Effects of major urban redesign on sedentary behavior, physical activity, active transport and health-related quality of life in adults.

BACKGROUND: The built environment is increasingly recognized as a determinant for health and health behaviors. Existing evidence regarding the relationship between environment and health (behaviors) is varying in significance and magnitude, and more high-quality longitudinal studies are needed. The aim of this study was to evaluate the effects of a major urban redesign project on physical activity (PA), sedentary behavior (SB), active transport (AT), health-related quality of life (HRQOL), social activities (SA) and meaningfulness, at 29-39 months after opening of the reconstructed area. METHODS: PA and AT were measured using accelerometers and GPS loggers. HRQOL and sociodemographic characteristics were assessed using questionnaires. In total, 241 participants provided valid data at baseline and follow-up. We distinguished three groups, based on proximity to the intervention area: maximal exposure group, minimal exposure group and no exposure group. RESULTS: Both the maximal and minimal exposure groups showed significantly different trends regarding transport-based PA levels compared to the no exposure group. In the exposure groups SB decreased, while it increased in the no exposure group. Also, transport-based light intensity PA remained stable in the exposure groups, while it significantly decreased in the no exposure group. No intervention effects were found for total daily PA levels. Scores on SA and meaningfulness increased in the maximal exposure group and decreased in the minimal and no exposure group, but changes were not statistically significant. CONCLUSION: The results of this study emphasize the potential of the built environment in changing SB and highlights the relevance of longer-term follow-up measurements to explore the full potential of urban redesign projects. TRIAL REGISTRATION: This research was retrospectively registered at the Netherlands Trial Register (NL8108).

Effectiveness and implementation of a multidisciplinary lifestyle focused approach in the treatment of inpatients with mental illness (MULTI +): a stepped wedge study protocol.

BACKGROUND: People with mental illness have a reduced life expectancy compared to the general population. Despite the increasing evidence for the efficacy of lifestyle interventions there is little change in routine clinical care. This discrepancy is often referred to as the implementation gap and has caused a need for effectiveness and implementation research in real-world settings. Our study assesses the effectiveness and implementation of a multidisciplinary lifestyle focused approach in the treatment of inpatients with mental illness (MULTI +). METHODS: An open cohort stepped wedge cluster randomized trial in inpatients psychiatric wards of GGz Centraal, the Netherlands. The wards are divided into three clusters based on geographical region. These clusters are randomly allocated to one of the three pre-defined steps to integrate MULTI + . MULTI + can be tailored to fit individual psychiatric wards and includes 10 core components aimed at improving lifestyle factors. The primary outcome is to investigate the difference in the mean QRISK3 score of patients receiving MULTI + compared to patients receiving TAU. Secondary outcomes include somatic and mental health outcomes, lifestyle factors, and implementation factors. Findings will be analysed using mixed model analyses. DISCUSSION: The MULTI + study is the first large-scale study evaluating the long-term effects of a multidisciplinary, multicomponent approach aimed at improving lifestyle factors in routine inpatient mental health care. A limitation of this study is the risk of missing data due to the large-scale, real-world setting of this study. Furthermore, implementation monitoring and external events that may influence outcomes could be difficult to account for. Strengths of this study are the focus on effectiveness as well as implementation and the inclusion of both patient and health care professionals' perspectives. Effectiveness studies in routine clinical care can advance our knowledge on lifestyle interventions in real-world settings. TRIAL REGISTRATION: ClinicalTrials.gov registration. Identifier: NCT04922749 . Retrospectively registered 3th of June 2021.

Does partnership diversity in intersectoral policymaking matter for health promoting intervention packages' composition? A multiple-case study in the Netherlands.

Intersectoral policymaking to improve public health includes integrated health promotion (HP) intervention packages that address a variety of health behavior determinants. The involvement of different partners is assumed to be necessary to implement such integrated packages. We examined how partnership diversity was associated with the composition of intervention packages implemented in Dutch municipalities. In a longitudinal multiple-case study (2012-14), we collected questionnaire data among 31 project leaders and 152 intervention implementers in 31 (alliances of) municipalities. Package composition was assessed in terms of intervention strategies, implementation settings and targeted behavioral determinants. Partnership diversity during the adoption and implementation phases was assessed in terms of the actors and sectors, as well as private partners and citizens involved. The association between partnership diversity and package composition was examined using crosstabs. Almost all packages integrated multiple strategies, but mostly education, facilitation and case finding, in multiple, but mostly health and public settings, such as schools. The packages targeted diverse behavioral determinants, although mainly personal and social environmental factors. A variety of partners from multiple sectors was involved, during both adoption and implementation of the packages. However, partners from the health, welfare and education sectors were mostly involved. More partnership diversity, especially during implementation, was associated with more integrated intervention packages. In intersectoral policymaking, investment in diversely composed partnerships seems worthwhile for implementing integrated intervention packages. However, investments in other conditions, like framing health issues and network management, are also needed to make environmental determinants of health behavior the object of HP.

Greywater characterization and generation rates in a peri urban municipality of a developing country.

The quantity and quality of combined greywater from houses with in-house water supply and houses that rely on external sources of a peri-urban area in a developing country were determined. Data for quantity of greywater was collected from 36 households while 180 samples of greywater were collected from 60 households between December 2016 and February 2017. The results indicate that, average water consumption from households with in-house access was 82.51 ± 12.21 Lc-1d-1 while households which rely on external sources was 36.64 ± 4.31 Lc-1d-1 with return factors of 74.16% and 88.57% respectively. Quality analysis also showed significant differences between greywater from the two sources with most of the quality parameters exceeding the regulatory limit. The ratio between biochemical oxygen demand (BOD5) and chemical oxygen demand (COD) ranged between 0.22 and 0.59 for greywater from in-house sources and 0.23-0.62 for external sources indicating low biodegradability of the greywater. The nutrients recorded exceeded the trigger levels for eutrophication while significant levels of microorganisms such as E. Coli and Salmonella spp. were also detected in both streams. Direct reuse of greywater for irrigation was found to be unsuitable based on the salinity and sodium hazard analysis. Principal component analysis of the data indicated that the characteristics of the combined greywater in the study area is influenced by cooking and cleaning practices, personal hygiene, biodegradability, frequency of water use before disposal and sanitary practices in the bathroom. The greywater discharged is detrimental to the environment and poses a health risk to humans and livestock. There is therefore the need for authorities involved to prioritize greywater management and treatment in peri-urban areas of developing countries.

The effect of a school-centered multicomponent intervention on daily physical activity and sedentary behavior in primary school children: The Active Living study.

The aim of the current study was to examine the effectiveness of a school-centered multicomponent PA intervention, called 'Active Living', on children's daily PA levels. A quasi-experimental design was used including 9 intervention schools and 9 matched control schools located in the Netherlands. The baseline measurement took place between March-June 2013, and follow-up measurements were conducted 12months afterwards. Accelerometer (ActiGraph, GT3X+) data of 520 children aged 8-11years were collected and supplemented with demographics and weather conditions data. Implementation magnitude of the interventions was measured by keeping logbooks on the number of implemented physical environmental interventions (PEIs) and social environmental interventions (SEIs). Multilevel multivariate linear regression analyses were used to study changes in sedentary behavior (SB), light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA) between baseline and follow-up. Finally, effect sizes (ESs) were calculated using Cohen's d. No pooled effects on PA and SB were found between children exposed and not exposed to Active Living after 12months. However, children attending Active Living schools that implemented larger numbers of both PEIs and SEIs engaged in 15 more minutes of LPA per weekday at follow-up than children in the control condition (ES=0.41; p<.05). Moreover, children attending these schools spent less time in SB at follow-up (ES=0.33), although this effect was non-significant. No significant effects were found on MVPA. A school-centered multicomponent PA intervention holds the potential to activate children, but a comprehensive set of intervention elements with a sufficient magnitude is necessary to achieve at least moderate effect sizes.

Effects of a web-based decision aid regarding diagnostic self-testing. A single-blind randomized controlled trial.

UNLABELLED: Currently, there are many diagnostic self-tests on body materials available to consumers. The aim of this study was to assess the effect of an online decision aid on diagnostic self-testing for cholesterol and diabetes on knowledge among consumers with an intention to take these tests. A randomized controlled trial was designed. A total of 1259 consumers with an intention to use a diagnostic cholesterol or diabetes self-test were selected from an existing Dutch Internet panel. The intervention group was invited to view an online decision aid offering general information on self-testing and test-specific information on cholesterol and diabetes self-testing, including indications for testing, how to perform the test and interpreting the result. The placebo condition consisted of a limited information sheet. Multiple regression analysis showed that the knowledge level in the diabetes arm was higher in the intervention group than in the control group (B = 0.657; 95% CI, 0.011-1.303), as was the number of participants with an informed choice (OR, 1.672; 95% CI, 1.134-2.465). No differences were found in the cholesterol arm. Consumers who are considering doing a self-test should have access to independent information on self-testing and be encouraged to read this information. TRIAL REGISTRATION: Dutch Trial Register: NTR 3149.

Active Living: development and quasi-experimental evaluation of a school-centered physical activity intervention for primary school children.

BACKGROUND: The worldwide increase in the rates of childhood overweight and physical inactivity requires successful prevention and intervention programs for children. The aim of the Active Living project is to increase physical activity and decrease sedentary behavior of Dutch primary school children by developing and implementing tailored, multicomponent interventions at and around schools. METHODS/DESIGN: In this project, school-centered interventions have been developed at 10 schools in the south of the Netherlands, using a combined top-down and bottom-up approach in which a research unit and a practice unit continuously interact. The interventions consist of a combination of physical and social interventions tailored to local needs of intervention schools. The process and short- and long-term effectiveness of the interventions will be evaluated using a quasi-experimental study design in which 10 intervention schools are matched with 10 control schools. Baseline and follow-up measurements (after 12 and 24 months) have been conducted in grades 6 and 7 and included accelerometry, GPS, and questionnaires. Primary outcome of the Active Living study is the change in physical activity levels, i.e. sedentary behavior (SB), light physical activity (LPA), moderate-to-vigorous physical activity (MVPA), and counts-per-minute (CPM). Multilevel regression analyses will be used to assess the effectiveness of isolated and combined physical and social interventions on children's PA levels. DISCUSSION: The current intervention study is unique in its combined approach of physical and social environmental PA interventions both at school(yard)s as well as in the local neighborhood around the schools. The strength of the study lies in the quasi-experimental design including objective measurement techniques, i.e. accelerometry and GPS, combined with more subjective techniques, i.e. questionnaires, implementation logbooks, and neighborhood observations. TRIAL REGISTRATION: Current Controlled Trials ISRCTN25497687 (registration date 21/10/2015), METC 12-4-077, Project number 200130003.

Factors influencing perceived sustainability of Dutch community health programs.

We assessed the perceived sustainability of community health programs organized by local intersectoral coalitions, as well as the factors that collaborating partners think might influence sustainability. Semi-structured interviews were conducted among 31 collaborating partners of 5 community health programs in deprived neighborhoods in the southern part of the Netherlands. The interview guide was based on a conceptual framework that includes factors related to the context, the leading organization, leadership, the coalition, collaborating partners, interventions and outcomes. Interviews were recorded, transcribed and content analyzed using NVivo 8.0. Participants in each of the programs varied in their perceptions of the sustainability of the program, but those people collaborating in pre-existing neighborhood structures expressed relatively high faith in their continuation. The participating citizens in particular believed that these structures would continue to address the health of the community in the future. We found factors from all categories of the conceptual framework that were perceived to influence sustainability. The program leaders appeared to be crucial to the programs, as they were frequently mentioned in close interaction with other factors. Program leaders should use a motivating and supportive leadership style and should act as 'program champions'.

Clarifying concepts of food parenting practices. A Delphi study with an application to snacking behavior.

Inconsistencies in measurements of food parenting practices continue to exist. Fundamental to this problem is the lack of clarity about what is understood by different concepts of food parenting practices. The purpose of this study was to clarify food parenting practice concepts related to snacking. A three round Delphi study among an international group of experts (n = 63) was conducted. In the first round, an open-ended survey was used to collect food parenting practice descriptions and concept labels associated with those practices. In the second round, participants were asked to match up descriptions with the appropriate concept labels. The third and final round allowed participants to reconsider how descriptions and concept labels were matched, taking into account the opinions expressed in round two. Round one produced 408 descriptions of food parenting practices and 110 different concept names. Round two started with 116 descriptions of food parenting practices and 20 concept names. On 40 descriptions, consensus regarding the underlying concept name was reached in round two. Of the remaining 76 descriptions, consensus on 47 descriptions regarding the underlying concept name was reached in round three. The present study supports the essential process of consensus development with respect to food parenting practices concepts.

Patterns in bottlenecks for implementation of health promotion interventions: a cross-sectional observational study on intervention-context interactions in the Netherlands.

BACKGROUND: From a complex systems perspective, implementation should be understood as the introduction of an intervention in a context with which it needs to interact in order to achieve its function in terms of improved health. The presence of intervention-context interactions could mean that during implementation particular patterns of crucial interaction points might arise. We examined the presence of - and regularities in - such 'bottlenecks for implementation', as this could create opportunities to predict and intervene in potential implementation problems. METHODS: We conducted a cross-sectional observational study against the background of municipal intersectoral policymaking in the Netherlands. We asked implementers of health promotion interventions to identify bottlenecks by rating the presence and importance of conditions for implementation in a range of intervention systems. We used descriptive statistics to characterize these systems (by their behaviour change method, health theme and implementation setting) and the conditions that acted as bottlenecks. After stratifying bottlenecks by intervention system and the system's characteristics, we tested our hypotheses by comparing the number and nature of the bottlenecks that emerged. RESULTS: More than half of the possible conditions were identified as a bottleneck for implementation. Bottlenecks occurred in all categories of conditions, e.g., relating to the implementer, the intervention, and political and administrative support, and often connected with intersectoral policymaking, e.g., relating to the co-implementer and the co-implementer's organization. Both our hypotheses were supported: (1) Each intervention system came across a unique set of - a limited number of - conditions hampering implementation; (2) Most bottlenecks were associated with the characteristics of the system in which they occurred, but bottlenecks also appeared in the absence of such an association, or remained absent in the presence thereof. CONCLUSIONS: We conclude that intervention-context interactions in integrated health policymaking may lead to both regularities and variations in bottlenecks for implementation. Regularities may partly be predicted by the function of an intervention system, and may serve as the basis for building the capacity needed for the structural changes that can bring about long-lasting health improvements. Variations may point at the need for flexibility in further tailoring the implementation approach to the - mostly unpredictable - problems at individual sites.

The BeweegKuur programme: a qualitative study of promoting and impeding factors for successful implementation of a primary health care lifestyle intervention for overweight and obese people.

BACKGROUND: The aim of the study was to identify promoting and impeding factors for successful implementation of a Dutch primary health care-based lifestyle programme called 'BeweegKuur'. BeweegKuur aims to increase the physical activity and change the diet of people at increased health risk due to overweight or obesity. OBJECTIVE: To determine perceived promoting and impeding factors in the implementation of the BeweegKuur programme for overweight and obese people. METHODS: This study consisted of 3 focus group meetings with intervention participants, 15 interviews with health care professionals (HCPs) and 1 focus group session with dieticians. The interviews and focus groups were recorded and transcribed verbatim. The data were analysed with the Nvivo qualitative research software package. RESULTS: For some intervention participants, the invitation to participate in BeweegKuur came unexpectedly, as they had not been diagnosed with an illness. HCPs were aware of this and took time to explain to participants that the programme was appropriate and safe for them. Participants as well as professionals were generally positive about the feasibility of the programme for overweight and obese people. CONCLUSIONS: HCPs as well as intervention participants were motivated to participate in the programme, and generally indicated that the intervention was in accordance with their needs. The multidisciplinary approach and the combination of physical activity and dietary behaviour change can make the BeweegKuur programme a success if potential impeding factors like those identified in the present study are overcome.

Visualizing changes in physical activity behavioral patterns after redesigning urban infrastructure.

The aim of this study was to explore effects of a major urban reconstruction on physical activity (PA) behavior by comparing PA intensity hotspots before and after the tunneling of a highway with a new infrastructure prioritized for walking and cycling. In total, 126 individuals participated before and after the tunneling. GPS loggers and accelerometers were used to assess location and PA levels. A geographic information system (GIS) was used to perform optimized hotspot analyses on PA data, both on transport and stationary data points. The results showed several changes in PA hotspots on trip data, even if total PA levels did not change. At follow-up, PA intensity hotspots were more connected, with the new infrastructure as a central connection. This was true for higher and lower educated individuals. Therefore, if changes in the built environment do not result in changes on population-level outcomes, this does not imply that they have no impact on behavior.

Product samples stimulate choice of unfamiliar healthful food products.

The purpose of this study was to assess whether the availability of a product sample of an unfamiliar low-fat or fruit and vegetable products stimulates choice for this product among food neophobic young adults. The study had a 2 (experimental vs. control group) by 4 (low-fat bread spread, low-fat cheese, fruit juice, fruit and vegetable juice) between subjects design with a pre-and post-experiment questionnaire. The study was conducted in restaurant rooms of several educational institutions in the Netherlands among a convenience sample of 197 food neophobic young adults aged 17-25 years. A small bite or sip-sized sample of the target product was provided as an intervention. The effect measure was choice of either an unfamiliar healthful food product or a traditional food product. Offering a sample of an unfamiliar healthful food product resulted in 51% of the participants in the experimental group choosing this product vs. 36.4% in the control group. Providing food product samples seems to be a promising strategy in healthy diet promotion programs for food neophobic young adults to increase first-time trial of unfamiliar low-fat and fruit and vegetable products.

Information about the taste stimulates choice of unfamiliar healthful food products.

BACKGROUND: The present study aimed to assess whether taste information about unfamiliar low-fat and fruit and vegetable products leads to more positive taste expectations and stimulates choice for these products. The impact of level of food neophobia on such effects was studied. METHODS: The present study had a two (taste information: yes/no) by four (food products: low-fat cheese/very low-fat margarine spread/fruit juice/fruit and vegetable juice) between subjects design among a convenience sample of 396 university students. Taste information was delivered by means of a poster providing information on the taste of the offered food product. Primary outcome measurements were taste expectations and product choice. Level of food neophobia, appetite level, mood states, usual intake of fruit, vegetables and fat, and demographics were taken into account as potential confounders. RESULTS: Taste information had no effect on taste expectations, although it had a positive effect on choosing unfamiliar healthful products. These effects were not moderated by level of food neophobia. CONCLUSIONS: Offering taste information on unfamiliar healthful products appears to be a promising strategy for increasing the first-time trial of such products, independent of the participants' level of food neophobia.

Child-care use and the association with body mass index and overweight in children from 7 months to 2 years of age.

OBJECTIVES: Studies regarding the association of child-care use with body mass index (BMI), overweight or obesity development show contradictory results. This study examined the relationship between child-care use and BMI z-scores and overweight, as well as associates of child-care use in children up to 2 years old. METHODS: Longitudinal data originated from the Dutch KOALA Birth Cohort Study. Questionnaires assessed child-care use at ages 7 months and 1 and 2 years (N=2396). Height and weight assessed at 1 and 2 years were used to calculate BMI z-scores. Overweight was defined as a BMI z-score of ≥85th percentile. The influence of child-care use on weight development was tested using backward linear and logistic regression analyses. Outcomes were: (1) BMI z-score at 1 and 2 years; (2) change in BMI z-score between 1 and 2 years; (3) overweight vs non-overweight at 1 and 2 years; and (4) change from normal weight to overweight vs remaining normal weight between 1 and 2 years. The association between child-care use and parental background characteristics was tested using backward logistic regression analyses. RESULTS: Child-care use (no/yes) at 1 and 2 years positively predicted BMI z-scores at age 2 years, as well as change in BMI z-score between 1 and 2 years. These associations were adjusted for various covariates (for example, parental working hours). Furthermore, child-care use significantly increased the odds of being overweight at age 1 year. There were few differences in BMI or overweight between intensive (>16 h per week) and limited child-care use (≤16 h). Child-care use was positively associated with various parental characteristics, including parental working hours and maternal educational level. CONCLUSION: The findings suggest a small influence of child-care use on weight development in very young children. The child-care setting could have an important role in preventive interventions against overweight and obesity development in young children.

Child-care environment and dietary intake of 2- and 3-year-old children.

BACKGROUND: Previous research has shown that children in child-care do not comply with dietary intake recommendations (i.e. either exceeding or not meeting recommendations), which may be attributable to specific features of the child-care environment. The present study explored the relationship between the social and physical child-care (day-care) environment and dietary intake of 2- and 3-year-olds in Dutch child-care centres. METHODS: The dietary intake of 135 children, aged 2 and 3 years, who were in child-care was assessed by observing randomly selected children at three meals (morning snack, lunch and afternoon snack) to determine dietary intake (i.e. saturated fat, dietary fibre and energy intake). The environment was observed using the Environment and Policy Assessment and Observation checklist, a structured instrument assessing the physical and social environment. RESULTS: Children consumed a mean of 486 kJ (116 kcal) during the morning snack, 2043 kJ (488 kcal) during lunch and 708 kJ (169 kcal) during the afternoon snack. There were some gender and age differences in dietary intake. Several environmental factors (e.g. serving style and staff's model dietary behaviour) were significantly associated with the children's dietary intake. CONCLUSIONS: Overall, energy intake was in the upper range of recommended intake for children in child-care. The associations of several environmental factors with dietary intake stress the importance of the child-care environment for children's dietary behaviour. Intervening in this setting could possibly contribute to the comprehensive prevention of childhood obesity.

General movements in the first fourteen days of life in extremely low birth weight (ELBW) infants.

OBJECTIVE: To assess the quality of general movements (GMs) in the first fourteen days of life in relation to obstetric and postnatal risk factors and neurodevelopmental outcome in extremely low birth weight (ELBW) infants. STUDY DESIGN: The GMs of nineteen infants were assessed on days 2, 4, 6, 10 and 14 with Prechtl's method. Additionally, detailed GM assessment produced optimality scores (OSs). GMs and the OSs were related to obstetric and postnatal data and to neurodevelopmental outcome at 18 months. RESULTS: GMs and OSs fluctuated substantially during the first fourteen days of life. Most infants had abnormal GMs, especially poor repertoire (PR) GMs. No relation was found between GMs and obstetric factors. Regarding postnatal factors, septicaemia correlated to hypokinesia (H) and artificial ventilation correlated to a lower OS. CONCLUSIONS: Due to physiological disturbances the quality of GM in ELBW infants fluctuates substantially during the first fourteen days of life. Abnormal GMs, especially PR GMs, are mostly seen for the same reason. Septicaemia and artificial ventilation are associated with deterioration of the GMs (lower OSs), and in case of septicaemia also with hypokinesia.

Complexity of Organ Donation Registration: Determinants of Registration Behavior Among Lower-educated Adolescents.

BACKGROUND: Registration rates are low for organ donation among lower educated adolescents in The Netherlands. This could be improved by preparing them for making a decision regarding donation when they become 18 years old. To do so, more insight is needed into their beliefs about organ donation and registration. METHODS: A cross-sectional quantitative study was conducted among students in intermediate vocational education schools. Data were gathered my means of self-administrated questionnaires. The outcome measurements included current registration status, being an organ donor, intention to register, and intention to become a donor. Correlation coefficients were used to assess the strength of associations between beliefs and each of the 4 outcome measurements. RESULTS: A total of 405 participants (mean age, 18.86 years) were included, of whom 26.6% had already registered a decision. Most beliefs showed a significant correlation with one or more of the outcomes. In general, the correlations were of small to medium size and participants scored around the middle of the scales on the beliefs. CONCLUSION: Means and correlations need to be combined to gain insight into the importance of certain beliefs for future interventions. However, it is plausible that, in addition to these explicit beliefs, implicit factors play a role in registration behavior. This could be explored in future research. Results could support intervention development for increasing registration rates.

Stress, Anxiety, and Weight Gain among University and College Students: A Systematic Review.

BACKGROUND: Stress and anxiety levels are elevated among university and college students. Although high stress levels can lead to an increase in adiposity, it is not clear whether stress and anxiety experienced when in university or college have an influence on students' weight. OBJECTIVE: The aim of this systemic review was to investigate whether stress and anxiety levels encountered during university and college enrollment were associated with higher adiposity or weight changes among students. METHOD: A search strategy was used to identify peer-reviewed studies published between 1985 and March 2017 using the following databases: Medline using Ovid; PubMed, CINAHL using EBSCO, Embase using Ovid, PSYCHINFO, and Open Access Theses and Dissertation. Two reviewers independently assessed the title, abstract, and then the full article of the studies that met the inclusion criteria. Data were extracted and quality assessment was conducted for the included studies. RESULTS: Twenty-five observational studies were identified in this review (23 cross-sectional and two longitudinal); 11 found that there was no association between stress and body mass index or weight change. In addition, five studies did not find a significant association between anxiety and body mass index. A few studies revealed stress and anxiety might be associated with higher or lower weight status, thus there is a possibility that stress can increase or decrease weight, demonstrating that a bidirectional influence on body mass index may exist. CONCLUSIONS: The current data in this review are inadequate to draw firm conclusions about the role of stress on weight change in university and college students. The inconsistency of results in the literature reviewed for this article suggest that a focus on longitudinal studies with adequate sample size would better evaluate the relationship between stress or anxiety and its influence on weight status or weight change among college and university students.

The effect of infrastructural changes in the built environment on physical activity, active transportation and sedentary behavior - A systematic review.

This systematic review examined the effect of built environment infrastructural changes (BEICs) on physical activity (PA), active transportation (AT) and sedentary behavior (SB). A literature search resulted in nineteen eligible articles. On- and off-road bicycling and/or walking trails resulted in inconsistent effects on overall PA and walking, and in predominantly positive effects on bicycling. More extensive BEICs led to mixed results, with mainly non-significant effects. However, positive effects on bicycling were found for people living closer to BEICs. None of the studies assessed SB. Improved understanding of the potential of BEICs to increase PA levels and decrease SB at population level asks for more high-quality, in-depth research, that takes into account the broader system.