Brug, J.

Computer screen saver hand hygiene information curbs a negative trend in hand hygiene behavior (Article)

2012-03-13T00:00:00Z

Background: Appropriate hand hygiene among health care workers is the most important infection prevention measure; however, compliance is generally low. Gain-framed messages (ie, messages that emphasize the benefits of hand hygiene rather than the risks of noncompliance) may be most effective, but have not been tested. Methods: The study was conducted in a 27-bed neonatal intensive care unit. We performed an inter- rupted time series analysis of objectively measured hand disinfection events. We used electronic devices in hand alcohol dispensers, which continuously documented the frequency of hand disinfection events. In addition, hand hygiene compliance before and after the intervention period were directly observed. Results: The negative trend in hand hygiene events per patient-day before the intervention (decrease by 2.3 [standard error, 0.5] per week) changed to a significant positive trend (increase of 1.5 [0.5] per week) after the intervention (P < .001). The direct observations confirmed these results, showing a significant improvement in hand hygiene compliance from 193 of 303 (63.6%) observed hand hygiene events at pretest to 201 of 281 (71.5%) at posttest. Conclusions: We conclude that gain-framed messages concerning hand hygiene presented on screen savers may improve hand hygiene compliance.

Associations between availability of facilities within three different neighbourhood buffer sizes and objectively assessed physical activity in adolescents (Article)

2011-11-01T00:00:00Z

This study aims to explore whether objectively measured availability of parks and sports facilities within three different buffer sizes are associated with moderate-to-vigorous physical activity (MVPA) among adolescents, and to identify potential cognitive mediators of this association. Data were obtained from adolescents (N=209, mean age: 14.5 (SD: 0.6) years) at the follow-up measurement of the Children Living in Active Neighbourhoods study in 2004. MVPA was measured using accelerometers. Availability of parks and sport facilities were measured within 400, 800 and 2000. m buffers around participants' residential homes. Potential mediators (self-efficacy, attitude and the perceived availability of parks and sports grounds) were measured by self-administered questionnaires. No direct association was found between the objectively measured availability of facilities and objective assessments of MVPA and no evidence for mediation by cognitions was found in any of the buffer sizes. More specific and sensitive measures may be needed to understand environmental correlates of MVPA.

Biomarker Evaluation Does Not Confirm Efficacy of Computer-tailored Nutrition Education (Article)

2011-09-01T00:00:00Z

Objective: To evaluate the efficacy of computer-tailored nutrition education with objective outcome measures. Design: A 3-group randomized, controlled trial with posttests at 1 and 6 months post-intervention. Setting: Worksites and 2 neighborhoods in the urban area of Rotterdam. Participants: A convenience sample of healthy Dutch adults (n = 442). Interventions: A computer-tailored intervention delivered on CD-ROM; a computer-tailored intervention delivered in print; and a generic information condition. Main Outcome Measures: Blood lipids (total, high-density lipoprotein, and low-density lipoprotein cholesterol, and triacylglycerol) were measured by analyzing venous blood samples. Analysis: Linear mixed model procedure. Results: There were no significant differences among the 3 intervention groups in total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triacylglycerol. Conclusions and Implications: Contrary to results based on self-report data, no effects of the computer-tailored interventions were found based on objective outcomes. This contradiction calls for a critical reflection on the use of computer-tailored nutrition education interventions and the need to improve those interventions. Furthermore, this study indicates that feasible methods are needed to objectively assess the impact of computer-tailored nutrition education interventions in free-living subjects.

Longitudinal associations between cycling to school and weight status (Article)

2011-08-01T00:00:00Z

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 = 1.417.24) while those continued cycling had lower odds of being overweight (OR = 0.44; 95% CI = 0.210.88), 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.

More or better: Do the number and specificity of implementation intentions matter in increasing physical activity? (Article)

2011-07-01T00:00:00Z

Objectives: To examine 1) the specificity and number of implementation intentions people form for increasing physical activity, 2) the relation between motivation and the number and specificity of implementation intentions, and 3) the relation between number and specificity of implementation intentions and physical activity change. Design: Content analyses of implementation intentions and prospective design. Methods: Secondary data analyses on the implementation intentions 342 adults made in a larger randomized controlled trial. Implementation intentions formed at baseline were rated on specificity. BMI, self-concordance and intentions to increase physical activity were assessed at baseline. Physical activity was assessed at baseline and again two weeks later. Results: Respondents formed on average 2.18 (SD = .84) implementation intentions, but over 30% did not form at least one specific implementation intention. Individuals motivated to increase physical activity formed better, but not more implementation intentions. Regardless of their motivation, respondents who formed better implementation intentions were more physically active two weeks later. The number of implementation intentions people formed was not related to physical activity, except when additional implementation intentions were formed with maximal specificity. Conclusions: Forming implementation intentions of maximal specificity is crucial for behaviour change. Implementation intention interventions might become more effective if individuals are trained to form specific implementation intentions, especially to specify 'when to act'.

Do Trends in Physical Activity, Sedentary, and Dietary Behaviors Support Trends in Obesity Prevalence in 2 Border Regions in Texas? (Article)

2011-07-01T00:00:00Z

Objective: The aim of the study was to compare the change in energy balance-related behaviors from 2000-2002 to 2004-2005 between 2 Texas regions with distinct patterns in obesity prevalence (decrease in the El Paso region [EP] and leveling off in the Rio Grande Valley region [RGV]) and to determine the role of the behaviors in the difference in obesity prevalence between the regions. Design: Cross-sectional measurements of the School Physical Activity and Nutrition Study. Setting: Elementary schools. Participants: 3,949 children (9-10 years). Variables Measured: Body mass index (objectively measured) and behaviors (self-assessed). Analysis: Probability and post-stratification weighting procedures and mediation analysis. Results: Compared to students in the RGV, students in the EP experienced a smaller decrease in sports team participation, an increase in regular meal consumption, and an increase in the frequency of milk/yogurt, cereal, sweet snacks, and frozen dessert consumption between measurement periods. Prevalence of frequent television viewing was lower in the EP. The lower body mass index in the EP was associated with regular meal consumption, and higher milk/yogurt and sweet snack consumption. Conclusions and Implications: Improvement of physical activity, sedentary behaviors, and healthful diet, but not unhealthful diet like sweet snack consumption, seem to be related to the decrease in obesity in the EP.

Parental and home influences on adolescents' TV viewing: A mediation analysis (Article)

2011-06-01T00:00:00Z

Objective. To explore the association between home environmental variables and television (TV) time, and the mediating pathways underlying this association. Methods. The current study used data from the longitudinal ENDORSE study. Self-reported data was available for 1 265 adolescents (mean age of 12-15 years at baseline) on home environment (availability of a TV in the bedroom, perceived parental modelling, family rules), potential mediators (intention, attitude, perceived behavioural control, subjective norm towards TV viewing) and TV viewing time. Mediation analyses were conducted using General Estimating Equations and mediation effects were calculated as the product-of-coefficients. Results. Significant overall positive associations were found for the presence of a TV in the bedroom and parental modelling with self-reported TV viewing. Controlling family rules showed an inverse association with reported TV time. Similarly, parental modelling and a TV in the bedroom were significantly positively associated with the Theory of Planned Behaviour variables and habit strength, while family rules showed an inverse association with these potential mediators. In turn, most potential mediators were positively associated with TV viewing. Intention, attitude and habit strength were the strongest mediators in all three associations explaining more than 55% of the overall association. Habit strength alone explained 38.2%-58.0% of the overall associations. Conclusions. Home and family environmental predictors of TV time among adolescents may be strongly mediated by habit strength and other personal factors. Future intervention studies should explore if changes in home and family environments indeed lead to reductions in TV time through these mediators.

A systematic review of environmental factors and obesogenic dietary intakes among adults: Are we getting closer to understanding obesogenic environments? (Article)

2011-05-01T00:00:00Z

This study examined whether physical, social, cultural and economical environmental factors are associated with obesogenic dietary behaviours and overweight/obesity among adults. Literature searches of databases (i.e. PubMed, CSA Illumina, Web of Science, PsychInfo) identified studies examining environmental factors and the consumption of energy, fat, fibre, fruit, vegetables, sugar-sweetened drinks, meal patterns and weight status. Twenty-eight studies were in-scope, the majority (n= 16) were conducted in the USA. Weight status was consistently associated with the food environment; greater accessibility to supermarkets or less access to takeaway outlets were associated with a lower BMI or prevalence of overweight/obesity. However, obesogenic dietary behaviours did not mirror these associations; mixed associations were found between the environment and obesogenic dietary behaviours. Living in a socioeconomically-deprived area was the only environmental factor consistently associated with a number of obesogenic dietary behaviours. Associations between the environment and weight status are more consistent than that seen between the environment and dietary behaviours. The environment may play an important role in the development of overweight/obesity, however the dietary mechanisms that contribute to this remain unclear and the physical activity environment may also play an important role in weight gain, overweight and obesity. © 2010 The Authors. obesity reviews

Interventions for the prevention of overweight and obesity in preschool children: A systematic review of randomized controlled trials (Article)

2011-05-01T00:00:00Z

The objective of this study was to analyse interventions for the prevention of overweight and obesity in children under 5 years of age. We carried out a systematic review focusing exclusively on randomized controlled trials (RCTs). Data sources include Medline, Cochrane Library, EMBASE, CINHAL, PsychInfo and Web of Science. Data were extracted from seventeen articles describing seven RCTs identified through electronic search, screening of references in systematic reviews, own files and contact with authors. RCTs were assessed with the Jadad scale. Four trials were carried out in preschool settings, one with an exclusive educational component, two with an exclusive physical activity component and one with both. Two trials were family-based, with education and counselling for parents and children. The remaining trial was carried out in maternity hospitals, with a training intervention on breastfeeding. None of the interventions had an effect in preventing overweight and obesity. The failure to show an effect may be due to the choice of outcomes, the quality of the RCTs, the suboptimal implementation of the interventions, the lack of focus on social and environmental determinants. More rigorous research is needed on interventions and on social and environmental factors that could impact on lifestyle. © 2010 The Authors. obesity reviews

The association between home environmental variables and soft drink consumption among adolescents. Exploration of mediation by individual cognitions and habit strength (Article)

2011-04-01T00:00:00Z

Soft-drink consumption is one of the important target behaviours for the prevention of excessive weight gain among adolescents. To be able to modify these behaviours in obesity prevention interventions, further understanding of the underlying factors and mediational pathways is required. The present study aimed to explore associations between home environment variables and adolescent soft drink consumption and potential mediation of these associations by individual cognitions derived from the Theory of Planned Behaviour and habit strength. The ENDORSE study (N=1005) provided data on soft drink consumption and on home environment variables related to soft drink consumption (availability, accessibility, parental modelling, and parental rules), cognitive variables (intention, attitude, perceived behaviour control, and parental norm) and habit strength. Multiple mediation analyses were conducted using regression analyses according to the steps described by MacKinnon to assess the association between home environment variables and soft drink consumption and mediation of these associations by cognitive variables and habit strength. The bootstrapping method was used to calculate the confidence intervals. There were significant associations between the home environment variables and soft drink consumption. After inclusion of the mediators the strength of these associations was reduced. In the multiple mediator models, habit strength (39.4-62.6%) and intention (19.1-36.6%) were the strongest mediators. Intention and habit strength partly mediate the associations between home environment factors and soft drink consumption, suggesting that home environment variables influence soft drink consumption both indirectly and directly.

Adolescents risky MP3-player listening and its psychosocial correlates (Article)

2011-04-01T00:00:00Z

Analogue to occupational noise-induced hearing loss, MP3-induced hearing loss may be evolving into a significant social and public health problem. To inform prevention strategies and interventions, this study investigated correlates of adolescents' risky MP3-player listening behavior primarily informed by protection motivation theory. We invited 1687 adolescents (12- to 19-year old) of Dutch secondary schools to complete questionnaires about their MP3-player listening, sociodemographic characteristics and presumed psychosocial determinants of MP3-player listening. Of all participants, 90% reported listening to music through earphones on MP3 players; 28.6% were categorized as listeners at risk for hearing loss due to estimated exposure of 89 dBA for ≥1 hour per day. Compared with listeners not at risk for hearing loss, listeners at risk were more likely not to live with both parents, to experience rewards of listening to high-volume levels, to report a high habit strength related to risky MP3 listening, and were less likely to be motivated to protect their hearing. Habit strength was the strongest correlate of risky listening behavior, suggesting that voluntary behavior change among adolescents might be difficult to achieve and that a multiple strategy approach may be needed to prevent MP3-induced hearing loss.

School-based interventions promoting both physical activity and healthy eating in Europe: A systematic review within the HOPE project (Article)

2011-03-01T00:00:00Z

It is the purpose of this study to systematically review the evidence of school-based interventions targeting dietary and physical activity behaviour in primary (6-12 years old) and secondary school (12-18 years old) children in Europe. Eleven studies (reported in 27 articles) met the inclusion criteria, six in primary school and five in secondary school children. Interventions were evaluated in terms of behavioural determinants, behaviour (diet and physical activity) and weight-related outcomes (body mass index [BMI] or other indicators of obesity). The results suggest that combining educational and environmental components that focus on both sides of the energy balance give better and more relevant effects. Furthermore, computer-tailored personalized education in the classroom showed better results than a generic classroom curriculum. Environmental interventions might include organized physical activities during breaks, or before and after school; improved availability of physical activity opportunities in and around the school environment; increased physical education lesson time; improved availability or accessibility of healthy food options; and restricted availability and accessibility of unhealthy food options. More high-quality studies are needed to assess obesity-related interventions in Europe.

Strategies to facilitate exposure to internet-delivered health behavior change interventions aimed at adolescents or young adults: A systematic review (Article)

2011-02-01T00:00:00Z

The Internet is considered to be a promising delivery channel of interventions aimed at promoting healthful behaviors, especially for adolescents and young adults. Exposure to these interventions, however, is generally low. A more extensive exploration of methods, strategies, and their effectiveness with regard to facilitating exposure is therefore timely, because this knowledge is crucial to improve the use of such interventions and, subsequently, to increase behavioral change. Therefore, a systematic review of the literature was conducted, resulting in 838 studies based on title selection, of which 26 studies met the eligibility criteria. The systematic review resulted in an overview of methods and strategies that have been used to facilitate exposure. Patterns of effective strategies could be observed, such as the combination of tailored communication and the use of reminders and incentives. Nevertheless, exposure-specific theories need to be developed and objective exposure measures should be tracked and reported in future studies.

The association between cycling to school and being overweight in Rotterdam (The Netherlands) and Kristiansand (Norway) (Article)

2011-02-01T00:00:00Z

Active transportation is a behavior that might contribute to energy balance. However, no clear association between active commuting to school and weight status has been reported in the international literature. Also, new studies indicate that cycling to school might have a greater health potential than walking to school. The purpose of the present study is to assess the potential association between cycling to school and weight status in two European cities, Rotterdam and Kristiansand, where cycling to school remains common. Data from two studies, ENDORSE (Rotterdam) and Youth in Balance (Kristiansand), were used including, respectively, 1361 and 1197 adolescents with mean ages of 14.1 and 14.4 years. The adolescents were categorized as cyclist or non-cyclist based on questionnaires on the usual mode of transportation to school. A total of 25% and 18% were categorized as overweight, and 35% and 31% were categorized as cyclists, in Rotterdam and Kristiansand, respectively. In multilevel logistic analyses, after adjusting for potential moderators, the odds ratios for cyclists being overweight compared with non-cyclists were, respectively, 0.63 (95% CI=0.45-0.89) and 0.52 (95% CI=0.34-0.78) in Rotterdam and Kristiansand. The results presented clearly show a negative association between cycling to school and overweight among adolescents both in Rotterdam and in Kristiansand.

Which intervention characteristics are related to more exposure to internet-delivered healthy lifestyle promotion interventions? A systematic review (Article)

2011-01-01T00:00:00Z

Background: The Internet has become a popular medium for the delivery of tailored healthy lifestyle promoting interventions. The actual reach of Internet-delivered interventions seems, however, lower than expected, and attrition from interventions is generally high. Characteristics of an intervention, such as personally tailored feedback and goal setting, are thought to be among the important factors related to of use of and exposure to interventions. However, there is no systematic overview of which characteristics of Internet-delivered interventions may be related to more exposure. Objective: The present study aims to identify (1) which potentially exposure-promoting methods and strategies are used in existing Internet interventions, (2) which objective outcome measures are used to measure exposure to Internet interventions, and (3) which potentially exposure-promoting methods and strategies are associated with better exposure. Methods: A systematic review of the literature was conducted based on the Cochrane guidelines. Papers published between 1995 and 2009 were searched in the PubMed, PsycINFO, and Web of Science databases. In total, 64 studies were included that reported objective exposure measures such as completion of an initial visit, number of log-ins, and time spent on the website. Information about intervention-related characteristics (ie, interactive behavior change strategies, interactive elements for fun, peer or counsel support, email/phone contact, and regular updates of the website) that could potentially contribute to better exposure and objective exposure outcomes were abstracted from the studies and qualitative systematic descriptive analyses were performed. Results: The results showed that a large variety of behavior change techniques and other exposure-promoting elements were used in the interventions and that these methods and strategies varied for the various lifestyle behaviors. Feedback, interactive elements, and email/phone contact were used most often. In addition, there was much variety and a lack of consistency in the exposure measures that were reported. Of all the categories of intervention characteristics that may be associated with better exposure, there were indications that peer and counselor support result in a longer website visit and that email/phone contact and updates of the website result in more log-ins. Conclusions: Results of this qualitative systematic review indicate that of all intervention characteristics that could potentially enhance exposure, only peer support, counselor support, email/phone contact with visitors, and updates of the intervention website were related to better exposure. The diversity of intervention methods used and the inconsistency in the report of exposure measures prevented us from drawing firmer conclusions. More research is needed to identify whether other characteristics of Internet interventions are associated with greater exposure.

The effects of a fruit and vegetable promotion intervention on unhealthy snacks during mid-morning school breaks: Results of the Dutch Schoolgruiten Project (Article)

2010-12-01T00:00:00Z

Background: Ample fruit and vegetable (F&V) intake has been associated with a decreased risk of chronic disease. The health-enhancing effects of increased F&V consumption, however, would be even more apparent if the increased F&V consumption additionally led to a lower intake of unhealthy, high calorie snacks. Therefore, the present study aimed to investigate whether a primary school-based intervention (the Dutch Schoolgruiten Project) that promoted F&V intake could additionally reduce the intake of unhealthy, high calorie snacks during school breaks.Methods: The study applied a longitudinal design with baseline and two follow-up measurements. Children were aged 9-10 years old at baseline; 705 children were included. The main strategy was a F&V scheme that improved the availability, accessibility and exposure to F&V at school by providing one serving of fruit or vegetables twice a week at no cost. The amounts of F&V and unhealthy snacks for consumption at school were measured using a single-item question included in a questionnaire. Multilevel autoregressive logistic regression models with a three-level structure (school, child and time) were used to assess the effect of the intervention on both F&V and unhealthy snack consumption.Results: The children of the intervention group brought F&V from home to school at follow-up significantly more often than the children of the control schools [odds ratio (OR) = 1.41, 95% confidence interval (CI) = 1.04; 1.90] and brought fewer unhealthy snacks (OR = 0.56, 95% CI = 0.34; 0.92).Conclusion: The present study provides some evidence that the Schoolgruiten intervention effect on F&V intake also reduced unhealthy snacking during school breaks. @ 2010 The Authors. Journal compilation @ 2010 The British Dietetic Association Ltd.

The impact of an education program on hand hygiene compliance and nosocomial infection incidence in an urban Neonatal Intensive Care Unit: An intervention study with before and after comparison (Article)

2010-10-01T00:00:00Z

Background: Nosocomial bloodstream infections are a major cause of morbidity and mortality in neonatal intensive care units. Appropriate hand hygiene is singled out as the most important measure in preventing these infections. However, hand hygiene compliance among healthcare professionals remains low despite the well-known effect on infection reduction. Objectives: We studied the effectiveness of a hand hygiene education program on the incidence of nosocomial bloodstream infections. Design: Observational study with two pretests and two posttest measurements and interrupted time series analysis. Setting: A 27 bed level IIID neonatal intensive care unit in a teaching hospital in the Netherlands. Participants: Healthcare professionals who had physical contact with very low birth weight (VLBW) infants. Methods: The study was conducted during a period of 4 years. Medical and nursing staff followed a problem-based education program on hand hygiene. Hand hygiene practices before and after the education program were compared by guided observations. The incidence of nosocomial infections in VLBW infants was compared. In addition, numbers of nosocomial bloodstream infections per day-at-risk in very low birth weight infants were analyzed by a segmented loglinear regression analysis. Results: During 1201 observations hand hygiene compliance before patient contact increased from 65% to 88% (p< 0.001). Median (interquartile range) drying time increased from 4. s (4-10) to 10. s (7-14) (p< 0.001).The proportion of very low birth weight infants with one or more bloodstream infections and the infection rate per 1000 patient days (relative risk reduction) before and after the education program on hand hygiene intervention decreased from 44.5% to 36.1% (18.9%, p= 0.03) and from 17.3% to 13.5% (22.0%, p= 0.03), respectively.At the baseline the nosocomial bloodstream infections per day-at-risk decreased by +0.07% (95% CI -1.41 to +1.60) per month and decreased with -1.25% (95% CI -4.67 to +2.44) after the intervention (p= 0.51). The level of instant change was -14.8% (p= 0.48). Conclusions: The results are consistent with relevant improvement of hand hygiene practices among healthcare professionals due to an education program. Improved hand hygiene resulted in a reduction in nosocomial bloodstream infections.

Early-life determinants of overweight and obesity: A review of systematic reviews (Article)

2010-10-01T00:00:00Z

The aim of this paper was to review the evidence for early-life (from conception to 5 years of age) determinants of obesity. The design is review of published systematic reviews. Data sources included Medline, Embase, Web of Science, Cochrane Library, CINAHL, PsycINFO. Identification of 22 eligible reviews from a database of 12 021 independent publications. Quality of selected reviews assessed using the Assessment of Multiple Systematic Reviews score. Articles published after the reviews were used to confirm results. No review was classified as high quality, 11 as moderate and 11 as low. Factors associated with later overweight and obesity: maternal diabetes, maternal smoking, rapid infant growth, no or short breastfeeding, obesity in infancy, short sleep duration, <30 min of daily physical activity, consumption of sugar-sweetened beverages. Other factors were identified as potentially relevant, although the size of their effect is difficult to estimate. Maternal smoking, breastfeeding, infant size and growth, short sleep duration and television viewing are supported by better-quality reviews. It is difficult to establish a causal association between possible determinants and obesity, and the relative importance of each determinant. Future research should focus on early-life interventions to confirm the role of protective and risk factors and to tackle the high burden obesity represents for present and future generations.

Systematic development of the YouRAction program, a computer-tailored physical activity promotion intervention for Dutch adolescents, targeting personal motivations and environmental opportunities (Article)

2010-08-13T00:00:00Z

Background. Increasing physical activity (PA) among adolescents is an important health promotion goal. PA has numerous positive health effects, but the majority of Dutch adolescents do not meet PA requirements. The present paper describes the systematic development of a theory-based computer-tailored intervention, YouRAction, which targets individual and environmental factors determining PA among adolescents. Design. The intervention development was guided by the Intervention Mapping protocol, in order to define clear program objectives, theoretical methods and practical strategies, ensure systematic program planning and pilot-testing, and anticipate on implementation and evaluation. Two versions of YouRAction were developed: one that targets individual determinants and an extended version that also provides feedback on opportunities to be active in the neighbourhood. Key determinants that were targeted included: knowledge and awareness, attitudes, self-efficacy and subjective norms. The extended version also addressed perceived availability of neighbourhood PA facilities. Both versions aimed to increase levels of moderate-to-vigorous PA among adolescents. The intervention structure was based on self-regulation theory, comprising of five steps in the process of successful goal pursuit. Monitoring of PA behaviour and behavioural and normative feedback were used to increase awareness of PA behaviour; motivation was enhanced by targeting self-efficacy and attitudes, by means of various interactive strategies, such as web movies; the perceived environment was targeted by visualizing opportunities to be active in an interactive geographical map of the home environment; in the goal setting phase, the adolescents were guided in setting a goal and developing an action plan to achieve this goal; in the phase of active goal pursuit adolescents try to achieve their goal and in the evaluation phase the achievements are evaluated. Based on the results of the evaluation adolescents could revise their goal or choose another behaviour to focus on. The intervention is delivered in a classroom setting in three lessons. YouRAction will be evaluated in a cluster-randomized trial, with classes as unit of randomization. Evaluation will focus on PA outcomes, cognitive mediators/moderators and process measures. Discussion. The planned development of YouRAction resulted in two computer-tailored interventions aimed at the promotion of PA in a Dutch secondary school setting. Trial registration. NTR1923.

Characteristics of visitors and revisitors to an Internet-delivered computer-tailored lifestyle intervention implemented for use by the general public (Article)

2010-08-10T00:00:00Z

The Internet has become important for the delivery of behavior change interventions. This observational study examines how many people visited, registered and revisited a web-based computer-tailored intervention promoting heart-healthy behaviors when it is implemented for use by the general public. Among registered visitors, the association between visitors' characteristics and initiating, completing and revisiting the website and/or its behavior-specific modules was analyzed. Server statistics showed that 285146 visitors from unique IP addresses landed on the home page in a 36-month period; of these, >50% left the intervention website within 30 s. In total, 81574 (28.6%) visitors completed the registration procedure and gained access to the intervention; 99% of registered visitors initiated one module, 91% completed at least one module and 6% revisited the intervention. The majority of the registered visitors were women, medium to highly educated, with a body mass index (BMI) <25. Women, visitors aged 40-50 years, visitors with a medium educational level and visitors with a BMI <25 were more likely to initiate and finish the modules. It is concluded that a heart-healthy computer-tailored Internet program can reach substantial numbers of people, but additional research is needed to develop promotional strategies that reach the high-risk population, i.e. men, older and lower educated persons.

Monitoring of risk perceptions and correlates of precautionary behaviour related to human avian influenza during 2006 - 2007 in the Netherlands: results of seven consecutive surveys. (Article)

2010-08-08T00:00:00Z

BACKGROUND: Avian influenza (AI) is a public health challenge because of ongoing spread and pandemic potential. Non-pharmaceutical measures are important to prevent the spread of AI and to contain a pandemic. The effectiveness of such measures is largely dependent on the behaviour of the population. Risk perception is a central element in changing behaviour. This study aimed to investigate perceived vulnerability, severity and precautionary behaviour related to AI in the Netherlands during seven consecutive surveys in 2006 - 2007 as well as possible trends in risk perception and self-reported precautionary behaviours. METHODS: Seven web-based surveys were conducted including 3,840 respondents over a one-year period. Time trends were analyzed with linear regression analyses. Multivariate analysis was used to study determinants of precautionary behaviour. RESULTS: While infection with AI was considered a very severe health problem with mean score of 4.57 (scale 1 - 5); perceived vulnerability was much lower, with a mean score of 1.69. While perceived severity remained high, perceived vulnerability decreased slightly during a one-year period covering part of 2006 and 2007. Almost half of the respondents (46%) reported taking one or more preventive measures, with 36% reporting to have stayed away from (wild) birds or poultry. In multivariate logistic regression analysis the following factors were significantly associated with taking preventive measures: time of the survey, higher age, lower level of education, non-Dutch ethnicity, vaccinated against influenza, higher perceived severity, higher perceived vulnerability, higher self efficacy, lower level of knowledge, more information about AI, and thinking more about AI. Self efficacy was a stronger predictor of precautionary behaviour for those who never or seldom think about AI (OR 2.3, 95% CI 1.9 - 2.7), compared to those who think about AI more often (OR 1.5, 95% CI 1.2 - 1.9). CONCLUSIONS: The fact that perceived severity of AI appears to be high and remains so over time offers a good point of departure for more specific risk communications to promote precautionary actions. Such communications should aim at improving knowledge about the disease and preventive actions, and focus on perceived personal vulnerability and self efficacy in taking preventive measures.

Why do poor people perceive poor neighbourhoods? The role of objective neighbourhood features and psychosocial factors (Article)

2010-07-01T00:00:00Z

Compared to people with a high socioeconomic status, those with a lower socioeconomic status are more likely to perceive their neighbourhood as unattractive and unsafe, which is associated with their lower levels of physical activity. Agreement between objective and perceived environmental factors is often found to be moderate or low, so it is questionable to what extent 'creating supportive neighbourhoods' would change neighbourhood perceptions. This study among residents (N=814) of fourteen neighbourhoods in the city of Eindhoven (the Netherlands), investigated to what extent socioeconomic differences in perceived neighbourhood safety and perceived neighbourhood attractiveness can be explained by five domains of objective neighbourhood features (i.e. design, traffic safety, social safety, aesthetics, and destinations), and to what extent other factors may play a role. Unfavourable neighbourhood perceptions of low socioeconomic groups partly reflected their actual less aesthetic and less safe neighbourhoods, and partly their perceptions of low social neighbourhood cohesion and adverse psychosocial circumstances.

Availability of sports facilities as moderator of the intention-sports participation relationship among adolescents (Article)

2010-06-04T00:00:00Z

This longitudinal study aimed to identify individual and environmental predictors of adolescents' sports participation and to examine whether availability of sports facilities moderated the intention-behaviour relation. Data were obtained from the ENvironmental Determinants of Obesity in Rotterdam SchoolchildrEn study (2005/2006 to 2007/2008). A total of 247 adolescents (48% boys, mean age at follow-up 15 years) completed the surveys at baseline and follow-up. At baseline, adolescents completed a survey that assessed engagement in sports participation, attitude, subjective norm, perceived behavioural control and intention towards sports participation. Availability of sports facilities (availability) was assessed using a geographic information system. At follow-up, sports participation was again examined. Multiple logistic regression analyses were conducted to test associations between availability of sports facilities, theory of planned behaviour variables and the interaction of intention by availability of sports facilities, with sports participation at follow-up. Simple slopes analysis was conducted to decompose the interaction effect. A significant availability × intention interaction effect [odds ratio: 1.10; 95% confidence interval: 1.00-1.20] was found. Simple slopes analysis showed that intention was more strongly associated with sports participation when sports facilities were more readily available. The results of this study indicate that the intention-sports participation association appears to be stronger when more facilities are available.

Estimating adolescent risk for hearing loss based on data from a large school-based survey (Article)

2010-06-01T00:00:00Z

Objectives. We estimated whether and to what extent a group of adolescents were at risk of developing permanent hearing loss as a result of voluntary exposure to high-volume music, and we assessed whether such exposure was associated with hearing-related symptoms. Methods. In 2007, 1512 adolescents (aged 12-19 years) in Dutch secondary schools completed questionnaires about their music-listening behavior and whether they experienced hearing-related symptoms after listening to highvolume music. We used their self-reported data in conjunction with published average sound levels of music players, discotheques, and pop concerts to estimate their noise exposure, and we compared that exposure to our own "loosened" (i.e., less strict) version of current European safety standards for occupational noise exposure. Results. About half of the adolescents exceeded safety standards for occupational noise exposure. About one third of the respondents exceeded safety standards solely as a result of listening to MP3 players. Hearing symptoms that occurred after using an MP3 player or going to a discotheque were associated with exposure to high-volume music. Conclusions. Adolescents often exceeded current occupational safety standards for noise exposure, hiqhliqhtinq the need for specific safety standards for leisure-time noise exposure.

A systematic review of studies on socioeconomic inequalities in dietary intakes associated with weight gain and overweight/obesity conducted among European adults (Article)

2010-06-01T00:00:00Z

This Review examined socioeconomic inequalities in intakes of dietary factors associated with weight gain, overweight/obesity among adults in Europe. Literature searches of studies published between 1990 and 2007 examining socioeconomic position (SEP) and the consumption of energy, fat, fibre, fruit, vegetables, energy-rich drinks and meal patterns were conducted. Forty-seven articles met the inclusion criteria. The direction of associations between SEP and energy intakes were inconsistent. Approximately half the associations examined between SEP and fat intakes showed higher total fat intakes among socioeconomically disadvantaged groups. There was some evidence that these groups consume a diet lower in fibre. The most consistent evidence of dietary inequalities was for fruit and vegetable consumption; lower socioeconomic groups were less likely to consume fruit and vegetables. Differences in energy, fat and fibre intakes (when found) were small-to-moderate in magnitude; however, differences were moderate-to-large for fruit and vegetable intakes. Socioeconomic inequalities in the consumption of energy-rich drinks and meal patterns were relatively under-studied compared with other dietary factors. There were no regional or gender differences in the direction and magnitude of the inequalities in the dietary factors examined. The findings suggest that dietary behaviours may contribute to socioeconomic inequalities in overweight/obesity in Europe. However, there is only consistent evidence that fruit and vegetables may make an important contribution to inequalities in weight status across European regions.

Young People: Taking Few Precautions Against Hearing Loss in Discotheques (Article)

2010-05-01T00:00:00Z

This study evaluated adolescents' music-listening risk and protective behaviors in discotheques. While frequently standing close to the loudspeakers, taking few breaks, and hardly using hearing-protection devices, many are at risk of developing permanent hearing loss. Assessing visiting mode may be a first and quick screener to identify adolescents at risk.

Overweight and obesity in infants and pre-school children in the European Union: A review of existing data (Article)

2010-05-01T00:00:00Z

The objective of this study was to synthesize available information on prevalence and time trends of overweight and obesity in pre-school children in the European Union. Retrieval and analysis or re-analysis of existing data were carried out. Data sources include WHO databases, Medline and Google, contact with authors of published and unpublished documents. Data were analysed using the International Obesity Task Force reference and cut-offs, and the WHO standard. Data were available from 18/27 countries. Comparisons were problematic because of different definitions and methods of data collection and analysis. The reported prevalence of overweight plus obesity at 4 years ranges from 11.8% in Romania (2004) to 32.3% in Spain (1998-2000). Countries in the Mediterranean region and the British islands report higher rates than those in middle, northern and eastern Europe. Rates are generally higher in girls than in boys. With the possible exception of England, there was no obvious trend towards increasing prevalence in the past 20-30 years in the five countries with data. The use of the WHO standard with cut-offs at 1, 2 and 3 standard deviations yields lower rates and removes gender differences. Data on overweight and obesity in pre-school children are scarce; their interpretation is difficult. Standard methods of surveillance, and research and policies on prevention and treatment, are urgently needed.

Understanding the correlates of adolescents' TV viewing: A social ecological approach (Article)

2010-03-19T00:00:00Z

Objective. To examine associations between social ecological factors and Dutch adolescents' TV viewing. Design. Cross-sectional examination of predictors of adolescents' TV viewing. Participants. A total of 338 adolescents, aged 14 years (55% boys). Measurements. Adolescents self-reported their age, ethnicity and TV viewing (dichotomized at two hours/day) and responded to items from all three social ecological domains; individual (cognitions based on the Theory of Planned Behaviour and TV viewing habit strength, and other behaviours, such as computer use), social (parental rules about TV viewing and parental TV viewing behavior) and physical environmental factors (TV in bedroom, physical activity equipment available). Parents reported demographic factors (e.g., ethnicity, education level), and their own TV viewing (mins/day); adolescents' weight status (not overweight vs. overweight/obese) was calculated from objective measures of height and weight. Logistic regression analyses examined associations between socio-ecological factors and adolescents' TV viewing, and whether associations were moderated by adolescents' sex, parents' education and ethnicity. Results. Compared with others, overweight/obese adolescents (odds ratio (OR)3.0; p≤0.001), those with high computer use (OR2.3; p≤0.0001), with high TV viewing habit strength (OR1.3; p≤0.0001), and those whose parents had high levels of TV viewing (OR2.4; p≤0.01) were more likely to exceed two hours of TV viewing per day. The association with habit strength was moderated by gender, and the association with parents' TV viewing was moderated by parents' education and ethnicity. Conclusions. Interventions should target parents' TV viewing behaviors and aim to amend habitual, 'mindless' TV viewing among adolescents.

Systematic review of studies on compliance with hand hygiene guidelines in hospital care (Article)

2010-03-01T00:00:00Z

objectives. To assess the prevalence and correlates of compliance and noncompliance with hand hygiene guidelines in hospital care. Design. A systematic review of studies published before January 1, 2009, on observed or self-reported compliance rates. Methods. Articles on empirical studies written in English and conducted on general patient populations in industrialized countries were included. The results were grouped by type of healthcare worker before and after patient contact. Correlates contributing to compliance were grouped and listed. Results. We included 96 empirical studies, the majority (n=65) in intensive care units. In general, the study methods were not very robust and often ill reported. We found an overall median compliance rate of 40%. Unadjusted compliance rates were lower in intensive care units (30%-40%) than in other settings (50%-60%), lower among physicians (32%) than among nurses (48%), and before (21%) rather than after (47%) patient contact. The majority of the time, the situations that were associated with a lower compliance rate were those with a high activity level and/or those in which a physician was involved. The majority of the time, the situations that were associated with a higher compliance rate were those having to do with dirty tasks, the introduction of alcohol-based hand rub or gel, performance feedback, and accessibility of materials. A minority of studies (n=12) have investigated the behavioral determinants of hand hygiene, of which only 7 report the use of a theoretical framework with inconclusive results. Conclusions. Noncompliance with hand hygiene guidelines is a universal problem, which calls for standardized measures for research and monitoring. Theoretical models from the behavioral sciences should be used internationally and should be adapted to better explain the complexities of hand hygiene.

Cognitive and home environmental predictors of change in sugar-sweetened beverage consumption among adolescents (Article)

2010-03-01T00:00:00Z

Sugar-sweetened beverage (SSB) consumption may increase risk for unnecessary weight gain. To develop interventions discouraging consumption, more insight is needed about cognitive and environmental predictors related to the decrease in SSB consumption. The present paper aims (1) to describe the relationship between potential cognitive determinants of change (attitudes, subjective norms, perceived behavioural control and intentions) and perceived environmental factors (family food rule and home availability of SSB) with changes in SSB consumption between baseline and 4-month follow-up and (2) to study whether the relationships between the environmental factors and SSB consumption are mediated by the cognitive determinants. Information on possible predictors and SSB intake at baseline and 4-month follow-up was provided by 348 Dutch adolescents (aged 12-13 years) through online questionnaires that were completed at school. Multilevel logistic regression and mediation analyses were used to determine direct and indirect associations between predictors and behaviour. The present results show that a high perceived behavioural control to decrease intake at baseline was associated with a decrease in consumption of SSB between baseline and follow-up (OR=053). Low availability and a stricter family food rule were associated with a decrease in SSB consumption between baseline and follow-up (OR=239, 054). The association between availability and decrease in SSB consumption was for 68% mediated by perceived behavioural control to drink less. In conclusion, interventions to decrease SSB intake should focus on improving attitudes and perceived behavioural control to reduce intake, and on limiting home availability and stimulating stricter family food rules regarding SSB consumption.

Effectiveness of school-based interventions in Europe to promote healthy nutrition in children and adolescents: Systematic review of published and grey literature (Article)

2010-03-01T00:00:00Z

The objective of the present review was to summarise the existing European published and grey literature on the effectiveness of school-based interventions to promote a healthy diet in children (6-12 years old) and adolescents (13-18 years old). Eight electronic databases, websites and contents of key journals were systematically searched, reference lists were screened, and authors and experts in the field were contacted for studies evaluating school-based interventions promoting a healthy diet and aiming at primary prevention of obesity. The studies were included if they were published between 1 January 1990 and 31 December 2007 and reported effects on dietary behaviour or on anthropometrics. Finally, forty-two studies met the inclusion criteria: twenty-nine in children and thirteen in adolescents. In children, strong evidence of effect was found for multicomponent interventions on fruit and vegetable intakes. Limited evidence of effect was found for educational interventions on behaviour, and for environmental interventions on fruit and vegetable intakes. Interventions that specifically targeted children from lower socio-economic status groups showed limited evidence of effect on behaviour. In adolescents, moderate evidence of effect was found for educational interventions on behaviour and limited evidence of effect for multicomponent programmes on behaviour. In children and adolescents, effects on anthropometrics were often not measured, and therefore evidence was lacking or delivered inconclusive evidence. To conclude, evidence was found for the effectiveness of especially multicomponent interventions promoting a healthy diet in school-aged children in European Union countries on self-reported dietary behaviour. Evidence for effectiveness on anthropometrical obesity-related measures is lacking.

Weight status, energy-balance behaviours and intentions in 9-12-year-old inner-city children (Article)

2010-02-01T00:00:00Z

Background: Dutch youth health care promotes four so-called energy-balance behaviours for the prevention of obesity: increasing physical activity, reducing sedentary behaviour and sugar-containing drinks, and eating breakfast. However, data on the prevalence of these behaviours and intentions to engage in them among primary schoolchildren is limited, especially for multi-ethnic, inner-city populations. The present study aimed to provide these data and explore differences according to socio-demographic characteristics and weight status. Methods: Data on behaviours and accompanying intentions were collected using classroom questionnaires. Stature and body weight were measured by trained staff. Twenty primary schools in Rotterdam participated. Data on 1095 9-12 year olds (81.7% response rate) were available for analysis. Multiple logistic regression analyses were conducted to determine associations between behaviours (favourable or unfavourable), intentions (positive or not), gender, age, ethnicity, neighbourhood income level and weight status. Results: The prevalence of being overweight was 30.4%, including 9.0% obesity. Engagement in energy-balance behaviours varied from 58.6% for outdoor play (>1 h previous day) to 85.9% for active transportation to school (day of survey). The highest positive intentions were reported for taking part in sports (83.9%), and lowest for reducing computer time (41.3%). Small differences in behaviours and intentions according to socio-demographic characteristics were found, most notably a lower engagement in physical activity by girls. Skipping breakfast and total number of energy-balance behaviours were associated with being overweight. Conclusions: The prevalence of being overweight among Dutch inner-city schoolchildren is high. A general rather than a differentiated approach is needed to improve engagement in energy-balance behaviours among inner-city schoolchildren. © 2010 The Authors. Journal compilation

Why do parents with toddlers store poisonous products safely? (Article)

2010-01-01T00:00:00Z

Unintentional poisoning is a major cause of nonfatal injuries in children aged 0-24 months. Associations between self-reported habits on the child safe storage of medication and cleaning products and family, and psychosocial factors were assessed, using a model based on the Protection Motivation Theory. By identifying correlates of safety behavior in this manner, more insight in factors which influence this behavior is obtained. Health promotion activities in order to promote safety behavior should address these factors in order to increase the effectiveness of the health message. Data were gathered from a cross-sectional survey using self-administered questionnaires, mailed to a population sample of 2470 parents with toddlers. The results indicate that the promotion of safe storage of medication and cleaning products should address the family situation, personal cognitive factors as well as social factors. Interventions should particularly focus on parents' self-efficacy of storing poisonous products in a child safe manner and on the vulnerability of their child in their home concerning an unintentional poisoning incident.

Gender, ethnic and school type differences in overweight and energy balance-related behaviours among Dutch adolescents (Article)

2009-11-27T00:00:00Z

Objective. The aim of this study was to investigate gender, ethnic and school type differences in overweight and energy balance-related behaviours: snack, soft drink and breakfast consumption, walking, bicycling, and playing sports during leisure time, active commuting to school, television viewing and computer use among 1215-year-old adolescents. Methods. Cross-sectional data on weight status and energy balance-related behaviours were obtained from 1 206 adolescents (200506). Energy balance-related behaviours were self-reported and body mass index was calculated from measured height and weight. Gender, ethnic and school type differences in weight status and behaviours were examined with multi-level logistic regression analyses. Results. Overweight and unfavourable energy balance-related behaviours were more likely among youth from non-Western ethnic backgrounds and those attending vocational schools. Analyses stratified by ethnicity showed that girls from non-Western ethnic backgrounds were more likely to be overweight (OR = 1.5) and to report not bicycling (OR = 2.4) and watching more than two hours of television (OR = 2.3) compared with boys from non-Western ethnic backgrounds. Vocational students from Western ethnic backgrounds were more likely to report high levels of soft drink consumption (OR = 3.2), watching television (OR = 2.9) and computer use (OR = 2.1) compared with higher-level education students from Western ethnic backgrounds. Conclusions. The study findings indicate important ethnic and educational differences in overweight and energy balance-related behaviours. Future research should focus on what kind of interventions work and for which target groups they work, taking demographic variables, such as gender, ethnicity, school type into account.

Music venues and hearing loss: Opportunities for and barriers to improving environmental conditions (Article)

2009-11-04T00:00:00Z

This study explores the opportunities for and barriers to improving environmental conditions in order to reduce the risk for music-induced hearing loss in people who attend music venues. Individual semi-structured interviews were held with 20 representatives of music venues and of governmental organizations, according to a semi-structured interview guide. The interviews were audiotaped, transcribed, and systematically coded using a content-analysis technique. Reported opportunities to reduce music volume included improving the acoustics and installing advanced speaker systems. The most important barrier reported was the lack of clear definitions of what levels of high-volume music are hazardous. Other barriers mentioned included economic considerations, and the beliefs that visitors demand high-volume music in music venues and are personally responsible for their own hearing. Before measures to improve environmental conditions are implemented, the exact dangers of exposure to high-volume music have to be established. Evidence-based guidelines and safety standards for leisure-time noise exposure should therefore be developed.

What makes people decide to visit and use an internet-delivered behavior-change intervention?: A qualitative study among adults (Article)

2009-10-16T00:00:00Z

Purpose- The purpose of this study is to explore adults' cognitive deliberations in deciding to visit an internet intervention, to extend the visit to use and process the intervention's content, and to revisit the intervention. Design/methodology/approach: A qualitative study was conducted consisting of five focus group interviews (n= 29, 25-69 years). The interview transcriptions were subjected to systematic content analysis. Findings: The results indicate that being motivated to change a health behavior and curiosity about the content were important factors in the decision to visit an internet intervention. To extend a visit, mainly intervention aspects were considered such as visual appeal, the number of questions needed to complete within the program, and the existence of a registration procedure. To induce revisits, regularly updated content and the possibility to monitor behavior change were important. Practical implications: These findings suggest that activities to promote use of internet interventions need to be directed at motivating adults to think about potential behavior change. Furthermore, intervention aspects need to meet various criteria, such as a professional appearance, concise and easy to understand texts and an explanation for the use of a registration procedure. Originality/value: The results of this explorative study can be used as a basis for further studies aimed at improving dissemination and use of internet-delivered behavior change interventions.

Objective and perceived availability of physical activity opportunities: Differences in associations with physical activity behavior among urban adolescents (Article)

2009-10-15T00:00:00Z

Background: This study examined the associations of the perceived and objective environment with adolescent engagement in sports activities and walking and cycling in leisure time. It also explored the degree of agreement between objective and perceived availability of physical activity (PA) facilities in neighborhoods. Methods: Cross-sectional data on physical activity, the perceived availability of physical activity opportunities (perceived physical environment) was assessed through a questionnaire and the objective availability of PA opportunities (objective physical environment) was obtained through GIS data. The final sample included 654 adolescents with a mean age of 14.1 (SD = 1.2) years. Results: Perceived availability of sports facilities and parks was significantly associated with engaging in sports (OR: 1.73; 95% CI: 1.16-2.56) and with walking and cycling in leisure time (OR: 1.66; 95% CI: 1.07-2.57) respectively. Agreement between objective and perceived environment was low to moderate with Kappa values ranging from -0.005 to 0.053. Conclusion: The perceived environment was the stronger correlate of PA behavior among adolescents. There were substantial differences between assessments of objective and perceived physical environment.

A conceptual framework for understanding and improving adolescents' exposure to Internet-delivered interventions (Article)

2009-09-01T00:00:00Z

Although exposure is crucial to improve the public health impact of Internet-delivered interventions, it appears that in practice exposure to such interventions is low. Therefore, a conceptual framework, which incorporates elements of user experience of websites, is applied to Internet-delivered health behaviour change interventions aimed at adolescents and results from previous explorative research are incorporated. This framework, described from the point of view of an intervention's development team, can be used in practice to optimize user experience and therewith improving exposure rates to Internet-delivered interventions and increasing the number of revisiting users.

The past, present and future of the International Journal of Behavioral Nutrition and Physical Activity (Article)

2009-08-15T00:00:00Z

Long-term effects of the Dutch Schoolgruiten Project - Promoting fruit and vegetable consumption among primary-school children (Article)

2009-08-01T00:00:00Z

Objectives: To evaluate the long-term effects of the Schoolgruiten Project, a Dutch primary school-based intervention providing free fruit and vegetables (F&V). In addition, we assessed whether children's appreciation of the project mediated these intervention effects. Design and methods: Participating schoolchildren (mean age 9.9 years at baseline) and their parents completed parallel questionnaires at baseline, at 1-year and at 2-year follow-up, including questions on usual F&V intake of the child, potential behavioural determinants, their appreciation of the project and general demographics. Primary outcomes were usual F&V intakes as assessed by parent and child self-reported food frequency measures. Secondary outcome measures were taste preference, knowledge of daily recommendations, availability and accessibility for fruit intake. Multilevel linear regression analyses were used to assess differences at second follow-up adjusted for baseline values between control and intervention groups. Subjects: Reports were available for 346 intervention children (148 parents) and 425 control children (287 parents). Results: Both child and parent reports indicated that the intervention group had a significantly higher fruit intake at 2-year follow-up (difference, servings/d: 0.15; 95 % CI 0.004, 0.286 for child reports; 0.19; 95 % CI 0.030, 0.340 for parent reports). No significant effects on vegetable intake were observed. Significant positive intervention effects were also found for knowledge of fruit recommendations among boys. Some evidence was found for partial mediation analyses of the effects on fruit intake. Conclusion: The present study indicates that the Schoolgruiten scheme was effective in increasing children's fruit intake and that appreciation of the project partially mediated this effect.

Effectiveness of online word of mouth on exposure to an Internet-delivered intervention (Article)

2009-07-01T00:00:00Z

The use of online word of mouth (WOM) seems a promising strategy to motivate young people to visit Internet-delivered interventions. An Internet-delivered intervention aimed at changing implicit attitudes related to alcohol was used in two experiments to test effectiveness of e-mail invitations on a first visit to the intervention. The results of the first experiment (N = 196) showed that an invitation by e-mail from a friend was more effective to attract young adults (aged 18-24 years) to the intervention website than an invitation from an institution. A 2 × 2 design was used in the second experiment (N = 236) to test manipulations of argument strength and the use of peripheral cues in invitations. Results showed that weak arguments were more effective to attract young adults to the intervention website when an incentive was withheld. These results need to be taken into account when using online WOM as a strategy to improve exposure to Internet-delivered interventions.

Should implementation intentions interventions be implemented in obesity prevention: the impact of if-then plans on daily physical activity in Dutch adults. (Article)

2009-06-06T00:00:00Z

Background Forming implementation intentions (specifying when, where and how to act) has been proposed as a potentially effective and inexpensive intervention, but has mainly been studied in controlled settings for straightforward behaviors. Purpose To examine if forming implementation intentions (II) could be used in large-scale, population-based interventions that aim to promote more complex and clinically relevant behavior change, we tested the impact of different II on increasing daily physical activity (PA) aimed at weight maintenance among 709 Dutch adults. Methods At T0, participants were randomly allocated to a control group or to form II for 1) a prescribed action (walking), 2) self-selected activities, 3) self-selected activities and repeat making these II two times. All participants were asked to increase PA by at least two hours a week (15–20 minutes per day). Post-tests took place two weeks (response 85%), three months (response 78%) and six months (response 79%) post-intervention. Results No main effects of II formation on BMI or physical activity were found. Intention to increase physical activity moderated the effects of repeated II, but not of the other II conditions. Forming repeated II had a positive effect on total PA and number of active days for respondents with strong intentions. Conclusion Implementation intention interventions may not yet be ready for implementation on its own for large-scale obesity prevention in the general public. Future research should test strategies for optimal II formation in both initiating and maintaining behavioral change.

Socioeconomic differences in lack of recreational walking among older adults: the role of neighbourhood and individual factors (Article)

2009-06-06T00:00:00Z

Background People with a low socioeconomic status (SES) are more likely to be physically inactive than their higher status counterparts, however, the mechanisms underlying this socioeconomic gradient in physical inactivity remain largely unknown. Our aims were (1) to investigate socioeconomic differences in recreational walking among older adults and (2) to examine to what extent neighbourhood perceptions and individual cognitions regarding regular physical activity can explain these differences. Methods Data were obtained by a large-scale postal survey among a stratified sample of older adults (age 55–75 years) (N = 1994), residing in 147 neighbourhoods of Eindhoven and surrounding areas, in the Netherlands. Multilevel logistic regression analyses assessed associations between SES (i.e. education and income), perceptions of the social and physical neighbourhood environment, measures of individual cognitions derived from the Theory of Planned Behaviour (e.g. attitude, perceived behaviour control), and recreational walking for ≥10 minutes/week (no vs. yes). Results Participants in the lowest educational group (OR 1.67 (95% CI, 1.18–2.35)) and lowest income group (OR 1.40 (95% CI, 0.98–2.01)) were more likely to report no recreational walking than their higher status counterparts. The association between SES and recreational walking attenuated when neighbourhood aesthetics was included in the model, and largely reduced when individual cognitions were added to the model (with largest effects of attitude, and intention regarding regular physical activity). The assiation between poor neighbourhood aesthetics and no recreational walking attenuated to (borderline) insignificance when individual cognitions were taken into account. Conclusion Both neighbourhood aesthetics and individual cognitions regarding physical activity contributed to the explanation of socioeconomic differences in no recreational walking. Neighbourhood aesthetics may explain the association between SES and recreational walking largely via individual cognitions towards physical activity. Intervention and policy strategies to reduce socioeconomic differences in lack of recreational walking among older adults would be most effective if they intervene on both neighbourhood perceptions as well as individual cognitions.

Strategies for the prevention of MP3-induced hearing loss among adolescents: Expert opinions from a Delphi study (Article)

2009-05-01T00:00:00Z

OBJECTIVE. To identify parties involved in the prevention of MP3-induced hearing loss among adolescents and potentially effective prevention strategies and interventions. METHODS. Thirty experts in fields such as scientific research, medical practice, community health professions, education, youth work, music entertainment, and enforcement authorities participated in a qualitative, electronic, 3-round, Web-based Delphi study. RESULTS. Multiple parties involved in the prevention of MP3-induced hearing loss among adolescents were identified; the most relevant are the adolescents themselves, their parents, manufacturers of MP3 players and earphones, and the authorities. The experts did not expect that adolescents in general would perform the necessary protective behaviors to prevent MP3-induced hearing loss. Two environmental health protection measures were identified as both relevant and feasible to be implemented (ie, authorities encourage manufacturers to produce safer products, and public health campaigns will be held to improve knowledge of the risks of high-volume music, possible protective measures, and consequences of hearing loss). CONCLUSIONS. Authorities, the music industry in general, and especially manufacturers of MP3 players and earphones should recognize their responsibility and create a safer MP3-listening environment by taking measures to protect today's youth from the dangers of listening to high-volume music on MP3 players. Copyright

Household and food shopping environments: do they play a role in socioeconomic inequalities in fruit and vegetable consumption? A multilevel study among Dutch adults (Article)

2009-04-10T00:00:00Z

BACKGROUND: Fruit and vegetables are protective of a number of chronic diseases; however, their intakes have been shown to vary by socioeconomic position (SEP). Household and food shopping environmental factors are thought to contribute to these differences. To determine whether household and food shopping environmental factors are associated with fruit and vegetable (FV) intakes, and contribute to socioeconomic inequalities in FV consumption. METHODS: Cross-sectional data were obtained by a postal questionnaire among 4333 adults (23-85 years) living in 168 neighbourhoods in the south-eastern Netherlands. Participants agreed/disagreed with a number of statements about the characteristics of their household and food shopping environments, including access, prices and quality. Education was used to characterise socioeconomic position (SEP). Main outcome measures were whether or not participants consumed fruit or vegetables on a daily basis. Multilevel logistic regression models examined between-area variance in FV consumption and associations between characteristics of the household and food shopping environments and FV consumption. RESULTS: Only a few household and food shopping environmental factors were significantly associated with fruit and vegetable consumption, and their prevalence was low. Participants who perceived FV to be expensive were more likely to consume them. There were significant socioeconomic inequalities in fruit and vegetable consumption (ORs of not consuming fruit and vegetables were 4.26 and 5.47 among the lowest-educated groups for fruit and vegetables, respectively); however, these were not explained by any household or food shopping environmental factors. CONCLUSIONS: Improving access to FV in the household and food shopping environments will only make a small contribution to improving population consumption levels, and may only have a limited effect in reducing socioeconomic inequalities in their consumption.

Sources of information and health beliefs related to SARS and avian influenza among Chinese Communities in the United Kingdom and the Netherlands, compared to the general population in these countries (Article)

2009-03-01T00:00:00Z

Background: Ethnic minorities in Europe such as the Chinese may need a special strategy with regard to risk communication about emerging infectious diseases. To engage them in precautionary actions, it is important to know their information sources, knowledge, and health beliefs. Purpose: This study's purpose is to study the use of information sources, knowledge, and health beliefs related to SARS and avian flu of Chinese people in the UK and The Netherlands, and to make comparisons with the general population in these countries. Method: Results of a self-administered questionnaire among 300 British/Dutch Chinese were compared to data obtained from a computer-assisted phone survey among the general population (n∈=∈800). Results: British/Dutch Chinese got most information about emerging diseases from family and friends, followed by Chinese media and British/Dutch TV. They had less confidence than general groups in their doctor, government agencies, and consumer/patient interest groups. Their knowledge of SARS was high. They had a lower perceived threat than general populations with regard to SARS and avian flu due to a lower perceived severity. They had higher self-efficacy beliefs regarding SARS and avian flu. Conclusion: In case of new outbreaks of SARS/avian flu in China, local authorities in the UK and The Netherlands can best reach Chinese people through informal networks and British/Dutch TV, while trying to improve confidence in information from the government. In communications, the severity of the disease rather than the susceptibility appears to need most attention.

The perceived threat of SARS and its impact on precautionary actions and adverse consequences: A qualitative study among chinese communities in the United Kingdom and the Netherlands (Article)

2009-03-01T00:00:00Z

Background: Although the SARS outbreak involved few probable cases of infection in Europe, swift international spread of infections raised the possibility of outbreaks. In particular, SARS presented a sociopsychological and economic threat to European Chinese communities because of their close links with the outbreak's origins. Methods: A qualitative study was conducted among Chinese residents in the United Kingdom and the Netherlands to identify the origins of SARS risk perceptions and their impact on precautionary actions and adverse consequences from the perspective of vulnerable communities living in unaffected regions. Analysis was informed by protection motivation theory. Results: Results revealed that information from affected Asia influenced risk perceptions and protective behavior among the Chinese in Europe when more relevant local information was absent. When high risk perceptions were combined with low efficacy regarding precautionary measures, avoidance-based precautionary action appeared to dominate responses to SARS. These actions may have contributed to the adverse impacts of SARS on the communities. Conclusions: Experiences of European Chinese communities suggest that practical and timely information, and consistent implementation of protective measures from central governments are essential to protect vulnerable populations in unaffected regions from unnecessary alarm and harm during outbreaks of emerging infections.

Risk perceptions and behaviour: Towards pandemic control of emerging infectious diseases. (Article)

2009-03-01T00:00:00Z

In the beginning of 2003, the world was alarmed by the emergence of a new and apparently fatal infectious disease. The disease was labelled SARS. Thanks to enormous efforts made by national and international organisations, the epidemic was brought under control by the summer of that year. In recent years, the world has also been confronted with outbreaks or threats of outbreaks of other emerging infectious diseases such as avian influenza. To control new infectious diseases, the identification of the organisms, the infectivity, development of vaccines and therapies, contact tracing, isolation and screening may all be important. 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...

Perceived threat, risk perception, and efficacy beliefs related to SARS and other (emerging) infectious diseases: Results of an international survey (Article)

2009-03-01T00:00:00Z

Purpose: To study the levels of perceived threat, perceived severity, perceived vulnerability, response efficacy, and self-efficacy for severe acute respiratory syndrome (SARS) and eight other diseases in five European and three Asian countries. Method: A computer-assisted phone survey was conducted among 3,436 respondents. The questionnaire focused on perceived threat, vulnerability, severity, response efficacy, and self-efficacy related to SARS and eight other diseases. Results: Perceived threat of SARS in case of an outbreak in the country was higher than that of other diseases. Perceived vulnerability of SARS was at an intermediate level and perceived severity was high compared to other diseases. Perceived threat for SARS varied between countries in Europe and Asia with a higher perceived severity of SARS in Europe and a higher perceived vulnerability in Asia. Response efficacy and self-efficacy for SARS were higher in Asia compared to Europe. In multiple linear regression analyses, country was strongly associated with perceived threat. Conclusions: The relatively high perceived threat for SARS indicates that it is seen as a public health risk and offers a basis for communication in case of an outbreak. The strong association between perceived threat and country and different regional patterns require further research.

SARS knowledge, perceptions, and behaviors: A comparison between finns and the dutch during the SARS outbreak in 2003 (Article)

2009-03-01T00:00:00Z

Background: The SARS outbreak served to test both local and international outbreak management and risk communication practices. Purpose: The study compares SARS knowledge, perceptions, behaviors, and information between Finns and the Dutch during the SARS outbreak in 2003. Method: The participants of the study, who used a modified SARS Psychosocial Research Consortium survey, were drawn from Internet panels in Finland (n∈=∈308) and the Netherlands (n∈=∈373) in June 2003. Multiple logistic regression analyses were used to calculate odds ratios (with 95% confidence intervals) to compare Finns with the Dutch for various levels of perceptions and behaviors. Results: Adjusted for age, education, and income, Finns were more likely to be knowledgeable and worried about SARS as well as to have low perceived comparative SARS risk and poor personal efficacy beliefs about preventing SARS. Finns were also more likely than the Dutch to have high confidence in physicians on SARS issues but less likely to have received information from the Internet and have confidence in Internet information. Conclusions: The study shed light on how two European populations differed substantially regarding lay responses to SARS. Understanding these differences is needed in formulating and executing communication and outbreak management.

Mechanisms of adolescent smoking cessation: Roles of readiness to quit, nicotine dependence, and smoking of parents and peers (Article)

2009-01-01T00:00:00Z

Multiple levels of influence should be considered in interventions aimed at the adolescent smoker, including psychological, addiction, peer and parental influences. However, the mechanism by which these variables influence the process of smoking cessation in adolescents is not well elucidated. Therefore, this prospective study tested two models among 850 adolescent smokers, specifying the direct and indirect relations between adolescents' readiness to quit smoking, levels of nicotine dependence, and smoking behavior of their parents and friends. One year later smoking cessation was assessed. Results showed that, among adolescent smokers, readiness to quit was positively associated with quit attempts, while nicotine dependence was inversely associated with successful cessation. Instead of a direct relation, parental and peers' smoking were inversely related to smoking cessation through nicotine dependence. The findings emphasize that interventions should be developed and tested within and outside the school setting, as well as within the family situation. In addition, the strong impact of nicotine dependence on successful cessation indicates that a more direct approach is needed to lower nicotine dependence among adolescents.

Why do parents' education level and income affect the amount of fruits and vegetables adolescents eat? (Article)

2008-12-01T00:00:00Z

Background: There are large socioeconomic disparities in food behaviours. The objective of the present study is to longitudinally explore socioeconomic disparities in adolescents' fruit and vegetable (FV) intake and to assess mediators of the disparity. Methods: A longitudinal study containing 896 adolescents from 20 randomly selected elementary schools within two Norwegian counties (response rate 84%). Questionnaires were administered in May 2002 (mean age 12.5 years) and again in May 2005. FV intake was measured by four food frequency questions (times/week). Socioeconomic status was based on parents' reports of their own educational level and family income (both dichotomized). Data were analysed with repeated mixed models. Results: A disparity in adolescents' FV intake was observed with family income (1.1 times/week, P = 0.05). An interaction between parental education and time (survey) was found for parental education (P = 0.04) and the educational disparity was greater in 2005 (2.4 times/week, P < 0.001) than in 2002 (1.3 times/week, P = 0.03). In multiple mediation analyses, a total of 92% (2002) and 60% (2005) of the educational disparity and 89% of the income disparity, were explained. For both, the adolescents' reports of the accessibility of FV at home explained most of the disparity. Conclusions: Perceived accessibility appears to be the strongest mediator of the relationship between adolescents' FV intake and their parents' educational level and income and may therefore be an important target for future interventions that aim to reduce socioeconomic disparities in adolescents' FV intake.

Appreciation and implementation of a school-based intervention are associated with changes in fruit and vegetable intake in 10- to 13-year old schoolchildren - The Pro Children study (Article)

2008-12-01T00:00:00Z

The purpose was to investigate the degree of implementation and appreciation of a comprehensive school-randomized fruit and vegetable intervention program and to what extent these factors were associated with changes in reported fruit and vegetable intake. The study was conducted among 10- to 13-year old children exposed to the intervention during the school year 2003-04 in Norway, Spain and the Netherlands. Children, parents and teachers completed questionnaires regarding (i) the implementation of the school curriculum, (ii) parental involvement, (iii) distribution of fruit and vegetables at school, (iv) children's appreciation of the project and (v) children's intake levels. Univariate analyses of covariance and multilevel multivariate regression analyses indicated that teacher-reported level of implementation of the school curriculum and schoolchildren's appreciation of the project were important determinants of changes in intake. The results point to the importance of optimal implementation of an attractive school curriculum.

Effectiveness of smoking cessation interventions among adults: A systematic review of reviews (Article)

2008-11-01T00:00:00Z

The objective of this study was to identify the most effective intervention strategies and policies for smoking cessation among adults. The Medline and Cochrane Library databases were searched, limited to publications since January 2000. A 'review of reviews' approach was followed. Systematic reviews and meta-analyses were included. Reviews aimed at adolescents or specific subgroups were excluded. Two reviewers independently assessed titles and abstracts. For every intervention strategy, only the most recent publication was included. Twenty-three studies met the inclusion criteria. The included intervention strategies and policies were ranked according to their effect size, taking into account the number of original studies, the proportion of studies with a positive effect and the presence of a long-term effect. Evidence of effectiveness for the following strategies was found: group behavioural therapy [odds ratio (OR) 2.17, confidence interval (CI) 1.37-3.45], bupropion (OR 2.06, CI: 1.77-2.40), intensive physician advice (OR 2.04, CI: 1.71-2.43), nicotine replacement therapy (OR 1.77, CI: 1.66-1.88), individual counselling (OR 1.56, CI: 1.32-1.84), telephone counselling (OR 1.56, CI: 1.38-1.77), nursing interventions (OR 1.47, CI: 1.29-1.67) and tailored self-help interventions (OR 1.42, CI: 1.26-1.61). A 10% increase in price increased cessation rates by 3-5%. Comprehensive clean indoor laws increased quit rates by 12-38%. These results show and confirm that a wide array of effective smoking cessation intervention approaches and policies can have a large impact on smoking cessation rates.

A school-based intervention to reduce overweight and inactivity in children aged 6–12 years: study design of a randomized controlled trial (Article)

2008-10-31T00:00:00Z

Background Effective interventions to prevent overweight and obesity in children are urgently needed especially in inner-city neighbourhoods where prevalence of overweight and inactivity among primary school children is high. A school based intervention was developed aiming at the reduction of overweight and inactivity in these children by addressing both behavioural and environmental determinants. Methods/design The main components of the intervention (Lekker Fit!) are the re-establishment of a professional physical education teacher; three (instead of two) PE classes per week; additional sport and play activities outside school hours; fitness testing; classroom education on healthy nutrition, active living and healthy lifestyle choices; and the involvement of parents. The effectiveness of the intervention is evaluated through a cluster randomized controlled trial in 20 primary schools among grades 3 through 8 (6–12 year olds). Primary outcome measures are BMI, waist circumference and fitness. Secondary outcome measures are assessed in a subgroup of grade 6–8 pupils (9–12 year olds) through classroom questionnaires and constitute of nutrition and physical activity behaviours and behavioural determinants. Multilevel regression analyses are used to study differences in outcomes between children in the intervention schools and in control schools, taking clustering of children within schools into account. Discussion Hypotheses are that the intervention results in a lower prevalence of children being overweight and an improved mean fitness score, in comparison with a control group where the intervention is not implemented. The results of our study will contribute to the discussion on the role of physical education and physical activity in the school curriculum. Trial registration [ISRCTN84383524]

The ENDORSE study: Research into environmental determinants of obesity related behaviors in Rotterdam schoolchildren (Article)

2008-10-31T00:00:00Z

Background: Children and adolescents are important target groups for prevention of overweight and obesity as overweight is often developed early in life and tracks into adulthood. Research into behaviors related to overweight (energy balance-related behaviors) and the personal and environmental determinants of these behaviors is fundamental to inform prevention interventions. In the Netherlands and in other countries systematic research into environmental determinants of energy balance related behaviors in younger adolescents is largely lacking. This protocol paper describes the design, the components and the methods of the ENDORSE study (Environmental Determinants of Obesity in Rotterdam SchoolchildrEn), that aims to identify important individual and environmental determinants of behaviors related to overweight and obesity and the interactions between these determinants among adolescents. Methods: The ENDORSE study is a longitudinal study with a two-year follow-up of a cohort of adolescents aged 12–15 years. Data will be collected at baseline (2005/2006) and at two years follow-up (2007/2008). Outcome measures are body mass index (BMI), waist circumference, time spent in physical activity and sedentary behaviors, and soft drink, snack and breakfast consumption. The ENDORSE study consists of two phases, first employing qualitative research methods to inform the development of a theoretical framework to examine important energy balance related behaviors and their determinants, and to inform questionnaire development. Subsequently, the hypothetical relationships between behavioral determinants, energy balance related behaviors and BMI will be tested in a quantitative study combining school-based surveys and measurements of anthropometrical characteristics at baseline and two-year follow-up. Discussion: The ENDORSE project is a comprehensive longitudinal study that enables investigation of specific environmental and individual determinants of overweight and obesity among younger adolescents. The project will result in specific recommendations for obesity prevention interventions among younger adolescents.

Mothers' involvement in a school-based fruit and vegetable promotion intervention is associated with increased fruit and vegetable intakes - The Pro Children study (Article)

2008-10-15T00:00:00Z

Background: Several school-based fruit and vegetable interventions include activities to involve parents, but not much is know about the effectiveness of such a family component on child and parent intake levels. The current study evaluated the effects of the multi-component school-based intervention, 'the Pro Children Study', on mothers' intake levels. Furthermore, associations between level of involvement in the project and improvement in the mothers' intake levels were assessed. Methods: Effect was evaluated in a cluster randomized controlled trial in Spain, Norway and the Netherlands among mothers of 11-year-olds. Of the 1253 mothers with complete data at baseline, 754 and 476 had complete data at first and second follow-up respectively. Fruit and vegetable intake, level of involvement and demographic variables were assessed by a parental questionnaire. Data was analyzed using multilevel regression analyses. Results: Results showed no effect of the intervention on mothers' fruit and vegetable intake after one year and two year follow-up. Participation rate for the different activities varied by activity and by country, e.g. 3.7-9.4% visited the website, while 26.4-72.6% of the mothers participated in the home work assignments. Results further showed that higher involvement levels were associated with higher intake at follow-up. Conclusion: The Pro Children Intervention could not increase the fruit and vegetable consumption of the mothers of participating pupils, which might be explained by the low involvement in the project. More research is needed to increase mothers' involvement in school-based interventions.

Socio-demographic factors as correlates of active commuting to school in Rotterdam, the Netherlands (Article)

2008-10-01T00:00:00Z

Objective: Report frequencies of adolescents' active commuting to school in an inner city environment in the Netherlands, and to explore potential socio-demographic correlates of active commuting to school. Methods: Cross-sectional data were obtained from the ENDORSE study (2005-2006) including 1361 adolescents (response = 82%), aged 12-15 from 16 schools in Rotterdam. Socio-demographic variables were assessed by questionnaire, height and weight were measured and distance to school was calculated based on route planner information. Multilevel logistic regressions were performed to analyze the data. Results: The proportions of participants categorized as walkers, cyclists, non-active commuters were 12%, 35% and 34% respectively. With cyclists as the reference category, adolescents of non-Western ethnic background were more likely to be walkers (OR = 4.1; 95% CI = 2.1-8.2) and non-active commuters (OR = 5.1; 95% CI = 3.3-7.9), compared to native Dutch adolescents. A further distance from home to school was inversely associated with being a walker (OR = 0.22; 95% CI = 0.17-0.29) and being a cyclist (OR = 0.83; 95% CI = 0.79-0.86) and positively associated with being a non-active commuter (OR = 1.2; 95% CI = 1.16-1.23). Conclusion: Almost 50% of the adolescents reported to actively commute to school on most school days, and mode of commuting was associated with ethnicity and distance. Further research is needed to examine main barriers to active commuting among adolescents from non-Western ethnic background.

Examining the minimal required elements of a computer-tailored intervention aimed at dietary fat reduction: Results of a randomized controlled dismantling study (Article)

2008-10-01T00:00:00Z

This study investigated the minimally required feedback elements of a computer-tailored dietary fat reduction intervention to be effective in improving fat intake. In all 588 Healthy Dutch adults were randomly allocated to one of four conditions in an randomized controlled trial: (i) feedback on dietary fat intake [personal feedback (P feedback)], (ii) P feedback and feedback on one's own behavior relative to that of peers [personal-normative feedback (PN feedback)], (iii) PN feedback and practical suggestions on how to change fat intake [personal - normative - action feedback (PNA feedback)] and (iv) generic information. Data on fat intake, awareness of one's own fat intake and intention to change were collected 1 and 6 months post-intervention. Between-group differences were tested with analysis of variance. Among respondents with high fat intakes at baseline (risk consumers) and those who underestimated their fat intake at baseline (underestimators), differences in awareness and (saturated) fat intake were found between the generic and PNA feedback conditions. Compared with generic information P feedback was more effective in changing awareness and intention among the underestimators, and PN feedback was more effective in changing intention among both risk consumers and underestimators. In conclusion, the combination of personal, normative and action feedback is required for inducing change in fat intake and improving awareness of fat intake.

Do the transtheoretical processes of change predict transitions in stages of change for fruit intake? (Article)

2008-10-01T00:00:00Z

In a longitudinal study, it is examined whether the transtheoretical processes of change do predict stage transitions in fruit intake. A random sample of an existing Internet research panel resulted in a cohort of 735 adults, who were examined three times with electronic questionnaires assessing stages of change, processes of change, and fruit intake. Cross-sectional differences were found for the processes of change between precontemplation and all further stages. Experiential as well as behavioral processes increased from precontemplation to action with similar patterns. Both experiential and behavioral processes predicted forward transition out of precontemplation and forward transition into action, whereas only behavioral processes predicted forward transition out of contemplation. The results indicate that the transtheoretical processes of change predict stage transitions for fruit intake, but that the pattern of relevant processes for fruit intake is not as straightforward as outlined by the transtheoretical model of behavior change.

Assessing psychosocial correlates of parental safety behaviour using Protection Motivation Theory: stair gate presence and use among parents of toddlers (Article)

2008-09-15T00:00:00Z

Unintentional injury due to falls is one of the main reasons for hospitalization among children 0–4 years of age. The goal of this study was to assess the psychosocial correlates of parental safety behaviours to prevent falls from a staircase due to the lack of or the lack of adequate use of a stair gate. Data were collected from a cross-sectional survey using self-administered questionnaires mailed to a population sample of 2470 parents with toddlers. Associations between self-reported habits on the presence and use of stair gates and family and psychosocial factors were analysed, using descriptive statistics and multiple regression models, based on Protection Motivation Theory. The presence of stair gates was associated with family situation, perceived vulnerability, response efficacy, social norms and descriptive norms. The use of stair gates was associated with family situation, response efficacy, self-efficacy and perceived advantages of safe behaviour. The full model explained 32 and 24% of the variance in the presence of stair gates and the use of stair gates, respectively, indicating a large and medium effect size. Programmes promoting the presence and adequate use of stair gates should address the family situation, personal cognitive factors as well as social factors.

Design and evaluation protocol of "FATaintPHAT", a computer-tailored intervention to prevent excessive weight gain in adolescents (Article)

2008-09-15T00:00:00Z

Computer tailoring may be a promising technique for prevention of overweight in adolescents. However, very few well-developed, evidence-based computer-tailored interventions are available for this target group. We developed and evaluated a computer-tailored intervention for adolescents targeting energy balance-related behaviours: i.e. consumption of snacks, sugar-sweetened beverages, fruit, vegetables, and fibre, physical activity, and sedentary behaviours. This paper describes the planned development of a school-based computer-tailored intervention aimed at improving energy balance-related behaviours in order to prevent excessive weight gain in adolescents, and the protocol for evaluating this intervention. Methods/design Intervention development: Informed by the Precaution Adoption Process Model and the Theory of Planned Behaviour, the computer-tailored intervention provided feedback on personal behaviour and suggestions on how to modify it. The intervention (VETisnietVET translated as 'FATaintPHAT') has been developed for use in the first year of secondary school during eight lessons. Evaluation design: The intervention will be evaluated in a cluster-randomised trial including 20 schools with a 4-months and a 2-years follow-up. Outcome measures are BMI, waist circumference, energy balance-related behaviours, and potential determinants of these behaviours. Process measures are appreciation of and satisfaction with the program, exposure to the program's content, and implementation facilitators and barriers measured among students and teachers. Discussion This project resulted in a theory and evidence-based intervention that can be implemented in a school setting. A large-scale randomised controlled trial with a short and long-term follow-up will provide sound statements about the effectiveness of this computer-tailored intervention in adolescents.

A systematic review of the evidence regarding efficacy of obesity prevention interventions among adults (Article)

2008-09-01T00:00:00Z

In the past, interventions aimed at reducing obesity have mainly targeted at weight loss treatment in obese adults, with limited long-term effects. With the increasing number of people being obese and being at risk for obesity, there has been a shift in focus towards prevention of obesity. We conducted a systematic review of the peer-reviewed literature on the efficacy of obesity prevention interventions in adults in order to identify effective interventions and intervention elements. Pubmed, OVID, and Web of Science databases were searched from January 1996 to June 2006. Interventions aimed at primary prevention of weight gain among adults achieved by focusing on dietary intake, physical activity or the combination of both were included. The outcome measure had to be difference in change in body mass index or body weight between the intervention and the control groups. Nine studies were included, five long-term studies (at least 1 year) and four short-term (3 months to 1 year). Seven studies evaluated an intervention that focused on a combination of diet and physical activity to prevent weight gain, one on diet only and one on physical activity only. One dietary intervention (long-term), and three combined dietary and physical activity interventions (one long-term and two short-term) produced significantly positive results at end of follow-up. The two long-term, effective interventions consisted of intensive and long-term intervention implementation, including groups sessions designed to promote behavioural changes. The current evidence of efficacy of obesity prevention interventions is based on a very small number of studies. Some studies showed a positive impact on body mass index or weight status, but there was too much heterogeneity in terms of study design, theoretical underpinning and target population to draw firm conclusions about which intervention approaches are more effective than others. More research is urgently needed to extend the body of evidence.

Saturated fat consumption and the Theory of Planned Behaviour: Exploring additive and interactive effects of habit strength (Article)

2008-09-01T00:00:00Z

The additive and interactive effects of habit strength in the explanation of saturated fat intake were explored within the framework of the Theory of Planned Behaviour (TPB). Cross-sectional data were gathered in a Dutch adult sample (n = 764) using self-administered questionnaires and analyzed using hierarchical regression analyses and simple slope analyses. Results showed that habit strength was a significant correlate of fat intake (β = -0.11) and significantly increased the amount of explained variance in fat intake (R2-change= 0.01). Furthermore, based on a significant interaction effect (β = 0.11), simple slope analyses revealed that intention was a significant correlate of fat intake for low levels (β = -0.29) and medium levels (β = -0.19) of habit strength, but a weaker and non-significant correlate for high levels (β = -0.07) of habit strength. Higher habit strength may thus make limiting fat intake a non-intentional behaviour. Implications for information and motivation-based interventions are discussed.

The School Food Environment. Associations with Adolescent Soft Drink and Snack Consumption (Article)

2008-09-01T00:00:00Z

Background: Because students may purchase food and drinks in and around their schools, the school food environment may be important for obesity-related eating behaviors such as soft drink and snack consumption. However, research exploring the associations between school environments and specific eating behaviors is sparse. Methods: Associations of the availability of canteen food and drinks, the presence of food stores around schools, and individual cognitions (attitudes, norms, modeling, perceived behavioral control, and intentions) with soft drink and snack consumption were examined in a cross-sectional study (2005-2006) among 1293 adolescents aged 12-15 years. Soft drink and snack consumption and related cognitions were assessed with self-administered questionnaires. The presence of food stores and the distance to the nearest food store were calculated within a 500-meter buffer around each school. Data on the availability of soft drinks and snacks in school canteens were gathered by observation. In 2007, multilevel regression models were run to analyze associations and mediation pathways between cognitions, environmental factors, and behaviors. Results: Adolescents' attitudes, subjective norms, parental and peer modeling, and intentions were positively associated with soft drink and snack consumption. There was an inverse association between the distance to the nearest store and the number of small food stores with soft drink consumption. These effects were mediated partly by cognitions. Conclusions: This study provided little evidence for associations of environmental factors in the school environment with soft drink and snack consumption. Individual cognitions appeared to be stronger correlates of intake than physical school-environmental factors. Longitudinal research is needed to confirm these findings.

Environmental determinants of healthy eating: In need of theory and evidence (Article)

2008-08-01T00:00:00Z

In order to promote healthful nutrition, insight is needed into the determinants of nutrition behaviours. Behavioural determinant research and behavioural nutrition interventions have focused mostly on individual-level motivational factors. It has been argued that the individual's socio-cultural and physical environments may be the main determinants of nutrition behaviours. However, the theoretical basis and empirical evidence for environmental determinants of nutrition behaviours are not strong. The present paper is a narrative review informed by a series of systematic reviews and recent original studies on associations between environmental factors and nutrition behaviours to provide an overview and discussion of the evidence for environmental correlates and predictors of nutrition behaviour. Although the number of studies on potential environmental determinants of nutrition behaviours has increased steeply over the last decades, they include only a few well-designed studies with validated measures and guided by sound theoretical frameworks. The preliminary evidence from the available systematic reviews indicates that socio-cultural environmental factors defining what is socially acceptable, desirable and appropriate to eat may be more important for healthful eating than physical environments that define the availability and accessibility of foods. It is concluded that there is a lack of well-designed studies on environmental determinants of healthful eating behaviours. Preliminary evidence indicates that social environmental factors may be more important than physical environmental factors for healthful eating. Better-designed studies are needed to further build evidence-based theory on environmental determinants to guide the development of interventions to promote healthful eating.

Adolescents' movement towards cessation of smoking: Role and relative value of the processes of change and nicotine dependence (Article)

2008-08-01T00:00:00Z

The present study addresses the applicability of the Transtheoretical Model's processes of change in explaining adolescents' readiness to quit smoking. Furthermore, the association between nicotine dependence and readiness to quit was assessed both directly, as well as indirectly through the processes of change. A cross-sectional survey was conducted, identifying 1547 weekly smokers aged 14-18 years. Structural equation modelling showed that the processes of change were only marginally associated with readiness to quit. Adding nicotine dependence to the model showed a direct association between nicotine dependence and readiness to quit. Only one process of change, self-liberation (i.e. choice/commitment to change and belief in the ability to change), was found to mediate this association. Nicotine dependence appeared to be highly important in adolescents' readiness to quit.

The Efficacy of Web-based and Print-delivered Computer-tailored Interventions to Reduce Fat Intake: Results of a Randomized, Controlled Trial (Article)

2008-07-01T00:00:00Z

Objective: To test and compare the efficacy of interactive- and print-delivered computer-tailored nutrition education targeting saturated fat intake reduction. Design: A 3-group randomized, controlled trial (2003-2005) with posttests at 1 and 6 months post-intervention. Setting: Worksites and 2 neighborhoods in the urban area of Rotterdam. Participants: A convenience sample of healthy Dutch adults (n = 442). Interventions: An interactive, computer-tailored intervention delivered on a CD-ROM (interactive-tailored condition); a print-delivered, computer-tailored intervention (print-tailored condition); and print-delivered, generic information. Main Outcome Measures: Total and saturated fat intake (grams/day and percentage-energy) and energy intake per day assessed with validated food frequency questionnaires at 1 and 6 months post-intervention. Analysis: Multilevel linear regression analyses. Results: Mean total fat, saturated fat, and energy intakes were significantly lower in both tailored conditions compared to the generic condition at 1-month follow-up. These differences were still significant for the print-tailored condition at 6-months follow-up. Effects were most pronounced among participants with unfavorable fat intakes at baseline. There were no significant differences between the 2 tailoring conditions. Conclusions and Implications: The results indicate that interactive and print-delivered computer-tailored interventions can have similar short-term effects on fat intake and that the effects of the print-delivered tailored feedback are maintained in the longer term.

An exploration of factors related to dissemination of and exposure to internet-delivered behavior change interventions aimed at adults: A Delphi study approach (Article)

2008-07-01T00:00:00Z

Background: The Internet is an attractive medium for delivering individualized, computer-tailored behavior change interventions to large numbers of people. However, the actual numbers of people reached seem to fall behind the high expectations. Insight into factors that determine use of and exposure to these Internet interventions is important to be able to increase the reach and improve exposure. Objective: The aim was to identify potentially important factors that determine whether adults visit an Internet-delivered behavior change intervention, extend their visit, and revisit the intervention. Methods: A systematic, three-round Delphi study was conducted among national and international experts from Internet intervention research and practice, e-marketing/e-commerce, Web design, and technical website development. In the first round, 30 experts completed a structured, open-ended online questionnaire assessing factors that were, in their opinion, important for a first visit, an extended visit, a revisit and for effective promotion strategies. Based on the responses in this first questionnaire, a closed-ended online questionnaire was developed for use in the second round. A total of 233 experts were invited to complete this questionnaire. Median and interquartile deviation (IQD) scores were computed to calculate agreement and consensus on the importance of the factors. The factors for which no consensus was obtained (IQD > 1) were included in the third-round questionnaire. Factors with a median score of six or higher and with an IQD ≤ 1 were considered to be important. Results: Of the 62 experts invited for the first round, 30 completed the questionnaire (48% response rate); 93/233 experts completed the second-round questionnaire (40% response rate), and 59/88 completed the third round (67% response rate). Being motivated to visit an Internet intervention and perceiving the intervention as personally relevant appeared to be important factors related to a first visit. The provision of tailored feedback, relevant and reliable information, and an easy navigation structure were related to an extended visit. Provision of regular new content and the possibility to monitor personal progress toward behavior change were identified as important factors to encourage a revisit. Primarily traditional promotion strategies, like word-of-mouth by family and friends, a publicity campaign with simultaneous use of various mass media, and recommendation by health professionals, were indicated as effective ways to encourage adults to visit an Internet intervention. Conclusions: This systematic study identified important factors related to the dissemination of and exposure to Internet interventions aimed at adults. In order to improve optimal use of and exposure to Internet interventions, potential users may need to be motivated to visit such an intervention and the information provided needs to be personally relevant. Furthermore, several (technical) aspects of the intervention itself need to be taken into account when developing Internet interventions.

Comparison of use and appreciation of a print-delivered versus CD-ROM-delivered, computer-tailored intervention targeting saturated fat intake: Randomized controlled trial (Article)

2008-07-01T00:00:00Z

Background: Computer-tailored health education, a promising health education technique, is increasingly being delivered interactively, for example, over the Internet. It has been suggested that there may be differences in use and appreciation between print and interactive delivery of computer-tailored interventions, which may influence information processing. This may especially be the case for women, older people, and people of lower socioeconomic status. Knowledge about differences in use and appreciation could help in choosing the appropriate delivery mode for a particular target audience. Objective: The study investigates a content-identical, computer-tailored intervention addressing saturated fat intake delivered via print or CD-ROM. We analyzed consumer use and appreciation of the feedback information and explored whether possible differences exist among gender, age, and education subgroups. Methods: Healthy Dutch adults (18-65 years), none of whom were under treatment for hypercholesterolemia, were randomly allocated to receive a computer-tailored program on CD-ROM (n = 151) or in print (n = 141). At baseline, data were collected on gender, age, and education level. One month post-intervention, data were collected on the use (feedback information read, saved, discussed) and appreciation (trustworthiness, perceived individualization, perceived personal relevance, and user-friendliness) of the feedback. Statistical analyses on the use and appreciation items were performed using chi-square tests and independent-samples t tests. Results: After exclusion of individuals with missing values, a total of 257 and 240 respondents were included in the analyses of the use outcomes of feedback read and saved, respectively. The results indicate that among the total population, the print feedback was read more often than the CD-ROM feedback (95% vs 81%; P = .001) and saved more often than the CD-ROM feedback (97% vs 77%; P < .001). Similar results were found among the gender, age, and education subgroups. After exclusion of individuals who did not read the information and those with missing values, a total of 208-223 respondents were included in the analyses of the use outcome of feedback discussed and the appreciation items. The personal relevance of the print feedback was rated higher than for the CD-ROM-delivered feedback (0.97 vs 0.68; P = .04), but the effect size was small (0.28). These differences in personal relevance were also seen among women (1.06 vs 0.67; P = .04) and respondents aged 35-49 years (1.00 vs 0.58; P = .03), with moderate effect sizes (0.38 and 0.44, respectively). Conclusions: Despite the possible advantages of interactive feedback, the present study indicates that interactive-delivered feedback was used less and perceived as less personally relevant compared to the print-delivered feedback. These differences in use and appreciation of delivery modes should be taken into consideration when selecting a delivery mode for a specific subgroup in order to optimize exposure. Trial Registration: ISRCTN 01557410; http://www.webcitation.org/5XMylWleH.

Effects of tailoring health messages on physical activity (Article)

2008-06-01T00:00:00Z

Computer-tailored printed education can be a promising way of promoting physical activity. The present study tested whether computer-tailored feedback on physical activity is effective and whether there are differences between respondents with low and high motivation to change. Respondents (n = 487) were randomly assigned to a tailored intervention group or a no information control group. Physical activity and determinants were measured at baseline and after 3 months. At post-test, the motivated respondents in the control group were more likely not to meet the recommendation for physical activity than to meet it, and motivated respondents in the experimental group were more likely to engage in transport-related activities and showed more improvement over time for the total activity score than respondents in the control group (β = 0.24, P = 0.02). Both groups improved their behaviour over time. No group differences in physical activity were found for the unmotivated respondents. The results showed that the effects of the tailored feedback were restricted to respondents who had a positive motivation to change at baseline. Possible explanations could be that unmotivated respondents were unwilling to read and process the information because they felt 'no need to change'. Alternatively, one tailored feedback letter may not have been sufficient for this unmotivated group.

Internet-delivered interventions aimed at adolescents: A Delphi study on dissemination and exposure (Article)

2008-06-01T00:00:00Z

It appears that in practice exposure to Internet-delivered behaviour change interventions, encouraging a healthy lifestyle for adolescents with regard to health risk behaviours, is quite low. There is, however, a lack of evidence-based insight into how to disseminate such interventions and how to reach optimal exposure. A more extensive exploration is therefore timely since this knowledge is crucial to improve the public health impact of such interventions. By means of a three-round Delphi study factors associated with dissemination of and exposure (first visit, stay long enough and revisit) to Internet-delivered interventions aimed at adolescents had been identified, as well as the extent to which experts agree on the importance of these factors. Results showed that there was a high rate of consensus among experts from several disciplines with regard to the importance of factors like word of mouth recommendation, the interface of the intervention and utilization of all features provided by the Internet. Experts do not agree, however, on a gold standard for successful dissemination. Overall, the results of this exploration serve as a handle for the formation of further research questions to be tested and answered in research among adolescents.

Socioeconomic position at different stages of the life course and its influence on body weight and weight gain in adulthood: A longitudinal study with 13-year follow-up (Article)

2008-06-01T00:00:00Z

Socioeconomic inequalities in body weight have been demonstrated in numerous cross-sectional studies; however, little research has investigated these inequalities from a life course and longitudinal perspective. We examined the association between child- and adulthood socioeconomic position (SEP) and BMI and overweight/obesity in 1991 (baseline) and changes in BMI and the prevalence of overweight and obesity between 1991 and 2004. Data from the 1991 and 2004 waves of the longitudinal Dutch GLOBE study were used. Participants (n = 1,465) were aged 40-60 years at baseline. BMI was calculated from self-reported height and weight collected by postal questionnaire. Retrospective recall of father's occupation was used as childhood socioeconomic indicator, and adulthood SEP was measured by the occupation of the main income earner of the household. The findings showed that among women, childhood SEP exerted a greater influence on body weight than SEP in adulthood: at baseline, women from disadvantaged backgrounds in childhood had a higher BMI and were more likely to be overweight or obese, and they gained significantly more weight between baseline and follow-up. In contrast, adult SEP had a greater impact than childhood circumstances on men's body weight: those from disadvantaged households had a higher mean BMI and were more likely to be overweight or obese at baseline, and they gained significantly more weight between 1991 and 2004. The findings suggest that exposure to disadvantaged circumstances at critically important periods of the life course is associated with body weight and weight gain in adulthood. Importantly, these etiologically relevant periods differ for men and women, suggesting gender-specific pathways to socioeconomic inequalities in body weight in adulthood.

Are positive changes in potential determinants associated with increased fruit and vegetable intakes among primary schoolchildren? Results of two intervention studies in the Netherlands: The Schoolgruiten Project and the Pro Children Study (Article)

2008-04-25T00:00:00Z

Background: To investigate if positive changes or maintenance high scores on potential behavioral determinants of fruit and vegetable (F&V) intake are associated with increased or maintenance favorable levels of F&V intake frequency in the same time lapse or later in time. Data were used from two intervention studies in the Netherlands: the Schoolgruiten Project and the Pro Children Study. Methods: A design with baseline and two follow-up measurements. 344 children of the Dutch Schoolgruiten Project and 258 children of the Pro Children Study completed questionnaires, including questions on general demographics, usual F&V intake frequency, important potential determinants of F&V intake, such as taste preferences of F&V, availability of F&V, knowledge of recommended intake levels of F&V, self-efficacy for eating F&V, and parental influences for eating F&V. Three different associations between changes in determinants of F&V intake and changes in F&V intake frequency were assessed by multilevel multinomial regression analyses. Results: Results of one of the investigated associations indicated that in both studies behavior change (increase in F&V intake frequency) was preceded by changes in the following variables; liking of fruit, parental facilitation of vegetables, family rules for eating vegetables and availability at home of vegetables. Furthermore, changes in F&V intake frequency preceded changes in liking of F&V later in time. Conclusion: In accordance with behavior change theories, the present study provides some evidence that behavior change was preceded by changes in certain potential determinants of F&V intake. Potential determinants of F&V intake that appear to be important to induce behavior change were liking of fruit, parental facilitation of vegetables, family rules for eating vegetables and availability at home of vegetables. Some evidence was also found that behavior changes may precede changes in presumed determinants of F&V intake, such as liking of F&V.

Effects of a comprehensive fruit- and vegetable-promoting school-based intervention in three European countries: The Pro Children Study (Article)

2008-04-01T00:00:00Z

The objective of the present study was to evaluate the effects of the Pro Children intervention on schoolchildren's fruit and vegetable (FV) intake after 1 and 2 years of follow-up. The intervention combined a FV curriculum with efforts to improve FV availability at schools and at home. Effects were examined in a group-randomised trial among 1472 10-11-year-old children from sixty-two schools in Norway, the Netherlands and Spain. FV intake was assessed by means of validated self-administered questionnaires completed before the intervention (September 2003), immediately after the first year of the intervention (May 2004) and 1 year later (May 2005). Data were analysed using multilevel linear regression analyses with age and sex as covariates. Significant intervention effects for FV intake were found at first follow-up in the total sample. The adjusted FV intake reported by the children from intervention schools was 20% higher than FV intake reported by children from control schools. At 1 year later, a significant impact was only observed in Norway. Positive intervention effects on FV intake occurred both at school and outside school. We conclude that the Pro Children intervention is a promising means to promote European schoolchildren's FV intakes, but mainly fruit intake, in the short term. As shown in Norway, where the intervention was best implemented, the intervention might also result in longer-term effects. Further strategies need to be developed that can improve implementation, have an impact on vegetable intake and can secure sustained effects.

Efficacy and use of an internet-delivered computer-tailored lifestyle intervention, targeting saturated fat intake, physical activity and smoking cessation: A randomized controlled trial (Article)

2008-04-01T00:00:00Z

Background: Although experts claim that computer-tailored interventions provided over the Internet have great potential to promote health behavior change, few studies have tested the efficacy of computer-tailored lifestyle interventions online-delivered over the Internet. Purpose: To evaluate the short-term (1 month) efficacy of an Internet-delivered, computer-tailored lifestyle intervention targeting saturated fat intake, physical activity (PA), and smoking cessation, and to evaluate exposure to the intervention. Methods: A pretest-posttest randomized controlled trial with an intervention group and a no intervention waiting list control group was conducted. Self-reported behavior and determinants were assessed at baseline and 1 month follow-up. Exposure to the intervention was monitored through server registrations. The data were analyzed using multiple linear and logistic regression analysis. Results: The intervention resulted in a significantly lower self-reported saturated fat intake (b=-0.76, p<0.01) and a higher likelihood of meeting the PA guidelines among respondents who were insufficiently active at baseline (OR=1.34, 95%CI=1.001-1.80). No significant intervention effects were found for self-reported smoking status. Of the participants, 81% actually visited the website. Conclusions: The Internet-delivered, computer-tailored lifestyle intervention was effective in reducing self-reported saturated fat intake and in increasing self-reported PA among participants who completed the study.

Why do boys eat less fruit and vegetables than girls? (Article)

2008-03-01T00:00:00Z

Objective: To explore why boys eat less fruit and vegetables (F&V) than girls, using longitudinal data following pupils from the age of 12.5 to 15.5 years, including perceived accessibility, modelling, intention, preferences, self-efficacy and knowledge of recommendations as potential mediators. Design/setting/subjects: A longitudinal study, based on data collected among the control schools within the intervention project 'Fruits and Vegetables Make the Marks'. This sample contains 896 6th and 7th graders from 20 randomly selected elementary schools within two Norwegian counties. Questionnaires were administered in May 2002 and May 2005 (when the participants were in 9th and 10th grade in 18 secondary elementary schools). Results: In single mediation analyses all determinants mediated parts of the gender difference, but only preferences decreased the gender difference to a level below statistical significance. Preferences alone explained 81% of the gender difference. In the multiple mediation analyses, the six mediators together explained 91% of the gender difference, but only preferences and perceived accessibility contributed uniquely to the explanation, with 25% and 10% respectively. Conclusions: Preference appears as the strongest mediator of the difference in F&V intakes between boys and girls. Further research should explore why girls like F&V more than boys.

Exploring environmental determinants of physical activity-The road to the future is always under construction (Article)

2008-03-01T00:00:00Z

MP3 Players and Hearing Loss: Adolescents' Perceptions of Loud Music and Hearing Conservation (Article)

2008-03-01T00:00:00Z

Objective: To explore adolescents' behaviors and opinions about exposure to loud music from MP3 players. Study design: We conducted a qualitative analysis of focus-group discussions with adolescents aged 12 to 18 years from 2 large secondary schools (1 urban and 1 rural) for pre-vocational and pre-university education. The semi-structured question route was theoretically framed within the protection motivation theory. Results: Most adolescents-especially male students and students from pre-vocational schools-indicated that they often played their MP3 players at maximum volume. Although they appeared to be generally aware of the risks of exposure to loud music, they expressed low personal vulnerability to music-induced hearing loss. Most adolescents said that they would not accept any interference with their music-exposure habits. Conclusions: Interventions should target students from pre-vocational schools and should focus on increasing adolescents' knowledge of the risks of loud music and how to protect themselves. Besides hearing education for adolescents and technical modifications of MP3 players, volume-level regulations for MP3 players may be warranted.

Qualitative assessment of adolescents' views about improving exposure to internet-delivered interventions (Article)

2008-02-26T00:00:00Z

Purpose - The purpose of this paper is to gain first insight into factors which might be associated with exposure to internet-delivered interventions. Design/methodology/approach - Semi-structured focus group interviews were conducted with five groups of Dutch adolescents (n=54), aged 12-17 years. Several aspects of exposure: a first visit; staying long enough actually to use and process the information; and revisiting the intervention, were explored. Findings - Several factors that are likely to improve exposure to internet-delivered interventions were identified, such as the use of "word of mouth" marketing, comparison of own behaviour with friends and the use of reminders. Research limitations/implications - Focus group interviews are only a first step in the generation of ideas and opinions. A next step would be to conduct observational, experimental and longitudinal studies to test if and how these factors improve exposure to internet-delivered interventions. Practical implications - This paper is a useful source for those developing internet-delivered interventions who want to improve exposure rates to their interventions. Originality/value - The results of this exploration serve as an important first step to gain more insight into factors that improve exposure to internet-delivered interventions.

Reply to absinthe and tobacco - A new look at an old problem? [2] (Article)

2008-02-01T00:00:00Z

Associations between the transtheoretical processes of change, nicotine dependence and adolescent smokers' transition through the stages of change (Article)

2008-02-01T00:00:00Z

Aims: To examine the significance of the transtheoretical processes of change in predicting transition through the stages of change in adolescent smokers, as well as the relative role of nicotine dependence in predicting stage transitions. Design: In grades 9 and 10, adolescents' stage of change, the use of processes of change and nicotine dependence were assessed (T1). Stage transitions were assessed 1 year later (T2). Response rate was 73.2%. Setting: Twenty-five secondary schools throughout the Netherlands participated in the present study. Participants: Respondents were 721 adolescents who were classified as smokers at T1 and consequently completed the paper-and-pencil questionnaire at T2. Measurements: Stages of change and processes of change were assessed according to the original transtheoretical measures. Nicotine dependence was measured using a newly developed multi-dimensional scale consisting of 11 items. Findings: Few associations were found between the processes of change and stage transitions. Nicotine dependence contributed significantly to the explanation of adolescents' transition from preparation to action, after adjustment for processes of change. No evidence for a moderating effect of nicotine dependence in the relation between the processes of change and stage transitions was found. Conclusions: Processes of change do not seem significant in explaining adolescents' stage transitions. As an alternative for promoting the use of the processes of change for intervention purposes in adolescents, it might be more useful to focus on treating nicotine dependence.

Feeling Fat Rather than Being Fat May Be Associated with Psychological Well-Being in Young Dutch Adolescents (Article)

2008-02-01T00:00:00Z

Purpose: To contribute to a further exploration of the association of psychosocial well-being with overweight and weight perception among young Dutch adolescents. Methods: Data from the ongoing Rotterdam Youth Health Monitor were used from 1,923 9-10-year-olds and 3,841 12-13-year-olds. The association of mental health indicators with weight status based on self-report and measured height and weight was studied with logistic regression analyses in both age groups cross-sectionally. Additional longitudinal analyses were conducted among the 787 pupils for whom follow-up data were available. Interactions with gender and ethnic background were explored. Among the 12-13-year-olds, the role of weight perception was also studied. Results: We found that 9-10-year-old obese boys scored more favourably on social anxiety than nonoverweight boys. Among 12-13-year-olds body weight perception, rather than self-reported or measured weight status was associated with mental health indicators. Mental health indicators at age 9-10 years did not predict self-reported weight status at age 12-13 or change in weight status between 9-10 and 12-13 years, nor did weight status at age 9-10 years predict later mental health indicators or change in these indicators. Conclusions: This study provides no evidence that overweight does coincide with less favorable psychological well-being in young adolescents. In 12-13-year-old adolescents, feeling overweight, rather than being overweight, appears to be important.

Socioeconomic status, environmental and individual factors, and sports participation (Article)

2008-01-01T00:00:00Z

PURPOSE: To examine the contribution of neighborhood, household, and individual factors to socioeconomic inequalities in sports participation in a multilevel design. METHODS: Data were obtained by a large-scale postal survey among a stratified sample of the adult population (age 25-75 yr) of Eindhoven (the fifth-largest city of the Netherlands) and surrounding areas, residing in 213 neighborhoods (N = 4785; response rate 64.4%). Multilevel logistic regression analyses were performed with sports participation as a binary outcome (no vs yes); that is, respondents not doing any moderate- or high-intensity sports at least once a week were classified as nonparticipants. RESULTS: Unfavorable perceived neighborhood factors (e.g., feeling unsafe, small social network), household factors (material and social deprivation), and individual physical activity cognitions (e.g., negative outcome expectancies, low self-efficacy) were significantly associated with doing no sports and were reported more frequently among lower socioeconomic groups. Taking these factors into account reduced the odds ratios of doing no sports among the lowest educational group by 57%, from 3.99 (95% CI, 2.99-5.31) to 2.29 (95% CI, 1.70-3.07), and among the lowest income group by 67%, from 3.02 (95% CI, 2.36-3.86) to 1.66 (95% CI, 1.22-2.27). CONCLUSIONS: A combination of neighborhood, household, and individual factors can explain socioeconomic inequalities in sports participation to a large extent. Interventions and policies should focus on all three groups of factors simultaneously to yield a maximal reduction of socioeconomic inequalities in sports participation.

Does habit strength moderate the intention-behaviour relationship in the Theory of Planned Behaviour? the case of fruit consumption (Article)

2007-12-01T00:00:00Z

The present study examined if habit strength moderated the influence of intention on fruit consumption in a Dutch adult sample (N = 521, 46.3% males, mean age = 34.50, SD = 10.87), using the theoretical relations of the Theory of Planned Behaviour (TPB). TPB variables and habit strength were assessed at baseline. Fruit consumption was assessed with a validated questionnaire five weeks later. Three groups were created: low habit strength (n = 180), medium habit strength (n = 185) and high habit strength (n = 156). Confirmatory factor analyses and multi-group path analyses were performed using AMOS 4.0. A good fit was obtained for the overall measurement model and the structural models. Multi-group path analyses showed that intention was a significant predictor of fruit consumption in the low habit ( = 0.36, p 0.001) and medium habit group ( = 0.30, p 0.001), but a non-significant predictor in the high habit group ( = 0.05, p = 0.596). Implications for information-based and motivation-based interventions are discussed.

Association of eating attitudes between teenage girls and their parents (Article)

2007-11-01T00:00:00Z

Background: Mothers of eating disordered adolescents were more likely to have an eating disorder. However, some contradictory findings were reported because some studies failed to find this association. Aims: The main objective of the study was to determine the association of eating attitudes in adolescent girls with eating attitudes in their parents. Methods: A sample of 969 girls from Osona County (Barcelona, Spain) and their parents participated in the study. Girls completed the Eating Attitudes Test (EAT-26) and their weight and height were measured. Parents completed questionnaire with self-reported weight and height, demographic characteristics and EAT-26. Results: 10.1% of girls showed high EAT-26 scores (> 20 points), indicating abnormal eating attitudes. Female adolescents were almost three times more likely to have abnormal eating attitudes if their mothers scored high on EAT-26 (OR = 2.8; 95% CI 1.5-5.2). Other significant predictors of high EAT-26 scores were age and obesity. Conclusions: An abnormal eating attitude of the mother was identified as a potential risk factor in the development of eating disorders in female adolescents.

Factorial and convergent validity of nicotine dependence measures in adolescents: Toward a multidimensional approach (Article)

2007-11-01T00:00:00Z

The present study investigated the possibility of forming a multidimensional scale for the measurement of nicotine dependence among adolescents, based on the modified Fagerström Tolerance Questionnaire (mFTQ) and the Hooked on Nicotine Checklist (HONC). A survey was conducted among 33 Dutch secondary schools, resulting in 2,041 smokers who completed the questionnaire. Motivation to quit and number of quit attempts were assessed and used as convergent construct variables for the construct of nicotine dependence. The findings show that combining the items of the mFTQ and the HONC results in three distinct dimensions: behavioral aspects of nicotine dependence, craving, and nervousness during abstinence. We examined this new multidimensional model in a second sample using confirmatory factor analysis. The new multidimensional measure fitted the data satisfactorily and showed good psychometric properties. Results of this study support the notion that nicotine dependence among adolescents is multidimensional.

The evaluation of a mass media campaign aimed at weight gain prevention among young Dutch adults (Article)

2007-11-01T00:00:00Z

Objective: The objective was to evaluate a 3-year nationwide mass media campaign aimed at preventing weight gain. The campaign was aimed primarily at raising awareness of the importance of weight-gain prevention and bringing these issues to the attention of the Dutch public. Research Methods and Procedures: Eleven serial, independent, cross-sectional, population-based telephone surveys were used to assess campaign awareness and impact (N ranged between 483 and 493 for each of the 11 surveys). The surveys were conducted before and after six campaign waves. Multiple linear and logistic regression analyses were used to test for trends over time and for differences among the surveys for campaign awareness, message recall, perceived body weight status, overweight-related risk perceptions, attitudes, perceived social support, self-efficacy expectations, and motivations for preventing weight gain. Results: Campaign awareness ranged from 61% after the 1st campaign wave to 88.4% after the final wave. The campaign's television broadcasting activities were an important source of campaign awareness, from both the campaign's television commercials and television-based free publicity. Message recall ranged from 41.9% to 68.1%. Small positive differences were found in attitudes, perceived social support, and intentions for preventing weight gain. Additionally, the results suggest mixed effects on self-efficacy expectations and a negative effect on risk perception. Discussion: The campaign resulted in high campaign awareness, especially as a result of television commercials and free publicity on television. The results suggest that the campaign was able to create more positive attitudes and motivation but lower risk perceptions and efficacy for preventing weight gain. Copyright

Presence and use of stair gates in homes with toddlers (11-18 months old) (Article)

2007-09-01T00:00:00Z

Background: The aim of this study was to assess demographic correlates of the presence and use of stair gates in homes with toddlers. Methods: In 2004, self-administered questionnaires were mailed to 2470 parents with toddlers living in both urban and rural areas (response rate 70.1%). The questionnaires were sent by the youth healthcare providers that the parents visited regarding their toddler. Results: In total, 83% of the parents reported to have at least one stair gate installed; however, 50% of these parents reported that they did not always close the stair gate. Households with a non-Dutch ethnic mother, one child, a female child, a young child or a child who cannot crawl, were less likely to have a stair gate. Households with one child, a toddler who cannot walk, and a mother with a higher educational level were less likely to use the gate adequately. Conclusions: This study shows that parents of toddlers often report to have a stair gate; however, in homes with a gate the parents do not necessarily use the gate adequately. Different demographic characteristics were shown to be correlated with both having a stair gate and the use of a stair gate.

Presence and use of stair gates in homes with toddlers (11-18 months old) (Article)

2007-09-01T00:00:00Z

The authors reply [2] (Article)

2007-09-01T00:00:00Z

Potential environmental determinants of physical activity in adults: A systematic review (Article)

2007-09-01T00:00:00Z

The objective of this systematic review of observational studies was to gain insight into potential determinants of various types and intensities of physical activity among adult men and women. Studies were retrieved from Medline, PsycInfo, Embase and Social scisearch. The ANGELO framework was used to classify environmental factors. In total, 47 publications were identified. Social support and having a companion for physical activity were found to be convincingly associated with different types of physical activity [(neighbourhood) walking, bicycling, vigorous physical activity/sports, active commuting, leisure-time physical activity in general, sedentary lifestyle, moderately intense physical activity and a combination of moderately intense and vigorous activity]. Availability of physical activity equipment was convincingly associated with vigorous physical activity/sports and connectivity of trails with active commuting. Other possible, but less consistent correlates of physical activity were availability, accessibility and convenience of recreational facilities. No evidence was found for differences between men and women. In conclusion, supportive evidence was found for only very few presumed environmental determinants. However, most studies used cross-sectional designs and non-validated measures of environments and/or behaviour. Therefore, no strong conclusions can be drawn and more research of better quality is clearly needed.

Two-year follow-up of sequential and simultaneous interactive computer-tailored interventions for increasing physical activity and decreasing fat intake (Article)

2007-08-27T00:00:00Z

Background: Limited evidence exists on long-term efficacy of interactive computer-tailored interventions for increasing physical activity and decreasing fat intake, and even more so when they are implemented simultaneously or sequentially. Purpose: This study aims to examine long-term efficacy of interactive computer-tailored physical activity and fat intake interventions, and evaluate their efficacy in a simultaneous or sequential implementation over 2 years. Methods: Participants (392) were randomly assigned to a simultaneous group receiving both interventions at baseline; a sequential group first receiving the physical activity intervention and 3 months later the fat intake intervention; and a sequential group first receiving the fat intake intervention and 3 months later the physical activity intervention. Results: Strong time effects were seen for total physical activity (F =3 8.7, p < .001) and fat intake (F = 103.9, p < .001), indicating that intervention effects remained over 2 years for those participants that were still available for the 2-year follow-up. At 2-year follow-up the interventions resulted in a 10% and a 27% increase of participants that met public health recommendations for physical activity and fat intake, respectively. Overall the interventions were more effective for participants not meeting the public health recommendations at baseline. The sequential intervention mode was overall slightly more effective than the simultaneous mode in maintaining intervention effects. Conclusions: Both interventions showed efficacy in maintaining long-term health behavior changes. More research is needed on sequential and simultaneous intervening modes.

Using Intervention Mapping to develop a programme to prevent sexually transmittable infections, including HIV, among heterosexual migrant men (Article)

2007-08-20T00:00:00Z

Background. There is little experience with carefully developed interventions in the HIV/STI prevention field aimed at adult heterosexual target groups in the Netherlands. The ability to apply intervention development protocols, like Intervention Mapping, in daily practice outside of academia, is a matter of concern. An urgent need also exists for interventions aimed at the prevention of STI in migrant populations in the Netherlands. This article describes the theory and evidence based development of HIV/STI prevention interventions by the Municipal Public Health Service Rotterdam Area (MPHS), the Netherlands, for heterosexual migrant men with Surinamese, Dutch-Caribbean, Cape Verdean, Turkish and Moroccan backgrounds. Methods. First a needs assessment was carried out. Then, a literature review was done, key figures were interviewed and seven group discussions were held. Subsequently, the results were translated into specific objectives ("change objectives") and used in intervention development for two subgroups: men with an Afro-Caribbean background and unmarried men with a Turkish and Moroccan background. A matrix of change objectives was made for each subgroup and suitable theoretical methods and practical strategies were selected. Culturally-tailored interventions were designed and were pre-tested among the target groups. Results. This development process resulted in two interventions for specific subgroups that were appreciated by both the target groups and the migrant prevention workers. The project took place in collaboration with a university center, which provided an opportunity to get expert advice at every step of the Intervention Mapping process. At relevant points of the development process, migrant health educators and target group members provided advice and feedback on the draft intervention materials. Conclusion. This intervention development project indicates that careful well-informed intervention development using Intervention Mapping is feasible in the daily practice of the MPHS, provided that sufficient time and expertise on this approach is available. Further research should test the effectiveness of these interventions.

Young people's exposure to loud music: a summary of the literature (Article)

2007-08-01T00:00:00Z

OBJECTIVES: This descriptive summary of the literature provides an overview of the available studies (published before October 2006) on sociodemographic, psychosocial, and other correlates of risk and protective behaviors for hearing loss in young people aged 12 to 25 years. METHODS: Publications were identified by a structured search in PubMed, PsycINFO, and Web of Science, and by scrutinizing the reference lists of relevant articles. The protection motivation theory was used as the theoretical framework for categorizing the psychosocial correlates. RESULTS: Thirty-three papers were included that identified several sociodemographic and psychosocial correlates, such as age, gender, school level, ethnicity, music preference, physical activity, social influence, and free supply of hearing protection. CONCLUSIONS: For the development of effective interventions we recommend theory-based longitudinal studies among those frequently exposed to loud music to assess these correlates in greater depth.

Comparing stage of change and behavioral intention to understand fruit intake (Article)

2007-08-01T00:00:00Z

We explored if the pre-action Transtheoretical stages of change are indeed discrete stages for fruit intakes. In a longitudinal design, a cohort of 735 adults completed electronic questionnaires assessing fruit intake, stages of change and intention to increase fruit intake at baseline and 35 and 67 days follow-up. A dichotomization of a continuous intention measure ('pseudostages') was compared with precontemplation and contemplation stages. The results showed (i) that pseudostages and stages of change were strongly associated; (ii) that for most respondents, stability and transitions in stages of change resembled transitions in pseudostage, while test-retest reliabilities for both measures were similar and (iii) that pseudostages and the continuous intention measure were stronger predictors of fruit intake than stage of change. We conclude that pre-action stages of change for fruit are not different from a mere categorization of a continuous intention measure.

Absinthe - Is its history relevant for current public health? (Article)

2007-08-01T00:00:00Z

This paper briefly addresses the history of the social experience with absinthe in France during the 19th century and the beginning of the 20th. We draw on some important parallels of this history with that of smoking to demonstrate that public health threats in the form of (ill-)health related behaviour recur in different disguises, while the social causes if these threats are left to endure. Probably the most important of the parallels between absinthe and smoking is their association with social disadvantage. Nevertheless, it appears that it is not yet fully realized that tackling these threats requires an equity approach.

Socioeconomic inequalities in food purchasing: The contribution of respondent-perceived and actual (objectively measured) price and availability of foods (Article)

2007-07-01T00:00:00Z

Background.: Research has shown that lower socioeconomic groups purchase foods that are less consistent with dietary recommendations. The price and availability of foods are thought to be important mediating factors between socioeconomic position and food purchasing. Objectives.: We examined the relative contribution of the perceived and objectively measured price and availability of recommended foods to household income differences in food purchasing. Methods.: Using a face-to-face interview, a random sample of Brisbane residents (n = 812) were asked about their food purchasing choices in 2000. They were also asked about their perceptions of the price and availability of 'recommended' foods (i.e. choices lower in fat, saturated fat, sugar, salt or higher in fibre) in the supermarkets where they usually shopped. Audits measuring the actual availability and price of identical foods were conducted in the same supermarkets. Results.: Lower socioeconomic groups were less likely to make food purchasing choices consistent with dietary guideline recommendations. Objective availability and price differences were not associated with purchasing choices, nor did they contribute to socioeconomic inequalities in food purchasing choices. Perceived availability and price differences were associated with the purchase of recommended foods. Perceived availability made a small contribution to inequalities in food purchasing, however perceived price differences did not. Conclusion.: Socioeconomic inequalities in food purchasing are not mediated by differential availability of recommended foods and differences in price between recommended and regular foods in supermarkets, or by perceptions of their relative price. However, differential perceptions of the availability of recommended foods may play a small role in food purchasing inequalities.

The NHF-NRG In Balance-project: The application of Intervention Mapping in the development, implementation and evaluation of weight gain prevention at the worksite (Article)

2007-07-01T00:00:00Z

Very few examples of theory-driven and systematically developed weight gain prevention interventions for adults have been described in the literature. The present paper systematically describes the development, implementation and evaluation framework of a weight gain prevention programme directed at young adults at the worksite, namely the NHF-NRG In Balance-project. It not only can be used as a guide to systematically develop weight gain prevention interventions, but also gives an overview of the current theoretical and empirical knowledge-base in the field of obesity prevention. The outline of the paper follows the Intervention Mapping protocol, which includes a systematic inventory of important health issues, their risk behaviours and determinants of these risk behaviours, and specification of the proximal objectives of the programme directed at both energy intake and energy expenditure. The objectives are translated into behaviour change methods and strategies, which are combined in a stepwise intervention programme, and used for a detailed evaluation plan (process and effect evaluation). The NHF-NRG In Balance-project combines mass media and individually tailored communications with worksite environmental changes to raise awareness, to motivate and to enable energy balance behaviour changes. A quasi-experimental pre-test-multiple post-test control group design was applied in 12 worksites (>500 employees).

Perceived environmental determinants of physical activity and fruit and vegetable consumption among high and low socioeconomic groups in the Netherlands (Article)

2007-06-01T00:00:00Z

A focus group study was conducted to explore how perceptions of environmental influences on health behaviours pattern across socioeconomic groups in the Netherlands. Participants perceived their spouse’s and friend’s health behaviour and support as highly important. People from lower socioeconomic backgrounds reported poor neighbourhood aesthetics, safety concerns and poor access to facilities as barriers for being physically active, while easy accessibility to sports facilities was mentioned by high socioeconomic participants. The availability of fruits and vegetables at home was perceived as good by all particpants. Overall, lower socioeconomic groups expressed more price concerns. Possible pathways between socioeconomic status, environmental factors and health behaviours are represented in a framework, and they should be investigated further in longitudinal research.

Aging, retirement, and changes in physical activity: Prospective cohort findings from the GLOBE study (Article)

2007-06-01T00:00:00Z

There is increased recognition that determinants of health should be investigated in a life-course perspective. Retirement is a major transition in the life course and offers opportunities for changes in physical activity that may improve health in the aging population. The authors examined the effect of retirement on changes in physical activity in the GLOBE Study, a prospective cohort study known by the Dutch acronym for "Health and Living Conditions of the Population of Eindhoven and surroundings," 1991-2004. They followed respondents (n = 971) by postal questionnaire who were employed and aged 40-65 years in 1991 for 13 years, after which they were still employed (n = 287) or had retired (n = 684). Physical activity included 1) work-related transportation, 2) sports participation, and 3) nonsports leisure-time physical activity. Multinomial logistic regression analyses indicated that retirement was associated with a significantly higher odds for a decline in physical activity from work-related transportation (odds ratio (OR) = 3.03, 95% confidence interval (CI): 1.97, 4.65), adjusted for sex, age, marital status, chronic diseases, and education, compared with remaining employed. Retirement was not associated with an increase in sports participation (OR = 1.12, 95% CI: 0.71, 1.75) or nonsports leisure-time physical activity (OR = 0.80, 95% CI: 0.54, 1.19). In conclusion, retirement introduces a reduction in physical activity from work-related transportation that is not compensated for by an increase in sports participation or an increase in nonsports leisure-time physical activity. Copyright

Effectiveness of an online computer-tailored physical activity intervention in a real-life setting (Article)

2007-06-01T00:00:00Z

The aim of this study was to evaluate the effectiveness of a computer-tailored physical activity intervention delivered through the Internet in a real-life setting. Healthy adults (n = 526), recruited in six worksites, between 25 and 55 years of age were randomized to one of three conditions receiving, respectively, (i) online-tailored physical activity advice + stage-based reinforcement e-mails, (ii) online-tailored physical activity advice only, (iii) online non-tailored standard physical activity advice. At 6-month follow-up, no differences in physical activity between study conditions were found; total physical activity, physical activity at moderate intensity and physical activity in leisure time significantly increased in all study conditions between baseline and follow-up. Further evaluation of the intervention materials showed that the tailored advice was more read, printed and discussed with others than the standard advice. Most of the respondents in the e-mail group indicated to be satisfied about the number, frequency and usefulness of the stage-based e-mails. In conclusion, although tailored advice was appreciated more than standard advice, no evidence was found that an online-tailored physical activity intervention program outperformed online standard information.

Short-term effects of school-based weight gain prevention among adolescents (Article)

2007-06-01T00:00:00Z

Objective: To determine whether a multicomponent health promotion intervention for Dutch adolescents would be successful in influencing body composition and aerobic fitness. Design: Randomized controlled trial. Setting: Ten intervention and 8 control prevocational secondary schools. Participants: A total of 978 adolescents (mean age, 12.7 years). Intervention: An interdisciplinary multicomponent intervention program with an adapted curriculum for 11 biology and physical education lessons and environmental change options, including additional lessons on physical education and advice on the school canteen selection. Main Outcome Measures: Body height and weight, hip and waist circumference, 4 skinfold thickness measurements, and aerobic fitness. Results: Multilevel analyses showed significant differences in changes after the 8-month intervention period in favor of the intervention group with regard to hip circumference (mean difference, 0.53 cm; 95% confidence interval, 0.07 to 0.98) and sum of skinfolds among girls (mean difference, ?2.31 mm; 95% confidence interval, ?4.34 to ?0.28). In boys, the intervention resulted in a significant difference in waist circumference (mean difference, ?0.57 cm; 95% confidence interval, ?1.10 to ?0.05). No significant intervention effects were found related to aerobic fitness. Conclusions: The multicomponent Dutch Obesity Intervention in Teenagers program positively influenced several measures of body composition among both girls and boys. Our results indicate that secondary prevocational school curriculum changes may contribute to excessive weight gain prevention among adolescents.

Towards an evidence-based guideline for counselling of chronic hepatitis B virus infected patients (Article)

2007-06-01T00:00:00Z

Adolescent screen-viewing behaviour is associated with consumption of sugar-sweetened beverages: The role of habit strength and perceived parental norms (Article)

2007-05-01T00:00:00Z

The association between adolescent screen-viewing behaviour (i.e., television viewing and computer use) and the consumption of sugar-sweetened beverages was studied in a Dutch sample of adolescents (N=383) using self-administered questionnaires. In particular, the previously understudied role of habit and perceived parental norms in the execution of these behaviours was investigated. Results showed that screen-viewing behaviour was associated with consumption of sugar-sweetened beverages (r=.32). Habit strength of both behaviours correlated with a large effect size (r=.50). The interaction between both behaviours was underlined by the finding that consumption of sugar-sweetened beverages was explained by perceived parental norms regarding screen-viewing behaviour (β=.12; adjusted for the behaviour and perceived parental norm regarding sugar-sweetened beverage consumption). Consequences of the identified role of habit and parental norms in the interplay between sedentary behaviour and consumption of sugar-sweetened beverages among adolescents are discussed.

Feasibility, reliability, and validity of adolescent health status measurement by the Child Health Questionnaire Child Form (CHQ-CF): Internet administration compared with the standard paper version (Article)

2007-05-01T00:00:00Z

Aims: In this study we evaluated indicators of the feasibility, reliability, and validity of the Child Health Questionnaire-Child Form (CHQ-CF). We compared the results in a subgroup of adolescents who completed the standard paper version of the CHQ-CF with the results in another subgroup of adolescents who completed an internet version, i.e., an online, web-based CHQ-CF questionnaire. Methods: Under supervision at school, 1,071 adolescents were randomized to complete the CHQ-CF and items on chronic conditions by a paper questionnaire or by an internet administered questionnaire. Results: The participation rate was 87%; age range 13-17 years. The internet administration resulted in fewer missing answers. All but one multi-item scale showed internal consistency reliability (Cronbach's α > 0.70). All scales clearly discriminated between adolescents with no, a few, or many self-reported chronic conditions. The paper administration resulted in statistically significant, higher scores on 4 of 10 CHQ-CF scales compared with the internet administration (P < 0.05), but Cohen's effect sizes d were ≤ 0.21. Mode of administration interacted significantly with age (P < 0.05) on four CHQ-CF scales, but Cohen's effect sizes for these differences were also ≤ 0.21. Conclusion: This study supports the feasibility, internal consistency reliability of the scales, and construct validity of the CHQ-CF administered by either a paper questionnaire or online questionnaire. Given Cohen's suggested guidelines for the interpretation of effect sizes, i.e., 0.20-0.50 indicates a small effect, differences in CHQ-CF scale scores between paper and internet administration can be considered as negligible or small.

Associations of social-environmental and individual-level factors with adolescent soft drink consumption: Results from the SMILE study (Article)

2007-04-01T00:00:00Z

Adolescent obesity is positively associated with soft drink consumption. We investigated the association of social-environmental and individual-level factors with soft drink consumption in a Dutch adolescent sample. Data were gathered in a longitudinal Dutch adolescent sample (n = 208, 62% girls). Soft drink consumption, social cognitions from the Theory of Planned Behaviour and parenting practices towards limited soft drink intake, and Big Five personality dimensions were assessed. Data were analyzed using three-step linear regression analyses. Effect sizes were used as the informational source for the explanatory value of the model. Interaction terms were computed to test the individual-environment interaction. Attitude and subjective norm were significantly associated with soft drink consumption. When controlling for social cognitions, the distal variables parenting practices and the personality dimension Agreeableness remained significantly associated with soft drink consumption. Agreeableness moderated the association of parenting practices with adolescent soft drink consumption. Standardized regression coefficients ranged from 0.16 to 0.24 and explained 14% of the variance in soft drink consumption, indicating a medium effect size. Stricter parenting practices were associated with less soft drink consumption and these effects were moderated by adolescent personality. The direct effects of practices and personality are noteworthy from a theoretical perspective. Implications for obesity prevention interventions are discussed.

Perceived parenting style and practices and the consumption of sugar-sweetened beverages by adolescents (Article)

2007-04-01T00:00:00Z

The purpose of this study was to investigate whether perceived parenting practices and parenting style dimensions (strictness and involvement) are associated with adolescents' consumption of sugar-sweetened beverages. In this cross-sectional study, secondary school students (n = 383, mean age 13.5 years) completed a self-administered questionnaire on their consumption of sugar-sweetened beverages, attitude, social influences, self-efficacy, habit strength, food-related parenting practices and the general parenting style dimensions of 'strictness' and 'involvement'. Data were analyzed using multiple linear regression analyses. More restrictive parenting practices were associated with lower consumption of sugar-sweetened beverages (β = -38.0 ml; 95% CI = -48.1, -28.0). This association was highly mediated (∼55%) by attitude, self-efficacy and modeling from parents. Nevertheless, a significant direct effect remained (β = -17.1 ml; 95% CI = -27.2, -6.90). Interactions between perceived parenting style and parenting practices showed that the association between parenting practices and sugar-sweetened beverage consumption was stronger among adolescents who perceived their parents as being moderately strict and highly involved. Parents influence their children's sugar-sweetened beverage consumption and should therefore be involved in interventions aimed at changing dietary behaviors. Interventions aimed at the promotion of healthy parenting practices will improve when they are tailored to the general parenting style of the participants.

A systematic review of environmental correlates of obesity-related dietary behaviors in youth (Article)

2007-04-01T00:00:00Z

There is increasing interest in the role the environment plays in shaping the dietary behavior of youth, particularly in the context of obesity prevention. An overview of environmental factors associated with obesity-related dietary behaviors among youth is needed to inform the development of interventions. A systematic review of observational studies on environmental correlates of energy, fat, fruit/vegetable, snack/fast food and soft drink intakes in children (4-12 years) and adolescents (13-18 years) was conducted. The results were summarized using the analysis grid for environments linked to obesity. The 58 papers reviewed mostly focused on sociocultural and economical-environmental factors at the household level. The most consistent associations were found between parental intake and children's fat, fruit/vegetable intakes, parent and sibling intake with adolescent's energy and fat intakes and parental education with adolescent's fruit/vegetable intake. A less consistent but positive association was found for availability and accessibility on children's fruit/vegetable intake. Environmental factors are predominantly studied at the household level and focus on sociocultural and economic aspects. Most consistent associations were found for parental influences (parental intake and education). More studies examining environmental factors using longitudinal study designs and validated measures are needed for solid evidence to inform interventions.

Patterns in sedentary and exercise behaviors and associations with overweight in 9-14-year-old boys and girls - A cross-sectional study (Article)

2007-03-09T00:00:00Z

Background. Before starting interventions addressing energy-balance related behaviors, knowledge is needed about the prevalence of sedentary behaviors and low physical exercise, their interrelationships, possible gender differences. Therefore this study aimed to describe gender differences in sedentary and physical exercise behaviors and their association with overweight status in children from nine European countries. Additionally, to identify clusters of children sharing the same pattern regarding sedentary and physical exercise behavior and compare these groups regarding overweight status. Methods. Cross-sectional study among 11-year-old children in nine countries (n = 12538). Self-administered questionnaires assessed the time spent on TV viewing during dinner and during the day, PC use and on physical exercise. The parents reported children's weight and height. Descriptive statistics, cluster analyses, and logistic regression analyses were used for data analyses. Results. Boys spent more time on sedentary behaviors but also more on physical exercise than girls. High TV viewing and low exercise behavior independently increased the risk of being overweight. Based on the behaviors, five clusters were identified. Among boys, clear associations with being overweight were found, with the most unhealthy behavior pattern having the highest risks of being overweight. Among girls, high TV viewers and high PC users had increased risk of being overweight. In girls sedentary behaviors seemed more important than physical exercise with regard to overweight status. Conclusion. Despite selective non-response on BMI and reliance on self-reports, the associations between clusters and overweight in boys were clear, and differences between boys and girls regarding the behaviors and risks for overweight are noteworthy. These differences need to be considered when developing tailored intervention strategies for prevention of overweight.

Formation of Implementation Intentions Promotes Stair Use (Article)

2007-03-01T00:00:00Z

The effectiveness of implementation intentions in stimulating stair use in a sample of 143 academic hospital employees is evaluated. In 2005, participants underwent anthropometric measurements in an examination room in the basement of the hospital, and completed a questionnaire, which included items regarding gender, attitude toward stair use as a means to watch one's weight, intention to be more physically active at work, and past behavior regarding stair use. Data analysis showed a loss to follow-up of 39%, resulting from the proportion of participants remaining on the same floor. Individuals in the intervention condition were more likely to take the stairs immediately after forming an implementation intention than those in the control condition. The studies can also examine their use via a more automated self-regulatory mechanism such as e-mail, rather than in-person instruction.

Evaluation of an interactive computer-tailored nutrition intervention in a real-life setting (Article)

2007-03-01T00:00:00Z

Background: Studies testing Web-based computer-tailored education in real-life settings are now needed. Purpose: The aim of this study is to examine the effectiveness and applicability of an interactive computer-tailored fat reduction intervention, which was previously tested as efficacious in a controlled setting, delivered to a broader population by local health promotion services. The impact of the computer-tailored intervention is compared with a generic intervention and with a no-intervention control group. Methods: A quasi-experimental design was used assigning 6 companies randomly to (a) the computer-tailored intervention condition, (b) the generic intervention condition, and (c) the no-intervention control condition. Participants (N = 337) completed validated baseline and posttest questionnaires and received the personal feedback immediately through the company's intranet. A structured interview with the project coordinators assessed the process that the companies had passed through to disseminate the fat intake intervention. Results: Six months postbaseline, the results showed that the computer-tailored intervention to reduce fat intake implemented through worksites was more effective in decreasing employees 'fat intake compared with a generic intervention, F = 23.5, p < .001, or no intervention, F = 28.1, p < .001. Moreover, the dissemination strategy used is feasible for local health promotion services. Conclusions: This study can be regarded as an effective "real-life" trial with an implementation strategy that can be used for large scale dissemination.

Environmental correlates of physical activity in youth - A review and update (Article)

2007-03-01T00:00:00Z

Obesogenic environments are thought to underlie the increased obesity prevalence observed in youth during the past decades. Understanding the environmental factors that are associated with physical activity (PA) in youth is needed to better inform the development of effective intervention strategies attempting to halt the obesity epidemic. We conducted a systematic semi-quantitative review of 150 studies on environmental correlates of youth PA published in the past 25 years. The ANalysis Grid for Environments Linked to Obesity (ANGELO) framework was used to classify the environmental correlates studied. Most studies retrieved used cross-sectional designs and subjective measures of environmental factors and PA. Variables of the home and school environments were especially associated with children's PA. Most consistent positive correlates of PA were father's PA, time spent outdoors and school PA-related policies (in children), and support from significant others, mother's education level, family income, and non-vocational school attendance (in adolescents). Low crime incidence (in adolescents) was characteristic of the neighbourhood environment associated with higher PA. Convincing evidence of an important role for many other environmental factors was, however, not found. Further research should aim at longitudinal and intervention studies, and use more objective measures of PA and its potential (environmental) determinants.

Differences Between Parents' and Adolescents' Perceptions of Family Food Rules and Availability (Article)

2007-03-01T00:00:00Z

Objective: To test the hypotheses that adolescents have different perceptions of family-environmental factors than do their parents, and that dietary intake of adolescents is more highly associated with the adolescent's own perceptions than those of their parents. Design: Data from self-administered questionnaires were used. Participants: Five-hundred two students aged 12 to 14 years, and one of each student's parents. Main Outcome Measures: Two types of family-environmental factors (ie, family food rules and home availability and accessibility of food) for 3 self-reported dietary behaviors (ie, fruit, snack, and breakfast intake). Analysis: Unpaired t tests, chi-square tests, percentage (gross) disagreement, standardized regression coefficients, and linear regression analyses. Results: For most rules and most perceptions of availability and accessibility, considerable disagreement was found between parents and students. Self-reported intake of fruit and snacks was more highly associated with student measures, but breakfast intake was more highly associated with parent measures of rules and availability. Implications for Research and Practice: The findings might explain mixed results on the associations between family-environmental factors and children's dietary intake that were found in earlier studies. Researchers need to be aware that in studies into family-environmental determinants of dietary habits using self-reports, the results are possibly influenced by whether the data were reported by parents or by children.

Feasibility, acceptability, and quality of Internet-administered adolescent health promotion in a preventive-care setting (Article)

2007-02-01T00:00:00Z

An Internet tool for monitoring, personalized feedback and referral was developed to support routine adolescent preventive care and was compared with usual practice using paper and pencil (P&P). A total of 1071 students (average age 15 years) from seven secondary schools were randomly assigned to the Internet or P&P group. The Internet group received a health and health-behavior assessment, tailored feedback on health and health behavior (specifically fruit consumption), and an online referral to see a physician/nurse if necessary. The P&P group received the same assessment, preprinted generic advice on fruit consumption and a mailed referral (where applicable). Students and physicians/nurses completed evaluation forms to assess indicators of feasibility, acceptability (i.e. satisfaction) and quality of each administration mode. Student participation rate was 87%. The electronic health feedback was positively evaluated. Students perceived the Internet-tailored fruit advice as more pleasant, more personally targeted and more enjoyable, but less credible than the generic preprinted advice (P < 0.01). No differences in indicators of acceptability and quality of consultation were found (P ≥ 0.05). Thus, the Internet can be a valuable tool to support physicians/nurses in the field of preventive care. It is recommended to further optimize and evaluate the Internet as a tool.

Moderators of Environmental Intervention Effects on Diet and Activity in Youth (Article)

2007-02-01T00:00:00Z

Background: The complexity of the relationship between environmental factors on the one hand and dietary behavior and physical activity on the other necessitates the search for moderators of environmental influences. The current evidence base is reviewed regarding potential moderating factors in the effectiveness of environmental interventions aimed at diet and/or physical activity of children and adolescents. Methods: The following databases were used: (1) Medline, (2) PubMed, (3) PsychInfo, (4) Web of Science, and (5) ERIC. Additionally, all potentially relevant references in recent reviews were checked. Results: Of the 41 studies included in the review, only seven studies (17%) were identified that reported tests of potential moderators of intervention effects. Gender proved to be the most frequently studied potential moderator. Additionally, race, age, and site have been studied regarding their potential role in modifying the effect of environmental interventions. Discussion: The small number of studies identified in this review prohibited us from attempting to formulate a conclusion on differential environment-behavior relationships in distinct subgroups. Rather than being an exception, it is argued that tests of effect modifiers should become common practice in behavioral nutrition and physical activity research to increase our understanding of mechanisms of behavior change and to optimize interventions.

Training Dietitians in Basic Motivational Interviewing Skills Results in Changes in Their Counseling Style and in Lower Saturated Fat Intakes in Their Patients (Article)

2007-01-01T00:00:00Z

Objective: To test if basic training for dietitians in motivational interviewing (MI) resulted in changes in dietitians' counseling style and improvements in their patients' diet and risk parameters. Design: A randomized controlled trial. Setting: 9 home-care organizations in the Netherlands. Participants: 37 dietitians, 209 baseline patients, and 142 follow-up diabetes patients. Intervention: Dietitians were randomly allocated to receive basic training in motivational interviewing (MI dietitians, n=18) or not (control dietitians, n=19). Main Outcome Measures: Counseling style of dietitians; total self-reported saturated fat, fruit, and vegetable intake, measured body mass index (BMI), waist circumference, and glycated hemoglobin (Hemoglobin A1c, HbA1c) of patients. Analysis: Analyses of variance and multiple linear regression analyses. Alpha = .05. Results: MI dietitians were significantly more empathetic, more often showed reflection during consultations, and were more likely than control dietitians to let their patients talk for the majority of the consultation. Patients of MI dietitians had significantly lower saturated fat intake levels at posttest compared to patients of control dietitians. No effects on HbA1c, BMI, and waist circumference were found. Conclusions and Implications: Basic training in MI changed the dietitians' counseling style and resulted in lower saturated fat intakes in their patients.

Differences in fruit and vegetable intake and determinants of intakes between children of Dutch origin and non-Western ethnic minority children in the Netherlands - a cross sectional study. (Article)

2006-09-22T00:00:00Z

BACKGROUND: Fruit and vegetable consumption is low in the Netherlands and a key target in healthy diet promotion. However, hardly any information is available on differences in fruit and vegetable consumption between Dutch children and ethnic minority children. Therefore, the aim of present study was to determine differences in usual fruit and vegetable intake between native Dutch and non-Western ethnic minority children and to study differences in and mediating effects of potential psychosocial and environmental determinants. METHODS: Ethnicity, usual fruit and vegetable consumption, psychosocial and environmental determinants and mothers' educational level were measured with a self-administered questionnaire during school hours in primary schools in Rotterdam, the Netherlands. Complete data was available for 521 10-11 year-old-children, of which 50.5% of non-Western origin. Differences between the groups regarding potential determinants and fruit and vegetable intake were assessed with Mann Whitney tests or multiple regression analyses. Multiple regression analyses were also conducted to assess mediating effects. RESULTS: Ethnic minority girls ate fruit more frequently (1.41 +/- 1.0 times/day) than Dutch girls (1.03 +/- 0.82 times/day); no differences in frequency of intake were found for vegetables or among boys. Ethnic differences were found for almost all potential determinants. The Dutch children reported lower scores on these determinants than the ethnic minority children, except for perceived self-efficacy and barriers to eat fruit and vegetables. Knowledge of recommendations and facilitating behaviors of the parents mediated the association between ethnicity and fruit consumption among girls. CONCLUSION: Ethnic minority girls in the Netherlands appear to have more favorable fruit intakes than Dutch girls, and ethnic minority children in general show more positive prerequisites for fruit and vegetable consumption. Interventions addressing multi-ethnic populations of children must take such differences into account.

Order is needed to promote linear or quantum changes in nutrition and physical activity behaviors: a reaction to 'A chaotic view of behavior change' by Resnicow and Vaughan. (Article)

2006-09-19T00:00:00Z

Recently, Drs. Ken Resnicow and Roger Vaughan published a thought-provoking paper in the International Journal of Behavioral Nutrition and Physical Activity (IJBNPA). They argue that the most often used social-cognition theories in behavioral nutrition and physical activity are of limited use. These models describe behavior change as a linear event, while Resnicow and Vaughan posit that behavior change is more likely to occur in quantum leaps that are impossible to predict. They introduce Chaos Theory into the behavioral nutrition and physical activity domain as a more valid framework to study the complex process of health behavior change. The present paper is a commentary on Resnicow and Vaughan's article by Resnicow's opponent in a recent debate-session at the annual meeting of the International Society of Behavioral Nutrition and Physical Activity. The chair of that meeting, Prof. Tom Baranowski, provides a separate commentary on Resnicow and Vaughan's paper also published recently in the IJBNPA. In the present commentary I relate Resnicow and Vaughan's paper to the other contributions to the Theory debate in the IJBNPA. I recognize the limited success of social cognition models, and, next to a better application of these models and more thorough research to test these model, also support research to further test the quantum and chaotic character of health behavior change. However, if such research supports the chaotic and quantum nature of health behavior change, the implications for behavioral nutrition and physical activity interventions may be limited, because even if behavior change is quantum rather than linear, the social cognition models are still relevant to inform interventions to promote quantum leaps in behavior change.

Environmental determinants of fruit and vegetable consumption among adults: a systematic review (Article)

2006-01-01T00:00:00Z

The current ecological approach in health behaviour research recognises that health behaviour needs to be understood in a broad environmental context. This has led to an exponential increase in the number of studies on this topic. It is the aim of this systematic review to summarise the existing empirical evidence pertaining to environmental influences on fruit and vegetable (FV) consumption. The environment was defined as ‘all factors external to the individual’. Scientific databases and reference lists of selected papers were systematically searched for observational studies among adults (18–60 years old), published in English between 1 January 1980 and 31 December 2004, with environmental factor(s) as independent factor(s), and fruit intake, vegetable intake or FV intake combined as one outcome measure as dependent factor(s). Findings showed there was a great diversity in the environmental factors studied, but that the number of replicated studies for each determinant was limited. Most evidence was found for household income, as people with lower household incomes consistently had a lower FV consumption. Married people had higher intakes than those who were single, whereas having children showed mixed results. Good local availability (e.g. access to one’s own vegetable garden, having low food insecurity) seemed to exert a positive influence on intake. Regarding the development of interventions, improved opportunities for sufficient FV consumption among low-income households are likely to lead to improved intakes. For all other environmental factors, more replicated studies are required to examine their influence on FV intake.

Theory, evidence and Intervention Mapping to improve behavior nutrition and physical activity interventions. (Article)

2005-04-04T00:00:00Z

BACKGROUND: The present paper intends to contribute to the debate on the usefulness and barriers in applying theories in diet and physical activity behavior-change interventions. DISCUSSION: Since behavior theory is a reflection of the compiled evidence of behavior research, theory is the only foothold we have for the development of behavioral nutrition and physical activity interventions. Application of theory should improve the effectiveness of interventions. However, some of the theories we use lack a strong empirical foundation, and the available theories are not always used in the most effective way. Furthermore, many of the commonly-used theories provide at best information on what needs to be changed to promote healthy behavior, but not on how changes can be induced. Finally, many theories explain behavioral intentions or motivation rather well, but are less well-suited to explaining or predicting actual behavior or behavior change.For more effective interventions, behavior change theory needs to be further developed in stronger research designs and such change-theory should especially focus on how to promote action rather than mere motivation. Since voluntary behavior change requires motivation, ability as well as the opportunity to change, further development of behavior change theory should incorporate environmental change strategies. CONCLUSION: Intervention Mapping may help to further improve the application of theories in nutrition and physical activity behavior change.

Correlates of motivation to prevent weight gain: a cross sectional survey. (Article)

2005-03-16T00:00:00Z

BACKGROUND: This study is an application of the theory of planned behaviour (TPB) with additional variables to predict the motivations to prevent weight gain. In addition, variations in measures across individuals classified into Precaution Adoption Process stages (PAPM-stages) of behaviour change were investigated. METHODS: A cross-sectional survey among 979 non-obese Dutch adults aged 25-35 years was conducted. Multiple binary logistic regression analysis was conducted to assess the associations of Body Mass Index (BMI), demographic factors and psychosocial variables from the TPB with the intention to prevent weight gain. Differences in BMI, demographic and psychosocial factors between PAPM-stages were explored using one-way analysis of variance and chi-square tests. RESULTS: Eighty-five percent of respondents intended to prevent weight gain. Age, attitudes and risk perceptions related to weight gain were the strongest correlates of intention (age: OR = 1.12, 95%CI: 1.04-1.20; attitude OR = 7.91, 95%CI: 5.33-11.74; risk perception OR = 1.24, 95%CI: 1.11-1.38). Significant differences were detected between the PAPM-stages in almost all variables. Notably, perceived behavioural control was lowest among people who had decided to prevent weight gain. CONCLUSION: Messages to influence attitudes towards the prevention of weight gain and risk perception may affect people who are not yet motivated to prevent weight gain. Interventions increasing people's perceived behavioural control in overcoming barriers to prevent weight gain may help people to act on their intentions.

Gedrag & gedram (Inaugural Lecture)

2003-10-03T00:00:00Z

Past, present, and future of computer-tailored nutrition education (Article)

2003-01-01T00:00:00Z

Computer-tailored nutrition education is an innovative and promising tool to motivate people to make healthy dietary changes. It provides respondents with individualized feedback about their dietary behaviors, motivations, attitudes, norms, and skills and mimics the process of "person-to-person" dietary counseling. The available evidence indicates that computer-tailored nutrition education is more effective in motivating people to make dietary changes than general nutrition information, especially for reduction of dietary fat. The effectiveness of computer tailoring has been attributed to the fact that individualized feedback commands greater attention, is processed more intensively, contains less redundant information, and is appreciated better than more general intervention materials. Interactive technology (eg, the Internet, the World Wide Web) offers good opportunities for the application of computer-tailored nutrition education, and a first controlled study of Web-based computer tailoring shows promising results. However, using the Web for interactive personalized nutrition education also presents new challenges.