Association of alcohol control policies with adolescent alcohol consumption and with social inequality in adolescent alcohol consumption: A multilevel study in 33 countries and regions.

Background Previous research found inconsistent associations between alcohol control policies and socioeconomic inequality with adolescent drinking outcomes. This study expands the focus beyond individual associations to examine whether a combination of policies is related to socioeconomic inequality in adolescent drinking outcomes and whether this relationship varies across survey years. Methods Multilevel modelling of 4 waves of repeat cross-sectional survey data (2001/02, 2005/06, 2009/10, and 2013/14) from the Health Behaviour in School-aged Children (HBSC) study was carried out. The sample was composed of 671,084 adolescents (51% girls) aged 11, 13, and 15 (mean age=13.58; SD=1.65) from 33 European and North American countries/regions. The dependent variables were lifetime alcohol consumption, weekly alcohol consumption, and lifetime drunkenness. Independent variables were of three types: individual-level variables (age, sex, Family Affluence Scale, and the Perceived Family Wealth), time-level variable (survey year), and context-level variables (minimum legal drinking age, physical availability, advertising restrictions, a total alcohol policy index, and affordability of alcohol). Results The total alcohol policy index showed a negative relationship with both lifetime and weekly consumption. Higher affordability of alcohol was related to higher lifetime and weekly consumption and higher lifetime drunkenness. Family Affluence Scale was positively related to all three alcohol measures and Perceived Family Wealth was negatively related to lifetime drunkenness, with these associations increasing across survey years. The total alcohol policy index buffered the associations of Family Affluence Scale and Perceived Family Wealth with adolescent drinking outcomes. Conclusion A combination of alcohol control policies is more effective in reducing adolescent drinking outcomes than single policy measures. Reducing the affordability of alcohol stood out as the most successful single measure. Socioeconomic inequalities (i.e. higher alcohol consumption and drunkenness in adolescents with higher family affluence and higher drunkenness in adolescents perceiving their families to be poor) have persisted and even increased across survey years. A combined alcohol control policy can help in tackling them.

Development and validation of a quantitative snack and beverage food frequency questionnaire for adolescents.

BACKGROUND: A short, reliable and valid tool to measure snack and beverage consumption in adolescents, taking into account the correct definitions, would benefit both epidemiological and intervention research. The present study aimed to develop a short quantitative beverage and snack food frequency questionnaire (FFQ) and to assess the reliability and validity of this FFQ against three 24-h recalls. METHODS: Reliability was assessed by comparing estimates of the FFQ administered 14 days apart (FFQ1 and FFQ2) in a convenience sample of 179 adolescents [60.3% male; mean (SD) 14.7 (0.9) years]. Validity was assessed by comparing FFQ1 with three telephone-administered 24-h recalls in a convenience sample of 99 adolescents [52.5% male, mean (SD) 14.8 (0.9) years]. Reliability and validity were assessed using Bland-Altman plots, classification agreements and correlation coefficients for the amount and frequency of consumption of unhealthy snacks, healthy snacks, unhealthy beverages, healthy beverages, and for the healthy snack and beverage ratios. RESULTS: Small mean differences (FFQ1 versus FFQ2) were observed for reliability, ranking ability ranged from fair to substantial, and Spearman coefficients fell within normal ranges. For the validity, mean differences (FFQ1 versus recalls) were small for beverage intake but large for snack intake, except for the healthy snack ratio. Ranking ability ranged from slightly to moderate, and Spearman coefficients fell within normal ranges. CONCLUSIONS: Reliability and validity of the FFQ for all outcomes were found to be acceptable at a group level for epidemiological purposes, whereas for intervention purposes only the healthy snack and beverage ratios were found to be acceptable at a group level.

Stability of physical activity, fitness components and diet quality indices.

BACKGROUND: Regular physical activity (PA), a high level of fitness and a high diet quality are positively associated with health. However, information about stability of fitness components and diet quality indices is limited. This study aimed to evaluate stability of those parameters. METHODS: This study includes 652 adults (men=57.56 (10.28) years; women=55.90 (8.34) years at follow-up) who participated in 2002-2004 and returned for follow-up at the Policy Research Centre Leuven in 2012-2014. Minutes sport per day and Physical activity level (PAL) were calculated from the Flemish Physical Activity Computerized Questionnaire. Cardiorespiratory fitness (CRF), morphological fitness (MORF; body mass index and waist circumference) and metabolic fitness (METF) (blood cholesterol and triglycerides) were used as fitness components. Diet quality indices (Healthy Eating Index-2010 (HEI), Diet Quality Index (DQI), Mediterranean Diet Score (MDS)) were calculated from a diet record. Tracking coefficients were calculated using Pearson/Spearman correlation coefficients (rPearson) and intra-class correlation coefficients (rICC). RESULTS: In both men (rPearson&ICC=0.51) and women (rPearson=0.62 and rICC=0.60) PAL showed good stability, while minutes sport remained stable in women (rPearson&ICC=0.57) but less in men (rPearson&ICC=0.45). Most fitness components remained stable (r⩾0.50) except some METF components in women. In general the diet quality indices and their components were unstable (r<0.50). CONCLUSIONS: PAL and the majority of the fitness components remained stable, while diet quality was unstable over 10 years. For unstable parameters such as diet quality measurements are needed at both time points in prospective research.

Using a gamified monitoring app to change adolescents' snack intake: the development of the REWARD app and evaluation design.

BACKGROUND: As the snacking pattern of European adolescents is of great concern, effective interventions are necessary. Till now health promotion efforts in children and adolescents have had only limited success in changing adolescents' eating patterns and anthropometrics. Therefore, the present study proposes an innovative approach to influence dietary behaviors in youth based on new insights on effective behavior change strategies and attractive intervention channels to engage adolescents. This article describes the rationale, the development, and evaluation design of the 'Snack Track School' app. The aim of the app is to improve the snacking patterns of Flemish 14- to 16-year olds. METHODS: The development of the app was informed by the systematic, stepwise, iterative, and collaborative principles of the Intervention Mapping protocol. A four week mHealth intervention was developed based on the dual-system model with behavioral change strategies targeting both the reflective (i.e., active learning, advance organizers, mere exposure, goal-setting, monitoring, and feedback) and automatic processes (i.e., rewards and positive reinforcement). This intervention will be evaluated via a controlled pre-post design in Flemish schools among 1400 adolescents. DISCUSSION: When this intervention including strategies focused on both the reflective and automatic pathway proves to be effective, it will offer a new scientifically-based vision, guidelines and practical tools for public health and health promotion (i.e., incorporation of learning theories in intervention programs). TRIAL REGISTRATION: NCT02622165 registrated November 15, 2015 on clinicaltrials.gov.

Perceived environmental correlates of cycling for transport among adults in five regions of Europe.

Regular cycling for transport is an important potential contributor to daily physical activity among adults. Characteristics of the physical environment are likely to influence cycling for transport. The current study investigated associations between perceived physical environmental neighbourhood factors and adults' cycling for transport across five urban regions across Europe, and whether such associations were moderated by age, gender, education and urban region. A total of 4,612 adults from five European regions provided information about their transport-related cycling and their neighbourhood physical environmental perceptions in an online survey. Hurdle models adjusted for the clustering within neighbourhoods were performed to estimate associations between perceived physical environmental neighbourhood factors and odds of engaging in cycling for transport and minutes of cycling for transport per week. Inhabitants of neighbourhoods that were perceived to be polluted, having better street connectivity, having lower traffic speed levels and being less pleasant to walk or cycle in had higher levels of cycling for transport. Moderation analyses revealed only one interaction effect by gender. This study indicates that cycling for transport is associated with a number of perceived physical environmental neighbourhood factors across five urban regions across Europe. Our results indicated that the majority of the outcomes identified were valid for all subgroups of age, gender, education and across regions in the countries included in the study.

Changes in weight, body composition and physical fitness after 1.5 years at university.

BACKGROUND/OBJECTIVES: This study examined changes in Belgian students' weight, body composition and physical fitness after 1.5 years at university. Furthermore, this study investigated whether these changes differed by gender and weight status. SUBJECTS/METHODS: In this longitudinal study, 172 students' weight, body mass index (BMI) and waist circumference (WC) were objectively measured, whereas fat%, fat mass, fat-free mass, dynamic leg strength, handgrip strength, hamstring flexibility and cardiorespiratory fitness were estimated using validated instruments. Measurements were conducted at the start of the first semester (T0), after the first semester (T1) and after 1.5 years (T2) at university. RESULTS: Female students' weight and BMI did not change, whereas male students gained 2.7 kg of weight and showed a 0.7 kg/m(2) BMI increase after 1.5 years. After the first semester, an increase in fat% was observed in the total group of students, whereas this time effect did not remain significant when comparing T0 and T2. In contrast to females, increases in 2.1 kg of fat-free mass and 1.8 cm of WC were found in males after 1.5 years. Higher baseline BMI and WC predicted greater BMI and fat% increases in males. Handgrip strength improved for both sexes, whereas no changes in other physical fitness components were found across the 1.5-year period. CONCLUSIONS: The greatest weight and BMI gains as well as unfavourable changes in body composition were found in male students with higher baseline BMI and WC. The observed changes in body composition did not cohere with changes in physical fitness.

IPAQ interview version: convergent validity with accelerometers and comparison of physical activity and sedentary time levels with the self-administered version.

AIM: This study aimed to assess convergent validity of International Physical Activity Questionnaire (IPAQ) interview (long form, last seven days), and to examine differences in reported physical activity and sedentary time between the self-administered and interview versions of the long IPAQ (last seven days); and whether these differences depend on gender, age, educational level and weight status. METHODS: In total, 542 Belgian adults (45.3% male, 43.8±12.1 years) completed the IPAQ self-administered version. Data of these adults were compared with data of 542 adults (45.2% male, 43.5±12.3 years) who completed the IPAQ interview version and wore an accelerometer for seven consecutive days. Samples were matched on gender, age, education, neighborhood characteristics and time of data collection. RESULTS: Convergent validity of the IPAQ interview version was moderate for total physical activity (Spearman ρ=0.37, P<0.001) and high for sedentary time (Spearman ρ=0.67; P<0.001). Bland-Altman plots showed that systematic and proportional biases were present for total physical activity; for sedentary time only systematic bias was present. Adults who completed the self-administered IPAQ reported higher means for most types of physical activity and less sedentary time than those who completed the IPAQ interview version. Differences between the two IPAQ versions were larger in males, lower-educated, older and overweight/obese adults. CONCLUSION: Convergent validity of assessing total physical activity using IPAQ interview was similar to previous studies examining validity of the IPAQ, but stronger results were found for sedentary time. In general, and especially in males, lower-educated, older and overweight/obese adults, the use of the IPAQ interview version assessed by trained researchers, should be recommended to collect self-reported data on physical activity and sedentary time.

A longitudinal analysis of gross motor coordination in overweight and obese children versus normal-weight peers.

BACKGROUND: The relationship of childhood overweight (OW) and obesity (OB) with motor skill and coordination is gaining due attention; however, longitudinal evidence is currently lacking. OBJECTIVE: The dual purpose of this study was (1) to investigate the short-term evolution in the level of gross motor coordination according to children's weight status, and (2) to identify those factors predicting their gross motor coordination performance over a 2-year interval. SUBJECTS: Participants were 50 children with OW, including 8 with OB (aged 6-10 years at baseline, with 52% boys), and 50 with normal-weight (NW) matched for gender and age. MEASUREMENTS: Anthropometrics (body height, body weight, body mass index (BMI), %body fat) and level of gross motor coordination (Körperkoordinationstest für Kinder, KTK) were assessed in 2007 (baseline) and 2 years later in 2009 (follow-up). At baseline, participants completed a survey based on the Flemish Physical Activity Questionnaire (FPAQ) to obtain socio-demographic information and to determine physical activity levels in diverse domains. RESULTS: The evolution in the level of gross motor coordination over time was strongly related to children's weight status. Participants in the NW group showed more progress than their OW/OB peers, who demonstrated significantly poorer performances. Accordingly, between-group differences in KTK outcomes (that is, raw item scores and total motor quotient) became more evident over time. Multiple linear regression analysis further indicated that, in addition to BMI per se (negative predictor), participation in organized sports within a sports club (positive predictor) determines gross motor coordination performance(s) 2 years later. CONCLUSION: Our results provide conclusive evidence for an increasingly widening gap of OW/OB children's gross motor coordination relative to NW peers across developmental time in the absence of targeted initiatives. Special attention is thus needed for OW/OB children, especially for those not practicing sports in a club environment, in terms of motor skill improvement to promote regular participation in physical activity.

Correlates of energy balance-related behaviours in preschool children: a systematic review.

Childhood overweight is a multifactorial health problem influenced by several factors. The interaction of behaviours such as physical activity, sedentary behaviour and eating behaviour determines whether or not a positive energy balance or weight gain is experienced. Knowing the correlates of these behaviours in 4- to 6-year-old children is of major interest for intervention development. According to the systematic literature search, attending a rural preschool was positively associated with physical activity. Gender, age and socioeconomic status were not associated with physical activity, while an indeterminate result was found for ethnicity. Gender and ethnicity were not associated with sedentary behaviour and indeterminate results were found for age and socioeconomic status. Preschoolers were more physically active as well as sedentary on weekdays. Watching television was associated with a higher consumption of snacks and sweet beverages. Strategies aiming to influence energy balance-related behaviours in preschoolers should target both boys and girls and all ethnic groups from low as well as high social status. During the week, there should be a focus on decreasing sedentary behaviour and in the weekend on increasing physical activity. Focusing on television viewing and the consumption of snacks and sweet beverages could/should also be a strategy.

A cognitive-behavioural pedometer-based group intervention on physical activity and sedentary behaviour in individuals with type 2 diabetes.

The purpose of this study was to investigate the benefits of a pedometer and a cognitive-behavioural group intervention for promoting physical activity (PA) in type 2 diabetes patients. We recruited 41 participants and randomized them into an intervention group (IG) (n=20) and a control group (CG) (n = 21). The intervention consisted of five sessions within 12 weeks, a booster session after 22 weeks and a pedometer. Primary outcome was PA assessed by accelerometer (minutes per day) and pedometer (steps per day). Secondary outcomes were weight, body mass index, blood pressure, haemoglobin A1c and total cholesterol. After 12 weeks, the IG increased with more than 2000 steps day(-1) compared with the CG, whereas sedentary behaviour decreased more than 1 hour day(-1) in the IG and showed no change in the CG. There was no intervention effect on the accelerometer-based PA nor on health measurements. After 1 year, the increase in steps per day remained significant in the IG, but sedentary activity increased again to baseline levels. This pilot study showed that the combination of a 12-week cognitive-behavioural intervention and a pedometer has a significant short-term impact on daily steps and sedentary behaviour but that the effects on total PA and long-term effects were limited.

Perceived social and physical environmental correlates of physical activity in older adolescents and the moderating effect of self-efficacy.

OBJECTIVE: To determine if perceptions of the social and physical environment are associated with active transport and leisure-time sports among Belgian youth and to investigate if this relationship is moderated by self-efficacy. METHODS: In February-May 2008, 1445 adolescents (17.4+/-0.6 yrs) were recruited in 20 randomly selected Belgian schools. Physical activity, psychosocial, and environmental factors were assessed using validated questionnaires. Moderated multilevel regression analysis was used to examine the association between physical activity and possible correlates. RESULTS: Social environmental variables (modeling and social support) were positively associated with active transportation and leisure-time sports (p<0.05). Higher land use mix diversity, higher street connectivity, more attractive environments, better access to recreational facilities, and higher emotional satisfaction with the neighborhood were associated with more active transportation (p<0.05). Higher perceived safety from traffic, better access to recreational facilities, more physical activity equipment at home, and fewer electronic devices in the bedroom were associated with more leisure-time sports (p<0.05). Lower perceived safety and poorer access to (recreational) facilities were only associated with lower active transport among youth with lower self-efficacy (p<0.05). CONCLUSION: Creating more supportive environments could have the potential to affect the physical activity levels of Belgian adolescents with both high and low self-efficacy.

Explaining the effect of a 1-year intervention promoting physical activity in middle schools: a mediation analysis.

OBJECTIVE: The aim of the present study was to examine the mediation effects of changes in psychosocial determinants of physical activity (attitude, social support, self-efficacy, perceived benefits and barriers) on changes in physical activity. DESIGN: One-year intervention study with baseline and 1-year post measures of physical activity habits and psychosocial correlates. SETTING: Fifteen middle schools. SUBJECTS: Boys and girls (n = 2840) aged 11-15 years completed the validated questionnaires during class hours. RESULTS: The product-of-coefficients test was used to asses the mediating effects. Self-efficacy for physical activity at school was found to be the only significant mediator of physical activity change. Specifically, self-efficacy for physical activity at school partly mediated the effect of the intervention on total and school-related physical activity change in the intervention group with parental support (P < 0.05). None of the other potential mediators, attitudes, social support, perceived benefits and perceived barriers, seemed to have had a positive effect. Even a suppressor effect was found for attitudes. Given that the effects of self-efficacy and attitudes were of opposite direction, the total mediated/suppressed effects of the intervention were not statistically significant. CONCLUSIONS: Positive changes in total and school-related physical activity in adolescents could be partly explained by increases in self-efficacy for physical activity at school through a physical activity intervention in middle schools with parental support. However, the suppressor effect of attitudes decreased this effect. As this is one of the first true mediation analyses in this age group, further research is needed to replicate the importance of these mediators.

The contribution of psychosocial and home environmental factors in explaining eating behaviours in adolescents.

OBJECTIVE: The present study aimed at investigating the influence of food availability, rules and television viewing habits on eating behaviours in adolescents. DESIGN: Cross-sectional study. SETTING: Four randomly selected middle schools. SUBJECTS: A sample of 534 seventh and eighth graders. INTERVENTIONS: Validated questionnaires were used to measure the family environment and fat, soft drink and fruit consumption. Hierarchical regression analyses on fat, soft drink and fruit consumption, with demographic and psychosocial variables entered as the first and environmental factors as the second block were conducted in boys and girls. RESULTS: Boys with more unhealthy products available at home consumed more fat (P< or =0.001, 95% CI: 8.2-29.4) and more soft drinks (P< or =0.01, 95% CI: 0.2-1.4). Boys who reported better television viewing habits ate more fruit (P< or =0.001, 95% CI: -1.7 to -0.5). Girls who reported better television viewing habits consumed less fat (P< or =0.01, 95% CI: 1.4-9.0) and more fruit (P< or =0.05, 95% CI: -1.0 to -0.1). Girls who reported higher availability of healthy products at home (P< or =0.05, 95% CI: 0.3-3.1) and more food rules (P< or =0.001, 95% CI: -1.8 to -0.5), consumed more fruit. Environmental factors were poor predictors of soft drink consumption among girls. CONCLUSION: Availability of (un)healthy food products, family food rules and TV viewing habits were related to one or more eating behaviours in boys or girls. Although home environmental factors can play an important role in influencing adolescents' eating behaviours, these factors were generally less predictive than demographic and psychosocial variables.

Physical activity and endurance in normal weight versus overweight boys and girls.

AIM: Some studies found lower levels of physical activity and fitness in overweight children, compared to normal weight children, while others have failed to observe any difference. Therefore, the purpose of the present study was to reinvestigate the differences in physical activity and running capacity between overweight and normal weight children. METHODS: A random sample of 121 males and 101 females, 11 to 13 years old, was selected. Children were divided into overweight/fat and normal weight/fat groups based on measures of body mass index and percentage of body fat. Physical activity level was assessed by accelerometers and a Physical Activity Questionnaire. Running capacity was measured by the Cooper Test. RESULTS: Accelerometer data revealed that overweight/fat children were less moderate to vigorous physically active when compared to normal weight/fat children. They also performed worse on the running capacity test (P<0.001). Overweight children reported to be less active in leisure time (P<0.05) compared to normal weight children. Overfat girls reported to participate less in sports activities compared to normal fat girls (P<0.05). CONCLUSION: The present study found clear differences in physical activity and running capacity between overweight/fat and normal weight/fat 11- to 13-year olds. A major strength of the present study is that similar results were shown based on different estimates of overweight and activity in a relatively large sample of children.

Post-treatment phone contact: a weight maintenance strategy in obese youngsters.

This study investigated the effect of post-treatment phone contact on weight-loss maintenance and activity behaviour in obese youngsters. In all, 20 patients who completed a weight reduction program were randomly assigned to a 5-month maintenance programme (experimental) or control condition. Following the maintenance programme, patients sent a weekly activity diary to the therapist, who in turn phoned them biweekly to discuss their activities. Body weight, stature and physical activity were measured before and after the maintenance programme. The control group showed a continuous increase in overweight after initial treatment, while the experimental group showed a steep increase during the summer holidays (no intervention), but this increase slowed down during the maintenance programme (P<0.05). Moderate-to-high intensity activities increased during the maintenance programme in the experimental group, but decreased in the control group (P<0.001). In conclusion, post-treatment phone contact appears to have the potential to be an effective maintenance strategy in obese youngsters.

Effects of distraction on treadmill running time in severely obese children and adolescents.

OBJECTIVE: (1) To examine the effects of attentional distraction on running time in an incremental treadmill test in obese youngsters; (2) to investigate whether distraction works at the same extent at the beginning and at the end of residential treatment; and (3) to explore the underlying mechanisms of the possible distraction effects. METHODS: Thirty severely obese youngsters (10 boys, 20 girls, age range 9-17) who were following a 10 month residential treatment, performed a treadmill test until exhaustion in four different sessions using a within subjects design. The two sessions at the beginning of the treatment and the two sessions at the end the treatment were counterbalanced, one with attentional distraction (music) and one without distraction. RESULTS: Obese youngsters ran significantly longer during distraction. This distraction effect seemed to be larger at the beginning compared to at the end of obesity treatment. The absence of differences between the condition with music and the condition without music on perceived bodily symptoms is in line with the idea that it took longer to perceive sufficient bodily sensations to decide to stop the treadmill test in the distraction condition. This interpretation is further corroborated by the physiological data indicating a superior peak performance in the condition with distraction. CONCLUSIONS: Attentional distraction has a positive effect on perseverance in obese youngsters. Further research has to show the usefulness of attentional distraction as a technique to increase exercise adoption and adherence in obesity treatment.

Differences in psychosocial determinants of physical activity in older adults participating in organised versus non-organised activities.

BACKGROUND: With the introduction of the new consensus on 30 minutes of moderate physical activity preferably on all days of the week, exercise implemented into daily activities is promoted whereas structured activity programs lose importance. Activity levels of most older people don't come up with current recommendations. Therefore strategies to enhance attendance of older adults in physical activities should be developed. Group programs may be more effective in changing exercise behaviour of older adults than non-supervised physical activity. The purpose of this study was to investigate the differences in level of activity and psychosocial determinants of physical activity between seniors involved in an exercise class and seniors not engaged in any organised physical activity. METHODS: Seventy-five elderly who were currently involved in structured exercise classes and 75 elderly who did not participate in any organised physical activity during the previous year were recruited in senior citizens' centres and were asked to fill out a questionnaire. RESULTS: Subjects involved in an exercise program had higher levels of activity and reported more social influences and higher self-efficacy compared to the respondents practising on an individual basis. No differences were found in perceived barriers or benefits. CONCLUSIONS: Exercising in a group program gives the opportunity to accumulate some extra physical activity and positively affects the level of activity outside the program. Stimulating older adults to join a structured activity program in the company of family or friends in order to enhance supporting social influences and perceived competence could be an important intervention strategy.