Comparison of energy balance-related behaviours and measures of body composition between Turkish adolescents in Turkey and Turkish immigrant adolescents in the Netherlands.

OBJECTIVE: To explore the influences of migration to a Western country on obesity and related risk factors by comparing measures of body composition and energy balance-related behaviours between Turkish adolescents in Turkey (TR-TR) and adolescents from Turkish immigrant ethnicity in the Netherlands (TR-NL). DESIGN: Cross-sectional survey or baseline intervention data from six Dutch school-based studies and one Turkish study. SETTING: Primary and secondary schools. SUBJECTS: A total of 915 (49 % girls; mean age 13·1 (sd 0·8) years) TR-TR adolescents and 433 (51 % girls; mean age 11·7 (sd 1·3) years) TR-NL adolescents were included. Outcome measures were self-reported sugar-containing beverage consumption, fruit and vegetable intake, screen time, physical activity, measured body height and weight, BMI, waist and hip circumferences, and skinfold thicknesses. RESULTS: Our data showed that more TR-NL adolescents were overweight (31 % v. 26 %) and obese (9 % v. 6 %) and had significantly higher mean BMI (21·1 v. 20·0 kg/m2), waist circumference (72·2 v. 71·3 cm) and suprailiac skinfold thickness (19·8 v. 13·1 mm) than TR-TR adolescents. TR-NL adolescents reported significantly higher sugar-containing beverage consumption (1173 v. 115 ml/d), less fruit and vegetable intake (295 v. 647 g/d), less screen time (253 v. 467 min/d) and higher physical activity levels (61 v. 27 min/d) than TR-TR adolescents. CONCLUSIONS: Immigrant adolescents in the Netherlands were more often overweight and had a less favourable dietary pattern than their peers in Turkey, while their physical activity and screen time patterns were more favourable. These results suggest that adolescents from Turkish immigrant ethnicity in the Netherlands have adopted lifestyles towards the host culture.

A mixed methods process evaluation of the implementation of JUMP-in, a multilevel school-based intervention aimed at physical activity promotion.

BACKGROUND: The aim of the present study was to investigate factors influencing the adoption, implementation, and institutionalization process of JUMP-in-a multilevel school-based physical activity promotion program-to optimize the dissemination of the intervention and improve its effectiveness. The process evaluation concerned the constraints and success and failure factors at sociopolitical, organizational, user, and intervention levels. METHODS: A mixed methods approach including qualitative and quantitative data was conducted during two school years (2006-2008). RESULTS: JUMP-in was successfully embedded in the Amsterdam municipal policy and in the organizational structure and daily practices of the sectors involved. A general impeding factor was the complexity of the multilevel programme requiring multidisciplinary collaboration between organizations. In addition, there was a discrepancy between the recommendation to standardize and simplify the innovation and the need to tailor the strategies to local environmental, social, and cultural aspects. CONCLUSIONS: This process evaluation provides challenges and remedies for managing discrepancies between prerequisites for an effective innovation and demands of daily implementation practice. The main recommendations are (a) standardized, simplified guidelines; (b) stepwise implementation; (c) formalized coalitions, integration of policy, and synchronization of tasks and protocols; and (d) smart planning and control by clear communication and feedback instruments. If these recommendations are incorporated into the JUMP-in intervention and organization, increased effectiveness and long-term effects can be expected.

Mediators of the effect of the JUMP-in intervention on physical activity and sedentary behavior in Dutch primary schoolchildren from disadvantaged neighborhoods.

BACKGROUND: Important health benefits can be achieved when physical activity in children from low socio-economic status is promoted and sedentariness is limited. By specifying the mediating mechanisms of existing interventions one can improve future physical activity interventions. This study explored potential mediators of the long-term effect of the school-based multicomponent JUMP-in intervention on sport participation, outdoor play and screen time in Dutch primary schoolchildren from disadvantaged neighborhoods. METHODS: In total, 600 primary schoolchildren (aged 9.8 ± 0.7, 51% girls, 13% Dutch ethnicity, 35% overweight) from 9 intervention and 10 control schools were included in the analyses. JUMP-in was developed using Intervention Mapping, and targeted psychological and environmental determinants of physical activity. Outcome behaviors were self-reported sport participation, outdoor play, TV-viewing behavior and computer use. Potential mediators were self-reported psychological, social and physical environmental factors. RESULTS: JUMP-in was effective in improving sport participation after 20 months, but not in improving outdoor play, or reducing TV-viewing or computer time. JUMP-in was not effective in changing hypothesized mediators so no significant mediated effects could be identified. However, changes in self-efficacy, social support and habit strength were positively associated with changes in sport participation, and changes in social support, self-efficacy, perceived planning skills, enjoyment and habit strength were positively associated with changes in outdoor play. Changes in enjoyment was positively associated with changes in TV-viewing while parental rules were negatively associated. Having a computer in the bedroom and enjoyment were positively associated with changes in computer use, while changes in parental rules were negatively associated. CONCLUSIONS: Besides a significant positive effect on sports participation, no significant intervention effect on outdoor play, screen time or any of the potential mediators was found. This suggest that other (unmeasured) factors operated as mediating mechanisms of the intervention, that we used unsuccessful intervention strategies, that the strategies were inappropriately implemented, or that children are unable to accurately recall past activities and cognitions. Additionally, the school setting might not be the sole channel to influence leisure time activities. Still, several personal and environmental constructs were found to be relevant in predicting change in sport participation, outdoor play and screen behavior and seem to be potential mediators. Future interventions are recommended including more effective strategies targeting these relevant constructs, addressing different constructs (e.g. pedagogic skills of parents), and focusing on different implementation settings. TRIAL REGISTRATION: [corrected] ISRCTN17489378.

Effectiveness of JUMP-in, a Dutch primary school-based community intervention aimed at the promotion of physical activity.

PURPOSE: The aim of the present study was to investigate the effect of the JUMP-in programme on sports participation, overall physical activity (PA), shuttle run score and body composition in 6-12-year-old children. METHODS: JUMP-in is a school-based strategy combining environmental policy, neighbourhood, parents- and personal components. A controlled trial was carried out in 19 primary schools including 2848 children (50% boys). Measures were performed at the beginning of the first school year (T0: 2006) and repeated at the end of the first (T1: 2007) and second school year (T2: 2008). RESULTS: A significant beneficial intervention effect was found on organised sports participation (OR 2.8 (2.2 to 3.6)). Effects were stronger for girls (OR 3.6 (2.3 to 5.6)), and for Moroccan (OR 4.2 (3.6 to 5.7)) and Turkish children (OR 3.2 (1.9 to 5.2)). Participation in organised sports was associated with increased shuttle run score. No significant intervention effects on overall daily PA rates and body composition were observed. CONCLUSION: The present study proves that a school-based strategy combining environmental and personal interventions was successful in improving structural sports participation among children.

Using health promotion outcomes in formative evaluation studies to predict success factors in interventions: an application to an intervention for promoting physical activity in Dutch children (JUMP-in).

JUMP-in is a systematically developed intervention aimed at promoting physical activity among primary school children. It is a joint project involving different authorities and entails six school-based programme components. Measuring effects of such an intervention is a complex challenge. A common problem is the lack of valid instruments to measure physical activity and its determinants. In addition, it usually takes years to find improvements in physical activity and related constructs like weight and fitness, or even in causal factors. For this reason different authors advocate for the establishment of 'health promotion outcomes'; (i) health literacy, (ii) social action and influence and (iii) healthy public policy and organizational practice. It is presumed that these health promotion outcomes lead to changes in determinants, behaviour and finally in health. Insight in these health promotion outcomes and information about input and through-put are important in discussing the impact and output. The formative evaluation study of the JUMP-in pilot shows the health promotion outcomes of the intervention. The health promotion outcomes 'social action and influence' and 'healthy public policy and organizational practices' were found to be positive. By measuring the presence of the conditions to achieve 'health literacy', it became clear that more attention must be paid to implementation in the future. Based on the health promotion outcomes, we expect that JUMP-in will be an effective intervention in the future.

A controlled trial of a school-based environmental intervention to improve physical activity in Dutch children: JUMP-in, kids in motion.

Interventions to promote physical activity are important in preventing children from becoming overweight. Many projects have been developed but only a few showed (moderate) effects. JUMP-in is a systematically developed primary-school-based intervention that focuses on the use of theory, environmental changes, parental influences and cooperation with multi-level parties in intervention development. The effects of JUMP-in were evaluated with a quasi-experimental pre-test/post-test research design. In total, 510 children from Grades 4, 5 and 6 of four intervention schools and two control schools in Amsterdam were followed for an intervention period of one school year. Changes in physical activity as well as in the social cognitive determinants were assessed using self-reports. In addition, a process evaluation has been executed. The results show that JUMP-in was effective in influencing physical activity, especially among children from Grade 6. Children in the control group decreased their level of physical activity considerably, while activity levels in intervention children from Grade 6 remained stable. The intervention effects could not be explained by changes in the measured social cognitive determinants. In contrast, process information illuminated differences in intervention effects between the participating schools. The results from the JUMP-in study show the importance of intervention designs that focus on a theory-based mix of relevant environmental and social cognitive factors.