Mekdes Gebremariam

• Infanti, Jennifer Jean; Korpela, Jessica Omija; Stephenson, Chloe Maria; Blystad, Astrid; Sørensen, Jane Brandt & Einarsdóttir, Jónína [Show all 18 contributors for this article] (2025). Student experiences and perspectives on decolonising global health education: a qualitative study across five Nordic countries. Global health action. ISSN 1654-9716. 18(1). doi: 10.1080/16549716.2025.2512624. Full text in Research Archive Show summary

  Background: Decolonisation has become a global health priority, addressing inequities rooted in colonial histories that continue to shape power dynamics and knowledge systems. Nordic global health programmes bring together students and faculty from diverse backgrounds in a region defined by inclusive ideals but shaped by underexamined colonial legacies. This context offers a valuable setting to examine how decolonial perspectives are integrated or overlooked in global health education. Objective: To explore students’ perspectives on decolonisation in global health education, focusing on their understanding, experiences, and views on potential pedagogical change. Methods: A qualitative study involving 72 students from Nordic countries and other world regions, enrolled in global health programmes at 11 academic institutions across five Nordic countries. Fourteen focus group discussions were conducted, and the data were analysed using qualitative content analysis principles. Results: Students shared nuanced understandings of systemic power imbalances in global health practice and education and expressed the need for structural changes. They identified gaps in curricula and pedagogy, including limited integration of decolonial perspectives and inequities in knowledge production. Students called for more inclusive and culturally relevant curricula that reflect diverse contexts. They emphasised student agency in shaping education while acknowledging barriers such as institutional biases and inconsistent faculty engagement. Conclusions: Decolonising Nordic global health education is a long-term process requiring sustained institutional commitment. Student-informed strategies include embedding reflexivity into curricula, engaging with Nordic colonial histories, and designing reciprocal international learning arrangements. While context-specific, these findings may inform broader efforts to decolonise global health educational practices.

• Yitayew, Teferi Mekonnen; Gebremariam, Mekdes; Andersen, Lene Frost; Lien, Nanna; Brantsæter, Anne Lise & Coutinho, Sílvia [Show all 8 contributors for this article] (2025). The impact of hypothetical early life interventions on rapid weight gain during infancy and body mass index at 5 and 8 years in Norway: The Norwegian Mother, Father, and Child Cohort Study (MoBa). Pediatric Obesity. ISSN 2047-6302. 20(6). doi: 10.1111/ijpo.70008. Full text in Research Archive Show summary

  Objectives: This study examined the impact of hypothetical interventions on (i) early life factors (prenatal and early postnatal) on rapid weight gain during infancy, and (ii) early life factors and child energy balance-related behaviours (EBRB) on children's body mass index (BMI)-for-age at 5 and 8 years. Methods: Data from the Norwegian Mother, Father, and Child Cohort Study included participants aged 2 (n = 48 109), 5 (n = 18 810) and 8 (n = 10 830) years. Early life intervention variables were maternal smoking during pregnancy, maternal weight before and during pregnancy, exclusive/partial breastfeeding for 6 months, and introduction of complementary food at 6 months. Child EBRB intervention variables for the 5-year outcome included screen time, fruit and vegetable intake, and sugar-sweetened soft drink intake assessed at 3 years. For the 8-year outcome, interventions included screen time, presence of a television in the child's bedroom, sleep hours and breakfast intake assessed at 5 years. The parametric g-formula was used for analysis. Results and Conclusions: The average population-level difference in rapid weight gain during infancy at 2 years under the intervention targeting the prenatal, early postnatal factors and these factors combined with 95% confidence intervals were −0.012 (−0.017, −0.007), −0.009 (−0.012, −0.005) and −0.020 (−0.025, −0.015), respectively. The average population-level differences in children's BMI-for-age z-score for interventions targeting early life factors, child EBRB and these factors combined were −0.225 (−0.244, −0.207), 0.02 (−0.021, 0.024) and −0.223 (−0.249, −0.196), respectively among 5-year-olds and −0.265 (−0.295, −0.236), −0.020 (−0.029, −0.011) and −0.285 (−0.315, −0.256), respectively among 8-year-olds. Our results suggested joint interventions on early life factors may reduce childhood BMI-for-age z-scores.

• Dygrýn, Jan; Brazo-Sayavera, Javier; Cruz, Joana; Gebremariam, Mekdes; Ribeiro, José Carlos & Capranica, Laura [Show all 8 contributors for this article] (2025). Definitions of determinants of physical activity behaviour: process and outcome of consensus from the DE-PASS expert group. International Journal of Behavioral Nutrition and Physical Activity. 22(1). doi: 10.1186/s12966-025-01728-5. Full text in Research Archive Show summary

  Background Despite extensive research on physical activity behaviour (PAB), consensus is lacking on related terms and definitions, thereby hindering the ability to compare findings between studies and to develop reliable assessment tools. This study therefore aimed to establish consensus on the definitions of key PAB determinants. Methods First, an international expert steering committee was established, comprising members of the European Cooperation in Science and Technology (COST) action “DEterminants of Physical ActivitieS in Settings” (DE-PASS). Recently published review-level studies were used to identify key determinants of PAB. Two independent reviewers systematically reviewed the literature to catalogue the range of definitions used for key determinants of PAB (steps 1–2). A two-round modified Delphi survey was conducted online from February to September 2023, to determine the optimal definition for each determinant. In round 1, experts selected the most suitable definition for each of the 41 initially identified determinants. In round 2, experts ranked the appropriateness of the definition selected from round 1 on a 5-point Likert scale. Consensus was defined a priori as ≥ 75% agreement on the definition (i.e., ratings of ≥ 4 points). A professional English language expert ensured concise, coherent wording and high-quality editing of the definitions (steps 3–6). Results Eighty-five experts in PAB research participated in round 1, and sixty-nine experts in round 2. Consensus of definitions was achieved for 39 of the 41 determinants (88.4%–98.6% agreement). The consensus threshold was not achieved for two determinants: genetic profile and regulation (69.6%) and backyard access/size (73.9%). Conclusions The findings of this study offer a consensus-based set of definitions for 39 key determinants of PAB. These definitions can be used homogenously in academic research on physical activity.

• Lie, Anne Kveim; Gebremariam, Mekdes; Lichtwarck, Hanne Ochieng; Mmbaga, Elia & Miltenburg, Andrea Solnes (2024). Kortvarig hospitering må planlegges nøye. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 144(15). doi: 10.4045/tidsskr.24.0376. Full text in Research Archive
• Medin, Anine Christine; Vik, Frøydis Nordgård; Helle, Christine; Helland, Sissel Heidi; Wills, Andrew Keith & Osorio, Natalie Garzon [Show all 22 contributors for this article] (2024). 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. Frontiers in Public Health. 11. doi: 10.3389/fpubh.2023.1326787. Full text in Research Archive Show summary

  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.

• Andersen, Oddbjørn Klomsten; Gebremariam, Mekdes; Kaupang, Oda Bjørge; Lien, Nanna & Kolle, Elin (2024). Built for movement: Neighborhoods and adolescent physical activity behaviors, and the moderating role of socioeconomic position and gender. Health and Place. ISSN 1353-8292. 89. doi: 10.1016/j.healthplace.2024.103313. Full text in Research Archive Show summary

  This study examined whether the built environment was associated with physical activity among adolescents in Oslo, Norway, and the role of socioeconomic position and gender as potential moderators of this association. We used data from 897 adolescents who participated in the TACKLE cross-sectional study conducted in 2020. Built environment features (recreational facilities, parks, forest, public transport, traffic calming devices, and schools) were assessed objectively using Geographical Information Systems. Physical activity data included device-measured moderate-to-vigorous physical activity, total physical activity, and self-reported active transportation to school. Using general linear models and logistic regression, we found that most built environment features were unrelated to the participants’ device-measured physical activity. Longer distances to school and to traffic calming devices were associated with decreased likelihood of participants reporting active transportation to school. Our moderated regression analysis showed that adolescents with low socioeconomic backgrounds seemed less affected by longer distances to school compared with their high socioeconomic counterparts. Furthermore, boys appeared to be more sensitive to traffic safety relative to girls. Implementing traffic calming devices may enhance active transportation to school and improve traffic safety for Norwegian adolescents.

• Daas, Merel Celine; Gebremariam, Mekdes; Poelman, Maartje P.; Andersen, Lene Frost; Klepp, Knut Inge & Bjelland, Mona [Show all 7 contributors for this article] (2024). Mediators and Moderators of the Effects of a School-based Intervention on Adolescents' Fruit and Vegetable Consumption: The HEIA Study. Public Health Nutrition (PHN). ISSN 1368-9800. 27(1). doi: 10.1017/S1368980024000260. Full text in Research Archive Show summary

  Objective: To examine whether targeted determinants mediated the effects of the HEalth In Adolescents (HEIA) intervention on fruit and vegetable (FV) consumption and explore if these mediating effects were moderated by sex, parental education or weight status. Design: Cluster-randomised controlled trial. Setting: The HEIA study (2007–2009) was a Norwegian 20-month multi-component school-based intervention to promote healthy weight development. FV consumption and targeted determinants were self-reported at baseline, mid-way (8 months) and post-intervention (20 months). Participants: Adolescents (11–13-year-old) in twenty-five control schools (n 746) and twelve intervention schools (n 375). Results: At post-intervention, more adolescents in the intervention group compared with the control group had knowledge of the FV recommendations (OR: 1·4, 95 % CI 1·1, 1·9) and reported a decreased availability of vegetables at home (β: –0·1, 95 % CI –0·2, 0·0). Availability/accessibility of FV at home, availability of vegetables at dinner, taste preferences for different types of FV and knowledge of the FV recommendations were positively associated with the consumption of FV. However, none of the post-intervention determinants significantly mediated the intervention effects on FV consumption. Although no moderating influences by sex, parental education or weights status were observed on the mediating effects, exploratory analyses revealed significant moderations in the b-paths. Conclusions: Since none of the targeted determinants could explain the increase in FV consumption, it remains unclear why the intervention was effective. Reporting on a wide range of mediators and moderators in school-based interventions is needed to reveal the pathways through which intervention effects are achieved.

• Osorio, Natalie Garzon; Vik, Frøydis Nordgård; Helle, Christine; Hillesund, Elisabet Rudjord; Øverby, Nina Cecilie & Helland, Sissel Heidi [Show all 15 contributors for this article] (2024). Implementing an early-life nutrition intervention through primary healthcare: staff perspectives. BMC Health Services Research. 24(1). doi: 10.1186/s12913-024-11582-z. Full text in Research Archive Show summary

  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.

• Palmeira, A.L.; Jelsma, J.G.M.; Sousa-Sá, E.; Pereira, S.; Videira-Silva, A. & Condello, G. [Show all 9 contributors for this article] (2024). Determinants of physical activities in settings (DE-PASS): Approach for selecting the core measures for determinants of physical activity behaviours in 9-12 old children. Journal of Sports Sciences. ISSN 0264-0414. doi: 10.1080/02640414.2024.2422200. Full text in Research Archive
• Yitayew, Teferi Mekonnen; Papadopoulou, Eleni Zoumpoulia; Lien, Nanna; Andersen, Lene Frost; Pinho, Maria Gabriela Matias & Havdal, Hanne Hennig [Show all 8 contributors for this article] (2023). Mediators of parental educational differences in the intake of carbonated sugar-sweetened soft drinks among adolescents, and the moderating role of neighbourhood income. Nutrition Journal. 22(1). doi: 10.1186/s12937-023-00872-7. Full text in Research Archive Show summary

  Background: Existing evidence suggests that the intake of sugar-sweetened beverages (SSB) among adolescents remains a public health concern and that socioeconomic differences in intake exist. Tackling these challenges requires identifying the factors associated with SSB intake and the mediators of socioeconomic differences in SSB intake among adolescents. Thus, this study aimed to explore (i) factors at different levels of the ecological model associated with the intake of carbonated soft drinks with added sugar (hereafter called soft drinks), (ii) mediators of the association between parental education and the intake of soft drinks(iii) whether neighbourhood income moderates the indirect effect of parental education on adolescents’ soft drink intake through potential mediators. Methods: Data from 826 7th graders in Oslo, Norway, who participated in the TACKLE cross-sectional study conducted in 2020 were used. The association between factors at the individual, interpersonal and neighbourhood food environment levels and the intake of soft drinks among adolescents was assessed, as well as the mediating roles of these factors for the differences in intake by parental education, using multiple logistic regression and mediation analysis, respectively. Moderated mediation analyses were used to explore whether an indirect effect of parental education on adolescents' soft drink intake through potential mediators varies across neighbourhood income areas. Results: Higher perceived accessibility of SSB at home, increased parental modelling for SSB intake, and increased frequency of food/drink purchased from the neighbourhood store were associated with a higher intake of soft drinks among adolescents and mediated the differences in intake by parental education. Neighbourhood food environment factors were neither statistically significantly associated with adolescents’ higher intake of soft drinks nor explained the differences in intake by parental education. Moderated mediation analysis showed that the mediating effect of perceived accessibility of SSB at home on the association between parental education and adolescent soft drink intake was stronger among those living in low neighbourhood income. Conclusions: Our study identified modifiable factors at the intrapersonal level (perceived accessibility of SSB at home and frequency of food/drink purchased from neighbourhood shops) and interpersonal levels (parental modelling for SSB intake) associated with a higher intake of soft drinks among adolescents and mediated the differences in the intake by parental education. The modifiable factors identified in this study could be targeted in public health initiatives among adolescents aimed at reducing the intake of soft drinks and the related differences by parental education.

• Meshkovska, Biljana; Gebremariam, Mekdes; Atukunda, Prudence; Iversen, Per Ole; Wandel, Margareta & Lien, Nanna (2023). Barriers and facilitators to implementation of nutrition-related actions in school settings in low- and middle-income countries (LMICs): a qualitative systematic review using the Consolidated Framework for Implementation Research (CFIR). Implementation Science Communications. 4(1). doi: 10.1186/s43058-023-00454-y. Full text in Research Archive Show summary

  Background Low- and middle-income countries (LMICs) are particularly vulnerable to the double burden of malnutrition: co-existence of underweight, overweight, obesity, and/or diet-related non-communicable diseases. Nutrition-related double-duty actions in school settings have been identified as one of the ways to address this challenge. However, to be able to take full advantage of the potential impact, it is important to understand their implementation as well. The aim of this paper is to systematically review qualitative research on barriers and facilitators to the implementation of nutrition-related actions in the school settings in LMICs. Methods The following databases were searched: EMBASE, ERIC, MEDLINE, Global Health and PsycInfo (all on Ovid), Scopus (Elsevier), the Web of Science Social Sciences Citation Index, and Global Index Medicus from the World Health Organization. Of the 4253 identified records, 4030 were excluded after the abstract and title screen, leaving 223 for the full-text screen. A final 36 papers were included in this review. The consolidated framework for implementation research (CFIR) was used in the analysis. Results We identified barriers and facilitators to implementation linked to the following CFIR constructs/sub-constructs: design quality and packaging, cost (intervention characteristics); target group needs and resources, cosmopolitanism, external policy and incentives (outer setting); structural characteristics, readiness for implementation (inner setting); knowledge and beliefs (characteristics of individuals) and engaging, executing (process). All identified constructs apart from target group needs and resources, knowledge and beliefs, and engaging were predominantly barriers. Available resources were the most prevalent barriers across studies. Conclusion This review identified barriers and facilitators to the implementation of nutrition-related actions based on qualitative articles in the school setting in LMICs, using the CFIR. Schools face continuous challenges in regard to funding and the government sector may have a role to play not only by offering financial assistance, but also through policy-making that would support healthy eating practices on school grounds.

• Coutinho, Sílvia; Andersen, Oddbjørn Klomsten; Lien, Nanna & Gebremariam, Mekdes (2023). Neighborhood deprivation, built environment, and overweight in adolescents in the city of Oslo. BMC Public Health. 23. doi: 10.1186/s12889-023-15261-2. Full text in Research Archive Show summary

  Background: Even though the social and built environment characteristics of neighborhoods have been studied as potential determinants of social inequalities in obesity among adults, fewer studies have focused on children. Our first aim was to investigate whether there were differences in the food and physical activity environments between different neighborhood deprivation levels in the city of Oslo. We also explored whether there was an association between the prevalence of overweight (including obesity) among adolescents and (i) neighborhood deprivation levels and (ii) food and physical activity environments of the neighborhoods they live in. Methods: We conducted a food and physical activity environment mapping (using ArcGIS Pro) in all neighborhoods of Oslo, which were defined by administrative boundaries (sub-districts). The neighborhood deprivation score was calculated based on the percentage of households living in poverty, unemployment in the neighborhood, and residents with low education. A cross-sectional study including 802 seventh graders from 28 primary schools in Oslo residing in 75 out of 97 sub-districts in Oslo was also performed. MANCOVA and partial correlations were ran to compare the built environment distribution between different neighborhood deprivation levels, and multilevel logistic regression analyses were used to explore the effect of neighborhood deprivation and the food and physical activity environments on childhood overweight. Results: We found that deprived neighborhoods had greater availability of fast food restaurants and fewer indoor recreational facilities compared to low-deprived neighborhoods. Additionally, we observed that the residential neighborhoods of the adolescents with overweight had greater availability of grocery and convenience stores when compared to the residential neighborhoods of the adolescents without overweight. Adolescents living in neighborhoods with high deprivation had a two-fold higher odds (95% CI = 1.1–3.8) to have overweight compared to adolescents living in neighborhoods with low deprivation, regardless of participants’ ethnicity and parental education. However, the built environment did not determine the relationship between neighborhood deprivation and overweight in adolescents. Conclusion: The neighborhoods in Oslo with higher deprivation levels had more obesogenic characteristics than the low-deprived neighborhoods. Adolescents living in high-deprived neighborhoods were more likely to have overweight than their counterparts from low-deprived neighborhoods. Thus, preventive measures targeting adolescents from high-deprived neighborhoods should be put in place in order to reduce incidence of overweight.

• Kabeta, Teshome; Holst, Rene; Wondafrash, Beyene; Frigessi, Arnoldo & Gebremariam, Mekdes (2023). Determinants of household dietary diversity in rural Ethiopia: A household panel study. Journal of Agriculture and Food Research. 12. doi: 10.1016/j.jafr.2023.100550. Full text in Research Archive Show summary

  Background Diet diversification ensures nutritional security and hence helps in meeting nutrient requirements in humans. Despite its importance, diet diversification remains a challenge, especially in rural communities in developing countries. This study aimed to identify the determinants of DD in rural Ethiopia. Methods In this study, we used an agricultural and nutrition household panel data. This study collected data from 1200 households twice a year for two years in nine districts. The household dietary diversity score (HDDS) was used as the outcome measure. Several potential demographic, social, economic, and geographic determinants of HDDS were assessed. Mixed effects truncated Poisson regression was used to identify which of these determinants were associated with HDDS at household level. Result The HDDS value ranged from 1 to 10 with a mean of 5.52 and standard deviation (SD) of 1.54. A unit increment in the variety of crop production gave a 3.4% [95% CI: 1.9%, 4.9%,] increase in relative change (RC) of HDDS. A birr increases in income generated from livestock products resulted in a 2.6% [1.5%, 3.7%] increase in RC of HDDS. The post-harvesting season contributed to a 6.4% [3.6%, 9.3%] increase in RC of HDDS compared to the pre-harvesting. Households headed by a woman had an HDDS that was −7.9% [-12.5%, −3.3%] lower in RC of HDDS than male-lead households. An additional year of education of the household head resulted in a 1.2% [0.7%, 1.7%] increase in RC of HDDS. As the mean women's decision-making score increased by one point, the RC in HDDS increased by 3.8% [1.1%, 6.4%]. No significant association was found between the time taken to reach local markets and HDDS. Conclusion This study identified economic, educational, social, and seasonal factors associated with HDDS, which should be considered when planning interventions aimed at improving HDDS in rural Ethiopia or elsewhere.

• Rodriguez, Anaely Aguiar; Gebremariam, Mekdes; Romanenko, Eduard; Onal, Furkan; Kopainsky, Birgit & Savona, Natalie [Show all 9 contributors for this article] (2023). System dynamics simulation models on overweight and obesity in children and adolescents: A systematic review. Obesity Reviews. ISSN 1467-7881. 24(S2). doi: 10.1111/obr.13632. Full text in Research Archive Show summary

  It has increasingly been recognized that developing successful obesity prevention policies and interventions requires understanding of the complex mechanisms driving the obesity pandemic and that models could be useful tools for simulating policies. This paper reviews system dynamics simulation models of mechanisms driving childhood overweight and obesity and/or testing of preventive interventions. A systematic literature search was conducted in six databases from inception to January 2023 using terms related to overweight/obesity, children, and system dynamics. Study descriptives, mechanisms, and where to intervene (the leverage points), as well as quality assessments of the simulation models were extracted by two researchers into a predetermined template and narratively synthesized. Seventeen papers describing 15 models were included. Models describing the mechanisms ranged from only intrapersonal factors to models cutting across multiple levels of the ecological model, but mechanisms across levels were lacking. The majority of interventions tested in the simulation models were changes to existing model parameters with less emphasis on models that alter system structure. In conclusion, existing models included mechanisms driving youth obesity at multiple levels of the ecological model. This is useful for developing an integrated simulation model combining mechanisms at multiple levels and allowing for testing fundamental system changes.

• Ousman, Seman Kedir; Gebremariam, Mekdes; Sundby, Johanne Sommerschild & Magnus, Jeanette H. (2022). Maternal exposure to intimate partner violence and uptake of maternal healthcare services in Ethiopia: Evidence from a national survey. PLOS ONE. 17(8). doi: 10.1371/journal.pone.0273146. Full text in Research Archive Show summary

  Background Women exposed to Intimate Partner Violence (IPV) often do not utilize maternal health care optimally both because of stigma and other social problems. The current study aims to explore an association between maternal healthcare seeking and violence exposure among Ethiopian women and to assess if educational attainment and wealth status moderate this association. Methods The analyses included 2836 (weighted) currently married women with one live birth. We focus on the five years preceding the 2016 Ethiopian Demographic and Health Survey (EDHS) who participate, in the domestic violence sub-study. Exposure was determined by maternal reports of physical, emotional, sexual IPV or any form of IPV. The utilization of antenatal care (ANC) and place of delivery were used as proxy outcome variables for uptake of skilled maternal healthcare utilization. Women’s education attainment and wealth status were selected as potential moderators, as they can enable women with psychological and financial resources to counteract impact of IPV. Multilevel logistic regression analyses were used to explore the association between spousal IPV and maternal health outcomes. Moderation effects by education and wealth status were tested, and the data stratified. Using statistical software Stata MP 16.1, the restricted maximum likelihood method, we obtained the model estimates. Results About 27.5% of the women who reported exposure to any form of IPV had a health facility delivery. While 23.4% and 22.4% visited four or more antenatal care services among mothers exposed to emotional IPV and sexual IPV, respectively. After adjusting for potential confounding factors, only the association between maternal exposure to emotional IPV and adequate use of ANC was statistically significant (OR = 0.73, (95% CI:0.56–0.95)). But we found no significant association between IPV and utilization of health facility delivery. Some moderation effects of education and wealth in the association between IPV and maternal healthcare service utilization outcome were found. Conclusion Exposure to emotional IPV was associated with poor uptake of maternal health care service utilization for married Ethiopian women. While developing interventions to improve women’s maternal healthcare service use, it is crucial to consider the effects of socio-economic variables that moderate the association especially with the intersection of IPV.

• Yitayew, Teferi Mekonnen; Brantsæter, Anne Lise; Andersen, Lene Frost; Lien, Nanna; Arah, Onyebuchi A. & Gebremariam, Mekdes [Show all 7 contributors for this article] (2022). Mediators of differences by parental education in weight-related outcomes in childhood and adolescence in Norway. Scientific Reports. 12(1), p. 1–13. doi: 10.1038/s41598-022-09987-z. Full text in Research Archive Show summary

  Studies exploring mediators of socioeconomic inequalities in excess weight gain in early-life and subsequent overweight/obesity (OW/OB) among youth are limited. Thus, this study examined the mediating role of prenatal and early postnatal factors and child energy balance-related behaviours (EBRB) in the effects of parental education on (i) excess weight gain from birth to 2 years and (ii) OW/OB at 5, 8 and 14 years. The Norwegian Mother, Father and Child Cohort Study was used to include participants at the ages of 2 (n = 59,597), 5 (n = 27,134), 8 (n = 28,285) and 14 (n = 11,278) years. Causal mediation analyses using the inverse odds weighting approach were conducted. Children of low-educated parents had a higher conditional excess weight gain at 2 years compared to children of high-educated parents (total effect, RRTE = 1.06; 95% CI 1.01, 1.10). The joint mediation effects of the prenatal and early postnatal factors explained most of the total effect of low education on conditional excess weight gain at 2 years. Children of low-educated parents had a higher risk of OW/OB at 5, 8 and 14 years compared to children of high-educated parents. The mediators jointly explained 63.7%, 67% and 88.9% of the total effect of parental education on OW/OB among 5, 8 and 14 year-old-children, respectively. Of the total mediated effects at 5, 8 and 14 years, the prenatal and early postnatal mediators explained 59.2%, 61.7% and 73.7%, whereas the child EBRB explained 10.3%, 15.8.0%% and 34.8%. The mediators included were found to have a considerable mediating effect in the associations explored, in particular the prenatal and early postnatal factors. If truly causal, the findings could indicate potential targets for interventions to tackle socioeconomic inequalities in OW/OB from birth to adolescence.

• Havdal, Hanne Hennig; Fosse, Elisabeth Minda; Gebremariam, Mekdes; Stronks, Karien; Andersen, Oddbjørn Klomsten & Lien, Nanna (2022). Does the socioeconomic positioned neighbourhood matter? Norwegian adolescents’ perceptions of barriers and facilitators for physical activity. Scandinavian Journal of Public Health. ISSN 1403-4948. doi: 10.1177/14034948211066673. Full text in Research Archive Show summary

  Background and aims: A higher proportion of adolescents from lower socioeconomic position families tend to be less physically active than their counterparts from higher socioeconomic position families. More research is needed to understand the causes of these differences, particularly the influence of the neighbourhood environment. This qualitative study aims to explore how adolescents and their parents from higher and lower socioeconomic neighbourhoods perceive the social, organisational and physical environment influencing adolescents’ physical activity behaviours. Method: We conducted six semi-structured focus groups with 35 13–14-year-olds and eight interviews with some of their parents. The interviewees were recruited from one higher and two lower socioeconomic neighbourhoods in Oslo, Norway. Theme-based coding was used for analysis, and the results discussed in light of an ecological framework. Results: The results indicate that factors like social norms in a neighbourhood could shape adolescents’ physical activity behaviour, and a social norm of an active lifestyle seemed to be an essential facilitator in the higher socioeconomic neighbourhood. Higher availability of physical activity and high parental engagement seemed to facilitate higher physical activity in this neighbourhood. In the lower socioeconomic neighbourhoods, the availability of local organised physical activity and volunteer engagement from parents varied. Programmes from the municipality and volunteer organisations seemed to influence and be essential for adolescents’ physical activity behaviour in these neighbourhoods. Conclusions: The results illustrate the complexity of behaviour and environment interaction, and a limitation in explaining the phenomenon by focusing primarily on the individual level rather than an ecological perspective.

• Andersen, Oddbjørn Klomsten; Gebremariam, Mekdes; Kolle, Elin & Tarp, Jakob (2022). Socioeconomic position, built environment and physical activity among children and adolescents: a systematic review of mediating and moderating effects. International Journal of Behavioral Nutrition and Physical Activity. 19. doi: 10.1186/s12966-022-01385-y. Full text in Research Archive Show summary

  Background: Physical activity behaviors among children and adolescents are socioeconomically patterned. Understanding if, and how, the built environment contributes to socioeconomic inequalities in physical activity and for whom built environments are most important, can lead to the identification of intervention entry points to reduce inequalities in physical activity. Objective: To summarize the existing evidence among children and adolescents on (a) whether the built environment mediates the association between socioeconomic position and physical activity and (b) whether socioeconomic position moderates the association between the built environment and physical activity. Methods: A systematic literature search was conducted using PubMed, Embase, PsycINFO and Web of Science. Two independent reviewers screened articles for eligibility, extracted information from included studies and assessed risk of bias with the Quality Assessment Tool for Observational Cohort and Cross-Sectional studies. We performed a narrative evidence synthesis considering the totality of the evidence and by study characteristics such as geographic region, age group, and exposure-outcome assessment methodology. The reporting was conducted in agreement with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Results: A total of 28 papers were included. In general, the studies were of low methodological quality. There was no evidence to support that the built environment functions as a mediator in the relationship between socioeconomic position and physical activity. We observed inconclusive moderation patterns with five studies reporting stronger associations between features of the built environment and physical activity among high socioeconomic positioned youths. Seven studies reported stronger associations among low socioeconomic positioned youth and fourteen studies reported no difference in associations. We observed different moderation patterns across geographical regions (Europe vs. US) indicating that, in Europe, having a walkable neighborhood is important for low socioeconomic positioned youth only. No differences in moderation patterns were observed for younger vs. older children or activity domains. Conclusion: Current evidence does not support a strong interplay between built environment and socioeconomic position on physical activity in youth. However, given the low quality of the evidence, firm conclusions cannot be made, and additional high-quality research is likely to have substantial impact on the evidence base.

• Andersen, Oddbjørn Klomsten; O'Halloran, Siobhan Anne; Kolle, Elin; Lien, Nanna; Lakerveld, Jeroen & Arah, Onyebuchi A. [Show all 7 contributors for this article] (2021). Adapting the SPOTLIGHT Virtual Audit Tool to assess food and activity environments relevant for adolescents: a validity and reliability study. International Journal of Health Geographics. 20:4, p. 1–14. doi: 10.1186/s12942-021-00258-0. Full text in Research Archive Show summary

  Background: Physical inactivity and unhealthy diet are key behavioral determinants underlying obesity. The neighborhood environment represents an important arena for modifying these behaviors, and hence reliable and valid tools to measure it are needed. Most existing virtual audit tools have been designed to assess either food or activity environments deemed relevant for adults. Thus, there is a need for a tool that combines the assessment of food and activity environments, and which focuses on aspects of the environment relevant for youth. Objective: The aims of the present study were: (a) to adapt the SPOTLIGHT Virtual Audit Tool (S-VAT) developed to assess characteristics of the built environment deemed relevant for adults for use in an adolescent population, (b) to assess the tool’s inter- and intra-rater reliability, and (c) to assess its criterion validity by comparing the virtual audit to a field audit. Methods: The tool adaptation was based on literature review and on results of a qualitative survey investigating how adolescents perceived the influence of the environment on dietary and physical activity behaviors. Sixty streets (148 street segments) in six neighborhoods were randomly selected as the study sample. Two raters assessed the inter- and intra-rater reliability and criterion validity, comparing the virtual audit tool to a field audit. The results were presented as percentage agreement and Cohen’s kappa (κ). Results: Intra-rater agreement was found to be moderate to almost perfect (κ = 0.44–0.96) in all categories, except in the category aesthetics (κ = 0.40). Inter-rater agreement between auditors ranged from fair to substantial for all categories (κ = 0.24–0.80). Criterion validity was found to be moderate to almost perfect (κ = 0.56–0.82) for most categories, except aesthetics and grocery stores (κ = 0.26–0.35). Conclusion: The adapted version of the S-VAT can be used to provide reliable and valid data on built environment characteristics deemed relevant for physical activity and dietary behavior among adolescents.

• Yitayew, Teferi Mekonnen; Papadopoulou, Eleni Zoumpoulia; Arah, Onyebuchi A.; Brantsæter, Anne Lise; Lien, Nanna & Gebremariam, Mekdes Kebede (2021). Socioeconomic inequalities in children's weight, height and BMI trajectories in Norway. Scientific Reports. 11, p. 1–9. doi: 10.1038/s41598-021-84615-w. Full text in Research Archive Show summary

  Abstract Studies exploring when social inequalities in body mass index (BMI) and its composites emerge and how these evolve with age are limited. Thus, this study explored parental income and education related inequalities in children’s weight, height, weight velocity and body mass index among Norwegian children from 1 month to 8 years. The study population included 59,927 family/children pairs participating in the Norwegian Mother, Father, and Child Cohort Study. Growth was modelled using the Jenss–Bayley model and linear mixed effects analyses were conducted. Maternal and paternal educational differences in children’s weight and BMI trajectories emerged during infancy, continuing to age 8 years. Parental income-related inequalities in children’s weight were observed from the age of 1 month to 4 years for maternal and up to 1 year for paternal income-related differences but then disappeared. Parental income-related inequalities in child’s BMI were observed from 18 months to 8 years for maternal income, and from 9 months to 8 years for paternal income-related differences. These results suggest that social inequalities in children’s BMI present early in infancy and continue to 8 years of age. The inequalities sometimes differed by indicator of socioeconomic position used. Interventions to combat these inequalities early in life are, thus needed.

• Gebremariam, Mekdes Kebede; Nianogo, Roch A.; Lien, Nanna; Bjelland, Mona; Klepp, Knut Inge & Bergh, Ingunn Holden [Show all 8 contributors for this article] (2021). The impact of hypothetical interventions on adiposity in adolescence. Scientific Reports. 11. doi: 10.1038/s41598-021-90415-z. Full text in Research Archive Show summary

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

• Sibhatu, Biadgilign; Gebremariam, Mekdes Kebede & Tennyson, Mgutshini (2021). The association of household and child food insecurity with overweight/obesity in children and adolescents in an urban setting of Ethiopia. BMC Public Health. 21(1336). doi: 10.1186/s12889-021-11392-6. Full text in Research Archive Show summary

  Background Existing evidence on the association between food insecurity and childhood obesity is mixed. In addition, literature from developing countries in general and Ethiopia in particular on the nexus and impact of household and child food insecurity on childhood obesity in the context of urbanization remains limited. The objective of this study was to explore the association between household and child food insecurity and childhood obesity in an urban setting of Ethiopia. Methods An observational population based cross-sectional study was conducted in five sub-cities of Addis Ababa. Multi-stage sampling techniques were employed to identify the study unit from the selected sub-cities. Multivariable logistic regression models with robust estimation of standard errors were utilized to determine the associations. Interactions by age and sex in the associations explored were tested. Results A total of 632 children and adolescents-parent dyads were included in the study. About 29.4% of those in food secure households and 25% of those in food insecure households were overweight/obese. Similarly, 29.8% of food secure children and 22% of food insecure children were overweight/obese. Household and child food insecurity status were not significantly associated with child and adolescent overweight or obesity in the final adjusted models. Conclusions Household and childhood food insecurity status were not associated with child and adolescent overweight/obesity in the study setting. Interventions aimed at combating overweight and obesity in the study setting should target children and adolescents irrespective of their food security status.

• Osman, Seman Kedir; Magnus, Jeanette H.; Sundby, Johanne & Gebremariam, Mekdes Kebede (2020). Uptake of Skilled Maternal Healthcare in Ethiopia: A Positive Deviance Approach. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 17(5). doi: 10.3390/ijerph17051712. Full text in Research Archive Show summary

  Risk factor approaches are often used when implementing programs aimed at enforcing advantageous health care behaviors. A less frequently-used strategy is to identify and capitalize on those who, despite risk factors, exhibit positive behaviors. The aim of our study was to identify positive deviant (PD) mothers for the uptake of skilled maternal services and to explore their characteristics. Data for the study came from two waves of the Ethiopian Demographic and Health Surveys conducted in 2011 and in 2016. PD mothers were defined as those reporting no formal education but with adequate use of antenatal care (ANC) and/or institutional delivery services. Two-level multilevel regression analysis was used to analyze the data. Factors associated with PD for the use of ANC services were: partner’s education status, involvement in household decision making, exposure to media, and distance to the health facility. Factors associated with PD for health facility delivery were: partner’s education, woman’s employment status, ANC visit during index pregnancy, exposure to media, and perceived challenge to reach health facility. Rural-urban and time-related differences were also identified. The positive deviance approach provides a means for local policy makers and program managers to identify factors facilitating improved health behaviour and ultimately better health outcomes while acknowledging adverse risk profiles.

• Gebremariam, Mekdes Kebede; Henjum, Sigrun; Terragni, Laura & Torheim, Liv Elin (2020). Correlates of screen time and mediators of differences by parental education among adolescents. BMC Pediatrics. 20(279). doi: 10.1186/s12887-020-02181-y. Full text in Research Archive Show summary

  Background: Existing literature shows that there is an inverse association between socioeconomic position and screen time among adolescents. What is less known is the mechanism behind these differences. The study aimed to explore individual, interpersonal and neighborhood environmental correlates of total screen time (TST) among adolescents and to assess their mediating role in the association between parental education and TST. Methods: A cross-sectional study including 706 adolescents (mean age of 13.6 (SD = 0.3)) was used to collect data at schools through an online questionnaire. Multiple regression analyses were used to explore factors associated with TST. Mediation analyses were conducted to assess whether these factors mediated the association between parental education and TST. Results: Multiple linear regression analyses, adjusted for gender and age, showed that parental modelling of TV and movie streaming, TV/movie streaming during dinner and access to screens were positively related to TST. Self- efficacy towards limiting TV and movie streaming, self-efficacy towards limiting computer/electronic game use, and the perceived opportunities for physical activity in the neighborhood were inversely related to total screen time. All of these factors except self-efficacy towards limiting TV and movie streaming mediated the association between parental education and TST. Conclusions: The study identified several modifiable factors at the individual, interpersonal and neighborhood environmental levels that can be targeted in interventions aimed at decreasing screen time among youth in general and among those with a low socioeconomic position in particular.

• Chortatos, Arthur; Henjum, Sigrun; Torheim, Liv Elin; Terragni, Laura & Gebremariam, Mekdes Kebede (2020). Comparing three screen-based sedentary behaviours' effect upon adolescents' participation in physical activity: The ESSENS study. PLOS ONE. 15(11). doi: 10.1371/journal.pone.0241887. Full text in Research Archive Show summary

  Background Literature focusing on the association between sedentary behaviours and physical activity has provided equivocal results and has been dominated by TV viewing as the indicator of sedentary behaviour. There is a need for more studies exploring the association between contemporary screen activities and physical activity among youth. Methods A cross-sectional study including 742 adolescents was conducted in 2016. Data were collected at school through an online questionnaire. Regression analyses were used to explore the association between different screen-based sedentary behaviours and participation in physical activity. Results The results showed that those with lower (vs higher) time spent on TV/movie streaming and electronic game playing both on weekdays and weekend days had significantly higher odds of participating in physical activity. There were no significant associations between socializing/surfing online both on weekdays and weekend days and physical activity in adjusted models. Conclusions TV/movie streaming and electronic game playing during both weekdays and weekend days were significantly inversely related with participating in physical activity. Initiatives aimed at reducing screen-based sedentary activities might result in favourable effects on physical activity levels among adolescents.

• Havdal, Hanne Hennig; Fosse, Elisabeth; Gebremariam, Mekdes Kebede; Lakerveld, Jeroen; Arah, Onyebuchi A. & Stronks, Karien [Show all 7 contributors for this article] (2020). Perceptions of the social and physical environment of adolescents’ dietary behaviour in neighbourhoods of different socioeconomic position. Appetite. ISSN 0195-6663. 159, p. 1–10. doi: 10.1016/j.appet.2020.105070. Full text in Research Archive
• O'Halloran, Siobhan Anne; Eksteen, Gabriel; Gebremariam, Mekdes Kebede & Alston, Laura (2020). Measurement methods used to assess the school food environment: A systematic review. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 17:1623(5), p. 1–23. doi: 10.3390/ijerph17051623. Full text in Research Archive Show summary

  Children consume approximately half of their total daily amount of energy at school. Foods consumed are often energy-dense, nutrient-poor. The school food environment represents an effective setting to influence children’s food choices when dietary habits are established and continue to track into adulthood. The aim of this review was to: (1) group methods used for assessing the school food environment according to four food environment dimensions: Physical, economic, socio-cultural and policy and (2) assess the quality of the methods according to four criteria: Comprehensiveness, relevance, generalizability and feasibility. Three databases were searched, and studies were used to assess food and beverages provided at school canteens, tuck shops or cafeterias were included. The review identified 38 global studies (including 49 methods of measuring the food environment). The physical environment was the primary focus for 47% of articles, aspects of policy environment was assessed by 37% articles and a small number of studies assessed the economic (8%) and socio cultural (8%) environment. Three methods were rated ‘high’ quality and seven methods received ‘medium’ quality ratings. The review revealed there are no standardized methods used to measure the school food environment. Robust methods to monitor the school food environment across a range of diverse country contexts is required to provide an understanding of obesogenic school environments.

• Yitayew, Teferi Mekonnen; Havdal, Hanne Hennig; Lien, Nanna; O'Halloran, Siobhan Anne; Arah, Onyebuchi A. & Papadopoulou, Eleni Zoumpoulia [Show all 7 contributors for this article] (2020). Mediators of socioeconomic inequalities in dietary behaviours among youth: A systematic review. Obesity Reviews. ISSN 1467-7881. 21(7), p. 1–17. doi: 10.1111/obr.13016. Full text in Research Archive Show summary

  Children and adolescents with a lower socioeconomic position have poorer dietary behaviours compared to their counterparts with a higher socioeconomic position. A better understanding of the mechanisms behind such socioeconomic inequalities is vital to identify targets for interventions aimed at tackling these inequalities. This systematic review aimed to summarize existing evidence regarding the mediators of socioeconomic differences in dietary behaviours among youth. A systematic literature search of MEDLINE, Embase, PsycINFO, and Web of Science databases yielded 20 eligible studies. The dietary behaviours included in the reviewed studies were the intake of fruit and vegetables, sugar‐sweetened beverages, unhealthy snacks/fast food and breakfast. The consistent mediators of the effects of socioeconomic position on dietary behaviours among youth were: self‐efficacy, food preferences and knowledge at the intrapersonal level; and availability and accessibility of food items at home, food rules and parental modelling at the interpersonal level. Few studies including mediators at the organisational, community or policy levels were found. Our review found several modifiable factors at the intrapersonal and interpersonal levels that could be targeted in interventions aimed at combating inequalities in dietary behaviours among youth. Rigorous studies exploring organisational, community and policy level mediators are warranted.

• Gebremariam, Mekdes Kebede; Arah, Onyebuchi A.; Bergh, Ingunn Holden; Andersen, Lene Frost; Ommundsen, Yngvar & Totland, Torunn Holm [Show all 9 contributors for this article] (2019). Gender-specific mediators of the association between parental education and adiposity among adolescents: the HEIA study. Scientific Reports. 9. doi: 10.1038/s41598-019-43604-w. Full text in Research Archive Show summary

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

• Himberg-Sundet, Anne; Kristiansen, Anne Lene; Gebremariam, Mekdes Kebede; Moser, Thomas; Andersen, Lene Frost & Bjelland, Mona [Show all 7 contributors for this article] (2019). Exploring workplace climate and culture in relation to food environment-related factors in Norwegian kindergartens. The BRA-Study. PLOS ONE. 14(12). doi: 10.1371/journal.pone.0225831. Full text in Research Archive Show summary

  Background Kindergartens represent an important arena for promoting vegetable intake when it is essential to establish healthy dietary behaviours early in life. To develop and implement successful interventions targeting dietary behaviours in kindergartens, a good understanding of the factors influencing their food environment and the interplay between these factors is essential. The present study aimed to explore associations between workplace climate and culture in the kindergarten setting and the staff’s food-related practices, vegetables served and the possible mediating role of staff’s food-related practices. Method Vegetables served, staff’s food-related practices, and data on workplace climate and culture were collected using a 5-day, weighted, vegetable diary and three paper-based questionnaires. Seventy-three kindergartens in the Norwegian counties of Vestfold and Buskerud participated in the study. Spearman’s rho was used to assess the association between workplace climate and culture, and staff’s food-related practices and vegetables served. Mediation analyses were conducted to assess the mediating role of staff’s food-related practices in the relationship between workplace climate and culture and vegetables served in this setting. Results There was one significant positive correlation between factors in the workplace climate and culture, and staff’s food-related practices and vegetables served. The staff’s food-related practices were found to mediate the association between support from superior and the variety of vegetables served. They also mediated the association between commitment to the organization and the frequency, as well as the variety, of vegetables served. Conclusion The results identified commitment to the organization and support from superior as two important factors in the workplace climate and culture. Furthermore, these two factors seems to be important to target when developing kindergarten-based interventions aimed at increasing the variety and frequency of vegetables served as they were associated with more favourable food-related practices among staff.

• Gebremariam, Mekdes Kebede; Arah, Onyebuchi A.; Bergh, Ingunn Holden; Andersen, Lene Frost; Bjelland, Mona & Grydeland, May [Show all 7 contributors for this article] (2019). Factors affecting the dose of intervention received and the participant satisfaction in a school-based obesity prevention intervention. Preventive Medicine Reports. 15. doi: 10.1016/j.pmedr.2019.100906. Full text in Research Archive Show summary

  This study assessed factors associated with the perceived dose of intervention received and with the participantsatisfaction in a school-based obesity prevention intervention. It also explored the variance in the dose of in-tervention received that was at the school level. Process evaluation data from a school-based intervention studyconducted in Oslo in 2007–2009 were used. A total of 542 11-year-olds from 12 intervention schools wereincluded. A web-based questionnaire was used to collect data. Descriptive analyses and multilevel regressionanalyses were conducted. Females and those with medium (vs. low) parental education had higher odds ofreporting a high vs. low dose of intervention received at mid-way (8 months after baseline). Perceived socialcapital and perceived social support for physical activity from friends at baseline were positively associated withthe dose of intervention received at mid-way. Perceived social capital at mid-way was positively associated withthe dose of intervention reported post-intervention (20 months after baseline). Around 20% of the variance inthe perceived dose of intervention received was at the school level. Satisfaction with the intervention was highoverall and higher for females for several intervention components at mid-way and at post-intervention. Thefactors identified in this study should be taken into consideration when planning future obesity preventioninterventions among youth.

• Gebremariam, Mekdes Kebede; Arah, Onyebuchi A.; Lien, Nanna; Næss, Øyvind; Ariansen, Inger Kristine Holtermann & Kjøllesdal, Marte Karoline Råberg (2018). Change in BMI Distribution over a 24-Year Period and Associated Socioeconomic Gradients: A Quantile Regression Analysis. Obesity. ISSN 1930-7381. 26(4), p. 769–775. doi: 10.1002/oby.22133. Full text in Research Archive Show summary

  ObjectiveThis study assessed the change in body mass index (BMI) distribution among 18- or 19-year-olds over 24 years. It also investigated parallel changes in the distribution of birth weight and in the association between birth weight and later risk of overweight and/or obesity. Parental educational variations in the trends and associations were explored. MethodsThe study used data on 606,832 male military conscripts enlisted between 1985 and 2008. Quantile regression was used to assess the temporal change in BMI and birth weight distribution. The association between birth weight and overweight and/or obesity at age 18 or 19 years was quantified by using logistic regression. ResultsIncreases in BMI over time were found namely in the 90th, 95th, 97th, and 99th percentiles. Socioeconomic differences in this increase were documented in the 75th to 97th percentiles. The distribution of birth weight and the association between birth weight and the risk of overweight and/or obesity at age 18 or 19 years remained stable over time. ConclusionsThe difference in the increase in BMI between low and high percentiles indicates the limited role of mean BMI in reflecting population changes. The results suggest a need to focus on those with low socioeconomic position in the upper ends of the BMI distribution to combat increasing disparities in obesity-related outcomes.

• Chortatos, Arthur; Terragni, Laura; Henjum, Sigrun; Gjertsen, Marianne K.; Torheim, Liv Elin & Gebremariam, Mekdes Kebede (2018). Consumption habits of school canteen and non-canteen users among Norwegian young adolescents: a mixed method analysis. BMC Pediatrics. 18(1). doi: 10.1186/s12887-018-1299-0. Full text in Research Archive Show summary

  Background: Food/drinks available to adolescents in schools can influence their dietary behaviours, which once established in adolescence, tend to remain over time. Food outlets’ influence near schools, known to provide access to unhealthy food/drinks, may also have lasting effects on consumption behaviours. This study aimed to gain a better understanding of the consumption habits of adolescents in the school arena by comparing different personal characteristics and purchasing behaviours of infrequent and regular school canteen users to those never or seldom using the canteen. Methods: A convergent mixed methods design collected qualitative and quantitative data in parallel. A crosssectional quantitative study including 742 adolescents was conducted, with data collected at schools via an online questionnaire. Focus group interviews with students and interviews with school administrators formed the qualitative data content. Quantitative data were analysed using descriptive statistics and logistic regression; thematic content analysis was used to analyse qualitative data. Results: Sixty-seven percent of adolescents reported never/rarely using the school canteen (NEV), whereas 13% used it ≥2 times per week (OFT). When the two groups were compared, we found a significantly higher proportion of the NEV group were female, having parents with a high education, and with a high self-efficacy, whilst a significantly higher proportion of the OFT group consumed salty snacks, baked sweets, and soft-drinks ≥3 times per week, and breakfast at home <5 days in the school week. The OFT group had significantly higher odds of purchasing food/drink from shops near school during school breaks and before/after school compared to the NEV group (adjusted odds ratio (aOR)=1.80, 95% CI 1.07–3.01, and aOR=3.61, 95% CI 2.17–6.01, respectively). The interviews revealed most students ate a home packed lunch, with the remainder purchasing either at the school canteen or at local shops. Conclusions: Students using the canteen often are frequently purchasing snacks and sugar-soft drinks from shops near school, most likely owing to availability of pocket money and an emerging independence. School authorities must focus upon satisfying canteen users by providing desirable, healthy, and affordable items in order to compete with the appeal of local shops.

• Gebremariam, Mekdes Kebede; Nianogo, Roch A. & Arah, Onyebuchi A. (2018). Weight gain during incarceration: systematic review and meta-analysis. Obesity Reviews. ISSN 1467-7881. 19(1), p. 98–110. doi: 10.1111/obr.12622. Full text in Research Archive
• Gebremariam, Mekdes Kebede; Lien, Nanna; Nianogo, Roch A. & Arah, Onyebuchi A. (2017). Mediators of socioeconomic differences in adiposity among youth: a systematic review. Obesity Reviews. ISSN 1467-7881. 18(8), p. 880–898. doi: 10.1111/obr.12547. Full text in Research Archive
• Gebremariam, Mekdes Kebede; Henjum, Sigrun; Hurum, Elisabeth; Utne, Jorun; Terragni, Laura & Torheim, Liv Elin (2017). Mediators of the association between parental education and breakfast consumption among adolescents : the ESSENS study. BMC Pediatrics. 17(61), p. 1–8. doi: 10.1186/s12887-017-0811-2. Full text in Research Archive Show summary

  Background: Regular breakfast consumption has several health benefits. However, breakfast skipping is common among adolescents, in particular among those with a low socioeconomic background. The aims of the study were to explore individual and home environmental correlates of breakfast consumption, and to assess their potential mediating role in the association between parental education and breakfast consumption. Methods: A cross-sectional study including 706 adolescents with a mean age of 13.6 (SD = 0.3) was conducted between October and December 2016. Data were collected at school through an online questionnaire. Regression analyses were used to explore whether parental modelling, parental co-participation in breakfast consumption, parental rules, the availability of breakfast foods at home and screen time were associated with breakfast consumption. Mediation analyses were conducted to assess whether these factors mediated the association between parental education and breakfast consumption. Results: Breakfast consumption was significantly positively associated with parental education (OR = 1.97 (95% CI 1. 43 – 2.72)). A higher parental modelling (OR = 2.17 (95% CI 1.70 – 2.79)), a higher parental co-participation in breakfast consumption (OR = 1.37 (95% CI 1.26, 1.49)), higher parental rules (OR = 1.36 (95% CI 1.21, 1.53)) and a higher availability of breakfast foods at home (OR = 2.21 (95% CI 1.65, 2.97)) were associated with higher odds of being a daily breakfast consumer. Higher levels of screen time (hrs/day) were associated with lower odds of being a daily breakfast consumer (OR = 0.85 (95% CI 0.79, 0.91). Parental modelling ( B = 0.254 (95% CI 0.149, 0.358)) and the availability of breakfast foods at home ( B = 0.124 (95% CI 0.033, 0.214)) were significantly positively related to parental education, whereas screen time (hrs/day) ( B = − 1.134 (95% CI − 1.511, − 0.758)) was significantly inversely related to parental education. Parental modelling, the availability of breakfast foods at home and screen time were found to mediate parental educational differences in breakfast consumption. Conclusions: Increasing the availability of breakfast food, improving parental modelling of breakfast consumption and targeting screen time might be promising strategies to reduce parental educational differences in breakfast consumption.

• Gebremariam, Mekdes Kebede; Vaqué-Crusellas, Cristina; Andersen, Lene Frost; Stok, F. Marijn; Stelmach-Mardas, Marta & Brug, Johannes [Show all 7 contributors for this article] (2017). Measurement of availability and accessibility of food among youth: A systematic review of methodological studies. International Journal of Behavioral Nutrition and Physical Activity. 14:22, p. 1–19. doi: 10.1186/s12966-017-0477-z. Full text in Research Archive Show summary

  Background Comprehensive and psychometrically tested measures of availability and accessibility of food are needed in order to explore availability and accessibility as determinants and predictors of dietary behaviors. The main aim of this systematic review was to update the evidence regarding the psychometric properties of measures of food availability and accessibility among youth. A secondary objective was to assess how availability and accessibility were conceptualized in the included studies. Methods A systematic literature search was conducted using Medline, Embase, PsycINFO and Web of Science. Methodological studies published between January 2010 and March 2016 and reporting on at least one psychometric property of a measure of availability and/or accessibility of food among youth were included. Two reviewers independently extracted data and assessed study quality. Existing criteria were used to interpret reliability and validity parameters. Results A total of 20 studies were included. While 16 studies included measures of food availability, three included measures of both availability and accessibility; one study included a measure of accessibility only. Different conceptualizations of availability and accessibility were used across the studies. The measures aimed at assessing availability and/or accessibility in the home environment (n = 11), the school (n = 4), stores (n = 3), childcare/early care and education services (n = 2) and restaurants (n = 1). Most studies followed systematic steps in the development of the measures. The most common psychometrics tested for these measures were test-retest reliability and criterion validity. The majority of the measures had satisfactory evidence of reliability and/or validity. None of the included studies assessed the responsiveness of the measures. Conclusions The review identified several measures of food availability or accessibility among youth with satisfactory evidence of reliability and/or validity. Findings indicate a need for more studies including measures of accessibility and addressing its conceptualization. More testing of some of the identified measures in different population groups is also warranted, as is the development of more measures of food availability and accessibility in the broader environment such as the neighborhood food environment.

• Morseth, Marianne S.; Torheim, Liv Elin; Gebremariam, Mekdes Kebede; Chandyo, Ram Krishna; Ulak, Manjeswori & Shrestha, Sanjaya Kumar [Show all 8 contributors for this article] (2017). Tracking of infant and young child feeding practices among 9- to 24-month-old children in Nepal: The MAL-ED Birth Cohort Study. Public Health Nutrition (PHN). ISSN 1368-9800. 21(2), p. 355–364. doi: 10.1017/S1368980017002294. Full text in Research Archive Show summary

  Objective: The present study aimed to assess infant and young child feeding (IYCF) practices and the tracking of dietary diversity score (DDS), intakes of Fe- and vitamin A-rich foods and meal frequency in a peri-urban area in Nepal. Furthermore, to explore whether sociodemographic factors were associated with tracking patterns of these IYCF practices. Design: Longitudinal study. Monthly food intake was measured by 24 h recall. Four time slots were used (9–12, 13–16, 17–20 and 21–24 months). Tracking of IYCF practices was investigated using generalized estimating equations (GEE) models and Cohen’s weighted kappa. Multinominal logistic regression was used to identify determinants for tracking of the IYCF practices. Setting: Bhaktapur municipality, Nepal. Subjects: Children (n 229) aged 9–24 months, randomly selected. Results: Prevalence of minimum meal frequency was higher than for minimum dietary diversity at all time slots. Tracking based on absolute measures (GEE models) was moderate for DDS (0·48) and meal frequency (0·53), and low for intakes of Fe- (0·23) and vitamin A-rich (0·35) foods. Tracking based on rank measured was moderate for DDS and meal frequency, and fair for Fe- and vitamin A-rich foods. Low socio-economic status significantly increased the odds (OR; 95 % CI) of tracking of low v. high DDS (3·31; 1·44, 7·60) and meal frequency (3·46; 1·54, 7·76). Conclusions: Low tracking for intakes of Fe- and vitamin A-rich foods implies that interventions to improve these IYCF practices must address underlying causes for irregular intake to have sustainable effects.

• Gebremariam, Mekdes Kebede; Chinapaw, Mai J.; Bringolf-Isler, Bettina; Bere, Elling; Kovács, Éva & Verloigne, Maïté [Show all 10 contributors for this article] (2017). Screen-based sedentary time: Association with soft drink consumption and the moderating effect of parental education in European children: The ENERGY study. PLOS ONE. 12(2). doi: 10.1371/journal.pone.0171537. Full text in Research Archive Show summary

  Aim The aim of the present study was to explore if children who spend more time on screen-based sedentary behaviors (i.e.TV viewing and computer use) drink more sugar-sweetened soft drinks. The study also assessed whether these associations were independent of individual and home environmental correlates of soft drink consumption and whether they were moderated by parental education. Methods Data were collected from 7886 children participating in the EuropeaN Energy balance Research to prevent excessive weight Gain among Youth (ENERGY) survey conducted in eight European countries. Self-report questionnaires were used. Multilevel linear regression analyses with soft drink consumption as dependent variable, TV viewing and computer use as independent variables and age, gender, parental education, attitude towards soft drinks, self-efficacy, parental modelling, parental rules and home availability of soft drinks as covariates were conducted. Further interactions were tested to explore if these associations were moderated by parental education. Country-specific analyses were conducted. Results In six of the eight included countries, a significant positive association was observed between TV viewing (min/day) and soft drink consumption (ml/day), independent of individual and home environmental correlates of soft drink consumption (B = 0.46 (0.26–0.66) in Greece, B = 0.77 (0.36–1.17) in Norway, B = 0.82 (0.12–1.51) in Hungary, B = 1.06 (0.67–1.46) in Spain, B = 1.21 (0.67–1.74) in Belgium and B = 1.49 (0.72–2.27) in Switzerland). There was no significant association between computer use and soft drink consumption in six of the eight included countries in the final models. Moderation effects of parental education in the association between TV viewing and soft drink consumption were found in Norway and Hungary, the association being stronger among those with low parental education. Conclusions TV viewing appears to be independently associated with soft drink consumption and this association was moderated by parental education in two countries only. Reducing TV time might therefore favorably impact soft drink consumption.

• Gebremariam, Mekdes Kebede; Lien, Nanna; Torheim, Liv Elin; Andersen, Lene Frost; Melbye, Elisabeth Lind & Glavin, Kari [Show all 9 contributors for this article] (2016). Perceived rules and accessibility: measurement and mediating role in the association between parental education and vegetable and soft drink intake. Nutrition Journal. 15:76. doi: 10.1186/s12937-016-0196-3. Full text in Research Archive Show summary

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

• Gebremariam, Mekdes Kebede; Henjum, Sigrun; Terragni, Laura & Torheim, Liv Elin (2016). Correlates of fruit, vegetable, soft drink, and snack intake among adolescents: The ESSENS study. Food & Nutrition Research (FNR). ISSN 1654-6628. 60. doi: 10.3402/fnr.v60.32512. Full text in Research Archive Show summary

  Background : Identifying modifiable correlates of dietary behaviors is of utmost importance for the promotion of healthy dietary behaviors. Objective : This study explores individual, home, and school/neighborhood environmental correlates of dietary behaviors (intake of fruits, vegetables, soft drinks, and unhealthy snacks) among adolescents. Methods : In total, 742 adolescents with a mean age of 13.6 (SD 0.3) were included in this cross-sectional study conducted in 11 secondary schools located in the eastern part of Norway. A web-based questionnaire was used to collect data. Univariable and multivariable linear regression analyses were used to explore factors associated with the dietary behaviors included. Results : A higher frequency of food/drink purchase in the school canteen was related to a higher consumption of soft drinks and snacks. A higher frequency of food/drink purchase in shops around schools during break or recess was related to a higher consumption of snacks. A higher frequency of food/drink purchase in shops around the neighborhood on the way to and from school was related to a higher consumption of soft drinks. Perceived parental modeling and perceived accessibility at home were found to be positively associated with all dietary behaviors. Perceived parental rules were inversely associated with soft drink and snack consumption; self-efficacy related to healthy eating was positively associated with fruit and vegetable consumption. Other included school and neighborhood environmental correlates were not associated with the dietary behaviors. Conclusions : There is a need to address the food purchasing behavior of the adolescents using different approaches. The findings also highlight the important role of parents and the home environment for healthy and unhealthy dietary behaviors of adolescents.

• Gebremariam, Mekdes; Andersen, Lene Frost; Bjelland, Mona; Bergh, Ingunn Holden; Totland, Torunn Holm & Ommundsen, Yngvar [Show all 8 contributors for this article] (2015). Are weight-related attitudes and behaviours associated with the accuracy of BMI derived from self-reported weight and height among 13-year-olds? Scandinavian Journal of Public Health. ISSN 1403-4948. 43(2), p. 130–137. doi: 10.1177/1403494814563370. Full text in Research Archive
• Gebremariam, Mekdes; Altenburg, Teatske; Lakerveld, Jeroen; Andersen, Lene Frost; Stronks, Karien & Chinapaw, Mai J. [Show all 7 contributors for this article] (2015). Associations between socioeconomic position and correlates of sedentary behaviour among youth: A systematic review. Obesity Reviews. ISSN 1467-7881. 16(11), p. 988–1000. doi: 10.1111/obr.12314. Full text in Research Archive
• Totland, Torunn Holm; Lien, Nanna; Bergh, Ingunn Holden; Bjelland, Mona; Gebremariam, Mekdes & Klepp, Knut Inge [Show all 7 contributors for this article] (2013). The relationship between parental education and adolescents’ soft drink intake from the age of 11–13 years, and possible mediating effects of availability and accessibility. British Journal of Nutrition. ISSN 0007-1145. 110(5), p. 926–933. doi: 10.1017/S0007114512005946. Full text in Research Archive
• Totland, Torunn Holm; Bjelland, Mona; Lien, Nanna; Bergh, Ingunn Holden; Gebremariam, Mekdes & Grydeland, May [Show all 8 contributors for this article] (2013). Adolescents' prospective screen time by gender and parental education, the mediation of parental influences. International Journal of Behavioral Nutrition and Physical Activity. 10. doi: 10.1186/1479-5868-10-89. Full text in Research Archive Show summary

  Background: The present study investigated associations in gender dyads of parents’ and adolescents’ time spent on television and video viewing (TV/DVD), and computer and electronic game use (PC/games) at the ages of 11 and 13 years. Possible mediating effects of parental modelling and parental regulation in the relationship between parental education and adolescents’ prospective TV/DVD and PC/game time were further examined. Methods: A total of 908 adolescents, participating at both ages 11 and 13 years in the Norwegian HEalth In Adolescents (HEIA) cohort study (2007–2009), were included in the analyses. Data on adolescents’, mothers’ and fathers’ self reported time spent on TV/DVD and PC/games were measured at both time points by questionnaires. Correlation coefficients were used to examine gender dyads of parents’ and adolescents’ reports. Mediation analyses using linear regression investigated possible mediation effects of parental modelling and parental regulation in the prospective relationship between parental education and adolescents’ time spent on TV/DVD and PC/games between the ages of 11 and 13 years. Results: Correlations of screen time behaviours in gender dyads of parents and adolescents showed significant associations in time spent on TV/DVD at the age of 11 and 13 years. Associations between mothers and sons and between fathers and daughters were also observed in time spent on PC/games at the age of 11 years. Maternal and paternal modelling was further found to mediate the relationship between parental education and adolescents’ prospective TV/DVD time between the ages of 11 and 13 years. No mediation effect was observed for parental regulation, however a decrease in both maternal and paternal regulation at the age of 11 years significantly predicted more TV/DVD time among adolescents at the age of 13 years. Conclusion: Cross-sectional and longitudinal relationships were observed in gender dyads of parents’ and adolescents’ screen time behaviours at the ages of 11 and 13 years, and further studies including both parents and their children should be emphasized. Moreover, maternal and paternal modelling were found to be important target variables in interventions aiming to reduce social differences by parental education in adolescents’ prospective time spent on TV/DVD.

• Totland, Torunn Holm; Gebremariam, Mekdes; Lien, Nanna; Bjelland, Mona; Grydeland, May & Bergh, Ingunn Holden [Show all 8 contributors for this article] (2013). Does tracking of dietary behaviours differ by parental education in children during the transition into adolescence? Public Health Nutrition (PHN). ISSN 1368-9800. 16(4), p. 673–682. doi: 10.1017/S1368980012003060. Full text in Research Archive
• Gebremariam, Mekdes; Bergh, Ingunn Holden; Andersen, Lene Frost; Ommundsen, Yngvar; Totland, Torunn Holm & Bjelland, Mona [Show all 8 contributors for this article] (2013). Are screen-based sedentary behaviors longitudinally associated with dietary behaviors and leisure-time physical activity in the transition into adolescence? International Journal of Behavioral Nutrition and Physical Activity. 10. doi: 10.1186/1479-5868-10-9. Full text in Research Archive Show summary

  Background: There is a need for more longitudinal studies investigating the associations between screen-based sedentary behaviors (SB), dietary behaviors and leisure-time physical activity (PA). Methods: In the HEIA cohort study, 908 children were followed from age 11 to age 13 (September 2007 – May 2009). The children self-reported their intake of fruits, vegetables, soft drinks with sugar and snacks. TV/DVD use, computer/game use and leisure-time PA were also self-reported. Multilevel generalized linear mixed model analysis was used to assess longitudinal associations between the screen-based SB and each of the two other behaviors. Results: Twenty-month changes in TV/DVD use and computer/game use were positively associated with changes in the consumption of soft drinks with sugar and unhealthy snacks in the same period; and inversely associated with change in vegetable consumption. Change in computer/game use was also inversely related to change in fruit consumption. An inverse but non-substantive association was found between change in TV/DVD use and change in leisure-time PA. Change in computer/game use was not significantly associated with change in leisure-time PA. Conclusions: Changes in screen-based SB were associated with multiple unfavorable changes in dietary habits, although the associations were weak. These associations need to be further investigated in intervention/experimental studies, to assess whether changing screen-based SB will result in clinically relevant changes in dietary behaviors. However, the findings of this study suggest that screen-based SB and leisure-time PA are largely independent behaviors which should be addressed separately in health promotion activities.

• Gebremariam, Mekdes; Bergh, Ingunn Holden; Andersen, Lene Frost; Ommundsen, Yngvar; Bjelland, Mona & Lien, Nanna (2012). Stability and change in potential correlates of physical activity and association with pubertal status among Norwegian children in the transition between childhood and adolescence. International Journal of Behavioral Nutrition and Physical Activity. 9. doi: 10.1186/1479-5868-9-56. Full text in Research Archive Show summary

  Background: Whereas tracking and change in physical activity (PA) in children and adolescents have been well documented, studies investigating these patterns in its correlates are lacking. The present study aims to address this gap and in addition explore the impact of pubertal status on PA and its potential psychological and social-environmental correlates in a sample of Norwegian children over a 20-month period. Methods: A total of 885 students from 25 control schools of an intervention study, the HEalth In Adolescents (HEIA) study were included (mean age at baseline 11.2 (0.3)). The baseline took place in September 2007, the first follow-up in May 2008 and the second follow-up in May 2009. PA and its potential correlates (enjoyment of PA, self-efficacy related to barriers to PA, perceived support for PA from parents, friends and teachers, perceived social inclusion and perceived environmental opportunities for PA) were self-reported. Pubertal status was assessed using the Pubertal Development Scale. Repeated-measures ANOVA was used to explore changes. Tracking was assessed using Spearman’s rank order correlation. Pubertal groups were compared using ANOVA or ANCOVA (controlling for BMI). Multiple regression analyses were used to investigate whether pubertal stage at age 11 would predict levels of correlates and PA at age 13. Results: Potential correlates of PA and the behaviour itself were found to track moderately in the transition between childhood and adolescence. Small but significant changes in enjoyment of PA and teachers’ support for PA in both genders and in friends’ support for PA and perceived environmental opportunities for PA in females in a direction unfavourable to PA were detected. A few weak positive associations between pubertal stage and correlates of PA at age 11 were noted among boys. Conclusions: Enjoyment of PA, self-efficacy related to barriers to PA, perceived social support for PA, perceived social inclusion, perceived environmental opportunities for PA and the behaviour itself were found to be moderately stable in the transition between childhood and adolescence. Health promotion efforts in childhood targeting PA and its psychosocial and social-environmental correlates might have favourable effects in later years.

• Gebremariam, Mekdes; Totland, Torunn Holm; Andersen, Lene Frost; Bergh, Ingunn Holden; Bjelland, Mona & Grydeland, May [Show all 8 contributors for this article] (2012). Stability and change in screen-based sedentary behaviours and associated factors among Norwegian children in the transition between childhood and adolescence. BMC Public Health. 12. doi: 10.1186/1471-2458-12-104. Full text in Research Archive Show summary

  Background In order to inform interventions to prevent sedentariness, more longitudinal studies are needed focusing on stability and change over time in multiple sedentary behaviours. This paper investigates patterns of stability and change in TV/DVD use, computer/electronic game use and total screen time (TST) and factors associated with these patterns among Norwegian children in the transition between childhood and adolescence. Methods The baseline of this longitudinal study took place in September 2007 and included 975 students from 25 control schools of an intervention study, the HEalth In Adolescents (HEIA) study. The first follow-up took place in May 2008 and the second follow-up in May 2009, with 885 students participating at all time points (average age at baseline = 11.2, standard deviation ± 0.3). Time used for/spent on TV/DVD and computer/electronic games was self-reported, and a TST variable (hours/week) was computed. Tracking analyses based on absolute and rank measures, as well as regression analyses to assess factors associated with change in TST and with tracking high TST were conducted. Results Time spent on all sedentary behaviours investigated increased in both genders. Findings based on absolute and rank measures revealed a fair to moderate level of tracking over the 2 year period. High parental education was inversely related to an increase in TST among females. In males, self-efficacy related to barriers to physical activity and living with married or cohabitating parents were inversely related to an increase in TST. Factors associated with tracking high vs. low TST in the multinomial regression analyses were low self-efficacy and being of an ethnic minority background among females, and low self-efficacy, being overweight/obese and not living with married or cohabitating parents among males. Conclusions Use of TV/DVD and computer/electronic games increased with age and tracked over time in this group of 11-13 year old Norwegian children. Interventions targeting these sedentary behaviours should thus be introduced early. The identified modifiable and non-modifiable factors associated with change in TST and tracking of high TST should be taken into consideration when planning such interventions.

• Gebremariam, Mekdes; Andersen, Lene Frost; Bjelland, Mona; Klepp, Knut Inge; Totland, Torunn Holm & Bergh, Ingunn Holden [Show all 7 contributors for this article] (2012). Does the school food environment influence the dietary behaviours of Norwegian 11-year-olds? The HEIA study. Scandinavian Journal of Public Health. ISSN 1403-4948. 40(5), p. 491–497. doi: 10.1177/1403494812454948. Full text in Research Archive Show summary

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

• Gebremariam, Mekdes; Bjune, Gunnar Aksel & Frich, Jan C (2011). Lay beliefs of TB and TB/HIV co-infection in Addis Ababa, Ethiopia: a qualitative study. BMC Research Notes. 4. doi: 10.1186/1756-0500-4-277. Full text in Research Archive Show summary

  Background Knowledge about lay beliefs of etiology, transmission and treatment of TB, and lay perceptions of the relationship between TB and HIV is important for understanding patients' health seeking behavior and adherence to treatment. We conducted a study to explore lay beliefs about TB and TB/HIV co-infection in Addis Ababa, Ethiopia. Findings We conducted a qualitative study using in-depth interviews with 15 TB/HIV co-infected patients and 9 health professionals and focus group discussions with 14 co-infected patients in Addis-Ababa, Ethiopia. We found that a predominant lay belief was that TB was caused by exposure to cold. Excessive sun exposure, exposure to mud, smoking, alcohol, khat and inadequate food intake were also reported as causes for TB. Such beliefs initially led to self-treatment. The majority of patients were aware of an association between TB and HIV. Some reported that TB could transform into HIV, while others said that the body could be weakened by HIV and become more susceptible to illnesses such as TB. Some patients classified TB as either HIV-related or non-HIV-related, and weight loss was a hallmark for HIV-related TB. The majority of patients believed that people in the community knew that there was an association between TB and HIV, and some feared that this would predispose them to HIV-related stigma. Conclusion There is a need for culturally sensitive information and educational efforts to address misperceptions about TB and HIV. Health professionals should provide information about causes and treatment of TB and HIV to co-infected patients.

• Gebremariam, Mekdes; Bjune, Gunnar Aksel & Frich, Jan C (2010). Barriers and facilitators of adherence to TB treatment in patients on concomitant TB and HIV treatment: a qualitative study. BMC Public Health. 10. doi: 10.1186/1471-2458-10-651. Full text in Research Archive Show summary

  Background Tuberculosis is a major public health problem in Ethiopia, and a high number of TB patients are co-infected with HIV. There is a need for more knowledge about factors influencing treatment adherence in co-infected patients on concomitant treatment. The aim of the present study is to explore patients' and health care professionals' views about barriers and facilitators to TB treatment adherence in TB/HIV co-infected patients on concomitant treatment for TB and HIV. Methods Qualitative study using in-depth interviews with 15 TB/HIV co-infected patients and 9 health professionals and focus group discussions with 14 co-infected patients. Results We found that interplay of factors is involved in the decision making about medication intake. Factors that influenced adherence to TB treatment positively were beliefs in the curability of TB, beliefs in the severity of TB in the presence of HIV infection and support from families and health professionals. Barriers to treatment adherence were experiencing side effects, pill burden, economic constraints, lack of food, stigma with lack of disclosure, and lack of adequate communication with health professionals. Conclusion Health professionals and policy makers should be aware of factors influencing TB treatment in TB/HIV co-infected patients on concomitant treatment for TB and HIV. Our results suggest that provision of food and minimal financial support might facilitate adherence. Counseling might also facilitate adherence, in particular for those who start ART in the early phases of TB treatment, and beliefs related to side-effects and pill burden should be addressed. Information to the public may reduce TB and HIV related stigma.

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• Gele, Abdi; Mahmud, Amina Jama; Kumar, Bernadette Nirmal; Wangamati, Cynthia Khamala; Duale, Hodan A & Malik, Mamunur Rahman [Show all 8 contributors for this article] (2024). Editorial: Encouraging health research productivity in complex humanitarian crises: Somalia. Frontiers in Public Health. 12. doi: 10.3389/fpubh.2024.1377036. Full text in Research Archive
• Ling, Jiying & Gebremariam, Mekdes (2023). Embracing parenting role in childhood obesity. BMC Public Health. 23. doi: 10.1186/s12889-023-16039-2. Full text in Research Archive Show summary

  Active parental engagement is crucial in controlling childhood obesity. However, optimal strategies to engage parents and mechanisms linking parents’ involvement to childhood obesity prevention need further investigation. In this editorial, we provide a background to invite contributions to the BMC Public Health collection titled ‘Parenting role in childhood obesity’.

• Øverby, Nina Cecilie; Hillesund, Elisabet Rudjord; Helland, Sissel Heidi; Helle, Christine; Wills, Andrew Keith & Lamu, Admassu Nadew [Show all 23 contributors for this article] (2023). 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. Frontiers in Endocrinology. 13. doi: 10.3389/fendo.2022.1071489. Full text in Research Archive Show summary

  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.

• Khudair, Mohammed; Marcuzzi, Anna; Ng, Kwok; Tempest, Gavin Daniel; Bartoš, František & Peric, Ratko [Show all 64 contributors for this article] (2022). DE-PASS Best Evidence Statement (BESt): modifiable determinants of physical activity and sedentary behaviour in children and adolescents aged 5-19 years-a protocol for systematic review and meta-analysis. BMJ Open. 12(9), p. e059202–e059202. doi: 10.1136/bmjopen-2021-059202. Full text in Research Archive Show summary

  Introduction Physical activity among children and adolescents remains insufficient, despite the substantial efforts made by researchers and policymakers. Identifying and furthering our understanding of potential modifiable determinants of physical activity behaviour (PAB) and sedentary behaviour (SB) is crucial for the development of interventions that promote a shift from SB to PAB. The current protocol details the process through which a series of systematic literature reviews and meta-analyses (MAs) will be conducted to produce a best-evidence statement (BESt) and inform policymakers. The overall aim is to identify modifiable determinants that are associated with changes in PAB and SB in children and adolescents (aged 5–19 years) and to quantify their effect on, or association with, PAB/SB. Methods and analysis A search will be performed in MEDLINE, SportDiscus, Web of Science, PsychINFO and Cochrane Central Register of Controlled Trials. Randomised controlled trials (RCTs) and controlled trials (CTs) that investigate the effect of interventions on PAB/SB and longitudinal studies that investigate the associations between modifiable determinants and PAB/SB at multiple time points will be sought. Risk of bias assessments will be performed using adapted versions of Cochrane’s RoB V.2.0 and ROBINS-I tools for RCTs and CTs, respectively, and an adapted version of the National Institute of Health’s tool for longitudinal studies. Data will be synthesised narratively and, where possible, MAs will be performed using frequentist and Bayesian statistics. Modifiable determinants will be discussed considering the settings in which they were investigated and the PAB/SB measurement methods used.

• Gebremariam, Mekdes Kebede; Henjum, Sigrun; Terragni, Laura & Torheim, Liv Elin (2016). The influence of the school and neighborhood food environment on the dietary behaviors of youth in Norway. Full text in Research Archive
• Totland, Torunn Holm; Lien, Nanna; Bergh, Ingunn Holden; Bjelland, Mona; Gebremariam, Mekdes Kebede & Klepp, Knut Inge [Show all 7 contributors for this article] (2013). Prediction of parental education on adolescents’ soft drink intake, and mediation effects of availability and accessibility at home. Full text in Research Archive
• Rodriguez, Anaely Aguiar; Gebremariam, Mekdes Kebede; Kopainsky, Birgit & Lien, Nanna (2019). Review of existing system dynamics models on overweight/obesity in children and ado-lescents. D7.1 H2020 project CoCREATE. H2020 project CoCreate. Full text in Research Archive

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