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.