Mediators and moderators of the effects of a school-based intervention on adolescents' fruit and vegetable consumption: the HEIA study.

OBJECTIVE: To examine whether targeted determinants mediated the effects of the HEalth In Adolescents (HEIA) intervention on fruit and vegetable (FV) consumption and explore if these mediating effects were moderated by sex, parental education or weight status. DESIGN: Cluster-randomised controlled trial. SETTING: The HEIA study (2007-2009) was a Norwegian 20-month multi-component school-based intervention to promote healthy weight development. FV consumption and targeted determinants were self-reported at baseline, mid-way (8 months) and post-intervention (20 months). PARTICIPANTS: Adolescents (11-13-year-old) in twenty-five control schools (n 746) and twelve intervention schools (n 375). RESULTS: At post-intervention, more adolescents in the intervention group compared with the control group had knowledge of the FV recommendations (OR: 1·4, 95 % CI 1·1, 1·9) and reported a decreased availability of vegetables at home (ß: -0·1, 95 % CI -0·2, 0·0). Availability/accessibility of FV at home, availability of vegetables at dinner, taste preferences for different types of FV and knowledge of the FV recommendations were positively associated with the consumption of FV. However, none of the post-intervention determinants significantly mediated the intervention effects on FV consumption. Although no moderating influences by sex, parental education or weights status were observed on the mediating effects, exploratory analyses revealed significant moderations in the b-paths. CONCLUSIONS: Since none of the targeted determinants could explain the increase in FV consumption, it remains unclear why the intervention was effective. Reporting on a wide range of mediators and moderators in school-based interventions is needed to reveal the pathways through which intervention effects are achieved.

Implementing an early-life nutrition intervention through primary healthcare: staff perspectives.

BACKGROUND: Nutrition interventions targeting early childhood can be cost-effective and may provide lifelong, intergenerational benefits. From October 2022 to April 2023 the Nutrition Now (NN) e-learning resource was implemented within Early Childhood Education and Care centres and the Maternal and Child Healthcare Centre (MCHC) in a southern Norwegian municipality. As part of the NN project, the present study aims to explore the MCHC staff's experiences with implementing the NN resource, to gain insights into measures important to scale up digital early-life nutrition interventions. METHODS: Three group interviews were conducted among public health nurses and midwives alongside one individual interview with the department leader of a MCHC in May 2023. An inductive thematic analysis, as described by Braun and Clarke, was conducted to generate the key themes and subthemes regarding the implementation process of NN within the MCHC. RESULTS: Three main themes were generated: [1] Important resource but not always utilized; [2] Parents are interested but had issues with access; and [3] Staff and stakeholder buy-in and commitment needed from the start. Overall, the staff viewed the NN resource as a potential tool for promoting diet-related topics and believed it could support the guidance they were already providing parents. However, few staff members fully familiarized themselves with the resource. While staff perceived parents as positive when informed about NN, they believed issues such as access challenges, competing platforms, and time constraints reduced parental engagement. Lastly, staff suggested improvements for NN's implementation, including enhanced training, better planning, assigning champions, and lowering the threshold for access. CONCLUSION: The findings of this study suggest that the real-world implementation of digital evidence-based health behaviour interventions is feasible but would be enhanced by employing strategies focusing on engagement and utilization. TRIAL REGISTRATION: The main study is registered in the ISRCTN registry with ID ISRCTN10694967, https://doi.org/10.1186/ISRCTN10694967 . (Registration date: 19-06-2022).

Mediators of parental educational differences in the intake of carbonated sugar-sweetened soft drinks among adolescents, and the moderating role of neighbourhood income.

BACKGROUND: Existing evidence suggests that the intake of sugar-sweetened beverages (SSB) among adolescents remains a public health concern and that socioeconomic differences in intake exist. Tackling these challenges requires identifying the factors associated with SSB intake and the mediators of socioeconomic differences in SSB intake among adolescents. Thus, this study aimed to explore (i) factors at different levels of the ecological model associated with the intake of carbonated soft drinks with added sugar (hereafter called soft drinks), (ii) mediators of the association between parental education and the intake of soft drinks(iii) whether neighbourhood income moderates the indirect effect of parental education on adolescents' soft drink intake through potential mediators. METHODS: Data from 826 7th graders in Oslo, Norway, who participated in the TACKLE cross-sectional study conducted in 2020 were used. The association between factors at the individual, interpersonal and neighbourhood food environment levels and the intake of soft drinks among adolescents was assessed, as well as the mediating roles of these factors for the differences in intake by parental education, using multiple logistic regression and mediation analysis, respectively. Moderated mediation analyses were used to explore whether an indirect effect of parental education on adolescents' soft drink intake through potential mediators varies across neighbourhood income areas. RESULTS: Higher perceived accessibility of SSB at home, increased parental modelling for SSB intake, and increased frequency of food/drink purchased from the neighbourhood store were associated with a higher intake of soft drinks among adolescents and mediated the differences in intake by parental education. Neighbourhood food environment factors were neither statistically significantly associated with adolescents' higher intake of soft drinks nor explained the differences in intake by parental education. Moderated mediation analysis showed that the mediating effect of perceived accessibility of SSB at home on the association between parental education and adolescent soft drink intake was stronger among those living in low neighbourhood income. CONCLUSIONS: Our study identified modifiable factors at the intrapersonal level (perceived accessibility of SSB at home and frequency of food/drink purchased from neighbourhood shops) and interpersonal levels (parental modelling for SSB intake) associated with a higher intake of soft drinks among adolescents and mediated the differences in the intake by parental education. The modifiable factors identified in this study could be targeted in public health initiatives among adolescents aimed at reducing the intake of soft drinks and the related differences by parental education.

Does the socioeconomic positioned neighbourhood matter? Norwegian adolescents' perceptions of barriers and facilitators for physical activity.

BACKGROUND AND AIMS: A higher proportion of adolescents from lower socioeconomic position families tend to be less physically active than their counterparts from higher socioeconomic position families. More research is needed to understand the causes of these differences, particularly the influence of the neighbourhood environment. This qualitative study aims to explore how adolescents and their parents from higher and lower socioeconomic neighbourhoods perceive the social, organisational and physical environment influencing adolescents' physical activity behaviours. METHOD: We conducted six semi-structured focus groups with 35 13-14-year-olds and eight interviews with some of their parents. The interviewees were recruited from one higher and two lower socioeconomic neighbourhoods in Oslo, Norway. Theme-based coding was used for analysis, and the results discussed in light of an ecological framework. RESULTS: The results indicate that factors like social norms in a neighbourhood could shape adolescents' physical activity behaviour, and a social norm of an active lifestyle seemed to be an essential facilitator in the higher socioeconomic neighbourhood. Higher availability of physical activity and high parental engagement seemed to facilitate higher physical activity in this neighbourhood. In the lower socioeconomic neighbourhoods, the availability of local organised physical activity and volunteer engagement from parents varied. Programmes from the municipality and volunteer organisations seemed to influence and be essential for adolescents' physical activity behaviour in these neighbourhoods. CONCLUSIONS: The results illustrate the complexity of behaviour and environment interaction, and a limitation in explaining the phenomenon by focusing primarily on the individual level rather than an ecological perspective.

Embracing parenting role in childhood obesity.

Active parental engagement is crucial in controlling childhood obesity. However, optimal strategies to engage parents and mechanisms linking parents' involvement to childhood obesity prevention need further investigation. In this editorial, we provide a background to invite contributions to the BMC Public Health collection titled 'Parenting role in childhood obesity'.

Neighborhood deprivation, built environment, and overweight in adolescents in the city of Oslo.

BACKGROUND: Even though the social and built environment characteristics of neighborhoods have been studied as potential determinants of social inequalities in obesity among adults, fewer studies have focused on children. Our first aim was to investigate whether there were differences in the food and physical activity environments between different neighborhood deprivation levels in the city of Oslo. We also explored whether there was an association between the prevalence of overweight (including obesity) among adolescents and (i) neighborhood deprivation levels and (ii) food and physical activity environments of the neighborhoods they live in. METHODS: We conducted a food and physical activity environment mapping (using ArcGIS Pro) in all neighborhoods of Oslo, which were defined by administrative boundaries (sub-districts). The neighborhood deprivation score was calculated based on the percentage of households living in poverty, unemployment in the neighborhood, and residents with low education. A cross-sectional study including 802 seventh graders from 28 primary schools in Oslo residing in 75 out of 97 sub-districts in Oslo was also performed. MANCOVA and partial correlations were ran to compare the built environment distribution between different neighborhood deprivation levels, and multilevel logistic regression analyses were used to explore the effect of neighborhood deprivation and the food and physical activity environments on childhood overweight. RESULTS: We found that deprived neighborhoods had greater availability of fast food restaurants and fewer indoor recreational facilities compared to low-deprived neighborhoods. Additionally, we observed that the residential neighborhoods of the adolescents with overweight had greater availability of grocery and convenience stores when compared to the residential neighborhoods of the adolescents without overweight. Adolescents living in neighborhoods with high deprivation had a two-fold higher odds (95% CI = 1.1-3.8) to have overweight compared to adolescents living in neighborhoods with low deprivation, regardless of participants' ethnicity and parental education. However, the built environment did not determine the relationship between neighborhood deprivation and overweight in adolescents. CONCLUSION: The neighborhoods in Oslo with higher deprivation levels had more obesogenic characteristics than the low-deprived neighborhoods. Adolescents living in high-deprived neighborhoods were more likely to have overweight than their counterparts from low-deprived neighborhoods. Thus, preventive measures targeting adolescents from high-deprived neighborhoods should be put in place in order to reduce incidence of overweight.

Socioeconomic position, built environment and physical activity among children and adolescents: a systematic review of mediating and moderating effects.

BACKGROUND: Physical activity behaviors among children and adolescents are socioeconomically patterned. Understanding if, and how, the built environment contributes to socioeconomic inequalities in physical activity and for whom built environments are most important, can lead to the identification of intervention entry points to reduce inequalities in physical activity. OBJECTIVE: To summarize the existing evidence among children and adolescents on (a) whether the built environment mediates the association between socioeconomic position and physical activity and (b) whether socioeconomic position moderates the association between the built environment and physical activity. METHODS: A systematic literature search was conducted using PubMed, Embase, PsycINFO and Web of Science. Two independent reviewers screened articles for eligibility, extracted information from included studies and assessed risk of bias with the Quality Assessment Tool for Observational Cohort and Cross-Sectional studies. We performed a narrative evidence synthesis considering the totality of the evidence and by study characteristics such as geographic region, age group, and exposure-outcome assessment methodology. The reporting was conducted in agreement with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. RESULTS: A total of 28 papers were included. In general, the studies were of low methodological quality. There was no evidence to support that the built environment functions as a mediator in the relationship between socioeconomic position and physical activity. We observed inconclusive moderation patterns with five studies reporting stronger associations between features of the built environment and physical activity among high socioeconomic positioned youths. Seven studies reported stronger associations among low socioeconomic positioned youth and fourteen studies reported no difference in associations. We observed different moderation patterns across geographical regions (Europe vs. US) indicating that, in Europe, having a walkable neighborhood is important for low socioeconomic positioned youth only. No differences in moderation patterns were observed for younger vs. older children or activity domains. CONCLUSION: Current evidence does not support a strong interplay between built environment and socioeconomic position on physical activity in youth. However, given the low quality of the evidence, firm conclusions cannot be made, and additional high-quality research is likely to have substantial impact on the evidence base.

Adapting the SPOTLIGHT Virtual Audit Tool to assess food and activity environments relevant for adolescents: a validity and reliability study.

BACKGROUND: Physical inactivity and unhealthy diet are key behavioral determinants underlying obesity. The neighborhood environment represents an important arena for modifying these behaviors, and hence reliable and valid tools to measure it are needed. Most existing virtual audit tools have been designed to assess either food or activity environments deemed relevant for adults. Thus, there is a need for a tool that combines the assessment of food and activity environments, and which focuses on aspects of the environment relevant for youth. OBJECTIVE: The aims of the present study were: (a) to adapt the SPOTLIGHT Virtual Audit Tool (S-VAT) developed to assess characteristics of the built environment deemed relevant for adults for use in an adolescent population, (b) to assess the tool's inter- and intra-rater reliability, and (c) to assess its criterion validity by comparing the virtual audit to a field audit. METHODS: The tool adaptation was based on literature review and on results of a qualitative survey investigating how adolescents perceived the influence of the environment on dietary and physical activity behaviors. Sixty streets (148 street segments) in six neighborhoods were randomly selected as the study sample. Two raters assessed the inter- and intra-rater reliability and criterion validity, comparing the virtual audit tool to a field audit. The results were presented as percentage agreement and Cohen's kappa (κ). RESULTS: Intra-rater agreement was found to be moderate to almost perfect (κ = 0.44-0.96) in all categories, except in the category aesthetics (κ = 0.40). Inter-rater agreement between auditors ranged from fair to substantial for all categories (κ = 0.24-0.80). Criterion validity was found to be moderate to almost perfect (κ = 0.56-0.82) for most categories, except aesthetics and grocery stores (κ = 0.26-0.35). CONCLUSION: The adapted version of the S-VAT can be used to provide reliable and valid data on built environment characteristics deemed relevant for physical activity and dietary behavior among adolescents.

The association of household and child food insecurity with overweight/obesity in children and adolescents in an urban setting of Ethiopia.

BACKGROUND: Existing evidence on the association between food insecurity and childhood obesity is mixed. In addition, literature from developing countries in general and Ethiopia in particular on the nexus and impact of household and child food insecurity on childhood obesity in the context of urbanization remains limited. The objective of this study was to explore the association between household and child food insecurity and childhood obesity in an urban setting of Ethiopia. METHODS: An observational population based cross-sectional study was conducted in five sub-cities of Addis Ababa. Multi-stage sampling techniques were employed to identify the study unit from the selected sub-cities. Multivariable logistic regression models with robust estimation of standard errors were utilized to determine the associations. Interactions by age and sex in the associations explored were tested. RESULTS: A total of 632 children and adolescents-parent dyads were included in the study. About 29.4% of those in food secure households and 25% of those in food insecure households were overweight/obese. Similarly, 29.8% of food secure children and 22% of food insecure children were overweight/obese. Household and child food insecurity status were not significantly associated with child and adolescent overweight or obesity in the final adjusted models. CONCLUSIONS: Household and childhood food insecurity status were not associated with child and adolescent overweight/obesity in the study setting. Interventions aimed at combating overweight and obesity in the study setting should target children and adolescents irrespective of their food security status.

Perceptions of the social and physical environment of adolescents' dietary behaviour in neighbourhoods of different socioeconomic position.

A higher proportion of adolescents from families in a lower socioeconomic position (SEP) tends to have more unhealthy dietary behaviours, and overweight and obesity, than their counterparts in higher SEPs. More research is needed to understand the causes of these differences, in particular the influence of the neighbourhood environment, which has been explored less. The presented qualitative study explores how adolescents and their parents from higher and lower SEP neighbourhoods perceive the social and physical environment influencing adolescents' dietary behaviours. We conducted 6 semi-structured focus groups with 35 13-14 year olds and 8 interviews with some of their parents. The interviewees were recruited from one higher and two lower SEP neighbourhoods in Oslo, Norway. Theme-based inductive coding was used for analysis, and the results discussed in light of an ecological framework. The results indicate that all the adolescents experience several barriers to healthy dietary behaviours. For adolescents in the lower SEP neighbourhood, one or both parents desired their cultural cuisine served at home, whereas the adolescents wanted and often consumed western dishes. Fast-food restaurants or hanging out at the mall was perceived as the preferred social arena, often due to lack of involvement in either leisure-time physical activities or youth clubs as a safe, engaging option. The adolescents in the higher SEP neighbourhood perceived social norms which accentuated healthy dietary choices. When more possibilities for activities were present and the adolescents expressed being highly engaged in leisure-time physical activity, this also seemed to facilitate healthier dietary behaviours. These findings indicate how several factors simultaneously can influence dietary behaviour. Use of a multi-layered approach when exploring the environmental influences could increase knowledge about tackling social inequalities in dietary behaviours among adolescents.

Correlates of screen time and mediators of differences by parental education among adolescents.

BACKGROUND: Existing literature shows that there is an inverse association between socioeconomic position and screen time among adolescents. What is less known is the mechanism behind these differences. The study aimed to explore individual, interpersonal and neighborhood environmental correlates of total screen time (TST) among adolescents and to assess their mediating role in the association between parental education and TST. METHODS: A cross-sectional study including 706 adolescents (mean age of 13.6 (SD = 0.3)) was used to collect data at schools through an online questionnaire. Multiple regression analyses were used to explore factors associated with TST. Mediation analyses were conducted to assess whether these factors mediated the association between parental education and TST. RESULTS: Multiple linear regression analyses, adjusted for gender and age, showed that parental modelling of TV and movie streaming, TV/movie streaming during dinner and access to screens were positively related to TST. Self-efficacy towards limiting TV and movie streaming, self-efficacy towards limiting computer/electronic game use, and the perceived opportunities for physical activity in the neighborhood were inversely related to total screen time. All of these factors except self-efficacy towards limiting TV and movie streaming mediated the association between parental education and TST. CONCLUSIONS: The study identified several modifiable factors at the individual, interpersonal and neighborhood environmental levels that can be targeted in interventions aimed at decreasing screen time among youth in general and among those with a low socioeconomic position in particular.

Tracking of infant and young child feeding practices among 9- to 24-month-old children in Nepal: the MAL-ED Birth Cohort Study.

OBJECTIVE: The present study aimed to assess infant and young child feeding (IYCF) practices and the tracking of dietary diversity score (DDS), intakes of Fe- and vitamin A-rich foods and meal frequency in a peri-urban area in Nepal. Furthermore, to explore whether sociodemographic factors were associated with tracking patterns of these IYCF practices. DESIGN: Longitudinal study. Monthly food intake was measured by 24 h recall. Four time slots were used (9-12, 13-16, 17-20 and 21-24 months). Tracking of IYCF practices was investigated using generalized estimating equations (GEE) models and Cohen's weighted kappa. Multinominal logistic regression was used to identify determinants for tracking of the IYCF practices. SETTING: Bhaktapur municipality, Nepal. SUBJECTS: Children (n 229) aged 9-24 months, randomly selected. RESULTS: Prevalence of minimum meal frequency was higher than for minimum dietary diversity at all time slots. Tracking based on absolute measures (GEE models) was moderate for DDS (0·48) and meal frequency (0·53), and low for intakes of Fe- (0·23) and vitamin A-rich (0·35) foods. Tracking based on rank measured was moderate for DDS and meal frequency, and fair for Fe- and vitamin A-rich foods. Low socio-economic status significantly increased the odds (OR; 95 % CI) of tracking of low v. high DDS (3·31; 1·44, 7·60) and meal frequency (3·46; 1·54, 7·76). CONCLUSIONS: Low tracking for intakes of Fe- and vitamin A-rich foods implies that interventions to improve these IYCF practices must address underlying causes for irregular intake to have sustainable effects.

Consumption habits of school canteen and non-canteen users among Norwegian young adolescents: a mixed method analysis.

BACKGROUND: Food/drinks available to adolescents in schools can influence their dietary behaviours, which once established in adolescence, tend to remain over time. Food outlets' influence near schools, known to provide access to unhealthy food/drinks, may also have lasting effects on consumption behaviours. This study aimed to gain a better understanding of the consumption habits of adolescents in the school arena by comparing different personal characteristics and purchasing behaviours of infrequent and regular school canteen users to those never or seldom using the canteen. METHODS: A convergent mixed methods design collected qualitative and quantitative data in parallel. A cross-sectional quantitative study including 742 adolescents was conducted, with data collected at schools via an online questionnaire. Focus group interviews with students and interviews with school administrators formed the qualitative data content. Quantitative data were analysed using descriptive statistics and logistic regression; thematic content analysis was used to analyse qualitative data. RESULTS: Sixty-seven percent of adolescents reported never/rarely using the school canteen (NEV), whereas 13% used it ≥2 times per week (OFT). When the two groups were compared, we found a significantly higher proportion of the NEV group were female, having parents with a high education, and with a high self-efficacy, whilst a significantly higher proportion of the OFT group consumed salty snacks, baked sweets, and soft-drinks ≥3 times per week, and breakfast at home < 5 days in the school week. The OFT group had significantly higher odds of purchasing food/drink from shops near school during school breaks and before/after school compared to the NEV group (adjusted odds ratio (aOR) = 1.80, 95% CI 1.07-3.01, and aOR = 3.61, 95% CI 2.17-6.01, respectively). The interviews revealed most students ate a home packed lunch, with the remainder purchasing either at the school canteen or at local shops. CONCLUSIONS: Students using the canteen often are frequently purchasing snacks and sugar-soft drinks from shops near school, most likely owing to availability of pocket money and an emerging independence. School authorities must focus upon satisfying canteen users by providing desirable, healthy, and affordable items in order to compete with the appeal of local shops.

Measurement of availability and accessibility of food among youth: a systematic review of methodological studies.

BACKGROUND: Comprehensive and psychometrically tested measures of availability and accessibility of food are needed in order to explore availability and accessibility as determinants and predictors of dietary behaviors. The main aim of this systematic review was to update the evidence regarding the psychometric properties of measures of food availability and accessibility among youth. A secondary objective was to assess how availability and accessibility were conceptualized in the included studies. METHODS: A systematic literature search was conducted using Medline, Embase, PsycINFO and Web of Science. Methodological studies published between January 2010 and March 2016 and reporting on at least one psychometric property of a measure of availability and/or accessibility of food among youth were included. Two reviewers independently extracted data and assessed study quality. Existing criteria were used to interpret reliability and validity parameters. RESULTS: A total of 20 studies were included. While 16 studies included measures of food availability, three included measures of both availability and accessibility; one study included a measure of accessibility only. Different conceptualizations of availability and accessibility were used across the studies. The measures aimed at assessing availability and/or accessibility in the home environment (n = 11), the school (n = 4), stores (n = 3), childcare/early care and education services (n = 2) and restaurants (n = 1). Most studies followed systematic steps in the development of the measures. The most common psychometrics tested for these measures were test-retest reliability and criterion validity. The majority of the measures had satisfactory evidence of reliability and/or validity. None of the included studies assessed the responsiveness of the measures. CONCLUSIONS: The review identified several measures of food availability or accessibility among youth with satisfactory evidence of reliability and/or validity. Findings indicate a need for more studies including measures of accessibility and addressing its conceptualization. More testing of some of the identified measures in different population groups is also warranted, as is the development of more measures of food availability and accessibility in the broader environment such as the neighborhood food environment.

Mediators of the association between parental education and breakfast consumption among adolescents : the ESSENS study.

BACKGROUND: Regular breakfast consumption has several health benefits. However, breakfast skipping is common among adolescents, in particular among those with a low socioeconomic background. The aims of the study were to explore individual and home environmental correlates of breakfast consumption, and to assess their potential mediating role in the association between parental education and breakfast consumption. METHODS: A cross-sectional study including 706 adolescents with a mean age of 13.6 (SD = 0.3) was conducted between October and December 2016. Data were collected at school through an online questionnaire. Regression analyses were used to explore whether parental modelling, parental co-participation in breakfast consumption, parental rules, the availability of breakfast foods at home and screen time were associated with breakfast consumption. Mediation analyses were conducted to assess whether these factors mediated the association between parental education and breakfast consumption. RESULTS: Breakfast consumption was significantly positively associated with parental education (OR = 1.97 (95% CI 1.43-2.72)). A higher parental modelling (OR = 2.17 (95% CI 1.70-2.79)), a higher parental co-participation in breakfast consumption (OR = 1.37 (95% CI 1.26, 1.49)), higher parental rules (OR = 1.36 (95% CI 1.21, 1.53)) and a higher availability of breakfast foods at home (OR = 2.21 (95% CI 1.65, 2.97)) were associated with higher odds of being a daily breakfast consumer. Higher levels of screen time (hrs/day) were associated with lower odds of being a daily breakfast consumer (OR = 0.85 (95% CI 0.79, 0.91). Parental modelling (B = 0.254 (95% CI 0.149, 0.358)) and the availability of breakfast foods at home (B = 0.124 (95% CI 0.033, 0.214)) were significantly positively related to parental education, whereas screen time (hrs/day) (B = -1.134 (95% CI -1.511, -0.758)) was significantly inversely related to parental education. Parental modelling, the availability of breakfast foods at home and screen time were found to mediate parental educational differences in breakfast consumption. CONCLUSIONS: Increasing the availability of breakfast food, improving parental modelling of breakfast consumption and targeting screen time might be promising strategies to reduce parental educational differences in breakfast consumption.

Perceived rules and accessibility: measurement and mediating role in the association between parental education and vegetable and soft drink intake.

BACKGROUND: The existence of socioeconomic differences in dietary behaviors is well documented. However, studies exploring the mechanisms behind these differences among adolescents using comprehensive and reliable measures of mediators are lacking. The aims of this study were (a) to assess the psychometric properties of new scales assessing the perceived rules and accessibility related to the consumption of vegetables and soft drinks and (b) to explore their mediating role in the association between parental education and the corresponding dietary behaviors. METHODS: A cross-sectional survey including 440 adolescents from three counties in Norway (mean age 14.3 years (SD = 0.6)) was conducted using a web-based questionnaire. Principal component analysis, test-retest and internal reliability analysis were conducted. The mediating role of perceived accessibility and perceived rules in the association between parental education and the dietary behaviors was explored using linear regression analyses. RESULTS: Factor analyses confirmed two separate subscales, named "accessibility" and "rules", both for vegetables and soft drinks (factor loadings >0.60). The scales had good internal consistency reliability (0.70-0.87). The test-retest reliability of the scales was moderate to good (0.44-0.62). Parental education was inversely related to the consumption of soft drinks and positively related to the consumption of vegetables. Perceived accessibility and perceived rules related to soft drink consumption were found to mediate the association between parental education and soft drink consumption (47.5 and 8.5 % of total effect mediated). Accessibility of vegetables was found to mediate the association between parental education and the consumption of vegetables (51 % of total effect mediated). CONCLUSION: The new scales developed in this study are comprehensive and have adequate validity and reliability; they are therefore considered appropriate for use among 13-15 year-olds. Parents, in particular those with a low educational background, should be encouraged to increase the accessibility of vegetables and to decrease the accessibility of soft drinks, in particular during dinner. Enforcing parental rules limiting soft drink intake in families with low parental education also appears relevant.

Are weight-related attitudes and behaviours associated with the accuracy of BMI derived from self-reported weight and height among 13-year-olds?

AIMS: The aim was to explore the association between weight-related attitudes and behaviours and the accuracy of body mass index (BMI) derived from self-reported weight and height. METHODS: A total of 828 adolescents from the Health In Adolescents study were included. Self-reported and objective weight and height data were collected, and BMI was computed. Information about weight-related attitudes and behaviours was obtained. The association between weight-related attitudes and behaviours and the difference between BMI computed from self-reported and objective measures was assessed using generalized linear mixed model analyses. RESULTS: BMI was under-reported by overweight girls (p<0.001) and boys (p<0.001) compared to their normal weight counterparts. Underweight girls on the other hand over-reported their BMI (p=0.002). Girls who reported trying to lose weight under-reported their BMI compared to girls who had not tried to do anything about their weight (p=0.02). Girls who perceived their weight as being too much under-reported their BMI compared to girls who thought their weight was ok, the association was however borderline significant (p=0.06); this association was also found among boys (p=0.03). Self-weighing and the reported importance of weight for how adolescents perceive themselves were not associated with the accuracy of BMI. CONCLUSIONS: weight perception and weight control behaviour among girls only were related to the accuracy of self-reported BMI; no association was found with self-weighing behaviour and the perceived importance of weight for how adolescents perceive themselves. Knowledge of such factors will allow for a better interpretation and possibly adjustment/correction of results of surveys based on self-reported weight and height data.

Built for movement: Neighborhoods and adolescent physical activity behaviors, and the moderating role of socioeconomic position and gender.

This study examined whether the built environment was associated with physical activity among adolescents in Oslo, Norway, and the role of socioeconomic position and gender as potential moderators of this association. We used data from 897 adolescents who participated in the TACKLE cross-sectional study conducted in 2020. Built environment features (recreational facilities, parks, forest, public transport, traffic calming devices, and schools) were assessed objectively using Geographical Information Systems. Physical activity data included device-measured moderate-to-vigorous physical activity, total physical activity, and self-reported active transportation to school. Using general linear models and logistic regression, we found that most built environment features were unrelated to the participants' device-measured physical activity. Longer distances to school and to traffic calming devices were associated with decreased likelihood of participants reporting active transportation to school. Our moderated regression analysis showed that adolescents with low socioeconomic backgrounds seemed less affected by longer distances to school compared with their high socioeconomic counterparts. Furthermore, boys appeared to be more sensitive to traffic safety relative to girls. Implementing traffic calming devices may enhance active transportation to school and improve traffic safety for Norwegian adolescents.

Are screen-based sedentary behaviors longitudinally associated with dietary behaviors and leisure-time physical activity in the transition into adolescence?

BACKGROUND: There is a need for more longitudinal studies investigating the associations between screen-based sedentary behaviors (SB), dietary behaviors and leisure-time physical activity (PA). METHODS: In the HEIA cohort study, 908 children were followed from age 11 to age 13 (September 2007-May 2009). The children self-reported their intake of fruits, vegetables, soft drinks with sugar and snacks. TV/DVD use, computer/game use and leisure-time PA were also self-reported. Multilevel generalized linear mixed model analysis was used to assess longitudinal associations between the screen-based SB and each of the two other behaviors. RESULTS: Twenty-month changes in TV/DVD use and computer/game use were positively associated with changes in the consumption of soft drinks with sugar and unhealthy snacks in the same period; and inversely associated with change in vegetable consumption. Change in computer/game use was also inversely related to change in fruit consumption. An inverse but non-substantive association was found between change in TV/DVD use and change in leisure-time PA. Change in computer/game use was not significantly associated with change in leisure-time PA. CONCLUSIONS: Changes in screen-based SB were associated with multiple unfavorable changes in dietary habits, although the associations were weak. These associations need to be further investigated in intervention/experimental studies, to assess whether changing screen-based SB will result in clinically relevant changes in dietary behaviors. However, the findings of this study suggest that screen-based SB and leisure-time PA are largely independent behaviors which should be addressed separately in health promotion activities.