The dynamics in food selection stemming from price awareness and perceived income adequacy: a cross-sectional study using 1-year loyalty card data.

BACKGROUND: Higher cost of healthy foods may explain unhealthy dietary patterns in lower-income households. Unfortunately, combining food selection and nutrient intake data to price and expenditure is challenging. Food retailer's customer loyalty card data, linked to nutrient composition database, is a novel method for simultaneous exploration of food purchases, price, and nutrition. OBJECTIVES: We studied the associations between perceived income adequacy (PIA) as a grouping variable with price (per kilogram or megajoule) and the volume of purchases (percentage of expenditure or energy) simultaneously as outcome variables for 17 most purchased food groups. METHODS: We used 1-year (2018) loyalty card data from the largest grocery chain in Finland. Participants were 28,783 loyalty cardholders who made ≥41% of food purchases from the retailer and answered an online questionnaire at the midpoint of data collection. The 5-level PIA described the perceived financial situation in the household. Energy and nutrient content of foods purchased were from the Finnish Food Composition Database Fineli. We calculated the Nutrient Rich Food Index per 100 g food using 11 nutrients. Trends in prices and expenditures between PIA levels were analyzed using 2-sided Jonckheere-Terpstra tests, with false discovery rate control (Benjamini-Hochberg method) and confounder adjustments (inverse probability weighting). RESULTS: Lower PIA participants selected cheaper foods per kilogram and megajoule within most food groups. They also favored unhealthy food groups cheap in energy [<1 € (USD 1.18)/MJ]. Despite lower purchase price, the expenditure (%) among lower PIA was higher on alcohol, snacks, sugar-sweetened beverages, and sweets and chocolates. CONCLUSIONS: Participants with lower PIA showed stronger price awareness. It is crucial to consider the pricing of competing alternative food groups, when steering toward environmentally sustainable and healthier food purchases. Package labeling might also direct the selection of healthier choices among the less expensive items within a food group.

Socio-economic factors, mood, primary care utilization, and quality of life as predictors of intervention cessation and chronic stress in a type 2 diabetes prevention intervention (PREVIEW Study).

BACKGROUND: Sedentary lifestyle and unhealthy diet combined with overweight are risk factors for type 2 diabetes (T2D). Lifestyle interventions with weight-loss are effective in T2D-prevention, but unsuccessful completion and chronic stress may hinder efficacy. Determinants of chronic stress and premature cessation at the start of the 3-year PREVIEW study were examined. METHODS: Baseline Quality of Life (QoL), social support, primary care utilization, and mood were examined as predictors of intervention cessation and chronic stress for participants aged 25 to 70 with prediabetes (n = 2,220). Moderating effects of sex and socio-economic status (SES) and independence of predictor variables of BMI were tested. RESULTS: Participants with children, women, and higher SES quitted intervention earlier than those without children, lower SES, and men. Lower QoL, lack of family support, and primary care utilization were associated with cessation. Lower QoL and higher mood disturbances were associated with chronic stress. Predictor variables were independent (p ≤ .001) from BMI, but moderated by sex and SES. CONCLUSIONS: Policy-based strategy in public health should consider how preventive interventions may better accommodate different individual states and life situations, which could influence intervention completion. Intervention designs should enable in-built flexibility in delivery enabling response to individual needs. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01777893.

Wealth and Sedentary Time Are Associated With Dietary Patterns Among Preadolescents in Nairobi City, Kenya.

OBJECTIVE: The study aimed to compare dietary patterns in preadolescents in urban areas with different physical activity and socioeconomic profiles in Nairobi, Kenya. DESIGN: Cross-sectional. PARTICIPANTS: Preadolescents aged 9-14 years (n = 149) living in low- or middle-income areas in Nairobi. VARIABLES MEASURED: Sociodemographic characteristics were collected using a validated questionnaire. Weight and height were measured. Diet was assessed using a food frequency questionnaire and physical activity by accelerometer. ANALYSIS: Dietary patterns (DP) were formed through principal component analysis. Associations of age, sex, parental education, wealth, body mass index, physical activity, and sedentary time with DPs were analyzed with linear regression. RESULTS: Three DPs explained 36% of the total variance in food consumption: (1) snacks, fast food, and meat; (2) dairy products and plant protein; and (3) vegetables and refined grains. Higher wealth was associated with higher scores of the first DP (P < 0.05). CONCLUSIONS AND IMPLICATIONS: Consumption of foods often deemed unhealthy (eg, snacks and fast food) was more frequent among preadolescents whose families were wealthier. Interventions that seek ways to promote healthy lifestyles among families residing in urban areas of Kenya are warranted.

Food purchase behaviour in a Finnish population: patterns, carbon footprints and expenditures.

OBJECTIVE: To identify food purchase patterns and to assess their carbon footprint and expenditure. DESIGN: Cross-sectional. SETTING: Purchase patterns were identified by factor analysis from the annual purchases of 3435 product groups. The associations between purchase patterns and the total purchases' carbon footprints (based on life-cycle assessment) and expenditure were analysed using linear regression and adjusted for nutritional energy content of the purchases. PARTICIPANTS: Loyalty card holders (n 22 860) of the largest food retailer in Finland. RESULTS: Eight patterns explained 55 % of the variation in food purchases. The Animal-based pattern made the greatest contribution to the annual carbon footprint, followed by the Easy-cooking, and Ready-to-eat patterns. High-energy, Traditional and Plant-based patterns made the smallest contribution to the carbon footprint of the purchases. Animal-based, Ready-to-eat, Plant-based and High-energy patterns made the greatest contribution, whereas the Traditional and Easy-cooking patterns made the smallest contribution to food expenditure. Carbon footprint per euros spent increased with stronger adherence to the Traditional, Animal-based and Easy-cooking patterns. CONCLUSIONS: The Animal-based, Ready-to-eat and High-energy patterns were associated with relatively high expenditure on food, suggesting no economic barrier to a potential shift towards a plant-based diet for consumers adherent to those patterns. Strong adherence to the Traditional pattern resulted in a low energy-adjusted carbon footprint but high carbon footprint per euro. This suggests a preference for cheap nutritional energy rather than environment-conscious purchase behaviour. Whether a shift towards a plant-based pattern would be affordable for those with more traditional and cheaper purchase patterns requires more research.

Association between breakfast frequency and physical activity and sedentary time: a cross-sectional study in children from 12 countries.

BACKGROUND: Existing research has documented inconsistent findings for the associations among breakfast frequency, physical activity (PA), and sedentary time in children. The primary aim of this study was to examine the associations among breakfast frequency and objectively-measured PA and sedentary time in a sample of children from 12 countries representing a wide range of human development, economic development and inequality. The secondary aim was to examine interactions of these associations between study sites. METHODS: This multinational, cross-sectional study included 6228 children aged 9-11 years from the 12 International Study of Childhood Obesity, Lifestyle and the Environment sites. Multilevel statistical models were used to examine associations between self-reported habitual breakfast frequency defined using three categories (breakfast consumed 0 to 2 days/week [rare], 3 to 5 days/week [occasional] or 6 to 7 days/week [frequent]) or two categories (breakfast consumed less than daily or daily) and accelerometry-derived PA and sedentary time during the morning (wake time to 1200 h) and afternoon (1200 h to bed time) with study site included as an interaction term. Model covariates included age, sex, highest parental education, body mass index z-score, and accelerometer waking wear time. RESULTS: Participants averaged 60 (s.d. 25) min/day in moderate-to-vigorous PA (MVPA), 315 (s.d. 53) min/day in light PA and 513 (s.d. 69) min/day sedentary. Controlling for covariates, breakfast frequency was not significantly associated with total daily or afternoon PA and sedentary time. For the morning, frequent breakfast consumption was associated with a higher proportion of time in MVPA (0.3%), higher proportion of time in light PA (1.0%) and lower min/day and proportion of time sedentary (3.4 min/day and 1.3%) than rare breakfast consumption (all p ≤ 0.05). No significant associations were found when comparing occasional with rare or frequent breakfast consumption, or daily with less than daily breakfast consumption. Very few significant interactions with study site were found. CONCLUSIONS: In this multinational sample of children, frequent breakfast consumption was associated with higher MVPA and light PA time and lower sedentary time in the morning when compared with rare breakfast consumption, although the small magnitude of the associations may lack clinical relevance. TRIAL REGISTRATION: The International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) is registered at (Identifier NCT01722500 ).

Associations of neighborhood social environment attributes and physical activity among 9-11 year old children from 12 countries.

We investigated whether associations of neighborhood social environment attributes and physical activity differed among 12 countries and levels of economic development using World Bank classification (low/lower-middle-, upper-middle- and high- income countries) among 9-11 year old children (N=6161) from the International Study of Childhood Obesity, Lifestyle, and the Environment (ISCOLE). Collective efficacy and perceived crime were obtained via parental/guardian report. Moderate-to-vigorous physical activity (MVPA) was assessed with waist-worn Actigraph accelerometers. Neighborhood environment by country interactions were tested using multi-level statistical models, adjusted for covariates. Effect estimates were reported by country and pooled estimates calculated across World Bank classifications for economic development using meta-analyses and forest plots. Associations between social environment attributes and MVPA varied among countries and levels of economic development. Associations were more consistent and in the hypothesized directions among countries with higher levels economic development, but less so among countries with lower levels of economic development.

Socioeconomic status and dietary patterns in children from around the world: different associations by levels of country human development?

BACKGROUND: Although 'unhealthy' diet is a well-known risk factor for non-communicable diseases, its relationship with socio-economic status (SES) has not been fully investigated. Moreover, the available research has largely been conducted in countries at high levels of human development. This is the first study to examine relationships among dietary patterns and SES of children from countries spanning a wide range of human development. METHODS: This was a multinational cross-sectional study among 9-11 year-old children (n = 6808) from urban/peri-urban sites across 12 countries. Self-reported food frequency questionnaires were used to determine the children's dietary patterns. Principal Components Analysis was employed to create two component scores representing 'unhealthy' and 'healthy' dietary patterns. Multilevel models accounting for clustering at the school and site level were used to examine the relationships among dietary patterns and SES. RESULTS: The mean age of participants in this study (53.7% girls) was 10.4 years. Largest proportions of total variance in dietary patterns occurred at the individual, site, and school levels (individual, school, site: 62.8%; 10.8%; 26.4% for unhealthy diet pattern (UDP) and 88.9%; 3.7%; 7.4%) for healthy diet pattern (HDP) respectively. There were significant negative 'unhealthy' diet-SES gradients in 7 countries and positive 'healthy' diet-SES gradients in 5. Within country diet-SES gradients did not significantly differ by HDI. Compared to participants in the highest SES groups, unhealthy diet pattern scores were significantly higher among those in the lowest within-country SES groups in 8 countries: odds ratios for Australia (2.69; 95% CI: 1.33-5.42), Canada (4.09; 95% CI: 2.02-8.27), Finland (2.82; 95% CI: 1.27-6.22), USA (4.31; 95% CI: 2.20-8.45), Portugal (2.09; 95% CI: 1.06-4.11), South Africa (2.77; 95% CI: 1.22-6.28), India (1.88; 95% CI: 1.12-3.15) and Kenya (3.35; 95% CI: 1.91-5.87). CONCLUSIONS: This study provides evidence of diet-SES gradients across all levels of human development and that lower within-country SES is strongly related to unhealthy dietary patterns. Consistency in within-country diet-SES gradients suggest that interventions and public health strategies aimed at improving dietary patterns among children may be similarly employed globally. However, future studies should seek to replicate these findings in more representative samples extended to more rural representation.

Household-level correlates of children's physical activity levels in and across 12 countries.

OBJECTIVE: Household factors (electronic media equipment, play equipment, physical activity in the home, and social support) have been associated with childhood moderate- to vigorous-intensity physical activity (MVPA), but little is known about how these factors differ across diverse countries. The objective was to explore household correlates of objective MVPA in children from 12 countries. METHODS: Overall, 5,859 nine- to eleven-year-old children from 12 countries representing a range of human and socioeconomic development indicators wore an accelerometer for 7 days and parents reported on household factors. Multilevel general linear models explored associations among household factors and MVPA variables controlling for age, sex, and parental education. RESULTS: Across sites, children with at least one piece of bedroom electronic media had lower MVPA (∼4 min/day; P < 0.001) than those who did not. More frequent physical activity in the home and yard, ownership of more frequently used play equipment, and higher social support for physical activity were associated with more MVPA (all P < 0.001). The association between play equipment ownership and MVPA was inconsistent across countries (interaction P < 0.01). CONCLUSIONS: With the exception of play equipment ownership, modifiable household factors showed largely consistent and important associations with MVPA across high-, mid-, and low-income countries.

Correlates of Total Sedentary Time and Screen Time in 9-11 Year-Old Children around the World: The International Study of Childhood Obesity, Lifestyle and the Environment.

PURPOSE: Previously, studies examining correlates of sedentary behavior have been limited by small sample size, restricted geographic area, and little socio-cultural variability. Further, few studies have examined correlates of total sedentary time (SED) and screen time (ST) in the same population. This study aimed to investigate correlates of SED and ST in children around the world. METHODS: The sample included 5,844 children (45.6% boys, mean age = 10.4 years) from study sites in Australia, Brazil, Canada, China, Colombia, Finland, India, Kenya, Portugal, South Africa, the United Kingdom, and the United States. Child- and parent-reported behavioral, household, and neighborhood characteristics and directly measured anthropometric and accelerometer data were obtained. Twenty-one potential correlates of SED and ST were examined using multilevel models, adjusting for sex, age, and highest parental education, with school and study site as random effects. Variables that were moderately associated with SED and/or ST in univariate analyses (p<0.10) were included in the final models. Variables that remained significant in the final models (p<0.05) were considered correlates of SED and/or ST. RESULTS: Children averaged 8.6 hours of daily SED, and 54.2% of children failed to meet ST guidelines. In all study sites, boys reported higher ST, were less likely to meet ST guidelines, and had higher BMI z-scores than girls. In 9 of 12 sites, girls engaged in significantly more SED than boys. Common correlates of higher SED and ST included poor weight status, not meeting physical activity guidelines, and having a TV or a computer in the bedroom. CONCLUSIONS: In this global sample many common correlates of SED and ST were identified, some of which are easily modifiable (e.g., removing TV from the bedroom), and others that may require more intense behavioral interventions (e.g., increasing physical activity). Future work should incorporate these findings into the development of culturally meaningful public health messages.

Longitudinal changes in functional capacity: effects of socio-economic position among ageing adults.

INTRODUCTION: Health and functional capacity have improved especially in Western countries over the past few decades. Nevertheless, the positive secular trend has not been able to decrease an uneven distribution of health. The main aim of this study was to follow-up changes in functional capacity among the same people in six years time and to detect whether the possible changes vary according to socio-economic position (SEP). In addition, it is of interest whether health behaviours have an effect on these possible changes. METHODS: This longitudinal follow-up study consisted of 1,898 individuals from three birth cohorts (1926-1930, 1936-40, 1946-50) who took part in clinical check-ups and answered to a survey questionnaire in 2002 and 2008. A sub-scale of physical functioning from the RAND-36 was used to measure functional capacity. Education and adequacy of income were used as indicators of socio-economic position. Repeated-measures ANOVA was used as a main method of analysis. RESULTS: Physical functioning in 2002 and 2008 was poorest among those men and women belonging to the oldest cohort. Functional capacity deteriorated in six years among men in the oldest cohort and among women in all three cohorts. Socio-economic disparities in functional capacity among ageing people existed. Especially lower adequacy of income was most consistently associated with poorer functional capacity. However, changes in functional capacity by socio-economic position remained the same or even narrowed independent of health behaviours. CONCLUSION: Socio-economic disparities in physical functioning are mainly incorporated in the level of functioning at the baseline. No widening socioeconomic disparities in functional capacity exist. Partly these disparities even seem to narrow with ageing.

Panel discussion does not improve reliability of peer review for medical research grant proposals.

OBJECTIVE: Peer review is the gold standard for evaluating scientific quality. Compared with studies on inter-reviewer variability, research on panel evaluation is scarce. To appraise the reliability of panel evaluations in grant review, we compared scores by two expert panels reviewing the same grant proposals. Our main interest was to evaluate whether panel discussion improves reliability. METHODS: Thirty reviewers were randomly allocated to one of the two panels. Sixty-five grant proposals in the fields of clinical medicine and epidemiology were reviewed by both panels. All reviewers received 5-12 proposals. Each proposal was evaluated by two reviewers, using a six-point scale. The reliability of reviewer and panel scores was evaluated using Cohen's kappa with linear weighting. In addition, reliability was also evaluated for the panel mean scores (mean of reviewer scores was used as panel score). RESULTS: The proportion of large differences (at least two points) was 40% for reviewers in panel A, 36% for reviewers in panel B, 26% for the panel discussion scores, and 14% when the means of the two reviewer scores were used. The kappa for panel score after discussion was 0.23 (95% confidence interval: 0.08, 0.39). By using the mean of the reviewer scores, the panel coefficient was similarly 0.23 (0.00, 0.46). CONCLUSION: The reliability between panel scores was higher than between reviewer scores. The similar interpanel reliability, when using the final panel score or the mean value of reviewer scores, indicates that panel discussions per se did not improve the reliability of the evaluation.

Register-based data indicated nonparticipation bias in a health study among aging people.

OBJECTIVES: To examine nonparticipation in a survey by linking it with register information and identify potential nonresponse bias of inequalities in health status among aging people. STUDY DESIGN AND SETTING: Cross-sectional questionnaire survey with clinical checkups carried out in 2002 among persons born in 1926-1930, 1936-1940, and 1946-1950 in Southern Finland. The sample was linked with register information from Statistics Finland and analyzed in terms of participation and health status as measured by medicine reimbursements. RESULTS: Participation in the survey was more frequent among those who were older, female, married or cohabiting, higher educated and nonurban residents, and those with higher income and moderate health. Among nonrespondents, women were less healthy than men, whereas among respondents, the results were reversed. Among nonrespondents, better income was associated with unfavorable health. Poor health was generally more common among nonrespondents than respondents in several subgroups. CONCLUSION: Differences in response rates were found in sociodemographic factors, health, and socioeconomic position. Favorable health was generally more frequent among respondents than nonrespondents. In particular, health inequalities by gender and income differed between respondents and nonrespondents. Thus, nonresponse may lead to bias in analyses of health inequalities among aging people.

Physical activity counseling in maternity and child health care - a controlled trial.

BACKGROUND: The purpose of the study is to examine the effects and feasibility of individual physical activity (PA) counseling in maternity and child health clinics in Finland. METHODS: Three clinics including both maternity and child health care signed up for the experimental (EXP) and three for the control group (CON). The participants were 132 pregnant and 92 postpartum primiparas. The nurses in EXP integrated a primary and four booster PA counseling sessions into routine visits. An option for supervised group exercise was offered. In CON former practices, usually including brief PA advice, were continued. Leisure-time PA (LTPA) prior to pregnancy was elicited by questionnaire and followed 16-18 and 36-37 weeks' gestation in maternity clinics and 5 and 10 months postpartum in child health clinics. Feasibility included safety, participant responsiveness, realization of counseling and applicability. RESULTS: According to analysis of covariance adjusted for baseline LTPA and possible confounders, no relative between-group differences in LTPA were found at the first follow-up in either maternity or child health clinics. At the last follow-up in maternity clinics the weekly number of at least moderate-intensity LTPA days was 43% (95% CI: 9, 87) higher and the weekly duration of at least moderate-intensity LTPA 154% (95% CI: 16, 455) higher in EXP compared with CON. Counseling proved feasible in both maternity and child health clinics. CONCLUSION: Counseling encouraged pregnant women to sustain their moderate-intensity LTPA and was feasible in routine practices. No effects were observed if counseling was initiated postpartum. TRIAL REGISTRATION: Current Controlled Trials ISRCTN21512277.

Reducing postpartum weight retention--a pilot trial in primary health care.

BACKGROUND: Postpartum weight retention may contribute to the development of obesity. We studied whether individual counselling on diet and physical activity from 2 to 10 months postpartum has positive effects on diet and leisure time physical activity and increases the proportion of primiparas returning to their pre-pregnancy weight. METHODS: A controlled trial including ninety-two postpartum primiparas was conducted in three intervention and three control child health clinics in primary health care in Finland. The intervention included individual counselling on diet and physical activity during five routine visits to a public health nurse; the controls received the usual care. RESULTS: In total, 50% of the intervention group and 30% of the control group returned to their pre-pregnancy weight (weight retention

Trends and socioeconomic differences in overweight among physically active and inactive Finns in 1978-2002.

OBJECTIVE: The aim was to study the associations of physical activity and socioeconomic status with overweight from 1978 to 2002 and to explore whether the trend in overweight was different across educational groups or leisure time and commuting physical activity groups. METHOD: The study population comprised 37,084 women and 34,191 men who participated in cross-sectional postal surveys carried out annually from 1978 to 2002. The surveys included independent nationally representative random samples of Finns aged 25 to 64 years. Information on weight, height, leisure time and commuting physical activity was self-reported. The level of education was obtained from national register data. Overweight was defined as a body mass index (kg/m2) of 25 or higher. RESULTS: Overweight was more prevalent among the physically inactive and lower educated. The prevalence of overweight increased over time. Across the study years, those men and women who participated in leisure time or commuting physical activity had a lower prevalence of overweight in all educational groups. The increase in the prevalence of overweight followed a similar pattern in all physical activity and education groups. CONCLUSION: Engagement in physical activity has not prevented an increase in the prevalence of overweight in any socioeconomic group among Finnish men and women from 1978 to 2002.

Rural-urban differences in health and health behaviour: a baseline description of a community health-promotion programme for the elderly.

STUDY OBJECTIVE: To (1) describe the setting and design of the Good Ageing in Lahti Region (GOAL) programme; (2) by using the baseline results of the GOAL cohort study, to examine whether living in urban, semi-urban, or rural communities is related to risk factors for chronic diseases and functional disability in ageing individuals. DESIGN: The baseline data of a cohort study of ageing individuals living in three community types (urban, semi-urban, rural). Data were collected by two questionnaires and laboratory assessments. SETTING: Fourteen municipalities in the Lahti region (Päijät-Häme County) in Finland. PARTICIPANTS: A regionally and locally stratified random sample of men and women born in 1946-50, 1936-40, and 1926-30. A total of 4,272 were invited and 2,815 (66%) participated. MAIN RESULTS: Elevated serum cholesterol, obesity, disability, sedentary lifestyle (<2 times/week walking), and high fat intake were more prevalent in rural vs. urban and semi-urban communities. After adjustment for sex, age, education, obesity, diet, physical activity, smoking, and alcohol use, rural communities remained the only community type with increased (p<0.05) probability for high BMI (OR 1.33) and high waist circumference (OR 1.43). CONCLUSIONS: The unfavourable health and lifestyle profile, together with an old population, makes health promotion for elderly citizens a special challenge for rural communities such as those in Päijät-Häme County, Finland. Most, if not all, of the differences in health between the three community types were explained by educational background, physical activity, and smoking.

Weight loss strategies for obese adults: personalized weight management program vs. standard care.

OBJECTIVE: The objective of this study was to evaluate the effect of a 32-week personalized Polar weight management program (PWMP) compared with standard care (SC) on body weight, body composition, waist circumference, and cardiorespiratory fitness in overweight or obese adults. RESEARCH METHODS AND PROCEDURES: Overweight or obese (29 +/- 2 kg/m(2)) men and women (n = 74) 38 +/- 5 years of age were randomly assigned into either PWMP (men = 20, women = 21) or SC (men = 15, women = 18). Both groups managed their own diet and exercise program after receiving the same standardized nutrition and physical activity advice. PWMP also received a weight management system with literature to enable the design of a personalized diet and exercise weight loss program. Body weight and body composition, waist circumference, and cardiorespiratory fitness were measured at weeks 0, 16, and 32. RESULTS: Eighty percent of participants completed the 32-week intervention, with a greater proportion of the dropouts being women (PWMP: 2 men vs. 7 women; SC: 2 men vs. 4 women). At 32 weeks, PWMP completers had significantly (p < 0.001) greater losses in body weight [6.2 +/- 3.4 vs. 2.6 +/- 3.6 (standard deviation) kg], fat mass (5.9 +/- 3.4 vs. 2.2 +/- 3.6 kg), and waist circumference (4.4 +/- 4.5 vs. 1.0 +/- 3.6 cm). Weight loss and fat loss were explained by the exercise energy expenditure completed and not by weekly exercise duration. DISCUSSION: More effective weight loss was achieved after treatment with the PWMP compared with SC. The results suggest that the PWMP enables effective weight loss through tools that support self-monitoring without the requirement of more costly approaches to program supervision.

Health psychological theory in promoting population health in Päijät-Häme, Finland: first steps toward a type 2 diabetes prevention study.

In public health promotion, behavioural science theories and theory-based methods should be translated into practical strategies that fit environmental conditions and are feasible for implementation. In this article, an effort to meet this challenge is presented. As a starting point we describe the conditions for development and success of the previous generation of public health promotion programmes in Finland. However, changes both in the population structure and in the population health bring new demands for programme development. We consider possibilities offered by health psychology and give a practical example of how theories and theory-based methods are applied in a community programme for type 2 diabetes prevention implemented in the Finnish primary health care.