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This study aims to assess the prevalence of different modes of commuting to school and work for 10–12 year-olds and their parents; to assess the associations with demographic variables (country, sex, parental education and ethnicity) and with weight status in eight European countries. As part of the ENERGY project a cross-sectional survey was conducted in 2010 in which modes of commuting and socio-demographic variables for children (N = 7903) and one of their parents (n = 6455) were measured by questionnaires. Children's weight and height were objectively measured; parents self-reported their weight and height. Logistic multilevel regression analyses assessed the associations between mode of commuting and overweight. Differences between countries and differences in mode of commuting according to demographic variables were tested using χ2-test and Marascuilo's Post-hoc analysis. There were marked differences between countries, especially regarding cycling to school, which was common in The Netherlands and Norway and rare in Greece and Spain. Demographic variables were associated with mode of commuting in children and parents. Mode of commuting was not associated with being overweight in children, after adjustment for demographic variables. Bicycling to work, but not other modes of commuting, was significantly inversely associated with being overweight among parents (OR = 0.74 (95%CI 0.57–0.97)). Interventions targeting active commuting may promote cycling, and should take into account the differences regarding demographic variables.

This individual patient data meta-analysis aimed to evaluate the effects of exercise on quality of life (QoL) and physical function (PF) in patients with cancer, and to identify moderator effects of demographic (age, sex, marital status, education), clinical (body mass index, cancer type, presence of metastasis), intervention-related (intervention timing, delivery mode and duration, and type of control group), and exercise-related (exercise frequency, intensity, type, time) characteristics. Relevant published and unpublished studies were identified in September 2012 via PubMed, EMBASE, PsycINFO, and CINAHL, reference checking and personal communications. Principle investigators of all 69 eligible trials were requested to share IPD from their study. IPD from 34 randomised controlled trials (n = 4519 patients) that evaluated the effects of exercise compared to a usual care, wait-list or attention control group on QoL and PF in adult patients with cancer were retrieved and pooled. Linear mixed-effect models were used to evaluate the effects of the exercise on post-intervention outcome values (z-score) adjusting for baseline values. Moderator effects were studies by testing interactions. Exercise significantly improved QoL (β = 0.15, 95%CI = 0.10;0.20) and PF (β = 0.18, 95%CI = 0.13;0.23). The effects were not moderated by demographic, clinical or exercise characteristics. Effects on QoL (βdifference_in_effect = 0.13, 95%CI = 0.03;0.22) and PF (βdifference_in_effect = 0.10, 95%CI = 0.01;0.20) were significantly larger for supervised than unsupervised interventions. In conclusion, exercise, and particularly supervised exercise, effectively improves QoL and PF in patients with cancer with different demographic and clinical characteristics during and following treatment. Although effect sizes are small, there is consistent empirical evidence to support implementation of exercise as part of cancer care. Alpe d’HuZes foundation/Dutch Cancer Society (VU 2011-5045) 8.122 JCR (2017) Q1, 21/222 Oncology 3.420 SJR (2017) Q1, 62/2878 Medicine (miscellaneous), 19/378 Oncology, 6/344 Radiology, Nuclear Medicine and Imaging No data IDR 2017 UEM

Objective: This study examined the occurrence and duration of sedentary bouts and explored the cross-sectional association with health indicators in children applying various operational definitions of sedentary bouts. Methods: Accelerometer data of 647 children (10-13 years old) were collected in five European countries. We analyzed sedentary time (. 100. cpm within bouts. Health indicators included anthropometrics (i.e. waist circumference and body mass index (BMI)) and in a subsample from two European countries (n. =. 112) fasting capillary blood levels of glucose, C-peptide, high-density- and low-density cholesterol, and triglycerides. Data collection took place from March to July 2010. Associations were adjusted for age, gender, moderate-to-vigorous physical activity, total wear time and country. Results: Occurrence of sedentary bouts varied largely between the various definitions. Children spent most of their sedentary time in bouts of >. 5. min while bouts of >. 20. min were rare. Linear regression analysis revealed few significant associations of sedentary time accumulated in bouts of >. 5-30. min with health indicators. Moreover, we found that more associations became significant when allowing no tolerance time within sedentary bouts. Conclusion: Despite a few significant associations, we found no convincing evidence for an association between sedentary time accumulated in bouts and health indicators in 10-13 year old children.

OBJECTIVES: The aim of study was to determine prevalence and identify demographic correlates of active and non-active gaming among adolescents.DESIGN: Cross-sectional.METHODS: A survey, assessing game behavior and correlates, was conducted among adolescents (12-16 years, n = 373), recruited via schools. Multivariable logistic regression analyses were conducted to examine demographic correlates of active gaming (≥ 1 h per week) and non-active gaming (>7h per week).RESULTS: Of all participants (n=373), 3% reported to play exclusively active games, 40% active games and non-active games, 40% exclusively non-active games, and 17% not playing video games at all. Active gaming adolescents played active games on average on 1.5 (sd = 1.2) days per school week for 36 (sd = 32.9)min and 1 (sd = 0.54) day per weekend for 42 (sd = 36.5)min. Non-active gaming adolescents played on average on 3.3 (sd = 1.6) days per school week for 65 (sd = 46.0)min and 1.4 (sd = 0.65) days per weekend for 80 (sd = 50.8)min. Adolescents attending lower levels of education were more likely to play active games ≥ 1 h per week than adolescents attending higher educational levels. Boys and older adolescents were more likely to play non-active games >7h per week, than girls or younger adolescents.CONCLUSIONS: Many adolescents play active games, especially those following a lower educational level, but time spent in this activity is relatively low compared to non-active gaming. To be feasible as a public health strategy, active gaming interventions should achieve more time is spent on active gaming at the expense of non-active gaming.

Objectives: This study aims to describe the time devoted to sedentary and physical activities at school in five European countries and to examine differences according to country, sex, ethnicity, parental education and weight status. Design: cross-European cross-sectional survey. Methods: Primary schoolchildren (n=1025) aged 10-12 years in Belgium, Greece, Hungary, the Netherlands, and Switzerland wore accelerometers for at least six consecutive days. Only weekdays were used for this study to calculate the percentages of school-time spent in sedentary activities and moderate to vigorous intensity activity. Trained research assistants measured height and weight. Sex and date of birth were self-reported by the child and parental education and ethnicity were parent-reported. Results: European schoolchildren spent on average 65% of their time at school in sedentary activities and 5% on moderate to vigorous intensity activities, with small differences between countries. Girls spent a significant larger amount of school-time in sedentary activities (67%) than boys (63%; p

Objective. Report frequencies of adolescents' active commuting to school in an inner city environment in the Netherlands, and to explore potential socio-demographic correlates of active commuting to school. Methods. Cross-sectional data were obtained from the ENDORSE study (2005-2006) including 1361 adolescents (response=82%), aged 12-15 from 16 schools in Rotterdam. Socio-demographic variables were assessed by questionnaire. height and weight were measured and distance to school was calculated based on route planner information. Multilevel logistic regressions were performed to analyze the data. Results. The proportions of participants categorized as walkers, cyclists, non-active commuters were 12%, 35% and 34% respectively. With cyclists as the reference category, adolescents of non-Western ethnic background were more likely to be walkers (OR=4.1; 95% CI=2.1-8.2) and non-active commuters (OR=5.1; 95% CI=3.3-7.9), compared to native Dutch adolescents. A further distance from home to school was inversely associated with being a walker (OR=0.22; 95% CI=0.17-0.29) and being a cyclist (OR=0.83; 95% CI=0.79-0.86) and positively associated with being a non-active commuter (OR=1.2; 95% CI=1.16-1.23). Conclusion. Almost 50% of the adolescents reported to actively commute to school on most school days, and mode of commuting was associated with ethnicity and distance. Further research is needed to examine main barriers to active commuting among adolescents from non-Western ethnic background. (C) 2008 Elsevier Inc. All rights reserved.

Background: Because students may purchase food and drinks in and around their schools, the school food environment may be important for obesity-related eating behaviors such as soft drink and snack consumption. However, research exploring the associations between school environments and specific eating behaviors is sparse. Methods: Associations of the availability of canteen food and drinks, the presence of food stores around schools, and individual cognitions (attitudes, norms, modeling, perceived behavioral control, and intentions) with soft drink and snack consumption were examined in a cross-sectional study (2005-2006) among 1293 adolescents aged 12-15 years. Soft drink and snack consumption and related cognitions were assessed with self-administered questionnaires. The presence of food stores and the distance to the nearest food store were calculated within a 500-meter buffer around each school. Data on the availability of soft drinks and snacks in school canteens were gathered by observation. In 2007, multilevel regression models were run to analyze associations and mediation pathways between cognitions, environmental factors, and behaviors. Results: Adolescents' attitudes, subjective norms, parental and peer modeling, and intentions were positively associated with soft drink and snack consumption. There was an inverse association between the distance to the nearest store and the number of small food stores with soft drink consumption. These effects were mediated partly by cognitions. Conclusions: This study provided little evidence for associations of environmental factors in the school environment with soft drink and snack consumption. Individual cognitions appeared to be stronger correlates of intake than physical school-environmental factors. Longitudinal research is needed to confirm these findings.

Objective: To test if basic training for dietitians in motivational interviewing (MI) resulted in changes in dietitians' counseling style and improvements in their patients' diet and risk parameters. Design: A randomized controlled trial. Setting: 9 home-care organizations in the Netherlands. Participants: 37 dietitians, 209 baseline patients, and 142 follow-up diabetes patients. Intervention: Dietitians were randomly allocated to receive basic training in motivational interviewing (MI dietitians, n=18) or not (control dietitians, n=19). Main Outcome Measures: Counseling style of dietitians; total self-reported saturated fat, fruit, and vegetable intake, measured body mass index (BMI), waist circumference, and glycated hemoglobin (Hemoglobin A1c, HbA1c) of patients. Analysis: Analyses of variance and multiple linear regression analyses. Alpha = .05. Results: MI dietitians were significantly more empathetic, more often showed reflection during consultations, and were more likely than control dietitians to let their patients talk for the majority of the consultation. Patients of MI dietitians had significantly lower saturated fat intake levels at posttest compared to patients of control dietitians. No effects on HbA1c, BMI, and waist circumference were found. Conclusions and Implications: Basic training in MI changed the dietitians' counseling style and resulted in lower saturated fat intakes in their patients.

Background The objective of this project was to assess the current nature and level of preventive actions that parents take to avoid unintentional poisoning among toddlers (11–18 months old). Methods In 2004, we conducted a cross-sectional observational survey with self-administered questionnaires among parents with toddlers ( n = 1722). Data were obtained on storage locations of medicines and cleaning products and supervision of children. Results Overall, 50.1% of the toddlers were exposed to unsafe storage of possible poisonous products in the home. Parents were more likely to store medicines safely than cleaning products, and products were most often stored unsafely in the kitchen, where children were left unattended most often (69%). Households with one child were associated with unsafe storage of both medicines and cleaning products. Lower educational level of the mother and unemployment of the mother were both associated with safe storage of medicines. Mother's ethnicity, the child's ability to walk, and the education level of the father were associated with storage of cleaning products. Conclusions The results of this study are an important first step for the development of effective interventions to reduce unintentional poisoning in toddlers’ homes.

Objective: The present study examined (1) whether respondents who were encouraged to make implementation intentions to eat more fruit increased their fruit intakes, as measured by three measures of fruit intake; (2) whether the effects of implementation intentions on fruit intake were dependent on positive goal intentions at baseline; and (3) the respondents' commitment to perform their implementation intentions. Design: Dutch adults (n = 535) were randomly assigned to either receive implementation intention instructions or not. Two questionnaires were completed with a 1.5-week time interval. Respondents in the implementation intention condition were asked to form implementation intentions to eat an extra serving of fruit per day during one week. Results: Respondents in the implementation intention group reported a high frequency of eating an extra serving of fruit per day. The implementation intention effect on frequency of extra fruit did not depend on goal intention at baseline. The more committed respondents were to carrying out their implementation intention, the more likely they were to increase their fruit intake. Conclusion: These results provide some indications that implementation intentions could be a useful strategy to induce a short-term increase in fruit intake. © 2006 SOCIETY FOR NUTRITION EDUCATION.

We investigated the association between the neighbourhood socioeconomic environment and physical inactivity, and explored the contribution of neighbourhood characteristics to this association. Data were analysed of 20-69 years old participants of the Dutch GLOBE study who lived in 78 neighbourhoods of Eindhoven (n = 8.767). The neighbourhood socioeconomic environment was assessed from aggregated self-reported information of participants' education and occupation level, and employment status. Aspects of physical inactivity investigated were based on the time spent on (a) walking and cycling to shops or work, (b) walking, cycling and gardening in leisure time, and (c) participation in sports activities. Characteristics of neighbourhoods included the proximity to food shops, general physical design of neighbourhoods, quality of green facilities, noise pollution from traffic and required police attention as evaluated by municipal services (professionals) responsible for these characteristics. Compared to those living in the most advantaged neighbourhoods, residents living in the quartile of socio-economically most disadvantaged neighbourhoods were more likely to walk or cycle to shops or work, but less likely to walk, cycle or garden in leisure time and less likely to participate in sports activities (adjusted for age, sex and individual educational level). Neighbourhood inequalities in walking or cycling to shops or work were not mediated by specific neighbourhood characteristics included in our analyses. The increased probability of almost never walking, cycling and gardening in leisure time in the most disadvantaged neighbourhoods was partly mediated by a poorer general physical design in these neighbourhoods. Similarly, the increased probability of almost never participating in sports activities in the most disadvantaged neighbourhoods was partly mediated by larger amounts of required police attention. The direction of neighbourhood inequalities differs for aspects of physical inactivity. Neighbourhood characteristics are related to physical inactivity and contribute to neighbourhood socioeconomic inequalities in physical inactivity.

The need for a better co-ordinated interdisciplinary approach to cancer is widely recognised. An analysis of strengths and weaknesses has emphasised the importance of a better understanding of the behavioural and social factors which determine the success of preventative and screening programmes and those which will enhace the quality of care and support available to patients and their families. The european commission provided funds to establish a consultation to formulate a strategy for the development of research in the behavioural, social and related sciences relevant to cancer. The key objectives were to inform research organisations of the steps necessary to enhance research capacity in these areas and identify the most productive directions for research in the forseeable future. The expert group identified 11 areas in which research might be expected to improve cancer control and treatment.

A randomised controlled trial with process evaluation was conducted ( n =103) to study the use and impact of a Frequently Asked Questions checklist as a means to prepare coronary outpatients for a regular visit to their cardiologist. It was hypothesised that use of the checklist would result in better patient–doctor communication, lower state anxiety and higher knowledge scores among patients, resulting in greater patient satisfaction. The patients in the experimental group ( n =53) received the checklist, with written instructions in addition to a brochure from the Dutch Heart Foundation, at home to prepare for their visit. The control patients only received the brochure. State anxiety immediately before the visit was significantly lower among experimental patients. No significant differences in patient satisfaction or knowledge were found. Using the checklist did not result in longer patient–doctor consultations. Experimental patients regarded the checklist as a useful tool to prepare for their visits to the clinic. We conclude that the checklist may be a useful tool for cardiac patients to prepare for their visits to their cardiologist.

Open University, Department of Social Sciences, Netherlands. HANS.BRUG@OUH.NLComputer-tailored nutrition education may be more effective than general nutrition education because messages are tailored to individual behavior, needs and beliefs of subjects. Therefore, the messages are likely to be of more personal relevance and may have stronger motivational effects. Computer-generated nutrition education has been studied for different dietary behaviors, in different target populations, and in different settings. In recent years, eight studies have been published that assessed the impact of comprehensive computer-generated nutrition interventions that were based on behavior change theory. In this article, the process of providing people with computer-tailored nutrition education is described and the studies on the impact of computer-tailored nutrition education are reviewed. The results point to the conclusion that computer-tailored nutrition education is more likely to be read, remembered, and experienced as personally relevant compared to standard materials. Furthermore, computer-tailored nutrition education also appears to have a greater impact in motivating people to change their diet, their fat intake in particular, although at present no definite conclusions can be drawn.

This issue of Patient Education and Counseling discusses the development, application and effectiveness of computer-tailored interventions. Computer-tailored interventions are a relatively new health education approach. The interventions are characterised by the fact that the content of the materials is adapted, with the aid of computers, to the specific characteristics of a particular person. The use of computers also facilitates addressing large segments of the population, who can now receive materials that are not general but highly individualized. This thematic issue features papers dealing with a wide range of topics. These articles describe the application of behavioural change theories to this new approach, the advantages of computer-tailored interventions over more general mass media approaches, their effectiveness and future directions for research on computer-tailored interventions. This editorial paper introduces computerised tailoring and provides a brief overview of its elements and applications as well as of the papers in this issue, and summarises the main conclusions and suggestions for future research on computer-tailored interventions.

This study reports the discrepancy between two methods to assess fruit and vegetable consumption in a Dutch adult population (N = 367). The consumption of fruit and vegetables was assessed by telephone interviews in two ways: it was estimated objectively by using a food frequency method (the number of grams of fruit and vegetables that subjects ate every day), and it was estimated subjectively by assessing the self-rated fruit and vegetable intake of subjects. Besides behavior, intention was measured in two ways: the intention to eat fruit and vegetables each day and the intention to eat more fruit and vegetables. Also, determinants were measured using a theoretical model including the attitude toward fruit and vegetable consumption, self-efficacy expectation, and the social influence to eat fruit and vegetables. Results show that there were large differences between the self-rated and estimated objective consumption of fruit and vegetables. Subjects rated their own intake as much higher than their estimated objective intake. Furthermore, multiple regression analyses show that the determinants predicted the self-rated consumption much better than the estimated objective consumption. Subjects who rated their own consumption as high had more positive beliefs concerning fruit and vegetable consumption, experienced more positive social influence to eat fruit and vegetables, and had higher self-efficacy expectations of being able to eat fruit and vegetables than subjects who rated their own consumption as low. It is concluded that nutrition education aimed at stimulating fruit and vegetable consumption should especially focus on making people aware of their own fruit and vegetable intake, in addition to changing attitudes and self-efficacy expectations.

In order to study the role of awareness of dietary fat intake as a possible factor in the process of dietary behavior change, data on 1507 adult subjects gathered in The Netherlands were analyzed. Objective assessments of dietary fat intake were compared to self-rated, or subjective, dietary fat intake among a Dutch study population. A majority of the respondents had an unrealistic view of their own fat intake. Men were more often unrealistic than women. Underestimation of fat intake was especially prevalent. Self-rated dietary fat intake, and not objectively assessed fat intake, proved to be a significant correlate of intention to reduce fat consumption in the near future among women. Psychosocial determinants of fat intake were stronger correlates of self-rated fat intake than of objectively assessed fat intake. It was concluded that underestimation of one's own dietary fat intake could be a major barrier in healthy diet promotion aimed at reducing fat consumption in The Netherlands. Therefore, improving dietary fat intake awareness should be given priority as a first step in healthy diet promotion strategies. Personal feedback and advice could be a means to improving the realistic estimation of dietary fat intake.

Introduction Within the ENERGY-project [1] , a school-based intervention to reduce and to break up sedentary time (UP4FUN) was developed for children aged 10 to 12 years. This study examined the UP4FUN intervention effect on objectively measured overall sedentary time and sedentary pattern variables among Belgian children. Sedentary pattern variables included number of breaks in sedentary time, number of sedentary bouts (≥ 10 minutes) and total and average amount of time spent in those sedentary bouts. Methods The six weeks intervention was tested in a randomized controlled trial with pre-test post-test design with five intervention and five control schools in Belgium. The total sample included 354 children from the 5th and 6th grade (mean age: 10.9 ± 0.7 years; 59% girls) with valid ActiGraph accelerometer data at both pre- and post-test. Multilevel analyses were conducted to take clustering of children in schools into account. Results There were no significant intervention effects on the overall sedentary time and only few and small intervention effects were found on sedentary pattern variables, namely on total time spent in sedentary bouts immediately after school hours (95% CI = –6.70; –0.31) and on average time spent in sedentary bouts before school hours (95% CI = –8.65; –1.00) and immediately after school hours (95% CI = –4.41; –1.02) in favour of children from intervention schools. Unexpectedly, girls from intervention schools decreased the number of breaks during school hours (95% CI = –34.37; –9.68) and increased the number of sedentary bouts on a weekend day (95% CI = 0.14;1.67), whereas girls in control schools showed an increase in number of breaks and a decrease in number of bouts. Conclusions In conclusion, UP4FUN did not have a consistent or substantial effect on children's overall sedentary time and on breaking up sedentary time. These data suggest that more intensive and longer lasting interventions are needed.

EMGO Institute for Health and Care Research and the Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The etherlands EMGO Institute for Health and Care Research and the Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The etherlands Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium The Federal Institute of Sport, Magglingen, Switzerland Department of Nutrition and Dietetics, Harokopio University of Athens, Athens, Greece Department of Paediatrics, University of Pecs, Pecs, Hungary