Oenema, A.

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.

The ACCOMPLISH study. A cluster randomised trial on the cost-effectiveness of a multicomponent intervention to improve hand hygiene compliance and reduce healthcare associated infections (Article)

2011-10-03T00:00:00Z

Background: Public health authorities have recognized lack of hand hygiene in hospitals as one of the important causes of preventable mortality and morbidity at population level. The implementation strategy ACCOMPLISH (Actively Creating COMPLIance Saving Health) targets both individual and environmental determinants of hand hygiene. This study aims to evaluate the cost-effectiveness of a multicomponent implementation strategy aimed at the reduction of healthcare associated infections in Dutch hospital care, by promotion of hand hygiene. Methods/design. The ACCOMPLISH package will be evaluated in a two-arm cluster randomised trial in 16 hospitals in the Netherlands, in one intensive care unit and one surgical ward per hospital. Intervention. A multicomponent package, including e-learning, team training, introduction of electronic alcohol based hand rub dispensers and performance feedback. Variables. The primary outcome measure will be the observed hand hygiene compliance rate, measured at baseline and after 6, 12 and 18 months; as a secondary outcome measure the prevalence of healthcare associated infections will be measured at the same time points. Process indicators of the intervention will be collected pre and post intervention. An ex-post economic evaluation of the ACCOMPLISH package from a healthcare perspective will be performed. Statistical analysis. Multilevel analysis, using mixed linear modelling techniques will be conducted to assess the effect of the intervention strategy on the overall compliance rate among healthcare workers and on prevalence of healthcare associated infections. Questionnaires on process indicators will be analysed with multivariable linear regression, and will include both behavioural determinants and determinants of innovation. Cost-effectiveness will be assessed by calculating the incremental cost-effectiveness ratio, defined here as the costs for the intervention divided by the difference in prevalence of healthcare associated infections between the intervention and control group. Discussion. This study is the first RCT to investigate the effects of a hand hygiene intervention programme on the number of healthcare associated infections, and the first to investigate the cost-effectiveness of such an intervention. In addition, if the ACCOMPLISH package proves successful in improving hand hygiene compliance and lowering the prevalence of healthcare associated infections, the package could be disseminated at (inter)national level. Trial registration. NTR2448.

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.

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.

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.

Preferences for postpartum lifestyle counseling among women sharing an increased cardiovascular and metabolic risk: A focus group study (Article)

2011-02-01T00:00:00Z

Objective. To describe women's preferences for postpartum lifestyle counseling after a pregnancy complicated by preeclampsia, intrauterine growth restriction, and/or gestational diabetes. Methods. Thirty-six women who had experienced these pregnancy complications participated in six focus group interviews. Results. All women expressed a need for participation in postpartum lifestyle counseling. They preferred participation to be tailored to individual preferences. A combination of face-to-face counseling supported by computer-tailored lifestyle advice appealed to them. Conclusion. Postpartum lifestyle counseling aimed at these women should be tailored to individual needs and preferences.

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.

Systematic development of a self-regulation weight-management intervention for overweight adults (Article)

2010-10-29T00:00:00Z

Background. This paper describes the systematic development of an intervention for the prevention of obesity among overweight adults. Its development was guided by the six steps of Intervention Mapping (IM), in which the establishment of program needs, objectives and methods is followed by development of the intervention and an implementation and evaluation plan. Methods. Weight gain prevention can be achieved by making small changes in dietary intake (DI) or physical activity (PA). The intervention objectives, derived from self-regulation theory, were to establish goal-oriented behaviour. They were translated into a computer-tailored Internet-delivered intervention consisting of four modules. The intervention includes strategies to target the main determinants of self-regulation, such as feedback and action planning. The first module is intended to ensure adults' commitment to preventing weight gain, choosing behaviour change and action initiation. The second and third modules are intended to evaluate behaviour change, and to adapt action and coping plans. The fourth module is intended to maintain self-regulation of body weight without use of the program. The intervention is being evaluated for its efficacy in an RCT, whose protocol is described in this paper. Primary outcomes are weight, waist circumference and skin-fold thickness. Other outcomes are DI, PA, cognitive mediators and self-regulation skills. Discussion. The IM protocol helped us integrating insights from various theories. The performance objectives and methods were guided by self-regulation theory but empirical evidence with regard to the effectiveness of theoretical methods was limited. Sometimes, feasibility issues made it necessary to deviate from the original, theory-based plans. With this paper, we provide transparency with regard to intervention development and evaluation. Trial registration. NTR1862.

Improving hand hygiene behaviour of nurses using action planning: A pilot study in the intensive care unit and surgical ward (Article)

2010-10-01T00:00:00Z

Compliance with hand hygiene guidelines by hospital physicians and nurses is universally low and there is a need to apply powerful intervention methods from social sciences in order to improve compliance. One method is the formation of implementation intentions (or action planning) in which concrete 'if then' plans are formulated to link an environmental cue with performance of an intended behavioural action. This pilot study explored the practicality and effects of action planning on the hand hygiene behaviour (HHB) of nurses in an ICU and surgical ward of a university teaching hospital. A pre-post test design was used, and 17 nurses were invited to participate. A trained researcher observed HHB of nurses before and three weeks after the intervention in which action plans were formulated. Frequencies were calculated and logistic regression analysis was performed to assess changes in HHB. Of the 17 participants, 10 (seven in surgical ward, three in ICU) had complete data and were included in the analyses. In total, 283 potential moments for hand hygiene were identified, 142 in the surgical ward and 141 in the ICU. HHB increased from 9.3% at baseline to 25.4% post intervention (odds ratio: 3.3; confidence interval: 1.7-6.5; P<0.001). Although this was a small scale study, the results show promise for the use of action planning to improve the HHB of nurses in the short term. Action planning has shown success in closing the intention-behaviour gap in other fields, and its use for improving HHB in healthcare should be further investigated.

Lifestyle changes and reduction of colon cancer incidence in Europe: a scenario study of physical activity promotion and weight reduction (Article)

2010-09-01T00:00:00Z

Background: Across Europe, there are over 300,000 new cases of colorectal cancer annually. Major risk factors include excess body weight (usually expressed by a high body mass index, BMI) and physical inactivity (PA). In this study we modeled the potential long-term effects on colon cancer incidence of changes in prevalence of excess body weight and physical inactivity in 7 European countries across Europe with adequate data. Methods: We addressed the impact of interventions aimed at preventing weight gain and increasing physical activity on colon cancer incidence using the Prevent model as refined in the FP-6 Eurocadet project. Relative risk (RR) estimates were derived from meta-analyses; sex- and country-specific prevalences of BMI and PA were determined from survey data. Models were made for Czech Republic, Denmark, France, Latvia, the Netherlands, Spain and the United Kingdom. Results: In a hypothetical scenario in which a whole population had obtained an ideal weight distribution in the year 2009, up to 11 new cases per 100,000 person-years would be avoided by 2040. The population attributable fractions (PAF) for excess weight were much higher for males (between 13.5% and 18.2%) than for females (2.3%-4.6%). In contrast, using the optimum scenario where everybody in Europe would adhere to the recommended guideline of at least 30 minutes of moderate PA 5 days per week, the PAFs for PA in various countries were substantially greater in women (4.4% - 21.2%) than in men (3.2%-11.6%). Sensitivity analyses were performed assuming underreporting of BMI by using self-reports (difference of 5 and 0.8 percent-points in males and females, respectively), using different risk estimates (between 5.8 and 11.5 percent-points difference for BMI for men and women, respectively, and up to 11.6 percent-points difference for PA for women). Interpretation: Changes in lifestyle can indeed result in large health benefits, including for colon cancer. Two interesting patterns emerged: for colon cancer, achieving optimum BMI levels in the population appears to offer greatest health benefits in population attributable fractions in males, while increased physical activity might offer the greatest fraction of avoidable cancers in females. These observations suggest a sex-specific strategy to colon cancer prevention.

Lifestyle changes and reduction of colon cancer incidence in Europe: a scenario study of physical activity promotion and weight reduction (Article)

2010-09-01T00:00:00Z

Increased consumption of fruit and vegetables and future cancer incidence in selected European countries (Article)

2010-09-01T00:00:00Z

Cancer is one of the major causes of death in western countries. Fruit and vegetable consumption may reduce the risk of cancers of the oropharynx, oesophagus, lung, stomach and colorectum. We investigated the potential effect of interventions aimed at increasing the intake of fruits and vegetables to the recommended level (500 g/d) on future cancer incidence in Europe. Data on cancer incidence and daily intake of fruit and vegetables were compiled for France, Germany, The Netherlands, Spain and Sweden. We also performed a meta-analysis of European observational studies to arrive at a quantitative estimate on the association between fruit and vegetable intake and cancer risk. Predictions on the future cancer incidence were modelled using PREVENT 3.01. Our study predicted 212,000 fruit-and vegetable-related cancer cases in these countries in 2050, out of which 398 (0.19%) might be prevented if the 500 g/d fruit and vegetable intake were achieved in the aforementioned countries. The largest absolute impact was observed for lung cancer with 257 (out of 136,517) preventable cases if the intervention was successfully implemented. Sweden would benefit the most from intervention to increase fruit and vegetable consumption with a 2% reduction in expected cases. Increasing fruit and vegetable consumption has a small impact on reducing the burden of cancer in Europe. Health impact assessment tools such as PREVENT can provide the basis for decision making in chronic disease prevention.

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.

'BeSAFE', effect-evaluation of internet-based, tailored safety information combined with personal counselling on parents' child safety behaviours: Study design of a randomized controlled trial (Article)

2010-08-11T00:00:00Z

Background. Injuries in or around the home are the most important cause of death among children aged 0-4 years old. It is also a major source of morbidity and loss of quality of life. In order to reduce the number of injuries, the Consumer Safety Institute introduced the use of Safety Information Leaflets in the Netherlands to provide safety education to parents of children aged 0-4 years. Despite current safety education, necessary safety behaviours are still not taken by a large number of parents, causing unnecessary risk of injury among young children. In an earlier study an E-health module with internet-based, tailored safety information was developed and applied. It concerns an advice for parents on safety behaviours in their homes regarding their child. The aim of this study is to evaluate the effect of this safety information combined with personal counselling on parents' child safety behaviours. Methods/Design. Parents who are eligible for the regular well-child visit with their child at child age 5-8 months are invited to participate in this study. Participating parents are randomized into one of two groups: 1) internet-based, tailored safety information combined with personal counselling (intervention group), or 2) personal counselling using the Safety Information Leaflets of the Consumer Safety Institute in the Netherlands for children aged 12 to 24 months (control group). All parents receive safety information on safety topics regarding the prevention of falling, poisoning, drowning and burning. Parents of the intervention group will access the internet-based, tailored safety information module when their child is approximately 10 months old. After completion of the assessment questions, the program compiles a tailored safety advice. The parents are asked to devise and inscribe a personal implementation intention. During the next well-child visit, the Child Health Clinic professional will discuss this tailored safety information and the implementation intention with the parents. The control group will receive usual care, i.e. the provision of Safety Information Leaflets during their well-child visit at the child's age of 11 months. Discussion. It is hypothesized that the intervention, internet-based, tailored safety information combined with personal counselling results in more parents' child safety behaviours.

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.

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.

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.

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.

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.

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.

Environmental and cognitive correlates of adolescent breakfast consumption. (Article)

2009-08-17T00:00:00Z

OBJECTIVE: This study aimed to identify cognitive and environmental correlates of daily adolescent breakfast consumption. METHODS: Adolescents (n=1089) aged 12-15 years in schools in Rotterdam, The Netherlands, completed a questionnaire measuring daily breakfast consumption, individual cognitions, and home environmental factors during the 2005-2006 school year. Multilevel logistic regression analysis was performed to determine the association between the environmental variables, cognitions and everyday breakfast consumption. Additionally, mediation of the effect of the environmental variables through the individual cognitions on breakfast consumption was explored. RESULTS: Attitude, perceived behavioral control, modeling by friends and parents, and intention were associated with daily breakfast consumption. Political (breakfast rules), physical (available breakfast products), and socio-cultural (having breakfast with a parent, having the evening meal with a parent, eating the evening meal in front of the TV) environments were also associated with daily breakfast consumption. Associations of the environmental factors were partly mediated by the individual cognitions. CONCLUSIONS: Individual cognitions and a supportive home environment are associated with adolescent breakfast consumption. Since parents primarily shape the home environment, interventions aimed at improving adolescent breakfast consumption should target the parent as well as the adolescent.

'Be active, eat right', evaluation of an overweight prevention protocol among 5-year-old children: design of a cluster randomised controlled trial (Article)

2009-07-02T00:00:00Z

BACKGROUND: The prevalence of overweight and obesity in children has at least doubled in the past 25 years with a major impact on health. In 2005 a prevention protocol was developed applicable within Youth Health Care. This study aims to assess the effects of this protocol on prevalence of overweight and health behaviour among children. METHODS AND DESIGN: A cluster randomised controlled trial is conducted among 5-year-old children included by 44 Youth Health Care teams randomised within 9 Municipal Health Services. The teams are randomly allocated to the intervention or control group. The teams measure the weight and height of all children. When a child in the intervention group is detected with overweight according to the international age and gender specific cut-off points of BMI, the prevention protocol is applied. According to this protocol parents of overweight children are invited for up to three counselling sessions during which they receive personal advice about a healthy lifestyle, and are motivated for and assisted in behavioural change.The primary outcome measures are Body Mass Index and waist circumference of the children. Parents will complete questionnaires to assess secondary outcome measures: levels of overweight inducing/reducing behaviours (i.e. being physically active, having breakfast, drinking sweet beverages and watching television/playing computer games), parenting styles, parenting practices, and attitudes of parents regarding these behaviours, health-related quality of life of the children, and possible negative side effects of the prevention protocol. Data will be collected at baseline (when the children are aged 5 years), and after 12 and 24 months of follow-up. Additionally, a process and a cost-effectiveness evaluation will be conducted. DISCUSSION: In this study called 'Be active, eat right' we evaluate an overweight prevention protocol for use in the setting of Youth Health Care. It is hypothesized that the use of this protocol will result in a healthier lifestyle of the children and an improved BMI and waist circumference. TRIAL REGISTRATION: Current Controlled Trials ISRCTN04965410.

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.

Are starting and continuing breastfeeding related to educational background? The generation R study (Article)

2009-06-01T00:00:00Z

OBJECTIVE. To assess the effect of a woman's educational level on starting and continuing breastfeeding and to assess the role of sociodemographic, lifestyle-related, psychosocial, and birth characteristics in this association. METHODS. We used the data of 2914 participants in a population-based prospective cohort study. Information on educational level, breastfeeding, sociodemographic (maternal age, single parenthood, parity, job status), lifestyle-related (BMI, smoking, alcohol use), psychosocial (whether the pregnancy was planned, stress), and birth (gestational age, birth weight, cesarean delivery, place and type of delivery) characteristics were obtained between pregnancy and 12 months postpartum. Odds ratios and 95% confidence intervals of starting and continuing breastfeeding for educational level were obtained by logistic regression, adjusted for each group of covariates and for all covariates simultaneously. RESULTS. Of 1031 highest-educated mothers, 985 (95.5%) started breastfeeding; the percentage was 73.1% (255 of 349) in the lowest-educated mothers. At 6 months, 39.3% (405 of 1031) of highest-educated mothers and 15.2% (53 of 349) of lowest-educated mothers were still breastfeeding. Educationally related differences were present in starting breastfeeding and the continuation of breastfeeding until 2 months but not in breastfeeding continuation between 2 and 6 months. Lifestyle-related and birth characteristics attenuated the association between educational level and breastfeeding, but the association was hardly affected by sociodemographic and psychosocial characteristics. CONCLUSIONS. Decisions to breastfeed were underlain by differences in educational background. The underlying pathways require further research. For the time being, interventions on promoting breastfeeding should start early in pregnancy and should increase their focus on low-educated women. Copyright

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.

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.

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.

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.

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.

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.

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.

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.

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.

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

Ethnic differences in determinants of participation and non-participation in prenatal screening for Down syndrome: A theoretical framework (Article)

2007-10-01T00:00:00Z

Objective: To develop a theoretical framework for analysing ethnic differences in determinants of participation and non-participation in prenatal screening for Down syndrome. Methods: We applied Weinstein's Precaution Adoption Process (PAP) Model to the decision of whether or not to participate in prenatal screening for Down syndrome. The prenatal screening stage model was specified by reviewing the empirical literature and by data from seven focus group interviews with Dutch, Turkish and Surinamese pregnant women in the Netherlands. Results: We identified 11 empirical studies on ethnic differences in determinants of participation and nonparticipation in prenatal screening for Down syndrome. The focus group interviews showed that almost all stages and determinants in the stage model were relevant in women's decision-making process. However, there were ethnic variations in the relevance of determinants, such as beliefs about personal consequences of having a child with Down syndrome or cultural and religious norms. Discussion: The prenatal screening stage model can be applied as a framework to describe the decision-making process of pregnant women from different ethnic backgrounds. It provides scope for developing culturally sensitive, tailored methods to guide pregnant women towards informed decision-making on participation or non-participation in prenatal screening for Down syndrome. Copyright

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.

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.

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.