Health and health behaviours in adolescence as predictors of education and socioeconomic status in adulthood - a longitudinal study.

BACKGROUND: The positive association of health with education level and socioeconomic status (SES) is well-established. Two theoretical frameworks have been delineated to understand main mechanisms leading to socioeconomic health inequalities: social causation and health selection but how these work in adolescence is poorly known. We studied if adolescent health and health behaviours predict higher education and higher SES in adulthood and if family background and school performance in adolescence explain these associations. METHODS: Surveys on health and health behaviours were sent to representative samples of 12-18-year-old Finns in 1981-1997 every second year (response rate 77.8%, N = 55,682). The survey data were linked with the respondents' and their parents' socioeconomic data from the Finnish national registries. Both latent variables, namely, health (perceived health, health complaints, chronic disease), health-compromising behaviours (smoking status, drunkenness frequency), and family background (parents' occupation-based SES, education, family type) and variables directly measuring health-enhancing behaviours (toothbrushing, physical activity) and school performance were used to predict higher education and higher occupation-based SES at age 34. Logistic regression analysis and structural equation models (SEM) were used. RESULTS: In logistic regression analyses, good health, health-enhancing behaviours, and lack of health-compromising behaviours were related to higher education and SES, also after controlling for family background and school performance. In the SEM analyses, good health, health-enhancing behaviours, and lack of health-compromising behaviours directly predicted higher SES and higher education, although the standardised coefficients were low (from 0.034 to 0.12). In all models, health, lack of health-compromising behaviours, and health-enhancing behaviours predicted school performance, which in turn, predicted the outcomes, suggesting indirect routes to these. Good socioeconomic prospects in terms of family background predicted good health, healthy behaviours, and good school performance in adolescence and higher SES and higher education in adulthood. CONCLUSION: Health and health behaviours in adolescence predicted education and SES in adulthood. Even though the relationships were modest, they support the health selection hypotheses and emphasise the importance of adolescence for health inequalities during the life-course. Health and health behaviours were strongly associated with school performance and family background which together modified the paths from health and health behaviours to the outcomes.

Online health information-seeking behaviour and mental well-being among Finnish higher education students during COVID-19.

Online health information-seeking behaviour has increased since the World Health Organization declared COVID-19 a global pandemic in March 2020. This study examined whether health-related information on COVID-19 searched on the internet was associated with mental well-being among higher education students. A cross-sectional internet survey was conducted among 18- to 34-year-old students in Finland (N = 2976; mean age 24.61 years and median 24) in the spring of 2020. The data were analysed using descriptive statistics, Pearson's chi-square tests, Kruskal-Wallis nonparametric H tests, and a two-way ANOVA. The results indicated that most students (86% of females, 82% of males) used the internet to search for information on COVID-19. Students' self-perceived abilities to determine the relevance of online information on COVID-19 were associated with mental well-being.

A Chronic Disease in Adolescence and Selection to an Educational Path-A Longitudinal Study.

Chronic disease may affect adolescents' educational success. We study whether adolescents with a somatic chronic condition have lower school performance, lower odds for academic education, and a delayed start of upper-secondary studies. Seventh graders and ninth graders in the Helsinki Metropolitan Region, Finland, were invited to participate in a school survey in 2011 and 2014, respectively. The respondents (2011, N = 8960; 2014, N = 7394) were followed using a national application registry until 2017. The chronic conditions were asthma, diabetes, and epilepsy. Outcomes were grade point average (GPA), study place in an academic school, and delayed start of secondary education. Adolescents with a chronic disease needing medication had lower GPAs in both grades. Chronic disease with medication in the seventh grade predicted higher odds for the non-academic track (OR = 1.3) and the delayed start (OR = 1.4). In the ninth grade, chronic disease predicted non-academic studies univariately (OR = 1.2) and was not associated with the delayed start. The somatic chronic condition with medication, particularly epilepsy, slightly lowers students' school performance, which is a mediator between the chronic condition and selection into educational paths. Compared to gender and parents' education, and particularly to GPA, the role of chronic conditions on educational outcomes is small.

A qualitative study on multisector activities to prevent childhood obesity in the municipality of Seinäjoki, Finland.

BACKGROUND: Multisector activities are needed to prevent childhood obesity due to its multifactorial background. The first aim was to identify the activities that had been undertaken for obesity prevention and deduce their main targets. Second, we analyzed the public health policy approaches (upstream, midstream, and downstream) which were followed. Finally, we studied the perception of interviewees regarding their sectors' roles in implementing the local obesity program. METHODS: Deductive content analysis was used to analyze semi-structured interviews with 34 key professionals (from seven administrative sectors) who had participated in multisector health promotion during 2009-2016 and five representatives of other core parties. RESULTS: Several midstream and upstream activities were targeted at making physical activity (PA) and healthy eating (HE) integral parts of children's lifestyle. One long-term strategy was to create environments for PA accessible to every inhabitant and build and renovate the interiors and yards of schools and day-care centers. The healthiness of meals was increased progressively. In addition to midstream and upstream activities, as a downstream activity, an intervention targeting children at risk of obesity was implemented. The impact of management on the activities was considerable; childhood obesity prevention was included in the city strategy and systematically coordinated at the highest managerial level. Altogether, various sectors operated efficiently to promote obesity-preventing lifestyles; however, not all (important) sectors recognized their role in the multisector process. CONCLUSION: Most of the activities to guide children towards obesity-preventing lifestyles were either at the midstream or upstream level. Among the latter, considerable work is aimed at creating opportunities to practice PA and making it a natural part of the daily life. The aim of familiarizing children with lifestyles that include PA and HE was shared across sectors, including sectors that had not yet acknowledged their role in obesity prevention. Strong support from city management and systematic coordination of the activity are important factors that contribute to the engagement of several administrative sectors in working towards a shared aim, such as the prevention of childhood obesity.

Relationship between screen time and sleep among Finnish preschool children: results from the DAGIS study.

STUDY OBJECTIVES: To examine the associations between screen time, the time spent on different screen devices, and sleep in a sample of Finnish preschool children. METHODS: The current study analyzed cross-sectional data from the DAGIS study carried out in Finland in 2015-2016 on 736 children aged 3-6 years. Parents reported in a 7-day diary the durations the child used screen devices daily, with separate details about watching TV or DVDs, using tablets or smartphones, and using computers. In addition, parents reported children's bedtimes and wake-up times, which were further used in calculating sleep duration. Parents answered questions regarding their child's sleep consistency. Statistical analyses included adjusted general linear modeling. RESULTS: An hourly increase in total screen time was associated with 11 min later bedtime (p < 0.001) and 10 min shorter sleep duration (p < 0.001). More TV/DVD watching was associated with later bedtimes (p = 0.016) and a shorter sleep duration (p = 0.001). More smartphone/tablet use was associated with later bedtimes (p = 0.005), later wake-up times (p = 0.038), and weaker sleep consistency (p = 0.024). More computer use was associated with later bedtimes (p = 0.046). Results did not differ between genders. CONCLUSIONS: Increased screen time was associated with later bedtimes and shorter sleep duration among preschool children. Adverse associations with sleep outcomes were found for each screen device. Attention should be paid to promoting balanced use of screens and regular sleep habits in young children.

Association of screen time with long-term stress and temperament in preschoolers: results from the DAGIS study.

Screen time is increasing rapidly in young children. The aim of this study was to examine associations of long-term stress and temperament with screen time in Finnish preschool children and the moderating role of socioeconomic status. Cross-sectional DAGIS data were utilized. Long-term stress was assessed using hair cortisol concentration, indicating values of the past 2 months. Temperament was reported by the parents using the Children's Behavior Questionnaire (the Very Short Form), and three broad temperament dimensions were constructed: surgency, negative affectivity, and effortful control. Screen time was reported by the parents over 7 days. The highest education level in the household was used as an indicator of socioeconomic status. In total, 779 children (mean age, 4.7 ± 0.9 years, 52% boys) were included in the study. Of the temperament dimensions, a higher effortful control was associated with less screen time (B = - 6.70, p = 0.002). There was no evidence for an association between hair cortisol concentration and screen time nor a moderating role of socioeconomic status in the associations (p > 0.05).Conclusion: Our findings indicate that preschool children with a higher score in effortful control had less screen time. Because effortful control reflects general self-regulatory abilities, promoting these skills may be effective in reducing screen time in young children. What is Known: • Screen time has increased rapidly during the last decades, and higher screen time has been linked with numerous adverse health consequences in children. • There are no previous studies investigating associations of long-term stress and temperament with screen time in young children. What is New: • Of the temperament dimensions, effortful control was associated with higher screen time in preschool children, but there was no association found between long-term stress and screen time. • Since effortful control reflects general self-regulatory abilities, promoting these skills may be effective in reducing screen time in young children.

Social determinants of adolescent smoking over three generations.

Aim: We studied how multigenerational socioeconomic circumstances influence adolescents' smoking. Previous studies have shown that low academic achievement as well as parents' low socioeconomic circumstances are associated with adolescents' smoking, but there are few studies on grandparents' influence on their grandchildren's smoking. For the chain of three generations, we hypothesised that high socioeconomic circumstances of both parents and grandparents decrease the probability of smoking and adolescents' own education and circumstances contribute to this association. We further investigated the role of intergenerational social mobility. Method: Survey data from 1979 to 1997 on 12- to 18-year-old Finns (n=54,487) were linked with 1970-2009 registry-based data of their grandparents, parents and themselves. Socioeconomic circumstances among parents and grandparents were measured by socioeconomic status, education and material resources and among adolescents by academic achievement, educational orientation, family structure and parental smoking. Logistic regression analysis was used to study the associations. Results: Associations of adolescent smoking with grandparental socioeconomic circumstances were weak and mediated through parental circumstances. Parental smoking and divorce and living in a non-intact family increased smoking. Adolescents' low academic achievement and orientation to low education level were the most important predictors of smoking. Upward intergenerational social mobility between fathers and children decreased the risk of smoking, whereas downward mobility increased it. Conclusions: The influence of grandparents' low socioeconomic circumstances on grandchildren's smoking is mediated through parents' socioeconomic circumstances. Low academic achievement in adolescence is a strong predictor of smoking and adolescents orient towards the group of their future education level, not that of their parents.

Late start of upper secondary education and health-compromising behaviours among Finnish adolescents-a follow-up study.

BACKGROUND: The Finnish government has emphasized the need to expedite educational transitions. We study if a late start of upper secondary education is related to health-related selection, namely health-compromising behaviours in adolescence. METHODS: A large cohort of adolescents from the seventh (12-13 years) and ninth (15-16 years) grades answered online classroom surveys (total n = 10 873). They were followed to the start of upper secondary education, obtained from the Joint Application Registry. We compared those who continued studies directly from the ninth grade with later starters. We measured late bedtime, breakfast not every school day, tooth brushing less than twice-a-day, monthly alcohol consumption, weekly smoking, daily energy drinks, physical activity <6 days/week and excessive screen time. Multilevel logistic regressions and latent class analyses were conducted. RESULTS: In gender and school adjusted models in the seventh grade, all behaviours except physical activity predicted the late start. The strongest predictor was smoking, OR = 2.96 (CI = 2.25-3.89). In the ninth grade, smoking, breakfast, tooth brushing and energy drinks, OR = 1.80, (CI = 1.36-2.39, strongest), were predictive. After controlling for sociodemographic background and academic achievement, associations for alcohol and screen time became non-significant in the seventh grade. In the ninth grade, only screen time remained significant, OR = 1.33 (CI = 1.04-1.71). Health-compromising behaviours formed clusters. Belonging to the unhealthy cluster predicted the late start in both grades, in adjusted models only in the seventh grade. CONCLUSIONS: Students with health-compromising behaviours are less likely to start upper secondary education directly after the compulsory education. This may increase the risk for fragmentary educational trajectories and work careers.

Compliance with the 24-h movement guidelines and the relationship with anthropometry in Finnish preschoolers: the DAGIS study.

BACKGROUND: Recent 24-h movement guidelines for the early years established recommendations for physical activity (PA), screen time (ST), and sleep. To date, few studies have focused on compliance with meeting the guidelines and their associations with health outcomes. Thus, we aimed to investigate: 1) compliance with the 24-h movement guidelines, and 2) associations between compliance and anthropometry in Finnish preschoolers. METHODS: We utilized DAGIS survey data that were collected in 2015-2016 (N = 864). PA was assessed 24 h/day over 7 days using a waist-worn ActiGraph wGT3X-BT accelerometer. ST and sleep were reported by the parents during the same 7 days. Anthropometry was assessed using body mass index (BMI, kg/m2) and waist circumference (WC, cm). Children were classified as meeting the guidelines if they averaged ≥180 min/day of PA, which consisted of ≥60 min of moderate-to-vigorous intensity; ≤60 min/day of ST; and 10-13 h/day of sleep. In total, 778 children (51% boys, mean age: 4.7 ± 0.9 years) were included in the study. The compliance with meeting the 24-h movement guidelines was calculated for each behavior separately and in combinations. Adjusted linear regression analyses were applied to examine associations of compliance with BMI and WC. RESULTS: Children were physically active on average 390 (±46.2) min/day and spent 86 (±25.5) min/day in moderate-to-vigorous PA. They spent 76 (±37.4) min/day on ST and had on average 10:21 (±0:33) h:min/day of sleep. The compliance rate in meeting all three movement guidelines overall was 24%. The highest compliance rate was found for PA (85%), followed by sleep (76%) and ST (35%). Meeting guidelines separately for PA or sleep, or for both, were associated with lower WC (PA: B = -1.37, p < 0.001; Sleep: B = -0.72, p = 0.009; PA + Sleep: B = -1.03, p < 0.001). In addition, meeting guidelines for sleep or for both PA and sleep were associated with lower BMI (Sleep: B = -0.26, p = 0.027; PA + Sleep: B = -0.30, p = 0.007). There were no significant associations found regarding ST. CONCLUSIONS: Meeting recommendations for PA and sleep may have an important role in supporting a healthy weight status in young children. However, there is still a need to improve compliance with the 24-h movement guidelines, especially for ST.

Health and educational aspirations in adolescence: a longitudinal study in Finland.

BACKGROUND: The health selection hypothesis suggests that poor health leads to low educational attainment during the life course. Adolescence is an important period as poor health might prevent students from making the best educational choices. We test if health in adolescence is associated with educational aspirations and whether these associations persist over and above sociodemographic background and academic achievement. METHODS: Using classroom surveys, a cohort of students (n = 5.614) from the Helsinki Metropolitan Region was followed from the 7th (12-13 years,) up to the 9th grade (15-16 years) when the choice between the academic and the vocational track is made in Finland. Health factors (Strengths and Difficulties Questionnaire (SDQ), self-rated health, daily health complaints, and long-term illness and medicine prescribed) and sociodemographic background were self-reported by the students. Students' educational aspirations (applying for academic versus vocational track, or both) and their academic achievement were obtained from the Joint Application Registry held by the Finnish National Agency for Education. We conducted multilevel multinomial logistic regression analyses, taking into account that students are clustered within schools. RESULTS: All studied health factors were associated with adolescents' educational aspirations. For the SDQ, daily health complaints, and self-rated health these associations persisted over and above sociodemographic background and academic achievement. Students with better health in adolescence were more likely to apply for the academic track, and those who were less healthy were more likely to apply for the vocational track. The health in the group of those students who had applied for both educational tracks was in between. Inconsistent results were observed for long-term illness. We also found robust associations between educational aspirations and worsening health from grade 7 to grade 9. CONCLUSIONS: Our findings show that selection by health factors to different educational trajectories takes place at early teenage much before adolescents choose their educational track, thus supporting the health selection hypothesis in the creation of socioeconomic health inequalities. Our findings also show the importance of adolescence in this process. More studies are needed to reveal which measures would be effective in helping students with poor health to achieve their full educational potential.

The Contribution of Preschool Meals to the Diet of Finnish Preschoolers.

Preschool meals may influence the formation of children's dietary habits and health. We assessed the contribution of preschool meals to the diet of Finnish children. We used food record data from the cross-sectional DAGIS survey and selected recording days which included all three meals (breakfast, lunch, afternoon snack) at preschool. We analyzed the diet of three- to four-year-olds (n = 324) and five- to six-year-olds (n = 233). Preschool meals accounted for 54% of the weekday's energy intake in both age groups, and provided ≥60% of total fiber, polyunsaturated fatty acids, and vitamins D and E. More than 60% of fish dishes but only one third of total daily fresh fruit were consumed at preschool. The mean (SD) percentages of energy from protein and fat at preschool were 17% (3%) and 30% (7%) in the younger and 17% (3%) and 31% (6%) in the older age group, respectively. The mean proportions of energy from added sugar at preschool were below 5% in both age groups. On average, salt intake exceeded recommendations and 60% of salt came from preschool food. Tackling high salt intake should be a future goal of guidance for early childhood education and care food services.

Fruit, Vegetable, and Fibre Intake among Finnish Preschoolers in Relation to Preschool-Level Facilitators and Barriers to Healthy Nutrition.

Preschool is a major factor affecting food consumption among young children in Finland, given that most preschoolers eat three meals a day in that setting. Thus, it is important to recognise the determinants of dietary intake at preschool. The aim of this study was to examine food-related factors at the preschool and manager level, and their association with the dietary intake of children in childcare. The study was a part of the cross-sectional DAGIS survey conducted in 2015 to 2016 in Finland. The managers of 58 preschools filled in a questionnaire related to food and nutrition at their preschools. Preschool personnel kept food records for the children (n = 585) on two preschool days. Multilevel linear and logistic regression analyses were conducted with age, gender, and municipality as covariates, preschool-level factors as independent variables, and children's vegetable (g/day) and fruit (yes vs. no) consumption and fibre intake (g/MJ) as outcome variables. Having many written food policies in the preschool was associated with a higher intake of vegetables (p = 0.01) and fibre (p = 0.03) among the children. Having at least two out of three cooperation-related challenges with the catering service was associated with a higher intake of fibre (p = 0.03) and lower odds of eating fruit (p = 0.01). Factors that are relatively distal from meal situations may have an effect, and should be taken into account in the promotion of healthy eating at preschool, but more studies are needed.

Timing of puberty and reserve capacity in adolescence as pathways to educational level in adulthood-a longitudinal study.

BACKGROUND: Family socioeconomic status (SES) is related to a child's educational success. Intermediate pathways for this relationship, such as through pubertal timing and reserve capacity, occur in adolescence. AIM: To study whether family SES affects a child's adult education through a psychosocial and behavioural pathway (reserve capacity) and/or a biological pathway (pubertal timing) or only through school achievement in adolescence. SUBJECTS AND METHODS: Finnish adolescents sampled in five cross-sectional surveys from 1985 to 1995 (n = 37,876) were followed through the Registry of Completed Education and Degrees until 2009, when they were 29-43 years old. Family SES data also came from this registry. Structural equation modelling adjusted for ages at baseline and follow-up was used. RESULTS: Low family SES increased the probability of low adult education, delayed pubertal timing (in boys), weak reserve capacity and low school achievement. Reserve capacity and school achievement directly affected adult education and mediated the relationship of family SES with the outcome. Delayed pubertal timing predicted low adult education, except when school achievement was added to the model. CONCLUSIONS: The results show that family SES affects the child's adult education level through psychosocial and biobehavioural pathways, but the biological pathway is mediated by school achievement.

A cross-sectional study of children's temperament, food consumption and the role of food-related parenting practices.

Although evidence exists of the association between children's temperament and weight, only few studies have examined how temperament is associated with actual food consumption among preschoolers. We examined concurrent associations between children's temperament and the consumption of different foods, and investigated whether the association between children's temperament and vegetable consumption is mediated by vegetable-related parenting practices. We utilized the data from the cross-sectional DAGIS study of 864 preschool children aged between three to six and their families, conducted between 2015 and 2016 in Finland. The parents reported their children's temperament, food consumption, and their vegetable-related parenting practices. Adjusted logistic regression analyses found positive associations between surgency and vegetable consumption as well as between effortful control and vegetable consumption. Both associations were mediated by one examined vegetable-related parenting practice: enhanced availability and autonomy support. No associations were found between children's negative affectivity and food consumption or vegetable-related parenting practices. In conclusion, children's temperament may be an important factor behind food-related parenting practices and children's diet. However, further longitudinal research and research covering different food-related parenting practices and home environment factors is necessary to better understand the complex associations between temperament and food consumption among young children.

Neighborhood Socioeconomic Status and Feeding Practices in Finnish preschools.

Aims: Certain feeding practices, such as role modeling healthy eating and encouragement are recommended to be used in preschools. Little is known about whether preschool characteristics are associated with the use of these feeding practices. Our aim was to examine whether the socioeconomic status (SES) of the preschool neighborhood is associated with the feeding practices in preschools. Methods: This study was part of the cross-sectional DAGIS study. We studied 66 municipal preschools and 378 early childhood educators (ECEs). Preschool neighborhood SES was assessed with map grid data. Feeding practices were assessed by questionnaires and lunchtime observation. Associations between preschool neighborhood SES and feeding practices were tested with logistic regression analyses adjusted for ECEs' educational level and municipal policies on ECEs' lunch prices, and on birthday foods. Results: The crude model showed that in high-SES neighborhood preschools ECEs were more likely to eat the same lunch as the children (OR 2.46, 95% CI 1.42-4.24) and to reward children with other food for eating vegetables (OR 2.48, 95% CI 1.40-4.41). Furthermore, in high-SES preschools it was less likely that birthday foods outside of the normal menu were available on birthdays (OR 0.29, 95% CI 0.12-0.71). In the adjusted model, rewarding with other food remained associated with preschool neighborhood SES (OR 2.13, 95% CI 1.12-4.07). Conclusions: After adjustments, preschool neighborhood SES was mostly unassociated with the feeding practices in preschools. Municipal policies may have a significant impact on feeding practices and ultimately on young children's food intake in Finland where most children attend municipal preschools.

Health and socioeconomic circumstances over three generations as predictors of youth unemployment trajectories.

BACKGROUND: Youth unemployment is a critical life event, which may trigger other labour market-related disadvantages and detrimental health implications. To better understand the processes causing unemployment, we study how socioeconomic circumstances of successive generations and familial and health factors in adolescence predict youth unemployment trajectories between ages 16 and 28 in Finland from 2000 to 2009. METHODS: We used survey data from 1979 to 1997 on 12- to 18-year-old Finns (n = 43 238) linked with 1970-2009 registry-based data of their grandparents, parents and themselves. Growth mixture modelling and multivariate logistic regression analyses were used. RESULTS: Three latent youth unemployment trajectories emerged; low (46%), decreasing (38%) and high (16%) risk groups. Of adolescent factors, low school achievement was the most important predictor of youth unemployment followed by smoking, stress symptoms and poor self-rated health. Grandparents' education predicted their grandchildren's unemployment but the effects of other grandparental socioeconomic circumstances mediated through parents' socioeconomic status (SES). Parents' low SES and education, and long-term unemployment increased the risk of the child's unemployment. Youth unemployment was related to low education at the age of 29. CONCLUSION: Grandparents' education, family socioeconomic circumstances and adolescents' health and school achievement predict the developmental trajectory of youth unemployment. Youth unemployment is also related to low education in early adulthood. Our findings suggest that the health selection of unemployment works already in adolescence.

Increased Health and Wellbeing in Preschools (DAGIS) Study-Differences in Children's Energy Balance-Related Behaviors (EBRBs) and in Long-Term Stress by Parental Educational Level.

This paper describes the Increased Health and Wellbeing in Preschools (DAGIS) survey process and socioeconomic status (SES) differences in children's energy balance-related behaviors (EBRBs), meaning physical activity, sedentary and dietary behaviors, and long-term stress that serve as the basis for the intervention development. A cross-sectional survey was conducted during 2015⁻2016 in 66 Finnish preschools in eight municipalities involving 864 children (3⁻6 years old). Parents, preschool personnel, and principals assessed environmental factors at home and preschool with questionnaires. Measurement of children's EBRBs involved three-day food records, food frequency questionnaires (FFQ), seven-day accelerometer data, and seven-day sedentary behavior diaries. Children's long-term stress was measured by hair cortisol concentration. Parental educational level (PEL) served as an indicator of SES. Children with low PEL had more screen time, more frequent consumption of sugary beverages and lower consumption of vegetables, fruit, and berries (VFB) than those with high PEL. Children with middle PEL had a higher risk of consuming sugary everyday foods than children with high PEL. No PEL differences were found in children's physical activity, sedentary time, or long-term stress. The DAGIS intervention, aiming to diminish SES differences in preschool children's EBRBs, needs to have a special focus on screen time and consumption of sugary foods and beverages, and VFB.

Dietary patterns and their associations with home food availability among Finnish pre-school children: a cross-sectional study.

OBJECTIVE: To study the associations between home food availability and dietary patterns among pre-school children. DESIGN: Cross-sectional study in which parents of the participating children filled in an FFQ and reported how often they had certain foods in their homes. We derived dietary pattern scores using principal component analysis, and composite scores describing the availability of fruits and vegetables as well as sugar-enriched foods in the home were created for each participant. We used multilevel models to investigate the associations between availability and dietary pattern scores. SETTING: The DAGIS study, Finland. SUBJECTS: The participants were 864 Finnish 3-6-year-old children recruited from sixty-six pre-schools. The analyses included 711 children with sufficient data. RESULTS: We identified three dietary patterns explaining 16·7 % of the variance. The patterns were named 'sweets-and-treats' (high loadings of e.g. sweet biscuits, chocolate, ice cream), 'health-conscious' (high loadings of e.g. nuts, natural yoghurt, berries) and 'vegetables-and-processed meats' (high loadings of e.g. vegetables, cold cuts, fruit). In multivariate models, the availability of fruits and vegetables was inversely associated with the sweets-and-treats pattern (ß=-0·05, P<0·01) and positively associated with the health-conscious (ß=0·07, P<0·01) and vegetables-and-processed meats patterns (ß=0·06, P<0·01). The availability of sugar-enriched foods was positively associated with the sweets-and-treats pattern (ß=0·10, P<0·01) and inversely associated with the health-conscious pattern (ß=-0·03, P<0·01). CONCLUSIONS: Considering dietary patterns, the availability of sugar-enriched foods in the home seems to have a stronger role than that of fruits and vegetables. Parents should restrict the availability of unhealthy foods in the home.

Accuracy in the estimation of children's food portion sizes against a food picture book by parents and early educators.

Validated methodological aids for food quantification are needed for the accurate estimation of food consumption. Our objective was to assess the validity of an age-specific food picture book, which contains commonly eaten foods among Finnish children, for parents and early educators in estimating food portion sizes. The food picture book was developed to assist in portion size estimation when filling in food records in the Increased health and wellbeing in preschools (DAGIS) study. All ninety-five food pictures in the book, each containing three or four different portion sizes, were evaluated at real-time sessions. Altogether, seventy-three parents and 107 early educators or early education students participated. Each participant evaluated twenty-three or twenty-four portions by comparing presented pre-weighed food portions against the corresponding picture from the food picture book. Food portions were not consumed by participants. The total proportion of correct estimations varied from 36 % (cottage cheese) to 100 % (fish fingers). Among the food groups, nearly or over 90 % of the estimations were correct for bread, pastries and main courses ('piece products' such as meatballs and chicken nuggets). Soups, porridges, salads and grated and fresh vegetables were least correctly estimated (<65 % correct estimations). There were small differences in evaluations of berries and fresh fruits, warm vegetables and pastries between the parents and early educators, but other estimations were mostly similar. The children's food picture book was found to be a useful aid for the estimation of food portion sizes. Parents and early educators evaluated the portion sizes with similar accuracy.

Adolescent reserve capacity, socioeconomic status and school achievement as predictors of mortality in Finland - a longitudinal study.

BACKGROUND: Despite robust evidence on the inverse relationship between socioeconomic status (SES) and mortality, deviations from expected results have been observed likely due to school achievement and psychosocial resources, termed as "reserve capacity." Since adolescence is a critical period in developing sound psychological and behavioural patterns and adolescent markers of SES were seldom used, we determine if family SES in adolescence predicts later mortality. We also study how reserve capacity (perceived health, health-promoting behaviour and social support) and school achievement modify this relationship and reduce the negative effects of low SES. METHODS: A longitudinal study was designed by linking baseline data on 12 to 18 year-old Finns in 1985-95 (N = 41,833) from the Adolescent Health and Lifestyle Surveys with register data on mortality and SES from Statistics Finland. Average follow-up time was 18.4 years with a total of 770,161 person-years. Cox regression models, stratified by sex, were fitted to determine the effects of variables measured during adolescence: family SES, reserve capacity and school achievement on mortality risk. RESULTS: All reserve capacity dimensions significantly predicted mortality in boys. Perceived health and social support predicted that in girls. Adolescents with the lowest school achievement were more than twice at risk of dying compared to those with better school performance. Low SES increased the risk of death in boys (Hazard ratios: 1.6, 95% CI 1.1-2.4) but not in girls. Reserve capacity and school achievement weakened the effects of low SES on boys' risk of death. CONCLUSIONS: High reserve capacity and good school achievement in adolescence significantly reduce the risk of mortality. In boys, these also mitigate the negative effect of low SES on mortality. These findings underscore the roles of reserve capacity and school achievement during adolescence as likely causal or modifying factors in SES-health inequalities.