Impact of social norms and social support on diet, physical activity and sedentary behaviour of adolescents: a scoping review

The influence of environment on adolescents' physical exercise behavior based on family community and school micro-systems

Environment is the driving force to promote the development of adolescent physical exercise behavior. This study uses the ecosystem theory as the breakthrough point, based on Chinese education tracking survey data (CEPS), using hierarchical linear model (HLM), mainly test the youth environment microsystem, family, community, school environment on the youth physical exercise behavior mechanism, from the perspective of environment to improve the youth physical exercise behavior. The study found that: (1) the parents' education level, parent-child relationship, educational expectation and community environment have a positive impact on the physical exercise behavior of teenagers; (2) the school environment positively affects the physical exercise behavior of teenagers; (3) the home-school relationship has a regulating effect, that is, a good home-school relationship will improve the physical exercise behavior of teenagers by affecting the educational expectation.

The role of social media messages and content creators in shaping COVID-19 vaccination intentions

Introduction

Social media plays a crucial role in shaping health behaviors by influencing users' perceptions and engagement with health-related content. Understanding these dynamics is important as new social media technologies and changing health behaviors shape how people engage with health messages.

Aim

The current study explored the relationship between the characteristics of content creators, the messaging strategies employed in social media, and users' engagement with social media content, and whether these features are linked to users' behavioral intentions.

Methods

This study adopts a cross-sectional survey design. A total of 1,141 participants were recruited. We have developed a structural equation model to investigate the relationships between the characteristics of content creators, the messaging strategies employed in social media, users' perceived HBM constructs, user engagement, and users' behavioral intentions.

Results

Results revealed that social media posts focusing on self-efficacy were linked to increased willingness to engage in healthy behaviors. Additionally, individuals who demonstrate stronger perceptions of HBM constructs-such as higher perceived susceptibility and benefits of vaccination-are more likely to engage with posts, which was associated with higher vaccination intention. Posts authored by celebrities garnered a relatively higher number of favorites, while a greater proportion of politicians as content creators was linked to increased user comment intention.

Conclusion

Our study underscores the potential of integrating the Health Belief Model into social media to help promote health behaviors like the COVID-19 vaccination. Furthermore, our findings offer valuable insights for professionals and policymakers, guiding them in crafting effective message strategies and selecting appropriate sources to promote health behaviors on social media platforms.

Equalizing the Playing Field and Improving School Food Literacy Programs Through the Eyes of Teens: A Grounded Theory Analysis Using a Gender and Sport Participation Lens

Background: School food literacy programs (e.g., home economics) are an opportunity to improve the dietary habits of teens. However, the literature suggests that girls and athletes have better food literacy, and it is not clear how school programs contribute to this inequality. To address this, we explored how gender and sport influenced teens' perspectives of their school food literacy experiences and how they can be improved. Methods: Using semi-structured interviews and a Grounded Theory analysis, we generated a theoretical understanding of how to improve school food literacy programs for athletes and non-athletes of diverse genders. Thirty-three teens were recruited to balance sport participation (n = 18 athletes) and gender (n = 15 boys; n = 14 girls; n = 4 non-binary) based on data saturation. Results: Teens expressed four categories to improve school programs that aligned with principles of the Capability, Opportunity, Motivation and Behaviours (COM-B) Model of behaviour change. Programs should Provide a challenge (e.g., more advanced recipes), Make it fun (e.g., explore new cuisines in interactive ways) and Establish importance (e.g., health impacts). Practice is key for teens' self-confidence and development of food skills (e.g., meal planning) as well. Boys emphasized Make it fun whereas girls and non-binary teens emphasized Establishing importance. Athletes valued Practice is key more than non-athletes. Conclusions: School programs should relay the importance of food literacy in fun and tailored ways to teens (e.g., meal planning among athletes). It may be especially salient for programs to tailor their activities and messaging, where possible, to appeal to diverse teens who play sports and those who do not.

Clustering Patterns of Unhealthy Lifestyle Behaviours Among Adolescents: A Multilevel Analysis of a Nationally Representative School-Based Survey from 73 Countries

Background: Adolescence is a crucial stage when young people adopt various lifestyle behaviours that can impact their health. However, the broader determinants of these behaviours remain underexplored. This study aimed to investigate clustering patterns of lifestyle behaviours, including physical activity, sedentary behaviour, and dietary habits, among adolescents and examine their determinants across individual, community, and societal levels. Methods: This study utilised nationally representative Global School-based Student Health Survey data. The lifestyle behaviours were dichotomised based on specific definitions, and the clustering patterns of multiple unhealthy behaviours were compared at various levels of factors. Multilevel logistic regression analysis was employed to identify individual, community, and societal level determinants of multiple unhealthy behaviours. Results: The study included 293,770 adolescents from 73 countries and territories across five World Health Organization (WHO) regions. The overall prevalence of one, two, three, four, and five unhealthy behaviours was 6.9%, 29.9%, 36.5%, 21.5%, and 4.5%, respectively. The odds of multiple unhealthy behaviours (defined by ≥4) increase with age and are higher among female adolescents [(AOR: 1.06, 95% CI:1.05, 1.07); (AOR: 1.16, 95% CI: 1.14, 1.19)], respectively. Adolescents from supportive families, peer environments, or food-secure households had lower odds of engaging in these behaviours [(AOR: 0.84, 95% CI: 0.82, 0.86); (AOR: 0.96, 95% CI: 0.94, 0.98); (AOR: 0.91, 95% CI: 0.87, 0.95)], respectively. The odds of exhibiting multiple unhealthy behaviours were significantly higher among adolescents in countries with high (0.7-0.79) and very high (0.8-1.0) Human Development Indexes (HDI) compared to those in low (<0.55) HDI countries [(AOR: 1.84, 95% CI: 1.16, 2.94); (AOR: 3.00, 95% CI: 1.48, 6.08)], respectively. Conclusion: The study findings reveal that multiple unhealthy lifestyle behaviours, including insufficient physical activity, sedentary behaviour, inadequate fruit and vegetable consumption, frequent soft drink intake, and fast-food consumption, are globally prevalent among adolescents. These behaviours have distinct clustering patterns associated with individual characteristics, family and peer environments, and broader socio-economic and societal contexts.

Converging perspectives on the processes exacerbating adolescent obesity: An integrative systems approach

Adolescent obesity is a complex public health challenge with steadily increasing and variable prevalence among countries. This paper synthesises the driving feedback mechanisms of adolescent obesity studied in the CO-CREATE project, furthering our understanding of the complexity of this issue. Using systems thinking principles and causal loop diagramming, we integrated the following knowledge and perspectives derived from diverse sources into a causal loop diagram (CLD): a systems map generated by adolescents through participatory modelling workshops, a comprehensive literature review, and input from subject-matter experts during validation workshops. We used a structured and iterative approach to include drivers and to identify feedback loops exacerbating adolescent obesity. The CLD identified 27 key feedback loops across four themes: twelve related to the commercial food environment, six to the physical activity environment, four to mental wellbeing and five to social norms. These loops indicate not only diet and physical activity as drivers of obesity but also stress and other emotional and social pressures. Recognising the imperative need to integrate the perspectives and experiences of adolescents into our analysis, this work advocates for the synthesis of experiential insights with empirical research. The integrated CLD can be used as a visual tool that fosters collaboration among stakeholders and engenders a more comprehensive and inclusive system understanding that can provide holistic intervention considerations to tackle adolescent obesity. Additionally, the CLD lays a foundation for subsequent quantitative modelling works to further address this issue and develop context-based approaches to prevention and evaluation of adolescent obesity.

The Healthy Supermarket Coach: effects of a nutrition peer-education intervention in Dutch supermarkets on adolescents' food purchases

BACKGROUND

Dutch adolescents predominantly purchase unhealthy snacks in supermarkets, which negatively influence their health. The aim of this study was to investigate the short- and longer-term effects of a nutrition peer-education intervention in supermarkets on food purchases and determinants of food purchase behaviour among adolescents of different education levels.

METHODS

We performed a quasi-experimental study in three supermarkets (two intervention and one comparison school) in Amsterdam, the Netherlands. The intervention schools received a 45-min peer-education workshop in the supermarket near their school, and the comparison school received no intervention. The workshops also included a 2-week 'healthy snacking challenge' and were led by two young supermarket employees. Measurements were performed 2 weeks before the intervention (T0) 2 weeks after (T1) and 3 months (T2) after the intervention. Cash receipts were used to examine food purchases (n = 458) and questionnaires to examine determinants of food purchase behaviour (n = 463).

RESULTS

The nutrition peer-education intervention did not improve food purchases but did improve several determinants of food purchase behaviour. Adolescents from the intervention schools reported improved nutritional knowledge (β = 0.38, 95% CI: 0.04-0.72) at T1, more favourable attitudes (β = 0.21, 95% CI: 0.00-0.42) and stronger social support (β = 0.27, 95% CI: 0.02-0.53) for healthy food purchases at T2 compared to those from the comparison schools. Adolescents with a low level of education reported more short- and longer-term improvements of determinants of food purchase behaviour compared to those with a higher level of education.

CONCLUSIONS

While nutrition peer education in supermarkets did not improve adolescents' food purchases in the supermarket, determinants of food purchase behaviour did improve. The intervention was especially effective among adolescents with a low level of education. Nevertheless, to promote healthy food purchases of adolescents in supermarkets, more efforts are needed.

Lifestyles of university students: analyzing the role of social support and family dynamics

BACKGROUND

Youth is a critical stage for developing healthy lifestyles, as the habits and behaviors formed during this period can persist into adulthood. Understanding the relationship between family factors and the lifestyles of university students can contribute to creating strategies to improve this important health determinant. This research aimed to analyze the relationship between social support, family dynamics, and lifestyles in young university students.

DESIGN

A cross-sectional descriptive study.

METHODS

A probability sample of 530 young university students was analyzed. The main measurements included social support, family dynamics, and lifestyles. Descriptive analysis of quantitative and qualitative variables was performed. Pearson correlation coefficient was used for bivariate analysis, and Student's t-test was used to analyze differences between male and female participants. Additionally, multivariate analysis was conducted using multiple linear regression.

RESULTS

For the total sample, a positive and moderate association was found between family dynamics (r = 0.28) and social support (r = 0.32) with the lifestyles of young individuals.

CONCLUSIONS

Our results indicated that social support and family dynamics are possible protective factors that have a positive effect on the lifestyles of university students. The findings of this study highlight the importance of family and familial support in adopting healthy lifestyles among university students.

Association between snack intake behaviors of children and neighboring women: A population-based cross-sectional analysis with spatial regionalization

Background

Accumulated evidence indicates that neighborhood environments affect children's health behaviors. However, measuring neighborhood environments remains challenging because there exist strengths and weaknesses both in objective and perceived environment measures. Drawing on a recent conceptual model of how environment, perception, and behavior interact, we hypothesized that neighbors' behavioral similarities indicate the combined influence of physical and social environmental opportunities on specific behaviors. We then examined how these similarities (i.e. the behavioral tendencies of children's adult neighbors) relate to children's obesogenic dietary behaviors.

Methods

We used data for 2275 women and 821 elementary schoolchildren from a 2012-2013 population-based survey in greater Tokyo, Japan. Snack intake was defined as the total consumption of various types of snacks, estimated using a validated self-administered diet history questionnaire. Spatial regionalization, a type of spatial clustering, was used to empirically identify segments that could effectively differentiate regional variation in women's snack intake behaviors. We conducted multiple regression analysis to assess the cross-sectional association between children's snack intake and the mean snack intake of neighborhood women, adjusting for mother's intake.

Results

A 1-g increase in the mean snack intake of neighborhood women was associated with a 0.23-g (95% confidence interval: 0.00-0.45) increase in children's intake, while a 1-g increase in mother's intake was associated with a 0.34-g (95% confidence interval: 0.26-0.41) increase in children's intake.

Discussion

The results suggest that the out-of-home physical and social neighborhood environments may have non-ignorable associations with children's dietary behaviors by offering behavioral opportunities in addition to maternal influence.

Familial confounding of internalising symptoms and obesity in adolescents and young adults; a co-twin analysis

BACKGROUND

Obesity and internalising disorders, including depression and anxiety, often co-occur. There is evidence that familial confounding contributes to the co-occurrence of internalising disorders and obesity in adults. However, its impact on this association among young people is unclear. Our study investigated the extent to which familial factors confound the association between internalising disorders and obesity in adolescents and young adults.

SUBJECTS/METHODS

We used a matched co-twin design to investigate the impact of confounding by familial factors on associations between internalising symptoms and obesity in a sample of 4018 twins aged 16 to 27 years.

RESULTS

High levels of internalising symptoms compared to low levels increased the odds of obesity for the whole cohort (adjusted odds ratio [AOR] = 3.1, 95% confidence interval [CI]: 1.5, 6.8), and in females (AOR = 4.1, 95% CI 1.5, 11.1), but not in males (AOR = 2.8 95% CI 0.8, 10.0). We found evidence that internalising symptoms were associated with an increased between-pair odds of obesity (AOR 6.2, 95% CI 1.7, 22.8), using the paired analysis but not using a within-pair association, which controls for familial confounding. Sex-stratified analyses indicated high internalising symptoms were associated with increased between-pair odds of obesity for females (AOR 12.9, 95% CI 2.2, 76.8), but this attenuated to the null using within-pair analysis. We found no evidence of between or within-pair associations for males and weak evidence that sex modified the association between internalising symptoms and obesity (likelihood ratio test p = 0.051).

CONCLUSIONS

Some familial factors shared by twins confound the association between internalising symptoms and obesity in adolescent and young adult females. Internalising symptoms and obesity were not associated for adolescent and young adult males. Therefore, prevention and treatment efforts should especially address familial shared determinants of obesity, particularly targeted at female adolescents and young adults with internalising symptoms and those with a family history of these disorders.

Effect of Gender Attitudes of Young Adults on Levels of Perceived Social Support in Health Behaviors

The current cross-sectional descriptive study was performed to determine the effect of young adults' attitudes regarding social gender roles on perceived social support level in health behaviors. Participants comprised 209 young adults aged 18 to 21 years. Data collection tools included a sociodemographic characteristics form, the Gender Roles Attitude Scale, and Child and Adolescent Social Support Scale for Healthy Behaviors (CASSS-HB). Data were analyzed using percentile, correlation, and regression analysis. A significant positive correlation was found between total CASSS-HB score and the egalitarian gender role subdimension of the Gender Roles Attitude Scale. It was determined that participants with an egalitarian perspective toward gender roles had increased levels of social support in health behaviors. [Journal of Psychosocial Nursing and Mental Health Services, 62(4), 17-23.].

Psychosocial Correlates of Motivation for Abstinence Among People Who Used Drugs After Community Rehabilitation Treatment in China: A Structural Equation Modelling

Background

Enhancing abstinence motivation of drugs is an effective strategy for the rehabilitation of people who used drugs and prevention of drug use relapse. However, little is known about its risk and protective factors. This study aimed to examine the potential intrapersonal (ie, impulsivity, depression, anxiety, sleep quality) and interpersonal factors (ie, perceived social support) of abstinence motivation among people who completed the community rehabilitation treatment.

Methods

A total of 222 participants (mean age = 43; male = 89.2%) were recruited from eleven communities located in Wenzhou, China. Data were collected using a self-reported questionnaire in counselling room settings between April and June 2021.

Results

The proportions of participants with depression, anxiety, and poor sleep quality were 38.8%, 19.5%, and 21.2%, respectively. Age and family history of physical disease were significant background factors of abstinence motivation. Impulsivity, depressive symptoms, anxiety symptoms, and poor quality of sleep were negatively associated with abstinence motivation. Perceived social support from family and important others was positively associated with abstinence motivation. Structural equation modeling fitted the data well in which impulsivity and perceived social support were both associated with abstinence motivation indirectly through mental health problems.

Conclusion

The identified psychosocial factors should be addressed in community rehabilitation treatment and follow-up service to enhance abstinence motivation and the long-term effectiveness of the treatment.

Characterization of trajectories of physical activity and cigarette smoking from early adolescence to adulthood

BACKGROUND

Cigarette smoking and physical inactivity are two critical risk factors for noncommunicable diseases and all-cause mortality. However, few studies have compared the long-term trajectories of both behaviors, as well as multilevel factors associated with trajectory patterns. Using the National Longitudinal Study of Adolescent to Adult Health (Add Health) Wave I through V survey data, this study characterized distinct subgroups of the population sharing similar behavioral patterns from adolescence to adulthood, as well as predictors of subgroup membership for physical activity (PA) and cigarette smoking behavior respectively.

METHODS

Using the Add Health Wave I through V survey data, we identified the optimal number of latent classes and class-specific trajectories of PA and cigarette smoking from early adolescence to adulthood, fitting latent growth mixture models with standardized PA score and past 30-day cigarette smoking intensity as outcome measures and age as a continuous time variable. Associations of baseline sociodemographic factors, neighborhood characteristics, and sociopsychological factors with trajectory class membership were assessed using multinomial logistic regression.

RESULTS

We identified three distinct subgroups of non-linear PA trajectories in the study population: moderately active group (N = 1067, 5%), persistently inactive group (N = 14,257, 69%) and worsening activity group (N = 5410, 26%). Foror cigarette smoking, we identified three distinct non-linear trajectory subgroups: persistent non-smoker (N = 14,939, 72%), gradual quitter (N = 2357, 11%), and progressing smoker (N = 3393, 16%). Sex, race/ethnicity, neighborhood environment and perceived peer support during adolescence were significant predictors of both physical activity and cigarette smoking trajectory subgroup membership from early adolescence to adulthood.

CONCLUSIONS

There are three distinct subgroups of individuals sharing similar PA and cigarette smoking behavioral profile respectively from adolescence to adulthood in the Add Health study population. Behavioral interventions that focus on neighborhood environment (e.g. establish community-based activity center) and relationship to peers during adolescence (e.g. peer counseling) could be key to long-term PA promotion and cigarette smoking cessation.

Striking the right balance: co-designing the Health4Me healthy lifestyle digital health intervention with adolescents

BACKGROUND

Adolescents are navigating a period of rapid growth and development within an era of digitalization. Mobile phone ownership among adolescents is nearly ubiquitous, and this provides an opportunity to harness text messaging to promote a healthy lifestyle and reduce chronic disease risk factors. Inclusion of adolescents throughout the design process has been recognized as essential for engagement and future implementation of such interventions. This study aimed to co-design a bank of text messages to promote a healthy lifestyle which are useful, acceptable, and engaging for adolescents aged 12-18 years old.

METHODS

Iterative, mixed-methods design with consumer partnership. Co-design occurred over three stages: text message development, text message review and final refinement and testing. The text message development included literature searches and consumer partnership with an established youth advisory group (n = 16). Participants who gave e-consent participated in text message review. Demographic characteristics were collected, and quantitative surveys were distributed to adolescents (n = up to 50) and health professionals (n = up to 30), who rated text message content for understanding, usefulness and appropriateness (total score out of 15). Final refinement was completed by the research team to edit or remove messages which had low scores and to assess readability and interactivity of the text messages.

RESULTS

The Heath Advisory Panel for Youth at the University of Sydney (HAPYUS) identified the top six lifestyle health issues for young people today in relation to chronic disease prevention, which became the key content areas for the text message bank and drafted new text messages. Following text message development, 218 messages were available for review. Adolescents (n = 18, mean age 16.3 [SD 1.4]) and healthcare professionals (n = 16) reviewed the text messages. On average, all reviewers found that the text messages were easy to understand (mean = 13.4/15) and useful (mean = 12.7/15). Based on scoring and open ended-feedback, 91 text messages were edited and 42 deleted. The final text message bank included 131 text messages. The overall program is suitable for a seventh-grade reading level, and interactive.

CONCLUSIONS

This study describes the process of effectively engaging adolescents to co-design a text message bank intervention, which are useful, acceptable and engaging for an adolescent audience. The effectiveness of the co-designed text message bank is currently being tested in the Health4Me RCT.

Impact of social support on the dietary behaviors of international college students in the United States

OBJECTIVE

International students in the US often adopt unhealthy dietary behaviors, perhaps due to lack of familiarity and social support. This study examined the impact of social support on international college students' dietary behaviors.

PARTICIPANTS

This study surveyed international students (N = 318) from five public universities in one Midwest state.

METHODS

Participants completed an electronic survey assessing self-reported eating habits and perceived social support using the Social Support for Eating Habits and the Starting the Conversation (STC) scales. Data analyses included multiple linear regression and multiple logistic regression to test the study's hypotheses. Comparisons were made to explore the impact of perceived social support on international students' dietary behaviors.

RESULTS

Significant predictors of unhealthy dietary behaviors included region of origin (specifically, being from East Asia, Europe and North America) and having families that discouraged healthy eating habits. Additionally, living with immediate family members significantly decreased students' likelihood of having higher friend encouragement for healthy eating habits. Finally, the amount of time participants spent in the US significantly increased their likelihood of having more discouragement of healthy eating from their friends.

CONCLUSIONS

International students' unhealthy eating habits increased when their families discouraged them from healthy eating. Interventions promoting healthy diet among international students should consider including family members to increase social support for healthy eating habits.

Potential impact of the adult-targeted LiveLighter "Sugary Drinks" campaign on adolescent consumption: Findings from a national cross-sectional school survey

ISSUE ADDRESSED

To examine the potential impact on trends in reported adolescent sugar-sweetened beverage (SSB) consumption following the adult-targeted Western Australian (WA) LiveLighter "Sugary Drinks" campaign, which is a television-led healthy lifestyle promotion and education mass media campaign that aired in multiple bursts between July 2013 and December 2018.

METHODS

Data were from a repeated cross-sectional survey of Australian secondary school students aged 12-17 years conducted nation-wide in 2009-2010 (n = 13 790 from 238 schools), 2012-2013 (n = 10 309 from 196 schools) and 2018 (n = 9102 from 104 schools).

RESULTS

Significant declines in high SSB consumption (≥4 cups/week) were observed between 2009-2010 and 2012-2013 among students in both WA (27.1% vs 20.3%; odds ratio [OR] = 0.65, 95% confidence interval [CI] = 0.50-0.84, P = .001) and all other states and territories combined (30.6% vs 21.4%; OR = 0.60, 95% CI = 0.53-0.68, P < .001). Compared to 2012-2013, the proportion of students in WA who reported high SSB consumption was significantly lower in 2018 (20.3% vs 9.6%; OR = 0.37, 95% CI = 0.21-0.65, P = .001), whereas this significant decrease was not observed in all other states and territories combined (21.4% vs 17.8%; OR = 0.81, 95% CI = 0.67-0.97, P = .024). Interaction testing indicated that the recent decline observed in WA was more pronounced among female than male students.

CONCLUSIONS

Mass media campaigns targeted towards the Australian adult population may have favourable effects among adolescents with the steeper decline in high SSB consumption observed in WA between 2012-2013 and 2018 coinciding with the repeated airing of the LiveLighter "Sugary Drinks" campaign in this state. SO WHAT?: Government investment in mass media campaigns may hasten declines in adolescents' SSB consumption.

Do Individual Characteristics and Social Support Increase Children's Use of an MHealth Intervention? Findings from the Evaluation of a Behavior Change MHealth App, Aim2Be

Purpose: Mobile health (mHealth) apps may support improved health behavior practice among youth living in larger bodies. However, long-term use is low, limiting effectiveness. This study evaluated whether youths' motivation, satisfaction, engagement with social features, or parent co-participation supported long-term use of an app named Aim2Be. Methods: A secondary analysis of two versions of Aim2Be (preteen and teen versions) using covariate-adjusted multivariable regression was conducted. We evaluated associations between social support features (a virtual coach, a social poll, or a social wall), parent co-participation (time spent in the parent app), and app satisfaction on use (time spent in Aim2Be). Models were stratified by age and satisfaction was explored as a moderator. Results: Preteens (n = 83) engagement with the social poll (β = 0.26, p < 0.001), virtual health coach (β = 0.24, p = 0.01), app satisfaction (β = 0.31, p = 0.01), and parent co-participation (β = 0.24, p = 0.01) predicted use. In teens (n = 90), engagement with the virtual coach (β = 0.31, p < 0.001) and full utilization of social wall features (β = 0.41, p < 0.001) predicted use. Furthermore, satisfaction moderated the effects of partial utilization of the social wall among teens (β = 0.32 p = 0.02). Conclusion: Social support in mHealth apps may impact users differently depending on age. Features that include health professionals or peers may be more advantageous across ages. App developers should consider age when designing interventions. Clinical Trial Registration NCT03651284.

Boys and girls differ in their rationale behind eating: a systematic review of intrinsic and extrinsic motivations in dietary habits across countries

Background

Boys' and girls' food habits diverge in adolescence (13-18 years). This contributes to unequal risks of adverse health outcomes based on sex and gender in adulthood (e.g., heart diseases in men vs. disorder eating in women). Though multi-factorial, why these dietary differences occur is unclear.

Purpose

To identify the reasons why adolescents' motivation behind dietary habits differs among genders.

Methods

Four databases were searched following PRISMA guidelines. Eligible studies had to use qualitative methodology and report at least one gender unique theme. Reported themes were thematically analyzed, with a sub-analysis by country where the studies were conducted. Quality appraisals were assessed using the Critical Appraisal Skills Programme checklist.

Results

In the 34 eligible articles (n = 1,694 returned) two overarching themes emerged that dictated dietary habits in adolescents: Self-motivators and Uncontrollable factors. Gender differences arose whereby girls highlighted more external motivators (e.g., eat healthier, change dietary habits around boys and be thin to fit traditional norms) over their dietary habits. In contrast, boys focused on more internal motivators (e.g., gain autonomy, eat for enjoyment and pursue gains in physical performance). This suggests that motivation underlying how boys and girls eat differs. These trends were largely consistent across countries.

Conclusion

Boys' and girls' food habits are not motivated by the same factors. To create more effective dietary interventions targeting health promotion, unique motivations behind food habits need to be understood and incorporated.

Systematic review registration

Identifier: CRD42022298077.

How Czech Adolescents Perceive Their Physical Activity

Adolescence is a critical stage in the development of an individual's physical activity (PA) habits and preferences. Adolescents' perceptions of PA can influence their motivation to engage in PA and, consequently, their overall level of PA. Thus, our primary aim was to investigate whether Czech adolescents misperceive their peers' PA. Our dataset comprised cross-sectional data on 1289 adolescents aged 11-15 years. PA was measured using self-reported items used in the HBSC study. To describe the gender and school grade differences in VPA, independent samples T, ANOVA, Mann-Whitney U, and Kruskal-Wallis H tests were performed. To analyze the effect of gender, school grade, school, and participants' own PA on the underestimation of PA, binomial regression models were used. Our study points out that there is a discrepancy between self-perceived levels of PA and the perceived descriptive norms of peers' PA. Adolescents underestimate the prevalence of sufficient PA, and thus perceived descriptive norms in PA as being worse than levels of own PA. These findings indicate room for targeted interventions based on social-norms-based approaches to increase the PA of adolescents or at least strengthen their actual positive behavior.

The role of perceived social norms in non-suicidal self-injury and suicidality: A systematic scoping review

Social norms are an important influence on health-related behaviours and intention formation. As both suicidal behaviour and non-suicidal self-injury (NSSI) can be motivated by intentions, perceived social norms may have an important role in suicide and NSSI outcomes, although no existing reviews of this association exist. Following the PRISMA Scoping Review extension guidance, a scoping review based on systematic searches of key databases was conducted to identify published English language studies investigating the role of perceived social norms in suicidality and NSSI. Information regarding the types of social norms studied, their relationship to suicidality/NSSI outcomes, study samples and designs was charted. Thirty-six eligible studies (31 quantitative, 4 qualitative, 1 mixed methods) sampling various populations across mostly non-clinical settings were identified and narratively synthesised. Studies varied in how social norms were operationalised, measured, and investigated/explored. Most studies focused on the role of conformity to perceived masculine social norms or to some form of subjective, descriptive, or injunctive norms; there were limited studies on female/feminine norms, pro-social/protective norms, or broader gender/sexuality norms. Most studies (n = 31) were cross-sectional (quantitative) in design, few were based on existing theories of suicide/NSSI or social norms, and none concurrently tested theories of social norms and NSSI/suicidality. Perceived social norms and stronger conformity to norms were generally associated with worse NSSI/suicidality, although some pro-social norms appeared to be protective (e.g., perceived parental norms for adolescents). Whilst conformity to restrictive perceived social norms may be related to poorer suicide and NSSI outcomes, there is a lack of consistency in the literature in how social norms are defined and measured, a lack of theory-based hypothesis testing, and few longitudinal studies. There is a need for more nuanced, theory-based, investigations of how, when, where, why, and for whom, perceived norms have a causal role in NSSI and suicidality outcomes.

Factors Influencing Saudi Youth Physical Activity Participation: A Qualitative Study Based on the Social Ecological Model

BACKGROUND

The growing improvement in urbanisation, modes of transportation and the expansion of sedentary behaviour, both at work and home, have resulted in declining rates of physical activity (PA) worldwide. Nearly one-third of the global population aged 15 and over are insufficiently active. The negative effect of physical inactivity has been evidenced and ranked fourth as the lethal cause of death globally. Therefore, the aim of this research was to explore the factors influencing PA participation among youths from different geographical locations in the Kingdom of Saudi Arabia.

METHODS

Sixteen focus groups (males = 8 and females = 8) were conducted with a total of 120 secondary school students (male = 63 and female = 57) aged between 15 and 19 years. The focus groups were analysed to identify key themes through the process of thematic analysis.

RESULTS

Results from the focus groups indicated that a lack of time, safety, parental support, policies, access to sport and PA facilities, and transportation, as well as climate were reported as barriers to PA participation.

DISCUSSION AND CONCLUSION

The current research contributes to the scarce literature focused on the multidimensional effects on Saudi youth PA behaviour from different geographical locations. This qualitative approach has provided the participants a voice, and the overall study offers valuable evidence as well as invaluable information to policymakers, public health departments, and local authorities for PA intervention based on the environment and the community.

Sociodemographic Characteristics, Dietary Intake, and Body Image Dissatisfaction Among Saudi Adolescent Girls

This study assesses sociodemographic characteristics, dietary intake and body image dissatisfaction (BID) among Saudi adolescent girls. A total of 399 girls ages 13-14 were randomly selected from intermediate schools in Arar, Saudi Arabia. Data on anthropometric measurements, sociodemographic characteristics, dietary intake and body image (BI) were collected. Multiple linear regression was used to predict the association between variables. Most adolescents had a normal weight based on their body mass index (BMI), normal waist circumference (WC), and normal waist-to-height ratio (WHtR). Fried chicken and Kabsa rice were the most frequently consumed foods; most girls consumed excessive fat. Most girls had BID (81.5%), and 51.4% desired to lose weight. BMI was positively correlated with age and current BI (p<0.001) and negatively associated with dairy product intake (p=0.004) and desired BI (p<0.001). WC had a positive association with age (p=0.001) and current BI (p<0.001) and a negative association with dairy product intake, cereal and grain intake (p=0.001) and ideal BI (p<0.001). WHtR was positively associated with current BI (p<0.001) and negatively associated with cereal and grain intake (p=0.005), dairy product intake and desired BI (p<0.001). Although most participants had a normal weight, they consumed excessive fat and were dissatisfied with their BI, which are significant predictors of obesity. Saudi adolescent girls require nutritional interventions to help them transition to a healthy diet, positive BI and healthy lifestyle.

The influence of social support, social affiliation and intrinsic motivation for increasing underserved youth's physical activity: A social climate-based intervention study

The purpose of this study was to investigate the influences of intrinsic motivation, social affiliation orientations and reciprocal social support for physical activity (PA) on underserved youths' afterschool period moderate-to-vigorous (MVPA) changing trajectories across the 16-week Connect through PLAY intervention, a social-motivational climate intervention. A total of 113 youth (61.06% African American, 56.64% girls) provided full data. Youths' intrinsic motivation, social affiliation orientations and social support were measured by youth responses to a set of surveys at baseline and post-intervention. Youths' afterschool period MVPA was measured using data from 7-day ActiGraph accelerometer wear at baseline, midpoint and post-intervention. Hierarchical linear modelling analysis found that youth daily afterschool period (3pm-6pm) MVPA increased, on average, 37.94 min across the 16-week intervention. Increases in intrinsic motivation, social affiliation orientations and social support were positive predictors of youth afterschool MVPA changing trajectory. The findings clarify the contributions that a social-motivational climate intervention can have on youth afterschool period MVPA through increasing youth intrinsic motivation, social affiliation and reciprocal social support.

Interviews with parents of adolescents with intellectual and developmental disabilities in a weight management study

BACKGROUND

Adolescents and young adults with intellectual and developmental disabilities are at risk of obesity. Parents influence their diet and physical activity behaviours and therefore, can play important roles in weight management. The aims of this qualitative study were to explore parents' experiences assisting their son or daughter to participate in a weight management study.

METHODS

Interviews were completed at 6 months with 27 parents whose adolescent or young adult had completed the weight loss portion of an 18-month weight management study. Interviews were recorded, transcribed and thematic analysis performed.

RESULTS

Parents shared insights about how well program components worked with their family, and what strategies worked best to adopt healthier dietary choices and become more physically active. The importance of meeting regularly with someone outside the family to encourage healthier habits was stressed.

CONCLUSIONS

Future weight management studies should involve parents and their adolescents to help tailor strategies and adapt intervention approaches.

A Qualitative Evaluation of a Community-Based Intervention on Health-Related Behaviors in Disadvantaged Women

Purpose: Grounded in social ecological model and self-determination theory, the aim of this study was to qualitatively evaluate the first and second year follow-ups of a community-based healthy lifestyle programme on health-related behaviors, and outcomes in disadvantaged adult women. Methods: Eleven disadvantaged adult women (M = 37.72; SD = 8.34) (seven of them from the Roma population) participated in this community-based participatory action research. Discussion groups, semi-structured interviews, and field notes were used to assess the effects of the intervention programme on health-related behaviors and health outcomes through thematic analysis. Results: Women perceived improvements in PA-related variables, healthy eating, and other health-related outcomes throughout two years. Most women mentioned these behavior changes in the first year, while others perceived them in the second year. Conclusions: These findings highlight the importance of developing contextual and culturally tailored interventions that address the specific problems and needs that emerge from ethnic groups. Given that some of these behavior changes were only mentioned by most of these women in the second year, long-term interventions seem to be ideally required in this population.

Does the socioeconomic positioned neighbourhood matter? Norwegian adolescents' perceptions of barriers and facilitators for physical activity

BACKGROUND AND AIMS

A higher proportion of adolescents from lower socioeconomic position families tend to be less physically active than their counterparts from higher socioeconomic position families. More research is needed to understand the causes of these differences, particularly the influence of the neighbourhood environment. This qualitative study aims to explore how adolescents and their parents from higher and lower socioeconomic neighbourhoods perceive the social, organisational and physical environment influencing adolescents' physical activity behaviours.

METHOD

We conducted six semi-structured focus groups with 35 13-14-year-olds and eight interviews with some of their parents. The interviewees were recruited from one higher and two lower socioeconomic neighbourhoods in Oslo, Norway. Theme-based coding was used for analysis, and the results discussed in light of an ecological framework.

RESULTS

The results indicate that factors like social norms in a neighbourhood could shape adolescents' physical activity behaviour, and a social norm of an active lifestyle seemed to be an essential facilitator in the higher socioeconomic neighbourhood. Higher availability of physical activity and high parental engagement seemed to facilitate higher physical activity in this neighbourhood. In the lower socioeconomic neighbourhoods, the availability of local organised physical activity and volunteer engagement from parents varied. Programmes from the municipality and volunteer organisations seemed to influence and be essential for adolescents' physical activity behaviour in these neighbourhoods.

CONCLUSIONS

The results illustrate the complexity of behaviour and environment interaction, and a limitation in explaining the phenomenon by focusing primarily on the individual level rather than an ecological perspective.

Exploring the relationship between perceived social support and college students' autonomous fitness behavior: Chain mediating effect test

Objective

This study aims to explore the effect of perceived social support on college students' autonomous fitness behavior, and the mediating role of mental toughness and exercise self-efficacy.

Methodology

A survey participated by 985 college Students (average age, 19.55) was conducted by applying the following scales: The Perceived Social Support Scale, the Adolescent Self-Government Behavior Scale, the Mental Toughness Scale, and the Exercise Self-efficacy Scale (ESES).

Results

(1) Perceived social support can directly and positively predict autonomous fitness behavior, mental toughness, and exercise self-efficacy; mental toughness can directly and positively predict exercise self-efficacy. Likewise, perceived social support, mental toughness, and exercise self-efficacy can positively predict autonomous fitness behavior. (2) The indirect effect of the path with mental toughness as the mediating variable is 0.078, the indirect effect of the path with exercise self-efficacy as the mediating variable is 0.122, and the indirect effect of the path with mental toughness and exercise self-efficacy as the mediating variable is 0.082. (3) The total of all indirect effects is 0.282, and the effects of the three indirect pathways account for 18.25, 28.62, and 19.37% of the total, respectively.

Conclusion

The perceived social support can indirectly predict college students' autonomous fitness behavior through the independent mediating effect of mental toughness and self-efficacy, as well as the chain mediating effect of the two. The claim that mental toughness and exercise self-efficacy perform a chain-mediate role in the positive effect brought by perceived social support on autonomous fitness behavior has been supported. This study revealed the relationship and mechanism between perceived social support and college students' autonomous fitness behavior and further improved the research on the impact of perceived social support on college students' autonomous fitness behavior.

The Value of Sport: Wellbeing Benefits of Sport Participation during Adolescence

Insight into the unique benefits of sport participation above and beyond those associated with participation in other physical activities among adolescents is limited in Aotearoa New Zealand (NZ). The purpose of this study was to examine the association between wellbeing and organised sport participation among adolescents whilst accounting for demographic characteristics and other recreational physical activity. Demographic characteristics (age, gender, ethnicity, deprivation, (dis)ability status), organized sport, recreational physical activity, and wellbeing were assessed in cohorts of NZ adolescents (11–17 years) between 2017 and 2019. After adjusting for demographics, better wellbeing was associated with participation in any recreational physical activity (OR = 2.49, 95%CI = 1.97–3.13), meeting physical activity recommendations (OR = 1.63, 95%CI = 1.47–1.81), and each additional hour of recreational physical activity (OR = 1.03, 95%CI = 1.02–1.04). After adjusting for demographics and overall recreational physical activity participation, better wellbeing was also associated with participation in any organized sport (OR = 1.66, 95%CI = 1.49–1.86), and each additional hour of organized sport (OR = 1.09, 95%CI = 1.07–1.11). Although participation in recreational physical activity appears to be beneficial for wellbeing, organized sport appears to offer unique additional wellbeing benefits. Positive experiences of organized sport participation may offer additional wellbeing value above and beyond other recreational physical activity types in young people who are active.

A qualitative study on multisector activities to prevent childhood obesity in the municipality of Seinäjoki, Finland

Background

Multisector activities are needed to prevent childhood obesity due to its multifactorial background. The first aim was to identify the activities that had been undertaken for obesity prevention and deduce their main targets. Second, we analyzed the public health policy approaches (upstream, midstream, and downstream) which were followed. Finally, we studied the perception of interviewees regarding their sectors’ roles in implementing the local obesity program.

Methods

Deductive content analysis was used to analyze semi-structured interviews with 34 key professionals (from seven administrative sectors) who had participated in multisector health promotion during 2009–2016 and five representatives of other core parties.

Results

Several midstream and upstream activities were targeted at making physical activity (PA) and healthy eating (HE) integral parts of children’s lifestyle. One long-term strategy was to create environments for PA accessible to every inhabitant and build and renovate the interiors and yards of schools and day-care centers. The healthiness of meals was increased progressively. In addition to midstream and upstream activities, as a downstream activity, an intervention targeting children at risk of obesity was implemented. The impact of management on the activities was considerable; childhood obesity prevention was included in the city strategy and systematically coordinated at the highest managerial level. Altogether, various sectors operated efficiently to promote obesity-preventing lifestyles; however, not all (important) sectors recognized their role in the multisector process.

Conclusion

Most of the activities to guide children towards obesity-preventing lifestyles were either at the midstream or upstream level. Among the latter, considerable work is aimed at creating opportunities to practice PA and making it a natural part of the daily life. The aim of familiarizing children with lifestyles that include PA and HE was shared across sectors, including sectors that had not yet acknowledged their role in obesity prevention. Strong support from city management and systematic coordination of the activity are important factors that contribute to the engagement of several administrative sectors in working towards a shared aim, such as the prevention of childhood obesity.

A Community-Based Participatory Action Research with Women from Disadvantaged Populations: Strengths and Weaknesses of a Multiple Health Behaviour Change Intervention

Disadvantaged populations usually adopt risk behaviours, resulting in obesity and mental health-related disorders. Grounded in the socioecological model and self-determination theory, the aims were firstly to describe and implement a two-year multiple health behaviour change intervention, and secondly, to assess the strengths and weaknesses of the intervention. In total, 11 women from a disadvantaged population participated in this programme, which encompassed 117 sessions. Qualitative techniques were used to collect data and a thematic analysis was conducted. The variety of activities and the group-based intervention were the main strengths, and the decrease in attendance and the programme's tight schedule were the main weaknesses. This is the first intervention in a disadvantaged population mainly comprised of Roma women. The design described in detail and its assessment provide relevant knowledge to improve their health status and decrease inequalities. The practical implications for future research are useful for replicating interventions in similar contexts.

Dietary Behaviors, Physical Activity, and Reported Role Models Among Emerging and Young Adults With Overweight and Obesity

This article characterizes role models identified by emerging/young adults for healthy eating and physical activity (PA), explores variations in reported role models by age, sex and race/ethnicity, and examines dietary/physical activity behaviors in relation to role models. Emerging/young adults (n=397) enrolled in a randomized controlled weight management trial completed assessments at baseline: self-reported role models for healthy eating and PA, Healthy Eating Index, device-measured PA, and demographics. Participants were 78% female, 50% non-White, with mean age 23.3 years, mean BMI 31.1 kg/m². For both healthy eating and PA, the most frequently reported role model was friend (diet: 35%; PA: 39%). Parent was reported second most frequently for healthy eating (21%) and third most frequently for PA (11%). Role models for healthy eating, but not PA, differed by race/ethnicity. Role models did not differ by age or sex. Results may inform future interventions to promote healthy behaviors in emerging adults.

The 'big four' health risk behaviors among Vietnamese adolescents: co-occurrence and socio-cultural risk factors

Background

Health Risk Behaviors (HRBs) represent significant health threats for adolescents. However, there has been relatively little research on multiple HRBs in low-and-middle-income countries (LMIC), where the majority of the world’s youth reside. This study’s objective was to investigate common HRB, their co-occurrence, and socio-demographic risk and protective factors among Vietnamese adolescents.

Methods

A cross-sectional self-report survey examined four major HRBs (tobacco use, alcohol consumption, physical inactivity, unhealthy diet) among 431 adolescents aged 15–17 years in five Vietnam provinces. Key HRB risk and protective factors assessed included perceived social norms, parental monitoring of adolescents’ behavior, and health behavior literacy.

Results

Forty-one percent of participants reported no HRB, 39% reported one, and 20% reported two or more HRBs. The four HRBs appeared to be independent, with an exploratory factor analysis indicating no common factors. The most prevalent HRB was unhealthy diet (45%), the least prevalent smoking (1%). The most frequent co-occurring HRBs were unhealthy diet and physical inactivity. Adolescents’ perceptions of norms regarding HRBs and related healthy behaviors were the most consistent risk factor for the HRB. Diet was the HRB most influenced by the social variables perceived norms, monitoring, and health literacy.

Conclusions

Results highlight the importance of future research identifying the temporal order of co-occurrence of multiple HRB, how differing conceptualizations of socio-cultural roles impact on HRB, and health-related effects of HRB co-occurrence. Such information will be useful for maximizing the efficiency and effectiveness of prevention and intervention programs in LMIC.

The Effect of Interventions That Target Multiple Modifiable Health Behaviors on Symptoms of Anxiety and Depression in Young People: A Meta-Analysis of Randomized Controlled Trials

PURPOSE

This meta-analysis aimed to determine the effect of interventions targeting multiple modifiable health behaviors (i.e., physical activity/sedentary behaviors, nutrition/diet, sleep, substance use) on depression and anxiety in young people.

METHODS

A search of electronic databases from inception until May 2020 was conducted. Randomized controlled trials (RCTs) that explicitly targeted at least two modifiable health behaviors, measured anxiety or depression at baseline and after intervention using a validated instrument, and included participants with an average age between 12 and 25 years were included. The effect of interventions was synthesized using random effects meta-analysis.

RESULTS

A total of 14 RCTs reporting on depression and six RCTs reporting on anxiety were included in the quantitative synthesis. Results showed that although interventions targeting multiple modifiable health behaviors did not produce significant reductions in symptoms of depression (g¯ = -.16, 95% confidence interval [CI] = [-.34, .02], 95% prediction interval [PI] = [-.80, .48], very low certainty evidence) or anxiety (g¯ = -.55, 95% CI = [-1.36, .26], 95% PI = [-3.48, 2.83], very low certainty evidence) across all young people, there was a significant difference in the effect of interventions on depression based on intervention type (Q = 8.37, df = 2, p = .012). Specifically, interventions targeting multiple modifiable health behaviors delivered to groups of young people with an elevated risk of depression had a favorable effect (g¯ = -.28, 95% CI = [-.52, -.05], 95% PI = [-1.04, .47]) on symptoms of depression compared with controls.

CONCLUSIONS

Although not universally effective, this meta-analysis establishes the potential efficacy of targeted interventions aiming to improve multiple modifiable health behaviors to address depression in young people at elevated risk of depression. More research is needed to understand the effect of such interventions on symptoms of anxiety in young people.

Reverse thinking: taking a healthy diet perspective towards food systems transformations

Food systems that deliver healthy diets without exceeding the planet’s resources are essential to achieve the worlds’ ambitious development goals. Healthy diets need to be safe, accessible, and affordable for all, including for disadvantaged and nutritionally vulnerable groups such as of smallholder producers, traders, and consumers in low- and middle-income countries. Globally, food systems are experiencing rapid and drastic changes and are failing to fulfil these multiple duties simultaneously. The international community therefore calls for rigorous food systems transformations and policy solutions to support the achievement of healthy diets for all. Most strategies, however, are essentially supply- and market-oriented. Incorporation of a healthy diet perspective in food system transformation is essential to enable food systems to deliver not only on supplying nutritious foods but also on ensuring that consumers have access can afford and desire healthy, sustainable, and culturally acceptable diets. This paper argues that this should be guided by information on diets, dietary trends, consumer motives, and food environment characteristics. Transformational approaches and policies should also take into account the stage of food system development requiring different strategies to ensure healthier diets for consumers. We review current knowledge on drivers of consumer choices at the individual and food environment level with special emphasis on low- and middle income countries, discuss the converging and conflicting objectives that exist among multiple food-system actors, and argue that failure to strengthen synergies and resolve trade-offs may lead to missed opportunities and benefits, or negative unintended consequences in food system outcomes. The paper proposes a menu of promising consumer- and food-environment- oriented policy options to include in the food systems transformation agenda in order to shift LMIC consumer demand towards healthier diets in low- and middle income countries.

How can an agent-based model explore the impact of interventions on children's physical activity in an urban environment?

Insufficient physical activity (PA) among most children and adolescents is a global problem that is undermining the realisation of numerous developmental and health benefits. The aim of this study was to explore the potential impact of interventions on PA by using an agent-based model (ABM) simulating children's daily activities in an urban environment. Three domains for interventions were explored: outdoor play, school physical education and active travel. Simulated interventions increased children's average daily moderate-to-vigorous PA by 2–13 min and reduced the percentage of children not meeting PA guidelines, from 34% to 10%–29%, depending on the intervention. Promotion of active travel and outdoor play benefited more those in a higher socio-economic position. Agents' interactions suggested that: encouraging activity in diverse groups will reduce percentage of the least active in the population; and initiating outdoor events in neighbourhoods can generate an enhancing effect on children's engagement in PA. The ABM provided measurable outcomes for interventions that are difficult to estimate using reductionist methods. We suggest that ABMs should be used more commonly to explore the complexity of the social-environmental PA system.

•

We developed an agent-based model simulating children's daily physical activity.

•

Agents perform typical daily activities in a virtual urban model of Glasgow city.

•

Simulations explore impact of interventions on outdoor play, school, active travel.

•

Promotion of active travel had a differential impact across socio-economic position.

•

Outdoor play intervention produced a non-linear increase in physical activity.

Perceived social support and diet quality among ethnic minority groups in Yunnan Province, Southwestern China: a cross-sectional study

Background

Social support is an important health determinant and may affect dietary behaviors. The purpose of this study was to examine the relations between perceived social support and the Chinese Diet Balance Index-16 (DBI-16) among ethnic minority groups in Southwest China.

Methods

This cross-sectional study was conducted between May 2019 and August 2020 among six ethnic minority groups native to Yunnan Province (n = 3564). Perceived social support from family, friends and significant others were measured with the Multi-dimensional Scale of Perceived Social Support (MSPSS). Dietary data were obtained using a 100-item Food Frequency Questionnaire (FFQ) and a lifestyle questionnaire. Lower Bound Score (LBS), Higher Bound Score (HBS) and Diet Quality Distance (DQD) which represent inadequate, excessive and unbalanced food intake respectively were calculated to measure the compliance with the recommendations of the Dietary Guidelines for Chinese 2016.

Results

One thousand four hundred ninety-six men and two thousand sixty-eight women were included. 51.2% of the subjects had moderate or high levels of inadequate intake; 21.3% had moderate or high levels of excessive intake; and 74.0% had moderate or high levels of unbalanced dietary intake. With potential confounders adjusted, support from family was negatively associated with inadequate intake, while support from friends was positively associated with inadequate and excessive intake. No significant associations were found between perceived social support from significant others and diet quality indicators.

Conclusions

An unbalanced diet is common among adults of the ethnic minority groups in Yunnan Province, Southwest China. Social support should be taken into account in designing nutrition interventions rather than focusing solely on individuals.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11787-5.

Adolescents' Experiences and Perspectives on Physical Activity and Friend Influences Over Time

Purpose: Understanding friend influences on adolescents' PA, and how these change over time, is fundamental to developing interventions for promoting active lifestyles yet the latter in particular remains unexplored. This study explored the experiences and perspectives of physically active and inactive adolescents regarding the influence of their friends on their PA throughout childhood and adolescence. Methods: Following the completion of a questionnaire, 16 adolescents, 8 boys (4 physically inactive, 4 active) and 8 girls (4 inactive, 4 active), aged 17 ± 1.0 years, were selected from two schools. A qualitative design was adopted whereby each adolescent was interviewed individually. Using the constant comparative method, the interviews were inductively and thematically analyzed. Results: Four main themes were identified: I) PA journeys; II) Friends provide PA benefits); III) Friends matter in PA, but change; IV) Against all odds-rising above others. Compared to the inactive, active adolescents perceived that their friends were fundamental to them becoming and remaining active, specifically in terms of: offering support to internalize an active sense of belonging in different contexts when family support diminished; providing opportunities to be active at key transition points; and helping them to overcome peer victimization. Conclusion: This study confirms the important role of friends in adolescents' PA, and provides new evidence concerning the changing patterns and influence of friends from childhood to late adolescence. Recommendations are made relating to the role of friends in youth PA with a view to improving the effectiveness of approaches to promoting active lifestyles.

Correlations between Physical Activity Participation and the Environment in Children and Adolescents: A Systematic Review and Meta-Analysis Using Ecological Frameworks

Physical activity (PA) and sports are efficient ways to promote the young generation’s physical and mental health and development. This study expected to demonstrate the complexity of correlates associated with children’s and adolescents’ non-organized PA participation. Following the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA), a systematic review and meta-analysis were applied. Seven electronic databases were systematically searched to identify eligible articles based on a series of inclusion and exclusion criteria. The internal validity of the systematic reviews thus identified was evaluated using a validated quality instrument. Calculations were produced in SPSS 27.0 and Comprehensive Meta-Analysis 3.3. Thirty-nine eligible studies (N = 324,953) with moderate to high quality were included. No potential publication bias was detected using statistical analyses. The meta-analysis revealed that the overall ecological factors correlated positively with children and adolescents’ PA; the meta-analytic average of the correlations was (′r = 0.32, p < 0.001). Results from subgroup analysis indicated that theory-based influence factors achieved moderate effect with boys (′r = 0.37, p < 0.001) and girls (′r = 0.32, p < 0.001) in PA participation. Interestingly, higher correlations were found between ecological factors and twins’ PA participation (′r = 0.61, p = 0.001). Further, individual (′r = 0.32, p < 0.001), macro-, and chronosystems factors (′r = 0.50, p < 0.001) appeared slightly more influential than microsystems factors (′r = 0.28, p < 0.001) on children and adolescents’ PA participation. Although findings from the included studies covered were to some extent heterogeneous, it is possible to identify consistent correlates of PA in children and adolescents. The results supported that PA is a complex and multi-dimensional behavior, which is determined by numerous biological, psychological, sociocultural, and environmental factors. Future studies that focus on the integration effect of macrosystem and chronosystem environmental factors, and apply longitudinal designs and objective measurements are encouraged to further unfold the complexity of the ecological system and its implications in promoting children and adolescents’ PA participation.

Where Do Online Games Fit into the Health Behaviour Ecology of Emerging Adults: A Scoping Review

Online video games are a common pastime for emerging adults (EAs). EAs are an age group that is of interest in health communication because habits formed during this life stage can cause or prevent disease later in life. Guided by three research questions, this scoping review identifies the current state of research into socio-ecological influences on physical activity and diet behaviours of EAs. The review also examines the role that online video games play within this behavioural ecology. In total, 112 articles were found that focused on behavioural ecological influences for physical activity and diet behaviour among EAs. Seven of these articles focused on the impact of online video games, although only in conjunction with their influence on physical activity, identifying a gap in understanding the influence of online games on diet. Results show that online video games are currently under-researched in terms of impacts on physical activity and diet despite the prevalence of the use of these games within the EA cohort.

Variations in perceptions of parenting role related to children's physical activity and sedentary behaviours - a qualitative study in a Northern European context

Background

The aim of the study was to increase understanding of the variation in parental perceptions of their roles and responsibilities in relation to children’s physical activity and sedentary behaviours.

Methods

This qualitative study was based on data from the Healthy School Start intervention study II, in the form of recorded motivational interviewing (MI) sessions with mothers and fathers participating in the intervention. Forty-one MI sessions where parents discussed physical activity and/or sedentary behaviour were selected for analysis. Data analysis was performed using a phenomenographic approach.

Results

Three categories describing a structural relationship of parents’ different views on their own role in relation to their child’s habits were identified: 1) The parent decides – Child physical activity according to my beliefs and views as a parent and where I, as a parent, decide, 2) Parent-child interaction – child physical activity is formed in interaction between me as a parent and my child or 3) The child/someone else decides – The child or someone other than me as a parent decides or has the responsibility for my child’s physical activity. All three categories included four subcategories of specific activities: organised activity, activity in everyday life, being active together and screen time, describing practical approaches used in each of the three categories.

Conclusions

This study found variation in mothers’ and fathers’ perceptions of their roles and responsibilities for their child’s physical activity and sedentary behaviours related to specific types of activities. The results indicate areas where parents need support in how to guide their children and how parental responsibility can have a positive influence on children’s physical activity and sedentary habits.

Experiences of parent-adolescent dyads regarding a Facebook-based intervention to improve overweight/obesity treatment in adolescents: A qualitative study

APOLO-Teens is a Facebook-based psychological intervention aiming to optimize hospital treatment for adolescents with overweight/obesity. The present qualitative study aims to explore (1) how adolescents experienced participation in APOLO-Teens and (2) how parents perceived adolescents' participation. Sixteen adolescent-parent dyads were interviewed by telephone using semistructured guides. An inductive approach of thematic analysis was used to analyze data by two independent codifiers. The consensus was used to resolve differences in coding/themes, and two independent auditors reviewed the codes and the themes proposed. We identified four themes from adolescents' interviews, namely, expectations, perception of outcomes, participation in the intervention, and sharing of acquired knowledge. From parents' interviews, we identified five themes: expectations for son/daughter participation, perception of adolescents' outcomes, son/daughter participation, parental role, and use of social networks in intervention programs for adolescents. Both elements of the dyad indicated that adolescents' participation in APOLO-Teens contributed to favorable outcomes, further highlighting the use of online interventions to complement the hospital treatment of adolescents with overweight/obesity. Future studies should address the viewpoints of adolescents and parents in the design of Facebook-based interventions, namely, to implement tailored, shorter, less time-demanding interventions that favor engagement between participants and parental involvement.

Psychosocial correlates of objectively measured in-school and out-of-school physical activity among Brazilian adolescents

Physical activity is influenced by an interplay of time and setting, thus, the role of psychosocial factors on behavior is expected to vary across the day. This cross-sectional study identified the psychosocial correlates of time spent in physical activity during in-school (i.e., 08:00-11:59) and out-of-school (i.e., 12:00-22:00) time segments. The sample consisted of adolescents (7th to 9th grade) of two public schools in Florianópolis, Brazil. Accelerometer measured light-intensity (LPA) and moderate-to-vigorous-intensity physical activity (MVPA) were estimated. Psychosocial correlates of physical activity (i.e., outcome expectations, attitude, self-efficacy, support from parents, and support from peers) were self-reported. Linear mixed models were applied and interaction effects of gender and age were also analyzed. From a total of 194 participants, 138 and 112 provided in-school and out-of-school valid data, respectively. Outcome expectations were associated with out-of-school MVPA (β = 0.18; p = .006). Age interaction effects were observed for the associations between outcome expectations and out-of-school LPA (β = 0.21; p = .009) and between self-efficacy and out-of-school MVPA (β = 0.19; p = .009). In conclusion, psychosocial correlates were positively associated with out-of-school physical activity and the effects varied according to age. No psychosocial correlates were identified for LPA and MVPA performed during schooltime.

Resilience and lifestyle-related factors as predictors for health-related quality of life among early adolescents: a cross-sectional study

Objective

To examine whether lifestyle-related factors and resilience predict health-related quality of life (HRQoL) in a sample of early adolescents.

Methods

A total of 611 eighth grade pupils (response rate: 79%) participated in this cross-sectional study. The variables measured were physical activity (accelerometer), cardiorespiratory fitness (Andersen test) and a questionnaire assessing dietary habits, sleep disturbance, resilience (Resilience Scale for Adolescents) and HRQoL (KIDSCREEN-27).

Results

A total of 36% of the sample met the official recommendations of 60 minutes of daily physical activity. Univariate analysis identified physical activity, dietary habits, sleep disturbances, body mass index (BMI), cardiorespiratory fitness and resilience, but not sedentary time, as predictors of HRQoL. Multivariate regression analysis identified resilience as a positive predictor (β 0.18 to 0.27) of all HRQoL domains and sleep disturbance as a negative predictor (β −0.65 to −0.24) of four HRQoL domains. BMI (β = −0.27) and cardiorespiratory fitness (β = 0.021) were predictors of the HRQoL domain physical well-being. Adherence to dietary recommendations was both a positive and a negative predictor of HRQoL (β −0.45 to 0.59).

Conclusion

Resilience and sleep disturbances were the main predictors of HRQoL.

The Theory of Planned Behavior and the USDA Summer Food Service Program

OBJECTIVE

Examine the impact of the Summer Food Service Program (SFSP) on the intentions to positively change fruit and vegetable consumption in a rural, low-income adolescent population using the Theory of Planned Behavior.

DESIGN

Quantitative data collected via a pre-post intervention survey to determine predictors of positive nutrition behaviors and changes in self-reported fruit and vegetable consumption.

SETTING

A mid-sized university.

PARTICIPANTS

Fifty-seven high school students. Participants were primarily female (n = 36) and white (n = 56).

INTERVENTION

Participants followed the standards of the SFSP for 5 weeks and were provided with mandatory and optional nutrition education sessions.

MAIN OUTCOME MEASURE

Intentions to change nutrition behaviors.

ANALYSIS

Multiple regression.

RESULTS

Paired-sample t test showed a significant increase in knowledge from pretest (mean [M] = 11.18, SD = 1.68) to posttest (M = 12.91, SD = 1.76); t[56] = -8.09, P < 0.001; (t[56] = -8.09, P < 0.001) and in self-reported fruit and vegetable intake from pretest (M = 13.96, SD = 4.23) to posttest (M = 16.80, SD = 5.42); (t[56] = -3.20, P = 0.002). Regression demonstrated that all constructs of the Theory of Planned Behavior were significant (F[4, 52] = 14.56, P < 0.001 with an R² of 0.53) for their effects on behavior intentions with perceived behavioral control being the most salient predictor.

CONCLUSIONS AND IMPLICATIONS

Opportunities for shaping adolescent nutrient intake and eating behaviors during enrollment in the SFSP exist. Reinforcing positive attitudes, subjective norms, and perceived behavioral control may help to increase nutrition behavioral intentions and nutrition behaviors.

Qualitative evaluation of a social media campaign to improve healthy food habits among urban adolescent females in Indonesia

OBJECTIVE

The current study focuses on how adolescent girls in urban Indonesia accept technology in a social media (SM) campaign to promote healthy eating habits.

DESIGN

The study was a qualitative evaluation of the online campaign. In-depth interviews using semi-structured interview guidelines and focus group discussions were used to collect data. Data were analysed using a general inductive approach to provide simple and straightforward answers to our study questions.

SETTINGS

The study was conducted in two urban areas in Indonesia: Jakarta and Jogjakarta.

PARTICIPANTS

Adolescent girls aged 16-19 years.

RESULTS

The SM campaign was perceived as beneficial for increasing participants' knowledge. The campaign helped increase participants' awareness of healthy diets and the health risks of unhealthy diets as well as increase their motivation to change their behaviour and avoid foods containing salt, sugar and excess fat. The participants perceived information from the online campaign as complete and trustworthy. Instagram was cited as the easiest platform to use, while the website was cited as having the most complete information. YouTube provided the best viewing experience but was considered a data-heavy platform. The barriers to change were perceptions of taste, limited choices for healthy but affordable ingredients and family-related factors.

CONCLUSIONS

The online nutrition campaign was well accepted by Indonesian urban adolescent females and motivated them to act to protect their health. Future nutrition-related SM campaigns aimed at this demographic should focus on platforms with the greatest benefit and ease of use.

Peer Support Groups for Weight Loss

Purpose of Review

Social support, especially from peers, has been found to contribute to successful weight loss and long-term weight loss maintenance. Peer support groups may represent a particularly effective intervention technique for weight loss. This review focuses upon peer support weight loss interventions with the objective of identifying common elements of successful programs.

Recent Findings

Peer support interventions often consist of expert-led educational content, supplemented by peer-led activities or discussion. Peer groups may provide support to individuals who have little social support in their normal lives. Interventions are often designed for pre-existing groups, especially high-risk groups such as women from ethnic minorities. Men are underrepresented in weight loss programs and often perceive “dieting” as feminine. However, several peer programs for male sports fans have successfully resulted in weight loss and fostering support for healthy lifestyle among male peers. In addition to professionally created peer support groups, many online weight loss communities are created and moderated by peers. Online communities allow participants to share peer support similar to in-person formats.

Summary

Many peer support interventions show significant short-term weight loss. Group members frequently report that peer support was critical to their weight loss success. A sense of community among likeminded individuals with similar goals was frequently cited. Online peer support groups are becoming increasingly prevalent, may fulfill similar needs to in-person groups, and have additional advantages in accessibility, and access to a larger peer network, and may facilitate long-term adherence.

The Effect of Supportive Implementation of Healthier Canteen Guidelines on Changes in Dutch School Canteens and Student Purchase Behaviour

We developed an implementation plan including several components to support implementation of the "Guidelines for Healthier Canteens" in Dutch secondary schools. This study evaluated the effect of this plan on changes in the school canteen and on food and drink purchases of students. In a 6 month quasi-experimental study, ten intervention schools (IS) received support implementing the guidelines, and ten control schools (CS) received only the guidelines. Changes in the health level of the cafeteria and vending machines were assessed and described. Effects on self-reported purchase behaviour of students were analysed using mixed logistic regression analyses. IS scored higher on healthier availability in the cafeteria (77.2%) and accessibility (59.0%) compared to CS (60.1%, resp. 50.0%) after the intervention. IS also showed more changes in healthier offers in the cafeteria (range -3 to 57%, mean change 31.4%) and accessibility (range 0 to 50%, mean change 15%) compared to CS (range -9 to 46%, mean change 9.7%; range -30 to 20% mean change 7% resp.). Multi-level logistic regression analyses on the intervention/control and health level of the canteen in relation to purchase behaviour showed no relevant relations. In conclusion, the offered support resulted in healthier canteens. However, there was no direct effect on students' purchase behaviour during the intervention.

How Czech Adolescents Perceive Active Commuting to School: A Cross-Sectional Study

To achieve a healthy lifestyle, adolescents must be physically active and meet physical activity (PA) guidelines. One of the most natural ways of increasing the amount of PA is active commuting (AC) to school. Recent reviews suggest that peer norms have the potential to shape PA during adolescence in particular. Thus, our primary aim was to investigate whether Czech adolescents misperceive their peers’ AC behaviors and attitudes towards AC. Our dataset comprised cross-sectional data on 1586 adolescents aged 11–15 years. Basic descriptive statistics, chi-square tests, and correlation analyses were used to analyze the data. Regarding traveling to school, 68% of the Czech adolescents in this study are daily active commuters (walking, cycling, or riding a scooter or skateboard). Less than half of the respondents believed that most of their classmates were commuting to school actively almost daily. The students who believed that most of their classmates commuted to school actively had significantly higher chances of being regular active commuters themselves. The results showed that most of the Czech adolescents misperceived the AC norms of their peers. Thus, there could be potential in using a social norms approach aimed at increasing the level of AC in Czech adolescents through targeted interventions.

School- and Leisure Time Factors Are Associated With Sitting Time of German and Irish Children and Adolescents During School: Results of a DEDIPAC Feasibility Study

Objective: The study aims to investigate to what extent school- and leisure time-related factors are associated with sedentary behavior during school in German and Irish children and adolescents. Methods: The study based on a sample of 198 children and adolescents surveyed in 2015. Sedentary and activity behavior were measured using the activPAL physical activity monitor. Information on socio-economic status, school- and leisure-time related factors were provided by questionnaires. Associations between school- and leisure time-related factors and sedentary time during school were estimated using linear multi-level models. Results: Access to play equipment in school was associated with reduced sitting time (hours/day) of children (ß = 0.78; 95%CI = 0.06-1.48). Media devices in bedroom and assessing the neighborhood as activity friendly was associated with increased sitting time of children (ß = 0.92; 95%CI = 0.12-1.72 and ß = 0.30; 95%CI = 0.01-0.60, respectively). The permission to use media devices during breaks was associated with increased sitting time (hours/day) of adolescents (ß = 0.37; 95% CI = 0.06-0.69). A less safe traffic surrounding at school was associated with reduced sitting time of adolescents (ß = -0.42; 95% CI = -0.80 to -0.03). Conclusion: Results suggest that school- and leisure time-related factors are associated to the sedentary behavior during school. We suggest that future strategies to reduce sedentary time should consider both contexts.