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Purpose. This study examined whether eating practices and psychosocial factors differed across stages of change for fruit and vegetables. Design. Data were collected using a self-administered written survey among a convenience sample of 739 Dutch adults. Response rate was 92%. Setting. Data were collected as part of the baseline assessment for a nutrition intervention study. Measures. Fruit and vegetable intake was measured as self-reported consumption with a validated eight-item food frequency questionnaire. Psychosocial variables were measured with six items on bipolar seven-point scales and stage-of-change classifications were based on separate four-item algorithms for fruits and vegetables. Differences in psychosocial factors and consumption were analyzed using one-way analysis of variance with Scheffé's multiple-comparison test. Results. Significant differences were found between stages of change in dietary intake, attitudes, self-efficacy, and judgment of one's own intake compared to others. Attitudes were most positive in preparation and action and least positive in precontemplation. Intake and self-efficacy were more positive in action/maintenance than in pre-action stages. Conclusions. The findings suggest that nutrition education aimed at encouraging higher intake of fruits and vegetables might be most effective if it is stage-tailored. Messages to influence attitudes about fruits and vegetables are likely to affect people in precontemplation, and self-efficacy information to increase confidence in overcoming barriers to consumption is likely to be effective with persons in contemplation and preparation stages.

Background: Mothers of eating disordered adolescents were more likely to have an eating disorder. However, some contradictory findings were reported because some studies failed to find this association. Aims: The main objective of the study was to determine the association of eating attitudes in adolescent girls with eating attitudes in their parents. Methods: A sample of 969 girls from Osona County (Barcelona, Spain) and their parents participated in the study. Girls completed the Eating Attitudes Test (EAT-26) and their weight and height were measured. Parents completed questionnaire with self-reported weight and height, demographic characteristics and EAT-26. Results: 10.1% of girls showed high EAT-26 scores (> 20 points), indicating abnormal eating attitudes. Female adolescents were almost three times more likely to have abnormal eating attitudes if their mothers scored high on EAT-26 (OR = 2.8; 95% CI 1.5—5.2). Other significant predictors of high EAT-26 scores were age and obesity. Conclusions: An abnormal eating attitude of the mother was identified as a potential risk factor in the development of eating disorders in female adolescents.

Purpose. To examine associations between decisional balance, self-efficacy, fruit intake, and stage of change transition from precontemplation and contemplation with cross-sectional and longitudinal methods. Design. A longitudinal cohort study with the use of electronic questionnaires was conducted. Three measurements were analyzed cross-sectionally, and the two intervals between the measurements were analyzed longitudinally. Setting. A random sample of 1500 individuals from an existing Dutch Internet panel resulted in a cohort of 735 individuals. Of the cohort, 648 (response rate 88%), 592 (response rate 81%), and 570 (response rate 78%) respondents completed questionnaires at the start of the present study (T1), 53 days after T1 (T2), and 106 days after T1 (T3), respectively. Subjects. Mean age was 37.5 years, 51% were women, and 57% ate less than the recommended intake of 250 g of fruit per day. Measures. Questionnaires included items measuring stage of change, factors favoring (pros) or working against (cons) behavior change, and self-efficacy. A food frequency questionnaire was used to assess fruit intake. Results. Logistic regression analyses showed that pros, fruit intake, and self-efficacy predicted forward stage transition from precontemplation. Self-efficacy predicted forward stage transition from contemplation. Cons did not predict stage transitions. Results from longitudinal analyses were similar to cross-sectional results, except for self-efficacy: no differences between early stages in self-efficacy were found, whereas self-efficacy predicted these early stage transitions. Conclusions. Within the limitations posed by the sampling frame, results provided support for the Transtheoretical Model, although determinants might not always be stage specific.

Objective: Sedentary behaviour is increasingly recognized as an important health risk, but comparable data across Europe are scarce. The objective of this study was to explore the prevalence and correlates of self-reported sitting time in adults across and within the 28 European Union Member States. Methods: This study reports data from the Special Eurobarometer 412. In 2013, 27,919 randomly selected Europeans (approximately 1000 per Member State) were interviewed face-to-face. Sitting time on a usual day was self-reported and dichotomised into sitting less- and more than 7.5 hours per day. Uni- and multivariate odds ratios of sitting more than 7.5 hours per day were assessed by country and socio-demographic variables using binary logistic regression analyses. The analyses were stratified by country to study the socio-demographic correlates of sitting time within the different countries. Results: A total of 26,617 respondents were included in the analyses. Median sitting time was five hours per day. Across Europe, 18.5 percent of the respondents reported to sit more than 7.5 hours per day, with substantial variation between countries (ranging from 8.9 to 32.1 percent). In general, northern European countries reported more sitting than countries in the south of Europe. 'Current occupation' and 'age when stopped education' were found to be the strongest correlates of sitting time, both across Europe and within most Member States. Compared to manual workers, the odds ratio of sitting more than 7.5 hours per day was 5.00 for people with white collar occupations, 3.84 for students, and 3.65 for managers. Conclusions: There is substantial variation in self-reported sitting time among European adults across countries as well as socio-demographic groups. While regular surveillance of (objectively measured) sedentary behaviour is needed, the results of this study provide entry points for developing targeted interventions aimed at highly sedentary populations, such as people with sedentary occupations.

Purpose. Assess whether family environmental factors affected changes in fruit and snack consumption among 12- to 14-year-old adolescents participating in a Dutch healthy diet promotion program. Design. Data were derived from pretest and posttest questionnaires completed by adolescents in 10 schools in the intervention arm of the program trial and questionnaires completed by their parents during program implementation. Setting. Lower vocational schools in the southern and central parts of The Netherlands. Subjects. Questionnaire answers of 502 parents were matched with those of their children. Intervention. Eight school lessons using various theory-based materials and strategies. Measures. Dietary intake, ethnicity, education level, employment status, parenting style, food purchase considerations, family food rules, and food availability and accessibility at home. Analysis. Regression analyses. Results. No significant family environmental predictors of program-induced changes in either fruit or snack intake were found. Conclusion. A limitation of the study was that all data were self-reported. No evidence was found that there were subgroups of adolescents who profited less from the program because of family environmental factors.

Purpose. To explore psychosocial correlates and predictors of stage transitions in the precaution adoption process model (PAPM) for fruit intake. Design. A cohort completed three electronic questionnaires, at baseline (time 0), 35 days later (time 1), and another 32 days later (time 2). Setting. Secured Internet Web site. Subjects. A cohort of 735 adults was formed from a random sample of an existing Internet panel. The mean age was 37.5 years, 51% were women, and 90% were of Dutch origin. Most respondents (48%) had a medium level of education. Measures. Precaution adoption process model stage, risk perception, perception of own fruit intake level, attitude, pros, cons, subjective norms, social support, modeling, self-efficacy, and fruit intake (assessed using a food frequency questionnaire). Analysis. Cross-sectional differences in psychosocial variables and fruit intake across PAPM stages at baseline were analyzed using analysis of variance with Tukey multiple comparisons tests. Predictors of PAPM stage transitions between time 0 and time 1 and between time 1 and time 2 were analyzed using logistic regression analysis. Results. Factors related to attitude and social influences may be important if one is to decide to act, whereas strong self-efficacy may also be required for acting on the decision to act. Conclusion. Although the results should be replicated in a larger and more representative sample, the PAPM seems a good framework for studying fruit intake.

Purpose. Public-private partnerships may help to promote healthy diets. We assessed customers' exposure to and the acceptability of a Dutch public-private healthy diet campaign in butcher's shops and investigated the effects on the purchase of lean meat and the use of liquid cooking margarine and potential behavioral determinants. Methods. The pretest-posttest control group design included 486 customers (242 experimental and 244 control) of butcher shops representing 64% of the original sample. Campaign exposure, acceptability, and behavioral effects were measured by a questionnaire. Results. Seventy-one percent of the customers noticed the campaign. Scores on the acceptability were positive to very positive. Regression analysis revealed that customers in the experimental condition evaluated the campaign better (B = .415; p < .05) and felt more encouraged to buy lean meat (B = .252; p < .05) than customers in the control condition. No effects on behavior were found. Discussion. Study design limitations included possible campaign exposure of control group participants. The study shows the feasibility and acceptability of a joint health-promoting activity through a public-private partnership, but there were no effects on behavior.

Abstract Background In 2006, the Dutch government initiated Hello World, an email-based program promoting healthy lifestyles among pregnant women through quizzes with pregnancy-related questions. In 2008, an updated version was released. The present study aimed to (1) examine the reach of Hello World and the representativeness of its users for all pregnant women in the Netherlands, (2) explore the relationship between program engagement and lifestyle characteristics, and (3) explore the relationship between the program content participants accessed (content on smoking, physical activity, and nutrition) and their lifestyle characteristics. Methods Data from 4,363 pregnant women were included. After registration, women received an online questionnaire with demographic and lifestyle questions. To evaluate their representativeness, their demographic characteristics were compared with existing data for Dutch (pregnant) women. Women were classified on the following lifestyle characteristics: smoking, nutrition, physical activity, and pre-pregnancy weight status. Program use was tracked and the relationships between lifestyle characteristics, program engagement, and the percentage of smoking, physical activity, and nutrition questions accessed after opening a quiz were explored using Mann–Whitney U tests and Kruskal-Wallis tests. Results Hello World reached ±4% of its target population. Ten percent of participants were low educated and 22% immigrants. On average, women received 6.1 (SD:2.8) quiz emails and opened 32% of the associated quizzes (2.0, SD:2.1). A significant positive association was found between the number of quizzes opened and the number of healthy lifestyle characteristics. After opening a quiz, women accessed most smoking, nutrition, and physical activity questions. Significant relationships were found between several lifestyle characteristics and the percentage of smoking, physical activity, and nutrition questions accessed. However, between-group differences were small, quiz topics were largely unrelated to their lifestyle characteristics, and inconsistencies were found regarding the directions of these associations. Conclusions Hello World reached ±4% of its target population, which is lower than the reach of its previous version (±8%). Relatively few low educated and immigrant women registered for the program. Active participation in the program was positively associated with the number of healthy behaviours participants engaged in. The program content participants chose to access was largely unrelated to their lifestyle characteristics.

Context: Multiple studies have been conducted on correlates of dietary behavior in adults, but a clear overview is currently lacking. Objective: An umbrella review, or review-of-reviews, was conducted to summarize and synthesize the scientific evidence on correlates and determinants of dietary behavior in adults. Data Sources: Eligible systematic reviews were identified in four databases: PubMed, PsycINFO, The Cochrane Library, and Web of Science. Only reviews published between January 1990 and May 2014 were included. Study Selection: Systematic reviews of observable food and dietary behavior that describe potential behavioral determinants of dietary behavior in adults were included. After independent selection of potentially relevant reviews by two authors, a total of 14 reviews were considered eligible. Data Extraction: For data extraction, the importance of determinants, the strength of the evidence, and the methodological quality of the eligible reviews were evaluated. Multiple observers conducted the data extraction independently. Data Synthesis: Social-cognitive determinants and environmental determinants (mainly the social-cultural environment) were included most often in the available reviews. Sedentary behavior and habit strength were consistently identified as important correlates of dietary behavior. Other correlates and potential determinants of dietary behavior, such as motivational regulation, shift work, and the political environment, have been studied in relatively few studies, but results are promising. Conclusions: The multitude of studies conducted on correlates of dietary behavior provides mixed, but sometimes quite convincing, evidence. However, because of the generally weak research design of the studies covered in the available reviews, the evidence for true determinants is suggestive, at best.

Background: The aim was to investigate which individual and family environmental factors are related to television and computer time separately in 10- to-12-year-old children within and across five European countries (Belgium, Germany, Greece, Hungary, Norway). Methods: Data were used from the ENERGY-project. Children and one of their parents completed a questionnaire, including questions on screen time behaviours and related individual and family environmental factors. Family environmental factors included social, political, economic and physical environmental factors. Complete data were obtained from 2022 child–parent dyads (53.8 % girls, mean child age 11.2 ± 0.8 years; mean parental age 40.5 ± 5.1 years). To examine the association between individual and family environmental factors (i.e. independent variables) and television/computer time (i.e. dependent variables) in each country, multilevel regression analyses were performed using MLwiN 2.22, adjusting for children's sex and age. Results and discussion: In all countries, children reported more television and/or computer time, if children and their parents thought that the maximum recommended level for watching television and/or using the computer was higher and if children had a higher preference for television watching and/or computer use and a lower self-efficacy to control television watching and/or computer use. Most physical and economic environmental variables were not significantly associated with television or computer time. Slightly more individual factors were related to children's computer time and more parental social environmental factors to children's television time. We also found different correlates across countries: parental co-participation in television watching was significantly positively associated with children's television time in all countries, except for Greece. A higher level of parental television and computer time was only associated with a higher level of children's television and computer time in Hungary. Having rules regarding children's television time was related to less television time in all countries, except for Belgium and Norway. Conclusions: Most evidence was found for an association between screen time and individual and parental social environmental factors, which means that future interventions aiming to reduce screen time should focus on children's individual beliefs and habits as well parental social factors. As we identified some different correlates for television and computer time and across countries, cross-European interventions could make small adaptations per specific screen time activity and lay different emphases per country. Keywords: Screen time, Children, Parents ; publishedVersion

Abstract Background The aim was to investigate which individual and family environmental factors are related to television and computer time separately in 10- to-12-year-old children within and across five European countries (Belgium, Germany, Greece, Hungary, Norway). Methods Data were used from the ENERGY-project. Children and one of their parents completed a questionnaire, including questions on screen time behaviours and related individual and family environmental factors. Family environmental factors included social, political, economic and physical environmental factors. Complete data were obtained from 2022 child–parent dyads (53.8 % girls, mean child age 11.2 ± 0.8 years; mean parental age 40.5 ± 5.1 years). To examine the association between individual and family environmental factors (i.e. independent variables) and television/computer time (i.e. dependent variables) in each country, multilevel regression analyses were performed using MLwiN 2.22, adjusting for children's sex and age. Results and discussion In all countries, children reported more television and/or computer time, if children and their parents thought that the maximum recommended level for watching television and/or using the computer was higher and if children had a higher preference for television watching and/or computer use and a lower self-efficacy to control television watching and/or computer use. Most physical and economic environmental variables were not significantly associated with television or computer time. Slightly more individual factors were related to children's computer time and more parental social environmental factors to children's television time. We also found different correlates across countries: parental co-participation in television watching was significantly positively associated with children's television time in all countries, except for Greece. A higher level of parental television and computer time was only associated with a higher level of children's television and computer time in Hungary. Having rules regarding children's television time was related to less television time in all countries, except for Belgium and Norway. Conclusions Most evidence was found for an association between screen time and individual and parental social environmental factors, which means that future interventions aiming to reduce screen time should .

Abstract Background This umbrella review aimed at identifying evidence-based conditions important for successful implementation of interventions and policies promoting a healthy diet, physical activity (PA), and a reduction in sedentary behaviors (SB). In particular, we examined if the implementation conditions identified were intervention-specific or policy-specific. This study was undertaken as part of the DEterminants of DIet and Physical Activity (DEDIPAC) Knowledge Hub, a joint action as part of the European Joint Programming Initiative a Healthy Diet for a Healthy Life. Methods A systematic review of reviews and stakeholder documents was conducted. Data from nine scientific literature databases were analyzed (95 documents met the inclusion criteria). Additionally, published documentation of eight major stakeholders (e.g., World Health Organization) were systematically searched (17 documents met the inclusion criteria). The RE-AIM framework was used to categorize elicited conditions. Across the implementation conditions 25 % were identified in at least four documents and were subsequently classified as having obtained sufficient support. Results We identified 312 potential conditions relevant for successful implementation; 83 of these received sufficient support. Using the RE-AIM framework eight implementation conditions that obtained support referred to the reach in the target population; five addressed efficacy of implementation processes; 24 concerned adoption by the target staff, setting, or institutions; 43 referred to consistency, costs, and adaptations made in the implementation process; three addressed maintenance of effects over time. The vast majority of implementation conditions (87.9 %; 73 of 83) were supported by documents referring to both interventions and policies. There were seven policy-specific implementation conditions, which focused on increasing complexities of coexisting policies/legal instruments and their consequences for implementation, as well as politicians' collaboration in implementation. Conclusions The use of the proposed list of 83 conditions for successful implementation may enhance the implementation of interventions and policies which pursue identification of the most successful actions aimed at improving diet, PA and reducing SB.

We examined explanatory pathways for the association between spatial access to fast food outlets and body weight in 5,076 European adults (18+). The total effect of spatial access to fast food outlets on self-reported weight status was examined using regression analyses accounting for clustering at the neighborhood level. Perceived availability and usage of fast food outlets, and fast food consumption, were considered as potential mediators and age, gender, socioeconomic status, and urban region as potential moderators. Spatial access to fast food outlets was not significantly related to weight status. Spatial access to fast food outlets was associated with perceptions about and usage of fast food outlets, and this was in turn associated with greater reported fast food consumption and unhealthier weight status. We found limited evidence for mediation effects and no evidence for effect modification.

This study assessed to what extent genetic and environmental factors contributed to individual differences in adolescent sleep duration, and whether genetic and environmental contributions to sleep duration changed throughout adolescence. A twin-family design was used to gain insight into the genetic and environmental contributions to variation in sleep duration. The study sample consisted of 6,319 adolescent twins (44% males) and 1,359 non-twin siblings (44% males) in the age range of 12 to 20 years (mean age = 16.85,SD= 1.40). The participants self-reported usual sleep duration, which was categorized as less than 8 hours per night, 8–9 hours per night, and more than 9 hours per night. Results showed that the prevalence of shorter than optimum sleep duration, that is, less than 8 hours per night, was high, with the highest prevalence rates in later adolescence. The contribution of genetic and environmental factors to individual differences in sleep duration was dependent on age. Variation in sleep duration at the age of 12 years was accounted for by genetic (boys: 34%, girls: 36%), shared environmental (boys: 28%, girls: 45%), and non-shared environmental factors (boys: 38%, girls: 19%). At the age of 20 years, the role of genetic (boys: 47%, girls: 33%) and non-shared environmental factors (boys: 53%, girls: 67%) was more pronounced. It can be concluded from the results that individual differences in sleep duration were accounted for by genetic and non-shared environmental factors throughout adolescence, whereas shared environmental factors account for a substantial part of variation during early adolescence only.