Personal and social-environmental correlates of objectively measured physical activity in Norwegian pre-adolescent children.

The aim of this study was to examine modifiable biological, psychological, behavioral and social-environmental correlates of physical activity among 1129 Norwegian 11-year-old children within a cross-sectional sample from the HEalth In Adolescents study. Physical activity was assessed by accelerometer, and weight and height were measured objectively. Age- and gender-specific cut-off points proposed by the International Obesity Task Force were used to define body mass index. Social-environmental variables were self-reported by questionnaire. Hierarchical regression (linear mixed models) revealed that normal weight children scored higher on percentage daily moderate-to-vigorous physical activity [% daily moderate to vigorous physical activity (MVPA)] than overweight/obese children (P<0.001). Self-efficacy (P<0.01) and perceived social support from friends (P<0.01) were positively associated with children's % daily MVPA, and a negative association was found for computer/game-use on weekends (P<0.01). A moderator effect of weight category (normal vs overweight/obese) in the relationship between computer/game-use on weekends and % daily MVPA was detected (P<0.05), reflecting that higher computer/game-use on weekends was associated with lower % MVPA among the overweight/obese, but not among the normal weight. Modifiable correlates from multiple domains accounted for 14% of the variance in % daily MVPA. Prospective and intervention studies are needed to examine whether these factors act as mediators for physical activity change in pre-adolescent children.

Overweight and waist circumference among Norwegian 11-year-olds and associations with reported parental overweight and waist circumference: The HEIA study.

AIMS: The aim of this paper is to investigate anthropometric characteristics in 11-year-old Norwegian by gender and parental education, and to study associations between adolescents' overweight and waist circumference (WC) and maternal and paternal overweight and WC. METHODS: A total of 1483 adolescents, 1156 mothers, and 1016 fathers participated in the baseline survey of the HEalth In Adolescents (HEIA) study (September 2007). Anthropometric measures of the adolescents were assessed by project staff according to standard procedures. Self-reported data about pubertal status were collected through questionnaires. Parental education and anthropometric measures of parents were collected by self-report. RESULTS: The prevalence of overweight (including obesity) determined by the cut-offs for body mass index (BMI) suggested by the International Obesity Task Force was 14.6% among girls and 13.6% among boys. The highest prevalence of overweight was observed among adolescents with parents who had less than 12 years of education (18.8%). Overweight and WC in girls was strongly associated with maternal overweight and WC. For boys, overweight and WC was strongly associated with both maternal and paternal overweight and WC. CONCLUSIONS: There was a social gradient in anthropometric characteristics and overweight rates among Norwegian 11-year-old adolescents. Maternal overweight and WC was associated with overweight and WC in girls and boys, while paternal overweight and WC were associated with overweight and WC in boys. The results indicate that mothers are key persons in prevention of overweight among adolescents, despite gender. Fathers are important as role models for their sons. Targeting parental overweight/ obesity could be a strategy in future interventions.

Design of a 20-month comprehensive, multicomponent school-based randomised trial to promote healthy weight development among 11-13 year olds: The HEalth In Adolescents study.

BACKGROUND AND PURPOSE: The lack of effective school-based interventions for preventing obesity in children has caused a call for longer duration of interventions and better reporting on design and evaluation methodology. The purpose of this paper is to present the development of the intervention, the design of the effectiveness study, and the test-retest reliability of the main outcome measures in the HEalth In Adolescents (HEIA) study. METHODS/DESIGN: The HEIA intervention programme was developed based on literature reviews, a social ecological framework, and focus groups. The intervention aimed to increase total physical activity (PA) and consumption of fruit and vegetables and to decrease screen time and consumption of sugar-sweetened beverages. The intervention programme consisted of a classroom component, including dietary behaviour lessons, computer tailoring, fruit/vegetable and PA breaks, and posters, and an environmental component including active transport campaigns, equipment, suggestions for easy improvements of schoolyards, inspirational courses for teachers (all with regards to PA), and fact sheets to parents. The effect of the intervention programme is evaluated in a cluster randomised controlled trial design (intervention = 12 schools, control = 25 schools) including process evaluation. Main outcomes include anthropometry, PA, screen time, and consumption of fruit, vegetables, and sugar-sweetened beverages. A 2-week test- retest study was conducted among 114 pupils. Determinants of the behaviours were assessed. Similar data were collected from parents. Children's PA was measured objectively by accelerometers. CONCLUSIONS: The HEIA study represents a theoretically informed randomised trial comprising a comprehensive set of multilevel intervention components with a thorough evaluation using reliable outcome measures. The study will contribute to a better understanding of determinants of healthy weight development among young people and how such determinants can be modified.

Appreciation and implementation of a school-based intervention are associated with changes in fruit and vegetable intake in 10- to 13-year old schoolchildren--the Pro Children study.

The purpose was to investigate the degree of implementation and appreciation of a comprehensive school-randomized fruit and vegetable intervention program and to what extent these factors were associated with changes in reported fruit and vegetable intake. The study was conducted among 10- to 13-year old children exposed to the intervention during the school year 2003-04 in Norway, Spain and the Netherlands. Children, parents and teachers completed questionnaires regarding (i) the implementation of the school curriculum, (ii) parental involvement, (iii) distribution of fruit and vegetables at school, (iv) children's appreciation of the project and (v) children's intake levels. Univariate analyses of covariance and multilevel multivariate regression analyses indicated that teacher-reported level of implementation of the school curriculum and schoolchildren's appreciation of the project were important determinants of changes in intake. The results point to the importance of optimal implementation of an attractive school curriculum.

Effects of a comprehensive fruit- and vegetable-promoting school-based intervention in three European countries: the Pro Children Study.

The objective of the present study was to evaluate the effects of the Pro Children intervention on schoolchildren's fruit and vegetable (FV) intake after 1 and 2 years of follow-up. The intervention combined a FV curriculum with efforts to improve FV availability at schools and at home. Effects were examined in a group-randomised trial among 1,472 10-11-year-old children from sixty-two schools in Norway, the Netherlands and Spain. FV intake was assessed by means of validated self-administered questionnaires completed before the intervention (September 2003), immediately after the first year of the intervention (May 2004) and 1 year later (May 2005). Data were analysed using multilevel linear regression analyses with age and sex as covariates. Significant intervention effects for FV intake were found at first follow-up in the total sample. The adjusted FV intake reported by the children from intervention schools was 20 % higher than FV intake reported by children from control schools. At 1 year later, a significant impact was only observed in Norway. Positive intervention effects on FV intake occurred both at school and outside school. We conclude that the Pro Children intervention is a promising means to promote European schoolchildren's FV intakes, but mainly fruit intake, in the short term. As shown in Norway, where the intervention was best implemented, the intervention might also result in longer-term effects. Further strategies need to be developed that can improve implementation, have an impact on vegetable intake and can secure sustained effects.

Free school fruit--sustained effect 1 year later.

This study reports the effect of a school-randomized fruit and vegetable intervention consisting of a subscription to the Norwegian School Fruit Programme at no parental cost, and the Fruit and Vegetables Make the Marks (FVMM) educational programme, both delivered in the school year of 2001-02. Nine randomly chosen schools received the intervention and 10 schools served as control schools. Participating pupils completed questionnaires at baseline (September 2001), at Follow-up 1 (May-June 2002) and at Follow-up 2 (May 2003). A total of 517 pupils (84%; mean age, 11.3 years at baseline) participated in all three surveys. At both Follow-up 1 and Follow-up 2, strong intervention effects were observed for all-day fruit and vegetable intake (effect sizes were 0.6 and 0.5 portions, respectively). The sustained effect at Follow-up 2, 1 year after the end of the intervention, can partly be explained by greater participation rates in the School Fruit Programme (standard paid subscription). We conclude that the effects observed are most likely due to the no-cost subscription and not due to the FVMM educational programme, and that providing pupils with a piece of fruit or a vegetable at school at no cost for the parents is an effective strategy to increase school children's intake of fruit and vegetables. The effect is also sustained 1 year after the end of the no-cost subscription, providing increased health benefits.

Outcome and process evaluation of a Norwegian school-randomized fruit and vegetable intervention: Fruits and Vegetables Make the Marks (FVMM).

This study reports the effect of the Fruits and Vegetables Make the Marks intervention, a school-based fruit and vegetable intervention consisting of a home economics classroom component and parental involvement and encouraged participation in the Norwegian School Fruit Programme, all delivered during the school year of 2001-02. Nine randomly chosen schools received the intervention and 10 schools served as control schools. Participating pupils completed questionnaires at baseline (September 2001), at Follow-up 1 (May-June 2002) and at Follow-up 2 (May 2003). A total of 369 pupils (69%; mean age, 11.3 years at baseline) participated in all three surveys. No effect of the intervention was found for intake of fruit and vegetables eaten at school or all day, neither at Follow-up 1 nor at Follow-up 2. On analysing the effects on potential mediators, significant differences between intervention and control groups were found for Awareness of the five-a-day recommendations only. The intervention programme was rated as very good by the teachers, and the pupils reported that they enjoyed it. However, the intervention failed to change fruit and vegetable intake, probably because it did not succeed in changing the pupils' preferences for or the accessibility of fruit and vegetables--the two strongest correlates of children's fruit and vegetable intake.