Determinants of eating behaviour in university students : a qualitative study using focus group discussions

Background: College or university is a critical period regarding unhealthy changes in eating behaviours in students. Therefore, the purpose of this study was to explore which factors influence Belgian (European) university students' eating behaviour, using a qualitative research design. Furthermore, we aimed to collect ideas and recommendations in order to facilitate the development of effective and tailored intervention programs aiming to improve healthy eating behaviours in university students. Methods: Using a semi-structured question guide, five focus group discussions have been conducted consisting of 14 male and 21 female university students from a variety of study disciplines, with a mean age of 20.6 +/- 1.7 yrs. Using Nvivo9, an inductive thematic approach was used for data analysis. Results: After the transition from secondary school to university, when independency increases, students are continuously challenged to make healthful food choices. Students reported to be influenced by individual factors (e. g. taste preferences, self-discipline, time and convenience), their social networks (e. g. (lack of) parental control, friends and peers), physical environment (e. g. availability and accessibility, appeal and prices of food products), and macro environment (e. g. media and advertising). Furthermore, the relationships between determinants and university students' eating behaviour seemed to be moderated by university characteristics, such as residency, student societies, university lifestyle and exams. Recommendations for university administrators and researchers include providing information and advice to enhance healthy food choices and preparation (e. g. via social media), enhancing self-discipline and self-control, developing time management skills, enhancing social support, and modifying the subjective as well as the objective campus food environment by e. g. making healthy foods price-beneficial and by providing vending machines with more healthy products. Conclusions: This is the first European study examining perceived determinants of eating behaviour in university students and collecting ideas and recommendations for healthy eating interventions in a university specific setting. University characteristics (residency, exams, etc.) influence the relationships between individual as well as social environmental determinants and university students' eating behaviour, and should therefore be taken into account when designing effective and tailored multilevel intervention programs aiming to improve healthy eating behaviours in university students

Associations between different types of physical activity and teachers' perceived mental, physical, and work-related health

Background: The teaching profession is characterized by high levels of stress and physical complaints, which might be improved through regular participation in physical activity (PA). However, the effect of PA on mental and physical health is not always consistent and depends on the type of PA performed. The aim of this study was to examine the mental, physical, and work-related health of Flemish secondary school teachers and identify the impact on those health variables by demographic and teaching-related factors and various types of PA. Methods: This study included an online survey conducted across a representative sample of secondary school teachers (n = 1066, average age 40 years; 68 percent female). Level of PA and sitting time were estimated using the International Physical Activity Questionnaire, and perceived mental health and physical health were estimated using the Short Form 36. Work-related factors such as job satisfaction, occupational stress, and absenteeism were also collected. T-tests, ANOVAs, and linear regression analyses were performed. Results: Flemish secondary school teachers have poorer perceived mental and physical health than a general healthy population. This difference is particularly evident among female teachers, who reported lower perceived health, more occupational stress, and more absent days compared to their male colleagues. Higher participation in leisure-time PA was associated with a more positive perceived health. In contrast, higher levels of occupational PA and sitting time had a negative impact on perceived health. Total amount of PA, total amount of moderate-to-vigorous PA, transportation-related PA, and PA at home were not associated to teachers' perceived health. Conclusion: Because secondary school teachers' levels of perceived health are low, they are an important target group for interventions aiming to improve health. Only leisure-time PA was associated with more positive perceived health. This finding may indicate that teachers performing more exercise during leisure time, or in a more autonomous way, may be more resistant to physical and mental health problems. Future research should verify whether promoting leisure-time PA among teachers has the potential to improve their mental and physical health, and counteract the negative associations between teachers' health and their occupational PA

Longitudinal study on the association between three dietary indices, anthropometric parameters and blood lipids

Background: From a health promotion perspective, the use of dietary indices is preferred above single nutrients and foods to evaluate diet quality. Longitudinal research about the association between dietary indices and respectively anthropometric parameters and blood lipids is lacking. The aim of this study was to investigate the longitudinal association between three dietary indices (Healthy Eating Index-2010 (HEI), Mediterranean Diet Score (MDS) and Diet Quality Index (DQI)) and respectively anthropometric parameters and blood lipids. Methods: A three day diet record was completed by 373 men and 197 women in 2002-2004 and 2012-2014. HEI, MDS and DQI were calculated. Waist circumference (WC) and Body Mass Index (BMI) were used as anthropometric parameters. A linear regression analysis was performed to investigate associations between changes in dietary indices and changes in respectively anthropometric parameters and blood lipids, adjusted for potential confounders. Results: Only in men an increase in all three dietary indices was associated with a decrease in WC and BMI in the non-adjusted analysis and for HEI and DQI also in the adjusted analysis. No longitudinal associations were found between dietary indices and blood lipids both in men and women. Conclusions: Only few associations were found between dietary indices and anthropometric parameters, whilst no associations were found with blood lipids. An increase in dietary indices was associated with an improvement in anthropometric parameters only in men. As this is the first study investigating associations between changes in dietary indices and changes in respectively anthropometric parameters and blood lipids, further research is needed to evaluate these possible associations

Weight, socio-demographics, and health behaviour related correlates of academic performance in first year university students

Background: This study aimed to examine differences in socio-demographics and health behaviour between Belgian first year university students who attended all final course exams and those who did not. Secondly, this study aimed to identify weight and health behaviour related correlates of academic performance in those students who attended all course exams. Methods: Anthropometrics of 101 first year university students were measured at both the beginning of the first (T1) and second (T2) semester of the academic year. An on-line health behaviour questionnaire was filled out at T2. As a measure of academic performance student end-of-year Grade Point Averages (GPA) were obtained from the university's registration office. Independent samples t-tests and chi(2)-tests were executed to compare students who attended all course exams during the first year of university and students who did not carry through. Uni- and multivariate linear regression analyses were conducted to identify correlates of academic performance in students who attended all course exams during the first year of university. Results: Students who did not attend all course exams were predominantly male, showed higher increases in waist circumference during the first semester and consumed more French fries than those who attended all final course exams. Being male, lower secondary school grades, increases in weight, Body Mass Index and waist circumference over the first semester, more gaming on weekdays, being on a diet, eating at the student restaurant more frequently, higher soda and French fries consumption, and higher frequency of alcohol use predicted lower GPA's in first year university students. When controlled for each other, being on a diet and higher frequency of alcohol use remained significant in the multivariate regression model, with frequency of alcohol use being the strongest correlate of GPA. Conclusions: This study, conducted in Belgian first year university students, showed that academic performance is associated with a wide range of weight and health related behaviours. Future studies should investigate whether interventions aiming at promoting healthy behaviours among students could also have a positive impact on academic performance

Dietary pattern analysis : a comparison between matched vegetarian and omnivorous subjects

Background: Dietary pattern analysis, based on the concept that foods eaten together are as important as a reductive methodology characterized by a single food or nutrient analysis, has emerged as an alternative approach to study the relation between nutrition and disease. The aim of the present study was to compare nutritional intake and the results of dietary pattern analysis in properly matched vegetarian and omnivorous subjects. Methods: Vegetarians (n = 69) were recruited via purposeful sampling and matched non-vegetarians (n = 69) with same age, gender, health and lifestyle characteristics were searched for via convenience sampling. Two dietary pattern analysis methods, the Healthy Eating Index-2010 (HEI-2010) and the Mediterranean Diet Score (MDS) were calculated and analysed in function of the nutrient intake. Results: Mean total energy intake was comparable between vegetarians and omnivorous subjects (p > 0.05). Macronutrient analysis revealed significant differences between the mean values for vegetarians and omnivorous subjects (absolute and relative protein and total fat intake were significantly lower in vegetarians, while carbohydrate and fibre intakes were significantly higher in vegetarians than in omnivorous subjects). The HEI and MDS were significantly higher for the vegetarians (HEI = 53.8.1 +/- 11.2; MDS = 4.3 +/- 1.3) compared to the omnivorous subjects (HEI = 46.4 +/- 15.3; MDS = 3.8 +/- 1.4). Conclusions: Our results indicate a more nutrient dense pattern, closer to the current dietary recommendations for the vegetarians compared to the omnivorous subjects. Both indexing systems were able to discriminate between the vegetarians and the non-vegetarians with higher scores for the vegetarian subjects

Longitudinal study on the association between cardiorespiratory fitness, anthropometric parameters and blood lipids

Background: Longitudinal evidence concerning the association between cardiorespiratory fitness (CRF) and blood lipids and between anthropometric parameters (ANTP) and blood lipids is limited. This study aimed to investigate the association between changes in CRF and ANTP and changes in blood lipids. Methods: In 2002-2004 and 2012-2014,652 participants were tested. CRF was measured as VO(2)peak using a maximal ergometer test. Waist circumference (WC) and Body Mass Index (BMI) were used as ANTP. Blood samples were analyzed for total cholesterol (TC), HDL cholesterol, LDL cholesterol and triglycerides. A linear regression analysis was performed to investigate associations between changes in CRF and ANTP and changes in blood lipids. Results: After adjustment a decrease in CRF was associated with an increase in triglycerides and a decrease in HDL cholesterol in men. An increase in WC was associated with an increase in TC, LDL cholesterol and ratio total/HDL cholesterol and a decrease in HDL cholesterol, while an increase in BMI was associated with an increase in ratio total/HDL cholesterol and a decrease in HDL cholesterol. Conclusions: WC and BMI were more longitudinally associated with blood lipids compared with CRF. Improving ANTP can enhance the blood lipid profile, while CRF had only limited influence

Comparison of nutritional quality of the vegan, vegetarian, semi-vegetarian, pesco-vegetarian and omnivorous diet

The number of studies comparing nutritional quality of restrictive diets is limited. Data on vegan subjects are especially lacking. It was the aim of the present study to compare the quality and the contributing components of vegan, vegetarian, semi-vegetarian, pesco-vegetarian and omnivorous diets. Dietary intake was estimated using a cross-sectional online survey with a 52-items food frequency questionnaire (FFQ). Healthy Eating Index 2010 (HEI-2010) and the Mediterranean Diet Score (MDS) were calculated as indicators for diet quality. After analysis of the diet questionnaire and the FFQ, 1475 participants were classified as vegans (n = 104), vegetarians (n = 573), semi-vegetarians (n = 498), pesco-vegetarians (n = 145), and omnivores (n = 155). The most restricted diet, i.e., the vegan diet, had the lowest total energy intake, better fat intake profile, lowest protein and highest dietary fiber intake in contrast to the omnivorous diet. Calcium intake was lowest for the vegans and below national dietary recommendations. The vegan diet received the highest index values and the omnivorous the lowest for HEI-2010 and MDS. Typical aspects of a vegan diet (high fruit and vegetable intake, low sodium intake, and low intake of saturated fat) contributed substantially to the total score, independent of the indexing system used. The score for the more prudent diets (vegetarians, semi-vegetarians and pesco-vegetarians) differed as a function of the used indexing system but they were mostly better in terms of nutrient quality than the omnivores

Psychosocial and environmental correlates of walking, cycling, public transport and passive transport to various destinations in Flemish older adolescents

BACKGROUND: Active transport is a convenient way to incorporate physical activity in adolescents' daily life. The present study aimed to investigate which psychosocial and environmental factors are associated with walking, cycling, public transport (train, tram, bus, metro) and passive transport (car, motorcycle, moped) over short distances (maximum eight kilometres) among older adolescents (17-18 years), to school and to other destinations. METHODS: 562 older adolescents completed an online questionnaire assessing socio-demographic variables, psychosocial variables, environmental variables and transport to school/other destinations. Zero-inflated negative binomial regression models were performed. RESULTS: More social modelling and a higher residential density were positively associated with walking to school and walking to other destinations, respectively. Regarding cycling, higher self-efficacy and a higher social norm were positively associated with cycling to school and to other destinations. Regarding public transport, a higher social norm, more social modelling of siblings and/or friends, more social support and a higher land use mix access were positively related to public transport to school and to other destinations, whereas a greater distance to school only related positively to public transport to school. Regarding passive transport, more social support and more perceived benefits were positively associated with passive transport to school and to other destinations. Perceiving less walking and cycling facilities at school was positively related to passive transport to school only, and more social modelling was positively related to passive transport to other destinations. CONCLUSIONS: Overall, psychosocial variables seemed to be more important than environmental variables across the four transport modes. Social norm, social modelling and social support were the most consistent psychosocial factors which indicates that it is important to target both older adolescents and their social environment in interventions promoting active transport. Walking or cycling together with siblings or friends has the potential to increase social norm, social modelling and social support towards active transport

Older adults’ environmental preferences for transportation cycling

Introduction: Cycling is a non-polluting and healthy transportation mode for older adults. However, there is limited knowledge about the infrastructural changes necessary to stimulate cycling among older adults (>= 65 years). This is particularly true for electric cycling (e-biking), an increasingly popular form of cycling. The current experiment with manipulated photographs examined the environmental preferences for transportation cycling among older adults. Additionally, it examined whether subgroups with different environmental preferences exist and whether these subgroups differ on socio-demographics, health characteristics, transport behaviour, e-bike use and cycling levels. Methods: A structured questionnaire and choice-based conjoint exercise was completed by 895 Flemish older adults. The conjoint exercise included 13 choice tasks each presenting two street situations, which were manipulated on nine environmental attributes. Hierarchical Bayes and latent class analyses were applied to obtain environmental preferences and identify subgroups. Results: In the total sample, type of cycle path was the most important environmental attribute (importance = 40.0, 95% CI = 39.0-41.0) determining older adults' preference for transportation cycling. The second most important attribute was traffic density (16.7, 95% CI = 15.9-17.4), followed by cycle path evenness (11.8, 95% CI = 11.4-12.1) and distance (10.6, 95% CI = 10.1-11.0). Six subgroups with different environmental preferences were identified. These subgroups could be characterized based on differences in cycling limitations, driving status, e-bike use and cycling levels. Conclusions: The provision of well-separated cycle paths should be considered a priority in urban planning initiatives aiming to stimulate transportation cycling among older adults. Such initiatives should be evaluated to validate the current findings and optimize future initiatives

A smartphone app to promote an active lifestyle in lower-educated working young adults : development, usability, acceptability, and feasibility study

BACKGROUND: Physical activity (PA) levels are problematic in lower-educated working young adults (18-26 years). To promote PA, smartphone apps have great potential, but there is no evidence for their effectiveness in this population. To increase the likelihood that a newly developed app will be effective, formative research and user testing are required. OBJECTIVE: The aim of this study was to describe the development, usability, acceptability, and feasibility of a new theory- and evidence-based smartphone app to promote an active lifestyle in lower-educated working young adults. METHODS: The new app was developed by applying 4 steps. First, determinants important to promote an active lifestyle in this population were selected. Second, evidence-based behavior change techniques were selected to convert the determinants into practical applications. Third, a new smartphone app was developed. Fourth, volunteers (n=11, both lower and higher educated) tested the app on usability, and lower-educated working young adults (n=16) tested its acceptability and feasibility via (think aloud) interviews, a questionnaire, and Google Analytics. The app was accordingly adapted for the final version. RESULTS: A new Android app, Active Coach, was developed that focused on knowledge, attitude, social support, and self-efficacy (based on outcomes from step 1), and that applied self-regulation techniques (based on outcomes from step 2). The app consists of a 9-week program with personal goals, practical tips, and scientific facts to encourage an active lifestyle. To ensure all-day and automatic self-monitoring of the activity behavior, the Active Coach app works in combination with a wearable activity tracker, the Fitbit Charge. Issues detected by the usability test (eg, text errors, wrong messages) were all fixed. The acceptability and feasibility test showed that participants found the app clear, understandable, and motivating, although some aspects needed to be more personal. CONCLUSIONS: By applying a stepwise, user-centered approach that regularly consulted the target group, the new app is adapted to their specific needs and preferences. The Active Coach app was overall positively evaluated by the lower-educated working young adults at the end of the development process