Adolescents' capacity to take action on obesity: A concurrent controlled before-and-after study of the European CO-CREATE project.

This study evaluated the effect on reported readiness for action and attitudes toward obesity prevention among older adolescents (mean age 17) who took part in a youth-led participatory action research European initiative (CO-CREATE Youth Alliances) compared with a comparison group that acted as controls. This was a concurrent before-and-after controlled study across five countries and took place between September 2019 and October 2020. Adolescents (n = 159) recruited from schools and youth organizations came together with researchers and formed 15 Youth Alliances. An online questionnaire measuring their readiness for action and attitudes toward obesity prevention was administered. Alliance members (n = 62) who filled in the questionnaire at both baseline and postinitiative, and adolescents from the comparison group (n = 132) who completed the questionnaire twice were included in the main analysis. Two-level linear mixed models controlling for country-related variance were fitted. Alliance members scored significantly higher than the comparison group on two factors in each of the readiness for action, responsibility, and drivers of behavior concepts. The findings suggest that involving youth in co-creating policies to prevent obesity may increase adolescents' readiness for action and promote a shift in adolescents' conceptualization of obesity from an individual perspective to a societal responsibility and drivers of behavior.

System mapping with adolescents: Using group model building to map the complexity of obesity.

Public health research and practice is increasingly employing systems thinking to help grapple with complex issues, from obesity to HIV treatment. At the same time, there is growing recognition that to address a given problem it is essential collaborate with those most at risk of or affected by it. Group model building (GMB), a process grounded in system dynamics, combines systems thinking and participatory methods to structure and address complex issues. As part of the CO-CREATE project we conducted GMB sessions with young people in six countries to create causal loop diagrams showing the factors that they believe drive obesity. This paper describes the background to GMB and the process we used to construct causal loop diagrams; it discusses how GMB contributed to generating noteworthy and useful findings, and the strengths and limitations of the method. Using GMB, we identified areas of concern to adolescents in relation to obesity that have so far had little attention in obesity research and policy: mental health and online activity. In using GMB, we also helped answer calls for a more participatory approach to youth involvement in research and policy development.

Assessing adolescents' readiness for action and attitudes toward obesity prevention: Instrument development and psychometric properties.

Engaging adolescents in obesity prevention is a main objective of the CO-CREATE project. This paper presents the development of a questionnaire to assess readiness for action and attitudes toward obesity prevention among adolescents. The questionnaire was developed based on literature searches and internal discussions with experts in the CO-CREATE consortium. The questionnaire was translated, back translated, and pretested for time and comprehensiveness by adolescents from five countries (the Netherlands, Norway, Poland, Portugal, and the United Kingdom). Exploratory factor analysis was performed, and internal reliability of the resulting factors was determined using baseline data from Poland and Norway. Furthermore, test-retest reliability was assessed in a sample of Norwegian adolescents. The exploratory factor analysis on readiness for action identified four factors. Analysis on attitudes toward obesity prevention identified four factors on responsibility and five factors on drivers of behavior. Six of the factors had a Cronbach's alpha value above 0.70, five factors had a value between 0.60-0.70, whereas the remaining two factors were below 0.60. The test-retest correlation ranged from 0.46 to 0.87. The exploratory factor analyzes on readiness for action identified the same factors as hypothesized in the development of the questionnaire, whereas attitudes toward obesity prevention identified more factors than initially assumed. The questionnaire is considered reliable as a tool for measuring adolescents' readiness for action and attitudes toward obesity prevention.

Dietary diversity is related to socioeconomic status among adult Saharawi refugees living in Algeria.

BACKGROUND: There is limited knowledge about dietary quality among the adult population in low- and middle income countries (LMICs). This study aims to describe dietary quality among the adult Saharawi refugee population and to investigate whether dietary quality is associated with socioeconomic status. METHODS: In 2014, a cross-sectional survey was carried out in the Saharawi refugee camps, Algeria. A three-staged cluster sampling was performed and 180 women and 175 men, aged 18-82 years, were randomly selected. The dietary intake was assessed by 24-h dietary recall and dietary diversity score (DDS) was calculated. Socioeconomic status was assessed using the WAMI index (sanitation, assets, education and income). RESULTS: The mean DDS among the total sample was 3.8 ± 1.4 and 2/3 of participant were at risk of low dietary adequacy. The main food groups consumed were starchy staple foods, flesh foods, and dairy. Vitamin A-rich dark green leafy vegetables, nuts and seeds and eggs were the food groups least consumed. The multiple regression model showed a positive association between DDS and the WAMI index (P < 0.001) and a negative association between DDS and age (p = 0.01). CONCLUSIONS: Low DDS was associated with low socioeconomic status. Programmes to improve the dietary quality among the Saharawi refugees should be implemented.

Food and Nutrient Intake among 12-Month-Old Norwegian-Somali and Norwegian-Iraqi Infants.

The aim of the present paper was to describe food and nutrient intake among 12-month-old Norwegian-Somali and Norwegian-Iraqi infants, with a focus on iron and vitamin D intake. A cross-sectional survey was conducted from August 2013 through September 2014. Eighty-nine mothers/infants of Somali origin and 77 mothers/infants of Iraqi origin residing in Eastern Norway participated in the study. Data were collected using two 24-h multiple-pass recalls. Forty percent of the Norwegian-Somali infants and 47% of the Norwegian-Iraqi infants were breastfed at 12 months of age (p = 0.414). Median energy percentages (E%) from protein, fat and carbohydrates were within the recommended intake ranges, except the level of saturated fats (12-13 E%). Median intakes of almost all micronutrients were above the recommended daily intakes. Most of the infants consumed iron-enriched products (81%) and received vitamin D supplements (84%). The median intakes of iron and vitamin D were significantly higher among infants receiving iron-enriched products and vitamin D supplements compared to infants not receiving such products (p < 0.001). The findings indicate that the food and nutrient intake of this group of infants in general seems to be in accordance with Norwegian dietary recommendations. Foods rich in iron and vitamin D supplements were important sources of the infants' intake of iron and vitamin D and should continue to be promoted.

Breast-feeding and complementary feeding practices in the first 6 months of life among Norwegian-Somali and Norwegian-Iraqi infants: the InnBaKost survey.

OBJECTIVE: To examine breast-feeding and complementary feeding practices during the first 6 months of life among Norwegian infants of Somali and Iraqi family origin. DESIGN: A cross-sectional survey was performed during March 2013-February 2014. Data were collected using a semi-quantitative FFQ adapted from the second Norwegian national dietary survey among infants in 2006-2007. SETTING: Somali-born and Iraqi-born mothers living in eastern Norway were invited to participate. SUBJECTS: One hundred and seven mothers/infants of Somali origin and eighty mothers/infants of Iraqi origin participated. RESULTS: Breast-feeding was almost universally initiated after birth. Only 7 % of Norwegian-Somali and 10 % of Norwegian-Iraqi infants were exclusively breast-fed at 4 months of age. By 1 month of age, water had been introduced to 30 % of Norwegian-Somali and 26 % of Norwegian-Iraqi infants, and infant formula to 44 % and 34 %, respectively. Fifty-four per cent of Norwegian-Somali and 68 % of Norwegian-Iraqi infants had been introduced to solid or semi-solid foods at 4 months of age. Breast-feeding at 6 months of age was more common among Norwegian-Somali infants (79 %) compared with Norwegian-Iraqi infants (58 %; P=0·001). Multivariate analyses indicated no significant factors associated with exclusive breast-feeding at 3·5 months of age. Factors positively associated with breast-feeding at 6 months were country of origin (Somalia) and parity (>2). CONCLUSIONS: Breast-feeding initiation was common among Iraqi-born and Somali-born mothers, but the exclusive breast-feeding period was shorter than recommended in both groups. The study suggests that there is a need for new culture-specific approaches to support exclusive breast-feeding and complementary feeding practices among foreign-born mothers living in Norway.

Development and pilot testing of 24-hour multiple-pass recall to assess dietary intake of toddlers of Somali- and Iraqi-born mothers living in Norway.

The aim of this study was to develop, test, and evaluate a 24-h recall procedure to assess the dietary intake of toddlers of Somali- and Iraqi-born mothers living in Norway. A protocol for a 24-h multiple-pass recall procedure, registration forms, and visual tools (a picture library for food identification and portion size estimation) was developed and tested in 12 mothers from Somalia and Iraq with children aged 10-21 months. Five female field workers were recruited and trained to conduct the interviews. Evaluation data for the 24-h recall procedure were collected from both the mothers and the field workers. Nutrient intake was calculated using a Norwegian dietary calculation system. Each child's estimated energy intake was compared with its estimated energy requirement. Both the mothers and the field workers found the method feasible and the visual tools useful. The estimated energy intake corresponded well with the estimated energy requirement for most of the children (within mean ± 2 SD, except for three). The pilot study identified the need for additional foods in the picture library and some crucial aspects in training and supervising the field workers to reduce sources of error in the data collection.