Scandinavian Journal of Public Health

Aims: To assess adolescents’ eating/drinking habits of a selection of healthy and unhealthy food items at school, variations in gender and socioeconomic status in these eating habits, and variations between the schools. Methods: A cross-sectional study among 2870 adolescents (mean age: 15.5 years) within the Fruits and Vegetables Make the Marks (FVMM) project. A survey questionnaire was completed by the pupils in the classroom in the presence of a trained project worker. One school lesson (45 minutes) was used to complete the questionnaire. A total of two healthy (fruit and vegetables (FV), water) and five unhealthy (candy and/or potato chips, sweet bakery, instant noodles, regular soft drinks, and diet soft drinks) food items were assessed by food frequency questions. All variables were dichotomised to less than once a week and once a week or more. Results: Several pupils reported to consume snacks (33%), sweet bakery (36%) and regular soft drinks (24%) at school at least once a week. The proportion of pupils who reported to eat FV at least once a week (40%) was low. Girls and pupils with plans of higher education had a more favourable intake of healthy versus unhealthy food items at school. In two-level variance component analyses the proportional school variation ranged from 3.4% (diet soft drinks) to 30.7% (noodles). Conclusions: A large number of adolescents consume unhealthy food items at school and few eat FV. Large differences were observed between groups of pupils and between the schools in consumption of these foods.

Aim: To assess the relationship between number of meals eaten and weight status, and to assess potential confounders of this relationship. Methods: A total of 2870 (participation rate: 85%) 9th and 10th graders (mean age: 15.5 years) at 33 schools completed questionnaires in May 2005. Number of meals was measured with questions asking whether they ate breakfast, lunch, dinner, and supper the day before, giving a scale ranging from zero to four meals/day. Data on gender, height, weight, education plans, intake of fruits and vegetables, consumption of unhealthy snacks, TV/computer time, physical activity level, and dieting were also collected. Results: The proportions of overweight adolescents related to the number of meals eaten were: 10% (0—1 meals, n = 107), 18% (2 meals, n = 399), 14% (3 meals, n = 925), and 10% (4 meals, n = 1402), p ≤ 0.001. Low education plans, high TV/computer time, low physical activity level, and dieting were all positively associated with both being overweight and not having four meals. Being a boy was positively associated with being overweight but negatively associated with not having four meals. High intake of unhealthy snacks was negatively associated with being overweight, but positively associated with not having four meals. In a logistic regression analysis, adjusting for all variables mentioned, odds ratio for being overweight were 0.8 (95% CI 0.3—1.9), 1.8 (95% CI 1.2—2.7) and 1.6 (95% CI 1.2—2.3), respectively, for eating one or zero, two, and three meals compared to four meals. Conclusions: Eating four meals/day was significantly negatively related to being overweight, also when controlling for potential confounding factors.

Aims: The aim of this paper is to investigate anthropometric characteristics in 11-year-old Norwegian by gender and parental education, and to study associations between adolescents’ overweight and waist circumference (WC) and maternal and paternal overweight and WC. Methods: A total of 1483 adolescents, 1156 mothers, and 1016 fathers participated in the baseline survey of the HEalth In Adolescents (HEIA) study (September 2007). Anthropometric measures of the adolescents were assessed by project staff according to standard procedures. Self-reported data about pubertal status were collected through questionnaires. Parental education and anthropometric measures of parents were collected by self-report. Results: The prevalence of overweight (including obesity) determined by the cut-offs for body mass index (BMI) suggested by the International Obesity Task Force was 14.6% among girls and 13.6% among boys. The highest prevalence of overweight was observed among adolescents with parents who had less than 12 years of education (18.8%). Overweight and WC in girls was strongly associated with maternal overweight and WC. For boys, overweight and WC was strongly associated with both maternal and paternal overweight and WC. Conclusions: There was a social gradient in anthropometric characteristics and overweight rates among Norwegian 11-year-old adolescents. Maternal overweight and WC was associated with overweight and WC in girls and boys, while paternal overweight and WC were associated with overweight and WC in boys. The results indicate that mothers are key persons in prevention of overweight among adolescents, despite gender. Fathers are important as role models for their sons. Targeting parental overweight/ obesity could be a strategy in future interventions.

Background: Environmental settings seem to influence the activity patterns of children in neighbourhoods and schoolyards, the latter being an important arena to promote physical activity (PA) in school children. New technology has made it possible to describe free-living PA in interaction with the environment. Aims of study: This study focused on how schoolyard environments influenced the activity patterns and intensity levels in 14-year-old children and whether PA levels in adolescents complied with official recommendations. Another objective was to introduce methodology of using a mobile global positioning system (GPS) device with synchronous heart rate (HR) recordings as a proxy for PA level and a geographical information system (GIS) for spatial analyses. Methods: The sample constituted of 81 children (aged 14 years) from two schools. Movement patterns and activity levels were recorded during lunch break applying a GPS Garmin Forerunner 305 with combined HR monitoring and analysed in a GIS by an overlaid grid and kriging interpolation. Results: Spatial data from GPS recordings showed particular movement patterns in the schoolyards. Low activity levels (mean HR < 120 bpm) dominated in both schools with no gender differences. Activities located to a handball goal area showed the highest monitored HR (>160 bpm) with higher intensity in girls than in boys. Conclusions: Movement patterns and PA generated in GIS for visualisation and analysis enabled direct and realistic description of utilising of schoolyard facilities and activity levels. Linking GPS data and PA levels to spatial structures made it possible to visualise the environmental interaction with PA and which environments promoted low or high PA.

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

Aims: To explore barriers to healthy dietary changes experienced by Pakistani immigrant women participating in a culturally adapted intervention, and whether these barriers were associated with intentions to change dietary behaviours. Methods: Participants were randomly assigned to control and intervention group. The 7-month intervention consisted of six educational group sessions on diet and physical activity, based on knowledge about Pakistani lifestyle and focusing on blood glucose control. Data on barriers for and intentions to healthy dietary changes were collected through an interview with help of a questionnaire. The article is based on data from follow-up assessments in the intervention group, comprising 82 women, aged 28—62 years, without a history of type 2 diabetes. Results: The most important barriers to healthy dietary changes were preferences of children and other family members and perceived expectations during social gatherings. The perceived pressure from other family members was especially strong when the women were trying to change to more vegetables, lentils, and fish and to use less oil in food preparation. The barriers were inversely related to intentions to change. Conclusions: The women encountered various types of barriers when trying to change to healthier food habits, the most prominent being those related to the social dimensions of food consumption, as well as to awareness of the amount of oil used for cooking.

Background: Gestational diabetes mellitus (GDM) and obesity may cause adverse pregnancy outcomes for mothers and offspring. We have set up a research programme to identify predictors for GDM and fetal growth in a multiethnic population in Oslo to improve the identification of high risk pregnancies and reduce adverse short and long-term outcomes for mothers and offspring. Aims: To present the rationale, methods, study population and participation rates. Methods: Population-based cohort study of pregnant women attending the Child Health Clinics (CHC) in Groruddalen, Oslo, and their offspring. Questionnaire data, blood pressure, anthropometric measurements, and fasting blood and urine samples are collected (gestational weeks 8—20 and 28, and 12 weeks postpartum) and an oral glucose tolerance test (28 weeks). Physical activity is measured, three ultrasound measurements are performed and paternal questionnaire data collected. Routine hospital data are available for all mothers and offspring. Umbilical venous blood and placentas are collected, sampled, and stored and neonatal anthropometric measurements performed. Ethnicity is self-reported country of birth. Results: 823 women were included, 59% of non-Western origin. The participation rate was 74% (64—83% in main ethnic groups), mean age 29.8 years (95% CI 29.5—30.1) and median parity 1 (inter-quartile range 1). The cohort is representative for women attending the CHC with respect to ethnicity and age. A slight selection towards lower parity (South Asians) and age (Africans) was found. Few were lost to follow-up. Conclusions: Unique information is collected from a representative group of multiethnic women to address important public health problems and mechanisms of disease. Participation rates are high in all ethnic groups.

Aims: This article explores judgemental and disciplining attitudes and ‘‘gazes’’ found in magazines and among Norwegian men and women concerning body ideals and body practices. The analysis is informed by Michel Foucault’s argument on governmentality and Nikolas Rose’s on governing the soul. Methods: The data consist of 20 qualitative interviews and four selected Norwegian magazines. Results: The analysis shows a corresponding relationship of how magazines depict ideal bodies and how the informants describe good-looking bodies. The interviews also indicate that people who train (ie work out) give more detailed and clear descriptions of good-looking bodies than those who do not train. Body dissatisfaction is present among both men and women, but seems more widespread among women. Body dissatisfaction is understood as a public health issue. Conclusions: The analysis suggests that the Norwegian men and women in the study are governed by ‘‘healthism’’ and dominant body ideals depicted in media discourses concerning description of ideal bodies and their own body practices. In addition, the material shows widespread body dissatisfaction particularly among women, and suggests that this is a health issue and an indication of new forms of patriarchal power governing the thoughts of women and to an increasing degree also men. Having a free choice concerning body practices is thus suggested to be an illusion.

Aims: To explore aspects of treatment clients identify as having had a positive effect on their process of change. Method: The first author conducted data collection for one year through both participant observation and interviews. Results: Certain, apparently commonplace, informal interaction situations appear to constitute emotionally moving and identity-constructing contexts that have a significant impact on clients. These are situations in which new, ‘‘straight’’ identities can be proffered, tried out and explored. The situations in question seem to move clients, emotionally, mentally and biographically in a positive direction. Conclusions: The process of change is presented as an upside-down version of the traditional labelling theory: if normal people can be labeled as deviants, deviants can be re-labeled as normal. This study concludes that commonplace interactions are powerful labeling situations. These situations seem at first glance to be trivial, superficial and very common. Still, and perhaps because of their ‘‘smallness’’, they are identified as authentic and thereby trustworthy contributors to new narratives of worthy selves.

Aims: To investigate psychotropic drug use among women ever exposed to intimate partner violence (IPV) in relation to mental distress and sociodemographic, lifestyle and somatic health characteristics, and to assess whether drug use differed for physical and/or sexual violence compared with psychological abuse alone. Methods: Cross-sectional data from women aged 30—60 years were drawn from self-reported questionnaires in the Oslo Health study 2000—2001. Women reporting hypnotic, anxiolytic and/or antidepressant drug use in the previous four weeks were defined as users. Differences in psychotropic drug use by IPV exposure were examined by logistic regression analyses. Results: In total, 880 (14%) of 6,471 included women reported ever experiencing IPV; 494 (8%) reported physical and/or sexual IPV, and 386 (6%) reported psychological IPV alone. Physical and/or sexual IPV was significantly associated with use of all psychotropic drugs: hypnotics (odds ratio (OR) 2.28; 95% confidence interval (95% CI), 1.73—3.00); anxiolytics (OR 3.29; 95% CI, 2.43—4.44); and antidepressants (OR 2.72; 95% CI, 1.97—3.76). The associations remained significant for anxiolytics (OR 1.67; 95% CI, 1.14—2.45) and antidepressants (OR 1.50; 95% CI, 1.02—2.19) after adjusting for mental distress, sociodemographic, lifestyle and somatic health characteristics. Psychological IPV alone was associated with use of anxiolytics (OR 1.81; 95% CI, 1.20—2.75) and antidepressants (OR 2.38; 95% CI, 1.64—3.45). After adjustments the association persisted for use of antidepressants only (OR 1.64; 95% CI, 1.05—2.55). Conclusions: Women exposed to IPV were more likely to report use of psychotropic drugs, even after adjusting for mental distress. The study indicates that exposure to IPV; including psychological abuse should be evaluated as a possible source of distress when psychotropic drug treatment is considered.

Aims: To investigate characteristics of families with adolescent children who have visited practitioners of complementary and alternative medicine (CAM). Methods: The Nord-Trøndelag Health Studies (HUNT) invited all inhabitants aged 13 years and older to a population-based study. The data of parents and adolescents were merged through the Norwegian family register. A family CAM visitor was a family where either the adolescent or the mother or father had visited a CAM practitioner in the previous year. The data were analyzed using multivariable logistic regression. Results: A total of 7,888 adolescents with mother and/or fathers were included. The prevalence of families visiting CAM practitioners was 19.8%. The odds of a family visiting a CAM practitioner was significantly associated (p < 0.01) with a father with poor self-reported global health (adjusted odds ratio (adjOR) 3.0, 95% confidence interval (95% CI) 1.7—5.3), who exercised (adjOR 1.3, 1.1—1.5) or smoked daily (adjOR 0.7, 0.6—0.8). Family CAM visits were also associated with the mother having a recent health complaint (adjOR 1.4, 1.1—1.7) or having fair global health (adjOR 1.6, 1.2—2.0), or with the adolescent, mother or father having visited a general practitioner during the past year (adolescent adjOR 1.3, 1.2—1.5; mother 1.7, 1.5—2.0; father 1.4, 1.2—1.6). For family visits to a homeopath, the strongest association was the mother having visited a general practitioner (adjOR 1.9, 1.4—2.5). For visits to chiropractors the strongest association was whether the father was currently working (adjOR 2.1, 1.2—3.8). Conclusions: The factor most strongly associated with families’ visits to CAM practitioners was a father who had poor self-reported health.

Aims: To study the association between self-reported physical activity (PA) and objectively measured PA, resting heart rate, and physical fitness. Methods: During 2007—08, 5017 men and 5607 women aged 30—69 years attended the sixth survey of the Tromsø study. Self-reported PA during leisure-time and work were assessed and resting heart rate was measured. In a sub-study, the activity study, PA (Actigraph LLC) and physical fitness (VO2max) were objectively measured among 313 healthy men and women aged 40—44 years. Results: Self-reported leisure PA was significantly correlated with VO2max (ml/kg/min) (women 0.40, p < 0.001, men 0.44 p < 0.001) and moderate-to-vigorous PA (>2000 counts/min) (women 0.28, p < 0.01, men 0.25, p < 0.01). The intra-class correlation coefficient between self-reported leisure PA and overall PA (counts/min) measured by accelerometer was 0.62 (95% CI 0.51, 0.71) for women and 0.59 (95% CI 0.47, 0.69) for men, and for VO2max the intra-class correlation coefficient was 0.86 (95% CI 0.81, 0.90) for both sexes. Among all participants, an inverse dose—response relationship was observed between self-reported leisure PA and resting heart rate for both men and women (p < 0.0001). More women than men met the international recommendations of 10,000 step counts/day (27% vs. 22%) and the recommendation of at least 30 minutes/day of moderate-to-vigorous intensities (30% vs. 22 %). Conclusions: The Tromsø physical activity questionnaire has acceptable validity and provides valid estimates of high-intensity leisure activity. However, these results underscore the need for collecting objectively PA measurements in large epidemiological studies.

Background: In this paper we present multilevel models of individuals’ residential history at multiple time points through the life course and their application and discuss some advantages and disadvantages for their use in epidemiological studies. Methods: Literature review of research using longitudinal multilevel models in studies of neighbourhood effects, statistical multilevel models that take individuals’ residential history into account, and the application of these models in the Oslo mortality study. Results: Measures of variance have been used to investigate the contextual impact of membership to collectives, such as area of residence, at several time points. The few longitudinal multilevel models that have been used suggest that early life area of residence may have an effect on mortality independently of residence later in life although the proportion of variation attributable to area level is small compared to individual level. The following multilevel models have been developed: simple multilevel models for each year separately, a multiple membership model, a cross-classified model, and finally a correlated cross-classified model. These models have different assumptions regarding the timing of influence through the life course. Conclusions: To fully recognise the origin of adult chronic diseases, factors at all stages of the life course at both individual and area level needs to be considered in order to avoid biased estimates. Important challenges in making life course residential data available for research and assessing how changing administrative coding over time reflect contextual impact need to be overcome before these models can be implemented as normal practice in multilevel epidemiology.

Aims: To study 50-year mortality trends in men and women of northern and southern Western Europe. Methods: The World Health Organization mortality data base and multiple decrement life table methods was used to compute all-cause and cause-specific risks of middle-age death (40—69 years of age) for northern (Denmark, Finland, Germany, Ireland, Netherlands, Norway, Sweden, and UK) and southern (France, Italy, Spain, and Switzerland) Western European countries. Results: From 1952 to 2001, the risk of a cardiovascular death in middle age was higher in the north compared to the south. The north/ south cardiovascular mortality ratios (MR) peaked in 1990—1993 and were 1.57 among women and 1.47 among men in 2001. In 1952, the all-cause risks of middle-age death were similar in the north and south for both women and men (39% and 27%, respectively). In 2001, middle-age death risks were similar for men in the north and the south (24% and 23%, MR = 1.05), but higher among women in the north compared to the south (14% and 11%, MR = 1.28). Cause-specific death risks demonstrated that the cardiovascular advantage for southern European men was countered by a disadvantage in cancer death risk (2001 north/south cancer MR = 0.85). For northern European women in 2001, there was a disadvantage also in the other major cause-of-death groups: cancer (MR = 1.22) and other diseases (MR = 1.28). Conclusions: The southern European cardiovascular middle-age mortality advantage extended to total mortality much more for women than for men. We suggest that forces behind this gender difference in this north/south mortality gradient include life style factors.