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Background: In promoting physical activity, it is important to gain insight into environmental factors that facilitate or hinder physical activity and factors that may influence this environment-behavior relationship. As the personality factor of action orientation reflects an individual's capacity to regulate behavior it may act as a moderator in the environment-behavior relationship. The current study addressed the relationship between neighborhood walkability and walking behavior and the influence of action orientation on this relationship., Methods: Three hundred and forty-seven Dutch inhabitants [mean age 43.1 (SD 17.1)] completed a web based questionnaire assessing demographic variables, neighborhood walkability (Neighborhood Environment Walkability Scale), variables of the Theory of Planned Behavior, action orientation, and walking behavior., Results: The results show that high levels of neighborhood walkability are positively associated with walking behavior and that this influence is largely unmediated by cognitive processes. A positive influence of neighborhood walkability on walking behavior was identified in the action-oriented subpopulation, whereas in the state-oriented part of the population, this influence was absent., Conclusions: The findings suggest that the influence of neighborhood environment on walking behavior has a relatively large unconscious, automatic component. In addition, the results suggest that the walkability-walking relationship is moderated by action orientation.

Energy balance-related behavioral patterns find their origin in early childhood. The current paper provides an overview of studies that have examined such behavioral patterns, i.e., the clustering of dietary behaviors, physical activity, and/or sedentary behavior. The paper discusses the importance of examining energy balance-related behavioral patterns in children, outlines methods to examine these patterns, and provides examples of patterns that have been found (e.g., the universal sedentary-snacking and healthy intake patterns, as well as more unique or local patterns), child and parental characteristics predicting such patterns (e.g., child gender and maternal educational level), and the relationship of these patterns with overweight and related measures.

This study examined clustering of food and activity preferences in Dutch primary school children. It also explored whether the preference clusters are associated with child and parental background characteristics and with parenting practices. Data were used from 1480 parent-child dyads participating in the IVO Nutrition and Physical Activity Child cohort (INPACT). Children aged 8-11years reported their preferences for food (e.g. fruit and sweet snacks) and activities (e.g. biking and watching television) at school with a newly-developed, visual instrument designed for primary school children. Parents completed a questionnaire at home. Principal component analysis was used to identify preference clusters. Backward regression analyses were used to examine the relationship between child and parental characteristics with cluster scores. We found (1) a clustering of preferences for unhealthy foods and unhealthy drinks, (2) a clustering of preferences for various physical activity behaviours, and (3) a clustering of preferences for unhealthy drinks and sedentary behaviour. Boys had a higher cluster score than girls on all three preference clusters. In addition, physical activity-related parenting practices were negatively related to unhealthy preference clusters and positively to the physical-activity-preference cluster. The next step is to relate our preference clusters to child dietary and activity behaviours, with special attention to gender differences. This may help in the development of interventions aimed at improving children's food and activity preferences., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Aim: To examine factors explaining motivation among health care professionals to implement and continue a multidisciplinary primary care-based lifestyle intervention, called BeweegKuur, to support prevention and treatment of type 2 diabetes mellitus., Methods: Questionnaire research with two measurements among Dutch general practitioners, practice nurses and physiotherapists participating in a pilot study. At baseline, professionals were generally preparing to start the implementation. At second measurement, all practices were implementing BeweegKuur., Results: The results reveal a positive motivation among professionals to implement and continue the intervention. The motivation of practice nurses to continue implementation was lower compared with other professionals. Social support by colleagues, compatibility and perceived relative advantage of the intervention for the professionals were associates of the baseline motivation to implement it. High-baseline self-efficacy and profession (i.e. not being practice nurse) positively predicted the motivation to continue the intervention at second measurement., Conclusions: Professionals in our study can be characterized as innovators or early adopters, and inclusion of BeweegKuur in the basic health insurance package may persuade other adoption categories to implement the intervention. An intensified focus on skills building (e.g. motivational interviewing skills, general lifestyle counselling skills) is expected to contribute to sustained high-quality implementation of the intervention., (© 2011 Blackwell Publishing Ltd.)

Background: The recruitment of participants for childhood overweight and obesity prevention interventions can be challenging. The goal of this study was to identify barriers that Dutch youth health care (YHC) professionals perceive when referring parents of overweight children to an obesity prevention intervention., Methods: Sixteen YHC professionals (nurses, physicians and management staff) from eleven child health clinics participated in semi-structured interviews. An intervention implementation model was used as the framework for conducting, analyzing and interpreting the interviews., Results: All YHC professionals were concerned about childhood obesity and perceived prevention of overweight and obesity as an important task of the YHC organization. In terms of frequency and perceived impact, the most important impeding factors for referring parents of overweight children to an intervention were denial of the overweight problem by parents and their resistance towards discussing weight issues. A few YHC professionals indicated that their communication skills in discussing weight issues could be improved, and some professionals mentioned that they had low self-efficacy in raising this topic., Conclusions: We consider it important that YHC professionals receive more training to increase their self-efficacy and skills in motivating parents of overweight children to participate in obesity prevention interventions. Furthermore, parental awareness towards their child's overweight should be addressed in future studies.

Background: Reversing the obesity epidemic requires the development and evaluation of childhood obesity intervention programs. Lifestyle Triple P is a parent-focused group program that addresses three topics: nutrition, physical activity, and positive parenting. Australian research has established the efficacy of Lifestyle Triple P, which aims to prevent excessive weight gain in overweight and obese children. The aim of the current randomized controlled trial is to assess the effectiveness of the Lifestyle Triple P intervention when applied to Dutch parents of overweight and obese children aged 4-8 years. This effectiveness study is called GO4fit., Methods/design: Parents of overweight and obese children are being randomized to either the intervention or the control group. Those assigned to the intervention condition receive the 14-week Lifestyle Triple P intervention, in which they learn a range of nutritional, physical activity and positive parenting strategies. Parents in the control group receive two brochures, web-based tailored advice, and suggestions for exercises to increase active playing at home. Measurements are taken at baseline, directly after the intervention, and at one year follow-up. Primary outcome measure is the children's body composition, operationalized as BMI z-score, waist circumference, and fat mass (biceps and triceps skinfolds). Secondary outcome measures are children's dietary behavior and physical activity level, parenting practices, parental feeding style, parenting style, parental self-efficacy, and body composition of family members (parents and siblings)., Discussion: Our intervention is characterized by a focus on changing general parenting styles, in addition to focusing on changing specific parenting practices, as obesity interventions typically do. Strengths of the current study are the randomized design, the long-term follow-up, and the broad range of both self-reported and objectively measured outcomes., Trial Registration: Current Controlled Trials NTR 2555 MEC AZM/UM: NL 31988.068.10 / MEC 10-3-052.

This study examines the association between parental and child fruit consumption in the context of general parenting, parental education and ethnic background. A cross-sectional study was performed among 1762 parent-child dyads. Mean age of the children was 8 years. One parent completed a questionnaire to measure their own and their child's fruit consumption, parenting style, education level and ethnicity. In mediation and moderation analyses, child fruit consumption was regressed on parental fruit consumption, parenting style, parental education and ethnicity. Participating children consumed on average 7.5 pieces of fruit per week. Fourteen percent met the recommended Dutch norm of two pieces of fruit per day. Parental and child fruit consumption were positively associated. The association was more pronounced under higher levels of psychological control and behavioural control, and among ethnic groups. Additionally, parental education and child fruit consumption were positively associated. Parental fruit consumption partially mediated this association. Interventions are needed to increase child fruit consumption. Interventions should focus on increasing parental fruit consumption and positive parental modelling, with particular focus on low-SES families. Additionally, interventions that combine positive modelling with positive general parenting skills (e.g. increasing behavioural control) may be more effective than interventions that focus on parental modelling alone., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

In this article, we examined the factorial validity of the Dutch translation of the Children's Behavior Questionnaire (CBQ) and the Very Short Form scores. In addition, we conducted cross-cultural comparisons of temperament structure. In total, 353 parents of 6- to 8-year-olds completed the instrument. The original higher order factor structure of the different CBQ forms was generally replicated and represented the three broad dimensions of temperament: Surgency/Extraversion, Negative Affectivity, and Effortful Control. For the Standard Form, results demonstrated a relatively high degree of factor similarity of the Dutch sample with other cultures (e.g., China and Japan). The findings provide evidence for applicability of the CBQ in Western Europe as a promising instrument to comprehensively assess reactive and self-regulative temperamental dimensions in young children., (2011 APA, all rights reserved)

Objective: This paper aims to provide an overview of different theoretical approaches in the study of determinants of energy balance-related behaviors (EBRBs)., Methods: The Environmental Research framework for weight Gain prevention (EnRG) is used as a general framework to guide the overview., Results: Theoretical approaches in the integrated study of EBRBs are discussed, as well as theories addressing environmental factors, mediating factors, moderating factors and automatic environment-behavior links., Conclusion: Five distinct topics should be deliberated when researchers conceptualize their research model: (1) to apply a theory-based approach in their determinants study within the broader perspective of systematic obesity prevention, (2) to incorporate the notion of potential clustering of (motives to engage in) EBRBs, (3) to accompany research towards environmental determinants of EBRBs with the operationalization of factors that may mediate the environmental influence, (4) to hypothesize both mediated and unmediated paths in environment-behavior relations, and (5) to incorporate potential moderators of the studied influences on EBRBs in the research design., Practice Implications: The choice for change objectives and subsequent obesity prevention intervention strategies may be optimized when relevant determinants are interpreted as either primary (direct) causal factors, mediated determinants, mediating determinants or as moderators of causal factors., (Copyright 2010 Elsevier Ireland Ltd. All rights reserved.)

Objectives: To explore the associations between objectively assessed intensity levels of physical activity and academic achievement and test whether cardiovascular fitness mediates the association between physical activity and academic achievement., Study Design: Cross-sectional data were gathered in Swedish 9th-grade students (n = 232; mean age = 16 years; 52% girls). School grades, pubertal phase, skinfold thickness, cardiovascular fitness, and physical activity were measured objectively. Mother's education, family structure, and parental monitoring were self-reported. Data were analyzed with linear regression analyses., Results: After controlling for confounding factors, academic achievement was associated with vigorous physical activity in girls (beta = .30, P < .01; explained variance of the model 26%), which remained after inclusion of fitness (beta = .23, P < .05; explained variance 29%). The association was not mediated by fitness. In boys, academic achievement was associated with pubertal phase (beta = .25, P < .05). After inclusion of fitness, it was only associated with fitness (beta = .25, P < .05; explained variance of the model 30%)., Conclusion: In girls, academic achievement was associated with vigorous physical activity and not mediated by fitness, whereas in boys only fitness was associated with academic achievement. Further studies are necessary to investigate the potential longitudinal effect of vigorous physical activity on academic achievement, the role of fitness herein and the implications of these findings for schools.

Objective: Examine the effectiveness of the worksite-based weight gain prevention program Netherlands Heart Foundation-Netherlands Research program weight Gain prevention In Balance, with regard to behavioral changes and corresponding cognitive determinants., Methods: A nonrandomized pretest-repeated posttest control group design was applied in 12 worksites. Intervention groups received individual and environmental interventions, directed at physical activity and food intake. Measurements were executed at baseline and after 12 and 24 months., Results: Nearly all behaviors in the intervention group improved more than in the control group, even though improvements in behaviors were often too small to reach statistical significance. No positive intervention effects were observed for the cognitive factors., Conclusion: Differential changes between the intervention and control group were observed for several important dietary and physical activity behaviors. Valuable information is gained regarding the implementation of weight gain prevention programs in worksites.

Objective: To examine clustering of energy balance-related behaviors (EBRBs) in young children. This is crucial because lifestyle habits are formed at an early age and track in later life. This study is the first to examine EBRB clustering in children as young as 2 years., Study Design: Cross-sectional data originated from the Child, Parent and Health: Lifestyle and Genetic Constitution (KOALA) Birth Cohort Study. Parents of 2578 2-year-old children completed a questionnaire. Correlation analyses, principal component analyses, and linear regression analyses were performed to examine clustering of EBRBs., Results: We found modest but consistent correlations in EBRBs. Two clusters emerged: a "sedentary-snacking cluster" and a "fiber cluster." Television viewing clustered with computer use and unhealthy dietary behaviors. Children who frequently consumed vegetables also consumed fruit and brown bread more often and white bread less often. Lower maternal education and maternal obesity were associated with high scores on the sedentary-snacking cluster, whereas higher educational level was associated with high fiber cluster scores., Conclusions: Obesity-prone behavioral clusters are already visible in 2-year-old children and are related to maternal characteristics. The findings suggest that obesity prevention should apply an integrated approach to physical activity and dietary intake in early childhood.

This study examined the relationship between diet-related parenting practices, parental characteristics, child characteristics, and 2-year-old child's dietary intake. Cross-sectional data (N=2578) originated from the KOALA Birth Cohort Study. Principal component analyses revealed two restrictive parenting practice clusters: a cluster characterized by prohibition of the intake of various snacks and soft drinks, and a separate cluster characterized by prohibition of cookies and cake. Regression analyses showed that these clusters were related to the children's behavioural style (i.e. oppositional, depressive and/or aggressive behaviour) and to educational level, age and alternative lifestyle of the mother. The clusters also had a favourable influence on dietary intake (i.e. restrictive parenting practices were related to less consumption of the restricted (unhealthy) items and higher consumption of items considered to be healthy), which was moderated by child characteristics. The parenting practices showed a stronger association with dietary intake in children with a favourable behavioural style (i.e. non-depressed, low anxious, low overactive), a favourable eating style or a lower BMI. The findings suggest opportunities for preventive interventions focussing on parents of young children, and indicate that different approaches to parenting practice interventions are needed for different types of children.

Background: Many health behaviors have a history of repetition and, as a result, may become habitual. Because including a measure of habit strength may add depth to current theoretical models on health behavior, the present study explored the issue of habit strength within the context of the theory of planned behavior regarding adult bicycle use as a means of transportation., Methods: Cross-sectional data were gathered in a Dutch adult sample (n=317; mean age=42.09 years; 46.7% men) in 2006 using self-administered questionnaires. Variables for the theory of planned behavior were assessed regarding bicycle use as a means of transportation; habit strength regarding bicycle use as a means of transportation was assessed with the validated Self-Reported Habit Index. Hierarchical regression analyses and interaction analyses using simple slope analyses were conducted., Results: After controlling for variables for the theory of planned behavior, habit strength was the strongest predictor of bicycle use. In addition, simple slope analyses based on a significant interaction term, intention x habit, showed that intention was a significant predictor of bicycle use among those at low levels of habit strength for bicycle use (beta=0.67, p<0.001) but a weaker and nonsignificant predictor at high levels of habit strength (beta=0.10, p=0.136)., Conclusions: Habit strength is a moderator of the intention-behavior relationship regarding bicycle use, with intention becoming less relevant when bicycle use increases in habit strength. Future determinant and intervention studies on physical activity may benefit from including a measure of habit strength--for instance, by identifying the differential effects of informational and environmental interventions.

The association between adolescent screen-viewing behaviour (i.e., television viewing and computer use) and the consumption of sugar-sweetened beverages was studied in a Dutch sample of adolescents (N=383) using self-administered questionnaires. In particular, the previously understudied role of habit and perceived parental norms in the execution of these behaviours was investigated. Results showed that screen-viewing behaviour was associated with consumption of sugar-sweetened beverages (r=.32). Habit strength of both behaviours correlated with a large effect size (r=.50). The interaction between both behaviours was underlined by the finding that consumption of sugar-sweetened beverages was explained by perceived parental norms regarding screen-viewing behaviour (beta=.12; adjusted for the behaviour and perceived parental norm regarding sugar-sweetened beverage consumption). Consequences of the identified role of habit and parental norms in the interplay between sedentary behaviour and consumption of sugar-sweetened beverages among adolescents are discussed.

Adolescent obesity is positively associated with soft drink consumption. We investigated the association of social-environmental and individual-level factors with soft drink consumption in a Dutch adolescent sample. Data were gathered in a longitudinal Dutch adolescent sample (n = 208, 62% girls). Soft drink consumption, social cognitions from the Theory of Planned Behaviour and parenting practices towards limited soft drink intake, and Big Five personality dimensions were assessed. Data were analyzed using three-step linear regression analyses. Effect sizes were used as the informational source for the explanatory value of the model. Interaction terms were computed to test the individual-environment interaction. Attitude and subjective norm were significantly associated with soft drink consumption. When controlling for social cognitions, the distal variables parenting practices and the personality dimension Agreeableness remained significantly associated with soft drink consumption. Agreeableness moderated the association of parenting practices with adolescent soft drink consumption. Standardized regression coefficients ranged from 0.16 to 0.24 and explained 14% of the variance in soft drink consumption, indicating a medium effect size. Stricter parenting practices were associated with less soft drink consumption and these effects were moderated by adolescent personality. The direct effects of practices and personality are noteworthy from a theoretical perspective. Implications for obesity prevention interventions are discussed.

Background: The complexity of the relationship between environmental factors on the one hand and dietary behavior and physical activity on the other necessitates the search for moderators of environmental influences. The current evidence base is reviewed regarding potential moderating factors in the effectiveness of environmental interventions aimed at diet and/or physical activity of children and adolescents., Methods: The following databases were used: (1) Medline, (2) PubMed, (3) PsychInfo, (4) Web of Science, and (5) ERIC. Additionally, all potentially relevant references in recent reviews were checked., Results: Of the 41 studies included in the review, only seven studies (17%) were identified that reported tests of potential moderators of intervention effects. Gender proved to be the most frequently studied potential moderator. Additionally, race, age, and site have been studied regarding their potential role in modifying the effect of environmental interventions., Discussion: The small number of studies identified in this review prohibited us from attempting to formulate a conclusion on differential environment-behavior relationships in distinct subgroups. Rather than being an exception, it is argued that tests of effect modifiers should become common practice in behavioral nutrition and physical activity research to increase our understanding of mechanisms of behavior change and to optimize interventions.

A minority of child abuse cases is recognized by professionals, making the role of non-professional bystanders essential. The stages of change construct, as proposed by the Transtheoretical Model, may provide a useful approach to explain non-professional helping behavior. The objective of this study was to test the applicability of the stages of change construct by (i) assessing whether cognitive determinants distinguish between the stages, (ii) testing the predictive value of the stages for future helping behavior and (iii) examining the mediating role of the stages in the relation between previous and future helping behavior. Data of 126 adult non-professional bystanders were analyzed. Respondents were questioned by telephone or via an Internet questionnaire, at baseline and after a follow-up of about two months later. Attitude toward helping was significantly less positive in pre-contemplation than in the other stages, and self-efficacy expectations were significantly higher in preparation compared with the other stages. Moreover, baseline preparators were more likely to conduct future helping behavior than those in the two earlier stages. Finally, the stages of change mediated the relation between previous and future helping behavior. Initial support was found for the applicability of the stages of change construct for helping behavior by non-professional bystanders.

Overweight and obesity are important determinants of population health. Prevention of weight gain is dependent on the successful balancing of eating and physical activity behaviors. Planned promotion of healthful behavior requires insights into important and changeable determinants and correlates of behavior change. The modest effects of health education have induced a shift in focus from personal to environmental correlates of eating and physical activity behaviors. Six systematic reviews were conducted in 2005 of observational studies of environmental correlates and environmental interventions for weight-related eating behaviors and physical activity for children, adolescents, and adults. The reviews of 297 observational studies showed that few investigations of environmental associations have been replicated, and that most studies used weak research designs and nonvalidated self-report measures, were restricted to micro-environmental factors, and failed to apply multilevel analyses. There is, therefore, very little evidence for an association between environmental factors and weight-related behaviors. However, the reviews of 112 intervention studies indicated much stronger evidence for positive effects of micro-physical and sociocultural environmental changes on eating and physical activity behaviors. Inspired by quotes from Kurt Lewin, we argue that before large-scale environmental change interventions are launched, better-designed and -conducted research on the true importance of environmental factors, including macrolevel factors, for obesogenic behavioral change is needed. Such research should (1) develop better measures of environmental exposure, (2) attempt to integrate personal and environmental correlates of obesogenic behaviors, (3) take a solution-oriented, rather then a problem-oriented approach, and (4) identify access points for inducing behavior change instead of finding explanations for existing behavioral patterns.

Few studies describe the factors associated with smoking behaviour in Portuguese adolescents. Hence, smoking prevention activities are not based on research findings. This study analyses the differences between smokers and nonsmokers and factors associated with smoking behaviour in a sample of Portuguese adolescents. A questionnaire was administrated to seventh grade students of 25 schools from five municipalities near Lisbon (n=3064). The majority of them were never smokers (71.3%), 21.9% smoked less than monthly, 2.1% monthly and 4.7% weekly or more frequently. Smokers were older, had lower school achievement, had more money available to spend, preferred less to be together with nonsmoking people and were more likely to be allowed to smoke at home, to use alcohol and to perform various risky behaviours. Nonsmokers were less convinced of the advantages and more convinced of the disadvantages of smoking, encountered more social norms against smoking, perceived less smoking in others, felt less pressure to smoke from peers, were more confident to refuse cigarettes and had a lower intention to smoke next year. Intention to smoke, self-efficacy expectations to refuse smoking, social influence and alcohol consumption were the most relevant variables associated with smoking behaviour. Consequently, Portuguese smoking prevention programmes should include activities aimed to help adolescents to deal with pressure to smoke from peers and to improve self-efficacy expectations to refuse cigarettes. Our findings also confirm the link between smoking and alcohol use suggesting that the prevention of these two behaviours should be complementary.

Interventions to promote physical activity are important in preventing children from becoming overweight. Many projects have been developed but only a few showed (moderate) effects. JUMP-in is a systematically developed primary-school-based intervention that focuses on the use of theory, environmental changes, parental influences and cooperation with multi-level parties in intervention development. The effects of JUMP-in were evaluated with a quasi-experimental pre-test/post-test research design. In total, 510 children from Grades 4, 5 and 6 of four intervention schools and two control schools in Amsterdam were followed for an intervention period of one school year. Changes in physical activity as well as in the social cognitive determinants were assessed using self-reports. In addition, a process evaluation has been executed. The results show that JUMP-in was effective in influencing physical activity, especially among children from Grade 6. Children in the control group decreased their level of physical activity considerably, while activity levels in intervention children from Grade 6 remained stable. The intervention effects could not be explained by changes in the measured social cognitive determinants. In contrast, process information illuminated differences in intervention effects between the participating schools. The results from the JUMP-in study show the importance of intervention designs that focus on a theory-based mix of relevant environmental and social cognitive factors.

Rationale, Aims and Objectives: To assess the criterion validity of paper-and-pencil vignettes to assess guideline adherence by physiotherapists in the Netherlands. The evidence-based physiotherapy practice guideline for low back pain was used as an example., Methods: Four vignettes were constructed and pre-tested. Three vignettes were found to represent an adequate case-mix. They described one patient with specific low back pain, one with non-specific low back pain and a normal recovery process and one with non-specific low back pain and a delay in the recovery process. Invited to participate were 113 primary care physiotherapists who had joined an randomized controlled trial study 8 months before, in which guideline adherence had been measured by means of semi-structured treatment recording forms. The criterion validity was determined with Spearman's r(s), using Cohen's classification for the behavioural sciences to categorize its effect size., Results: Of the 72 physiotherapists who agreed to participate, 39 completed the questions on the vignettes. In the end, both adherence measures were available for 34 participants, providing 102 vignettes and 268 recording forms. Mean guideline adherence scores were 57% (SD = 17) when measured by vignettes and 74% (SD = 15) when measured by recording forms. Spearman's r(s) was 0.31 (P = 0.036), which, according to Cohen's classification, is a medium effect size., Conclusion: Vignettes are of acceptable validity, and are an inexpensive and manageable instrument to measure guideline adherence among large groups of physiotherapists. Further validation studies could benefit from the use of standardized patients as a gold standard, a more diverse case mix to better reflect real physiotherapy practice, and the inclusion of longitudinal vignettes that cover the patients' course of treatment.

Background: Recent calls have been made to consider both environmental factors and individual-level factors in the explanation of physical activity (PA). The present study tested a conceptual model that integrated past PA, relevant environmental-level and individual-level factors and their associations with adolescent PA, using the tenets of the Theory of Planned Behavior (TPB)., Methods: Data were gathered in an adolescent sample (n=221; 60% girls) using questionnaires. PA was assessed in May 2003 and November 2003. Theory of Planned Behavior cognitions regarding PA and the environmental factors under study were assessed in November 2003. Confirmatory factor analyses and path analyses were performed using AMOS software., Results: The initial structural model did not provide an acceptable fit to the data. Including a direct path from past PA to current PA significantly improved model fit to an acceptable fit. Including a direct path from past PA to environmental perceptions did not significantly improve model fit. Including a direct path from the environmental variables to current PA did not significantly improve model fit. Current PA was most strongly influenced by past PA, while environmental aesthetics and distance to PA opportunities were indirectly related to adolescents' intention to be physically active. Significant standardized path coefficients ranged from 0.14 to 0.34 and explained 17% variance in current PA., Conclusions: Combining past PA, Theory of Planned Behavior cognitions, and environmental factors increased our understanding of their relative influences on adolescent PA. Implications for future research on physical activity are discussed.

Personality is regarded as a distal determinant of health behavior and has been found to be associated with health behavior in young adults. Research investigating the association between personality and health behaviors in adolescents, however, is lacking. The present study explored the direct associations between Big Five personality dimensions with fruit and vegetable consumption and physical activity (PA) in two Dutch adolescent samples [Sample 1: n = 504; mean age = 14.5 years (SD = 1.7); response rate 20%; Sample 2: n = 476; mean age = 14.9 (SD = 2.0); response rate 17%]. Behavioral outcomes and personality were assessed with validated self-administered questionnaires. Bivariate correlations and multiple regression analyses were conducted, and Cohen's effect sizes were used to interpret the associations found. Agreeableness was positively associated with vegetable consumption, while Openness to Experience was positively associated with fruit consumption and vegetable consumption. Extraversion was positively associated with sports-related PA. Standardized regression coefficients for personality dimensions ranged from 0.09 to 0.13, explaining 3-6% of variance in behavior, indicating small effect sizes. Our results suggest that personality dimensions are associated with fruit and vegetable consumption and sports-related PA in adolescents. Future research should explore possible mediators between personality and health behavior in adolescents.

Background: The prevalence of obesity has reached epidemic proportions in many countries and is largely due to behavioral factors that disrupt the energy balance. The purpose of the study was to test how well our conceptual model, combining features from the Theory of Planned Behavior and the Theory of Triadic Influence, explained two behaviors related to the energy balance, namely bicycle use for transportation and snacking behavior in a Dutch adolescent sample., Methods: Data was gathered in an 1997 cross-sectional sample of adolescents (n = 3,859; mean age 14.8 years SD = 1.6) on snacking behavior, bicycle use, demographics, and potential environmental, cognitive and psychological determinants. Data was analyzed using bivariate correlations, multiple linear and binary logistic regression analyses., Results: Less snacking behavior was associated with female gender and a more positive intention, a more positive attitude, and stronger perceived behavioral control towards restricting snacking. Students who used their bicycle for transportation were more likely to attend secondary education, to be native Dutch, to go to school in a less-urbanized city, to be younger, had a more positive intention and perceived stronger behavioral control and subjective norm towards bicycle use., Conclusions: The inclusion of environmental factors increased our understanding of bicycle use for transportation and snacking behavior in adolescents. The environmental factors are suggested to be taken into account in interventions aimed at changing these behaviors in more healthy directions.

The burden of disease as a result of overweight and obesity calls for in-depth examination of the main causes of behavioural actions responsible for weight gain. Since weight gain is the result of a positive energy balance, these behavioural actions are referred to as 'energy balance-related behaviours' (EBRBs). In the broadest sense, there are only two EBRBs: food intake and physical activity. However, both diet and physical activity are complex behavioural categories that involve a variety of actions. This article discusses the potential problems and opportunities related to the assessment of cognitive determinants of energy intake and energy expenditure behaviours. We argue for the necessity of studying determinants of EBRBs within an energy balance approach, i.e. focusing on energy input as well as output, instead of only studying dietary change or physical activity behaviour. As a result, however, theoretically sound questionnaires assessing determinants of EBRBs are likely to annoy respondents. It is especially the measurement of the behaviours and the use of belief-based constructs that cause questionnaires to be long, which may lead to low response rates and invalid data. In this article, we propose a careful and systematic consideration of the inclusion or exclusion of measures of cognitive determinants. First, if studies show that an EBRB is strongly influenced by environmental factors and is not or only to a minor extent under intentional control, measurement of cognitions is of little use. Second, only when we have proof that attitudes, norms and perceived behavioural control predict intentions, should we aim to assess the underlying beliefs. Third, since assessment of beliefs results in similar or better prediction than using belief-valuation combinations, we should not 'annoy' respondents with valuation items. Finally, we argue that the traditional paper-and-pencil survey is still the most reliable and practical data collection method. However, pilot studies applying computerised adaptive methods to determinants of EBRBs are encouraged.

Despite intensive efforts, most smoking prevention interventions have had disappointing results. In the present paper, the assumption underlying these efforts that smoking initiation is the result of a rational decision or plan, is questioned. The process of adolescent smoking initiation is described, based on a recently conducted series of studies. It is argued that smoking initiation among adolescents is unplanned behaviour. Therefore, interventions regarding smoking initiation should not only include a focus on smoking-specific cognitions. Models that incorporate both conscious and unconscious processes need to be used in mapping smoking prevention efforts. Further, programmes that help adolescents to quit smoking need more attention. Finally, it is argued that smoking prevention interventions should aim at influencing the image of nonsmoking by using mass media interventions and restrictive policies.

The importance of the social environment for dietary behaviour has been highlighted in the past decade. A type of environmental influence that has received increasing research attention in recent years is the influence that parents can have on their children's dietary behaviour through food-related parenting practices. Much of the work done so far, however, has reported inconsistent findings and poorly understood mechanisms of influence. The present study aimed to explore the possible environmental influence of general parenting style on adolescent food choice patterns. Data were collected at schools (N=643; mean age 16.5 years), using self-administered questionnaires on parenting style, fruit intake behaviour and fruit-specific cognitions. Consistent and theoretically predictable differences were found between adolescents who described their parents as authoritative, authoritarian, indulgent or neglectful. Fruit consumption and fruit-specific cognitions were most favourable among adolescents who were being raised with an authoritative parenting style. Children of parents with indulgent parenting styles consumed more fruit than adolescents from authoritarian or neglectful homes. Consequences of these results for the interpretation of earlier studies on the influence of parenting practices are discussed, and a research model is proposed for future studies of parental influences on adolescent dietary behaviours.

Background: For the first time a comprehensive international research-based smoking prevention programme addressing adolescents has been launched in Denmark. The ESFA cohort study started in 1997, and this article presents baseline findings. Factors that relate to the initiation of adolescent smoking are found among the concepts of attitude, social norms, social pressure and self-efficacy beliefs., Methods: Baseline findings from Danish adolescents (n = 1770) in secondary school (mean age 13.8 years)., Results: The cross-sectional baseline data show that the attitude-social influence-efficacy-model proves to be of value in highlighting the associations of adolescent smoking behaviour. Social self-efficacy, peer smoking behaviour and the intention to smoke proved to have the strongest associations with smoking., Conclusion: It is recommended that self-efficacy beliefs and the individual intentions to smoke should be included in the future in smoking prevention programmes in Denmark. Furthermore, a distinction between the roles of parents and peers should be emphasized when addressing the social environment of adolescents in health promotion.