Food environment and whole-diet in children : Studies on parental role modelling and food availability

Since food behaviors are learned during childhood and may also track into adulthood, promoting healthy food habits among children and families is of special importance. Health promotion has traditionally been focused on individuals, but during the recent decades, the attention has shifted more and more towards environments. The food environment – a concept that encompasses physical, social, cultural, economic and political environmental factors associated with food behavior – is especially important for children, who cannot be considered to be fully responsible for their food choices. Arguably, home, preschool and school are the most prominent food environments for children. It has been shown that parental food consumption and home food availability – the two most commonly used measures for food environment - are consistently associated with dietary behavior among children. However, most of the studies investigating parent-child dietary resemblance have focused on the consumption of single food groups, such as consumption of fruit and vegetables. Similarly, home food availability has mostly been measured unidimensionally: as the availability of a single food group or as healthy/unhealthy food availability. Additionally, the outcomes used in the studies have mostly been food groups or theory-based dietary indices. However, the use of data-driven dietary patterns may give a more realistic picture of the actual diets of the participants. Thus, this study aimed at investigating social and physical environmental factors associated with whole-diet among children. This thesis used data from two cross-sectional studies. Papers I and II were based on data from the DAGIS study, which was conducted in 66 Finnish preschools and investigated health behaviors and associated factors. The participants were 864 children from the groups of 3–6-year-olds. Food consumption among the children and both parents was measured using a food frequency questionnaire (FFQ) filled in by the parents. The parents also reported home food availability and sociodemographic factors of the family. Paper III used data from the ISCOLE study, which examined obesity-related lifestyle and environmental factors among 9–11-year-olds in 12 study sites worldwide. Altogether 6560 children (54% girls) were included in the current analyses. The children reported their own food consumption, whereas the parents of the participating children reported home food availability. Detailed school audits were performed in all participating schools (n=256) to measure school food availability. In paper I, parent-child dietary resemblance and associated sociodemographic factors were studied. A novel statistical method was used in order to compare food consumption of the parent and that of the child on a whole-diet level. Based on the consumption frequency, the food items were ranked separately in the child’s and the parents’ FFQs. A dietary resemblance measure was calculated for each parent-child pair: a similar ranking in both the child’s and the parent’s FFQ yielded a resemblance measure of +1, whereas no resemblance in ranking resulted in the resemblance measure of 0. Father-child resemblance was on average 0.50 (95% CI, confidence interval 0.48–0.52), whereas mother-child resemblance was 0.57 (95% CI 0.55–0.58). However, having mother as a respondent (providing food consumption information on behalf of the child) was inversely associated with father-child resemblance, and a tendency for similar reporter-bias was also seen in the mother-child resemblance. Additionally, the number of weekly family meals was positively associated with mother-child dietary resemblance. Parental educational level was not associated with parent-child dietary resemblance. In papers II and III, the availability of unhealthy foods in the home was positively associated with dietary patterns generally regarded as unhealthy. Although having healthy foods in the home was inversely associated with unhealthy dietary patterns, the abundance of unhealthy foods seemed to at least partly overrule this inverse relation. Respectively, the availability of healthy foods in the home was positively and that of unhealthy foods inversely associated with dietary patterns generally regarded as healthy. The results were similar both among preschoolers and school-aged children. School food availability was not associated with dietary patterns. In conclusion, parent-child dietary resemblance was moderate regardless of the socio-economic background of the family. In addition, an important observation was made: the diet of the child resembled more the diet of the parent providing food consumption data on behalf of the child. Since the possible reporter-bias can affect the interpretation of the results, it would be advisable for researchers to report who filled in food consumption information for the child and take this into account in further analyses. Furthermore, in order to capture the social food environment more comprehensively, fathers – not only mothers - should be involved as parents in family-based studies. Additionally, since the availability of unhealthy foods in the home was associated with unhealthy eating regardless of the availability of healthy foods, the results suggest that it is particularly important to limit the availability of unhealthy foods in the home. The results of this study can be used in planning and carrying out health promotion programs aiming at improving the diets of the families.Ruokatottumukset kehittyvät lapsuudessa ja voivat myös säilyä aikuisuuteen. Siksi lasten ja perheiden kannustaminen terveellisiin ruokatottumuksiin on tärkeää. Terveydenedistämisessä on perinteisesti keskitytty yksilöihin, mutta viime vuosikymmeninä huomio on kiinnittynyt yhä enemmän ympäristöihin. Ruokaympäristöllä tarkoitetaan ruokakäyttäytymiseen liittyviä fyysisiä, sosiaalisia, kulttuurisia, taloudellisia ja poliittisia ympäristötekijöitä. Ruokaympäristöllä on erityinen merkitys lapsille, sillä heidän ei voida ajatella olevan täysin vastuussa omista ruokavalinnoistaan. Lapsen elämässä merkittävimpiä ruokaympäristöjä ovat koti, päiväkoti ja koulu. On näyttöä siitä, että sekä vanhempien ruoankäyttö että kodin ruokasisustus – käytetyimmät ruokaympäristön mittarit – ovat johdonmukaisesti yhteydessä ruoankäyttöön lapsilla. Suurin osa tutkimuksista, jotka ovat selvittäneet vanhemman ja lapsen ruoankäytön samankaltaisuutta, on kuitenkin keskittynyt yksittäisen ruokaryhmän, kuten kasvisten ja hedelmien, käyttöön. Samoin ruokasisustusta on yleisimmin mitattu yksiulotteisesti yksittäisen ruokaryhmän tai terveellisten/epäterveellisten ruokien saatavuutena kotona. Lisäksi tutkimusten vasteina on useimmiten ollut ruoankäyttö ruokaryhmätasolla tai teoriapohjainen ruokavalioindeksi, vaikka aineistolähtöiset ruokavaliotyylit voisivat kuvata tutkittavien ruokavalioita totuudenmukaisemmin. Tämän tutkimuksen tavoitteena oli tutkia kokonaisruokavalioon liittyviä sosiaalisia ja fyysisiä ympäristötekijöitä lapsilla. Tutkimuksen aineisto koostui kahdesta poikkileikkaustutkimuksesta. Julkaisuissa I ja II käytettiin aineistoa DAGIS-tutkimuksesta, joka tutki terveyskäyttäytymistä ja siihen liittyviä tekijöitä 66 suomalaisessa päiväkodissa. Tutkittavina oli 864 lasta 3–6-vuotiaiden ryhmistä. Lasten ja heidän vanhempiensa ruoankäyttöä mitattiin vanhempien täyttämällä ruokafrekvenssikyselyllä (FFQ, engl. food frequency questionnaire). Lisäksi vanhemmat raportoivat kodin ruokasisustuksesta sekä perheeseen liittyvistä sosiodemografisista tekijöistä. Julkaisussa III käytettiin aineistoa 12 maan ISCOLE-tutkimuksesta, joka tutki lihavuuteen liittyviä elintapoja ja ympäristötekijöitä 9–11-vuotiailla lapsilla. Analyyseissä oli mukana yhteensä 6560 lasta (54 % tyttöjä). Ruoankäyttöä mitattiin lasten täyttämällä FFQ:lla, ja lasten vanhemmat raportoivat kodin ruokasisustuksesta. Koulujen ruokasisustusta selvitettiin havainnoimalla kaikissa osallistuvissa kouluissa (n=256). Julkaisussa I tutkittiin vanhemman ja lapsen ruoankäytön samankaltaisuutta ja siihen liittyviä sosiodemografisia tekijöitä. Kokonaisruokavalion samankaltaisuuden määrittämiseen käytettiin uudenlaista tilastollista menetelmää, jossa sekä vanhemman että lapsen FFQ:n ruokarivit järjestettiin käyttötiheyden mukaan. Tämän jälkeen jokaiselle vanhempi-lapsi-parille laskettiin samankaltaisuutta kuvaava luku siten, että tismalleen sama ruokarivien järjestys lapsen ja vanhemman FFQ:ssa tuotti samankaltaisuudeksi +1. Jos ruokarivien järjestys lapsen FFQ:ssa ei muistuttanut lainkaan vanhemman vastaavaa, samankaltaisuudeksi saatiin 0. Isän ja lapsen välinen samankaltaisuus oli keskimäärin 0,50 (95 %:n luottamusväli 0,48–0,52), kun taas äidin lapsen välinen samankaltaisuus oli 0,57 (95 % luottamusväli 0,55–0,58). Jos äiti oli raportoinut lapsen ruoankäytön, isän ja lapsen välinen samankaltaisuus oli pienempi verrattuna tilanteeseen, jossa isä oli sijaisraportoijana. Myös äidin ja lapsen samankaltaisuudessa nähtiin viitteitä vastaavasta raportoijaan liittyvästä harhasta. Lisäksi viikoittaisten perheaterioiden määrä oli positiivisesti yhteydessä äidin ja lapsen ruokavalion samankaltaisuuteen. Vanhempien koulutustaso ei ollut yhteydessä vanhemman ja lapsen ruokavalion samankaltaisuuteen. Julkaisuissa II ja III havaittiin, että epäterveellisten ruokien saatavuus kotona oli positiivisesti yhteydessä yleisesti epäterveellisinä pidettyihin ruokavaliotyyleihin. Vaikka terveellisten ruokien saatavuus kotona oli käänteisesti yhteydessä epäterveellisiin ruokavaliotyyleihin, vaikutti siltä, että yhteys ainakin osittain kumoutui, jos myös epäterveellisiä ruokia oli runsaasti saatavilla. Vastaavasti kodin terveellisten ruokien saatavuus oli positiivisesti ja epäterveellisten käänteisesti yhteydessä yleisesti terveellisinä pidettyihin ruokavaliotyyleihin. Tulokset olivat samanlaisia sekä päiväkoti- että kouluikäisillä lapsilla. Koulun ruokasisustus ei ollut yhteydessä ruokavaliotyyleihin. Vanhemman ja lapsen ruokavaliot muistuttivat toisiaan kohtalaisesti riippumatta perheen sosioekonomisesta taustasta. Lisäksi tutkimuksessa tehtiin tärkeä havainto: lapsen ruokavalio muistutti enemmän sitä vanhempaa, joka oli raportoinut lapsen ruoankäytön tämän puolesta. Tällä mahdollisella sijaisraportoijaan liittyvällä harhalla voi olla vaikutusta tulosten tulkintaan. Siksi tutkijoiden tulisi aina raportoida, kuka toimi lapsen sijaisraportoijana, ja ottaa tämä huomioon analyyseissä. Äitien lisäksi myös isät tulee huomioida perheiden ruoankäyttötutkimuksissa, jolloin sosiaalinen ruokaympäristö kyetään kuvaamaan kokonaisvaltaisemmin. Koska epäterveellisten ruokien saatavuus oli yhteydessä epäterveelliseen syömiseen riippumatta terveellisten ruokien saatavuudesta, tutkimuksen tulokset painottavat epäterveellisten ruokien saatavuuden rajoittamista kotona. Tämän tutkimuksen tuloksia voidaan hyödyntää perheiden ruokavalion parantamiseen tähtäävien terveydenedistämiskampanjoiden suunnittelussa ja toteutuksessa

What Would Be the Principles for Successful Trollbot Design?

As far as we know, trollbots that would be indistinguishable from humans and would succeed in luring people into endless frustrating conflicts without being recognized as bots do not yet exist in social media. It is though very likely, that there is a desire to design one for malicious purposes. Here we speculate on the idea of designing a successful trollbot for research purposes by using concepts that derive from Conversation Analysis and Natural Language Framework. Based on our ongoing reseach on trolling, we argue that a successful trollbot would need to prevent its interlocutor from reaching their goal in a given context, but at the same time manage to keep the other party expecting that they would be able to reach a common ground at some point.Non peer reviewe

Reproducibility of preschool personnel and guardian reports on energy balance-related behaviors and their correlates in Finnish preschool children

Peer reviewe

Investigating the Effectiveness of an Educational Escape Game for Increasing Nutrition-Related Knowledge in Young Adolescents: A Pilot Study

Objective: As a pilot trial under the Games of Food consortium, this study assessed the effectiveness of an educational escape game alongside a self-study method as a nutrition knowledge intervention. Furthermore, this study explored the use of an escape game as an educational tool for young adolescents. Materials and Methods: Altogether three schools participated, one from Finland and two from the UK. Baseline questionnaires assessing knowledge were administered before intervention day. Participants from each class were randomly allocated by the researchers into either the escape game condition, where participants played a nutrition education escape game with a focus on plant-based protein sources, or the self-study condition, where participants received an educational leaflet with identical content. In addition to the knowledge post-assessment, the educational escape game condition answered an enjoyment and intrinsic motivation questionnaire to evaluate the game experience. Paired t-tests were used to determine significant changes within intervention conditions and ANCOVA was used to estimate the differences in knowledge. Results: The participants were 130 children (11-14 years), divided into educational escape game (n = 68) and self-study (n = 62) conditions. Both the educational escape game (20.7 vs. 23, p < 0.001) and self-study (21.1 vs. 23.1, p = 0.002) had improved overall knowledge scores. No significant differences in gained knowledge existed between groups. Of the educational escape game participants, 60% reported the game as mostly enjoyable and 46% reported added use and value for learning. Conclusion: The educational escape game condition was comparable to the self-study method for nutrition education in adolescents. However, since the educational escape game provides an enjoyable experience that may enhance intrinsic motivation to promote learning and possible behavior change, the use of escape games for nutrition education warrant further investigation.Peer reviewe

Parental Education and Pre-School Children's Objectively Measured Sedentary Time : The Role of Co-Participation in Physical Activity

Parental co-participation in physical activity (PA) may be a beneficial parenting practice for diminishing children's sedentary time (ST). Less information is available, however, on the explanatory role of co-participation in PA regarding parental educational differences in children's ST. Preschool-aged children (N = 864, mean age 4.8, 52% boys) with their parents participated in a cross-sectional DAGIS (Increased Health and Wellbeing in Pre-schools) study between years 2015 and 2016. Children (N = 821) wore an accelerometer for one week. Parents were informed of their educational background, and the frequency of visits with their child in nature, to parks or playgrounds, their own yard, and indoor sport facilities (N = 808). Testing the associations required multiple regression analyses. Parents with a low educational background reported more frequent visits with their child to their own yard, and these visits were associated with children's lower ST. More highly educated parents co-visited indoor sport facilities more frequently, although this did not have a significant association with children's ST. More frequent visits in nature were associated with a lower ST at weekdays, regardless of educational background. Future health promotion strategies should inform parents that frequent co-participation in PA, for example, in one's own yard, is beneficial for lowering children's ST.Peer reviewe

The Relationship between Dietary Habits and Work Engagement among Female Finnish Municipal Employees

Background: Work engagement reflects work-related well-being. It is positively associated with health, life satisfaction, work efficiency, income level, and occupational prospects. However, little is known about the relationship between work engagement and diet. Methods: A cross-sectional study was conducted among female Finnish municipal employees (n = 630) in 2015. Work engagement was assessed using the Utrecht Work Engagement Index. The consumption of healthy and unhealthy food items was determined using a food frequency questionnaire. Sociodemographic factors, health behaviors, depressive and anxiety symptoms were assessed with self-administrated questionnaires. Results: Work engagement had a positive relationship with the daily consumption of healthy food items. This association remained significant even after adjusting for age, education years, financial situation, and physical activity. The frequency of consuming unhealthy food items showed no relationship with work engagement. Anxiety and depressive symptoms decreased linearly with the greater consumption of healthy foods. Conclusion: Frequent consumption of healthy food items is associated with higher work engagement, irrespectively of the consumption of unhealthy nutrients. These results encourage health care professionals to recommend healthy food items instead of forbidding unhealthy food, as well as employers to support healthy dietary habits among employees

The Relationship between Dietary Habits and Work Engagement among Female Finnish Municipal Employees

Background: Work engagement reflects work-related well-being. It is positively associated with health, life satisfaction, work efficiency, income level, and occupational prospects. However, little is known about the relationship between work engagement and diet. Methods: A cross-sectional study was conducted among female Finnish municipal employees (n = 630) in 2015. Work engagement was assessed using the Utrecht Work Engagement Index. The consumption of healthy and unhealthy food items was determined using a food frequency questionnaire. Sociodemographic factors, health behaviors, depressive and anxiety symptoms were assessed with self-administrated questionnaires. Results: Work engagement had a positive relationship with the daily consumption of healthy food items. This association remained significant even after adjusting for age, education years, financial situation, and physical activity. The frequency of consuming unhealthy food items showed no relationship with work engagement. Anxiety and depressive symptoms decreased linearly with the greater consumption of healthy foods. Conclusion: Frequent consumption of healthy food items is associated with higher work engagement, irrespectively of the consumption of unhealthy nutrients. These results encourage health care professionals to recommend healthy food items instead of forbidding unhealthy food, as well as employers to support healthy dietary habits among employees

Effects of the Preschool-Based Family-Involving DAGIS Intervention on Family Environment: A Cluster Randomised Trial

Interventions promoting young children’s healthy energy balance-related behaviours (EBRBs) should also examine changes in the family environment as this is an important determinant that may affect the effectiveness of the intervention. This study examines family environmental effects of the Increased Health and Wellbeing in Preschools (DAGIS) intervention study, and whether these effects differed when considering three parental educational level (PEL) groups. The DAGIS intervention was conducted in preschools and involving parents in Southern Finland from September 2017 to May 2018. It was designed as a randomised trial, clustered at preschool-level. Parents of 3–6-year-olds answered questionnaires recording PEL, parental role modelling for EBRBs, and the family environment measured as EBRBs availability and accessibility. Linear Mixed Models with Repeated Measures were used in order to detect intervention effects. Models included group by time interactions. When examining intervention effects separated by PEL groups, models with three-level interactions (group × time-points × PEL) were evaluated. There was an interaction effect for the availability of sugary everyday foods and drinks (p = 0.002). The analyses showed that the control group increased availability (p = 0.003), whereas in the intervention group no changes were detected (p = 0.150). In the analysis separated by PEL groups, changes were found only for the accessibility of sugary treats at home; the high PEL control group increased the accessibility of sugary treats (p = 0.022) (interaction effect: p = 0.027). Hence, results suggest that the DAGIS multicomponent intervention had a limited impact on determinants for children’s healthy EBRBs, and no impact was found in the low PEL group

Effects of the Preschool-Based Family-Involving DAGIS Intervention on Family Environment: A Cluster Randomised Trial

Interventions promoting young children’s healthy energy balance-related behaviours (EBRBs) should also examine changes in the family environment as this is an important determinant that may affect the effectiveness of the intervention. This study examines family environmental effects of the Increased Health and Wellbeing in Preschools (DAGIS) intervention study, and whether these effects differed when considering three parental educational level (PEL) groups. The DAGIS intervention was conducted in preschools and involving parents in Southern Finland from September 2017 to May 2018. It was designed as a randomised trial, clustered at preschool-level. Parents of 3–6-year-olds answered questionnaires recording PEL, parental role modelling for EBRBs, and the family environment measured as EBRBs availability and accessibility. Linear Mixed Models with Repeated Measures were used in order to detect intervention effects. Models included group by time interactions. When examining intervention effects separated by PEL groups, models with three-level interactions (group × time-points × PEL) were evaluated. There was an interaction effect for the availability of sugary everyday foods and drinks (p = 0.002). The analyses showed that the control group increased availability (p = 0.003), whereas in the intervention group no changes were detected (p = 0.150). In the analysis separated by PEL groups, changes were found only for the accessibility of sugary treats at home; the high PEL control group increased the accessibility of sugary treats (p = 0.022) (interaction effect: p = 0.027). Hence, results suggest that the DAGIS multicomponent intervention had a limited impact on determinants for children’s healthy EBRBs, and no impact was found in the low PEL group