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Purpose.This study provides insight into decision making about food choices in the family and its relationship with (un)healthy eating, by including the responses of four members of the family as a sampling unit.Setting.The study was conducted through four medical centers, visited by 69 classes from 19 different schools in Belgium.Subjects.Ninety-two family quartets, including both parents and two adolescents between 12 and 18 years old, completed questionnaires independently.Measures.Four previously investigated measures of decision-making power (30 items on a seven-point scale) were administered, along with a short food choice questionnaire and demographic variables.Results.Results indicate that the influence of fathers but more especially that of children is important in food decisions. Moreover, the relative influence of each family member is dependent on the kind of product or product group considered. Differences in perceptions between the four family members show the importance of considering the responses of all the people involved in family decision making. Finally, it is clear that in families where adolescents have more power, food choices are less healthy.Conclusions.Our main conclusion is the rejection of the "gatekeeper hypothesis" as an artifact of biased measurement. A multidimensional approach to the issue of influence in food decision making in the family is potentially richer and leads to different conclusions. The necessity of the involvement of the entire family for the introduction and adoption of healthy eating is emphasized.

Considering the complexity of drug dependence and the multiplicity of services for substance abusers, co-ordination and continuity of care are important prerequisites for the quality of substance abuse treatment. However, several shortcomings concerning co-operation, communication and co-ordination have been reported in most European countries. In this study, different aspects of co-ordination and continuity (e.g. first contact, intake, referral, follow-up) have been studied among all services (n = 27) that are addressed by substance abusers in a clear-cut region in Belgium. Structured interviews with key informants show a lack of systematic communication between services and a lack of follow-up of clients. A study of 57 client records in 12 of these 27 centers illustrates that relatively little information is registered concerning the course of the treatment process and that only 10% of all client files contain a treatment plan. Following the introduction of a formalized plan that was regarded as a precondition for systematizing and optimizing communication between services, key informants considered the implementation of a model of case management as an appropriate way of improving co-ordination and continuity of care in this region.

Purpose.Explore the impact of general parenting style and specific food-related parenting practices on children's dietary habits.Design.Cross-sectional study of sixth graders and their parents.Setting.Data were gathered (in 2003) in 69 of 100 randomly selected elementary schools in Belgium.Subjects.All sixth graders (N = 1957) were invited to participate; 82.4% of their parents gave consent and completed questionnaires, resulting in 1614 parent-child pairs.Measures.Children's consumption of breakfast, fruit, vegetables, soft drinks, and sweets was assessed by self-administered food frequency questionnaires. Parents completed questionnaires on sociodemographic characteristics, general parenting styles (authoritarian, authoritative, indulgent, or neglecting) and specific food-related parenting practices (pressure, reward, encouragement through negotiation, catering on children's demands, permissiveness, avoiding negative modeling, and praise).Analysis.Logistic regression analyses were performed, with general parenting style and specific food-related parenting practices as predictors and dietary habits as dependent variables, controlling for sociodemographic characteristics and children's weight status.Results.General parenting style did not show any significant impact on dietary habits. In contrast, the food-related parenting practice "encouragement through negotiation" showed a significant positive impact, whereas "pressure," "catering on demand," and "permissiveness" were practices with an unhealthy impact.Conclusion.Nutrition education programs that guide parents in firm but not coercive food parenting skills are likely to have a positive impact upon children's dietary habits.

Purpose. This study investigated the variance in sitting, walking, and moderate and vigorous physical activity explained by neighborhood design and recreational environmental variables above and beyond the variance accounted for by individual demographic variables. Design. Cross-sectional analyses of self-reported survey data. Setting. A random sample of inhabitants of Ghent, Belgium, aged 18–65 years, was drawn. Subjects. Five hundred twenty-one adults completed questionnaires (52.1% response rate). The average age of the sample was 41 years, and 48.2% were female. Measures. A questionnaire developed to assess neighborhood design and recreational environmental variables with a total of 81 items was administered. The environmental questionnaire showed acceptable to good reliability and acceptable validity. The previously validated International Physical Activity Questionnaire (IPAQ) was used to quantify physical activity in the past 7 days. Additional demographic information was also obtained. Results. Regression analyses showed that environmental variables were related to all types of physical activity in both sexes. However, the range of variance explained by the models including demographic and environmental variables was low, only 5% to 13%. Minutes of walking and of moderate-intensity activity were related to quality of sidewalks and accessibility of shopping and public transportation. Vigorous physical activity was related to presence of activity supplies in the home and number of convenient activity facilities outside the home. Conclusions. Both neighborhood design and recreational environment variables had small but significant associations with multiple types of physical activity in a sample of Belgian adults.

In Western countries, the popularity of running events has increased exponentially during the last three decades. However, little is known about the profile of non-participants. This knowledge is crucial to tailor promotional actions towards people who are currently not participating. Therefore, this study aimed: (1) to examine which socio-ecological factors are related to participation in running events, (2) to give an overview of the barriers towards participation, and (3) to examine differences in barriers depending on gender, age and educational level. Flemish adults (n = 308) completed an online questionnaire about their socio-demographic and psychosocial characteristics, physical activity levels, participation in running events and barriers towards participation. Results showed that motivation, family social support, knowledge about running events and physical activity levels were associated with participation in running events. Among non-participants, the main barriers were bad physical condition, lack of time and lack of interest. In participants, lack of time, distance to the event and financial barriers were most prevalent. With some exceptions, barriers were relatively similar across socio-demographic subgroups. This study confirmed a democratization among participants of running events and provided evidence about which barriers should be tackled to increase participation among population subgroups that are currently underrepresented in such events.

Purpose. To examine if adults and adolescents living in the same high- and low-walkable neighborhoods have different environmental perceptions and if this is reflected in distinct associations between environmental perceptions and active transportation. Design. Cross-sectional study with observational design. Setting. In Ghent, 24 neighborhoods were selected, stratified on objectively assessed walkability, and matched on neighborhood income. This resulted in four walkability/income quadrants, each consisting of six neighborhoods. Subjects. Living in the 24 neighborhoods were 1166 adults (20–65 years, 52.1% women) and 477 adolescents (13–15 years, 49.7% girls). Measures. All participants completed a sociodemographic questionnaire, the International (adults) or Flemish (adolescents) Physical Activity Questionnaire and the Neighborhood Environmental Walkability Scale. Analysis. Multilevel (two-level: participant-neighborhood) moderated regression models, using MLwiN 2.23. Results. Both adults and adolescents living in objectively high-walkable neighborhoods perceived their environment as more activity friendly than their low-walkable neighborhoods counterparts (11 out of 13 main effects walkability: p < .05). However, perceived residential density (p < .05), land use mix (p < .01), safety for cycling (p < .05), and perceived walkability (p < .001) were associated with active transportation only in adults. Conclusion. Different environmental intervention strategies are probably needed to increase active transportation in Belgian adults and adolescents living in the same neighborhoods. In adults, changing objective or perceived environmental characteristics might be effective, whereas in adolescents, the current environmental focus should be changed towards multidimensional research.

Purpose. Neighborhood built environments are related to obesity and physical activity (PA), but inconsistently to sedentary behaviors. This study investigated the mediating effects of PA and sedentary time on the associations of neighborhood environmental factors and body mass index (BMI) among Nigerian adults. Design. The study design was cross-sectional. Setting. The study setting was metropolitan Maiduguri, Nigeria. Subjects. Nigerian adults (n = 1411) were randomly selected from diverse neighborhoods and had complete data (43.1% women, 33.8% overweight or obese). Measures. PA, sedentary time, and 16 perceived neighborhood environmental factors were measured using Nigerian adaptations of validated international questionnaires. Outcomes were measured BMI and interviewer-led self-reports of moderate to vigorous PA, walking, total PA, and sitting time. Analysis. The product-of-coefficient test using generalized linear models was used to assess the mediating effects of outcomes on the associations between environmental factors and BMI. Results. Walking and total PA significantly mediated the association between BMI and perception of higher residential density (αβ = –.025 and –.037, respectively), absence of garbage (αβ = –.046 and –.076, respectively), and more safety from crime at night (αβ = –.044 and –.083, respectively). In addition, walking, moderate to vigorous PA, and total PA significantly mediated the association between BMI and perception of better aesthetics (αβ = –.035, –.022, and –.071, respectively). Sedentary time was not a significant mediator of any associations between environmental factors and BMI. Conclusion. The association of several neighborhood environmental variables with BMI was partially mediated by PA in Nigerian adults. Including questions on specific types of sedentary behaviors in future prospective studies may improve understanding of the relative influence of sedentary behavior and physical activity on obesity control and prevention among sub-Saharan African adults.

AbstractAs cyberbullying is a phenomenon that is inherently social, the normative social influence of significant others can play an important role in the behaviour of adolescents involved in cyberbullying incidents. Using data from 525 adolescent bystanders of cyberbullying, we created a path model in order to investigate whether injunctive and descriptive norms of certain reference groups can cause bystanders to experience social pressure and join in cyberbullying. The results showed that social pressure fully mediated the relationship between the injunctive norm of friends approving of cyberbullying and joining in cyberbullying as a bystander. Furthermore, both the injunctive norm of parents approving of cyberbullying and bystanders' involvement in cyberbullying perpetration were related to joining in cyberbullying as a bystander.

BACKGROUND: Research on the influence of the physical environment on physical activity is rapidly expanding and different measures of environmental perceptions have been developed, mostly in the US and Australia. The purpose of this paper is to (i) provide a literature review of measures of environmental perceptions recently used in European studies and (ii) develop a questionnaire for population monitoring purposes in the European countries. METHODS: This study was done within the framework of the EU-funded project 'Instruments for Assessing Levels of Physical Activity and Fitness (ALPHA)', which aims to propose standardised instruments for physical activity and fitness monitoring across Europe. Quantitative studies published from 1990 up to November 2007 were systematically searched in Pubmed, Web of Science, TRIS and Geobase. In addition a survey was conducted among members of the European network for the promotion of Health-Enhancing Physical Activity (HEPA Europe) and European members of the International Physical Activity and Environment Network (IPEN) to identify published or ongoing studies. Studies were included if they were conducted among European general adult population (18+y) and used a questionnaire to assess perceptions of the physical environment. A consensus meeting with an international expert group was organised to discuss the development of a European environmental questionnaire. RESULTS: The literature search resulted in 23 European studies, 15 published and 8 unpublished. In these studies, 13 different environmental questionnaires were used. Most of these studies used adapted versions of questionnaires that were developed outside Europe and that focused only on the walkability construct: The Neighborhood Environment Walkability Scale (NEWS), the abbreviated version of the NEWS (ANEWS) and the Neighborhood Quality of Life Study (NQLS) questionnaire have been most commonly used. Based on the results of the literature review and the output of the meeting with international experts, a European environmental questionnaire with 49 items was developed. CONCLUSION: There is need for a greater degree of standardization in instruments/methods used to assess environmental correlates of physical activity, taking into account the European-specific situation. A first step in this process is taken by the development of a European environmental questionnaire.

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.