A nationwide school fruit and vegetable policy and childhood and adolescent overweight: A quasi-natural experimental study.

BACKGROUND: School free fruit and vegetable (FFV) policies are used to promote healthy dietary habits and tackle obesity; however, our understanding of their effects on weight outcomes is limited. We assess the effect of a nationwide FFV policy on childhood and adolescent weight status and explore heterogeneity by sex and socioeconomic position. METHODS AND FINDINGS: This study used a quasi-natural experimental design. Between 2007 and 2014, Norwegian combined schools (grades 1-10, age 6 to 16 years) were obligated to provide FFVs while elementary schools (grades 1-7) were not. We used 4 nationwide studies (n = 11,215 children) from the Norwegian Growth Cohort with longitudinal or cross-sectional anthropometric data up to age 8.5 and 13 years to capture variation in FFV exposure. Outcomes were body mass index standard deviation score (BMISDS), overweight and obesity (OW/OB), waist circumference (WC), and weight to height ratio (WtHR) at age 8.5 years, and BMISDS and OW/OB at age 13 years. Analyses included longitudinal models of the pre- and post-exposure trajectories to estimate the policy effect. The participation rate in each cohort was >80%, and in most analyses <4% were excluded due to missing data. Estimates were adjusted for region, population density, and parental education. In pooled models additionally adjusted for pre-exposure BMISDS, there was little evidence of any benefit or unintended consequence from 1-2.5 years of exposure to the FFV policy on BMISDS, OW/OB, WC, or WtHR in either sex. For example, boys exposed to the FFV policy had a 0.05 higher BMISDS (95% CI: -0.04, 0.14), a 1.20-fold higher odds of OW/OB (95% CI: 0.86, 1.66) and a 0.3 cm bigger WC (95% CI: -0.3, 0.8); while exposed girls had a 0.04 higher BMISDS (95% CI: -0.04, 0.13), a 1.03 fold higher odds of OW/OB (95% CI: 0.75, 1.39), and a 0-cm difference in WC (95% CI: -0.6, 0.6). There was evidence of heterogeneity in the policy effect estimates at 8.5 years across cohorts and socioeconomic position; however, these results were inconsistent with other comparisons. Analysis at age 13 years, after 4 years of policy exposure, also showed little evidence of an effect on BMISDS or OW/OB. The main limitations of this study are the potential for residual confounding and exposure misclassification, despite efforts to minimize their impact on conclusions. CONCLUSIONS: In this study we observed little evidence that the Norwegian nationwide FFV policy had any notable beneficial effect or unintended consequence on weight status among Norwegian children and adolescents.

A comprehensive multicomponent school-based educational intervention did not affect fruit and vegetable intake at the 14-year follow-up.

The intake of fruit and vegetables is associated with beneficial health outcomes, and studies aimed at increasing fruit and vegetable intake lack long-term follow-up. The primary objective of this study was to evaluate the long-term (14-year) effects of a multicomponent school-based educational intervention targeted to increase fruit and vegetable intake in children. The secondary objective was to evaluate the potential synergistic effect between free school fruit and the educational program. A cluster randomized school-based intervention was initiated in 2001 in Norway, known as the Fruit and Vegetable Make the Marks study. In total, 38 schools were randomized; for the intervention (n = 18) and as control schools (n = 20). A subsample of the intervention schools (n = 9) were additionally given free school fruit, resulting in two intervention groups - one with and one without free fruit. Participants completed questionnaires in September 2001 (baseline, mean age 11.8), May 2002 (at the end of the intervention), May 2003, May 2005, September 2009 and throughout 2016 (mean age 26.5). Of 1950 participants, 982 (50.4%) completed the 14-year follow-up and were considered as the current study sample. Analysis yielded no 14-year effects of the educational program on fruit and vegetable intake. A synergistic effect between the educational program and free fruit was not observed either. Future studies might benefit from increased focus on more extensive parental involvement, increased home availability, and a longer intervention period. However, more long-term studies are needed to evaluate the effects of school-based interventions into adulthood. Trial registration number: Ethical approval and research clearance was obtained from The National Committees for Research Ethics in Norway (file number S-01076) and The Norwegian Centre for Research Data (file number 12395).

The Norwegian Healthy Life Centre Study: A pragmatic RCT of physical activity in primary care.

AIMS: The aim of this study was to evaluate the effect of behaviour change interventions at Norwegian Healthy Life Centres (HLCs) on participants' moderate to vigorous intensity physical activity (MVPA) six months after baseline. We also explore predictors of change in MVPA, and if level of education and MVPA at baseline modify the effect. METHODS: A randomised controlled trial with inclusion criteria age ⩾ 18 years and ability to participate in group-based physical activity. Participants were randomised to either behaviour change interventions or a waiting list (control). Objective recordings of physical activity were the main outcome, analysed with simple and multiple linear regression. RESULTS: We recruited 118 participants from six HLCs. Participants with mental, musculoskeletal, or chronic somatic disease were more likely to drop out. We revealed no differences in MVPA or sedentary time between the groups. Types of motivation or several characteristics of disadvantage at baseline could not explain changes in MVPA. Across both groups, 83% achieved the recommended 150 minutes of MVPA per week, and participants with a lower level of education were less likely to improve. Participants in the intervention group who were least active at baseline significantly increased their MVPA. CONCLUSIONS: The study revealed that the intervention had no short-term effect on time spent on MVPA or sedentary. This study does not support a strong emphasis on behaviour change on an individual level as a way of targeting general health and risk reduction at a population level. Although less active people benefitted more from the HLC intervention, the intervention was unable to counteract widening of inequity across educational groups.

Participants at Norwegian Healthy Life Centres: Who are they, why do they attend and how are they motivated? A cross-sectional study.

AIMS: We examine the characteristics of participants entering Norwegian Healthy Life Centres, their reasons for attending and whether socio-economic status, motivation, self-efficacy and social support relate to physical activity and sedentary behaviour. METHODS: This cross-sectional study is part of a randomised controlled trial. Inclusion criteria are that participants should be ≥ 18 years old and able to take part in a physical activity group intervention. Exclusion criteria are severe mental illness and general learning disability. We analysed data using simple and multiple linear regression analyses. RESULTS: We recruited 118 participants from eight Norwegian municipalities between June 2014 and September 2015. Of these, 77% were female, mean (standard deviation) age 48.6 (13.4) years, body mass index 34.0 (5.8) kg/m2 and mean gross family income €61,000. The proportion of participants with upper-secondary school or less as their highest level of education was 55%. The most frequent reasons given for attendance at Healthy Life Centres were being overweight, increasing physical activity, improving diet and having musculoskeletal health challenges. Participants had high levels of autonomous motivation and 79% achieved national recommendations for physical activity. Respect and appreciation in childhood, self-esteem and self-rated health were associated with self-efficacy and social support for physical activity. CONCLUSIONS: Participants were predominantly obese, physically active, female and motivated for change. A high proportion had low educational attainment and low incomes. The trial will reveal whether interventions succeed in increasing physical activity further, or in decreasing sedentary behaviour, and whether health inequalities narrow or widen across groups.

Fun, influence and competence-a mixed methods study of prerequisites for high school students' participation in physical education.

BACKGROUND: Many adolescents do not reach the recommended levels of physical activity (PA), and students attending vocational studies are less committed to take part in physical education (PE) than other students. The purpose of the present study was twofold: 1) to examine differences in physical activity, diet, smoking habits, sleep and screen time among Norwegian vocational high school students who selected either a PE model focusing on PA skills, technique and improvement of physical performance ("Sports enjoyment") or more on health, play and having fun when participating in PE lessons ("Motion enjoyment"), and 2) to explore the students' experiences with PE programs. METHODS: In this mixed methods study 181 out of 220 invited students (82%) comprising 141 (78%) girls and 40 (22%) boys attending vocational studies of Restaurant and Food Processing (24%), Design, Arts and Crafts (27%) or Healthcare, Childhood and Youth Development (49%) were recruited for participation in the new PE program. PA level, sedentary time and sleep were objectively recorded using the SenseWear Armband Mini. A self-report questionnaire was used to assess dietary habits, smoking and snuffing habits, use of alcohol, screen use and active transportation. Four focus group interviews with 23 students (12 boys) were conducted to explore how the students experienced the new PE program. RESULTS: Students attending "Motion enjoyment" accrued less steps/day compared to the "Sports enjoyment" group (6661 (5514, 7808) vs.9167 (7945, 10390) steps/day) and reported higher screen use (mean, 3.1; 95% CI, 2.8, 3.5) vs. 2.4 (2.0, 2.9) hours/day). Compared to those attending "Sports enjoyment", a higher number of students attending "Motion enjoyment" reported an irregular meal pattern (adjusted odds ratio, 5.40; 95% confidence interval (CI), 2.28, 12.78), and being a current smoker (12.22 (1.62, 107.95)). The students participating in the focus group interviews emphasized the importance of having competent and engaging teachers, being able to influence the content of the PE program themselves, and that PE classes should include a variety of fun activities. CONCLUSION: Students selecting "Motion enjoyment" accrued less steps/day and reported overall more unhealthy lifestyle habits, including higher screen time, a more irregular meal pattern and a higher number were current smokers, compared to those selecting "Sports enjoyment". Program evaluation revealed that both groups of students valued competent PE teachers and having influence on the content of the PE program.

The Norwegian Healthy Life Study: protocol for a pragmatic RCT with longitudinal follow-up on physical activity and diet for adults.

BACKGROUND: The Norwegian Directorate of Health recommends that Healthy Life Centres (HLCs) be established in primary health care to support behaviour change and reduce the risk of non-communicable diseases. The aim of the present study protocol is to present the rationale, design and methods of a combined pragmatic randomized controlled trial (RCT) and longitudinal cohort study of the effects of attending HLCs concerning physical activity, sedentary behaviour and diet and to explore how psychological well-being and motivational factors may mediate short- and long-term effects. METHODS: The present study will combine a 6-month RCT with a longitudinal cohort study (24 months from baseline) conducted at six HLCs from June 2014 to Sept 2017. Participants are randomized to behavioural change interventions or a 6-month waiting list control group. DISCUSSION: A randomized trial of interventions in HLCs has the potential to influence the development of policy and practice for behaviour change interventions and patient education programmes in Norway. We discuss some of the important preconditions for obtaining valid results from a complex intervention and outline some of the characteristics of ecological approaches in health care research that can enable a pragmatic intervention study. TRIAL REGISTRATION: The study was retrospectively registered on September 19, 2014 and is available online at ClinicalTrials.gov (ID: NCT02247219 ).

High doses of vitamin C plus E reduce strength training-induced improvements in areal bone mineral density in elderly men.

PURPOSE: Resistance training is beneficial for maintaining bone mass. We aimed to investigate the skeletal effects of high doses of antioxidants [vitamin C + E (α-tocopherol)] supplementation during 12-week supervised strength training in healthy, elderly men METHODS: Design: double-blinded randomized placebo-controlled study. Participants followed a supervised, undulating periodic exercise program with weekly adjusted load: 3 sessions/week and 3-15 repetitions maximum (RM) sets/exercise. The control group (CG, n = 17, 67 ± 5 years) received placebo and the antioxidant group (AO, n = 16, 70 ± 7 years) 1000 mg vitamin C + 235 mg vitamin E, daily. Areal bone mineral density (aBMD) at whole body, lumbar spine (L1-L4), total hip, and femoral neck were measured by dual energy X-ray absorptiometry and muscle strength by 1RM. Serum analyses of bone-related factors and adipokines were performed. RESULTS: In the CG, total hip aBMD increased by 1.0% (CI: 0.3-1.7) versus pretest and lumbar spine aBMD increased by 0.9% (CI: -0.2 to 2.0) compared to the AO. In the CG, there was an increase in serum concentrations of insulin-like growth factor 1 [+27.3% (CI: -0.3 to 54.9)] and leptin [+31.2% (CI: 9.8-52.6)) versus pretest, and a decrease in sclerostin [-9.9% (CI: 4.4-15.3)] versus pretest and versus AO. Serum bone formation markers P1NP and osteocalcin increased in both groups, while the bone resorption marker CTX-1 remained unchanged. CONCLUSION: High doses of antioxidant supplementations may constrain the favorable skeletal benefits of 12 weeks of resistance exercise in healthy elderly men.

Stakeholders' expectations of Healthy Life Centers: A focus group study.

AIMS: The aims of this study were to explore stakeholders' expectations of municipal Healthy Life Centers (HLCs) in Norway, and to evaluate whether these expectations were compatible with current guidelines and recommendations. METHODS: A multidisciplinary team of researchers arranged focus group sessions with Healthy Life Centre staff, municipality administration, county administration, general practitioners and representatives of three patient organizations. We audiotaped and transcribed the sessions verbatim. In analyses we used Systematic Text Condensation and an editing analysis style. RESULTS: Expectations spanned from primary prevention among children to rehabilitation of adults with established disease, depending on the stakeholders' assumptions of the role of HLCs. Healthcare providers emphasized person-centered advice based on the participant's willingness to change, and their impressions of the participant's presenting condition and life circumstances. Many participants represented underprivileged groups, not reached by population-based information strategies. Consistent with self-determination theory, participants who contacted the HLCs themselves more often expressed a will for lifestyle change than those referred from general practitioners, and less often dropped out. Participants with complex challenges and insufficient coping strategies often strived with follow-up. Among these, many suffered from mental health problems. CONCLUSIONS: The Norwegian HLC is still a concept in development and is trying to define its position in the public healthcare system. In accordance with national recommendations to reduce social health inequalities, the stakeholders emphasized providing effective, evidence-based HLC programs including underprivileged groups. They also expressed concern about prioritizing between an individual and population approach, and between different target groups and tasks.

Exploring the relationship between physical activity, life goals and health-related quality of life among high school students: a cross-sectional study.

BACKGROUND: Two models were developed to increase high school students' participation in physical education (PE): "motion enjoyment" and "sport enjoyment". The first model focuses on increasing knowledge about the health benefits of a physically active lifestyle and thereby promoting a positive attitude towards physical activity, whereas the second model focuses on techniques and practices for enhancing athletic performance. The aims of the present study are to investigate and understand the similarities and differences between students selecting "motion enjoyment" vs. "sport enjoyment" and to examine the extent to which life goals and reported physical activity are associated with health-related quality of life (HRQOL). METHOD: A total of 156 high school students (mean age, 16 years [standard deviation = 0.8], 123 girls and 33 boys) were included in this cross-sectional study. HRQOL and life goals were measured using KIDSCREEN-10 and the Adolescent Life Goal Profile Scale, respectively. Physical activity was measured using a self-reporting questionnaire intended to describe the students' leisure-time activity. Independent sample t-tests, chi-square, one-way analyses of variance and multiple regression analysis were applied. RESULTS: Self-reported physical activity level and HRQOL were higher among students in the "sport enjoyment" program, while the perceived importance of life goals was the same regardless of the preferred PE model. Multiple regression analyses revealed that the perceived importance of relations-oriented life goals (B = -5.61; 95 % confidence interval CI = -10.53 to -0.70; p = .026), perceived importance of generativity-oriented life goals (B = 4.14.; 95 % CI = 0.85 to 7.422; p = .014), perceived attainability of relations-oriented life goals (B = 7.28; 95 % CI = 2.49 to 12.07; p = .003), age (B = -7.29; 95 % CI = -11.38 to -3.20; p = .001) and gender, with boys as the reference group (B = -12.10; 95 % CI = -19.09 to -5.11; p = .001), were independently associated with increased HRQOL. In exploring the relationships of self-reported physical activity during leisure time, stage of change (B = 3.53; 95 % CI = 1.49 to 5.51; p = .001), gender, with boys as the reference group (B = -8.90; 95 % CI = -15.80 to -2.00; p = .012), and age (B = -6.62; 95 % CI = -10.57 to -2.66; p = .001) were independently associated with increased HRQOL. CONCLUSION: Self-reported physical activity habits and life goals were associated with HRQOL to a limited extent. However, the perceived importance of life goals appears to reflect other aspects of individual well-being than HRQOL.

Meal pattern among Norwegian primary-school children and longitudinal associations between meal skipping and weight status.

OBJECTIVE: To investigate meal pattern longitudinally and explore whether meal skipping was associated with overweight among Norwegian children and adolescents. DESIGN: Longitudinal study. Children's meal frequencies were reported by their parents using a retrospective FFQ. Weight and height were measured by public health nurses. Descriptive data comparing 4th and 7th grade were analysed by paired-sample t tests for continuous variables and χ 2 tests for categorical variables. Odds ratio estimates, including confidence intervals, with BMI category (normal/overweight) as the dependent variable, were determined through logistic regression analyses. SETTING: Primary schools, Telemark County, Norway. SUBJECTS: A cohort of 428 Norwegian boys and girls; 4th graders in 2007, 7th graders in 2010. RESULTS: The number of children eating four main meals per day (regular meal frequency) decreased from 4th grade (47 %) to 7th grade (38 %; P = 0·001). Those who ate regular meals in 4th grade but not in 7th grade had higher odds (OR = 3·1; 95 % CI 1·1, 9·0) of being overweight in 7th grade after adjusting for gender, maternal education and physical activity, but the odds ratio was not statistically significant after adjusting for overweight in 4th grade (OR = 2·8; 95 % CI 0·7, 11·6). CONCLUSIONS: The present study showed significant increases in overall meal skipping among children between 4th and 7th grade. The results indicate an association between overweight and meal skipping, but additional prospective and longitudinal analyses and intervention trials are warranted to confirm this relationship.

Physical education Teachers' and public health Nurses' perception of Norwegian high school Students' participation in physical education - a focus group study.

BACKGROUND: High quality physical education programs in high schools may facilitate adoption of sustainable healthy living among adolescents. Public health nurses often meet students who avoid taking part in physical education programs. We aimed to explore physical education teachers' and public health nurses' perceptions of high school students' attitudes towards physical education, and to explore physical education teachers' thoughts about how to facilitate and promote students' participation in class. METHODS: Prior to an initiative from physical education teachers, introducing a new physical education model in two high schools in the South of Norway, we conducted focus groups with 6 physical education teachers and 8 public health nurses. After implementation of the new model, we conducted two additional focus group interviews with 10 physical education teachers. In analyses we used Systematic Text Condensation and an editing analysis style. RESULTS: In general, the students were experienced as engaged and appreciating physical education lessons. Those who seldom attended often strived with other subjects in school as well, had mental health problems, or were characterized as outsiders in several arenas. Some students were reported to be reluctant to expose their bodies in showers after class, and students who seldom attended physical education class frequently visited the school health services. Although the majority of students were engaged in class, several of the students lacked knowledge about physical fitness and motoric skills to be able to master daily activities. The participants related the students' competence and attitude towards participation in physical education class to previous experiences in junior high school, to the competence of physical education teachers, and to possibility for students to influence the content of physical education programs. CONCLUSIONS: The participants suggested that high school students' attitudes towards participation in physical education is heterogeneous, depends on the students' previous experiences, and on their present health and quality of life. All participants recommended adolescents to take part in program development, and selecting activities that generate competence, fun and enjoyment.

Association of lifestyle habits and academic achievement in Norwegian adolescents: a cross-sectional study.

BACKGROUND: While healthy lifestyle habits are generally assumed to be important for high academic achievement, there has been little research on this topic among adolescents. The aim of this study was therefore to examine the associations between several lifestyle habits and academic achievement in adolescent girls and boys. METHODS: The study included 2,432 Norwegian adolescents, 15-17 years old. A self-report questionnaire was used to assess dietary-, physical activity-, smoking- and snuffing habits and academic achievement. Logistic regression models were adjusted for body mass index (BMI) and parental education. RESULTS: In both girls and boys, high academic achievement was associated with a regular consumption of breakfast (AOR: 3.30 (2.45-4.45) and AOR: 1.76 (1.32-2.34), respectively) and lunch (AOR: 1.44 (1.08-1.93) and AOR: 1.43 (1.09-1.89), respectively), and in boys, with a regular consumption of dinner (AOR: 1.44 (1.16-1.79)) and a regular meal pattern in general (AOR: 1.50 (1.10 - 2.03)). In both girls and boys, high academic achievement was associated with a high intake of fruit and berries (AOR: 2.09 (1.51-2.88) and AOR: 1.47 (1.04-2.07), respectively), and in girls, with a high intake of vegetables (AOR: 1.82 (1.30-2.53)). In both girls and boys, high academic achievement was associated with a high leisure time physical activity level (AOR: 1.51 (1.10-2.08) and AOR: 1.39 (1.05-1.85), respectively) and use of active commuting (AOR: 1.51 (1.10-2.08) and AOR: 1.72 (1.26-2.35), respectively). In both girls and boys, high academic achievement was associated with a low intake of lemonade (AOR: 0.42 (0.27-0.64) and AOR: 0.67 (0.48-0.94), respectively), and in girls, with a low intake of sugar-sweetened soft drinks (AOR: 0.47 (0.35- 0.64)) and salty snacks (AOR: 0.63 (0.47-0.85)). Lastly, high academic achievement was inversely associated with smoking and snuffing in both girls (AOR: 0.18 (0.12-0.25) and AOR: 0.25 (0.17-0.37), respectively) and boys (AOR: 0.37 (0.25-0.54) and AOR: 0.51 (0.36-0.72), respectively). CONCLUSIONS: A regular meal pattern, an intake of healthy food items and being physically active were all associated with increased odds of high academic achievement, whereas the intake of unhealthy food and beverages, smoking cigarettes and snuffing were associated with decreased odds of high academic achievement in Norwegian adolescents.

Longitudinal evidence of the influence of early life circumstances, family characteristics, social ties and psychological distress on healthy behaviours of Brazilian adults: The Pro-Saude cohort study.

BACKGROUND: This study examined the influence of early life circumstances, family characteristics, social ties and psychological distress in adulthood on adult's health-related behaviours. METHODS: A cohort study (Pro-Saúde Study) involving technical and administrative civil servants at university campuses in Rio de Janeiro State, Brazil was conducted in Rio de Janeiro, Brazil. Data from 2155 adults were collected at baseline (1999) and after a 13-year period (2012-13). Family characteristics at 12 years of age were assessed retrospectively in 1999. Gender, marital status, living situation, social support, social networks of relatives and psychological distress were also measured in 1999. Data collection in 2012-13 included information about marital status, social networks of relatives, cigarette smoking, fruit and vegetable consumption and physical exercise. A conceptual model testing the relationships between variables was assessed through structural equation modelling. RESULTS: Female gender (ß = 0.043), better social networks of relatives in 1999 (ß = 0.053) and 2012-13 (ß = 0.069) and low psychological distress (ß = -0.048) directly predicted less smoking. Better social networks of relatives in 2012-13 was directly linked to higher consumption of fruits (ß = 0.045) and vegetables (ß = 0.051) and being physically active (ß = 0.070). Low psychological distress directly predicted higher fruit consumption (ß = -0.040). Family characteristics at 12 years-old, marital status and living with other people were linked indirectly with health behaviours through social networks, social support and psychological distress. CONCLUSIONS: Adults with better early life family and social circumstances, and those who were married reported positive health behaviours through indirect pathways. Stronger social ties and lower psychological distress represented the pathways by which early life circumstances and relationship status influenced positive health behaviours.

Changes in beverage consumption in Norwegian children from 2001 to 2008.

OBJECTIVE: To analyse (i) differences in beverage pattern among Norwegian children in 2001 and 2008; (ii) beverage intake related to gender, parental education and family composition; and (iii) potential disparities in time trends among the different groups. DESIGN: Within the Fruits and Vegetables Make the Marks (FVMM) project, 6th and 7th grade pupils filled in a questionnaire about frequency of beverage intake (times/week) in 2001 and 2008. SETTING: Twenty-seven elementary schools in two Norwegian counties. SUBJECTS: In 2001 a total of 1488 and in 2008 1339 pupils participated. RESULTS: Between 2001 and 2008, a decreased consumption frequency of juice (from 3·6 to 3·4 times/week, P = 0·012), lemonade (from 4·8 to 2·5 times/week, P < 0·001) and regular soft drinks (from 2·7 to 1·6 times/week, P < 0·001), but an increased consumption frequency of diet soft drinks (from 1·2 to 1·6 times/week, P < 0·001), were observed. From 2001 to 2008, boys increased their frequency of juice consumption (from 3·1 to 3·3 times/week) whereas girls decreased their frequency of juice consumption (3·8 to 3·4 times/week; interaction time × gender P = 0·02). Children with higher educated parents increased their frequency of juice consumption (3·6 to 3·8 times/week) whereas those with lower educated parents decreased their frequency of juice consumption (3·3 to 3·0 times/week; interaction time × parental education P = 0·04). CONCLUSION: A lower frequency of consumption of sugar-sweetened beverages was observed among pupils in 2008 than in 2001. This is in accordance with the Norwegian health authority's goals and strategies for this time period, and is an important step to improve the dietary health of adolescents.

Mapping the Concept, Content, and Outcome of Family-Based Outdoor Therapy for Children and Adolescents with Mental Health Problems: A Scoping Review.

Outdoor therapy and family-based therapy are suggested to be promising interventions for the treatment of mental health problems. The aim of the present scoping review was to systematically map the concept, content, and outcome of combining family- and outdoor-based therapy for children and adolescents with mental health problems. The Joanna Briggs Institute methodology and PRISMA guidelines were applied. Eligible qualitative and quantitative studies were screened, included, and extracted for data. Seven studies were included. Findings from these studies indicated that family-based outdoor therapy programs have a positive impact on family- and peer relationships, adolescent behavior, mental health, self-perceptions (self-concept), school success, social engagement, and delinquency rates. However, participant characteristics, study design, and content and mode of delivery of the interventions varied substantially, hence preventing detailed comparison of outcomes across studies. In addition, most of the studies included few participants and lacked population diversity and comparable control groups. Although important ethical concerns were raised, such as non-voluntary participation in some of the programs, there was a lack of reporting on safety. This review indicates that a combination of family- and outdoor-based therapy may benefit mental health among children and adolescents, but due to the limited number of studies eligible for inclusion and high levels of heterogeneity, it was difficult to draw firm conclusions. Thus, future theory-based studies using robust designs are warranted.

Changes in meal pattern among Norwegian children from 2001 to 2008.

OBJECTIVE: The present study aimed to analyse changes in meal pattern among Norwegian children from 2001 to 2008 in general; to analyse associations between meal pattern and gender, parental educational level and number of parents in the household; and to analyse the association between intake of unhealthy snacks, meal pattern and the mentioned variables. DESIGN: Within the Fruits and Vegetables Make the Marks (FVMM) project, two cross-sectional studies were conducted, one in 2001 and one in 2008, where participants from the same schools filled in a questionnaire on meals eaten the previous day. SUBJECTS: Participants were 6th and 7th grade pupils, n 1488 in 2001 and n 1339 in 2008. SETTING: Twenty-seven elementary schools in two Norwegian counties. RESULTS: There were no significant changes in children's meal pattern from 2001 to 2008. For both years more than 90 % of the participants reported that they had breakfast yesterday, while 95 % had lunch, 94 % had dinner and 82 % had supper. More girls than boys reported that they had lunch yesterday (96 % v. 94 %, P = 0·03). More children with higher v. lower educated parents reported that they had breakfast yesterday (93 % v. 88 %, P < 0·001). More children living with two parents v. one parent had breakfast (93 % v. 88 %, P = 0·001) and lunch yesterday (97 % v. 93 %, P < 0·001). CONCLUSIONS: There were no changes in meal pattern from 2001 to 2008 among Norwegian children. Characteristics associated with skipping meals were living in a one-parent family and having lower educated parents.

Body weight, weight perceptions and food intake patterns. A cross-sectional study among male recruits in the Norwegian National Guard.

BACKGROUND: Young men tend to have a low intake of vegetables and fruit. Unfortunately, this group is difficult to reach with health information. Furthermore, knowledge about weight perceptions and the relationship to food behaviour among young men is scant. The purpose of this study was to explore the relationship between BMI, health and weight perceptions and food intake patterns among young men in the military. METHODS: Data were collected with a 4-day food diary among 578 male recruits (age 18-26, mean 19.7) in the Norwegian National Guard (response rate 78%), in addition to a questionnaire, including questions about health and weight perceptions, and food frequency when still living at home. Weight and height were objectively measured. Food patterns were explored with principal component analysis, based on the diary data. A multivariate linear regression analysis determined the association between BMI and food patterns, and attitudes to health and slenderness, adjusting for smoking, physical activity and phase of data collection. RESULTS: Twenty eight percent of the recruits were overweight/obese (BMI > 25 kg/m(2)). Two-thirds meant that it is important for them to be slender, and these recruits reported more of both light (p = 0.025) and hard (p = 0.016) physical activity than the others. It was a positive association between the recruits' food frequency at home, and the amount of intake in the military camp for several food items. A principal component analysis identified three distinct food patterns, loading on 1) plant foods, 2) fast food/soft drinks, 3) milk/cereals. Those who stated that it is important for them to be slender, or to have good health, did not have significantly different food intake patterns than the others. BMI was inversely related to scores on the plant food pattern, and positive attitudes to slenderness. CONCLUSION: The majority of the recruits find it important to be slender. This orientation had a bearing on their physical activity pattern, but less on the food intake pattern. The data also indicate that subjects with high intakes of plant foods were less likely to have a high BMI than others. It is important to raise awareness of healthy eating in young men.

Changes in food habits amongst Norwegian adolescents in 2016 and 2019 according to gender and socioeconomic status.

BACKGROUND: Monitoring dietary habits is important in order to identify risk groups and as a basis for targeted public health initiatives. OBJECTIVE: To study trends in consumption of selected foods and beverages from 2016 to 2019 amongst Norwegian adolescents according to gender and parental education. DESIGN: Repeated cross-sectional study amongst 25,996 adolescents, aged 14-17 years old. Consumption of selected food and beverages was measured by an online food frequency questionnaire and general linear models were applied to estimate changes in dietary habits. RESULTS: Between 2016 and 2019, we observed a reduced frequency of consumption of vegetables (from 4.7 to 4.4 times/week), fruit and berries (from 4.4 to 4.2 times/week), whole-grain bread (from 5.1 to 4.2 times/week), and fish (from 2.3 to 1.6 times/week). During this time period, we also observed a reduced frequency of consumption of salty snacks (from 2.1 to 1.9 times/week), sweets (from 2.3 to 2.0 times/week), sugar-sweetened beverages (from 2.8 to 2.6 times/week), and artificially sweetened beverages (from 2.2 to 1.5 times/week). In girls, there was a decrease in the reported frequency of consumption of fruit and berries (-4%, vs. no change in boys). The decrease in consumption frequency of whole-grain bread was larger in girls than in boys (-19% vs. -14%). Further, a 17% decrease in consumption of sweets was observed amongst adolescents with no or only one parent having college/university education compared to a 13% decrease in adolescents whose both parents had college/university education. CONCLUSION: Our results showed a decrease in frequency of consumption of selected healthy and unhealthy food and beverages amongst adolescents between 2016 and 2019. The gender gap in consumption of fruit and berries and whole-grain bread seemed to decrease during this time period, and the socio-economic gap in consumption of sweets seemed to disappear.

Overweight, obesity, and thinness among a nationally representative sample of Norwegian adolescents and changes from childhood: Associations with sex, region, and population density.

OBJECTIVE: To estimate the prevalence of overweight, obesity, and thinness among Norwegian 13-year-olds and the changes from childhood (age 8 years) to adolescence (age 13 years); and to explore associations with sex, region, and population density from childhood to adolescence. DESIGN: We used longitudinal, anthropometric data collected by school health nurses conducted in Norway. Weight status was classified according to the International Obesity Task Force cut-offs for overweight, obesity, and thinness, and according to mean body mass index (kg/m2). PARTICIPANTS: The Norwegian Youth Growth Study, consisting of a nationally representative sample of Norwegian 13-year-olds (n = 1852; 50.7% girls), which is a part of The Norwegian Growth Cohort. RESULTS: Among 13-year-old Norwegians, the prevalence of overweight (including obesity), obesity, and thinness was 15.8%, 2.5%, and 7.3%, respectively. There was little evidence that these had changed from 8 to 13 years. From 8 to 13 years, the odds of obesity was highest in the Northern region of Norway compared to the South-East (odds ratio (OR): 3.78 (95% confidence interval (CI): 1.13, 12.65; p = 0.036) and in rural areas (OR: 4.76 (95% CI: 1.52, 14.90; p = 0.027). Over the same age period, girls had a trend towards a higher odds of thinness compared to boys (OR: 1.65 (95% CI: 0.98, 2.78; p = 0.057). CONCLUSIONS: In Norway, the prevalence of overweight, obesity, and thinness among 13-year-olds seem to be established by age 8 years. The prevalence of obesity was higher in the North and in rural areas. The results indicate the continued need for early prevention and treatment, and targeted interventions to certain areas.