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

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

The centrality of food in Norwegian adolescents' life; a photo elicitation study among Norwegian youth.

The purpose of the study was to explore how adolescents from a high school in Viken county define and interact with food systems in their immediate environments to understand if and how health and sustainability affect their food choices. A qualitative case study design and a participatory approach were employed. Data were collected through photo elicitation combined with group interviews. Pictures were analyzed in collaboration with participants, and the group interview through systematic text condensation. Results indicate that adolescents perceive food systems as being a substantial part of their everyday life, that they care about their health and that of the planet, and they wish to take sustainability and health into consideration when making food choices. Their food choices are affected by aspects such as family, friends, marketing, price, time, availability and accessibility. They perceive that their agency to influence their own diet and food systems is limited. Adolescents hold unique and important knowledge of their food-related behaviors and value their autonomy to make food choices. Future research and policies aiming to help adolescents make healthy and sustainable food choices should therefore actively include adolescents.

Estrategias educativas para la promoción del consumo de frutas y verduras en el medio escolar: proyecto pro children / School based education strategies to promote fruit and vegetable consumption: the pro children project

Los datos disponibles sugieren que un porcentaje elevado de niños y jóvenes europeos consumen cantidades insuficientes de frutas y verduras. Las estrategias de promoción de hábitos alimentarios saludables y actividad física en el medio escolar tienen un efecto potencial muy positivo. El proyecto Pro Children tiene como finalidad estimar el consumo de frutas y verduras y sus factores determinantes en niños europeos de 11 años y sus familias. También pretende evaluar la eficacia y viabilidad de un programa de educación nutricional orientado a mejorar el consumo de este grupo alimentario. En la primera fase se realizó un estudio transversal en muestra aleatorias representativas de la población de 11 años de 9 países europeos, contemplando análisis de la ingesta y un cuestionario de evaluación de los determinantes del consumo. Se ha diseñado un programa de intervención nutricional en el medio escolar basado en el modelo "Actitudes, Influencias Sociales y Autonomía: (ASE), con un marco teórico similar pero adaptado al contexto sociocultural de cada uno de los países de intervención. A lo largo de dos cursos escolares se evaluará la eficacia del programa en tres países. Cada punto de intervención aplica el programa en 10 centros docentes y considera otros 10 centros control. La planificación de la intervención se realizó siguiendo un procedimiento de mapeo de intervenciones. Se identificaron las conductas a modificar y sus factores determinantes y se formularon los objetivos educativos. Uno de los componentes destacados de la intervención es el suministro de fruta y verdura en el colegio. El programa consta de fichas de actividades para el aula; actividades con la familia; un programa informático de consejo nutricional para los niños y un componente de refuerzo comunitario a elegir para los tres países participantes entre programa de salud escolar; programa en tiendas de alimentación o implicación de los medios de comunicación de masas. A pesar de la diversidad cultural y social, es posible diseñar estrategias similares de intervención con el fin de fomentar el consumo de frutas y verduras en la población escolar. La adpatación a las situaciones específicas favorecerá un mayor éxito