Motivational stages of adolescent smoking initiation: predictive validity and predictors of transitions

Motivational stages of adolescent smoking initiation: predictive validity and predictors of transitions. Kremers SP, de Vries H, Mudde AN, Candel M. Department of Health Education and Health Promotion, Faculty of Health Sciences, Universiteit Maastricht, P.O. Box 616, 6200 MD Maastricht, The Netherlands. [email protected] The present study tested the use and validity of a stage model of adolescent smoking initiation. The model aims to identify adolescents who are currently not smoking, but who are cognitively predisposed to start smoking in the future. Research on subtypes within the precontemplation stage of adolescent smoking initiation and the concept of susceptibility to smoking led to the construction of a motivational stage model of four distinct stages: committer, immotive, progressive, and contemplator. Using longitudinal data on a large international sample of European adolescents (n=7117), the model proved to have value in predicting smoking initiation at 12 months follow up. The odds ratio to take up regular smoking behavior appeared to double with each forward stage transition. Although effect sizes were small to moderate, unique predictors of transitions from the various stages were identified. Implications of the findings are discusse

Parental and child fruit consumption in the context of general parenting, parental education and ethnic background

This study examines the association between parental and child fruit consumption in the context of general parenting, parental education and ethnic background. A cross-sectional study was performed among 1762 parent-child dyads. Mean age of the children was 8. years. One parent completed a questionnaire to measure their own and their child's fruit consumption, parenting style, education level and ethnicity. In mediation and moderation analyses, child fruit consumption was regressed on parental fruit consumption, parenting style, parental education and ethnicity. Participating children consumed on average 7.5 pieces of fruit per week. Fourteen percent met the recommended Dutch norm of two pieces of fruit per day. Parental and child fruit consumption were positively associated. The association was more pronounced under higher levels of psychological control and behavioural control, and among ethnic groups. Additionally, parental education and child fruit consumption were positively associated. Parental fruit consumption partially mediated this association. Interventions are needed to increase child fruit consumption. Interventions should focus on increasing parental fruit consumption and positive parental modelling, with particular focus on low-SES families. Additionally, interventions that combine positive modelling with positive general parenting skills (e.g. increasing behavioural control) may be more effective than interventions that focus on parental modelling alone

Associations of Children's Appetitive Traits with Weight and Dietary Behaviours in the Context of General Parenting

Background: Individual variations in child weight can be explained by genetic and behavioural susceptibility to obesity. Behavioural susceptibility can be expressed in appetite-related traits, e.g. food responsiveness. Research into such behavioural factors is important, as it can provide starting points for (preventive) interventions. Objectives: To examine associations of children's appetitive traits with weight and with fruit, snack and sugar-sweetened beverage intake, and to examine whether parenting style interacts with appetite in determining child weight/intake. Methods: Data were used from 1275 children participating in the INPACT study in 2009-2010, with a mean age of 9 years in 2009. Their height and weight were measured to calculate body mass index (BMI). Parents completed a questionnaire to measure children's appetitive traits, children's dietary intake and parenting style. Child BMI z-scores, fruit, snack and sugar-sweetened beverage intake were regressed on appetitive traits. Moderation by parenting style was tested by adding interaction terms to the regression analyses. Results: Food-approaching appetitive traits were positively, and food-avoidant appetitive traits were negatively related to child BMI z-scores and to child fruit intake. There were no or less consistent associations for snack and sugar-sweetened beverage intake. Authoritative parenting voided the negative association between food fussiness and fruit intake, while neglecting parenting strengthened the positive association between food-approaching appetitive traits and weight. Conclusions: Early assessment of appetitive traits could be used to identify children at risk for overweight. As parenting style can moderate the associations between appetitive traits and weight/intake in a favourable way, parents are a promising target group for preventive interventions aimed at influencing the effect of appetitive traits on children

The coaching on lifestyle (CooL) intervention for obesity, a study protocol for an action-oriented mixed-methods study

Background: Combined lifestyle interventions (CLIs) have proved to be effective in changing and maintaining behavioural lifestyle changes and reducing overweight and obesity, in clinical and real-world settings. In this CLI, lifestyle coaches are expected to promote lifestyle changes of participants regarding physical activity and diet. In the Coaching on Lifestyle (CooL) intervention, which takes a period of 8 to 10 months, lifestyle coaches counsel adults and children aged 4 years and older (and their parents) who are obese or are overweight with an increased risk of developing cardiovascular diseases or type II diabetes. In group and individual sessions, themes such as physical activity, dietary behaviours, sleep and stress are addressed. The aim of the present study is to monitor the implementation process of the CooL intervention and to examine how the lifestyle coaches contribute to a healthier lifestyle of the participants. Methods: This action-oriented study involves monitoring the implementation process of the CooL intervention and examining the lifestyle changes achieved by participants over time, in a one-group pre-post design using mixed methods. Methods include semi-structured interviews, observations, document analysis, biomedical parameters and questionnaires. Discussion: The added value of the CooL study lies in its action-oriented approach and the use of mixed methods, including both qualitative and quantitative research methods. The long-term coaching used in the CooL intervention is expected to have beneficial effects on sustained lifestyle changes

The Association Between the Physical Environment of Primary Schools and Active School Transport

This study examined the relationship between the physical environment characteristics of primary schools and active school transport among 3,438 5- to 12-year-old primary school children in the Netherlands. The environmental characteristics were categorized into four theory-based clusters (function, safety, aesthetics, and destination). The correlations between the clusters and active school transport were examined, and multilevel regression analyses were used to examine the association between the clusters and active school transport. No correlations were found between environmental clusters and active school transport for younger children (age 5-9), but for older children (age 9-12), strong positive correlations were found between aesthetics and active transport as were found for safety and active transport. School neighborhood aesthetics were related to active transport for older primary school children. Presence of parks, good maintenance of green spaces, and absence of litter in the school environment contributed most to the positive association between aesthetics and active school transport. © 2014 SAGE Publication

The ENCOMPASS framework:a practical guide for the evaluation of public health programmes in complex adaptive systems

BackgroundSystems thinking embraces the complexity of public health problems, including childhood overweight and obesity. It aids in understanding how factors are interrelated, and it can be targeted to produce favourable changes in a system. There is a growing call for systems approaches in public health research, yet limited practical guidance is available on how to evaluate public health programmes within complex adaptive systems. The aim of this paper is to present an evaluation framework that supports researchers in designing systems evaluations in a comprehensive and practical way.MethodsWe searched the literature for existing public health systems evaluation studies. Key characteristics on how to conduct a systems evaluation were extracted and compared across studies. Next, we overlaid the identified characteristics to the context of the Lifestyle Innovations Based on Youth Knowledge and Experience (LIKE) programme evaluation and analyzed which characteristics were essential to carry out the LIKE evaluation. This resulted in the Evaluation of Programmes in Complex Adaptive Systems (ENCOMPASS) framework.ResultsThe ENCOMPASS framework includes five iterative stages: (1) adopting a system dynamics perspective on the overall evaluation design; (2) defining the system boundaries; (3) understanding the pre-existing system to inform system changes; (4) monitoring dynamic programme output at different system levels; and (5) measuring programme outcome and impact in terms of system changes.ConclusionsThe value of ENCOMPASS lies in the integration of key characteristics from existing systems evaluation studies, as well as in its practical, applied focus. It can be employed in evaluating public health programmes in complex adaptive systems. Furthermore, ENCOMPASS provides guidance for the entire evaluation process, all the way from understanding the system to developing actions to change it and to measuring system changes. By the nature of systems thinking, the ENCOMPASS framework will likely evolve further over time, as the field expands with more completed studies