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Background If boys and girls are known to have different levels of quality of life (HRQoL), less is known about behavioural factors such as physical activity (PA), sedentary behaviour (SB) that can explain it. We aimed to analyse the mediation effect of PA and SB on the association of sex and HRQoL among adolescents. Methods 2448 adolescents (1378, 56.3% of Girls) from the PRALIMAP trial with 2-year follow-up were included. HRQoL (physical, mental, social and general dimension scores; range 0-100), PA (walking, moderate vigorous and total) and SB (sitting time) were assessed using the Duke Health profile and the IPAQ questionnaires, respectively. The 2-year mean PA and SB were calculated and categorized into high or low PA (? 1hour/day) or SB (2 hours/day out of school). We conducted a mediation analysis to investigate the causal mechanism of gender (reference=Girls) on HRQoL through PA and SB by estimating total effect (TE), natural direct effect (NDE), natural indirect effects (NIE) as well as proportion mediated (PM: proportion of sex-HRQoL relationship mediated by PA or SB). Results The direct relationship of gender and HRQoL (NDE) was significant whatever the HRQoL dimension. When using vigorous PA as mediator, PM was estimated at 13.7% (TE:11.0 [9.5 to 12.5]; NIE:1.5[0.9 to 2.1]), 19.4% (TE: 12.3 [10.6 to 14.1]; NIE: 2.4 [1.6 to 3.1]), 70.0% (TE:4.6 [3.1 to 6.2] ; NIE: 3.3 [2.5 to 4.0]) and 25.6% (TE: 9.3 [8.1 to 10.5]; NIE:2.4 [1.8 to 2.9]) for physical, mental, social and general HRQoL, respectively. Similar but less important mediation effect was observed for moderate and walking PA. For Total PA, PM was estimated 7.0%, 8.7%, 47.4% and 14.7% for physical, mental, social and general HRQoL while for SB, the mediation was inverse and less important (PM: -1.5%, -1.4%, -2.0% and -1.5% for physical, mental, social and general HRQoL respectively). Conclusion HRQoL is significantly higher in boys compared to girls among adolescents and this difference is shown to be partially mediated by differences in PA practice, especially vigorous PA. Additionally to the impact of adolescent PA in preventing non-communicable diseases in adulthood, it can also enhance their well-being.

Objective:To investigate clustering of risk behaviours in adolescents with excess weight.Design:Cross-sectional analysis of baseline data from the PRALIMAP-INÈS trial. Information on food frequency consumption (fruit, vegetables, sugary products and beverages), physical activity, sedentary behaviour (week and weekend days), smoking and alcohol consumption (current frequency and intoxication episodes) and socio-demographic data was collected using self-reported questionnaires. Behavioural risk factors were entered as categorical variables in a two-step clustering procedure: multiple correspondence analysis followed by hierarchical clustering. Associations between cluster membership and socio-demographic variables were investigated using multivariable multinomial logistic regression.Setting:French PRALIMAP-INÈS trial.Participants:Adolescents with excess weight.Results:A total of 1391 participants (13–18 years old, 58·2 % female) were included in the analysis, which resulted in the identification of four groups of participants, including, respectively, 543 (39·0 %), 373 (26·8 %), 246 (17·7 %) and 229 (16·5 %) participants. Clusters 1 and 4 showed associations of rather healthy behaviours (high physical activity and low consumption of sugary products; high consumption of fruit and vegetables, respectively), while clusters 2 and 3 showed associations of rather unhealthy behaviours (high sedentary behaviour and low consumption of fruit and vegetables; smoking and alcohol consumption, respectively). Both social status and family structure were associated with cluster membership.Conclusions:Risk behaviour patterns in adolescents with excess weight were clustered in both healthier and less healthy ways, with a complex interplay with socio-demographic factors.

Background: This study aimed to quantify the 2-year mediating effects of physical activity (PA) and eating behavior (EB) on socioeconomic and sex inequalities in quality of life (QoL) among French adolescents. Methods: Adolescents from a 2-year school-based trial were included. PA and EB were assessed at baseline, 1 year, and 2 years using the International Physical Activity Questionnaire and an eating habits questionnaire, respectively. QoL was measured at 2 years using the Duke Health Profile questionnaire. The mediating effect of adherence to PA and EB guidelines in the associations between socioeconomic status or sex and QoL was analyzed with a counterfactual method. Results: Among the 3562 included adolescents (mean age, 15.2 [0.6] y), being a boy and having a high socioeconomic status was associated with high QoL. Differences in QoL by socioeconomic status were mediated by adherence to guidelines for PA (up to 10.2%) and EB (up to 8.8%), and differences in QoL by sex were predominantly mediated by adherence to guidelines for PA (up to 163.8%). Conclusions: Policies, programs, and interventions designed to reduce socioeconomic and sex inequalities in QoL among adolescents could use PA and EB as leverage.

International audience; Social differences in prevalence of overweight and obesity among adolescents, known as the weight social gradient, could be explained by differences in behaviours between social classes. This study examined the respective association of physical activity (PA), sedentary behaviour (SB) and weight status with adolescents' socioeconomic status. We used cross-sectional data for 1935 adolescents (13-18 years old) with overweight or obesity who participated in the PRALIMAP-INÉS (PRomotion de l'ALImentation et de l'Activité Physique - INÉgalités de Santé) trial conducted in northeastern France between 2012 and 2015. Adolescents completed the International Physical Activity Questionnaire for PA and SB and the Family Affluence Scale for socioeconomic status. Weight status was assessed by the body mass index (BMI) and BMI z-score. Social gradient of weight status, PA and SB were described according to the Family Affluence Scale (slopes) and evidenced by the linear trend test (p). Adolescents' socioeconomic status was positively associated with PA practice (frequency, vigorous PA and leisure-time PA), but there was no association with their SB. The results confirmed a significant weight social gradient: BMI (β = 0.37, p

International audience; BACKGROUND: A high prevalence of overweight/obesity among low socioeconomic status adolescents contributes to health inequalities. However, evidence-based interventions for reducing social inequalities in adolescent weight are lacking. We aimed to investigate whether strengthened care management for adolescents with low socioeconomic status has an equivalent effect in reducing overweight as standard care management in adolescents with high status.METHODS: PRALIMAP-INÈS was a multicentre trial including 35 state-run high and middle schools in the north-eastern France. A population-based sample of 1639 adolescents aged 13-18 years with screened and clinically confirmed overweight/obesity were proposed for inclusion and divided into two groups by the Family Affluence Scale score: advantaged (score > 5), receiving standard care management (A.S) and less-advantaged randomly assigned to two groups (1:2 ratio): standard care management (LA.S) and standard and strengthened care management (LA.S.S). Interventions were based on the proportionate universalism principle: universal standard care for all groups and proportionate care for the LA.S.S group. Main outcome was body mass index z-score (BMIz) assessed before and 1 year after inclusion.RESULTS: A total of 1419 adolescents were included and 1143 followed up at 1 year: 649 in A.S, 158 in LA.S and 336 in LA.S.S groups. BMIz decreased significantly for boys (-0.11 [95% CI, -0.13 to -0.08]; p

Contexte A l’adolescence, la corpulence diminue avec l’augmentation du statut socio-economique (SSE). Cette relation est connue sous le nom de gradient social de corpulence (GSC). L’essai PRALIMAP (Promotion de l’ALImentation et de l’Activite Physique) a permis de montrer qu’une intervention universelle comprenant une strategie de depistage et de prise en charge etait un moyen efficace pour reduire la prevalence du surpoids et de l’obesite chez les adolescents. Cependant, la question de son impact sur la reduction du GSC n’a pas encore ete abordee. L’objectif de la presente etude etait d’evaluer l’impact de l’intervention PRALIMAP sur le GSC chez les adolescents. Methode Les donnees longitudinales de 3504 adolescents ayant participe a l’essai PRALIMAP entre 2006 et 2009 ont ete utilisees. Le statut ponderal des adolescents a ete mesure par l’indice de masse corporelle (IMC), le z-score de l’IMC et la prevalence du surpoids et de l’obesite. L’indice de position sociale des eleves a ete utilise pour mesurer le SSE des adolescents. Des modeles de regression lineaire et hierarchique ont respectivement ete utilises pour mesurer le GSC a l’inclusion et son evolution apres l’intervention. Resultats Pour l’ensemble des adolescents (âge moyen ± ecart type : 15,2 ± 0,6), un GSC a ete mis en evidence a l’inclusion. La corpulence diminuait significativement et lineairement avec l’augmentation du SSE : z-score de l’IMC (β=−0,06 ; p Conclusion Cette etude n’a pas permis de montrer que l’intervention universelle PRALIMAP etait un moyen efficace pour reduire les inegalites sociales de corpulence chez les adolescents. Il apparait necessaire d’envisager des interventions qui prennent en compte les differences sociales pour lutter contre ces inegalites.

Objective To evaluate the feasibility of an innovative peer intervention promoting healthy eating and physical activity, which purposefully selected peer facilitators according to socioeconomic status to target less-advantaged overweight receivers. Setting Nine high schools, two middle schools. Participants One hundred and fifty-six adolescents were approached to become facilitators, of whom 18 were trained. Thirty-two of 56 potential receivers agreed to participate. Intervention The peer intervention was carried out in 2013–2014 and embedded in a larger trial: PRALIMAP-INÈS (Promotion de l’ALIMentation et l’Activité Physique-INEgalité de Santé). Facilitanoators were selected and trained to organise weight-control activities with specific peer receivers participating in the programme. Primary and secondary outcome measures Different types of data were collected to assess demand, acceptability, implementation and practicality of the intervention. For the facilitators, this included 6 training sessions, 11 mid-programme interviews, 4 end-of-programme sessions, telephone notes and text message exchanges. All six potential receivers in one school were also interviewed. Sociodemographic and health characteristics were also analysed. Results Agreeing to participate was more likely when asked by a peer compared with a professional (51.2% discordant pairs; p

Initial participation in PRALIMAP-INÉS group activities was high among disadvantaged teenagers with financial difficulties, but it was more difficult to maintain their participation throughout the programme. Identification of factors that can maintain participation is a major challenge for continuity of the programme./ce:para.

Background Social differences among adolescents in physical activity and sedentary behaviour have been identified but are not well explained. The current study aimed to identify socioeconomic, family and school-related associated factors with physical activity and sedentary behaviour among high-school adolescents. Methods This was a cross-sectional analysis of T0 physical activity and sedentary behaviour of 2523 students 14 – 18 years old recruited for the PRALIMAP trial from 24 French state-run high schools. Data were collected by self-administered questionnaire at the start of grade 10. Adolescents completed the International Physical Activity Questionnaire for physical activity and sedentary behaviour and an ad hoc questionnaire for active commuting and sport participation. Statistical analyses involved linear and logistic regressions. Results Socioeconomic, family or school variables were associated with levels of physical activity and sedentary behaviour for both boys and girls, but no factor, except perceived parental physical activity level, was associated with total energy expenditure (total physical activity) for either gender. Adolescents with privileged and less privileged socioeconomic status reported the same total amount of energy expenditure. Conclusions Total physical activity score alone is not sufficient to assess the physical activity of adolescents. These findings may have implications for better understanding of social inequalities in this context and recommendations to prevent overweight. Trial registration This trial is registered at ClinicalTrials.gov (NCT00814554). The date of registration: 23 December 2008. Registration was not required at the time of the start of PRALIMAP for public health and prevention programmes and trials. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4070-9) contains supplementary material, which is available to authorized users.

International audience

International audience

International audience; BACKGROUND:The directionality of the association of physical activity (PA) and sedentary behaviour (SB) with health-related quality of life (HRQoL) remains unknown in adolescents. This study aimed to investigate the association of 2-year cumulative level of PA and SB with HRQoL and the reverse association.METHODS:We included 1445 adolescents in France from a 2-year longitudinal study with three follow-up times (PRALIMAP trial). At each follow-up, adolescents completed the International Physical Activity Questionnaire for PA and SB and the Duke Health Profile for HRQoL. Statistical analyses involved linear and logistic regressions adjusted for socio-demographic characteristics.RESULTS:The cumulative number of times an adolescent achieved the PA recommendations during the 2 years was associated with better physical, mental, social and general HRQoL (p for trend < 0.0001). In contrast, high SB predicted low HRQoL for most dimensions except social HRQoL (p = 0.12). Combining PA and SB, the effect of recommended PA on HRQoL was offset in part by high SB. In the reverse association, high HRQoL predicted high PA (overall, vigorous, moderate and recommended PA), but was not associated with SB.CONCLUSIONS:The association between PA and HRQoL was cumulative and bidirectional among adolescents, whereas low HRQoL seemed to be a consequence of high SB rather than a cause (cumulative but not bidirectional). Promoting recommended PA and low SB may help improve HRQoL among adolescents, with a possible virtuous cycle with regard to PA.

BackgroundAlthough information and communication technology interventions appear to be a promising means of reducing the health inequality gap in overweight and obesity prevention, research on information and communication technology interventions is lacking outside the Anglo-Saxon world. ObjectiveThe aim of this study was to assess the reach and acceptability of 2 information and communication technology interventions delivered as part of a French nutritional program: an SMS text messaging (short message service, SMS) attendance-reminder for collective sessions strategy and a Facebook challenge group. MethodsThis study sample comprised 262 socially less advantaged overweight adolescents aged between 13 and 18 years. The information and communication technology interventions were carried out during the 2013-2014 academic year in 33 French state-run schools. For the SMS attendance-reminder for collective sessions strategy, at the start of the academic year, adolescents were asked to give their mobile number. SMS attendance-reminders were sent shortly before each of the 5 collective sessions. For the Facebook challenge group, adolescents were invited to join a closed Facebook group in which challenges on physical activity and on diet were posted weekly. Process data and 2 sets of face-to-face interviews were also used to interpret participation rates and access to Facebook. Appreciation for both interventions was evaluated by a questionnaire at the end of the academic year. ResultsOf the recruited adolescents, 79.0% (207/262) gave their mobile number, reflecting high access to a mobile phone. Giving a number was significantly more likely for girls (odds ratio [OR] 2.1, 95% CI 1.1-3.9; P=.02) and adolescents in a vocational or general high school as opposed to middle school (OR 1.0, 95% CI 0.4-2.7; OR 0.2, 95% CI 0.1-0.5; P

Cet article présente les résultats d'une revue de la documentation couvrant les années 1968 à 1993 et portant sur les liens entre la monoparentalité, la pauvreté et la santé mentale. A partir des banques de données courantes, 56 articles ont été retenus. Les mères monoparentales sont de plus en plus nombreuses et de plus en plus pauvres. Sur six variables de santé mentale répertoriées, quatre (détresse psychologique, estime de soi, sentiments de compétence et isolement psychologique) démontrent que ces mères sont en moins bonne santé mentale que les mères biparentales. L'estime de soi, la détresse et le bien-être psychologique des mères sont affectés par les variables économiques. Les résultats varient donc en fonction de la variable mesurée. Les mères monoparentales vivent plus de malaises psychologiques que les biparentales, mais elles ne semblent pas vivre plus de troubles sévères de santé mentale. Les recherches éventuelles devraient tenir compte d'un certain nombre d'aspects afin de rendre compte des liens entre la monoparentalité, la pauvreté et de la santé mentale., The goal of this article is to discuss an overview of literature published from 1968 to 1993 and dealing with links between singleparenting, poverty and mental health. A total of 56 articles were selected based on the most current data banks. Results show that the population of single-parent mothers is growing and that they are becoming increasngly poor. Of the six mental health variables listed by the author, four (psychological distress, self-esteem, perception of one's own skills and psychological isolation) clearly demonstrate that single-parent mothers are in a less healthy mental state than are mothers in two-parent families. Results also indicate that self-esteem, distress and psychological well-being are affected by economic variables. Results therefore vary according to the variable being measured. Although single-parent mothers experience more psychological discomfort than mothers in two-parent families, they do not seem to experience more serious mental health problems. The authors argue that future research on the subject should take into consideration a certain number of aspects, discussed in the conclusion of this article, which account for links between single-parenting, poverty and mental health.

Introduction et but de l’etude La prevalence du surpoids et de l’obesite continue de croitre dans les categories les moins favorisees, mais se stabilise, voire regresse dans les categories les plus favorisees contribuant a aggraver les inegalites sociales. Cette situation justifie leur prise en compte lors d’intervention a visee preventive ou therapeutique. Cette etude a pour objectif de mesurer les inegalites sociales de corpulence chez les adolescents et leurs evolutions apres la mise en place d’une intervention en milieu scolaire. Materiel et methodes Mille quatre cent dix-huit adolescents (âges de 13 a 18 ans) issus des classes de troisieme et de seconde de 36 etablissements scolaires du departement des Vosges ont ete inclus dans l’etude Pralimap-Ines, dont 1142 avec un suivi a la fin de l’annee scolaire. A l’entree et a la fin de l’annee scolaire, ils ont ete peses et mesures (poids, taille, perimetre abdominal) et ont repondu a des questionnaires sur leur milieu social (score selon la FAS : Family Affluence Scale, de 0 a 9), leur alimentation, leur activite physique et leur etat de sante general. Le score selon la FAS a ete categorise en cinq classes : tres defavorises [0–2], defavorises [3–4], intermediaires [5], favorises [6–7] et tres favorise [8–9]. Les interventions ont consiste en une prise en charge standard pour les adolescents de milieux favorises (FAS > 5) et en une prise en charge adaptee pour les adolescents de milieu defavorises (FAS ≤ 5). Le gradient social correspond a une relation lineaire entre le niveau social et l’etat de sante. Des modeles de regression lineaire (analyse de pente et test de tendance lineaire) ont ete utilises pour decrire le GS. Resultats A l’inclusion, plus le milieu social etait eleve, plus la corpulence etait basse traduisant un gradient social : β = −0,6 kg/m2, p Conclusion Ces donnees confirment l’existence d’un reel gradient social de corpulence chez les adolescents qui est coherent avec les determinants du surpoids. Une intervention ciblee a partir du milieu scolaire et tenant compte du milieu social parait efficace sur l’attenuation de ce gradient.

Introduction La prevalence du surpoids et de l’obesite continue de croitre dans les categories les moins favorisees mais se stabilise voire regresse dans les categories les plus favorisees contribuant a aggraver les inegalites sociales. Cette situation justifie leur prise en compte lors d’intervention a visee preventive ou therapeutique. Cette etude a pour objectif de mesurer les inegalites sociales de corpulence chez les adolescents et leurs evolutions apres la mise en place d’une intervention en milieu scolaire. Materiel et methodes Au total, 1419 adolescents (13–18 ans) issus des classes de 3e et de 2nde de 36 etablissements scolaires du departement des Vosges ont ete inclus dans l’etude PRALIMAP-INES dont 1143 avec un suivi a la fin de l’annee scolaire. A l’entree et a la fin de l’annee scolaire, ils ont ete peses et mesures (poids, taille, perimetre abdominal) et ont repondu a des questionnaires sur leur milieu social (score FAS : « Family Affluence Scale », de 0 a 9), leur alimentation, leur activite physique et leur etat de sante general. Le score du FAS a ete categorise en cinq classes : Tres defavorises [0–2], Defavorises [3–4], Intermediaires [5], Favorises [6–7] et Tres favorises [8–9]. Les interventions ont consiste en une prise en charge standard pour les adolescents de milieux favorises (>5) et en une prise en charge adaptee pour les adolescents de milieu defavorises (≤5). Le gradient social (GS) correspond a une relation lineaire entre le niveau social et l’etat de sante. Des modeles de regression lineaire (analyse de pente et test de tendance lineaire) ont ete utilises pour decrire le GS. Resultats A l’inclusion, plus le milieu social est eleve, plus la corpulence est basse traduisant un GS : β = −0,6 kg/m2, p Conclusion Ces donnees confirment l’existence d’un reel GS de corpulence chez les adolescents qui est coherent avec les determinants du surpoids. Une intervention ciblee a partir du milieu scolaire et tenant compte du milieu social parait efficace sur l’attenuation de ce gradient. Finacement INCA (Institut national du cancer)

Background:explaining why and how overweight prevention programs were effective was a real need; especially the potential role of physical activity (PA) and sedentary behavior (SB) should be highlighted. This study aimed to evaluate the 2-year effectiveness of a screening and care strategy in adolescents’ weight reduction with regards to PA and SB change.Methods:1745 adolescents aged 15.1 years from PRALIMAP trial was included (n = 840 for screening and care group and n = 905 for control group). PA and SB time (international physical activity questionnaire: IPAQ), body mass index (BMI), and BMI z-score were assessed at inclusion and after 2-year intervention. Hierarchical mixed models were applied.Results:Compared with the control group, screening and care strategy was associated with an increase in global PA (58 min/week), a moderate PA (43 min/week), the adherence to the French PA guidelines (OR = 1.3), and a decrease in SB (−198 min/week). The 2-year weight change decreased when adjusted for PA and SB suggesting that the effect of screening and care strategy was partly mediated by PA and SB.Conclusion:Screening and care intervention seemed to be effective in increasing PA and decreasing SB. The induced PA and SB modifications contributed to the observed weight change.