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Aims: There is a lack of longitudinal, population-based studies on the association between education and smoking cessation. A more thorough examination of this association is needed to address inequalities in smoking. Methods: The longitudinal Health 2000 Survey and Health 2011 Survey, representing the Finnish population aged ⩾30 years, were analysed. Of the 1352 baseline daily smokers, 945 (70%) provided a smoking status at the follow-up. The analytic sample size was 884 (excluding the follow-up occasional smokers). Self-reported questionnaire data and measurements (e.g. plasma cotinine) from the baseline were utilised. The outcome variable was smoking cessation at the follow-up, and the main explanatory variable was education. Logistic regression was the main method for statistical analyses. All of the analyses accounted for the sampling design. Results: At the follow-up, 28% of the baseline daily smokers had quit smoking. An adjusted regression model showed that highly educated respondents had a higher likelihood of quitting smoking compared with those with basic education. Controlling for demographic and health-related variables had a modest effect on this association. Higher scores for plasma cotinine, symptoms of depression and heavy alcohol use were associated with a lower likelihood of quitting smoking. The association between education and smoking cessation was weaker for women than it was for men. Conclusions: High education is associated with smoking cessation among the general adult population, especially among men. A higher plasma cotinine level is strongly associated with continued smoking among both sexes. Background variables only modestly affected the association between education and smoking cessation.

Background Perceived disease risk may reflect actual risk indicators and/or motivation to change lifestyle. Yet, few longitudinal studies have assessed how perceived risk relates to risk indicators among different disease risk groups. We examined in a 5-year follow-up, whether perceived risks of diabetes and cardiovascular disease predicted physical activity, body mass index (BMI kg/m2), and blood glucose level, or the reverse. We examined further whether perceived risk, self-efficacy, and outcome beliefs together predicted changes in these risk indicators. Method Participants were high diabetes risk participants (N = 432) and low/moderate-risk participants (N = 477) from the national FINRISK 2002 study who were followed up in 2007. Both study phases included questionnaires and health examinations with individual feedback letters. Data were analyzed using gender- and age-adjusted structural equation models. Results In cross-lagged autoregressive models, perceived risks were not found to predict 5-year changes in physical activity, BMI, or 2-h glucose. In contrast, higher BMI and 2-h glucose predicted 5-year increases in perceived risks (β-values 0.07–0.15, P-values β-values 0.10–0.16, P-values 0.005–0.034). Higher outcome beliefs predicted lower BMI among the low/moderate-risk sample (β-values − 0.04 to − 0.05, P-values 0.008–0.011). Conclusion Perceived risk of chronic disease rather follows risk indicators than predicts long-term lifestyle changes. To promote sustained lifestyle changes, future intervention studies need to examine the best ways to combine risk feedback with efficient behavior change techniques.

OBJECTIVE: Many adolescents report a lack of physical activity (PA) and excess screen time (ST). Psychological theories aiming to understand these behaviours typically focus on predictors of only one behaviour. Yet, behaviour enactment is often a choice between options. This study sought to examine predictors of PA and ST in a single model. Variables were drawn from dual process models, which portray behaviour as the outcome of deliberative and automatic processes. DESIGN: 411 Finnish vocational school students (age 17-19) completed a survey, comprising variables from the Reasoned Action Approach (RAA) and automaticity pertaining to PA and ST, and self-reported PA and ST four weeks later. MAIN OUTCOME MEASURES: Self-reported time spent on PA and ST and their predictors. RESULTS: PA and ST correlated negatively (r = -.17, p = .03). Structural equation modelling revealed that intentions and habit for PA predicted PA while ST was predicted by intentions and habit for ST and negatively by PA intentions. RAA-cognitions predicted intentions. CONCLUSION: PA and ST and their psychological predictors seem to be weakly interlinked. Future studies should assess more behaviours and related psychological influences to get a better picture of connections between different behaviours. UNLABELLED: HighlightsPhysical activity and screen time are largely mutually exclusive classes of behaviours and might therefore be related in terms of their psychological predictors.411 adolescent vocational school students self-reported variables from the Reasoned Action Approach and behavioural automaticity related to physical activity and leisure time screen time behaviours as well as those behaviours.Structural equation modelling revealed expected within-behaviour predictions but, against expectations, no strong connections between the two behaviour classes in terms of their predictors. Only intentions to engage in physical activity negatively predicted screen time.Future research should aim to measure a wider range of mutually exclusive classes of behaviours that cover a large share of the day to uncover relations between behaviours and their respective predictors. publishedVersion

Studies indicate that the healthy Nordic diet may improve heart health, but its relation to weight change is less clear. We studied the association between the adherence to the healthy Nordic diet and long-term changes in weight, BMI and waist circumference. Furthermore, the agreement between self-reported and measured body anthropometrics was examined. The population-based DIetary, Lifestyle and Genetic Determinants of Obesity and Metabolic syndrome Study in 2007 included 5024 Finns aged 25–75 years. The follow-up was conducted in 2014 (n 3735). One-third of the participants were invited to a health examination. The rest were sent measuring tape and written instructions along with questionnaires. The Baltic Sea Diet Score (BSDS) was used to measure adherence to the healthy Nordic diet. Association of the baseline BSDS and changes in BSDS during the follow-up with changes in body anthropometrics were examined using linear regression analysis. The agreement between self-reported and nurse-measured anthropometrics was determined with Bland–Altman analysis. Intra-class correlation coefficients between self-reported and nurse-measured anthropometrics exceeded 0·95. The baseline BSDS associated with lower weight (β=−0·056, P=0·043) and BMI (β=−0·021, P=0·031) over the follow-up. This association was especially evident among those who had increased their BSDS. In conclusion, both high initial and improved adherence to the healthy Nordic diet may promote long-term weight maintenance. The self-reported/measured anthropometrics were shown to have high agreement with nurse-measured values which adds the credibility of our results.

Food Go/No-Go training aims to alter implicit food biases by creating associations between perceiving unhealthy foods and withholding a dominant response. Asking participants to repeatedly inhibit an impulse to approach unhealthy foods can decrease unhealthy food intake in laboratory settings. Less is known about how people engage with app-based Go/No-Go training in real-world settings and how this might relate to dietary outcomes. This pragmatic observational study investigated associations between the number of completed app-based food Go/No-Go training trials and changes in food intake (Food Frequency Questionnaire; FFQ) for different healthy and unhealthy food categories from baseline to one-month follow-up. In total, 1234 participants (m(BMI) = 29 kg/ m2, m(age) = 43years, 69% female) downloaded the FoodT app and completed food-Go/No-Go training at their own discretion (mean number of completed sessions = 10.7, sd = 10.3, range: 1-122). In pre-registered analyses, random-intercept linear models predicting intake of different foods, and controlled for baseline consumption, BMI, age, sex, smoking, metabolic syndrome, and dieting status, revealed small, significant associations between the number of completed training trials and reductions in unhealthy food intake (b = -0.0005, CI95 = [-0.0007;0.0003]) and increases in healthy food intake (b = 0.0003, CI95 = [0.0000; 0.0006]). These relationships varied by food category, and exploratory analyses suggest that more temporally spaced training was associated with greater changes in dietary intake. Taken together, these results imply a positive association between the amount of training completed and beneficial changes in food intake. However, the results of this pragmatic study should be interpreted cautiously, as self-selection biases, motivation and other engagement-related factors that could underlie these associations were not accounted for. Experimental research is needed to rule out these possible confounds and establish causal dose-response relationships between patterns of engagement with food Go/No-Go training and changes in dietary intake.

Background Prechoolers’ significant portions of sedentary time (ST) is a public-health concern due to its high prevalence and negative health consequences. However, few studies have explored correlates of preschoolers’ ST covering individual-, home- and preschool- factors within one study. The aim of this study was to identify the associations between multiple individual-, home- and preschool-level factors and preschoolers’ ST. In addition, it was studied how much individual-, home- and preschool-level factors explained the variance in children’s ST. Methods A total of 864 children aged three to six, their parents and 66 preschools participated in the cross-sectional DAGIS study, which occurred between 2015 and 2016. The children wore an accelerometer for 1 week. Guardians, principals and early educators completed questionnaires covering the potential correlates of children’s ST, for example, temperament, practices, self-efficacy and regulations. Multilevel regression analyses were conducted in multiple steps; calculation of marginal and conditional R2 values occurred in the final phase. Results Of the 29 studied correlates, the following factors remained significant in the final models. Being a boy (p p p = 0.014) were associated with lower ST. Higher parental perceived barriers related to children’s outside PA (p = 0.032) was associated with higher ST. None of the preschool setting factors remained significant in the final model. Approximately 11% of the variance in children’s ST was attributed to factors related to the individual level whereas 5% was attributed to home-level factors; and 2% to preschool-level factors. Conclusions This study identified a set of correlates of preschool children’s ST. Interventions aimed at reducing children’s ST should develop strategies targeting established correlates of preschoolers’ ST covering individual-, home- and preschool-level factors. The preschool-level factors included in this study explained little the variance in children’s ST. However, the included measures may not have captured the essential preschool-level factors that specifically influence children’s ST. Therefore, more studies are needed regarding potential preschool-level factors.

Background Emotional eating (i.e. eating in response to negative emotions) has been suggested to be one mechanism linking depression and subsequent development of obesity. However, studies have rarely examined this mediation effect in a prospective setting and its dependence on other factors linked to stress and its management. We used a population-based prospective cohort of adults and aimed to examine 1) whether emotional eating mediated the associations between depression and 7-year change in body mass index (BMI) and waist circumference (WC), and 2) whether gender, age, night sleep duration or physical activity moderated these associations. Methods Participants were Finnish 25- to 74-year-olds who attended the DILGOM study at baseline in 2007 and follow-up in 2014. At baseline (n = 5024), height, weight and WC were measured in a health examination. At follow-up (n = 3735), height, weight and WC were based on measured or self-reported information. Depression (Center for Epidemiological Studies - Depression Scale), emotional eating (Three-Factor Eating Questionnaire-R18), physical activity and night sleep duration were self-reported. Age- and gender-adjusted structural equation models with full information maximum likelihood estimator were used in the analyses. Results Depression and emotional eating were positively associated and they both predicted higher 7-year increase in BMI (R2 = 0.048) and WC (R2 = 0.045). The effects of depression on change in BMI and WC were mediated by emotional eating. Night sleep duration moderated the associations of emotional eating, while age moderated the associations of depression. More specifically, emotional eating predicted higher BMI (P = 0.007 for the interaction) and WC (P = 0.026, respectively) gain in shorter sleepers (7 h or less), but not in longer sleepers (9 h or more). Depression predicted higher BMI (P

Preschool children&rsquo, s high levels of sedentary time (ST) is a public health concern. As preschool reaches a large population of children from different socioeconomic status (SES) backgrounds, more knowledge on how the preschool setting is associated with children&rsquo, s ST is relevant. Our aims were to examine (1) the associations of preschool setting (covering social, physical, and organizational level) with children&rsquo, s ST, and (2) the moderating role of the setting on the association between parental SES and children&rsquo, s ST. In the cross-sectional DAGIS (increased health and wellbeing in preschools) study, the participating children (n = 864, aged 3&ndash, 6 years) were asked to wear an accelerometer for one week. In total, 779 children had valid ST accelerometer data during preschool hours. Preschool setting and parental SES was assessed by questionnaires and observation. Multilevel linear regression models with cross-level interactions were applied to examine the associations. Early educators&rsquo, practice of breaking children&rsquo, s ST often, more frequent physical activity (PA) theme weeks, and higher number of physical education (PE) lessons were associated with lower children&rsquo, s ST. Higher parental SES was associated with higher children&rsquo, s ST in preschools (1) with organized sedentary behavior theme weeks, (2) with a lower number of PA theme weeks, and (3) with a lower number of PE lessons. The factors identified in this study could be targeted in future interventions.

Aims: Swedish smokeless tobacco (snus) is a lower-risk tobacco product than cigarette smoking for individuals. However, the public health impact of snus use is less well studied. Critically, it is uncertain whether use of snus leads to the onset of smoking. This study aimed to investigate prospectively the association between snus experimentation in late adolescence and daily cigarette smoking in early adulthood among Finnish young men. Methods: Data were obtained from 1090 young men within the population-based FinnTwin12 cohort. At baseline (mean age 17 years), we assessed lifetime use of cigarettes and snus, plus other potential predictors of cigarette smoking. At follow-up (mean age 24 years), participants were categorized according to their current smoking status. The final analyses were conducted among 375 young men who were never smokers at baseline with adequate data on follow-up smoking status and other potential predictors of cigarette smoking. Results: Age-adjusted logistic regressions showed an increased risk of becoming a daily smoker at follow-up among those participants who had at least tried snus but had never smoked cigarettes at baseline (odds ratio (OR) 6.48, 95% confidence interval (CI) 2.02–20.7), compared with those who had never used snus. When additionally adjusted for monthly alcohol intoxication, maternal smoking, and peer drug use, the association between snus experimentation and later daily cigarette smoking was attenuated, but remained significant (OR 3.94, 95% CI 1.22–12.7). Conclusions: Our data support the proposition that snus experimentation during late adolescence is longitudinally associated with daily cigarette smoking in early adulthood. Although a causal association cannot be inferred with certainty, snus experimentation might constitute an indicator of the propensity to proceed to regular snus use and initiation of use of other tobacco or nicotine products.

Go/No‐Go tasks, which require participants to inhibit automatic responses to images of palatable foods, have shown diagnostic value in quantifying food‐related impulses. Moreover, they have shown potential for training to control impulsive eating. To test the hypothesis that training modulates early neural markers of response inhibition, the current study investigated how the N2 event‐related brain potential to high‐ and low‐calorie food images changes along Go‐/No‐Go training and how the N2 is related to later eating behavior. 50 healthy adults, (mBMI = 23.01) first completed a food Go/No‐Go task in which high‐ and low‐calorie food images were accompanied by Go‐and No‐Go‐cues with equal frequency. Participants then completed a training block in which high‐calorie foods were predominantly paired with a No‐Go cue and the low‐calorie foods with a Go cue, followed by a block with reversed coupling (order of the training blocks counterbalanced between participants). After each training, there was a snacking opportunity during which calorie intake was measured. Against our preregistered hypotheses, the N2‐amplitudes were not significantly affected by the calorie‐content and there was no training‐related modulation in the N2. In addition , food intake was not influenced by the preceding training blocks and the N2 amplitude did not predict the food intake. Our study suggests that the link between N2 obtained in a food‐related Go/No‐Go task and impulse control is not clear‐cut and may be limited to specific task characteristics. The results are of high importance as they question the previously assumed mechanism of Go/No‐Go training in food‐related inhibitory control.

Purpose This study examined the developmental trajectories of self-esteem and body mass index (BMI) from adolescence to mid-adulthood and the way the association between self-esteem and BMI changed during a 26-year follow-up. Methods Participants of a Finnish cohort study in 1983 at 16 years (N = 2194) were followed up at ages 22 (N = 1656), 32 (N = 1471), and 42 (N = 1334) using postal questionnaires. Measures at each time point covered self-esteem and self-reported weight and height. Analyses were done using latent growth curve models (LGM) and difference scores. Results In LGM analyses among females both the initial levels (r = -0.13) and slopes (r = -0.26) of the self-esteem and BMI trajectories correlated negatively. Among males, there were no significant correlations between self-esteem and BMI growth factors. The association between increasing BMI and decreasing self-esteem among females was strongest between ages 22 and 32 (r = -0.16), while among males, increases in BMI and self-esteem correlated positively (r = 0.11) during that period. Among females, cross-sectional correlations between self-esteem and BMI showed an increasing trend (p

OBJECTIVES: There is no consensus on whether cognitive control over food intake (that is, restrained eating) is helpful, merely ineffective or actually harmful in weight management. We examined the interplay between genetic risk of obesity, restrained eating and changes in body weight and size. METHODS: Participants were Finnish aged 25-74 years who attended the Dietary. Lifestyle and Genetic determinants of Obesity and Metabolic syndrome study at baseline in 2007 and follow-up in 2014. At baseline (n=5024), height, weight and waist circumference (WC) were measured in a health examination and participants self-reported their weight at age 20 years. At follow-up (n=3735), height, weight and WC were based on measured or self-reported information. We calculated 7-year change in body mass index (BMI) and WC and annual weight change from age 20 years to baseline. Three-Factor Eating Questionnaire-R18 was used to assess restrained eating. Genetic risk of obesity was assessed by calculating a polygenic risk score of 97 known BMI-related loci. RESULTS: Cross-lagged autoregressive models indicated that baseline restrained eating was unrelated to 7-year change in BMI (beta=0.00; 95% confidence interval (CI) =-0.01, 0.02). Instead, higher baseline BMI predicted greater 7-year increases in restrained eating (beta = 0.08; 95% CI =0.05, 0.11). Similar results were obtained with WC. Polygenic risk score correlated positively with restrained eating and obesity indicators in both study phases, but it did not predict 7-year change in BMI or WC. However, individuals with higher genetic risk of obesity tended to gain more weight from age 20 years to baseline, and this association was more pronounced in unrestrained eaters than in restrained eaters (P=0.038 for interaction). CONCLUSIONS: Our results suggest that restrained eating is a marker for previous weight gain rather than a factor that leads to future weight gain in middle-aged adults. Genetic influences on weight gain from early to middle adulthood may vary according to restrained eating, but this finding needs to be replicated in future studies.

Background Literature on persuasion suggests compliance increases when requests are accompanied with a reason (i.e. the “because-heuristic”). The reliability of outcomes in physical activity research is dependent on sufficient accelerometer wear-time. This study tested whether SMS reminders—especially those that provided a rationale—are associated with increased accelerometer wear-time. Methods We conducted a within-trial partially randomised controlled trial during baseline data collection in a school-based physical activity intervention trial. Of 375 participants (mean age = 18.1), 280 (75%) opted to receive daily SMS reminders to wear their accelerometers. These 280 participants were then randomised to receive either succinct reminders or reminders including a rationale. Data was analyzed across groups using both frequentist and Bayesian methods. Results No differences in total accelerometer wear minutes were detected between the succinct reminder group (Mdn = 4909, IQR = 3429–5857) and the rationale group (Mdn = 4808, IQR = 3571–5743); W = 8860, p = 0.65, CI95 = − 280.90–447.20. Similarly, we found no differences in wear time between participants receiving SMS reminders (Mdn = 4859, IQR = 3527–5808) and those not receiving them (Mdn = 5067, IQR = 3201–5885); W = 10,642.5, p = 0.77, CI95 = − 424.20–305.30. Bayesian ANOVA favored a model of equal weartime means, over one of unequal means, by a Bayes Factor of 12.05. Accumulated days of valid accelerometer wear data did not differ either. Equivalence testing indicated rejection of effects more extreme than a Cohen’s d (standardised mean difference) of ±~0.3. Conclusions This study casts doubt on the effectiveness of using the because-heuristic via SMS messaging, to promote accelerometer wear time among youth. The because-heuristic might be limited to face-to-face communication and situations where no intention for or commitment to the behavior has yet been made. Other explanations for null effects include non-reading of messages, and reminder messages undermining the self-reminding strategies which would occur naturally in the absence of reminders. Trial registration DRKS DRKS00007721. Registered 14.04.2015. Retrospectively registered. Electronic supplementary material The online version of this article (10.1186/s12889-018-6121-2) contains supplementary material, which is available to authorized users.

Dual-process models integrate deliberative and impulsive mental systems and predict dietary behaviours better than deliberative processes alone. Computerised tasks such as the Go/No-Go, Stop-Signal, Approach-Avoidance, and Evaluative Conditioning have been used as interventions to directly alter implicit biases. This meta-analysis examines the effects of these tasks on dietary behaviours, explores potential moderators of effectiveness, and examines implicit bias change as a proposed mechanism. Thirty randomised controlled trials testing implicit bias interventions (47 comparisons) were included in a random-effects meta-analysis, which indicated small cumulative effects on eating-related behavioural outcomes (g = −0.17, CI95 = [−0.29; −0.05], p = .01) and implicit biases (g = −0.18, CI95 = [−0.34; −0.02], p = .02). Task type moderated these effects, with Go/No-Go tasks producing larger effects than other tasks. Effects of interventions on implicit biases were positively related to effects on eating...

Theories of behaviour change and health behaviour change interventions are most often evaluated in between-person designs. However, behaviour change theories apply to individuals not groups and behavioural interventions ultimately aim to achieve within-person rather than between-group change. Within-person methodology, such as N-of-1 (also known as single case design), can circumvent this issue, though has multiple design-specific challenges. This paper provides a conceptual review of the challenges and potential solutions for undertaking N-of-1 studies in health psychology. Key challenges identified include participant adherence to within-person protocols, carry-over and slow onset effects, suitability of behaviour change techniques for evaluation in N-of-1 experimental studies, optimal allocation sequencing and blinding, calculating power/sample size, and choosing the most suitable analysis approach. Key solutions include involving users in study design, employing recent technologies for unobtrusive data collection and problem solving by design. Within-person designs share common methodological requirements with conventional between-person designs but require specific methodological considerations. N-of-1 evaluation designs are appropriate for many though not all types of interventions. A greater understanding of patterns of behaviours and factors influencing behaviour change at the within-person level is required to progress health psychology into a precision science. Video abstract: Supplementary Material 1.

The introduction of Web 2.0 technology, along with a population increasingly proficient in Information and Communications Technology (ICT), coupled with the rapid advancements in genetic testing methods, has seen an increase in the presence of participant-centred research initiatives. Such initiatives, aided by the centrality of ICT interconnections, and the ethos they propound seem to further embody the ideal of increasing the participatory nature of research, beyond what might be possible in non-ICT contexts alone. However, the majority of such research seems to actualise a much narrower definition of ‘participation’—where it is merely the case that such research initiatives have increased contact with participants through ICT but are otherwise non-participatory in any important normative sense. Furthermore, the rhetoric of participant-centred initiatives tends to inflate this minimalist form of participation into something that it is not, i.e. something genuinely participatory, with greater connections with both the ICT-facilitated political contexts and the largely non-ICT participatory initiatives that have expanded in contemporary health and research contexts. In this paper, we highlight that genuine (ICT-based) ‘participation’ should enable a reasonable minimum threshold of participatory engagement through, at least, three central participatory elements: educative, sense of being involved and degree of control. While we agree with criticisms that, at present, genuine participation seems more rhetoric than reality, we believe that there is clear potential for a greater ICT-facilitated participatory engagement on all three participatory elements. We outline some practical steps such initiatives could take to further develop these elements and thereby their level of ICT-facilitated participatory engagement., This study was funded by COST (grant number = COST Action IS1303); Brigida Riso is supported by FCT-the Portuguese Foundation for Science and Technology under the PhD grant SFRH/BD/100779/2014.

Background Designing evidence-based interventions to address socioeconomic disparities in health and health behaviours requires a better understanding of the specific explanatory mechanisms. We aimed to investigate a comprehensive range of potential theoretical mediators of physical activity (PA) and screen time in different socioeconomic status (SES) groups: a high SES group of high school students, and a low SES group of vocational school students. The COM-B system, including the Theoretical Domains Framework (TDF), was used as a heuristic framework to synthesise different theoretical determinants in this exploratory study. Methods Finnish vocational and high school students (N = 659) aged 16–19, responded to a survey assessing psychological, social and environmental determinants of activity (PA and screen time). These determinants are mappable into the COM-B domains: capability, opportunity and motivation. The outcome measures were validated self-report measures for PA and screen time. The statistical analyses included a bootstrapping-based mediation procedure. Results Regarding PA, there were SES differences in all of the COM-B domains. For example, vocational school students reported using less self-monitoring of PA, weaker injunctive norms to engage in regular PA, and fewer intentions than high school students. Mediation analyses identified potential mediators of the SES-PA relationship in all of three domains: The most important candidates included self-monitoring (CI95 for b: 0.19–0.47), identity (0.04–0.25) and material resources available (0.01–0.16). However, SES was not related to most determinants of screentime, where there were mainly gender differences. Most determinants were similarly related with both behaviours in both SES groups, indicating no major moderation effect of SES on these relationships. Conclusions This study revealed that already in the first years of educational differentiation, levels of key PA determinants differ, contributing to socioeconomic differences in PA. The analyses identified the strongest mediators of the SES-PA association, but additional investigation utilising longitudinal and experimental designs are needed. This study demonstrates the usefulness of combining constructs from various theoretical approaches to better understand the role of distinct mechanisms that underpin socioeconomic health behaviour disparities.

Background. As school days among adolescents include long periods of prolonged sitting, teachers are key agents to deliver interventions to reduce youth sedentary behavior. To develop an intervention, acceptability and feasibility of alternative strategies should be tested. We aimed to examine teachers’ current use and willingness to use various strategies to decrease student sitting and potential barriers and facilitators of use. Method. Mixed-methods design with college teachers using an online cross-sectional survey (n = 192) and focus group interviews (n = 13). Findings. Although a vast majority (87%) of the teachers found reducing prolonged sitting an important goal, only 47% were actually including practices to reduce sitting in their classroom. 89% of the teachers reported willingness to use at least one of the five alternative strategies presented. Focus groups revealed a discussion emphasis on environmental opportunity and motivation as key to implementation. Teachers also generated additional ideas for intervention content. Discussion. Despite low levels of current sitting reduction, teachers were willing to try at least one strategy to reduce sitting. Results informed intervention development regarding parameters of use for each strategy. When possible, interventions should provide teachers with a variety of alternative strategies that are easy to use to reduce prolonged sitting.

This study tested the predictive validity of a multitheory process model in which the effect of autonomous motivation from self-determination theory on physical activity participation is mediated by the adoption of self-regulatory techniques based on control theory. Finnish adolescents (N = 411, aged 17–19) completed a prospective survey including validated measures of the predictors and physical activity, at baseline and after one month (N = 177). A subsample used an accelerometer to objectively measure physical activity and further validate the physical activity self-report assessment tool (n = 44). Autonomous motivation statistically significantly predicted action planning, coping planning, and self-monitoring. Coping planning and self-monitoringmediated the effect of autonomous motivation on physical activity, although self-monitoring was the most prominent. Controlled motivation had no effect on self-regulation techniques or physical activity. Developing interventions that support autonomous motivation for physical activity may foster increased engagement in self-regulation techniques and positively affect physical activity behavior.

Family history is a useful and inexpensive tool to assess risks of multifactorial diseases. Family history enables individualized disease prevention, but its effects on perceived risks of various diseases need to be understood in more detail. We examined how family history relates to perceived risk of diabetes mellitus, cardiovascular disease (CVD), cancer, and depression, and whether these associations are independent of or moderated by sociodemographic factors, health behavior/weight status (smoking, alcohol consumption, physical activity, BMI [kg/m(2)]), or depressive symptoms.Participants were Finnish 25-74-year-olds (N=6258) from a population-based FINRISK 2007 study. Perceived absolute lifetime risks (Brewer et al., 2004; Becker, 1974; Weinstein and Nicolich, 1993; Guttmacher et al., 2004; Yoon et al., 2002) and first-degree family history of CVD, diabetes, cancer and depression, and health behaviors were self-reported. Weight and height were measured in a health examination.Family history was most prevalent for cancer (36.7%), least for depression (19.6%). Perceived risk mean was highest for CVD (2.8), lowest for depression (2.0). Association between family history and perceived risk was strongest for diabetes (β=0.34, P0.001), weakest for depression (β=0.19, P0.001). Adjusting for sociodemographics, health behavior, and depressive symptoms did not change these associations. The association between family history and perceived risk tended to be stronger among younger than among older adults, but similar regardless of health behaviors or depressive symptoms.Association between family history and perceived risk varies across diseases. People's current understandings on heritability need to be acknowledged in risk communication practices. Future research should seek to identify effective strategies to combine familial and genetic risk communication in disease prevention.

ObjectiveA low socio-economic status (SES) is related to less healthy dietary habits, but the reasons for this remain unclear. We examined whether the absolute or relative importance of various food choice motives contributed to SES disparities in vegetable/fruit and energy-dense food intake.DesignWe analysed cross-sectional data from the FINRISK Study 2007 by means of structural equation modelling and used a shortened version of the Food Choice Questionnaire to assess the absolute importance of health, pleasure, convenience, price, familiarity and ethicality motives. We calculated the relative importance of each motive by dividing the participant's rating of it by his/her mean score on all motives. Dietary intake was measured with an FFQ.SettingA population-based survey in Finland.SubjectsMen (n 1691) and women (n 2059) aged 25–64 years.ResultsHigher education and income were related to a greater vegetable/fruit intake (β = 0·12, P < 0·001), while education was associated negatively with the consumption of energy-dense foods (β = −0·09, P < 0·001). Socio-economically disadvantaged individuals considered price and/or familiarity more important in their food choices in both absolute and relative terms. A higher income was related to a greater relative importance of health considerations. Relative motives were more strongly associated with vegetable/fruit and energy-dense food consumption than absolute motives and the relative importance of price, familiarity and health partly mediated the effects of the SES indicators on the consumption of these food items.ConclusionsIndividual priorities in food choice motives, rather than the absolute importance of single motives, play a role in producing SES disparities in diet.

Although previous studies have shown that unhealthy eating is associated with a positive image of a typical unhealthy eating peer (prototype), their focus on prototypes is typically narrow/limited. The present study addresses this gap in the literature and investigates two aspects in peer evaluations: (1) healthy vs. unhealthy and (2) abstainer vs. chooser. Moreover, their mean differences, interrelationships and associations with eating behavior will be examined. Methods: Men in military service (N = 1824, Age M = 19.8) reported their eating behaviors and evaluated either (a) Vegetable chooser and Vegetable abstainer prototypes (N = 920) or b) Fat chooser and Fat abstainer prototypes (N = 904) on a scale containing 17 antonyms. Exploratory and confirmatory factor analyses suggested a three-factor structure: Self-regulation, Social standing in peer group and Appearance (Comparative Fit Indexes 0.82–0.87; Tucker–Lewis index 0.78–0.84; Root Mean Square Error of Approximation 0.07–0.08). Results: Healthy eaters (i.e. Vegetable chooser and Fat abstainer) were evaluated higher on Self-regulation and Appearance than respective unhealthy eaters (i.e. Vegetable abstainer and Fat chooser) (ps

Background The role and meaning of genetic information has grown considerably in the recent decades. We examined changes in causal beliefs about morbidity as well as the associations between causal beliefs, health behaviors and obesity, and health outcome beliefs from 1982 to 2002. Methods In five population-based risk-factor surveys (the FINRISK Studies) of individuals aged 25 to 64 years conducted from 1982 to 2002 (n = 37,503), respondents chose the most important cause of morbidity from a list of ten alternatives. Health outcome beliefs were assessed with two items. Physical inactivity and smoking status were based on self-reports and obesity was based on measured height and weight. Results The prevalence of those who endorse genetic factors as the most important cause of morbidity increased from 4% in 1982 to 10% in 1992 and remained at that level until 2002. During the study period, lack of exercise and overweight increased, whereas inappropriate diet and stress diminished as causal beliefs about morbidity. Smokers and physically inactive were more likely to endorse genetic than behavioral causes of morbidity, whereas obese respondents were more likely to choose overweight over genetic causes of morbidity. Those who endorse genetic factors as the most important cause had more pessimistic outcome beliefs about health behavior changes, but these outcome beliefs became more positive in all causal belief groups during the study period. Conclusion Despite increased public discussion of genomics, the relative proportion of those who endorse genetic factors as the most important cause of morbidity has remained low. However, within this group beliefs about benefits of health behavior changes have become more positive. This could indicate that increase in genomic health information does not lead to more negative appraisals of efficacy of lifestyle changes. BioMed Central open access

INTRODUCTION: Concern over weight gain after smoking cessation has been hypothesized to discourage quit attempts and consequently reduce smoking cessation rates. The aim of this study was to examine the association between smoking status and weight concerns among a population-based sample of Finnish ever-smokers. METHODS: Data were collected in conjunction with the National FINRISK 2007 Study from a population-based sample of 25- to 74-yearold Finns. These analyses were based on a subsample of 1,614 ever-smokers. Participants were divided into 4 groups (daily smokers, occasional smokers, recent quitters, and former smokers) based on the self-reported smoking status. Weight concerns were analyzed as a sum score including 6 items (range 0-24). Regression analyses were used to examine the association between smoking status and weight concerns, while adjusting for multiple confounders. RESULTS: Smoking status was significantly associated with weight concerns, current daily smokers reporting the highest levels of weight concerns. After adjusting for potential confounders (age, gender, body mass index, socioeconomic status, and health behavior), the weight concerns of daily smokers remained significantly higher in comparison with all other groups. Although women were more concerned about their weight than men, no gender-specific associations were found between weight concerns and smoking status. CONCLUSIONS: Current daily smokers are more concerned about their weight than recent quitters, as well as former and occasional smokers. Weight concerns should be taken into account in tobacco dependence treatment.

Aims: Socioeconomic health inequalities are partly attributed to different physical activity (PA) patterns. Psychosocial factors interacting with PA are suggested to explain the socioeconomic differences in PA to some extent. The aim of the present study was to examine whether PA self-efficacy, PA social support, and general self-control contribute to the socioeconomic status (SES) differences in leisure time physical activity (LTPA) and in total PA. Methods: The sample consisted of 25–74-year-old Finnish men ( n = 2325) and women ( n = 2699), who participated in the cross-sectional FINRISK Study in 2007. Physical activity was measured as total PA (MET-h/week) and as LTPA (inactive/active). A psychosocial factor questionnaire included scales measuring PA self-efficacy, PA social support, and general self-control. SES was defined by household gross income and years of education. Results: Both higher education and income were associated with higher levels of LTPA, whereas total PA was higher among those with lower SES. Subjects with high SES reported higher levels of PA self-efficacy and PA social support, but general self-control correlated only with higher income. PA self-efficacy, PA social support and general self-control had positive associations with both LTPA and total PA. These psychosocial factors partly explained the SES differences in LTPA, but not in total PA. Conclusions: Future intervention studies should examine whether, by influencing PA self-efficacy, PA social support, and general self-control, it is possible to diminish the SES differences in PA.

ObjectivesThis study examined the associations of parental socioeconomic status (SES) with preschoolers’ objectively measured sedentary time (SED) over the course of a week and with parent-reported children’s screen and reading times at home as indicators of sedentary behaviours (SB).DesignCross-sectional.SettingIn years 2015 and 2016 in Finland.Participants864 children, aged 3–6 years, with their parents.Outcome measuresChildren’s accelerometer data were transformed into average SED minutes per hour in different contexts (preschool, home during preschool days, weekend and total). Parent-reported children’s screen and reading times were expressed as average daily minutes. The SES indicators (maternal and paternal education and relative household income) were grouped into three categories. Linear or logistic regression analyses were used, with municipality, season, and children’s gender and age as covariates. CIs were adjusted for clustering at the preschool group level.ResultsChildren with low maternal (β=17.21, 95% CI: 8.71 to 25.71) and paternal (β=10.54, 95% CI: 0.77 to 20.30) education had more overall screen time at home than their more advantaged counterparts. SES differences in overall screen time were mostly explained by TV viewing. Children with low as opposed to high maternal education (β=−2.66, 95% CI: −4.95 to –0.38) had less reading time at home. Children whose fathers were on the middle (β=−1.15, 95% CI: −2.01 to –0.29) educational level had less weekend SED than those with high paternal education. Otherwise, parental SES was not related to objectively measured SED.ConclusionsThe results of this study highlight the fact that the associations between parental SES and preschoolers’ SB are dependent on the indicators of SES and SBs, and vary between different contexts. Generally, parental SES was not associated with SED, whereas some SES differences existed in screen time and reading time at home. Interventions aiming to diminish SES differences in children’s SB should focus on home hours.Trial registration numberISRCTN57165350.

Background: Measurement of social cognitive variables is often restricted to long-term and health-related outcomes. A more comprehensive measurement of cognitive determinants would enable evidence-based design of health behavior interventions with a focus on the most relevant targets. The purpose of this study was to examine the relative impact of different social cognitive determinants on fruit and vegetable (FV) and fast food consumption. Methods: Finnish male conscripts (N = 855, age M = 20) filled in questionnaires on social cognitive factors when entering the military service, and on food consumption frequency after two months. The data were analysed using structural equation modeling. Results: Physical well-being expectation and bad taste expectation were most strongly related to both FV and fat avoidance intentions. Perceived weight gain risk predicted fat avoidance intention, whereas perceived risk for other health problems predicted FV intention. Social self-efficacy was associated with FV intention only. Consumption of both FV and fast food was predicted by action planning and intention. Conclusions: A more careful evaluation of subtypes of social cognitions sheds light on the specific content behind motivation. Such understanding might help in designing more effective intervention messages.

This study examines whether parental smoking and single parenting were related to adolescents' school achievement and anti-smoking parental practices as well as how these factors predicted later smoking. The sample comprised 1163 Finnish students in Grades 7 through 9. Results show that at the beginning of the seventh grade, parental smoking and single parenting were related to adolescents' lower levels of school achievement. Moreover, parental smoking had moderate association with lack of house smoking rules. At the beginning of the ninth grade, these associations were strengthened and lack of house smoking rules as well as loosened perceived parental punishment for smoking was related to both parental smoking and single parenting. The likelihood of ninth grade regular smoking was greater among adolescents whose parents smoked, who had no smoking rules in their homes and had substandard school achievement. These results suggest that smoking parents and single parents had similar anti-smoking regulations for their children at the baseline but once children became older smoking parents were not able to maintain these rules as successfully as non-smoking parents and families with two parents. Motivating parents to uphold these anti-smoking regulations offers a prospective intervention opportunity.

Aims: Poor academic achievement is strongly related to smoking but studies that examine the mechanism between academic achievement and smoking are lacking. The aim of this study, therefore, was to examine the smoking-related cognitions (i.e. attitude, social influence, self-efficacy and intention to smoke) in relation to academic achievement and determine whether these cognitions explain different patterns of smoking. Methods: The study uses the data of a longitudinal study that was carried out in Finland, and the sample comprised 1,096 students in grades seven to nine. Results: During the seventh-grade students with poor academic achievement reported more positive attitudes to smoking and a greater social influence of their peers regarding smoking, weaker self-efficacy to refuse smoking and more intentions to smoke in the future compared to students with high academic achievement. Moreover, the follow-up analyses after a 24-month interval revealed that self-efficacy to refuse smoking of students with poor grades had become weaker compared to students with high grades. Furthermore, the influence of seventh-grade academic achievement predicting ninth-grade weekly smoking was partially mediated through the self-efficacy beliefs and the intention to smoke. Conclusions: Differences in academic achievement may have an impact on adolescents’ self-efficacy beliefs and the intention to smoke in the future. To reduce health inequalities a strong input on continuing research to improve smoking prevention methods, especially for students with low academic achievement, is needed.

The aim of this study was to explore a longitudinal bi-directional relationship between school achievement and smoking behavior. The sample consists of 2,188 Finnish students in grades 7-9. Data were collected at three separate occasions between the years 1998 and 2000. Three hypothesized conceptual models were developed and tested using path analyses by structural equation modeling (SEM). Students that performed poorly at school smoked weekly six times more than those who achieved the highest school grade point averages at the age of 15. Using SEM, the findings suggest that not only does deterioration of school achievement contribute to progression in smoking uptake continuum but also vice versa progression in smoking uptake continuum to deterioration of school achievement over time (CFI = .997). There were no moderating effects of gender or treatment condition in the proposed models. Both deterioration of school achievement and progression in smoking uptake continuum predicted changes in other behavior during the first two years in secondary school in Finland.

We studied the factors that predict liking for vegetables and preference for a variety of vegetables among schoolchildren. Additionally, we examined if there were gender differences in the predictors that explain the hypothesized higher scores in liking vegetables and preferences among girls. The data from the PRO GREENS project included 424 Finnish children (response rate 77%) aged 11 to 12. The children completed validated measures about social and environmental factors related to their liking for vegetables and preferences both at baseline 2009 and follow-up 2010. The associations were examined with regression and mediation analyses. The strongest predictors of both girls' and boys' liking and preferences were higher levels of eating vegetables together with the family, previous vegetable intake and a lower level of perceived barriers. Liking was additionally predicted by a lower level of parental demand that their child should eat vegetables. Girls reported higher levels of liking and preferences in the follow-up. This gender difference was mainly explained by girls' lower level of perceived barriers related to vegetable intake and girls' higher previous vegetable intake. Interventions that aim to increase the low vegetable intake among boys by increasing their liking for vegetables and preference for a variety of vegetables could benefit from targeting perceived barriers, namely boys' perception and values concerning the consumption of vegetables.

Aims To examine the progression of oral moist snuff use among adolescents and its relation to smoking behaviour and nicotine addiction. Design and setting A 3-year smoking prevention study in 27 schools of Helsinki, Finland, starting with the seventh grade to the ninth grade. Participants and measurements Pupils (n = 2816) completed questionnaires four times, which included information on smoking behaviour, snuff experiments, nicotine addiction (Fagerstrom Tolerance Questionnaire) and other activities. Findings The prevalence of snuff experimentation rose among boys from 7% in the seventh grade to 43% 3 years later in the ninth grade, and among girls from 2% to 13% for the corresponding period. Among boys, smoking predicted later snuff use in all assessments and snuff experimentation predicted later weekly smoking. The impact of snuff experimentation upon later smoking experimentation was smaller than vice versa. Among boys active in sports, smoking was less common but snuff use was more common. Combined use was common; by the end of the follow-up only 10% of weekly smokers had not tried oral snuff. Nicotine dependence scores increased linearly with snuff use among weekly smokers. Conclusions Despite the European Union sales ban on oral snuff products since 1995, in Finland snuff use is common among boys. Although combined use of snuff and cigarettes is associated with higher levels of nicotine dependence among adolescent boys, the direction of causality is not known. Unlike cigarette smoking, oral snuff use was tried among boys who spent their free time with sports-related activities.

Aims: To examine whether smoking habits, nicotine dependence (ND) and plasma cotinine levels differ by diurnal type. Design: Data originated from the national FINRISK 2007 survey. Regression analyses were calculated to examine the association between diurnal type and smoking status, ND, and nicotine intake. Participants: 7091 FINRISK participants with smoking and diurnal type information and a subset of 1746 ever smokers with detailed smoking, and ND assessments. Measurements: Diurnal type assessed with a six-item sum scale was categorized as morning, intermediate and evening type. Smoking status was determined as current (daily or occasional), former, and never smokers. ND was measured with the Fagerstrom Test for Nicotine Dependence (FTND), the Hooked on Nicotine Checklist (HONC), and the Nicotine Dependence Syndrome Scale (NDSS). For current smokers, plasma cotinine was analyzed as biochemical measurement of nicotine intake. Findings: Evening type was associated with current smoking (OR=1.66, 95% CI 1.40, 1.97). A significant association with diurnal type was seen for FTND among men (beta= -0.46, 95% CI -0.72, -0.21), sexes combined for HONC (beta= -0.31, 95% CI -0.52, -0.11) and NDSS (beta= -0.86, 95% CI -1.43, -0.29) and for cotinine among men (beta= -0.73, 95% CI -1.16, -0.29). Adjustment for depressive symptoms attenuated the association of diurnal type with NDSS to be non-significant. Conclusions: Diurnal type was associated with multiple ND measures and nicotine intake, interestingly more so among men. Evening type persons are at higher risk of dependence, but depressive symptoms attenuates this association clearly.

Background Over the decades, global public health efforts have sought to reduce socio-economic health differences, including differences in mental health. Only a few studies have examined changes in socio-economic differences in psychological symptoms over time. The aim of this study was to assess trends in socio-economic differences in self-reported insomnia and stress over a 24-year time period in Finland. Methods The data source is a repeated cross-sectional survey “Health Behaviour and Health among the Finnish Adult Population” (AVTK), from the years 1979 to 2002, divided into five study periods. Indicators for socio-economic status included employment status from the survey, and educational level and household income from the Statistics Finland register data. We studied the age group of 25–64 years (N = 70115; average annual response rate 75%). Outcome measures were single questions of self-reported insomnia and stress. Results The overall prevalence of insomnia was 18-19% and that of stress 16-19%. Compared to the first study period, 1979–1982, the prevalence of stress increased until study period 1993–1997. The prevalence of insomnia increased during the last study period, 1998–2002. Respondents who were unemployed or had retired early reported more insomnia and stress over time among both men and women. Lower education was associated with more insomnia especially among men; and conversely, with less stress among both sexes. Compared to the highest household income level, those in the intermediate levels of income had less stress whereas those in the lowest income levels had more stress among both sexes. Income level differences in insomnia were less consistent. In general, socio-economic differences in self-reported insomnia and stress fluctuated some, but did not change substantially over the study period 1979–2002. Conclusions Self-reported insomnia and stress were more common during later study periods. The socio-economic differences in insomnia and stress have remained fairly stable over a 24-year time period. However, some of the associations in socio-economic differences were curvilinear and converse. Future studies are needed to explore the complex socio-economic gradients, especially in stress.

The socio-economic differences in five hostility measures were studied using a population survey that covered 1,547 men and 1,856 women, aged 25-64 years. Respondents completed the cynical distrust (CynDis), trait anger ( Anger ), anger suppression ( AX/In ), control ( AX/Con ), and expression ( AX/Out ) scales. Respondents in lower socioeconomic status (SES) groups had higher cynical distrust scores but anger expression scores were higher among respondents in higher SES groups. AX/Out and CynDis were not related to each other, but both correlated positively with trait anger. Among lower SES groups trait anger and anger suppression have a strong positive correlation compared to higher SES groups. It can be argued that anger expression reflects higher self-confidence among higher SES groups in their ability to express anger when necessary, while elevated cynicism among lower SES groups may be a consequence of cumulative negative experiences during their respective lifetimes. Divergent results between hosti...

Background Socioeconomic inequalities in smoking begin to manifest in adolescence. Poor school-performance and non-academic orientation are known risk factors for smoking initiation. In Finland, inequalities are visible between the main educational tracks: daily smoking is multifold in vocational upper secondary schools (VUSS) compared to general upper secondary schools (GUSS). Other health risks, such as overweight and heavier drinking patterns, also accumulate in VUSS. In 2010, age-based (

The aim of this study was to increase understanding of the associations between different dimensions of morningness-eveningness, depressive symptoms, and emotional eating in the general population. The participants were 25-to-74-year-old Finnish men (n = 2325) and women (n = 2699) from the National FINRISK Study conducted in 2007. The Center for Epidemiological Studies - Depression Scale and the Three-Factor Eating Questionnaire-R18 were used to measure depressive symptoms and emotional eating. Chronotype was assessed with a shortened version of Horne and Östberg's Morningness-Eveningness Questionnaire (MEQ). Structural equation modeling was used as an analytical approach. Confirmatory factor analysis indicated a two-factor structure for the six-item MEQ with separate factors for morning alertness and circadian preference for daily activities (r = 0.65). Higher alertness in the morning and preference for morning hours were both related to lower depressive symptoms (βtotal effect = -0.36 and -0.11, respectively) and emotional eating (βtotal effect = -0.20 and -0.09; βindirect effect through depressive symptoms = -0.12 and -0.04, respectively), even though the relationships with morning alertness were stronger. However, the associations of circadian preference with depressive symptoms and emotional eating were reversed after adjustment for morning alertness. Finally, among participants who rarely or never experienced sleeping sufficiently, those in the lowest (i.e. eveningness) and higher (i.e. morningness) circadian preference/morning alertness quartiles had the highest depressive symptom scores. In conclusion, the findings emphasize the importance of separating between different dimensions of chronotype when examining its relationships with psychological factors such as depressive symptoms and overeating tendencies.

Predictive genetic testing for cancer allows identification of those with the mutation (mutation positive) who should undergo cancer surveillance aiming at early detection of cancer and those without the mutation (mutation negative), whose unnecessary worry can be alleviated and who need not undergo frequent surveillance. However, there is a risk that predictive testing might have a harmful emotional impact on an individual. In the course of a predictive genetic testing protocol, we assessed general anxiety (by the State-Trait Anxiety Inventory [STAI]), fear of cancer and death, satisfaction with life and attitude to the future using a questionnaire survey in 271 individuals tested for hereditary non-polyposis colorectal cancer (HNPCC). Measurements were made before the first counseling (baseline), at the test disclosure session (STAI only) and 1 and 12 months after disclosure. Although at every measurement, the mutation-positive individuals were more afraid of cancer than those who were mutation negative, in both groups fear of cancer decreased significantly from baseline after disclosure. The mutation-positive subjects were more anxious than their counterparts immediately after the test disclosure, but the differences had disappeared at the follow-ups. In other variables, neither differences between the groups defined by mutation status nor changes with time were detected. Our findings suggest that counseling and testing relieve fear of cancer; no harmful emotional impact was detectable at the 1-year follow-up. To confirm these findings, however, the impact of testing should be studied after a longer interval. Furthermore, to evaluate the ultimate interpretation of these results, studies are needed to investigate the impact of fear of cancer on surveillance behavior among the mutation-positive subjects.

Objective To examine in a prospective setting whether different hostility measures, including Cynical Distrust, Trait Anger, Anger Out, Anger In, and Anger Control, are related to cardiovascular disease (CVD) and ischemic heart disease (IHD). Methods Participants comprised 25- to 74-year-old men (n = 3850) and women (n = 4083), followed up for 10 to 15 years. Trait Anger, Anger Out, Anger In, and Anger Control were assessed with the Spielberger State-Trait Anger Expression Inventory and Cynical Hostility with the Cynical Distrust Scale. Incident CVD and IHD were derived from hospital records/death certificates. Subjects with a history of CVD or IHD at baseline were excluded. Results Subjects in the lowest Anger Control tertile had a higher risk of first nonfatal and fatal CVD incidence (relative risk [RR], 1.35; 95% confidence interval [CI], 1.06-1.73) than subjects in the highest tertile after adjustment for age, gender, education, marital status, smoking, body mass index, blood pressure, cholesterol, alcohol consumption, and depressive symptoms. Higher Cynical Distrust scores predicted nonfatal and fatal CVD (RR, 1.31; 95% CI, 1.09-1.56) and IHD (RR, 1.37; 95% CI, 1.08-1.74) events after adjustment for age, but these associations disappeared after further adjustment for gender, education, and marital status. Other hostility measures, i.e., Trait Anger, Anger Out, or Anger In, were not related to CVD or IHD outcomes. Conclusions This is the first study to show that compared with four other hostility dimensions, low Anger Control predicts CVD events. Further studies should examine whether Anger Control is specific to anger or reflects more general psychosocial factors.

We examined the associations of emotional eating and depressive symptoms with the consumption of sweet and non-sweet energy-dense foods and vegetables/fruit, also focusing on the possible interplay between emotional eating and depressive symptoms. The participants were 25–64-year-old Finnish men ( n = 1679) and women ( n = 2035) from the FINRISK 2007 Study (DILGOM substudy). The Three-Factor Eating Questionnaire-R18, Center for Epidemiological Studies Depression Scale, and a 132-item Food Frequency Questionnaire were used. Emotional eating and depressive symptoms correlated positively ( r = 0.31 among men and women), and both were related to a higher body mass. Emotional eating was related to a higher consumption of sweet foods in both genders and non-sweet foods in men independently of depressive symptoms and restrained eating. The positive associations of depressive symptoms with sweet foods became non-significant after adjustment for emotional eating, but this was not the case for non-sweet foods. Depressive symptoms, but not emotional eating, were related to a lower consumption of vegetables/fruit. These findings suggest that emotional eating and depressive symptoms both affect unhealthy food choices. Emotional eating could be one factor explaining the association between depressive symptoms and consumption of sweet foods, while other factors may be more important with respect to non-sweet foods and vegetables/fruit.

Purpose We examine the relationships between depressive symptoms and all-cause mortality and cardiovascular disease (CVD) in a representative sample of the Finnish population. Methods Subjects included men ( N = 3,850) and women ( N = 4,083) aged 25–74 years who had participated in risk factor surveys (The FINRISK Study) conducted in Finland in 1992 and 1997. Depressive symptoms were measured with the Beck Depression Inventory (BDI). Results During a 10–15 year follow-up, there were 422 deaths and 305 nonfatal and fatal CVD events among men and 195 deaths and 145 CVD events among women. Subjects in the third BDI quartile and the highest BDI quartile had higher risk for all-cause mortality than subjects in the first quartile (relative risk [RR], 1.39; 95% confidence interval [CI]: 1.03–1.86; RR, 1.64; 95% CI, 1.24–2.17, respectively) after adjustment for age, gender, education, smoking, alcohol consumption, and chronic diseases. Among women without a history of CVD, females in the highest BDI quartile had a relative risk of 1.84 (95% CI, 1.06–3.20) compared with those in the first quartile for nonfatal and fatal CVD events after adjusting for age, education, smoking, body mass index, blood pressure, cholesterol, and alcohol consumption. Conclusions The relationship between depressive symptoms and CVD varies according to gender and previous history of CVD.

Objective: Few studies investigated the use of complementary and alternative medicine (CAM) by subjects with mental disorders. We examined the relationship between depressive, anxiety and alcohol-use disorders and their comorbidity, as well as the relationship between use of CAM and use of mental health services. Method: The Finnish adult (≥30 years) population-based Health 2000 Study (n = 5987) collected information on use of CAM plus health and mental health care services. Results: Generalised anxiety disorder and panic disorder were positively associated and alcohol abuse was negatively associated with use of CAM. The prevalence was highest in persons with comorbidity of anxiety and depressive disorders. The use or perceived usefulness of mental health services did not differ between CAM users and other participants. Conclusion: The relationship between the use of CAM and mental disorders appears to vary depending on the type of mental disorder. Use of CAM seems unrelated to the use and the perceived usefulness of mental health services.

The strong negative correlations observed between the sense of coherence (SOC) scale and measures of depression and anxiety raise the question of whether the SOC scale inversely measures the other constructs. The main aim of the present study was to examine the discriminant validity of the three measures by comparing their associations with health indicators and behaviours. The participants were 25 to 74-year-old Finnish men (n = 2351) and women (n = 2291) from the National Cardiovascular Risk Factor Survey conducted in 1997. The SOC scale had high inverse correlations with both depression (r = −0.62 among both men and women) and anxiety measures (r = −0.57 among the men and r = −0.54 among the women). Although confirmatory factor analyses suggested that it was possible to differentiate between SOC, cognitive depressive symptoms and anxiety, the estimated correlations were even higher than those mentioned above. Education was related only to SOC, but the associations of SOC, cognitive depressive symptoms and anxiety with self-reported and clinically measured health indicators (body mass index, blood pressure, cholesterol) and health behaviours were almost identical. The variation in the lowest SOC tertile was more strongly associated with health variables than in the highest tertile. To conclude, the size of the overlap between the SOC and depression scales was the same as between depression and anxiety measures. This indicates that future studies should examine the discriminant validity of different psychosocial scales more closely, and should compare them in health research in order to bring parallel concepts into the same scientific discussion.

Background: Federation of Bosnia and Herzegovina (FBiH) has high cardiovascular disease mortality as other countries in Eastern Europe and situation has even deteriorated in the post war period. Reliable information on risk factor levels and patterns needed in prevention planning and disease management has been lacking. Methods: A cross sectional population survey was conducted in the FBiH in autumn 2002. A random sample of population, aged 25–64 years, was taken using a three stage stratified sampling methodology. Altogether, 2750 persons participated in the survey (1121 men and 1629 women). The survey was done according to internationally established standards and protocols. Results: The mean systolic blood pressure was 132 mmHg among men and 135 mmHg among women. The mean diastolic blood pressure was 84 mmHg in both genders. Almost 40% of the participants were recognized as hypertensive (blood pressure level over 140/90 mmHg). The prevalence of hypertension among men was 36% and among women 45%. The mean Body Mass Index (BMI) was 26.5 kg/m2 among males and 27.0 kg/m2 among females. About 75% of both men and women were overweight (BMI > 25 kg/m2) and 16% of men and 20% of women were obese (BMI > 30 kg/m2). About 50% of men and 30% of women reported to be daily smokers. Conclusions: As a whole the non-communicable disease risk factor levels in the FBiH seems to be relatively high. The data can be utilized in health promotion planning and as a baseline for future monitoring activities with possibility of international comparison of results.

Aims: To examine whether consonant smokers (who say they would not like to quit) differ from dissonant smokers (who would like to quit) in other forms of health-related behaviour and socioeconomic background. Methods: The participants included 2,709 male and 1,774 female smokers (aged 25-64 years old) from six annual population-based samples, examined between 1989 and 1994 via a mailed questionnaire. Results : Consonant male smokers were more likely to be heavy drinkers, use mostly butter on bread, and to not eat vegetables. Particularly in the middle educational and income groups, consonant male smokers were more likely to be heavy drinkers. Consonant female smokers were more often heavy drinkers and more sedentary than dissonant female smokers. If a male smoker belonged to the lower income group he was more likely to be a consonant smoker. Conclusions: Consonant male smokers had more adverse health behaviours compared to dissonant smokers, but nearly half of them did not have any other adverse health behaviours. However, a negative attitude towards smoking cessation was associated with other adverse health behaviours. There were no socioeconomic differences in willingness to quit smoking among female smokers and those differences between male smoker groups were small. Factors other than motivation to quit should be targeted to diminish socioeconomic differences in smoking cessation.

Background No school-based physical activity (PA) interventions among older adolescents have demonstrated long-term effectiveness, and few of them so far have addressed sedentary behaviour (SB). Based on behavioural theories and evidence, we designed a multi-level intervention to increase PA and decrease SB among vocational school students. This study investigates feasibility and acceptability of two main intervention components and research procedures. We also examine uptake of behaviour change techniques (BCTs) by the participants. Methods Design was an outcome assessor blinded, cluster-randomised controlled trial. Four classes of students (matched pairs) were randomised into one intervention and one control arm. The intervention consisted of (1) a 6-h group-based intervention for students, (2) two 2-h training workshops to reduce their students’ sitting in class for teachers, and (3) provision of light PA equipment in classrooms. At baseline (T1), mid-intervention (T2) at 3 weeks, post-intervention (T3) and 6 months after baseline (T4) we measured hypothesised psychosocial mediators and self-reported PA and sitting. Objective assessment of PA and SB (7-day accelerometry) was conducted at T1, T3 and T4. Body composition (bioimpedance) was measured at T1 and T4. Students and teachers in the intervention arm filled in acceptability questionnaires at T3. Results Recruitment rate was 64% (students) and 88.9% (teachers), and at T3, all post-intervention measurements were completed by 33 students (retention 76.7%) and 15 teachers (retention 93.8%). Acceptability ratings of sessions were high (students M = 6.29, scale 1–7), and data collection procedures were feasible. Intervention arm students reported increased use of BCTs, but uptake of some key BCTs was suboptimal. BCT use correlated highly with objective measures of PA. Based on both self-report and student evaluation, teachers in the intervention arm increased the use of sitting reduction strategies at post-intervention and T4 follow-up (p, published version, peerReviewed

Background Physical activity (PA) has been shown to decline during adolescence, and those with lower education have lower levels of activity already at this age, calling for targeted efforts for them. No previous study has demonstrated lasting effects of school-based PA interventions among older adolescents. Furthermore, these interventions have rarely targeted sedentary behaviour (SB) despite its relevance to health. The Let’s Move It trial aims to evaluate the effectiveness and the cost-effectiveness of a school-based, multi-level intervention, on PA and SB, among vocational school students. We hypothesise that the intervention is effective in increasing moderate-to-vigorous-intensity physical activity (MVPA), particularly among those with low or moderate baseline levels, and decreasing SB among all students. Methods The design is a cluster-randomised parallel group trial with an internal pilot study. The trial is conducted in six vocational schools in the Helsinki Metropolitan area, Finland. The intervention is carried out in 30 intervention classes, and 27 control classes retain the standard curriculum. The randomisation occurs at school-level to avoid contamination and to aid delivery. Three of the six schools, randomly allocated, receive the ‘Let’s Move It’ intervention which consists of 1) group sessions and poster campaign targeting students’ autonomous PA motivation and self-regulation skills, 2) sitting reduction in classrooms via alterations in choice architecture and teacher behaviour, and 3) enhancement of PA opportunities in school, home and community environments. At baseline, student participants are blind to group allocation. The trial is carried out in six batches in 2015–2017, with main measurements at pre-intervention baseline, and 2-month and 14-month follow-ups. Primary outcomes are for PA, MVPA measured by accelerometry and self-report, and for SB, sedentary time and breaks in sedentary time (accelerometry). Key secondary outcomes include measured body composition, self-reported well-being, and psychological variables. Process variables include measures of psychosocial determinants of PA (e.g. autonomous motivation) and use of behaviour change techniques. Process evaluation also includes qualitative interviews. Intervention fidelity is monitored. Discussion The study will establish whether the Let’s Move It intervention is effective in increasing PA and reducing SB in vocational school students, and identify key processes explaining the results. Trial registration ISRCTN10979479. Registered: 31.12.2015 Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3094-x) contains supplementary material, which is available to authorized users.

Background: Education is believed to have positive spillover effects across network connections. Partner’s education may be an important resource preventing the incidence of disease and helping patients cope with illness. We examined how partner’s education predicted myocardial infarction (MI) incidence and survival net of own education and other socioeconomic resources in Finland. Methods: A sample of adults aged 40–69 years at baseline in Finland in 1990 was followed up for MI incidence and mortality during the period 1991–2007 (n = 354,100). Results: Lower own and spousal education both contributed independently to a higher risk of MI incidence and fatality when mutually adjusted. Having a partner with basic education was particularly strongly associated with long-term fatality in women with a hazard ratio of 1.53 (95% confidence interval, 1.22–1.92) compared with women with tertiary level educated partners. There was some evidence that the incidence risk associated with basic spousal education was weaker in those with own basic education. The highest risks of MI incidence and fatality were consistently found in those without a partner, whereas the most favorable outcomes were in households where both partners had a tertiary level of education. Conclusions: Accounting for spousal education demonstrates how health-enhancing resources accumulate to some households. Marriage between people of similar educational levels may therefore contribute to the widening of educational differences in MI incidence and survival.

Motivation is a proximal determinant of behaviour, and increasing motivation is central to most health behaviour change interventions. This systematic review and meta-analysis sought to identify features of physical activity interventions associated with favourable changes in three prominent motivational constructs: intention, stage of change and autonomous motivation. A systematic literature search identified 89 intervention studies (k = 200; N = 19,212) which assessed changes in these motivational constructs for physical activity. Intervention descriptions were coded for potential moderators, including behaviour change techniques (BCTs), modes of delivery and theory use. Random effects comparative subgroup analyses identified 18 BCTs and 10 modes of delivery independently associated with changes in at least one motivational outcome (effect sizes ranged from d = 0.12 to d = 0.74). Interventions delivered face-to-face or in gym settings, or which included the BCTs 'behavioural goal setting', 'self-monitoring (behaviour)' or 'behavioural practice/rehearsal', or which combined self-monitoring (behaviour) with any other BCT derived from control theory, were all associated with beneficial changes in multiple motivational constructs (effect sizes ranged from d = 0.12 to d = 0.46). Meta-regression analyses indicated that increases in intention and stage of change, but not autonomous motivation, were significantly related to increases in physical activity. The intervention characteristics associated with changes in motivation seemed to form clusters related to behavioural experience and self-regulation, which have previously been linked to changes in physical activity behaviour. These BCTs and modes of delivery merit further systematic study, and can be used as a foundation for improving interventions targeting increases in motivation for physical activity.

Background Methodological guidelines for intervention reporting emphasise describing intervention content in detail. Despite this, systematic reviews of quality improvement (QI) implementation interventions continue to be limited by a lack of clarity and detail regarding the intervention content being evaluated. We aimed to apply the recently developed Behaviour Change Techniques Taxonomy version 1 (BCTTv1) to trials of implementation interventions for managing diabetes to assess the capacity and utility of this taxonomy for characterising active ingredients. Methods Three psychologists independently coded a random sample of 23 trials of healthcare system, provider- and/or patient-focused implementation interventions from a systematic review that included 142 such studies. Intervention content was coded using the BCTTv1, which describes 93 behaviour change techniques (BCTs) grouped within 16 categories. We supplemented the generic coding instructions within the BCTTv1 with decision rules and examples from this literature. Results Less than a quarter of possible BCTs within the BCTTv1 were identified. For implementation interventions targeting providers, the most commonly identified BCTs included the following: adding objects to the environment, prompts/cues, instruction on how to perform the behaviour, credible source, goal setting (outcome), feedback on outcome of behaviour, and social support (practical). For implementation interventions also targeting patients, the most commonly identified BCTs included the following: prompts/cues, instruction on how to perform the behaviour, information about health consequences, restructuring the social environment, adding objects to the environment, social support (practical), and goal setting (behaviour). The BCTTv1 mapped well onto implementation interventions directly targeting clinicians and patients and could also be used to examine the impact of system-level interventions on clinician and patient behaviour. Conclusions The BCTTv1 can be used to characterise the active ingredients in trials of implementation interventions and provides specificity of content beyond what is given by broader intervention labels. Identification of BCTs may provide a more helpful means of accumulating knowledge on the content used in trials of implementation interventions, which may help to better inform replication efforts. In addition, prospective use of a behaviour change techniques taxonomy for developing and reporting intervention content would further aid in building a cumulative science of effective implementation interventions. Electronic supplementary material The online version of this article (doi:10.1186/s13012-015-0248-7) contains supplementary material, which is available to authorized users.