Hein de Vries

Parenting style and adolescent fruit consumption

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 childrens 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.

A qualitative study on detecting cancer symptoms and seeking medical help; an application of Andersen’s model of total patient delay

Patient delay is the interval between the day someone first becomes aware of an unexplained symptom and the day they seek medical consultation. This pre-diagnostic period is comprised of several stages which may involve delay on the part of the individual. This study investigated factors influencing the process of detecting cancer symptoms and consulting a general practitioner (GP). Twenty-three patients were interviewed about their experiences during this process. Among factors stimulating the process of detection and consultation were associating symptoms with cancer, and discussing symptoms with others. Being ashamed or embarrassed about the symptoms and attributing symptoms to common ailments were among the impeding factors. The findings of the present study suggest that future health education on early detection of cancer should focus on increasing knowledge and providing positive information about early detection of cancer. It is recommended that educational materials be disseminated to the general public via more channels, including non-medical channels.

Misconceptions of Fruit and Vegetable Consumption: Differences between Objective and Subjective Estimation of Intake

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

TAILORING INFORMATION TO ENHANCE QUITTING IN SMOKERS WITH LOW MOTIVATION TO QUIT : THREE BASIC EFFICACY QUESTIONS

Tailoring information to a target individuals features is a promising line of development in self-help interventions. In this article, 752 smokers with explicit low intention to quit were randomly assigned to 1 of 5 conditions: (a) multiple tailored letters with self-help guide, (b) multiple tailored letters only, (c) a single tailored letter with a self-help guide, (d) a single tailored letter only, or (e) a nontailored intervention. Follow-up assessment took place 4 months after the intervention. Results indicated that the single tailored intervention only had no surplus value compared with a nontailored look-alike intervention. The addition of a self-help guide to a tailored intervention was only useful in highly dependent smokers, and multiple tailoring was more effective than single tailoring. It remains important to elucidate why and for whom certain tailored interventions are more effective.

Trends in socioeconomic inequalities in smoking prevalence, consumption, initiation, and cessation between 2001 and 2008 in the Netherlands. Findings from a national population survey

BackgroundWidening of socioeconomic status (SES) inequalities in smoking prevalence has occurred in several Western countries from the mid 1970’s onwards. However, little is known about a widening of SES inequalities in smoking consumption, initiation and cessation.MethodsRepeated cross-sectional population surveys from 2001 to 2008 (n ≈ 18,000 per year) were used to examine changes in smoking prevalence, smoking consumption (number of cigarettes per day), initiation ratios (ratio of ever smokers to all respondents), and quit ratios (ratio of former smokers to ever smokers) in the Netherlands. Education level and income level were used as indicators of SES and results were reported separately for men and women.ResultsLower educated respondents were significantly more likely to be smokers, smoked more cigarettes per day, had higher initiation ratios, and had lower quit ratios than higher educated respondents. Income inequalities were smaller than educational inequalities and were not all significant, but were in the same direction as educational inequalities. Among women, educational inequalities widened significantly between 2001 and 2008 for smoking prevalence, smoking initiation, and smoking cessation. Among low educated women, smoking prevalence remained stable between 2001 and 2008 because both the initiation and quit ratio increased significantly. Among moderate and high educated women, smoking prevalence decreased significantly because initiation ratios remained constant, while quit ratios increased significantly. Among men, educational inequalities widened significantly between 2001 and 2008 for smoking consumption only.ConclusionsWhile inequalities in smoking prevalence were stable among Dutch men, they increased among women, due to widening inequalities in both smoking cessation and initiation. Both components should be addressed in equity-oriented tobacco control policies.

The Utilization of Qualitative and Quantitative Data for Health Education Program Planning, Implementation, and Evaluation: A Spiral Approach

The process of development of a Dutch smoking prevention project is described. An essential feature of the project is the combination and interaction of qualitative and quantitative research methods. It is advocated that each method has its own contribution and can be considered as a separate methodology contributing to social science in general and health education research in particular. Combining the two approaches in a spiral approach will result in a synergistic effect, because of the interaction of both approaches. The results of both methods suggest that qualitative methods enhanced the generation of ideas and theories. Qualitative methods were used to formulate ideas for improving quantitative data gathering, analyzing and comparing ideas with respect to program development, and for testing the internal validity of a quantitative design. The quantitative method enabled testing of results in different groups and detecting detailed differences. It also provided information that one of the assumptions of the program, the development of a teacher independent program, was not completely realized. The major advantage of using both methods is that this provides feedback between assumptions and data, thus enhancing comparison of results and critical reflection during the whole project.

Subtypes within the precontemplation stage of adolescent smoking acquisition

The present study examined the existence of three possible subtypes within the precontemplation stage of smoking acquisition: committers, immotives, and progressives. The sample of the study included young people from six European countries (mean age = 13 years) who had never smoked regularly (n = 21 535). A cross-sectional design was used to assess cognitive determinants of smoking behavior: attitudes towards smoking, perceived social influences, and self-efficacy to remain a nonsmoker. Adolescents within the various stages of smoking acquisition were compared with regard to standardized T scores on these risk factors. The results showed that adolescents in the three subgroups of precontemplation differed from each other on every cognitive determinant tested, revealing a higher risk to start smoking among progressives than among immotives. Immotives revealed a higher risk to start smoking than committers. It is concluded that the use of subtypes within acquisition precontemplation in research on adolescent smoking may be a promising tool for investigating the initiation continuum and for improving the quality of both the implementation and evaluation of prevention programs.

Socio-economic differences in smoking: Dutch adolescents' beliefs and behaviour

Smoking behaviour is more frequent among those who have a low than those who have a high socio-economic status. The present study confirms that this is also true for Dutch adolescents. The purpose of this study was to investigate whether adolescents with a low socio-economic status (LSES) have different motives for smoking or non-smoking than those with a high socio-economic status (HSES), the aim being to formulate more specific recommendations for prevention strategies for the various groups. HSES adolescents perceived a stronger association between smoking and a number of health-related, personal and social disadvantages, while linking smoking more clearly with the discovery of the taste and with relief from boredom than LSES adolescents. LSES adolescents viewed smoking as a way of meeting people. HSES adolescents experienced less positive norms and less social pressure towards smoking than did LSES adolescents. Smoking among LSES adolescents seems to be embedded in the social culture, and has a stronger social function. Smoking prevention programmes for this group will have to be integrated into a broader, community-based approach, which should also pay attention to the smoking behaviour of the social environment in general and that of the parents in particular. Finally, improved legislation with regard to smoking prevention will be required, in order to facilitate the adoption and implementation of smoking prevention programmes.

Efficacy of a single computer-tailored e-mail for smoking cessation: results after 6 months

To date, few Internet-delivered smoking cessation interventions have been tested. This study tested the efficacy, understandability, credibility and personal relevance of an e-mail-delivered computer-tailored smoking cessation intervention. It included tailored action plan feedback, as recent studies have demonstrated the importance of planning in facilitating quitting smoking. Participants (Dutch adults) were randomly assigned to the intervention (computer-tailored e-mail; N = 224) or the control group (generic, non-tailored e-mail; N = 234). The results 6 months after baseline (N = 195) showed that significantly more participants in the intervention group reported not having smoked in the last 24 hours (21.5%) and 7 days (20.4%) in contrast with participants in the control group (9.8 and 7.8%, respectively). Intention-to-treat analyses revealed similar results, though overall lower quitting percentages. Furthermore, participants in the intervention group appreciated the computer-tailored e-mail significantly more in terms of understandability, credibility and personal relevance. Hence, the computer-tailored intervention is effective for the Dutch smoking population motivated to quit smoking. Further research is needed into the efficacy of the intervention for smokers who are not motivated to quit smoking and into the benefits of (multiple) e-mail-delivered tailored letters with tailored action plan feedback over and above tailoring without action plan feedback.

Subtypes within a sample of precontemplating smokers: a preliminary extension of the stages of change.

Precontemplating smokers are not planning to quit within the next 6 months. There are indications that this group is not homogeneous. The present investigation aimed at identifying relevant subgroups within this large group of smokers in order to refine stage-matched interventions. Precontemplators were asked whether they were planning to quit (1) within the next year. (2) within the next 5 years, (3) not within the next 5 years but sometime, (4) never, or (5) none of the above. Smokers who were planning to quit within 5 years (redefined precontemplators) differed from smokers who were not planning to quit within the next 5 years (immotives) on the pros of quitting but not on self-efficacy scores. Compared to smokers in the other groups, immotives scored significantly lower on specific factors within the pros of quitting.