanding which aspects of this physical environment may be of influence on adult obesity is thus important for public health and urban planning. We have conducted an updated review of the scientific literature on associations of physical environmental factors with adult weight status, in which we have explicitly taken the methodological quality of the reviewed studies into account. This study was just published online in BMC Public Health. Joreintje Mackenbach was first authors on this paper, and the study was part of the European Commission-funded SPOTLIGHT project. Based on the available scientific literature, urban sprawl and land use mix are consistently associated with weight status. However this available evidence is based on North American studies only.

Measured sedentary time and physical activity during the school day

In a study just published online in the Journal of Science and Medicine in Sport, with Dr. Maartje van Stralen as first author, we investigated the time devoted to sedentary and physical activities during school hours in five European countries and to examine differences according to country, sex, ethnicity, parental education and weight status. The study was part of the ENERGY project. More than 1000 10-12 y old primary schoolchildren in Belgium, Greece, Hungary, the Netherlands, and Switzerland wore accelerometers for at least six consecutive days. Only weekdays were used for this study to calculate the percentages of school-time spent in sedentary activities and moderate to vigorous intensity activity.
European schoolchildren spent on average 65% of their time at school in sedentary activities and 5% on moderate to vigorous intensity activities, with small differences between countries. Girls spent somewhat more school-time in sedentary activities than boys, and spent less time in moderate to vigorous intensity activities. Overweight children spent significantly less time in moderate to vigorous intensity activities than normal weight children. Parental education or ethnicity were not associated with time spent in sedentary or physical activities. European schoolchildren thus spend a small amount of their school-time in moderate to vigorous intensity activities and a large amount in sedentary activities, with small but significant differences across countries.

Differences between youth in Turkey and from Turkish origin in the Netherlands in body weight, diet and physical activity

In the Netherlands, a fair number of people are from Turkish origin. In a paper just published in e-pub in the journal Public Health Nutrition, in a collaboration between Turkish and Dutch researchers, we compared measures of body weight and fat distribution as well as dietary, physical activity and sedentary behaviors between Turkish adolescents in Turkey (TR-TR) and adolescents from Turkish immigrant ethnicity in the Netherlands (TR-NL). We compared data on TR_NL from six Dutch school-based studies with data from a cross-sectional survey conducted in Turkey. This enabled us to compare data from 915 TR-TR adolescents to  data from 433 TR-NL adolescents. We looked at self-reported sugar-containing beverage (soft drinks, fruit juices et cetera) consumption, fruit and vegetable intake, screen (TV and PC) time, physical activity, measured body height and weight, BMI, waist and hip circumferences, and skinfold thicknesses.
Our results showed that more TR-NL adolescents were overweight (31 % v. 26 %) and obese (9 % v. 6 %) and had significantly higher mean BMI, waist circumference and skinfold thickness  than TR-TR adolescents. TR-NL had higher sugared drinks intakes (1173 v. 115 ml/d), ate less fruits and vegetables (295 v. 647 g/d), less screen time (253 v. 467 min/d) and higher physical activity levels (61 v. 27 min/d) than TR-TR adolescents.
Adolescents from Turkish ethnicity in the Netherlands were thus more often overweight and had a less favorable dietary pattern than their peers in Turkey, while their physical activity and screen time patterns were more favorable. These results suggest that adolescents from Turkish immigrant ethnicity in the Netherlands have adopted lifestyles more similar to the Dutch.

Neighborhood social capital and sports participation in youth

In a study just published online in pre-pub in the journal Social Science and Medicine, with Dr. Rick Prins as first author, we explored the role of neighborhood social capital as a relevant factor for sports participation in youth. We studied if such social capital interacted with individual level determinants of participation in sports, such as attitudes towards doing sports, perceived behavioral control and intentions. The study used data from the YouRAction trial investigating the effects of computer-tailored feedback and advice to promote physical activity among adolescents. Self-administered questionnaires were used to learn the adolescents' frequency of sports participation, perceived neighbourhood social capital, cognitions (attitude, subjective norm, perceived behavioural control and intention toward sport participation) and demographics. Ecometric methods were used to aggregate perceived neighbourhood social capital to the neighborhood level. We found that adolescents who experienced positive social capital in their neighborhood were more than 5 times as likely to comply with the so-called 'fit norm', i.e. participating in sports for at least three times per week. Moreover, neighborhood social capital moderated the association of attitude, perceived behavioural control and intention with fit norm compliance: the associations of these cognitions with fit norm compliance were stronger in case of more neighborhood social capital, suggesting that the 'effect' of these attitudes and intentions was stronger in case of more social capital.