Ski tour through Norways highlands

I was away from the office for a bit more than a week for a cross country ski tour from Finse on Hardangervidda to Gjendesheim in Jotenheimen, Norway. About 190 km across rough mountain landscape packed with a good two meters of snow. Very good to exhaust your body and free your mind. And completely unable to keep a neutral energy balance, even On a high calorie diet enriched with Norwegian brown cheese, Marzipan, chocolate, and Moose burgers. Now back to work! Click here for some pictures.

The ENERGY project has started

Today we had the kick off meeting of the Energy project. ENERGY stands for “EuropeaN Energy balance Research to prevent excessive weight Gain among Youth : Theory and evidence-based development and validation of an intervention scheme to promote healthy nutrition and physical activity.”
ENERGY is funded by the European Commission through its 7th framework program, and the EMGO+ Institute coordinates the project, with Amika Singh as project coordinator. Within the ENERGY project 14 partners from 11 countries will work in 11 work packages to use behaviour change theory, existing scientific evidence and original research to build and test a school-based and family-involved intervention scheme to help curb the obesity epidemic among school-aged children. The ENERGY consortium includes experts from the Obesity Related Behaviour Research Group of Durham University, UK, University of Ghent, Belgium, Universities of Oslo and Agder in Norway, Harokopio University in Athens, Greece, and partners from Denmark, Hungary, Slovenia, and Germany. WHO Europe and the European Association for the Study of Obesity are also involved. The ResCon Research company has been subcontracted to help us with the data collection and data management.
Soon the ENERGY website will be launched with more information about the project. I will also report on the progress of the project here. The picture shows the participants of the kick off meeting, and a wise advice from our EU-liasson officer.
Klick here for more pictures.

Processes underlying smoking cessation among adolescents

Today Marloes Kleinjan defended her doctoral thesis on processes underlying smoking cessation among adolescents.
Smoking habits are often initiated in adolescence. Once adolescents have smoked long enough (and that happens sooner rather than later), they are likely to develop dependency symptoms and chances are high that they will continue smoking into adulthood. Marloes Kleinjan’s thesis explores the development of smoking dependence among adolescents, as well as the process of what underlies motivation and actions related to smoking cessation in this important target population.
The Transtheoretical model (TTM), with the ‘stages of change’ as one of its cores, is well known and very popular in health behaviour change research and interventions. The model has been applied to many health behaviours, but it was developed mostly based on smoking cessation research. TTM was initiated by Prochaska and DiClemente, and a stronghold for TTM research is the Cancer Prevention Research Center in Rhode Island. TTM basically posits that health behaviour change occurs in different distinct ‘stages of change’, i.e. precontemplation, contemplation, preparation, action and maintenance. TTM further argues that different processes of change are important and necessary to help people to proceed through the different stages.
In recent years different studies and reviews argued that the validity of the model’s application to other health behaviours such, especially nutrition and physical activity, is rather doubtful, or just not good enough (see for example papers by Emely de Vet et al.).
Research supporting TTM is mostly cross-sectional research. Such studies only provide evidence for associations between for example processes of change and stages of change. These associations can often not be found in longitudinal or experimental studies.
Marloes Kleinjan’s thesis now indicates that we should also be careful in applying TTM to smoking cessation among youth. In different studies, hardly any evidence could be found that supported the hypothesis that distinct process of change are important for distinct stage transitions.

The Ghost Map

John Snow is, of course, well known as one of or maybe the founding father of public health. I have just finished Steven Johnson's book 'The Ghost Map' which reads like a detective story and describes the story of the cholera epidemic that hit Soho, London in 1854 (see a video with an interview with Steve Johnson about his book). The book gives a very lively account of what London must have been like in the years before and the time of the epidemic, and of the 'heroes' of the story, Dr. John Snow and Reverend Henry Whitehead in particular.
The story begins to descibe what led to the epidemic. The over-crowded inner city of London had become one big stink of human waste. The so-called cess pools meant to collect human waste, and supposed to be regularly emptied and the waste transported to fertilize the soil surrounding the big city, had become too few, too small, and just insufficient. Therefore, cellars and backyards in London city were filled with raw sewage; London was kind of drowning in its own filth. Johnson very nicely describes how a false theory of causation can lead to disastrous measures to promote public health that have the opposite effect. The miasma theory claimed that cholera was transmitted by air. The basic idea was that the stench from the enourmous collection of human waste was what caused cholera to spread. To contribute to rid the city of this presumed cause of cholera, infected air, London city passed the "Nuisance Removal and Contagious Disease Prevention Act" (Nuisane meaning human waste...) which resulted in using the existing London drainage system to transport human waste from the cess pools, cellars and back yards right into the river Thames; that is, the main source of drinking water for the city.
I think Steven Johnson's book is a very nice and entertaining must-read for people interested in epidemiology and public health. It describes the very start of our interesting field of research and practice. But, even more so, it illustrates what harm can come from bad or insufficient researched theories on public health risks, and how good research can help to set things straight.
Today we are faced with another serious public health problem with probable causes in how we have shaped our physical environment. The present-day obesity epidemic is likely to be partly rooted in what has been called the 'obesogenic environment', an environment that promotes eating energy-dense foods almost always and anywhere, and that discourages and prevents physical activity. However, convincing evidence on what really constitutes this obesogenic environment is mostly lacking. Snow's lesson so nicely described in Johnson's book is that we should be prudent in taking far fetching public health measures before we really know what we are doing. We should conduct the right research first. We aim to contribute to building the evidence-base in the Health promotion through Obesity Prevention across Europe project (HOPE).

Diet and overweight perception among ethnic minorities in the Netherlands

Yesterday Mary Nicolaou defended her doctoral thesis entitled “Diet and overweight perception. An explorative study among Turkish, Moroccan and Surinamese living in the Netherlands.”
People from non-western origin make up about 11% of the Dutch population, but in some age ranges in the larger cities, this is close to 50%. For such a large proporion of the population, we know very little about eating habits and nutrition behavioral determinants. Mary’s thesis research shows that the diet of these population groups is to some extent more healthful than that of native Dutch: more fruits, vegetables and fish, and less red meat. Nevertheless, prevalence of obesity and metabolic disease is higher.
In one of the studies presented in the thesis and to be published in the Journal of Nutrition Education and Behavior, determinants of food choice and eating habits were explored by means of focus group discussions among Dutch residents from Moroccan and Turkish origin. The study indicated that social environmental factors, especially the central role of food in hospitality, firmly rooted in cultural and religious tradition, appeared to be a driver of food habits. The central role of food in the western environment of abundance may be one of the determinants of the higher obesity prevalence. Other studies presented in the thesis appeared in Journal of Human Nutrition and Dietetics, Public Health Nutrition, and Public Health.

International Research on Risk Perception in the Control of Emerging Infectious Diseases

To control new infectious diseases, such as SARS or avian flu, the identification of the organisms, the infectivity, development of vaccines and therapies, contact tracing, isolation and screening are all of great importance. Many of these issues are partly dependent on human behaviours. For example, the success of prevention of infectivity (e.g. engaging in precautionary behaviours such as wearing masks, hand hygiene, isolation etc.), vaccination, contact tracing and population screening are all more or less dependent on whether people at risk comply with behavioural recommendations. Especially in the early phases of a possible epidemic, compliance to precautionary behaviours among the populations at risk is often the only means of prevention of a further spread of the disease. However, very little research has been conducted to explore the determinants of behavioural responses to infectious
disease outbreaks [1, 2].
A special series of the International Journal of Behavioral Medicine is dedicated to this research. This month the first three papers in this series were published ‘on line’ by the International Journal of Behavioral Medicine. Together with my co-authors Drs. Arja Aro and Jan Hendrik Richardus I wrote an introduction to the series.
On February 11, Onno de Zwart, co-director of the municipal health service of the Rotterdam area, will defend his doctoral thesis which further explored the associations between risk perceptions and emerging infectious diseases.

A one day retreat to discuss the strategic agenda for the CaRe research school

On Friday January 23 the annual CaRe ‘retreat’ was held in Maastricht, in conjunction with the annual PhD student days of this research school. CaRe (The Netherlands School of Primary Care Research) was established as a research school and recognized by the Royal Netherlands Academy of Arts and Sciences in 1995. The participating institutes are the School for Public Health and Primary Care (CAPHRI) of Maastricht University, the Centre for Evidence Based Practice (NCEBP) of the University Medical Centre Radboud in Nijmegen, the EMGO Institute for Health and Care Research (EMGO+) of the VU University Medical Center in Amsterdam and the Netherlands Institute for Health Services Research (NIVEL) in Utrecht.
Last Friday the directorates of the participating partners, the Board of CaRe, and a selection of senior researchers met in Maastricht to discuss the school’s mission and strategic priorities.
Led by the CaRe director Prof. Guy Widdershoven, the participants discussed and agreed that CaRe should further develop itself as a ‘network’ and lobby organization, facilitating collaborations, exchange and joint education, master class and expertise development programs, as well as joint actions to stress and endorse the importance of public health and primary care research and development for population health in the Netherlands and abroad. Specific strategic actions were explored that will be further detailed and disseminated to pursue the CaRe agenda.