Do Crowding-Out Effects Explain the Low Effect of a Health Promotion Intervention among Young People at a Vocational School?

In recent years, school-based interventions have increasingly been used as a strategy to promote good eating habits and physical activity among young people at school. However, little is known about the effect that this kind of public involvement has on the overall behavior of young people. Economists refer to the existence of a crowding-out effect when public sector engagement in influencing behavior is counteracted by behaviors at the individual level. The aim of this study was to investigate the effects of a health promotion intervention program among young people at a vocational school on the overall behavior of the students and consider whether a crowding-out effect existed when it came to health behavior. This study used data from the Gearing up the Body (GUB) intervention that was carried out at the vocational school of Uddannelsescenter Holstebro, Denmark. The study included 130 students from two vocational programs. Answers were collected from survey questions in three waves. Our results showed that intervening in the school setting had the intended impact on physical activity but an unintended impact on eating behavior. In the GUB study, we found signs of countervailing behaviors in and out of school that need to be further explored.

Does It Run in the Family? How Family Background Affects Attachment Styles for Students in Higher Education.

BACKGROUND: Socioeconomic background has traditionally been the most important determinant of an individual's social advantage. Studies have used social class and opportunities based on parental income and education to predict such advantage. There is limited evidence that stratification mechanisms other than socioeconomic background can play an important role. The purpose of the study is to examine the influence of the traditional factors (income and education) of family background on students' social attachment styles compared to other background variables (civil status and number of children). METHODS: We used the Vulnerable Attachment Style Questionnaire as an outcome measure to assess students' social attachment advantage. As a point of departure, we use theories of social psychology to categorize social relations in terms of secure or insecure bonding, respectively. RESULTS: A cross-sectional data set of 912 university students from five European countries was used. With respect to social attachment, the likelihood of being a student with robust relations increases by 23% if the students have high-income parents. Students with robust relations also have a decreased likelihood of poor body self-esteem by 19% when compared with other students. CONCLUSIONS: Stratification mechanisms other than social class, such as parental characteristics, civil status, and number of siblings, all affect the privileged students' social relations.

Responsible Governance for a Food and Nutrition E-Infrastructure: Case Study of the Determinants and Intake Data Platform.

The focus of the current paper is on a design of responsible governance of food consumer science e-infrastructure using the case study Determinants and Intake Data Platform (DI Data Platform). One of the key challenges for implementation of the DI Data Platform is how to develop responsible governance that observes the ethical and legal frameworks of big data research and innovation, whilst simultaneously capitalizing on huge opportunities offered by open science and the use of big data in food consumer science research. We address this challenge with a specific focus on four key governance considerations: data type and technology; data ownership and intellectual property; data privacy and security; and institutional arrangements for ethical governance. The paper concludes with a set of responsible research governance principles that can inform the implementation of DI Data Platform, and in particular: consider both individual and group privacy; monitor the power and control (e.g., between the scientist and the research participant) in the process of research; question the veracity of new knowledge based on big data analytics; understand the diverse interpretations of scientists' responsibility across different jurisdictions.

Validation of a novel image-weighed technique for monitoring food intake and estimation of portion size in hospital settings: a pilot study.

OBJECTIVE: Optimal nutrition for hospital patients is crucial and routine monitoring of patients' nutrient intake is imperative. However, personalised monitoring and customised intervention using traditional methods is challenging and labour-intensive, consequently it is often neglected in hospital settings. The present pilot study aimed to examine the reliability and validity of the Dietary Intake Monitoring System (DIMS) against the weighed food method (WFM). DESIGN: The DIMS 2.0 is composed of an integrated digital camera, weighing scale, radio-frequency identification sensor and WIFI connection for real-time image and weight dietary data acquisition and analysis. The DIMS equipment was used to collect data for a paired set of meals both before and after meal consumption at lunchtime. SETTING: Odense University Hospital, Denmark. SUBJECTS: Photos and weights of seventeen patient meals were captured. RESULTS: The results showed a significant correlation between DIMS and WFM for energy (r=0·99, P<0·01) and protein intake (r=0·98, P<0·01). Intraclass correlation coefficients (ICC) revealed a high degree of agreement among the four non-trained assessors for estimates of portion size of each food item before (0·88, P<0·01) and after consumption (0·99, P<0·01). The ICC for energy and protein intake were 0·99 (P<0·01) and 0·99 (P<0·01), respectively. Bland-Altman plots revealed no systematic bias. CONCLUSIONS: Considering the huge benefits associated with routine monitoring, technological advances have made it possible to develop a novel, easy-to-use DIMS that, according to the findings, is a valid alternative for use in hospital settings.

Substituting sugar confectionery with fruit and healthy snacks at checkout - a win-win strategy for consumers and food stores? a study on consumer attitudes and sales effects of a healthy supermarket intervention.

BACKGROUND: The widespread use of in-store marketing strategies to induce unhealthy impulsive purchases has implications for shopping experience, food choice and possibly adverse health outcomes. The aim of this study was to examine consumer attitudes and evaluate sales effects of a healthy checkout supermarket intervention. The study was part of Project Sundhed & Lokalsamfund (Project SoL); a Danish participatory community-based health promotion intervention. METHODS: Consumer attitudes towards unhealthy snack exposure in supermarkets were examined in a qualitative pre-intervention study (29 short in-store interviews, 11 semi-structured interviews and three focus group interviews). Findings were presented to food retailers and informed the decision to test a healthy checkout intervention. Sugar confectionery at one checkout counter was substituted with fruit and healthy snacking items in four stores for 4 weeks. The intervention was evaluated by 48 short exit interviews on consumer perceptions of the intervention and by linear mixed model analyses of supermarket sales data from the intervention area and a matched control area. RESULTS: The qualitative pre-intervention study identified consumer concern and annoyance with placement and promotion of unhealthy snacks in local stores. Store managers were willing to respond to local consumer concern and a healthy checkout intervention was therefore implemented. Exit interviews found positive attitudes towards the intervention, while intervention awareness was modest. Most participants believed that the intervention could help other consumers make healthier choices, while fewer expected to be influenced by the intervention themselves. Statistical analyses suggested an intervention effect on sales of carrot snack packs when compared with sales before the intervention in Bornholm control stores (P < 0.05). No significant intervention effect on sales of other intervention items or sugar confectionery was found. CONCLUSIONS: The present study finds that the healthy checkout intervention was positively evaluated by consumers and provided a 'responsible' branding opportunity for supermarkets, thus representing a win-win strategy for store managers and consumers in the short term. However, the intervention was too modest to draw conclusions on long-term sales and health implications of this initiative. More research is needed to assess whether retailer-researcher collaborations on health promotion can be a winning strategy for public health.

Defining Neighbourhoods as a Measure of Exposure to the Food Environment.

Neighbourhoods are frequently used as a measure for individuals' exposure to the food environment. However, the definitions of neighbourhoods fluctuate and have not been applied consistently in previous studies. Neighbourhoods defined from a single fixed location fail to capture people's complete exposure in multiple locations, but measuring behaviour using traditional methods can be challenging. This study compares the traditional methods of measuring exposure to the food environment to methods that use data from GPS tracking. For each of the 187 participants, 11 different neighbourhoods were created in which the exposure to supermarkets and fast food outlets were measured. ANOVA, Tukey's Honestly Significant Difference (HSD) test and t-tests were performed to compare the neighbourhoods. Significant differences were found between area sizes and the exposure to supermarkets and fast food outlets for different neighbourhood types. Second, significant differences in exposure to food outlets were found between the urban and rural neighbourhoods. Neighbourhoods are clearly a diffused and blurred concept that varies in meaning depending on each person's perception and the conducted study. Complexity and heterogeneity of human mobility no longer appear to correspond to the use of residential neighbourhoods but rather emphasise the need for methods, concepts and measures of individual activity and exposure.

The association between organic school food policy and school food environment: results from an observational study in Danish schools.

AIMS: School food in many countries has become the object of change and innovation processes, not only in relation to policies for healthier eating but also in relation to policies for more sustainable food consumption and procurement. The purpose of this study was to examine the possible influence that organic food sourcing policies in Danish school meal systems may have on the development of healthier school food environments. METHODS: The study was a cross-sectional analysis undertaken among 179 school food coordinators (SFCs) through a web-based questionnaire (WBQ) in a sample of Danish public primary schools. The 'organic' schools were compared to 'non-organic' schools. The questionnaire explored the attitudes, intentions/policies and actions in relation to organic and healthy foods served in the schools. RESULTS: Data indicates that 20 'organic' schools were associated with the indicators of healthier school environments, including adopting a Food and Nutrition Policy (FNP) in the school (p = .032), recommending children to eat healthily (p = .004). CONCLUSIONS: The study suggests that organic food policies in schools may have potential to support a healthier school food environment.

Do attitudes, intentions and actions of school food coordinators regarding public organic food procurement policy improve the eating environment at school? Results from the iPOPY study.

OBJECTIVE: The present study investigates whether public organic food procurement policies have the potential to induce changes in the school food service environment. DESIGN: A comparative cross-national survey was conducted in public primary and/or secondary schools in Finland, Germany and Italy. The school food coordinators completed a web-based questionnaire on their attitudes, intentions and actions towards organic school food provision. SETTING: In Germany, 122 out of 2050 schools in the state of Hesse responded. In Finland, 250 out of 998 schools across the country responded. In Italy, 215 out of 940 schools from eight provinces responded. SUBJECTS: School food coordinators in the sample of schools in the three countries. RESULTS: The German and Finnish school food coordinators separately most agreed with the promotion of healthy eating habits (P < 0·001) and organic food (P < 0·001) by schools. The Finnish schools were most likely to adopt a food and nutrition policy (P < 0·001), a health-promoting school policy according to WHO principles (P < 0·001), to have a playground (P < 0·001), to involve physical activity themes in teaching (P = 0·012) and to have a canteen (P < 0·001). The Italian schools were most likely to involve the food and nutrition policy in pedagogical activities (P = 0·004), to serve nutritional school meals (P < 0·001) and to recommend children to eat healthily (P < 0·001). In the three countries, the non-organic schools were less likely to adopt a food and nutrition policy (P < 0·001), a WHO health-promoting policy (P < 0·001) and have a canteen (P = 0·017) than the organic schools. CONCLUSIONS: The study suggests that there is a gap in the effects of public organic food procurement policy on building a healthier school food environment.

Understanding hospital meal experiences by means of participant-driven-photo-elicitation.

A patients' hospital meal experiences can be complex and often difficult to capture using traditional methods. This study investigated patients' hospital meal experiences using participant-driven-photo-elicitation (PDPE). PDPE invites respondents to photograph their daily lives and combines this with interviews, which can provide deeper insight into multisensory experiences beyond verbal or written discourse. The sample consisted of eight hospitalised patients. Patients completed a photo-essay of their hospital meal experience during a single day at a Danish hospital and afterwards participated in an open-ended interview. Two inductive analytical approaches were selected to assess the patients' reflections on their hospital meal experiences. First, the interview transcripts were analysed using the Semiotic Analysis approach using qualitative data analysis software NVivo 9. Second, the 91 produced photographs and the participants' engagement with the photographs were analysed by means of a Reflexive Content Analysis. The study found that PDPE is a research method that can be used for expanding the conceptualisation of hospital meal experiences, revealing the significance of the meal context, materiality and memories beyond food per se.

Physical activity and play in kindergarten age children.

PERISCOPE project assesses factors promoting or preventing obesity development in early age. A specific aim is to assess preschool children's physical activity habits in three different European countries. PERISCOPE has been implemented in 1094 children attending kindergartens in Denmark, Italy and Poland. The parents' and children's physical activity habits and attitudes assessed by a questionnaire filled by the parents. Overweight and obesity assessed by Cole's BMI cut-off points. Statistical analysis performed by χ(2) test and the test of proportion. Denmark shows the lowest rate (14.6 %) of overweight, followed by Poland (17.1%), while Italy shows the highest (21.2 %) (p < 0.0001). The Polish families show the highest rate of walking from home to kindergarten and back, followed by the Italians and, lastly, the Danish ones (p < 0.001). Almost all the Danish and Polish children, but only the 50.1 % of the Italians play outside (p < 0.001). During the weekdays, 34.9 % of Polish children, 22.2 % of Italians and 19.8 % of the Danish play outside more than one hour a day (p < 0.0001). During the weekend, 91.1 % of Polish children, 86.7 % of Danish children, but only 54.4 % of Italians play outside more than one hour (p < 0.0001). 53.5 % of Danish children, 31.9 % of Polish children, and 18.2 % of Italian ones practice sport (p < 0.0001). Danish children are the most active, the Polish are in the middle and the Italians are the least active. The difference in infrastructures (safety of walking streets, access to playgrounds/parks, etc.) can play an important role, in addition to cultural and social family characteristics, to the development of overweight.

Long-term sustainability of a worksite canteen intervention of serving more fruit and vegetables.

OBJECTIVE: To analyse the 5-year sustainability of a worksite canteen intervention of serving more fruit and vegetables (F&V). DESIGN: Average F&V consumption per customer per meal per day was assessed in five worksite canteens by weighing F&V served and subtracting waste. Data were collected by the canteen staff during a 3-week continuous period and compared to data from the same five canteens measured at baseline, at end point and at 1-year follow-up. The intervention used a participatory and empowering approach, self-monitoring and networking among the canteen staff, management and a consultant. The method focused on providing ideas for increased F&V for lunch, making environmental changes in the canteens by giving access to tasteful and healthy food choices and reducing the availability of unhealthy options. SETTING: Five Danish worksites serving from 50 to 500 meals a day: a military base, an electronic component distributor, a bank, a town hall and a waste-handling facility. SUBJECTS: Worksite canteen managers, canteen staff. RESULTS: Four of the five worksite canteens were able to either maintain the intervention or even increase the consumption of F&V. The average increase from baseline to 5-year follow-up was 95 g per customer per meal per day (18, 144, 66, 105 and 141 g, respectively). On average, the five canteens at the long-term follow-up had an F&V consumption of 208 g/meal per customer. CONCLUSIONS: The present study indicates that sustainability of F&V is possible in worksites where the participatory and empowering approach, self-monitoring, environmental change, dialogue with suppliers and networking among worksite canteens are applied.

The European view of hospital undernutrition.

Disease-related undernutrition is significant in European hospitals but is seldom treated or prevented. In 1999, the Council of Europe decided to collect information regarding nutrition programs in hospitals, and for this purpose, a network consisting of national experts from 12 of the Partial Agreement member states was established. The aim was to review the current practices in Europe regarding hospital food provision, to highlight deficiencies, and to issue recommendations to improve the nutritional care and support of hospitalized patients. Five major common problems were identified: 1) lack of clearly defined responsibilities, 2) lack of sufficient education, 3) lack of influence and knowledge of the patients, 4) lack of cooperation between different staff groups, and 5) lack of involvement from the hospital management. To solve the problems highlighted, a combined timely and concerted effort is required from national authorities and hospital staff, including managers, to ensure appropriate nutritional care and support.