Beyond femininity or masculinity: gender typologies and healthy eating in early adulthood.

PURPOSE: In the field of health sciences gender is often confused with biological sex (male/female) or reduced to a dichotomous classification (masculinity/femininity). The concepts of sex and gender interact with each other, but they are not equivalent. According to Sandra Bem four gender typologies can be established (androgynous, masculine, feminine and undifferentiated). A relationship has been shown to exist between gender and health. Yet, there is little evidence as to the relationship between gender typologies and adherence to the Mediterranean diet. The aim of this research is to evaluate the association between Bem's gender typologies and adherence to the Mediterranean diet. METHODS: Mediterranean Diet Adherence Screener (MEDAS) and Bem's gender typologies were the main variables. Sex, age, socioeconomic status (SES), body mass index (BMI) and obesity were analyzed as covariates. RESULTS: Multilevel multivariate analysis showed that androgynous typology was associated with increased adherence to Mediterranean diet (ß = 0.46 (SE 0.21), p = 0.033), adjusting by covariates, in a university population in Spain. Moreover, this was not the case with masculinity or femininity typologies. CONCLUSION: Thus, the results of this study suggest (1) that androgynous typology is not only associated with better mental health but also with healthy/healthier lifestyles, and (2) the complexity of the relationship between sex-gender and health would advise researchers avoid dichotomies such as male/female or masculinity/femininity.

Television viewing time and risk of eating disorders in Spanish adolescents: AVENA and AFINOS studies.

BACKGROUND: Effective preventive interventions for both eating disorders and obesity in adolescence should be focused on shared risk factors. We analyzed the association between television (TV) viewing time and the risk of eating disorders, as well as the potential role of obesity in this association. METHODS: The sample consisted of a total of 3458 Spanish adolescents, aged 13-18.5 years, from the Food and Assessment of the Nutritional Status of Adolescents (AVENA) and Physical Activity as a Preventive Measure of the Development of Overweight, Obesity, Allergies, Infections, and Cardiovascular Risk Factors in Adolescents (AFINOS) studies. Adolescents' TV time was assessed by self-report. Body mass index was calculated and the adolescents were classified into non-overweight and overweight-obesity. The risk of eating disorders was evaluated using the SCOFF questionnaire. RESULTS: Adolescents who watched TV >1 h/day had a higher risk for eating disorders, compared with those adolescents who watch TV <1 h/day. Also, overweight-obese adolescents had a higher risk for eating disorders than those who were non-overweight. Analyses across groups of TV viewing time and weight status showed similar trends, so that the higher the time spent in TV viewing, the higher the risk of eating disorders, regardless of weight status. CONCLUSIONS: TV viewing time might be a focal point for prevention of both eating disorders and obesity in adolescence.

ENTREN-F family-system based intervention for managing childhood obesity: Study protocol for a randomized controlled trial at primary care.

BACKGROUND: Pediatric obesity is a primary public health concern, and designing effective programs for managing it is of the utmost importance. The objective of this study was to describe the protocol study of a three-arm, parallel, randomized controlled trial aimed at assessing the efficacy of a family-system-based intervention ("ENTREN-F" program) for managing childhood obesity, compared to the "ENTREN" program (no "F" - without specific family-system-based workshop) and a control group (behavioral monitoring). METHODS/DESIGN: The ENTREN-F program was a multicomponent family-system-based intervention carried out by a multidisciplinary team in the primary health care setting. The program targeted children between 8 and 12 years with overweight and obesity (P ≥ 85th). Parents were actively involved in the process. The contents were designed using the Cognitive Behavioral Therapy (CBT) principles. The program comprised individual behavioral monitoring, a healthy habits workshop for children and their parents, a CBT workshop for children, and a family-system-based workshop for parents, enhancing parental management skills plus family functioning. The trial's primary outcomes included changes in child body mass index (BMI) z-scores, child's psychological well-being, and family functioning over six months. Secondary outcomes included changes in eating behavior, physical activity, self-esteem, parental distress, parental feeding practices, and parental modeling. DISCUSSION: To our knowledge, this is one of the few randomized controlled trials to assess the efficacy of a multicomponent program that considers health from a comprehensive perspective, trying to improve children's psychological well-being and family functioning besides weight loss. This study, therefore, addresses a gap in the literature. If found to be efficacious, it suggests a new potential health service for translation into National Primary Health Care services in Spain, one of the ten countries with the highest prevalence of obesity in Europe.

Physical Activity Coparticipation and Independent Mobility as Correlates of Objectively Measured Nonschool Physical Activity in Different School Grades. The UP&DOWN Study.

BACKGROUND: The aim was to investigate the association of (i) parental, sibling, and friend coparticipation in physical activity (PA); and (ii) independent mobility (IM) for walking, cycling, and taking public transport with objectively measured nonschool PA on week- and weekend days in different school grades. METHODS: A total of 1376 Spanish youngsters (50.8% boys; mean age 11.96 ± 2.48 years) participated in the study. Participants reported the frequency of their parental, sibling, and best friend coparticipation in PA with them and their IM for walking, cycling, and taking public transport. PA was objectively measured by accelerometry. RESULTS: Coparticipation in PA and IM were more frequently related to nonschool PA among adolescents than among children. Friend coparticipation in PA was positively associated with higher levels of nonschool PA in adolescents. IM for walking and IM for cycling in adolescents were related to nonschool PA on weekdays. CONCLUSIONS: Our results highlight the need for age-focused interventions and the integration of family and friends to promote PA in youth.

Physical activity during high school recess in spanish adolescents: the AFINOS study.

BACKGROUND: The morning recess period during school days represents a regular opportunity to accumulate physical activity (PA). However, little is known about the contribution of recess to PA guidelines (60 min/day in moderate-to-vigorous PA [MVPA]) in adolescents. METHODS: This study comprised 1065 Spanish adolescents (52% girls), aged 13 to 16 years. Adolescents completed a validated Recess PA Recall in 2007-2008. Differences in levels of PA during the recess period were analyzed by gender, age group, type of school, school location, immigrant status, weight status, fitness levels and snack eating during recess. RESULTS: Adolescent boys spent more time in MVPA (7.7 vs. 6.4 min in MVPA, P = .009) and were more active (29.6% vs. 24.5% in MVPA, P = .007) than girls during the recess period. Adolescent boys in the youngest age group and with the school located in cities were more active than their peers (all P < .05). There were no differences in levels of PA during recess by all the descriptive characteristics in adolescent girls (all P > .05). CONCLUSIONS: These findings suggest that recess in Spanish high schools may contribute to the daily recommended MVPA for adolescents, but greater efforts must be implemented to increase PA levels among adolescent girls during this school period.

Reliability and validity of an adapted version of the ALPHA environmental questionnaire on physical activity in Spanish youth.

INTRODUCTION: Previous studies suggest that the physical environment is associated with youth physical activity levels. OBJECTIVE: The present study aimed at assessing the reliability and validity of an adapted version of the ALPHA environmental questionnaire (short version) to adults for application with Spanish youth. METHODS: The reliability was evaluated in a sample (n = 190, 80 girls, 14.08 ± 1.38 years) using the Intraclass Correlation Coefficient (ICC) and Weighted kappa. In other sample (n = 140, 61 girls, 13.03 ± 1.40 years) the validity was assessed using the Spearman correlation (rho) for its association with self-reported and objective (accelerometers) physical activity (PA). RESULTS: The test-retest reliability showed ICC = 0.69 for the total questionnaire score, ranging from k = 0.42 to 0.77 for individual items. The total score showed significant correlations with PA reported by PACE questionnaire (rho = 0.18, p = 0.040), the Finnish Physical Activity Index (rho = 0.26, p = 0.002) and active commuting for girls (rho = 0.34, p = 0.010), as well as vigorous PA measured by accelerometry (rho = 0.18, p = 0.038). DISCUSSION: The adapted version of the ALPHA environmental questionnaire has moderate to good reliability and acceptable validity to assess environmental factors that may influence PA in youth.

Introducción: Estudios anteriores sugieren que el entorno físico está asociado con los niveles de actividad física de la juventud. Objetivo: El objetivo de este estudio fue valorar la fiabilidad y validez de una versión adaptada del cuestionario ambiental ALPHA de adultos (versión corta) para su aplicación en población juvenil española. Métodos: La fiabilidad del cuestionario se evaluó en una muestra (n=190; 80 chicas; 14.08±1.38 años) mediante el Coeficiente de Correlación Intraclase (CCI) y el índice Kappa ponderado. En otra muestra (n=140; 61 chicas; 13.03±1.40 años), se evaluó la validez del cuestionario mediante la asociación con la actividad física (AF), tanto auto-reportada como medida con acelerometría, a través de la correlación de Spearman (rho). Resultados: La fiabilidad test-retest mostró un CCI = 0.69 para la puntuación total del cuestionario, y un coeficiente Kappa de k = 0.42 a 0.77 en los ítems individuales. La puntuación total mostró correlaciones significativas con la AF auto-reportada mediante el cuestionario PACE (rho = 0.18; p = 0.040), el Índice Finlandés de Actividad Física (IFAF) (rho = 0.26, p = 0.002) y el transporte activo (rho = 0.34, p = 0.010 en chicas), así como con la AF vigorosa medida con acelerometría (rho = 0.18; p = 0.038). Discusión: La versión adaptada del cuestionario ambiental ALPHA, presenta una fiabilidad de moderada a buena y una aceptable validez para evaluar los factores ambientales que pueden influir en la práctica de AF de los jóvenes.

Adherence to dietary recommendations among Spanish and immigrant adolescents living in Spain; the AFINOS study.

OBJECTIVES: This study compares the adherence of immigrant and Spanish adolescents residing in the Madrid region (Spain) to national dietary recommendations. The factors compared were the consumption of items from the eight basic food groups (vegetables, fruits, bread/cereals, meat, eggs, fish, legumes and milk/dairy products), including the excessive or deficient consumption of eggs, meat and fish. In addition, the evaluation of excessive sweet foods or soft drinks in the diet was also considered. Subsequently, the influence of length of residence on dietary habits was examined. MATERIALS AND METHODS: Self-reported data were collected in a cross-sectional survey conducted over the period November 2007 to February 2008. The study participants were a representative sample of adolescents aged 13 to 17 years (n=2081, 1055 girls) living in the Madrid region. Participants were recruited from secondary schools (grades 7th to 10th) randomly selected according to the geographic distribution of adolescents in the region. RESULTS: Immigrant adolescents showed a greater likelihood of not fulfilling recommendations for the consumption of meat, fish, eggs, legumes, bread/cereals, and milk/dairy products. Their diets were also more likely to lack sufficient fish and they also consumed more eggs and more sweet foods and soft drinks than their native counterparts. Spanish adolescents were more likely not to meet recommendations for the intake of vegetables. Length of residence weakly affected dietary habits, with both negative and positive effects observed. CONCLUSION: The likelihood of not fulfilling dietary recommendations was higher among the immigrant adolescents with the exception of the intake of fruits and vegetables.

Objetivos: Este estudio compara la adherencia a las recomendaciones nutricionales de adolescentes inmigrantes y españoles residentes en la Comunidad de Madrid, España. Se comparó el consumo de ocho grupos principales de alimentos (verduras, frutas, pan/cereales, carne, huevos, pescado, legumbres, leche/derivados lácteos) incluyendo el consumo excesivo y deficiente de huevos, carne y pescado. También fue valorado el consumo excesivo de dulces y bebidas azucaradas. Posteriormente se analizó la influencia del tiempo de residencia en España sobre los mencionados hábitos de dieta. Material y método: Se llevó a cabo un estudio transversal en el que fueron recogidos datos auto-reportados durante el periodo comprendido entre Noviembre 2007 y Febrero 2008. Se obtuvo una muestra representativa de adolescentes con edades comprendidas entre 13 y 17 años (n=2081, 1055 mujeres) residentes en la Comunidad de Madrid. Los participantes pertenecían a centros de enseñanza secundaria seleccionados aleatoriamente según la distribución geográfica de los adolescentes en la región. Resultados: Los inmigrantes adolescentes presentaron una mayor probabilidad de no cumplir las recomendaciones nutricionales para el consume de carne, pescado, legumbres, pan/cereales y leche/derivados, de consumir una cantidad insuficiente de pescado y más dulces y bebidas azucaradas que sus compañeros españoles. Los adolescentes españoles mostraron una mayor probabilidad de no cumplir con la recomendación establecida para verduras. El tiempo de residencia afectó débilmente los hábitos de dieta, asociando aspectos tanto positivos como negativos. Conclusiones: La probabilidad de no cumplir las recomendaciones nutricionales fue mayor entre los adolescentes inmigrantes con excepción del consumo de frutas y verduras.

Association between excessive body fat and eating-disorder risk in adolescents: the AFINOS Study.

BACKGROUND AND OBJECTIVE: Overweight and obesity, together with eating disorders, are important public health concerns in adolescence. The aim of this study was to assess the association between excessive body fat and the risk of eating disorders. SUBJECTS AND METHOD: The sample consisted of 195 adolescents (97 girls) aged 13 to 18 years. Eating-disorder risk was evaluated by applying the SCOFF questionnaire. Body mass index, sum of 6 skinfolds, waist and hip circumferences and waist-hip and waist-height ratios were used to assess body fat. RESULTS: 24.7% of girls and 17.3% of boys were at risk of eating disorders, and 31.6% of boys and 21.6% of girls presented overweight (including obesity) according to Cole's cut-off points. Those adolescents classified above the 85th percentile on all the anthropometric measurements, as well as overweight adolescents, were at increased risk of developing an eating disorder (OR: 2.8-4.30, all p < 0.01). CONCLUSION: Regardless of the anthropometric measurements used, adolescents with excessive body fat showed a higher risk of having eating disorders than those with normal weight.