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Background: Parents and peers are both likely to influence children's dietary behaviour. However, their actual influence may depend on the age and life stage of the individual child. Therefore, this study examined the influence of parents (home snack availability and consumption rules) and peers on 11-year-old children's snack consumption, and whether these associations were mediated by children's snack-purchasing behaviour. It was hypothesized that children are more likely to buy unhealthy snacks if these are not always available at home, if restrictive rules apply to their consumption and if a child is sensitive to peer influence. It was also assumed that children who buy snacks out of their pocket money would consume more snacks. Methods: Data were taken from 1203 parent-child dyads who completed a questionnaire in the INPACT study (IVO Physical Activity Child cohorT). Multivariable regression models were used to (i) analyze associations between children's consumption and parents' and peers' influence and (ii) determine whether these associations were mediated by children's snack-purchasing behaviour. Results: Of the parental factors, home availability of snacks was associated with higher snack consumption (B=1.03, P<0.05). Parental factors and children's snack-purchasing behaviour were not associated. Children who were sensitive to peer influence consumed more snacks (B = 307, P<0.01) and bought more snacks out of their pocket money (odds ratio 3.27, P<0.0.01). Children's snack-purchasing behaviour explained part (8.6%) of the association between peer influence and children's snack consumption. Conclusion: As these findings indicate that both parents and peers influence children's snack consumption, health promotion may benefit from targeting the broader social environment. [ABSTRACT FROM AUTHOR]

Background. The aims of this study are 1) to investigate the association between maternal educational level and healthy eating behaviour of 11-year-old children (fruit, vegetables and breakfast consumption), and 2) to examine whether factors in the home food environment (parental intake of fruit, vegetables and breakfast; rules about fruit and vegetables and home availability of fruit and vegetables) mediate these associations. Methods. Data were obtained from the Dutch INPACT study. In total, 1318 parent–child dyads were included in this study. Multilevel regression models were used to investigate whether factors of the home food environment mediated the association between maternal educational level and children’s healthy eating behaviour. Results. Children of mothers with a high educational level consumed more pieces of fruit per day (B = 0.13, 95% CI: 0.04-0.22), more grams of vegetables per day (B = 23.81, 95% CI = 14.93- 32.69) and were more likely to have breakfast on a daily basis (OR = 2.97, 95% CI: 1.38- 6.39) than children of mothers with a low educational level. Home availability, food consumption rules and parental consumption mediated the association between maternal education level and children’s fruit and vegetable consumption. Parental breakfast consumption mediated the association between maternal education level and children’s breakfast consumption. Conclusions. Factors in the home food environment play an important role in the explanation of socioeconomic disparities in children’s healthy eating behaviour and may be promising targets for interventions. [ABSTRACT FROM AUTHOR]

Background: Schools can play an important role in the prevention of obesity, e.g. by providing an environment that stimulates healthy eating habits and by developing a food policy to provide such an environment. The effectiveness of a school food policy is affected by the content of the policy, its implementation and its support by parents, teachers and principals. The aim of this study is to detect opportunities to improve the school food policy and/or implementation at Dutch primary schools. Therefore, this study explores the school food policy and investigates schools' (teachers and principals) and parents' opinion on the school food policy. Methods: Data on the schools' perspective of the food policy was collected from principals and teachers by means of semi-structured interviews. In total 74 principals and 72 teachers from 83 Dutch primary schools were interviewed. Data on parental perceptions about the school food policy were based on a cross-sectional survey among 1,429 parents from the same schools. Results: Most principals (87.1%) reported that their school had a written food policy; however in most cases the rules were not clearly defined. Most of the principals (87.8%) believed that their school paid sufficient attention to nutrition and health. Teachers and principals felt that parents were primarily responsible to encourage healthy eating habits among children, while 49.8% of the parents believed that it is also a responsibility of the school to foster healthy eating habits among children. Most parents reported that they appreciated the school food policy and comply with the food rules. Parents' opinion on the enforcement of the school food policy varied: 28.1% believed that the school should enforce the policy more strongly, 32.1% was satisfied, and 39.8% had no opinion on this topic. Conclusion: Dutch primary schools could play a more important role in fostering healthy eating habits among children. The school food policy could be improved by clearly formulating food rules, simplifying supervision of the food rules, and defining how to enforce the food rules. In addition, the school food policy will only influence children's dietary behaviour if both the school and the parents support the policy. [ABSTRACT FROM AUTHOR]

Background: This study examines the prevalence and correlates of stages of change of smoking, in terms of psychosocial, structural and sociodemographic factors, among inhabitants of deprived neighbourhoods. Methods: Cross-sectional data were obtained from a survey on health related behaviour. Subjects were 2009 current and former smokers, aged 20-46, living in deprived neighbourhoods in Rotterdam, the second largest city in the Netherlands. Three groups of smokers were formed according to the stages of change-definitions of the Transtheoretical Model: smokers not planning to quit (precontemplators), smokers planning to quit (contemplators/preparators) and former smokers (actors/maintainers). Smokers planning to quit and smokers not planning to quit were compared regarding psychosocial factors (attitude, social norm, self-efficacy), structural factors (neighbourhood problems, material deprivation, financial problems, employment status) and sociodemographic factors (age, gender, marital status, cultural background, educational level). Former smokers were compared with smokers planning to quit regarding structural and sociodemographic factors. Logistic regression was used to assess correlates of stages of change. Results: Smokers planning to quit (prevalence = 19%) reported a more positive attitude, stronger social norms and higher self-efficacy expectations in quitting smoking than smokers not planning to quit (prevalence = 57%). Smokers planning to quit less often were Dutch-born, more often had attended higher vocational schooling or university and more often reported experiencing two or more neighbourhood problems compared to smokers not planning to quit. Former smokers (prevalence = 24%) were older, more often Dutch-born, married, employed and higher educated, compared to smokers planning to quit. Furthermore, former smokers less often reported material deprivation and financial problems than smokers planning to quit. Conclusion: Among people living in deprived neighbourhoods, different factors correlate with different stages of change of smoking. Implications for health promotion are discussed. [ABSTRACT FROM AUTHOR]

Objectives. We investigated the relationship among father's occupational group, daily smoking, and smoking determinants in a cohort of New Zealand adolescents. Methods. The longitudinal Multidisciplinary Health and Development Study provided information on adolescents' self-reported smoking behavior and potential predictors of smoking, such as social and material factors, personality characteristics, educational achievement, and individual attitudes and beliefs regarding smoking. Longitudinal logistic generalized estimating equation analyses were used. Results. Adolescents whose fathers were classified in the lowest-status occupational group were twice as likely as those whose fathers occupied the highest-status occupational group to be daily smokers. This high risk of daily smoking among the adolescents from the lowest occupational group was largely predicted by their lower intelligence scores and by the higher prevalence of smoking among fathers and friends. Conclusions. To prevent socioeconomic differences in smoking, school-based interventions should seek to prevent smoking uptake among adolescents, particularly those of lower socioeconomic status. Programs need to provide positive, nonsmoking role models consonant with the culture and norms of lower-socioeconomic-status groups. Adolescents need to acquire resistance skills and protective behaviors against social pressure and influences. (Am J Public Health. 2005;95:681-688.). [ABSTRACT FROM AUTHOR]

Background: The GLOBE study is a prospective cohort study specifically aimed at the explanation of socio-economic inequalities in health in the Netherlands. The returns of the study are reviewed after ten years of follow-up, and the studies' contribution to the development of policy measures to reduce inequalities in health in the Netherlands are described. Methods: The study started in 1991 with a baseline postal survey (response rate 70.1% or n=18973, 15-74 years of age). Two sub-samples of respondents to this survey were subsequently interviewed in 1991 (response 79.4% and 72.3%, n=5667). Baseline data collection included measures of socio-economic position, health and possible explanatory factors. Follow-up involved repeated postal surveys and interviews, and routinely collected data on hospital admissions, cancer incidence and mortality by cause of death. Results: Compared with higher socio-economic groups, lower socio-economic groups showed higher prevalence rates of poor self-reported health (perceived general health, health complaints, chronic conditions, disabilities), higher incidence rates of specific conditions (myocardial infarction) and higher rates of all-cause mortality. The higher prevalence of adverse material circumstances, unhealthy behaviour, adverse psychosocial characteristics, and adverse childhood circumstances in the lower socio-economic groups was important in the explanation of socio-economic inequalities in health. Socio-economic differences in health care utilization did not contribute to the explanation. Conclusions: The GLOBE study contributed significantly to the understanding of the explanation of socio-economic inequalities in health in the Netherlands. Study results were a main source of information in the development of policy measures aimed at the reduction of socio-economic inequalities in health in the Netherlands. [ABSTRACT FROM AUTHOR]

Presents a study on the contribution of hostility to the association between educational level and perceived general health (PGH). Description of which part of the contribution of hostility to the association between education and PGH runs through health-related behaviors and leisure time physical activity; Effect of hostility on the association between educational level and PGH; Models that have been proposed to explain the association between hostility and cardiovascular disease.

Objective: To examine: (i) the association between home availability of fruit and vegetables and children’s fruit and vegetable intake; (ii) the association between parental perception of the local food shopping environment and the home availability of fruit and vegetables; and (iii) whether the home availability of fruit and vegetables mediates the association between parental perception of the local food environment and children’s fruit and vegetable consumption., Design: Cross-sectional study., Setting: A total of ninety-one primary schools in the Netherlands., Subjects: In total 1501 primary caregivers completed a questionnaire to measure children’s fruit and vegetable consumption, home availability of fruit and vegetables, parental perceptions of the local food shopping environment (price, quality and availability), the child’s socio-economic status, the child’s ethnicity and maternal height and weight., Results: The home availability of fruit and vegetables was positively associated with children’s fruit and vegetable intake (P,0?01 and P,0?001, respectively). Negative parental perceptions of the local food shopping environment were associated with less fruit available at home (P,0?05, P,0?01 and P,0?05 for price, quality and availability of fruit, respectively). No significant associations were found between parental perception of the local food shopping environment and children’s fruit and vegetable consumption. We found no evidence that home availability of fruit and vegetables mediates the association between parental perception of the local food environment and children’s fruit and vegetable intake., Conclusions: Interventions focusing on improving the home availability of fruit and vegetables may help to increase children’s fruit and vegetable consumption. However, more data are required on factors influencing the home availability of fruit and vegetables.

Background: This article describes the association of external and psychosocial factors with the stages of change for moderate-intensity physical activity among individuals with generally low socioeconomic positions., Methods: A self-administered questionnaire among individuals aged 18-65 years (response rate 60%, n = 2781) in deprived neighborhoods in Eindhoven, The Netherlands, was conducted in September 2000. To identify factors associated with stages of change an ordinal logistic regression model, the "Threshold of Change model (TCM)", was used to analyze the data., Results: Thirty-six percent of the respondents were in the pre-action stages, 15% was in action and 49% in maintenance. Individuals who were, older, lower educated, had low health locus of control, had less knowledge of physical activity issues, and presented other risky health behaviors, were more likely to be in a lower stage of change category. A positive attitude, high self-efficacy expectations, perceiving the physical activity level of others as high, and much social support were associated with the higher stages of change categories., Conclusion: The distribution across the stages of change supports the need to improve physical activity behavior in these deprived neighborhoods. Interventions need to be tailored to the psychosocial, and the external factors that are likely to play a role in the behavioral change process.

Background: At this time, the mechanisms by which socioeconomic differences in smoking develop are not completely understood. In this paper the Theory of Planned Behaviour as a potential explanatory framework for socioeconomic differences in smoking is tested. It was hypothesized that components of the Theory of Planned Behaviour may be unequally distributed over educational groups and therefore contribute to the explanation of socioeconomic differences in smoking. Educational differences in the intention to quit smoking are described and attempts are made to understand these in the light of educational patterns in attitude towards smoking cessation, perceived subjective norm concerning quitting smoking, and self-efficacy., Methods: This cross-sectional study was part of the longitudinal GLOBE study on socioeconomic differences in The Netherlands. Components of the Theory of Planned Behaviour were measured in 1997 among 602 Dutch daily smokers., Results: No educational differences in the intention to quit smoking were found. Persons with a more positive attitude towards smoking cessation and a high subjective norm significantly more often intended to quit smoking. But, positive attitude and high subjective norm were not related to education, which explains the lack of educational differences in intention to quit smoking. Higher educated respondents reported significantly higher self-efficacy to refrain from smoking, which, however, was not related to the intention to quit smoking., Conclusion: It is anticipated that, from all components of the Theory of Planned Behaviour, only the direct effect of self-efficacy on behaviour may contribute to educational differences in smoking cessation.

This paper describes educational differences in starting excessive alcohol consumption during 6 1/2 years of follow-up among 1648 initially alcohol-consuming Dutch adults. The longitudinal GLOBE study provides the unique possibility to study explanations for educational differences due to the collection of extensive baseline information on educational level, alcohol consumption, stressors (tension reduction theory) and vulnerability indicators (differential vulnerability theory) in 1991. Alcohol consumption was again assessed in 1997. We report that lower educated people were almost three times more likely to start excessive alcohol consumption during follow-up compared to the highest educated persons. Both educational differences in exposure to stressors (financial problems) and vulnerability (low social support) contributed to the educational differences in starting excessive alcohol consumption and explained 23% of the educational variation in starting excessive alcohol consumption. Remaining educational differences were however still statistically significant. These results are discussed with regard to implications for interventions and possible additional explanatory mechanisms.