OBJECTIVES: The Health-promotion through Obesity Prevention across Europe (HOPE) project aims to bring the European scientific knowledge on overweight, obesity and their determinants together and use the expertise of researchers across Europe to contribute to tackling the obesity epidemic. DESIGN/SUBJECTS/RESULTS: This special issue of Public Health Nutrition presents important results from one of the work packages of the HOPE project that aims at gaining and integrating knowledge on the determinants of nutrition, physical activity and obesity among schoolchildren and adolescents (aged 10-18 years) in different European regions. It includes contributions from Northern Europe (Norway), Central and Eastern Europe (Germany, Poland and the Czech Republic), Southern Europe (Greece) and Western Europe (Belgium and The Netherlands), as well as an overview of the availability of good-quality data on prevalence rates and trends in overweight (including obesity) among adolescents in European Union (EU) countries. The studies that are included report prevalence differences, data on relevant nutrition and physical activity behaviours, as well as potential physical and environmental behavioural determinants. CONCLUSION: These papers provide further evidence on differences in obesity and overweight prevalence among different EU regions and countries, and contribute to the further exploration of risk factors that may or should be addressed in obesity prevention efforts for school-aged children and adolescents in EU countries.
BACKGROUND/AIMS: An adequate fruit and vegetable intake provides essential nutrients and nutritive compounds and is considered an important part of a healthy lifestyle. No simple instrument has been available for the assessment of fruit and vegetable intake as well as its determinants in school-aged children applicable in different European countries. Within the Pro Children Project, such an instrument has been developed. This paper describes the cross-sectional survey in 11-year-olds in 9 countries. METHODS: The cross-sectional survey used nationally, and in 2 countries regionally, representative samples of schools and classes. The questionnaires, including a precoded 24-hour recall component and a food frequency part, were completed in the classroom. Data were treated using common syntax files for portion sizes and for merging of vegetable types into four subgroups. RESULTS: The results show that the fruit and vegetable intake in amounts and choice were highly diverse in the 9 participating countries. Vegetable intake was in general lower than fruit intake, boys consumed less fruit and vegetables than girls did. The highest total intake according to the 24-hour recall was found in Austria and Portugal, the lowest in Spain and Iceland. CONCLUSION: The fruit and vegetable intake in 11-year-old children was in all countries far from reaching population goals and food-based dietary guidelines on national and international levels.
OBJECTIVE: To describe and compare fruit and vegetable intakes of mothers of 11-year-old children across Europe. METHODS: Cross-sectional surveys were carried out in 9 European countries in October/November 2003. Self-administered questionnaires assessing fruit and vegetable consumption were used for data collection. The current paper presents dietary intake data obtained by a precoded 24-hour recall and a food frequency questionnaire. RESULTS: The consumption levels of fruit and vegetables (without fruit juice) were in line with World Health Organization recommendations of > or =400 g/day for only 27% of all participating mothers. Based on both instruments, the Pro Children results showed comparatively high average fruit intake levels in Portugal, Denmark and Sweden (211, 203 and 194 g/day) and the lowest intake in Iceland (97 g/day). High vegetable intake levels were found in Portugal and Belgium (169 and 150 g/day), the lowest in Spain (88 g/day). A south-north gradient could not be observed in the Pro Children study. CONCLUSION: Fruit and vegetable intakes are low in mothers of 11-year-olds across Europe. Especially vegetable consumption can be regarded as marginal in most of the studied European countries. A high percentage of mothers indicated to eat fruit and vegetables less than once a day. The results have shown that national and international interventions are necessary to promote fruit and especially vegetable consumption in the European population of mothers.
The aim was to investigate which individual and family environmental factors are related to television and computer time separately in 10- to-12-year-old children within and across five European countries (Belgium, Germany, Greece, Hungary, Norway).
Data were used from the ENERGY-project. Children and one of their parents completed a questionnaire, including questions on screen time behaviours and related individual and family environmental factors. Family environmental factors included social, political, economic and physical environmental factors. Complete data were obtained from 2022 child-parent dyads (53.8 % girls, mean child age 11.2 ± 0.8 years; mean parental age 40.5 ± 5.1 years). To examine the association between individual and family environmental factors (i.e. independent variables) and television/computer time (i.e. dependent variables) in each country, multilevel regression analyses were performed using MLwiN 2.22, adjusting for children's sex and age.
In all countries, children reported more television and/or computer time, if children and their parents thought that the maximum recommended level for watching television and/or using the computer was higher and if children had a higher preference for television watching and/or computer use and a lower self-efficacy to control television watching and/or computer use. Most physical and economic environmental variables were not significantly associated with television or computer time. Slightly more individual factors were related to children's computer time and more parental social environmental factors to children's television time. We also found different correlates across countries: parental co-participation in television watching was significantly positively associated with children's television time in all countries, except for Greece. A higher level of parental television and computer time was only associated with a higher level of children's television and computer time in Hungary. Having rules regarding children's television time was related to less television time in all countries, except for Belgium and Norway.
Most evidence was found for an association between screen time and individual and parental social environmental factors, which means that future interventions aiming to reduce screen time should focus on children's individual beliefs and habits as well parental social factors. As we identified some different correlates for television and computer time and across countries, cross-European interventions could make small adaptations per specific screen time activity and lay different emphases per country.
Cites: Int J Epidemiol. 2012 Oct;41(5):1460-7123045206
Abstract Objective. The objective of the present study was to assess the longitudinal association between cycling to school and weight status in two cities where cycling to school is common - Kristiansand (Norway) and Rotterdam (The Netherlands). Methods. Data from two studies ENDORSE (Rotterdam) and YOUTH IN BALANCE (Kristiansand) were used. Both studies were longitudinal with two years between time (T) 1 and T2 measurements, and with mean age at T1 of 13.2 and 13.4 years, respectively. The sample was categorized into the following groups according to responses about main mode of commuting to school at the two time points: NO cycling, STARTED cycling, STOPPED cycling and CONTINUED cycling. Measured weight and height were obtained at both time points, and weight status (overweight vs. not overweight) was calculated using international classification criteria for BMI. The two datasets were analyzed separately and together. Results. In multilevel logistic regression models of the combined sample, adjusting for weight status at Time 1, those who stopped cycling had greater odds of being overweight at T2 (OR = 3.19; 95% CI = 1.41-7.24) while those continued cycling had lower odds of being overweight (OR = 0.44; 95% CI = 0.21-0.88), separately compared to the other three groups together. The same trend was observed in both study samples. Conclusions. This study shows that there are longitudinal associations between cycling to school and weight status in two cities where cycling to school is common, implying that interventions aiming at reducing overweight/obesity among adolescents might consider the promotion of sustained cycling behaviour.
To explore mediators of gender and educational differences in sugarsweetened soft drinks consumption (SDC) and whether gender and level of future education moderate the associations of accessibility, modelling, attitudes and preferences with SDC.
A cross-sectional school-based survey within the Fruits and Vegetables Makes the Marks (FVMM) project from 2005.
The questionnaires were completed by the pupils in the classroom guided by a trained project worker during one class session. The questionnaire included questions on SDC (times/week), the potential mediators and moderators. Multilevel linear regression models were used to calculate the mediating and moderating effects.
A total of 2870 children in 9th and 10th grade (mean age 15?5 years) at thirty-three Norwegian secondary schools were included in the present study.
Girls (B521?06) and pupils planning higher education (B520?69) reported lower frequency of SDC. The strongest mediators were accessibility and modelling for future educational plans differences (explaining alone respectively 69% and 44 %) and attitudes and preferences for gender differences (explaining were found, and all associations between the mediators and SDC were in the same direction for both genders and for those with and without plans of higher future education.
Preferences and modelling may contribute to gender and educational differences in SDC. The small moderating effects indicate that interventions aiming to reduce SDC can target the same mediators for boys and girls and children planning different levels of future education.
BACKGROUND/AIMS: The importance of careful theory-based intervention planning is recognized for fruit and vegetable promotion. This paper describes the application of the Intervention Mapping (IM) protocol to develop the Pro Children intervention to promote consumption of fruit and vegetable among 10- to 13-year-old schoolchildren. METHODS: Based on a needs assessment, promotion of intake of fruit and vegetable was split into performance objectives and related personal, social and environmental determinants. Crossing the performance objectives with related important and changeable determinants resulted in a matrix of learning and change objectives for which appropriate educational strategies were identified. Theoretically similar but culturally relevant interventions were designed, implemented and evaluated in Norway, the Netherlands and Spain during 2 school years. RESULTS: Programme activities included provision of fruits and vegetables in the schools, guided classroom activities, computer-tailored feedback and advice for children, and activities to be completed at home with the family. Additionally, optional intervention components for community reinforcement included incorporation of mass media, school health services or grocery stores. School project committees were supported. CONCLUSION: The Pro Children intervention was carefully developed based on the IM protocol that resulted in a comprehensive school-based fruit and vegetable promotion programme, but culturally sensible and locally relevant.
BACKGROUND/AIMS: The Pro Children Project was designed to assess fruit and vegetable consumption in European schoolchildren and their parents, as well as determinants of the children's consumption patterns. A second objective was to develop and test strategies, applicable across Europe, for promoting consumption of fruits and vegetables among schoolchildren and their parents. In this paper, the rationale, theoretical background, overall design and implementation of the project is presented. METHODS: Surveys of national, representative samples of 11-year-old schoolchildren and their parents were conducted in 9 countries, i.e. in Austria, Belgium, Denmark, Iceland, the Netherlands, Norway, Portugal, Spain and Sweden. Comprehensive school-based educational programmes have been developed and tested in three settings, i.e. in Spain, the Netherlands and in Norway. A precoded 24-hour recall form combined with a set of food frequency questions assessing regular intake were used to assess fruit and vegetable consumption. Determinants were assessed employing a comprehensive theoretical framework including personal, social and environmental factors related to fruit and vegetable consumption. The intervention programmes have been tested employing a group-randomized trial design where schools have been randomly allocated to an intervention arm and a delayed intervention arm. Surveys among all participating children and their parents were conducted prior to the initiation of the intervention, immediately after the end of the intervention and at the end of the subsequent school year. CONCLUSION: The project is expected to provide new information of great importance for improving our understanding of consumption patterns of fruits and vegetables and for guiding future efforts to promote increased consumption patterns across Europe.
The objective of this study was to pool, harmonise and re-analyse national accelerometer data from adults in four European countries in order to describe population levels of sedentary time and physical inactivity.
Five cross-sectional studies were included from England, Portugal, Norway and Sweden. ActiGraph accelerometer count data were centrally processed using the same algorithms. Multivariable logistic regression analyses were conducted to study the associations of sedentary time and physical inactivity with sex, age, weight status and educational level, in both the pooled sample and the separate study samples.
Data from 9509 participants were used. On average, participants were sedentary for 530 min/day, and accumulated 36 min/day of moderate to vigorous intensity physical activity. Twenty-three percent accumulated more than 10 h of sedentary time/day, and 72% did not meet the physical activity recommendations. Nine percent of all participants were classified as high sedentary and low active. Participants from Norway showed the highest levels of sedentary time, while participants from England were the least physically active. Age and weight status were positively associated with sedentary time and not meeting the physical activity recommendations. Men and higher-educated people were more likely to be highly sedentary, while women and lower-educated people were more likely to be inactive.
We found high levels of sedentary time and physical inactivity in four European countries. Older people and obese people were most likely to display these behaviours and thus deserve special attention in interventions and policy planning. In order to monitor these behaviours, accelerometer-based cross-European surveillance is recommended.
Cites: Med Sci Sports Exerc. 2010 May;42(5):971-6 PMID 19997000
Cites: Med Sci Sports Exerc. 2014 Jan;46(1):99-106 PMID 23793232
This study systematically reviewed the evidence pertaining to socioeconomic inequalities in different domains of physical activity (PA) by European region.
Studies conducted between January 2000 and December 2010 were identified by a systematic search in Pubmed, Embase, Web of Science, Psychinfo, Sportdiscus, Sociological Abstracts, and Social Service Abstracts. English-language peer-reviewed studies undertaken in the general population of adults (18-65?years) were classified by domain of PA (total, leisure-time including sport, occupational, active transport), indicator of socioeconomic position (education, income, occupation), and European region. Distributions of reported positive, negative, and null associations were evaluated.
A total of 131 studies met the inclusion criteria. Most studies were conducted in Scandinavia (n = 47). Leisure-time PA was the most frequently studied PA outcome (n = 112). Considerable differences in the direction of inequalities were seen for the different domains of PA. Most studies reported that those with high socioeconomic position were more physically active during leisure-time compared to those with low socioeconomic position (68% positive associations for total leisure-time PA, 76% for vigorous leisure-time PA). Occupational PA was more prevalent among the lower socioeconomic groups (63% negative associations). Socioeconomic differences in total PA and active transport PA did not show a consistent pattern (40% and 38% positive associations respectively). Some inequalities differed by European region or socioeconomic indicator, however these differences were not very pronounced.
The direction of socioeconomic inequalities in PA in Europe differed considerably by domain of PA. The contradictory results for total PA may partly be explained by contrasting socioeconomic patterns for leisure-time PA and occupational PA.