Tania Gaspar

Family‐related predictors of body weight and weight‐related behaviours among children and adolescents: a systematic umbrella review

This umbrella review analysed the relationships between family variables and child/adolescent body weight, diet and physical activity. In line with theories of health behaviour change, it was assumed that behaviour-specific family variables (i.e. beliefs, perceptions and practices referring to food intake or physical activity) would have stronger support than more general family variables (i.e. socio-economic status or general parental practices). Data obtained from 18 systematic reviews (examining 375 quantitative studies) were analysed. Reviews of experimental trials generally supported the effectiveness of reward/positive reinforcement parental strategies, parental involvement in treatment or prevention programmes, and cognitive-behavioural treatment in reducing child/adolescent body mass and/or obesity. Results across reviews of correlational studies indicated that healthy nutrition of children/adolescents was related to only one parental practice (parental monitoring), but was associated with several behaviour-specific family variables (e.g. a lack of restrictive control over food choices, high intake of healthy foods and low intake of unhealthy foods by parents and siblings, low pressure to consume foods). With regard to adolescent physical activity, stronger support was also found for behaviour-specific variables (e.g. physical activity of siblings), and for certain socio-economic variables (e.g. parental education). Child and adolescent obesity prevention programmes should account for behaviour-specific family variables.

Effects of School-based Interventions Targeting Obesity-Related Behaviors and Body Weight Change: A Systematic Umbrella Review

This umbrella review analyzed the effectiveness of school-based interventions, applying body weight or behavioral outcomes. Twelve systematic reviews and five meta-analyses (examining 196 trials) were included. Results indicated that the effectiveness was usually referred to body weight or BMI change, with 1/3 of trials (per review) indicating significant changes in BMI or obesity prevalence. Meta-analyses yielded mixed effects (three showed significant changes in weight, BMI, or obesity). Interventions were more effective if they aimed at a reduction of sedentary behaviors, incorporated moderate-to-vigorous physical activity, and parental involvement. The inclusion of a nutrition component moderated the long-term effects of interventions. More efficient interventions lasted at least 3 months, did not aim solely at environmental changes, and were implemented in general population. Female and younger participants may benefit more from the interventions. The role of psychological theories and behavioral or cognitive mediators was rarely investigated.

Qualidade de vida e bem-estar em crianças e adolescentes

The Portuguese team “Aventura Social” Project carried on during 2006, the translation and adaptation process of Kidscreen instruments (children/adolescents version and parents version). The aim of Kidscreen European project was built a standardized instrument, to estimate the subjective quality of life in children and adolescents and their parents. A sample of 3195 children and adolescents and their parents (n= 2256) were inquired. Questionnaires were applied in classroom setting, after a random selection of classes and schools, through the all country. The present study focus only in the Kidscreen children and adolescents versions. The results showed a good internal consistency, between auto-perception dimension (±= 0, 60) and economical issues (±= 0, 88). By using ANOVAs analyses were identified gender, age, and socio-economic status and nationality differences concerning the perception about their Health-Related quality of life. This study intends to increase the knowledge about Health-Related Quality of Life, the identification of risk factors and promote specific intervention programs (individual, interpersonal and in the community), contextualized and assessed

Access to excess: how do adolescents deal with unhealthy foods in their environment?

PURPOSE Easy access to unhealthy foods is believed to contribute to the current overweight epidemic. It remains unclear, however, how access to unhealthy foods is related to self-regulation of food intake. This study tests the hypothesis that using self-regulation strategies buffers the negative influences of easy access to unhealthy foods. METHODS Cross-sectional survey data from 2764 adolescents aged 10-17 years from four European countries (The Netherlands, UK, Poland and Portugal) about use of self-regulation strategies, access to unhealthy foods and intake of unhealthy foods (sweet and salty snacks and sugar-sweetened beverages) were used. RESULTS Both access to unhealthy foods and use of self-regulation strategies were independently, but in opposing directions, related to intake of unhealthy foods. Easy access to unhealthy food products was associated with higher consumption, but this effect could be attenuated by use of self-regulation strategies to facilitate healthy eating even when the food environment tempts one to do otherwise. CONCLUSIONS Health promotion policy and programs should not only address the food environment but could also teach young people better strategies to deal with it.

The Role of Individual- and Macro-Level Social Determinants on Young Adolescents’ Psychosomatic Complaints:

This study examines the social determinants of psychosomatic complaints in young adolescents. Using data from the Health Behaviour in School-aged Children (HBSC) study, psychosomatic complaints are studied in 98,773 adolescents (11- and 13-year-olds; 48% 11-year-olds, 52% 13-year-olds; 52% females, 48% males) from 34 European countries. Individual-level determinants, including family-, peer- and school-related factors as well as country-level determinants (Human Development Index [HDI]) are considered. In line with existing evidence, results revealed more psychosomatic complaints in young adolescents experiencing stress inducing familial-, peer- and school-related factors. Negative effects of poor friendships, negative class climate, school pressure, and high media use were more pronounced for girls. After controlling for these factors, a higher HDI was related to a lower risk for psychosomatic complaints. Gender-specific intervention programs should aim at improving the quality of relationships, especially among peers, to prevent psychosomatic complaints among young adolescents.

Health-related quality of life in portuguese children and adolescents

O KIDSCREEN e um instrumento europeu transcultural e padronizado que avalia dez dimensoes da qualidade de vida de criancas, adolescentes e seus pais. Este instrumento e usado para validar evidencias a fim de apoiar inferencias gerais sobre medidas de qualidade de vida obtidas pela versao portuguesa do KIDSCREEN-10 para criancas e adolescentes, no contexto de uma pesquisa de investigacao feita em Portugal. O presente estudo centra-se apenas na versao KIDSCREEN para adolescentes e criancas. Uma amostra de 8.072 criancas e adolescentes portugueses frequentando a 5a serie (19,3%), 6a serie (19,2%), 7a serie (20,3%), 8a serie (21,6%) e 10a serie (19,7%) em escolas do pais foram intrevistadas, com uma idade media de 13,2; DP 2,06, distribuidos aleatoriamente em relacao ao sexo. A versao portuguesa do instrumento KIDSCREEN-10 mostrou uma boa consistencia interna de 0,78. Os indices de ajuste escolhidos indicam bom ajuste aos dados. Especificamente na solucao final o RMSEA foi inferior a 0,03, o limite superior do intervalo de confianca de 90% foi inferior a 0,05 e CFI foi superior a 0,95. Resultados indicaram que a estrutura atual do item 10 e invariavel entre grupos de idade, nacionalidade e nivel socio-economico. O questionario KIDSCREEN-10 e um instrumento confiavel para estimar a percepcao da qualidade de vida em criancas e adolescentes. Orientacoes psicometricas sao apresentadas para a populacao portuguesa entre 10 e 16 anos de idade.

Micro-environmental characteristics related to body weight, diet, and physical activity of children and adolescents: a systematic umbrella review

This umbrella review analyzed the relationships between social and physical micro-environmental (neighborhood, school) characteristics as predictors of child and adolescent diet, physical activity, and body weight. Eight systematic reviews, discussing 132 original studies (97% correlational, 3% experimental) yielded 98 social, physical, and socio-economic characteristics, as categorized in the original reviews. Among micro-environmental predictors stronger support (i.e., replicated results) was obtained for 12 out of 98 original micro-environmental variables, with physical activity as the outcome in 10 out of 12 cases. In particular, replicated significant relationships were found for several physical activity-specific neighborhood and school characteristics (e.g., community opportunities to exercise, lower costs of physical activity facilities, physical activity build environment) and adolescent physical activity. Among more general (i.e., not behavior-specific) micro-environmental characteristics, stronger support was found for low crime level, school type, and child/adolescent physical activity.

Food Culture in the Home Environment : Family Meal Practices and Values Can Support Healthy Eating and Self-Regulation in Young People in Four European Countries

BACKGROUND Overweight epidemics, including among children and adolescents, are fuelled by contemporary obesogenic environments. Recent research and theory highlight the importance of socio-cultural factors in mitigating adverse impacts of the abundance of food in high-income countries. The current study examines whether family meal culture shapes young peoples eating behaviors and self-regulation. METHODS Young people aged 10-17 years were recruited through schools in four European countries: the Netherlands, Poland, Portugal and the United Kingdom. A total of 2,764 participants (mean age 13.2 years; 49.1% girls) completed a self-report questionnaire in class, providing information on healthy and unhealthy eating, joint family meals and communal meal values and use of eating-related self-regulation strategies. RESULTS Path analysis found that family meal culture variables were significantly associated with young peoples eating behaviors, as was self-regulation. Significant indirect effects of family meal culture were also found, through self-regulation. CONCLUSIONS Results confirm that family meal culture, encompassing values as well as practices, shapes young peoples eating behaviors. Findings extend and link previously separate lines of enquiry by showing how food cultures can play out in the home environment. Importantly, the study contributes novel evidence suggesting that self-regulation is shaped by the home environment and mediates its influence.

Assessing self-regulation strategies: development and validation of the tempest self-regulation questionnaire for eating (TESQ-E) in adolescents

BackgroundApplying self-regulation strategies have proven important in eating behaviors, but it remains subject to investigation what strategies adolescents report to use to ensure healthy eating, and adequate measures are lacking. Therefore, we developed and validated a self-regulation questionnaire applied to eating (TESQ-E) for adolescents.MethodsStudy 1 reports a four-step approach to develop the TESQ-E questionnaire (n = 1097). Study 2 was a cross-sectional survey among adolescents from nine European countries (n = 11,392) that assessed the TESQ-E, eating-related behaviors, dietary intake and background characteristics. In study 3, the TESQ-E was administered twice within four weeks to evaluate test-retest reliability (n = 140). Study 4 was a cross-sectional survey (n = 93) that assessed the TESQ-E and related psychological constructs (e.g., motivation, autonomy, self-control). All participants were aged between 10 and 17 years.ResultsStudy 1 resulted in a 24-item questionnaire assessing adolescent-reported use of six specific strategies for healthy eating that represent three general self-regulation approaches. Study 2 showed that the easy-to-administer theory-based TESQ-E has a clear factor structure and good subscale reliabilities. The questionnaire was related to eating-related behaviors and dietary intake, indicating predictive validity. Study 3 showed good test-retest reliabilities for the TESQ-E. Study 4 indicated that TESQ-E was related to but also distinguishable from general self-regulation and motivation measures.ConclusionsThe TESQ-E provides a reliable and valid measure to assess six theory-based self-regulation strategies that adolescents may use to ensure their healthy eating.

Parent-child Perceptions of Quality of Life: Implications for Health Intervention

Abstract The KIDSCREEN-52 is an instrument that assesses 10 dimensions of health-related quality of life (HRQoL). It was developed as a result of studies by the European KIDSCREEN Group, University of Berlin (www.kidscreen.org; see also Bisegger et al., 2005). During the Portuguese validation process, a model was developed to examine the perceptions of children and their parents on these dimensions. Structural equation modelling was used in order to estimate the fit of this model, in both cases according to gender and age. The specific aim of the present study was to examine the extent to which results differ by gender and age. An additional aim was to explore differences between the child and parent versions of the instrument, globally as well as by gender and age of the children. The results are based on a nationally representative sample of 3195 children from 5th and 7th grades. Data from each child were paired with data from their parents (2256 matched sets of data were generated). Most of the subscales exhibited good internal consistency in both the children’s and parent’s versions of KIDSCREEN-52, with values of the alpha coefficient approaching or above .80 for most scales. The exception was the subscale concerned with self-perception where the coefficient was approximately .64 for both children and parents. Subscale scores for children’s and parents’ versions correlated moderately strongly in the sample of matched pairs. This indicates that children and their parents view their health-related quality of life consistently, although parents tend to perceive their children’s quality of life as better than their children do. Analysis of variance suggested that there were small differences in scores associated with gender and age. The results confirm that the KIDSCREEN-52 questionnaire is a relevant instrument to estimate the perception of quality of life both in children and their parents. The findings that parents are not totally aware of their children’s subjective health-related quality of life perceptions and that parents have different perceptions according to the gender and the age of their children, have implications for professional practice and intervention with families of school-aged children.