Marianne Wind

Reliability and validity of a questionnaire to measure personal, social and environmental correlates of fruit and vegetable intake in 10-11-year-old children in five European countries

OBJECTIVES To investigate the internal consistency of the scales and the test-retest reliability and predictive validity of behaviour theory-based constructs measuring personal, social and environmental correlates of fruit and vegetable intake in 10-11-year-old children. DESIGN Test-retest with one-week interval. SETTING Five European countries: Norway, Spain, Denmark, Portugal, Belgium. SUBJECTS Three hundred and twenty-six children completed the questionnaire during class hours. RESULTS For the total sample across all countries, the test-retest reliability was good to very good (intra-class correlation coefficient (ICC) >0.60) for 12 out of the 15 fruit constructs and also for 12 out of the 15 vegetable constructs. Acceptable ICCs, ranging between 0.50 and 0.59, were found for the remaining constructs. Test-retest reliability was comparable across countries. Only in Portugal were some significantly lower ICCs found for some constructs (knowledge and barriers related to fruit, general self-efficacy related to fruit and vegetables) compared with the other countries. Cronbachs alpha values were moderate to high (range 0.52 to 0.89) with the exception of the general self-efficacy scale, which had a value below 0.50 for both fruit (alpha=0.42) and vegetables (alpha=0.49). Spearman correlations with intake ranged between -0.16 and 0.54 for personal determinants and between 0.05 and 0.38 for environmental determinants. Compared with other studies, predictive validity can be considered moderate to good. CONCLUSIONS The questionnaire provides a reliable, valid and easy-to-administer tool for assessing personal, social and environmental factors of potential influence on fruit and vegetable intake in 10-11-year-olds.

Personal, social and environmental predictors of daily fruit and vegetable intake in 11-year-old children in nine European countries

Objective:To investigate potential personal, social and physical environmental predictors of daily fruit intake and daily vegetable intake in 11-year-old boys and girls in nine European countries.Subjects:The total sample size was 13 305 (90.4% participation rate).Results:Overall, 43.2% of the children reported to eat fruit every day, 46.1% reported to eat vegetables every day. Daily fruit intake and daily vegetable intake was mainly associated with knowledge of the national recommendations, positive self-efficacy, positive liking and preference, parental modeling and demand and bringing fruit to school (odds ratio between 1.40 and 2.42, P<0.02). These factors were associated fairly consistently with daily fruit intake across all nine European countries, implying that a rather uniform intervention strategy to promote fruit can be used across Europe. For vegetables, the pattern was, however, less consistent. Differences between countries in cooking and preparing vegetables might be responsible for this larger diversity.Conclusions:This study showed that especially a combination of personal and social factors is related to daily fruit and vegetable intake in schoolchildren. This shows that a comprehensive multilevel intervention strategy based upon a series of individual and social correlates will be most promising in the promotion of daily fruit and vegetable intake in children.

Determinants of fruit and vegetable intake among 11-year-old schoolchildren in a country of traditionally low fruit and vegetable consumption

BackgroundFruit and vegetable consumption is traditionally low in Iceland. The results of the Pro Children cross-Europe survey showed that the consumption was lowest among children in Iceland. The aim of this study was to identify determinants of fruit and vegetable intake among 11-year-old schoolchildren in Iceland.MethodsA cross-sectional survey was performed in Iceland in the autumn of 2003 as a part of the Pro Children cross-Europe survey. The survey was designed to provide information on actual consumption levels of vegetables and fruits by 11-year-old school children and to assess potential determinants of consumption patterns. A total of 1235 Icelandic children (89%) from 32 randomly chosen schools participated. Hierarchical regression analyses were performed to determine the explained variance of the childrens fruit and vegetable intake. In these analyses socio-demographic background variables were entered as a first block, perceived physical-environmental variables as a second block, perceived socio-environmental variables as a third block and personal variables as a fourth block.Results64% of the children ate fruit less than once a day, and 61% ate vegetables less than once a day. Respectively, 31% and 39% of the variance in childrens fruit and vegetable intake was explained by the determinants studied. About 7% and 13% of the variance in fruit and vegetable intake was explained by the perceived physical-environmental determinants, mainly by availability at home. About 18% and 16% of the variance in fruit and vegetable intake was explained by the personal determinants. For both fruit and vegetable intake, the significant personal determinants were preferences, liking, knowledge of recommendations and self-efficacy.ConclusionInterventions to increase fruit and vegetable intake among children should aim at both environmental factors such as greater availability of fruit and vegetables, and personal factors as self-efficacy and knowledge levels concerning nutrition.

Personal, social and environmental factors regarding fruit and vegetable intake among schoolchildren in nine European countries.

Background/Aims: Children in Europe are consuming less fruit and vegetables than recommended. Knowledge about the potential determinants of fruit and vegetable intake is vital to understand discrepancies in intake and to guide interventions. The aim of the present study was to assess personal, social and environmental factors regarding fruit and vegetable intake among 11- to 12-year-old children in Europe. Methods: A cross-sectional survey was undertaken, with nationally or regionally representative samples of in total 13,305 children (mean age 11.4 years) from nine European countries. Pupils in the classroom completed a self-administered questionnaire measuring fruit and vegetable intake and personal, social and environmental factors during one school lesson. Age-adjusted covariance analyses were carried out by gender, for the full sample and for each country separately. Proportions responding positively to the constructs are presented. Results: Overall, European children held a positive attitude towards fruit and vegetable intake. For some constructs, large between-country differences were found. Children had a more positive attitude towards fruit than towards vegetables, and girls were on average more positive than boys. The children perceived their social environment as supportive towards fruit and vegetable intake. They reported good to very good availability of fruit and vegetables at home. However, availability at school and during leisure time activities seemed to be low, both for fruit and for vegetables. Conclusion: A large majority of the children reported positively to the personal and social factors regarding fruit and vegetable intake. As regards availability of fruit and vegetables at school and leisure time, and accessibility of fruit and vegetables at home, there is room for improvement.

A qualitative exploration of determinants of fruit and vegetable intake among 10- and 11-year-old schoolchildren in the low countries.

Background: For the development of fruit and vegetable promotion interventions, insight is needed into determinants of health behaviour. This study presents results of focus group interviews held with 10- to 11-year-old schoolchildren from Ghent (Belgium-Flanders) and Rotterdam (the Netherlands) to explore personal beliefs and motivations and environmental factors related to schoolchildren’s fruit and vegetable intake, to inform the Pro Children intervention development. Methods: Twelve focus groups were held with 92 schoolchildren. The interviews were recorded and transcribed and NVivo was used to analyse the transcripts. Results: Positive health beliefs, taste preferences, lack of knowledge and practical barriers were identified as personal factors related to fruit and vegetable intake. Home and school availability of fruits and vegetables, as well as parenting practices were identified as important environmental factors. Conclusion: A fruit and vegetable promotion intervention should aim to increase fruit and vegetable accessibility and should include educational and motivational activities tailored to these personal and environmental factors. These indications should be further evaluated in quantitative research among representative samples.

Television viewing and exposure to food-related commercials among European school children, associations with fruit and vegetable intake: a cross sectional study

BackgroundFruit and vegetable intake is low among European children and exposure to TV is negatively associated with the intake of fruit and vegetables. The aim of the present study was to explore exposure to food commercials on TV in nine European countries. Associations between such exposure and intake of fruit and vegetables and possible mediating effects of attitudes toward and liking of fruit and vegetables were assessed.MethodsA cross-sectional survey was performed in nine European countries, i.e. Austria, Belgium, Denmark, Iceland, the Netherlands, Norway, Portugal, Spain and Sweden, from October-December 2003, as a part of the Pro Children study. Data on usual intake of fruit and vegetables, and related correlates were collected by means of a self-administered questionnaire among 11-year-old school children (mean age 11.4 (sd = 0.48), 50.2% boys). Complete data was available for 13,035 children. Differences in exposure to TV ads between countries, gender and social class were explored by analysis of variance. Multiple linear regression analysis was used to test associations between exposure to TV ads and intake and to assess mediating effects.ResultsThe large majority of children in all nine countries report recent exposure to a number of TV ads for food, and they were more often exposed to ads for unhealthy food than for fruit and vegetables (mean of 2.2 (sd = 1.0) unhealthy ads vs. mean of 1.7 (sd = 1.0) healthy ads; p < 0.001). Boys reported somewhat higher TV viewing than girls did (2.5 (sd = 1.7) vs. 2.2 (sd = 1.6) hours per day; p < 0.001), and children from lower social classes reported higher TV viewing than higher social class children did (2.4 (sd = 1.7) vs. 2.0 (sd = 1.5); p < 0.001). Across all countries, exposure to TV ads for healthy foods was positively associated (r = 0.09–0.16) with reported fruit and vegetable intake. This association was in part mediated by attitudes toward and liking of fruit and vegetables.ConclusionExposure to TV ads for fruit and vegetables appear to be associated with fruit and vegetable consumption among European school children. This relationship is in part mediated through cognitive factors such as attitudes and preferences concerning fruit and vegetables.

Availability of data assessing the prevalence and trends of overweight and obesity among European adolescents.

OBJECTIVE To review recent data on objectively measured overweight/obesity in national representative samples of European adolescents (aged 10-18 years), as well as availability of studies assessing trends in overweight/obesity in this target group. Attention was paid to the ability of the data to describe the obesity epidemic, especially in sociodemographic subgroups. DESIGN/SETTING/SUBJECTS Data on prevalence and trends in overweight/obesity among adolescents in the twenty-seven European Community member states, Iceland, Norway and Switzerland, available as scientific publications as well as reports or unpublished data by the end of 2009, were retrieved. Reports on the most recent objectively measured data from national representative samples were selected and described with regard to the years of data collection, sample sizes, response rates, age ranges included, trends by age, type of measures of overweight/obesity, sociodemographic variables and the sources of information. RESULTS Objectively measured data on national representative samples were identified for only half of the countries, and the trend studies were mainly conducted applying subnational samples. Most studies used the criteria from the International Obesity Task Force (IOTF) to define overweight/obesity, but the age ranges studied and the years of data collection varied, and information on sample sizes and response rates were often not presented. Data on trends of overweight/obesity over time are increasing, and the most recent studies indicate that the prevalence rate of overweight/obesity has stabilized. Few studies reported data by sociodemographic subgroups other than gender and age. CONCLUSIONS Objectively measured data on national representative samples of adolescents appear scattered, and there is a large heterogeneity with respect to the quality and comparability of available data. Increasing use of the IOTF criteria for overweight/obesity contributes to improved comparability across studies. Data by sociodemographic subgroups, and in particular by socio-economic status, are scarce.

Toothbrushing at school: Effects on toothbrushing behaviour, cognitions and habit strength

Purpose – To assess the impact of a school‐based toothbrushing intervention aimed at encouraging primary school children to brush their teeth daily at school, on cognitions, toothbrushing behaviour and habit strength.Design/methodology/approach – The effects of an intervention were examined in a quasi‐experimental trial among 296 fifth‐graders in seven schools. The schools were randomly assigned to be an intervention group or a control group. Children in the intervention schools brushed their teeth at school under supervision. Effects on toothbrushing behaviour were assessed with written questionnaires before, during, immediately after, and one year after the intervention period. Effects on cognitions and habit strength were assessed one year after the intervention period. Analyses of variance were conducted to detect differences in frequency of toothbrushing, cognitions about toothbrushing, and habit strength.Findings – During the intervention period, brushing teeth at school resulted in a significant in...

Direct and indirect association between environmental factors and fruit intake, mediation by psychosocial factors: the Pro Children study.

OBJECTIVES To explore direct associations between home and school availability of fruit and fruit intake, and the mediating role of attitude towards fruit, liking, perceived barriers and self-efficacy. DESIGN Cross-sectional study. SETTING Primary schools in nine European countries. SUBJECTS Within the Pro Children study, data were collected on perceived home and school availability of fruit, psychosocial factors related to fruit intake and its frequency among 13 305 11-year-old schoolchildren. RESULTS Significant overall associations were found between child-reported home availability of fruit and fruit intake in all countries and in the total sample. School availability of fruit was associated with fruit intake in the pooled sample and in country-specific analyses in Sweden and the Netherlands. Liking (13·2-49·4 %) and self-efficacy (14·0-25·1 %) were the strongest mediators in the home availability-fruit intake relationship, but there was also a direct association between home availability and fruit intake, except in Spain and the Netherlands. Mediating pathways of the school availability-fruit intake relationship could only be assessed for Norway, Sweden and the total sample. Attitude was a significant mediator in Norway (80·4 %) and in Sweden (25·3 %), while in the total sample also liking (38·7 %) and self-efficacy (23·0 %) were identified as significant mediators. CONCLUSIONS The association between home availability of fruit and fruit intake is at least partly mediated by personal factors such as liking and self-efficacy indicates that fruit intake is not a complete automatic or unconscious behaviour.

The application of a social cognition model in explaining fruit intake in Austrian, Norwegian and Spanish schoolchildren using structural equation modelling

BackgroundThe aim of this paper was to test the goodness of fit of the Attitude – Social influence – self-Efficacy (ASE) model in explaining schoolchildrens intentions to eat fruit and their actual fruit intake in Austria, Norway and Spain; to assess how well the model could explain the observed variance in intention to eat fruit and in reported fruit intake and to investigate whether the same model would fit data from all three countries.MethodsSamples consisted of schoolchildren from three of the countries participating in the cross-sectional part of the Pro Children project. Sample size varied from 991 in Austria to 1297 in Spain. Mean age ranged from 11.3 to 11.4 years. The initial model was designed using items and constructs from the Pro Children study. Factor analysis was conducted to test the structure of the measures in the model. The Norwegian sample was used to test the latent variable structure, to make a preliminary assessment of model fit, and to modify the model to increase goodness of fit with the data. The original and modified models were then applied to the Austrian and Spanish samples. All model analyses were carried out using structural equation modelling techniques.ResultsThe ASE-model fitted the Norwegian and Spanish data well. For Austria, a slightly more complex model was needed. For this reason multi-sample analysis to test equality in factor structure and loadings across countries could not be used. The models explained between 51% and 69% of the variance in intention to eat fruit, and 27% to 38% of the variance in reported fruit intake.ConclusionStructural equation modelling showed that a rather parsimonious model was useful in explaining the variation in fruit intake of 11-year-old schoolchildren in Norway and Spain. For Austria, more modifications were needed to fit the data.