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Objective:The aim of the current study was to evaluate the effect on frequency, variety and amount of vegetables served and staff’s food-related practices in the multicomponent BRA intervention.Design:Cluster randomised controlled trial, conducted between Spring 2015 and Spring 2016. For allocation of the kindergartens, a stratified block randomisation was used. Data were collected in three ways: (i) a questionnaire for pedagogical leaders assessing the variety and frequency of vegetables served, including staff’s food-related practices assumed to be related to vegetable intake; (ii) a questionnaire for kindergarten assistants assessing staff’s food-related practices; (iii) a 5-d weighted vegetable diary assessing amount of vegetables served in a department.Setting:The target group for this study was public and private kindergartens in the counties of Vestfold and Buskerud, Norway.Participants:A total of seventy-three kindergartens participated.Results:At follow-up I, the amount of vegetables served increased by approximately 20 g per person per day (P = 0·002), and the variety in served vegetables increased by one-and-a-half kind per month (P = 0·014) in the intervention group compared to the control group. No effects on the frequency of vegetables served or on staff’s food-related practices were found.Conclusions:The BRA intervention was successful in increasing the amount and variety of vegetables served within intervention kindergartens. Further research is needed to understand the mechanisms that can affect the staff’s food-related practices.

Objective The present study aimed to explore kindergarten staffs’ perceived usefulness of intervention components in association with changes in children’s vegetable intake and vegetables served in the kindergarten. Assessment of the perceived usefulness of intervention components consisted of a paper-based questionnaire for the kindergarten staff assessing usefulness of posters, supplementary material and 1-day inspirational course. Children’s vegetable intake in the kindergarten was assessed by direct observation, while vegetables served was assessed by a 5-day weighted vegetable diary. Results Seventy-three kindergartens in two counties in Norway participated (response rate 15%) and parental consent was obtained for 633 children 3–5 years of age at baseline (response rate 39%). Mixed effect models indicated a tendency that posters were associated with increased child vegetable intake (P = 0.062). Surprisingly, a low degree of perceived usefulness of supplementary material was associated with the largest increase in child vegetable intake (P = 0.020). No significant associations between perceived usefulness of intervention components and vegetables served in the kindergarten were found. This study indicated a tendency that posters were associated with increased child vegetable intake; however, this may also be due to synergies between multiple intervention components. Trial registration International Standard Randomized Controlled Trials ISRCTN51962956 (http://www.isrctn.com/ISRCTN51962956). Registered 21 June 2016 (retrospectively registered).

Identifying the mechanisms behind socioeconomic inequalities in adiposity among youth is vital for efforts aimed at combating these inequalities. The study explored whether a broad range of behavioral and familial factors mediated the associations between parental education and indicators of adiposity among adolescents. Baseline data from a school-based intervention study conducted in 2007 among 11-year-old adolescents were used. Anthropometric outcomes, physical activity and sedentary time among adolescents were objectively measured. Other behavioral variables and parental waist circumference were self-reported. Mediation analyses were conducted. Among boys, maternal waist circumference (WC), paternal WC and TV viewing mediated 16%, 11.5% and 13% of the association between parental education and adolescent WC. The respective proportions when body fat percentage was used as the outcome variable were 22.5%, 16% and 21%. Among girls, maternal and paternal WC mediated 20% and 14% of the association between parental education and WC. The respective proportions when body fat percentage was used as the outcome variable were 14% and 10%. Other included variables did not play any mediating role. Parental WC was found to be a mediator of socioeconomic differences in adiposity in both genders; underlying mechanisms were however not investigated. Among boys, reducing TV time could contribute to the reduction of social inequalities in adiposity.

Background Family environment is crucial to the development of health behaviors into adolescence and adulthood. The aims of this study were (1) to explore the reliability of the General Functioning Scale (GFS) among Norwegian 13-15-year-olds, and (2) to assess whether family functioning reported by adolescents was associated with family dinner frequency. Methods In total 440 secondary-school students were invited to participate in this cross-sectional web-based questionnaire survey, with 54 participating in the test-retest study. Test-retest and internal consistency were assessed for the 12-item GFS-scale. Associations between family functioning and family dinner frequency were tested using multiple logistic regression. Results The GFS had high internal consistency (corrected item-total correlations ranging from 0.40 to 0.65, Cronbach’s α = 0.85), and excellent test–retest reliability (intra-class correlation coefficient = 0.83). In the logistic regression model, a higher score on GFS (poorer family functioning) was associated with a reduced likelihood of having dinner together on a daily basis (i.e., 6–7 times per week, OR = 0.36, CI = 0.20–0-64) after adjusting for age, gender, ethnicity, living situation and parental education level. Conclusions The GFS had high reliability. As poorer family functioning was associated with less frequent family dinners, the family environment may be an important (contextual) target to influence adolescent health behaviors. It would be of interest to further explore the role of family functioning in relation to adolescents’ dietary habits, besides shared family meals, and to reveal the mechanisms underlying such relationships.

Objective:To describe associations between adolescents’ frequency of vegetable consumption, food parenting practices and socioemotional family characteristics, and to explore potential mediated relationships that may contribute to an understanding of the family processes involved.Design:Cross-sectional survey among adolescents aged 13–15 years.Setting:A survey questionnaire including self-report measures on adolescents’ frequency of vegetable consumption, perceived food parenting practices (i.e. family dinner frequency, maternal/paternal healthy eating guidance (HEG), maternal/paternal social support for vegetable consumption) and socioemotional family characteristics (i.e. general family functioning and level of cohesion and conflict within the family) was distributed in a convenience sample of secondary school students.Participants:Four hundred forty students from five secondary schools in eastern Norway completed the questionnaire.Results:Results from multiple linear regression analysis revealed positive and statistically significant associations between adolescents’ frequency of vegetable consumption, maternal HEG and family cohesion. A partial indirect (mediated) association between family cohesion and adolescents’ frequency of vegetable consumption, working through maternal HEG, was also found.Conclusions:Results from the present study suggest that perceived family cohesion may influence adolescents’ frequency of vegetable consumption both directly and indirectly. However, there is a need for continued investigation of family-related factors influencing adolescent eating. In particular, the role of socioemotional family characteristics should be further scrutinised in future studies.

In order to develop effective public health initiatives aimed at promoting healthy weight development, identifying the interventions/combination of interventions with the highest beneficial effect on body weight is vital. The study aimed to estimate the mean BMI at age 13 under hypothetical interventions targeting dietary behavior, physical activity and screen time at age 11. We used data from a school-based cohort study of 530 participants followed between the ages of 11 and 13. We used g-computation, a causal modeling method, to estimate the impact of single and combined hypothetical behavioral interventions at age 11 on BMI at age 13. Of the hypothetical interventions, the one with the largest population mean difference in BMI was the one combining all interventions (dietary behavior, physical activity and screen time interventions) and assuming 100% intervention adherence, with a population mean differences of − 0.28 (95% CI − 0.59, 0.07). Isolated behavioral interventions had a limited impact on BMI. This study demonstrated that a combination of healthy dietary behavior and physical activity promotion, as well as screen time reduction interventions at age 11 could have the highest beneficial effect on the reduction of BMI at age 13, although the change in BMI was small. The findings highlight the importance of a systems approach to obesity prevention focusing on multicomponent interventions.

This is an author accepted manuscript. Aim: The aim of the present study was to explore the associations between the economic, political, sociocultural and physical environments in kindergartens, along with the frequency and variety of vegetables served, and the amount of vegetables eaten. Method: The BRA Study collected data through two paper-based questionnaires answered by the kindergarten leader and pedagogical leader of each selected kindergarten, and a five-day vegetable diary from kindergartens (n = 73) in Vestfold and Buskerud Counties, Norway. The questionnaires assessed environmental factors, and the frequency and variety of vegetables served. The non-parametric Mann–Whitney U and Kruskal–Wallis tests were used to explore the associations between factors in the kindergarten environments and vegetables served and eaten. Results: Kindergartens that included expenditures for food and beverages in the parental fees served a larger variety of vegetables (p = 0.046). A higher frequency of served vegetables (p = 0.014) and a larger amount (p = 0.027) of vegetables eaten were found in kindergartens where parents paid a monthly fee of 251 NOK or more. Similarly, the amount of vegetables eaten was higher (p = 0.017) in kindergartens where the employees paid a monthly fee to eat at work. Furthermore, a larger amount (p = 0.046) of vegetables was eaten in kindergartens that had written guidelines for food and beverages that were offered. Conclusions: This study indicates that the economic environment in a kindergarten seems to be positively associated with the vegetables served and eaten there. This is of high relevance for public health policy as vegetable consumption is an important factor in reducing the risk of non-communicable diseases.

Background Many people with intellectual disabilities (ID) living in community-based residences have been found to have unhealthy diet and weight disturbances. In Norway, a majority of people with ID live in such residences. Aims The aim of the study was to examine factors affecting the caregivers’ opportunity to promote a healthy diet among the residents. Methods and procedures A concept mapping methodology was adopted, including group-based brainstorming, idea synthesising, sorting, rating and analysis of the results. Informants were caregivers in four different community residences for people with mild to moderate ID in the southeast of Norway. A total of 13 informants were recruited (12 females and 1 male), and 10 informants completed two sessions. Results Eight clusters were identified as affecting the caregivers’ ability to promote a healthy diet: “Availability and accessibility”, “Guidance and autonomy”, “Competence among staff”, “Planning and involvement”, “Customization”, “External conditions affecting staff”, “Legislation, rules and structure” and “Everyday challenges”, each including both barriers and facilitators. Conclusions and implications Multiple factors affect the caregivers’ ability to promote a healthy diet. Caregivers’ opportunity to promote a healthy diet is complex. Availability and accessibility of healthy food is crucial, but a healthy diet also requires time and competence among the caregivers.

ObjectiveTo report on long-term effects of a cluster randomized controlled kindergarten-based intervention trial, which aimed to increase vegetable intake among Norwegian preschool children (3–5 years at baseline). The effects of the intervention at follow-up 1 (immediately post-intervention) have previously been published. This paper presents the effects of the intervention from baseline to follow-up 2 (12 months post-intervention).ResultsParental consents were obtained for 633 out of 1631 eligible children (response rate 38.8%). The effects of the intervention from baseline to follow-up 2 were assessed by mixed-model analyses taking the clustering effect of kindergartens into account. Children’s vegetable intake was reported by the parents at baseline (spring 2015), at follow-up 1 (spring 2016) and at follow-up 2 (spring 2017). No significant long-term effects in child vegetable intake were found. A mean difference of − 0.1 times per day (95% CI − 0.5, 0.2) (P = 0.44) was found for the daily frequency of vegetable intake. A mean difference of – 0.2 different kinds of vegetables eaten over a month (95% CI − 1.0, 0.7) (P = 0.70) was found and for daily amount of vegetables a mean difference of − 15.0 g vegetables (95% CI − 38.0, 8.0) (P = 0.19) was found.Trial registrationInternational Standard Randomised Controlled Trials ISRCTN51962956 (http://www.isrctn.com/ISRCTN51962956). Registered 21 June 2016 (retrospectively registered)

Background Early childhood represents a critical period for the establishment of long-lasting healthy dietary habits. Limited knowledge exists on how to successfully increase vegetable consumption among preschool children. The overall aim of the present study was to improve vegetable intake among preschool children in a kindergarten-based randomized controlled trial. Methods The target group was preschool children born in 2010 and 2011, attending public or private kindergartens in two counties in Norway. Data about child intake of vegetables were collected by three methods. First, parents filled in a web-based questionnaire of the child’s vegetable intake. Second, among a subsample, trained researchers observed children’s vegetable intake in the kindergarten. Thirdly, a parental web-based 24-h recall assessing the child’s vegetable intake was filled in. For allocation of kindergartens to intervention and control groups, a stratified block randomization was used. Multiple intervention components were implemented from September 2015 to February 2016 and components focused at influencing the four determinants availability, accessibility, encouragement and role modelling. The effect of the intervention from baseline (spring 2015) to follow-up 1 (spring 2016) was assessed by mixed-model analysis taking the clustering effect of kindergartens into account. Results Parental consent was obtained for 38.8% of the children (633 out of 1631 eligible children). Based on the observational data in the kindergarten setting (n 218 in the control group and n 217 in the intervention group), a tendency to a small positive effect was seen as a mean difference of 13.3 g vegetables/day (95% CI: − 0.2, 26.9) (P = 0.054) was observed. No significant overall effects were found for the total daily vegetable intake or for the parental reported frequency or variety in vegetable intake. Conclusions Based on the observational data in the kindergarten setting, a tendency to a small positive effect was seen with a mean difference of about 13 g vegetables/day, while no other effects on child vegetable intake were found. Additionally, further research to understand the best strategies to involve parents in dietary interventions studies is warranted. Trial registration International Standard Randomised Controlled Trials ISRCTN51962956 . Registered 21 June 2016 (retrospectively registered).

The intake of fruit and vegetables is associated with beneficial health outcomes, and studies aimed at increasing fruit and vegetable intake lack long-term follow-up. The primary objective of this study was to evaluate the long-term (14-year) effects of a multicomponent school-based educational intervention targeted to increase fruit and vegetable intake in children. The secondary objective was to evaluate the potential synergistic effect between free school fruit and the educational program. A cluster randomized school-based intervention was initiated in 2001 in Norway, known as the Fruit and Vegetable Make the Marks study. In total, 38 schools were randomized; for the intervention (n = 18) and as control schools (n = 20). A subsample of the intervention schools (n = 9) were additionally given free school fruit, resulting in two intervention groups - one with and one without free fruit. Participants completed questionnaires in September 2001 (baseline, mean age 11.8), May 2002 (at the end of the intervention), May 2003, May 2005, September 2009 and throughout 2016 (mean age 26.5). Of 1950 participants, 982 (50.4%) completed the 14-year follow-up and were considered as the current study sample. Analysis yielded no 14-year effects of the educational program on fruit and vegetable intake. A synergistic effect between the educational program and free fruit was not observed either. Future studies might benefit from increased focus on more extensive parental involvement, increased home availability, and a longer intervention period. However, more long-term studies are needed to evaluate the effects of school-based interventions into adulthood. Trial registration number: Ethical approval and research clearance was obtained from The National Committees for Research Ethics in Norway (file number S-01076) and The Norwegian Centre for Research Data (file number 12395).

This study assessed factors associated with the perceived dose of intervention received and with the participant satisfaction in a school-based obesity prevention intervention. It also explored the variance in the dose of intervention received that was at the school level. Process evaluation data from a school-based intervention study conducted in Oslo in 2007–2009 were used. A total of 542 11-year-olds from 12 intervention schools were included. A web-based questionnaire was used to collect data. Descriptive analyses and multilevel regression analyses were conducted. Females and those with medium (vs. low) parental education had higher odds of reporting a high vs. low dose of intervention received at mid-way (8 months after baseline). Perceived social capital and perceived social support for physical activity from friends at baseline were positively associated with the dose of intervention received at mid-way. Perceived social capital at mid-way was positively associated with the dose of intervention reported post-intervention (20 months after baseline). Around 20% of the variance in the perceived dose of intervention received was at the school level. Satisfaction with the intervention was high overall and higher for females for several intervention components at mid-way and at post-intervention. The factors identified in this study should be taken into consideration when planning future obesity prevention interventions among youth. Keywords: Adolescents, Obesity, Intervention, Process evaluation, Physical activity, Dietary behaviors

The present study aimed to explore the process in which impulsivity might influence soft drink consumption in adolescents, addressing potential mediating effects of perceived parental regulation regarding unhealthy eating. A cross-sectional survey was performed among 440 13-15-year-olds in Eastern Norway. The survey questionnaire included measures of impulsivity, six types of maternal and paternal regulation (as perceived by the adolescents), and consumption of sugar-sweetened beverages (SSB). Parallel multiple-mediator analyses were performed to reveal potential mediating effects of perceived parental regulatory behaviors on the association between adolescent impulsivity and SSB consumption. Separate models were run for maternal and paternal regulation. Results from our model analyses (both maternal and paternal models) indicated that all the six measured parental regulatory behaviors jointly acted as mediators on the association between adolescent impulsivity and SSB consumption. However, only perceived maternal and paternal legitimacy of regulation showed a unique contribution to the mediated effect. This finding suggests that adolescents' perception of parental legitimate authority is of particular importance in explaining the relationship between impulsivity and unhealthy eating behaviors in adolescents. Future nutrition interventions targeting adolescents and their parents should take personal factors such as adolescents' level of impulsivity into account. Ultimately; what may be an appropriate approach to impulsive individuals and their parents may diverge from what may be an appropriate approach to less impulsive individuals and their parents.

Aims: The aim was to explore the association between weight-related attitudes and behaviours and the accuracy of body mass index (BMI) derived from self-reported weight and height. Methods: A total of 828 adolescents from the Health In Adolescents study were included. Self-reported and objective weight and height data were collected, and BMI was computed. Information about weight-related attitudes and behaviours was obtained. The association between weight-related attitudes and behaviours and the difference between BMI computed from self-reported and objective measures was assessed using generalized linear mixed model analyses. Results: BMI was under-reported by overweight girls ( p

Background: Parents play an important role in modelling healthy behaviours to their children. This study investigated associations between parent and child physical activity and screen time behaviours across specific domains, including moderating effects by parent and child gender. Method: The sample comprised 3300 school children and 2933 parents participating in the UP4FUN project (mean ages: child 11.2 ± 0.8 years, mother 40.0 ± 4.9 years, father 43.4 ± 5.8 years; 49% boys, 83% mothers). Data were collected in 2011 in Belgium, Greece, Hungary, Germany and Norway. Questionnaires assessed physical activity (sport, outdoor activities, walking and cycling for transport) and screen time (TV/DVD viewing, computer/games console use) in children and parents. Multilevel multivariate regression was applied to assess associations between parent and child physical activity and screen time. Results: Maternal, but not paternal, participation in sport, outdoor activities and walking for transport were associated with higher participation in these activities in children ( P < 0.001). In contrast, both maternal and paternal TV/DVD viewing and computer/games console use were related to higher engagement in these screen-based activities in children ( P < 0.01). Furthermore, maternal modelling of outdoor activities was significantly associated with outdoor activities in girls ( P < 0.001). In contrast, paternal modelling of TV/DVD viewing and computer/games console were significantly associated with these screen-based behaviours in boys ( P < 0.001). Conclusions: Maternal modelling of healthy active behaviours may have a greater influence on children compared to paternal modelling, whereas unhealthy sedentary behaviours seem to be modelled by both parents equally.

Background: The importance of family meals to the consumption of healthful food choices has been stated in recent reviews. However, little information is available on barriers that interfere with regular family meal patterns during childhood.Objective: Describe family meal patterns among 11-year-old children across Europe and identify correlates of irregular family breakfast and dinner consumption.Design: Cross-sectional survey involving samples of 13,305 children from nine European countries in 2003.Results: The proportions of children who regularly ate family breakfast and dinner were 62% and 90%, respectively. Correlates of irregular family breakfasts and dinners were less vegetable consumption, and irregular family breakfasts were associated with more television viewing. Social differences in the consumption of family breakfasts were observed.Discussion: Strengths of this study are the large sample size and validated research method. Limitations are the cross-sectional design and self-reported data.Conclusion: The majority of 11-year-old children regularly ate breakfast and dinner with their families. More television viewing and less vegetable consumption were associated with irregular family breakfasts and dinners, respectively. Social differences were observed in the regularity of family breakfasts. Promoting family meals across social class may lead to healthier eating and activity habits, sustainable at the population level.

The home environment is the first environment to shape childhood dietary habits and food preferences, hence greater understanding of home environmental factors associated with vegetable consumption among young children is needed. The objective has been to examine questionnaire items developed to measure the sociocultural home environment of children focusing on vegetables and to assess the psychometric properties of the resulting factors. Further, to explore associations between the environmental factors and vegetable consumption among Norwegian 3–5 year olds. Parents (n 633) were invited to participate and filled in a questionnaire assessing the child's vegetable intake and factors potentially influencing this, along with a 24-h recall of their child's fruit and vegetable intake. Children's fruit and vegetable intakes at two meals in one day in the kindergarten were observed by researchers. Principal components analysis was used to examine items assessing the sociocultural home environment. Encouragement items resulted in factors labelled “reactive encouragement”, “child involvement” and “reward”. Modelling items resulted in the factors labelled “active role model” and “practical role model”. Items assessing negative parental attitudes resulted in the factor labelled “negative parental attitudes” and items assessing family pressure/demand resulted in the factor labelled “family demand”. The psychometric properties of the factors were for most satisfactory. Linear regression of the associations between vegetable intake and the factors showed, as expected, generally positive associations with “child involvement”, “practical role model” and “family demand”, and negative associations with “negative parental attitudes” and “reward”. Unexpectedly, “reactive encouragement” was negatively associated with vegetable consumption. In conclusion, associations between sociocultural home environmental factors and children's vegetable consumption showed both expected and unexpected associations some of which differed by maternal education – pointing to a need for further comparable studies.

ObjectiveFirst, to explore item pools developed to measure the physical home environment of pre-school children and assess the psychometric properties of these item pools; second, to explore associations between this environment and vegetable consumption among Norwegian 3–5-year-olds.DesignData were collected in three steps: (i) a parental web-based questionnaire assessing the child’s vegetable intake and factors potentially influencing the child’s vegetable consumption; (ii) direct observation of the children’s fruit, berry and vegetable intakes at two meals in one day in the kindergarten; and (iii) a parental web-based 24 h recall.SettingThe target group for this study was pre-school children born in 2010 and 2011, attending public or private kindergartens in the counties of Vestfold and Buskerud, Norway.SubjectsA total of 633 children participated.ResultsPrincipal component analysis on the thirteen-item pool assessing availability/accessibility resulted in two factors labelled ‘availability at home’ and ‘accessibility at home’, while the eight-item pool assessing barriers resulted in two factors labelled ‘serving barriers’ and ‘purchase barriers’. The psychometric properties of these factors were satisfactory. Linear regression of the associations between vegetable intake and the factors showed generally positive associations with ‘availability at home’ and ‘accessibility at home’ and negative associations with ‘serving barriers’.ConclusionsThis age group has so far been understudied and there is a need for comparable studies. Our findings highlight the importance of targeting the physical home environment of pre-school children in future interventions as there are important modifiable factors that both promote and hinder vegetable consumption in this environment.

ObjectiveThe present study investigates the changes and tracking of dietary behaviours in Norwegian 11-year-olds and examines the association between parental education and dietary tracking over a time period of 20 months.DesignLongitudinal data from the Norwegian HEalth In Adolescents (HEIA) cohort study followed up at three time points (2007–2009).SettingIntakes of fruits, vegetables and snacks were assessed by frequency and intakes of sugar-sweetened soft drinks and squash were assessed by frequency and amount. Tracking of dietary behaviours was assessed by adolescents’ relative position in rank over time and Cohen's kappa was used to measure tracking coefficients. Multinomial logistic regression analyses were performed to assess the association between parental education and the tracking of dietary behaviours.SubjectsIn total, 885 adolescents from the HEIA cohort study participated by answering Internet-based questionnaires at three time points.ResultsThe results indicated that boys and girls maintained their relative position in rank of dietary intake over time, when grouped by baseline consumption. Fair to moderate tracking coefficients of dietary variables were observed. An inverse association was found between parental education and stability of soft drink and squash consumption during the 20 months.ConclusionsThe observed tracking pattern indicates the importance of promoting healthy dietary behaviours at an even earlier age. Furthermore, interventions should focus particularly on adolescents from families with low parental education and their consumption of sugar-sweetened beverages.

Aims: The aim of the study is to investigate the influence of the school food environment on the dietary behaviours of 11-year-old Norwegian children in elementary schools. Methods: Baseline data from a school-based intervention study: the Health In Adolescents study was used. A total of 1425 11-year-old children from 35 schools from the eastern part of Norway were included. School administrators provided information on the physical, political, and sociocultural school food environment and students reported their intake of fruits, vegetables, sugar-sweetened beverages (SSB), and snacks. Multilevel modelling was used to assess the school-level variance in dietary behaviours and to investigate the association of school food environmental factors with these dietary behaviours. Results: After adjustment for student characteristics, the school level accounted for a small proportion (1.1%–3.0%) of the variance in the dietary behaviours investigated. None of the investigated school food environmental factors were found to be related to the children’s reported intake of fruits, vegetables, snacks or SSB. Conclusions: Most of the variance in the dietary behaviours investigated was at the personal level. Thus in this sample, the investigated school-level factors do not appear to exert a strong influence on the dietary behaviours of children. Longitudinal studies using validated measures of the school food environment are needed.

Parental involvement is often advocated as important for school-based interventions, however, to date, only inconsistent evidence is available. Therefore, this study aimed at determining the impact of parental involvement in school-based obesity prevention interventions in children and adolescents.A systematic review of obesity prevention studies published from 1990 to 2010 including a comparison between school-based interventions with and without parental component was conducted. Only studies reporting effects on health behaviour-related outcomes were included.Some positive effects of parental involvement were found on children's behaviours and behavioural determinants. Parental modules including different strategies and addressing several home-related determinants and parenting practices concerning eating and physical activity behaviours were more likely to be effective. However, no conclusive evidence could be provided concerning the added value of parent involvement, because of the paucity of studies to test this hypothesis. The few studies that are available provide inconsistent evidence.There is a need for more studies comparing school-based interventions with and without a parental component, and dose, strategies and content of parental components of school-based interventions should be better reported in articles.

Background The existence of socioeconomic differences in dietary behaviors is well documented. However, studies exploring the mechanisms behind these differences among adolescents using comprehensive and reliable measures of mediators are lacking. The aims of this study were (a) to assess the psychometric properties of new scales assessing the perceived rules and accessibility related to the consumption of vegetables and soft drinks and (b) to explore their mediating role in the association between parental education and the corresponding dietary behaviors. Methods A cross-sectional survey including 440 adolescents from three counties in Norway (mean age 14.3 years (SD = 0.6)) was conducted using a web-based questionnaire. Principal component analysis, test-retest and internal reliability analysis were conducted. The mediating role of perceived accessibility and perceived rules in the association between parental education and the dietary behaviors was explored using linear regression analyses. Results Factor analyses confirmed two separate subscales, named “accessibility” and “rules”, both for vegetables and soft drinks (factor loadings >0.60). The scales had good internal consistency reliability (0.70–0.87). The test–retest reliability of the scales was moderate to good (0.44–0.62). Parental education was inversely related to the consumption of soft drinks and positively related to the consumption of vegetables. Perceived accessibility and perceived rules related to soft drink consumption were found to mediate the association between parental education and soft drink consumption (47.5 and 8.5 % of total effect mediated). Accessibility of vegetables was found to mediate the association between parental education and the consumption of vegetables (51 % of total effect mediated). Conclusion The new scales developed in this study are comprehensive and have adequate validity and reliability; they are therefore considered appropriate for use among 13–15 year-olds. Parents, in particular those with a low educational background, should be encouraged to increase the accessibility of vegetables and to decrease the accessibility of soft drinks, in particular during dinner. Enforcing parental rules limiting soft drink intake in families with low parental education also appears relevant.

Background and purpose: The lack of effective school-based interventions for preventing obesity in children has caused a call for longer duration of interventions and better reporting on design and evaluation methodology. The purpose of this paper is to present the development of the intervention, the design of the effectiveness study, and the test-retest reliability of the main outcome measures in the HEalth In Adolescents (HEIA) study. Methods/design: The HEIA intervention programme was developed based on literature reviews, a social ecological framework, and focus groups. The intervention aimed to increase total physical activity (PA) and consumption of fruit and vegetables and to decrease screen time and consumption of sugar-sweetened beverages. The intervention programme consisted of a classroom component, including dietary behaviour lessons, computer tailoring, fruit/vegetable and PA breaks, and posters, and an environmental component including active transport campaigns, equipment, suggestions for easy improvements of schoolyards, inspirational courses for teachers (all with regards to PA), and fact sheets to parents. The effect of the intervention programme is evaluated in a cluster randomised controlled trial design (intervention = 12 schools, control = 25 schools) including process evaluation. Main outcomes include anthropometry, PA, screen time, and consumption of fruit, vegetables, and sugar-sweetened beverages. A 2-week test— retest study was conducted among 114 pupils. Determinants of the behaviours were assessed. Similar data were collected from parents. Children’s PA was measured objectively by accelerometers. Conclusions: The HEIA study represents a theoretically informed randomised trial comprising a comprehensive set of multilevel intervention components with a thorough evaluation using reliable outcome measures. The study will contribute to a better understanding of determinants of healthy weight development among young people and how such determinants can be modified.

The purpose was to investigate the degree of implementation and appreciation of a comprehensive school-randomized fruit and vegetable intervention program and to what extent these factors were associated with changes in reported fruit and vegetable intake. The study was conducted among 10- to 13-year old children exposed to the intervention during the school year 2003-04 in Norway, Spain and the Netherlands. Children, parents and teachers completed questionnaires regarding (i) the implementation of the school curriculum, (ii) parental involvement, (iii) distribution of fruit and vegetables at school, (iv) children's appreciation of the project and (v) children's intake levels. Univariate analyses of covariance and multilevel multivariate regression analyses indicated that teacher-reported level of implementation of the school curriculum and schoolchildren's appreciation of the project were important determinants of changes in intake. The results point to the importance of optimal implementation of an attractive school curriculum.

Background : Interventions conducted in school-aged children often involve parents, but few studies have reported effects on parents’ own behaviour as a result of these interventions. Objective : To determine if a multi-component, cluster randomized controlled trial targeting 11–13 year olds influenced their consumption of fruit, vegetables, sugar-sweetened soft drinks and fruit drinks, and to explore whether the results varied by gender, adolescent weight status or parental educational level. A final aim was to assess whether the parents’ intakes were affected by the intervention. Design : Participants were 1,418 adolescents, 849 mothers and 680 fathers. Baseline and post-intervention data from the 20 months intervention study HEIA (HEalth In Adolescents) were included. Data were collected assessing frequency (and amounts; beverages only). Results : No significant differences were found at baseline between the intervention and control groups, except for the parental groups (educational level and intakes). At post-intervention, the adolescents in the intervention group consumed fruit more frequently ( P

Background Research suggests an inverse association between parental rules and screen time in pre-adolescents, and that parents’ style of communication with their children is related to the children’s time spent watching TV. The aims of this study were to examine associations of parental rules and parental style of communication with children’s screen time and perceived excessive screen time in five European countries. Methods UP4FUN was a multi-centre, cluster randomised controlled trial with pre- and post-test measurements in each of five countries; Belgium, Germany, Greece, Hungary and Norway. Questionnaires were completed by the children at school and the parent questionnaire was brought home. Three structural equation models were tested based on measures of screen time and parental style of communication from the pre-test questionnaires. Discussion Of the 152 schools invited, 62 (41 %) schools agreed to participate. In total 3325 children (average age 11.2 years and 51 % girls) and 3038 parents (81 % mothers) completed the pre-test questionnaire. The average TV/DVD times across the countries were between 1.5 and 1.8 h/day, while less time was used for computer/games console (0.9–1.4 h/day). The children’s perceived parental style of communication was quite consistent for TV/DVD and computer/games console. The presence of rules was significantly associated with less time watching TV/DVD and use of computer/games console time. Moreover, the use of an autonomy-supportive style was negatively related to both time watching TV/DVD and use of computer/games console time. The use of a controlling style was related positively to perceived excessive time used on TV/DVD and excessive time used on computer/games console. With a few exceptions, results were similar across the five countries. Conclusions This study suggests that an autonomy-supportive style of communicating rules for TV/DVD or computer/ games console use is negatively related to children’s time watching TV/DVD and use of computer/games console time. In contrast, a controlling style is associated with more screen time and with more perceived excessive screen time in particular. Longitudinal research is needed to further examine effects of parental style of communication on children’s screen time as well as possible reciprocal effects. Trial registration International Standard Randomized Controlled Trial Number Register, registration number: ISRCTN34562078 . Date applied29/07/2011, Date assigned11/10/2011.

ObjectiveTo examine tracking of body size among children participating in the Norwegian Mother and Child Cohort Study (MoBa) from birth to 7 years of age and additionally to explore child and parental characteristics associated with maintenance of a high body size in this period of life.DesignAnthropometric data at birth and at 1, 3 and 7 years of age were collected by questionnaires addressed to the mother.SettingParticipants were recruited from all over Norway during the period 1999–2008.SubjectsA total of 3771 children had complete anthropometric data at birth and at 1, 3 and 7 years of age; the sample includes children born between 2002 and 2004.ResultsCohen’s weighted kappa pointed to fair (0·36) to moderate (0·43) tracking of body size from birth to 7 years of age. Generalized estimating equations further indicated that children in the highest tertile of ponderal index at birth had nearly one unit higher BMI (kg/m2) at the age of 7 years compared with children in other tertiles of ponderal index at birth. Having parents with high BMI (≥25·0 kg/m2) increased the odds of having a stable high body size from birth to 7 years of age; moreover, girls had significantly higher odds compared with boys.ConclusionsThe study indicates fair to moderate tracking of body size from birth to 7 years of age. From a public health perspective, early prevention of childhood overweight and obesity seems to be especially important among children of parents having a high BMI.

This study reports the effect of the Fruits and Vegetables Make the Marks intervention, a school-based fruit and vegetable intervention consisting of a home economics classroom component and parental involvement and encouraged participation in the Norwegian School Fruit Programme, all delivered during the school year of 2001-02. Nine randomly chosen schools received the intervention and 10 schools served as control schools. Participating pupils completed questionnaires at baseline (September 2001), at Follow-up 1 (May-June 2002) and at Follow-up 2 (May 2003). A total of 369 pupils (69%; mean age, 11.3 years at baseline) participated in all three surveys. No effect of the intervention was found for intake of fruit and vegetables eaten at school or all day, neither at Follow-up 1 nor at Follow-up 2. On analysing the effects on potential mediators, significant differences between intervention and control groups were found for Awareness of the five-a-day recommendations only. The intervention programme was rated as very good by the teachers, and the pupils reported that they enjoyed it. However, the intervention failed to change fruit and vegetable intake, probably because it did not succeed in changing the pupils' preferences for or the accessibility of fruit and vegetables--the two strongest correlates of children's fruit and vegetable intake.

This study reports the effect of a school-randomized fruit and vegetable intervention consisting of a subscription to the Norwegian School Fruit Programme at no parental cost, and the Fruit and Vegetables Make the Marks (FVMM) educational programme, both delivered in the school year of 2001-02. Nine randomly chosen schools received the intervention and 10 schools served as control schools. Participating pupils completed questionnaires at baseline (September 2001), at Follow-up 1 (May-June 2002) and at Follow-up 2 (May 2003). A total of 517 pupils (84%; mean age, 11.3 years at baseline) participated in all three surveys. At both Follow-up 1 and Follow-up 2, strong intervention effects were observed for all-day fruit and vegetable intake (effect sizes were 0.6 and 0.5 portions, respectively). The sustained effect at Follow-up 2, 1 year after the end of the intervention, can partly be explained by greater participation rates in the School Fruit Programme (standard paid subscription). We conclude that the effects observed are most likely due to the no-cost subscription and not due to the FVMM educational programme, and that providing pupils with a piece of fruit or a vegetable at school at no cost for the parents is an effective strategy to increase school children's intake of fruit and vegetables. The effect is also sustained 1 year after the end of the no-cost subscription, providing increased health benefits.

Background To improve effectiveness of future screen behaviour interventions, one needs to know whether an intervention works via the proposed mediating mechanisms and whether the intervention is equally effective among subgroups. Parental regulation is identified as a consistent correlate of screen behaviours, but prospective evidence as well as the mediation role of parental regulation is largely lacking. This study investigated post-intervention main effects on screen behaviours in the HEIA-intervention – a Norwegian school-based multiple-behaviour study, as well as mediation effects of parental regulation by adolescents’ and parents’ report. In addition, moderating effects of gender and weight status on the intervention and mediating effects were explored. Methods Participating schools were randomized to control (n = 25) or intervention (n = 12) condition. Adolescents (n = 908 Control; 510 Intervention) self-reported their weekday and weekend TV-viewing and computer/game-use. Change in adolescents’ behaviours was targeted through school and parents. Adolescents, mothers (n = 591 Control; 244 Interventions) and fathers (n = 469 Control; 199 Intervention) reported parental regulation of the screen behaviours post-intervention (at 20 month). The product-of-coefficient test using linear regression analysis was conducted to examine main and mediating effects. Results There was no intervention effect on the screen behaviours in the total sample. Gender moderated effect on weekend computer/game-use, while weight status moderated the effect on weekday TV-viewing and computer/game-use. Stratified analyses showed a small favourable intervention effect on weekday TV-viewing among the normal weight. Parental regulation did not mediate change in the screen behaviours. However, stronger parental regulation was associated with less TV-viewing and computer/game-use with effects being conditional on adolescents’ versus parental reports. Parental regulation of the screen behaviours, primarily by the parental report, was associated with change in the respective behaviours. Conclusion Multiple behaviour intervention may not affect all equally well, and the effect may differ by weight status and gender. In future interventions parents should be encouraged to regulate their adolescents’ TV-viewing and computer/game-use on both weekdays and weekends as parental regulation was identified as a determinant of these screen behaviours. However, future intervention studies may need to search for more effective intervention strategies targeting parental regulation. Trial registration Current Controlled Trials ISRCTN98552879

Background A few studies have investigated tracking of dietary patterns or nutrient intake in pre-school children, but no studies have been identified examining tracking of sugar-sweetened beverages (SSB), fruit and vegetable intakes in early childhood (1–7 year olds). The purpose of this study was to investigate changes and tracking of intakes of fruit, vegetables and SSB, and association between maternal education and dietary tracking, from 18 months to 7 years of age. Methods Longitudinal data from the nation-wide Norwegian Mother and Child Cohort Study, conducted by the Norwegian Institute of Public Health were used, including 9 025 children participating at three time points (18 months, 36 months and 7 years). Frequencies of fruit, vegetables and SSB were assessed by questionnaire. Slightly different questions were used at each time point to collect information about intake. Maternal education was categorized into ≤ 12 years, 13–16 years, ≥ 17 years. Cross-tabulation, Spearman’s rho and multinomial logistic regression were used for assessing change, tracking and differences by maternal education. Results Analyses by gender indicated largest changes for intake of fruit and SSB from age 18 months to 7 years. Fair to moderate tracking coefficients (Spearman’s rho = 0.23-0.46) for intake of fruit, vegetables and SSB were found and children assigned to low, medium and high frequency of consumption at 18 months continued to be in the same group at age 36 months and 7 years. Children of mothers with low education consumed fruit and vegetables less often and SSB more often compared to children of mothers with high education at 18 months of age. Children with higher educated mothers had lower odds for increasing fruit intake or decreasing SSB intake, compared to children with lower educated mothers showing a stable intake. Conclusions The tracking coefficients for intakes were fair to moderate and differences in intakes according to maternal education were found already at age 18 months. This suggests that promotion of healthy dietary behaviours at an early age is important to prevent unfavourable dietary behaviours later in childhood. Moreover, it seems important to target mothers in nutrition interventions for improving dietary habits among children.