Evaluation of an eHealth intervention aiming to promote healthy food habits from infancy -the Norwegian randomized controlled trial Early Food for Future Health

Outcome measurement instruments used to measure diet-related outcomes in infancy: A scoping review

INTRODUCTION

Supporting positive diet behaviours during infancy is essential to support child health and prevent childhood obesity. How infant diet-related outcomes are measured in trials is crucial to determining intervention effectiveness. This scoping review examined what and how outcome measurement instruments are currently used to measure 13 infant diet-related outcomes from a previously developed core outcome set.

METHODS

The databases EMBASE, MEDLINE, CINAHL and PsycINFO were searched from inception to September 2023. Eligible studies reported trials that included infants ≤1 year old and at least one diet-related outcome measurement instrument. Titles/abstracts and full texts were independently screened in duplicate. Data were narratively synthesised.

RESULTS

136 studies reporting 133 trials were included. Outcome measurement instruments used included 66 questionnaires (n = 70 studies), 65 individual questions (n = 45 studies), 24 food diaries/records (n = 21 studies), 11 24-hour dietary recall (n = 11 studies), and healthcare record data (n = 6 studies). Outcome measurement instruments were predominantly self-administered by researchers in participants homes. There was a lack of reporting for some outcome measurements used.

CONCLUSION

Review findings highlight the need to improve clarity and completeness of outcome reporting. The findings also provide an important first step to address heterogeneity in measurement of infant diet-related outcomes. Consistent measurement of diet-related outcomes is needed to improve synthesis and evaluation of obesity prevention interventions.

Effect of video-assisted educational intervention on improving knowledge, attitude and practice among mothers of children below five years on malnutrition: A systematic review

OBJECTIVES

This review aimed to assess the effect of video-assisted educational interventions in enhancing knowledge, attitudes, and practices (KAP) among mothers of malnourished children aged <5 years.

STUDY DESIGN

This was a systematic review.

METHODS

A systematic search was conducted across PubMed, Scopus, and EMBASE databases from inception until November 2022. The selection criteria adhered to the PICOS framework, targeting randomized controlled trials (RCTs) involving mothers who received video-assisted educational interventions alongside comparison groups to evaluate malnutrition-associated KAP outcomes. Risk of bias was assessed using the Cochrane risk of bias assessment tool. Two independent reviewers performed study selection, data extraction, and quality assessment, resolving any disagreements through discussion or consultation with a third reviewer.

RESULTS

Among 11,434 screened articles, seven RCTs met the inclusion criteria, focusing on mothers of children aged <5 years. Statistically significant improvements were observed in maternal knowledge (n = 2), attitude (n = 1), and practice (n = 6) with respect to the feeding practices following video-assisted educational interventions. However, the effect of the educational intervention on children's z-scores remained inconclusive.

CONCLUSIONS

Video-assisted educational interventions were effective in KAP concerning feeding practices among mothers of children aged <5 years. However, their impact on children's z-scores remain inconclusive, emphasising the need for further research to explore factors influencing these outcomes. Further research is needed to determine the long-term effect on children's nutritional status.

Multimorbidity patterns and premature mortality in a prospective cohort: effect modifications by socioeconomic status and healthy lifestyles

BACKGROUND

Few studies have explored the impact of multimorbidity patterns on premature mortality. This study aimed to assess the associations between multimorbidity patterns and long-term mortality and whether the associations were modified by socioeconomic status (SES) and healthy lifestyles.

METHODS

Data were from the National Health and Nutrition Examination Survey (NHANES) 1999-2018 in the US. The latent class analysis was used to establish multimorbidity patterns based on 11 chronic conditions. Mortality outcomes were ascertained by linking with the public-use mortality data from the National Death Index through December 31, 2019. Accelerated failure time models were used to estimate time ratios (TRs) and corresponding 95% confidence intervals (CIs) for the associations between multimorbidity patterns and all-cause and CVD mortality and to exmine the extent to which SES and healthy lifestyles modified those associations.

RESULTS

In our study, six multimorbidity patterns were identified, including "relatively healthy", "hypercholesterolemia", "metabolic", "arthritis-respiratory", "CKD-vascular-cancer", and "severely impaired" classes. Compared with the "relatively healthy" class, TRs for all-cause and CVD mortality progressively decreased across the multimorbidity classes, with the "severely impaired" class showing the shortest survival time (TR, 0.53; 95% CI: 0.48, 0.58 for all-cause mortality; 0.42; 0.35, 0.50 for CVD mortality). A significant interaction was noted between SES and multimorbidity patterns for survival time, with a stronger positive association in individuals with low SES. Adherence to healthy lifestyles was related to longer survival time across all multimorbidity patterns, especially in those with relatively less severe multimorbidity.

CONCLUSIONS

Multiple multimorbidity patterns were identified and associated with mortality. Lower SES was associated with higherexcess multimorbidity-associated mortality, while adopting healthy lifestyles contributed to longer survival regardless of multimorbidity patterns. Efforts should be mobilized to reduce SES gaps and promote healthy lifestyles to alleviate the health burden of multimorbidity.

Community-Level Characteristics Associated With Resilience After Adversity: A Scoping Review of Research in Urban Locales

The objective of this study was to document the current knowledge on characteristics measured at the community level and their relationship to individual or community well-being. The review specifically focuses on studies in urban locations. The main aim was to describe and organize evidence-based community strengths using a multidimensional portfolio approach to resilience. A scoping review using PRISMA-ScR guidelines was performed through searches of English-language articles in PsycINFO and PubMed databases. Inclusion criteria encompassed strengths or deficit factors assessed at the community-level of analysis. Our initial searches produced a pool of 2,246 articles, with 87 meeting full criteria for this review. Community-level variables were often measured as deficits or risk factors. Most studies were conducted in North America. Relationships between community variables and individual well-being showed mixed results for social characteristics but, more consistently, positive associations for strengths-based measures of natural and built environments such as access to green spaces and walkability. Models of resilience, including those focused on individuals, should include environmental characteristics. Findings of the current study suggest foundational concepts for a community resilience portfolio model to complement the more individual-focused models currently in use.

Novel model of childhood appetitive traits in children with obesity

BACKGROUND/OBJECTIVES

Appetitive traits have a central role in energy intake and development of obesity. Child Eating Behavior Questionnaire (CEBQ) is a validated psychometric tool to measure appetitive traits in children. This study sought to assess the CEBQ factor structure in children with obesity. We hypothesized that hedonic traits are more prominent with obesity and in older children.

SUBJECTS/METHODS

This cross-sectional observational study used CEBQ data from three geographically diverse centers in children with obesity. Eight known CEBQ subscales and the established factor model were compared by severity of obesity, age and sex. Exploratory factor analysis (EFA) to define the appetitive trait factor structure was undertaken in a training dataset and validated in a test set.

RESULTS

Children with obesity (n = 814) showed higher food response, enjoyment of food, emotional overeating and desire to drink compared to population-based controls (p < 0.001) that correlated with obesity severity. The EFA identified a novel six-factor model with a new "Food avidity" factor that explained 15.8% of the variance. Satiety responsiveness (p < 0.001) and emotional undereating (p = 0.03) were lower in youth over 6 years compared to younger, while food fussiness and food avidity were the same, without any sex differences.

CONCLUSIONS

CEBQ is useful to assess appetitive traits in children with obesity. The novel factor structure in youth with obesity suggests that temporal or phenotypic differences necessitate a revision of the established factor model. The new factor structure may be used to develop a hyperphagia questionnaire.

Implementation strategies: lessons learned during an e-learning intervention to improve dietary behaviors and feeding practices in early childhood education and care

BACKGROUND

Early Childhood Education and Care (ECEC) centers play an important role in fostering healthy dietary habits. The Nutrition Now project focusing on improving dietary habits during the first 1000 days of life. Central to the project is the implementation of an e-learning resource aimed at promoting feeding practices among staff and healthy dietary behaviours for children aged 0-3 years in ECEC. Implementing new interventions often presents challenges. This study explores ECEC staff views and experiences with selected strategies for implementing an e-learning resource in ECEC centers in a municipality in Southern Norway.

METHODS

The study is a part of the Nutrition Now study, a hybrid type 1 non-randomized controlled trial. The implementation process followed the Dynamic Integrated Evaluation Model (DIEM). Implementation strategies were selected from the Expert Recommendations for Implementing Change (ERIC) project and included identify and prepare champions, conduct educational meetings, distribute educational materials, create a learning collaborative, and remind clinicians. ECEC teachers from participating ECEC centers in the intervention municipality were recruited as champions. Brief (5-7 min minutes), semi-structured phone interviews, covering key points, were conducted with the champions 8 times, evenly distributed over six months. The interviews were analysed using qualitative thematic analysis.

RESULTS

In total, 29 of the invited ECEC centers (53%) participated, and 260 brief interviews (88%) were conducted with champions (n = 37). An evaluation of the feedback from the champions suggests that the five selected implementation strategies were acceptable. Five main themes were developed by qualitative analysis: 1) Being a champion resembles what I already do. 2) Educational meetings are fine but take time. I prefer when peers share experiences. 3) Newsletters were helpful and reminded me, but I do not always have enough time to read. 4) Evaluations have increased my awareness, and we do them informally and formally. 5) The regular phone calls reminded me I could receive support and express my opinion.

CONCLUSION

This study's findings suggest that several implementation strategies are acceptable for stakeholders in an ECEC e-learning healthy eating intervention. However, time constraints among champions may hinder deep engagement. These results provide valuable insights into how the selected implementation strategies may function in practice and how they are perceived and experienced by the ECECs staff.

TRIAL REGISTRATION

Trial registration on June 6, 2022: ISRCTN10694967 .

Associations between nature exposure, screen use, and parent-child relations: a scoping review

BACKGROUND

Recent research suggests that children spend increasing amounts of time engaging in screen-based activities and less time outdoors in natural environments. There is a growing body of theory-driven literature evidencing that child screen use and exposure to nature are associated with wellbeing outcomes in contrasting ways. However, few studies have explored their combinative effects, and the relational family context has been largely overlooked.

OBJECTIVE

This scoping review explored associations between early-late childhood nature exposure, screen use, and parent-child relations to identify research gaps and inform future research direction.

METHODS

This review was guided by Arksey and O'Malley's five-stage methodological framework and other relevant guidelines for scoping reviews. A search of five electronic databases (PsycINFO, MEDLINE complete, ERIC, EMBASE, and Cochrane library) was conducted along with additional hand-searches from inception to 9/08/2024. Peer-reviewed articles published in English between 2012 and 2024 were included.

RESULTS

A total of 390 articles were screened by title and abstract and full text review of 96 articles was conducted. Following additional searches (hand-search and reference lists), a total of 23 eligible articles were identified. Evidence is presented in tabular and textual form and described using qualitative thematic analysis. The synthesis revealed that the relevant body of research is novel, heterogenous, and fragmented. There are various pathways through which children's screen use and engagement with nature interact within the family context; however, research exploring their synchronous and bidirectional effects on relational family processes is limited.

CONCLUSION

Findings emphasize the importance of investigating children's screen use and engagement with nature from a relational paradigm. Future studies should explore the mechanisms underpinning the reciprocal influences of nature and screen use on dyadic family processes and relational outcomes across early-late childhood. OSF REGISTRATION: https://doi.org/10.17605/OSF.IO/TFZDV .

Novel Model of Childhood Appetitive Traits in Children with Obesity

Background/Objectives

Appetitive traits have a central role in energy intake and development of obesity. Child Eating Behavior Questionnaire (CEBQ) is a validated psychometric tool to measure appetitive traits in children. This study sought to assess the CEBQ factor structure in children with obesity. We hypothesized that hedonic traits are more prominent with obesity and in older children.

Subjects/Methods

This cross-sectional observational study used CEBQ data from three geographically diverse centers in children with obesity. Eight known CEBQ subscales and the established factor model were compared by severity of obesity, age and sex. Exploratory factor analysis (EFA) to define the appetitive trait factor structure was undertaken in a training dataset and validated in a test set.

Results

Children with obesity (n=814) showed higher food response, enjoyment of food, emotional overeating and desire to drink compared to population-based controls (p < 0.001) that correlated with obesity severity. The EFA identified a novel six-factor model with a new "Food avidity" factor that explained 15.8% of the variance. Satiety responsiveness (p < 0.001) and emotional undereating (p = 0.03) were lower in youth over six years compared to younger, while food fussiness and food avidity were the same, without any sex differences.

Conclusions

CEBQ is useful to assess appetitive traits in children with obesity. The novel factor structure in youth with obesity suggests that temporal or phenotypic differences necessitate a revision of the established factor model. The new factor structure may be used to develop a hyperphagia questionnaire.

Racial and Ethnic Variations in Resilience Factors Among Sexual and Gender Minority Midlife and Older Adults

BACKGROUND AND OBJECTIVES

This study explores resilience factors among sexual and gender minority (SGM) midlife and older adults, identifying historical/environmental, psychological, social, and behavioral predictors, and examining variations across racial/ethnic subgroups. By adopting a resilience-focused perspective, this research contributes to understanding strengths in the SGM community in the context of aging.

RESEARCH DESIGN AND METHODS

Using weighted survey data from Aging with Pride: National Health, Aging, and Sexuality/Gender Study, this research investigates distinct risk and protective factors associated with resilience among SGM midlife and older adults. Subgroup variations were assessed using regression models. Factors moderated by race/ethnicity were integrated into final interaction models.

RESULTS

Hispanic and Black individuals showed significantly higher resilience than non-Hispanic Whites. Lifetime victimization and day-to-day discrimination were negatively associated with resilience. Positive associations were found for higher income, identity affirmation, larger network size, greater social participation, increased physical activity, and sufficient food intake. Interaction models revealed nuanced patterns by subgroups; education negatively impacted resilience among Black individuals, while income positively influenced Hispanic individuals' resilience. The Other racial/ethnic group demonstrated unique associations between optimal sleep and resilience.

DISCUSSION AND IMPLICATIONS

This study shifts from a deficit-based to a resilience-focused approach among SGM midlife and older adults, revealing key strengths within diverse subgroups. Results underscore the significance of recognizing racial/ethnic differences in factors promoting resilience and posing risks for SGM midlife and older adults. Tailoring interventions to address the intersectional needs of SGM aging populations is essential for enhancing their abilities to bounce back from adverse events.

A web-based and mobile randomised controlled trial providing complementary feeding guidelines to first-time parents in France to promote responsive parental feeding practices, healthy children's eating behaviour and optimal body mass index: the NutrienT trial study protocol

BACKGROUND

Childhood obesity is a crucial public health issue. Early childhood is a critical time to foster the establishment of healthy eating behaviours and growth, which are partly shaped by parental feeding practices. To inform French parents of the recently updated national complementary feeding guidelines for 0-3 years (in terms of nutrition and responsive feeding as a mean to encourage infant appetite control skills and promote healthy growth), an official printed brochure was developed and nationally disseminated in 2021 by the French public health agency, Santé publique France. This randomised controlled trial aims to investigate whether the provision of guidelines through digital (smartphone application) and printed (brochure) tools (vs. the printed brochure alone, usual service) results in healthier parental feeding practices, infant eating behaviours and weight status.

METHODS

This double-blinded monocentric 2-arm trial is currently conducted among first-time parents living in the area of Dijon (France) and recruited in a maternity ward. From child age 3 to 36 months (mo), an app provides a range of 106 age-adapted messages, including dietary recommendations, educational advice, recipes, and tips (intervention group only). Additionally, parents of both groups are provided with 48 messages related to child general development and the printed brochure at child age 2.7 mo. The primary outcome is the body mass index (BMI) z-score at child age 36 mo. Secondary outcome measures include a combination of online parents' reports and behavioural assessments (experimental meals) of parental feeding practices and infant eating behaviours from inclusion to 36 months of age. Analyses of covariance on these outcomes will assess the effect of the intervention, adjusted for relevant confounders. Complementary mediation and moderation analyses will be conducted. Sample size was determined to be n = 118 in each arm of the trial, plus 20% to compensate for potential attrition.

DISCUSSION

This is the first public eHealth randomised control trial in France to assess the effect of a web-based and mobile intervention targeted to first-time parents to improve child feeding practices and child growth.

TRIAL REGISTRATION

This trial was registered at clinicaltrials.gov as NCT05285761 (March 18, 2022).

Practices for introducing complementary foods in Taiwan: A nationwide survey from 2013 to 2016

BACKGROUND/PURPOSE

Introducing complementary foods to infants is a critical stage in their healthy growth and development process. In this study, we analyzed the feeding habits and choices of caregivers in Taiwan during this essential transition period.

METHODS

Data from the 2013-2016 Nutrition and Health Survey in Taiwan were analyzed. Using a multistage stratified sampling technique, we collected data through questionnaires on the feeding practices, challenges, and information sources associated with complementary feeding. We also investigated the timing of introducing various foods. Certain feeding indicators recommended by the World Health Organization were modified and used for analysis.

RESULTS

Among 439 caregivers of infants aged 2-24 months, complementary feeding typically began at 5 months, and it primarily began with cereals and pureed foods. At 6-8 months of age, 98.29% of the infants received these foods. Only 48.39% of infants aged 6-24 months consumed eggs or flesh foods. Among the primary challenges for caregivers were concerns regarding infants' adaptation to new foods (38.2%), refusal of foods by infants (37.1%), and uncertainty regarding which foods to introduce (11.4%). The main sources of information were friends and family (46.9%), the Internet (46.5%), and baby care books (35.6%). Notably, approximately 51% of the respondents used commercial baby foods.

CONCLUSION

In Taiwan, although the majority of infants begin complementary feeding on time, the introduction of eggs and flesh foods is typically delayed. Given the growing reliance on the Internet in the modern age, accurate feeding information should be disseminated online.

Interventions for increasing fruit and vegetable consumption in children aged five years and under

BACKGROUND

Insufficient consumption of fruits and vegetables in childhood increases the risk of future non-communicable diseases, including cardiovascular disease. Testing the effects of interventions designed to increase children's consumption of fruit and vegetables, including those focused on specific child-feeding strategies or broader multicomponent interventions targeting the home or childcare environment, is required to assess the potential to reduce this disease burden.

OBJECTIVES

To assess the benefits and harms of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase and two clinical trials registries to identify eligible trials on 25 March 2023. We searched Proquest Dissertations and Theses in December 2022. We reviewed reference lists of included trials and contacted authors of the included trials to identify further potentially relevant trials.

SELECTION CRITERIA

We included randomised controlled trials (RCTs), including cluster-randomised controlled trials (C-RCTs) and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both amongst children aged five years and under compared to no-intervention control, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted data and assessed the risks of bias of included trials; a third review author resolved disagreements. We used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures. We conducted assessments of risks of bias and evaluated the certainty of evidence (GRADE approach) using Cochrane procedures.

MAIN RESULTS

We included 53 trials with 120 trial arms and 12,350 participants. Sixteen trials examined the impact of child-feeding practice interventions only (e.g. repeated food exposure) in increasing child vegetable intake. Twenty trials examined the impact of multicomponent interventions primarily conducted in the childcare setting (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. Seventeen trials examined the impact of parent nutrition education only in increasing child fruit and vegetable intake. Two trials examined the effect of a nutrition education intervention delivered to children only in increasing child fruit and vegetable intake and one each examined a child-focused mindfulness intervention or providing families with fruit and vegetable interventions. We judged nine of the 53 included trials as free from high risks of bias across all domains. Performance, detection and attrition bias were the most common domains judged at high risk of bias for the remaining trials. There is moderate-certainty evidence that child-feeding practice interventions versus no-intervention control probably have a small positive effect on child vegetable consumption, equivalent to an increase of 15.5 grams as-desired consumption of vegetables (SMD 0.44, 95% confidence interval (CI) 0.24 to 0.65; 15 trials, 1976 participants; mean post-intervention follow-up = 12.3 weeks). No trials in this comparison reported information about intervention costs. One trial reported no harms or serious unintended adverse consequences (low-certainty evidence). Multicomponent interventions versus no-intervention control probably have a small effect on child consumption of fruit and vegetables (SMD 0.27, 95% CI 0.11 to 0.43; 14 trials, 4318 participants; moderate-certainty evidence; mean post-intervention follow-up = 4.0 weeks), equivalent to an increase of 0.34 cups of fruit and vegetables a day. One trial, which tested a multicomponent garden-based intervention, reported the installation of the garden as part of the intervention to be USD 1500 per childcare centre (low-certainty evidence). No trials in this comparison reported information about unintended adverse consequences of interventions. Parent nutrition education interventions may have little to no short-term impact on child consumption of fruit and vegetables versus no-intervention control (SMD 0.10, 95% CI -0.02 to 0.22; 14 trials, 4122 participants; low-certainty evidence; mean post-intervention follow-up = 6.4 weeks). One trial reported the total estimated cost of delivering a parent nutrition education intervention for infant feeding, physical activity and sedentary behaviours delivered by a dietitian as approximately AUD 500 per family (low-certainty evidence). One trial reported no unintended adverse consequences on family food expenditure following implementation of an intervention delivered over the telephone to improve parental knowledge and skills about the home food environment (low-certainty evidence). Trials reported receiving governmental or charitable funds, except for one trial reporting industry funding.

AUTHORS' CONCLUSIONS

There was moderate-certainty evidence that child-feeding practice interventions and multicomponent interventions probably lead to only small increases in fruit and vegetable consumption in children aged five years and under. Parent nutrition education interventions may have little or no effect on increasing fruit and vegetable consumption in children aged five years and under. Future research should be prioritised on assessment and reporting of both intervention cost and adverse effects, and development and evaluation of interventions in research gaps, including in a broader range of settings and in low- and middle-income countries. This review continues to be maintained as a living systematic review with monthly searches for new evidence and incorporation of relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.

Implementing an early-life nutrition intervention through primary healthcare: staff perspectives

BACKGROUND

Nutrition interventions targeting early childhood can be cost-effective and may provide lifelong, intergenerational benefits. From October 2022 to April 2023 the Nutrition Now (NN) e-learning resource was implemented within Early Childhood Education and Care centres and the Maternal and Child Healthcare Centre (MCHC) in a southern Norwegian municipality. As part of the NN project, the present study aims to explore the MCHC staff's experiences with implementing the NN resource, to gain insights into measures important to scale up digital early-life nutrition interventions.

METHODS

Three group interviews were conducted among public health nurses and midwives alongside one individual interview with the department leader of a MCHC in May 2023. An inductive thematic analysis, as described by Braun and Clarke, was conducted to generate the key themes and subthemes regarding the implementation process of NN within the MCHC.

RESULTS

Three main themes were generated: [1] Important resource but not always utilized; [2] Parents are interested but had issues with access; and [3] Staff and stakeholder buy-in and commitment needed from the start. Overall, the staff viewed the NN resource as a potential tool for promoting diet-related topics and believed it could support the guidance they were already providing parents. However, few staff members fully familiarized themselves with the resource. While staff perceived parents as positive when informed about NN, they believed issues such as access challenges, competing platforms, and time constraints reduced parental engagement. Lastly, staff suggested improvements for NN's implementation, including enhanced training, better planning, assigning champions, and lowering the threshold for access.

CONCLUSION

The findings of this study suggest that the real-world implementation of digital evidence-based health behaviour interventions is feasible but would be enhanced by employing strategies focusing on engagement and utilization.

TRIAL REGISTRATION

The main study is registered in the ISRCTN registry with ID ISRCTN10694967, https://doi.org/10.1186/ISRCTN10694967 . (Registration date: 19-06-2022).

The Accumulative Effect of Multiple Postnatal Risk Factors with the Risk of Being Overweight/Obese in Late Childhood

Most past studies focused on the associations of prenatal risk factors with the risks of childhood overweight/obesity. Instead, more postnatal risk factors are modifiable, with less knowledge of their cumulative effects on childhood obesity. We analyzed data of 1869 children in an Australian birth cohort. Key postnatal risk factors included: maternal and paternal overweight/obesity during the child's infancy, tobacco exposure, low family socioeconomic score, breastfeeding duration < 6 months, early introduction of solid foods, and rapid weight gain during infancy. The risk score was the sum of the number of risk factors. The primary outcome is overweight/obesity in late childhood (11-12 years); secondary outcomes are high-fat mass index (FMI), body fat percentage (BF%), and waist-to-height ratio (WHtR). Poisson regression models were used in the analyses. Children with higher risk scores had higher risks of overweight/obesity (p-for-trends < 0.001). After adjusting covariates, compared with those with 0-1 risk factors, children with 4-6 risk factors had 4.30 (95% confidence interval: 2.98, 6.21) times higher risk of being overweight/obesity; the relative risks for high FMI, BF%, and WHtR were 7.31 (3.97, 13.45), 4.41 (3.00, 6.50), and 6.52 (3.33, 12.74), respectively. Our findings highlighted that multiple postnatal risk factors were associated with increased risks of being overweight/obesity in late childhood.

Scoping review showed that obesity prevention in Nordic countries had limited effects on children from birth to 7 years of age

AIM

The aim of this scoping review was to map and summarise clinical trials that attempted to prevent obesity in children from birth to 7 years of age in any of the Nordic countries.

METHODS

PubMed, CINAHL Plus and clinicaltrials.gov were searched for peer-reviewed papers and registered trials published in English or Swedish. The overall search period was from 1 January 2002 to 13 December 2022. We included randomised and non-randomised trials initiated from birth to 7 years of age that aimed to prevent obesity in Denmark, Finland, Iceland, Norway and Sweden.

RESULTS

The search resulted in 414 papers and 14 were included. Despite having diverse settings and designs, none of them reported consistently favourable results for anthropometric outcomes, apart from beneficial trends in subgroups with a high body mass index at baseline. Most studies reported temporarily improved dietary patterns.

CONCLUSION

There is a gap in the current research about how to best prevent obesity in children. We suggest that researchers should focus on risk groups and that interventions that last a number of years are needed.

The cost-effectiveness of school-based interventions for chronic diseases: a systematic review

BACKGROUND

Chronic diseases, or non-communicable diseases (NCD), are conditions of long duration and often influenced and contributed by complex interactions of several variables, including genetic, physiological, environmental, and behavioral factors. These conditions contribute to death, disability, and subsequent health care costs. Primary and secondary school settings provide an opportunity to deliver relatively low cost and effective interventions to improve public health outcomes. However, there lacks systematic evidence on the cost-effectiveness of these interventions.

METHODS

We systematically searched four databases (PubMed/Medline, Cochrane, Embase, and Web of Science) for published studies on the cost-effectiveness of chronic-disease interventions in school settings. Studies were eligible for inclusion if they assessed interventions of any chronic or non-communicable disease, were conducted in a school setting, undertook a full cost-effectiveness analysis and were available in English, Spanish, or French.

RESULTS

Our review identified 1029 articles during our initial search of the databases, and after screening, 33 studies were included in our final analysis. The most used effectiveness outcome measures were summary effectiveness units such as quality-adjusted life years (QALYs) (22 articles; 67%) or disability-adjusted life years (DALYs) (4 articles; 12%). The most common health condition for which an intervention targets is overweight and obesity. Almost all school-based interventions were found to be cost-effective (30 articles; 81%).

CONCLUSION

Our review found evidence to support a number of cost-effective school-based interventions targeting NCDs focused on vaccination, routine physical activity, and supplement delivery interventions. Conversely, many classroom-based cognitive behavioral therapy for mental health and certain multi-component interventions for obesity were not found to be cost-effective.

Associations between dimensions of the social environment and cardiometabolic risk factors: Systematic review and meta-analysis

Aim

The social environment (SE), including social contacts, norms and support, is an understudied element of the living environment which impacts health. We aim to comprehensively summarize the evidence on the association between the SE and risk factors of cardiometabolic disease (CMD).

Methods

We performed a systematic review and meta-analysis based on studies published in PubMed, Scopus and Web of Science Core Collection from inception to 16 February 2021. Studies that used a risk factor of CMD, e.g., HbA1c or blood pressure, as outcome and social environmental factors such as area-level deprivation or social network size as independent variables were included. Titles and abstracts were screened in duplicate. Study quality was assessed using the Newcastle-Ottawa Scale. Data appraisal and extraction were based on the study protocol published in PROSPERO. Data were synthesized through vote counting and meta-analyses.

Results

From the 7521 records screened, 168 studies reported 1050 associations were included in this review. Four meta-analyses based on 24 associations suggested that an unfavorable social environment was associated with increased risk of cardiometabolic risk factors, with three of them being statistically significant. For example, individuals that experienced more economic and social disadvantage had a higher "CVD risk scores" (OR = 1.54, 95%CI: 1.35 to 1.84). Of the 458 associations included in the vote counting, 323 (71%) pointed towards unfavorable social environments being associated with higher CMD risk.

Conclusion

Higher economic and social disadvantage seem to contribute to unfavorable CMD risk factor profiles, while evidence for other dimensions of the social environment is limited.

Screen Time and Child Behavioral Disorders During COVID-19 Pandemic: A Systematic Review

Background

The extensive use of various electronic games and communication devices, particularly among children and adolescents, has raised concerns, particularly during the COVID-19 pandemic. This study investigated the link between screen time and internalizing disorders, such as anxiety and depression, among individuals aged ≤18 during the global COVID-19 pandemic.

Methods

This systematic review aims to summarize scientific publications from 2019 to early 2022 by searching databases, including the Cochrane Library, PubMed, Web of Science, Scopus, and PsycINFO, to identify suitable studies. In each paper, we searched the following keywords and their synonyms: screen, child, high school, middle school, and psychiatric disorders. The quality of the selected papers was evaluated using a checklist recommended by the National Institutes of Health (NIH) for observational cohort studies.

Results

Out of 986 reports identified, we included 12 papers with 14,483 participants. The study revealed a negative correlation between screen time (TV, computer, video games, and mobile phones) and behavioral outcomes. Smartphones were the most frequently used devices, with video games being more prevalent among older participants for education, communication, and entertainment purposes. The prevalence of depression ranged between 10% and 25%. Furthermore, anxiety and depression were identified as predictors of increased screen usage. Some results displayed variation based on the type of screen exposure, the questionnaires used, and the age of the participants.

Conclusions

The findings imply an indirect association between increased screen time and depression and anxiety. It is crucial to consider limitations on screen time exposure and parental supervision as measures to prevent certain mental disorders.

The use of internet-based smartphone apps consistently improved consumers' healthy eating behaviors: a systematic review of randomized controlled trials

Introduction

Digital tools, such as mobile apps and the Internet, are being increasingly used to promote healthy eating habits. However, there has been inconsistent reporting on the effectiveness of smartphones and web-based apps in influencing dietary behaviors. Moreover, previous reviews have been limited in scope, either by focusing on a specific population group or by being outdated. Therefore, the purpose of this review is to investigate the impacts of smartphone- and web-based dietary interventions on promoting healthy eating behaviors worldwide.

Methods

A systematic literature search of randomized controlled trials was conducted using databases such as Google Scholar, PubMed, Global Health, Informit, Web of Science, and CINAHL (EBSCO). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to prepare the entire document. EndNote (version 20) was used for reference management. The risk of bias in the articles was assessed using the "Revised Cochrane Risk of Bias tool for randomized trials (RoB 2.0)" by the Cochrane Collaboration. Narrative synthesis, using text and tables, was used to present the results. The study was registered in PROSPERO under protocol number CRD42023464315.

Results

This review analyzed a total of 39 articles, which consisted of 25 smartphone-based apps and 14 web-based apps. The studies involved a total of 14,966 participants. Out of the 25 studies, 13 (52%) showed that offline-capable smartphone apps are successful in promoting healthier eating habits. The impact of smartphone apps on healthy adults has been inconsistently reported. However, studies have shown their effectiveness in chronically ill patients. Likewise, internet-based mobile apps, such as social media or nutrition-specific apps, have been found to effectively promote healthy eating behaviors. These findings were consistent across 14 studies, which included healthy adults, overweight or obese adults, chronically ill patients, and pregnant mothers.

Conclusion

Overall, the findings suggest that smartphone apps contribute to improving healthy eating behaviors. Both nutrition-specific and social media-based mobile apps consistently prove effective in promoting long-term healthy eating habits. Therefore, policymakers in the food system should consider harnessing the potential of internet-based mobile apps and social media platforms to foster sustainable healthy eating behaviors.

Scaling up evidence-based digital early life nutrition interventions in a county setting: an implementation trial - protocol for Phase 2 of the Nutrition Now project

Background

Few effective health interventions transition from smaller efficacy or effectiveness studies to real-world implementation at scale, representing a gap between evidence and practice. Recognising this, we have developed Nutrition Now - a tailored digital resource building on four efficacious dietary interventions, aiming to improve nutrition in the important first 1,000 days of life. Nutrition Now targets and guides expectant parents and parents of 0-2 year olds, serves as a reliable source of evidence-based information for midwives and public health nurses at maternal and child healthcare (MCH) centres, and offers pedagogical tools for early childhood education and care (ECEC) staff. The aim of this study is to implement Nutrition Now at scale and evaluate the impact of different sets of multifaceted implementation strategies on implementation outcomes.

Methods

A quasi-experimental design with three study arms will be used, providing either low, medium or high implementation support, when rolled out in 50 municipalities in 2 counties in Norway. Nutrition Now will be implemented in MCH and ECEC settings and made available to expectant parents and parents of 0-2 year olds through social media and MCH. The implementation support builds on strategies described in the Expert Recommendations for Implementing Change (ERIC) implementation framework and is informed by dialogues with stakeholders. Impact of the different degree of implementation support will be assessed by examining reach, adoption, fidelity, and sustainability using usage data generated from the Nutrition Now resource, publicly available municipal data and qualitative interviews with MCH and ECEC staff.

Discussion

Nutrition Now Phase 2 will break new ground by scaling up successively delivered and complementary dietary interventions in the first 1,000 days of life in a real-life context. The project also seeks to identify what level of implementation support is most effective when implementing digital, scalable, evidence-based early-life nutrition interventions in community settings. The project will inform implementation research and provide knowledge about effective implementation strategies to be used in a national scale-up of Nutrition Now.

Trial registration

The study is registered prospectively (submitted 14/06/2022, registration date: 19/06/2022) in the International Standard Randomised Controlled Trial Number registry (ISRCTN): reg. Number: ISRCTN10694967, https://doi.org/10.1186/ISRCTN10694967.

Children's behaviour and childhood obesity

Childhood obesity is a major complex and multifaceted public health challenge with significant short- and long-term health consequences. It is also associated with a significant reduction in quality of life and poorer mental health outcomes. In general, obesity occurs when energy intake exceeds energy expenditure. In children, however, the former can be interpreted as when a child has a body mass index (BMI) at or above the 95th percentile for children of the same age, sex, and ethnicity on growth charts. Obesity in children is influenced by a complex interplay of genetic, environmental, socio-economic, and behavioural factors. The relationship between a child's behaviour and childhood obesity is multifaceted and influenced by various factors, including dietary habits, physical activity levels, sedentary behaviours, family dynamics, socio-economic status, and environmental factors. Effective strategies for preventing and managing childhood obesity require a comprehensive, multi-sectoral approach that addresses individual, family, community, and educational institutes. Thus, addressing childhood obesity requires a comprehensive approach that addresses not only biological and environmental factors but also behavioural factors that influence children's eating behaviours, physical activity levels, sleep patterns, and emotional well-being. Early intervention and ongoing support are crucial for promoting healthy growth and development and reducing the burden of childhood obesity on individuals, families, and societies. This review discusses factors that influence the child's behaviour and the relationship between the child's behaviour and childhood obesity.

Maternal mental health is associated with children's frequency of family meals at 12 and 24 months of age

Diet during the child's first years is important for growth and development. In toddlerhood, higher diet quality is reported among children eating meals together with family. Although previous literature has documented several associations between maternal mental health and early child feeding practices, less is known about the relationship between maternal mental health and child frequency of shared family meals. This study explores associations between maternal symptoms of anxiety and depression, measured by The Hopkins Symptoms Checklist (SCL-8), and toddler participation in family meals. We used cross-sectional data from the Norwegian study Early Food for Future Health, in which participants responded to questionnaires at child age 12 (n = 455) and 24 months (n = 295). Logistic regression was used to explore associations between maternal mental health and child having regular (≥5 per week) or irregular (<5 per week) family meals (breakfast and dinner), adjusting for relevant child and maternal confounding variables. Children of mothers with higher scores of anxiety and depression had higher odds of Irregular family meals at both timepoints; (OR: 2.067, p = 0.015) and (OR: 2.444, p = 0.023). This is one of few studies exploring associations between maternal mental health and child frequency of shared family meals in early childhood, a period where the foundation for life-long health is shaped. Given the high prevalence of mental ailments and disorders, these findings are important and may inform future public health interventions. Further exploration of this relation is needed, including longitudinal research to test predictive associations and qualitative studies to increase insight and understanding.

Mental health and well-being in children and adolescents

The guideline discusses the various milestones in typical neurodevelopment and the various checkpoints where atypical development can be picked up. There is also a remarkable influence of epigenetics and parenting on child development and well - being. It is also essential to establish effective communication to facilitate healthy child development. Well being in children is largely impacted by schooling, curricular design, inclusivity, teacher training and awareness of newer developments, parent teacher interaction. A clinician must also be well acquainted with the National Education Program and its impact. A healthy environment, exercise, adequate nutrition, microplastics on children and adolescents, global warming are key factors in the development of children. It is indispensable for clinicians to approach well- being in a scientific way and get a clear understanding of the laws and policies for child welfare and protection.

Context and Expectations Matter: Social, Recreational, and Independent Functioning among Youth with Psychosis in Chennai, India and Montreal, Canada

OBJECTIVES

Most cross-cultural psychosis research has focused on a limited number of outcomes (generally symptom-related) and perspectives (often clinician-/observer-rated). It is unknown if the purported superior outcomes for psychosis in some low- and middle-income countries extend to patient-reported measures of social, recreational, and independent functioning. Addressing this gap, this study aimed to compare these outcomes in first-episode psychosis at a high-income site and a lower middle-income site.

METHODS

Patients receiving similarly designed early intervention for psychosis in Chennai, India (N = 164) and Montreal, Canada (N = 140) completed the self-reported Social Functioning Scale-Early Intervention, which measures prosocial, recreation, and independence-performance functioning. Their case managers rated expected independence-performance functioning. Both sets of assessments were done at entry and Months 6, 18, and 24. Linear mixed model analyses of differences between sites and over time were conducted, accounting for other pertinent variables, especially negative symptoms.

RESULTS

Linear mixed models showed that prosocial, recreation, and independence-performance functioning scores were significantly higher in Montreal than Chennai and did not change over time. Expected independence-performance was also higher in Montreal and increased over time. Negative symptoms and education independently predicted prosocial, recreation, and expected independence-performance functioning. When added to the model, expected independence-performance predicted actual independence-performance and site was no longer significant. At both sites, prosocial and recreation scores were consistently lower (<40%) than independence-performance (40-65%).

CONCLUSION

This is the first cross-cultural investigation of prosocial, recreation, and independent functioning in early psychosis. It demonstrates that these outcomes differ by socio-cultural context. Differing levels of expectations about patients, themselves shaped by cultural, illness, and social determinants, may contribute to cross-cultural variations in functional outcomes. At both sites, social, recreational, and independent functioning were in the low-to-moderate range and there was no improvement over time, underscoring the need for effective interventions specifically designed to impact these outcomes.

Doctors' recommendations and healthy lifestyle behaviors among individuals with hypertension in Brazil

Little is known about whether doctors' recommendations encourage healthy behaviors among individuals with hypertension in Brazil. This study examined the biological, social, and health factors related to doctor's recommendations and the associations between doctor's recommendations and healthy behaviors. The sample consisted of individuals with hypertension (N = 18,260) from Brazil's 2019 National Health Survey. The outcomes examined included smoking, drinking, diet, salt intake, physical activity, and doctor visits. Study findings indicated that more than 80% of people with hypertension in Brazil received doctors' recommendations to adhere to medical care and engage in healthy behaviors. Those who received recommendations were more likely to practice healthy eating and exercise regularly but also to be obese/overweight, smoke, and drink excessively. Nonetheless, the findings concerning diet and exercise suggest the value of doctors' recommendations for individuals with hypertension in Brazil.

CO-Creation and Evaluation of Food Environments to Advance Community Health (COACH)

Introduction

Food environments are a key determinant of food intake and diet-related health. This paper describes the development of an iterative, adaptive, context-specific framework for health-enabling food environments embedded in cocreation theory.

Methods

A 3-stage multimethod framework for the coproduction and prototyping of public health interventions was followed in an iterative manner during the development of the framework. These 3 stages were (1) evidence review, including systematic review, consultation with experts, and observation of current work; (2) codesign of the framework prototype with multiple stakeholders; and (3) coproduction through refinement of the prototype through stakeholder workshops and expert reviews with incorporation of researcher notes and workshop evaluation. We use the term prototype during the development phase and the term framework to report on the final product.

Results

COACH (CO-creation and evaluation of food environments to Advance Community Health) is a process framework that describes what best practice application of cocreation in health-enabling food retail environments should involve. COACH consists of 10 interdependent factors within a 4-phase continuous quality improvement cycle. The 4 phases of the cycle are engagement and governance establishment, communication and policy alignment, codesign and implementation, and monitoring and evaluation.

Conclusions

Utilizing cocreation theory represents an innovative step in research and practice to improve the healthiness of food retail environments. COACH provides a specific, unique, and comprehensive guide to the utilization of cocreation to improve the healthiness of food environments in practice.

A Person-Centered Perspective on Physical Activity-Related Barriers Perceived by Male Fluctuators 50 Plus: A Cross-Sectional Study

Men aged 50 or older (50 plus) represent a hard-to-reach target group for health-enhancing physical activity (PA) interventions. However, a considerable percentage of men 50 plus do not entirely fail to achieve the PA milestones set by the World Health Organization (WHO) guidelines. They show fluctuating PA behavior, influenced by various barriers hindering or preventing regular PA participation. As "one-size-fits-all" behavioral change interventions are only partially effective in specific subgroups, it is essential to tailor PA promotion measures to the particular needs of male fluctuators 50 plus. The standardized questionnaire included validated instruments measuring participants' current stage of behavioral change, their perceived barriers to PA, questions on selected psychosocial correlates of PA, and sociodemographic variables. Out of 1,013 participants, 133 men (13.1%) classified themselves as fluctuators. Using a person-centered approach, we formed groups with similar intra-individual relevant barrier profiles using hierarchical cluster analysis (Ward method) followed by k-means clustering. We identified four clusters. Cluster 1 (n = 31) involves men predominantly perceiving physical constraints. Cluster 2 (n = 33) represents men lacking self-motivation and struggling with their weaker selves. Men in Cluster 3 (n = 51) primarily indicate professional and private obligations that prevent them from being physically active. Finally, men in Cluster 4 (n = 18) miss appropriate sports courses that meet their individual needs. Our findings support identifying individually tailored strategies designed to promote regular PA in male fluctuators 50 plus. Further research is required to determine the effectiveness of this approach in improving adherence to PA guidelines and corresponding health-enhancing effects for men 50 plus.

Awareness of a disconnect between the value assigned to health and the effort devoted to health increases the intention to become more physically active

Background

Intrinsic values and priorities influence decision-making and are, therefore, important to consider explicitly in intervention development. Although health is generally considered an important value, individuals often make unhealthy choices, indicating a values disconnect.

Study aim

To investigate how becoming aware of a disconnect between the value assigned to health and the effort devoted to health is related to intentions and commitment for behavioural change and physical activity among inactive adults.

Methods

We performed a secondary exploratory analysis on previously collected data. The intervention included a values exercise based on the Disconnected Values Model (DVM) that made disconnected values explicit to participants in two study arms. We compared participants with a disconnect (n = 138) with participants without a disconnect (n = 101) regarding intentions and commitment for behavioural change and physical activity and sitting time 2-4 weeks follow-up. Logistic and linear regression analyses were performed to analyse the data.

Results

Between-group differences were found for the intention to devote more effort to health (OR = 3.75; 95%CI: 2.05; 6.86) and for the intention to become more physically active (OR = 2.21; 95%CI: 1.10; 4.46), indicating that significantly more participants with a disconnect were motivated to change, compared to participants without a disconnect. No between-group differences were found for commitment, intention strength, follow-up physical activity and sitting time.

Conclusion

Making explicit a disconnect regarding health in an active choice intervention was associated with intentions to become more physically active. Still, it did not translate in significant behaviour change at 2-4 weeks follow-up.

Trial registration

ClinicalTrials.gov: NCT04973813. Retrospectively registered.

Trial registration

ClinicalTrials.gov identifier: NCT04973813..

Digital Parenting Interventions for Fathers of Infants From Conception to the Age of 12 Months: Systematic Review of Mixed Methods Studies

BACKGROUND

Digital interventions help address barriers to traditional health care services. Fathers play an important parenting role in their families, and their involvement is beneficial for family well-being. Although digital interventions are a promising avenue to facilitate father involvement during the perinatal period, most are oriented toward maternal needs and do not address the unique needs of fathers.

OBJECTIVE

This systematic review describes the digital interventions that exist or are currently being developed for fathers of infants from conception to 12 months postpartum.

METHODS

A systematic search of the MEDLINE, PsycINFO, Cochrane Central Register of Controlled Trials, Embase (using Ovid), and CINAHL (using EBSCO) databases was conducted to identify articles from database inception to June 2022, of which 39 met the inclusion criteria. Articles were included if they were peer-reviewed and described a digital intervention that targeted fathers of fetuses or infants aged ≤12 months. Systematic reviews, meta-analyses, and opinion pieces were excluded. Data from these studies were extracted and themed using a narrative synthesis approach. Quality appraisal of the articles was conducted using the Mixed Methods Appraisal Tool.

RESULTS

A total of 2816 articles were retrieved, of which 39 (1.38%) met the inclusion criteria for eligibility after removing duplicates and screening. Eligible articles included 29 different interventions across 13 countries. Most articles (22/29, 76%) described interventions that were exclusively digital. There were a variety of digital modalities, but interventions were most commonly designed to be delivered via a website or web-based portal (14/29, 48%). Just over half (21/39, 54%) of the articles described interventions designed to be delivered from pregnancy through the postpartum period. Only 26% (10/39) of the studies targeted fathers exclusively. A wide range of outcomes were included, with 54% (21/39) of the studies including a primary outcome related to intervention feasibility. Qualitative and mixed methods studies reported generally positive experiences with digital interventions and qualitative themes of the importance of providing support to partners, improving parenting confidence, and normalization of stress were identified. Of the 18 studies primarily examining efficacy outcomes, 13 (72%) reported a statistically significant intervention effect. The studies exhibited a moderate quality level overall.

CONCLUSIONS

New and expecting fathers use digital technologies, which could be used to help address father-specific barriers to traditional health care services. However, in contrast to the current state of digital interventions for mothers, father-focused interventions lack evaluation and evidence. Among the existing studies on digital interventions for fathers, there seem to be mixed findings regarding their feasibility, acceptability, and efficacy. There is a need for more development and standardized evaluation of interventions that target father-identified priorities. This review was limited by not assessing equity-oriented outcomes (eg, race and socioeconomic status), which should also be considered in future intervention development.

Impact and evaluation of an online culinary nutrition course for health, education and industry professionals to promote vegetable knowledge and consumption

BACKGROUND

Poor diet, including inadequate vegetable intake, is a leading risk factor for noncommunicable disease. Culinary and nutrition education provided to trainee and practising health and education professionals is an emerging strategy to promote improved dietary intake, including vegetable consumption. We evaluated the impact and feasibility of an online culinary medicine and nutrition (CM/CN) short course for health, education and vegetable industry professionals. The course aimed to improve participants' skills and confidence to prepare vegetables, knowledge of evidence-based nutrition information and recommendations for improving vegetable consumption and diet quality.

METHODS

A pre-post study consisting of two separate groups participating in two course rounds recruited practising professionals (n = 30) working in health; community, adult and/or culinary education; and the vegetable industry. Evaluation assessed diet quality, vegetable consumption barriers, cooking and food skill confidence, nutrition knowledge and process measures.

RESULTS

Seventeen participants (68%) completed the programme. Pre- to postintervention statistically significant increases in vegetables (M 1.3, SD 2.2), fruit (M 1.6, SD 3.1), and breads and cereal (M 1.1, SD 1.7) intakes were observed. Statistically significant increases and large effect sizes for mean food skill confidence scores (M 8.9, SD 15.4, Cohen's d 0.56) and nutrition knowledge scores (M 6.2, SD 15.4, Cohen's d 0.83) were also observed pre- to postintervention.

CONCLUSIONS

The short online course was feasible and improved diet quality, food skill confidence and nutrition knowledge. Online CM/CN education for practising professionals represents a promising area of research. Future research involving a larger study sample and a more rigorous study design such as a randomised control trial is warranted.

Effectiveness of a Smartphone App (MINISTOP 2.0) integrated in primary child health care to promote healthy diet and physical activity behaviors and prevent obesity in preschool-aged children: randomized controlled trial

BACKGROUND

Childhood overweight and obesity is a public health priority. We have previously reported the efficacy of a parent-oriented mobile health (mHealth) app-based intervention (MINISTOP 1.0) which showed improvements in healthy lifestyle behaviors. However, the effectiveness of the MINISTOP app in real-world conditions needs to be established.

OBJECTIVE

To evaluate the real-world effectiveness of a 6-month mHealth intervention (MINISTOP 2.0 app) on children's intake of fruits, vegetables, sweet and savory treats, sweet drinks, moderate-to-vigorous physical activity, and screen time (primary outcomes), and on parental self-efficacy (PSE) for promoting healthy lifestyle behaviors, and children's body mass index (BMI) (secondary outcomes).

METHODS

A hybrid type 1 effectiveness-implementation design was utilized. For the effectiveness outcomes, a two-arm, individually randomized controlled trial was conducted. Parents (n = 552) of 2.5-to-3-year-old children were recruited from 19 child health care centers across Sweden, and, randomized to either a control (standard care) or intervention group (MINISTOP 2.0 app). The 2.0 version was adapted and translated into English, Somali and Arabic to increase reach. All recruitment and data collection were conducted by the nurses. Outcomes were assessed at baseline and after six months, using standardized measures (BMI) and a questionnaire (health behaviors, PSE).

RESULTS

Among the participating parents (n = 552, age: 34.1 ± 5.0 years), 79% were mothers and 62% had a university degree. Twenty-four percent (n = 132) of children had two foreign-born parents. At follow-up, parents in the intervention group reported lower intakes of sweet and savory treats (-6.97 g/day; p = 0.001), sweet drinks (-31.52 g/day; p < 0.001), and screen time (-7.00 min/day; p = 0.012) in their children compared to the control group. The intervention group reported higher total PSE (0.91; p = 0.006), PSE for promoting healthy diet (0.34; p = 0.008) and PSE for promoting physical activity behaviors (0.31; p = 0.009) compared to controls. No statistically significant effect was observed for children's BMI z-score. Overall, parents reported high satisfaction with the app, and 54% reported using the app at least once a week.

CONCLUSION

Children in the intervention group had lower intakes of sweet and savory treats, sweet drinks, less screen time (primary outcomes) and their parents reported higher PSE for promoting healthy lifestyle behaviors. Our results from this real-world effectiveness trial support the implementation of the MINISTOP 2.0 app within Swedish child health care.

TRIAL REGISTRATION

Clinicaltrials.gov NCT04147039; https://clinicaltrials.gov/ct2/show/NCT04147039.

Factors related to the implementation and scale-up of physical activity interventions in Ireland: a qualitative study with policy makers, funders, researchers and practitioners

BACKGROUND

Current literature reports a gap between development of effective interventions to promote physical activity and the systematic uptake into real-world settings. Factors relating to implementation and scale-up of physical activity interventions have been examined, however the perspectives of multiple stakeholders from different domains are not well researched. The purpose of this study was to examine the perceived factors related to physical activity intervention implementation and scale-up in different domains from different stakeholders on the island of Ireland.

METHODS

Practitioners, researchers, funders and policy makers in Ireland were invited to take part in a semi-structured interview exploring factors related to the implementation and scale-up of eleven different physical activity interventions. A thematic analysis was conducted to identify factors related to the implementation and scale-up of the included interventions. The data collection and analysis were guided by the Consolidated Framework for Implementation Research.

RESULTS

Thirty-eight participants took part in the interviews which identified factors related to 1) intervention planning and practical considerations; 2) organisational structures, staffing and resources related to delivery; 3) reflection, evaluation and updating of the intervention; and 4) practical consideration related to scale-up. Furthermore, participants referred to the ongoing commitment, engagement, and support needed throughout the implementation process.

CONCLUSIONS

Future research and practice needs to consider how different factors are experienced at different implementation stages and by the different stakeholder groups involved. The findings highlight multiple inter-related factors that influence the implementation and scale-up of physical activity interventions, but also identifies many strategies that can be utilised to aid future successes.

The role of neighbourhood design in cycling activity during COVID-19: An exploration of the Melbourne experience

COVID-19 restrictions imposed significant changes on human mobility patterns, with some studies finding significant increases or decreases in cycling. However, to date there is little understanding on how the neighbourhood-level built environment influenced cycling behaviour during the COVID-19 restrictions. As different neighbourhood have different built environment characteristics, it is possible that cycling trends varied across different built environment settings. We aimed to answer this question by examining recreational cycling during different stages of lockdown in Melbourne, Australia. We compared self-reported recreational cycling frequency (weekly) data from 1344 respondents between pre-COVID and two different stages in lockdown. We tested whether the built environment of their residential neighbourhood and different sociodemographic characteristics influenced leisure cycling rates and whether the effect of these factors varied between different stages of COVID-19 restriction. We found that cycling declined significantly during the two stages of COVID-19 lockdown. Cycling infrastructure density and connectivity are two built environment factors that had a significant effect on limiting the decline in leisure cycling during the pandemic. Furthermore, men and younger people had higher cycling rates in comparison to other groups, suggesting that restrictions on indoor activities and travel limits were not enough to encourage women or older people to cycle more during the pandemic.

A critical analysis of walking policy in Ireland and its contribution to both national and international development goals

Introduction

Increasing population levels of walking holds benefits for public and planetary health. While individual level interventions to promote walking have been shown to be efficacious, upstream interventions such as policies harness the greatest potential for impact at the population level. However, little is known about the nature and presence of walking policy in Ireland and the extent to which it aligns to national and global goals. This paper aims to provide an overview of local and national walking policy in Ireland and to understand the potential of Irish walking policy to contribute to national and global targets.

Methods

This study used multiple methods to provide a critical overview of walking policy. Firstly, a six-phase process was employed to conduct a content analysis of local and national walking policy in Ireland. Secondly, conceptual linkage exercises were conducted to assess the contribution of walking, and national walking policy in Ireland, to Ireland's National Strategic Outcomes and the United Nations Sustainable Development Goals.

Results

Overall, half (n = 13) of the counties in the Republic of Ireland were found to have no local level walking policies. Results from the content analysis suggest that counties which had walking specific local level policies (n = 2) were outdated by almost two decades. Walking was identified to hold the potential to contribute to over half (n = 6) of Ireland's National Strategic Outcomes, and over half (n = 7) of the United Nations Sustainable Development Goals. Ireland's only national level walking specific policy, the Get Ireland Walking Strategy and Action Plan 2017-2020, was identified to potentially contribute to four of Ireland's National Strategic Outcomes and three United Nations Sustainable Development Goals.

Discussion

Multidisciplinary action is required to update walking-related policy with embedded evaluation and governance mechanisms in all local walking systems. Furthermore, given sufficient collaboration across sectors, walking policy in Ireland has the potential to contribute to a wider breadth of national and global targets beyond the health, sport, tourism, and transport sectors.

Clinical Practices and Experiences about Screen Time: From the Perspective of Child and Adolescent Psychiatrists in Turkey - An Online Survey

Background

Both mental and physical preventable health problems related to screen time (ST) in children and adolescents are increasing. It is important that psychiatrists have awareness to prevent problems in this area.

Objective

The aim of our study was to evaluate the child psychiatrists' awareness about ST, their interventions for ST, and to what extent the recommendations of the associations are implemented.

Method

All child and adolescent psychiatrists in the country who could be reached via smartphone were invited to participate in the study. Child and adolescent psychiatrists were included regardless of whether they had attended any ST courses/panels. Data were collected through an online questionnaire. A total of 302 physicians volunteered for the study.

Results

It was determined that very few child and adolescent psychiatrists had attended an ST course/training in the past or followed any guidelines. A statistically significant difference was found between physicians who received training/courses and those who did not in terms of informing patients and offering interventions (p<0.05). Similarly, a significant difference was found between those who followed the guidelines and those who did not.

Conclusion

Raising awareness, increasing psychiatrist participation in trainings, and following guidelines can increase the effectiveness of ST interventions, in order to achieve good results.

Prevalence and correlates of compliance with 24-h movement guidelines among children from urban and rural Kenya-The Kenya-LINX project

BACKGROUND

Like many countries in sub-Saharan Africa, Kenya has experienced rapid urbanization in recent years. Despite the distinct socioeconomic and environmental differences, few studies have examined the adherence to movement guidelines in urban and rural areas. This cross-sectional study aimed at examining compliance to the 24-hour movement guidelines and their correlates among children from urban and rural Kenya.

METHOD

Children (n = 539) aged 11.1 ± 0.8 years (52% female) were recruited from 8 urban and 8 rural private and public schools in Kenya. Physical activity (PA) and sleep duration were estimated using 24-h raw data from wrist-worn accelerometers. Screen time (ST) and potential correlates were self- reported. Multi-level logistic regression was applied to identify correlates of adherence to combined and individual movement guidelines.

RESULTS

Compliance with the combined movement guidelines was low overall (7%), and higher among rural (10%) than urban (5%) children. Seventy-six percent of rural children met the individual PA guidelines compared to 60% urban children while more rural children also met sleep guidelines (27% vs 14%). The odds of meeting the combined movement guidelines reduced with age (OR = 0.55, 95% CI = 0.35-0.87, p = 0.01), was greater among those who could swim (OR = 3.27, 95% CI = 1.09-9.83, p = 0.04), and among those who did not engage in ST before school (OR = 4.40, 95% CI = 1.81-10.68, p<0.01). The odds of meeting PA guidelines increased with the number of weekly physical education sessions provided at school (OR = 2.1, 95% CI = 1.36-3.21, p<0.01) and was greater among children who spent their lunch break walking (OR = 2.52, 95% CI = 1.15-5.55, p = 0.02) or running relative to those who spent it sitting (OR = 2.33, 95% CI = 1.27-4.27, p = 0.01).

CONCLUSIONS

Prevalence of meeting movement guidelines among Kenyan children is low and of greatest concern in urban areas. Several correlates were identified, particularly influential were features of the school day, School is thus a significant setting to promote a healthy balance between sleep, sedentary time, and PA.

Features of effective staff training programmes within school-based interventions targeting student activity behaviour: a systematic review and meta-analysis

BACKGROUND

Evaluations of school-based activity behaviour interventions suggest limited effectiveness on students' device-measured outcomes. Teacher-led implementation is common but the training provided is poorly understood and may affect implementation and student outcomes. We systematically reviewed staff training delivered within interventions and explored if specific features are associated with intervention fidelity and student activity behaviour outcomes.

METHODS

We searched seven databases (January 2015-May 2020) for randomised controlled trials of teacher-led school-based activity behaviour interventions reporting on teacher fidelity and/or students' device-measured activity behaviour. Pilot, feasibility and small-scale trials were excluded. Study authors were contacted if staff training was not described using all items from the Template for Intervention Description and Replication reporting guideline. Training programmes were coded using the Behaviour Change Technique (BCT) Taxonomy v1. The Effective Public Health Practice Project tool was used for quality assessment. Promise ratios were used to explore associations between BCTs and fidelity outcomes (e.g. % of intended sessions delivered). Differences between fidelity outcomes and other training features were explored using chi-square and Wilcoxon rank-sum tests. Random-effects meta-regressions were performed to explore associations between training features and changes in students' activity behaviour.

RESULTS

We identified 68 articles reporting on 53 eligible training programmes and found evidence that 37 unique teacher-targeted BCTs have been used (mean per programme = 5.1 BCTs; standard deviation = 3.2). The only frequently identified BCTs were 'Instruction on how to perform the behaviour' (identified in 98.1% of programmes) and 'Social support (unspecified)' (50.9%). We found moderate/high fidelity studies were significantly more likely to include shorter (≤6 months) and theory-informed programmes than low fidelity studies, and 19 BCTs were independently associated with moderate/high fidelity outcomes. Programmes that used more BCTs (estimated increase per additional BCT, d: 0.18; 95% CI: 0.05, 0.31) and BCTs 'Action planning' (1.40; 0.70, 2.10) and 'Feedback on the behaviour' (1.19; 0.36, 2.02) were independently associated with positive physical activity outcomes (N = 15). No training features associated with sedentary behaviour were identified (N = 11).

CONCLUSIONS

Few evidence-based BCTs have been used to promote sustained behaviour change amongst teachers in school-based activity behaviour interventions. Our findings provide insights into why interventions may be failing to effect student outcomes.

TRIAL REGISTRATION

PROSPERO registration number: CRD42020180624.

Prevalence of meeting 24-Hour Movement Guidelines from pre-school to adolescence: A systematic review and meta-analysis including 387,437 participants and 23 countries

BACKGROUND

Meeting the 24-Hour Movement Guidelines (physical activity, screen time, and sleep duration) has been associated with positive health indicators. However, there are no previous meta-analyses that have examined the overall adherence to the 24-Hour Movement Guidelines from pre-school to adolescence across the world. Therefore, the main purpose of this systematic review and meta-analysis was to examine the overall (non)adherence to the 24-Hour Movement Guidelines among preschoolers, children, and adolescents worldwide.

METHODS

Four electronic databases (MEDLINE, Scopus, Web of Science, and Cochrane Database of Systematic Reviews) were searched for quantitative studies published in Spanish and English between January 2016 and May 2021. Studies that were conducted with apparently healthy participants and reported the overall (non)adherence to the 24-Hour Movement Guidelines in preschoolers and/or children and/or adolescents were included.

RESULTS

Sixty-three studies comprising 387,437 individuals (51% girls) aged 3-18 years from 23 countries were included. Overall, 7.12% (95% confidence interval (95%CI): 6.45%-7.78%) of youth met all three 24-Hour Movement Guidelines, and 19.21% (95%CI: 16.73%-21.69%) met none of the 3 recommendations. Concerning sex, adherence to all recommendations was significantly lower in girls (3.75%, 95%CI: 3.23%-4.27%) than in boys (6.89%, 95%CI: 5.89%-7.89%) (p < 0.001). However, there were no sex differences regarding adherence to any of the 3 individual recommendations (girls, 15.66%, 95%CI: 8.40%-22.92%; boys, 12.95%, 95%CI: 6.57%-19.33%). In terms of age group, adherence to the 3 recommendations was 11.26% (95%CI: 8.68%-13.84%), 10.31% (95%CI: 7.49%-13.12%), and 2.68% (95%CI: 1.78%-3.58%) in preschoolers, children, and adolescents, respectively. Conversely, 8.81% (95%CI: 5.97%-11.64%) of preschoolers, 15.57% (95%CI: 11.60%-19.54%) of children, and 28.59% (95%CI: 22.42%-34.75%) of adolescents did not meet any of the recommendations. South America was the region with the lowest adherence (all: 2.93%; none: 31.72%). Overall adherence to the 24-Hour Movement Guidelines was positively related to country Human Development Index (β = -0.37, 95%CI: -0.65 to -0.09; p = 0.010).

CONCLUSION

Most young people fail to meet the three 24-Hour Movement Guidelines, particularly adolescents, girls, and those who are from countries with a lower Human Development Index. Moreover, 1 in 5 young people did not meet any of these recommendations. Therefore, these results highlight the need to develop age- and sex-specific strategies to promote these movement behaviors from the early stages of life.

Preventing and treating childhood overweight and obesity in children up to 5 years old: A systematic review by intervention setting

The prevalence of childhood obesity is increasing worldwide with long-term health consequences. Effective strategies to stem the rising childhood obesity rates are needed but systematic reviews of interventions have reported inconsistent effects. Evaluation of interventions could provide more practically relevant information when considered in the context of the setting in which the intervention was delivered. This systematic review has evaluated diet and physical activity interventions aimed at reducing obesity in children, from birth to 5 years old, by intervention setting. A systematic review of the literature, consistent with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, was performed. Three electronic databases were searched from 2010 up to December 2020 for randomised controlled trials aiming to prevent or treat childhood obesity in children up to 5 years old. The studies were stratified according to the setting in which the intervention was conducted. Twenty-eight studies were identified and included interventions in childcare/school (n = 11), home (n = 5), community (n = 5), hospital (n = 4), e-health (n = 2) and mixed (n = 1) settings. Thirteen (46%) interventions led to improvements in childhood obesity measures, including body mass index z-score and body fat percentage, 12 of which included both parental/family-based interventions in conjunction with modifying the child's diet and physical activity behaviours. Home-based interventions were identified as the most effective setting as four out of five studies reported significant changes in the child's weight outcomes. Interventions conducted in the home setting and those which included parents/families were effective in preventing childhood obesity. These findings should be considered when developing optimal strategies for the prevention of childhood obesity.

Use of an Elevated Avenue for Leisure-Time Physical Activity by Adults from Downtown São Paulo, Brazil

Leisure-time physical activity (LTPA) is associated with access and use of public open spaces. The President João Goulart Elevated Avenue, currently denominated Minhocão, is a facility for leisure activities that is open for people during the night and weekends. The aim of this study was to examine if the prevalence of LTPA among individuals living in the surroundings of Minhocão is different according to proximity to, and use of, the facility. We conducted a cross-sectional study with cluster sampling with people aged ≥18 years who lived in households up to 500 m, and between 501 m and 1500 m of Minhocão. The survey was conducted between December 2017 and March 2019 using an electronic questionnaire. We conducted a bivariate analysis and Poisson regression to examine possible differences in LTPA according to the proximity of residences and use of Minhocão. The analysis used post-stratification weights. A total of 12,030 telephone numbers of people were drawn (≤500 m = 6942; and >500 m to ≤1500 m = 5088). The final sample included 235 residents who returned the questionnaires. There was a higher prevalence of individuals engaging in at least 150 min per week of LTPA among users than non-users (Prevalence Ratio = 2.19, IC95% 1.66 to 2.90), independently of sex, age, education, the distance of houses to nearest accesses and number of barriers. The main five barriers related to the usage of the Minhocão were safety issues in and around the Minhocão, rainy weather, lack of vegetation, and lack of facilities. People who used the park had higher prevalence of all types of LTPA than non-users. The results can serve to inform government decision-making on the future of Minhocão.

Outcomes from a hybrid implementation-effectiveness study of the living well during pregnancy Tele-coaching program for women at high risk of excessive gestational weight gain

Background

Excess gestational weight gain (GWG) is associated with short-term perinatal complications and longer term cardiometabolic risks for mothers and their babies. Dietitian counselling and weight gain monitoring for women at risk of high pregnancy weight gain is recommended by clinical practice guidelines. However, face-to-face appointments, during a time with high appointment burden, can introduce barriers to engaging with care. Telephone counselling may offer a solution. The Living Well during Pregnancy (LWdP) program is a dietitian-delivered telephone coaching program implemented within routine antenatal care for women at risk of excess GWG. This program evaluation used a hybrid implementation-effectiveness design guided by the RE-AIM framework to report on the primary outcomes (reach, adoption, implementation, maintenance) and secondary outcomes (effectiveness) of the LWdP intervention.

Methods

The LWdP program evaluation compared data from women participating in the LWdP program with a historical comparison group (pregnant women receiving dietetic counselling for GWG in the 12 months prior to the study). The primary outcomes were described for the LWdP program. Between group comparisons were used to determine effectiveness of achieving appropriate GWG and pre and post intervention comparisons of LWdP participants was used to determine changes to dietary intake and physical activity.

Results

The LWdP intervention group (n = 142) were compared with women in the historical comparison group (n = 49). Women in the LWdP intervention group attended 3.4 (95% CI 2.9–3.8) appointments compared with 1.9 (95% CI, 1.6–2.2) in the historical comparison group. GWG was similar between the two groups, including the proportion of women gaining weight above the Institute of Medicine recommendations (70% vs 73%, p = 0.69). Within group comparison showed that total diet quality, intake of fruit and vegetables and weekly physical activity were all significantly improved from baseline to follow-up for the women in LWdP, while consumption of discretionary food and time spent being sedentary decreased (all p < 0.05).

Conclusion

The LWdP program resulted in more women accessing care and positive improvements in diet quality, intuitive eating behaviours and physical activity. It was as effective as face-to-face appointments for GWG, though more research is required to identify how to engage women earlier in pregnancy and reduce appointment burden.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08002-5.

Effectiveness of medical nutrition therapy in adolescents with type 1 diabetes: a systematic review

BACKGROUND

Medical nutrition therapy (MNT) has an integral role in overall diabetes management. During adolescence, consideration of physiological and psychosocial changes is essential for implementing an optimal diabetes treatment.

OBJECTIVES

Our aim was to identify, summarize, and interpret the published literature about MNT in adolescents with type 1 diabetes.

METHODS

The Medline (PubMed) and EMBASE databases were searched from January 1959 to December 2021. The inclusion criteria were interventional studies with MNT in adolescents with type 1 diabetes with a disease duration over 1 year, including the following outcomes: dietary intake and daily eating patterns (assessed with validated tools, two or more 24 h dietary recall or 3-day dietary records), the diabetes self-management education and support (DSMES), glycemic control, lipid profile and body mass index (BMI). The exclusion criteria were studies without a control group (except for pre-post studies), the lack of randomization and those studies that assessed only a single nutrient, food or meal consumption, as well as reviews, and in-vitro/in-vivo studies. The risk of bias assessment was performed using the Cochrane risk-of-bias tool for randomized trials. A narrative synthesis was performed to present the results. The quality of evidence was assessed with the GRADE guidance.

RESULTS

From a total of 5377 records, 12 intervention studies (9 RCT and 3 pre-post intervention studies) were included. The data were assessed in order to perform a meta-analysis; however, the studies were too heterogeneous. The studies showed conflicting results about the effectiveness of MNT on dietary pattern, DSMES, glycemic control, lipid profile and BMI.

CONCLUSIONS

Clinical research studies on the effectiveness of MNT in adolescents with type 1 diabetes are scarce. The limited number of studies with a high risk of bias precludes establishing robust conclusions on this issue. Further research is warranted.

The association between Geographic Information System-based neighborhood built environmental factors and accelerometer-derived light-intensity physical activity across the lifespan: a cross-sectional study

Background

Evidence on associations between environmental factors and accelerometer-derived light-intensity physical activity (LPA) is scarce. The aim of this study was to examine associations between Geographic Information System (GIS)-based neighborhood built environmental factors and accelerometer-derived LPA, and to investigate the moderating effect of age group (adolescents, adults, older adults) on these associations.

Methods

Objective data were used from three similar observational studies conducted in Ghent (Belgium) between 2007 and 2015. Accelerometer data were collected from 1,652 participants during seven consecutive days, and GIS-based neighborhood built environmental factors (residential density, intersection density, park density, public transport density, entropy index) were calculated using sausage buffers of 500 m and 1,000 m around the home addresses of all participants. Linear mixed models were performed to estimate the associations.

Results

A small but significant negative association was observed between residential density (500 m buffer) and LPA in the total sample (B = -0.002; SE = 0.0001; p = 0.04), demonstrating that every increase of 1,000 dwellings per surface buffer was associated with a two minute decrease in LPA. Intersection density, park density, public transport density and entropy index were not related to LPA, and moderating effects of age group were absent.

Conclusions

The small association, in combination with other non-significant associations suggests that the neighborhood built environment, as classically measured in moderate-to-vigorous intensity physical activity research, is of limited importance for LPA. More research is needed to unravel how accelerometer-derived LPA is accumulated, and to gain insight into its determinants.

Profiling the variability and inequity in the residential environment in Cyprus according to citizens' ratings: a cross-sectional internet-based "Place Standard" survey

Background

The “Place Standard Tool” (PST) offers a practical framework for structuring conversations about physical and social dimensions of Place which impact on health and well-being. The aim of this study was to survey citizens’ perceptions of Place across diverse settings in Cyprus. While the PST has been extensively used in the context of community engagement, its properties as a measurement tool haven’t been explored.

Methods

An open call was addressed to citizens to rate their neighbourhood environment across the 14 PST items (1: large to 7: little room for improvement). Exploratory factor, cluster and regression analyses were used to explore the dimensionality of the scale, depict neighbourhood profiles and explore differences in ratings according to socio-demographic characteristics, area-level census indicators and residents’ assessment of neighbourhood social position (10-step ladder).

Results

With the exception of safety (M = 4.4, SD = 1.7), 492 participants (mean age 42, 50% residents for > 10 years) from 254 postcodes (21.7% islandwide) did not rate other features favourably, with lowest scores for “influence and sense of control” and “public transport”. A stepwise pattern of dissatisfaction was observed along the social position continuum both for features rated less as well as more favourably (e.g. social contact). For instance, among participants who placed their neighbourhood at the three top steps of the ladder, 48.8% gave a low rating for “influence and sense of control”, while the equivalent figure was 81.0% at the bottom three steps (OR = 4.5, 95% CI 2.3, 8.6). A clear dimensionality of Built (6 items, Cronbach’s α = 0.798), Physical (3 items, α = 0.765), Social (2 items, α = 0.749) and Service (3 items, α = 0.58) environment was identified. A social gradient was evident according to census measures of socio-economic disadvantage (e.g. pre-1980 housing, single-parent households) with larger differences in terms of the built than the social environment.

Conclusions

The study profiled the variability and documented the inequity in the health-related neighbourhood environment across Cypriot communities. The readily interpretable dimensionality of the scale supports its construct validity, allowing calculation of composite scores. The PST can be used as measurement tool in research as well as public health practice to advocate for neighbourhood initiatives which support and enhance citizens’ participation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12706-y.

Associations between infant and maternal characteristics measured at child age 5 months and maternal feeding styles and practices up to child age two years

Facilitating positive feeding practices from infancy may be an important strategy to prevent childhood overweight and obesity. Since the feeding situation early in life constitutes a bidirectional relationship, it is important to understand the impact of both maternal and infant characteristics on maternal feeding practices to intervene in a customized and tailored way. Few studies have concurrently examined associations between maternal and infant characteristics in relation to early maternal feeding practices. The aim of the present study was to explore potential associations between infant and maternal characteristics measured at child age five months, and maternal feeding styles and practices during the child’s first two years. Cross-sectional data from a Norwegian randomized controlled trial in which participants responded to questionnaires at child age 5 months (n = 474), 12 months (n = 293) and 24 months (n = 185) were used to explore potential associations. All maternal and child predictor variables were collected at child age five months. Maternal feeding styles and practices were mapped using subscales from the Infant Feeding Questionnaire at child age 5 and 12 months and the Child Feeding Questionnaire and the Parental Feeding Style Questionnaire at child age 24 months. The subscale-scores were split into roughly equal tertiles, and the upper or lower tertile for the outcome of interest were used to create binary outcome variables. Multivariable binary logistic regression models were conducted for each outcome. We found that maternal education and mental health symptoms as well as infant weight, temperament and feeding mode were associated with maternal feeding styles and practices over time. Our findings indicate that risk factors which may have long-term implications for child weight and health outcomes can be identified early. Larger, population-based studies with a longitudinal design are needed to further explore these pathways.

Evaluating the effectiveness and implementation of evidence-based early-life nutrition interventions in a community setting a hybrid type 1 non-randomized trial - the Nutrition Now project protocol

Disappointingly few efficacious health interventions are successfully scaled up and implemented in real world settings. This represents an evidence-to-practice gap, with loss of opportunity to improve practice. Aiming to improve nutrition in the first 1000 days of life, we have combined four efficacious dietary interventions into a single adapted digital resource (Nutrition Now) for implementation in a Norwegian community setting. Nutrition Now targets pregnant women and parents of 0-2-year-olds with messages focusing on healthy dietary behaviours. Early childhood education and care (ECEC) staff are provided with pedagogical tools addressing healthy food exposure and child food acceptance. Objectives: a) evaluate the effectiveness of provision of the Nutrition Now resource on child diet and diet-related outcomes, with special attention to the influence of socio-economic position, b) gather information on the effectiveness of the implementation process to inform forthcoming scale-up and c) perform trial- and model-based economic evaluations. This is a hybrid type 1 implementation study, focusing on evaluation of effectiveness. A quasi-experimental design with pre- and post-tests, where one municipality gets access to the resource (n~800), while a matched non-equivalent control municipality (n~800) does not, will be used. Effectiveness will be assessed by examining e.g., diet outcomes, developmental outcomes, and feeding practices. The resource will be implemented in ECEC settings and made available to pregnant women and parents through the Norwegian system of maternal and child health (MCH) care. The implementation process includes iterative adjustments and implementation strategies from the implementation framework Expert Recommendations for Implementing Change (ERIC) informed by dialogues with stakeholders. Implementation outcomes (e.g., acceptability and adoption) will be assessed through questionnaires and interviews with parents, ECEC and MCH staff, with particular attention to ethnic diverse groups. Both within-trial and modelling-based economic evaluation will be performed. Nutrition Now will bridge the existing evidence-to-practice gap through rigorous scientific effectiveness evaluation of municipal scale up and inform subsequent county scale up. The study is the first to implement efficacious nutrition interventions in early life with potential for health improvement using technology to maximise the reach and impact of both parental and MCH dietary guidance and ECEC practice.

CLINICAL TRIAL REGISTRATION

https://www.isrctn.com/, identified ISRCTN10694967.

Remote Home-Based Exercise Program to Improve the Mental State, Balance, and Physical Function and Prevent Falls in Adults Aged 65 Years and Older During the COVID-19 Pandemic in Seoul, Korea

BACKGROUND The COVID-19 pandemic can affect the elderly population's general health. This study aimed to compare the effects of a remote home-based exercise program to improve the mental state, balance, and physical function and to prevent falls in adults aged 65 years and older during the COVID-19 pandemic in Seoul, Korea. MATERIAL AND METHODS Seventy participants were randomly assigned to an experimental group of 35 participants who underwent a remote home-based fall prevention exercise program and a control group of 35 participants. The experimental group performed an exercise program twice weekly for 8 weeks from June 2 to July 21, 2021. The Geriatric Depression Scale, 5 times sit to stand test, grip strength, 10-m walk test, gait analysis, Timed Up and Go test, and static balance test were assessed before and after the 8-week program. RESULTS The group-by-time interaction effect was statistically significant for the Geriatric Depression Scale, five times sit to stand test, grip strength, 10-meter walk, gait speed, step length, stride length, Timed Up and Go test, and static balance test (P<0.05). Compared with the control group, the experimental group showed a significant effect in all dependent variables except dynamic balance (P<0.05). CONCLUSIONS In this population, the remote home-based fall prevention exercise program resulted in a significant improvement in physical function, psychological factors, and balance during the COVID-19 pandemic. The findings may have implications for community public health measures to protect the vulnerable during future epidemics and pandemics of infectious disease.

Effectiveness of a digital dietary intervention program targeting young adults before parenthood: protocol for the PREPARED randomised controlled trial

INTRODUCTION

The importance of preconception health for lifelong physical and mental health in the next generation has gained increasing recognition in recent years. Preconception paternal and maternal risk factors such as obesity and inadequate diet affect the metabolic and cardiovascular health of their offspring later in life. This highlights the importance of diet and dietary behaviour in the years before parenthood. In our project, PREPARED, we will evaluate the effectiveness of a digital intervention targeting young adults. Our primary aim is to improve participants' preconception diet, and our secondary aim is to improve preconception quality of life and maternal and child perinatal outcomes.

METHODS AND ANALYSIS

We plan to recruit 7000 men and women individually, aged 20-35 years without children, to be randomised to an intervention or a control group. The intervention group will receive access to a digital resource for 6 months promoting a healthy diet for their health now, later in life and for the next generation. Follow-up is up to 20 years or until they have their first child. To evaluate intervention effects, we will collect dietary data (2×24-hour dietary recalls and a screener). For those participants for which birth ensues, we will link study data with data from the Medical Birth Registry of Norway on maternal and child perinatal outcomes.

ETHICS AND DISSEMINATION

The study is approved by the Regional Ethics Committee, the Norwegian Data Protection Service and our Faculty Ethical Committee (REC: 78104, NSD: 907212, FEC 20/10119). Participation is voluntary and all participants will provide informed consent. Participants can withdraw their consent without giving any reason. Findings will be communicated to the public through a project website and social media, and to professionals through conferences and peer-reviewed papers.

TRIAL REGISTRATION NUMBER

ISRCTN44294662.

Evaluation of health-related quality of life in physically active and physically inactive students during the COVID-19 pandemic in Iran

Covid-19 is an acute respiratory syndrome that can effect on lifestyles. The aim of the present study was to compare the health-related quality of life (HRQoL), physical component summary (PCS) and mental component summary (MCS) scores in physically active (PA) and physically inactive (PI) during the Covid-19 pandemic. Three hundred and twenty-six (182 women; 144 men) studying at the Persian Gulf University participated in the study. The HRQoL Questionnaire (SF-12) was used to collect information. Significant differences in HRQoL score, MCS score and PCS score were observed between physically active and inactive men and women, as well as between physically active and inactive men, and finally between physically active and inactive women (P < 0.01). Data from the present study suggests higher levels of physical activity, even during social restrictions imposed by the current global pandemic, results in significantly greater scores for HRQoL.