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Background: The obesity epidemic presents a major public health challenge, and a poor diet quality has been identified as one of the most important contributing factors. Whereas a sufficient fruit and vegetable consumption has been associated with several positive health outcomes, the long-term effect on overweight and obesity is unclear. Thus, the aims of this study were to investigate if one year with free school fruit had any effect on weight status 14 years later, and if it affected the birth weight of the participants’ children. Methods: In 2001, 10 -12-year old Norwegian children, received one year of free school fruit in the intervention study “Fruits and Vegetables Make the Marks” (FVMM) and in 2016, a total of 1081 participants of 2049 eligible responded to a follow-up survey. Multilevel logistic regression was used to investigate if one year of free school fruit was associated with weight status and with birthweight status of the offspring. The analyses were adjusted for gender, educational level, and the offspring analysis also for parents’ weight status, and the nested design (child/parent). Results: The odds ratios of being overweight (OR: 0.93, 95% CI: 0.70, 1.24) or having a child with high or low birth weight (OR: 0.52, 95% CI: 0.21, 1.30) in the intervention group compared to the control group were not statistically significant, 14 years after the intervention period. Conclusions: One year of free school fruit did not have an effect on weight status on the participants or birth weight of their offspring, 14 years after the intervention period. Although, results from the present study contribute to fill the knowledge gaps concerning long-term effects of public health efforts on weight status, more follow-up studies with larger samples are warranted. [ABSTRACT FROM AUTHOR]

This study aims to assess the prevalence of different modes of commuting to school and work for 10-12year-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. [ABSTRACT FROM AUTHOR]

Background: Levels of physical activity (PA) decrease when transitioning from adolescence into young adulthood. Evidence suggests that social support and intrapersonal factors (self-efficacy, outcome expectations, PA enjoyment) are associated with PA. The aim of the present study was to explore whether cross-sectional and longitudinal associations of social support from family and friends with leisure-time PA (LTPA) among young women living in disadvantaged areas were mediated by intrapersonal factors (PA enjoyment, outcome expectations, self-efficacy). Methods: Survey data were collected from 18–30 year-old women living in disadvantaged suburbs of Victoria, Australia as part of the READI study in 2007–2008 (T0, N = 1197), with follow-up data collected in 2010–2011 (T1, N = 357) and 2012–2013 (T2, N = 271). A series of single-mediator models were tested using baseline (T0) and longitudinal data from all three time points with residual change scores for changes between measurements. Results: Cross-sectional analyses showed that social support was associated with LTPA both directly and indirectly, mediated by intrapersonal factors. Each intrapersonal factor explained between 5.9–37.5% of the associations. None of the intrapersonal factors were significant mediators in the longitudinal analyses. Conclusions: Results from the cross-sectional analyses suggest that the associations of social support from family and from friends with LTPA are mediated by intrapersonal factors (PA enjoyment, outcome expectations and self-efficacy). However, longitudinal analyses did not confirm these findings. [ABSTRACT FROM AUTHOR]

Introduction: This study aims to assess (i) the prevalence of having regular family breakfast, lunch, dinner (i.e. 5-7days/week together with their family) among 10-12year olds in Europe, (ii) the association between family meals and child weight status, and (iii) potential differences in having family meals according to country of residence, gender, ethnicity and parental levels of education.Methods: 7716 children (mean age: 11.5±0.7years, 52% girls) in eight European countries (Belgium, Greece, Hungary, The Netherlands, Norway, Slovenia, Spain, Switzerland) participated in a cross-sectional school-based survey in 2010. Data on family meals were self-reported by the parents and children's height and weight were objectively measured to determine overweight status. Binary regression analyses assessed the associations of having regular family meals (adjusted for potential confounders) with children's overweight/obesity and to assess potential differences in having family meals according to gender, ethnicity and parental education, in the total sample and for each country respectively.Results: The prevalence of regular family meals was 35%, 37% and 76% for breakfast, lunch and dinner respectively. Having regular family breakfast, but not lunch or dinner, was inversely associated with overweight (OR=0.78 (95% CI 0.67-0.91)). Children of higher educated parents were more likely to have regular family breakfast (1.63 (95% CI 1.42-1.86)) and less likely to have regular family lunch (0.72 (95% CI 0.63-0.82)) compared to children of lower educated parents.Conclusion: This study showed that having regular family breakfast - but not other family meals- was inversely associated with children's weight status. [ABSTRACT FROM AUTHOR]

Background: Research suggests an inverse association between parental rules and screen time in pre-adolescents, and that parents' style of communication with their children is related to the children's time spent watching TV. The aims of this study were to examine associations of parental rules and parental style of communication with children's screen time and perceived excessive screen time in five European countries.Methods: UP4FUN was a multi-centre, cluster randomised controlled trial with pre- and post-test measurements in each of five countries; Belgium, Germany, Greece, Hungary and Norway. Questionnaires were completed by the children at school and the parent questionnaire was brought home. Three structural equation models were tested based on measures of screen time and parental style of communication from the pre-test questionnaires.Discussion: Of the 152 schools invited, 62 (41 %) schools agreed to participate. In total 3325 children (average age 11.2 years and 51 % girls) and 3038 parents (81 % mothers) completed the pre-test questionnaire. The average TV/DVD times across the countries were between 1.5 and 1.8 h/day, while less time was used for computer/games console (0.9-1.4 h/day). The children's perceived parental style of communication was quite consistent for TV/DVD and computer/games console. The presence of rules was significantly associated with less time watching TV/DVD and use of computer/games console time. Moreover, the use of an autonomy-supportive style was negatively related to both time watching TV/DVD and use of computer/games console time. The use of a controlling style was related positively to perceived excessive time used on TV/DVD and excessive time used on computer/games console. With a few exceptions, results were similar across the five countries.Conclusions: This study suggests that an autonomy-supportive style of communicating rules for TV/DVD or computer/ games console use is negatively related to children's time watching TV/DVD and use of computer/games console time. In contrast, a controlling style is associated with more screen time and with more perceived excessive screen time in particular. Longitudinal research is needed to further examine effects of parental style of communication on children's screen time as well as possible reciprocal effects.Trial Registration: International Standard Randomized Controlled Trial Number Register, registration number: ISRCTN34562078 . Date applied29/07/2011, Date assigned11/10/2011. [ABSTRACT FROM AUTHOR]

ObjectiveTo describe fruit and vegetable intake of 11-year-old children in ten European countries and compare it with current dietary guidelines.DesignCross-sectional survey. Intake was assessed using a previously validated questionnaire containing a pre-coded 24 h recall and an FFQ which were completed in the classroom. Portion sizes were calculated using a standardized protocol.SettingSurveys were performed in schools regionally selected in eight countries and nationally representative in two countries.SubjectsA total of 8158 children from 236 schools across Europe participating in the PRO GREENS project.ResultsThe total mean consumption of fruit and vegetables was between 220 and 345 g/d in the ten participating countries. Mean intakes did not reach the WHO population goal of ≥400 g/d in any of the participating countries. Girls had a significantly higher intake of total fruit and vegetables than boys in five of the countries (Sweden, Finland, Iceland, Bulgaria and Slovenia). Mean total fruit intake ranged between 114 and 240 g/d and vegetable intake between 73 and 141 g/d. When using the level ≥400 g/d as a cut-off, only 23·5 % (13·8–37·0 %) of the studied children, depending on country and gender, met the WHO recommendation (fruit juice excluded).ConclusionsFruit and vegetable consumption was below recommended levels among the schoolchildren in all countries and vegetable intake was lower than fruit intake. The survey shows that there is a need for promotional activities to improve fruit and vegetable consumption in this age group. [ABSTRACT FROM AUTHOR]

ObjectiveFamily meals have been negatively associated with overweight in children, while television (TV) viewing during meals has been associated with a poorer diet. The aim of the present study was to assess the association of eating family breakfast and dinner, and having a TV on during dinner, with overweight in nine European countries and whether these associations differed between Northern and Southern & Eastern Europe.DesignCross-sectional data. Schoolchildren reported family meals and TV viewing. BMI was based on parental reports on height and weight of their children. Cut-off points for overweight by the International Obesity Task Force were used. Logistic regressions were performed adjusted by age, gender and parental education.SettingSchools in Northern European (Sweden, the Netherlands, Iceland, Germany and Finland) and Southern & Eastern European (Portugal, Greece, Bulgaria and Slovenia) countries, participating in the PRO GREENS project.SubjectsChildren aged 10–12 years in (n 6316).ResultsIn the sample, 21 % of the children were overweight, from 35 % in Greece to 10 % in the Netherlands. Only a few associations were found between family meals and TV viewing during dinner with overweight in the nine countries. Northern European children, compared with other regions, were significantly more likely to be overweight if they had fewer family breakfasts and more often viewed TV during dinner.ConclusionsThe associations between family meals and TV viewing during dinner with overweight were few and showed significance only in Northern Europe. Differences in foods consumed during family meals and in health-related lifestyles between Northern and Southern & Eastern Europe may explain these discrepancies. [ABSTRACT FROM AUTHOR]

Background: Parents and their parenting practices play an important role in shaping their children's environment and energy-balance related behaviours (EBRBs). Measurement of parenting practices can be parent- or child-informed, however not much is known about agreement between parent and child perspectives. This study aimed to assess agreement between parent and child reports on parental practices regarding EBRBs across different countries in Europe and to identify correlates of agreement. Methods: Within the ENERGY-project, a cross-sectional survey was conducted among 10-12 year old children and their parents in eight European countries. Both children and parents filled in a questionnaire on 14 parental practices regarding five different EBRBs (i.e. soft drink, fruit juice and breakfast consumption, sports activity and watching TV) and socio-demographic characteristics. Children's anthropometric measurements were taken at school. We calculated percentages of agreement between children and their parents and weighted kappa statistics (for ordinal variables) per practice and country and assessed factors associated with agreement using multilevel linear regression. Results: Reports of 6425 children and their parents were available for analysis. Overall mean agreement between parent and child reports was 43% and varied little among countries. The lowest agreement was found for questions assessing joint parent-child activities, such as sports (27%; Kappa (κ) = 0.14) or watching TV (30%;κ = 0.17), and for parental allowance of the child to have soft drinks (32%;κ = 0.24) or fruit juices (32%;κ = 0.19), or to watch TV (27%;κ = 0.17). Having breakfast products available at home or having a TV in the child's bedroom were the only practices with moderate to good agreement (>60%;κ = 0.06 and 0.77, respectively). In general, agreement was lower for boys, younger children, younger parents, parents with less than 14 years of education, single parents, parents with a higher self-reported body mass index and parents who perceived their child to be underweight. Conclusions: Parents and children perceive parental practices regarding dietary, physical activity and sedentary behaviours differently in all parts of Europe, with considerable variation across specific practices and countries. Therefore, future studies should assess both, parents and children's view on parental practices. [ABSTRACT FROM AUTHOR]

Objective: To investigate associations of family-related factors with children’s breakfast consumption and BMI-z-score and to examine whether children’s breakfast consumption mediates associations between family-related factors and children’s BMI-z-score. Subjects: Ten- to twelve-year-old children (n = 6374; mean age = 11.6±0.7 years, 53.2% girls, mean BMI-z-score = 0.4±1.2) and one of their parents (n = 6374; mean age = 41.4±5.3 years, 82.7% female, mean BMI = 24.5±4.2 kg/m2) were recruited from schools in eight European countries (Belgium, Greece, Hungary, the Netherlands, Norway, Slovenia, Spain, and Switzerland). The children self-reported their breakfast frequency per week. The body weight and height of the children were objectively measured. The parents responded to items on family factors related to breakfast (automaticity, availability, encouragement, paying attention, permissiveness, negotiating, communicating health beliefs, parental self-efficacy to address children’s nagging, praising, and family breakfast frequency). Mediation analyses were performed using multi-level regression analyses (child-school-country). Results: Three of the eleven family-related variables were significantly associated with children’s BMI-z-score. The family breakfast frequency was negatively associated with the BMI-z-score; permissiveness concerning skipping breakfast and negotiating about breakfast were positively associated with the BMI-z-score. Children’s breakfast consumption was found to be a mediator of the two associations. All family-related variables except for negotiating, praising and communicating health beliefs, were significantly associated with children’s breakfast consumption. Conclusions: Future breakfast promotion and obesity prevention interventions should focus on family-related factors including the physical home environment and parenting practices. Nevertheless, more longitudinal research and intervention studies to support these findings between family-related factors and both children’s breakfast consumption and BMI-z-score are needed. [ABSTRACT FROM AUTHOR]

ObjectiveTo determine whether an association exists between different clusters of fruit- and vegetable-specific family-environmental factors and children's daily fruit and vegetable intake, and whether these associations differ between countries with different school lunch policies.DesignCross-sectional data from four European countries participating in the Pro Greens project in 2009. These countries have different school food policies: two serve free school lunches and two do not. Self-administered data were used. Food frequency questions served to assess fruit and vegetable intakes. The study assessed sixteen children-perceived family-environmental factors, which were clustered based on principal component analysis into five sum variables: fruit and vegetable encouragement; vegetable modelling, family routine and demand; fruit modelling; fruit and vegetable snacking practices; and fruit and vegetable allowing.SettingSchools in Finland, Germany, Sweden and the Netherlands.SubjectsSchoolchildren aged 11 years (n 3317).ResultsMultilevel logistic regression analyses revealed positive associations between nearly all clustered family-environmental factors and daily fruit and vegetable intake. The study tested a moderation effect between family-environmental factors and school lunch policy. In five out of twenty models significant interactions occurred. In the stratified analyses, most of the associations between family-environmental factors and raw and cooked vegetable intake were stronger in Germany and the Netherlands, neither of which provided free school lunches.ConclusionsChildren reporting more fruit- and vegetable-promoting family-environmental factors had a more frequent intake of fruits and vegetables; the associations were stronger for vegetable intakes in countries providing no free school lunches, suggesting that parental involvement is crucial when schools offer no vegetables. [ABSTRACT FROM PUBLISHER]

Background: It is well known that the prevalence of overweight and obesity is considerably higher among youth from lower socio-economic families, but there is little information about the role of some energy balance-related behaviors in the association between socio-economic status and childhood overweight and obesity. The objective of this paper was to assess the possible mediation role of energy balance-related behaviors in the association between parental education and children's body composition. Methods: Data were obtained from the cross sectional study of the "EuropeaN Energy balance Research to prevent excessive weight Gain among Youth" (ENERGY) project. 2121 boys and 2516 girls aged 10 to 12 from Belgium, Greece, Hungary, the Netherlands, Norway, Slovenia and Spain were included in the analyses. Data were obtained via questionnaires assessing obesity related dietary, physical activity and sedentary behaviors and basic anthropometric objectively measured indicators (weight, height, waist circumference). The possible mediating effect of sugared drinks intake, breakfast consumption, active transportation to school, sports participation, TV viewing, computer use and sleep duration in the association between parental education and children's body composition was explored via MacKinnon's product-of-coefficients test in single and multiple mediation models. Two different body composition indicators were included in the models, namely Body Mass Index and waist circumference. Results: The association between parental education and children's body composition was partially mediated by breakfast consumption, sports participation, TV viewing and computer use. Additionally, a suppression effect was found for sugared drinks intake. No mediation effect was found for active transportation and sleep duration. The significant mediators explained a higher proportion of the association between parental education and waist circumference compared to the association between parental education and BMI. Conclusions: Tailored overweight and obesity prevention strategies in low SES preadolescent populations should incorporate specific messages focusing on the importance of encouraging daily breakfast consumption, increasing sports participation and decreasing TV viewing and computer use. However, longitudinal research to support these findings is needed. [ABSTRACT FROM AUTHOR]

Background: Sport participation makes an important contribution to children's overall physical activity. Understanding influences on sports participation is important and the family environment is considered key, however few studies have explored the mechanisms by which the family environment influences children's sport participation. The purpose of this study was to examine whether attitude, perceived behavioural control, health belief and enjoyment mediate associations between the family environment and 10-12 year-old children's sports participation. Methods: Children aged 10-12 years ( = 7234) and one of their parents (n = 6002) were recruited from 175 schools in seven European countries in 2010. Children self-reported their weekly duration of sports participation, physical activity equipment items at home and the four potential mediator variables. Parents responded to items on financial, logistic and emotional support, reinforcement, modelling and co-participation in physical activity. Cross-sectional single and multiple mediation analyses were performed for 4952 children with complete data using multi-level regression analyses. Results: Availability of equipment (OR = 1.16), financial (OR = 1.53), logistic (OR = 1.47) and emotional (OR = 1.51) support, and parental modelling (OR = 1.07) were positively associated with participation in ≥30 mins/wk of sport. Attitude, beliefs, perceived behavioural control and enjoyment mediated and explained between 21-34% of these associations. Perceived behavioural control contributed the most to the mediated effect for each aspect of the family environment. Conclusions: Both direct (unmediated) and indirect (mediated) associations were found between most family environment variables and children's sports participation. Thus, family-based physical activity interventions that focus on enhancing the family environment to support children's sport participation are warranted. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Neighborhoods that discourage physical activity may encourage indoor activities such as television viewing; however few studies have examined associations between neighborhood characteristics and sedentary activities. This study examined cross-sectional and longitudinal associations between perceived and objective measures of the physical and social neighborhood environment and TV viewing among children and adolescents. Design: Cross-sectional and longitudinal. Methods: Parents of 190 children and 169 adolescents completed questionnaire items regarding facilities for physical activity, neighborhood safety (general and traffic), social trust/cohesion, social networks and their child''s TV viewing in 2006. Adolescents self-reported their TV viewing. Objective measures of reported crime and neighborhood destinations, road connectivity and traffic exposure were also collected. Questions about TV viewing were repeated in 2008 (longitudinal sample: 157 children; 105 adolescents). Results: In children, cul-de-sac density and reported crime were positively and parental agreement that their neighborhood has good sporting facilities was negatively associated with TV viewing in cross-sectional analyses. There were no longitudinal associations among children. In adolescents, number of sports options and parental agreement that there is so much traffic that it is difficult/unpleasant for their child to walk were negatively associated with TV viewing 2 years later. Conclusions: Crime and a lack of quality sporting facilities or options may contribute to greater TV viewing among youth. [Copyright &y& Elsevier]

Background: Important health benefits can be achieved when physical activity in children from low socio-economic status is promoted and sedentariness is limited. By specifying the mediating mechanisms of existing interventions one can improve future physical activity interventions. This study explored potential mediators of the long-term effect of the school-based multicomponent JUMP-in intervention on sport participation, outdoor play and screen time in Dutch primary schoolchildren from disadvantaged neighborhoods. Methods: In total, 600 primary schoolchildren (aged 9.8 ± 0.7, 51% girls, 13% Dutch ethnicity, 35% overweight) from 9 intervention and 10 control schools were included in the analyses. JUMP-in was developed using Intervention Mapping, and targeted psychological and environmental determinants of physical activity. Outcome behaviors were self-reported sport participation, outdoor play, TV-viewing behavior and computer use. Potential mediators were self-reported psychological, social and physical environmental factors. Results: JUMP-in was effective in improving sport participation after 20 months, but not in improving outdoor play, or reducing TV-viewing or computer time. JUMP-in was not effective in changing hypothesized mediators so no significant mediated effects could be identified. However, changes in self-efficacy, social support and habit strength were positively associated with changes in sport participation, and changes in social support, self-efficacy, perceived planning skills, enjoyment and habit strength were positively associated with changes in outdoor play. Changes in enjoyment was positively associated with changes in TV-viewing while parental rules were negatively associated. Having a computer in the bedroom and enjoyment were positively associated with changes in computer use, while changes in parental rules were negatively associated. Conclusions: Besides a significant positive effect on sports participation, no significant intervention effect on outdoor play, screen time or any of the potential mediators was found. This suggest that other (unmeasured) factors operated as mediating mechanisms of the intervention, that we used unsuccessful intervention strategies, that the strategies were inappropriately implemented, or that children are unable to accurately recall past activities and cognitions. Additionally, the school setting might not be the sole channel to influence leisure time activities. Still, several personal and environmental constructs were found to be relevant in predicting change in sport participation, outdoor play and screen behavior and seem to be potential mediators. Future interventions are recommended including more effective strategies targeting these relevant constructs, addressing different constructs (e.g. pedagogic skills of parents), and focusing on different implementation settings. [ABSTRACT FROM AUTHOR]